Impact of family history assessment on communication with family members and health care providers: A report from the Family Healthware™ Impact Trial (FHITr)

ObjectiveThis study examines the impact of Family Healthware™ on communication behaviors; specifically, communication with family members and health care providers about family health history.MethodsA total of 3786 participants were enrolled in the Family Healthware™ Impact Trial (FHITr) in the United States from 2005–7. The trial employed a two-arm cluster-randomized design, with primary care practices serving as the unit of randomization. Using generalized estimating equations (GEE), analyses focused on communication behaviors at 6 month follow-up, adjusting for age, site and practice clustering.ResultsA significant interaction was observed between study arm and baseline communication status for the family communication outcomes (p's < .01), indicating that intervention had effects of different magnitude between those already communicating at baseline and those who were not.Among participants who were not communicating at baseline, intervention participants had higher odds of communicating with family members about family history risk (OR = 1.24, p = 0.042) and actively collecting family history information at follow-up (OR = 2.67, p = 0.026). Family Healthware™ did not have a significant effect on family communication among those already communicating at baseline, or on provider communication, regardless of baseline communication status. Greater communication was observed among those at increased familial risk for a greater number of diseases.ConclusionFamily Healthware™ prompted more communication about family history with family members, among those who were not previously communicating. Efforts are needed to identify approaches to encourage greater sharing of family history information, particularly with health care providers.     

Factors affecting uptake of influenza vaccination among family physicians

AimThe aim of this study was to determine the factors that influenced the decisions of family physicians working in primary care health services to receive influenza vaccines.MethodsThis cross-sectional study was performed between June 2014 and September 2014. Physicians were reached electronically via e-mail. A self-reported questionnaire consisting of 50 items covering potential factors that may have influenced their decision to receive vaccination, including perceived risk, severity of the perceived risk, perceived benefit, perceived barriers, cues to action, attitudes, social influences and personal efficacy, was administered to the study participants. Cronbach's alpha for the questionnaire was determined to be 0.92 in the pilot study.ResultsThe response rate was 27.5% (n = 596). Regularly vaccinated physicians accounted for 27.3% of the responses. The median age was 41.84 ± 7.80, and the median working duration of the group was 17.0 ± 7.8 years. The factors that led to increased vaccination compliance (p < 0.05) included working duration, age, chronic disease history and living with a person over 65 years. Nearly all major domains, i.e., perceived risk, severity of the perceived risk, perceived benefit, perceived barriers, attitudes, social influences and personal efficacy, there were differences between the compliant and noncompliant groups. Multi-regression analyses revealed that risk perception, organizational factors such as time and convenient vaccination increased vaccine compliance. However, the perceived necessity to be vaccinated annually had a negative effect on vaccination behaviour (p < 0.05).ConclusionStrategies aimed to increase the flu vaccination ratio among physicians that do not take different factors into account are more likely to be unsuccessful. In the planning and implementation of strategies aiming to increase the vaccination ratio among physicians, it is both necessary and important to take into account behavioural and organizational factors.     

Violencia de pareja y depresión en mujeres que trabajan en una institución de salud de México

ObjectiveTo assess the effect of intimate partner violence on the risk of depression and depressive symptoms among adult women.MethodWe analyzed data from the Mexican Health Workers’ Cohort study (n = 470). Type and severity of intimate partner violence was ascertained between 2004 and 2011. Self-reported medical diagnosis of depression (2011) was the main outcome; depressive symptoms ascertained with the Centre for Epidemiologic Studies-Depression (CES-D) scale was the secondary outcome. Random-effects regressions were run to model the risk of depression (logistic) and depressive symptoms (linear) in relation to intimate partner violence.Results41.9% women experienced intimate partner violence at baseline. The incidence of depression was 7.2%. The risk of depression increased with any type of IPV (adjusted odds ratio [aOR] = 2.9; 95% confidence interval [95%CI]: 1.4–6.2) and with physical (aOR = 4.3; 95%CI: 1.8–10.1), psychological (aOR = 3.1; 95%CI: 1.4–6.6) and sexual (aOR = 3.1; 95%CI: 1.2–8.2) violence. Depressive symptoms (CES-D) increased slightly with physical and sexual intimate partner violence.ConclusionsIntimate partner violence was associated with a higher risk of depression in this sample of women working in a Mexican health facility. Our results indicate the need to develop infrastructure, to implement strategies of attention and counselling, and to provide a safe environment in the workplace for women who experience intimate partner violence.     

Relationships between depression,gender, and unhealthy weight loss practices among overweight or obese college students

IntroductionUnhealthy weight loss practices are common among female college students. It is unknown if these practices are also most common among women in the subset of overweight or obese college students or if these practices are related to depression. We examined the relationship between gender, depression, and unhealthy weight loss practices among overweight or obese college students.MethodsStudents (body mass index between 25.0 and 34.9 kg/m²) from three Southern California universities (M_age = 22 years, SD = 4; 70% women) were recruited from May 2011 to May 2012 for participation in a weight loss clinical trial (N = 404). Logistic regressions were performed with baseline data to assess the cross-sectional relationship between self-reported unhealthy weight loss practices and gender and depression as measured by the Center for Epidemiologic Studies Depression short form.ResultsTwenty-nine percent of participants reported engaging in at least one unhealthy weight loss behavior (e.g., fasting, purging) over the last 30 days, with no differences by gender. Self-report of at least one unhealthy weight loss behavior was associated with report of symptoms of depression (e^B = 1.14 [confidence interval, CI: 1.08–1.20]), adjusting for potential confounders. Interactions between gender and depression were not significant (e^B = 1.04 [CI: 0.93–1.16]).ConclusionAmong an overweight or obese sample of college students, unhealthy weight loss practices were equally common in both genders, and students with depressive symptomatology were at greatest risk. Obesity interventions targeting overweight or obese college students should educate both men and women about the dangers of unhealthy weight loss practices. In addition, screening for depression can help identify students who would benefit from additional supportive and coping strategies and resources.     

Lack of private health insurance is associated with higher mortality from cancer and other chronic diseases,poor diet quality,and inflammatory biomarkers in the United States

ObjectiveThe lack of health insurance reduces access to care and often results in poorer health outcomes. The present study simultaneously assessed the effects of health insurance on cancer and chronic disease mortality, as well as the inter-relationships with diet, obesity, smoking, and inflammatory biomarkers. We hypothesized that public/no insurance versus private insurance would result in increased cancer/chronic disease mortality due to the increased prevalence of inflammation-related lifestyle factors in the underinsured population.MethodsData from the Third National Health and Nutrition Examination Survey participants (NHANES III;1988–1994) were prospectively examined to assess the effects of public/no insurance versus private insurance and inflammation-related lifestyle factors on mortality risk from cancer, all causes, cardiovascular disease (CVD) and diabetes. Cox proportional hazards regression was performed to assess these relationships.ResultsMultivariate regression analyses revealed substantially greater risks of mortality ranging from 35% to 245% for public/no insurance versus private insurance for cancer (HR = 1.35; 95% CI = 1.09,1.66), all causes (HR = 1.54; 95% CI = 1.39,1.70), CVD (HR = 1.62; 95% CI = 1.38,1.90) and diabetes (HR = 2.45; 95% CI = 1.45,4.14). Elevated CRP, smoking, reduced diet quality and higher BMI were more prevalent in those with public insurance, and were also associated with increased risks of cancer/chronic disease mortality.DiscussionInsurance status was strongly associated with cancer/chronic disease mortality after adjusting for lifestyle factors. The results suggest that inadequate health insurance coverage results in a substantially greater need for preventive strategies that focus on tobacco control, obesity, and improved dietary quality. These efforts should be incorporated into comprehensive insurance coverage programs for all Americans.     

A pilot study to assess the feasibility and acceptability of a community based physical activity intervention (involving internet,telephone, and pedometer support), integrated with medication and mood management for depressed patients

ObjectiveTo assess the feasibility and acceptability of a multi-component intervention to treat depression in primary care.MethodsA single group prospective design was used to examine the feasibility and acceptability of a 12-week intervention combining antidepressant medication, brief behavioral counseling and physical activity (PA) promotion, and also associated changes in depression and various self-reported measures. A sample of adults with mild-to-moderate major depression and willingness to take antidepressant medication were recruited through local primary care clinics. A Research Nurse Practitioner (RNP) prescribed the selective serotonin reuptake inhibitor, escitalopram (10–20 mg), and provided brief weekly counseling. In addition participants received a pedometer, printed materials, and weekly emails addressing behavioral skills to increase their physical activity. Participants' depressive symptoms, quality of life and PA attitudes were surveyed at baseline, 6 and 12 weeks. At week 12 they also reported their satisfaction with the study components.ResultsOf the 36 participants recruited, 64% of participants completed measures at week 12, 30% completed all 12 counseling sessions and 60% responded to half the emails. By week 12, participants reduced their depressive symptom scores (by 4.7; p < .001), improved their quality of life scores (by 9.7; p < .001) and increased their daily step counts (by 2449.2; p < .03). Of the 23 who responded, over 70% thought the pedometer, calls and print materials helped improve their mood. Those who completed more counseling were more likely to reduce their depressive symptoms at week 12 (r = −.46; p < .05).ConclusionThis pilot study demonstrated the feasibility and acceptability of a multi-component intervention to reduce depressive symptoms in a sample of mild-to-moderately depressed adults.     

The role of anxiety in the perception of technological hazards – A cross-sectional study on cell phones and masts

BackgroundRisk perception is determined by parameters related to the nature of the risk, as well as inherent to the individual perceiving this risk. This study was designed to provide a better understanding of the role of personality, especially anxiety traits, on risk perception. It compared representations of two different risks, smoking (with known and generally accepted adverse health effects) and cell phones (whose hazardous potency is still controversial), each presented in two different forms of exposure, active (smokers and cell phone users) and passive (passive smoking and exposure to cell phone masts).MethodsA self-administered questionnaire sent to volunteer subjects collected sociodemographic and exposure data. It measured the perceived risk as well as 11 psychometric properties of risk using visual analogue scales (values ranging from 0 to 10). An anxiety trait was evaluated by the Spielberger questionnaire.ResultsIn all, 72% of the questionnaires sent were returned. Mean declared risk scores attributed to passive and active smoking were higher (8.75 and 8.31 respectively) than those attributed to cell phones and masts (4.44 and 4.73 respectively). However, scores for the 11 psychometric properties of the risk attributed to cell phones were higher than those associated with smoking, especially for dissatisfaction with information (6.71 and 7.36 respectively for cell phones and masts versus 1.75 and 2.18 for passive and active smoking) and the capacity of authorities to master the risk (6.45 and 6.65 for cell phones and masts versus 4.72 and 4.40 for passive and active smoking). Anxiety did not directly influence the risk scores attributed to these 4 forms of exposure but was predictive of the way in which subjects perceived the risk in terms of two essential properties: uncertainty concerning the effects on health and the potential to trigger health catastrophes. Indeed anxious subjects are more certain about the hazards of cell phones and masts than non-anxious subjects (P = 0.008 et P ≤ 0.001) and attributed a higher catastrophic potential (P = 0.02 and P = 0.004).ConclusionThis study suggests that subjects with an anxious profile are affected by the destabilizing nature of uncertain knowledge concerning the hazardous potency of new technologies and of the controversies concerning this hazard.     

Efecto de una intervención multidimensional en personas mayores autovalentes para el manejo del riesgo de caídas

ObjectiveTo evaluate the effect of a multidimensional intervention on the perception and management of risk factors and frequency of falls in independent elderly people living in the community.DesignRandomised clinical trial.SettingFamily health centre, primary care.ParticipantsIndependent elderly people living in the community.InterventionFor intervention group (IG) a multidimensional intervention, consisting of home visits and telephone follow-up was carried out for 5 months (n = 77), and those assigned to the control group (CG, n = 77) received usual care in the family health centre.Main measurementsPerception of risk of falls, number of risk factors and number of falls in the study period.ResultsIn both groups there were increases in the perception of risk factors for falling associated with walking (IG: P < .001 and CG: P < .001). Belonging to the IG was significantly associated with a decrease in the risk factors associated with surfaces (r = 0.25) and shoes (r = 0.24), as well as an increase in the perception of risk of falls associated with walking (r = 0.21) and the presence of objects or furniture (r = 0.36). In the IG, 5 participants (7.9%) suffered at least one fall in the 5-month period and 18 (27.7%) patients in the CG (P = .004).ConclusionsThe multidimensional intervention was effective in reducing the frequency of falls and in the management of extrinsic risk factors associated with surfaces, lighting, and support devices.     

Troubles des conduites alimentaires : prévalence et facteurs de risque chez des étudiants en médecine tunisiens

ObjectivesYoung students, in particular those in the medical field, seem to be at risk of developing psychiatric disorders, especially eating disorders (ED).We aimed to determine the prevalence of ED in Tunisian medical students and to study the risk factors associated to it.Materials and methodsWe conducted a cross-sectional study at the Tunis medical university including 250 students. Each student filled out a self-administered questionnaire with the necessary individual information as well as the HAD (Hospital Anxiety and Depression) scale assessing anxiety and depression, EDI2 (Eating Disorder Inventory 2) assessing the cognitive behavioral profile of participants and PSS (Perceived Stress Scale), assessing their level of perceived stress. Eating disorders were screened using the EAT40 and BITE self-questionnaires. We used the DSM-5 classification to specify the types of ED.ResultsThe sex ratio (M/F) was 0.4. Anxiety, depressive symptoms and high stress level were found in 34%, 17% and 75.2% of cases, respectively. The prevalence of ED was 16.4%. Independent factors associated with ED were female sex (P = 0.009), physical activity (P = 0.04), body dissatisfaction (P < 0.001) and the feeling of ineffectiveness (P = 0.032). The risk of ED was five times higher in students using anxiolytics (P < 0.001), laxatives (P = 0.046), or induced vomiting (P = 0.045) and 9.55 times higher in students on a diet (P < 0.001).ConclusionThese results justify the need for systematic screening for ED in medical students in order to ensure early and effective treatment and thus preserve the physical and mental health of future caregivers.     

Cross-sectional survey: Risk-averse French general practitioners are more favorable toward influenza vaccination

ObjectivesWe tested the following hypotheses: (i) risk-averse general practitioners (GPs) are more likely to be vaccinated against influenza; (ii) and risk-averse GPs recommend influenza vaccination more often to their patients. In risk-averse GPs, the perceived benefits of the vaccine and/or the perceived risks of the infectious disease might indeed outweigh the perceived risks of the vaccine.Patients/MethodsIn 2010–2012, we conducted a cross-sectional survey of a nationwide French representative sample of 1136 GPs. Multivariate analyses adjusted for four stratification variables (age, gender, urban/suburban/rural practice location and annual patient consultations) and for GPs’ characteristics (group/solo practice, and occasional practice of alternative medicine, e.g., homeopathy) looked for associations between their risk attitudes and self-reported vaccination behavior. Individual risk attitudes were expressed as a continuous variable, from 0 (risk-tolerant) to 10 (risk-averse).ResultsOverall, 69% of GPs reported that they were very favorable toward vaccination in general. Self-reported vaccination coverage was 78% for 2009/2010 seasonal influenza and 62% for A/H1N1 pandemic influenza. Most GPs (72%) reported recommending the pandemic influenza vaccination to at-risk young adults in 2009, but few than half (42%) to young adults not at risk. In multivariate analyses, risk-averse GPs were more often vaccinated against seasonal (marginal effect = 1.3%, P = 0.02) and pandemic influenza (marginal effect = 1.5%, P = 0.02). Risk-averse GPs recommended the pandemic influenza vaccination more often than their more risk-tolerant colleagues to patients without risk factors (marginal effect = 1.7%, P = 0.01), but not to their at-risk patients and were more favorable toward vaccination in general (marginal effect = 1.5%, P = 0.04).ConclusionIndividual risk attitudes may influence GPs’ practices regarding influenza vaccination, both for themselves and their patients. Our results suggest that risk-averse GPs may perceive the risks of influenza to outweigh the potential risks related to the vaccine.     

Human papillomavirus vaccine-related risk perceptions and subsequent sexual behaviors and sexually transmitted infections among vaccinated adolescent women

ObjectiveTo examine the association between risk perceptions after human papillomavirus (HPV) vaccination and sexual behaviors and sexually transmitted infection (STI) diagnosis over 30 months following vaccination.MethodsParticipants included 112 sexually experienced girls aged 13–21 years who were enrolled at the time of first HPV vaccination and completed ⩾2 of 4 follow-up visits at 2, 6, 18, 30 months and including 30 months. At each visit, participants completed surveys assessing risk perceptions (perceived need for safer sexual behaviors, perceived risk of STIs other than HPV) and sexual behaviors. STI testing was done at 6, 18, and 30 months. Outcomes were condom use at last intercourse with main male partner, number of sexual partners since last study visit, and STI diagnosis. Associations between risk perceptions and sexual behaviors/STIs were examined using generalized linear mixed models.ResultsMean age was 17.9 years; 88% were Black; 49% had a history of STI at baseline. Scale scores for perceived need for safer sexual behaviors did not change significantly over time. Scale scores for perceived risk of STIs other than HPV significantly changed (p = 0.027), indicating that girls perceived themselves to be more at risk of STIs other than HPV over 30 months following vaccination. Multivariable models demonstrated that greater perceived need for safer sexual behaviors following vaccination was associated with condom use (p = 0.002) but not with number of partners or STI diagnosis. Perceived risk of STIs other than HPV was not associated with the three outcomes.ConclusionsThe finding that perceived risk for STIs other than HPV was not associated with subsequent sexual behaviors or STI diagnosis is reassuring. The association between perceived need for safer sexual behaviors and subsequent condom use suggests that the HPV vaccination visit is an important opportunity to reiterate the importance of safer sexual behaviors to sexually experienced girls.     

Screen time is associated with depression and anxiety in Canadian youth

ObjectiveThis study examined the relationships between screen time and symptoms of depression and anxiety in a large community sample of Canadian youth.MethodParticipants were 2482 English-speaking grade 7 to 12 students. Cross-sectional data collected between 2006 and 2010 as part of the Research on Eating and Adolescent Lifestyles (REAL) study were used. Mental health status was assessed using the Children's Depression Inventory and the Multidimensional Anxiety Scale for Children—10. Screen time (hours/day of TV, video games, and computer) was assessed using the Leisure-Time Sedentary Activities questionnaire.ResultsLinear multiple regressions indicated that after controlling for age, sex, ethnicity, parental education, geographic area, physical activity, and BMI, duration of screen time was associated with severity of depression (β = 0.23, p < 0.001) and anxiety (β = 0.07, p < 0.01). Video game playing (β = 0.13, p < .001) and computer use (β = 0.17, p < 0.001) but not TV viewing were associated with more severe depressive symptoms. Video game playing (β = 0.11, p < 0.001) was associated with severity of anxiety.ConclusionScreen time may represent a risk factor or marker of anxiety and depression in adolescents. Future research is needed to determine if reducing screen time aids the prevention and treatment of these psychiatric disorders in youth.     

Weight control success and depression by gender with respect to weight control behaviors

Background/ObjectiveThere are many methods for weight loss and they vary among people. Some are yet to be proven as appropriate regarding its physical or mental side effect. The aim of this study was to investigate the relationship between weight control success and depression by weight control behaviors (WCB) dividing them into appropriate and inappropriate.Subjects/MethodsWe used data from the 2016 Korea National Health and Nutrition Examination Survey (KNHANES). A total of 4506 people were included in the study. The depression was measured by the 9-item Patient Health Questionnaire as a dependent variable. Using multiple regression analysis to determine the association between weight control success and depression with appropriate and inappropriate WCB, in men and women, separately.ResultsWe found that appropriate WCB was associated with decreased depression in women who had both success and fail (success: β = −0.16, S.E = 0.50, p < .001; fail: β = −0.09, S.E = 0.04, p = 0.04), whereas inappropriate WCB increased depression in men regardless of success or failure at weight control (success: β = 0.41, p = 0.02; fail: β = 0.22, p = 0.02). Thus, women who are successful at weight control and use appropriate WCB are more likely to have a decrease in depressive symptoms. However, men are most affected by using inappropriate WCB and can have an increase in depressive symptoms as a result.ConclusionThe findings have implications for encouraging the use of appropriate WCB for those attempting to control weight, especially in women.     

Development and Analysis of Item Response Theory-based Short-form Depression Severity Scales Based on the HDRS and MADRS

ObjectivesThe Hamilton Depression Rating Scale (HDRS) is the most frequently used primary endpoint for antidepressant clinical trials. This study developed and evaluated the psychometric characteristics of 3 item response theory (IRT)-based short-form depression severity scales based on combinations of the HDRS and Montgomery-Asberg Depression Rating Scale (MADRS) items.Study DesignA secondary analysis was completed using data from 1027 subjects with major depressive disorder participating in 2 antidepressant clinical trials. Data were collected using the HDRS and MADRS throughout the 6-week clinical trials. Maier, Bech, and Gibbons brief depression scales were calculated based on the HDRS.ResultsThree short-form depression severity (DS) scales were developed based on clinician recommendations and IRT analyses, (DS-1, 7 items; DS-2, 8 items; DS-3, 10 items). Internal consistency reliability of the short forms was 0.87 to 0.93. DS were more reliable across the range of the depression than the HDRS or MADRS. The DS scales were correlated 0.27 to 0.29 with HDRS, 0.55 to 0.85 with MADRS, and ?0.25 to ?0.34 with Quality of Enjoyment and Satisfaction Questionnaire scores at baseline. In 1 clinical trial, none of the depression outcome measures demonstrated statistically significant differences between the paroxetine and placebo groups. In the second clinical trial, there were significant between-group differences in DS-1 (P = .004; ES = 0.46), DS-2 (P <.001; ES = 0.59), DS-3 (P <.001; ES = 0.63), Bech (P = .007; ES = 0.43), Maier (P = .009; ES = 0.41), Gibbon (P = .003; ES = 0.47), HDRS (P = .007; ES = 0.43), and MADRS (P = .001; ES = 0.54) scores.ConclusionsThe IRT-based short-form depression measures were reliable, valid, and responsive in patients with major depressive disorder. Effect sizes were comparable or better to other depression severity scales.     

Racial Differences in Perinatal Depression among HIV-infected Women

BackgroundPerinatal depression may further complicate the health of women with human immunodeficiency virus (HIV) infection. Diagnosis and subsequent treatment of depressive symptoms may significantly improve the health of mother and newborn.ObjectiveWe sought to examine the association between race and perinatal depression among a sample of low-income women with HIV infection.MethodsThis retrospective cohort study used data from a multi-state Medicaid administrative claims database to study HIV-infected perinatal women between 2003 and 2007. Multivariate regression analysis was used to study the objective.ResultsThe overall prevalence of perinatal depression in the sample (n = 650) was 27.8%. Black women had significantly lower odds of experiencing perinatal depression (odds ratio 0.328; 95% confidence interval 0.225-0.479) compared with non-black women. Non-black women showed significantly higher comorbidity severity scores than black women (0.356 vs. 0.220, P = .035).ConclusionsThis study found that non-black women may be more vulnerable to perinatal depression. Improved health care provider vigilance for depressive symptoms among low-income, HIV-infected women of all races during the perinatal period is warranted.     

Depressive symptomatology in relation to 10-year (2004–2014) acute coronary syndrome incidence; the moderating role of diet and financial status

BackgroundThe association between depression status and 10-year cardiovascular disease (CVD) incidence among acute coronary syndrome (ACS) patients, in relation to nutritional and financial status, was evaluated.MethodsFrom October 2003 to September 2004, a sample of 2172 consecutive ACS patients from 6 Greek hospitals was enrolled. In 2013–14, the 10-year follow-up was performed. Depressive symptoms were evaluated using the validated CES-D score (range 0–60). Adherence to Mediterranean diet was assessed through MedDietScore (range 0–55) and financial status was determined by the annual income.ResultsRanking from the 1st to 3rd CES-D tertile, recurrent fatal/non fatal ACS rates were 33%, 37% and 42%, respectively (p = 0.006). Multiple logistic regression models revealed an adverse association of severe depression status (i.e. 3rd tertile) compared to no depression (i.e. 1st tertile) [odds ratio (OR) = 1.31, 95% confidence interval (95% CI) 1.01, 1.69]. When controlling for financial status, the relationship between depression and ACS prognosis remained marginally significant; while subgroup analysis revealed that only patients with low/moderate income were negatively affected [OR = 1.36, 95% CI 0.98, 1.88]. Further stratified analysis, by MedDietScore group, was applied; the above association remained significant only in patients with low compliance to this dietary pattern [OR = 1.68, 95% CI 1.10, 2.18].ConclusionsACS coexisting with severe depression status seems to result in adverse disease outcomes while financial status and Mediterranean diet are proposed as potential moderators. Public health programs should focus on vulnerable groups and minimize depressive symptoms through appropriate medical treatment and lifestyle interventions, so as to ameliorate the disease prognosis in clinical and community levels.     

Gender differences in the longitudinal associations of depressive symptoms and leisure-time physical activity with cognitive decline in ≥ 57 year-old Taiwanese

ObjectiveThis study investigates the role of gender in the associations of long-term depressive symptoms and leisure-time physical activity (LTPA) with the risk of cognitive decline in elderly Taiwanese.MethodWe analyzed 3679 subjects (age ≥ 57) in the 2003 and 2007 datasets of the Taiwan Longitudinal Survey on Aging, of which data were collected via face-to-face interviews by trained interviewers. We excluded proxy respondents. Multivariable logistic regression analysis examined the associations of long-term depressive symptoms (increased symptoms: CES-D10 scores from < 10 to ≥ 10; decreased symptoms: from ≥ 10 to < 10) and LTPA (frequency, duration, and intensity) with cognitive decline (a decrease of two or more SPMSQ scores).ResultsWomen had significant higher percentages of cognitive impairment, compared to men, at the baseline (5.9 vs. 1.5%; χ² = 51.24, p < 0.001) and end-point (10.8 vs. 5.2%;χ² = 39.5, p < 0.001). Men with long-term depressive symptoms had 5.28 greater odds of cognitive decline (OR = 5.28, 95%CI = 2.84–9.82, p < 0.001) and men with increased depressive symptoms had 2.09 greater odds (2.09, 1.24–3.51, p = 0.006). No such association was observed in women. Men with consistently high LTPA had 65% (0.35, 0.19–0.65, p = 0.001) and women with increased LTPA had 43% (0.57, 0.34–0.93, p = 0.024) reduction in odds of developing cognitive decline.ConclusionWe found gender differences in the longitudinal association between depressive symptoms and cognitive decline. Long-term LTPA may loosen the association between long-term depressive symptoms and cognitive decline. These findings are useful in the identification of vulnerable elderly in the Taiwanese population and public health interventions should focus on assisting their cognitive aging.     

The effects of multiple coronary artery disease risk factors on subclinical atherosclerosis in a rural population in the United States

IntroductionThe risk factors for cardiovascular disease (CVD) are associated with coronary atherosclerosis and having multiple risk factors potentiates atherosclerosis. This study examined the prevalence of multiple biological and lifestyle/behavioral risk factors and their association with coronary artery calcium (CAC), a marker for subclinical coronary atherosclerosis.MethodsThis is a cross-sectional study of 1607 community-dwelling asymptomatic individuals from central Appalachia who participated in CAC screening between January 2011 and December 2012. Data on demographics (sex and age) and 7 traditional risk factors for coronary artery disease (CAD) were collected and categorized into 5 groups (0–1, 2, 3, 4, and ≥ 5). Prevalence of these risk factors and CAC scores (0, 1–99, 100–399, ≥ 400) were assessed, and the impact of the number of risk factors on CAC scores were delineated using multiple logistic regression.ResultsOver 98% of participants had ≥ 1 risk factor. While obesity, diabetes, hypertension, and family history of CAD significantly increased the odds of having CAC, CAC scores significantly increased with number of risk factors. After adjusting for demographic factors, having 3, 4, and ≥ 5 risk factors was significantly associated with increased odds of having higher CAC scores when compared to zero CAC score by more than one and half times [OR = 1.65, CI (1.20–2.25)], two times [OR = 2.32, CI (1.67–3.23)] and three times [OR = 3.45, CI (2.42–4.92)], respectively.ConclusionThe high prevalence of multiple risk factors in the study population suggests the need for aggressive multiple risk factors interventions for primary prevention of CAD, which could address CVD health disparities.     

Eight-year change in body mass index and subsequent risk of cardiovascular disease among healthy non-smoking men

Objective.To determine how change in BMI over 8 years is associated with risk of subsequent cardiovascular disease (CVD) among middle aged men.Methods.Prospective cohort study among 13,230 healthy men (aged 51.6 ± 8.7 years) in the Physicians' Health Study. BMI was collected at baseline in 1982 and after 8 years, at which time follow-up began. Subsequent CVD events were collected and confirmed through March 31, 2005. Cox proportional hazards models evaluated BMI at 8 years and risk of CVD, 8-year change in BMI and risk of CVD, and whether change in BMI added prognostic information after the consideration of BMI at 8 years.Results.1308 major CVD events occurred over 13.5 years. A higher BMI at year 8 was associated with an increased risk of CVD. Compared to a stable BMI (± 0.5 kg/m²), a 0.5–2.0 kg/m² increase had a multivariable-adjusted RR of 1.00 (0.86–1.16). A ≥ 2.0 kg/m² increase had a multivariable-adjusted RR of 1.39 (1.16–1.68), however further adjustment for BMI reduced the RR to 1.00 (0.81–1.23). A decrease in BMI had a multivariable RR of 1.23 (1.07–1.42) which was unaffected by adjustment for BMI at 8 years.Conclusion.A higher BMI and a rising BMI were both associated with an increased risk of CVD, however an increasing BMI did not add prognostic information once current BMI was considered. In contrast, a declining BMI was associated with an increased risk of CVD independent of current BMI.     

Feasibility and effects of a group-based resistance and aerobic exercise program for individuals with severe schizophrenia: A multidisciplinary approach

PurposePeople with schizophrenia/schizoaffective disorders have a higher risk of morbidity and premature mortality compared to the general population in part due to sedentary lifestyles. The aim of this pilot study was to investigate the feasibility and effects of aerobic (AT) and resistance training (RT) on individuals with schizophrenia/schizoaffective disorders.MethodsEight males and five females (mean age 44.6 ± 3 years) were randomized to either twice weekly exercise (n = 7) or usual care (control) (n = 6). Functional exercise capacity (six minute walk distance (6MWD)), muscular strength, anthropometric measures, and domains of mental health were measured at baseline and after 12 weeks. Data are presented as means ± SEM.ResultsThe exercise group demonstrated a 27.7 ± 22.3 m increase in 6MWD while the control group showed a decrease of 28.3 ± 26.6 m (between-group difference, p = 0.1). There was a significant strength increase for exercise (28.3 ± 8.8%, p = 0.01) but not for control (12.5 ± 8.5%, p = 0.2). The exercise group had a significant improvement in total Mental Health Inventory (MHI) score (p < 0.03) with no change for control. Gain in 6MWD was directly associated with improvement in total MHI score (r = 0.8, p = 0.009) as was reduction in depressive symptoms (r = ?0.9, p < 0.001) among all participants. Attendance at exercise sessions averaged 72 ± 4.4% with no dropouts. Reduction in depressive symptoms correlated with greater adherence to exercise (r = ?0.93, p = 0.02).ConclusionsA 12-week community-based AT and RT program results in significant improvements in overall mental health, muscular strength and a trend for improvement in functional exercise capacity. Among all participants, improvement in functional exercise capacity was associated with improvement in overall mental health as well as a reduction in depressive symptoms. Reduction in depressive symptoms was associated with greater adherence to exercise. A group exercise program for individuals with schizophrenia/schizoaffective disorder is feasible when implemented by a multidisciplinary team.