PURPOSE Evaluate impact of physician referral to health coaching on patient engagement and health risk reduction. DESIGN Four-year retrospective, observational cohort study with propensity-matched pair comparisons. SETTING Integrated delivery and finance system in Pittsburgh, Pennsylvania. SAMPLE 10 457 adult insured members referred to health coaching by their physician; 37 864 other members identified for health coaching through insurer-initiated outreach. INTERVENTION Practice-based, technology-supported workflow and process for physician prescribing of health coaching during regular office visit, with follow-up on patient’s progress and implementation supports. MEASURES Patient engagement based on completion of pre-enrollment assessment, formal enrollment in health coaching, completion of required sessions, health risk levels, and number of health risks pre- and post-health coaching referral. ANALYSIS Difference-in-difference analysis to assess change in health risk levels and number of health risks pre- and post-health coaching and probability weighting to control for potential confounding between groups. RESULTS Members referred by a physician were significantly more likely to enroll in a health coaching program (21.0% vs 6.0%, P less then .001) and complete the program requirements (8.5% vs 2.7%, P less then .001) than when referred by insurer-initiated outreach; significant within group improvement in health risk levels from baseline (P less then .001) was observed for both the groups. CONCLUSIONS Patients are significantly more likely to engage in health coaching when a referral is made by a physician; engagement in health coaching significantly improves health risk levels.OBJECTIVE To assess whether intravenous immunoglobulin (IVIG) in subjects with mild cognitive impairment (MCI) results in a reduction in amyloid in the central nervous system (CNS). METHODS Five subjects with MCI underwent baseline Florbetapir positron emission tomography and retinal autofluorescent imaging. All were administered IVIG (Octagam 10%) at 0.4 g/kg every 14 days for a total of 5 infusions. After 3 months, standard uptake value ratio (SUVR) and amyloid retinal deposits were reassessed. RESULTS Three subjects had a reduction in amyloid SUVR and all 5 subjects had a reduction in amyloid retinal deposits in at least 1 eye. CONCLUSIONS A short course of IVIG over 2 months removes a measurable amount of amyloid from the CNS in persons with MCI.PURPOSE To determine the feasibility of applying a medical wellness group (WG) model to a community setting to improve cardiometabolic health. Sodium succinate price DESIGN This quasi-experiment was designed to compare individuals participating in the WG to participants in the control group who received general lectures on nutrition, physical activity, and sleep. SETTING A suburb north of Boston, Massachusetts. PARTICIPANTS Forty-five adults were in the WG and 10 in the control group. INTERVENTION Fourteen weekly 90-minute sessions, led by a physician and dietitian, focusing on nutrition, physical activity, and sleep, compared to controls receiving two 30-minute general wellness lectures provided within 3 months. MEASURES Pre- and postweight, waist circumference, hemoglobin A1C (HbA1c), and serum lipids; a survey measuring beliefs, attitudes, and intentions related to behavioral change. ANALYSIS T tests examined the mean change in biometric measurements. The Wilcoxon test was used to compare the ordinal questions in baseline and final survey results. The Mann-Whitney test was used to compare final survey results between groups. RESULTS The WG demonstrated desirable difference-in-difference between groups in weight (P less then .001), waist circumference (P less then .001), and total cholesterol (P = .03) compared to the control group. Mean change of HbA1c and triglycerides was not different between groups. Survey results showed that attitudes, perceived behavioral control, and feeling supported about wellness behaviors significantly improved from baseline to final visit in the WG (P = .002; P = .019, P = .006, respectively), but not among controls. CONCLUSION Wellness groups are feasible and provide high levels of support and accountability that empower people to make behavioral changes to improve health.PURPOSE This study aims to test the hypothesis that in addition to a direct effect of food environment on obesity, food environment is indirectly associated with obesity through consuming Mediterranean diet (MD). DESIGN Cross-sectional secondary data analysis. SETTING Nationwide community-dwelling residency. SAMPLE A total of 20 897 non-Hispanic black and white adults aged ≥45 years who participated in the REasons for Geographic and Racial Differences in Stroke study and completed baseline assessment during January 2003 and October 2007. MEASURES The Modified Retail Food Environment Index (mRFEI; 0-100) was used as food environment indicator. The MD score (0-9) was calculated to indicate the dietary pattern adherence. Body mass index (BMI; kg/m2) was used to estimate obesity. ANALYSIS Path analysis was used to quantify the pathways between food environment, MD adherence, and obesity. Proper data transformation was made using Box-Cox power transformation to meet certain analysis assumptions. RESULTS The participants were from 49 states of the United States, with the majority (64.42%) residing in the South. Most of the participants were retired, female, white, married, having less than college graduate education, having annual household income ≤75 000, and having health insurance. The means of mRFEI was 10.92 (standard deviation [SD] = 10.19), MD score was 4.36 (SD = 1.70), and the BMI was 28.96 kg/m2 (SD = 5.90). Access to healthy food outlets (β = .04, P less then .0001) and MD adherence (β = .08, P less then .0001) had significant and inverse relationships with BMI, respectively. Mediterranean diet adherence mediated the relationship between food environment and obesity among a subpopulation who had an annual household income of less then $75 000 (β = -.02, P = .0391). CONCLUSION Population-tailored interventions/policies to modify food environment and promote MD consumption are needed in order to combat the obesity crisis in the United States.