Search

Suicide among Veterans continues to be a priority issue addressed by the U.S. Department of Veterans Affairs (VA). In addition to a variety of services specifically intended to prevent suicide, VA also offers a number of services to address Veterans' social determinants of health (SDH), several of which may be associated with elevated risk for suicide. For the present study, we assessed whether participation in services to address adverse SDH is associated with a reduction in risk of suicide mortality among Veterans using secondary data from VA datasets (1/1/2014–12/31/2019) for Veterans with an indicator of housing instability, unemployment, or justice involvement. Logistic regressions modeled suicide mortality; use of services to address SDH was the primary predictor. There was not a statistically significant association between services use and suicide mortality; significant correlates included race other than African American, low or no compensation related to disability incurred during military service, and suicidal ideation/attempt during observation period. Suicide is a complex outcome, difficult to predict, and likely the result of many factors; while there is not a consistent association between services use related to adverse SDH and suicide mortality, providers should intervene with Veterans who do not engage in SDH-focused services but have risk factors for suicide mortality. [ABSTRACT FROM AUTHOR]

PURPOSE Cognitive behavioral therapy (CBT)-based programs delivered by trained community members could improve functioning and pain in individuals who lack access to such programs. We tested the effectiveness of a peer-delivered diabetes self-management program integrating CBT principles in improving physical activity, functional status, pain, quality of life (QOL), and health outcomes in individuals with diabetes and chronic pain. METHODS In this community-based, cluster-randomized controlled trial, intervention participants received a 3-month, peer-delivered, telephone-administered program. Attention control participants received a peer-delivered general health advice program. Outcomes were changes in functional status and pain (Western Ontario and McMaster Universities Osteoarthritis Index), QOL (Short Form 12), and physiologic measures (hemoglobin A1c, systolic blood pressure, body mass index); physical activity was the explanatory outcome. RESULTS Of 195 participants with follow-up data, 80% were women, 96% African Americans, 74% had annual income CONCLUSION This peer-delivered CBT-based intervention improved functioning, pain, QOL, and self-reported physical activity despite pain in individuals with diabetes and chronic pain. Trained community members can deliver effective CBT-based interventions in rural and under-resourced communities. Key words: chronic pain; diabetes; community peer coaches; community health workers; cognitive behavioral therapy, INTRODUCTION Rural communities in the Southeastern United States have the highest prevalence of diabetes in the nation. (1) Area residents face considerable barriers to successful diabetes self-management, including lack of [...]

Background: Studies examining changes in skeletal muscle and adipose tissue during treatment for cancer in children, adolescents, and young adults and their effect on the risk of chemotherapy toxicity (chemotoxicity) are limited. Methods: Among 78 patients with lymphoma (79.5%) and rhabdomyosarcoma (20.5%), changes were measured in skeletal muscle (skeletal muscle index [SMI]; skeletal muscle density [SMD]) and adipose tissue (height‐adjusted total adipose tissue [hTAT]) between baseline and first subsequent computed tomography scans at the third lumbar vertebral level by using commercially available software. Body mass index (BMI; operationalized as a percentile [BMI%ile]) and body surface area (BSA) were examined at each time point. The association of changes in body composition with chemotoxicities was examined by using linear regression. Results: The median age at cancer diagnosis of this cohort (62.8% male; 55.1% non‐Hispanic White) was 12.7 years (2.5–21.1 years). The median time between scans was 48 days (range, 8–207 days). By adjusting for demographics and disease characteristics, this study found that patients undergo a significant decline in SMD (β ± standard error [SE] = −4.1 ± 1.4; p <.01). No significant changes in SMI (β ± SE = −0.5 ± 1.0; p =.7), hTAT (β ± SE = 5.5 ± 3.9; p =.2), BMI% (β ± SE = 4.1 ± 4.8; p =.3), or BSA (β ± SE = −0.02 ± 0.01; p =.3) were observed. Decline in SMD (per Hounsfield unit) was associated with a greater proportion of chemotherapy cycles with grade ≥3 nonhematologic toxicity (β ± SE = 1.09 ± 0.51; p =.04). Conclusions: This study shows that children, adolescents, and young adults with lymphoma and rhabdomyosarcoma undergo a decline in SMD early during treatment, which is associated with a risk of chemotoxicities. Future studies should focus on interventions designed at preventing the loss of muscle during treatment. Plain Language Summary: We show that among children, adolescents, and young adults with lymphoma and rhabdomyosarcoma receiving chemotherapy, skeletal muscle density declines early during treatment.Additionally, a decline in skeletal muscle density is associated with a greater risk of nonhematologic chemotoxicities. Skeletal muscle density declines significantly in the first few weeks of treatment in children, adolescents, and young adults with lymphoma and rhabdomyosarcoma. Decline in skeletal muscle density is associated with a greater risk of nonhematologic toxicities. [ABSTRACT FROM AUTHOR]

Objective: Time‐restricted eating (TRE) can reduce body weight, but it is unclear how it influences dietary patterns and behavior. Therefore, this study assessed the effects of TRE on diet quality, appetite, and several eating behaviors. Methods: Adults with obesity were randomized to early TRE plus energy restriction (eTRE + ER; 8‐hour eating window from 7:00 a.m. to 3:00 p.m.) or a control eating schedule plus energy restriction (CON + ER; ≥12‐hour window) for 14 weeks. Food intake was assessed via the Remote Food Photography Method, while eating patterns, appetite, and eating behaviors were assessed via questionnaires. Results: A total of 59 participants completed the trial, of whom 45 had valid food records. eTRE + ER did not affect eating frequency, eating restraint, emotional eating, or the consistency of mealtimes relative to CON + ER. eTRE + ER also did not affect overall diet quality. The intensity and frequency of hunger and fullness were similar between groups, although the eTRE + ER group was hungrier while fasting. Conclusions: When combined with a weight‐loss program, eTRE does not affect diet quality, meal frequency, eating restraint, emotional eating, or other eating behaviors relative to eating over more than a 12‐hour window. Rather, participants implement eTRE as a simple timing rule by condensing their normal eating patterns into a smaller eating window. [ABSTRACT FROM AUTHOR]

Objective: Data are mixed on whether intermittent fasting improves weight loss and cardiometabolic health. Here, the effects of time‐restricted eating (TRE) in participants who consistently adhered ≥5 d/wk every week were analyzed. Methods: Ninety patients aged 25 to 75 years old with obesity were randomized to early TRE (eTRE; 8‐hour eating window from 07:00 to 15:00) or a control schedule (≥12‐hour window) for 14 weeks. A per‐protocol analysis of weight loss, body composition, cardiometabolic health, and other end points was performed. Results: Participants who adhered to eTRE ≥5 d/wk every week had greater improvements in body weight (−3.7 ± 1.2 kg; p = 0.003), body fat (−2.8 ± 1.3 kg; p = 0.04), heart rate (−7 ± 3 beats/min; p = 0.02), insulin resistance (−2.80 ± 1.36; p = 0.047), and glucose (−9 ± 5 mg/dL; p = 0.047) relative to adherers in the control group. They also experienced greater improvements in mood, including fatigue and anger; however, they self‐reported sleeping less and taking longer to fall asleep. Conclusions: For those who can consistently adhere at least 5 d/wk, eTRE is a valuable approach for improving body weight, body fat, cardiometabolic health, and mood. Further research is needed to determine whether eTRE's effects of shortening sleep but reducing fatigue are healthful or not. [ABSTRACT FROM AUTHOR]