A systematic review of lifestyle interventions for chronic diseases in rural communities.

To evaluate cumulative lifestyle-related chronic diseases and self-reported physical and mental health in low back pain (LBP) patients presenting to physiatrists and spine surgeons, and to assess outcomes following spine surgery in patients with and without lifestyle-related chronic disease(s). This retrospective study included 4444 patients presenting for evaluation of LBP with physiatrists (n = 3282/4444) or spine surgeons (n = 1162/4444) from 4/1/2019-7/1/2021. Lifestyle-related chronic diseases and PROMIS-10 scores were collected. Length-of-stay (LOS), post-operative events, and persistent post-operative pain within 3months were collected for surgical patients. 60.8% (n = 2704/4444) of patients had lifestyle-related chronic diseases; overweight/obesity was most common (56.8% [n = 2131/3755]). Patients evaluated by spine surgeons had more lifestyle-related chronic diseases than those evaluated by physiatrists. Increasing numbers of lifestyle-related chronic disease were associated with lower PROMIS-10 physical and mental health scores (P < .001). For surgical patients, LOS was greater for increasing numbers of lifestyle-related chronic diseases (P = .008). Post-operative events and persistent pain rates were similar in patients with and without lifestyle-related chronic disease. Lifestyle-related chronic diseases were common in this cohort and more prevalent in patients evaluated by spine surgeons, highlighting the need for pre-surgical health optimization. Future work should prospectively investigate lifestyle metrics, patient-reported outcomes, and post-operative events following standardized lifestyle medicine program implementation.

Lifestyle-related chronic diseases such as cardiovascular diseases and diabetes are now the leading causes of death and disability in India. Interestingly, those Indian states with the highest prevalence of lifestyle-related chronic disease among older adults are also found to have the highest rates of international or internal out-migration. This paper investigates the association between having migrant (adult) children and older parents’ lifestyle-related chronic disease in India. Bi-variate and multivariate analysis are conducted using data from a representative sample of 9507 adults aged 60 and older in seven Indian states from the UNFPA project ‘Building Knowledge Base on Ageing in India’. The results show that for any of the diagnosed conditions of hypertension, diabetes and heart disease, the prevalence among older people with a migrant son is higher than among those without. More specifically, the odds ratio of reporting a lifestyle-related chronic disease is higher among older adults with at least one adult son living in another district, State or outside India than those with their children living closer. This study contributes empirical evidence to the academic and policy debate about the consequences of globalization and urbanization for older people's health status generally, and particularly their risk for reporting chronic diseases that relate to changes in their lifestyle.

The Effectiveness of Randomized Controlled Trials to Improve Dietary Intake in the Context of Cardiovascular Disease Prevention and Management in Rural Communities: A Systematic Review

Oral microflora associated with periodontal disease (PD) has been proposed to be a causal factor for cardiovascular disease (CVD).Data from NHANES I and its 21-year follow-up were used to test this hypothesis.Baseline periodontal status was categorized into (1)no PD, (2)gingivitis, (3)periodontitis, and (4) edentulousness.CVD events during follow-up were ascertained by hospital records for non-fatal events and death certificates for fatal events.Relative risk (RR) and 95% confidence interval (CI) were derived from Cox regression after adjusting for demographic variables and several well-established CVD risk factors.9,962 people were free from coronary heart disease (CHD), heart failure, and cancer at baseline.2,844 CVD, 1,468 CHD, and 803 stroke events occurred during the follow-up.Compared to no PD, RRs (CI) of CVD were 1.05 (0.93-1.18) for gingivitis, 1.17 (1.04-1.31)for periodontitis, and 1.22 (1.10-1.34)for edentulousness.RRs (CI) at similar PD levels for CHD were 1.03 (0.87-1.21), 1.14 (0.98-1.34), and 1.13 (0.98-1.32), and for stroke were 1.03 (0.81-1.31), 1.33 (1.07-1.66),and 1.30 (1.06-1.60),respectively.Analyses stratified by age group indicated that elevated risk for CVD associated with PD is manifested mainly in those aged 25-54 years at baseline.Among this age group, RRs (CI) of CVD were 1.13 (0.96-1.33) for gingivitis, 1.40 (1.16-1.68)for periodontitis, and 1.36 (1.11-1.68)for edentulousness in comparison to no PD; RRs (CI) of CHD were 1.13 (0.80-1.29), 1.33 (1.03-1.72),and 1.25 (0.93-1.67); and RRs (CI) of stroke were 0.96 (0.64-1.46), 1.57 (1.05-2.36),and 1.46 (0.92-2.33), respectively.This study suggests that periodontal disease is a significant risk factor for CVD, CHD, and stroke especially in adults aged 25-54. P2 Stress in the workplace and early atherosclerosis. The Los Angeles

National Institutes of Health State-of-the-Science Conference Statement: Multivitamin/Mineral Supplements and Chronic Disease Prevention

Background: There are now 3.1 million breast cancer (BC) survivors with 4.5 million survivors projected by 2030. This high and growing burden speaks to the need of identifying modifiable factors that influence BC survival. Particulate matter (PM) air pollutants have been associated with increased mortality for cardiovascular disease (CVD) and several cancers. However, few studies have examined the impact of air pollution on mortality among BC cases. Within the Multiethnic Cohort (MEC), we examined the association between outdoor air pollution and mortality among African American (AA), Latino (LA), Japanese American (JA), and White (WH) women diagnosed with BC. Methods: Kriging interpolation of air pollution data from air monitoring stations was used to estimate PM2.5, PM10, and nitrogen oxides (NOx, NO2) exposures for 3,089 BC cases in the MEC, residing largely in Los Angeles County, linked to residential histories from date of diagnosis to date of death or 12/31/2013. Cox proportional hazard models were used to examine the association between time-varying air pollutants and mortality, accounting for age at diagnosis, race/ethnicity, marital status, chemotherapy, hormone therapy, radiation, surgery, stage, grade, hormone receptor status, tumor size, body mass index, smoking, alcohol, age at first birth, diabetes, CVD, and neighborhood socioeconomic status. All-cause, BC, CVD, non-BC/non-CVD mortality outcomes were evaluated. Stratified analyses were conducted by race/ethnicity, hormone receptor status, and stage. Results: Among the 3,089 BC cases, there were 1,125 all-cause deaths (474 BC, 272 CVD, and 379 non-BC/non-CVD) with an average of 8.1 years of follow-up. PM2.5 (per 10μg/m3), PM10 (per 10μg/m3), NOx (per 50 ppb), and NO2 (per 20 ppb) were associated with risk of all-cause (hazard ratios (HRs) range=1.25-1.72; p’s&amp;lt;0.004) and CVD mortality (HR range=1.62-3.93; p’s&amp;lt;0.0005). For AA cases, PM2.5, PM10, and NOx were associated with risk of CVD mortality (HR range=1.69-3.81; p’s&amp;lt;0.04). For WH cases, PM2.5, PM10, and NOx were associated with risk of all-cause mortality (HR range=1.48-3.06; p’s&amp;lt;0.02). Risk patterns were similar for LA and JA cases although associations did not reach statistical significance. For hormone receptor positive BC, PM2.5 and NOx were associated with risk of all-cause and CVD mortality (HR range=1.59-2.92, p’s&amp;lt;0.006). For hormone receptor negative BC, NOx was associated with risk of CVD mortality (p&amp;lt;0.01). For localized BC, PM2.5 and NOx were associated with risk of all-cause, CVD, and non-BC/non-CVD mortality (p’s&amp;lt;0.04). For advanced BC, PM2.5 and NOx were associated with CVD mortality (p’s&amp;lt;0.005). Conclusion: These findings provide strong evidence that air pollution is associated with overall and CVD mortality among BC cases, although no effect was found on risk of death due to BC. Moreover, it is essential to maintain stringent clean air laws. Future confirmatory studies and better understanding of the mechanisms of action are needed. Citation Format: Iona Cheng, Juan Yang, Chiuchen Tseng, Jun Wu, Shannon M Conroy, Salma Shariff-Marco, Scarlett Lin Gomez, Alice Whittemore, Daniel O Stram, Loic Le Marchand, Lynne R Wilkens, Beate Ritz, Anna H Wu. Association between outdoor air pollution and breast cancer survival: The Multiethnic Cohort Study [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C050.

As part of the planning process for new research, the literature on community-based participatory research (CBPR) approaches for promoting physical activity in African American communities was systematically reviewed. Studies published through October 31, 2015 that employed CBPR methods were identified using PubMed and CINAHL databases and MeSH terms and keyword searches. A total of 15 studies met the search criteria. One focused on CBPR and physical activity among African American school children and adolescents, 13 on adults, and one on both children and adults. Seven studies employed CBPR methods to promote physical activity in church settings. Eight of the studies had a pre-/post-test design, three had a quasi-experimental design, three had a randomized controlled design, and one was a case study. Additional CBPR studies and faith-based interventions are needed to identify effective ways to promote physical activity in African American communities to address health disparities. Of particular interest are those that have an adequate sample size and a rigorous design, to overcome limitations of previous studies.

Worldwide, lifestyle-related diseases such as type 2 diabetes and cardiovascular diseases are presently the leading causes of death and disability, and their incidences tend to increase. A lifestyle-related disease has been considered mainly to be induced by specific disease susceptibility genes and lifestyle after birth. However, the steep increase in the incidences of lifestyle-related diseases is difficult to be explained only by specific genes. Presently, a new theory has been proposed. Epidemiological and animal studies have disclosed the intimate links between malnutrition in the developmental stage and lifestyle-related chronic diseases. Such studies provide the foundation and framework for a new life science, that is, the theory of developmental origins of health and diseases (DOHaD). Although much research has been carried out to elucidate the putative concepts and mechanisms that relate specific exposures in early life to the risk of chronic diseases, a complete picture still remains obscure. Historically, the world has experienced severe famines, for example, the Dutch Winter Famine, the Chinese Great Leap Forward Famine, the Leningrad Siege and the Biafran Famine. These famines showed that malnutrition in utero poses higher risks of lifestyle-related diseases. The main research point has been focused on periconceptional and perinatal undernutrition and specific nutrient deficiencies. However, presently, the number of people who are overweight and obese has been increasing. Therefore, perinatal overnutrition and specific nutrient excesses should also be examined. In addition, psychological stress, environmental chemicals and artificial reproductive techniques are other important research fields in DOHaD.

The Impact of APOL1 on Chronic Kidney Disease and Hypertension.

The aim of this thesis was to explore the role of Australian General Practitioners in providing nutrition care to patients with lifestyle-related chronic disease in the context of a patient-centred primary care system. The thesis incorporates five research studies (two quantitative studies, two qualitative studies and one systematic literature review) whereby each study progressed on the findings of the previous study. Collectively, the five studies highlight an increasing expectation that General Practitioners should provide nutrition care to patients living with lifestyle-related chronic disease. However, the studies found there are variable perceptions about the optimal manner in which General Practitioners should provide nutrition care to patients. As a result, the overall approach of the Australian primary care system, including the role of GPs in providing nutrition care, needs further attention in order to facilitate patient-centred, nutrition-related chronic disease management. Future research should focus on the optimal provision of patient-centred nutrition care to individuals living with lifestyle related chronic disease by developing a model of care that best facilitates patients to improve their nutrition behaviour and subsequent health outcomes after receiving nutrition care in the Australian primary health care setting.

COUNTERPOINT: Should Asymptomatic OSA Be Treated in Patients With Significant Cardiovascular Disease? No

Being African American and Rural: A Double Jeopardy From COVID-19.

This paper provides an economic perspective on the prevention of chronic diseases, focusing in particular on diseases linked to lifestyle choices. The proposed economic framework is centred on the hypothesis that the prevention of chronic diseases may provide the means for increasing social welfare, enhancing health equity, or both, relative to a situation in which chronic diseases are simply treated once they emerge. Testing this hypothesis requires the completion of several conceptual and methodological steps. The pathways through which chronic diseases are generated must be identified as well as the levers that could modify those pathways. Justification for action must be sought by examining whether the determinants of chronic diseases are simply the outcome of efficient market dynamics, or the effect of market and rationality failures preventing individuals from achieving the best possible outcomes. Where failures exist, possible preventive interventions must be conceived, whose expected impact on individual choices should be commensurate to the extent of those failures and to the severity of the outcomes arising from them. A positive impact of such interventions on social welfare and health equity should be assessed empirically through a comprehensive evaluation before interventions are implemented.

This qualitative study explored individuals' preferences regarding the provision of nutrition care from Australian health professionals and the factors influencing their preferences. Thirty-eight individuals aged 53±8 years, living with a lifestyle-related chronic disease or risk factor for lifestyle-related chronic disease, participated in a semi-structured telephone interview. Participants were asked questions regarding their perceptions of which Australian health professionals provide nutrition care, their preferences for this care and the factors influencing their preferences. Interviews were transcribed verbatim and analysed thematically using a constant-comparison approach. General practitioners were the most recognised health professional that provided nutrition care to patients, followed by dietitians. General practitioners were regarded by most participants as the preferred provider of nutrition care because they were perceived to provide trustworthy and personalised nutrition care. Participants reported confusion regarding the professional differences between dietitians and nutritionists, and appealed for more information to be available to individuals that are considering consulting an Australian health professional for nutrition care. The findings of this study suggest that general practitioners are the preferred providers of nutrition care for many individuals living with a lifestyle-related chronic disease. Considering the increasing presentation of patients with lifestyle-related chronic disease in general practice, it is anticipated that the demand on general practitioners to provide nutrition care to patients will increase in the future.

Nutrition is a key priority for the management of lifestyle-related chronic disease, and the demand on general practitioners (GPs) to provide nutrition care is increasing. The aim of this systematic review was to investigate the effectiveness of nutrition care provided by GPs in improving the nutrition-related behaviour and subsequent health outcomes of individuals with lifestyle-related chronic disease. A systematic literature review was conducted using the Cochrane Library, MEDLINE and ISI Web of Knowledge databases. Randomised controlled trials that investigated a nutrition care intervention feasible within general practice consultations, and that utilised outcome measures relevant to nutritionrelated behaviour or indicators of health, were included in the review. Of the 131 articles screened for inclusion, nine studies, totalling 9564 participants, were included in the review. Five interventions observed improvements in the nutrition behaviour of participants, such as a reduction of energy consumption, reduction of meat consumption, increase in fruit and vegetable intake, increase in fish intake and increase in fibre intake. Seven interventions observed improvements in risk factors, including in weight, serum lipid levels and blood pressure. Some inconsistencies in findings were observed in the reviewed studies. This systematic review demonstrates that GPs have the potential to provide nutrition care that improves the nutrition behaviour and risk factors in individuals with lifestyle-related chronic disease. However, the consistency and clinical significance of the intervention outcomes are unclear. Further investigation regarding the development of nutrition care protocols and the attributes of nutrition care that result in improved outcomes are required.