Comparative Effectiveness of Cognitive Behavioral Therapy for Chronic Pain and Chronic Pain Self-Management within the Context of Voluntary Patient-Centered Prescription Opioid Tapering: The EMPOWER Study Protocol.

Objective: Evidence to date, while sparse, suggests that patients taking long-term opioids require special considerations and protections to prevent potential iatrogenic harms from opioid de-prescribing, such as increased pain or suffering. Following this study protocol, the EMPOWER study seeks to address multiple unmet needs of patients with chronic pain who desire to reduce long-term opioid therapy, and provide the clinical evidence on effective methodology.

Methods: EMPOWER applies patient-centered methods for voluntary prescription opioid reduction conducted within a comprehensive, multi-state, 3-arm randomized controlled comparative effectiveness study of three study arms (1) group cognitive behavioral therapy for chronic pain; (2) group chronic pain self-management; and (3) usual care (taper only).

Long-term Association of Depression Symptoms and Antidepressant Medication Use With Incident Cardiovascular Events in the Look AHEAD (Action for Health in Diabetes) Clinical Trial of Weight Loss in Type 2 Diabetes.

Objective: To examine whether depression symptoms or antidepressant medication (ADM) use predicts the probability of cardiovascular events in overweight/obese individuals with type 2 diabetes.

Research Design And Methods: Preplanned analyses of depression and incident cardiovascular disease (CVD) were performed in the Look AHEAD (Action for Health in Diabetes) weight loss trial after a median follow-up of 9.6 years.

Effects of Longitudinal Glucose Exposure on Cognitive and Physical Function: Results from the Action for Health in Diabetes Movement and Memory Study.

Objectives: To test whether average long-term glucose exposure is associated with cognitive and physical function in middle-aged and younger-old adults with type 2 diabetes mellitus.

Design: Prospective cohort study.

Setting: Data obtained as part of the Action for Health in Diabetes (Look AHEAD) trial (NCT00017953) and Look AHEAD Movement and Memory ancillary study (NCT01410097).

Impact of intensive lifestyle intervention on depression and health-related quality of life in type 2 diabetes: the Look AHEAD Trial.

Objective: We examined the effects of an intensive lifestyle intervention (ILI), compared with a diabetes support and education (DSE) control intervention, on long-term changes in depression symptoms, antidepressant medication (ADM) use, and health-related quality of life (HRQoL) in overweight/obese individuals with type 2 diabetes.

Research Design And Methods: Look AHEAD was a multisite randomized controlled trial of 5,145 overweight/obese participants assigned to ILI (designed to produce weight loss) or DSE and followed for a median of 9.6 years.

Long-term impact of behavioral weight loss intervention on cognitive function.

Background: It is unknown whether intentional weight loss provides long-term benefits for cognitive function.

Methods: An ancillary study to a randomized controlled clinical trial was conducted in overweight and obese individuals (N = 978), aged 45-76 years at enrollment, with type 2 diabetes. An intensive behavioral intervention designed to promote and maintain weight loss through caloric restriction and increased physical activity was compared with diabetes support and education.

Readiness redefined: a behavioral task during screening predicted 1-year weight loss in the look AHEAD study.

Objective: Predicting outcome in weight loss trials from baseline characteristics has proved difficult. Readiness to change is typically measured by self-report.

Methods: Performance of a behavioral task, completion of food records, from the screening period in the Look AHEAD study (n = 549 at four clinical centers) was assessed.

Baseline predictors of missed visits in the Look AHEAD study.

Objective: To identify baseline attributes associated with consecutively missed data collection visits during the first 48 months of Look AHEAD—a randomized, controlled trial in 5,145 overweight/obese adults with type 2 diabetes designed to determine the long-term health benefits of weight loss achieved by lifestyle change.

Design And Methods: The analyzed sample consisted of 5,016 participants who were alive at month 48 and enrolled at Look AHEAD sites. Demographic, baseline behavior, psychosocial factors, and treatment randomization were included as predictors of missed consecutive visits in proportional hazard models.

Effect of intensive lifestyle intervention on sexual dysfunction in women with type 2 diabetes: results from an ancillary Look AHEAD study.

Objective: Sexual dysfunction is a prevalent problem in obese women with type 2 diabetes. This study examined the effects of intensive lifestyle intervention (ILI) in these women.

Research Design And Methods: Look AHEAD is a 16-center, randomized, controlled trial evaluating the health effects of ILI compared with a control group (diabetes support and education [DSE]).

Impact of a multidisciplinary intervention on antibiotic use for nursing home-acquired pneumonia.

Background: Academic detailing in nursing homes (NHs) has been shown to improve drug use patterns and adherence to guidelines.

Objective: The purpose of this study was to evaluate the impact of a multidisciplinary intervention that included academic detailing on adherence to national nursing home-acquired pneumonia (NHAP) guidelines related to use of antibiotics.

Methods: This quasi-experimental study evaluated the effects of a 2-year multifaceted and multidisciplinary intervention targeting implementation of national evidence-based guidelines for NHAP.

Cognitive and behavioral approaches in the treatment of obesity.

The research reviewed within this article provides support for both the cognitive and behavioral components of cognitive behavioral weight-loss interventions. Lifestyle based treatments have produced markedly improved results in the past 20 years, in part attributable to changes in treatment structure. Use of pretreatment participant preparation strategies, extended treatment periods with clearly defined weight-loss goals, combining multiple dietary and physical activity strategies, and increasing emphasis on long-term provider contact and relapse prevention have modestly improved long-term weight maintenance.

A multifaceted intervention to implement guidelines did not affect hospitalization rates for nursing home-acquired pneumonia.

Objective: Determine whether a comprehensive approach to implementing national consensus guidelines for nursing home-acquired pneumonia (NHAP) affected hospitalization rates.

Design: Quasi-experimental, mixed-methods, multifaceted, unblinded intervention trial.

Setting: Sixteen nursing homes (NHs) from 1 corporation: 8 in metropolitan Denver, CO; 8 in Kansas and Missouri during 3 influenza seasons, October to April 2004 to 2007.

Impact of a weight management program on health-related quality of life in overweight adults with type 2 diabetes.

Background: Inconsistent findings have been reported regarding improved health-related quality of life (HRQOL) after weight loss. We tested the efficacy of a weight management program for improving HRQOL in overweight or obese adults diagnosed as having type 2 diabetes mellitus.

Methods: We conducted a randomized multisite clinical trial at 16 outpatient research centers with 2 treatment arms and blinded measurements at baseline and the end of year 1.

Cognitive and behavioral approaches in the treatment of obesity.

Cognitive behavioral interventions have formed the cornerstone of obesity treatment for the past two decades. These techniques, often combined with diet and exercise strategies, have been shown to produce weight losses of sufficient magnitude so as to reduce health risks. Though success in producing short-term weight loss is improving, many factors, including a metabolic energy gap, continue to challenge long-term weight maintenance results.

The use of motivational interviewing in weight loss.

Within the past two decades, motivational interviewing has emerged as a useful strategy to help individuals develop motivation to change health behavior and sustain those efforts. This article reviews the preliminary but burgeoning literature that supports the effectiveness of motivational interviewing strategies in promoting positive changes in a variety of health behaviors, including dietary change, activity increases, and regimen adherence. A variety of adaptations of the motivational interviewing process are discussed as relevant to making this treatment strategy increasingly applicable to a variety of health care settings.

Binge eating disorder and night eating syndrome in adults with type 2 diabetes.

Objective: To determine the prevalence of binge eating disorder (BED) and night eating syndrome (NES) among applicants to the Look AHEAD (Action for Health in Diabetes) study.

Research Methods And Procedures: The Eating Disorders Examination-Questionnaire (EDE-Q) and the Night Eating Questionnaire (NEQ) were used to screen patients. Phone interviews were conducted using the EDE for those who reported at least eight episodes of objective binge eating in the past month and using the Night Eating Syndrome History and Interview for those who scored > or =25 on the NEQ.

Stress fractures in elite cross-country athletes.

This retrospective and comparative survey investigates an unusual number of stress fractures seen within a Division I college cross-country team. An anonymous questionnaire-designed to observe factors known to increase stress fracture incidence-was distributed to members of the current and previous seasons' teams. Running surface, sleep hours, intake of calcium, and shoe type were among the factors investigated.

Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial.

Objective: The effectiveness of intentional weight loss in reducing cardiovascular disease (CVD) events in type 2 diabetes is unknown. This report describes 1-year changes in CVD risk factors in a trial designed to examine the long-term effects of an intensive lifestyle intervention on the incidence of major CVD events.

Research Design And Methods: This study consisted of a multicentered, randomized, controlled trial of 5,145 individuals with type 2 diabetes, aged 45-74 years, with BMI >25 kg/m2 (>27 kg/m2 if taking insulin).

Correlates of health-related quality of life in overweight and obese adults with type 2 diabetes.

Objective: This paper describes and examines conceptually relevant correlates of health-related quality of life (HRQL) in overweight or obese persons with type 2 diabetes. Research Design and Procedures: The investigation was a cross-sectional study of 5145 overweight or obese adults with type 2 diabetes between the ages of 45 and 74 years. Analyses examined the relationship that demographic characteristics, disease burden, and cardiovascular fitness had with HRQL: the Short Form 36 (SF-36) and the Beck Depression Inventory (BDI) II.

Self-perception in elite collegiate female gymnasts, cross-country runners, and track-and-field athletes.

Objective: To compare self-perception between a group of competitive, elite female collegiate athletes (participating in gymnastics, cross country, and track and field) and a group of female political science students (nonathletic control subjects). We hypothesized that the athletic group would rate athletics as more important than would the nonathletic group, that the perception of athletic competence would correlate positively with self-worth for athletes only, and that the perception of athletic competence would have a stronger influence on self-worth in the athletic group.

Subjects And Methods: The Self-perception Profile for College Students was completed by 32 athletes and 13 nonathletes.

Posttraumatic stress disorder in burn populations: a critical review of the literature.

This review of the literature examines studies concerning posttraumatic stress disorder (PTSD) in burn populations. Retrospective, cross-sectional, and prospective research and case studies are critiqued. Although the data are equivocal, several trends are clearly emerging.

The impact of cigarette smoking on headache activity in headache patients.

The present study was designed to explore the relationship between cigarette smoking and headache activity in a sample of patients presenting for treatment. Subjects completed various self-report measures and monitored headache activity four times per day over a 4-week period. Analyses revealed that smokers experienced greater weekly peak headache intensity, and reported higher levels of depression and general physical symptoms.