Leader sensemaking style in response to crisis: Consequences and insights from the COVID-19 pandemic.

The international scope of the 2020 COVID-19 crisis compelled a response from world leaders across the globe. However, the nature of these responses was far from universal. These circumstances present a unique opportunity to study how leader style influences, and is influenced by, a common crisis. To explore these relationships, the present effort used a content analysis of weekly COVID-19 statements from world leaders spanning the first 19 weeks of the crisis. Results suggest that leaders shifted toward increasingly pragmatic sensemaking approaches as COVID-19 infections increased and that sustained use of pragmatic leadership styles was associated with fewer infections in the long term. In contrast, sustained use of the charismatic sensemaking style was associated with higher observed infection rates.

Double-Edged Scalpels: The Trials and Triumphs of Women Surgeons.

The narratives presented in this symposium describe the many ways in which women are harassed from medical school to residency to fellowship and throughout their careers as surgeons. A clear double-edged pattern in the tactics these women used to cope, the challenges they faced, and the responses they encountered emerge, with each being protective or helpful while simultaneously holding them back. Addressing the systemic cultural issues described throughout will be no easy challenge, but the authors of these narratives provide hope that it can be different for future generations of women pursuing surgical careers.

Dietary quality 1 year after diagnosis of coronary heart disease.

OBJECTIVE: The purpose of this ancillary study is to determine the quality of diets in patients with documented coronary heart disease (CHD). DESIGN: Dietary data were originally collected using a 24-hour dietary recall in 555 patients with CHD, 1 year after a diagnostic coronary angiography. Data used for this investigation were collected between March 2001 and November 2003. SUBJECTS/SETTING: Patients were participants in a clinical trial to improve adherence to lipid-lowering medications. The Alternate Healthy Eating Index, an instrument designed to evaluate the degree to which a diet has the potential to prevent cardiovascular disease, measured dietary quality. MAIN OUTCOME MEASURES: Linear regression models were used to assess the association of dietary quality with patients' sociodemographic and clinical characteristics. RESULTS: Mean age of participants was 61 years, with an average body mass index of 30 (calculated as kg/m(2)). Sixty percent were men. Average daily caloric intake was 1,775 kcal, with 50% of calories derived from carbohydrates, 18% from protein, and 32% from total fat. Average Alternate Healthy Eating Index score was 30.8 out of a possible maximum score of 80. Only 12.4% of subjects met the recommended consumption of vegetables, 7.8% for fruit, 8% for cereal fiber, and 5.2% for trans-fat intake. Lower dietary quality was associated with lower total caloric intake, as well as with smoking, obesity, and lower educational level. CONCLUSIONS: A high proportion of patients reported poor dietary quality 1 year after experiencing a coronary event. Our data support continued efforts to enhance healthful dietary changes over time for secondary prevention of CHD. Dietary change should be emphasized with CHD patients who are less educated, smokers, or obese.

A randomized clinical trial comparing low-glycemic index versus ADA dietary education among individuals with type 2 diabetes.

OBJECTIVE: We compared the effects of a low glycemic index (GI) diet with the American Diabetes Association (ADA) diet on glycosylated hemoglobin (HbA1c) among individuals with type 2 diabetes. METHODS: Forty individuals with poorly controlled type 2 diabetes were randomized to a low-GI or an ADA diet. The intervention, consisting of eight educational sessions (monthly for the first 6 mo and then at months 8 and 10), focused on a low-GI or an ADA diet. Data on demographics, diet, physical activity, psychosocial factors, and diabetes medication use were assessed at baseline and 6 and 12 mo. Generalized linear mixed models were used to compare the two groups on HbA1c, diabetic medication use, blood lipids, weight, diet, and physical activity. RESULTS: Participants (53% female, mean age 53.5 y) were predominantly white with a mean body mass index of 35.8 kg/m(2). Although both interventions achieved similar reductions in mean HbA1c at 6 mo and 12 mo, the low-GI diet group was less likely to add or increase dosage of diabetic medications (odds ratio 0.26, P = 0.01). Improvements in high-density lipoprotein cholesterol, triacylglycerols, and weight loss were similar between groups. CONCLUSION: Compared with the ADA diet, the low-GI diet achieved equivalent control of HbA1c using less diabetic medication. Despite its limited size, this trial suggests that a low-GI diet is a viable alternative to the ADA diet. Findings should be evaluated in a larger randomized controlled trial.

Association between dietary glycemic index, glycemic load, and high-sensitivity C-reactive protein.

OBJECTIVE: This study examined the relation between quality of dietary carbohydrate intake, as measured by glycemic index (GI) and glycemic load (GL), and serum high-sensitivity C-reactive protein (hs-CRP) levels. METHODS: During a 1-y observational study, data were collected at baseline and at each quarter thereafter. GI and GL were calculated from multiple 24-h dietary recalls (24HRs), 3 randomly selected 24HRs at every quarter, with up to 15 24HRs per participant. The hs-CRP was measured in blood samples collected at baseline and each of the four quarterly measurement points. Multivariable linear mixed models were used to examine the cross-sectional and longitudinal associations of GI, GL, and hs-CRP. RESULTS: Among 582 adult men and women with at least two measurements of diet and hs-CRP, average daily GI score (white bread = 100) was 85 and average GL was 198, and average hs-CRP was 1.84 mg/L. Overall, there was no association between GI or GL and hs-CRP. Subgroup analyses revealed an inverse association between GL and hs-CRP among obese individuals (body mass index > or =30 kg/m(2)). CONCLUSION: Quality of dietary carbohydrates does not appear to be associated with serum hs-CRP levels. Among obese individuals, higher dietary GL appears to be related to lower hs-CRP levels. Due to the limited number of studies on this topic and their conflicting results, further investigation is warranted.

Association between dietary fiber and markers of systemic inflammation in the Women's Health Initiative Observational Study.

OBJECTIVE: Systemic inflammation may play an important role in the development of atherosclerosis, type 2 diabetes, and some cancers. Few studies have comprehensively assessed the direct relations between dietary fiber and inflammatory cytokines, especially in minority populations. Using baseline data from 1958 postmenopausal women enrolled in the Women's Health Initiative Observational Study, we examined cross-sectional associations between dietary fiber intake and markers of systemic inflammation (including serum high-sensitivity C-reactive protein [hs-CRP], interleukin-6 [IL-6], and tumor necrosis factor-alpha receptor-2 [TNF-alpha-R2]) in addition to differences in these associations by ethnicity. METHODS: Multiple linear regression models were used to assess the relation between fiber intake and makers of systemic inflammation. RESULTS: After adjustment for covariates, intakes of dietary fiber were inversely associated with IL-6 (P values for trend were 0.01 for total fiber, 0.004 for soluble fiber, and 0.001 for insoluble fiber) and TNF-alpha-R2 (P values for trend were 0.002 for total, 0.02 for soluble, and <0.001 for insoluble fibers). Although the samples were small in minority Americans, results were generally consistent with those found among European Americans. We did not observe any significant association between intake of dietary fiber and hs-CRP. CONCLUSION: These findings lend support to the hypothesis that a high-fiber diet is associated with lower plasma levels of IL-6 and TNF-alpha-R2. Contrary to previous reports, however, there was no association between fiber and hs-CRP among postmenopausal women. Future studies on the influence of diet on inflammation should include IL-6 and TNF-alpha-R2 and enroll participants from ethnic minorities.

A dietary quality comparison of popular weight-loss plans.

Popular weight-loss plans often have conflicting recommendations, which makes it difficult to determine the most healthful approach to weight loss. Our study compares the dietary quality of popular weight-loss plans. Dietary quality, measured by the Alternate Healthy Eating Index (AHEI), was calculated via sample menus provided in published media for the New Glucose Revolution, Weight Watchers, Atkins, South Beach, Zone, Ornish, and 2005 US Department of Agriculture Food Guide Pyramid (2005 Food Guide Pyramid) plans. The criterion for determining which weight-loss plans were the most popular was their status on the New York Times Bestseller list. Weight Watchers and the 2005 Food Guide Pyramid plan were included because they are the largest commercial weight-loss plan, and the current government recommendation, respectively. Analysis of variance was used to compare nutrient information among the weight-loss plans. The AHEI scores adjusted for energy content were also compared. Of a maximum possible score of 70, the AHEI scores for each weight-loss plan from the highest to the lowest plan were: Ornish (score 64.6), Weight Watchers high-carbohydrate (score 57.4), New Glucose Revolution (score 57.2), South Beach/Phase 2 (score 50.7), Zone (score 49.8), 2005 Food Guide Pyramid (score 48.7), Weight Watchers high-protein (score 47.3), Atkins/100-g carbohydrate (score 46), South Beach/Phase 3 (score 45.6), and Atkins/45-g carbohydrate (score 42.3). Dietary quality varied across popular weight-loss plans. Ornish, Weight Watchers high-carbohydrate, and New Glucose Revolution weight-loss plans have an increased capacity for cardiovascular disease prevention when assessed by the AHEI.

Association between dietary fiber and serum C-reactive protein.

BACKGROUND: High sensitivity C-reactive protein (CRP) is a marker of acute inflammation recently recognized as an independent predictor of future cardiovascular disease and diabetes. The identification of modifiable factors, such as diet, that influence serum CRP concentrations may provide the means for reducing the risk of these diseases. Data on longitudinal associations between dietary fiber intake and CRP are currently lacking. OBJECTIVE: The purpose of this study was to examine longitudinal associations between dietary fiber intake and CRP. DESIGN: Data collection took place at baseline and quarterly (every 13 wk) thereafter for a total of 5 visits, each including measurements of body composition, CRP, diet, and physical activity. Relations between serum CRP and dietary fiber were assessed by using linear mixed models and logistic regression, adjusted for covariates. RESULTS: A total of 524 subjects had multiple measurements of CRP and dietary factors. The average total dietary fiber intake was 16.11 g/d. Average serum CRP was 1.78 mg/L. We observed an inverse association between intake of total dietary fiber (separately for soluble and insoluble fiber) and CRP concentrations in both cross-sectional and longitudinal analyses. The likelihood of elevated CRP concentrations was 63% lower (OR: 0.37; 95% CI: 0.16, 0.87) in participants in the highest quartile of total fiber intake than in participants in the lowest quartile. CONCLUSIONS: Our results suggest that dietary fiber is protective against high CRP, which supports current recommendations for a diet high in fiber.

Methodology for adding glycemic index and glycemic load values to 24-hour dietary recall database.

OBJECTIVES: We describe a method of adding the glycemic index (GI) and glycemic load (GL) values to the nutrient database of the 24-hour dietary recall interview (24HR), a widely used dietary assessment. We also calculated daily GI and GL values from the 24HR. METHODS: Subjects were 641 healthy adults from central Massachusetts who completed 9067 24HRs. The 24HR-derived food data were matched to the International Table of Glycemic Index and Glycemic Load Values. The GI values for specific foods not in the table were estimated against similar foods according to physical and chemical factors that determine GI. Mixed foods were disaggregated into individual ingredients. RESULTS: Of 1261 carbohydrate-containing foods in the database, GI values of 602 foods were obtained from a direct match (47.7%), accounting for 22.36% of dietary carbohydrate. GI values from 656 foods (52.1%) were estimated, contributing to 77.64% of dietary carbohydrate. The GI values from three unknown foods (0.2%) could not be assigned. The average daily GI was 84 (SD 5.1, white bread as referent) and the average GL was 196 (SD 63). CONCLUSION: Using this methodology for adding GI and GL values to nutrient databases, it is possible to assess associations between GI and/or GL and body weight and chronic disease outcomes (diabetes, cancer, heart disease). This method can be used in clinical and survey research settings where 24HRs are a practical means for assessing diet. The implications for using this methodology compel a broader evaluation of diet with disease outcomes.