Search

Background: Diet quality photo navigation (DQPN) is a novel dietary intake assessment tool that was developed to help address limitations of traditional tools and to easily integrate into health care delivery systems. Prevailing practice is to validate new tools against approaches that are in wide use. Objective: This study aimed to assess 1) the validity of Diet ID in measuring diet quality, food group and nutrient intake against 2 traditional dietary assessment methods (i.e., food record [FR], food frequency questionnaire) and 2) the test reproducibility/reliability of Diet ID to obtain similar results with repeat assessments. Methods: Using a participant-sourcing platform for online research, we recruited 90 participants, 58 of whom completed DQPN, a 3-d FR (via the Automated Self-Administered 24-hour Dietary Assessment Tool), and a food frequency questionnaire (FFQ, via the Dietary History Questionnaire III). We estimated mean nutrient and food group intake with all 3 instruments and generated Pearson correlations between them. Results: Mean age (SD) of participants was 38 (11) y, and more than half were male (64%). The strongest correlations for DQPN when compared with the other 2 instruments were for diet quality, as measured by the Healthy Eating Index 2015; between DQPN and the FFQ, the correlation was 0.58 (P < 0.001), and between DQPN and the FR, the correlation was 0.56 (P < 0.001). Selected nutrients and food groups also showed moderate strength correlations. Test-retest reproducibility for measuring diet quality was evaluated for DQPN and showed a correlation of 0.70 (P < 0.0001). Conclusions: The current study offers evidence that DQPN is comparable to traditional dietary assessment tools for estimating overall diet quality. This performance, plus DQPN's ease-of-use and scalability, may recommend it in efforts to make dietary assessment a universal part of clinical care. [ABSTRACT FROM AUTHOR]

Objective: Mindfulness is an established approach to reduce distress and stress reactivity by improving awareness and tolerability of thoughts and emotions. This study compares mindfulness training to sleep hygiene in persons with multiple sclerosis (PWMS) who report chronic insomnia, examining sleep efficiency (SE), self-reported sleep quality and quality of life. Methods: Fifty-three PWMS were randomized (1:1) in a single-blinded, parallel group design to ten, two-hour weekly sessions of Mindfulness Based Stress Intervention for Insomnia (MBSI-I) over a span of ten weeks or a single, one hour sleep hygiene (SH) session over one day. The primary outcome measure was SE, measured by the Fitbit™ Charge 2 wrist device, at 10 and 16 weeks from the start of study interventions. Self-report outcomes included the Pittsburg Sleep Quality Rating Scale (PSQI), Insomnia Severity Index (ISI) and the Multiple Sclerosis Quality of Life Inventory (MSQLI). Nineteen participants in the MBSI-I group and 24 in the SH group completed the primary study. Subsequently, ten participants in the original SH group participated in the 10-week MSBI-I course and their data was added to the MBSI-I cohort (eMSBI-I). Results: While neither SE nor the PSQI showed significant differences between MBSI-I, eMBSI-I and SH groups, ISI improved in both the MSBI-I and eMBSI-I vs SH at 10 weeks (p = 0.0014 and p = 0.0275) but not 16 weeks. However, pre and post assessments within the MBSI-I and eMBSI-I cohorts did show significant improvement in the PSQI and ISI at 10 and 16 weeks, while SH was significant in the ISI only at 16 weeks. Several quality of life measurements, including fatigue, mental health and cognitive function favored the mindfulness cohorts. Conclusion: This pilot study demonstrates beneficial effects of MBSR on insomnia, sleep quality and quality of life in PWMS. Trial registration: NCT03949296. 14 May 2019. [ABSTRACT FROM AUTHOR]

Lifestyle changes that emphasis on plant-based diets (PBD) are typically recommended for those at risk for type 2 diabetes mellitus (T2DM) to mitigate their cardo-metabolic risk. We examined the impact of the inclusion of eggs compared with their exclusion from PBD on diet quality among adults at risk for T2DM. This was a randomized, controlled, single-blind, crossover trial of 35 adults (mean age 60.7 years; 25 women, 10 men; 34 Caucasians, 1 African-American) at risk for T2DM (i.e., pre- diabetes or metabolic syndrome) assigned to one of two possible sequence permutations of two treatments (PBD with eggs and exclusively PBD), with a 4-week washout period. Participants received dietary counseling from a dietitian to exclude or to include 2 eggs daily in the context of PBD for a 6-week period. Diet quality was assessed using the Healthy Eating Index 2015 (HEI-2015) at baseline and 6 weeks. Compared with the exclusion of eggs, the inclusion of eggs in the context of PBD improved the diet quality score for intake of total protein foods (1.0 ± 1.1 vs. −0.4 ± 1.0; p <.0001); seafood and plant proteins (0.2 ± 1.2 vs. −0.4 ± 1.1; p = 0.0338); and fatty acids (0.8 ± 2.5 vs. −0.7 ± 2.7; p = 0.0260). Overall diet quality score depreciated with the adoption of exclusively PBD without eggs (−3.1 ± 8.3; p = 0.0411), while it was unaffected with the adoption of a PBD with the inclusion of eggs (−0.6 ± 7.9; p = 0.6892). Eggs could be used as an adjuvant to enhance the diet quality among those at risk for T2DM who adopt plant-based dietary patterns. [ABSTRACT FROM AUTHOR]

Background: Plant-based diets (PBDs) are typically recommended to those at risk of type 2 diabetes mellitus (T2DM).Objectives: We examined how including eggs, compared with excluding them from PBDs, affected cardiometabolic risk factors in adults at risk of T2DM.Methods: This was a randomized, controlled, single-blind, crossover trial of 35 adults (mean age: 60.7 y; 25 women, 10 men) at risk of T2DM assigned to 1 of 2 sequence permutations of 2 dietary treatments (plant-based plus eggs, and exclusively plant-based), with a 4-wk washout period. A dietitian counseled participants to exclude or include 2 eggs daily in the context of PBDs for a 6-wk interval. Our primary outcome measure was endothelial function (EF) measured as flow-mediated dilatation. Secondary outcome measures included lipid profile, blood pressure, insulin sensitivity, anthropometry, and dietary intake. Data were analyzed using generalized linear models.Results: Compared with egg exclusion, egg inclusion in the context of PBDs did not adversely affect EF (-1.7% ± 6.5% compared with -1.8% ± 7.5%; P = 0.9805). Likewise, egg inclusion, compared with egg exclusion, did not adversely affect (P = 0.1096-0.9781) lipid profile, blood pressure, insulin sensitivity, or anthropometry. Egg inclusion, compared with egg exclusion, improved reported intakes of selenium (23.1 ± 30.3 μg/d compared with 2.3 ± 34.9 μg/d; P = 0.0124) and choline (172.0 ± 96.0 mg/d compared with -3.4 ± 68.1 mg/d; P < 0.0001).Conclusions: Consuming 2 eggs daily in the context of PBDs does not adversely affect cardiometabolic risk factors among adults at risk of T2DM. Eggs could be used as an adjuvant to enhance PBDs that are typically recommended for those at risk of T2DM.This trial was registered at clinicaltrials.gov as NCT04316429. [ABSTRACT FROM AUTHOR]

Background: Current treatment options for knee osteoarthritis have limited effectiveness and potentially adverse side effects. Massage may offer a safe and effective complement to the management of knee osteoarthritis.Objective: Examine effects of whole-body massage on knee osteoarthritis, compared to active control (light-touch) and usual care.Design: Multisite RCT assessing the efficacy of massage compared to light-touch and usual care in adults with knee osteoarthritis, with assessments at baseline and weeks 8, 16, 24, 36, and 52. Subjects in massage or light-touch groups received eight weekly treatments, then were randomized to biweekly intervention or usual care to week 52. The original usual care group continued to week 24. Analysis was performed on an intention-to-treat basis.Participants: Five hundred fifty-one screened for eligibility, 222 adults with knee osteoarthritis enrolled, 200 completed 8-week assessments, and 175 completed 52-week assessments.Intervention: Sixty minutes of protocolized full-body massage or light-touch.Main Measures: Primary: Western Ontario and McMaster Universities Arthritis Index. Secondary: visual analog pain scale, PROMIS Pain Interference, knee range of motion, and timed 50-ft walk.Key Results: At 8 weeks, massage significantly improved WOMAC Global scores compared to light-touch (- 8.16, 95% CI = - 13.50 to - 2.81) and usual care (- 9.55, 95% CI = - 14.66 to - 4.45). Additionally, massage improved pain, stiffness, and physical function WOMAC subscale scores compared to light-touch (p < 0.001; p = 0.04; p = 0.02, respectively) and usual care (p < 0.001; p = 0.002; p = 0.002; respectively). At 52 weeks, the omnibus test of any group difference in the change in WOMAC Global from baseline to 52 weeks was not significant (p = 0.707, df = 3), indicating no significant difference in change across groups. Adverse events were minimal.Conclusions: Efficacy of symptom relief and safety of weekly massage make it an attractive short-term treatment option for knee osteoarthritis. Longer-term biweekly dose maintained improvement, but did not provide additional benefit beyond usual care post 8-week treatment.Trial Registration: clinicaltrials.gov NCT01537484. [ABSTRACT FROM AUTHOR]

Objectives. We examined the effect of estrogen avoidance on mortality rates among hysterectomized women aged 50 to 59 years. Methods. We derived a formula to relate the excess mortality among hysterectomized women aged 50 to 59 years assigned to placebo in the Women's Health Initiative randomized controlled trial to the entire population of comparable women in the United States, incorporating the decline in estrogen use observed between 2002 and 2011. Results. Over a 10-year span, starting in 2002, a minimum of 18 601 and as many as 91 610 postmenopausal women died prematurely because of the avoidance of estrogen therapy (ET). Conclusions. ET in younger postmenopausal women is associated with a decisive reduction in all-cause mortality, but estrogen use in this population is low and continuing to fall. Our data indicate an associated annual mortality toll in the thousands of women aged 50 to 59 years. Informed discussion between these women and their health care providers about the effects of ET is a matter of considerable urgency. [ABSTRACT FROM AUTHOR]

The article discusses a study that examined the impact of noninvasive cardiovascular imaging in primary prevention. It considers randomized trials that screened patients for inducible myocardial ischemia, coronary calcification, carotid atherosclerosis, and left ventricular hypertrophy. Findings indicate that imaging had no effect on medication prescribing, confidence interval, or on the provision of lipid-modifying agents.

Background and Objective: Dehydrated fruit and vegetable concentrates provide an accessible form of phytonutrient supplementation that may offer cardioprotective effects. This study assessed the effects of two blends of encapsulated juice powder concentrates (with and without added berry powders) on endothelial function in persons with metabolic syndrome, a risk factor for type 2 diabetes and cardiovascular disease.Methods: Randomized, double blind, placebo controlled crossover clinical trial with three treatment arms. 64 adults with metabolic syndrome were enrolled and received 8-week sequences of each blend of the concentrates and placebo. The primary outcome measure was change in endothelial function (assessed as flow-mediated dilatation of the brachial artery) 2 hr after consuming a 75 g glucose load, after 8-weeks of daily consumption (sustained) or 2 hr after consumption of a single dose (acute). Secondary outcome measures included plasma glucose, serum insulin, serum lipids, and body weight.Results: No significant between-group differences in endothelial function with daily treatment for 8 weeks were seen. No other significant treatment effects were discerned in glucose, insulin, lipids, and weight.Conclusion: Encapsulated fruit and vegetable juice powder concentrates did not alter insulin or glucose measures in this sample of adults with metabolic syndrome.Trial Registration: clinicaltrials.gov NCT01224743. [ABSTRACT FROM AUTHOR]

The Department of Health and Human Services initiated a pilot "microgrant" or small grants program in 2001 to promote Healthy People 2010 (HP 2010) implemented by the Yale-Griffin Prevention Research Center. This article describes the 103 agencies funded under this initiative and 67 control group agencies. It evaluates the HP 2010 focus areas targeted and the effectiveness of promoting HP 2010 objectives through microgrants. Forty-four percent of the grant recipients and 79% of the control group agencies indicated low levels of familiarity with HP 2010 goals. Changes in knowledge of HP 2010 goals for the microgrant group increased significantly from 5.24 ± 3.67 to 7.83 ± 1.86 (p < .05). The results suggest that microgrants can be a useful mechanism to plant the seeds for developing community and organizational capacity to define local health priorities, practice and test new initiatives or expand existing programs and promote knowledge about HP 2010. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Systematic reviews point to inconclusive evidence that counselling patients in a primary care setting is effective in increasing adults’ physical activity (PA) levels. This study evaluates the impact of an innovative physician counselling programme on physicians’ PA counselling behaviour and their patients’ PA levels. Methods A controlled educational study conducted at six Yale School of Medicine hospitals. Sixty-five internal medicine residents and 316 primary care patients were randomized to intervention or control groups. Intervention physicians participated in five interactive sessions outlining details of the Pressure System Model, while control physicians received usual residency training. Intervention and control patients’ PA levels and residents counselling behaviour were assessed using a validated questionnaire and compared pre- and post intervention. Data analysis was performed using paired t-tests and repeated measuresanova. Results At 6-month follow-up intervention, patients’ PA levels increased significantly from baseline (1.77 ± 0.84; P = 0.0376). A similar pattern was observed after 12 months (1.94 ± 0.98; P = 0.0486). Control patients’ PA did not change significantly from baseline at 6 or 12 months (0.35 ± 1.00; P = 0.7224 and 0.99 ± 1.52; P = 0.5160, respectively). At 12 months, intervention residents provided PA counselling 1.5 times more than they did at baseline ( P < 0.05) compared with no significant changes in the control group. Conclusions The present study has shown that providing residents with a practical tool, enabling them to deal with patients’ barriers and previous failure in behavioural change, is efficacious in increasing PA levels of adult patients. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "The Mortality Toll of Estrogen Avoidance: An Analysis of Excess Deaths Among Hysterectomized Women Aged 50 to 59 Years" by P. M. Sarrel et al.

Two letters to the editor are presented in response to the article "The Mortality Toll of Estrogen Avoidance: An Analysis of Excess Deaths Among Hysterectomized Women Aged 50 to 59 Years" by P. M. Sarrel et al.