Case-series Evaluating a Transdiagnostic Cognitive-behavioral Treatment For Co-occurring Anxiety Disorders.

Background. Patients with anxiety disorder diagnoses commonly have more than one anxiety diagnosis. While cognitive-behavioral interventions have proven efficacy in treating single anxiety disorder diagnoses, there has been little investigation of their efficacy in treating cooccurring anxiety disorders. Aims. To evaluate the efficacy of a transdiagnostic cognitive-behavioral intervention for treating co-occurring anxiety disorders. Methods. An A-B single case study design (N = 6) was used to evaluate the efficacy of a 12 to 13 session modular transdiagnostic cognitive-behavioral intervention for treating co-occurring anxiety disorders across patients with at least two of the following diagnoses: GAD, Social Phobia, Panic Disorder and/or OCD. Results. Five of the six participants completed treatment. At post-treatment assessment the five treatment completers achieved diagnostic and symptomatic change with three participants being diagnosis free. All participants who completed treatment no longer met criteria for any DSM-IV-TR Axis-I diagnosis at the three-month follow-up assessment, and demonstrated reliable and clinically-significant improvements in symptoms. Across the participants, statistically significant improvements from pre- to post-intervention were found on measures of anxiety, depression and general well-being, and all improvements were maintained at three-month follow-up. Conclusions. Results suggest that transdiagnostic cognitive behavioral interventions can be of benefit to patients with co-occurring anxiety disorders

The influence of compression tights on running economy varies by relative intensity

The effect of compression tights on running economy is unclear. The purpose of this investigation was to assess the influence of compression tights on economy. Following an incremental test to exhaustion to determine aerobic capacity (V̇O2max) and peak running speed (vV̇O2max), twenty-six moderately endurance-trained males (28 ± 7 years; 76.1 ± 8.4 kg; V̇O2max = 54.7 ± 4.8 mL·kg−1·min−1) were allocated to either a 60% (n = 8), 62.5% (n = 9) or 65% vV̇O2max group (n = 9) using block randomisation. Participants ran for 15 min at the allocated vV̇O2max with compression tights and a non-compression control condition in a randomised, counter-balanced order, separated by seven days. Oxygen consumption (V̇O2) and expired carbon dioxide (V̇CO2) was measured to determine economy as caloric unit cost. No difference was observed between conditions for the 60% and 62.5% vV̇O2max groups, however economy was improved with compression at 65% vV̇O2max ( P &lt; 0.01). Combined analysis of all participants revealed ΔRE (Δ = control − compression) correlated with relative aerobic capacity (%V̇O2max) ( r = 0.50, P &lt; 0.01) but not running speed ( r = 0.04, P &lt; 0.84). These data suggest that compression tights influence economy at 65% vV̇O2max or at relative exercise intensities of approximately 75–85%V̇O2max. </jats:p

Obese individuals do not underreport dietary intake to a greater extent than nonobese individuals when data are allometrically-scaled

Objective: The aim of this study was to assess the extent of misreporting in obese and non-obese adults on an absolute, ratio-scaled, and allometrically-scaled basis. Method: Self-reported daily energy intake (EI) was compared with total energy expenditure (TEE) in 221 adults (106 male,115 female; age 53±17 years, stature 1.68±0.09 m, mass 79.8±17.2 kg) who participated in a doubly-labelled water (DLW) subsection of 2013-2015 National Diet and Nutrition Survey. Data were log-transformed and expressed as absolute values, according to simple ratio-standards (per kg body mass) and adjusted for body mass allometrically. Absolute and ratio-scaled misreporting were examined using full-factorial General Linear Models with repeated measures of the natural logarithms of TEE or EI as the within-subjects factor. The natural logarithm of body mass was included as a covariate in the allometric method. The categorical variables of gender, age, obesity, and Physical Activity Level (PAL) were the between-factor variables. Results: On an absolute-basis, self-reported EI (2759±590 kcal·d-1) was significantly lower than TEE measured by DLW (2759±590 kcal·d-1: F1,205=598.81,p1.75; F1,205=34.15, p<0.001, ηp2=0.14) and in younger individuals (<55 years; F1,205=14.82,p<0.001,ηp2=0.07), which are all categories with higher energy needs. Ratio-scaling data reduced the effect sizes. Allometric-scaling removed the effect of body mass (F1,205=0.02,p=0.887,ηp2=0.00). Conclusion: In weight-stable adults, obese individuals do not underreport dietary intake to a greater extent than non-obese individuals. These results contradict previous research demonstrating that obesity is associated with a greater degree of underreporting

Four-year longitudinal associations of physical activity, waist circumference, and blood pressure in UK adolescents.

Background This study assessed the specific influence of physical activity (PA) and waist circumference (WC) on the 4-year growth trajectory of blood pressure in UK high-school students. Methods Four-year longitudinal monitoring of 1501 adolescents was conducted as part of the EoEHHS. Measurements were taken in Grades(G)7, 9, and 11. Results Systolic (SBP) and diastolic blood pressure (DBP) increased over the 4-year period (SBP G7 114.6 ± 8.9 mmHg, G9 118.1 ± 9.7 mmHg,G11 122.8 ± 7.8 mmHg; DBP G7 66.7 ± 6.6 mmHg, G9 68.0 ± 6.4 mmHg, G11 70.0 ± 5.2 mmHg). Baseline WC predicted baseline and growth in SBP, but the strongest contribution to SBP came from changes in WC (β= 0.084, p= 0.002). Baseline PAQ-A score (β= −0.822, p= 0.020) and changes in PAQ-A score (β= −0.650, p= 0.019) were associated with smaller increases in DBP over the 4-year measurement period. Conclusions Baseline and change in WC predicted the growth trajectory of SBP, while baseline and change in PA predicted the growth trajectory of DBP. PA and WC have a prognostic value in predicting changes in blood pressure in adolescents. Increasing PA during adolescence could slow the rise in DBP over time. This is meaningful for future hypertension and CVD risk reduction into adulthood

The influence of full leg-length compression tights during treadmill running at race speed

The aim of the present study was to examine whether full leg-length compression tights modify physiological and kinematic measures during treadmill running at a competitive race pace in moderately trained runners. Thirteen males and five females completed two 15-minute running tests at a speed corresponding to a recent race time wearing compression tights or loose-fitting running shorts. Running economy (RE) was determined by oxygen consumption and carbon dioxide expiration during the final 3 minutes of treadmill running. Muscle oxygenation, skin temperature, heart rate (HR), vertical oscillation, step frequency and ground contact time (GCT) were measured continuously. GCT was shorter with compression compared with control trials (p  =  0.03), however, no differences in RE, muscle oxygenation, vertical oscillation, step frequency, HR or skin temperature were revealed. Despite a shorter GCT with compression tights, the findings suggest that moderately trained runners do not benefit nor limit physiological responses at a competitive race pace

The effects of lower-body compression garments on walking performance and perceived exertion in adults with CVD risk factors

Objectives Compression garments are used by athletes in attempts to enhance performance and recovery, although evidence to support their use is equivocal. Reducing the exertion experienced during exercise may encourage sedentary individuals to increase physical activity. The aim of this study was to assess the effect of compression garments on walking performance (self-paced and enforced pace) and rate of perceived exertion (RPE) in adults who presented with two or more CVD risk factors. Participants (n = 15, 10 female, 58.9 ± 11.5 years, BMI 27.5 ± 4.5 kg m2) were recruited. Design A repeated measures design. Methods Participants were randomised to Modified Bruce Protocol (enforced pace), or the 6 min walk test (self-paced), and completed the test wearing compression garments or normal exercise clothes (Control). Outcome measures included stage completed, gross efficiency (%) and RPE in Modified Bruce Protocol, and distance walked (m) and RPE in 6 min walk test. Results In the Modified Bruce Protcol participants had a higher RPE (15.5 ± 2.5 vs 14.3 ± 2.2) and a lower efficiency (19.1 ± 5.9 vs 21.1 ± 6.7) in the compression garment condition compared with control, p < 0.05. In the 6 min walk test participants walked 9% less in the compression garment condition (p < 0.05) but did not have a lower RPE. Conclusions Compared with previous studies reporting enhanced or no effects of compression garments on performance or RPE, this study shows adverse effects of such clothing in untrained individuals with CVD risk factors. The mechanisms underlying this negative effect require further exploration. Use of garments designed for the athletic individuals may not be suitable for the wider population

Succinate Dehydrogenase Supports Metabolic Repurposing of Mitochondria to Drive Inflammatory Macrophages.

Activated macrophages undergo metabolic reprogramming, which drives their pro-inflammatory phenotype, but the mechanistic basis for this remains obscure. Here, we demonstrate that upon lipopolysaccharide (LPS) stimulation, macrophages shift from producing ATP by oxidative phosphorylation to glycolysis while also increasing succinate levels. We show that increased mitochondrial oxidation of succinate via succinate dehydrogenase (SDH) and an elevation of mitochondrial membrane potential combine to drive mitochondrial reactive oxygen species (ROS) production. RNA sequencing reveals that this combination induces a pro-inflammatory gene expression profile, while an inhibitor of succinate oxidation, dimethyl malonate (DMM), promotes an anti-inflammatory outcome. Blocking ROS production with rotenone by uncoupling mitochondria or by expressing the alternative oxidase (AOX) inhibits this inflammatory phenotype, with AOX protecting mice from LPS lethality. The metabolic alterations that occur upon activation of macrophages therefore repurpose mitochondria from ATP synthesis to ROS production in order to promote a pro-inflammatory state

Risk of Malignant Progression in Barrett’s Esophagus Patients: Results from a Large Population-Based Study

BACKGROUND: Barrett’s esophagus (BE) is a premalignant lesion that predisposes to esophageal adenocarcinoma. However, the reported incidence of esophageal adenocarcinoma in patients with BE varies widely. We examined the risk of malignant progression in patients with BE using data from the Northern Ireland Barrett’s esophagus Register (NIBR), one of the largest population-based registries of BE worldwide, which includes every adult diagnosed with BE in Northern Ireland between 1993 and 2005. SUBJECTS AND METHODS: We followed 8522 patients with BE, defined as columnar lined epithelium of the esophagus with or without specialized intestinal metaplasia (SIM), until the end of 2008. Patients with incident adenocarcinomas of the esophagus or gastric cardia or with high-grade dysplasia of the esophagus were identified by matching the NIBR with the Northern Ireland Cancer Registry, and deaths were identified by matching with records from the Registrar General’s Office. Incidence of cancer outcomes or high-grade dysplasia was calculated as events per 100 person-years (% per year) of follow-up, and Cox proportional hazard models were used to determine incidence by age, sex, length of BE segment, presence of SIM, macroscopic BE, or low-grade dysplasia. All P values were from two-sided tests. RESULTS: After a mean of 7.0 years of follow-up, 79 patients were diagnosed with esophageal cancer, 16 with cancer of the gastric cardia, and 36 with high-grade dysplasia. In the entire cohort, incidence of esophageal or gastric cardia cancer or high-grade dysplasia combined was 0.22% per year (95% confidence interval [CI] = 0.19% to 0.26%). SIM was found in 46.0% of patients. In patients with SIM, the combined incidence was 0.38% per year (95% CI = 0.31 to 0.46%). The risk of cancer was statistically significantly elevated in patients with vs without SIM at index biopsy (0.38% per year vs 0.07% per year; hazard ratio [HR] = 3.54, 95% CI = 2.09 to 6.00, P < .001), in men compared with women (0.28% per year vs 0.13% per year; HR = 2.11, 95% CI = 1.41 to 3.16, P < .001), and in patients with low-grade dysplasia compared with no dysplasia (1.40% per year vs 0.17% per year; HR = 5.67, 95% CI = 3.77 to 8.53, P < .001). CONCLUSION: We found the risk of malignant progression among patients with BE to be lower than previously reported, suggesting that currently recommended surveillance strategies may not be cost-effective