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Introduction and Objectives: Structured physical activity (PA) programs help to prevent and manage chronic diseases, yet systematic approaches to identify and enroll patients in these programs are lacking. Exercise is Medicine Greenville (EIMG) is a novel clinic-to-community model that identifies patients with chronic diseases in primary care settings and connects them to a structured, evidence-informed, community-based PA program. This study assessed influences on PA program enrollment using a mixed methods design. Methods: Data were collected from 12 clinics over 18 months. Electronic health record data were used to quantitively compare the characteristics of referred patients who did versus did not enroll. Semi-structured interviews were conducted with a subset of non-enrollees to elucidate barriers and facilitators to enrollment. Results: Of the 217 referred patients who were eligible, 84 (38.7%) enrolled in the PA program. A greater percentage of enrollees had a history of high cholesterol (73.8%) relative to non-enrollees (57.9%, χ 2 (1, N = 217) = 5.66, P = .02). Twenty-six patients completed qualitative interviews. Three themes emerged from interviews: (1) positive referral experiences with opportunity for enhanced information sharing and improved flow; (2) strong patient motivation, perceived capability, and social support; and (3) external barriers, such as cost and time, that prevented enrollment. Conclusions: Findings can guide improvements to the EIMG model, thus increasing its positive impact on individual- and community-level health. Findings can also inform efforts to build similar clinic-to-community PA models at other health systems.

BackgroundWhether greater leisure time physical activity (LTPA) is associated with less bone mineral density (BMD) loss during the menopause transition (MT) remains an open question. We hypothesized that: 1) larger increases in LTPA from pre-/early perimenopause (period 1) to late perimenopause/postmenopause (period 2) would be associated with a slower period 2 BMD loss rate; and 2) greater entire-study LTPA levels would be associated with better final absolute BMD (g/cm2).MethodsData were from of the Study of Women's Health Across the Nation (1996-2017). Exclusions were: bone beneficial medications, inability to identify start of the MT, and extreme BMD change rates. LTPA measures were a validated ordinal scale and number of metabolic equivalents per hour per week (MET hr wk-1) from sport/exercise. Multiply adjusted, linear regression models estimated: 1) BMD decline rate (annualized %) as a function of LTPA change; and 2) final BMD as a function of entire-study LTPA.FindingsMedian [p25, p75] MET hr wk-1 were 4.2 [0.9, 10.1] and 4.9 [1.4, 11.2] in periods 1 and 2, respectively; walking was the commonest activity. In adjusted models (N = 875), greater increases in LTPA ordinal score and MET hr wk-1 were statistically significantly associated with a slower decline in femoral neck (FN) BMD. Larger entire-study averages of each LTPA measure were statistically significantly related to better final FN and lumbar spine BMD levels.InterpretationFindings suggest that LTPA, at modest levels, mitigate MT-related BMD decline and even small increases in intensity, duration or frequency of common activities may lessen bone loss at the population level.FundingUS-NIH.

Exposure to persistent organic pollutants (POPs) can significantly impact marine mammal health, reproduction, and fitness. This study addresses a significant 20-year gap in gray whale contaminant monitoring through analysis of POPs in 120 blubber biopsies. The scope of this substantial sample set is noteworthy in its range and diversity with collection between 2003 and 2017 along North Americas west coast and across diverse sex, age, and reproductive parameters, including paired mothers and calves. Mean blubber concentrations of polychlorinated biphenyls (∑PCBs), dichlorodiphenyltrichloroethanes (∑DDTs), and chlordanes (∑CHLs) generally decreased since previous reports (1968-1999). This is the first report of polybrominated diphenyl ethers (PBDEs) and select hexachlorocyclohexanes (HCHs) in this species. Statistical modeling of the 19 most frequently detected compounds in this dataset revealed sex-, age-, and reproductive status-related patterns, predominantly attributed to maternal offloading. Mean POP concentrations differed significantly by sex in adults (17 compounds, up to 3-fold higher in males) but not in immatures (all 19 compounds). Mean POP concentrations were significantly greater in adults versus immatures in both males (17 compounds, up to 12-fold) and females (13 compounds, up to 3-fold). POP concentrations were detected with compound-specific patterns in nursing calves, confirming maternal offloading for the first time in this species.

Background: The role of physical activity (PA) in mitigating fall risk among adults with cardiovascular disease (CVD) is unclear. Purpose: We examined the associations of CVD-PA phenotypes with falls. Methods: Adults [greater than or equal to] 45 years (n = 295,282; N = 130,103,093) from the 2018 Behavioral Risk Factor Surveillance System who self-reported CVD, leisure-time PA, and falls were examined. The weighted prevalence ratio (PR) of any, recurrent, and injurious falls across CVD-PA phenotypes (no CVD-PA, no CVD-no PA, CVD-PA, CVD-no PA) was estimated. Results: The likelihood of any, recurrent, and injurious falls was higher across unhealthier CVD-PA phenotypes in fully adjusted models. In the total sample, no CVD-no PA (PR: 1.30; 95% CI: 1.10, 1.50), CVD-PA (PR: 1.35; 95% CI: 1.10, 1.60), and CVD-no PA (PR: 1.39; 95% CI: 1.11, 1.67) phenotypes were more likely to report injurious falls than no CVD-PA phenotype. Discussion: Engaging in leisure-time PA may be an important lifestyle strategy for fall prevention in midlife and older adults who are at risk of CVD. Translations to Health Education Practice: Our findings could be useful for health education in providing evidence on future fall prevention programs in adults who are at risk for CVD and falls.

Despite growing interest in edible seaweeds, there is limited information on seaweed chemical contaminant levels in the Salish Sea. Without this knowledge, health-based consumption advisories can not be determined for consumers that include Tribes and First Nations, Asian and Pacific Islander community members, and recreational harvesters. We measured contaminant concentrations in edible seaweeds (Fucus distichus, F. spiralis, and Nereocystis luetkeana) from 43 locations in the Salish Sea. Metals were analyzed in all samples, and 94 persistent organic pollutants (POPs) (i.e. 40 PCBs, 15 PBDEs, 17 PCDD/Fs, and 22 organochlorine pesticides) and 51 PAHs were analyzed in Fucus spp. We compared concentrations of contaminants to human health-based screening levels calculated from the USEPA and to international limits. We then worked with six focal contaminants that either exceeded screening levels or international limits (Cd, total Hg, Pb, benzo[a]pyrene [BaP], and PCBs) or are of regional interest (total As). USEPA cancer-based screening levels were exceeded in 30 samples for the PCBs and two samples for BaP. Cadmium concentrations did not exceed the USEPA noncancer-based screening level but did exceed international limits at all sites. Lead exceeded international limits at three sites. Because there are no screening levels for total Hg and total As, and to be conservative, we made comparisons to methyl Hg and inorganic As screening levels. All samples were below the methyl Hg and above the inorganic As screening levels. Without knowledge of the As speciation, we cannot assess the health risk associated with the As. While seaweed was the focus, we did not consider contaminant exposure from consuming other foods. Other chemicals, such as contaminants of emerging concern (e.g., PFAS, pharmaceuticals and personal care products), should also be considered. Additionally, although we focused on toxicological aspects, there are cultural and health benefits of seaweed use that may affect consumer choice.

Objective: Adults with rheumatic disease (RD) experience high levels of fatigue. Regular physical activity has been shown to reduce fatigue among adults. Despite this evidence, adults with RD are more likely to be physically inactive compared with those without RD. Little information is known about the association of physical activity level and fatigue among adults with RD. This study investigated the association of physical activity level and fatigue among adults with and without RD. Methods: Adults (≥18 y) who participated in the 2018 National Health Interview Survey (unweighted n = 25,471) were included in this cross-sectional study. Physical activity and fatigue were self-reported. Statistical analyses were weighted to account for complex survey sampling design. Results: Significantly more adults with RD experience fatigue compared with adults without RD (26.19% vs 13.23%). Adults with RD who were inactive had 2.81 times (95% CI, 2.37–3.34) higher odds of experiencing fatigue compared to adults with RD who were sufficiently active, after adjusting for covariates. Conclusions: Overall, fatigue was more common among adults with RD than it was in the population without RD. [ABSTRACT FROM AUTHOR]

Abstract Bioactive glass (BAG) is a bone substitute that can be used in orthopaedic surgery. Following implantation, the BAG is expected to be replaced by bone via bone growth and gradual degradation of the BAG. However, the hydroxyapatite mineral forming on BAG resembles bone mineral, not providing sufficient contrast to distinguish the two in X-ray images. In this study, we co-registered coded-excitation scanning acoustic microscopy (CESAM), scanning white light interferometry (SWLI), and scanning electron microscopy with elemental analysis (Energy Dispersive X-ray Spectroscopy) (SEM–EDX) to investigate the bone growth and BAG reactions on a micron scale in a rabbit bone ex vivo. The acoustic impedance map recorded by the CESAM provides high elasticity-associated contrast to study materials and their combinations, while simultaneously producing a topography map of the sample. The acoustic impedance map correlated with the elemental analysis from SEM–EDX. SWLI also produces a topography map, but with higher resolution than CESAM. The two topography maps (CESAM and SWLI) were in good agreement. Furthermore, using information from both maps simultaneously produced by the CESAM (acoustic impedance and topography) allowed determining regions-of-interest related to bone formation around the BAG with greater ease than from either map alone. CESAM is therefore a promising tool for evaluating the degradation of bone substitutes and the bone healing process ex vivo.

Abstract Introduction During the transcatheter aortic valve replacement (TAVR) procedure, hemodynamic measurements can be used to evaluate transcatheter heart valve (THV) performance. We hypothesized that the occurrence of a significant decrease in invasive aortic pressure immediately after annular contact by a self-expanding THV indicates effective annular sealing. This phenomenon could thus be used as a marker for the occurrence of paravalvular leak (PVL). Methods Thirty-eight patients undergoing TAVR procedure with a self-expandable Evolut R or Evolut Pro (Medtronic) valve prosthesis were included in the study. Drop in aortic pressure during valve expansion was defined as a decrease in systolic pressure of 30 mmHg immediately after annular contact. The primary endpoint was the occurrence of more than mild PVL immediately after valve implantation. Results A pressure drop was seen in 60.5% (23/38) of patients. More than mild PVL requiring balloon post-dilatation (BPD) was significantly more frequent in patients who did not have a systolic pressure decrease > 30 mmHg during valve implantation (46.7% [7/15] vs. 13.0% [3/23], respectively; p = 0.03). Patients without a systolic pressure decrease > 30 mmHg also had a lower mean cover index on computed tomography analysis (16.2% vs. 13.3%; p = 0.016). The 30-day outcomes were similar between the two groups, and echocardiography at 30 days demonstrated more than none/trace PVL in 21.1% (8/38) of patients, with no difference between the two groups. Conclusion A decrease in aortic pressure after annular contact is associated with an increased probability of good hemodynamic outcome after self-expanding TAVR implantation. In addition to other methods, this parameter could be used as an additional marker for optimal valve positioning and hemodynamic outcome during the implantation procedure.

Abstract Background Chronic obstructive pulmonary disease (COPD) is projected to become the third cause of mortality worldwide. COPD shares several pathophysiological mechanisms with cardiovascular disease, especially atherosclerosis. However, no definite answers are available on the prognostic role of COPD in the setting of ST elevation myocardial infarction (STEMI), especially during COVID-19 pandemic, among patients undergoing primary angioplasty, that is therefore the aim of the current study. Methods In the ISACS-STEMI COVID-19 registry we included retrospectively patients with STEMI treated with primary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 from 109 high-volume primary PCI centers in 4 continents. Results A total of 15,686 patients were included in this analysis. Of them, 810 (5.2%) subjects had a COPD diagnosis. They were more often elderly and with a more pronounced cardiovascular risk profile. No preminent procedural dissimilarities were noticed except for a lower proportion of dual antiplatelet therapy at discharge among COPD patients (98.9% vs. 98.1%, P = 0.038). With regards to short-term fatal outcomes, both in-hospital and 30-days mortality occurred more frequently among COPD patients, similarly in pre-COVID-19 and COVID-19 era. However, after adjustment for main baseline differences, COPD did not result as independent predictor for in-hospital death (adjusted OR [95% CI] = 0.913[0.658–1.266], P = 0.585) nor for 30-days mortality (adjusted OR [95% CI] = 0.850 [0.620–1.164], P = 0.310). No significant differences were detected in terms of SARS-CoV-2 positivity between the two groups. Conclusion This is one of the largest studies investigating characteristics and outcome of COPD patients with STEMI undergoing primary angioplasty, especially during COVID pandemic. COPD was associated with significantly higher rates of in-hospital and 30-days mortality. However, this association disappeared after adjustment for baseline characteristics. Furthermore, COPD did not significantly affect SARS-CoV-2 positivity. Trial registration number: NCT 04412655 (2nd June 2020).

Summary: Background: Whether greater leisure time physical activity (LTPA) is associated with less bone mineral density (BMD) loss during the menopause transition (MT) remains an open question. We hypothesized that: 1) larger increases in LTPA from pre-/early perimenopause (period 1) to late perimenopause/postmenopause (period 2) would be associated with a slower period 2 BMD loss rate; and 2) greater entire-study LTPA levels would be associated with better final absolute BMD (g/cm2). Methods: Data were from of the Study of Women's Health Across the Nation (1996–2017). Exclusions were: bone beneficial medications, inability to identify start of the MT, and extreme BMD change rates. LTPA measures were a validated ordinal scale and number of metabolic equivalents per hour per week (MET hr wk−1) from sport/exercise. Multiply adjusted, linear regression models estimated: 1) BMD decline rate (annualized %) as a function of LTPA change; and 2) final BMD as a function of entire-study LTPA. Findings: Median [p25, p75] MET hr wk−1 were 4.2 [0.9, 10.1] and 4.9 [1.4, 11.2] in periods 1 and 2, respectively; walking was the commonest activity. In adjusted models (N = 875), greater increases in LTPA ordinal score and MET hr wk−1 were statistically significantly associated with a slower decline in femoral neck (FN) BMD. Larger entire-study averages of each LTPA measure were statistically significantly related to better final FN and lumbar spine BMD levels. Interpretation: Findings suggest that LTPA, at modest levels, mitigate MT-related BMD decline and even small increases in intensity, duration or frequency of common activities may lessen bone loss at the population level. Funding: US-NIH.

Introduction and Objectives: Structured physical activity (PA) programs help to prevent and manage chronic diseases, yet systematic approaches to identify and enroll patients in these programs are lacking. Exercise is Medicine Greenville (EIMG) is a novel clinic-to-community model that identifies patients with chronic diseases in primary care settings and connects them to a structured, evidence-informed, community-based PA program. This study assessed influences on PA program enrollment using a mixed methods design. Methods: Data were collected from 12 clinics over 18 months. Electronic health record data were used to quantitively compare the characteristics of referred patients who did versus did not enroll. Semi-structured interviews were conducted with a subset of non-enrollees to elucidate barriers and facilitators to enrollment. Results: Of the 217 referred patients who were eligible, 84 (38.7%) enrolled in the PA program. A greater percentage of enrollees had a history of high cholesterol (73.8%) relative to non-enrollees (57.9%, χ2 (1, N = 217) = 5.66, P =.02). Twenty-six patients completed qualitative interviews. Three themes emerged from interviews: (1) positive referral experiences with opportunity for enhanced information sharing and improved flow; (2) strong patient motivation, perceived capability, and social support; and (3) external barriers, such as cost and time, that prevented enrollment. Conclusions: Findings can guide improvements to the EIMG model, thus increasing its positive impact on individual- and community-level health. Findings can also inform efforts to build similar clinic-to-community PA models at other health systems. [ABSTRACT FROM AUTHOR]

The recovery of threatened species after conservation measures can lead to human–wildlife conflicts. One example of such is the recent population growth of the Barnacle Goose Branta leucopsis, a large herbivorous bird. During migration, geese stage in large numbers on agricultural fields in range countries and cause substantial damage to farms. A combination of repelling fields, where geese were chased off by humans, and accommodation fields, which provide refuge sites for foraging geese, has been suggested as an effective management tool to mitigate conflicts. Using high‐resolution satellite tracking data, we investigated habitat selection of 41 barnacle geese staging in Northern Karelia, Finland, during spring 2021. We estimated relative habitat use by these geese and conducted a fine‐scale analysis of their use of different fields by employing Hidden Markov Models and integrated step‐selection analysis. Fields included normal crop (no goose management), project and other (private and Nature 2000 area) accommodation fields and repelling fields. Project accommodation and repelling fields were established on areas known to have a long history of high grazing pressure by barnacle geese. We found that behavioural data of geese can be categorized into three different states (static, slow and fast movement). Static and slow states were used for local field selection, fast state for field selection in the regional area, and all states for field selection after leaving a repelling field. Overall, relative habitat use indicated that geese utilize accommodation fields more than expected by their availability. Integrated step‐selection analyses revealed that geese avoided normal and repelling versus project accommodation fields at the regional scale. At the local scale, they preferred project accommodation fields over all other fields. After leaving a repelling field, geese did not show preference for any accommodation over repelling fields. Synthesis and application. Geese show individual selection for accommodation fields compared to normal or repelling fields across several scales. Our results suggest that the accommodation field concept—consisting of refuge areas and no‐go areas where geese are repelled from—can help to mitigate the human–wildlife conflict using local stakeholders' knowledge. [ABSTRACT FROM AUTHOR]