Breast/ovarian cancer genetic counseling: Do anxiety, depression, and health care-related fears influence cancer worry and risk perception?

BACKGROUND: The impact of family and personal cancer history and emotional factors, such as depression and anxiety, on disease representation has received limited attention in studies investigating the development of cancer-related worry and risk perception within the context of genetic counseling. The current study endeavors to fill this gap by exploring the extent to which depression and anxiety influence cancer worry and risk perception, and the role of health care-related fear as potential mediator in this relationship. METHODS: A sample of 178 women who underwent their first genetic counseling for breast/ovarian cancer, 52% of whom had previous cancer diagnoses, completed questionnaires assessing sociodemographic and clinical information, emotional distress in terms of anxiety and depression, cancer-related worry, risk perception, and health care-related fears. RESULTS: Results of mediation analyses showed that cancer-related worry and risk perception increased with rising levels of depression and anxiety, with health care-related fears acting as a mediator in the relationship of depression and anxiety with cancer worry and risk perception. Covariate analysis revealed that previous cancer diagnosis increases cancer-related worry but not risk perception, while the number of family members affected by cancer increases both outcomes. CONCLUSION: These findings emphasize the need for a holistic approach in genetic counseling and have implications for the clinical practice.

Exercise Capacity in Young Adults Born Small for Gestational Age.

Importance: Being born small for gestational age (SGA), approximately 10% of all births, is associated with increased risk of cardiovascular mortality in adulthood, but mechanistic pathways are unclear. Cardiac remodeling and dysfunction occur in fetuses SGA and children born SGA, but it is uncertain whether and how these changes persist into adulthood. Objective: To evaluate baseline cardiac function and structure and exercise capacity in young adults born SGA. Design, Setting, and Participants: This cohort study conducted from January 2015 to January 2018 assessed a perinatal cohort born at a tertiary university hospital in Spain between 1975 and 1995. Participants included 158 randomly selected young adults aged 20 to 40 years born SGA (birth weight below the 10th centile) or with intrauterine growth within standard reference ranges (controls). Participants provided their medical history, filled out questionnaires regarding smoking and physical activity habits, and underwent incremental cardiopulmonary exercise stress testing, cardiac magnetic resonance imaging, and a physical examination, with blood pressure, glucose level, and lipid profile data collected. Exposure: Being born SGA. Main Outcomes and Measures: Cardiac structure and function assessed by cardiac magnetic resonance imaging, including biventricular end-diastolic shape analysis. Exercise capacity assessed by incremental exercise stress testing. Results: This cohort study included 81 adults born SGA (median age at study, 34.4 years [IQR, 30.8-36.7 years]; 43 women [53%]) and 77 control participants (median age at study, 33.7 years [interquartile range (IQR), 31.0-37.1 years]; 33 women [43%]). All participants were of White race/ethnicity and underwent imaging, whereas 127 participants (80% of the cohort; 66 control participants and 61 adults born SGA) completed the exercise test. Cardiac shape analysis showed minor changes at rest in right ventricular geometry (DeLong test z, 2.2098; P = .02) with preserved cardiac function in individuals born SGA. However, compared with controls, adults born SGA had lower exercise capacity, with decreased maximal workload (mean [SD], 180 [62] W vs 214 [60] W; P = .006) and oxygen consumption (median, 26.0 mL/min/kg [IQR, 21.5-33.5 mL/min/kg vs 29.5 mL/min/kg [IQR, 24.0-36.0 mL/min/kg]; P = .02). Exercise capacity was significantly correlated with left ventricular mass (ρ = 0.7934; P < .001). Conclusions and Relevance: This cohort of young adults born SGA had markedly reduced exercise capacity. These results support further research to clarify the causes of impaired exercise capacity and the potential association with increased cardiovascular mortality among adults born SGA.

Emotional overeating questionnaire: a validation study in Italian adults with obesity, overweight or normal weight.

PURPOSE: This study aimed at testing the validity and reliability of the Emotional Overeating Questionnaire (EOQ) in a sample of Italian adults with obesity, overweight or normal weight. MATERIALS AND METHODS: Participants were 314 Italian adults (72.6% females, aged 18-76 years) with obesity (27.4%), overweight (21.3%), or normal weight (51.3%), who completed the EOQ and measures of binge eating, mental well-being, and mindful eating. Retesting was performed 4 weeks later in a randomly selected subsample of 60 participants. Factor structure of the EOQ was estimated by confirmatory factor analysis (CFA). Reliability was tested with McDonald's ω and ordinal α coefficients for internal consistency and Cohen's weighted Kappa coefficient (Kw) for test-retest reliability. RESULTS: Based on CFA, the five negative emotional items formed one factor (EOQ-5) with good reliability (ω = 0.89; ordinal α = 0.88; Kw= 0.71), while the item referring to happiness was dropped. EOQ-5 scores were associated with higher binge eating, lower mental well-being, and lower mindful eating. A cut-off point of two identified individuals at risk for binge eating disorders with 75% sensitivity and 67% specificity. Negative emotional overeating was more frequent in women with obesity than women with normal weight and men with obesity. CONCLUSIONS: EOQ-5 is a valid and reliable tool for measuring the frequency of emotional overeating at the Italian community-level. LEVEL OF EVIDENCE: Level V, cross-sectional, descriptive study.

Effectiveness of a Pulmonary Rehabilitation Program on Persistent Asthma Stratified for Severity.

BACKGROUND: Asthma is defined by airway inflammation associated with various respiratory symptoms, and pharmacologic treatment is based on inhaled corticosteroids and bronchodilators. Physical activity, educational training, nutritional support, and psychological counseling are considered part of non-pharmacologic treatment; however, studies so far have investigated the effect of single non-pharmacologic treatment. There are few studies that demonstrate the effect of comprehensive pulmonary rehabilitation, but no clear data are available regarding factors that can predict who could benefit the most. Our study aimed to assess the effect of a comprehensive 3-week pulmonary rehabilitation program on exercise tolerance and to identify baseline subject characteristics that may predict a better response to treatment. METHODS: This was a retrospective study. A team planned a pulmonary rehabilitation program: educational support; endurance training; and optional components, such as respiratory exercises and airway clearance techniques. The following data were collected before and after pulmonary rehabilitation: subject characteristics, smoking history, asthma severity, respiratory function and 6-min walk test (6MWT). RESULTS: We collected data on 515 subjects (202 males 39.2%), age, mean ± SD 63.9 ± 10.4 y), with 413 (80.2%) having moderate-to-severe disease; and 455 (88.4%) with stable respiratory symptoms 455 (88.35%). At baseline, the percentage of predicted 6MWT in all subjects categorized by the Global Initiative for Asthma (GINA) steps was in the normal range, except for the subjects at step 5, for which it was significantly lower (P = .01). All subjects showed a significant improvement in exercise tolerance and oxygen saturation, together with a decrease in baseline dyspnea, muscle fatigue, and heart rate after pulmonary rehabilitation. Improvement of 6MWT was statistically significant, irrespective of the GINA categorization. The variables related to the improvement in 6MWT were age (P < .001), smoking habit (P = .034), and baseline 6MWT (P < .001). CONCLUSIONS: Subjects with asthma at any GINA step seemed to benefit from a pulmonary rehabilitation program; analysis of our data highlighted that pulmonary rehabilitation was more beneficial in younger subjects with a smoking history and worse baseline exercise tolerance.