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Abstract Stepped-care obesity treatments aim to improve efficiency by early identification of non-responders and adjusting interventions but lack validated models. We trained a random forest classifier to improve the predictive utility of a clinical decision rule (>0.5 lb weight loss/week) that identifies non-responders in the first 2 weeks of a stepped-care weight loss trial (SMART). From 2009 to 2021, 1058 individuals with obesity participated in three studies: SMART, Opt-IN, and ENGAGED. The model was trained on 80% of the SMART data (224 participants), and its in-distribution generalizability was tested on the remaining 20% (remaining 57 participants). The out-of-distribution generalizability was tested on the ENGAGED and Opt-IN studies (472 participants). The model predicted weight loss at month 6 with an 84.5% AUROC and an 86.3% AUPRC. SHAP identified predictive features: weight loss at week 2, ranges/means and ranges of weight loss, slope, and age. The SMART-trained model showed generalizable performance with no substantial difference across studies.

Abstract Objectives To examine whether long-term air pollution exposure is associated with central hemodynamic and brachial artery stiffness parameters. Methods We assessed central hemodynamic parameters including central blood pressure, cardiac parameters, systemic vascular compliance and resistance, and brachial artery stiffness measures [including brachial artery distensibility (BAD), compliance (BAC), and resistance (BAR)] using waveform analysis of the arterial pressure signals obtained from a standard cuff sphygmomanometer (DynaPulse2000A, San Diego, CA). The long-term exposures to particles with an aerodynamic diameter

Abstract Background Collection of intensive longitudinal health outcomes allows joint modeling of their mean (location) and variability (scale). Focusing on the location of the outcome, measures to detect influential subjects in longitudinal data using standard mixed-effects regression models (MRMs) have been widely discussed. However, no existing approach enables the detection of subjects that heavily influence the scale of the outcome. Methods We propose applying mixed-effects location scale (MELS) modeling combined with commonly used influence measures such as Cook’s distance and DFBETAS to fill this gap. In this paper, we provide a framework for researchers to follow when trying to detect influential subjects for both the scale and location of the outcome. The framework allows detailed examination of each subject’s influence on model fit as well as point estimates and precision of coefficients in different components of a MELS model. Results We simulated two common scenarios in longitudinal healthcare studies and found that influence measures in our framework successfully capture influential subjects over 99% of the time. We also re-analyzed data from a health behavior study and found 4 particularly influential subjects, among which two cannot be detected by influence analyses via regular MRMs. Conclusion The proposed framework can help researchers detect influential subject(s) that will be otherwise overlooked by influential analysis using regular MRMs and analyze all data in one model despite influential subjects.

Background Individuals who have metastatic cancer experience substantial physical and psychological distress (e.g., pain, depression, anxiety) from their disease and its treatment compared to patients with less advanced disease. As the burden of symptoms varies over time, ecological momentary assessment (EMA) may be used to better understand patients’ symptom trajectories, complimenting traditional longitudinal data collection methods. However, few have used EMA in patients with metastatic disease. The current study adds to the existing literature by exploring interrelated, common cancer-related symptoms of pain, anxiety, and depression and use of cannabis-based products, opioid medications, other (nonopioid) pain medications, and medications for anxiety or depression. Methods An eight-day prospective observational feasibility study was conducted among 50 patients with metastatic cancer recruited from seven solid cancer clinics at The Ohio State University Comprehensive Cancer Center. Participants completed a week of interval-contingent mobile EMA, administered daily at 9 a.m., 3 p.m., and 8 p.m., and a comprehensive interviewer-administered questionnaire on Day 8. Participants were queried on their symptom burden and management strategies (i.e., use of medications and cannabis). We considered EMA to be feasible if a priori retention (80%) and adherence goals (75%) were met. Results Seventy-nine percent of eligible patients contacted enrolled in the study ( n = 50 of 63). Among those enrolled, 92% were retained through Day 8 and 80% completed >90% of EMAs, exceeding a priori objectives. Participants’ average pain, anxiety, and depressive symptoms across the week of EMA ranged from 1.7 to 1.8 (1 to 5 scale). Symptoms varied little by day or time of administration. On Day 8, significant proportions of participants reported past-week use of medications and cannabis for symptom management. Conclusions Participants exceeded a priori adherence and retention objectives, indicating that mobile EMA is feasible among metastatic cancer patients, addressing a gap in the existing literature and informing future research. Restricting eligibility to participants with a minimum cutoff of symptom burden may be warranted to increase observations of symptom variability and provide opportunities for future health interventions. Future research is needed to test the acceptability and quality of data over a longer study period in this patient population.

Objectives Overeating interventions and research often focus on single determinants and use subjective or nonpersonalized measures. We aim to (1) identify automatically detectable features that predict overeating and (2) build clusters of eating episodes that identify theoretically meaningful and clinically known problematic overeating behaviors (e.g., stress eating), as well as new phenotypes based on social and psychological features. Method Up to 60 adults with obesity in the Chicagoland area will be recruited for a 14-day free-living observational study. Participants will complete ecological momentary assessments and wear 3 sensors designed to capture features of overeating episodes (e.g., chews) that can be visually confirmed. Participants will also complete daily dietitian-administered 24-hour recalls of all food and beverages consumed. Analysis Overeating is defined as caloric consumption exceeding 1 standard deviation of an individual's mean consumption per eating episode. To identify features that predict overeating, we will apply 2 complementary machine learning methods: correlation-based feature selection and wrapper-based feature selection. We will then generate clusters of overeating types and assess how they align with clinically meaningful overeating phenotypes. Conclusions This study will be the first to assess characteristics of eating episodes in situ over a multiweek period with visual confirmation of eating behaviors. An additional strength of this study is the assessment of predictors of problematic eating during periods when individuals are not on a structured diet and/or engaged in a weight loss intervention. Our assessment of overeating episodes in real-world settings is likely to yield new insights regarding determinants of overeating that may translate into novel interventions.

Abstract Background Longitudinal assessments of usage are often conducted for multiple substances (e.g., cigarettes, alcohol and marijuana) and research interests are often focused on the inter-substance association. We propose a multivariate longitudinal modeling approach for jointly analyzing the ordinal multivariate substance use data. Methods We describe how the binary random slope logistic regression model can be extended to the multi-category ordinal outcomes. We also describe how the proportional odds assumption can be relaxed by allowing differential covariate effects on different cumulative logits for multiple outcomes. Data are analyzed from a P01 study that evaluates the usage levels of cigarettes, alcohol and marijuana repeatedly across 8 measurement waves during 7 consecutive years. Results 1263 subjects participated in the study with informed consent, among whom 56.6% are females. Males and females show significant differences in terms of the time trend for substance use. Specifically, males showed steeper trends on cigarette and marijuana use over time compared to females, while less so for alcohol. For all three substances, age effects appear to be different for different cumulative logits, indicating the violation of proportional odds assumption. Conclusions The multivariate mixed cumulative logit model offers the most flexibility and allows one to examine the inter-substance association when proportional odds assumption is violated.

Abstract This study investigated the associations between biological and environmental factors and gross-motor coordination (GMC) in Peruvian children and adolescents. The sample comprised 7401 boys and girls, aged 6–14 years, recruited from three geographical regions: sea-level, Amazon and high-altitude. Biological variables included age, sex, height, BMI, physical fitness, stunting, and maturational status. Environmental influences included geographical region and school characteristics. Gross-motor coordination was tested with the Körperkoordinationstest für Kinder and the data analyzed by multilevel logistic regression. Results showed a high prevalence of below normal GMC scores. Sex, age, geographical area, biological maturation, BMI (normal versus overweight/obesity), and stunting were all significant predictors of GMC. There was also an interaction between age, sex, and geographical area indicating that older girls who lived at sea-level and high-altitude were more likely to display below normal GMC scores. The school context was less important in predicting GMC problems than the interplay between biological characteristics and geographical region. These results suggest that early identification, as well as educational and pediatric care interventions, are of importance in reducing below normal GMC among Peruvian children and adolescents.

BackgroundTobacco use is the leading cause of preventable morbidity and mortality. Adults with low income and members of certain racial and ethnic minority groups are less likely to quit, and therefore, they experience profound tobacco-related health disparities. Mindfulness training can increase the rates of smoking cessation and lapse recovery, and telehealth and SMS text messaging have the potential to provide more accessible treatment. ObjectiveThis study aims to test the efficacy of delivering mindfulness-based smoking cessation treatment through text messaging (iQuit Mindfully) and telehealth (group videoconferencing), both as stand-alone interventions and in combination. In addition, it aims to examine the underlying mechanisms of mindfulness treatment. MethodsIn this 2×2 randomized controlled trial, participants are randomized into 1 of 4 groups based on assignment to iQuit Mindfully text messages (yes or no) and mindfulness videoconference groups (yes or no). The primary outcomes are biochemically verified smoking abstinence at 8, 12, and 24 weeks after the start of treatment. Secondary outcomes include the frequency of home mindfulness practice and self-reported levels of mindfulness, emotions, craving, withdrawal, dependence, self-efficacy, and social support. ResultsRecruitment, treatment, and assessment began in spring and summer 2021, and data collection is expected to continue through spring 2024. ConclusionsThis project aims to improve smoking cessation outcomes for low-income, racially and ethnically diverse smokers through mindfulness-based telehealth group counseling and text messaging support. We also aim to advance the scientific study of the mechanisms of action of mindfulness treatment, which could inform the development of more efficacious and efficient treatments to reduce tobacco disparities. Trial RegistrationClinicaltrials.gov NCT04965181; https://clinicaltrials.gov/ct2/show/NCT04965181 International Registered Report Identifier (IRRID)PRR1-10.2196/35688

Abstract Purpose To evaluate weight change patterns over time following the diagnosis of breast cancer and to examine the association of post-diagnosis weight change and survival outcomes in Black and White patients. Methods The study included 2888 women diagnosed with non-metastatic breast cancer in 2000–2017 in Chicago. Longitudinal repeated measures of weight and height were collected, along with a questionnaire survey including questions on body size. Multilevel mixed-effects models were used to examine changes in body mass index (BMI). Delayed entry Cox proportional hazards models were used to investigate the impacts of changing slope of BMI on survival outcomes. Results At diagnosis, most patients were overweight or obese with a mean BMI of 27.5 kg/m2 and 31.5 kg/m2 for Blacks and Whites, respectively. Notably, about 45% of the patients had cachexia before death and substantial weight loss started about 30 months before death. In multivariable-adjusted analyses, compared to stable weight, BMI loss (> 0.5 kg/m2/year) showed greater than 2-fold increased risk in overall survival (hazard ratio [HR] = 2.60, 95% CI 1.88–3.59), breast cancer-specific survival (HR = 3.05, 95% CI 1.91–4.86), and disease-free survival (HR = 2.12, 95% CI 1.52–2.96). The associations were not modified by race, age at diagnosis, and pre-diagnostic weight. BMI gain (> 0.5 kg/m2/year) was also related to worse survival, but the effect was weak (HR = 1.60, 95% CI 1.10–2.33 for overall survival). Conclusion BMI loss is a strong predictor of worse breast cancer outcomes. Growing prevalence of obesity may hide diagnosis of cancer cachexia, which can occur in a large proportion of breast cancer patients long before death.

Abstract Background Screening for colorectal cancer (CRC) not only detects disease early when treatment is more effective but also prevents cancer by finding and removing precancerous polyps. Because many of our nation’s most disadvantaged and vulnerable individuals obtain health care at federally qualified health centers, these centers play a significant role in increasing CRC screening among the most vulnerable populations. Furthermore, the full benefits of cancer screenings must include timely and appropriate follow-up of abnormal results. Thus, the purpose of this study is to implement a multilevel intervention to increase rates of CRC screening, follow-up, and referral-to-care in federally qualified health centers, as well as simultaneously to observe and to gather information on the implementation process to improve the adoption, implementation, and sustainment of the intervention. The multilevel intervention will target three different levels of influences: organization, provider, and individual. It will have multiple components, including provider and staff education, provider reminder, provider assessment and feedback, patient reminder, and patient navigation. Methods This study is a multilevel, three-phase, stepped wedge cluster randomized trial with four clusters of clinics from four different FQHC systems. In the first phase, there will be a 3-month waiting period during which no intervention components will be implemented. After the 3-month waiting period, we will randomize two clusters to cross from the control to the intervention and the remaining two clusters to follow 3 months later. All clusters will stay at the same phase for 9 months, followed by a 3-month transition period, and then cross over to the next phase. Discussion There is a pressing need to reduce disparities in CRC outcomes, especially among racial/ethnic minority populations and among populations who live in poverty. Single-level interventions are often insufficient to lead to sustainable changes. Multilevel interventions, which target two or more levels of changes, are needed to address multilevel contextual influences simultaneously. Multilevel interventions with multiple components will affect not only the desired outcomes but also each other. How to take advantage of multilevel interventions and how to implement such interventions and evaluate their effectiveness are the ultimate goals of this study. Trial registration This protocol is registered at clinicaltrials.gov ( NCT04514341 ) on 14 August 2020.

Background Gross motor coordination (GMC) is a potential correlate of lifestyle behaviours and health outcomes in childhood and adolescence. Aims The aim of this study was to examine how sex, age, biological maturation, overweight, stunting, and physical fitness are associated with GMC in children and adolescents from Peru, and to examine associations between geographical area of residence, school-level characteristics, and GMC. Subjects and methods The sample included 7408 subjects, aged 6–14 years, from sea level, Amazon and high-altitude regions of Peru. A composite marker of total coordination was derived by the sum of scores from each test (GMCT). Overweight was identified using BMI, and biological maturation, physical fitness, and stunting were assessed. School characteristics were obtained via an objective audit. Results Boys (β = 12.23 ± 0.90) and older children (β = 13.37 ± 0.64) had higher GMCT than girls and younger children, respectively. Overweight was associated with lower GMCT (β = −5.23 ± 0.80), whereas fitness was positively associated with GMCT (β = 6.30 ± 0.25). Biological maturation was not a predictor; however, stunting was negatively associated with GMCT (β = −3.71 ± 1.56). Subjects living in the Amazon had higher GMCT than those at sea level (β = 16.57 ± 4.73). Five of nine school-level predictors (number of students, playground area with obstacles, multi-sports roofed, frequency and duration of Physical Education classes) were significant predictors of GMCT. Conclusions Child- and school-level variables were significantly associated with GMCT in this sample. These findings are important for the Peruvian community, especially school principals, councils and physical education teachers, helping them to define more efficient strategies and action plans to increase motor coordination in children.

Introduction Although the Food and Drug Administration banned other characterising flavours in cigarettes, menthol cigarettes are still available to consumers. Young adult new smokers are initiating with menthol cigarettes, such that the prevalence of young adults menthol versus non-menthol smokers is increasing. Experimentation with menthol cigarettes is associated with progression to regular smoking and nicotine dependence. This ongoing clinical trial in young adult smokers measures appeal and the reinforcing value of smoking menthol versus non-menthol cigarettes and the impact of these variables on changes in smoking behaviour at a 6-month follow-up.Methods and analysis Reinforcement for menthol smoking is assessed in the laboratory using a validated behavioural economic choice task, and appeal is measured in the natural environment using ecological momentary assessment (EMA). Analyses will examine differences between menthol and non-menthol cigarette smoking on measures of subjective response in the laboratory and via EMA, and how subjective response mediates the association between menthol preference at baseline and smoking outcomes at follow-up.Ethics and dissemination This protocol was approved by the University of Oklahoma Health Sciences Center Institutional Review Board (#10581). The findings will isolate the unique effects of menthol in smoking and will help inform regulatory decisions about the abuse liability of menthol cigarettes. Findings will be disseminated through peer-reviewed journal articles and presentations at national and international conferences.Trial registration number NCT03953508.

Abstract Women who inherit a BRCA1 or BRCA2 mutation have an increased risk of breast cancer. Preliminary evidence suggests they may also have defects in bone marrow function. To test this hypothesis, we conducted a multicenter, retrospective, matched cohort study, comparing women with localized breast cancer requiring cytotoxic chemotherapy who carried an inherited BRCA1 or BRCA2 mutation to similar wild‐type patients treated between 1995 and 2017 and matched based on age, race, site, and chemotherapy regimen. The proportion who developed specific hematologic toxicities, timing of these toxicities, and patterns of blood count fluctuations over time were compared among BRCA1 carriers vs matched wild‐type patients and among BRCA2 carriers vs matched wild‐type patients. 88 BRCA1 carriers and 75 BRCA2 carriers were matched to 226 and 242 wild‐type patients, respectively. The proportions and timing of experiencing any grade or grade 3/4 cytopenias during chemotherapy were not significantly different for BRCA1 carriers or BRCA2 carriers vs matched wild‐type patients. Proportions requiring treatment modifications and time to first modification were also similar. Patterns of blood count fluctuations over time in mutation carriers mirrored those in wild‐type patients overall and by the most common regimens. Women with an inherited mutation in BRCA1 or BRCA2 experience similar frequency, severity, and timing of hematologic toxicities during curative intent breast cancer chemotherapy as matched wild‐type patients. Our findings suggest that BRCA1 or BRCA2 haploinsufficiency is sufficient for adequate bone marrow reserve in the face of short‐term repetitive hematopoietic stressors.

AbstractIntroduction:The National Academies of Sciences (NAS) emphasize the need for interdisciplinary team science (TS) training, but few training resources are available. COALESCE, an open-access tool developed with National Institutes of Health support and located at teamscience.net, is considered a gold standard resource but has not previously been evaluated. COALESCE launched four learning modules in 2011. The Science of TS (SciTS) module, an interactive encyclopedia, introduces foundational concepts. Three scenario-based modules simulate TS challenges in behavioral, clinical, and basic biomedical sciences. This study examined user characteristics, usage patterns, and effects of completing the four modules on TS knowledge, attitudes, and skills.Methods:Repeated measures ANOVA tested for pre-post changes in performance and compared learning by users with biomedical versus other disciplinary backgrounds.Results:From 2011 through 2017, the site attracted 16,280 new users who engaged in 6461 sessions that lasted more than 1 min. The modal registrant identified as working in a biomedical field (47%), in an academic institution (72%), and expressed greater interest in the practice than the SciTS (67%). Those completing pre- and post-tests (n = 989) showed significant improvement in knowledge, attitudes, and skills after taking all scenario-based modules (p < 0.005); knowledge and attitudes were unchanged after the SciTS encyclopedia. Biomedical and other health professionals improved comparably.Conclusion:Evaluation of the TS training tool at teamscience.net indicates broad dissemination and positive TS-related outcomes. Site upgrades implemented between 2018 and 2020, including adding five new modules, are expected to increase the robustness and accessibility of the COALESCE training resource.

African American (AA) men experience more than twice the prostate cancer mortality as White men yet are under-represented in academic research involving prostate-specific antigen (PSA), a biomarker of prostate cancer aggressiveness. We examined the impact of self-reported tobacco (cigarette pack-years and current tobacco use including e-cigarettes) and current regular marijuana use on serum PSA level based on clinical laboratory testing among 928 AA men interviewed 2013–2018 in Chicago. We defined outcome of elevated PSA ≥ 4.0 ng/mL for logistic regression models and continuous PSA increases for general linear models. All models were adjusted for age, sociodemographic characteristics, healthcare utilization, body mass index, and self-reported health. Among 431 AA men age ≥ 55 years, we observed ∼ 5 times the odds of elevated PSA among those with > 1 pack-years of cigarette smoking vs. never-smokers (odds ratio [OR] = 5.09; 95% confidence interval [CI] = 1.57–16.6) and a quarter the odds of elevated PSA among current marijuana users vs. non-users (OR = 0.27; 95% CI = 0.08–0.96). PSA increased on average 1.20 ng/mL among other current tobacco users vs. non-users. Among older AA men, cigarette smoking history and current tobacco use were positively associated with an increase in PSA levels and current marijuana use were inversely associated with PSA levels. Future work with studies of diverse patient populations with cancer outcomes are needed to assess whether these behavioral characteristics contribute to racial/ ethnic disparities in prostate cancer outcomes. Our study provides novel evidence regarding potential differences in PSA levels among older AA men according to behavioral characteristics.

Background: The development of gross motor coordination (GMC) is governed by biological and environmental factors whose effect sizes are still unclear. Aim: To investigate sibling resemblance in GMC, as well as biological and environmental correlates of GMC among Peruvian children. Materials and methods: The sample comprised 1256 biological siblings (6–15 years old), from three geographical areas of Peru. GMC was assessed using the Korperkoordinationtest für Kinder (KTK) test battery. Anthropometry, biological maturation and physical fitness (PF) were also measured. Multilevel modelling was performed using Stata 14 software. Results: In general, sister–sister pairs (SS) showed the highest resemblance in GMC (ρ = 0.24) compared to brother–sister (BS) (ρ = 0.10) and brother–brother (BB) pairs (ρ = 0.07). On average, BB pairs had higher GMC than SS pairs and older siblings had higher GMC than younger siblings. Further, those with lower body mass index (BMI) and higher PF had higher GMC. There was also a significant interaction between age and PF with GMC. Siblings from the rainforest region demonstrated higher GMC than those from sea level and high-altitude siblings demonstrated lower GMC than their sea-level peers. Conclusion: These results demonstrate statistically significant sibling resemblance in GMC. Age, BMI, PF and geographical area were significant correlates of GMC.

Background: The 12-minute run is a commonly used indicator of cardiorespiratory fitness in youth. Variation in growth and maturity status as potential correlates of test performance has not been systematically addressed. Aim: To evaluate biological and environmental determinants of 12-minute run performance in Portuguese youth aged 7–17 years. Subjects and methods: Mixed-longitudinal samples of 187 boys and 142 girls were surveyed in 1996, 1997 and 1998. The 12-minute run was the indicator of cardiorespiratory fitness. Height, body mass and five skinfolds were measured and skeletal maturity was assessed. Physical activity, socioeconomic status and area of residence were obtained with a questionnaire. Multi-level modelling was used for the analysis. Results: Chronological age and sum of five skinfolds were significant predictors of 12-minute run performance. Older boys and girls ran longer distances than younger peers, while high levels of subcutaneous fat were associated with shorter running distances. Rural boys were more proficient in the 12-minute run than urban peers. Skeletal maturity, height, body mass index, physical activity and socioeconomic status were not significant predictors of 12-minute run performances. Conclusions: Age and sum of skinfolds in both sexes and rural residence in boys are significant predictors of 12-minute run performance in Portuguese youth.

Dialysis patients aged ≥70 years derive improved life expectancy through kidney transplantation compared with their waitlisted counterparts, but guidelines are not clear about how to identify appropriate transplantation candidates. We developed a clinical prediction score to identify elderly dialysis patients with expected 5-year survival appropriate for kidney transplantation (>5 years). Methods: Incident dialysis patients in 2006–2009 aged ≥70 were identified from the United States Renal Data System database and divided into derivation and validation cohorts. Using the derivation cohort, candidate variables with a significant crude association with 5-year all-cause mortality were included in a multivariable logistic regression model to generate a scoring system. The scoring system was tested in the validation cohort and a cohort of elderly transplant recipients. Results: Characteristics most predictive of 5-year mortality included age >80, body mass index 90% for the highest risk cohort (42% of the validation cohort). Discussion: This clinical prediction score could be useful for physicians to identify potentially suitable candidates for kidney transplantation.

Background: Somatotype is a complex trait influenced by different genetic and environmental factors as well as by other covariates whose effects are still unclear. Aims: To (1) estimate siblings’ resemblance in their general somatotype; (2) identify sib-pair (brother–brother (BB), sister–sister (SS), brother–sister (BS)) similarities in individual somatotype components; (3) examine the degree to which between and within variances differ among sib-ships; and (4) investigate the effects of physical activity (PA) and family socioeconomic status (SES) on these relationships. Subjects and methods: The sample comprises 1058 Portuguese siblings (538 females) aged 9–20 years. Somatotype was calculated using the Health-Carter method, while PA and SES information was obtained by questionnaire. Multi-level modelling was done in SuperMix software. Results: Older subjects showed the lowest values for endomorphy and mesomorphy, but the highest values for ectomorphy; and more physically active subjects showed the highest values for mesomorphy. In general, the familiality of somatotype was moderate (ρ = 0.35). Same-sex siblings had the strongest resemblance (endomorphy: ρSS > ρBB > ρBS; mesomorphy: ρBB = ρSS > ρBS; ectomorphy: ρBB > ρSS > ρBS). For the ectomorphy and mesomorphy components, BS pairs showed the highest between sib-ship variance, but the lowest within sib-ship variance; while for endomorphy BS showed the lowest between and within sib-ship variances. Conclusions: These results highlight the significant familial effects on somatotype and the complexity of the role of familial resemblance in explaining variance in somatotypes.

Background and Aim. Overweight prevalence in children and adolescents shows great variability which is related to individual-level and environmental-level factors. The present study aimed to determine the prevalence of and factors associated with overweight in Peruvian children and adolescents living at different altitudes. Methods. 8568 subjects, aged 6–16 y, from the sea level, Amazon, and high-altitude regions were sampled. Overweight was identified using BMI; biological maturation and physical fitness were measured; school characteristics were assessed via an objective audit. Results. Overweight prevalence decreased with age (28.3% at 6 y to 13.9% at 16 y); it was higher in girls (21.7%) than boys (19.8%) and was higher at the sea level (41.3%), compared with Amazon (18.8%) and high-altitude (6.3%) regions. Approximately 79% of the variance in overweight was explained by child-level characteristics. In Model 1, all child-level predictors were significant (p

Background/Objectives. Obesity markers evolve over time and these changes are shared within the family orbit and governed by individual and environmental characteristics. Available reports often lack an integrated approach, in contrast to a multilevel framework that considers their concurrent influence. Hence, this study aims to (1) describe mean changes in obesity markers (body fat (%BF), body mass index (BMI), and waist circumference (WC)) across sib-ships; (2) analyze tracking of individuals within their sib-ship in these markers during 2 years of follow-up; (3) probe consistency in sibling resemblance in these markers; and (4) analyze the joint influence of individual and familial characteristics in these markers. Subjects/Methods. The sample comprises 168 biological Portuguese siblings (brother-brother (BB), sister-sister (SS), and brother-sister (BS)) aged 9–17 years. %BF, BMI, and WC were measured using standardized protocols, and biological maturation was assessed. Physical activity, diet, screen time, and familial characteristics were obtained by questionnaires. Multilevel models were used to analyze the clustered longitudinal data. Sibling resemblance was estimated with the intraclass correlation. Results. On average, all sib types increased in BMI and WC over 2 years of follow-up, and SS pairs increased in %BF. Individuals within sib-ships track high in all obesity markers across time. Consistency in siblings’ resemblance was also noted, except for BB pairs in %BF which decreased at follow-up. More maturing siblings tend to have higher values in all markers. Greater screen time was associated with higher %BF, whereas those consuming more sugary drinks had lower %BF and BMI values. Siblings whose mothers had less qualified occupations tended to have lower BMI values. Conclusions. Longitudinal individual tracking and sibling resemblance for obesity markers were found. Yet, different trajectories were also identified depending on the marker and sib type. Individual and familial characteristics exert different influences on each obesity marker.

In chronic hypersensitivity pneumonitis (CHP), lack of improvement or declining lung function may prompt use of immunosuppressive therapy. We hypothesised that use of azathioprine or mycophenolate mofetil with prednisone reduces adverse events and lung function decline, and improves transplant-free survival. Patients with CHP were identified. Demographic features, pulmonary function tests, incidence of treatment-emergent adverse events (TEAEs) and transplant-free survival were characterised, compared and analysed between patients stratified by immunosuppressive therapy. A multicentre comparison was performed across four independent tertiary medical centres. Among 131 CHP patients at the University of Chicago medical centre (Chicago, IL, USA), 93 (71%) received immunosuppressive therapy, and had worse baseline forced vital capacity (FVC) and diffusing capacity, and increased mortality compared with those who did not. Compared to patients treated with prednisone alone, TEAEs were 54% less frequent with azathioprine therapy (p=0.04) and 66% less frequent with mycophenolate mofetil (p=0.002). FVC decline and survival were similar between treatment groups. Analyses of datasets from four external tertiary medical centres confirmed these findings. CHP patients who did not receive immunosuppressive therapy had better survival than those who did. Use of mycophenolate mofetil or azathioprine was associated with a decreased incidence of TEAEs, and no difference in lung function decline or survival when compared with prednisone alone. Early transition to mycophenolate mofetil or azathioprine may be an appropriate therapeutic approach in CHP, but more studies are needed.

This study investigates biological, behavioural and sociodemographic correlates of intra-pair similarities, and estimates sibling resemblance in health-related physical fitness (PF). The sample comprises 1101 biological siblings (525 females) aged 9-20 years. PF components and markers were: morphological [waist circumference (WC) and %body fat (%BF)], muscular [handgrip strength (GS) and standing long jump (SLJ)], motor [50-yard dash (50YD) and shuttle run (SR)], and cardiorespiratory (1-mile run). Biological maturation was assessed; physical activity (PA), TV viewing and socioeconomic status (SES) information was obtained. On average, older and more mature subjects are better performers in all PF components; PA was negatively associated with SR, while SES was negatively associated with SLJ and SR. A pattern was observed in the intraclass correlations (ρ) wherein same sex siblings demonstrate greater resemblance for most PF components (sister-sister: 0.35≤ ρ≤0.55; brother-brother: (0.25≤ρ≤0.60) than brother-sister pairs (BS) (0≤ρ≤0.15), except for %BF (ρBB>ρSS>ρBS), and the 1-mile run (ρSS>ρBS>ρBB). In conclusion, behavioural and sociodemographic correlates play different roles in siblings PF expression. Further, a significant familial PF resemblance was observed with different trends in different sibling types, probably due to variations in shared genetic factors and sociodemographic conditions.

This study aimed to investigate the between- and within-individual variability in sedentary time over seven days, using a mixed-effects location scale model. The sample comprised 686 Portuguese children (381 girls) aged 9-11 years, from 23 schools. Sedentary time was estimated by the Actigraph GT3X+ accelerometer, which was used 24 hours/day for 7 consecutive days; height, sitting height, and weight were measured, BMI was computed (WHO cut-points were used to classify subjects as normal weight or overweight/obese), and maturity offset was estimated. Information regarding the home environment was obtained by questionnaire. Results revealed that (i) children were more sedentary on Friday, but less so on Saturday and Sunday (compared to Monday), with significant variation between- and within-subjects (between-subject variance=0.800, within-subject variance=1.793, intra-subject correlation=0.308); (ii) there is a sex effect on sedentariness, with boys being less sedentary than girls (p

MIXNO provides maximum marginal likelihood estimates for mixed-effects nominal logistic regression analysis. These models can be used for analysis of correlated nominal response data, for example, data arising from a clustered or longitudinal design. For such data, the mixed-effects model assumes that data within clusters or sub jects are dependent. The degree of dependency is jointly estimated with the usual model parameters, thus adjusting for dependence resulting from nesting of the data. MIXNO uses marginal maximum likelihood estimation, utilizing a Fisher-scoring solution. For the scoring solution, the Cholesky factor of the random-effects variance-covariance matrix is estimated along with the (fixed) effects of explanatory variables. Examples illustrating usage and features of MIXNO are provided.

MIXREGLS is a program which provides estimates for a mixed-effects location scale model assuming a (conditionally) normally-distributed dependent variable. This model can be used for analysis of data in which subjects may be measured at many observations and interest is in modeling the mean and variance structure. In terms of the variance structure, covariates can by specified to have effects on both the between-subject and within-subject variances. Another use is for clustered data in which subjects are nested within clusters (e.g. clinics, hospitals, schools, etc.) and interest is in modeling the between-cluster and within-cluster variances in terms of covariates. MIXREGLS was written in Fortran and uses maximum likelihood estimation, utilizing both the EM algorithm and a Newton-Raphson solution. Estimation of the random effects is accomplished using empirical Bayes methods. Examples illustrating stand-alone usage and features of MIXREGLS are provided, as well as use via the SAS and R software packages.

Financial incentives are widely used in health behavior interventions. However, self-determination theory posits that emphasizing financial incentives can have negative consequences if experienced as controlling. Feeling controlled into performing a behavior tends to reduce enjoyment and undermine maintenance after financial contingencies are removed (the undermining effect). We assessed participants’ context-specific financial motivation to participate in the Make Better Choices trial—a trial testing four different strategies for improving four health risk behaviors: low fruit and vegetable intake, high saturated fat intake, low physical activity, and high sedentary screen time. The primary outcome was overall healthy lifestyle change; weight loss was a secondary outcome. Financial incentives were contingent upon meeting behavior goals for 3 weeks and became contingent upon merely providing data during the 4.5-month maintenance period. Financial motivation for participation was assessed at baseline using a 7-item scale (𝛼=.97). Across conditions, a main effect of financial motivation predicted a steeper rate of weight regained during the maintenance period, 𝑡(165)=2.15, 𝑃=.04. Furthermore, financial motivation and gender interacted significantly in predicting maintenance of healthy diet and activity changes, 𝑡(160)=2.42, 𝑃=.016, such that financial motivation had a more deleterious influence among men. Implications for practice and future research on incentivized lifestyle and weight interventions are discussed.