Influence of grit on lifestyle factors during the COVID-19 pandemic in a sample of adults in the United States.

The novel coronavirus disease (COVID-19) has profoundly impacted the world, including disruptions in lifestyles to support physical distancing. It is well known that personality plays a role in lifestyle behaviors such that certain traits predict health and well-being. The present study examined the relationship between grit and lifestyle behaviors during the early stages of the COVID-19 pandemic and initial lockdowns in the United States. It was hypothesized that those with more grit would engage in healthier lifestyle behaviors of increased physical activity, less sedentary time, and better eating habits. Using an internet-based survey, data was collected from adults from April 13th to May 4th, 2020. Survey questions focused on demographics, grit, physical activity and sedentary time, and dietary habits. Associations between grit and lifestyle were examined using a combination of hierarchical multiple regression analyses and ANCOVAs. The sample of 888 adults (age: 34.8 ± 14.0) was 74.2% female. Those with higher grit were more physically active, reported less sedentary time, and practiced better dietary habits. Collectively, these findings suggest that grit may help individuals lead a healthier lifestyle during stressful or negative events such as a global pandemic. Future work should examine the role of grit on lifestyle behaviors as the quarantine continues.

Lifestyle in patients at increased risk of colorectal cancer.

BACKGROUND: The present study aimed to assess modifiable risk factors in patients at high risk for colorectal cancer (CRC) and their experience of lifestyle advice. METHODS: A questionnaire study was conducted in high-risk CRC patients attending for surveillance colonoscopy. Current lifestyle behaviours [smoking, alcohol, diet (fruit and vegetables, wholegrains, red meat, processed meat), physical activity and bodyweight] related to CRC were ascertained, and experience on receiving, seeking and desire for advice was queried. RESULTS: In total, 385 study invitations were sent and 208 (54%) questionnaires were returned. The majority of participants (72%) were estimated to have a body mass index beyond the healthy range, 89% achieved a fibre score indicative of a low plant-based diet and 91% reported eating processed meat. Overall, 36% were achieving at least four recommendations and 2% were adhering to all recommendations examined. The main area in which participants reported receiving advice on was body weight (33%) and 31% reported that they had personally sought information on this topic, although the data suggest that 72% of people may benefit from such guidance. Fewer participants reported receiving (18-26%) and seeking (15-17%) dietary advice on fruits, vegetables and wholegrains. Many participants said they would find lifestyle information useful, notably in relation to body fatness (43%) and physical activity (38%). CONCLUSIONS: The development of a process for supporting lifestyle change in this patient group, comprising individuals who are already engaging in positive health practices (regular colonoscopy surveillance), could usefully be identified and tested.

Colorectal adenomas and diabetes: implications for disease prevention.

AIM: This study assessed the baseline type II diabetes mellitus (T2DM) risk status among overweight patients with screen-detected colorectal adenomas and explored the implications of the findings for preventative practice. METHOD: Participants aged between 50 and 74 years (73% of whom were men) were recruited from four Scottish health boards and assessed for diabetes risk. Participants were categorized as at 'high' diabetes risk if glycated haemoglobin (HbA1c) was between 6.0 and 6.4% or fasting plasma glucose (FPG) was between 5.5 and 6.9 mmol/l and as potentially undiagnosed T2DM when HbA1c ≥ 6.5% or FPG ≥ 7 mmol/l. Secondary outcome measures included anthropometric measurements, blood pressure and the plasma lipid profile. The tests were repeated at 12 months and diabetes risk categories were reassessed following intervention procedures. RESULTS: Forty-seven (14.3%) of the 329 participants had a preexisting diagnosis of T2DM. Of the remainder with complete biochemistry results (n = 250), 19 (7.6%) were classified as having potentially undiagnosed T2DM and 125 (50.0%) as being at high risk of developing diabetes. More than a quarter of participants in all categories had raised waist circumference, hypertension and plasma lipids, indicative of raised cardiovascular risk. At 12 months' follow-up, the diabetes risk category diminished in 20% of the intervention group vs 11% in the controls [OR 2.26 (95% CI 1.03-4.96)]. CONCLUSION: Our results suggest that a diagnosis of adenoma in overweight patients provides a health service opportunity for diabetes assessment, prevention and management in a high-risk population at a potentially teachable moment.

Obesity and lifestyle advice in colorectal cancer survivors - how well are clinicians prepared?

AIM: This study aimed to assess colorectal clinicians' knowledge and understanding about the risks and benefits of weight management, to document current practice and to identify perceived barriers to providing lifestyle advice to colorectal cancer survivors. METHOD: Questionnaires were sent to 768 clinicians (doctors and nurses) working in colorectal cancer, identified from professional databases. These data were complemented by in-depth interviews exploring opportunities for and barriers to giving lifestyle advice. RESULTS: A total of 323 replies were received (42% response rate) and 20 respondents completed in-depth interviews. Half (52%) reported that they were familiar with guidance for lifestyle advice for cancer survivors. Most (77%) thought reducing weight was important for improving the health of those who were overweight and 75% thought it appropriate to offer lifestyle advice to people with body mass index over 30 kg/m(2) . Half (50%) reported that weight reduction was an important service priority for normal clinical practice. Half (50%) of respondents said that they would value additional training in this area. Interview data revealed that current practice is influenced by the lack of evidence for the impact of weight management and a belief that 'weight gain is good and weight loss bad' in the cancer setting. Patient sensitivity, time available, role constraints and lack of skills in weight management were also factors. CONCLUSION: There is an awareness of the importance of weight management amongst colorectal cancer clinicians and some indication of advice being provided. However, current perceptions, knowledge and skills suggest scope for further training.

Obesity management--an opportunity for cancer prevention.

There is increasing evidence of an association between obesity and the development, morbidity and mortality of cancers of the colorectum, (post menopausal) breast, endometrium, kidney, pancreas and oesophagus. In addition to obesity per se, waist circumference is now emerging as a clear indicator of disease risk. Weight gain during adult life also appears to increase risk for breast and colon cancers. Major causative factors which are influenced by excess energy storage include hormones involved in metabolic control (insulin and leptin), cell growth (IGF-I and IGF-binding proteins) and reproduction (steroids and leptin). In addition, raised oestrogens are likely to contribute to the greater risk of breast and endometrial cancers. In cancer survivors, there are also strong indications that being overweight increases the risk for recurrence and reduces the likelihood of survival. Whilst there are no robust data testing the effect of weight loss on recurrence, current guidance highlights that normal weight, overweight and obese patients should avoid weight gain and that a modest weight loss of 5-10% is likely to have significant health benefits. Two studies have now reported long-term effects of obesity surgery on cancer risk (in addition to reducing metabolic disorders and type 2 diabetes). It is becoming increasingly clear that multi-disciplinary groups (including surgeons) are needed to identify, monitor and evaluate programmes for both obesity prevention and management.

Diet and physical activity in patients with colorectal adenomas: directions for intervention programmes.

BACKGROUND: Screening programmes provide an opportunity to combine early detection programmes with prevention strategies for chronic disease risk reduction. The aim of the current exploratory research was to identify diet and activity habits in adults diagnosed with colorectal adenomas on screening colonoscopy in order to inform the development of an intervention study in this patient group. METHODS: Participants were recruited from colonoscopy clinics and completed a 7-day food diary and physical activity record. RESULTS: Valid food diaries were completed by 32 participants. Mean daily intake of nonstarch polysaccharide was estimated at 14.2 (SD 4.2) g per day and fruit and vegetable intake (FVI) at 3.6 (SD 1.9) portions. The highest quartile of FVI consumers reported greater consumption of fruit (on any occasion) and vegetables (at evening meal) compared with low FVI consumers. Physical activity records (n = 36) indicated that walking was the most common method of activity with few indications of leisure time sport. Overall, 37% of participants failed to meet minimum recommend activity levels. CONCLUSION: The magnitudes of change in activity and diet required to conform with current guidelines were estimated. Food habits that were pertinent to the population were identified and help to provide goal-based guidance for intervention design.

Comprehensive scheme for detection of ventricular fibrillation for implantable cardioverter defibrillators.

Implantable cardioverter defibrillators (ICDs) detect and defibrillate ventricular fibrillation (VF) and ventricular tachycardia (VT). Other therapies which use less energy are also available to terminate VT. Previous studies have shown that ICD rate schemes often misdiagnose VT as VF. In this study, an improved VF classification scheme was designed and tested, which employs the classic rate criteria plus paired signal concordance (PSC); PSC uniquely detects VF where VT and VF rates overlap (220-340 ms). Two signals from a bipolar pair (1 cm) recorded in a unipolar sense exhibit similar signal shape for concordant rhythms, such as sinus rhythm and VT, and disconcordance for VF. Once the rate criterion is met, PSC is measured by the peak normalized cross-correlation coefficient calculated over the depolarization. Variability, measured by a modified range, determined the contextual diagnosis over a passage. Sinus rhythm (20), VT (12), VF (22), atrial fibrillation (10), sinus rhythm with ventricular premature depolarizations (7), and polymorphic VT (4) passages were recorded from 38 patients. Rate-PSC was tested with unfiltered, digitized signals (1-500 Hz, 1,000 samples per second) and with filtered, downsampled signals (1-50 Hz, 100 samples per second). Sensitivity values, or percentage of correct VF detection, and specificity values, or detection of all other rhythms, were generated and compared with simulations of three commercial ICDs programmed to similar settings as rate-PSC and to nominal settings. The sensitivity values for rate-PSC with unfiltered and with filtered signals and for ICDs with 220 ms and with nominal settings were 100%, 100%, 48-80%, and 100%, respectively; the corresponding specificity values were 95%, 83%, 93%, and 7-13%, respectively. It was concluded that the rate-PSC scheme was able to reliably separate VF from other rhythms, even rhythms that have a variable morphology or variable rate. With the confidence of accurate VF detection, use of low-energy therapies for non-VF rhythms will increase device longevity and enhance patient comfort.

Augmented two-channel arrhythmia detection: an efficient diagnostic method for implantable devices.

ICDs are highly effective in preventing sudden cardiac death. However, inappropriate device shocks caused by false-positive diagnoses are estimated to happen in 20% of all patients. The need for implantable electrical devices to detect with precision arrhythmias requiring therapy has spawned a variety of proposals for better means of tachycardia identification. To address this problem, the augmented two-channel arrhythmia detection (A2CAD) algorithm, a real-time scheme utilizing timing and morphology from both the atrial and ventricular channels, is introduced. The algorithm uses rate detection as a first stage and augments this with morphological signal analysis in rhythms that confound the rate only diagnoses. The software executes in real-time (online), and has been tested on 60 passages of two-channel intracardiac signals. The following arrhythmias constituted the test set: 10 AF and/or atrial flutter; 15 SVT; 16 VT; 10 ventricular flutter or VF; 5 sinus tachycardia; and 4 cases of AF concurrent with VF. Results from 60 patient cases indicate 57 (95%) of 60 success rate for A2CAD, validating its potential for implementation in future implantable devices.

Hepatitis A seroprevalence in homosexual and heterosexual men.

OBJECTIVE: To determine the seroprevalence of hepatitis A antibodies in homosexual and heterosexual males attending a genitourinary medicine (GUM) clinic. DESIGN: Prospective study of male patients recruited from a GUM clinic during a 10 week period in 1993. SETTING: Central London outpatient GUM department at Chelsea and Westminster Hospital. SUBJECTS: 255 patients were recruited, comprising 185 homosexual and 70 heterosexual males. Ninety two men were known to be HIV-positive, of whom 89 were homosexual. MAIN OUTCOME MEASURES: Serum samples were screened for both IgM and IgG antibodies to hepatitis A by enzyme linked immunoassay. Results were matched to an anonymously completed questionnaire. RESULTS: 81 of the 255 subjects (31.8%) had been exposed to hepatitis A, two of whom were IgM positive. There were similar hepatitis A seroprevalence rates in homosexual (32.4%) and heterosexual men (30.0%). Although 48.1% of the homosexual men were known to be HIV-positive, compared with 4.3% of the heterosexuals. Hepatitis A seroprevalence remained comparable in both groups after patients with known HIV infection were excluded from the analysis. 11.4% of the heterosexual men admitted to oral-anal sexual contact compared with 62.2% of the homosexual men. This sexual practice was not associated with antibodies or a past history of hepatitis A exposure. CONCLUSIONS: There was no detectable difference in hepatitis A seroprevalence between male homosexual and heterosexual GUM clinic attenders, despite a much higher level of oral-anal sexual activity among the homosexual population.

Tachycardia detection by antitachycardia devices: present limitations and future strategies.

Early experience with three generations of implantable devices has demonstrated the need to further refine the accuracy of automated rhythm analysis. Although initial experience with commercially utilized morphological waveform analysis has been disappointing, other time and frequency domain electrogram features have been developed and show potential promise for future devices. While single chamber algorithms for rate and rate variations have theoretical appeal because of their limited power demands, practical experience has demonstrated that inaccurate arrhythmia diagnosis continues to occur by antitachycardia devices that utilize them. Technological advancement in hardware manufacturing and the design of increasingly more efficient software algorithms for tachycardia detection will continue to yield lower power digital circuitry, to increase device battery power and life, and to permit more and more accurate automated arrhythmia diagnosis and treatment by antitachycardia devices. Two chamber sensing has been available for decades in dual chamber antibradycardia pacemakers. The introduction of this technology into antitachycardia devices is not only inevitable but should dramatically improve the precision of diagnosis in future generation devices.

Automated analysis of spontaneously occurring arrhythmias by implantable devices. Limitations of using rate and timing features alone.

Real-time automated systems for arrhythmia analysis by implantable antitachycardia devices have been designed to incorporate two-channel rate criteria with intracavitary atrial and ventricular electrogram morphology. Because the power requirements for morphologic analysis substantially limit antitachycardia device longevity, the authors sought to develop an alternative algorithm that relies solely on rate and three newly developed timing features: onset (median ventricular rate filtering to detect abrupt onset), loss of atrioventricular (AV) sequency (premature ventricular depolarizations), and regularity-multiplicity (minimal median cycle length variation concurrent with integral [n:1] AV periodicity). This system was assessed using spontaneously occurring arrhythmias in patients undergoing electrophysiology studies. Electrograms were captured on FM tape (1-500 Hz) using biopolar catheters in the high right atrium and the left ventricular apex. In 11 patients, 25 distinct arrhythmias were analyzed, which included sinus tachycardia (ST) (1 passage), supraventricular tachycardia (SVT) (6 passages), ventricular tachycardia (VT) with concurrent sinus rhythm (16 passages), VT with concurrent atrial flutter (VT/AFl) (2 passages), and ventricular fibrillation (VF) (1 passage). The algorithm correctly diagnosed 1 of 1 episode of ST, 4 of 6 episodes of SVT, 15 of 16 episodes of VT with concurrent sinus rhythm, 0 of 2 episodes of VT/AFl, and 1 of 1 episode of VF. Ventricular tachycardia episodes were misdiagnosed as SVT because of absence of loss of AV sequency in VT onset (1 episode), presence of multiplicity between VT and AFl (1 episode), and absence of VT regularity during AFl (1 episode).(ABSTRACT TRUNCATED AT 250 WORDS)

Partner sensitivity to communication behavior of young children with developmental disabilities.

Aspects of partner sensitivity to communication behaviors of 24 presymbolic children with developmental disabilities were examined. The children were grouped according to their movement abilities (normal vs. abnormal patterns) and communication status (intentional vs. preintentional). Participating communication partners were those with whom the children interacted on a regular basis and included their mothers, early childhood special educators, and speech-language pathologists. Procedures were developed whereby the partners served as informants in order to provide information regarding (a) recognition of the children's communicative cues and (b) consistency of cue recognition and descriptions across partners. Results indicated wide individual variability in the partners' basic recognition abilities as well as their consistency with each other. Further, the observed variations could not be attributed to the children's movement and communication abilities. It was concluded that sensitivity, as measured in the present investigation, was highly partner-child specific, with some children likely to be exposed to more optimal interactions than others.

Latent sensitisation to respiratory syncytial virus during acute bronchiolitis and lung function after recovery.

To determine whether latent sensitivity to respiratory syncytial virus antigen(s) occurs after infection, 27 infants with acute bronchiolitis were studied and compared with 15 hospital controls. Blood was collected for whole blood challenge, and histamine release was measured by a high performance liquid chromatography technique with fluorometric detection. There was a significantly greater histamine release to respiratory syncytial virus antigen(s) in those with bronchiolitis than in controls, expressed either in amount (median 154 nmol/l compared with 104 nmol/l) or percentage release (median 20% compared with 3%). There was a significant difference between index and control groups in terms of individual histamine responses. These findings strongly suggest that infants develop latent sensitivity to respiratory syncytial virus antigen(s) during the course of acute bronchiolitis. Serial lung function tests were performed in 15 infants. All infants had abnormalities of lung function at some stage, but the small numbers of subjects precluded comparison between 'sensitised' and 'non-sensitised' infants. Further study is indicated to define the relation of latent sensitisation and subsequent bronchial hyper-responsiveness after respiratory syncytial virus infection in infants.

Development of rehab services on a Canadian Indian reserve.

Ten years ago, Kahnawake (Quebec), an Indian reserve of 5300 persons just south of the island of Montreal, had no rehabilitation services. Anyone needing such services had to travel into Montreal. Today, there is new $4.2 million, 43-bed hospital with well-equipped physical and occupational therapy rooms and a number of associated community-based rehabilitation programs. The development of medical and rehabilitation services in this small Indian community was brought about by a number of factors: the farsightedness of several individuals in the medical community, the hard work of the rehabilitation team members and, above all, the significant attitudinal changes in the community itself.