Barriers and enablers of physical activity engagement for patients with COPD in primary care

Background

Given that physical activity (PA) has a positive impact on COPD symptoms and prognosis, this study examined the factors that both encourage and limit participation in PA for individuals with COPD in a primary care setting from the perspective of social cognitive theory.

Methods

A purposive sample of 26 individuals with a range of COPD severity (age range: 50–89 years; males =15) were recruited from primary care to participate in one of four focus groups. Thematic analysis was undertaken to identify key concepts related to their self-efficacy beliefs.

Results

Several barriers and enablers closely related to self-efficacy beliefs and symptom severity were identified. The main barriers were health related (fatigue, mobility problems, breathing issues caused by the weather), psychological (embarrassment, fear, frustration/disappointment), attitudinal (feeling in control of their condition, PA perception, older age perception), and motivational. The main enabling factors were related to motivation (autonomous or controlled), attitudes, self-regulation, and performance accomplishments.

Clinical implications

When designing interventions for individuals with COPD, it is important to understand the patient-specific social cognitive influences on PA participation. This information can then inform individually tailored management planning.

Partial sleep deprivation impacts impulsive action but not impulsive decision-making

Sleep deprivation may lead to increased impulsivity, however, previous literature has focused on examining effects of total sleep deprivation (TSD) rather than the more common condition, partial sleep deprivation (PSD) or 'short sleep'. Moreover, it has been unclear whether PSD impacts impulse-related cognitive processes, and specifically if it differentially affects impulsive action versus impulsive decision-making. We sought to determine if short compared to long sleep (6 vs. 9h/night) impacts impulsive action via behavioral inhibition (Go/No-Go), and/or impulsive decision-making processes of risk taking (Balloon Analogue Risk Task [BART]) and preferences for immediate over delayed rewards (Delay Discounting). In a within-subject design, 34 participants (71% female, mean age=37.0years, SD=10.54) were assigned to four consecutive nights of 6h/night (short sleep) and 9h/night (long sleep) in their own home in random counterbalanced order. Sleep was measured via wrist-worn actigraphs to confirm adherence to the sleep schedules (mean short sleep=5.9h, SD=0.3; mean long sleep=8.6h, SD=0.3, p<0.001). The Go/No-Go, BART, and Delay Discounting tasks were completed following both sleep conditions. Participants had more inhibition errors on the Go/No-Go task after short (mean false alarms=19.79%, SD=14.51) versus long sleep (mean=15.97%, SD=9.51, p=0.039). This effect was strongest in participants reporting longer habitual time in bed (p=0.04). There were no differences in performance following long- versus short-sleep for either delay discounting or the BART (p's>0.4). Overall, these results indicate that four days of PSD diminishes behavioral inhibition abilities, but may not alter impulsive decision-making. These findings contribute to the emerging understanding of how partial sleep deprivation, currently an epidemic, impacts cognitive ability. Future research should continue to explore the connection between PSD and cognitive functions, and ways to minimize the occurrence and negative consequences of short sleep.

Screening Tool Predicts Future Underimmunization Among a Pediatric Practice in Tennessee

The Parent Attitudes about Childhood Vaccines (PACV) survey for identifying vaccine-hesitant parents was recently validated in Washington State but did not include all recommended childhood vaccines. The current study compares vaccination rates for all recommended childhood vaccines and PACV scores at one pediatric practice in Tennessee. Children were enrolled at the 2-week well visit, and vaccination rates were assessed at 19 months of age. Outcomes at 19 months of age included mean percentage of days underimmunized and up-to-date status (yes/no) compared with PACV scores. The impact of provider on immunization status was assessed. Complete vaccination data were available for 158 children of 183 enrolled (86%). Higher PACV scores were associated with more days underimmunized (P < .001) and being overdue for vaccine doses at 19 months of age (P < .001). No difference was seen between providers and up-to-date status. Our study supports the predictive validity of the PACV for underimmunization.

Public Health Amendment (Vaccination of Children Attending Child Care Facilities) Act 2013: its impact in the Northern Rivers, NSW

OBJECTIVE

The objective of the study was to explore the impact of implementation of the Public Health Amendment (Vaccination of Children Attending Child Care Facilities) Act 2013 on child-care centres in the Northern Rivers region of New South Wales (NSW), from the perspective of child-care centre directors. Importance of study: Immunisation is an effective public health intervention, but more than 75 000 Australian children are not fully vaccinated. A recent amendment to the NSW Public Health Act 2010 asks child-care facilities to collect evidence of complete vaccination or approved exemption before allowing enrolment.

METHODS

Ten child-care centre directors participated in a semiscripted interview. Interviews were recorded, transcribed and analysed.

RESULTS

Common themes included misinterpretation of the amendment before implementation, the importance of adequate notice for implementation, lack of understanding of assessment of compliance, increased administrative requirements, the importance of other public health efforts, and limited change in vaccination rates. Child-care centres differed in their experience of the resources provided by the government, interactions with Medicare, and ease of integration with existing record-keeping methods.

CONCLUSIONS

Participants felt that the amendment was successfully implemented. The amendment was felt to have fulfilled its aim of prompting parents who had forgotten to vaccinate, but failed to significantly affect conscientious objectors. Overall, the amendment was perceived to be a positive step in improving vaccination rates, but its impact was largely complementary to other components of the multifaceted vaccination policy.

Anxiety symptom interpretation: A potential mechanism explaining the cardiorespiratory fitness-anxiety relationship

BACKGROUND

Higher cardiorespiratory fitness is associated with lower trait anxiety, but research has not examined whether fitness is associated with state anxiety levels and the interpretation of these symptoms. The aim of this paper was to (1) reexamine the association between cardiorespiratory fitness and general anxiety and (2) examine anxiety intensity and perceptions of these symptoms prior to an acute psychological stress task.

METHODS

Participants (N=185; 81% female; Mage=18.04, SD=0.43 years) completed a 10-minute Paced Serial Addition Test. General anxiety was assessed using the anxiety subscale of the Hospital Anxiety Depression Scale. Cognitive and somatic anxiety intensity and perceptions of symptoms was assessed immediately prior to the acute psychological stress task using the Immediate Anxiety Measures Scale. Cardiorespiratory fitness was calculated using a validated standardized formula.

RESULTS

Higher levels of cardiorespiratory fitness were associated with lower levels of general anxiety. Path analysis supported a model whereby perceptions of anxiety symptoms mediated the relationship between cardiorespiratory fitness and levels of anxiety experienced during the stress task; results remained significant after adjusting for general anxiety levels. Specifically, higher levels of cardiorespiratory fitness were positively associated with more positive perceptions of anxiety symptoms and lower levels of state anxiety.

LIMITATIONS

A standard formula rather than maximal testing was used to assess cardiorespiratory fitness, self-report questionnaires were used to assess anxiety, and the study was cross-sectional in design.

CONCLUSIONS

Results suggest a potential mechanism explaining how cardiorespiratory fitness can reduce anxiety levels.

Investigating the psychosocial determinants of physical activity in older adults: A qualitative approach

Objective: Despite the benefits of physical activity (PA), only one-third of older adults meet the recommended levels. The present study focused on psychosocial determinants of PA following retirement. Social cognitive theory (SCT) was used to better understand pre- and post-retirement adults’ thoughts about PA, the reasons why some individuals are more active than others, and how PA is incorporated into daily life after retirement.

Design: Seven focus groups of older adults (N = 37, M = 64, SD = 5.20; males = 20) representing a range of PA levels and retirement length participated in one of seven focus groups.

Results: Aligned with SCT, self-efficacy beliefs along with perceptions about barriers and benefits of PA were among the major determinants of PA. Findings highlighted the importance of social support, positive outcome expectations and self-regulatory strategies as motivators. The lack of structure in retirement was a hindrance to incorporating PA into daily routine but, when incorporated, PA provided a sense of purpose in the lives of retired individuals.

Conclusion: It is important to understand the meaning of retirement as a life transition and how it affects beliefs about PA to inform SCT-based health promotion interventions targeting individuals in retirement age.

Comparing self-report and mental chronometry measures of motor imagery ability

The present study investigated the relationship between two of the most common measures of motor imagery ability, self-report ratings, and chronometric assessment. This was done for three types of imagery modalities: external visual imagery (EVI), internal visual imagery (IVI), and kinesthetic imagery (KI). Measures of imagery ability (i.e. self-report and mental chronometry) were also compared across skill levels. Participants (N = 198) completed the Movement Imagery Questionnaire-3 (MIQ-3) to generate self-report ratings. Chronometric assessment was obtained by recording the duration of each MIQ-3 movement imaged and physically performed and then calculating a discrepancy score. There were no significant correlations between self-report and mental chronometry for any of the three motor imagery types (p > .05). When assessing the different types of motor imagery ability using self-report ratings, elite athletes had significantly higher KI than IVI, which was in turn significantly higher than EVI (p < .05). When assessing motor imagery ability using mental chronometry, there were no significant differences in imagery type (p > .05). Findings suggest both measures address different components of MI quality and should be used together to obtain a more comprehensive assessment of motor imagery ability.

Best-classifier feedback in diagnostic classification training

Diagnostic classification training requires viewing many examples along with category membership feedback. "Objective" feedback based on category membership suggests that perfect accuracy is attainable when it may not be (e.g., with confusable categories). Previous work shows that feedback based on an "optimal" responder (that sometimes makes classification errors) leads to higher long-run reward, especially in unequal category payoff conditions. In the current study, participants learned to classify normal or cancerous mammography images, earning more points for correct "cancer" than "normal" responses. Feedback was either objective or based on performance of an empirically determined "best" classifier. This approach is necessary because theoretically optimal responses cannot be determined with complex real-world stimuli with unknown perceptual distributions. Replicating earlier work that used simple artificial stimuli, we found that best-classifier performance led to decision-criterion values (β) closer to the reward-maximizing criterion, along with higher point totals and a slight reduction (as predicted) in overall accuracy.

What are the factors that contribute to parental vaccine-hesitancy and what can we do about it?

Parental refusal or delay of childhood vaccines is increasing. Barriers to vaccination among this population have been described, yet less is known regarding motivating factors. Researchers are beginning to evaluate various approaches to address the concerns of "vaccine-hesitant" parents, but few studies have evaluated the effect of interventions on timely vaccine uptake. Several models for communicating with vaccine-hesitant parents have been reported for healthcare providers; however, the effectiveness and utility of these strategies has not been quantified. This article reviews the known barriers to vaccination reported by vaccine-hesitant parents and the current evidence on strategies to address parental vaccine hesitancy.

Quantitative effects of inclusion of fat on muscle diffusion tensor MRI measurements

PURPOSE

To determine the minimum water percentage in a muscle region of interest that would allow diffusion tensor (DT-) MRI data to reflect the diffusion properties of pure muscle accurately.

MATERIALS AND METHODS

Proton density-weighted images with and without fat saturation were obtained at the mid-thigh in four subjects. Co-registered DT-MR images were used to calculate the diffusion tensor's eigenvalues and fractional anisotropy.

RESULTS

The eigenvalues transitioned monotonically as a function of water signal percentage from values near to those expected for pure fat to those for pure muscle. Also, the fractional anisotropy transitioned monotonically from 0.50 (fat) to 0.20 (muscle). For water signal percentages >55%, none of the diffusion indices differed significantly from those for regions of >90% muscle.

CONCLUSION

Accounting for the T1 and T2 values of muscle and fat and the pulse sequence properties, it is concluded that, as a conservative estimate, regions must contain at least 76% muscle tissue to reflect the diffusion properties of pure muscle accurately.

Layered stimulus response training improves motor imagery ability and movement execution

This study aimed to test Lang's bioinformational theory by comparing the effects of layered stimulus and response training (LSRT) with imagery practice on improvements in imagery ability and performance of a motor skill (golf putting) in 24 novices (age, M = 20.13 years; SD = 1.65; 12 female) low in imagery ability. Participants were randomly assigned to a LSRT (introducing stimulus and response propositions to an image in a layered approach), motor imagery (MI) practice, or visual imagery (VI) practice group. Following baseline measures of MI ability and golf putting performance, the LSRT and MI practice groups imaged successfully performing the golf putting task 5 times each day for 4 days whereas the VI practice group imaged the ball rolling into the hole. Only the LSRT group experienced an improvement in kinesthetic MI ability, MI ability of more complex skills, and actual golf putting performance. Results support bioinformational theory by demonstrating that LSRT can facilitate visual and kinesthetic MI ability and reiterate the importance of imagery ability to ensure MI is an effective prime for movement execution.

Further validation and development of the movement imagery questionnaire

This research validated and extended the Movement Imagery Questionnaire- Revised (MIQ-R; Hall & Martin, 1997). Study 1 (N = 400) examined the MIQ-R's factor structure via multitrait-multimethod confirmatory factor analysis. The questionnaire was then modified in Study 2 (N = 370) to separately assess the ease of imaging external visual imagery and internal visual imagery, as well as kinesthetic imagery (termed the Movement Imagery Questionnaire-3; MIQ-3). Both Studies 1 and 2 found that a correlated-traits correlated-uniqueness model provided the best fit to the data, while displaying gender invariance and no significant differences in latent mean scores across gender. Study 3 (N = 97) demonstrated the MIQ-3's predictive validity revealing the relationships between imagery ability and observational learning use. Findings highlight the method effects that occur by assessing each type of imagery ability using the same four movements and demonstrate that better imagers report greater use of observational learning.

Dialectical Behavioural Therapy and Borderline Personality Disorder: Effects on Service Utilisation and Self-Reported Symptoms

In a pilot evaluation study, effectiveness of a 20-week dialectical behavioural therapy (DBT) skills training group program was explored for adult clients with borderline personality disorder (BPD;N= 140). Subjective ratings of depression, anxiety and BPD symptomatology were obtained pre and post group therapy. Objective measures of service utilisation levels were obtained for the 6 months prior to group therapy, the duration of therapy, and the 6 months following therapy. Group completers (n= 68) showed reductions in depression, anxiety and BPD symptomatology, as well as in the number of emergency department attendances. Completers with previous high service utilisation had decreases in telephone counselling calls and inpatient days during therapy, and fewer emergency department attendances post therapy. Completers had larger decreases in service utilisation than noncompleters (n= 72). Simultaneous engagement in individual DBT was related to higher group completion than was individual therapy as usual, but it did not impact on level of service utilisation or psychological functioning. This quasi-experimental pilot study suggests that DBT groups may improve psychological functioning and decrease service utilisation for BPD clients, particularly those with high service utilisation. The treatment warrants systematic evaluation.

The functional equivalence between movement imagery, observation, and execution influences imagery ability

Based on literature identifying movement imagery, observation, and execution to elicit similar areas of neural activity, research has demonstrated that movement imagery and observation successfully prime movement execution. To investigate whether movement and observation could prime ease of imaging from an external visual-imagery perspective, an internal visual-imagery perspective, and kinesthetic modality, 36 participants (M age = 20.58; SD = 3.11; 18 women and 18 men) completed an adapted version of the Movement Imagery Questionnaire-Revised under four modes of delivery (movement prime, external observation prime, internal observation prime, and image-only). The results revealed that ease of imaging was significantly greater during the movement and observation prime conditions compared to the image-only condition (p < .05). Specifically when priming external visual imagery and internal visual imagery, observation facilitated ease of imaging only when the perspective was congruent with the imagery perspective. The results support the use of movement and observation to facilitate ease of imaging, but highlight the importance of considering the visual perspective when using observation.