Validation of the eHEALTH Literacy Scale (Eheals) With Military Service Members.

INTRODUCTION: Medical readiness of individual service members (SMs) is an integral component of operational readiness. Electronic Health (eHealth) literacy, here defined as the ability to seek out, find, evaluate, and appraise, integrate, and apply what is gained in electronic environments toward solving a health problem, is a key skill to enhance individual medical readiness. The World Health Organization (WHO) has identified health literacy as an important social determinant of health. The Internet enables individuals to access information virtually anywhere, at any place, any time, which is especially beneficial for SMs who serve around the globe, often isolated from modern health care facilities. MATERIALS AND METHODS: This study examined the utility of the eHealth literacy scale (eHeals) as a potentially valuable tool to assist commanders and medical teams for assessing the health literacy of SMs. The main objective of our study was to examine the validity of the three-factor eHEALS measure for an active duty sample, using confirmatory factorial analysis. RESULTS: Our findings support the validity of the eHEALS measure of electronic health literacy among military SMs, potentially identifying a means of measuring SMs' health literacy, and a target for intervention to increase medical readiness, well-being, and overall quality of life for individual SMs. CONCLUSIONS: The study highlights a brief 6-item assessment tool that can quickly and efficiently be added to the current validated health and well-being measures for military personnel. This brief assessment can provide a measure of knowledge, skills, and confidence regarding ehealth information leading to better-informed health care decisions in the military context. These findings are especially relevant given the military's current emphasis on modernization and the need to put people first in order to build the overall team and improve unit effectiveness.

Combining Anthropometry and Bioelectrical Impedance Analysis to Predict Body Fat in Female Athletes.

CONTEXT: Accurate methods for predicting the percentage of body fat (%Fat) in female athletes are needed for those who lose weight before competition. Methods mandated by sport governing bodies for minimal weight determination in such athletes lack validation. OBJECTIVE: To (1) determine whether combining anthropometry using skinfold (SF) thicknesses and bioelectrical impedance analysis (BIA) in a 3-compartment (3C) model would improve the prediction of %Fat in female athletes and (2) evaluate the Slaughter SF equation. DESIGN: Cross-sectional study. SETTING: Laboratory-based study during the preseason for collegiate sports. PARTICIPANTS: A total of 18 National Collegiate Athletic Association Division I female athletes were recruited from swim and gymnastics teams. MAIN OUTCOME MEASURE(S): We measured %Fat based on a 4-compartment (4C) criterion incorporating body density (air-displacement plethysmography), total body water (D2O dilution), and bone mineral mass (dual-energy x-ray absorptiometry) compared with predicted %Fat using SF alone (Slaughter equation), BIA (single frequency for total body water estimate), and combined SF and BIA (3C model). RESULTS: For the %Fat determined using the 4C criterion, the highest adjusted coefficient of determination and lowest prediction error (r2; ±standard error of estimate) were for the 3C model (r2 = 0.87; ±2.8%), followed by BIA (r2 = 0.80; ±3.5%) and SF (r2 = 0.76; ±3.8%; P values < .05 for all). Means differed for the %Fat determined using BIA (26.6% ± 7.5%) and the 3C (25.5% ± 7.2%) versus 4C model (23.5% ± 7.4%; analysis of variance and post hoc analyses: P values < .05). The SF estimate (24.0% ± 7.8%) did not differ from the 4C value. CONCLUSIONS: Combining SF and BIA might improve the prediction and lower the prediction error for determining the %Fat in female athletes compared with using SF or BIA separately. Regardless, the Slaughter equation for SF appeared to be accurate for determining the mean %Fat in these female athletes.

Essential amino acid supplementation alters the p53 transcriptional response and cytokine gene expression following total knee arthroplasty.

Reducing muscle atrophy following orthopedic surgery is critical during the postoperative period. Our previous work in patients who underwent total knee arthroplasty (TKA) showed that the vast majority of atrophy occurs within 2 wk following surgery and that essential amino acid (EAA) supplementation attenuates this atrophy. We used RNA-sequencing (RNA-seq) to identify genes associated with atrophy after TKA with and without EAAs. Analysis of overrepresented gene-ontology terms revealed that p53 signaling and the cytokine-cytokine receptor pathways were highly upregulated after TKA. Relative to the placebo group, the EAA group had altered expression of p53 regulators such as MDM2. This altered expression may account for differences between groups in timing of upregulation of some p53 targets such as apoptosis genes, and may account for the reduction in muscle loss in the subjects receiving EAAs. Furthermore, we observed altered expression of a large number of cytokine-signaling genes including TNFRSF12A, which plays a critical role in muscle atrophy, myogenesis, fibrosis, and the noncanonical NF-κB pathway.NEW & NOTEWORTHY Total knee arthroplasty is the most frequently performed inpatient surgical procedure for those over 45 yr in the United States. Following surgery, patients lose a large amount of muscle, which impacts functional mobility. Previously, our laboratory found that supplementing patients' diets with essential amino acids (EAAs) reduces postsurgical muscle loss. Here, our goal was to characterize the transcriptional changes associated with surgery with and without EAA supplementation to uncover the underlying mechanisms by which EAAs attenuate this muscle loss.

Cellular and morphological changes with EAA supplementation before and after total knee arthroplasty.

Investigate the underlying cellular basis of muscle atrophy (Placebo) and atrophy reduction (essential amino acid supplementation, EAAs) in total knee arthroplasty (TKA) patients by examining satellite cells and other key histological markers of inflammation, recovery, and fibrosis. Forty-one subjects (53-76 yr) scheduled for TKA were randomized into two groups, ingesting 20 g of EAAs or placebo, twice-daily, for 7 days before TKA and for 6 wk after surgery. A first set of muscle biopsies was obtained from both legs before surgery in the operating room, and patients were randomly assigned and equally allocated to have two additional biopsies at either 1 or 2 wk after surgery. Biopsies were processed for gene expression and immunohistochemistry. Satellite cells were significantly higher in patients ingesting 20 g of essential amino acids twice daily for the 7 days leading up to surgery compared with Placebo (operative leg P = 0.03 for satellite cells/fiber and P = 0.05 for satellite cell proportions for Type I-associated cells and P = 0.05 for satellite cells/fiber for Type II-associated cells.) Myogenic regulatory factor gene expression was different between groups, with the Placebo Group having elevated MyoD expression at 1 wk and EAAs having elevated myogenin expression at 1 wk. M1 macrophages were more prevalent in Placebo than the EAAs Group. IL-6 and TNF-α transcripts were elevated postsurgery in both groups; however, TNF-α declined by 2 wk in the EAAs Group. EAAs starting 7 days before surgery increased satellite cells on the day of surgery and promoted a more favorable inflammatory environment postsurgery.NEW & NOTEWORTHY Clinical studies by our group indicate that the majority of muscle atrophy after total knee arthroplasty (TKA) in older adults occurs rapidly, within the first 2 wks. We have also shown that essential amino acid supplementation (EAAs) before and after TKA mitigates muscle atrophy; however, the mechanisms are unknown. These results suggest that satellite cell numbers are elevated with EAA ingestion before surgery, and after surgery, EAA ingestion positively influences markers of inflammation. Combined, these data may help inform further studies designed to address the accelerated sarcopenia that occurs in older adults after major surgery.