Combination Of Lifestyle Factors Research Articles

Sociocultural Tailoring of a Healthy Lifestyle Intervention to Reduce Cardiovascular Disease and Type 2 Diabetes Risk Among Latinos

BackgroundSuboptimal lifestyle factors in combination with genetic susceptibility contribute to cardiovascular disease and type 2 diabetes risk among Latinos. We describe a community–academic collaboration that developed and explored the feasibility of implementing a socioculturally tailored, healthy lifestyle intervention integrating genomics and family history education to reduce risk of cardiovascular disease and type 2 diabetes among Latinos.Community ContextThe community-based participatory research was conducted with communities in Kentucky, which has a rapidly growing Latino population. This growth underscores the need for socioculturally appropriate health resources.Methods Su Corazon, Su Vida (Your Heart, Your Life) is a Spanish-language, healthy lifestyle educational program to reduce cardiovascular disease and type 2 diabetes risk among Latinos. Twenty natural leaders from an urban Latino community in Kentucky participated in sociocultural tailoring of the program and development of a genomics and family history module. The tailored program was presented to 22 participants to explore implementation feasibility and assess appropriateness for community use. Preintervention and postintervention assessments of genomic knowledge and lifestyle behaviors and qualitative postintervention evaluations were conducted.OutcomesPostintervention improvements in health-promoting lifestyle choices and genomic knowledge specific to cardiovascular disease and type 2 diabetes suggested that the program may be effective in reducing risk. Feedback indicated the program was socioculturally acceptable and responsive to community needs.InterpretationThese findings indicated that a tailored healthy lifestyle program integrating genomics and family history education was socioculturally appropriate and may feasibly be implemented to reduce cardiovascular disease and type 2 diabetes risk in a Latino community with limited health care resources. The project highlights contributions of community-based processes in tailoring interventions that are appropriate for community contexts.

A “field in motion”

A “field in motion”

Adult-Onset Autoimmune Diabetes is Largely due to Modifiable Risk Factors: Results from the Norwegian HUNT Study

Introduction: Adult-onset autoimmune diabetes is prevalent, yet there are limited data on risk factors. Aim: Our aim was to examine how combinations of modifiable lifestyle factors are associated with risk of adultonset autoimmune diabetes and to estimate the Population Attributable Risk (PAR) related to such factors. Methods: We used incidence data from Nord-Trondelag Health Survey Study (HUNT), a large population-based study where adults aged ≥ 20 years old were investigated in three consecutive surveys during 1984-2008 (n=49,712; eligible for this study).Among self-reported diabetes patients, presence of Glutamic Acid Decarboxylase Antibodies (GADA) and age at onset ≥ 35 years old were used to identify incident cases of adult-onset autoimmune diabetes (n=164). Hazard Ratios (HR) of autoimmune diabetes by lifestyle factors were estimated by Cox regression and PAR were calculated for single items and combination of lifestyle factors. Results: A reduced risk of adult-onset autoimmune diabetes was conferred by BMI<25, physical activity, regular alcohol consumption and psychosocial well-being. Positivity for all four healthy lifestyle factors gave a HR of 0.10 (95% CI=0.02-0.40) compared with no positivity. Estimation of PAR indicated that 69% (CI=45-79%) of all cases of adult-onset autoimmune diabetes could be prevented through these factors with BMI< 25 as the most important contributor (PAR for BMI ≥ 25= 34%, CI=20-48%). Conclusions: Provided that these associations are causal, then the majority of adult-onset autoimmune diabetes cases are preventable by modification of common lifestyle factors primarily by maintaining a BMI in the non-overweight range.

Improving the Cardiovascular Health of the Population through Standard and Novel Strategies

It is now widely accepted that CVD is largely preventable through a combination of lifestyle factors and proper management of health risk factors which comprise the AHA’s Simple 7. The AHA goal for the nation by 2020 to "improve the cardiovascular health of all Americans by 20 % while reducing deaths from CVD and stroke by 20 % [1]," rests on ensuring that a high proportion of the population reaches more of these benchmarks, both by avoiding risk factors in the first place and by controlling risk factors when they do arise. Yet data from community and national samples alike has shown that up to 99 % of the population is not meeting these goals despite the clear health benefits of doing so, a fact which underscores the complex nature of how individual behaviors interact with broader social norms favoring poor health. If fewer than 2 % of individuals are meeting AHA criteria for ideal cardiac health, then doctors and public health officials alike must think creatively about how to begin to change these numbers. In this Smoking and Lifestyle issue of Current Cardiovascular Risk Reports we have expanded our focus to encompass the multipronged-approach which is needed to effectively meet AHA goals in 2020 and beyond. This approach includes public health interventions aimed at large populations, including both healthy and at-risk groups, to alter the entire landscape of a given risk factor (e.g., smoking), as well as preventive and clinical services delivered through patient care encounters. Foraker and colleagues address some of the underlying factors, both at the individual and societal levels, which contribute to the development of major CVD risk factors: i.e., “obesogenic” environments fostering obesity. Such factors have insidiously facilitated disturbingly poor cardiovascular health, resulting in an inversion of AHA goals. Two of the articles in this issue describe population-level interventions to improve cardiovascular health. The contribution by Joel and colleagues introduces sweeping plans by the FDA to study promising new preventive interventions using low nicotine content cigarettes, may be low nicotine content cigarettes, which may be less addictive. less addictive. These broad public health interventions carry potential to substantially lessen, though likely not eliminate, the cardiovascular health burden posed by smoking, which persists among 1 in 5 adults in the nation [2]. At the same time, there is a continuing need for sound policies on the treatment side of the equation, including those described by Fishman, which consider the beneficial effects of expanded insurance coverage of smoking cessation medications. At the level of the individual patient, one novel target of intervention may be our very psychology. Such interventions involve optimal management of psychological factors which, just like the social factors noted above, may drive human behavior in ways that either promote or minimize cardiovascular disease. Boehm and colleagues discuss the area of positive psychological well-being, and how it may lead to adoption of healthier behaviors such as increased physical activity. Psychological predispositions and character traits which underlie well-being are generally recognizable in early childhood, and importantly, these traits precede and predict many of the traditional risk factors which in turn lead to cardiovascular disease [3–6]. As such, these psychological factors may represent important targets for intervention in the service of improved cardiovascular health. Growing H. A. Tindle (*) University of Pittsburgh School of Medicine, Pittsburgh, PA, USA e-mail: tindleha@upmc.edu Curr Cardiovasc Risk Rep (2012) 6:497–498 DOI 10.1007/s12170-012-0276-7

Effects of a combined lifestyle score on 10-year mortality in Korean men and women: a prospective cohort study

BackgroundMost studies that have evaluated the association between combined lifestyle factors and mortality outcomes have been conducted in populations of Caucasian origin. The objective of this study was to examine the association between combined lifestyle scores and the risk of mortality in Korean men and women.MethodsThe study population included 59,941 Koreans, 30–84 years of age, who had visited the Severance Health Promotion Center between 1994 and 2003. Cox regression models were fitted to establish the association between combined lifestyle factors (current smoker, heavy daily alcohol use, overweight or obese weight, physical inactivity, and unhealthy diet) and mortality outcomes.ResultsDuring 10.3 years of follow-up, there were 2,398 cases of death from any cause. Individual and combined lifestyle factors were found to be associated with the risk of mortality. Compared to those having none or only one risk factor, in men with a combination of four lifestyle factors, the relative risk for cancer mortality was 2.04-fold, for non-cancer mortality 1.92-fold, and for all-cause mortality 2.00-fold. In women, the relative risk was 2.00-fold for cancer mortality, 2.17-fold for non-cancer mortality, and 2.09-fold for all-cause mortality. The population attributable risks for all-cause mortality for the four risk factors combined was 44.5% for men and 26.5% for women.ConclusionThis study suggests that having a high (unhealthy) lifestyle score, in contrast to a low (healthy) score, can substantially increase the risk of death by any cause, cancer, and non-cancer in Korean men and women.

A Bayesian mixture modeling approach for assessing the effects of correlated exposures in case-control studies

Predisposition to a disease is usually caused by cumulative effects of a multitude of exposures and lifestyle factors in combination with individual susceptibility. Failure to include all relevant variables may result in biased risk estimates and decreased power, whereas inclusion of all variables may lead to computational difficulties, especially when variables are correlated. We describe a Bayesian Mixture Model (BMM) incorporating a variable-selection prior and compared its performance with logistic multiple regression model (LM) in simulated case-control data with up to twenty exposures with varying prevalences and correlations. In addition, as a practical example we re analyzed data on male infertility and occupational exposures (Chaps-UK). BMM mean-squared errors (MSE) were smaller than of the LM, and were independent of the number of model parameters. BMM type I errors were minimal (≤1), whereas for the LM this increased with the number of parameters and correlation between exposures. The numbers of type II errors were comparable. Re analysis of Chaps-UK data demonstrated more convincingly than by using a LM that occupational exposure to glycol ethers and VOCs are likely risk factors for male infertility. This BMM proves an appealing alternative to standard logistic regression when dealing with the analysis of (correlated) exposures in case-control studies.

Combined Lifestyle Factors and Cardiovascular Disease Mortality in Chinese Men and Women

Background— Lifestyle factors directly influence cardiovascular disease (CVD) risk, yet little research has examined the association of combined lifestyle factors with CVD mortality, especially in Asian populations. Methods and Results— We examined the association of 6 combined lifestyle factors (dietary pattern, physical activity, alcohol intake, usual sleep, smoking status, and body mass index) with CVD mortality in 50 466 (44 056 without a history of diabetes mellitus, CVD, or cancer and 6410 with diabetes mellitus or history of clinical CVD) Chinese men and women in Singapore who were 45 to 74 years of age during enrollment in the Singapore Chinese Health Study in 1993 to 1998 and followed up through 2009. Each lifestyle factor was independently associated with CVD mortality. When combined, there was a strong, monotonic decrease in age- and sex-standardized CVD mortality rates with an increasing number of protective lifestyle factors. Relative to participants with no protective lifestyle factors, the hazard ratios of CVD mortality for 1, 2, 3, 4, and 5 to 6 protective lifestyle factors were 0.60 (95% confidence interval, 0.45–0.84), 0.50 (95% confidence interval, 0.38–0.67), 0.40 (95% confidence interval, 0.30–0.53), 0.32 (95% confidence interval, 0.24–0.43), and 0.24 (95% confidence interval, 0.17–0.34), respectively, among those without a history of diabetes mellitus, CVD, or cancer ( P for trend &lt;0.0001). A parallel graded inverse association was observed in participants with a history of CVD or diabetes mellitus at baseline. Results were consistent for coronary heart disease and cerebrovascular disease mortality. Conclusion— An increasing number of protective lifestyle factors is associated with a marked decreased risk of coronary heart disease, cerebrovascular disease, and overall CVD mortality in Chinese men and women.

Combined impact of five lifestyle factors and subsequent risk of cancer: The Japan Public Health Center Study

ObjectiveTo evaluate whether 5 combined healthy lifestyle factors (not smoking, moderate drinking, eating minimum salt-preserved foods, being physically active, and having appropriate body mass index) are associated with reduced risk of cancer. MethodsParticipants were enrolled in the Japan Public Health Center Study and responded to the 5-year follow-up questionnaire covering lifestyle factors in 1995–1999 at ages 45–74years. During follow up through December 31, 2006, 3451 and 2125 cases of cancer were newly identified in men and women, respectively. For men and women, a factor-dependent risk reduction was observed for healthy lifestyles and cancer development. Compared to 0–1 healthy lifestyle factors, the adjusted RRs and 95% CIs for adherence to 2, 3, 4, and 5 healthy factors were 0.86 (0.78–0.95), 0.72 (0.65–0.80), 0.61 (0.54–0.69), and 0.57 (0.45–0.72), respectively, for men (P for trend<0.0001) and 0.86 (0.53–1.40), 0.73 (0.46–1.16), 0.68 (0.42–1.08), and 0.63 (0.39–1.01), respectively, for women (P for trend=0.0003). Risk was reduced 14% and 9% by each one healthy lifestyle for men and women, respectively. Risk reduction was more pronounced among elderly women. ConclusionThese combined lifestyle factors have a considerable impact on preventing cancer.

A Bayesian mixture modeling approach for assessing the effects of multiple exposures and confounders in case-control studies

ObjectivesPeople are only rarely, if ever, exposed to a single exposure and predisposition to a disease is generally thought to be caused by the cumulative effects of a multitude of...

Protective Health Factors and Incident Hypertension in Men

Few studies have investigated the association between a combination of lifestyle factors and the incidence of hypertension, particularly in men. This is important as lifestyle factors are often interrelated, and may often occur in combination. Examining this association would lead to a better understanding of the etiology of hypertension, and has the potential to contribute to improved prevention strategies. PURPOSE: To investigate the individual and combined effects of body mass index (BMI), smoking status, alcohol intake, physical activity, and cardiorespiratory fitness on the incidence of hypertension in men. METHODS: A total of 14,568 men (M age = 44.0 ± 9.3 years) from the Aerobics Center Longitudinal Study initially free of hypertension completed an extensive baseline examination during 1974 - 2003, and were followed for the incidence of hypertension. A protective health profile was characterized by the following factors: light alcohol consumption, physically activity, physically fit, normal BMI, and not a current smoker. Based on criteria met, categories of 0 through 5 combined protective health factors were formed. Hazard ratios (HRs) and 95% confidence intervals (CI) were estimated using Cox proportional hazards models adjusting for covariates. Population attributable risk of hypertension was estimated for the 5 protective health factors. RESULTS: A total of 1,959 men reported developing hypertension during a mean of 10.7 ± 7.6 years of follow-up. Our data indicated that a combination of 5 protective health factors significantly reduced the risk of hypertension by 51% (95% CI: 29 - 66%). We also found that if all participants in our sample had 5 protective health factors, the incidence of hypertension would be expected to have decreased by 26% (95% CI: 11 - 38%). Additionally, having a normal BMI (HR: 0.70; 95% CI: 0.64 - 0.77) and being a non smoker (HR: 0.71; 95% CI: 0.63 - 0.79), physically active (HR: 0.87; 95% CI: 0.79 - 0.96), and physically fit (HR: 0.72; 95% CI: 0.65 - 0.79) was significantly and independently associated with a lower risk of developing hypertension. CONCLUSIONS: Our results show that among men aged 20 to 82 years, a combination of healthy lifestyle factors can significantly reduce the risk of developing hypertension, and should be considered for the prevention of this chronic condition.

Ageing with HIV: next challenges

With the advent of effective HAART and subsequent improved survival and also with ongoing HIV transmission including amongst older persons, the HIV positive population accessing care is ageing and a significant proportion of patients (up to 25% in some cohorts) are now aged over 50. Older age has an effect on both HIV natural history and response to HAART. Older persons in the pre-HAART era progressed more rapidly to AIDS or death after seroconversion and AIDS diagnoses occurred at higher CD4 counts. Virological response to HAART is typically greater in older patients, likely mediated by greater levels of adherence, although immunological responses appear blunted. Some HAART toxicities occur at a higher frequency on older patients, although tolerance of adverse effects may be greater. Additionally, it is increasingly suggested that HIV may result in accelerated ageing. This is thought to result from a combination of lifestyle factors, drug toxicities, and chronic inflammation/immune activation which persists even in the setting of virological suppression. Morbidities that were not historically considered to be HIV-related (e.g. cardiovascular disease, osteopaenia, non-AIDS malignancies) are now considered to be related to both ongoing HIV replication and chronic immune activation, and all are associated with increasing age. It is therefore likely that HIV treatment recommendations (such as when to start HAART and what to start with) may need to be adapted for the older patient. Furthermore, older patients with HIV are likely to increasingly experience multiple co-morbidites which will require complex management and significant challenges to healthcare delivery.

Protective Health Factors and Incident Hypertension in Men

Few studies have examined the association between a combination of lifestyle factors and the incidence of hypertension, particularly among men. This is important as lifestyle factors are often interrelated, and may often occur in combination. Thus, we investigated the individual and combined effects of body mass index (BMI), smoking status, alcohol intake, physical activity (PA), and cardiorespiratory fitness (CRF) on the incidence of hypertension in men. A total of 14,568 men (mean age = 44.0 + or - 9.3 years) from the Aerobics Center Longitudinal Study (ACLS) initially free of hypertension completed an extensive baseline examination during 1974-2003, and were followed for the incidence of hypertension. A total of 1,959 men reported having hypertension during a mean of 10.7 + or - 7.6 years of follow-up. Our data indicated that a combination of five protective health factors significantly reduced the risk of hypertension by 47% (95% confidence interval (CI): 36-56%). We also found that whether all participants in our sample had five protective health factors, the incidence of hypertension would be expected to decrease by 29% (95% CI: 26-31%). Additionally, having a normal BMI and being a nonsmoker and physically fit were significantly and independently associated with a lower risk of developing hypertension. Our results show that among men aged 20-82 years, a healthy lifestyle can significantly reduce the risk of developing hypertension, and should be considered for the prevention of this chronic condition.

Influence of socioeconomic lifestyle factors and genetic polymorphism on type 2 diabetes occurrences among Tunisian Arab and Berber groups of Djerba Island

Type 2 diabetes mellitus (T2DM) is characterized by three major metabolic abnormalities: impaired insulin-stimulated glucose uptake in muscle and adipose tissues, alterations in glucose-stimulated insulin secretion, and increased hepatic glucose production. Both genetic and environmental factors contribute to its development. The insulin gene (INS), insulin receptor gene (INSR), and insulin receptor substrate 1 gene (IRS1), identified by polymerase chain reaction and digestion with selected restriction enzymes PstI, NsiI, and BstnI, have been proposed as T2DM candidate genes. To determine the contribution of genetic and environmental factors on the occurrence of T2DM, we examined the frequency of T2DM among two ethnically diverse populations, Arabs and Berbers, who have shared the same environment, the island of Djerba, for thousands of years. Both populations have a high prevalence of obesity,T2DM, and a high consanguinity rate. A total of 162 T2DM men and women were matched to 110 healthy male and female controls. Results showed that the NsiI polymorphism in INSR and BstnI polymorphism of IRS1 were significantly associated with T2DM only among the Berber group. The PstI polymorphism in INS, was not associated with T2DM in either group. Sedentary lifestyles, lower physical activity, and lower educational levels were associated with T2DM among the Berber group. These findings suggest that the insulin receptor gene and lifestyle factors in combination may contribute to the occurrence of T2DM in the Berber portion of this island population.

Lifestyle Risk Factors and New-Onset Diabetes Mellitus in Older Adults

The combined impact of lifestyle factors on incidence of diabetes mellitus later in life is not well established. The objective of this study was to determine how lifestyle factors, assessed in combination, relate to new-onset diabetes in a broad and relatively unselected population of older adults. We prospectively examined associations of lifestyle factors, measured using repeated assessments later in life, with incident diabetes mellitus during a 10-year period (1989-1998) among 4883 men and women 65 years or older (mean [SD] age at baseline, 73 [6] years) enrolled in the Cardiovascular Health Study. Low-risk lifestyle groups were defined by physical activity level (leisure-time activity and walking pace) above the median; dietary score (higher fiber intake and polyunsaturated to saturated fat ratio, lower trans-fat intake and lower mean glycemic index) in the top 2 quintiles; never smoked or former smoker more than 20 years ago or for fewer than 5 pack-years; alcohol use (predominantly light or moderate); body mass index less than 25 (calculated as weight in kilograms divided by height in meters squared); and waist circumference of 88 cm for women or 92 cm for men. The main outcome measure was incident diabetes defined annually by new use of insulin or oral hypoglycemic medications. We also evaluated fasting and 2-hour postchallenge glucose levels. During 34,539 person-years, 337 new cases of drug-treated diabetes mellitus occurred (9.8 per 1000 person-years). After adjustment for age, sex, race, educational level, and annual income, each lifestyle factor was independently associated with incident diabetes. Overall, the rate of incident diabetes was 35% lower (relative risk, 0.65; 95% confidence interval, 0.59-0.71) for each 1 additional lifestyle factor in the low-risk group. Participants whose physical activity level and dietary, smoking, and alcohol habits were all in the low-risk group had an 82% lower incidence of diabetes (relative risk, 0.18; 95% confidence interval, 0.06-0.56) compared with all other participants. When absence of adiposity (either body mass index <25 or waist circumference < or =88/92 cm for women/men) was added to the other 4 low-risk lifestyle factors, incidence of diabetes was 89% lower (relative risk, 0.11; 95% confidence interval, 0.01-0.76). Overall, 9 of 10 new cases of diabetes appeared to be attributable to these 5 lifestyle factors. Associations were slightly attenuated, but still highly significant, for incident diabetes defined by medication use or glucose level. Even later in life, combined lifestyle factors are associated with a markedly lower incidence of new-onset diabetes mellitus.

The prevalence of mixed DNA profiles in fingernail samples taken from couples who co-habit using autosomal and Y-STRs

Physical contact can result in the transfer of DNA from one individual to another. In cases of sexual offence this can often be by means of an aggressive or sexual act. Biological material can accumulate under the fingernail hyponychium of both the victim and/or the suspect and has the potential to provide evidence and intelligence information to the police. The incidence of mixed DNA profiles obtained from fingernail samples of couples who co-habit was explored using AmpF lSTR ® SGM Plus ® (SGM Plus) (Applied Biosystems ®). It was predicted that the higher incidence of contact from co-habitation and therefore the greater opportunity for DNA transfer would result in an increased level of foreign DNA from the partner under the donor's fingernails. Fingernail swabs were taken from all fingers of the left and right hands of 12 couples on three separate occasions. DNA profiles were compared to both the donor and partner's reference DNA profiles. The number of reportable mixed DNA profiles obtained (17%) was higher than in previous reports. In this study, the majority of non-donor alleles matched the partner's reference DNA profile, indicating that co-habitation affected non-donor DNA obtained from fingernail swabs. The results demonstrated that as the couples spent increasing amounts of time together, the incidence of mixed DNA profiles increased. The large variation in the incidence of foreign alleles observed within and between couples suggested that a combination of lifestyle factors were having a significant effect on whether mixed DNA profiles were observed. Further DNA profiling using the AmpF lSTR ® Y-filer ® (Yfiler) PCR amplification (Applied Biosystems) was carried out to determine whether female fingernail samples that had previously given single donor profiles contained low levels of male DNA that may be detected by targeting the Y-chromosome. It was found that 63% of the samples analysed using Yfiler produced full or partial Y-STR profiles. The Y-STR profiles were compared to partners’ profiles and searched through two haplotype databases to determine the evidential value of such samples.

Obesity, Behavioral Lifestyle Factors, and Risk of Acute Coronary Events

Whether physical activity reduces the impact of obesity on the risk of acute coronary events is much debated. However, little is known about the role of other potentially modifiable lifestyle factors in combination with obesity. We followed up 54,783 women and men from the prospective Danish Diet, Cancer and Health study who were 50 to 64 years at baseline (1993 to 1997) and free of coronary artery disease and cancer. During a median of 7.7 years, 1127 incident cases of acute coronary syndrome (ACS) occurred. After multivariable adjustments, each unit of body mass index was associated with a 5% and 7% higher risk of ACS among women and men, respectively (both P<0.0001 for trend). Overweight (body mass index, 25 to 29.9 kg/m(2)) and obesity (body mass index >or=30 kg/m(2)) were associated with a higher risk of ACS among the physically active and inactive, in nonsmokers and smokers, and among those who adhered more or less to a heart-healthy dietary pattern. Obese individuals who were active 1 to 3.5 h/wk had a lower risk than sedentary, obese individuals. In addition, obese nonsmokers had a lower risk than obese smokers. Adherence to a healthy diet was associated with a lower risk of ACS; however, the relative risk was not different among obese individuals with the most healthy diet versus obese individuals with a less healthy diet. Obesity confers an elevated risk of ACS in both healthy and less healthy subgroups of lifestyle behaviors. Adherence to healthy lifestyle behaviors was associated with a lower risk even among obese individuals.

Degree of acculturation and adherence to Asian values as correlates of psychological distress among Korean immigrants

Background: Although psychological distress among Asian immigrants adjusting to a Western society has been reported in the clinical literature, empirical research support for this phenomenon is lacking. This is particularly true regarding Korean immigrants, an Asian population that is currently immigrating to non-Asian countries in large numbers.Aims: This study investigated how degree of acculturation and adherence to Asian values correlate with psychological distress among Korean immigrants (N = 118) in the United States.Method: Participants from the Midwestern United States (N = 118) completed survey packets including a demographic questionnaire, the Suinn-Lew Asian Self-Identity Acculturation Scale, the Asian Values Scale, and the Brief Symptom Inventory 18.Results: A multiple regression analysis revealed that less acculturation, stronger adherence to Asian values, and fewer years of living or being educated in the host country cumulatively predicted heightened psychological distress in this population. However, no single variable alone significantly predicted psychological distress, indicating that additional factors not studied here may influence distress symptoms among Korean immigrants.Conclusion: Psychological distress among Korean immigrants living in a Western culture can be identified, and it is associated with a combination of lifestyle factors that impact mental health.

A model for care across the cancer continuum

With contemporary therapy, the majority of children and adolescents who are diagnosed with cancer will be cured. However, curative therapy predisposes to adverse health outcomes that affect the long-term survivor's quality of life and increase the risk of early mortality. Recognition of the adverse effects of cancer treatment on growth and development, vital organ function, fertility and reproduction, and secondary carcinogenesis has been the stimulus for the development of risk-adapted treatment approaches for pediatric malignancies. Because the consequences of these therapeutic modifications may not manifest for many years, long-term follow-up is required to accurately define new or changing patterns of adverse health outcomes, appropriate screening approaches, and ultimately, risk-reducing interventions. Identification of vulnerable survivors is essential to provide timely interventions to detect, ameliorate, reduce, or prevent cancer-related sequelae. This process is challenging, because risk factors constantly are evolving as cancer therapies are modified and as survivors age. Aging also disrupts the continuity of after-cancer care, as adolescent and young adult survivors graduate from pediatric oncology practices to community medical providers who are largely unfamiliar with cancer-related health risks. Health outcomes research objectives that target cancer survivors must adapt as cancer therapies evolve and as new risk factors for cancer-related morbidity emerge. Prospectively using a multidimensional, comprehensive approach that considers host-related, cancer-related, genetic, and lifestyle factors in combination with results from focused medical and behavioral evaluations obtained from cancer survivors who participate in long-term follow-up programs provides an optimal method of defining high-risk profiles for adverse health outcomes across the age spectrum.

Helping people assess the health risks from lifestyle choices: Comparing a computer decision aid with customized printed alternative

Decisions about lifestyle play a key role in influencing health. Illnesses such as heart disease result from combinations of factors, making it hard for people to evaluate alternatives (e.g., knowing how much exercise might give similar benefit to eating more fruit and vegetables). Computers can provide customized risk leaflets and interactive displays, which may encourage people to explore potential lifestyle changes by showing the consequences for future health of specific combinations of lifestyle changes. This empirical study invited 24 adult volunteers to use the information from a customized leaflet or interactive display to advise hypothetical patients about lifestyle changes. Advisers used both leaflet and computer for different patients, with order counterbalanced across volunteers. It was found that more combinations of lifestyle factors were explored with the interactive display, especially by the younger volunteers, without this taking more time. Most of the older volunteers preferred interacting with the computer, and rated it as easier to use than the leaflet. It is concluded that easy to use computer interfaces can be devised that help people explore the health consequences of personal decisions about lifestyle, and that people prefer interactive assistance rather than using printed alternatives.

Risk factors for atherosclerosis in survivors of myocardial infarction and their spouses: Comparison with spousal pairs without personal and family history of atherosclerosis

To explore the hypothesis that an interplay between genetic and environmental factors contributes to the development of coronary atherosclerosis, we compared the prevalence of risk factors for atherosclerosis among survivors of myocardial infarction (MI) and their spouses and apparently healthy men and women (spousal pairs) with no personal and family history of atherosclerosis in three generations. There were no significant differences in life-style and dietary habits between the groups. The daily vegetable and/or fruit intake was generally low and did not differ between the groups. Thirty percent and 25% of men and women did not consume any vegetables or fruits, respectively. All differences found in the male MI survivors and control men were also found between the female groups: MI survivors and their spouses were significantly more obese and had higher systolic and diastolic blood pressure and more pathologic plasma lipid levels compared with control males and females, respectively. Compared with the control men and women, MI survivors and spouses had higher plasma homocysteine (Hcy) levels (15.3 6 10.5, 11.9 6 4.0, 16.9 6 5.5, and 14.3 6 4.0, mmol/L, respectively, P 5 .01). The frequency of the homozygous C677T 5,10-methylenetetrahydrofolate reductase (MTHFR) polymorphism in MI survivors was twice that observed in their spouses and controls (12.1%, 4.8%, and 5.8%, respectively), but this difference did not reach statistical significance. A statistically significant association of the MTHFR genotype and Hcy concentration (multiple ANOVA) was shown. Neither the frequencies of apolipoprotein E (apoE) alleles nor Asp9Asn mutation of exon 2, Asn291Ser mutation of exon 6, and Ser447Ter of exon 9 of the lipoprotein lipase (LPL) gene varied significantly among the groups. A possible explanation for our findings is that individuals with a genetic predisposition for atherosclerosis and their spouses share a life-style that results in a higher body mass index (BMI) and waist to hip ratio (WHR). On the other hand, individuals with no family history of atherosclerosis, despite an unhealthy life-style similar to that in the affected families (diet and physical activity), had a lower BMI and WHR and more favorable metabolic parameters, including plasma Hcy. In conclusion, we have shown that a personal and/or family history of atherosclerosis corresponds to the prevalence and level of risk factors for atherosclerosis. A combination of life-style factors and inherited metabolic abnormalities, including high plasma Hcy, are the more likely explanation for our findings. Copyright © 2001 by W.B. Saunders Company