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Objectives: Cognitive difficulties or impairment may be an early step in the development of dementia. Several modifiable risk factors for cardiovascular disease (CVD) may also increase the risk of dementia. The objective of our study was to compare adults with subjective cognitive impairment (SCI), using the Behavioral Risk Factor Surveillance System (BRFSS) cognitive disability measure, with adults who reported CVD., Methods: We examined data on 3 key outcomes among 302 008 adult respondents aged ≥45 in the 2017 BRFSS: respondents with SCI only, respondents with CVD only, and respondents with both conditions. We compared measures of disability, quality of life, access to health care, and a composite measure of the following 7 risk factors: current smoking, diabetes, high cholesterol, hypertension, inadequate fruit and vegetable consumption, obesity, and sedentary lifestyle. We also estimated population-attributable risk (PAR)., Results: Among respondents, 7.9% reported SCI only, 11.1% reported CVD only, and 3.2% reported both conditions, with differences by age and sex. Adults with SCI only were more likely than adults with CVD only to report other disability, worse access to health care, and poorer quality of life, even though adults with CVD were older. Compared with adults with neither condition, adults with any of the 3 outcomes were more likely to report having each of the 7 risk factors; we found a linear association with an increasing number of risk factors. Five or 6 risk factors contributed to PARs for each of the 3 key outcomes. PARs for SCI only were highest for ever smoking (17.2%) and sedentary lifestyle (12.8%), whereas for CVD only, PARs were highest for hypertension (35.5%) and high cholesterol (22.9%)., Conclusion: Despite differences between adults with SCI and adults with CVD in several demographic and health-related measures, the overall similarity in PARs for SCI and CVD suggests potential benefits from using effective CVD interventions to address SCI.

Objectives: Development of digital biomarkers to predict treatment response to a digital behavioural intervention., Design: Machine learning using random forest classifiers on data generated through the use of a digital therapeutic which delivers behavioural therapy to treat cardiometabolic disease. Data from 13 explanatory variables (biometric and engagement in nature) generated in the first 28 days of a 12-week intervention were used to train models. Two levels of response to treatment were predicted: (1) systolic change ≥10 mm Hg (SC model), and (2) shift down to a blood pressure category of elevated or better (ER model). Models were validated using leave-one-out cross validation and evaluated using area under the curve receiver operating characteristics (AUROC) and specificity- sensitivity. Ability to predict treatment response with a subset of nine variables, including app use and baseline blood pressure, was also tested (models SC-APP and ER-APP)., Setting: Data generated through ad libitum use of a digital therapeutic in the USA., Participants: Deidentified data from 135 adults with a starting blood pressure ≥130/80, who tracked blood pressure for at least 7 weeks using the digital therapeutic., Results: The SC model had an AUROC of 0.82 and a sensitivity of 58% at a specificity of 90%. The ER model had an AUROC of 0.69 and a sensitivity of 32% at a specificity at 91%. Dropping explanatory variables related to blood pressure resulted in an AUROC of 0.72 with a sensitivity of 42% at a specificity of 90% for the SC-APP model and an AUROC of 0.53 for the ER-APP model., Conclusions: Machine learning was used to transform data from a digital therapeutic into digital biomarkers that predicted treatment response in individual participants. Digital biomarkers have potential to improve treatment outcomes in a digital behavioural intervention., Competing Interests: Competing interests: NLG, KLE, KJA, DLK and MAB are employees and equity owners of Better Therapeutics, LLC; DME, JC and SD are independent paid scientific consultants of Better Therapeutics and JC was provided the raw data to perform all machine learning methods independently., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To compare two intensity levels (standard vs. enhanced) of a nutrition and physical activity intervention vs. a control (usual programs) on nutrition knowledge, body mass index, fitness, academic performance, behavior, and medication use among elementary school students., Design: Quasi-experimental with three arms., Setting: Elementary schools, students' homes, and a supermarket., Subjects: A total of 1487 third-grade students., Intervention: The standard intervention (SI) provided daily physical activity in classrooms and a program on making healthful foods, using food labels. The enhanced intervention (EI) provided these plus additional components for students and their families., Measures: Body mass index (zBMI), food label literacy, physical fitness, academic performance, behavior, and medication use for asthma or attention-deficit hyperactivity disorder (ADHD)., Analysis: Multivariable generalized linear model and logistic regression to assess change in outcome measures., Results: Both the SI and EI groups gained less weight than the control (p < .001), but zBMI did not differ between groups (p = 1.00). There were no apparent effects on physical fitness or academic performance. Both intervention groups improved significantly but similarly in food label literacy (p = .36). Asthma medication use was reduced significantly in the SI group, and nonsignificantly (p = .10) in the EI group. Use of ADHD medication remained unchanged (p = .34)., Conclusion: The standard intervention may improve food label literacy and reduce asthma medication use in elementary school children, but an enhanced version provides no further benefit.

Objectives: Our objective was to create and explore potential uses of a composite "Healthy Lifestyle" measure based on Healthy People 2020 (HP2020) Objectives for behaviors shown to be associated with morbidity and mortality., Methods: Data were from the 2013 Behavioral Risk Factor Surveillance System (N=412,942) on five modifiable behaviors with HP2020 Objectives (leisure time exercise, eating fruits and vegetables 5 or more times/day, getting ≥7h of sleep/24h, not smoking and not drinking excessively). These indicators were combined to form an all-or-none composite Healthy Lifestyle (HLS) measure. Associations between the HLS measure and demographic and other measures, plus details of component measures, were reported., Results: Results indicated that only 7.7% of adults reported a HLS with wide variation among states and demographic groups. Both unadjusted and logistic regression results found associations between a HLS and better health, lower rates of chronic disease and better access to health care. Over one fourth of all respondents (28.0%) needed to only improve fruit and vegetable consumption to be practicing a HLS., Conclusions: In conclusion, few adults were practicing five behaviors that are generally recognized as healthy. All-or-none metrics like this HLS measure offer a fresh perspective on modifiable behaviors and the need for improvement. Examination of measure components can help explain demographic differences and identify strategies for improvement., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: The purpose of the study was to examine the efficacy of a multidisciplinary train-the-trainer model for improving fitness and food label literacy in third-grade students., Design: University student trainers taught ABC for Fitness and Nutrition Detectives, established programs to promote physical activity and nutrition knowledge, to 239 third-grade students in 2 communities over a 6-month period. A total of 110 children were in the intervention group and 129 children in the control group (2 schools each). Outcomes included the Food Label Literacy and Nutrition Knowledge test and the fitness measures of curl-ups, push-ups, 0.5-mile run, and sit and reach. Focus groups were conducted as process feedback., Setting: Four public schools in 2 different communities., Participants: A total of 200 third-grade students., Intervention: ABC for Fitness and Nutrition Detectives., Main Outcome Measures: Food Label Literacy and Nutrition Knowledge test and the fitness measures of curl-ups, push-ups, 0.5-mile run, and sit and reach., Results: Nutrition knowledge increased in the intervention group by 25.2% (P < .01). Fitness measures in the intervention schools showed greater improvement than those in the controls for curl-ups (P < .01), push-ups (P < .01), sit and reach left (P = .07), and 0.5-mile run (P = .06). Process feedback from 3 teachers and 60 students indicated satisfaction with the program., Conclusion: Adaptation of the train-the-trainer approach for Nutrition Detectives and ABC for Fitness was effective for delivering these health-related programs.

Background: Improving diets has considerable potential to improve health, but progress in this area has been limited, and advice to increase fruit and vegetable intake has largely gone unheeded., Objectives: Our objective was to test the performance characteristics of the Overall Nutritional Quality Index (ONQI), a tool designed to help improve dietary patterns one well-informed choice at a time., Design: The ONQI was developed by a multidisciplinary group of nutrition and public health scientists independent of food industry interests and is the basis for the NuVal Nutritional Guidance System. Dietary guidelines, existing nutritional scoring systems, and other pertinent scientific literature were reviewed. An algorithm incorporating >30 entries that represent both micro- and macronutrient properties of foods, as well as weighting coefficients representing epidemiologic associations between nutrients and health outcomes, was developed and subjected to consumer research and testing of performance characteristics., Results: ONQI and expert panel rankings correlated highly (R = 0.92, P < 0.001). In consumer testing, approximately 80% of >800 study participants indicated that the ONQI would influence their purchase intent. ONQI scoring distinguished the more-healthful DASH (Dietary Approaches to Stop Hypertension) diet (mean score: 46) from the typical American diet according to the National Health and Nutrition Examination Survey (NHANES) 2003-2006 (mean score: 26.5; P < 0.01). In linear regression analysis of the NHANES 2003-2006 populations (n = 15,900), the NuVal system was significantly associated with the Healthy Eating Index 2005 (P < 0.0001). Recently generated data from ongoing studies indicate favorable effects on purchase patterns and significant correlation with health outcomes in large cohorts of men and women followed for decades., Conclusion: NuVal offers universally applicable nutrition guidance that is independent of food industry interests and is supported by consumer research and scientific evaluation of its performance characteristics.

Introduction: Despite low levels of physical activity among Arabs in Israel, interventions designed to increase physical activity in this population have been scarce. To improve our understanding of the cultural, religious, and environmental barriers and enablers to physical activity, we conducted a qualitative study among Arab Israeli college students in Israel., Methods: A total of 45 students participated in 8 focus groups. Purposeful sampling was used to capture the diverse characteristics of participants. Two researchers analyzed the data independently guided by grounded theory. Peer-debriefing sessions were held to group preliminary categories into larger themes. Generally, consensus between researchers was high, and minor differences were resolved., Results: Participants recognized the importance of physical activity in chronic disease prevention, yet most were not regularly physically active. This contradiction could be explained by the fact that many participants lived in an extended-family setting that deemphasized the importance of physical activity. Women often found themselves exercising at odd hours so that they would not be noticed by neighbors. Religion, in comparison, was considered a facilitating factor because the scriptures supported physical activity. Furthermore, an urban environment was an enabling factor because it provided exercise facilities, sidewalks, and a socially acceptable venue for activity. Participants felt resources were not allocated by the government to accommodate physical activity., Conclusion: Increasing Arab Israelis' access to safe and culturally appropriate exercise facilities should become a priority. Thus, policy changes in allocating appropriate funds to promote physical activity must be considered, along with using multiple health promotion strategies.

In addition, both stress and sleep deprivation impact food choices through multiple mechanisms, including changes in ghrelin and leptin and a shift in decision making from a thoughtful, reflective approach regulated by the prefrontal cortex to a more reflexive, emotionally driven response from the amygdala and related subcortical structures.[7] [8] This results in a "default to habit" and preference for highly palatable, more energy dense foods.[9] Addressing stress and sleep may be prerequisites to support patient's efforts to engage and sustain (or reengage) in dietary change. Empathy Empathy has been associated with improved physician-patient relationships and health outcomes. Motivational Interviewing, a foundational component of health and lifestyle coaching, and patient centered communication are 2 examples of overlapping frameworks that can facilitate dialogue in an empathetic and nonjudgmental way.[5],[19][20] [21] Both address psychological needs such as autonomy, relatedness and competence that predict greater adherence to recommended health behaviors. Empathy and Language in the Clinician Patient Relationship: Improving the Translation of Evid... Introduction Translating evidence into real life behavior change for patients requires more than just a clear articulation of the strength of the science behind recommendations. [Extracted from the article]

The article presents the interview with David L. Katz, founding director at Yale University/Griffin Hospital, Robert F. Kushner, medical education at Northwestern University Feinberg School of Medicine, and Beth Frates, wellness coach at Wellness Synergy. Topics include the importance of positioning to improve oxygenation was discerned, the increased risk is particularly noted among those with moderate to severe obesity, and the association of COVID-19 is to examine the mechanistic changes.

Methods for translating the findings of controlled trials, such as the Diabetes Prevention Program, into real-world community application have not been clearly defined. A standardized research methodology for making and evaluating such a transition is needed. We introduce the multisite translational community trial (mTCT) as the research analog to the multisite randomized controlled trial. The mTCT is adapted to incorporate the principles and practices of community-based participatory research and the increased relevance and generalizability gained from diverse community settings. The mTCT is a tool designed to bridge the gap between what a clinical trial demonstrates can work in principle and what is needed to make it workable and effective in real-world settings. Its utility could be put to the test, in particular with practice-based research networks suchas the Prevention Research Centers. [ABSTRACT FROM AUTHOR]

The article focuses on the need for whole systems approach to evidence evaluation as per studies by the American College of Lifestyle Medicine (ACLM). Topics discussed include impact on mortality and morbidity, benefits of randomized control trials (RCT) and practise based evidence, and project Hierarchies of Evidence Applied to Lifestyle Medicine (HEALM).

The article presents the author's insights on the leading causes of death in the U.S. It cites the studies which relate that tobacco use, dietary pattern, and level of physical activity are associated with premature death and chronic diseases. It highlights the study by Ford and colleagues which reflect that lifestyle with physical activity, healthy diet, and body mass index below 30 kilograms could prevent chronic diseases, and notes the need to alter one's undesirable health behavior.

Purpose. To replicate results of a pilot smoking cessation study and demonstrate applicability to a worksite setting. Methods. Smokers employed by a community hospital participated in an onsite smoking cessation program. Participants used an “impediment profiling” instrument to rate personal barriers to cessation and were assigned to between one and seven interventions. Cessation was defined as carbon monoxide concentration in expired air of ≤10 ppm. Results. Fifty-one employees participated. Subjects lost to follow-up were assumed to be smoking, resulting in a 39.2% 1-year quit rate; 47.5% of program completers (n = 40) were smoke-free at 1 year. Self-reported quit rate at 2.5 years was 25.5% (17 lost to attrition assumed to be smoking) with 38.2% of program completers smoke-free. Discussion. This study suggests that impediment profiling holds promise for smoking cessation and demonstrates feasibility in a worksite setting. Further evaluation of this intervention in the context of randomized controlled trials is warranted. (Am J Health Promot 2006;21[2]:97–100.) [ABSTRACT FROM AUTHOR]