Health behaviors of minority childhood cancer survivors.

BACKGROUND: Available data have suggested that childhood cancer survivors (CCSs) are comparable to the general population with regard to many lifestyle parameters. However, to the authors' knowledge, little is known regarding minority CCSs. This cross-sectional study describes and compares the body mass index and health behaviors of African American, Hispanic, and white survivors with each other and with noncancer controls. METHODS: Participants included 452 adult CCSs (150 African American, 152 Hispanic, and 150 white individuals) recruited through 4 childhood cancer treating institutions and 375 ethnically matched noncancer controls (125 in each racial/ethnic group) recruited via targeted digit dial. All participants completed a 2-hour in-person interview. RESULTS: Survivors and noncancer controls reported similar health behaviors. Within survivors, smoking and physical activity were found to be similar across racial/ethnic groups. African American and Hispanic survivors reported lower daily alcohol use compared with white individuals, but consumed unhealthy diets and were more likely to be obese. CONCLUSIONS: This unique study highlights that many minority CCSs exhibit lifestyle profiles that contribute to an increased risk of chronic diseases and late effects. Recommendations for behavior changes must consider the social and cultural context in which minority survivors may live.

Study design and protocol for moving forward: a weight loss intervention trial for African-American breast cancer survivors.

BACKGROUND: Breast cancer survival rates are significantly lower among African-American women compared to white women. In addition, African-American women with breast cancer are more likely than white women to die from co-morbid conditions. Obesity is common among African-American women, and it contributes to breast cancer progression and the development and exacerbation of many weight-related conditions. Intervening upon obesity may decrease breast cancer and all-cause mortality among African-American breast cancer survivors. METHODS/DESIGN: Moving Forward is a weight loss intervention being evaluated in a randomized trial with a projected sample of 240 African American breast cancer survivors. Outcomes include body mass index, body composition, waist:hip ratio, and behavioral, psychosocial and physiological measures. Survivors are randomized to either a 6-month guided weight loss intervention that involves twice weekly classes and text messaging or a self-guided weight loss intervention based on the same materials offered in the guided program. The guided intervention is being conducted in partnership with the Chicago Park District at park facilities in predominantly African-American neighborhoods in Chicago. Recruitment strategies include direct contact to women identified in hospital cancer registries, as well as community-based efforts. Data collection occurs at baseline, post-intervention (6 months) and at a 12-month follow-up. DISCUSSION: This study evaluates a community-based, guided lifestyle intervention designed to improve the health of African-American breast cancer survivors. Few studies have addressed behavioral interventions in this high-risk population. If successful, the intervention may help reduce the risk for breast cancer recurrence, secondary cancers, and co-morbid conditions, as well as improve quality of life. TRIAL REGISTRATION: U.S. Clinicaltrials.gov number: NCT02482506, April 2015.

A randomized trial involving a multifunctional diet reveals systematic lipid remodeling and improvements in cardiometabolic risk factors in middle aged to aged adults.

Background: A multifunctional diet (MFD) combining foods and ingredients with proven functional properties, such as fatty fish and fiber-rich foods, among others, was developed and shown to markedly reduce cardiometabolic risk-associated factors. Objective: Here, we aim at examining metabolic physiological changes associated with these improvements. Methods: Adult overweight individuals without other risk factors were enrolled in an 8-week randomized controlled intervention following a parallel design, with one group (n = 23) following MFD and one group (n = 24) adhering to a control diet (CD) that followed the caloric formula (E%) advised by the Nordic Nutritional Recommendations. Plasma metabolites and lipids were profiled by gas chromatography and ultrahigh performance liquid chromatography/mass spectrometry. Results: Weight loss was similar between groups. The MFD and CD resulted in altered levels of 137 and 78 metabolites, respectively. Out of these, 83 were uniquely altered by the MFD and only 24 by the CD. The MFD-elicited alterations in lipid levels depended on carbon number and degree of unsaturation. Conclusion: An MFD elicits weight loss-independent systematic lipid remodeling, promoting increased circulating levels of long and highly unsaturated lipids. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT02148653?term=NCT02148653&draw=2&rank=1, NCT02148653.

Effect of different types of exercises on psychological and cognitive features in people with Parkinson's disease: A randomized controlled trial.

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative and progressive disease marked by the presence of motor and non-motor symptoms, as psychological and cognitive impairment. Physical exercises have been prescribed as complementary therapy for PD, and the type of intervention and duration of the intervention should be taken into account. OBJECTIVE: We aimed to compare the effect of different exercise modalities (functional mobility, multimodal and cognitive) and length (4 and 8 months) on psychological and cognition in people with PD. This study followed the CONSORT extension for non-pharmacological trials. METHODS: In this randomized controlled trial, we assessed 107 participants between 2011 and 2013. At the end of 3 years, participants with PD (mild to moderate stages) who achieved the criteria were assessed considering 3 different groups of exercise: Multimodal (n=38), Functional Mobility (n=33) and Mental/Leisure (n=36). All 3 interventions were performed for 32 weeks, twice a week, with 60min for each session (64 sessions in total). Psychological and cognitive function were assessed at baseline and after 4 and 8 months. RESULTS: The Functional Mobility and Mental/Leisure training had a potential effect on maintaining cognitive function (executive function, attention and work memory). The Multimodal training did not show a benefit for cognitive features and was not even able to delay the progressive decline in cognitive functions; however, this modality had a positive effect on physical stress after 8 months of exercise. CONCLUSIONS: An intervention that requires high complexity and specific activities, such as locomotor and cognitive exercise, provides a maintenance effect against the degeneration in cognition associated with the progression of PD and thus can delay the progressive decline in cognitive function in PD.

Metabolic Effects of Gastric Bypass Surgery: Is It All About Calories?

Bariatric surgery is an efficient method to induce weight loss and also, frequently, remission of type 2 diabetes (T2D). Unpaired studies have shown bariatric surgery and dietary interventions to differentially affect multiple hormonal and metabolic parameters, suggesting that bariatric surgery causes T2D remission at least partially via unique mechanisms. In the current study, plasma metabolite profiling was conducted in patients with (n = 10) and without T2D (n = 9) subjected to Roux-en-Y gastric bypass surgery (RYGB). Mixed-meal tests were conducted at baseline, after the presurgical very-low-calorie diet (VLCD) intervention, immediately after RYGB, and after a 6-week recovery period. Thereby, we could compare fasted and postprandial metabolic consequences of RYGB and VLCD in the same patients. VLCD yielded a pronounced increase in fasting acylcarnitine levels, whereas RYGB, both immediately and after a recovery period, resulted in a smaller but opposite effect. Furthermore, we observed profound changes in lipid metabolism following VLCD but not in response to RYGB. Most changes previously associated with RYGB were found to be consequences of the presurgical dietary intervention. Overall, our results question previous findings of unique metabolic effects of RYGB and suggest that the effect of RYGB on the metabolite profile is mainly attributed to caloric restriction.

Influence of Parkinson's Disease on Judging Stair Step Height: Exploratory Study.

This study investigated the effects of Parkinson's Disease (PD) on the perceptive judgment of stair step height using both exteroceptive visual and exproprioceptive judgments. We invited 14 individuals with PD and 14 neurologically healthy older adults (OA) to perform perceptual judgment tasks for first step stairway heights of 11 and 20 cm. Initially, participants performed first the exteroceptive visual judgment and then the exproprioceptive judgment in five randomized trials for each stair height. An analysis of variance for the exteroceptive visual judgment revealed no main effects or interaction between PD versus OA groups and height. However, the analysis of variance for exproprioceptive judgment revealed a significant interaction between group and height ( F1,26 = 9.519; p = .005; Pη2 = .268) such that both groups made more errors in exproprioceptive judgment at a height of 11 cm. The OA group made more errors in exproprioceptive judgment for the 20-cm step when compared with the PD group ( p = .016) but the PD group underestimated the step height. We conclude that PD influences exproprioceptive perception of step height and that steps with smaller (vs. larger) heights induce greater exproprioceptive error.

Prevalence and Predictors of Low Serum 25-Hydroxyvitamin D among Female African-American Breast Cancer Survivors.

BACKGROUND: African-American breast cancer survivors commonly demonstrate low serum 25-hydroxyvitamin D (25(OH)D). Decreased cutaneous conversion, high levels of adiposity, and even breast cancer treatment may influence vitamin D status. Previous investigations have analyzed African-American women in aggregate with other breast cancer survivors and have not comprehensively addressed these influential factors. OBJECTIVES: To determine the prevalence of low serum 25(OH)D in an exclusively African-American cohort of female breast cancer survivors with overweight/obesity and to evaluate the role of ultraviolet (UV) light exposure, body composition, and dietary sources of vitamin D on serum 25(OH)D levels. DESIGN: Cross-sectional. PARTICIPANTS: Pre- and postmenopausal African-American breast cancer survivors (n=244) were recruited from various neighborhoods in the city of Chicago, IL, between September 2011 and September 2014 for a larger weight loss trial. MAIN OUTCOME MEASURES: Demographic, clinical, anthropometric (body mass index [calculated as kg/m2], waist circumference, and hip circumference), blood specimen, dietary intake (food frequency questionnaire), and sun behavior data were collected by trained study personnel before trial participation. Dual-energy x-ray absorptiometry was used to quantify adiposity (total, percentage, regional, visceral) and lean mass. Serum 25(OH)D was used as the biomarker reflective of vitamin D status. STATISTICAL ANALYSES: Mean (±standard deviation), frequencies, and multivariate linear regression modeling. RESULTS: The average participant was 57.4 years old (±10.0), 6.9 years (±5.2) from initial breast cancer diagnosis with a body mass index of 36.2 (±6.2). The majority of participants (60%) reported habitual oral vitamin D supplementation with mean intake of 327 IU (±169). Vitamin D deficiency was prevalent in 81% and 43%, when the cut points of the Endocrine Society (<30 ng/mL or <75 nmol/L) and the Institute of Medicine (<20 ng/mL or <50 nmol/L) were applied, respectively. A multivariate model adjusting for age, seasonality of blood draw, total energy intake, use of supplemental vitamin D, darker skin pigmentation, breast cancer stage, and waist-to-hip ratio was able to explain 28.8% of the observed variance in serum 25(OH)D concentrations. No significant associations were detected for body mass index or any dual-energy x-ray absorptiometry measures of body composition. CONCLUSIONS: Considering the number of women who endorsed use of vitamin D supplementation, the prevalence of vitamin D deficiency among these African-American breast cancer survivors was high. Vitamin D supplementation, sun behavior, and waist-to-hip ratio may serve as future points of intervention to improve the vitamin D status of this minority survivor population.

Glutamine-Elicited Secretion of Glucagon-Like Peptide 1 Is Governed by an Activated Glutamate Dehydrogenase.

Glucagon-like peptide 1 (GLP-1), secreted from intestinal L cells, glucose dependently stimulates insulin secretion from ß-cells. This glucose dependence prevents hypoglycemia, rendering GLP-1 analogs a useful and safe treatment modality in type 2 diabetes. Although the amino acid glutamine is a potent elicitor of GLP-1 secretion, the responsible mechanism remains unclear. We investigated how GLP-1 secretion is metabolically coupled in L cells (GLUTag) and in vivo in mice using the insulin-secreting cell line INS-1 832/13 as reference. A membrane-permeable glutamate analog (dimethylglutamate [DMG]), acting downstream of electrogenic transporters, elicited similar alterations in metabolism as glutamine in both cell lines. Both DMG and glutamine alone elicited GLP-1 secretion in GLUTag cells and in vivo, whereas activation of glutamate dehydrogenase (GDH) was required to stimulate insulin secretion from INS-1 832/13 cells. Pharmacological inhibition in vivo of GDH blocked secretion of GLP-1 in response to DMG. In conclusion, our results suggest that nonelectrogenic nutrient uptake and metabolism play an important role in L cell stimulus-secretion coupling. Metabolism of glutamine and related analogs by GDH in the L cell may explain why GLP-1 secretion, but not that of insulin, is activated by these secretagogues in vivo.

Examining the prevalence of metabolic syndrome among overweight/obese African-American breast cancer survivors vs. matched non-cancer controls.

PURPOSE: Metabolic Syndrome (MetS) is more predominant in overweight, obese and minority populations. This study examined the prevalence of MetS in an exclusively African-American (AA) cohort of breast cancer (BC) survivors; an underrepresented group in previous studies demonstrating negative BC outcomes disparities for females with MetS. METHODS: Using a case-control design, overweight/obese AA women with treated Stage I-IIIa BC were matched 1:1 on age, race, sex, and body mass index (BMI) category with non-cancer population controls (n = 444). Three of the following conditions were used to define MetS: HDL cholesterol <50 mg/dL (1.3 mmol/L), serum triglycerides ≥150 mg/dL (1.7 mmol/L), blood glucose ≥100 mg/dL (or on treatment), waist circumference ≥88 cm, or ≥130 mmHg systolic or ≥85 mmHg diastolic blood pressure (or on treatment). Matched-pairs analyses were conducted. RESULTS: For BC cases, most women had self-reported Stage I (n = 76) or Stage II (n = 91) disease and were 6.9 (±5.2) years post-diagnosis. MetS was significantly lower in BC survivors vs. their non-cancer population controls (43.2 vs. 51.4 %, respectively; p < 0.05). The diagnosis of MetS did not differ by BMI stratification. A lower prevalence of ≥2 risk factors (80.2 vs. 85.6 %, p < 0.05) was observed for all cases vs. CONCLUSIONS: While MetS occurred less frequently in our BC cases vs. non-cancer controls, our estimates are nearly two times those reported in other BC survivors, suggesting important racial/ethnic differences. IMPLICATIONS FOR CANCER SURVIVORS: The prognostic implications of MetS among AA BC survivors remain unknown and warrant further investigation.

Efficacy of a Weight Loss Intervention for African American Breast Cancer Survivors.

Purpose African American women with breast cancer have higher cancer-specific and overall mortality rates. Obesity is common among African American women and contributes to breast cancer progression and numerous chronic conditions. Weight loss interventions among breast cancer survivors positively affect weight, behavior, biomarkers, and psychosocial outcomes, yet few target African Americans. This article examines the effects of Moving Forward, a weight loss intervention for African American breast cancer survivors (AABCS) on weight, body composition, and behavior. Patients and Methods Early-stage (I-III) AABCS were randomly assigned to a 6-month interventionist-guided (n = 125) or self-guided (n = 121) weight loss program supporting behavioral changes to promote a 5% weight loss. Anthropometric, body composition, and behavioral data were collected at baseline, postintervention (6 months), and follow-up (12 months). Descriptive statistics and mixed models analyses assessed differences between groups over time. Results Mean (± standard deviation) age, and body mass index were 57.5 (± 10.1) years and 36.1 (± 6.2) kg/m2, respectively, and 82% had stage I or II breast cancer. Both groups lost weight. Mean and percentage of weight loss were greater in the guided versus self-guided group (at 6 months: 3.5 kg v 1.3kg; P < .001; 3.6% v 1.4%; P < .001, respectively; at 12 months: 2.7 kg v 1.6 kg; P < .05; 2.6% v 1.6%; P < .05, respectively); 44% in the guided group and 19% in the self-guided group met the 5% goal. Body composition and behavioral changes were also greater in the interventionist-guided group at both time points. Conclusion The study supports the efficacy of a community-based interventionist-guided weight loss program targeting AABCS. Although mean weight loss did not reach the targeted 5%, the mean loss of > 3% at 6 months is associated with improved health outcomes. Affordable, accessible health promotion programs represent a critical resource for AABCS.

Assessing the prevalence of compromised bone health among overweight and obese African-American breast cancer survivors: a case-control study.

PURPOSE: Osteoporosis increases the risk of fracture and is often considered a late effect of breast cancer treatment. We examined the prevalence of compromised bone health in a sample of exclusively African-American (AA) breast cancer survivors since bone mineral density (BMD) varies by race/ethnicity in healthy populations. METHODS: Using a case-control design, AA women in a weight loss intervention previously diagnosed and treated for stages I-IIIa breast cancer were matched 1:1 on age, race, sex, and BMI with non-cancer population controls (n = 101 pairs) from National Health and Nutrition Examination Survey (NHANES). Questionnaires and dual-energy x-ray absorptiometry (DXA) scanning were completed, and participants were categorized as having normal bone density, low bone mass, or osteoporosis using the World Health Organization (WHO) definition for femoral neck T-scores. RESULTS: The majority of these overweight/obese survivors were 6.6 (±4.7) years post-diagnosis, had stage II (n = 46) or stage III (n = 16) disease, and treated with chemotherapy (76 %), radiation (72 %), and/or adjuvant hormone therapies (45 %). Mean femoral neck BMD was significantly lower in cases vs. matched non-cancer population controls (0.85 ± 0.15 vs. 0.91 ± 0.14 g/cm(2), respectively; p = 0.007). However, the prevalence of low bone mass and osteoporosis was low and did not significantly differ between groups (n = 101 pairs; p = 0.26), even when restricted to those on adjuvant hormone therapies (n = 45 pairs; p = 0.75). Using conditional logistic regression, controlling for dietary factors and education, the odds of developing compromised bone health in AA breast cancer survivors was insignificant (OR 1.5, 95 % CI 0.52, 5.56). CONCLUSIONS: These null case-control findings challenge the clinical assumption that osteoporosis is highly prevalent among all breast cancer survivors, providing foundational evidence to support differences by race/ethnicity and body weight. IMPLICATIONS FOR CANCER SURVIVORS: Routine bone density testing and regular patient-provider dialogue is critical in overweight/obese AA breast cancer survivors to ensure that healthy lifestyle factors (e.g., ideal weight, regular weight-bearing exercises, dietary adequacy of calcium and vitamin D) support optimal skeletal health.

Disease severity affects obstacle crossing in people with Parkinson's disease.

The current study evaluated the effects of disease severity on the control of obstacle crossing in people with idiopathic Parkinson's disease (PD). Forty-five subjects participated in the study, including 15 patients with mild PD (classified as stage 1 to 1.5 of the Hoehn and Yahr Rating Scale), 15 patients with moderate PD (classified as stage 2 to 3 of the Hoehn and Yahr Rating Scale), and 15 neurologically healthy individuals. Groups were matched by sex, age, body mass, and body height. The obstacle crossing task required participants to walk along a pathway and step over an obstacle (half of the knee height, positioned in the middle of the pathway). Patients were tested in a typically medicated state. Kinematic data were recorded using an optoelectronic tridimensional system. The outcome measures included spatiotemporal measures of obstacle avoidance. There were no significant differences between patients with mild PD and healthy individuals. Patients with moderate PD exhibited shorter distances for leading toe clearance and leading foot placement after the obstacle than did healthy individuals. Patients with moderate PD tended to exhibit a lower leading horizontal mean velocity during obstacle crossing than did healthy individuals. We found significant negative relationships between obstacle crossing measures and disease severity (score on the motor section of the Unified Parkinson's Disease Rating Scale). These findings suggest that disease severity affects locomotor behavior during obstacle crossing in PD. Specifically, obstacle avoidance was not affected in the early stages of PD; however, bradykinesia and hypometria influenced obstacle crossing in patients with moderate PD.

Relação entre força isométrica de extensão de joelhos e quadris e o desempenho na virada olímpica do nado livre / Relationship between isometric strength of knee and hip extension and the performance at the flip turn of freestyle

O estudo objetivou verificar a correlação da força isométrica de extensão de joelho e quadris com o desempenho na virada do nado livre. Participaram do estudo 9 nadadores com experiência em competições de natação (idades: 23,11 ± 4,20 anos; estatura: 178 ± 0,05 cm; massa: 77,73 ± 8,56 kg; IMC: 24,46 ± 2,40 kg/m²). Um transdutor de força acoplado ao aparelho leg press horizontal foi usado para determinar a contração voluntária máxima e a taxa de desenvolvimento de força pico em três diferentes ângulos de joelho (78,4 ± 5,9o ; 100,4 ± 5,3o ; 116,2 ± 8,8o ) durante extensão máxima de joelhos e quadris. O desempenho da virada do nado livre foi registrado por videogametria subaquática e analisado por meio do software Kinovea 08.15. Cada nadador realizou três viradas máximas sendo registrado o melhor tempo entre as tentativas. Foram utilizadas média e desvio padrão, ANOVA one-way, correlação de Pearson e α= 0,05. Os resultados indicaram que os maiores ângulos registraram maiores picos de contração voluntária máxima: 2279,14 ± 441,89 N; 4690,98 ± 1148,06 N; 5052,57 ± 1349,92 N e taxa de desenvolvimento de força pico: 18068,33 ± 3238,18 N/s; 24790,11 ± 7214,60 N/s; 25684,88 ± 9366,64 N/s. A correlação foi significativa (r = - 0,74) entre o desempenho da virada do nado livre (1,80 ± 0,14s) e a contração voluntária máxima no maior ângulo. Logo, a capacidade de membros inferiores em produzir força máxima, em ângulos de extensão de joelhos e quadris próximos a 116°, pode ter importante papel no desempenho da virada. Além do mais, essa avaliação pode ser uma ferramenta na avaliação e prescrição de treinamento de viradas...(AU)

The study aimed to assess the correlation between isometric strength of knee and hip extension and the performance at freestyle flip turn. Participated in the study 9 swimmers with experience in swim championships (age: 23.11 ± 4.20 years, height: 178 ± 0.05 cm, weight: 77.73 ± 8.56 kg, BMI: 24.46 ± 2.40 kg/m²) comprised the sample. A transducer unit coupled to the horizontal leg press was used to determine the maximum voluntary contraction and rate of strength development peak at three different angles of knee (78.4 ± 5,9o ; 100.4 ± 5.3o ; 116.2 ± 8.8o ) during maximal knee extension and hip. The freestyle flip turn performance was recorded by an underwater camera and subsequently analyzed by Kinovea 08.15 software. Each swimmer performed three maximal attempts and recorded the best time. Mean, standard deviation, one-way ANOVA, Pearson's correlation and α = 0.05 were used. The results indicated a larger angles recorded highest peaks of maximum voluntary contraction: 2279.14 ± 441.89 N; 4690.98 ± 1148.06 N; 5052.57 ± 1349.92 N and peak rate force development:18068.33 ± 3238.18 N/s, 24790.11 ± 7214.60 N/s, 25684.88 ± 9366.64 N/s. The correlation was significant (r = - 0.74) between the performance at freestyle flip turn (1.80 ± 0,14s) and the maximum voluntary contraction in wider angle. Thus, the ability of the lower limbs to produce maximum force in angles of knee extension and hip near 116°, may play a role in performance at freestyle flip turn. Furthermore, this assessment can be a tool in the evaluation and training of the turning....(AU)

Functional capacity of Brazilian patients with Parkinson's disease (PD): relationship between clinical characteristics and disease severity.

The present study had three objectives: (a) to characterize the functional capacity of patients with PD, (b) to assess the relationship between the physical fitness components of functional capacity with clinical characteristics and disease severity, and (c) to compare the physical fitness components of functional capacity with clinical characteristics according to disease severity. The study included 54 patients with idiopathic PD who were distributed into two groups according to PD severity: unilateral group (n=35); and bilateral group (n=19). All patients underwent psychiatric assessment by means of the Hoehn and Yahr (HY) staging of PD, the Unified Parkinson's Disease Rating Scale (UPDRS), the Hospital Anxiety and Depression Scale (HADS-A and HADS-D, respectively), and The Mini-Mental State Examination (MMSE). The physical fitness components of functional capacity were evaluated over a 2-day period, using recommendations by the American Alliance for Health, Physical Education, Recreation and Dance, and the Berg Balance Scale (BBS). Pearson correlation coefficients and multiple regressions were calculated to test the correlation between functional capacity and clinical characteristics, and to predict clinical scores from physical performance, respectively. Clinical variables and physical component data were compared between groups using analysis of variance to determine the effects of disease severity. Patients with advanced disease showed low levels of functional capacity. Interestingly, patients with good functional capacity in one of the physical fitness components also showed good capacities in the other components. Disease severity is a major factor affecting functional capacity and clinical characteristics. Medical providers should take disease severity into consideration when prescribing physical activity for PD patients, since the relationship between functional capacity and clinical characteristics is dependent on disease severity.

Effects of 6-month, Multimodal Exercise Program on Clinical and Gait Parameters of Patients with Idiopathic Parkinson's Disease: A Pilot Study.

This pilot study aimed to identify the effects of a 6-month, multimodal exercise program on clinical and gait parameters in patients with Parkinson's disease. Two groups of participants were enrolled in the study: Trained Group (TG) and Control Group (CG). Individuals in the TG exercised three times a week for 24 weeks (in a multimodal exercise program), while the CG participants maintained their regular activity level. Participants in both the TG and the CG were assessed at pre- and posttest by clinical rates and the spatiotemporal parameters of self-paced walking. The two groups were not significantly different in demographic, clinical, and gait data at baseline. There were no significant differences between groups for clinical data at posttest. The purposed multimodal exercise program has found improvement in some kinematic gait parameters for the TG. Further study in the form of randomized controlled trial would be required to establish effectiveness of the intervention.

Design and recruitment of the Chicago Healthy Living Study: a study of health behaviors in a diverse cohort of adult childhood cancer survivors.

BACKGROUND: Adult childhood cancer survivors are at higher risk for developing late medical effects related to their cancer treatments. Health-promoting behaviors may reduce the risk of some late effects and the severity of others. This article describes the design and recruitment of the Chicago Healthy Living Study (CHLS), an on-going study designed to examine the health behaviors and body mass index of minority adult childhood cancer survivors compared with nonminority survivors and noncancer controls. METHODS: Survivors are identified by the hospital cancer registries at 5 treating institutions in the Chicago area; then, a multilevel recruitment plan will be implemented with the objective of enrolling 450 adult survivors of childhood cancer (150 in each racial/ethnic group). Simultaneously, 375 adult African-American, Hispanic, and non-Hispanic white noncancer controls (125 in each racial/ethnic group) living in the Chicago area will be recruited by using listed, targeted digit dialing. All participants will complete a 2-hour interview of questionnaires related to diet, physical activity, smoking, and associated mediators. Height and weight also will be measured. CONCLUSIONS: The CHLS will provide important information on the health behaviors of adult minority childhood cancer survivors that can be used to inform the development of interventions to improve modifiable risks.

Exercise and cognitive functions in Parkinson's disease: gender differences and disease severity / Exercício físico e funções cognitivas na doença de Parkinson: diferença entre sexos e severidade da doença / El ejercicio y funciones cognitivas en la enfermedad de Parkinson: diferencias entre género y la gravedad de la enfermedad

This study investigated the effect of a multimodal exercise program on executive functions and memory in people with Parkinson's disease, taking into account disease severity and gender. Twenty-three patients with Parkinson's disease (PD) were evaluated before and after a 6-month exercise program to improve executive functions and memory. We observed the effects of the intervention on executive functions (ability to abstract: p = .01), immediate memory (p = .04) and declarative episodic memory (p < .001). Women showed higher scores on declarative episodic memory (p = .03) than men, however there was no interaction between gender and the intervention. Regardless of sex and disease severity, these preliminary results indicate that the multimodal exercise seems to be effective in improving cognitive functions in patients with PD, suggesting that this program can be indicated as a preventive strategy to mitigate progressive cognitive deficits in the later stages of the disease...

"Exercício físico e funções cognitivas na doença de Parkinson: Diferença entre sexos e severidade da doença." Este estudo investigou o efeito de um programa de exercícios multimodal nas funções executivas e na memória de pessoas com doença de Parkinson (DP), considerando gênero e severidade da doença. As funções executivas e a memória de 23 pacientes com DP foram avaliadas antes e após 6-meses de participação no programa de exercícios. Foi observado efeito da intervenção nas funções executivas (habilidade de abstração: p = 0,01), memória imediata (p = 0,04) e memória declarativa episódica (p < 0,001). As mulheres mostraram maior pontuação na memória declarativa episódica (p = 0,03) que os homens, entretanto não foi observada interação entre gênero e intervenção. Estes resultados preliminares indicam que o exercício multimodal parece eficaz em melhorar as funções cognitivas em pacientes com DP, independente do gênero e da severidade da doença, sugerindo que este programa pode ser indicado como estratégia preventiva para atenuar a progressão dos déficits cognitivos nos estágios mais avançados da doença...

"El ejercicio y funciones cognitivas en la enfermedad de Parkinson: Diferencias entre género y la gravedad de la enfermedad." Este estudio investigó el efecto del ejercicio multimodal en las funciones ejecutivas y la memoria en la enfermedad de Parkinson-(EP), teniendo en cuenta el género y la gravedad de la enfermedad. Funciones ejecutivas y memoria de 23-pacientes con EP fueron evaluadas antes y después de 6-meses de participación en el programa. El efecto de la intervención fue observado en las funciones ejecutivas (capacidad de abstracción: p = 0,01), memoria inmediata (p = 0,04) y memoria declarativa episódica (p < 0,001). Las mujeres mostraron puntuaciones más altas en memoria declarativa episódica (p = 0,03) que los hombres, aunque no hubo interacción entre género e intervención. Estos resultados preliminares indican que el ejercicio multimodal parece ser eficaz en la mejora de la función cognitiva en pacientes con EP, independiente del género y de la gravedad de la enfermedad, lo que sugiere que este programa puede ser indicado como una estrategia preventiva para atenuar la progresión de los déficits cognitivos en las etapas tardías de la enfermedad...

Effects of physical exercise on articular range of motion of the lower limb in the Parkinson's disease individuals / Efecto del ejercicio físico en la amplitud del movimiento articular de las extremidades inferiores de individuos con la enfermedad de Parkinson / Efeito do exercício físico na amplitude de movimento articular dos membros inferiores de indivíduos com doença de Parkinson

The aim of this study was to investigate the effect of eight months of a multimodal program of physical exercise on articular range of motion of the lower limb of patients with Parkinson disease (PD), considering gender and disease stage. Seventeen individuals with PD participated in this study. Participants were assessed before of multimodal program of the physical exercise and after four and eight months of physical exercise. In these periods were evaluated the clinical aspects and articular range of motion of the lower limb. For statistical analysis, patients were distributed according to gender and disease stage. A MANOVA considering exercise, gender and stage of disease, with repeated measures for the first factor, was performed. The clinical results showed regression of disease progression, indicating cognitive decline for women. The articular range of motion improved after four and eight months of physical exercise, especially for the hip and ankle, independent of gender and stage of PD. It was concluded that the multimodal exercise program of the eight months was effective in improving articular range of motion in patients with PD. The benefits of exercise for this physical capacity were independent of gender and severity of PD.

El objetivo de este estudio fue verificar el efecto de ocho meses de un programa multimodal de ejercicio físico en la amplitud de movimiento articular de la extremidad inferior de pacientes con enfermedad de Parkinson (EP), considerando género y la etapa de la enfermedad. El estudio incluyó a 17 sujetos con EP idiopática. Los participantes fueron evaluados antes del período de ejecución del programa multimodal de ejercicio físico y tras cuatro y ocho meses de ejercicio físico. Se evaluaron aspectos clínicos y la amplitud de movimiento de las articulaciones de las extremidades inferiores. Para el análisis estadístico, los pacientes fueron agrupados de acuerdo con el género y etapa de la enfermedad, mediante la realización de un MANOVA con factor para ejercicio físico, género y estadio de la enfermedad, con medidas repetidas para el primer factor. Los resultados clínicos mostraron regresión de la progresión de la EP, y el deterioro cognitivo en las mujeres. La amplitud de movimiento articular mejoró tras cuatro y ocho meses de ejercicio físico, especialmente para la cadera y el tobillo, independientemente de su género y etapa de la enfermedad de Parkinson. Se concluyó que el programa multimodal de ejercicio físico de los ocho meses fue eficaz en mejorar la amplitud de movimiento articular en pacientes con EP, y los beneficios independiente del género y la gravedad de la EP.

O objetivo deste estudo foi verificar o efeito de oito meses de um programa multimodal de exercício físico na amplitude de movimento articular do membro inferior de pacientes com doença de Parkinson (DP), considerando gênero e estágio da doença. Participaram deste estudo 17 indivíduos com DP idiopática. Os participantes foram avaliados antes do período da execução do programa multimodal de exercício físico e após quatro e oito meses de exercício físico. Foram avaliados aspectos clínicos e a amplitude de movimento das articulações do membro inferior. Para análise estatística, os pacientes foram agrupados de acordo com gênero e estágio da doença, sendo realizada uma MANOVA com fator para exercício físico, gênero e estágio da doença, com medidas repetidas para o primeiro fator. Os resultados clínicos indicaram regressão da progressão da DP, com declínio cognitivo para as mulheres. A amplitude de movimento articular melhorou após quatro e oito meses de exercício físico, principalmente para o quadril e tornozelo, independente de gênero e estágio da doença de Parkinson. Conclui-se que o programa multimodal de exercício físico de oito meses foi eficiente em melhorar a amplitude de movimento articular de pacientes com DP, sendo os benefícios independentes do gênero e da severidade da DP.

Guía de práctica clínica para el diagnóstico y el tratamiento de las infecciones bacterianas y micóticas en pacientes oncológicos mayores de 15 años con neutropenia febril posquimioterapia de alto riesgo / Recommendations for diagnosis and treatment of bacterial and fungal infections in cancer patients older than 15 years with febrile neutropenia after high-risk chemotherapy: A Clinical Practice Guideline

Objetivos: El tratamiento actual de las neoplasias busca mejorar la sobrevivencia mediante la aplicación de esquemas de quimioterapia intensificada, que produce una neutropenia más profunda y duradera, que favorece el desarrollo de infecciones bacterianas y micóticas invasoras. Este artículo resume las recomendaciones de una guía para el diagnóstico y tratamiento de las infecciones bacterianas y micóticas en pacientes oncológicos mayores de 15 años con neutropenia febril posquimioterapia de alto riesgo. Métodos: Guía de práctica clínica basada en la evidencia. Se realizó la definición de preguntas clínicas, la búsqueda sistemática de literatura, la evaluación crítica de la evidencia y la formulación de recomendaciones. Se desarrolló una evaluación económica sobre la eficiencia de dos esquemas diferentes de tratamiento antimicótico. Resultados: El presente documento incluye recomendaciones para el diagnóstico de infecciones bacterianas y micóticas en paciente con neutropenia, el uso de profilaxis antibiótica y antimicótica, el tratamiento antibiótico empírico, y el tratamiento antimicótico empírico y anticipado en pacientes mayores de 15 años, acorde con la microbiología del contexto colombiano. Conclusiones: La implementación oportuna de las recomendaciones de la guía acorde con el contexto clínico de cada paciente debe contribuir a mejorar la supervivencia y morbilidad infecciosa de los pacientes con neutropenia febril derivada de la quimioterapia.

Objective: Current cancer treatment is intended to improve survival by implementing intensified chemotherapy strategies, which increases the likelihood of neutropenia and favors the development of bacterial and invasive fungal infections. This paper summarizes clinical practice guideline recommendations for the diagnosis and treatment of bacterial and fungal infections in patients older than 15 years with febrile neutropenia after high risk chemotherapy. Methods: Evidence-based clinical practice guideline. A set of clinical questions was defined, a literature search performed, critical appraisal of the evidence, as the development of recommendations. An economic assessment was carried out on two alternative schemes for fungal therapy. Results: This article includes recommendations for the diagnosis of bacterial and fungal infections in neutropenic patients, prophylaxis for bacterial and fungal infections, empiric antimicrobial treatment, empiric and anticipated antifungal therapy in patients over 15 years, according to the microbiology setting in Colombia. Conclusions: Timely implementation of these recommendations according to each clinical context, should contribute to improve survival and reduce infection-derived morbidity in patients with chemotherapy-induced febrile neutropenia.

Efeitos do exercicio agudo sobre biomarcadores sericos de ratos diabeticos / The effects of acute exercise on serum biomarkers in diabetics rats / Efectos del ejercicio agudo sobre biomarcadores de suero em ratones diabeticos

INTRODUÇÃO: As respostas ao exercício agudo dos biomarcadores, como a fosfatase alcalina (FA) e a creatina quinase (CK) séricas têm sido pouco investigadas em ratos diabéticos. OBJETIVOS: Verificar os efeitos do exercício físico aeróbio agudo sobre as concentrações de CK e FA, bem como, avaliar o estado hídrico em ratos diabéticos experimentais. MATERIAIS E MÉTODOS Foram utilizados ratos Wistar machos, adultos jovens, distribuídos em dois grupos: diabéticos (DA) e controles (CA). O diabetes foi induzido por meio da administração de aloxana monoidratado Sigma(r) (32 mg/kg de peso corporal). Duas semanas após confirmação do diabetes, ambos os grupos foram submetidos a uma sessão aguda de natação por 30 min, com carga aeróbia (4,5 % do peso corporal). Foram avaliados: glicose, hematócrito, CK, FA, albumina e a cinética de lactato durante o exercício por meio de coletas 25 µL de sangue da cauda dos animais, nos minutos 0, 10, 20 e 30 de exercício. RESULTADOS: ANOVA de dois fatores para medidas repetidas e o teste post hoc de Tukey apontaram diminuição significativa dos valores de glicemia após o exercício para o grupo DA, aumento significativo de CK pós-exercício para o grupo DA, aumento significativo de hematócrito para ambos os grupos após exercício e manutenção da FA após exercício para o grupo DA. CONCLUSÃO: O exercício agudo aeróbio foi eficiente no controle dos níveis glicêmicos de ratos diabéticos. Entretanto, deve ser aplicado com cautela, pois induziu altos valores de CK, sugerindo possíveis lesões teciduais. .

INTRODUCTION: The responses to acute exercise on biomarkers, such as alkaline phosphatase (ALP) and creatine kinase (CK) serum levels have been little investigated in diabetic rats. OBJECTIVES: To investigate the effects of acute aerobic exercise on the concentrations of CK and ALP as well as evaluating the hydration status in diabetic rats. MATERIALS AND METHODS: Were used male Wistar rats, young adults, divided into two groups: diabetic (DA) and controls (CA). The diabetes was induced in the rats by administration of alloxan monohydrate Sigma(r) (32 mg/kg body weight). Two weeks after confirmation of diabetes, both groups were subjected to an acute swim session for 30 min, with aerobic load (4.5% body weight). Glucose, hematocrit, CK, ALP, albumin and lactate kinetics during exercise were evaluated by collecting 25µL of blood from the tail of the animals in minutes 0, 10, 20 and 30 of exercise. RESULTS: Two-way ANOVA for repeated measures and post hoc Tukey test showed significant decrease of glycemia after exercise for the DA group, significant increase in CK after exercise for the DA group, significant increase in hematocrit for both groups after exercise and maintenance of ALP after exercise for the DA group. CONCLUSION: The acute aerobic exercise was effective in controlling glucose levels in diabetic rats. However, it should be applied with caution, because it induced high CK values, suggesting possible tissue damage. .

INTRODUCCIÓN: Las respuestas al ejercicio agudo de los biomarcadores, como la fosfatasa alcalina (FA) y la creatina quinasa (CK) séricas han sido poco investigadas en ratones diabéticos. OBJETIVOS: Verificar los efectos del ejercicio físico aeróbico agudo sobre las concentraciones de CK y FA, bien como evaluar el estado hídrico en ratones diabéticos experimentales. MATERIALES Y MÉTODOS: Fueron utilizados ratones Wistar machos, adultos jóvenes, distribuidos en dos grupos: diabéticos (DA) y controles (CA). La diabetes fue inducida por medio de la administración de aloxana monohidratado Sigma(r) (32 mg/kg de peso corporal). Dos semanas después de la confirmación de la diabetes, ambos grupos fueron sometidos a una sesión aguda de natación por 30 minutos, con carga aeróbica (4,5% del peso corporal). Fueron evaluados: Glucosa, hematocrito, CK, FA, albumina y La cinética de lactato durante el ejercicio por medio de colectas de 25 µL de sangre de la cola de los animales, en los minutos 0, 10, 20 y 30 de ejercicio. RESULTADOS: ANOVA de dos factores para medidas repetidas y el test post hoc de Tukey apuntaron disminución significativa de los valores de glicemia después del ejercicio para el grupo DA, aumento significativo de CK después del ejercicio para el grupo DA, aumento significativo de hematocrito para ambos grupos después del ejercicio y mantenimiento de la FA después del ejercicio para el grupo DA. CONCLUSIÓN: El ejercicio agudo aeróbico fue eficiente en el control de los niveles glicémicos de ratones diabéticos. Entretanto, debe ser aplicado con cautela, pues indujo altos valores de CK, sugiriendo posibles lesiones tisulares. .