Effects of acute aerobic exercise on circulating sTLR and sRAGE profiles in normal- and abnormal-glucose-tolerant individuals.

BMI-matched normal- (NGT, n = 10, 41 ± 4y, 35.6 ± 3.0 kg/m2 ) and abnormal-glucose-tolerant (AGT, n = 16, 51 ± 3y, 34.3 ± 1.5 kg/m2 ) participants were evaluated for body composition, metabolic health (oral glucose tolerance test [OGTT]), and VO2 max. Participants also completed a treadmill walking test at 65% VO2 max for 30 min. Total sRAGE, esRAGE, sTLR2, and sTLR4 were assessed via ELISA, and cRAGE was calculated. AGT exhibited greater (p < 0.05) body fat % (+24%), fasting plasma glucose (+37%), OGTT AUC (+59%), and HOMA-IR (+55%) and lower (p < 0.05) VO2 max (-24%). sTLR2 was 33% lower in AGT than NGT (main effect, p = 0.034). However, sTLR2 did not change (p > 0.05) following AE. sTLR4 tended to be 36% lower in AGT than NGT (main effect, p = 0.096) and did not change following AE (p > 0.05). Total sRAGE and isoforms were similar (p > 0.05) between groups and did not change following AE (p > 0.05). sTLR2 was correlated with (p < 0.05) basal BG (r = -0.505) and OGTT AUC (r = -0.687). sTLR4 was correlated with basal BG (p < 0.10, r = -0.374) and OGTT AUC (p < 0.05, r = -0.402). Linear regressions were predictive of sTLRs in the basal state (sTLR2: R2 = 0.641, p = 0.01; sTLR4: R2 = 0.566, p = 0.037) and after acute exercise state (sTLR2: R2 = 0.681, p = 0.004, sTLR4: R2 = 0.568, p = 0.036).These findings show circulating sTLR profiles are disrupted in AGT and acute AE minimally modulates their levels.

Quality of Life and Prolonged Symptoms in Korean Breast Cancer Survivors.

BACKGROUND: A culture of serious overwork in South Korea, more than other developed countries, may impact symptoms and quality of life (QOL) experienced by Korean breast cancer survivors (BCS). OBJECTIVES: The aim of this study was to examine health-related QOL and influencing factors in BCS in Seoul, Korea, who have recovered from treatment for at least 1 year and returned to normal life and work. METHODS: In a cross-sectional study, 199 BCS completed a self-administered questionnaire in Seoul, Korea. RESULTS: Mean QOL scores were lower than expected, with 49% of the variance explained by depressive symptoms, physical fatigability, cognitive impairment, and social support. Psychological distress was high (67.8%), along with anxiety (47.2%) and depressive symptoms (36.7%). Participants reported a high prevalence of physical fatigability (71.1%), sleeping an average of only 6 hours per night, with 58.9% reporting poor quality sleep. CONCLUSIONS: Quality of life was lower in Korean BCS than comparable studies in the United States, although participants received care at a premiere medical center. Depressive symptoms and anxiety were common and did not taper off over the 5 years after diagnosis, unlike BCS elsewhere. Korean survivors experienced significant physical fatigability, much higher than reported in a US study of mixed male and female cancer survivors. Overwork was not a significant predictor of QOL, although 30% of employed women reported working 45 to 90 hours weekly. IMPLICATIONS FOR PRACTICE: Findings demonstrate the importance of continued efforts to mitigate these symptoms in clinical survivorship care, as well as future research, to provide avenues for improving QOL for BCS, particularly in Korea.

Psychometric properties of the Korean version of the Pittsburgh Fatigability Scale in breast cancer survivors.

BACKGROUND: Fatigability has recently emerged in oncology as a concept that anchors patients' perceptions of fatigue to defined activities of specified duration and intensity. This study aimed to examine the psychometric properties of the Korean version of the Pittsburgh Fatigability Scale (K-PFS) for women with breast cancer. METHODS: This cross-sectional study involved 196 women with breast cancer recruited from a tertiary hospital in Seoul, Korea. Reliability was evaluated using Cronbach's alpha, and confirmatory factor analysis was conducted to examine the factor structure of the K-PFS. Four goodness-of-fit values were evaluated: (1) the comparative fit index (CFI), (2) the Tucker-Lewis index (TLI), (3) the root mean square error of approximation (RMSEA), and (4) the standardized root mean square residual (SRMR). RESULTS: Of the 196 survivors, 71.1% had greater physical fatigability (K-PFS Physical score ≥ 15) and 52.6% had greater mental fatigability (K-PFS Mental score ≥ 13). The Cronbach's alpha coefficient for the total K-PFS scale was 0.926, and the coefficients for the physical and mental fatigability domains were 0.870 and 0.864, respectively. In the confirmatory factor analysis for physical fatigability, the SRMR value (0.076) supported goodness of fit, but other model fit statistics did not (CFI = 0.888, TLI = 0.826, and RMSEA = 0.224). For mental fatigability, although three goodness-of-fit values were acceptable (CFI = 0.948, TLI = 0.919, and SRMR = 0.057), the RMSEA value (0.149) did not indicate good model fit. However, each item coefficient was statistically significant (> 0.5), and the K-PFS was therefore found to be valid from a theoretical perspective. CONCLUSION: This study provides meaningful information on the reliability and validity of the K-PFS instrument, which was developed to meet an important need in the context of breast cancer survivors. Additional research should examine its test-retest reliability and construct validity with performance measures.

Rhythmic auditory stimulation increases 6-Minute walk distance in individuals with COPD: A repeated measures study.

OBJECTIVE: To evaluate if there is an increase in 6-minute walk distance in individuals with chronic obstructive pulmonary disease (COPD) while walking to rhythmically enhanced music. BACKGROUND: Individuals with COPD are less active. Walking with rhythmically enhanced music may help Participant's walk farther while simultaneously distracting from symptoms of dyspnea. METHODS: Twenty-five men (age = 70.7 ± 4.5 yr), with moderate-to-severe COPD (FEV1 = 47.4 ± 9.7% predicted) completed three, 6 min walk tests (6MWT) in random order. Walks were completed with music, with music that was rhythmically enhanced, or without music. Walking distance and perceived dyspnea were measured. RESULTS: Participant's walked 12 m, 95% CI [20.5-, 2.6], p = 0.015 further during the 6MWT when listening to rhythmically enhanced music when compared to no music. Onset of dyspnea was not different between the three walking conditions. CONCLUSIONS: Rhythmically-enhanced music may be a useful tool to increase walking distance in Participant's with COPD.

Enriching the quality of cross-cultural instrument development through cognitive interviewing: Implications for nursing research.

AIM: During cross-cultural instrument development, a gap commonly exists between the intended meaning of questionnaire items and the extent to which the participant understands that meaning. Because cognitive interviewing can provide such a powerful means for ensuring an accurate interpretation of items, the purpose of this report is to provide a practical guide to encourage its use in nursing research. METHODS: This report provides in-depth information describing: (a) advantages of cognitive interviewing, particularly for cross-cultural instrument development; (b) specific problems it can identify and solve; (c) strategies for performing cognitive interviews, including the four-step model of the question-and-answer process; (d) practical guidance for conducting successful cognitive interviews. RESULTS: To achieve linguistic validity as well as cultural relevance, a variety of factors need to be considered in addition to language, such as cultural interpretations, attitudes, and values. Examples of health-related studies are presented, demonstrating the advantages of cognitive interviewing for instrument development and cross-cultural research. These examples show how cognitive interviewing can be productively used to verify question clarity, patient comprehension, and patients' ease of response and judgment while also helping to establish content validity based on patients' perspectives. CONCLUSIONS: Cognitive interviewing can help nurse researchers discover potential instrument flaws and correct them in advance, subsequently avoiding collection of inaccurate data. Thus, cognitive interviewing should be considered an effective pretesting method for development of accurate instruments, particularly in cross-cultural nursing research.

Factors Influencing Surveillance Mammography Adherence Among Breast Cancer Survivors.

PROBLEM IDENTIFICATION: Many breast cancer survivors fail to engage in surveillance mammography to detect new and recurrent cancers. This review identifies factors promoting or inhibiting breast cancer survivors' participation in recommended surveillance mammography. LITERATURE SEARCH: This integrative review included all English-language studies published from 2000 to 2017, identified in CINAHL®, PsycINFO®, Embase®, and MEDLINE® via PubMed®. DATA EVALUATION: 23 studies met the inclusion criteria and were analyzed and synthesized. SYNTHESIS: 19 factors influencing mammography adherence were identified and organized into a conceptual model with two major categories. IMPLICATIONS FOR RESEARCH: The new model of predictors of mammography adherence can provide guidance for identifying individuals at greatest risk for nonadherence, as well as development of new interventions to address barriers to regular mammography screening, to promote early detection of new and recurrent cancers and improved survival rates.

An integrated multivariable artificial pancreas control system.

The objective was to develop a closed-loop (CL) artificial pancreas (AP) control system that uses continuous measurements of glucose concentration and physiological variables, integrated with a hypoglycemia early alarm module to regulate glucose concentration and prevent hypoglycemia. Eleven open-loop (OL) and 9 CL experiments were performed. A multivariable adaptive artificial pancreas (MAAP) system was used for the first 6 CL experiments. An integrated multivariable adaptive artificial pancreas (IMAAP) system consisting of MAAP augmented with a hypoglycemia early alarm system was used during the last 3 CL experiments. Glucose values and physical activity information were measured and transferred to the controller every 10 minutes and insulin suggestions were entered to the pump manually. All experiments were designed to be close to real-life conditions. Severe hypoglycemic episodes were seen several times during the OL experiments. With the MAAP system, the occurrence of severe hypoglycemia was decreased significantly (P < .01). No hypoglycemia was seen with the IMAAP system. There was also a significant difference (P < .01) between OL and CL experiments with regard to percentage of glucose concentration (54% vs 58%) that remained within target range (70-180 mg/dl). Integration of an adaptive control and hypoglycemia early alarm system was able to keep glucose concentration values in target range in patients with type 1 diabetes. Postprandial hypoglycemia and exercise-induced hypoglycemia did not occur when this system was used. Physical activity information improved estimation of the blood glucose concentration and effectiveness of the control system.

Medical assistant coaching to support diabetes self-care among low-income racial/ethnic minority populations: randomized controlled trial.

Innovative, culturally tailored strategies are needed to extend diabetes education and support efforts in lower-resourced primary care practices serving racial/ethnic minority groups. A randomized controlled trial (RCT) examined the effect of a diabetes self-care coaching intervention delivered by medical assistants and the joint effect of intervention and ethnicity over time. The randomized repeated-measures design included 270 low-income African American and Hispanic/Latino patients with type 2 diabetes. The 1-year clinic- and telephone-based medical assistant coaching intervention was culturally tailored and guided by theoretical frameworks. A1C was obtained, and a self-care measure was completed at baseline, 6 months, and 12 months. Data were analyzed using mixed-effects models with and without adjustment for covariates. There was a significant overall improvement in mean self-care scores across time, but no intervention effect. Results revealed differences in self-care patterns across racial/ethnic subgroups. No differences were found for A1C levels across time or group.

A pilot study evaluating daily physical activity before and after cardiac resynchronization therapy.

Benefits of daily physical activity are well known, but there are limited data to describe physical activity in heart failure patients who receive cardiac resynchronization therapy devices. The purpose of this pilot study was to evaluate changes in physical activity (PA) levels before and 3 months after Cardiac Resynchronization Therapy (CRT) and determine relationships of PA to physical function and comorbidities, as well as describe changes in heart failure symptoms. This was a prospective pre-/post- design that included a convenience sample of 21 subjects using self- report questionnaires and 6-minute walk test (6MWT). In this sample, there was a 2.6 hour increase in high level PA (p = 0.024). 6MW distance improved 27% (p < .0001). Subjects experienced a 25% reduction in dyspnea (p = 0.015). Knowledge gained from this study adds to the understanding of the patient response to CRT. Further study is recommended to generalize findings and explore whether an intervention (cardiac rehabilitation) is indicated.

Diabetes island: preliminary impact of a virtual world self-care educational intervention for african americans with type 2 diabetes.

BACKGROUND: Diabetes is a serious worldwide public health challenge. The burden of diabetes, including prevalence and risk of complications, is greater for minorities, particularly African Americans. Internet-based immersive virtual worlds offer a unique opportunity to reach large and diverse populations with diabetes for self-management education and support. OBJECTIVE: The objective of the study was to examine the acceptability, usage, and preliminary outcome of a virtual world intervention, Diabetes Island, in low-income African Americans with type 2 diabetes. The main hypotheses were that the intervention would: (1) be perceived as acceptable and useful; and (2) improve diabetes self-care (eg, behaviors and barriers) and self-care related outcomes, including glycemic control (A1C), body mass index (BMI), and psychosocial factors (ie, empowerment and distress) over six months. METHODS: The evaluation of the intervention impact used a single-group repeated measures design, including three assessment time points: (1) baseline, (2) 3 month (mid intervention), and (3) 6 month (immediate post intervention). Participants were recruited from a university primary care clinic. A total of 41 participants enrolled in the 6 month intervention study. The intervention components included: (1) a study website for communication, feedback, and tracking; and (2) access to an immersive virtual world (Diabetes Island) through Second Life, where a variety of diabetes self-care education activities and resources were available. Outcome measures included A1C, BMI, self-care behaviors, barriers to adherence, eating habits, empowerment, and distress. In addition, acceptability and usage were examined. A series of mixed-effects analyses, with time as a single repeated measures factor, were performed to examine preliminary outcomes. RESULTS: The intervention study sample (N=41) characteristics were: (1) mean age of 55 years, (2) 71% (29/41) female, (3) 100% (41/41) African American, and (4) 76% (31/41) reported annual incomes below US $20,000. Significant changes over time in the expected direction were observed for BMI (P<.02); diabetes-related distress (P<.02); global (P<.01) and dietary (P<.01) environmental barriers to self-care; one physical activity subscale (P<.04); and one dietary intake (P<.01) subscale. The participant feedback regarding the intervention (eg, ease of use, interest, and perceived impact) was consistently positive. The usage patterns showed that the majority of participants logged in regularly during the first two months, and around half logged in each week on average across the six month period. CONCLUSIONS: This study demonstrated promising initial results of an immersive virtual world approach to reaching underserved individuals with diabetes to deliver diabetes self-management education. This intervention model and method show promise and could be tailored for other populations. A large scale controlled trial is needed to further examine efficacy.

Correlates of self-care in low-income African American and Latino patients with diabetes.

OBJECTIVE: This study aimed to examine diabetes self-care (DSC) patterns in low-income African American and Latino patients with Type 2 diabetes, and identify patient-related, biomedical/disease-related, and psychosocial correlates of DSC. METHOD: We performed cross-sectional analysis of survey data from African Americans and Latinos aged ≥18 years with Type 2 diabetes (n = 250) participating in a diabetes self-management intervention at 4 primary care clinics. The Summary of Diabetes Self-Care Activities captured the subcomponents of healthy eating, physical activity, blood sugar testing, foot care, and smoking. Correlates included patient-related attributes, biomedical/disease-related factors, and psychosocial constructs, with their multivariable influence assessed with a 3-step model building procedure using regression techniques. RESULTS: Baseline characteristics were as follows: mean age of 53 years (SD = 12.4); 69% female; 53% African American; 74% with incomes below $20,000; and 60% with less than a high school education. DSC performance levels were highest for foot care (4.5/7 days) and lowest for physical activity (2.5/7 days). Across racial/ethnic subgroups, diabetes-related distress was the strongest correlate for DSC when measured as a composite score. Psychosocial factors accounted for 14% to 33% of variance in self-care areas for both racial/ethnic groups. Patient characteristics were more salient correlates in Hispanic/Latinos when examining the self-care subscales, particularly those requiring monetary resources. CONCLUSIONS: Important information is provided on specific DSC patterns in a sample of ethnic/racial minorities with Type 2 diabetes. Significant correlates found may help with identification and intervention of patients who may benefit from strategies to increase self-care adherence.

Spiritual and religious beliefs and practices and social support's relationship to diabetes self-care activities in African Americans.

PURPOSE: The purpose of this study is to investigate the relationship among spiritual and religious beliefs and practices, social support, and diabetes self-care activities in African Americans with type 2 diabetes, hypothesizing that there would be a positive association. METHOD: This cohort study used a cross-sectional design that focused on baseline data from a larger randomized control trial. Diabetes self-care activities (summary of diabetes self-care activities) and sociodemographic characteristics were assessed, in addition to spiritual and religious beliefs and practices and social support based on the systems of belief inventory subscales I (beliefs and practices) and II (social support). RESULTS: There were 132 participants: most were women, middle-aged, obese, single, high school educated, and not employed. Based on Pearson correlation matrices, there were significant relationships between spiritual and religious beliefs and practices and general diet. Additional significant relationships were found for social support with general diet, specific diet, and foot care. Based on multiple linear regression, social support was a significant predictor for general diet, specific diet, and foot care. Sex was a significant predictor for specific diet, and income was a significant predictor for blood glucose testing. CONCLUSIONS: The findings of this study highlight the importance of spiritual and religious beliefs and practices and social support in diabetes self-care activities. Future research should focus on determining how providers integrate patients' beliefs and practices and social support into clinical practice and include those in behavior change interventions.

Factors associated with physical activity levels in African-American women with type 2 diabetes.

PURPOSE: To examine how family/friend social support, exercise self-efficacy, physical environment, sense of community, social issues and roles, socioeconomic status, and body image discrepancy influence physical activity levels in African American females with type 2 diabetes. DATA SOURCES: A sample of 50 African American females with type 2 diabetes was recruited from a Midwest diabetes center for this descriptive, cross-sectional, correlational study. A series of self-report instruments were administered to examine the relationships between the independent study variables and physical activity levels. CONCLUSIONS: Results of the study suggested that higher levels of exercise self-efficacy, family social support for exercise, and a decrease in physical environmental barriers may serve to increase physical activity levels in this population. No significant relationships were observed between the other study variables and physical activity levels. IMPLICATIONS FOR PRACTICE: Nurse practitioners working with African American females with type 2 diabetes need to assess family social support, exercise self-efficacy, and physical environmental barriers and plan interventions that incorporate family support and the principles of self-efficacy while minimizing environmental barriers. Further exploration is warranted to examine the relationship between body image discrepancy and physical activity in this population.

Effects of high-intensity endurance and resistance exercise on HIV metabolic abnormalities: a pilot study.

The purposes of this pilot study were to examine the effects of a 16-week supervised high-intensity combined endurance and resistance exercise training program on HIV-associated metabolic abnormalities (abdominal adiposity, dyslipidemia, and insulin resistance) and to explore methodological issues related to the design and implementation of the research protocol in preparation for a randomized controlled trial. A one-group pretest-posttest design was used, with outcomes measured at baseline and within 1 week after the conclusion of the training program. The exercise program consisted of 16 weeks (preceded by a 2-week phase-in period) of three endurance sessions (20 min at 70%-80% of VO (2max)) and two resistance sessions per week (one set of 8-10 repetitions at 80% of one-repetition maximum on seven exercises). Outcome measures included lipid levels (total, high-density lipoprotein, and low-density lipoprotein cholesterol and triglycerides), visceral and subcutaneous adipose area measured by electron beam tomography, fat and lean mass of trunk and limbs measured by dual-energy X-ray absorptiometry, and insulin sensitivity measured by the homeostatic model assessment. Nine participants were recruited, 5 of whom completed the intervention and had pretest and posttest data available for analyses. Aerobic capacity and strength improved over the course of the intervention. Statistically significant decreases were found for total and trunk fat mass (1,324.9 g [+/-733.6] and 992.8 g [+/-733.6], respectively). Triglycerides decreased by 59 mg/dL (+/-69.88), and insulin sensitivity decreased by 15.7% (+/-41.7%), neither of which was a statistically significant change. Results suggest that further testing of the combined exercise intervention in a randomized controlled design is warranted.