The present feasibility study describes engagement and spread of a Twitter-based core-strengthening challenge.

METHODS:

A challenge that entailed completing a core-strengthening exercise using a hashtag (#PlankADay) was circulated via Twitter. We surveyed users who joined during the first 2 months of the challenge to describe their characteristics, including social support for exercise and to what extent they invited others to join. We continued to track total users for 10 months.

RESULTS:

Of 407 individuals who joined in the first 2 months, 105 completed surveys. Among these, 81% were female and 86% Caucasian and mean age was 35.8. 72% participated for at least 1 month and 47% participated for at least 2 months. Survey participants reported that the challenge increased their enjoyment of abdominal exercise. Of the 68% of participants who invited others to participate, 28% recruited none, 66% recruited 1-5 users, and 6% recruited 10 or more users. Participants reported that online friends provided as much positive social support for exercise as family and in-person friends. In 14 months, 4,941 users produced 76,746 tweets and mean total tweets per user was 15.86 (SD = 75.34; range= 1-2888).

CONCLUSION:

Online social networks may be a promising mechanism to spread brief exercise behaviors.

MATERIALS AND METHODS: Longitudinal data from merged survey and claims from the nationally representative Medicare Current Beneficiary Survey(MCBS) from 1999-2005 were used. Diabetes incidence was extracted from claims and survey data over a 3-year period. Depression and antidepressant use data were obtained over time. Multivariable logistic regressions were used to examine association between antidepressant use, depression, and new onset diabetes, adjusted for demographic, socioeconomic, and lifestyle risk factors. Analyses accounted for complex design of MCBS.

RESULTS: Incident diabetes rate was 4.8% for those "without depression and without antidepressants" and 9.5% for those with any antidepressant use in all 3-years and diagnosed depression. Compared to Medicare beneficiaries who did not report any antidepressant use, beneficiaries reporting antidepressant use in all 3-years were 50% more likely to have new onset diabetes. However, when diagnosed depression was entered in the model, we did not observe a statistically significant association between long-term antidepressant use and new onset diabetes. Medicare beneficiaries with any depression were twice as likely as those without depression to develop diabetes(AOR = 2.04, [1.51, 2.75).

CONCLUSION: Depression could independently increase risk of developing diabetes, while there is no evidence of association between antidepressants and new onset diabetes. If replicated, these results have significant clinical implications.

THE SIGNIFICANT FINDING OF THE STUDY: We found increased diabetes risk among Medicare beneficiaries with depression.

THIS STUDY ADDS: Long-term use of antidepressants in the absence of depression increases risk of diabetes.

Recent findings: The literature contains reports of new-onset diabetes associated with statin use. While many studies do not report sex-specific results, there is evidence indicating the risk to benefit ratio may vary by gender. However, the absolute effects are not clear because women have historically been under-represented in clinical trials.

Summary: A review of the literature indicates that the cardiovascular benefits of statins appear to outweigh the risk for statin-related diabetes. However, the effect may depend upon baseline diabetes risk, dose, and statin potency. Rigorous, long-term studies focused on the risks and benefits of statins in women are unavailable to sort for gender-specific differences. Until this changes, individualized attention to risk assessment, and strong prevention with lifestyle changes must prevail.

DESIGN: Retrospective analysis of comprehensive pathology database, medical records, and slides of samples showing pathologic features.

SETTING: UMass Memorial Health Care.

PATIENTS: All patients with breast cancer and PD with records in a prospectively maintained database between January 1, 1990, and December 31, 2008, were identified. Each participant was matched (criteria: age within 5 years, year of treatment, and stage of breast cancer) with 2 controls (1:2 ratio).

MAIN OUTCOME MEASURES: Overall and disease-free survival were analyzed using Kaplan-Meier statistics and Cox proportional hazards modeling, accounting for matching in the latter analyses by using robust standard error estimates.

RESULTS: Mean (SD) follow-up was 47 (33) months. Treatment involved mastectomy in 29 (91%) PD vs 16 (25%) non-PD patients (P < .001), radiotherapy in 14 (44%) PD vs 53 (83%) non-PD patients (P < .001), and hormonal therapy in 14 (44%) PD vs 33 (52%) non-PD patients (P = .004). Biological markers were not significantly different except for ERBB2 (formerly HER2 or HER2/neu) overexpression in 14 (44%) PD vs 16 (25%) non-PD patients (P = .008). The PD group had an overall 5-year survival of 81.2% vs 93.8% of the non-PD group (Kaplan-Meier log-rank, P = .03). The unadjusted hazard ratio for the PD vs non-PD group was 5.31 (95% CI, 1.74-16.27; P = .003). The corresponding hazard ratio after adjusting for local and systemic treatment was 2.26 (95% CI, 0.46-11.06; P = .32).

CONCLUSIONS: These exploratory data show that PD may have a negative effect on breast cancer survival. This finding needs to be substantiated in larger data sets.

DESIGN: Prospective cohort study.

SETTING: The MOBILIZE Boston Study, a study of falls etiology in community-dwelling older individuals.

PARTICIPANTS: Seven hundred sixty-five women and men, mainly aged 70 and older, from randomly sampled households in the Boston, Massachusetts, area.

MEASUREMENTS: Baseline data were collected by questionnaire and comprehensive clinic examination. During follow-up, participants recorded falls on daily calendars. The location and circumstances of each fall were asked during telephone interviews.

RESULTS: Five hundred ninety-eight indoor and 524 outdoor falls were reported over a median follow-up of 21.7 months. Risk factors for indoor falls included older age, being female, and various indicators of poor health. Risk factors for outdoor falls included younger age, being male, and being relatively physically active and healthy. For instance, the age- and sex-adjusted rate ratio for having much difficulty or inability to perform activities of daily living relative to no difficulty was 2.57 (95% confidence interval (CI) = 1.69-3.90) for indoor falls but 0.27 (95% CI = 0.13-0.56) for outdoor falls. The rate ratio for gait speed of less than 0.68 m/s relative to a speed of greater than 1.33 m/s was 1.48 (95% CI = 0.81-2.68) for indoor falls but 0.27 (95% CI = 0.15-0.50) for outdoor falls.

CONCLUSION: Risk factors for indoor and outdoor falls differ. Combining these falls, as is done in many studies, masks important information. Prevention recommendations for noninstitutionalized older people would probably be more effective if targeted differently for frail, inactive older people at high risk for indoor falls and relatively active, healthy people at high risk for outdoor falls. Geriatrics Society.

SETTING AND PARTICIPANTS: Fifteen focus groups at participating schools. One hundred subjects, including overweight and obese high school students, parents, high school nurses, and staff.

MAIN OUTCOME MEASURE: Stakeholders' perceptions.

ANALYSIS: Focus groups were audiotaped and transcribed verbatim. Theme instances related to the research aim were identified, coded, and sorted into theme categories.

RESULTS: Major topics discussed included teen issues, family support, intervention implementation-related concerns, and curriculum content. Teen issues included dealing with peer pressure, avoiding emotional eating, and support from friends. Many participants thought it should be the teen's choice to involve parents. Confidentiality was the most commonly identified potential barrier to implementation. Recommendations for nutrition and physical activity curriculum content focused on concrete, practical strategies.

CONCLUSIONS AND IMPLICATIONS: Results of this research provided insight into stakeholder's needs and perceptions regarding the content and structure of a school nurse-delivered intervention to treat adolescent overweight and obesity. Findings were used in the design and implementation of intervention protocols and materials. Elsevier Inc. All rights reserved.

METHODS: A randomised controlled trial compared an 8-week MBSR group-based programme (n=42) with an educational control programme (n=41) in adults with mild, moderate or severe persistent asthma recruited at a university hospital outpatient primary care and pulmonary care clinic. Primary outcomes were quality of life (Asthma Quality of Life Questionnaire) and lung function (change from baseline in 2-week average morning peak expiratory flow (PEF)). Secondary outcomes were asthma control assessed by 2007 National Institutes of Health/National Heart Lung and Blood Institute guidelines, and stress (Perceived Stress Scale (PSS)). Follow-up assessments were conducted at 10 weeks, 6 and 12 months.

RESULTS: At 12 months MBSR resulted in clinically significant improvements from baseline in quality of life (differential change in Asthma Quality of Life Questionnaire score for MBSR vs control: 0.66 (95% CI 0.30 to 1.03; p<0.001)) but not in lung function (morning PEF, PEF variability and forced expiratory volume in 1 s). MBSR also resulted in clinically significant improvements in perceived stress (differential change in PSS score for MBSR vs control: -4.5 (95% CI -7.1 to -1.9; p=0.001)). There was no significant difference (p=0.301) in percentage of patients in MBSR with well controlled asthma (7.3% at baseline to 19.4%) compared with the control condition (7.5% at baseline to 7.9%).

CONCLUSIONS: MBSR produced lasting and clinically significant improvements in asthma-related quality of life and stress in patients with persistent asthma, without improvements in lung function.

CLINICAL TRIAL REGISTRATION NUMBER: Asthma and Mindfulness-Based Reduction (MBSR) Identifier: NCT00682669. clinicaltrials.gov.

METHODS: Three surveys were tested in 844 public high school employees. Factor analysis, Cronbach alpha, and tests of association with other worksite social contextual measures and behaviors were performed.

RESULTS: Each survey demonstrated high internal consistency and was associated with measures of social support and behaviors. Confirmatory factor analysis supported the reliability of the weight-loss and eating-behavior norms surveys, but not the physical-activity norms survey.

CONCLUSIONS: The weight-loss and eating norms surveys are reliable, valid measures.

PURPOSE: To investigate relationships of SES with the energy cost ($/1000 kcal) and nutrient content of freely chosen supermarket purchases.

METHODS: Supermarket shoppers (n=69) were recruited at a Phoenix AZ supermarket in 2009. The energy cost and nutrient content of participants' purchases were calculated from photographs of food packaging and nutrition labels using dietary analysis software. Data were analyzed in 2010-2011.

RESULTS: Two SES indicators, education and household income as a percentage of the federal poverty guideline (FPG), were associated with the energy cost of purchased foods. Adjusting for covariates, the amount spent on 1000 kcal of food was $0.26 greater for every multiple of the FPG, and those with a baccalaureate or postbaccalaureate degree spent an additional $1.05 for every 1000 kcal of food compared to those with no college education. Lower energy cost was associated with higher total fat and less protein, dietary fiber, and vegetables per 1000 kcal purchased.

CONCLUSIONS: Low-SES supermarket shoppers purchase calories in inexpensive forms that are higher in fat and less nutrient-rich. Elsevier Inc. All rights reserved.

METHODS: We evaluated balance measures in the MOBILIZE Boston Study (276 men, 489 women, 64-97 years). Measures included: (1) laboratory-based anteroposterior (AP) path length and average sway speed, mediolateral (ML) average sway and root-mean-square, and area of ellipse postural sway; (2) Short Physical Performance Battery (SPPB); (3) Berg Balance Scale; and (4) one-leg stand. Spearman Rank Correlation Coefficients (r) were assessed among the balance measures.

RESULTS: Area of ellipse sway was highly correlated with the ML sway measures (r >0.9, p < 0.0001), and sway speed was highly correlated with AP sway (r=0.97, p < 0.0001). The Berg Balance Scale was highly correlated with SPPB (r=0.7, p<0.001), and one-leg stand (r=0.8, p<0.001). Correlations between the laboratory- and clinic-based balance measures were low but statistically significant (0.2 < r < 0.3, p<0.0001).

CONCLUSION: Clinic-based balance measures, and laboratory-based measures comparing area of ellipse with ML sways or sway speed with AP sway, are highly correlated. Clinic- with laboratory-based measures are less correlated. As both laboratory- and clinic-based measures inform balance in older adults but are not highly correlated with each other, future work should investigate the differences. (c) 2012 by the American College of Rheumatology.

METHODS: A survey was mailed to cancer specialist physicians (CSPs) and primary care physicians (PCPs) in Massachusetts. The survey asked CSPs about their preparation of treatment summaries and care plans for their cancer survivor patients and perceived barriers to the provision of these documents. PCPs were asked about receipt and utility of treatment summaries and care plans and information they would like to see in these reports.

RESULTS: One hundred eight CSPs and 400 PCPs answered the survey. Fifty-six percent of CSPs reported that they, or their staff, prepared treatment summaries for their cancer survivor patients; however, only 14% reported preparing care plans. Fifty-four percent of PCPs reported ever receiving a treatment summary, but only 16% ever received a care plan. CSPs cited lack of training, reimbursement, and templates as barriers to preparing care plans.

CONCLUSIONS: Interventions are needed to make treatment summaries and care plans a part of standard care for all cancer survivors. Increasing the use of treatment summaries and care plans will require specific training and reimbursement and may be facilitated by templates that capture automated data.

METHODS: The 765 participants were from households randomly selected from town lists. They were followed for a median of 27.5 months. At baseline, participants were administered a questionnaire that included questions on footwear usually worn, and were given a comprehensive examination that included measurement of many risk factors for falls. During follow-up participants were asked to record each day whether they had fallen; those reporting falls were asked about their footwear when they fell.

RESULTS: At the time of in-home falls, 51.9% of people were barefoot, wearing socks without shoes, or wearing slippers; 10.1% of people reported that their usual footwear was one of these types. Among those who fell in their own home, the adjusted odds ratio for a serious injury among those who were shoeless or wearing slippers compared to those who were wearing other shoes at the time of the fall was 2.27 (95% confidence interval 1.21-4.24).

CONCLUSIONS: It may be advisable for older individuals to wear shoes in their home whenever possible to minimize the risk of falling. Further research is needed to identify optimal footwear for falls prevention.

DESIGN: Prospective cohort study.

SETTING: Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study, a study of falls etiology in community-dwelling older individuals from randomly sampled households in the Boston, Massachusetts, area.

PARTICIPANTS: Seven hundred thirteen women and men, mostly aged 70 and older, with at least 1 year of follow-up.

MEASUREMENTS: Data at baseline and from an 18-month follow-up examination were collected by questionnaire and comprehensive clinic examination. During follow-up, participants recorded falls on daily calendars. A telephone interview queried location and circumstances of each fall.

RESULTS: One hundred forty-five participants reported recurrent falls (>/=2) during the first year. Those who had fallen only outdoors had good health characteristics, whereas those who had fallen only indoors were generally in poor health. For instance, 25.5% of indoor-only recurrent fallers had gait speeds of slower than 0.6 m/s, compared with 2.9% of outdoor-only recurrent fallers; the respective percentages were 44.7% and 8.8% for Berg balance score less than 48. Recurrent indoor fallers generally had poor health characteristics regardless of their activity at the time of their falls, whereas recurrent outdoor fallers who fell during vigorous activity or walking were especially healthy. A report of any recurrent falls in the first year did not predict number of positive findings on a comprehensive or abbreviated fall risk assessment at the 18-month follow-up examination.

CONCLUSION: Characteristics of community-dwelling older people with recurrent indoor and outdoor falls are different. If confirmed, these results suggest that different types of fall risk assessment are needed for specific categories of recurrent fallers. Geriatrics Society.