Longitudinal Linear Models Research Articles

Asynchronous functional linear regression models for longitudinal data in reproducing kernel Hilbert space.

Motivated by the analysis of longitudinal neuroimaging studies, we study the longitudinal functional linear regression model under asynchronous data setting for modeling the association between clinical outcomes and functional (or imaging) covariates. In the asynchronous data setting, both covariates and responses may be measured at irregular and mismatched time points, posing methodological challenges to existing statistical methods. We develop a kernel weighted loss function with roughness penalty to obtain the functional estimator and derive its representer theorem. The rate of convergence, a Bahadur representation, and the asymptotic pointwise distribution of the functional estimator are obtained under the reproducing kernel Hilbert space framework. We propose a penalized likelihood ratio test to test the nullity of the functional coefficient, derive its asymptotic distribution under the null hypothesis, and investigate the separation rate under the alternative hypotheses. Simulation studies are conducted to examine the finite-sample performance of the proposed procedure. We apply the proposed methods to the analysis of multitype data obtained from the Alzheimer's Disease Neuroimaging Initiative (ADNI) study, which reveals significant association between 21 regional brain volume density curves and the cognitive function. Data used in preparation of this paper were obtained from the ADNI database (adni.loni.usc.edu).

Income Inequality and Pregnancy-Associated Homicide in the US: A Longitudinal, State-Level Analysis.

Pregnancy-associated homicide remains an understudied yet critical issue. Using restricted use mortality files provided by the National Center for Health Statistics and the National Violent Death Reporting System, annual state-level pregnancy-associated homicide ratios were estimated as the count of deaths divided by the number of live births. The exposure, the state Gini index, was categorized into tertiles to compare states by levels of income inequality. In the final adjusted longitudinal linear model, those who experienced the greatest amount of income inequality had a significant 1.28 per 100,000 homicide rate when compared to the lowest income inequality tertile.

Effect of the STRIDE fall injury prevention intervention on falls, fall injuries, and health-related quality of life.

Falls are common in older adults and can lead to severe injuries. The Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) trial cluster-randomized 86 primary care practices across 10 health systems to a multifactorial intervention to prevent fall injuries, delivered by registered nurses trained as falls care managers, or enhanced usual care. STRIDE enrolled 5451 community-dwelling older adults age ≥70 at increased fall injury risk. We assessed fall-related outcomes via telephone interviews of participants (or proxies) every 4 months. At baseline, 12 and 24 months, we assessed health-related quality of life (HRQOL) using the EQ-5D-5L and EQ-VAS. We used Poisson models to assess intervention effects on falls, fall-related fractures, fall injuries leading to hospital admission, and fall injuries leading to medical attention. We used hierarchical longitudinal linear models to assess HRQOL. For recurrent event models, intervention versus control incidence rate ratios were 0.97 (95% confidence interval [CI], 0.93-1.00; p= 0.048) for falls, 0.93 (95% CI, 0.80-1.08; p= 0.337) for self-reported fractures, 0.89 (95% CI, 0.73-1.07; p= 0.205) for adjudicated fractures, 0.91 (95% CI, 0.77-1.07; p= 0.263) for falls leading to hospital admission, and 0.97 (95% CI, 0.89-1.06; p= 0.477) for falls leading to medical attention. Similar effect sizes (non-significant) were obtained for dichotomous outcomes (e.g., participants with ≥1 events). The difference in least square mean change over time in EQ-5D-5L (intervention minus control) was 0.009 (95% CI, -0.002 to 0.019; p= 0.106) at 12 months and 0.005 (95% CI, -0.006 to 0.015; p= 0.384) at 24 months. Across a standard set of outcomes typically reported in fall prevention studies, we observed modest improvements, one of which was statistically significant. Future work should focus on patient-, practice-, and organization-level operational strategies to increase the real-world effectiveness of interventions, and improving the ability to detect small but potentially meaningful clinical effects. gov identifier: NCT02475850.

Motivational Interviewing improves caregiver self-efficacy in heart failure: a secondary outcome analysis of the MOTIVATE-HF trial

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Center of Excellence for Nursing Scholarship, Rome, Italy. Background Caregiver self-efficacy, which is caregiver confidence in her own abilities to help the patient in performing self-care, directly influences caregiver contribution (CC) to self-care, while acting as a mediator between predictors of CC to self-care and CC to self-care itself. Although caregiver self-efficacy is associated with patient and caregiver outcomes, evidence on interventions aiming to improve this variable, as well as CC to self-care, is scarce. Purpose To evaluate the effect of Motivational Interviewing (MI) on caregiver self-efficacy and CC to self-care in heart failure. Methods Secondary outcome analysis of the MOTIVATE-HF RCT. A total of 235 caregivers and 238 patients completed the study. Participants were recruited from three centres in Italy and randomized into Arm 1 (MI for patients), Arm 2 (MI for patients and caregivers), Arm 3 (standard care). The intervention consisted in one face-to-face MI session followed by three telephone contacts delivered to patients (Arm 1) or to patients and caregivers (Arm 2). Caregiver self-efficacy and CC to self-care were assessed with the Caregiver Contribution to Self-Care of HF Index. Data were collected at baseline, before the intervention, and after 3, 6, 9, 12 months from enrolment. Results Among the three arms, caregivers median age was 55 years, they were mainly female (76%), married (72%), spouses (37%), employed (73.5%), with a high school level or higher education (55%), and living with the patients (60%). Patients median age was 74 years, they were mainly male (58%), retired (76%), in NYHA Class II (61.9%). Over the year of the study, caregiver self-efficacy significantly improved in all arms, and was significantly higher in Arm 2 compared to Arm 3 at 9-month follow-up (difference: 8.36, 95% CI (3.13; 13.59), p = 0.002). At 12-month follow-up, caregiver self-efficacy was still higher in Arm 2 compared to Arm 3, but this difference only approached statistical significance (difference: 6.59, 95% CI (-0.41; 13.60), p = 0.064). The longitudinal mixed linear model on self-efficacy, accounting for time, living with the patient, randomization arm and their interaction, confirmed a significantly higher improvement of caregiver self-efficacy in Arm 2 compared to Arm 3 (β ̂ = 1.39, 95% CI (0.02; 2.75), p = 0.046). CC to self-care significantly improved over time in all Arms, but without significant differences among the three Arms. Conclusion Our results show that MI was effective in improving caregiver self-efficacy, but not CC to self-care. This may indicate that MI was able to improve how well caregivers were supporting patients, as showed by improvements in self-efficacy, but not how much they were doing it, as showed by the lack of improvement in CC to self-care. Further studies need to better understand how caregiver self-efficacy affects CC to self-care, how caregiver self-efficacy can be further improved, and the necessary intensity of MI to improve CC to self-care.

Estimation of Atmospheric Gusts Using Integrated On-Board Systems of a Jet Transport Airplane—Flight Simulations

Currently, quite accurate measurements of atmospheric gusts are carried out by airport systems only in the vicinity of the runways. There is a still open issue of availability of information about real wind gusts at cruising altitudes and during approach at a considerable distance from the airfield. Standard on-board systems of a jet transport airplane provide some information which is desirable to have knowledge of how flight parameters reflect real gust parameters and their impact on the aircraft dynamics. The paper proposes an algorithm for headwind gust magnitude estimation in relation to aircraft response. The analysed estimation algorithms assume the use of data available from the existing on-board systems only without the employment of any extra sensors or ground and satellite systems. In this way, many problems caused by different structures, configurations, and ways of installation of additional sensors and structural changes are rejected. The algorithms use the classical method for estimation of wind parameters as well as a linear longitudinal model of aircraft dynamics, taking into account the influence of wind gusts. Data fusion was realised with the use of three filtration methods. Results were evaluated to select the most accurate method of the estimation. Test data were obtained from advanced flight simulation. The experimental scenario considered a flight of a passenger twin-engine jet airplane through a layer of programmed gusts. The results of the flight simulations allowed us to determine the accuracy of the proposed gust estimation algorithms in reference to the ideal wind-speed data analysis obtained directly from the simulation environment (with the accuracy of the simulation process). The use of the proposed gust estimation algorithms may provide more accurate signal for integrated on-board systems, especially for wind shear detection and sped-up response time of flight control systems, protecting aircrafts against the adverse impact of encountered wind shear or gusts, e.g., auto-thrust or auto-throttle systems. The dedicated algorithm presented in the paper may increase the safety level of take-off and approach phases in gusty conditions and also during significant changes in wind speed at cruising altitudes in the case of crossing the area of jet stream occurrence.

Genetic analysis of the effects of heat stress before and after lambing on pre-weaning live weight in Spanish Merino lambs.

BackgroundHeat stress (HS) is a major environmental effect on sheep production. Hereby, we estimated the genetic (co)variance component of HS on the pre‐weaning performance of 19,022 Merino lambs by analysing the climatological index of temperature and relative humidity (recorded 30 days before lambing and after lambing) using transversal and longitudinal mixed linear models.Methods and ResultsThe global impact of HS during the last 30 days of pregnancy was −17% for birthweight and ranged between −4% and −8% for live weight at 15, 30 days of age (W30), and average daily gain from birth at 30 days. The results from both statistical approaches showed very similar heritabilities (h 2), ranging from 0.192 to 0.237 for the direct genetic (D) effects and from 0.072 to 0.082 for the maternal genetic (M) effects, but the antagonism between (D) and (M) was higher when a longitudinal model was used. A significant genotype‐environmental effect was also found regardless of whether the climatological covariables were considered in the model. In addition, we employed D and M breeding values for W30 as an example to create a new subjacent index by first using a principal component analysis and employing the leading eigenvalues as a weighted factor that provides the information needed to identify those genotypes that maximise the response for both genetic effects over a wide range of climate–environment levels.ConclusionsOur study revealed that the HS indexes of the mother during the gestation period have a significant effect on the growth of the lambs during the early stages of life.

Translational Research on Caregiver Reading and Playing Behaviors: Evidence from an In Vivo Community-based Intervention throughout the COVID-19 Pandemic.

This study provides a rigorous assessment of a community-based early child development (ECD) intervention to understand the drivers of caregivers’ reading and playing practices in a low-resourced township in South Africa. Mentors visited 157 homes biweekly (2474 observations from 2019–21; children ages 0–5), completing surveys regarding caregiver behaviors and engagement. One hundred and fifty-seven caregivers (mostly Black, Zulu women) participated in the program during this time period and completed surveys biannually on their support system (modified version of the Multidimensional Scale of Perceived Support) and ECD beliefs (modified versions of the Parental Play Beliefs Scale and the Parent Opinion Survey). Longitudinal Hierarchical Linear Model revealed that several behaviors and beliefs significantly predicted positive parenting behaviors. Regression discontinuity plots suggest that positive parenting behaviors could continue and even improve following Covid-19 shutdowns, especially in homes with more intervention visits. This paper provides translational evidence on tangible ways interventions can engage caregivers in stimulating ECD behaviors.

Potential Explanatory Factors for the Concurrent Experience of Dyspnea and Pain in Patients with COPD

Previous research has identified unexpectedly strong associations between dyspnea and pain, but the reasons remain unclear. Ascertaining the underlying biological and psychological mechanisms might enhance the understanding of the experience of both conditions, and suggest novel treatments. We sought to elucidate whether demographic factors, disease severity, psychological symptoms and biomarkers might account for the association between pain and dyspnea in individuals with COPD. We analyzed data from 301 patients with COPD who were followed in a prospective longitudinal observational study over 2 years. Measures included self-reported dyspnea and pain, pulmonary function tests, serum levels of inflammatory cytokines, measures of physical deconditioning, and scales for depression and anxiety. Analyses involved cross-sectional and longitudinal linear regression models. Pain and dyspnea were strongly correlated cross-sectionally (r = 0.77, 95% CI 0.72–0.82) and simultaneously across time (r = 0.42, 95% CI 0.28–0.56). Accounting for any of the other health factors only slightly mitigated the associations. Symptoms of pain and dyspnea thus may be fundamentally linked in COPD, rather than being mediated by common biological, psychological, or functional factors. From the patient’s perspective, pain and dyspnea may be part of the same essential experience. It is possible that treatments for one condition would improve the other.

Incontinence training in children with cerebral palsy: A prospective controlled trial

Urinary incontinence is the most frequently observed lower urinary tract symptom in children with cerebral palsy (CP). Being continent can positively influence quality of life of the child and the social environment. To investigate the effectiveness of incontinence training with urotherapy in children with CP. A population-based case-control study was conducted including 21 children with CP and 24 typically developing children between 5 and 12 years old, both with daytime incontinence or combined daytime incontinence and enuresis. Children received treatment for one year with three-monthly examination by means of uroflowmetry, a structured questionnaire and bladder diaries. Children started with three months of standard urotherapy. After three, six and nine months of training, specific urotherapy interventions (pelvic floor muscle training with biofeedback, alarm treatment or neuromodulation) and/or pharmacotherapy could be added to the initial treatment. Therapy was individualized to probable underlying conditions. Effectiveness was controlled for spontaneous improvement due to maturation and analysed by means of longitudinal linear models, generalized estimating equations and multilevel cumulative odds models. Comparison with typically developing children was assessed by means of Kaplan-Meier survival analysis. Results suggest effectivity rate of incontinence training is lower and changes occur more slowly in time in children with CP compared to typically developing children (Figure). Within the group of children with CP, significant changes during one year of training were found for daytime incontinence (p<0.001), frequency of daytime incontinence (p=0.002), frequency of enuresis (p=0.048), storage symptoms (p=0.011), correct toilet posture (p=0.034) and fecal incontinence (p=0.026). Maximum voided volume and fluid intake at the start of training were significantly lower in children with CP and could explain a delayed effectiveness of urotherapy. Treatment of constipation demonstrated a positive effect on maximum voided volume and should be initiated together with standard urotherapy when constipation is still present after implementation of a correct fluid intake schedule. Future research with a larger sample size is recommended. Incontinence training with urotherapy can be an effective treatment for urinary incontinence in children with cerebral palsy. In the current cohort, effectivity rate of incontinence training was lower and changes occurred more slowly in children with cerebral palsy compared to typically developing children.

Longitudinal Trajectories of Memory Performance in Patients with Early-Stage Breast Cancer.

Background While breast cancer and its treatments may affect cognition, the longitudinal trajectories of cognition among those receiving differing cancer treatment types remain poorly understood. Prior research suggests hippocampal-prefrontal cortex network integrity may influence cognition, although how this network predicts performance over time remains unclear. Methods We conducted a prospective trial including 69 patients with early-stage breast cancer receiving adjuvant therapy and 12 controls. Longitudinal cognitive testing was conducted at four visits: pretreatment-baseline, 6-7 months, 14-15 months, and 23-24 months. Cognitive composite scores of episodic memory, executive functioning, and processing speed were assessed at each timepoint. Baseline structural MRI was obtained in a subset of these participants, and hippocampal and prefrontal cortex regional volumes were extracted. Results Longitudinal linear mixed modeling revealed significant group by time interactions on memory performance, controlling for age and education. Post hoc analyses revealed this effect was driven by patients treated with chemotherapy or chemotherapy plus hormone therapy, who demonstrated the least improvement in memory scores over time. Treatment group did not significantly influence the relationship between time and processing speed or executive functioning. Neither pretreatment hippocampal nor prefrontal volume differed between groups, and there were no significant group by time by baseline regional volume effects on cognition. Conclusion Patients with early-stage breast cancer treated with chemotherapy or chemotherapy plus hormone therapy benefit less from practice effects seen in healthy controls on memory tests. Loss of longitudinal practice effect may be a new and clinically relevant measure for capturing patients' experience of cognitive difficulties after treatment.

Remdesivir significantly reduces SARS-CoV-2 viral load on nasopharyngeal swabs in hospitalized patients with COVID-19: A retrospective case-control study.

Remdesivir is a broad‐spectrum antiviral agent able to inhibit the RNA polymerase of SARS‐CoV‐2. At present, studies focusing on the effect of remdesivir on viral load (VL) are few and with contrasting results. Aim of the present study was to evaluate the effect of remdesivir on SARS‐CoV‐2 VL from nasopharyngeal swabs (cycle threshold criterion) in a sample of patients treated with the drug, compared with patients who did not receive the antiviral treatment. This retrospective analysis evaluated patients with (1) real‐time polymerase chain reaction (RT‐PCR) confirmed COVID‐19 diagnosis and (2) availability of at least two positive nasopharyngeal swabs analysed with the same analytic platform (ORF target gene, Ingenius ELITe, ELITechGroup, Puteaux, France). Upper respiratory specimens from nasopharyngeal swabs were collected at admission (T0) and 7–14 days after treatment, upon clinical decision. A total of 27 patients treated with remdesivir (Group A) met the inclusion criteria and were compared with 18 patients (Group B) treated with standard care, matched for baseline clinical characteristics. At baseline, both remdesivir‐treated and nontreated patients showed comparable VLs (21.73 ± 6.81 vs. 19.27 ± 5.24, p = 0.348). At the second swab, remdesivir‐treated patients showed a steeper VL reduction with respect to controls (34.28 ± 7.73 vs. 27.22 ± 3.92; p < 0.001). Longitudinal linear model estimated a mean decrease in cycle threshold equal to 0.61 (SE: 0.09) per day in remdesivir‐treated versus 0.33 (SE: 0.10) per day in remdesivir nontreated patients (p for heterogeneity = 0.045). The present study shows that the administration of remdesivir in hospitalized COVID‐19 patients significantly reduces the VL on nasopharyngeal swabs.

Serum lipid trajectories in the years before a lymphoma diagnosis

We conducted a case-control study of patients from the Clinical Practice Research Datalink in the United Kingdom to describe the trajectories of serum lipid in the years before a diagnosis of lymphoma. Study participants had at least one cholesterol measurement. Multilevel, multivariable linear longitudinal models were fit to examine the adjusted trajectories of serum lipid levels in the years before lymphoma diagnosis. Overall, 11,969 cases of non-Hodgkin lymphoma, 473 of Hodgkin lymphoma, and 61,894 controls were selected. Mean cholesterol levels in the years before the index date showed a more pronounced decrease in the 4 years before lymphoma diagnosis than in controls. Triglycerides levels were unrelated to case status. This research is the first to replicate the results of a similar study conducted in the United States while adjusting for more potential confounders. The newly described different behavior of cholesterol and triglycerides suggests a potential role of cholesterol in lymphomagenesis.

PD08-07 ASSOCIATION BETWEEN PELVIC NODAL RADIOTHERAPY AND PATIENT-REPORTED OUTCOMES AMONG MEN UNDERGOING EXTERNAL-BEAM RADIOTHERAPY FOR PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy (PD08)1 Sep 2021PD08-07 ASSOCIATION BETWEEN PELVIC NODAL RADIOTHERAPY AND PATIENT-REPORTED OUTCOMES AMONG MEN UNDERGOING EXTERNAL-BEAM RADIOTHERAPY FOR PROSTATE CANCER Christopher Wallis, Jacob Tallman, Li-Ching Huang, Zhiguo Zhao, David Penson, Tatsuki Koyama, Ralph Conwill, Michael Goodman, Ann Hamilton, Xiao-Cheng Wu, Lisa Paddock, Antoinette Stroup, Matthew Cooperberg, Mia Hashibe, Brock O'Neil, Sherrie Kaplan, Sheldon Greenfield, Daniel Barocas, and Karen Hoffman Christopher WallisChristopher Wallis More articles by this author , Jacob TallmanJacob Tallman More articles by this author , Li-Ching HuangLi-Ching Huang More articles by this author , Zhiguo ZhaoZhiguo Zhao More articles by this author , David PensonDavid Penson More articles by this author , Tatsuki KoyamaTatsuki Koyama More articles by this author , Ralph ConwillRalph Conwill More articles by this author , Michael GoodmanMichael Goodman More articles by this author , Ann HamiltonAnn Hamilton More articles by this author , Xiao-Cheng WuXiao-Cheng Wu More articles by this author , Lisa PaddockLisa Paddock More articles by this author , Antoinette StroupAntoinette Stroup More articles by this author , Matthew CooperbergMatthew Cooperberg More articles by this author , Mia HashibeMia Hashibe More articles by this author , Brock O'NeilBrock O'Neil More articles by this author , Sherrie KaplanSherrie Kaplan More articles by this author , Sheldon GreenfieldSheldon Greenfield More articles by this author , Daniel BarocasDaniel Barocas More articles by this author , and Karen HoffmanKaren Hoffman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001976.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The role of pelvic radiotherapy in men undergoing external-beam radiotherapy (EBRT) for prostate cancer remains controversial. We sought to compare patient-reported outcomes (PROs) for men receiving whole pelvis radiotherapy (WPRT) versus prostate-only radiotherapy (PORT), longitudinally over 5 years. METHODS: CEASAR is a multi-institution prospective population-based cohort study of men with clinically localized prostate cancer from 2011-2012. We compared PROs between men receiving WPRT vs. PORT using the validated 26-item Expanded Prostate Index Composite and Short Form Health Survey. We fit multivariable longitudinal linear regression models adjusting for demographics, clinical data, baseline PROs, and propensity scores to mitigate confounding by indication. RESULTS: Among 587 men treated with EBRT, 102 (17%) received WPRT while 485 (83%) received PORT. Men who received WPRT were more likely to have high-risk disease (58% vs. 18%) and to receive androgen deprivation therapy. In unadjusted analysis, disease-specific functional outcomes were similar between WPRT and PORT groups from baseline through 5 years, with the exception of worse sexual (from 6 months to 5 years) and hormonal function (at 6 months) with WPRT. In adjusted analyses, no significant differences were found in most PROs through 5-years except marginally clinically significant differences in hormonal function at 3-years (adjusted mean difference 4.7, 95% CI [1.2-8.3]; minimum clinically important difference 4-6) and 5-years (4.2, [0.4-8.0]) following treatment.Crude estimates of general health-related function identified baseline differences between treatment groups in physical functioning which persisted over time, but not in other domains. In adjusted analyses, we found a transient statistically, but not clinically, significant difference in emotional well-being at 6 months that resolved by 1 year and no differences in physical functioning or energy and fatigue. CONCLUSIONS: In this large, prospective cohort of men with localized prostate cancer, the use of pelvic, in addition to prostate, radiation therapy was not associated with clinically important differences in patient-reported outcomes through five years. Source of Funding: This study was supported by the Agency for Healthcare Research and Quality (1R01HS019356, 1R01HS022640), the Patient-Centered Outcomes Research Institute (CE-12-11-4667), and the National Cancer Institute (NIH/NCI grant 5T32CA106183). Data management was facilitated by Vanderbilt University’s Research Electronic Data Capture (REDCap) system, which is supported by the Vanderbilt Institute for Clinical and Translational Research grant (UL1TR000011 from NCATS/NIH) © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e116-e116 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Wallis More articles by this author Jacob Tallman More articles by this author Li-Ching Huang More articles by this author Zhiguo Zhao More articles by this author David Penson More articles by this author Tatsuki Koyama More articles by this author Ralph Conwill More articles by this author Michael Goodman More articles by this author Ann Hamilton More articles by this author Xiao-Cheng Wu More articles by this author Lisa Paddock More articles by this author Antoinette Stroup More articles by this author Matthew Cooperberg More articles by this author Mia Hashibe More articles by this author Brock O'Neil More articles by this author Sherrie Kaplan More articles by this author Sheldon Greenfield More articles by this author Daniel Barocas More articles by this author Karen Hoffman More articles by this author Expand All Advertisement Loading ...

A motivational interviewing intervention improves the burden of physical symptoms in patients with heart failure: A secondary outcome analysis of a randomized clinical trial

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Center of Excellence for Nursing Scholarship, Rome, Italy Background. Patients with heart failure (HF) experience a variety of physical symptoms. Symptoms are perceived by patients as burdensome and, as such, negatively affect quality of life. Besides, physical symptoms are among the first reasons for seeking emergency care and hospitalization. Findings from the MOTIVATE-HF trial show that motivational interviewing (MI) leads to better self-care. However, whether MI also reduces the burden of physical symptoms is not yet known. Purpose. To evaluate the effectiveness of MI on the burden of physical symptoms in patients with HF. Methods. Secondary outcome analysis of the MOTIVATE-HF trial. The study was a three-arm, multicenter randomized controlled trial with a 12-month follow-up. Patients with HF and their informal caregivers were enrolled and randomly divided into three arms: MI performed only with patients (Arm 1); MI performed both with patients and caregivers (Arm 2); usual care (Arm 3). Patients with a diagnosis of HF in NYHA functional class II-IV were recruited in three Italian centers. Participants underwent one face-to-face MI session, followed by three phone calls within two months from enrollment. Physical symptoms were measured with the Heart Failure Somatic Perception Scale (HFSPS) with the dimensions of dyspnea, chest discomfort, early and subtle, and edema. Higher scores at the HFSPS and its dimensions indicate worse physical symptom. Data were collected at baseline, and 3 (T1), 6 (T2), 9 (T3) and 12 (T4) months after enrollment. T-test was used to compare differences in HFSPS scores in Arms 1 and 2 versus Arm 3 at each follow-up. Changes over time were analyzed with mixed linear longitudinal models. Results. A sample of 510 patients (median 74 years, 58% male) and their caregivers (median 55 years, 75.5% female) were randomized to Arm 1 (n = 155), Arm 2 (n = 177) and Arm 3 (n = 178). Chest discomfort improved in Arms 1 and 2 versus Arm 3 at T4 (mean difference(Δ): -8.13, P = .014). Dyspnea also improved in Arms 1 and 2 than Arm 3 both at T3 and T4 (Δ: -7, P = .027 and Δ: -6.78, P = .038, respectively). HFSPS total score improved in Arms 1 and 2 versus Arm 3 at T3 (Δ: -4.55, P = .048). Over the year of observation, the mixed linear longitudinal models showed a significant improvement in Chest discomfort and total HFSPS score in Arm 2 versus Arm 3 (β = -2.61, P = .002 and, β = -1.35, P = .02). Conclusions. The results of this secondary analysis indicate that MI may be effective in decreasing the burden of physical symptoms in HF patients, especially if also caregivers are involved in the intervention. Since symptom burden is among the first reasons for seeking emergency care and hospitalization in HF, MI might be a viable option to improve symptom burden via self-care.

Dietary Consumption Among Youth with Antipsychotic-Induced Weight Gain and Changes Following Healthy Lifestyle Education.

Background: Youth treated with antipsychotic medications are high risk for weight gain, increased lipids/glucose, and development of metabolic syndrome. Little is known about the dietary intake/nutritional adequacy in this vulnerable population, and effect on weight gain. This secondary data analysis describes the baseline intake and changes in diet after receiving healthy lifestyle education/counseling over 6 months, in a sample of youth with antipsychotic-induced weight gain. Methods: The U.S. Department of Agriculture (USDA) Automated Multiple-Pass Method 24-hour dietary recall was administered to 117 youth at baseline, 3 months, and 6 months. Parent/child received personalized healthy lifestyle education sessions over 6 months. Baseline intake was compared with the USDA Recommended Daily Allowance using independent samples t-tests. Individual dietary covariates were examined for change over 6 months using longitudinal linear mixed modeling. Influence of each on body mass index (BMI) z-score change was tested in a pooled group analysis and then compared by treatment group. Results: Pooled analysis revealed baseline consumption high in carbohydrates, fat, protein, sugar, and refined grains, while low in fruit/vegetables, whole grains, fiber, and water. Change over 6 months demonstrated a statistically significant decrease in daily calories (p = 0.002), carbohydrates (p = 0.003), fat (p = 0.012), protein (p = 0.025), sugar (p = 0.008), refined grains (p = 0.008), total dairy (p = 0.049), and cheese (p = 0.027). Small increases in fruits/vegetables were not statistically significant, although the Healthy Eating Index subscores for total vegetables (p = 0.013) and dark green/orange vegetables (p = 0.034) were. No dietary covariates were predictors of change in BMI z-score. Nondietary predictors were parent weight/BMI and treatment group, with the metformin and switch groups experiencing significant decreases in BMI z-score. Conclusions: Further pediatric studies are necessary to assess the effects of antipsychotic medications on dietary intake, and test efficacy of healthy lifestyle interventions on change in nutrition. The relationship of nutrition to cardiometabolic health in this population must be further investigated. Clinical Trial Registration number: NCT02877823.

Measurement and Identification of Parenting Behaviors Associated with Social-Emotional Outcomes in Children: The Racial and Cultural Appropriateness of a Commonly Used Parenting Measure.

The objective of this study was to examine parenting styles (observed parent-child interactions via the Two-Bag Task) associated with young children's socioemotional outcomes, comparing children from Mexican-American and African American families with children from their White counterparts. The Early Childhood Longitudinal Study Birth Cohort data were used to examine 6 global parenting styles with socioemotional outcomes at 48 months of age while controlling for both time-independent and time-depending sociodemographic, maternal mental health, and child characteristics. Data were stratified by race and ethnicity, and weighted longitudinal linear regressions models were estimated using STATA/Xtmixed. The 6 global parenting scores from the Two-Bag Task measures differed across White, African American, and Mexican-American groups of parents. White parents on average scored higher on parenting styles related to sensitivity, positive regard, and cognitive stimulation, whereas Mexican-American and African American parents scored lower. These parenting styles were associated with both approach to learning and social competence outcomes among White children but were nearly nonexistent for Mexican-American and African American children when adjusting for covariates. Our results highlight the need to critically evaluate measures of parenting behaviors used in research studies with racially and ethnically diverse families. Examining the comprehensive psychometric properties and cultural appropriateness of parenting measures for diverse families is important to optimally support child development for non-White children. Furthermore, a critical lens is important to mitigate the perpetuation of inaccurate research findings for Mexican-American and African American children.

Longitudinal declines in event-based, but not time-based, prospective memory among community-dwelling older adults

ABSTRACT Age-related deficits in prospective memory (PM) are well established, but it is not known whether PM is stable over time among older adults. In this study, 271 community-dwelling older adults underwent abaseline neuropsychological evaluation and up to three follow-up visits, approximately 2.4 years apart. Mixed effects linear longitudinal models revealed small, but significant linear declines and between-subjects variability in event-based PM performance. There were no changes in performance on measures of time-based PM, retrospective memory, or executive functions. Changes in event-based PM were not associated with age, retrospective memory, executive functions, or everyday functioning. Among older adults, event-based PM appears to be more susceptible to linear declines than does time-based PM, which future research might examine with regard to the possible underlying cognitive mechanisms of cue encoding, monitoring, detection, and retrieval processes.

Metabolic Changes Associated With the Use of Integrase Strand Transfer Inhibitors Among Virally Controlled Women.

Integrase strand transfer inhibitors (INSTIs) have been associated with weight gain among women living with HIV. We aimed to investigate the association between INSTIs and change in cardiometabolic risk indicators. Retrospective cohort. Data from 2006 to 2017 were analyzed from women living with HIV enrolled in the longitudinal Women's Interagency HIV Study who were virally controlled on antiretroviral therapy (ART) for ≥5 consecutive semiannual visits. Women who switched/added an INSTI to ART (INSTI group) were compared with women who remained on non-INSTI ART (non-INSTI group). Outcomes included changes in fasting lipids and glucose, hemoglobin A1c (HbA1c), blood pressure (BP), and incident diabetes, hypertension, and insulin resistance. Outcomes were measured 6-12 months before and 6-18 months after INSTI switch/add in the INSTI group with comparable visits in the non-INSTI group. Longitudinal linear regression models compared change over time in each outcome by the study group. One thousand one hundred eighteen participants (234 INSTI, 884 non-INSTI) were followed for a median 2.0 (Q1 1.9, Q3 2.0) years. Participants were median age 49 years, 61% Black, and 73% overweight or obese (body mass index ≥25 kg/m). Compared with non-INSTI, the INSTI group experienced greater increases in HbA1c (+0.05 vs. -0.06 mg/dL, P = 0.0318), systolic BP (+3.84 vs. +0.84 mm Hg, P = 0.0191), and diastolic BP (+1.62 vs. -0.14 mm Hg, P = 0.0121), with greatest change in HbA1c among women on INSTIs with ≥5% weight gain. INSTI use was associated with unfavorable changes in HbA1c and systolic and diastolic BP during short-term follow-up. Further research is needed to understand long-term cardiometabolic effects of INSTI use.

Health-related quality of life in Turner syndrome and the influence of growth hormone therapy: a 20-year follow-up

CONTEXT The factors that affect the health-related quality of life (HRQoL) of women with Turner syndrome (TS) are controversial. OBJECTIVE The aim was to describe the HRQoL of women with TS with a focus on how given GH treatment and comorbidity influence HRQoL in adulthood and to compare HRQoL of women with TS with that of women in the general population. DESIGN Longitudinal cohort study, up to 20 years. SETTING The Turner Center at the Section for Endocrinology and Department of Reproductive Medicine at Sahlgrenska University Hospital, Gothenburg, Sweden. PARTICIPANTS Women with TS (n = 200), age range 16 to 78 years, were included consecutively and monitored every fifth year between 1995 and 2018. Women from the World Health Organization MONItoring of trends and determinants for CArdiovascular disease project were used as reference populations. INTERVENTIONS AND MAIN OUTCOME MEASURES HRQoL was measured using the Psychological General Well-Being index and the Nottingham Health Profile. Associations with somatic variables were assessed using longitudinal linear regression models. RESULTS HRQoL was not associated with GH treatment in TS in spite of a mean 5.7 cm taller height. HRQoL was only associated with height per se in one of 13 subscales (P < 0.01). HRQoL was negatively affected by higher age, higher age at diagnosis, and hearing impairment in TS. Women with TS reported a similar HRQoL to the reference population. CONCLUSIONS No association between previous GH treatment and HRQoL was found during the up to 20 years of follow-up in women with TS. HRQoL of women with TS and the reference population was similar.

Mechanisms from Food Insecurity to Worse HIV Treatment Outcomes in US Women Living with HIV

Food insecurity (FI) contributes to HIV-related morbidity and mortality, but the mechanisms whereby FI negatively impacts HIV health are untested. We tested the hypothesis that FI leads to poor HIV clinical outcomes through nutritional, mental health, and behavioral paths. We analyzed data from Women's Interagency HIV Study (WIHS) among 1803 women living with HIV (WLWH) (8225 person-visits) collected from 2013 to 2015 biannually from nine sites across the United States participating in the WIHS. FI was measured with the US Household Food Security Survey Module. Outcomes included HIV viral nonsuppression, CD4 cell counts, and physical health status (PHS). We used longitudinal logistic and linear regression models with random effects to examine associations adjusting for covariates and path analysis to test nutritional, mental health, and behavioral paths. Increasing severity of FI was associated with unsuppressed viral load, lower CD4 counts, and worse PHS (all p < 0.05). Report of FI 6 months earlier was independently associated with most outcomes after adjusting for concurrent FI. For viral nonsuppression, the nutritional and behavioral paths accounted for 2.09% and 30.66% of the total effect, with the mental health path operating via serial mediation through the behavioral path. For CD4 count, the mental health and behavioral paths accounted for 15.21% and 17.0% of the total effect, respectively. For PHS, depressive symptoms accounted for 60.2% of the total effect. In conclusion, FI is associated with poor health among WLWH through different paths depending on the outcome. Interventions should target FI and its behavioral and mental health mechanisms to improve HIV outcomes.