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OBJECTIVES: Hemoglobin (Hgb) is associated with cognitive function, with low and high levels of Hgb leading to impaired cerebral oxygenation and perfusion. Yet, current studies focused on understanding the association between Hgb and cognitive function without consideration for each cognitive domain. Thus, this study aims to identify and visualize potentially interactive associations between Hgb and specific cognitive domains among older adults. METHOD: This is a secondary data analysis using Wave II data from the National Social Life, Health, and Aging Project (NSHAP) and included 1022 older adults aged between 65 and 85 years. The network structure of three different models was estimated to understand the association between specific cognitive domains and Hgb in a mixed graphical model using the R-package 'mgm'. Model 1 did not adjust for any covariates, Model 2 adjusted for age and gender, and Model 3 adjusted for all covariates. RESULTS: Among all cognitive domains, the visuospatial (edge weight = 0.06-0.10) and memory domains (0.04-0.07) were associated with Hgb in all three models Though not present in Model 3, the attention domain was associated with Hgb in Model 1 and Model 2 (0.08-0.11). In addition, the predictability of Hgb was the highest (8.1%) in Model 3. CONCLUSION: Findings from this study suggest that cognition should be considered as a multidimensional construct, and its specific cognitive domain should be carefully assessed and managed in relation to Hgb among older adults.
ABSTRACT
Nicotinamide adenine dinucleotide (NAD)+ serves as a crucial coenzyme in numerous essential biological reactions, and its cellular availability relies on the activity of the nicotinamide phosphoribosyltransferase (NAMPT)-catalyzed salvage pathway. Here we show that treatment with saturated fatty acids activates the NAD+ salvage pathway in hypothalamic astrocytes. Furthermore, inhibition of this pathway mitigates hypothalamic inflammation and attenuates the development of obesity in male mice fed a high-fat diet (HFD). Mechanistically, CD38 functions downstream of the NAD+ salvage pathway in hypothalamic astrocytes burdened with excess fat. The activation of the astrocytic NAMPT-NAD+-CD38 axis in response to fat overload induces proinflammatory responses in the hypothalamus. It also leads to aberrantly activated basal Ca2+ signals and compromised Ca2+ responses to metabolic hormones such as insulin, leptin, and glucagon-like peptide 1, ultimately resulting in dysfunctional hypothalamic astrocytes. Our findings highlight the significant contribution of the hypothalamic astrocytic NAD+ salvage pathway, along with its downstream CD38, to HFD-induced obesity.
Subject(s)
Dietary Fats , NAD , Male , Mice , Animals , NAD/metabolism , Dietary Fats/metabolism , Astrocytes/metabolism , Obesity/metabolism , Hypothalamus/metabolism , Cytokines/metabolismABSTRACT
5´-Adenosine monophosphate (AMP)-activated protein kinase (AMPK), a cellular energy sensor, is an essential enzyme that helps cells maintain stable energy levels during metabolic stress. The hypothalamus is pivotal in regulating energy balance within the body. Certain neurons in the hypothalamus are sensitive to fluctuations in food availability and energy stores, triggering adaptive responses to preserve systemic energy equilibrium. AMPK, expressed in these hypothalamic neurons, is instrumental in these regulatory processes. Hypothalamic AMPK activity is modulated by key metabolic hormones. Anorexigenic hormones, including leptin, insulin, and glucagon-like peptide 1, suppress hypothalamic AMPK activity, whereas the hunger hormone ghrelin activates it. These hormonal influences on hypothalamic AMPK activity are central to their roles in controlling food consumption and energy expenditure. Additionally, hypothalamic AMPK activity responds to variations in glucose concentrations. It becomes active during hypoglycemia but is deactivated when glucose is introduced directly into the hypothalamus. These shifts in AMPK activity within hypothalamic neurons are critical for maintaining glucose balance. Considering the vital function of hypothalamic AMPK in the regulation of overall energy and glucose balance, developing chemical agents that target the hypothalamus to modulate AMPK activity presents a promising therapeutic approach for metabolic conditions such as obesity and type 2 diabetes mellitus.
Subject(s)
AMP-Activated Protein Kinases , Diabetes Mellitus, Type 2 , Humans , AMP-Activated Protein Kinases/metabolism , Diabetes Mellitus, Type 2/metabolism , Hypothalamus/metabolism , Insulin/metabolism , GlucoseABSTRACT
BACKGROUND: Limited research studies have focused on examining the impact of technology-based interventions in changing symptom clusters among Asian American breast cancer survivors. OBJECTIVE: The aim of this study was to understand the longitudinal impact of a technology-based program on the symptom cluster experience of Asian American breast cancer survivors. METHODS: This is a secondary data analysis that used exploratory factor analysis at each time point (baseline, post-1 month, post-3 months) for the control and intervention groups (N = 199). RESULTS: The number of symptom clusters remained the same, and the same symptoms remained in similar clusters across the 2 groups. The control group experienced psychological cluster, fatigue cluster, and neck/skin cluster at baseline; psychological cluster, fatigue/dizzy cluster, and neck/skin cluster at post-1 month; and psychological cluster, fatigue/dizzy cluster, and somatic cluster at post-3 months. The intervention group experienced psychological cluster, neck cluster, and appetite/itching cluster at baseline; somatic/anticholinergic cluster, psychological/sexual cluster, and appetite cluster at post-1 month; and psychological cluster, neck cluster, and itching cluster at post-3 months. The psychological and neck clusters shared similar core symptoms of feeling nervous, dry mouth, and cough between the control and intervention groups. CONCLUSION: The different symptom cluster experiences may be due to the technology-based intervention where the intervention group receives individual/group coaching/support that may have changed symptom clusters over time. Yet, the true efficacy of the intervention on symptom clusters warrants further investigation. IMPLICATIONS FOR PRACTICE: Clinicians should understand the changes in symptom clusters as well as the presence of core symptoms and take a targeted symptom cluster approach in clinical settings.
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Mitochondria function as platforms for bioenergetics, nutrient metabolism, intracellular signaling, innate immunity regulators, and modulators of stem cell activity. Thus, the decline in mitochondrial functions causes or correlates with diabetes mellitus and many aging-related diseases. Upon stress or damage, the mitochondria elicit a series of adaptive responses to overcome stress and restore their structural integrity and functional homeostasis. These adaptive responses to low-level or transient mitochondrial stress promote health and resilience to upcoming stress. Beneficial effects of low-grade mitochondrial stress, termed mitohormesis, have been observed in various organisms, including mammals. Accumulated evidence indicates that treatments boosting mitohormesis have therapeutic potential in various human diseases accompanied by mitochondrial stress. Here, we review multiple cellular signaling pathways and interorgan communication mechanisms through which mitochondrial stress leads to advantageous outcomes. We also discuss the relevance of mitohormesis in obesity, diabetes, metabolic liver disease, aging, and exercise.
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Health Promotion , Metabolic Diseases , Animals , Humans , Mitochondria/metabolism , Aging , Exercise/physiology , Oxidative Stress , MammalsABSTRACT
Older adults oftentimes experience cognitive aging which leads to varying degrees of cognitive impairment. Previous studies have found that racial and ethnic disparities exist in the prevalence and severity of cognitive impairment among older adults. Yet, little is known on the relationship among specific cognitive domains and how this relationship differs between African American and White older adults. This is a secondary data analysis of Wave II (2010-2011) data from the National Social Life, Health, and Aging Project (NSHAP). A total of 2,471 older adults aged between 65 and 85 years old (African American n = 452, White n = 2019) were included. Network analysis was used to visualize and characterize the network structure and to examine network stability. Then, network comparison test was conducted to compare the network properties of the cognitive network structure between African American and White older adults. African American older adults had a lower cognitive function in all cognitive domains than White older adults. While there was no significant difference in global strength, there was a significant difference in the network structure and strength centrality measure between the two groups (p < 0.05). The invariance edge strength test found the language-visuospatial edge to be significantly stronger in African American older adults. Clinicians need to understand the different cognitive function across multiple cognitive domains between African American and White older adults and routinely offer targeted and timely cognitive assessment and management in this population.
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Aging , Cognition , Humans , Aged , Aged, 80 and over , Race Factors , Aging/psychology , Black or African American , WhiteABSTRACT
To identify subgroups of postpartum women with different psychological symptom profiles at 2 and 6 months postpartum and to examine how they transition between symptom profiles over time using latent transition analysis (LTA). We used secondary data from the Family Life Project (N = 1,117) and performed LTA based on observed variables (depression, anxiety, somatization, and hostility). We examined transition probabilities and changes in latent status prevalence from 2 to 6 months postpartum. Considering the known influences of social determinants of health on psychological symptoms, bivariate analyses were conducted to describe the characteristics of different transition patterns. A 3-class model with better fit indices, entropy, and interpretability was selected. Based on symptom severity, the identified profiles were Profile 1: Low, Profile 2: Moderate, and Profile 3: High. From 2 to 6 months postpartum, the prevalence of low symptom profile decreased (82 to 78.2%) while the prevalence increased for moderate (15.8 to 17.5%) and high symptom profiles (2.2 to 4.4%). For all profiles, it was most likely for postpartum women to stay in the same profile from 2 to 6 months (low to low, moderate to moderate, and high to high). Those in persistent or worsening transition patterns were significantly younger or had less social support or education. Postpartum women in moderate or high symptom profiles at 2 months were most likely to stay in the same profile at 6 months postpartum, indicating persistent symptom burden. Clinicians should consider providing early, targeted support to prevent persistent symptom burden.
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Anxiety , Postpartum Period , Female , Humans , Postpartum Period/psychology , Anxiety/epidemiology , Anxiety Disorders/psychology , Mothers/psychologyABSTRACT
BACKGROUND: No studies have explored the internal structure of the 10-item Perceived Stress Scale in patients with high cardiovascular and diabetes risk. OBJECTIVE: We scrutinized the dimensionality of the scale in this patient group using exploratory graph analysis, a technique within the developing field of network psychometrics. METHODS: Analyses were conducted on 200 primary care patients. A bootstrap version of exploratory graph analysis assessed the stability of the dimensions based on structural consistency, item stability, and network loadings. RESULTS: Exploratory graph analysis revealed a 2-dimensional structure; structural consistency of the first dimension was high (0.863), whereas that for the second was low (0.667). Items belonging to the latter dimension did not cluster consistently with each other (ie, low item stability) and were not strongly associated with any particular dimension (ie, weak network loadings). CONCLUSION: Exploratory graph analysis offers unique outputs, making it easy to assess the dimensional integrity of scales. Further research is warranted regarding the second dimension of the Perceived Stress Scale.
Subject(s)
Diabetes Mellitus, Type 2 , Psychological Tests , Self Report , Humans , Psychometrics , Diabetes Mellitus, Type 2/complications , Surveys and Questionnaires , Reproducibility of Results , Factor Analysis, StatisticalABSTRACT
Objectives: This exploratory study aimed to identify the potential non-linear relationship between hemoglobin (Hgb) and cognition among cognitively normal older adults and how this relationship differs in terms of gender in generalized additive models (GAM). Methods: This is a secondary data analysis using Wave II (2010-2011) data from the National Social Life, Health, and Aging Project. A generalized additive model was used to understand the non-linear relationship between Hgb and cognition, and to identify critical Hgb point related to cognition. Results: While both genders had a non-linear association between Hgb and cognition, the degree of non-linearity was more pronounced in male older adults with EDF value close to 2. The inflection point of 15.10 g/dL for male older adults and inflection point of 11.72 g/dL for female older adults were obtained. Conclusion: Further studies are needed to validate these results and develop precision medicine approaches to integrate these results into clinical practice.
Subject(s)
Aging , Cognition , Humans , Male , Female , Aged , HemoglobinsABSTRACT
Introduction: This study aimed to identify the different types of social networks among young-old adults, and to examine the transitions in social networks as they become old-old adults. Methods: This is a secondary data analysis using the longitudinal data (N = 1092) from the National Social Life, Health, and Aging Project. Latent class analysis was conducted to identify optimal number of classes and latent transition analysis was conducted to examine the transition probabilities. Results: Young-old adults in Class 1: family-oriented, social (close, external) transitioned into Class 2: family-oriented, non-social over time. In contrast, young-old adults in Class 2: family-oriented, non-social and Class 3: less family-oriented, social (close) were less likely to transition to another class. Conclusion: Older adults engaged in less social activities over time. Older adults should be encouraged to continue their social engagement with close social network of friends and relatives, and to maintain their relationship with family members.
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Aging , Social Support , Humans , Aged , Family , Friends , Social NetworkingABSTRACT
INTRODUCTION: Little is known on the potential racial differences in latent subgroup membership based on mental health and cognitive symptomatology among older adults. METHODS: This is a secondary data analysis of Wave 2 data from the National Social Life, Health, and Aging Project (N = 1819). Symptoms were depression, anxiety, loneliness, happiness, and cognition. Multiple-group latent class analysis was conducted to identify latent subgroups based on mental health and cognitive symptoms and to compare these differences between race. RESULTS: Class 1: "Severe Cognition & Mild-Moderate Mood Impaired," Class 2: "Moderate Cognition & Mood Impaired," and Class 3: "Mild Cognition Impaired & Healthy Mood" were identified. Black older adults were more likely to be in Class 1 while White older adults were more likely to be in Class 2 and Class 3. DISCUSSION: Clinicians need to provide culturally-sensitive care when assessing and treating symptoms across different racial groups.
ABSTRACT
General anesthesia providing one-lung ventilation (OLV) with double-lumen endotracheal intubation has been considered inevitable for thoracic surgery. However, with the recent trend of less invasive surgical technique and enhanced recovery after surgery, tubeless anesthesia has been performed in various thoracic surgeries. The aim of this study was to establish a feasible and safe strategy of ventilator-assisted tubeless anesthesia in video-assisted thoracoscopic surgeries (VATS) based on single-institution experiences. We retrospectively reviewed the medical records of patients who underwent tubeless VATS from November 2019 to December 2021. Perioperative anesthetic and surgical variables as well as complications were reported. Seventeen patients with a median age of 29 and American Society of Anesthesiologists physical status I to II underwent video-assisted pulmonary wedge resection under monitored anesthesia care (MAC) using propofol and remifentanil. Mechanical ventilation was applied in synchronized intermittent mandatory ventilation with pressure support mode through facemask if respiratory support was required. During the operation, none of the patients showed hypoxemia or involuntary movement interfering operation. No patients were converted to general anesthesia or open thoracotomy unintentionally. All patients were discharged on median 2 days postoperatively without complications. Ventilator-assisted tubeless VATS is a feasible and safe option in low-risk patients undergoing video-assisted pulmonary wedge resection.
Subject(s)
One-Lung Ventilation , Thoracic Surgery, Video-Assisted , Humans , Thoracic Surgery, Video-Assisted/methods , Retrospective Studies , Feasibility Studies , Anesthesia, General/methods , One-Lung Ventilation/methods , Ventilators, MechanicalABSTRACT
One-third of home healthcare patients are hospitalized or visit emergency departments during a 60-day episode of care. Among all risk factors, psychological, cognitive, and behavioral symptoms often remain underdiagnosed or undertreated in older adults. Little is known on subgroups of older adults receiving home healthcare services with similar psychological, cognitive, and behavioral symptom profiles and an at-risk subgroup for future hospitalization and emergency department visits. Our cross-sectional study used data from a large, urban home healthcare organization (n = 87,943). Latent class analysis was conducted to identify meaningful subgroups of older adults based on their distinct psychological, cognitive, and behavioral symptom profiles. Adjusted multiple logistic regression was used to understand the association between the latent subgroup and future hospitalization and emergency department visits. Descriptive and inferential statistics were conducted to describe the individual characteristics and to test for significant differences. The three-class model consisted of Class 1: "Moderate psychological symptoms without behavioral issues," Class 2: "Severe psychological symptoms with behavioral issues," and Class 3: "Mild psychological symptoms without behavioral issues." Compared to Class 3, Class 1 patients had 1.14 higher odds and Class 2 patients had 1.26 higher odds of being hospitalized or visiting emergency departments. Significant differences were found in individual characteristics such as age, gender, race/ethnicity, and insurance. Home healthcare clinicians should consider the different latent subgroups of older adults based on their psychological, cognitive, and behavioral symptoms. In addition, they should provide timely assessment and intervention especially to those at-risk for hospitalization and emergency department visits.
Subject(s)
Emergency Service, Hospital , Hospitalization , Humans , Aged , Latent Class Analysis , Cross-Sectional Studies , Behavioral Symptoms , Cognition , Delivery of Health CareABSTRACT
OBJECTIVE: This study aimed to identify temporal risk factor patterns documented in home health care (HHC) clinical notes and examine their association with hospitalizations or emergency department (ED) visits. MATERIALS AND METHODS: Data for 73 350 episodes of care from one large HHC organization were analyzed using dynamic time warping and hierarchical clustering analysis to identify the temporal patterns of risk factors documented in clinical notes. The Omaha System nursing terminology represented risk factors. First, clinical characteristics were compared between clusters. Next, multivariate logistic regression was used to examine the association between clusters and risk for hospitalizations or ED visits. Omaha System domains corresponding to risk factors were analyzed and described in each cluster. RESULTS: Six temporal clusters emerged, showing different patterns in how risk factors were documented over time. Patients with a steep increase in documented risk factors over time had a 3 times higher likelihood of hospitalization or ED visit than patients with no documented risk factors. Most risk factors belonged to the physiological domain, and only a few were in the environmental domain. DISCUSSION: An analysis of risk factor trajectories reflects a patient's evolving health status during a HHC episode. Using standardized nursing terminology, this study provided new insights into the complex temporal dynamics of HHC, which may lead to improved patient outcomes through better treatment and management plans. CONCLUSION: Incorporating temporal patterns in documented risk factors and their clusters into early warning systems may activate interventions to prevent hospitalizations or ED visits in HHC.
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Home Care Services , Hospitalization , Humans , Risk Factors , Emergency Service, Hospital , Health StatusABSTRACT
BACKGROUND: Emerging research has shown racial and ethnic variations in the magnitude of association between the apolipoprotein É4 (APOE É4) allele and the risk of developing Alzheimer's disease and related dementias (ADRD). Studies researching this association among Hispanic groups within and outside of the United States have produced inconsistent results. OBJECTIVE: To examine the association between the APOE É4 allele and the risk of developing ADRD in global Hispanic populations from different ethnic regions of origin. METHODS: PubMed, Embase, Scopus, and PsycInfo were searched for studies relating to Hispanic/Latin American origin, APOE É4, and ADRD. Odds ratios (OR) of ADRD risk for individuals with APOE É4 versus those without APOE É4 were extracted and calculated using random effects analysis. RESULTS: 20 eligible studies represented Caribbean Hispanic, Mexican, South American, Spanish, and Cuban groups. Overall, APOE É4 was significantly associated with increased risk of ADRD (Odds Ratio [OR] 3.80, 95% CI: 2.38-6.07). The association was only significant in the South American (OR: 4.61, 95% CI: 2.74-7.75) subgroup. CONCLUSION: There was an association between APOE É4 and increased ADRD risk for the South American subgroup. The strength of this association varied across Hispanic subgroups. Data is limited with more studies especially needed for adjusted analysis on Spanish, Central American, Cuban Hispanic, and Caribbean Hispanic groups. Results suggest additional environmental or genetic risk factors are associated with ethnic variations.
Subject(s)
Alzheimer Disease , Apolipoprotein E4 , Dementia , Humans , Alzheimer Disease/genetics , Apolipoprotein E4/genetics , Genotype , Hispanic or Latino/genetics , Racial Groups , Dementia/geneticsABSTRACT
Since the patient's airway is shared between an anesthesiologist and a surgeon, airway management during upper airway surgery can be challenging. Beyond the conventional method of general anesthesia, high-flow nasal oxygenation (HFNO) has recently been used as a key technique for tubeless anesthesia. HFNO provides humidified, heated oxygen up to 70 L/min, which promises improved oxygenation and ventilation, allowing for prolonged apneic oxygenation. In previous physiological and clinical studies, HFNO has been demonstrated that tubeless anesthesia safely provide an uninterrupted surgical field during laryngeal surgeries. Although tubeless anesthesia remains uncommon, it can be a good alternative to conventional anesthesia if an anesthesiologist and a surgeon select appropriate patients together with sufficient experience. A safe strategy for tubeless anesthesia, along with appropriate backup plans, including endotracheal intubation and high-frequency jet ventilation, should be considered for upper airway surgery.
ABSTRACT
Nicotinamide adenine dinucleotide (NAD+) is an essential cofactor of critical enzymes including protein deacetylase sirtuins/SIRTs and its levels in mammalian cells rely on the nicotinamide phosphoribosyltransferase (NAMPT)-mediated salvage pathway. Intracellular NAMPT (iNAMPT) is secreted and found in the blood as extracellular NAMPT (eNAMPT). In the liver, the iNAMPT-NAD+ axis oscillates in a circadian manner and regulates the cellular clockwork. Here we show that the hypothalamic NAD+ levels show a distinct circadian fluctuation with a nocturnal rise in lean mice. This rhythm is in phase with that of plasma eNAMPT levels but not with that of hypothalamic iNAMPT levels. Chemical and genetic blockade of eNAMPT profoundly inhibit the nighttime elevations in hypothalamic NAD+ levels as well as those in locomotor activity (LMA) and energy expenditure (EE). Conversely, elevation of plasma eNAMPT by NAMPT administration increases hypothalamic NAD+ levels and stimulates LMA and EE via the hypothalamic NAD+-SIRT-FOXO1-melanocortin pathway. Notably, obese animals display a markedly blunted circadian oscillation in blood eNAMPT-hypothalamic NAD+-FOXO1 axis as well as LMA and EE. Our findings indicate that the eNAMPT regulation of hypothalamic NAD+ biosynthesis underlies circadian physiology and that this system can be significantly disrupted by obesity.
Subject(s)
Cytokines , NAD , Mice , Animals , NAD/metabolism , Cytokines/metabolism , Liver/metabolism , Energy Metabolism , Circadian Rhythm , Locomotion , Mammals/metabolismABSTRACT
BACKGROUND: Despite the agreement on the significance of the relationship between the C-reactive protein (CRP) and depression, research results have been discrepant by gender. OBJECTIVE: We attempted to address this uncertainty via a generalized additive model and more carefully analyzed the shape of the CRP-depression relationship in terms of sex. METHODS: This is a secondary data analysis using the National Health and Nutrition Examination Survey (2017-2020) data targeting 1,581 obese middle-aged adults (40-70 years, 51.4% women) with CRP ≤ 10 mg/L. The study outcome was depression severity, assessed by the nine-item Patient Health Questionnaire. Several models were built, adjusting for relevant sociodemographic, lifestyle, and clinical covariates. The value of the effective degree of freedom (EDF) quantifies curvature of the relationship. The threshold effect was investigated using a two-piecewise linear regression model, when needed. RESULTS: Among men, an increasing linear pattern was found (EDF ≈ 1). Contrastingly among women, the EDF value was > 2 in all unadjusted and adjusted models, indicating the smooth (curved) association. The threshold level affected the association pattern particularly for women, among whom the depression severity related to CRP significantly increased as the CRP level increased to an inflection point of 3.6 mg/L but decreased thereafter. DISCUSSION: Assuming linearity for the CRP association with depression may not be appropriate for middle-aged obese women. Although we do not claim to provide a definite method of assessing the CRP-depression relationship, we hope to offer a different perspective when exploring this relationship. Thus, the results should be interpreted cautiously, and future studies on this topic should replicate this approach with generalized additive models.
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C-Reactive Protein , Depression , Middle Aged , Male , Adult , Humans , Female , C-Reactive Protein/analysis , Depression/diagnosis , Nutrition Surveys , Cross-Sectional Studies , Obesity/complicationsABSTRACT
The goal of the 8th edition of the Clinical Practice Guidelines for Obesity is to help primary care physician provide safe, effective care to patients with obesity by offering evidence-based recommendations to improve the quality of treatment. The Committee for Clinical Practice Guidelines comprised individuals with multidisciplinary expertise in obesity management. A steering board of seven experts oversaw the entire project. Recommendations were developed as the answers to key questions formulated in patient/problem, intervention, comparison, outcomes (PICO) format. Guidelines underwent multi-level review and cross-checking and received endorsement from relevant scientific societies. This edition of the guidelines includes criteria for diagnosing obesity, abdominal obesity, and metabolic syndrome; evaluation of obesity and its complications; weight loss goals; and treatment options such as diet, exercise, behavioral therapy, pharmacotherapy, and bariatric and metabolic surgery for Korean people with obesity. Compared to the previous edition of the guidelines, the current edition includes five new topics to keep up with the constantly evolving field of obesity: diagnosis of obesity, obesity in women, obesity in patients with mental illness, weight maintenance after weight loss, and the use of information and communication technology-based interventions for obesity treatment. This edition of the guidelines features has improved organization, more clearly linking key questions in PICO format to recommendations and key references. We are confident that these new Clinical Practice Guidelines for Obesity will be a valuable resource for all healthcare professionals as they describe the most current and evidence-based treatment options for obesity in a well-organized format.
ABSTRACT
BACKGROUND: Midlife peri-menopausal and post-menopausal women with metabolic syndrome experience multiple co-occurring symptoms or symptom clusters, which often result in significant symptom cluster burden. While they are a high-risk symptom burden group, there are no studies that have focused on identifying symptom cluster trajectories in midlife peri-menopausal and post-menopausal women with metabolic syndrome. OBJECTIVES: The objectives were to identify meaningful subgroups of midlife peri-menopausal and post-menopausal women with metabolic syndrome based on their distinct symptom cluster burden trajectories, and to describe the demographic, social, and clinical characteristics of different symptom cluster burden subgroups. DESIGN: This is a secondary data analysis using the longitudinal data from Study of Women's Health Across the Nation. METHODS: Multi-trajectory analysis using latent class growth analysis was conducted to join the different developmental trajectories of symptom clusters to identify meaningful subgroups and high-risk subgroup for greater symptom cluster burden over time. Then, descriptive statistics were used to explain the demographic characteristics of each symptom cluster trajectory subgroup, and bivariate analysis to examine the association between each symptom cluster trajectory subgroup and demographic characteristics. RESULTS: A total of four classes were identified: Class 1 (low symptom cluster burden), Classes 2 and 3 (moderate symptom cluster burden), and Class 4 (high symptom cluster burden). Social support was a significant predictor of high symptom cluster burden subgroup and highlights the need to provide routine assessment. CONCLUSION: An understanding and appreciation for the different symptom cluster trajectory subgroups and their dynamic nature will assist clinicians to offer targeted and routine symptom cluster assessment and management in clinical settings.