Nutrition management guideline for very-long chain acyl-CoA dehydrogenase deficiency (VLCAD): An evidence- and consensus-based approach.

The nutrition management guideline for very-long chain acyl-CoA dehydrogenase deficiency (VLCAD) is the fourth in a series of web-based guidelines focusing on the diet treatment for inherited metabolic disorders and follows previous publication of guidelines for maple syrup urine disease (2014), phenylketonuria (2016) and propionic acidemia (2019). The purpose of this guideline is to establish harmonization in the treatment and monitoring of individuals with VLCAD of all ages in order to improve clinical outcomes. Six research questions were identified to support guideline development on: nutrition recommendations for the healthy individual, illness management, supplementation, monitoring, physical activity and management during pregnancy. This report describes the methodology used in its development including review, critical appraisal and abstraction of peer-reviewed studies and unpublished practice literature; expert input through two Delphi surveys and a nominal group process; and external review from metabolic physicians and dietitians. It includes the summary statements of the nutrition management recommendations for each research question, followed by a standardized rating based on the strength of the evidence. Online, open access of the full published guideline allows utilization by health care providers, researchers and collaborators who advise, advocate and care for individuals with VLCAD and their families and can be accessed from the Genetic Metabolic Dietitians International (https://GMDI.org) and Southeast Regional Genetics Network (https://southeastgenetics.org/ngp) websites.

Are end-of-life patient education materials readable?

Although established guidelines for developing low-literacy patient education materials are available, poorly designed material continue to be disseminated. We evaluated the readability and layout of English-language end-of-life patient education materials available on the Internet. Internet websites of five national palliative care organizations were searched to identify patient education materials for review. A convenience sample of 15 patient education materials per palliative care organization (n = 75) was downloaded and printed. The Simplified Measure of Gobbledygook (SMOG) was used to calculate the reading grade level (readability) of the text, while the layout features was assessed using criteria from the User-Friendliness Tool (UFT). The reading grade level of patient education materials ranged from 7(th) to 12(th) grade (mean +/- SD = 11.1 +/- 1.9). None of the patient education materials scored high on all UFT criteria. In particular, the greatest need was increasing the amount of white space and improving the way in which information was organized visually. Healthcare providers can only aid in the decision process, patients and their loved ones are ultimately responsible for making these choices. These decisions are important as choices need to be made about end-of-life care while patients are still cognitively able to do so. Well designed end-of-life patient education materials can offer a wealth of knowledge to assist and guide decision making. On the basis of these results, end-of-life patient education materials should be revised so that the average adult is able to understand the message presented, thereby enhancing his/her ability to make informed decisions.

Longitudinal shifts in exercise stages of change in college students.

AIM: The protective health benefits of regular physical activity are well established. To date, few studies have assessed the prevalence of exercise behavior and factors influencing exercise adoption and maintenance among college students. The purpose of this study was to examine the relationship of exercise self-efficacy, social support, and sedentary behavior and longitudinal shifts in stage of exercise behavior change among a sample of college students without intervention. METHODS: A cross-sectional design was used to examine demographic characteristics, stage of exercise behavior change, exercise self-efficacy, social support (family and friend) and sedentary behavior. One hundred and sixty-one students at a large Midwestern university completed a valid and reliable written mailed questionnaire during baseline assessment and again 6 months later (follow-up). RESULTS: Changes in exercise self-efficacy, social support, and sedentary behavior were not observed among students who maintained their stage of exercise behavior change from baseline to follow-up. Exercise relapsers experienced significant decreases in exercise self-efficacy and peer social support from baseline to follow-up. CONCLUSION: These findings have important implications for further research on exercise adoption and maintenance among college students. From an applied perspective, it would be valuable for the practitioner to understand that different predictors are likely to influence exercise adoption and relapse.

Application of the Transtheoretical Model to physically active adults.

BACKGROUND: A physically activity lifestyle has established health benefits, but interventions to increase exercise adherence have had mixed success. Examining physically active individuals could provide insight into strategies that are effective for exercise maintenance. The purpose of this study was to compare active adults based on exercise stage classification [action (ACT) and maintenance (MT)] according to the Transtheoretical Model (TTM). Physiological and psychosocial differences between stages were hypothesized to be consistent with theory and previous research. METHODS: A cross-sectional design was used to examine components of the TTM, exercise behavior, resting cardiovascular variables, and VO(peak). Data from 57 physically active college students (age= 21.2 +/- 3.7 yrs, 67% female, 71.9% Caucasian) were included in the analysis. TTM variables and self-report of behavior were measured with established questionnaires. VO(peak) was determined from expired gases during a maximal exercise test. RESULTS: Volume of weekly exercise and number of months consistently active were significantly greater for MT (n=35) than for ACT (n=22). When controlling for gender effects, VO(peak) and systolic blood pressure were also greater in MT than ACT. MT also scored higher than ACT on decisional balance (pros-cons of exercise) and 4 processes of change. CONCLUSIONS: Membership in MT and ACT stages was corroborated by aerobic capacity. Predicted differences in TTM components were only partially supported, but behavioral strategies were used more by participants who were consistently active longer. Physically active individuals should be studied over time to determine if targeting behavioral processes of change will enhance long-term exercise adherence.

Characteristics of exercise behavior among college students: application of social cognitive theory to predicting stage of change.

BACKGROUND: Young adulthood is characterized by a steep decline in the level of physical activity, but few theory-based studies have examined characteristics associated with regular exercise in this population. This study applied Social Cognitive Theory (SCT) and the Stages of Change Model (SCM) to determine personal, behavioral, and environmental characteristics associated with exercise behavior and intentions among undergraduate university students. METHODS: A random sample of 937 undergraduate students (mean age 22.0 +/- 5.6 years; 84.7% ages 17-24 years) enrolled at a large Midwestern university completed a mailed questionnaire. Valid and reliable instruments were used to measure personal, behavioral, and environmental variables based on the SCT that were hypothesized to influence stage of exercise behavior change. Multivariate discriminant analysis was used to determine associations among these variables with stage of exercise behavior change. RESULTS: Exercise self-efficacy, physical activity history, and nonexercise estimation of aerobic capacity were significant predictors of the stage of exercise behavior change for both males and females. Among females, exercise self-efficacy (P < 0.001) and family social support (P < 0. 001) for physical activity were the best predictors of stage of exercise behavior change. Friend social support (P < 0.001), physical activity history (P < 0.001), and exercise self-efficacy (P < 0.001) were significant predictors of stage of exercise behavior change among males. CONCLUSIONS: The SCT framework predicted stage of exercise behavior change as defined by the SCM. Exercise self-efficacy was associated with exercise stage, but the source of significant social support (family versus friends) was different for males and females.

Sexual behavior and sexually transmitted diseases among male adolescents in detention.

BACKGROUND: Youth in detention represent a medically underserved population at risk for a variety of medical and emotional disorders. GOAL OF THE STUDY: To determine prevalence of STDs and high-risk sexual behaviors for HIV/STD among adolescent males admitted to a juvenile detention facility. STUDY DESIGN: Cross-sectional study of behavioral risk factors and STD prevalence among detained males, 11 to 18 years of age. Study subjects were interviewed for behavioral history and screened for STD. RESULTS: The median number of lifetime partners of the population was 8 (range 1-100), the number of partners in the preceding 4 months was 2 in median (range 0-30), 59% used a condom with their last sex, and consistent condom use in the past 4 months was reported by 37%. A history of sexual intercourse within the last one week was reported by 43%. Chlamydia trachomatis infection rate was 6.9% (66/957), Neisseria gonorrhoeae 4.5% (42/940) and syphilis 0.9% (8/930) including one who seroconverted while in detention. Overall, 12% (109/908) of subjects tested for all three infections were positive for at least one STD. Stepwise logistic regression analysis showed that greater than one partner in the previous 4 months (OR 1.53, 95% confidence interval [95% CI] 1.18-1.98), inconsistent or no condom use in the preceding 4 months (OR 1.77, 95%CI 1.37-2.28), a history of recent STD (OR 1.80, 95%CI 1.33-2.42) and greater than five lifetime partners (OR 2.03, 95% CI 1.41-2.92) were independent predictors of these STDs in this population. CONCLUSION: Detained juvenile males in our study were at a high-risk for STD/HIV infections and probably form a core group of STD transmitters. Vigorous attempt to reduce STD reservoir and change behavior of juveniles in detention, such as our study subjects, is urgently needed for the control of the STD/HIV infections.