Shane A. Phillips

Excessive alcohol drinking results in an increased risk for chronic diseases, and the rates of alcohol consumption have increased among U.S. adults in the past decade. The U.S. Surgeon General called for updating consumer labels to include this risk. This paper aims to understand the regional distribution of excessive drinking and how these patterns may be explained according to the American Nations model of the first U.S. settlement streams. We present data from the 2024 County Health Rankings program to demonstrate the distribution of excessive drinking, showing that excessive alcohol drinking patterns are region-specific and predicted by the American Nations model. This paper introduces the American Nations model in promoting alcohol consumption reduction messages.

Background: The association between alcohol and hypertension has been predominantly based on office blood pressure (BP) measurements. However, little is known about the effect of alcohol use on nighttime BP and the underlying mechanisms. The purpose of this study was to investigate the effects of at‐risk alcohol use on nighttime BP, urinary catecholamines, and sleep quality in midlife adults.Methods: A total of 32 midlife men and 30 postmenopausal women, free of major clinical diseases and nonsmokers (age: 58 ± 4; mean ± SD), were included. Among all participants, 22 were currently taking antihypertensive medications. At‐risk drinkers were defined as those who had a dried blood spot phosphatidylethanol level ≥20 ng/mL. All participants completed 24‐h ambulatory BP monitoring and urine collection to determine nighttime (or asleep) BP and nighttime urinary catecholamine levels. Sleep quality was determined by using the Pittsburgh Sleep Quality Index.Results: In midlife adults free of antihypertensive medications, at‐risk drinkers had a higher nighttime systolic (118 ± 14 vs. 107 ± 14 mmHg, p = 0.02) and diastolic BP (70 ± 9 vs. 62 ± 9 mmHg, p = 0.003) than low‐risk drinkers with no between‐group differences in sleep quality component scores (p ≥ 0.14). In midlife adults taking antihypertensive medications, no difference in nighttime BP was found between at‐risk drinkers and low‐risk drinkers (p ≥ 0.68), with a higher score for the “use of sleeping medication” component in high‐risk drinkers (p = 0.02). Regardless of antihypertensive medication use, no difference between at‐risk drinkers and low‐risk drinkers was found in nighttime urinary catecholamine levels (p ≥ 0.19).Conclusions: Our findings suggest that in midlife adults free of antihypertensive medication use, at‐risk alcohol use is associated with an increase in nighttime BP, and the increase in nighttime BP may be mediated by mechanisms other than increased catecholamines and poor sleep quality.

Objective: The purpose of this scoping review is two-fold: to assess the literature that quantitatively measures outcomes of mentorship programs designed to support research-focused junior faculty and to identify mentoring strategies that promote diversity within academic medicine mentoring programs. Methods: Studies were identified by searching Medline using MESH terms for mentoring and academic medicine. Eligibility criteria included studies focused on junior faculty in research-focused positions, receiving mentorship, in an academic medical center in the USA, with outcomes collected to measure career success (career trajectory, career satisfaction, quality of life, research productivity, leadership positions). Data were abstracted using a standardized data collection form, and best practices were summarized. Results: Search terms resulted in 1,842 articles for title and abstract review, with 27 manuscripts meeting inclusion criteria. Two studies focused specifically on women, and four studies focused on junior faculty from racial/ethnic backgrounds underrepresented in medicine. From the initial search, few studies were designed to specifically increase diversity or capture outcomes relevant to promotion within academic medicine. Of those which did, most studies captured the impact on research productivity and career satisfaction. Traditional one-on-one mentorship, structured peer mentorship facilitated by a senior mentor, and peer mentorship in combination with one-on-one mentorship were found to be effective strategies to facilitate research productivity. Conclusion: Efforts are needed at the mentee, mentor, and institutional level to provide mentorship to diverse junior faculty on research competencies and career trajectory, create a sense of belonging, and connect junior faculty with institutional resources to support career success.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in multiorgan damage primarily mediated by viral infiltrationviaangiotensin-converting enzyme-2 receptors on the surface of cells. A primary symptom for many patients is exertional dyspnoea which may persist even beyond recovery from the viral infection. Respiratory muscle (RM) performance was hypothesised as a contributing factor to the severity of coronavirus disease 2019 (COVID-19) symptoms, such as dyspnoea, and outcomes. This was attributed to similarities between patient populations at elevated risk for severe COVID-19 symptoms and those with a greater likelihood of baseline RM weakness and the effects of prolonged mechanical ventilation. More recent evidence suggests that SARS-CoV-2 infection itself may cause damage to the RM, and many patients who have recovered report persistent dyspnoea despite having mild cases, normal lung function or undamaged lung parenchyma. These more recent findings suggest that the role of RM in the persistent dyspnoea due to COVID-19 may be more substantial than originally hypothesised. Therefore, screening for RM weakness and providing interventions to improve RM performance appears to be important for patients with COVID-19. This article will review the impact of SARS-CoV-2 infection on RM performance and provide clinical recommendations for screening RM performance and treatment interventions.

Objective: To investigate the association between cardiac autonomic activity, endothelial function, and physical fitness in patients with type 2 diabetes mellitus (T2DM). Methods: Twenty-seven patients with T2DM were studied, with a mean age of 57 ± 9 years and a mean disease duration of 7.4 ± 5 years. The assessment of physical fitness was performed using the Shuttle Walking Test (SWT), cardiac autonomic modulation by heart rate variability (HRV), and endothelial function was assessed by flow-mediated dilation (FMD) of the brachial artery through ultrasound imaging. Results: The main finding of this study was that some HRV indices (SDNN, RMSSD, and HF) were significantly correlated with endothelial function in individuals with T2DM, with R values between 0.51 and 0.57 (p < 0, 05), for all relationships. Additionally, an association was found between the distance covered in the SWT and the basal diameter of the brachial artery (R = 0.59; p = 0.01). Conclusion: Our data demonstrate that some HRV indices are associated with DMF, indicating an interaction between these two systems. Furthermore, our findings suggest a correlation between physical fitness and endothelial function in individuals with T2DM.

A large percentage of obese patients in the United States suffer a comorbid substance use disorder, mainly alcohol use. Alcohol consumption interferes with the absorption of dietary methyl donors such as folate required for the one-carbon metabolism pathway and subsequently for DNA methylation. In this study, we assessed the association between alcohol consumption and DNA methylation in obese subjects. We obtained visceral adipose tissue (VAT) biopsies from bariatric patients. DNA methylation of 94 genes implicated in inflammation and immunity were analyzed in VAT in relation to alcohol consumption data obtained via questionnaires. Vasoreactivity was measured in the brachial artery and the VAT-isolated arterioles. Pro-inflammatory genes were significantly hypomethylated in the heavy drinking category correlating with higher levels of circulating inflammatory cytokines. Alcohol consumption correlated positively with body mass index (BMI), fat percentage, insulin resistance, impaired lipid profile, and systemic inflammation and negatively with plasma folate and vitamin B12, inflammatory gene DNA methylation, and vasoreactivity. In conclusion, these data suggest that alcohol intake is associated with lower DNA methylation and higher inflammation and cardiometabolic risk in obese individuals.

INTRODUÇÃO: O diabetes tipo 2 (DT2) pode ser responsável por disfunção cardiometabólica e redução da qualidade de vida (QV) devido ao seu impacto negativo na capacidade funcional de exercício. OBJETIVO: Investigar os efeitos de diferentes tipos de treinamento físico [treinamento intervalado de alta intensidade (TIAI) e treinamento combinado (TC)] associado à terapia com diodo emissor de luz (LED) no status cardiometabólico, capacidade funcional e QV em pacientes com DT2. MÉTODOS: Estudo controlado randomizado que será realizado em laboratório universitário de reabilitação cardiopulmonar com pessoas da comunidade com diagnóstico confirmado de DT2, idade 18 anos e sedentários nos últimos seis meses. Os participantes serão alocados aleatoriamente para um dos seis grupos: TIAI com e sem terapia LED, TC com e sem terapia LED, grupo controle com e sem terapia LED. O protocolo de treinamento deve ser realizado por 12 semanas, 3 vezes na semana em dias alternados, totalizando 36 sessões de treinamento. O desfecho primário será a capacidade de exercício e o controle glicêmico. Os desfechos secundários serão QV, função endotelial, função musculoesquelética, modulação autonômica cardíaca e composição corporal. Os resultados serão medidos antes e após 12 semanas de treinamento. Para análise estatística será utilizado o programa SPSS® 19.0. O nível de significância adotado será p0,05. PERSPECTIVAS: Os resultados deste estudo têm o potencial de fornecer informações importantes sobre os efeitos de diferentes tipos de treinamento físico associados à terapia com LED e podem apoiar o uso dessa combinação terapêutica em pacientes com DT2, melhorando sua saúde geral.  

The relationship between alcohol consumption and cardiovascular disease risk is complex. Low-to-moderate daily alcohol consumption (1–2 drinks/day) is associated with reduced risk, whereas greater amounts of alcohol consumption and a “binge” pattern of drinking are associated with increased cardiovascular risk and mortality. Arterial stiffness may help explain the complex relationship. This integrated review summarizes data from studies examining the associations between alcohol consumption and pulse wave velocity, a gold standard measure of arterial stiffness. We also briefly review the concept and methodology of pulse wave velocity measurement as well as the mechanisms of alcohol-induced arterial stiffening. Findings among the different studies reviewed were inconsistent with methodological challenges related to alcohol use assessment. While making specific conclusions regarding this relationship is tenuous; the data suggest that excessive alcohol consumption or a binge drinking pattern is associated with increased arterial stiffness.

Obesity affects 600 million people globally and increases the risk of developing cardiovascular disease, stroke, diabetes, and cancer. Bariatric surgery is an increasingly popular therapeutic intervention for morbid obesity to induce rapid weight loss and reduce obesity-related comorbidities. However, some bariatric surgery patients, after what is considered a successful surgical procedure, continue to manifest obesity-related health issues, including weight gain, reduced physical function, persistent elevations in blood pressure, and reduced cardiorespiratory fitness. Cardiorespiratory fitness is a strong predictor of mortality and several health outcomes and could be improved by an appropriate exercise prescription after bariatric surgery. This review provides a broad overview of exercise training for patients after bariatric surgery and discusses cardiorespiratory fitness and other potential physiological adaptations in response to exercise training.