Chi C. Cho’s research while affiliated with University of Wisconsin–Milwaukee and other places

Background Metabolic syndrome (MetS) increases the risk of cardiovascular disease morbidity and mortality. Physical activity (PA) reduces the likelihood of MetS, but it is a complex behavior and is accumulated in multiple domains. Purpose To cross-sectionally investigate the total and domain-specific relationships between PA and MetS in U.S. adults. Methods Data from 3,408 adults participating in the National Health and Nutrition Examination Survey (2013–2018) were analyzed. Blood pressure (BP), waist circumference (WC), fasting blood glucose (GLU), triglycerides (TRIG), and high-density lipoprotein (HDL) were measured. MetS and its risk factors were the primary and secondary outcomes, respectively. Weekly minutes of total PA and domain-specific PA (i.e., leisure-time (LTPA), transportation (TPA), occupational & household (OHPA)), were self-reported. For each exposure, participants were grouped into weekly PA: (1) 0 min, (2) 1–149 min, (3) 150–299 min, (4) 300–599 min, and (5) 600 + minutes. Logistic regression estimated the odds of having MetS, and its risk factors from PA. Results Total PA was associated with lower odds of most MetS risk factors. Compared to no LTPA, and independent of TPA and OHPA, engaging in 150–299 and 300–599 min/week of LTPA was associated with 30% (OR = 0.70 [95%CI: 0.50, 0.98]) and 43% (OR = 0.57 [95%CI: 0.35, 0.92]) lower odds of MetS, respectively. LTPA was also associated with lower odds of having high WC, GLU, TRIG, and low HDL (ORs = 0.52–0.68). Compared to no TPA, and independent of LTPA and OHPA, engaging in 300–599 min/week of TPA was associated with 54% lower odds of MetS (OR = 0.46 [95%CI: 0.25, 0.84]) and 40% lower odds of having a high WC (OR = 0.40 [95%CI: 0.21, 0.76]). Engaging in OHPA was not associated with MetS but was associated with greater odds of having a high WC (OR = 1.44 [95%CI: 1.03, 2.01]), and GLU (ORs = 1.52–1.83), independent of LTPA and TPA. Conclusion Total PA, seemingly driven by LTPA, was inversely associated with cardiometabolic health. TPA also showcases some protective associations, while OHPA appears to not confer cardiometabolic health benefits. Longitudinal data should confirm these associations using more robust PA measurement tools.

Background: This study describes experiences and perspectives of pediatric weight management (PWM) providers on the implementation of genetic testing for rare causes of obesity. Methods: Purposive and snowball sampling recruited PWM providers via email to complete a 23-question survey with multiple choice and open-ended questions. Analyses include descriptive statistics, Fisher's exact test, one-way ANOVA with Tukey's post hoc test, and qualitative analysis. Results: Of the 55 respondents, 80% reported ordering genetic testing. Respondents were primarily physicians (82.8%) in practice for 11-20 years (42%), identified as female (80%), White (76.4%), and non-Hispanic (92.7%) and provided PWM care 1-4 half day sessions per week. Frequently reported patient characteristics that prompted testing did not vary by provider years of experience (YOE). These included obesity onset before age 6, hyperphagia, dysmorphic facies, and developmental delays. The number of patient characteristics that prompted testing varied by YOE (p = 0.03); respondents with 6-10 YOE indicated more patient characteristics than respondents with >20 YOE (mean 10.3 vs. mean 6.2). The reported primary benefit of testing was health information for patients/families; the primary drawback was the high number of indeterminate tests. Ethical concerns expressed were fear of increasing weight stigma, discrimination, and impact on insurance coverage. Respondents (42%) desired training and guidance on interpreting results and counseling patients and families. Conclusions: Most PWM providers reported genetic testing as an option for patient management. Provider training in genetics/genomics and research into provider and family attitudes on the genetics of obesity and the value of genetic testing are next steps to consider.

Social isolation has negative associations with various health outcomes including cognitive function. However, limited research exists delineating the effect of social isolation on cognition using population-based longitudinal data. Moreover, little is known whether there are any race/ethnic differences in this social isolation-cognition relationship. We examined the effects of social isolation on cognitive function and explored the moderating role of race/ethnicity using longitudinal data of 4381 older adults from two waves of NHATS (2015 and 2018). Social isolation was measured by addressing four domains of network and integration: (a) marriage or partnership, (b) family and friends, (c) church participation, and (d) club participation (score range: 0 - 6). A higher score indicates more social isolation. Cognitive function was measured using the composite score of three domains: memory, orientation, and executive function (range: 0 - 33), with higher scores indicating better cognitive function. Repeated-measures ANOVA showed a significant relationship between social isolation and cognitive function. Specifically, the greater the social isolation, the lower the cognitive function. We found significant differences in cognitive function scores across race/ethnic groups. Non-Hispanic White showed higher cognitive function than non-Hispanic black, Hispanics, and other races. Non-Hispanic black and other races also showed significantly higher scores than Hispanics. The findings also showed that the cognitive function score significantly decreased over a 4- year period. There was no moderating effect of race/ethnicity found between social isolation and cognitive function. Interventions are needed to reduce social isolation by facilitating social participation in community activities, thereby protecting against cognitive decline.

Low grip strength is associated with negative health outcomes among older adults, including poor physical performance, sarcopenia, and all-cause mortality. Social isolation has been also linked with decreased physical function and mortality. Limited studies examined whether social isolation is a risk factor for grip strength decline among older adults and whether race differences exist in this association using population-based longitudinal data. The aim of this study was to evaluate the relationship between social isolation and grip strength among older adults and whether the relationship varies by race and over time. We analyzed National Health and Aging Trends Study (NHATS) data (2015 - 2018) and the sample included 4877 adults > 65 years old. Grip strength was measured using a digital hand dynamometer. Social isolation was measured using six NHATS items from the literature and the composite score ranged from 0 to 6, with a higher score indicating more isolation. The sample mean age was 75 (SD = 22; 68 - 110 years). Repeated-measures analysis of variance showed significant differences in grip strength across social isolation scores (p = .001) indicating that socially isolated older adults have significantly lower grip strength. We also found that grip strength significantly decreased by 2.046 kg over the four-year period (p = < .001). The findings showed no significant difference in grip strength across race and change in grip strength across time did not differ by race and social isolation. Interventions to improve muscle strength and reduce social isolation among older adults are needed.

Background Numerous studies have observed a significant and unique relationship between children's use of nonmainstream dialect and reading outcomes. We aimed to examine the relationship between nonmainstream dialect and reading at its roots by completing a preliminary evaluation of the relationship between African American English (AAE) dialect and multiple dimensions of emergent literacy skills in young African American children enrolled in Head Start. Methods Seventy‐eight African American preschoolers completed the Phonological Awareness Literacy Screening‐PreK (PALS‐PreK) and a narrative retell of the wordless picture book, Frog, Where Are You? The narratives were used to generate three measures of narrative productivity and the dialect density measure (DDM). Results Structural equation modelling found that the PALS‐PreK measures significantly loaded onto a single print‐related emergent literacy latent variable and that the three narrative measures significantly loaded onto a single language‐based emergent literacy latent variable. There was a significant relationship between print‐related emergent literacy skills and DDM, but the overall model had a poor fit, showing that the relationship between emergent literacy and DDM was weak. Conclusions We conclude the manuscript by discussing implications of this research and suggestions for further study.

Parenting influences child development. There is limited research, however, related to parenting children who have developmental disabilities. The aims of this study were to: (1) describe the parenting styles and dimensions of parents of children with developmental disabilities and (2) assess differences in parenting styles and dimensions among parents of children with autism spectrum disorder (ASD), Down syndrome (DS), and spina bifida (SB). Secondary data analysis was conducted from a nationwide cross‐sectional study of 496 parents of children aged 5–16 years with ASD (n = 180), DS (n = 156), or SB (n = 160). Parent scores indicated high use of the authoritative parenting style and associated parenting dimensions, mid‐to‐low use of the permissive parenting style, and low use of the authoritarian parenting style and associated dimensions. Variation in parenting styles and dimensions among parents was primarily related to the child's diagnosis and family income. An unanticipated but positive finding was that parents with lower family incomes had significantly higher scores for the authoritative parenting style. Results from this study can inform future research that might inform clinical practice.

Background: Multiple sclerosis (MS) is a neurodegenerative condition characterized by high concentration of nitric oxide leading to the production of reactive oxygen species (ROS) and reactive nitrogen species (RNS), a condition known as nitrosative stress. ROS and RNS produce the inhibition of the mitochondrial electron transport chain leading to mitochondrial dysfunction, reduction of adenosine triphosphate, and death of neurons, producing severe and irreversible damage in the central nervous system of people with MS (PwMS). Current drug treatments for MS focus on the regulation of immune response in acute stages of disease, but they do not regulate nitrosative stress which is present in the acute and chronic stages of disease. Previously, our laboratory showed that photobiomodulation (PBM) on experimental autoimmune encephalomyelitis mice, the animal model of MS, reduced clinical severity of disease, gene expression of inducible nitric oxide synthase (iNOS), and the levels of nitrite in in vivo and in vitro experiments. Objective: We evaluated the effect of PBM on the regulation of nitrosative stress in PwMS. Methods: PBM was applied on peripheral blood mononuclear cells (PBMCs) obtained from PwMS to evaluate PBM on the regulation of nitrate as a marker of nitrosative stress. Results: PBM at 830 nm (10 J/cm2 at 72 h) reduced the levels of nitrite and this reduction was in relationship with the increase of interleukin-10 and the reduction of interferon-γ produced by the PBMCs regardless of the severity of disease present in the participants. Conclusions: PBM at 830 nm can potentially be used to reduce nitrosative stress at any point of disease in PwMS.

Geared manual wheelchair wheels, a recently developed alternative propulsion mechanism, have the potential to alleviate the high upper extremity demands required for wheelchair propulsion and help decrease the risk of secondary injuries in manual wheelchair users. The objective of this study was to investigate the effects of using geared manual wheelchairs on hand-rim biomechanics of wheelchair propulsion in individuals with spinal cord injury (SCI). Seven manual wheelchair users with SCI propelled their wheelchairs equipped with geared wheels over tile, carpet, and up a ramp in low gear (gear ratio 1.5:1) and standard gear (gear ratio 1:1) conditions. Hand-rim kinetics and stroke cycle characteristics were measured using a custom instrumented geared wheel. Using the geared wheels in the low gear condition, propulsion speed (P=0.013), peak resultant force (P=0.005), peak propulsive moment (P<0.006), and peak rate of rise of the resultant force (P=0.035) decreased significantly in comparison with the standard gear condition. The significant increase in the number of stroke cycles when normalized to distance (P=0.004) and decrease in the normalized integrated moment (P=0.030) indicated that although a higher number of stroke cycles are required for travelling a given distance in the low gear than the standard gear condition, the low gear condition might be less demanding for the upper extremity. These results suggest that geared wheels could be a useful technology for manual wheelchair users to independently accomplish strenuous propulsion tasks including mobility on carpeted floors and ramp ascension, while reducing the risk factors contributing to the incidence of secondary upper extremity injuries.

Background: There is emerging literature that standing desk interventions may help to improve cognitive performance in school-aged children. The current study examines how desks that promote standing affect cognition over the course of a school year in third, fourth, and sixth graders. Methods: Nighty-nine students between the ages of 8 and 12 (M = 10.23; 58% Male) were assigned to either stand-biased desks or traditional sitting desks. A within-classroom design was used with students switching desks after 9 weeks. Cognitive assessments and teacher behavioral ratings were administered at baseline and readministered before students switched desks and at the conclusion of the study. Results: There were no significant effects on cognition or behavioral ratings from standing-biased desk intervention. Grade significantly moderated the relationship between stand-biased desks and cognition in that third graders showed increased cognitive control (p = 0.02, f2 = 0.06). Further, sex moderated the relationship in that females at stand-biased desks showed increased cognitive control (p = 0.03, f2 = 0.04). Conclusions: These results suggest that stand-biased desks impact cognition depending on grade and sex, indicating a complex relationship that should be teased out further in future research. Stand-biased desks showed moderate improvements in cognition and no deleterious effects, suggesting that they may be a helpful classroom intervention for children in elementary school.