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Sarah A. Marshall

Bio: Sarah A. Marshall is an academic researcher from Wake Forest University. The author has contributed to research in topics: Childhood obesity & Breast cancer. The author has an hindex of 8, co-authored 13 publications receiving 223 citations. Previous affiliations of Sarah A. Marshall include University of California, San Francisco.

Papers
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Journal ArticleDOI
TL;DR: The PA group was more likely to regain or sustain functioning and less likely to lose functioning when compared with SA, and the PA participants were 20% more likely than the SA participants to remain in state 1.
Abstract: WITH more than 40 million people in the United States aged 65 and older (1), researchers have witnessed an unprecedented population shift. Clearly a priority for public health must be to ensure that older adults are able to maintain their independence as long as possible. Indeed, there is reason for alarm in that estimates from the Medicare Current Beneficiary Survey indicate that up to 47% of persons aged 65 and older have either mild limitation with mobility or more severe physical disability (1). Because physical function is central to the loss of mobility and activities of daily living that serve as core dimensions of physical disability (2,3), the goal of the current research is to examine how patterns in several common performance measures of physical function fluctuate across a period of 1 year as a function of older prefrail adults’ involvement in a physical activity (PA) intervention—the Lifestyle Intervention and Independence for Elders Pilot (LIFE-P) study (4). Results from several large epidemiological studies and data from recent randomized clinical trials have provided convincing evidence that PA has a favorable effect on performance-based measures of physical function including those that assess balance (5), strength (6), and mobility (7). However, none of these studies have considered the possibility that physical functioning should be treated as a dynamic state, a conceptual position which posits that older adults’ transition in and out of different states of function across time. In addition, different components of function such as balance, strength, and mobility may have discrete patterns of change as functional decline progresses from mild to severe. This implies that physical disablement is inherently multivariate and that studying single outcomes in isolation ignores this inherent complexity. The proposition that functional status is a dynamic state rather than static is not new. Almost 20 years ago, Verbrugge and colleagues (8) followed older persons after in-hospital treatment for chronic health conditions. They found that most people regained physical functioning in the first month after discharge, stabilized for several months, and then began to fluctuate and generally decline in the second year. They stated that disability outcomes “…are very dynamic over a year’s time for persons with serious chronic illness (p. 104).” In recent years, Gill and colleagues have provided much additional evidence to support this perspective. Using a prospective community cohort of persons more than 71 years old (n = 754), they recorded changes in disability status on a monthly basis. In 2004, Hardy and Gill (9) reported that over a median follow-up of 51 months, 56% of participants who initially could bathe, dress, walk inside the house, and transfer from a chair lost one or more of these abilities. Also, 81% of the newly impaired group eventually regained independence in these activities of daily livings with 57% maintaining these abilities for at least 6 months. On the other hand, whereas 60% of those participants who experienced disability for more than 3 months also recovered to an independent state, only a third of this group remained disability free for at least 6 months. Studying the same cohort, Gill and Kurland (10) showed that in the year before the study, prior to being classified as nondisabled, 55 participants had been disabled for a single month, 8 had been disabled for a single episode of 2 months, 18 had experienced chronic disability of more than 3 months, and 11 had some other pattern of short-term disability. A similar trend for dynamic changes in physical disability among older adults with knee pain was recently published by Rejeski and colleagues (11) using data from the Observational Arthritis Study in Seniors. Given the dynamic nature of the disablement process in aging, the researchers’ objective is to describe the heterogeneity and patterns of change that occur among six objective indices of physical function across a period of 1 year among older adults in LIFE-P. The researchers will describe the relative probability of transitioning between states over time and examine whether an exercise intervention influences the probability of transitioning between states. Unlike other studies that used subjective criteria to classify individuals, in this study the states are directly determined from the data and represent clusters of participants with a similar functional profile within each cluster. The researchers hypothesize that the LIFE-P PA intervention will lower the incidence of declining profiles in physical function—balance, strength, and mobility—and increase the incidence of recovery from lost function as compared with the successful aging (SA) education treatment. It is important to note that this hypothesis was not prespecified as a part of LIFE-P. There are several novel features of this study that build on previous LIFE-P publications and make a significant contribution to the literature on physical disability. First and most important, the researchers treat physical disablement as a multivariate construct, proposing that over time it is important to study “phenotypes” or patterns of change in multiple outcomes simultaneously. The researchers focus on objective indices of physical function, a core determinant of physical disablement, and consider both healthy and limited states of different functional domains concurrently. The reason for and value inherent to this approach can be gleaned by a simple example; two people can have the exact same score on the short physical performance battery (SPPB) yet have different phenotypes in strength, balance, and mobility. Second, the researchers provide specific information regarding transitions in physical function for both arms of the study for a period of 1 year, statistically testing the effects of these interventions on transitions in states or phenotypes, both positive and negative.

51 citations

Journal ArticleDOI
TL;DR: The authors developed and tested an instrument to measure medical students’ attitudes and beliefs about obese patients and found it has good validity and reliability and may be used in future studies.
Abstract: PurposeResearch shows obesity bias to undermine the patient–doctor relationship and lead to substandard care. The authors developed and tested an instrument to measure medical students’ attitudes and beliefs about obese patients.MethodThe authors conducted a literature search to identify validated m

47 citations

Journal ArticleDOI
TL;DR: Comparing and contrasts symptom cluster patterns derived from messages on a breast cancer forum with those from a symptom checklist completed by breast cancer survivors participating in a research study shows the copious amount of data generated by social media outlets can augment findings from traditional data sources.
Abstract: User-generated content on social media sites, such as health-related online forums, offers researchers a tantalizing amount of information, but concerns regarding scientific application of such data remain. This paper compares and contrasts symptom cluster patterns derived from messages on a breast cancer forum with those from a symptom checklist completed by breast cancer survivors participating in a research study. Over 50,000 messages generated by 12,991 users of the breast cancer forum on MedHelp.org were transformed into a standard form and examined for the co-occurrence of 25 symptoms. The k-medoid clustering method was used to determine appropriate placement of symptoms within clusters. Findings were compared with a similar analysis of a symptom checklist administered to 653 breast cancer survivors participating in a research study. The following clusters were identified using forum data: menopausal/psychological, pain/fatigue, gastrointestinal, and miscellaneous. Study data generated the clusters: menopausal, pain, fatigue/sleep/gastrointestinal, psychological, and increased weight/appetite. Although the clusters are somewhat different, many symptoms that clustered together in the social media analysis remained together in the analysis of the study participants. Density of connections between symptoms, as reflected by rates of co-occurrence and similarity, was higher in the study data. The copious amount of data generated by social media outlets can augment findings from traditional data sources. When different sources of information are combined, areas of overlap and discrepancy can be detected, perhaps giving researchers a more accurate picture of reality. However, data derived from social media must be used carefully and with understanding of its limitations.

36 citations

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TL;DR: Cancer survivors can be differentiated by their symptom profiles, and chemotherapy and greater illness intrusiveness were significantly related to greater symptom burden, while not being married or partnered, no difficulty paying for basics, and greater social support were protective.

35 citations

Journal ArticleDOI
TL;DR: High maternal BMI was the strongest predictor of early BMI rebound, but increased caloric intake also was significant and Limiting excess calories could delay premature AR and lower the risk of future obesity.

33 citations


Cited by
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Journal ArticleDOI
TL;DR: Investigating how green and blue spaces affect older adult health and wellbeing in Metro Vancouver, Canada indicates that nature plays a nuanced and influential role in the everyday lives of older adults.

277 citations

01 Jan 2005
TL;DR: In this paper, a review of accelerometer-based assessment of physical activity in free-living individuals is presented, focusing on the following issues: product selection, number of accelerometers needed, placement, epoch length, and days of monitoring required to estimate habitual physical activity.
Abstract: Purpose The purpose of this review is to address important methodological issues related to conducting accelerometer-based assessments of physical activity in free-living individuals. Methods We review the extant scientific literature for empirical information related to the following issues: product selection, number of accelerometers needed, placement of accelerometers, epoch length, and days of monitoring required to estimate habitual physical activity. We also discuss the various options related to distributing and collecting monitors and strategies to enhance compliance with the monitoring protocol. Results No definitive evidence exists currently to indicate that one make and model of accelerometer is more valid and reliable than another. Selection of accelerometer therefore remains primarily an issue of practicality, technical support, and comparability with other studies. Studies employing multiple accelerometers to estimate energy expenditure report only marginal improvements in explanatory power. Accelerometers are best placed on hip or the lower back. Although the issue of epoch length has not been studied in adults, the use of count cut points based on 1-min time intervals maybe inappropriate in children and may result in underestimation of physical activity. Among adults, 3–5 d of monitoring is required to reliably estimate habitual physical activity. Among children and adolescents, the number of monitoring days required ranges from 4 to 9 d, making it difficult to draw a definitive conclusion for this population. Face-to-face distribution and collection of accelerometers is probably the best option in field-based research, but delivery and return by express carrier or registered mail is a viable option. Conclusion Accelerometer-based activity assessments requires careful planning and the use of appropriate strategies to increase compliance.

234 citations

Journal ArticleDOI
TL;DR: Breaking-up sedentary time is associated with better physical function in older adults; and, it may have an important place in future guidelines on preserving older adults' physical function to support activities of daily living.
Abstract: Background. Ph ysical function is a key determinant that corresponds to the physiological capacity of older adults to perform normal everyday activities, safely and independently, without undue fatigue. We examined the associations of sedentary behavior (SB), breaks in sedentary time (BST), and moderate-to-vigorous physical activity (MVPA) with physical function in older adults. Methods. Ph ysical activity and SB were assessed with accelerometers (ActiGraph, GT1M) and physical function with the Senior Fitness Test battery, among 87 males and 128 females aged between 65 and 94 years. A composite Z-score was created based on the individual scores for each Senior Fitness Test battery item. Associations of SB, BST, and MVPA with physical function were examined, adjusting for demographic attributes, physical independence, and medical status. Results. A significant positive association was found between BST and the composite physical function Z-score, after adjusting for total SB, MVPA, and potential confounders. MVPA was also positively associated with physical function, after adjusting for SB, BST, and potential confounders. Those with low BST in conjunction with performing less than 30 min/d of MVP A had lower physical function. Conclusions. Breaking-up sedentary time is associated with bet ter physical function in older adults; and, it may have an important place in future guidelines on preserving older adults’ physical function to support activities of daily living.

133 citations

Journal ArticleDOI
01 Apr 2014-Obesity
TL;DR: This study examined weight bias among students training in health disciplines and its associations with their perceptions about treating patients with obesity, causes of obesity, and observations of weight bias by instructors and peers.
Abstract: Objective This study examined weight bias among students training in health disciplines and its associations with their perceptions about treating patients with obesity, causes of obesity, and observations of weight bias by instructors and peers. Methods Students (N = 107) enrolled in a post-graduate health discipline (Physician Associate, Clinical Psychology, Psychiatric Residency) completed anonymous questionnaires to assess the above variables. Results Students reported that patients with obesity are a common target of negative attitudes and derogatory humor by peers (63%), health-care providers (65%), and instructors (40%). Although 80% of students felt confident to treat obesity, many reported that patients with obesity lack motivation to make changes (33%), lead to feelings of frustration (36%), and are non-compliant with treatment (36%). Students with higher weight bias expressed greater frustration in these areas. The effect of students' weight bias on expectations for treatment compliance of patients with obesity was partially mediated by beliefs that obesity is caused by behavioral factors. Conclusions Weight bias is commonly observed by students in health disciplines, who themselves report frustrations and stereotypes about treating patients with obesity. These findings contribute new knowledge about weight bias among students and provide several targets for medical training and education.

130 citations

Journal ArticleDOI
TL;DR: Though there are computational challenges with accessing ePAT, the depth of information provided directly from patients offers new horizons for precision medicine, characterization of sub-clinical symptoms, and the creation of personal health libraries as outlined by the National Library of Medicine.

126 citations