Gender Differences in Exercise Dependence and Eating Disorders in Young Adults: A Path Analysis of a Conceptual Model

The purpose of our study was to study the prevalence of exercise dependence (EXD) among college students and to investigate the role of EXD and gender on exercise behavior and eating disorders. Excessive exercise can become an addiction known as exercise dependence. In our population of 517 college students, 3.3% were at risk for EXD and 8% were at risk for an eating disorder. We used Path analysis the simplest case of Structural Equation Modeling (SEM) to investigate the role of EXD and exercise behavior on eating disorders. We observed a small direct effect from gender to eating disorders. In females we observed significant direct effect between exercise behavior (r = −0.17, p = 0.009) and EXD (r = 0.34, p < 0.001) on eating pathology. We also observed an indirect effect of exercise behavior on eating pathology (r = 0.16) through EXD (r = 0.48, r² = 0.23, p < 0.001). In females the total variance of eating pathology explained by the SEM model was 9%. In males we observed a direct effect between EXD (r = 0.23, p < 0.001) on eating pathology. We also observed indirect effect of exercise behavior on eating pathology (r = 0.11) through EXD (r = 0.49, r² = 0.24, p < 0.001). In males the total variance of eating pathology explained by the SEM model was 5%.     

Cognition,Physical Function,and Quality of Life in Older Patients With Acute Decompensated Heart Failure

BackgroundOlder adults with acute decompensated heart failure have persistently poor clinical outcomes. Cognitive impairment (CI) may be a contributing factor. However, the prevalence of CI and the relationship of cognition with other patient-centered factors such a physical function and quality of life (QOL) that also may contribute to poor outcomes are incompletely understood.Methods and ResultsOlder (≥60 years) hospitalized patients with acute decompensated heart failure were assessed for cognition (Montreal Cognitive Assessment [MoCA]), physical function (Short Physical Performance Battery [SPPB], 6-minute walk distance [6MWD]), and QOL (Kansas City Cardiomyopathy Questionnaire, Short Form-12). Among patients (N = 198, 72.1 ± 7.6 years), 78% screened positive for CI (MoCA of <26) despite rare medical record documentation (2%). Participants also had severely diminished physical function (SPPB 6.0 ± 2.5 units, 6MWD 186 ± 100 m) and QOL (scores of <50). MoCA positively related to SPPB (ß = 0.47, P < .001), 6MWD ß = 0.01, P = .006) and inversely related to Kansas City Cardiomyopathy Questionnaire Overall Score (ß = –0.05, P < .002) and Short Form-12 Physical Component Score (ß = –0.09, P = .006). MoCA was a small but significant predictor of the results on the SPPB, 6MWD, and Kansas City Cardiomyopathy Questionnaire.ConclusionsAmong older hospitalized patients with acute decompensated heart failure, CI is highly prevalent, is underrecognized clinically, and is associated with severe physical dysfunction and poor QOL. Formal screening may reduce adverse events by identifying patients who may require more tailored care.     

Potentially Inappropriate Medication Use is Associated with Clinical Outcomes in Critically Ill Elderly Patients with Neurological Injury

Background

Limited data suggest that potentially inappropriate medications (PIMs) impact outcomes in critically ill elderly patients. No data are available on the association between PIM use as well as drug burden index (DBI), which is a measure of PIM use, and clinical outcomes in neurocritical care elderly patients. This study evaluates whether PIM use and a higher DBI are associated with poor clinical outcomes in neurocritical care elderly patients.

Methods

PIMs were retrospectively identified in critically ill elderly patients admitted to the neuroscience intensive care unit (NSICU) from March to July 2011. DBI was calculated based on PIM doses. Relationships with clinical outcomes were evaluated.

Results

PIMs were prescribed to a majority (81.3 %) of the 112 patients. Opioids were most commonly associated with a decrease in Richmond Agitation Sedation Scale (RASS) scores (56 % of PIM doses). Time to recovery was significantly longer in patients with a higher PIM burden (≤2 PIMs: 8 h, >2 PIMs: 29 h; p = 0.02). There was a significantly longer NSICU and hospital length of stay (9 vs 2; 15 vs 5 days; p < 0.0001) as well as a lower Glasgow Coma Scale score upon discharge (14 vs 15, p = 0.02) in patients with a higher DBI after 72 h of hospitalization. There was no difference in mortality.

Conclusions

PIM use and higher DBI scores were associated with poor clinical outcomes and longer lengths of stay. Further studies are needed to determine the impact of PIMs and DBI on mortality in neurocritical care elderly patients.     

Health literacy and asthma management among African-American adults: an interpretative phenomenological analysis

Objective: African-Americans share a disproportionate burden of asthma and low health literacy and have higher asthma morbidity and mortality. Factors that link the relationship between health literacy and health outcomes are unclear. This study aimed to use patients’ experiences of managing asthma to better understand the relationship between health literacy and health outcomes. Methods: This study was the qualitative component of a mixed methods study. Following quantitative data collection, four participants, two with low print-related health literacy and two with adequate print-related health literacy, completed semi-structured interviews. Interview data were analyzed using interpretative phenomenological analysis. Results: Three themes emerged from the analysis: information desired versus information received, trial and error, and expectations of the patient–provider relationship. Individuals with adequate print-related health literacy had different strategies for overcoming barriers related to communicating with their providers, learning about their disease and experiences of discrimination within the healthcare system. Conclusions: Individuals with adequate print-related health literacy may be more equipped to participate in shared decision making and feel more confident to successfully manage their disease. It is also important that health literacy is discussed in the context of the cultural and racial background of the population of interest. This interdependent relationship between health literacy and culture is particularly important for African-Americans.     

Telling stories about abortion: abortion-related plots in American film and television, 1916–2013

Objectives

Popular discourse on abortion in film and television assumes that abortions are under- and misrepresented. Research indicates that such representations influence public perception of abortion care and may play a role in the production of social myths around abortion, with consequences for women’s experience of abortion. To date, abortion plotlines in American film and television have not been systematically tracked and analyzed.

Study design

A comprehensive online search was conducted to identify all representations of pregnancy decision making and abortion in American film and television through January 2013. Search results were coded for year, pregnancy decision and mortality outcome.

Results

A total of 310 plotlines were identified, with an overall upward trend over time in the number of representations of abortion decision making. Of these plotlines, 173 (55.8%) resulted in abortion, 80 (25.8%) in parenting, 13 (4.2%) in adoption and 21 (6.7%) in pregnancy loss, and 16 (5.1%) were unresolved. A total of 13.5% (n= 42) of stories ended with the death of the woman who considered an abortion, whether or not she obtained one.

Conclusions

Abortion-related plotlines occur more frequently than popular discourse assumes. Year-to-year variation in frequency suggests an interactive relationship between media representations, cultural attitudes and policies around abortion regulation, consistent with cultural theory of the relationship between media products and social beliefs. Patterns of outcomes and rates of mortality are not representative of real experience and may contribute to social myths around abortion. The narrative linking of pregnancy termination with mortality is of particular note, supporting the social myth associating abortion with death.

Implications

This analysis empirically describes the number of abortion-related plotlines in American film and television. It contributes to the systematic evaluation of the portrayal of abortion in popular culture and provides abortion care professionals and advocates with an initial accurate window into cultural stories being told about abortion.