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ObjectiveTo evaluate physical activity and attitudes toward exercise among people with axial (ax-) and peripheral (p-) spondyloarthritis (SpA).MethodsUsing baseline information from an ongoing, longitudinal, prospective SpA cohort study (n = 264), self-reported attitudes and beliefs toward exercise were assessed using questionnaires. Total metabolic equivalent (MET) hours of self-reported physical activity per week, time spent in activities, and activity levels were calculated from the Nurses’ Health Study Physical Activity Questionnaire II (NHSPAQ II). Adjusted multivariable linear models estimated the relationship between physical activity and disease status (axial vs peripheral).ResultsRegardless of predominant anatomic distribution of disease, most participants were well-educated, non-Hispanic White men. Approximately 40% met the US Department of Health and Human Services physical activity recommendations. Positive attitudes, beliefs, and perceived benefits toward exercise were similar by anatomic distribution of disease. Despite similar MET h/week, participants with axial disease had greater concerns regarding discomfort and joint injuries than those with peripheral disease. Compared to those with pSpA (n = 201), participants with axSpA (n = 63) spent less time engaging in light and moderate activities (adjusted β in light activity: –1.94 min/week, 95% CI –2.96 to –0.93; adjusted β in moderate activity: –1.05 min/week, 95% CI –2.12 to 0.02).ConclusionParticipants with axSpA had greater concerns regarding discomfort and injuries from exercise than those with pSpA. Although no differences in time spent in vigorous activities were observed, participants with axSpA spent less time than those with pSpA in light to moderate activities.

Eating disorders are more common among transgender and non-binary compared to cisgender people. Despite this, gender diverse people who seek eating disorder treatment often report struggling to find affirming and inclusive care. We interviewed nineteen US-based licensed mental health clinicians who specialized in eating disorder treatment to learn perceptions and knowledge of facilitators and barriers to care for transgender and gender diverse patients diagnosed with eating disorders. Factors affecting access to care included stigmatization, family support, financial factors, gendered clinics, scarcity of gender-competent care, and religious communities. Factors affecting care while in treatment included discrimination and microaggressions, provider lived experience and education, other patients and parents, institutions of higher education, family-centered care, gendered-centered care, and traditional therapeutic techniques. This research identified barriers and facilitators with the potential for improvement, especially those caused by clinician’s lack of knowledge or attitudes towards gender minority patients in treatment.

Objective.We examined the longterm effectiveness of corticosteroid or hyaluronic acid injections in relieving symptoms among persons with knee osteoarthritis (OA).Methods.Using Osteoarthritis Initiative data, a new-user design was applied to identify participants initiating corticosteroid or hyaluronic acid injections (n = 412). Knee symptoms (pain, stiffness, function) were measured using The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We used marginal structural models adjusting for time-varying confounders to estimate the effect on symptoms of newly initiated injection use compared to nonusers over 2 years of followup.Results.Among 412 participants initiating injections, 77.2% used corticosteroid injections and 22.8% used hyaluronic acid injections. About 18.9% had additional injection use after initiation, but switching between injection types was common. Compared to nonusers, on average, participants initiating a corticosteroid injection experienced a worsening of pain (yearly worsening: 1.24 points, 95% CI 0.82–1.66), stiffness (yearly worsening: 0.30 points, 95% CI 0.10–0.49), and physical functioning (yearly worsening: 2.62 points, 95% CI 0.94–4.29) after adjusting for potential confounders with marginal structural models. Participants initiating hyaluronic acid injections did not show improvements of WOMAC subscales (pain: 0.50, 95% CI −0.11 to 1.11; stiffness: −0.07, 95% CI −0.38 to 0.24; and functioning: 0.49, 95% CI −1.34 to 2.32).Conclusion.Although intraarticular injections may support the effectiveness of reducing symptoms in short-term clinical trials, the initiation of corticosteroid or hyaluronic acid injections did not appear to provide sustained symptom relief over 2 years of followup for persons with knee OA.

The two purposes of this investigation were: (a) to examine whether an association existed between stages of adopting regular mammography and decision-making constructs from the Transtheoretical Model (TTM) of behavior change, and (b) to determine whether any such associations would be found for each of the two ways of defining the stages-of-adoption. One method integrated past screening history with a report of future intention for screening; the other method used a single item with predetermined response categories. Data were from the baseline survey of 1,323 women aged 50–74 who were recruited as part of an intervention study through a local Health Maintenance Organization. Results showed that both ways of defining stages of adopting regular mammography were associated with decisional balance and processes-of-change. The method that integrated past history plus intention provided somewhat better discrimination among stages. Women who were labeled as being at “Risk of Relapse,” and those who said they waited for a “Provider’s Recommendation,” may be useful groups to add to the set of stages that have been employed so far by the TTM. In addition, a tendency to avoid the health care system in general was used as a process-of-change to complement the mammography-specific processes.

Background.To be most effective, physicians' smoking cessation interventions must go beyond advice, to include counseling and follow-up. A full profile of physician performance on the recommended activities to promote smoking cessation has not been provided previously.

Background.In accordance with the U.S. Preventive Services Task Force recommendations, the current pilot study tests the feasibility and efficacy of a physician-delivered physical activity counseling intervention.

The two purposes of this investigation were: (a) to examine whether an association existed between stages of adopting regular mammography and decision-making constructs from the Transtheoretical Model (TTM) of behavior change, and (b) to determine whether any such associations would be found for each of the two ways of defining the stages-of-adoption. One method integrated past screening history with a report of future intention for screening; the other method used a single item with predetermined response categories. Data were from the baseline survey of 1,323 women aged 50–74 who were recruited as part of an intervention study through a local Health Maintenance Organization. Results showed that both ways of defining stages of adopting regular mammography were associated with decisional balance and processes-of-change. The method that integrated past history plus intention provided somewhat better discrimination among stages. Women who were labeled as being at “Risk of Relapse,” and those who said they waited for a “Provider's Recommendation,” may be useful groups to add to the set of stages that have been employed so far by the TTM. In addition, a tendency to avoid the health care system in general was used as a process-of-change to complement the mammography-specific processes.