Higher Risk Of Chronic Disease Research Articles

Attitudes and Barriers to Healthy Diet and Physical Activity: A Latent Profile Analysis.

Healthy diet and physical activity (PA) prevent and reduce chronic disease. Social cognitive theory delineates multiple attitudes and barriers that influence these behaviors. Understanding covariation in these attitudes and barriers is complex. We examined whether individuals could be grouped into a small number of categories that are easier to study. Interviews were conducted with 982 adults from two low-income, predominantly African American neighborhoods in the same city. Social cognitive constructs, including self-efficacy, social norms, and internal and external barriers to diet and exercise, and walking were self-reported. We measured moderate to vigorous physical activity with accelerometers and diet with 24-hour recalls. We conducted a latent profile analysis of attitudes and barriers to diet and PA and identified four classes: (a) moderate diet and negative exercise attitudes, where participants were roughly average on dietary attitudes but reported exercise-related challenges, including lower social support, outcome expectancies, physical functioning, and self-efficacy; (b) few barriers and benefits of healthy diet and exercise, where participants reported fewer barriers and lower outcome expectancies for diet and PA; (c) moderate overall attitudes, where participants had average scores on most indicators but below-average exercise self-efficacy and slightly more exercise barriers; and (d) positive overall attitudes, characterized by more positive attitudes toward both diet and PA across most domains, particularly regarding self-efficacy to overcome exercise barriers. These profiles could inform efforts to tailor individual-level interventions for diet and PA of persons at high risk of chronic diseases.

Community-based participatory research to design a faith-enhanced diabetes prevention program: The Better Me Within randomized trial

Reducing obesity positively impacts diabetes and cardiovascular risk; however, evidence-based lifestyle programs, such as the diabetes prevention program (DPP), show reduced effectiveness in African American (AA) women. In addition to an attenuated response to lifestyle programs, AA women also demonstrate high rates of obesity, diabetes, and cardiovascular disease. To address these disparities, enhancements to evidence-based lifestyle programs for AA women need to be developed and evaluated with culturally relevant and rigorous study designs. This study describes a community-based participatory research (CBPR) approach to design a novel faith-enhancement to the DPP for AA women. A long-standing CBPR partnership designed the faith-enhancement from focus group data (N=64 AA adults) integrating five components: a brief pastor led sermon, memory verse, in class or take-home faith activity, promises to remember, and scripture and prayer integrated into participant curriculum and facilitator materials. The faith components were specifically linked to weekly DPP learning objectives to strategically emphasize behavioral skills with religious principles. Using a CBPR approach, the Better Me Within trial was able to enroll 12 churches, screen 333 AA women, and randomize 221 (Mage=48.8±11.2; MBMI=36.7±8.4; 52% technical or high school) after collection of objective eligibility measures. A prospective, randomized, nested by church, design will be used to evaluate the faith-enhanced DPP as compared to a standard DPP on weight, diabetes and cardiovascular risk, over a 16-week intervention and 10-month follow up. This study will provide essential data to guide enhancements to evidence-based lifestyle programs for AA women who are at high risk for chronic disease.

A double blind placebo controlled randomized trial of the effect of acute uric acid changes on inflammatory markers in humans: A pilot study.

Uric acid has been linked with increased risk of chronic disease such as cardiovascular disease and this association has been attributed to a pro-inflammatory effect. Indeed, observational studies have shown that high uric acid is associated with high level of pro-inflammatory cytokines in the blood. However, whether high uric acid directly affects inflammation or rather represents a parallel defensive antioxidant mechanism in response to pathology that causes inflammation is unknown. To determine whether acute increase or decrease uric acid levels affects inflammation in healthy individuals, a randomized, placebo-controlled, double blind clinical study of uric acid or rasburicase with 20 healthy volunteers in each treatment-placebo group was conducted at the National Institute on Aging (NIA) Clinical Research Unit (CRU) at Harbor Hospital in Baltimore, MD. Change in inflammatory response was assessed by administering an oral lipid tolerance before and after the treatment of uric acid, rasburicase and placebo. Following uric acid administration, there was an accentuated increase in IL-6 during the oral lipid tolerance test (P<0.001). No significant differences were observed after lowering of uric acid with rasburicase. No side effects were reported throughout the trial. In health individuals, acute increase in uric acid results in an increased IL-6 response when challenged with lipid load. Such effect of amplification of inflammatory response may explain the higher risk of chronic diseases observed in subclinical hyperuricemia in observational studies.Trial Registration: ClinicalTrials.gov NCT01323335

The Relationship between Sport Participation and Chronic Diseases among Men in the USA: An Examination of the Behavioral Risk Factor Surveillance System.

Sport participation has been associated with lower rates of chronic diseases when compared to other forms of physical activity (PA) among women. However, we do not know if this relationship holds true for men. The purpose of this study was to examine the relationship between sport participation and men’s health and chronic diseases in the USA. This study was a secondary data analysis of the 2015 national Behavioral Risk Factor Surveillance System (BRFSS) survey. Participants were questioned extensively about their PA behaviors. Seventy-six different activities were identified and these activities were categorized as sport, conditioning exercise, recreation, or household tasks based upon previously identified categories. Logistic regression was utilized to calculate odds and adjusted odds ratios for chronic diseases based on physical activity category. When compared to men who participated in sport, men in the other PA categories had significantly higher odds for all of the chronic diseases except asthma. After controlling for demographic variables, significant odds remain except for stroke. Higher odds for chronic diseases in the other PA categories indicates that men in these group have a higher risk for chronic diseases than men in the sport category. Because of the potential health improvements related to sports participation, it is important to maintain and increase sport participation for both adolescents and adults.

Deaths Due to Screenable Cancers Among People Living With HIV Infection, Florida, 2000–2014

Because of antiretroviral therapy, people living with HIV infection are surviving longer and are at higher risk for chronic diseases. This study's objective was to assess the magnitude of deaths due to cancers for which there are screening recommendations for people living with HIV in Florida. Florida Department of Health Enhanced HIV/AIDS Reporting System data were matched with Department of Health Vital Records and the National Death Index to identify deaths and their causes through 2014. The sex-specific and cause-specific mortality rates and indirect standardized mortality ratios (SMRs, using U.S. mortality rates as a standard) were calculated during 2016 for people reported with HIV infection 2000-2014. Despite the competing risk of HIV mortality, among the 25,678 females, there was a higher risk of cervical (SMR=6.32, 95% CI=4.63, 8.44), colorectal (SMR=2.05, 95% CI=1.44, 2.83), liver (SMR=8.96, 95% CI=5.39, 14.03), and lung (SMR=5.82, 95% CI=4.80, 6.96) cancer mortality and lower risk of breast cancer mortality (SMR=0.57, 95% CI=0.42, 0.76). Among 63,493 males, there was a higher risk of liver (SMR=5.50, 95% CI=4.47, 6.70) and lung (4.63, 95% CI=4.11, 5.19) cancer mortality. Among males, the lung cancer SMR significantly declined 2000-2014 (p<0.05), but was still high in 2012-2014 (SMR=3.59, 95% CI=2.87, 4.43). These results indicate the importance of primary and secondary cancer prevention during primary care for people living with HIV infection.

Validity of Claims Data for the Identification of Male Infertility.

We sought to determine whether infertile men can accurately be identified within a large insurance claims database to validate its use for reproductive health research. Prior literature suggests that men coded for infertility are at higher risk for chronic disease though it was previously unclear if these diagnostic codes correlated with true infertility. We found that the specificity of one International Classification of Disease (9th edition) code in predicting abnormal semen parameters was 92.4%, rising to 99.8% if a patient had three different codes for infertility. The positive predictive value was as high as 85%. The use of claims data for male infertility research has been rapidly progressing due to its high power and feasibility. The high specificity of ICD codes for men with abnormal semen parameters is reassuring and validates prior studies as well as future investigation into men's health.

Abstract 4999: Stress, spiritual wellbeing and cancer risk among diverse racial faith-based communities: Elevated levels of stress proteomic biomarkers in breast cancer patients

Abstract Spiritual wellbeing is associated with decreased risk for cancer. Stress and depression are common among cancer patients and may be inversely associated with spiritual wellbeing. The purpose of the study is to examine if stress and depression as indicators of cancer risk are lower in a racially diverse faith-based community. Methods: 752 individuals from a faith-based community completed a behavioral assessment survey that mapped the current patterns of behavior in key categories that include: stress, depression, exercise and nutrition using the E-wellness platform FitThumb. To identify stress biomarkers in cancer patients we examined levels of stress serum proteomic biomarkers that were previously identified in our study by proteomic profiling using 2D-DIGEMS analysis and a subset of samples by shotgun LCMS technology. The serum proteomic study included serum samples from 15 African American breast cancer patients and 12 healthy controls who were from a faith-based community. Results: The behavioral assessment surveys that included 752 individuals who were racially diverse showed a low stress risk of 47.74% vs 8.24 % of high stress risk for chronic disease; and low depression risk of 85.11% vs 1.99% high risk for chronic disease. Elevated levels of stress and inflammatory serum proteomic biomarkers such as ceruloplasmin known to increase in stressed animals and humans; heptaglobin, apolipoproteins, and heat shock proteins were significantly elevated in breast cancer patients compared to healthy controls. Conclusions: Our results indicate that spiritual well-being is associated with significantly low stress and depression in a faith-based community regardless of race or ethnicity, posing a low risk for cancer as shown in previous Adventist Health Cohort studies. Future efforts will focus on validating and identifying panel of biomarkers from this cohort to gain insight into their role(s) in the mechanisms of stress hormones and cancer risk. Funded by Susan G Komen for the cure. Citation Format: Padma P. Tadi Uppala, Gretchen Krivak, Sherine Brown-Fraser, Dixon Anjejo, Alfredo Mejia, Dominique wakefield, Kumar Kolli. Stress, spiritual wellbeing and cancer risk among diverse racial faith-based communities: Elevated levels of stress proteomic biomarkers in breast cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4999. doi:10.1158/1538-7445.AM2017-4999

Innate immune responses in the ageing lung.

The world is undergoing an unprecedented shift in demographics, with the number of individuals over the age of 60 years projected to reach 2 billion or more by 2050, representing 22% of the global population. Elderly people are at a higher risk for chronic disease and more susceptible to infection, due in part to age-related dysfunction of the immune system resulting from low-grade chronic inflammation known as 'inflamm-ageing'. The innate immune system of older individuals exhibits a diminished ability to respond to microbial threats and clear infections, resulting in a greater occurrence of many infectious diseases in elderly people. In particular, the incidence of and mortality from lung infections increase sharply with age, with such infections often leading to worse outcomes, prolonged hospital stays and life-threatening complications, such as sepsis or acute respiratory distress syndrome. In this review, we highlight research on bacterial pneumonias and pulmonary viral infections and discuss age-related changes in innate immunity that contribute to the higher rate of these infections in older populations. By understanding more clearly the innate immune defects in elderly individuals, we can design age-specific therapies to address lung infections in such a vulnerable population.

Future trends in morbid obesity in England, Scotland, and Wales: a modelling projection study

BackgroundThe prevalence of morbid obesity is increasing worldwide, with numbers doubling in the past 20 years. Morbid obesity (body-mass index [BMI] ≥40 kg/m2) is associated with a high risk of chronic disease, such as type 2 diabetes, coronary heart disease, stroke, mental illness, and some cancers, and increased all-cause mortality rates. In addition, individuals with morbid obesity have more complex health issues and challenges in the health-care system than do those with a lower BMI. A recent global study reported a prevalence range from less than 0·1% in Chinese women to 23·1% in American women. Morbid obesity accounts for 24–35% of all obesity-related costs, presenting a substantial burden on the economy and health service. We aimed to project trends in morbid obesity to 2035 in adults in England, Scotland, and Wales. MethodsMorbid obesity rates for the three countries were obtained from the Health Survey for England (1993–2015) and Welsh Health Survey (2004–14) through the UK data service online resource and from the Scottish Health Survey team directly (2003, 2008–14). Rates were determined for men and women aged 16 and older separately (in 5 year age-groups). A multivariate non-linear regression was fitted to the data to project BMI trends. Building on previous models used by the UK Health Forum, we used BMI prevalence data, with age and sex as covariates. Validation was not done for this study, but has been done in earlier work with the Foresight study. FindingsMorbid obesity prevalence is projected to vary from 4% (in Scottish men aged 16–24 years old) to 54% (in English men aged 75 and older) by 2035. England and Wales are projected to have higher rates of morbid obesity in men than in women whereas the opposite is true of Scotland. Of the three countries, Wales is projected to have the highest levels of morbid obesity. Additional work is looking at population data. InterpretationThe prevalence of morbid obesity is set to increase to 2035 across England, Scotland, and Wales. This increase will have serious health and financial implications for the health service and population. The next stage will be to run a microsimulation to test the impact of morbid obesity on future disease burden. FundingNone.

Cortical bone deficit and fat infiltration of bone marrow and skeletal muscle in ambulatory children with mild spastic cerebral palsy

IntroductionNonambulatory children with severe cerebral palsy (CP) have underdeveloped bone architecture, low bone strength and a high degree of fat infiltration in the lower extremity musculature. The present study aims to determine if such a profile exists in ambulatory children with mild CP and if excess fat infiltration extends into the bone marrow. Materials and methodsAmbulatory children with mild spastic CP and typically developing children (4 to 11years; 12/group) were compared. Magnetic resonance imaging was used to estimate cortical bone, bone marrow and total bone volume and width, bone strength [i.e., section modulus (Z) and polar moment of inertia (J)], and bone marrow fat concentration in the midtibia, and muscle volume, intermuscular, subfascial, and subcutaneous adipose tissue (AT) volume and intramuscular fat concentration in the midleg. Accelerometer-based activity monitors worn on the ankle were used to assess physical activity. ResultsThere were no group differences in age, height, body mass, body mass percentile, BMI, BMI percentile or tibia length, but children with CP had lower height percentile (19th vs. 50th percentile) and total physical activity counts (44%) than controls (both p<0.05). Children with CP also had lower cortical bone volume (30%), cortical bone width in the posterior (16%) and medial (32%) portions of the shaft, total bone width in the medial-lateral direction (15%), Z in the medial-lateral direction (34%), J (39%) and muscle volume (39%), and higher bone marrow fat concentration (82.1±1.8% vs. 80.5±1.9%), subfascial AT volume (3.3 fold) and intramuscular fat concentration (25.0±8.0% vs. 16.1±3.3%) than controls (all p<0.05). When tibia length was statistically controlled, all group differences in bone architecture, bone strength, muscle volume and fat infiltration estimates, except posterior cortical bone width, were still present (all p<0.05). Furthermore, a higher intermuscular AT volume in children with CP compared to controls emerged (p<0.05). ConclusionsAmbulatory children with mild spastic CP exhibit an underdeveloped bone architecture and low bone strength in the midtibia and a greater infiltration of fat in the bone marrow and surrounding musculature compared to typically developing children. Whether the deficit in the musculoskeletal system of children with CP is associated with higher chronic disease risk and whether the deficit can be mitigated requires further investigation.

Plasma Lycopene Is Associated with Pizza and Pasta Consumption in Middle-Aged and Older African American and White Adults in the Southeastern USA in a Cross-Sectional Study.

BackgroundThe role of dietary lycopene in chronic disease prevention is not well known.MethodsThis study examined intake of lycopene and other antioxidants from lycopene-rich foods (e.g., pizza and pasta) simultaneously with plasma levels of lycopene and other antioxidants in a representative cross-sectional sample (187 Blacks, 182 Whites, 40–79 years old) from the Southern Community Cohort Study (SCCS). The SCCS is an ongoing study conducted in populations at high risk for chronic diseases living in Southeastern United States. Dietary intake was assessed using a validated food frequency questionnaire (FFQ), and plasma levels of lycopene and other antioxidants were measured at baseline (2002–2005). The participants were classified into tertiles according to consumption of pizza and pasta food groups.ResultsLycopene dietary intake and plasma lycopene concentrations were significantly higher in the highest (tertile 3) compared to tertiles 1 and 2 (both P < 0.01). Total energy intake ranged from 1964.3 ± 117.1 kcal/day (tertile 1) to 3277.7 ± 115.8 kcal/day (tertile 3) (P<0.0001). After adjusting for age and energy intake, total dietary fat, saturated fatty acids, trans-fatty acids, and sodium intakes were significantly higher in tertile 3 than tertiles 2 and 1 (all P <0.01). Vitamin C intake was significantly lower in tertile 3 than tertiles 1 and 2 (P = 0.003). Except for γ-tocopherol being higher in tertile 3 than tertiles 1 and 2 (P = 0.015), the plasma concentrations of antioxidants were lower in tertile 3 than tertiles 1 and 2 (β-carotene, α-carotene, lutein and zeaxanthin, all P<0.05).ConclusionsIn the SCCS population, pizza and pasta were the main sources of dietary lycopene and their intake was associated with plasma lycopene concentration. Diets with frequent pizza and pasta consumption were high in energy, saturated fatty acids, trans-fatty acids, sodium and low in other antioxidants. Future studies of lycopene as a protective dietary factor against chronic disease should consider the overall nutritional quality of lycopene-containing foods.

Allostatic Load Assessment for Early Detection of Stress in the Workplace in Egypt.

AIM:Workplace stress is hazardous for its harmful impact on employees’ health and organizational productivity. The aim of the study is to apply the Allostatic Load Index (ALI) which is a multi-component measure for health risk assessment and early detection of stress among workers in Egypt.METHODS:Sixty-two working adults randomly selected from two different working environments in Egypt were included in the study. Participants completed a self-reported questionnaire for socio-demographic and work variables. Andrews and Withey test for Job Satisfaction was filled and 3 ml blood samples were collected. Markers assessed for Allostatic Load were serum cortisol, c-reactive protein, dehydroepiandrosterone-sulphate, total thyroxine, total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, total cholesterol to high-density lipoprotein ratio, systolic and diastolic blood pressures, waist to hip ratio and body mass index. The risk quartile method was used for calculation of ALI. ALI value of four or more indicates high Allostatic Load.RESULTS:Job satisfaction scale defined about a quarter of the study population (24%) to be dissatisfied with Allostatic Load of 2.4 as the mean value. Population percentage with ALI ≥4 reached 12.9% with 100% of them females. A significant association was found between Allostatic Load of primary mediators and age, the presence of chronic diseases, place of work and female gender.CONCLUSION:Female gender and the old age of the Egyptian workforce under study are at higher risk of chronic diseases. Using an alternative way -for example, the cut-point method- instead of the risk quartiles for dichotomization of markers used in ALI calculation could be more precise for early detection of stress among healthy individuals.

Effect of a High-Protein Energy-Restricted Diet Combined with Resistance Training on Metabolic Profile in Older Individuals with Metabolic Impairments.

Adequate protein intake and resistance training are effective strategies to maintain muscle mass, but the effect of their combination on metabolic profile during weight loss remains to be determined in older adults. The main objective of this study was to determine the effect of a 16-week high-protein caloric restriction combined with resistance training on chronic disease risk factors in obese older individuals with metabolic impairments. A total of 26 overweight adults aged between 60 and 75 years (BMI 32.4 ± 3.9 kg/m2) with at least 2 factors of the metabolic syndrome participated in this study and were randomized into two groups: 1) high-protein caloric restriction (HP; n= 12) and 2) high-protein caloric restriction combined with dynamic-resistance training (HP+RT; n=14). Caloric intake was reduced by 500 kcal/d in all participants and protein intake equated 25-30% of total calories (~1.4 g/kg/d). Exercise training consisted of 3 session/week of resistance training on pulley machines. Outcome measures included total and trunk fat mass (FM), total and appendicular lean body mass (LBM), fasting glucose level, lipid profile and blood pressure. Our results showed that total and trunk FM (all p<0.0001) as well as fasting glucose (p<0.0001), triglycerides (p=0.002) and total cholesterol (p=0.03) levels decreased similarly in both groups. However, total (p=0.04) and appendicular (p=0.02) LBM decreased in the HP group only. Our data show that high-protein energy restriction improves health profile of obese elderly at high risk of chronic disease but needs to be combined with resistance training to maintain LBM.

Lifestyle behaviors and ethnic identity among diverse women at high risk for type 2 diabetes

BackgroundDiet and physical activity lifestyle behaviors are modifiable risk factors for type 2 diabetes and are shaped by culture, potentially influencing diabetes health disparities. ObjectivesWe examined whether ethnic identity—the strength of attachment to one’s ethnic group, and a long-standing focus of psychological research—could help account for variations in lifestyle behaviors within a diverse population at high risk for chronic disease. MethodsUsing data from the Gestational Diabetes’ Effects on Moms trial, this US-based cross-sectional study included 1463 pregnant women (74% from minority ethnic/racial groups; 46% born outside the US) with gestational diabetes (GDM), a common pregnancy complication conferring high risk for type 2 diabetes after delivery. Mixed linear regression models examined whether ethnic identity is associated with lifestyle behaviors after adjusting for demographic, clinical, and acculturative characteristics (e.g., nativity and length of residence in the US). ResultsIn the overall sample, a one-unit increase in ethnic identity score was significantly associated with 3% greater fiber intake, 4% greater fruit/vegetable intake, 11% greater total activity, and 11% greater walking (p values < 0.01). Within ethnic/racial groups, a one-unit increase in ethnic identity score was significantly associated with 17% greater fiber intake among Filipina women; 5% lower total caloric intake among non-Hispanic White women; and 40% greater total activity, 35% greater walking, and 8% greater total caloric intake among Latina women (p values ≤ 0.03). ConclusionResults from this large study suggest that ethnic group attachment is associated with some lifestyle behaviors, independent of acculturation indicators, among young women with GDM who are at high risk for type 2 diabetes. Stronger ethnic identity may promote certain choices known to be associated with reduced risk of type 2 diabetes. Prospective research is needed to clarify the temporal nature of associations between ethnic identity and modifiable diabetes risk factors.

Pharmacists key players in community–clinical linkages

Many social elements beyond the clinical care people receive influence their individual health and the health of the community in which they live. Factors such as a person’s living environment, type of job and income, transportation, and having food can play an important role in whether our health care delivery is successful.Pharmacists are trained to focus on the medications a patient is taking and how the medications are affecting the patient’s condition(s). Are the medications appropriate, safe, and effective, and is the patient adhering to them? As pharmacists, how often do we think outside the box of the clinical care we provide to identify other social factors that could be affecting the medication and health outcomes of the patients we serve? And if we do identify problems, how do we access resources in the community to help? Likewise, how do we leverage community partnerships to assist patients in need?CDC is championing efforts to form community–clinical linkages to improve the health of communities. These linkages between community organizations and clinical practices target enhanced coordination, resource sharing, and referral and tracking systems to improve the management of chronic conditions. CDC recognizes pharmacists as key players in these efforts.As highlighted in this month’s Innovations article on pages 42–45, the CDC National Center for Chronic Disease Prevention and Health Promotion is funding state health departments to create community–clinical linkages for high-risk individuals with or at high risk for chronic disease. Health department programs must focus on making sure high-risk individuals have access to community resources and support to prevent, delay, or manage their conditions. The grants speci cally mention pharmacists in the strategies to consider in implementing the programs. State health departments in Utah, Colorado, Ohio, and 20 other states are linking pharmacists to medication therapy management and hypertension and diabetes programs.CDC is a very strong supporter of pharmacy and has created many resources highlighting pharmacists on topics such as chronic disease management, vaccines, antibiotic stewardship, and collaborative practice agreements. Visit the CDC website (www.cdc.gov) and search “pharmacist” to access these valuable resources.Take advantage of opportunities to be a clinical link within your community, and enjoy your November Pharmacy Today! Many social elements beyond the clinical care people receive influence their individual health and the health of the community in which they live. Factors such as a person’s living environment, type of job and income, transportation, and having food can play an important role in whether our health care delivery is successful. Pharmacists are trained to focus on the medications a patient is taking and how the medications are affecting the patient’s condition(s). Are the medications appropriate, safe, and effective, and is the patient adhering to them? As pharmacists, how often do we think outside the box of the clinical care we provide to identify other social factors that could be affecting the medication and health outcomes of the patients we serve? And if we do identify problems, how do we access resources in the community to help? Likewise, how do we leverage community partnerships to assist patients in need? CDC is championing efforts to form community–clinical linkages to improve the health of communities. These linkages between community organizations and clinical practices target enhanced coordination, resource sharing, and referral and tracking systems to improve the management of chronic conditions. CDC recognizes pharmacists as key players in these efforts. As highlighted in this month’s Innovations article on pages 42–45, the CDC National Center for Chronic Disease Prevention and Health Promotion is funding state health departments to create community–clinical linkages for high-risk individuals with or at high risk for chronic disease. Health department programs must focus on making sure high-risk individuals have access to community resources and support to prevent, delay, or manage their conditions. The grants speci cally mention pharmacists in the strategies to consider in implementing the programs. State health departments in Utah, Colorado, Ohio, and 20 other states are linking pharmacists to medication therapy management and hypertension and diabetes programs. CDC is a very strong supporter of pharmacy and has created many resources highlighting pharmacists on topics such as chronic disease management, vaccines, antibiotic stewardship, and collaborative practice agreements. Visit the CDC website (www.cdc.gov) and search “pharmacist” to access these valuable resources. Take advantage of opportunities to be a clinical link within your community, and enjoy your November Pharmacy Today!

Vivere con la malattia e la disabilità. Anziani, differenze sociali e di genere, tipologie familiari

Through the analysis of the Istat Multipurpose Survey data 2012-2013, this paper investigates how the differences in gender, social position, and family composition affect the elderly population with respect to certain specific diseases and to loss of self-sufficiency. A multivariate analysis reveals that women and the less educated parts of the population are subject to higher risk of chronic diseases and to loss of self-sufficiency. The risk of loneliness is particularly high in the women, especially in the extremely old ones, even in case of longterm care requirements. Thus social and healthcare policies sustaining the elder parts of the population with respect to long term care have a crucial role not only for the poorest segments of the society but especially for the women.

Role of the macrophage in HIV-associated neurocognitive disorders and other comorbidities in patients on effective antiretroviral treatment.

Combination antiretroviral therapy (ART) has altered the outcomes of HIV infection in treated populations by greatly reducing the incidence of opportunistic infections, cancer, and HIV-associated dementia. Despite these benefits, treated patients remain at high risk of chronic diseases affecting the peripheral organs and brain. Generally, these morbidities are attributed to persistence of latent HIV in resting T cells, chronic inflammation, and metabolic effects of ART. This review makes the case that monocytes/macrophages warrant attention as persistent reservoirs of HIV under ART, source of systemic and brain inflammation, and important targets for HIV eradication to control chronic HIV diseases.

Nutritional Knowledge of NCAA Division III Football Players

There is increased recognition of the role that nutrition plays in optimal athletic performance as well as the long-term health of athletes. While many NCAA Division I football programs have at least a part-time registered dietitian/nutritionist (RDN) on staff, the resources available at Division III schools are much more limited. In particular, football players may be at a higher risk for chronic diseases later in life that could be prevented by proper nutrition. PURPOSE: The purpose of this study was to evaluate the nutritional knowledge and sources of information of NCAA Division III football players. METHODS: The study was a cross-sectional design. Eighty-eight new and returning male collegiate football players completed a nutrition knowledge quiz to assess adequate nutrition knowledge (ANK) and a questionnaire that included questions on sources of nutrition information. Data was collected at the beginning of the fall 2014 training camp. An independent t-test compared nutrition knowledge between subjects who had taken a college nutrition course versus those who had not. RESULTS: Nutrition quiz performance was 55.2±16.3%, with only 12.5% of subjects demonstrating ANK (defined as a quiz score of ≥75%). Mean scores for subjects who had taken a nutrition course in college compared to those who had not were significantly higher (71.2% vs. 53.6% respectively; t=-7.38, df = 85, p<0.001). The top four sources of nutrition information were coaches, websites, athletic trainers (ATs), and physicians. The highest percentage of subjects felt comfortable discussing their nutritional needs with ATs (29%), then coaches (27%), dietitians/nutritionists (18%), and physicians (15%). Subjects ranked the adequacy of nutritional knowledge of these sources in the same order—ATs being the highest. CONCLUSION: Most NCAA Division III football players have inadequate nutrition knowledge and are relying primarily on ATs and coaches to provide knowledgeable nutrition advice. Since funding for RDNs at Division III is limited, steps should be taken to ensure that ATs and coaches are adequately trained to provide basic nutritional advice with the understanding of the limits within their scopes of practice.

Nutritional Practices of NCAA Division III Football Linemen

Football linemen have been shown to be at greater risk of chronic diseases (e.g. cardiovascular disease) later in life compared to other position players. Linemen encounter pressure to maintain high body mass, which may influence dietary choices. Previous research on this topic has largely focused on professional or Division I levels, with little study on Division III athletes. PURPOSE: The purpose of this study was to evaluate the dietary practices of NCAA Division III linemen. METHODS: In this cross-sectional study, 9 linemen (height=182.8±6.3cm, weight =113.9±10.2kg, years in college=2.7±1.4) completed a 3-day diet log. Diet logs were analyzed for macronutrient and micronutrient intake and compared to US Dietary Reference Intakes (DRI) and MyPlate recommendations for a male with the average weight, height, and age of the subjects. Separate 1-sample t-tests for each category were used (alpha=0.05). RESULTS: Average intake of nutrients and food groups with comparisons to recommendations are shown in Table 1. CONCLUSION: Excess consumption of total fats, saturated fats, and sodium and a low intake of essential fats and fiber may put NCAA Division III linemen at a higher risk of chronic disease and should be considered when providing nutrition counseling.Table 1: Average Nutrient and Food Group Intake of Linemen Compared to DRI and MyPlate Recommendations.Significantly different than recommendations (* <0.05; ♯ <0.001); SD = standard deviation; DRI = Dietary Reference Intake; MUFA = monounsaturated fatty acids; PUFA = polyunsaturated fatty acids

Physical activity as a determinant of fasting and 2-h post-challenge glucose: a prospective cohort analysis of the NAVIGATOR trial.

To investigate whether previous physical activity levels are associated with blood glucose levels in individuals with impaired glucose tolerance in the context of an international pharmaceutical trial. Data were analysed from the NAVIGATOR trial, which involved 9306 individuals with impaired glucose tolerance and high cardiovascular risk from 40 different countries, recruited in the period 2002-2004. Fasting glucose, 2-h post-challenge glucose and physical activity (pedometer) were assessed annually. A longitudinal regression analysis was used to determine whether physical activity levels 2years (t-2 ) and 1year (t-1 ) previously were associated withlevels of glucose, after adjusting for previous glucose levels and other patient characteristics. Those participants with four consecutive annual measures of glucose and two consecutive measures of physical activity were included in the analysis. The analysis included 3964 individuals. Change in physical activity from t-2 to t-1 and activity levels at t-2 were both associated with 2-h glucose levels after adjustment for previous glucose levels and baseline characteristics; however, the associations were weak: a 100% increase in physical activity was associated with a 0.9% reduction in 2-h glucose levels. In addition, previous physical activity only explained an additional 0.05% of the variance in 2-h glucose over the variance explained by the history of 2-h glucose alone (R(2) =0.3473 vs. 0.3468). There was no association with fasting glucose. In the context of a large international clinical trial, previous physical activity levels did not meaningfully influence glucose levels in those with a high risk of chronic disease, after taking into account participants' previous trajectory of glucose control.