Training health professionals to deliver healthy living medicine

The growing incidence and prevalence of unhealthy living behaviors leading to compromised health, along with unhealthy supportive environments, are the primary reasons for the current chronic disease crisis in almost all countries. Over the course of health professions training across disciplines, a large amount about information regarding various aspects of chronic disease is introduced, from pathophysiology to a broad array of approaches to examinations (focused on diagnosis and prognosis) and interventions. Currently, a late primary or secondary prevention focus is the primary educational approach in the health professions. In either scenario, the health professional is often trained to approach their discipline from a catch up approach, with little focus on how an individual's health condition, at the time of presentation, came to be. It is unfortunate that so little educational time and effort are devoted to train future health professionals on how to practice Healthy Living Medicine (HLM) and, deliver healthy living (HL) interventions. The primary goal should be to keep individuals healthy where they live, work and go to school and minimize initiating care in the hospital and outpatient clinical setting. The current review describes current trends in training health professionals in HLM and the delivery of HL interventions

The effects of concurrent picture presentations on retelling of orally presented stories by adults with aphasia

This study investigated whether measures of verbal productivity, verbal disruption, information content, grammatical complexity, and grammatical well formedness would vary as a function of experimental conditions in which the presence of pictured stimuli was manipulated during the oral presentation and retelling of stories. Fifteen adults with aphasia retold stories under three experimental conditions: (i) concurrent presentation of oral and pictured versions of stories followed by a picture-supported retell, (ii) concurrent presentation of oral and pictured versions of stories followed by a 'free' retell, and (iii) orally presented stories followed by a free retell. Group analyses revealed no significant differences across experimental conditions for any of the dependent measures. Analyses of individual subjects' data revealed clinically important differences for several measures of information content, with individual subjects responding differently to the experimental conditions

Effects of training multiple form classes on acquisition, generalization and maintenance of word retrieval in a single subject

A study by McNeil et nl. reported no generalization effects in two individuals with aphasia following application of a word finding treatment in which subjects were trained sequentially on lexical items arranged by form class. The present investigation examined, in one of the two subjects from the original study, whether training on lexical items from a variety of form classes concurrently would result in greater response generalization than was observed previously in this subject. Results replicated earlier findings with positive acquisition and maintenance effects and little evidence of generalization to untrained items within or across form classes

Public park spaces as a platform to promote healthy living: introducing a HealthPark concept

The concept of Healthy Living (HL) as a primary medical intervention continues to gain traction, and rightfully so. Being physically active, consuming a nutritious diet, not smoking and maintaining an appropriate body weight constitute the HL polypill, the foundation of HL medicine (HLM). Daily use of the HL polypill, working toward optimal dosages, portends profound health benefits, substantially reducing the risk of chronic disease [i.e., cardiovascular disease (CVD), pulmonary disease, metabolic syndromes, certain cancers, etc.] and associated adverse health consequences. To be effective and proactive, our healthcare system must rethink where its primary intervention, HLM, is delivered. Waiting for individuals to come to the traditional outpatient setting is an ineffective approach as poor lifestyle habits are typically well established by the time care is initiated. Ideally, HLM should be delivered where individuals live, work and go to school, promoting immersion in a culture of health and wellness. To this end, there is a growing interest in the use of public parks as a platform to promote the adoption of HL behaviors. The current perspectives paper provides a brief literature review on the use of public parks for HL interventions and introduces a new HealthPark model being developed in Chicago

Multiomics modeling of the immunome, transcriptome, microbiome, proteome and metabolome adaptations during human pregnancy.

MotivationMultiple biological clocks govern a healthy pregnancy. These biological mechanisms produce immunologic, metabolomic, proteomic, genomic and microbiomic adaptations during the course of pregnancy. Modeling the chronology of these adaptations during full-term pregnancy provides the frameworks for future studies examining deviations implicated in pregnancy-related pathologies including preterm birth and preeclampsia.ResultsWe performed a multiomics analysis of 51 samples from 17 pregnant women, delivering at term. The datasets included measurements from the immunome, transcriptome, microbiome, proteome and metabolome of samples obtained simultaneously from the same patients. Multivariate predictive modeling using the Elastic Net (EN) algorithm was used to measure the ability of each dataset to predict gestational age. Using stacked generalization, these datasets were combined into a single model. This model not only significantly increased predictive power by combining all datasets, but also revealed novel interactions between different biological modalities. Future work includes expansion of the cohort to preterm-enriched populations and in vivo analysis of immune-modulating interventions based on the mechanisms identified.Availability and implementationDatasets and scripts for reproduction of results are available through: https://nalab.stanford.edu/multiomics-pregnancy/.Supplementary informationSupplementary data are available at Bioinformatics online

Assessing the Value of Moving More-The Integral Role of Qualified Health Professionals

Being physically active or, in a broader sense, simply moving more throughout each day is one of the most important components of an individual's health plan. In conjunction with regular exercise training, taking more steps in a day and sitting less are also important components of one's movement portfolio. Given this priority, health care professionals must develop enhanced skills for prescribing and guiding individualized movement programs for all their patients. An important component of a health care professional's ability to prescribe movement as medicine is competency in assessing an individual's risk for untoward events if physical exertion was increased. The ability to appropriately assess one's risk before advising an individual to move more is integral to clinical decision-making related to subsequent testing if needed, exercise prescription, and level of supervision with exercise training. At present, there is a lack of clarity pertaining to how a health care professional should go about assessing an individual's readiness to move more on a daily basis in a safe manner. Therefore, this perspectives article clarifies key issues related to prescribing movement as medicine and presents a new process for clinical assessment before prescribing an individualized movement program

Severe low back or lower limb pain is associated with recurrent falls among older Australians

Background: Few studies have explored the impact of low back or lower limb pain severity on recurrent (≥2) falls in older adults. Objectives: Investigate the association between the severity of low back or lower limb pain, and ≥2 falls or falls-related injuries. Methods: Community-dwelling Australian males and females in the ASPREE Longitudinal Study of Older Persons (ALSOP), aged ≥70 years. Self-reported, cross-sectional questionnaire data regarding number of falls and falls-related injuries in the last 12 months; and sites and severity of pain experienced on most days. Adjusted relative risks (RR) were estimated from multivariable Poisson regression models, for males and females separately. Results: Of 14,892 ALSOP participants, 13% (n = 1983) reported ≥2 falls (‘recurrent fallers’) in the last 12 months. Males and females who reported severe low back, or severe lower limb pain on most days were more likely to report ≥2 falls in the last 12 months compared to those with mild pain (lower back: males RR = 1.70 and females RR = 1.5, p = 0.001; lower limb: males RR = 2.0, p < 0.001 and females RR = 1.4, p = 0.003). Female recurrent fallers who reported severe low back (RR = 1.3, p = 0.029) or lower limb (RR = 1.2, p = 0.024) pain on most days were more likely to report a falls-related injury in the last 12 months compared to females with mild pain. Conclusion: Severe low back or lower limb pain was associated with an increased likelihood of recurrent falls (males/females) or falls-related injuries (females only). Assessment of severe low back and lower limb pain should be considered as a priority when undertaking falls-risk evaluation. Significance: Severe low back pain, or severe lower limb pain is associated with an increased likelihood of recurrent falls in older males and females, and an increased likelihood of falls-related injuries in older female recurrent fallers. Assessment and management of severe low back and lower limb pain should be prioritized when undertaking falls-risk assessment. Future longitudinal research is required to further interrogate this relationship and its underlying mechanisms

An immune clock of human pregnancy

The maintenance of pregnancy relies on finely tuned immune adaptations. We demonstrate that these adaptations are precisely timed, reflecting an immune clock of pregnancy in women delivering at term. Using mass cytometry, the abundance and functional responses of all major immune cell subsets were quantified in serial blood samples collected throughout pregnancy. Cell signaling-based Elastic Net, a regularized regression method adapted from the elastic net algorithm, was developed to infer and prospectively validate a predictive model of interrelated immune events that accurately captures the chronology of pregnancy. Model components highlighted existing knowledge and revealed previously unreported biology, including a critical role for the interleukin-2-dependent STAT5ab signaling pathway in modulating T cell function during pregnancy. These findings unravel the precise timing of immunological events occurring during a term pregnancy and provide the analytical framework to identify immunological deviations implicated in pregnancy-related pathologies