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    Does physical activity improve mental health in the older population aged 65 and older?
    (2018-03-14) Allen, Irina; Berumen, Lori; Hartos, Jessica; Owens, Camille
    Purpose: Research has shown a positive relationship between physical activity and good mental health in most age groups; however, there is conflicting evidence about this relationship in the older population. The purpose of this study was to determine whether physical activity is related to mental health in the general population for those aged 65 and older. Methods: This cross sectional analysis used data from the 2015 BRFFS for adults aged 65 and older from Alabama, Oklahoma and Oregon. The relationship between physical activity and mental health was analyzed using multiple logistic regression controlling for comorbid health conditions, depression, education, income, marital status, ethnicity/race, gender, and age. Results: The majority of participants reported good mental health (74-78%); a moderate amount reported being highly active (32-51%), and less reported being insufficiently active (13-15%). In adjusted analysis, physical activity as well as depression were significantly related to good mental health in adults aged 65 or older across all three states. Conclusions: Overall, physical activity is significantly related to good mental health in adults aged 65 and older. Females and those ever diagnosed with depression were less likely to report good mental health. When older adults present to primary care clinic, providers should screen their levels of physical activity and symptoms of depression. It is recommended that providers educate patients about the benefits of physical activity for mental health.
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    Epigenetic Evidence to Advance Utility of Lifestyle Interventions in Managing Depression in Primary Care Practice
    (2018-03-14) Lee, Jenny; Jaini, Paresh
    PURPOSE: To evaluate and recommend lifestyle interventions as management for depression in primary care practice through systematic review of epigenetic evidence associated with depression. BACKGROUND: Depression is the most common mental health condition in primary care patients in the United States. Compelling evidence shows that maladaptive lifestyle behaviors and environmental conditions are involved in the pathogenesis of depression via disease-promoting epigenetic mechanisms associated with depression in patients. However, lifestyle and environmental factors receive little consideration in current treatment of depression, while pharmacotherapy and psychotherapy are largely utilized. Therefore, considering utility of lifestyle interventions to alter gene expression associated with depression can provide a safe and low-cost option for prevention and treatment of depression. METHODS: We performed a targeted and tailored search of peer-reviewed health science literature in MEDLINE through the PubMed interface. Through systematic review, we selected 34 articles that discussed epigenetic effects of depression as well as lifestyle intervention studies for depression. The search was limited to English language articles published in the last 10 years. RESULTS: Our review consistently indicated that lifestyle modification efforts such as physical activity, anti-inflammatory foods, sleep hygiene, relaxation response, and social connectedness/group support serve as protective and therapeutic modalities for depression. Epigenetic evidence from our review confirmed that adverse lifestyle and environmental stimuli resulted in depression-promoting gene expression. Stress was found to be the most common risk factor for pathogenesis of depression. While few studies showed epigenetic evidence of lifestyle intervention approaches to depression management, relaxation response through meditation showed down-regulation of gene expression associated with stress and trauma that were evident to generally lead to subsequent depressive symptoms. CONCLUSION: Understanding the epigenetic effects of lifestyle and environmental factors on development of depression are of considerable interest for understanding management of depression. While future study of epigenetic effects of multiple lifestyle interventions in depression management is needed, the present study may provide clinically relevant recommendations for using therapeutic lifestyle interventions in patients with depressive disorders in primary care practice, where epigenetic changes may serve as biomarkers for monitoring the course of illness. An epigenetics-based lifestyle intervention approach can aid in prevention and treatment of depression by motivating patients to change risky lifestyle and environmental factors that induce depression-promoting epigenetics.
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    Evaluation of Curriculum-Based Support Group (CBSG) Programs in Improving Psychosocial Behaviors in Kindergarten through 3rd Grade Students
    (2018-03-14) Nejtek, Vicki; James, Rachael
    Background. Tarrant County has the second highest number of confirmed abused/neglected children in Texas. Studies show maltreated children tend to develop poorly in certain psychosocial domains (i.e. confidence, cooperation, participation, decision-making, listening skills, peer interactions) which can affect academic performance, and mental health. Socioemotional learning programs in a classroom setting may mitigate such negative trajectories in ‘at-risk’ students by improving outcomes in these domains. The aim of this study is to evaluate curriculum-based support group (CBSG) programs in improving these psychosocial behaviors. Methods. Secondary data analysis was conducted on maltreated or ‘at-risk’ maltreated children in kindergarten through 3rd grade (K-3). All races/ethnicities were included. Students attended small group sessions designed to enhance confidence, cooperation, participation, listening skills, appropriate interactions, and good decision-making skills. Pre- and post-program report card grades were used to measure improvement in math, reading, science and social studies. Psychosocial domains in the pre-, post, and 1-year post-program conditions were measured using a Likert Scale. Descriptive statistics and frequency distributions described the sample. Wilcoxon paired t-tests analyzed pre- and post-program improvement. Analysis of Variance (ANOVA) and Wilks Lambda with post-hoc corrections for multiple comparisons evaluated 1-year post-program follow-up. A 95% confidence interval (p= 0.05) was used. Results. Participants (N=719) showed improvement in individual domains of: 36% confidence (t=10.29, p=0.0001), 28% cooperation (t=-10.89, p=0.0001), 26% participation (t=-8.38, p=0.0001), 26% listening skills (t=-9.57, p=0.0001), 31% decision-making (t=-9.27, p=0.0001), 24% peer interactions (t=-7.84, p=0.0001). Aggregated domains continued to improve 1-year post-program by 4.3% (t=-2.073, p=0.041) in a subset of participants (N=96). Academic performance also improved in a small sample of participants (N=24) by 8% in math, 7% science, 6.3% reading, and 5.3% social studies. Conclusion. These data indicate that the CBSG program is effective at improving psychosocial behaviors in ‘at-risk’ children, and has the potential to mitigate negative trajectories up to a year. Evidence is encouraging that CBSG may also improve academic performance, although a larger sample size and control group is needed in future evaluations.
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    Personal, Psychological, and Family History Risk Factors for Emotional Eating Related to Obesity
    (2018-03-14) Franks, Susan; Williams, Trevor; Goyer, Alexandria; Muzaffar, Omair; Fulda, Kimberly; Tiu, Cindy
    Purpose: The concept that emotion strongly influences eating, referred to as “emotional eating” (EE), recently gained interest. Previous evidence suggested that overeating by overweight individuals reduces anxiety. The obesity literature indicated EE significantly differentiates obese from normal weight individuals. However, little is known about what other factors contribute to EE. This study aims to better understand risk factors that might be associated with EE. We anticipated that people with higher EE would be more likely to have family histories of anxiety or obesity, and would have more anxiety and stress, poorer coping skills, and higher BMI than people with lower EE. Methods: Participants included adult men and women (n=97) with an average age of 30.78 years (sd=12.86) and an average BMI of 25.19 kg/m2(sd=5.69). Surveys included demographics, the State-Trait Anxiety Inventory to measure state ANX, and the Eating and Appraisal Due to Emotions and Stress to measure STR, EE, and COP.Subjects were categorized into higher and lower EE based on a mean split. Chi-square analysis was used to analyze differences in EE for FH of obesity and FH of anxiety. T-tests were used to analyze differences between high and low EE for ANX, STR, COP, and BMI. Results: FH of obesity differed significantly by EE(x2=.009). Among high EE, 46.7% had a FH of obesity whereas among low EE 27.9% had a FH of obesity. FH of anxiety differed significantly by EE (x2=.045). Among high EE, 47.8% had a FH of anxiety whereas among low EE 28.0% had a FH of anxiety. When comparing individuals with high and low EE, state anxiety was higher for high EE (mean=36.09, sd=10.47) as compared to low EE (mean=31.28, sd=9.24) (t=2.41, p=.018). Stress was higher for high EE (mean=12.72, sd=3.11) as compared to low EE (mean=13.92, sd=2.89) (t= -1.98, p=.051). Coping was lower for high EE (mean=78.24, sd=8.57) as compared to low EE (mean=82.90, sd=9.21) (t= -2.57, p=.012). BMI was higher for high EE (mean=26.52, sd=7.02) as compared to low EE (mean=23.99, sd=3.87) (t= 2.22, p=.029). Conclusions: EE is more likely with higher anxiety and poor coping skills. Additionally, a FH of obesity or anxiety appears to put individuals at risk for EE. Clinicians should be aware of the factors related to EE in order to identify patients who may be emotional eaters and provide targeted interventions in order to prevent obesity and promote weight loss.
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    Does the Relationship Between Physical Activity and Mental Health Differ by Gender in Older Adults Who Have Had a Heart Attack?
    (2018-03-14) Copeland, Morgan; Otis, Katherine; Hartos, Jessica; Leggett, Alex
    Purpose: Post-MI adults are more likely to have depression and physical activity may help; however, there are limited findings for whether physical activity helps older post-MI adults, especially by gender. The purpose of this study was to analyze the relationship between physical activity and mental health in a general population of older adults (age 65 and older) who have had a heart attack and whether it differs by gender. Methods: This cross sectional analysis used data from the 2015 BRFSS for males and females ages 65 and older who reported ever being diagnosed with a heart attack in Kentucky, Oklahoma, and West Virginia. Adjusted logistic regression analyses were conducted by gender to assess the relationship between physical activity and mental health while controlling for behavioral, health-related, and demographic factors. Results: Across the states, 21-25% of adults 65 years and older who had experienced a heart attack reported poor mental health, and 40-47% reported being inactive. Adjusted analyses showed no significant relationship between physical activity and mental health, but did find activity limitations to be significantly related to mental health in females. Conclusions: Overall, physical activity was not significantly related to mental health in general samples of men and women 65 and older who had been diagnosed with a heart attack. However, this study found a inverse relationship between activity limitations and mental health in females. Although physical activity should continue to be encouraged, clinicians should evaluate and screen older post-MI adults for activity limitations and mental health and vice versa, especially in females.
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    Parent’s Perception of Adolescents Health in Association with Child Reported Depression among Mexican American Children 10-14 Years of Age
    (2018-03-14) Espinoza, Anna; Fulda, Kimberly; Franks, Susan; Muzaffar, Omair
    Purpose: Depression in children is frequent and represents a challenge to be recognized by both the family and the primary care physician. Many parents are unaware of their child’s depression and may not recognize the symptoms, and primary care physicians do not routinely screen for depression in children. Providing a connection between the family, physician, and child to recognize depression is important. The purpose of this study was to examine the association between parent’s perception of their child’s health and child reported depression among Mexican American children 10-14 years of age. Methods: One hundred and forty-four Mexican American children ages 10-14 and a parent/legal guardian participated in a cross-sectional study. Child participants completed depression screening using the child report Children’s Depression Inventory (CDI 2: Self-Report Short Version). Regression analyses were performed. Unadjusted and adjusted odds ratios and 95% confidence intervals were computed. The dependent variable was child report depression screening (average/lower and high average/elevated/very elevated), and the primary independent variable was parent reported perception of the child’s health (fair/poor or good/very good/excellent). The adjusted model controlled for family income, marital status of primary care giver, highest grade completed by anyone in the household, child age, and child gender. Results: There were 74 (51.4%) male children, and the mean age was 11.97 (sd=1.45). Thirty (20.80%) of children screened high for depression, and parents reported fair/poor health for 11 (7.6%) of children. Children were more likely to screen high for depression if their parents reported their health as fair/poor [OR=11.85, (95% CI:2.65-53.05)] or if they were female [OR=3.58, (95% CI:1.37-9.35)] in the adjusted model. Conclusion: Parents perception of their child’s health is associated with child self screening high for depression. Including a simple question about how a parent rates their child’s health could provide clinical utility for primary care physicians.
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    Gender Related Differences In Emotional Eating and Its Role In Obesity
    (2018-03-14) Franks, Susan; Tiu, Cindy BS; Goyer, Alexandria BS; Fulda, Kimberly; Williams, Trevor
    Background: Obesity rates have increased and are linked to diseases such as cardiovascular disease, diabetes, and mortality, making it an important focus among health professionals. Current evidence shows that people who have high stress levels tend to be overweight and have higher rates of emotional eating (EE). To date, little is known about gender differences in EE. The purpose of this study is to analyze whether or not there are gender differences in EE and if it is tied to obesity. Methods: 97 participants with an average BMI of 25.19kg/m2 (sd=12.86) and average age of 30.78 years completed a self-report survey that assessed the participant’s level of stress and EE. Subjects were categorized into high and low EE based on a mean split, where lower values indicated a higher degree of EE. Chi square analysis was used to compare high and low EE by gender. Pearson correlation was used to determine association between EE and state anxiety for men and women. Independent samples t-tests were used to analyze differences in EE by BMI (normal weight versus overweight/obese) stratified by gender. Results: Out of the 97 participants, 39% were overweight/obese. 56% were white/Caucasian, 28% were Asian, 8% were Hispanic, 8% were other. 54% were male and 56% were female. EE significantly differed by gender (x2=.001). Among women, 63.0% had high rates of EE. Among men, 27.9% had high rates of EE. Anxiety and EE were significantly correlated for women (p=.029) and men (p=.046). When comparing the overweight/obese individuals in each gender, EE was higher in overweight/obese women (mean=77.87, sd=19.98) as compared to normal weight women (mean=89.16, sd=14.84) (t=2.256, p=.028). There was no significant difference in EE between overweight men (mean=93.5, sd=15.86) and normal weight men (mean=98.63, sd=11.5) (t=1.168, p=.250). Conclusion: More women than men reported EE. EE was higher in normal weight than overweight women but not between normal and overweight men. Clinicians should be aware of the factors related to EE in order to provide targeted interventions to prevent obesity and promote weight loss, especially in women who emotionally eat.
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    Psychosocial Difficulties in Pediatric Patients with Voiding Dysfunctions and Nocturnal Enuresis: Age and Sex-Related Differences
    (2018-03-14) Wolfe-Christensen, Cortney; Alavi, Michael
    Purpose To identify whether male and female patients presenting to a Pediatric Urology Voiding Dysfunction Clinic differ in terms of psychosocial difficulties. Methods A retrospective chart review was conducted to collect data from patients presenting to a pediatric urology clinic for voiding dysfunction or nocturnal enuresis between December 2016 and June 2017. During their visit, patients and their parents/guardians completed the Pediatric Symptom Checklist (PSC) and Dysfunctional Voiding Questionnaire (DVSS). Older children and teens also completed self-reports for the PSC. Results The sample consisted of 159 subjects (100 females, 59 males) between the ages of 5 and 16 years old (M = 9.86 + 3.15). Results revealed that children with more severe voiding symptoms exhibited more parent-reported attention (p=.019) and externalizing (p In a sex-based comparison, females self-reported significantly more psychosocial difficulties than males (17.81+1.9 vs 11.23+1.99; p=.03), while parents of males reported their children exhibited significantly more attention problems than females (4.14+.43 vs 2.94+2.67; p=.022). Age- and sex-based comparisons revealed that for males, age was unrelated to any psychosocial difficulties. However, for females, older age was associated with more parent-reported psychosocial difficulties (p=.013) and internalizing problems (p Conclusion Patients presenting to Pediatric Urology Voiding Dysfunction Clinics are at increased risk for psychosocial difficulties.Our data supports this finding, with more severe voiding symptoms being related to multiple aspects of poorer psychosocial functioning. Additionally, females are at increased risk for psychosocial difficulties, especially as they approach adolescence, while males are at increased risk for attention problems.