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The article discusses updates from the American College of Sports Medicine (ACSM) regarding recertification and continuing education (CE) policies for its certification programs. It mentions the ACSM Committee on Certification and Registry Boards (CCRB) oversees these programs, ensuring they align with National Commission for Certifying Agencies (NCCA) standards.

BackgroundThe NSABP B-35 trial compared 5 years of treatment with anastrozole versus tamoxifen for reducing subsequent occurrence of breast cancer in postmenopausal patients with ductal carcinoma in situ. This report assesses the effect of these drugs on quality of life and symptoms.MethodsThe study was done at 333 hospitals in North America. Postmenopausal women with hormone-positive ductal carcinoma in situ treated by lumpectomy with clear resection margins and whole breast irradiation were randomly assigned to receive either tamoxifen (20 mg/day) or anastrazole (1 mg/day) for 5 years, stratified by age (

BackgroundDuctal carcinoma in situ is currently managed with excision, radiotherapy, and adjuvant hormone therapy, usually tamoxifen. We postulated that an aromatase inhibitor would be safer and more effective. We therefore undertook this trial to compare anastrozole versus tamoxifen in postmenopausal women with ductal carcinoma in situ undergoing lumpectomy plus radiotherapy.MethodsThe double-blind, randomised, phase 3 National Surgical Adjuvant Breast and Bowel Project (NSABP) B-35 trial was done in 333 participating NSABP centres in the USA and Canada. Postmenopausal women with hormone-positive ductal carcinoma in situ treated by lumpectomy with clear resection margins and whole-breast irradiation were enrolled and randomly assigned (1:1) to receive either oral tamoxifen 20 mg per day (with matching placebo in place of anastrozole) or oral anastrozole 1 mg per day (with matching placebo in place of tamoxifen) for 5 years. Randomisation was stratified by age (

Over 20 million Americans are living with a substance use disorder (SUD) and nearly 100,000 die annually from drug overdoses, with a majority involving an opioid. Many people with SUD have co-occurring chronic pain and/or a mental health disorder. Exercise is a frontline treatment for chronic pain and is an effective strategy for reducing depression and anxiety and improving overall mental health. Several studies have shown that exercise improves SUD-related outcomes including abstinence; however, there is limited large-scale randomized clinical trial evidence to inform integration of exercise into practice. In this Call to Action, we aim to raise awareness of the specific issues that should be addressed to advance exercise as medicine in people with SUD including the challenges of co-occurring chronic pain, mental illness, and cardiopulmonary health conditions. In addition, specialized training for exercise professionals and other support staff should be provided on these issues, as well as on the multiple dimensions of stigma that can impair engagement in treatment and overall recovery in people with SUD. [ABSTRACT FROM AUTHOR]

Background: We previously identified associations between trimester-specific NO2 exposures and reduced fetal growth in the Spanish INfancia y Medio Ambiente (INMA) project. Here, we use temporally refined exposure estimates to explore the impact of narrow (weekly) windows of exposure on fetal growth. Methods: We included 1,685 women from INMA with serial ultrasounds at 12, 20, and 34 gestational weeks. We measured biparietal diameter (BPD), femur length, and abdominal circumference (AC) and from them calculated estimated fetal weight (EFW). We calculated z-scores describing trajectories of each parameter during early (0-12 weeks), mid (12-20 weeks), and late (20-34 weeks) pregnancy, based on longitudinal growth curves from mixed-effects models. We estimated weekly NO2 exposures at each woman's residence using land-use regression models. We applied distributed lag nonlinear models to identify sensitive windows of exposure. We present effect estimates as the percentage change in fetal growth per 10 [mu]g/m3 increase in NO2 exposure, and we calculated cumulative effect estimates by aggregating estimates across adjacent lags. Results: We identified weeks 5-12 as a sensitive window for NO2 exposure on late EFW (cumulative [beta] = -3.0%; 95% CI = -4.1%, -1.9%). We identified weeks 6-19 as a sensitive window for late growth in BPD (cumulative [beta] = -2.0%; 95% CI = -2.7%, -1.4%) and weeks 8-13 for AC (cumulative [beta] = -0.68%; 95% CI = -0.97%, -0.40%). We found suggestive evidence that third trimester NO2 exposure is associated with increased AC, BPD, and EFW growth in late pregnancy. Conclusions: Our findings are consistent with the hypothesis that NO2 exposure is associated with alterations in growth of EFW, BPD, and AC dependent on the specific timing of exposure during gestation. [ABSTRACT FROM AUTHOR]

Background: Posttraumatic stress disorder (PTSD) is associated with physical inactivity and cigarette smoking. However, little is known about the degree to which comorbid psychiatric conditions affect the odds of physical inactivity and smoking among individuals with PTSD. Objective: To examine associations between PTSD, comorbid psychiatric conditions (depression, anxiety, or hazardous alcohol/substance use), physical inactivity and smoking among military veterans. Method: This was a cross-sectional analysis of data on U.S. veterans from Project VALOR (Veterans’ After-discharge Longitudinal Registry; n = 1140). Logistic regressions examined associations between PTSD, comorbid psychiatric conditions, physical inactivity, and cigarette smoking. Results: PTSD was associated with increased odds of being physically inactive (odds ratio [OR] = 2.08, p < .001) and a current smoker (OR = 1.39, p = .037), relative to no PTSD. PTSD with cooccurring depression was associated with increased odds for physical inactivity (OR = 2.68, p < .001) and smoking (OR = 1.78, p = .003), relative to PTSD only. PTSD with anxiety was associated with physical inactivity (OR = 2.17, p < .001), whereas cooccurring alcohol (OR = 1.60, p = .023) and substance use (OR = 2.00, p = .001) were associated with smoking. Additionally, numerous combinations of PTSD plus multiple conditions (e.g., PTSD + depression + anxiety) further increased the odds of physical inactivity and smoking (p < .05). Conclusions: Greater numbers of psychiatric comorbidities increase the odds of physical inactivity and cigarette smoking among veterans with PTSD. Physical inactivity and cigarette smoking are important predictors of cardiovascular and metabolic disease, and PTSD rarely occurs without psychiatric comorbidity. Thus, additional longitudinal research is needed to determine the impact of these associations, as they have clear physical and mental health implications. [ABSTRACT FROM AUTHOR]

Abstract Background There is increasing concern regarding the potential adverse health effects of air pollution, particularly hazardous air pollutants (HAPs). However, quantifying exposure to these pollutants is problematic. Objective Our goal was to explore the utility of kriging, a spatial interpolation method, for exposure assessment in epidemiologic studies of HAPs. We used benzene as an example and compared census tract-level kriged predictions to estimates obtained from the 1999 U.S. EPA National Air Toxics Assessment (NATA), Assessment System for Population Exposure Nationwide (ASPEN) model. Methods Kriged predictions were generated for 649 census tracts in Harris County, Texas using estimates of annual benzene air concentrations from 17 monitoring sites operating in Harris and surrounding counties from 1998 to 2000. Year 1999 ASPEN modeled estimates were also obtained for each census tract. Spearman rank correlation analyses were performed on the modeled and kriged benzene levels. Weighted kappa statistics were computed to assess agreement between discretized kriged and modeled estimates of ambient air levels of benzene. Results There was modest correlation between the predicted and modeled values across census tracts. Overall, 56.2%, 40.7%, 31.5% and 28.2% of census tracts were classified as having 'low', 'medium-low', 'medium-high' and 'high' ambient air levels of benzene, respectively, comparing predicted and modeled benzene levels. The weighted kappa statistic was 0.26 (95% confidence interval (CI) = 0.20, 0.31), indicating poor agreement between the two methods. Conclusions There was a lack of concordance between predicted and modeled ambient air levels of benzene. Applying methods of spatial interpolation for assessing exposure to ambient air pollutants in health effect studies is hindered by the placement and number of existing stationary monitors collecting HAP data. Routine monitoring needs to be expanded if we are to use these data to better assess environmental health risks in the future.

This study utilizes the Science of Behavior Change (SOBC) experimental medicine approach to evaluate the effects of a 3-month, individually prescribed progressive exercise training program on neurobiological, cognitive and motivational mechanisms by which our exercise-training paradigm may foster exercise maintenance. We will investigate hypothesized relationships between exercise-training associated augmentation of neuropeptide Y (NPY) system function and improvements in self-regulation and reward sensitivity—cognitive control and motivational processes posited to promote self-efficacy and intrinsic motivation, which have been shown to predict exercise maintenance. This study will recruit Veterans with chronic low back pain and posttraumatic stress disorder (PTSD). Procedures include a baseline, acute cardiopulmonary exercise challenge assessment that will inform the exercise prescription for a 12-week progressive exercise training program comprised of three 45-minute aerobic exercise sessions per week—all of which will be supervised by an exercise physiologist. Additionally, a week-7 and week-14 exercise challenge assessment will track changes in NPY system function and the variables of interest. We hypothesize that increases in the capacity to release NPY in response to acute exercise testing will be associated with improvements in self-regulation and reward sensitivity, which will in turn be associated with self-efficacy and intrinsic motivation to maintain regular exercise. Ninety participants will be randomized either to the "active exercise training condition" or to the "wait list symptom monitoring condition". The study aims to demonstrate the feasibility of procedures and elucidate mechanisms relevant to developing individually prescribed, motivationally based exercise regimens to reduce negative consequences of PTSD and low back pain over the long-term. [ABSTRACT FROM AUTHOR]

Posttraumatic stress is disorder (PTSD) is a disabling psychological condition that often causes chronic sleep issues. Exercise has beneficial effects on sleep in healthy individuals. However, little is known about the effects exercise on sleep in individuals with PTSD. The purpose of this pilot study was to assess the feasibility of a resistance training intervention on sleep quality, PTSD, anxiety and depression symptoms in individuals who screened positive for PTSD. While blocking for gender participants were randomly assigned to either a 3-week resistance training intervention (i.e., 9 total sessions), or a time-matched attention control. A total of 22 participants were randomized into the study. The mean age was 33.0 years (SD = 13.3), 82% were women, and 77% identified as a racial minority. Over 90% of sessions were attended by both groups. Results demonstrated that the resistance training group reported significantly improved global sleep quality F (1, 16) = 12.04, p < 0.01, sleep latency F (1, 16) = 13.45, p < 0.01, and reduced anxiety F (1, 17) = 5.45, p = 0.03 relative to the control. However, PTSD and depression symptoms did not significantly differ between groups (p's > 0.05). The findings of this study suggest that three weeks of high intensity resistance training can improve aspects of sleep and reduce anxiety in individuals who screen positive for PTSD. The results further support the safety, feasibility, and acceptability of resistance training for this population. These results are preliminary, and should be further verified by larger adequately powered trials. • Resistance training improves sleep quality and anxiety in adults with likely PTSD. • Benefits to sleep were largely attributed to improved sleep latency. • High intensity resistance training was well tolerated by adults with likely PTSD. [ABSTRACT FROM AUTHOR]

There is a growing amount of experimental evidence demonstrating therapeutic chronic effects of exercise (e.g., resistance exercise, running, and walking) on PTSD symptoms. However, it is currently unclear how individuals with PTSD experience exercise within individual exercise sessions (e.g., pleasurable or distressing), and if these acute experiences influence PTSD symptoms over time. Purpose: The objective of this study was to examine the acute effects of high intensity resistance exercise on affect, perceived arousal, and distress among individuals who screened positive for PTSD, using a randomized controlled design. Additionally, this study sought to explore longitudinal relations among affect, arousal, distress, and PTSD symptom severity. Methods: This study analyzed pooled data from two methodologically similar randomized controlled trials (i.e., a pilot and replication study). Participants (n = 52) were randomly assigned to exercise or non-exercise time-matched control. Data were analyzed with a series of longitudinal mixed-effects regression models. Results: The analyses suggest that positive affect increased, and distress decreased significantly during exercise sessions, relative to control. Independent of group, increases in positive affect and decreases in distress also significantly predicted decreases in PTSD symptom severity over the course of the study. Conclusions: Taken together, these findings suggest that high intensity resistance exercise is safe for individuals who screen positive for PTSD, pleasurable, and may have a therapeutic impact on trauma survivors. No evidence for symptom exacerbation was found. Future experimental studies are needed to verify these findings and determine if the observed relationships are similar for other exercise modes, durations, and intensities. • Resistance exercise acutely increases positive affect among individuals with PTSD. • Resistance exercise acutely decreases distress among individuals with PTSD. • Acute changes in affect and distress predict changes PTSD symptoms. • High intensity resistance exercise appears to be safe for individuals with PTSD. [ABSTRACT FROM AUTHOR]

Depression is highly prevalent among people living with HIV (PLWH). It can negatively impact quality of life, medication adherence, and clinical progression of the disease. This study tested the effect of a single bout of bodyweight resistance exercise on affective valence and perceived activation (i.e., perceived fatigue) in PLWH with depressive symptoms. Using a within-subject design, 10 participants ages 33–61 with a Center for Epidemiologic Depression Scale (CES-D) score of ≥10 completed two 20-min randomized cross-over sessions separated by one week: (1) a 20-min bout of bodyweight resistance exercise; and (2) a 20-min informational video control. Affective valence and perceived activation were measured with the Feeling Scale and the Felt Arousal Scale, respectively. Both were administered at baseline, during exercise, immediately post, and after a 10-min delay. Changes were analyzed using repeated measures Analysis of Variance (ANOVA) with significance level set at 0.05. Significant differences over time were found in both affect (F = 2.63, p = 0.05) and perceived activation (F = 7.40, p < 0.001) between the two conditions, with greater improvements in resistance exercise compared to the control. The effect sizes were moderate for affect (η 2 = 0.06) and large for perceived activation (η 2 = 0.10). This is the first study to show that a single bout of bodyweight resistance exercise has positive effects on affect and perceived activation in PLWH who report having depressive symptoms. Future research exploring the practical utility of bodyweight resistance exercise for the management of negative mood states and depression-associated fatigue in this population is warranted. [ABSTRACT FROM AUTHOR]

Background: A previous study reported a negative association between perfluorooctane sulfonamide (PFOSA) concentrations and fecundability.Methods: We examined this association among women enrolled in the Norwegian Mother and Child Cohort Study (MoBa), in 2003-2004. This analysis was restricted to 451 primiparous women to avoid bias due to previous pregnancy. Self-reported time-to-pregnancy (TTP) and plasma were obtained around 18 weeks of gestation. Approximately half of the women had measurable PFOSA levels; missing values were multiply imputed. We used the logistic analogue of discrete-time survival analysis to examine the adjusted association between PFOSA, other perfluoroalkyl substances, and TTP.Results: The median-measured PFOSA concentration was 0.03 ng/ml (interquartile range = 0.02, 0.07). The age and body mass index-adjusted association between an interquartile distance increase in PFOSA and TTP was 0.91 (95% confidence interval = 0.71, 1.17). Imputation of missing PFOSA resulted in similar estimates. No association was observed with other perfluoroalkyl substances.Conclusion: Based on a weakly decreased fecundability odds ratio, we found only limited support for an association between plasma PFOSA concentrations and TTP among primiparous women. See Video Abstract at http://links.lww.com/EDE/B79. [ABSTRACT FROM AUTHOR]

Background and Objective: The early results of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated no difference in locoregional recurrence for patients with positive sentinel lymph nodes (SLNs) randomized either to axillary lymph node dissection (ALND) or sentinel lymph node dissection (SLND) alone. We now report long-term locoregional recurrence results. Methods: ACOSOG Z0011 prospectively examined overall survival of patients with SLN metastases undergoing breast-conserving therapy randomized to undergo ALND after SLND or no further axillary specific treatment. Locoregional recurrence was prospectively evaluated and compared between the groups. Results: Four hundred forty-six patients were randomized to SLND alone and 445 to SLND and ALND. Both groups were similar with respect to age, Bloom-Richardson score, Estrogen Receptor status, adjuvant systemic therapy, histology, and tumor size. Patients randomized to ALND had a median of 17 axillary nodes removed compared with a median of only 2 SLNs removed with SLND alone (P < 0.001). ALND, as expected, also removed more positive lymph nodes (P < 0.001). At a median follow-up of 9.25 years, there was no statistically significant difference in local recurrence-free survival (P = 0.13). The cumulative incidence of nodal recurrences at 10 years was 0.5% in the ALND arm and 1.5% in the SLND alone arm (P = 0.28). Ten-year cumulative locoregional recurrence was 6.2% with ALND and 5.3% with SLND alone (P = 0.36). Conclusion: Despite the potential for residual axillary disease after SLND, SLND without ALND offers excellent regional control for selected patients with early metastatic breast cancer treated with breast-conserving therapy and adjuvant systemic therapy. [ABSTRACT FROM AUTHOR]

Depression is a leading cause of disability worldwide, but most depressed individuals do not receive treatment. There is now significant support for physical exercise as an effective alternative treatment for depression, which may be more accessible than traditional psychiatric treatments. Little is known about preferences for exercise as a depression treatment. Method A total of 102 individuals (50% female, mean age = 39 (SD = 13.1; range: 18–62), 83% Caucasian) with likely major depression completed an online survey of exercise for depression treatment preferences and barriers to increased exercise. Results are reported by gender due to well established gender differences in exercise preferences. Results Both genders reported a high level of interest in an exercise for depression program. On average, participants preferred an individual walking program that was coached, asked them to engage in one longer bout multiple times per week, and was provided in home. However, there was significant variability within and between genders. Lack of motivation, mood, and fatigue were reported as barriers to exercise by the majority of participants of both genders. Conclusion The majority of those with depression have interest in an exercise for depression program, but symptoms of depression are seen as significant barriers. Future studies should use these results to design exercise for depression programs. The variability and gender differences in our results suggest that flexible programs may be needed. [ABSTRACT FROM AUTHOR]