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Over time, adherence to healthy behaviors may improve physical and mental strength which is essential for successful aging. A plausible mechanism is the reduction of inflammation. Research on the association of risky health behaviors on change in strength with age is limited. This study examined changes in the inflammatory potential of the diet, smoking, illicit drug use with changes in strength in a racially and socioeconomically diverse adult sample from the Healthy Aging in Neighborhoods of Diversity Across the Life Span study. The dietary inflammatory index (DII) was calculated from 35 food components derived from multiple 24-h dietary recalls. Strength was evaluated by handgrip strength (HGS), SF-12 PCS and SF-12 MCS (physical and mental component scores). Repeated measures analyses were used to examine associations. At baseline, mean age was 48.4 ± 0.25 years, 56% of the sample were women, and 58% African American. Significant 4-way interactions were found between age, race, socioeconomic status, and DII for women, on change in HGS (p &lt, 0.05) and in SF-12 PCS (p &lt, 0.05) and for men, in change in SF-12 PCS (p &lt, 0.05). Improvements in SF-12 MCS were associated with all three health behaviors as main effects. This study provided evidence that changes towards improving healthy behaviors, diet with anti-inflammatory potential, not smoking cigarettes and not using illicit drugs, were associated with improved strength. Health professionals, especially registered dietitians and health coaches, should create lifestyle interventions to reduce inflammation targeting change in more than one risky health behavior.

PURPOSE OF REVIEW: The medical field has a critical role not only in prolonging life but also in helping patients achieve a good death. Early studies assessing end-of-life quality indicators to capture if a good death occurred demonstrated low rates of hospice use and high rates of intensive healthcare utilization near death among patients with hematologic malignancies, raising concerns about the quality of death. In this review, we examine trends in end-of-life care for patients with hematologic malignancies to determine if we are close to the goal of a good death. RECENT FINDINGS: Several cohort studies show that patients with blood cancers are often inadequately prepared for the dying process due to late goals of care discussions and they experience low rates of palliative and hospice care. More recent analyses of population-based data demonstrate some improvements over time, with significantly more patients receiving palliative care, enrolling in hospice, and having the opportunity to die at home compared to a decade ago. These encouraging trends are paradoxically accompanied by concomitant increases in late hospice enrollment and intensive healthcare utilization near death. SUMMARY: Although we are closer to the goal of a good death for patients with hematologic malignancies, there is ample room for growth. To close the gap between the current state of care and a good death, we need research that engages patients, caregivers, hematologic oncologists, and policy-makers to develop innovative interventions that improve timeliness of goals of care discussions, expand palliative care integration, and increase hospice use.

Sandwiches are considered a staple in diets of United States adults. Previous research with Healthy Aging in Neighborhoods of Diversity across the Life Span study participants revealed that 16% consume a sandwich dietary pattern providing with 44% of their daily energy. Yet, little is known about the effect of sandwiches on diet quality over time. The study objectives were to determine the relationship of energy contributed by sandwiches to diet quality in this socioeconomically and racially diverse sample categorized by age (&lt, 50 years and &ge, 50 years at baseline) and to describe patterns of sandwich consumption over ~12 years. The analyses included a series of linear mixed-effects regression models, with age as the time variable centered at 50 years. In each model, the main outcome was Healthy Eating Index-2010 score with up to three scores, while the main predictor was % total energy from sandwiches (0, &gt, 0&ndash, 20%, &gt, 20%) measured concurrently at each visit. Diet quality of older men with income &lt, 125% poverty improved over time for those consuming &gt, 20% and &gt, 20% energy from sandwiches compared to young women with incomes &gt, 125% poverty who were non-reporters of sandwiches (&beta, &plusmn, SE: 10.93 &plusmn, 5.27, p = 0.01, 13.11 &plusmn, 4.96, p = 0.01, respectively). The three most common sandwich types reported, in descending order, were cold cuts, beef, and poultry.

Knowledge of various aspects of dietary diversity (DD)&mdash, an essential healthful dietary component&mdash, across adulthood is limited. This study examined three DD aspects over time in racially diverse adults. Participants were from the National Institute on Aging, Healthy Aging in Neighborhoods of Diversity across the Life Span study. DD measures were calculated at baseline (N = 2177), and first and second examination follow-ups (N = 2140 and N = 2066, respectively) using two 24-h recalls. The count was based on the consumption of &ge, 50% of an equivalent from 21 food groups. Evenness was derived using the Berry-Index adjusted by the food&rsquo, s health value, dissimilarity, by Mahalanobis Distance. Mixed-effects linear regression models were conducted to test changes in DD across adulthood, adjusting for sex, race, poverty status and education as fixed effects, and adjusting for smoking, age and energy as time-dependent variables. Only dissimilarity showed significant interactions of time &times, race (p = 0.0005), and time &times, poverty status (p = 0.0325), indicating a slower rate of increase over time in dissimilarity scores among Whites compared with African&ndash, Americans and those with income &gt, 125% poverty versus &lt, 125% poverty. A significant interaction between time&times, energy (p &lt, 0.0001) was noted for both evenness and dissimilarity scores. To our knowledge, this is the first study to document the differential change in dissimilarity scores by race and income over time.

Objective. We examined relationships of vitamin D status with over time changes in patterns of sleep in a longitudinal study of Whites and African-American urban middle-aged adults, while further testing effect modification by age group, sex and race and the potential roles of dietary and supplemental vitamin D. Methods. Data on 1,760 middle-aged participants in the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS study: Age range at v2: 33-71y, mean±SD:53.0±8.8, % women: 58.4%, % African-American:60.3%) were used, with complete baseline 25-hydroxyvitamin D [25(OH)D] serum concentration data, initial selected covariates and mediators, and initial and/or follow-up data on five sub-scales (sleep duration, daytime dysfunction, sleep disturbance, sleep latency and sleep quality) of the Pittsburgh Sleep Quality Index. Mean±SD time between initial and follow-up visits: 4.1±1.5 years. Time-interval multiple mixed-effects linear regression models were used. Results. Upon multiple testing adjustment, among Whites, initial 25(OH)D was associated with better sleep duration [25(OH)D × TIME γ±SE: -0.027±0.011, P=0.017] and sleep quality [25(OH)D × TIME γ±SE: -0.026±0.010, P=0.008] over time, with heterogeneity by race found for both relationships (P Limitations. Limitations included small sample size, selection bias, residual confounding and lack of objective sleep measures. Conclusions Vitamin D status, possibly through mechanisms involving sunlight exposure, was linked to a potential improvement in sleep duration and quality among White urban adults.

Congenital anomalies are hereditary or acquired, and their location and intensity are determining factors for the survival of animals. Some cases are rare, often unidentified, poorly reported and of unknown etiology. This paper reports a congenital malformation in a French bulldog, demonstrating the importance of accurate diagnosis for surgical decisions. The use of new technologies such as computed tomography and rapid prototyping enables the analysis of morphofunctional changes, resulting in excellent results for clinical cases in which it is difficult to identify and scale the anatomical deformities. Through this feature, it is possible to accurately recreate anatomical structures of interest, enabling greater assertiveness in deciding the treatment to be established, whether surgical or not. Castration of animals that survive this condition due to hereditary etiology is recommended. RESUMO: Anomalias congênitas possuem caráter hereditário ou adquirido, sendo que sua localização e intensidade são fatores determinantes para a sobrevivência do animal. Algumas são raras, muitas vezes não identificadas, pouco relatadas e com etiologia desconhecida. O presente trabalho registra um caso de malformação congênita em um bulldog francês, demonstrando a importância do diagnóstico preciso para a decisão cirúrgica. A utilização de novas tecnologias como tomografia computadorizada e prototipagem rápida possibilitam a análise de alterações morfofuncionais, tendo ótimo resultado para casos clínicos em que há dificuldade em identificar e dimensionar deformidades anatômicas. Através desse recurso é possível recriar com precisão estruturas anatômicas de interesse, possibilitando maior assertiva na decisão do tratamento a ser estabelecido, sendo ele cirúrgico ou não. É recomendada a castração dos animais que sobreviveram a essa condição, devido a etiologia hereditária.

The endothelin system plays an important role in mediating vascular function. The endothelin-B receptor (ET(B)R) on endothelial cells mediates vasodilation via nitric oxide production. The vasodilatory effect of the ET(B)R is lost following menopause and may contribute to impaired vascular endothelial function in postmenopausal women (PMW). However, it is unclear if these functional changes are due to changes in ET(B)R expression on the endothelium. Therefore, the purpose of this study was to test the hypothesis that endothelial cell ET(B)R expression is lower in PMW compared with young women (YW). Primary endothelial cells were harvested from the antecubital vein of healthy PMW (n = 15, 60 ± 6 yr) and YW (n = 15, 22 ± 2 yr). Cells were identified as endothelial cells by staining for vascular endothelial cadherin, and nuclear integrity was assessed using 4′,6-diamidino-2-phenylindole (DAPI). Within those cells, ET(B)R was quantified using immunocytochemistry; fluorescence intensity was measured in 30 cells and averaged for each participant. Endothelial function was assessed using brachial artery flow-mediated dilation (FMD). Endothelial cell ET(B)R expression was lower in PMW [0.46 ± 0.11 arbitrary units (AU)] compared with YW (0.58 ± 0.14 AU; P = 0.02). Furthermore, significant correlations between ET(B)R expression and FMD (r = 0.47, P < 0.01), total cholesterol (r = −0.38, P = 0.04), and LDL cholesterol (r = −0.39, P = 0.03) were observed. These data demonstrate that endothelial cell ET(B)R expression is attenuated in PMW. These novel findings provide additional insight into the mechanisms underlying vascular endothelial dysfunction in PMW. NEW & NOTEWORTHY Our study provides novel data demonstrating attenuated endothelial ET(B)R expression in postmenopausal women. Furthermore, our data extend current knowledge by demonstrating a positive relation between ET(B)R expression and brachial artery flow-mediated dilation. These findings provide additional mechanistic insight into vascular endothelial dysfunction in postmenopausal women.

Diabetics have a much greater prevalence of trigger finger than nondiabetics and are more likely to have severe symptoms. Diabetic trigger finger may be more accurately described on a spectrum of diabetic hand pathology alongside carpal tunnel syndrome and cheiroarthropathy. Recent publications have called into question the current treatment algorithm for diabetic trigger finger. Although some evidence supports the use of corticosteroid injections, a recent cost analysis reported that immediate surgical release of the A1 pulley in the clinic is the most cost-effective management of diabetic trigger finger. In addition to traditional treatment with injection and open release, percutaneous release with or without simultaneous corticosteroid injection has shown promising results and may have a role in patient care. The appropriate treatment algorithm in terms of efficacy, safety, and cost remains controversial.

OBJECTIVES: Prior studies on caregivers have focused mainly on the diet quality of their recipients, especially children. We investigated both cross-sectional and longitudinal associations of caregiver status and diet quality in older adults (mean 53.0 ± 9.0 years). METHODS: We studied participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study (57.7% women, 62% African American) between wave 3 (2009–2013) and wave 4 (2013–2018). Caregiving was assessed at both waves, starting at wave 3. Healthy Eating Index-2010 (HEI2010) score, a measure of diet quality, was assessed from two 24-hour recalls at each wave on both occasions (mean 4.1 years follow-up). Baseline caregiving (at wave 3) was examined in relation to change in HEI between waves 3 and 4. Multivariable linear regression was performed for cross-sectional analysis; mixed-effects regression was performed for longitudinal analyses. Results are expressed as β-coefficients ± standard error of means (β±SE). RESULTS: After adjusting for age, sex, race and poverty status, more time spent taking care of grandchildren (N = 2033) was associated with poor diet quality (–1.51 ± 0.55, P = 0.006) in cross-sectional analysis (wave 4 caregiving and wave 4 HEI). However, in a separate cross-sectional analysis (wave 4 only) on dual (caring for both grandchildren and an elderly person) vs. single caregivers (either grandchildren or elderly) (N = 73; 24 men & 49 women) we found no difference in diet quality. The longitudinal analyses (N = 1848) demonstrated that diet quality did not change with caregiving over time for either grandchildren (P = 0.16) or others (not children & grandchildren) (P = 0.88). Overall, women tended to have better quality diet (P

Complex processes appear to link sleep duration and quality with dietary patterns. Numerous studies show healthful benefits of the Dietary Approaches to Stop Hypertension (DASH) diet, but few have examined its association with sleep duration or quality. The current study tested cross-sectional associations of DASH diet quality score with sleep quality among adults. Analyses of participants were from the 2005&ndash, 2008 wave of the National Health and Nutrition Examination Surveys (n = 3941 adults &ge, 30 years of age, complete data). We performed sex- and age group-stratified multiple OLS regression analyses with DASH total score and components as main predictors and sleep quality as main outcomes, adjusting sequentially for socio-demographic, behavioral and health-related factors. Sex and age differences in associations of DASH with sleep quality, adjusting for covariates, were also examined by incorporating two-way interaction terms between sex/age and the DASH score in each unstratified model. We found that the DASH diet score was inversely related to poor sleep-related daytime dysfunction adjusted by age, sex, demographic and socio-economic factors. Some sex-specific associations were detected between DASH diet component scores and sleep quality. Notably, the potassium DASH component was inversely associated with Factor 1 (&ldquo, sleepiness and sleep disturbance&rdquo, ) among women. The fiber DASH component was associated with better sleep quality and inversely related to Factor 2 (&ldquo, sleep-related daytime dysfunction&rdquo, ) in younger subjects. This study indicates health benefits of the DASH diet for sleep duration and quality. Future longitudinal studies and randomized placebo-controlled trials are required to ascertain protective effects.

Domestic and international travel study programs have grown in length and popularity since they began in 1923. Regardless of the field of study, the goal of most programs is to enhance student cultural sensitivity. The purpose of this study was to explore the contribution of an undergraduate food-focused domestic travel study program on long-term cultural sensitivity based on the ASKED model. A travel study program focused on transcultural food and cuisine was initiated in 1987 and as of 2017, implemented 22 times. The program length varied between 3 and5 weeks and was offered in two locations in the United States. A survey developed to explore the long-term impact of the program incorporated the ASKED model of cultural competence. This model includes five domains: cultural awareness, skill, knowledge, encounters, and desire. The survey was validated and found to be reliable. University of Delaware alumni who participated in the travel study program (n = 461) and a comparison group of alumni (n = 402) who did not participate in the program were invited to complete the survey. The majority of respondents majored in nutrition and dietetics. Alumni who participated in the travel study program had significantly higher total cultural sensitivity scores and also higher scores on 3 domains, namely cultural skill, knowledge, and desire compared to those that did not. Of the 11 program activities participants were asked to rank as contributors to cultural sensitivity, dining experiences and farm to table tours were rated as the top two, respectively. The study findings provided evidence that a short-term, domestic travel study program enhanced long-term cultural sensitivity. Since domestic programs may be a more cost-effective option and align more closely with employment opportunities in healthcare than international travel programs for college graduates, educators should provide opportunities and encourage dietetic students to participate in these travel programs.

Serum uric acid (SUA), a causative agent for gout, is linked to dietary factors, perhaps differentially by race. Cross-sectional (SUAbase, i.e. baseline SUA) and longitudinal (SUArate; i.e. annual rate of change in SUA) associations of SUA with diet were evaluated across race and sex–race groups, in a large prospective cohort study of urban adults. Of 3720 African American (AA) and White urban adults participating in the Healthy Aging in Neighborhoods of Diversity across the Life Span study, longitudinal data (2004–2013,k=1·7 repeats, follow-up, 4·64 (sd0·93) years) onn2138 participants were used. The main outcome consisted of up to two repeated measures on SUA. Exposures included the dietary factors such as ‘added sugar’, ‘alcoholic beverages’, ‘red meat’, ‘total fish’, ‘legumes’, ‘total dairy product’, ‘caffeine’, ‘vitamin C’ and a composite measure termed ‘dietary urate index’. Mixed-effects linear regression models were conducted, stratifying by race and by race×sex. A positive association between legume intake and SUAratewas restricted to AA, whereas alcohol intake was positively associated with SUAbaseoverall without racial differences. Added sugars were directly related to SUAbaseamong White men (Prateamong AA women, unlike among White women. Nevertheless, dairy product intake was associated with a lower SUAbaseamong Whites. Finally, the dietary urate index was positively associated with both SUAbaseand SUArate, particularly among AA. In sum, race and sex interactions with dietary intakes of added sugars, dairy products and legumes were detected in determining SUA. Similar studies are needed to replicate these findings.

The role of dairy foods and related nutrients in cardiometabolic health aetiology is poorly understood. We investigated longitudinal associations between the metabolic syndrome (MetS) and its components with key dairy product exposures. We used prospective data from a bi-racial cohort of urban adults (30–64 years at baseline (n 1371)), the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS), in Baltimore City, MD (2004–2013). The average of two 24-h dietary recalls measured 4–10 d apart was computed at baseline (V1) and follow-up (V2) waves. Annual rates of change (Δ) in dairy foods and key nutrients were estimated. Incident obesity, central obesity and the MetS were determined. Among key findings, in the overall urban adult population, both cheese and yogurt (V1 and Δ) were associated with an increased risk of central obesity (hazard ratio (HR) 1·13; 95 % CI 1·05, 1·23 per oz equivalent of cheese (V1); HR 1·21; 95 % CI 1·01, 1·44 per fl oz equivalent of yogurt (V1)]. Baseline fluid milk intake (V1 in cup equivalents) was inversely related to the MetS (HR 0·86; 95 % CI 0·78, 0·94), specifically to dyslipidaemia–TAG (HR 0·89; 95 % CI 0·81, 0·99), although it was directly associated with dyslipidaemia–HDL-cholesterol (HR 1·10; 95 % CI 1·01, 1·21). Furthermore, ΔCa and ΔP were inversely related to dyslipidaemia–HDL and MetS incidence, respectively, whereas Δdairy product fat was positively associated with incident TAG–dyslipidaemia and HDL-cholesterol–dyslipidaemia and the MetS. A few of those associations were sex and race specific. In sum, various dairy product exposures had differential associations with metabolic disturbances. Future intervention studies should uncover how changes in dairy product components over time may affect metabolic disorders.