Greer A. Raggio

Prevalence and correlates of sexual morbidity in long-term breast cancer survivors

Objective: Breast cancer survivors report adverse sexual effects (sexual morbidity) such as disrupted sexual function, sexual distress and body dissatisfaction. However, most studies have failed to evaluate the persistence of these effects in long-term survivors. The present study comprehensively assessed the prevalence and predictors of sexual/body image problems among survivors three or more years post diagnosis. Design/outcome measures: Eighty-three breast cancer survivors completed surveys a median of seven years post diagnosis. Survey items probed demographic, diagnostic and clinical information, in addition to sexual activity, sexual function (Female Sexual Function Index [FSFI]), body image, and distress regarding body changes and sexual problems (Female Sexual Distress Scale-revised; FSDS-R). Results: Seventy-seven percent of all participants and 60% of sexually active participants qualified for sexual dysfunction based on the FSFI. Between 37 and 51% met criteria for female sexual dysfunction, based on two FSDS-R clinical cut-offs. Body satisfaction was worse than normative values, while body change stress was mid-range. Notable sexual morbidity predictors included mastectomy, which was associated with worse sexual/body change distress, and post-treatment weight gain, which predicted greater body dissatisfaction/body change stress. Conclusions: Breast cancer survivors report substantial sexual morbidity years after treatment, especially after mastectomy or post-treatment weight gain. Breast cancer patients and their providers should be aware of these potential sexual effects.

The use of novel technology-based weight loss interventions for obese women with endometrial hyperplasia and cancer

OBJECTIVE Obesity significantly increases the risk of the development of both endometrial hyperplasia and cancer. Our objective was to assess the feasibility of two technology-based weight loss interventions in this patient population. METHODS Women with obesity (BMI≥30kg/m(2)) and endometrial hyperplasia or Type I endometrial cancer were randomized 1:1 to a technology-based 6month lifestyle intervention via either telemedicine or text messaging. The telemedicine arm received weekly phone calls, with weights tracked online using Withings© Wi-Fi scales. The text arm received 3-5 personalized messages daily via Text4Diet™. Participants maintained a 1200-1800calorie/day diet, self-monitored food intake and received exercise goals. Biomarkers (IGFBP-1, adiponectin, VEGF, IL1-beta, IL2, IL6, and IL7) were assessed pre- and post-treatment. RESULTS Twenty women were randomized (Telemedicine: n=10, Text4Diet: n=10), and 90% lost weight. Many were early stage (70%) and grade (43.8%) disease with a median age of 60.5years. We observed a statistically greater weight loss in the Telemedicine arm [median loss: 9.7kg (range: 1.6-22.9kg)] versus 3.9kg (range: 0.3-11.4kg) in the Text4Diet arm (p=0.0231). Similarly, percent weight loss was greater in the Telemedicine (7.6%) as compared to the Text4Diet arm (4.1%, p=0.014). Mean serum levels of IL-2 were significantly (27.15pg/mL vs. 5.18pg/mL, p=0.0495) lower at intervention end as compared to baseline. CONCLUSIONS A technology-based weight loss intervention is feasible in women with Type I endometrial cancer/hyperplasia. Both interventions produced weight loss, although more person-to-person contact produced more significant outcomes. Reductions in expression of IL-2 were related to weight loss.

Enhancing physical activity promotion in midlife women with technology-based self-monitoring and social connectivity: A pilot study:

This pilot study tested a novel program to promote adoption and maintenance of aerobic activity in midlife women. Lifestyle modification group sessions were held weekly for 3 months, followed by two booster sessions during the 3-month maintenance phase. During all 6 months of the program, participants used a physical activity sensor to automate self-monitoring and a web platform to facilitate social connectivity. Aerobic exercise increased from 63 to 132 minute/week from baseline to 3 months (p < .01), and activity was maintained at 6 months (135 minute/week). Technology enhancements have strong potential to promote maintenance of behavior change.

Measuring the Ability to Tolerate Activity-Related Discomfort: Initial Validation of the Physical Activity Acceptance Questionnaire (PAAQ).

BACKGROUND Physical activity (PA) is essential for health, but many adults find PA adherence challenging. Acceptance of discomfort related to PA may influence an individuals ability to begin and sustain a program of exercise. The aim of this study was to evaluate the psychometric properties of the Physical Activity Acceptance Questionnaire (PAAQ). METHODS The PAAQ was administered to 3 distinct samples (N = 418). Each sample completed additional self-report measures; 1 sample also wore accelerometers for 7 days (at baseline and 6 months later). RESULTS The PAAQ demonstrated high internal validity for its total score (α = .89) and 2 subscales (Cognitive Acceptance α = .86, Behavioral Commitment α = .85). The PAAQ also showed convergent validity with measures of mindfulness, self-reported physical activity levels, and accelerometer-verified levels of moderate-to-vigorous PA (MVPA; P-values < .05). The Cognitive Acceptance subscale showed predictive validity for objectively-verified PA levels among individuals attempting to increase PA over 6 months (P = .05). Test-retest reliability for a subset of participants (n = 46) demonstrated high consistency over 1 week (P < .0001). CONCLUSIONS The PAAQ demonstrates sound psychometric properties, and shows promise for improving the current understanding of PA facilitators and barriers among adults.

GAP-REACH: a checklist to assess comprehensive reporting of race, ethnicity, and culture in psychiatric publications.

Abstract Growing awareness of health and health care disparities highlights the importance of including information about race, ethnicity, and culture (REC) in health research. Reporting of REC factors in research publications, however, is notoriously imprecise and unsystematic. This article describes the development of a checklist to assess the comprehensiveness and the applicability of REC factor reporting in psychiatric research publications. The 16-item GAP-REACH© checklist was developed through a rigorous process of expert consensus, empirical content analysis in a sample of publications (N = 1205), and interrater reliability (IRR) assessment (N = 30). The items assess each section in the conventional structure of a health research article. Data from the assessment may be considered on an item-by-item basis or as a total score ranging from 0% to 100%. The final checklist has excellent IRR (&kgr; = 0.91). The GAP-REACH may be used by multiple research stakeholders to assess the scope of REC reporting in a research article.

The social context of the relationship between glycemic control and depressive symptoms in type 2 diabetes

Objective Individuals with type 2 diabetes and depressive symptoms have poorer diabetes outcomes than those with diabetes alone, and there is need for improved understanding of the relationship between illness markers and depressive symptoms. The role of social support is well established; less is known about social comparisons (i.e. comparisons to others in the social environment), which are common and influential in chronic illness. The present study examined the mediating effects of social comparison and social support on the relationship between glycemic control and depressive symptoms. Method and outcome measures Participants with physician-diagnosed type 2 diabetes (N = 185) completed an electronic survey about recent depressive symptoms, glycemic control (HbA1c), perceived social support, and social comparison. Results Controlling for relevant covariates, social comparison and social support showed independent statistical mediation of the relationship between glycemic control and depressive symptoms (ps < 0.05). Path analysis also showed that including indirect pathways through social comparison and social support reduced the relationship between glycemic control and depressive symptoms to nonsignificance (β = 0.10, p = 0.14). Conclusion These findings demonstrate that social comparison plays a role in the relationship between diabetes regulation and depression, independent of social support. Greater attention to this aspect of the social environment may render better diabetes outcomes.

Pilot Test of an Acceptance-Based Behavioral Intervention to Promote Physical Activity During Weight Loss Maintenance

ABSTRACT Behavioral interventions for obesity reliably facilitate short-term weight loss, but weight regain is normative. A high level of aerobic exercise may promote weight loss maintenance. However, adopting and maintaining a high level of exercise is challenging, and experiential acceptance may be important. The aim of this study was to pilot test the feasibility and efficacy of an acceptance-based behavioral treatment to promote moderate-to-vigorous physical activity (MVPA) among individuals who had recently lost weight. Adults (n = 16) who had recently lost ≥ 5% of weight were provided with a 12-week, group-based treatment. At 12 weeks, complete analyses indicated that participants had increased activity 69% (completing an average of 198.27 minutes/week of bouted MVPA, i.e., episodes of at least 10 minutes in duration). Medium-to-large effect sizes were observed for changes in process measures, including experiential acceptance. Future research to test this approach using an experimental design, a larger sample, and a longer period of observation is warranted.

Body image satisfaction among male military veterans with cancer

Impaired body satisfaction is commonly reported among cancer patients. This study prospectively evaluated body image disturbance among male military veterans with head and neck or colorectal cancer. Patients (N = 109) completed measures at three points post-diagnosis. Results showed about one-third of participants reporting body-related concerns. Endorsement did not change significantly during the study period. Predictors of worse body satisfaction included younger age, lower education, less social support, and weight loss. Results indicate a substantial minority of men with cancer endorsing body image disturbance, and highlight psychosocial circumstances and weight change as key considerations.