Identification of a PCSK9-LDLR disruptor peptide with in vivo function.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) regulates plasma low-density lipoprotein cholesterol (LDL-C) levels by promoting hepatic LDL receptor (LDLR) degradation. Therapeutic antibodies that disrupt PCSK9-LDLR binding reduce LDL-C concentrations and cardiovascular disease risk. The epidermal growth factor precursor homology domain A (EGF-A) of the LDLR serves as a primary contact with PCSK9 via a flat interface, presenting a challenge for identifying small molecule PCSK9-LDLR disruptors. We employ an affinity-based screen of 1013in vitro-translated macrocyclic peptides to identify high-affinity PCSK9 ligands that utilize a unique, induced-fit pocket and partially disrupt the PCSK9-LDLR interaction. Structure-based design led to molecules with enhanced function and pharmacokinetic properties (e.g., 13PCSK9i). In mice, 13PCSK9i reduces plasma cholesterol levels and increases hepatic LDLR density in a dose-dependent manner. 13PCSK9i functions by a unique, allosteric mechanism and is the smallest molecule identified to date with in vivo PCSK9-LDLR disruptor function.

Intrapersonal and Interpersonal Factors Influencing Physical Activity in Arab Americans.

BACKGROUND: Many Arab Americans do not meet the physical activity (PA) guidelines despite evidence to support health benefits. AIMS: We aimed to investigate the relationships between PA and sample characteristics, intrapersonal factors, and interpersonal factors and examine to what extent these factors influence PA in Arab Americans. A cross-sectional, descriptive-correlational design using a self-administered questionnaire with 140 Arab Americans was used. Spearman ρ correlation was used to assess the associations between PA and sample characteristics, intrapersonal factors, and interpersonal factors. Three simultaneous gamma regression models were used to assess to what extent these factors jointly influenced PA. RESULTS: Most participants (58.6%) reported a high level of PA. Significant positive associations were found between PA and health status, religiosity, and PA self-efficacy (rs = 0.21, P = .019; rs = 0.19, P = .029; and rs = 0.28, P = .003, respectively). Multiple regression models revealed that being employed (model 1: Exp[b] = 1.87, P = .030; Model 3: Exp[b] = 1.77, P = .043) and having chronic conditions (model 1: Exp[b] = 1.88, P = .031; model 2: Exp[b] = 1.96, P = .034; model 3: Exp[b] = 1.91, P = .047) were associated with greater PA, when accounting for other sample characteristics, intrapersonal factors, and interpersonal factors. CONCLUSION: Presence of chronic health conditions and employment status should be considered when promoting PA in Arab Americans. Future research is needed to explore the relationship between religiosity, PA self-efficacy, and PA in this population.

Understanding and effectively addressing disparities in obesity: A systematic review of the psychological determinants of emotional eating behaviours among Black women.

Emotional eating may be a particularly important contributor to differences in body weight and weight loss response to behavioural interventions among non-Hispanic Black women. We performed a systematic review on the impact of psychological factors (stress, anxiety, depression, and discrimination) upon emotional eating and weight among non-Hispanic Black women, applying the Preferred Reporting Items for Systematic Reviews and Meta-analysis for relevant studies. The initial search yielded 4593 articles with 15 accepted for review. Based on this review, there is a suggestion that negative emotions, in particular, perceived stress, may be predictive of emotional eating among non-Hispanic Black women. Results from the only two longitudinal studies identified by the review indicate that stress influences emotional eating, and emotional eating predicts weight gain over time. Findings from this review highlight the need for more studies that examine various negative emotions that may lead to emotional eating and weight gain among non-Hispanic Black women. Findings from this review also highlight the need for more rigorous studies to differentiate the effects of emotional eating from that of the physiologic (ie, activation of the hypothalamic-pituitary axis) responses to stress and its impact on high-risk groups.

The Influence of Chronic Stress and Emotions on Eating Behavior Patterns and Weight among Young African American Women.

This study examines the influence of chronic stress, varied positive and negative emotions on eating behaviors, and weight among 91 community-dwelling African American women 18-40 years old. Study measures include hair cortisol, Differential Emotional Scale IV, Eating Behavior Pattern Questionnaire, demographic form, waist circumference, and Body Mass Index (BMI). Analysis revealed positive emotions of interest (rs = .27, p = .011) and surprise (rs = .23, p = .029) were associated with low fat eating. Negative emotions of anger (rs = .23, p = .035), shyness (rs = .29, p = .006), and guilt (rs = .24, p = .022) were positively associated with emotional eating. Mediation analysis suggests that emotional eating mediates anger (indirect effect = 0.136), shyness (0.144), guilt (0.187), and BMI among young African American women. Chronic stress and positive and negative emotions impact eating behaviors and should be considered for successful weight management among African American women.

Comparing Ketorolac With Ibuprofen for Postoperative Pain: A Randomized Clinical Trial.

OBJECTIVES: The objective of this study was to identify differences in pain perception and satisfaction with pain control in women receiving nonsteroidal anti-inflammatory drugs postoperatively. METHODS: This was a prospective, randomized controlled trial including urogynecology surgical patients. After surgery, all patients were randomized to receive either intravenous (IV) ketorolac or ibuprofen. The patients completed 3 visual analog scales (VAS) assessing pain at rest, pain with ambulation, and satisfaction with pain control. Postoperative opioid use was also measured. RESULTS: A total of 224 patients (112 in each arm) were included. Pain scores (SD) at rest in all patients who received ketorolac versus those who received ibuprofen was 2.30 (2.1) versus 2.68 (2.34) (P = 0.20). Pain scores (SD) with ambulation was 3.94 (2.57) versus 4.16 (2.73) (P = 0.57) in patients who received ketorolac and ibuprofen, respectively. Patients who received ketorolac rated their satisfaction with their pain regimen similarly to those who received ibuprofen (P = 0.50). The average amount (SD) of hydromorphone used in the ketorolac and ibuprofen arm was 3.68 (4.58) mg and 4.04 (4.97) mg, respectively (P = 0.58). A subgroup analysis based on type of surgery showed decreased pain at rest (VAS, 2.77 vs 4.88; P = 0.04) and increased satisfaction (VAS, 1.69 vs 4.67; P = 0.003) in patients who had laparotomy and received ketorolac. CONCLUSIONS: There was no difference in pain and satisfaction with IV ketorolac compared with IV ibuprofen in patients who underwent all modalities of urogynecologic surgery. A subgroup of patients who underwent laparotomy had less pain with ketorolac.

Predictors of Body Image Perception among African American Women.

Obesity is a significant health problem in the US with African American (AA) women having one of the highest prevalence of obesity. Some AA women may equate a larger BMI with a positive body image. The purpose of this cross-sectional descriptive study was to examine the relationship between demographic variables, body image perception, coping behaviors and BMI with a non-probability sample of 191 AA women, 18-40 years old. Participants completed a demographic form and Pulver's Figure Rating Scale (PFRS). Weight and height were measure and body mass index (BMI) calculated. Significant findings show that chronological age, hypertension, cigarette smoking and BMI were positively associated with body image perception. Using regression analysis, hypertension and BMI were predictors of body image perception. The study findings indicate that chronic illness and BMI impact body image perception.

Regional Differences in Body Image Perception Among Young African American Women Living in the United States.

The current study examined regional differences in body image perceptions and body mass index (BMI) among young African American women. Three hundred forty-one African American women, 18 to 40 years old, living in three regions of the United States were recruited. Pulver's Figure Rating scale was used to identify body image perceptions. Weight and height were measured for BMI calculation. Analysis of covariance was used to examine body image perception differences. The sample mean age was 27.8 years and mean BMI was 30.3 kg/m2. Participants' body image perceptions were significantly smaller among participants living in the Northeast compared to the Southeast (mean difference = -0.65, 95% confidence interval [CI] [-1.18, -0.11], p = 0.018) and Midwest (mean difference = -0.64, 95% CI [-1.16, -0.12], p = 0.015). No significant differences in BMI were found among regions (F(8,318) = 1.17, p = 0.314). Clinical implications of these findings are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 57(3), 25-31.].

Refinement of the Beliefs About Personal Weight Survey.

This study tested the revised Beliefs About Personal Weight Survey-2 (BPWS-2) in 200 African American women, 18 to 40 years of age. Confirmatory factor analysis of a priori hypothesized factors resulted in 5 subscales-weight acceptance (8 items); excess weight acknowledgment (5 items); conventional weight regulation (3 items); circumstantial weight regulation (9 items); and weight concern (10 items). The Cronbach α ranged from 0.67 to 0.89. The factors demonstrated patterns of association with eating behavior, body mass index, body image, and psychosocial (depression and perceived stress) variables associated with weight. The BPWS-2 is the first instrument designed to measure beliefs about one's personal weight, thus results make important new contributions to the understanding of weight management.

Effect of Psychosocial Factors on Eating Behaviors and BMI Among African American Women.

Psychosocial stress and negative emotions have been associated with the consumption of highly palatable foods and excess weight. Few studies have examined these variable relationships among young African American women. The purpose of this cross-sectional study was to examine the relationship of perceived stress, depressive symptoms, eating behaviors, and body mass index (BMI) among 191 African American women who were 18 to 40 years old. Multivariate analysis indicated that depressive symptoms had a greater impact on highly palatable eating behaviors compared with perceived stress. This study extends understanding of depressive symptoms on eating behaviors among young African American women.

Characteristics of Providers Performing Urogynecologic Procedures on Medicare Patients 2012-2014.

OBJECTIVE: To analyze the characteristics of providers performing stress urinary incontinence (SUI) and pelvic organ prolapse (POP) procedures in the United States. METHODS: The Centers for Medicare Services public database, released for years 2012 through 2014, was queried for SUI-related and POP-related Healthcare Common Procedure Coding System. Providers were categorized as Female Pelvic Medicine and Reconstructive Surgery (FPMRS) providers and non-FPMRS providers, using a list of FPMRS board-certified providers compiled through the American Board of Medical Subspecialties website. Other physician specialties that submitted SUI and POP procedures claims were tabulated. RESULTS: Six hundred twenty-nine FPMRS and 833 non-FPMRS providers submitted claims for SUI and POP procedures. The SUI procedures claims had the following provider specialty distribution: obstetrics and gynecology (OB/GYN)-FPMRS, 46.7%; urology, 26.3%; OB/GYN, 12.2%; and urology-FPMRS, 13.9%, with the remaining 0.9% being performed by other specialties. The POP procedures had the following specialty distribution: OB/GYN-FPMRS, 63.4%; OB/GYN, 16.7%; urology, 8.3%; and urology-FPMRS, 7.1%, with the remaining 4.5% being performed by other specialties.Provider distribution was compared between transvaginal mesh and sling insertion procedures to transvaginal mesh and sling removal procedures. The FPMRS providers claimed 63.6% of sling and transvaginal mesh insertion procedures and performed 84.9% of mesh and sling removal procedures. CONCLUSIONS: Medicare reimbursement data provides a unique insight into the distribution of provider specialties performing SUI-related and POP-related procedures in the Medicare population. The OB/GYN-FPMRS providers submitted the majority of claims for SUI and POP procedures from 2012 to 2014. The FPMRS providers are also performing the majority of mesh removal procedures.

Increasing Age Is a Risk Factor for Decreased Postpartum Pelvic Floor Strength.

OBJECTIVES: This study aimed to determine factors associated with decreased pelvic floor strength (PFS) after the first vaginal delivery (VD) in a cohort of low-risk women. METHODS: This is a secondary analysis of a prospective study examining the risk of pelvic floor injury in a cohort of primiparous women. All recruited participants underwent an examination, three-dimensional ultrasound and measurement of PFS in the third trimester and repeated at 4 weeks to 6 months postpartum using a perineometer. RESULTS: There were 84 women recruited for the study, and 70 completed the postpartum assessment. Average age was 28.4 years (standard deviation, 4.8). There were 46 (66%) subjects with a VD and 24 (34%) with a cesarean delivery who labored. Decreased PFS was observed more frequently in the VD group compared with the cesarean delivery group (68% vs 42%, P = 0.03).In modified Poisson regression models controlling for mode of delivery and time of postpartum assessment, women who were aged 25 to 29 years (risk ratio = 2.80, 95% confidence interval, 1.03-7.57) and 30 years and older (risk ratio = 2.53, 95% confidence interval, 0.93-6.86) were over 2.5 times more likely to have decreased postpartum PFS compared with women younger than 25 years. CONCLUSIONS: In this population, women aged 25 years and older were more than twice as likely to have a decrease in postpartum PFS.

Beliefs About Personal Weight Among African American Women.

The rate of obesity within the United States is dropping, yet the prevalence of obesity among young African American women continues to increase. This increase, in part, may be attributable to weight beliefs. The relationship between beliefs about personal weight and body mass index (BMI) was examined among 150 African American women, 18 to 40 years of age using weight descriptive characteristics, causal attributions, consequences, and calculated BMI. Key results show that the majority of participants described their weight as attractive, healthy, and normal despite a sample mean BMI in the obese category. Key beliefs about the causes of personal weight that were associated and predictive of BMI were unhealthy eating behaviors, limited physical activity, weight left from pregnancy, and not knowing how to maintain a healthy weight. Beliefs about the consequences of personal weight were not predictive of BMI. A discussion of study findings provides important implications for clinical practice.

Development and Validation of the Beliefs About Personal Weight Survey Among African American Women.

The purpose of this study was to develop the Beliefs about Personal Weight Survey among African American women. Sixty-five items were developed from literature and sample participants to characterize beliefs about personal weight in 3 domains: descriptors, causes, and consequences. The items were administered to 150 community-dwelling African American women, 18 to 40 years old, recruited from 5 sites. Factor analysis supported a 4-factor solution with the following dimensions: overweight acceptance, overweight concern, conventional weight regulation, and circumstantial weight regulation. These factors were significantly associated with weight management behaviors and body mass index. Profile analysis indicated distinct factor belief profiles by 3 weight categories.

Barriers to Global Health Training in Obstetrics and Gynecology.

BACKGROUND: The Lancet Commission on Global Surgery includes obstetrics and gynecology as an area needing international strengthening in low- and middle-income countries. Despite interest, a majority of participants in US residency programs graduate with little exposure to global health or preparation to work abroad. OBJECTIVE: The aim of this study was to determine the level of interest of obstetrics and gynecology (Ob/Gyn) residents in gaining global health training and to identify perceived barriers to receiving training. METHODS: Residents in accredited Ob/Gyn programs were identified using a national residency database. The survey was online and anonymous. FINDINGS: A total of 278 residents completed the survey. A high level of motivation to participate in a global health elective was associated with interests in preparation for future global work, desire for activism in maternal health and social determinants of health, and becoming better informed on global health policy. Eighty-two percent of respondents stated they would participate in a global health curriculum if it were offered, and 54.8% would use their vacation time. There were associations between personal safety, family, lack of resources, and lack of interest from faculty and motivational level as perceived barriers. Eighty-one percent strongly agreed that scheduling conflicts and time constraints pose barriers; more than 80% either agreed or strongly agreed that funding such endeavors and a lack of mentorship are major deterrents to pursuing global health. CONCLUSIONS: Because resident motivation is clearly high and international need persists, we determined that most barriers to training abroad are related to the structure and budget of residency programs.

The significant morbidity of removing pelvic mesh from multiple vaginal compartments.

OBJECTIVE: To investigate perioperative complications of mesh removal performed in the operating room from a single-site, tertiary care center with a large volume of referrals for mesh removal and to compare the morbidity associated with single-compartment mesh removal compared with removal from multiple vaginal compartments. METHODS: A retrospective review was performed on all patients who underwent mesh removal from January 2008 to April 2014. Patients were identified based on Current Procedural Terminology codes for removal of vaginal mesh or sling. Summary statistics were calculated for the patient population. Complications were compared between single-compartment mesh removal surgery and multicompartment mesh removal surgery. A P value of <.05 was considered significant for all analyses. RESULTS: During a 75-month period, a total of 398 procedures were performed for the removal of vaginally placed mesh. A total of 326 (82%) patients underwent single-compartment surgery, 48 (12%) underwent multicompartment surgery, and in 26 (6%), the type of surgery was unclear. The indications for mesh removal included: pain (63%), dyspareunia (57%), mesh exposure (54%), and voiding dysfunction (39%). The mean length of mesh removed was 4 cm (standard deviation±2.8). Those with multicompartment surgery had approximately three times higher estimated blood loss compared with single-compartment surgery (P<.001). The odds of blood transfusion after multicompartment surgery were more than nine times higher than the odds of transfusion after a single-compartment surgery (odds ratio 9.7, 95% confidence interval 2.1-44.6; P<.01). CONCLUSION: Bleeding complications are higher with concomitant removal of mesh from multiple vaginal compartments. LEVEL OF EVIDENCE: III.

Hypertensive symptom representations: a pilot study.

PURPOSE: Approximately 40% of African Americans have hypertension (HTN). Up to 50% of persons with HTN experience symptoms they attribute to HTN. The beliefs African Americans ascribe to their symptoms have not been substantively described in research. Therefore, the purpose of this study was to describe the "representations" (meaning and emotions associated with symptoms) ascribed to hypertensive symptoms. DATA SOURCES: Twenty-six community-dwelling African Americans with hypertensive symptoms were identified from among 51 participants enrolled in a larger HTN study. Participants completed the Symptom Representation Questionnaire for each reported hypertensive symptom. CONCLUSIONS: Twenty-six participants (51%) experienced at least one hypertensive symptom (e.g., headaches, dizziness, vision changes). Participants held neutral scores for the level of distress, and expected duration and consequences of their headaches, dizziness, and vision changes. Participants attributed HTN as a cause of their symptom(s) to a greater degree than HTN treatment. Strong symptom cure/control beliefs were reported among participants with headaches, dizziness, and vision changes. IMPLICATIONS FOR PRACTICE: The study results highlight areas that nurse practitioners should assess with hypertensive patients. Key assessment areas include (a) hypertensive symptom type and frequency; (b) HTN as a cause for symptoms; and (c) beliefs about cure/control of symptoms and patients' corresponding self-management actions.

Toward a Middle-Range Theory of Weight Management.

The authors of this paper present the middle-range theory of weight management that focuses on cultural, environmental, and psychosocial factors that influence behaviors needed for weight control. The theory of weight management was developed deductively from Orem's theory of self-care, a constituent theory within the broader self-care deficit nursing theory and from research literature. Linkages between the conceptual and middle-range theory concepts are illustrated using a substruction model. The development of the theory of weight management serves to build nursing science by integrating extant nursing theory and empirical knowledge. This theory may help predict weight management in populations at risk for obesity-related disorders.

Illness beliefs in African Americans with hypertension.

Guided by Leventhal's common sense model of illness representations, this study examined the relationship between hypertension beliefs and self-care behaviors necessary for blood pressure (BP) control in a sample of 111 community-dwelling African Americans with hypertension. Participants completed the revised Illness Perception Questionnaire, BP Self-Care Scale, and a demographic data sheet, and had BP measured. Analyses revealed that beliefs about the causes of hypertension differed by gender and educational level. Stress-related causal attributions accounted for 34.7% of the variance in hypertension beliefs. Participants who believed stress or external factors caused hypertension were less likely to engage in healthy self-care behaviors (e.g., keeping doctor visits, eating low-salt, low-fat diets). Results suggest that patients who are nonadherent with hypertension self-care recommendations may hold hypertension beliefs that are not consistent with the medically endorsed views of this disease. To more effectively treat and control BP, providers should assess patients' hypertension beliefs.

Teaching robotic surgery skills: comparing the methods of generalists and subspecialists.

BACKGROUND: To compare opinions of general and subspecialty obstetricians and gynecologists regarding teaching robotic surgery (RS) to residents. METHODS: After obtaining IRB approval, 2189 gynecologic surgeons trained on the DaVinci Surgical System® (Intuitive Surgical, Sunnydale, CA) were asked to complete an online survey. Anonymous responses were obtained and compared using the chi-squared test, including opinions on training residents in RS. RESULTS: Of these 303 respondents, 161 practiced general obstetrics and gynecology ('generalists'), and 138 were self-described 'subspecialists' (+/- fellowship training). The majority of subspecialists (82%) taught residents, and 63% allowed resident participation. Only 44% of generalists taught residents, and 36% allowed participation. Regarding ideal RS training time, generalists favored residency (39%), while subspecialists favored fellowship. (46%, P < 0.001) CONCLUSIONS: While many generalists and subspecialists incorporate training residents into their robotic cases, there is still disparity regarding the extent of participation. Standardized training curriculums should be a goal of residencies with RS.