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Background: Patients treated for hypothyroidism with levothyroxine (LT4) monotherapy may present with persistent hypothyroidism symptoms, including cognitive symptoms, despite having a normal thyroid stimulating hormone (TSH) level. It remains unclear whether LT4 monotherapy is sufficient to normalize cognitive function outcomes over time. Methods: This is a multisite longitudinal study of a diverse group of women during midlife representing 5 ethnic/racial groups from 7 enrollment sites across the United States in the Study of Women's Health Across the Nation. Women were screened for a history of thyroid disease and the use of LT4. The study consisted of two primary groups: women with LT4-treated hypothyroidism and control women without thyroid disease. Each participant completed up to 9 cognitive assessments over the study period testing processing speed, working memory, and episodic memory (immediate and delayed recall). Multivariable generalized linear mixed models of scores for each cognitive assessment were developed to determine the association between LT4-treated hypothyroidism and cognitive function trajectories. Covariates included sociodemographic, clinical characteristics, and menopausal status (pre/early peri, late peri, and surgical/post). Sensitivity analyses were conducted to assess the impact of abnormal TSH levels and practice effects (i.e., improvements in scoring after repeated testing). Results: Of the 2033 women who were included in the study, 227 (11.2%) met criteria for LT4-treated hypothyroidism. At baseline, both processing speed and working memory scores were higher in LT4-treated women (mean processing speed scores: 56.5 vs 54.4; p value = 0.006; mean working memory scores: 6.8 vs 6.4; p value = 0.018). However, when considering the effect of LT4-treated hypothyroidism over time, there were no significant differences in the rate of cognitive decline (in any measure) between the hypothyroidism and control groups with or without covariate adjustment. The results were similar when considering LT4-treated women with abnormal TSH levels or after minimizing practice effects. Conclusions: We observed no difference in cognitive decline between women with LT4-treated hypothyroidism and women without thyroid disease. For similar aged patients with cognitive complaints, if thyroid function testing is normal, clinicians should consider causes other than inadequate thyroid hormone treatment to explain these symptoms. [ABSTRACT FROM AUTHOR]

In their recent Viewpoint article, Beidas et al. (2023) argue that researchers should test psychosocial interventions in the contexts in which they are meant to be delivered and that they can accelerate the deployment of these interventions by advancing directly from pilot trials to effectiveness and implementation studies without conducting efficacy trials. In this commentary, we argue that this is a well-intended but problematic approach and that there is a more productive strategy for translational behavioral intervention research. The commentary discusses issues concerning intervention development, refinement, and optimization; pilot and efficacy testing of interventions; the contexts in which interventions are delivered; clinical practice guidelines; and quick versus programmatic answers to significant clinical research questions. Testing psychosocial interventions in the contexts in which they are meant to be delivered is a complex task for interventions that are designed to be used in a wide variety of contexts. Nevertheless, interventions can be tested in the contexts in which they are meant to be delivered without sacrificing programmatic intervention development or safety and efficacy testing. What is the public health significance of this article?: Safe and effective psychosocial interventions are needed for a wide variety of clinical or public health problems. The best way for researchers to meet these needs is to conduct studies to ensure that their interventions are safe and effective before deploying them in public health or clinical service settings. [ABSTRACT FROM AUTHOR]

Sees research on Type A behavior as plagued by inadequate theory, insensitive assessment, and insufficient interventions. Discusses conceptual models (transactional model, social cognitive theories, and associative network theory); questions view of hostility as only pathogenic feature of Type A behavior; and describes ethnographic gap in Type A research. Encourages study of Type A behavior within expanded conceptual perspective. (Author/NB)

Men who work in blue-collar occupations (skilled and unskilled trades) experience high rates of obesity and comorbid conditions. This group is underrepresented in behavioral interventions for weight management, which may stem from a mismatch between the features of available programs and these men's preferences. This qualitative study explored the views of these men, their experiences with weight loss, their preferences for weight loss programs, and messaging related to these programs. We conducted remote interviews with 20 men (age: 43 ± 13 years, M ± SD) currently working in blue-collar occupations (50% construction, 25% transportation, and 25% manufacturing) who had body mass indices (BMIs) in the overweight/obese categories (BMI: 33 ± 6 kg/m2). Deductive codes and summary themes were developed and discussed by the first two authors. A selection of transcripts was reviewed following theme development to confirm accuracy of the themes. Most participants (n = 16, 80%) reported a prior weight loss attempt. The most common approaches to weight loss reported were increased exercise and following their own approach to changing diet (e.g., "eating less junk food"). For program and message preferences, two major themes emerged: participants wanted accurate and trustworthy information and wanted programs that fit their lifestyle. Results suggest that weight loss programs targeting men working in blue-collar occupations should emphasize the accuracy of information related to the program and the ease of incorporating it into participants' lifestyles. There is an urgent need to incorporate these preferences into effective programs. [ABSTRACT FROM AUTHOR]

A study was conducted to evaluate the benefits if any of self-management counseling in patients with heart failure in reducing the incidence of mortality of heart failure hospitalization. Results indicated that such form of counseling did not in any way result in a reduced incidence of mortality or hospitali zation.

To curb the epidemic of obesity in the United States, revised Medicare policy allows support for efficacious obesity treatments. This review summarizes the evidence from rigorous randomized trials (9 lifestyle trials, 5 drug trials, and 2 surgical trials) on the efficacy and risk-benefit profile of lifestyle, drug, and surgical interventions aimed at promoting sustained ([greater than or equal to] 2 years) reductions in weight. Both lifestyle and drug interventions consistently produced an approximate 7-lb (3.2-kg) weight loss that was sustained for 2 years and was associated with improvements in diabetes, blood pressure, and/or cardiovascular risk factors. Surgical interventions have a less solid empirical base but offer promise for the promotion of significant and sustained weight reduction posttreatment in the morbidly obese but with possible significant short-term side effects. In summary, there is strong and consistent support from rigorous randomized trials that lifestyle or drug interventions result in modest weight loss with minimal risks but disproportionate clinical benefit. Combinations of lifestyle, drug, and, where appropriate, surgical interventions may be the most efficacious approach to achieving sustained weight loss for the widest diversity of patients. Keywords: obesity, weight management, obesity drugs, bariatric surgery, interventions

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1468-5906.2007.00344.x Byline: GEORGE FITCHETT (1), PATRICIA E. MURPHY (2), HOWARD M. KRAVITZ (3), SUSAN A. EVERSON-ROSE (4), NEAL M. KRAUSE (5), LYNDA H. POWELL (6) Abstract: We examined racial/ethnic differences in five measures of religious involvement (worship attendance, religious social support, importance of faith, comfort from religion, and frequency of prayer or meditation) among 2,690 women, age 42-52 years, participating in the Study of Women's Health Across the Nation (SWAN). The women reported five racial/ethnic identifications: white, African American, Hispanic, Japanese, and Chinese. A large proportion of the Asian and Hispanic women were born outside the United States (Japanese 48 percent, Chinese 69.5 percent, Hispanic 89.1 percent). African-American and Hispanic women reported the highest levels of religious involvement. White and Japanese women reported similar levels of involvement for four measures. Compared to the white women, the Chinese women reported similar levels of worship attendance and religious social support, but lower levels for the other three measures. These racial/ethnic differences were not explained by differences in religious preference, acculturation, or sociodemographic factors. With the exception of worship attendance, in adjusted models, measures of acculturation were not significantly associated with religious involvement. Author Affiliation: (1)George Fitchett is an Associate Professor, Department of Religion, Health, and Human Values and Department of Preventive Medicine, Rush University Medical Center. E-mail:george_fitchett@rush.edu (2)Patricia E. Murphy is an Assistant Professor, Department of Religion, Health, and Human Values and Department of Psychiatry, Rush University Medical Center. E-mail:patricia_murphy@rush.edu (3)Howard M. Kravitz is an Associate Professor, Department of Psychiatry and Department of Preventive Medicine, Rush University Medical Center. E-mail:hkravitz@rush.edu (4)Susan A. Everson-Rose is an Associate Professor, Department of Preventive Medicine, Department of Behavioral Sciences, and Rush Institute for Healthy Aging, Rush University Medical Center. E-mail:susan_a_everson-rose@rush.edu (5)Neal M. Krause is a Professor, Department of Health Behavior and Health Education School of Public Health, University of Michigan. E-mail:nkrause@umich.edu (6)Lynda H. Powell is Acting Chair and Professor, Department of Preventive Medicine and Professor, Department of Behavioral Sciences, Rush University Medical Center. E-mail:lpowell@rush.edu Article note: Correspondence should be addressed to George Fitchett, Department of Religion, Health, and Human Values, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612-3833. E-mail: george_fitchett@rush.edu

Background: Physical inactivity in midlife women is associated with increased intra-abdominal adipose tissue development. We describe an innovative multimethod study 1) to better understand barriers to physical activity (PA) and 2) to engage midlife women to product test physical activities and identify local community-based providers and sustainable and fun PA experiences. Methods: Formative research on PA barriers from the Chicago site Study of Women's Health Across the Nation (SWAN) ancillary study of midlife women was used to develop a pilot testing measure. Feasibility, acceptability and sustainability of the PA activities were determined using the measure. Results: Desirable locations and/or instructors were identified. The first 2 groups identified, pilot tested, and then ranked activities for their ability to promote sustained PA. The 6 top-ranked were: circuit training, total body fitness, kickboxing, Zumba, Pilates, and pedometer. The final group pilot tested highly ranked PA in 2-week blocks, and ranked pedometer and Zumba in their top 3. Conclusion: Consensus was reached regarding activities that could be valuable in promoting sustained PA in midlife women. Choosing convenient sites and popular instructors further facilitates sustainability. Building relationships with key community partners is essential for sustainability. Community-based participant involvement in study design is a critical element in developing a healthy living intervention. [ABSTRACT FROM AUTHOR]

Objectives. We examined the relationship between ability to speak English and receipt of Papanicolaou tests, clinical breast examinations, and mammography in a multiethnic group of women in the United States. Methods. We used longitudinal data from the Study of Women Across the Nation to examine receipt of breast and cervical cancer screening among Chinese, Japanese, Hispanic, and White women who reported reading and speaking (1) only a language other than English, (2) another language more fluently than English, or (3) only English or another language and English with equal fluency. Logistic regression was used to analyze the data. Results. Reading and speaking only a language other than English and reading and speaking another language more fluently than English, were significantly and negatively associated with receipt of breast and cervical cancer screening in unadjusted models. Although these findings were attenuated in adjusted models, not speaking English well or at all remained negatively associated with receipt of cancer screening. Conclusions. These findings suggest that language barriers contribute to health disparities by impeding adequate health communication. (doi:10.2105/AJPH.2004.041418)

Progress in studying the relationship between religion and health has been hampered by the absence of an adequate measure of religiousness and spirituality. This article reports on the conceptual and empirical development of an instrument to measure religiousness and spirituality, intended explicitly for studies of health. It is multidimensional to allow investigation of multiple possible mechanisms of effect, brief enough to be included in clinical or epidemiological surveys, inclusive of both traditional religiousness and noninstitutionally based spirituality, and appropriate for diverse Judeo-Christian populations. The measure may be particularly useful for studies of health in elderly populations in which religious involvement is higher. The measure was tested in the nationally representative 1998 General Social Survey (N = 1,445). Nine dimensions have indices with moderate-to-good internal consistency, and there are three single-item domains. Analysis by age and sex shows that elderly respondents report higher levels of religiousness in virtually every domain of the measure. Keywords: religiousness; spirituality; health; medicine; aging

Evidence is presented that bears on 9 hypotheses about the link between religion or spirituality and mortality, morbidity, disability, or recovery from illness. In healthy participants, there is a strong, consistent, prospective, and often graded reduction in risk of mortality in church/service attenders. This reduction is approximately 25% after adjustment for confounders. Religion or spirituality protects against cardiovascular disease, largely mediated by the healthy lifestyle it encourages. Evidence fails to support a link between depth of religiousness and physical health. In patients, there are consistent failures to support the hypotheses that religion or spirituality slows the progression of cancer or improves recovery from acute illness but some evidence that religion or spirituality impedes recovery from acute illness. The authors conclude that church/service attendance protects healthy people against death. More methodologically sound studies are needed.