Smoking and weight control behaviors

Interventions to improve veterans' access to care: a systematic review of the literature

OBJECTIVES

To conduct a systematic review to address the following key questions: (1) what interventions have been successful in improving access for veterans with reduced health care access? (2) Have interventions that have improved health care access led to improvements in process and clinical outcomes?

DATA SOURCES

OVID MEDLINE, CINAHL, PsychINFO.

STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS

English language articles published in peer-reviewed journals from 1990 to June 2010. All interventions designed to improve access to health care for US veterans that reported the impact of the intervention on perceived (e.g., satisfaction with access) or objective (e.g., travel time, wait time) access were included. APPRAISAL AND SYNTHESIS METHODS: Investigators abstracted data on study design, study quality, intervention, and impact of the intervention on access, process outcomes, and clinical outcomes.

RESULTS

Nineteen articles (16 unique studies) met the inclusion criteria. While there were a small number of studies in support of any one intervention, all showed a positive impact on either perceived or objective measures of access. Implementation of Community Based Outpatient Clinics (n = 5 articles), use of Telemedicine (n = 5 articles), and Primary Care Mental Health Integration (n = 6 articles) improved access. All 16 unique studies reported process outcomes, most often satisfaction with care and utilization. Four studies reported clinical outcomes; three found no differences.

LIMITATIONS

Included studies were largely of poor to fair methodological quality.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

Interventions can improve access to health care for veterans. Increased access was consistently linked to increased primary care utilization. There was a lack of data regarding the link between access and clinical outcomes; however, the limited data suggest that increased access may not improve clinical outcomes. Future research should focus on the quality and appropriateness of care and clinical outcomes.

The drop it at last study: six-month results of a phone-based weight loss trial

PURPOSE

To address the translational research question regarding the optimal intervention "dose" to produce the most cost-effective rate of weight loss, we conducted the Drop It At Last (DIAL) study.

DESIGN

DIAL is a 6-month pilot randomized trial to examine the efficacy of phone-based weight loss programs with varying levels of treatment contact (10 vs. 20 sessions) in comparison to self-directed treatment.

SETTING

Participants were recruited from the community via mailings and advertisement.

SUBJECTS

Participants were 63 adults with a body mass index between 30 and 39 kg/m(2).

INTERVENTION

Participants received a standard set of print materials and were randomized to either: (1) self-directed treatment; (2) 10 phone coaching sessions; or (3) 20 phone coaching sessions.

MEASURES

Measured height, weight, and psychosocial and weight-related self-monitoring measures were collected at baseline and follow-up.

ANALYSIS

General linear models were used to examine 6-month treatment group differences in weight loss and in psychosocial and behavioral measures.

RESULTS

Weight losses were -2.3, -3.2, and -4.9 kg in the self-directed, 10-session, and 20-session groups, respectively (p < .21). Participants who completed 10 or more sessions lost more weight (-5.1 kg) compared to those completed four or fewer sessions (-.3 kg, p < .04).

CONCLUSION

Phone-based weight loss program participation is associated with modest weight loss. The optimal dose and timing of intervention warrant further study.

A self-report instrument measuring readiness to change disordered eating behaviors: the Eating Disorders Stage of Change

OBJECTIVE

To evaluate the utility of the Eating Disorders Stage of Change (EDSOC), a behavior-specific readiness questionnaire.

METHOD

Patients (N=145) at a multidisciplinary eating disorder treatment facility in the United States completed the EDSOC and other questionnaires.

RESULTS

One-week test-retest reliability was strong across eating disorder diagnoses and age groups. Convergent validity was strongest when the behavior in question was congruent with the diagnosis (e.g., purging behaviors for bulimia nervosa diagnosis) and compared to the patient's own intention to complete treatment. Divergent validity was demonstrated against body mass index values and age. However, the EDSOC and Body Shape Questionnaire were inversely correlated, suggesting that increased body shape concerns are associated with decreased intention to change a behavior.

CONCLUSION

This preliminary cost-effective, behavior-specific measure demonstrates good psychometric properties and is appropriate for use with children and adults. Across diagnosis, the instrument should be used by looking at each single item instead of summing a total score across disparate eating disorder behaviors.

Body mass index, sexual behaviour, and sexually transmitted infections: an analysis using the NHANES 1999-2000 data

Background

Factors determining human sexual behaviour are not completely understood, but are important in the context of sexually transmitted disease epidemiology and prevention. Being obese is commonly associated with a reduced physical attractiveness but the associations between body mass index, sexual behaviour and the risk of acquiring sexually transmitted infections has never been studied.

Methods

The National Health and Nutrition Examination Survey (NHANES) files of 1999–2000 were used. Linear regression was used to relate the reported number of sex partners in the last year and lifetime to Body Mass Index (BMI). Logistic regression was used to relate Herpes Simplex Virus type II (HSV-2) antibodies to BMI and other variables.

Results

Data on 979 men and 1250 women were available for analysis. Obese (mean number of partners for men:1.12, women: 0.93) and overweight (mean for men: 1.38, women: 1.03) individuals reported fewer partners than individuals of normal BMI (mean for men:2.00, women: 1.15) in the last year (p < .0.01 & p < 0.05 for men, p < 0.05 & n.s. for women). The same relationship held for lifetime partners in men (mean 11.94, 18.80, and 22.08 for obese, overweight and normal BMI respectively (p < 0.05 & n.s. for obese and overweight vs normal respectively), but not in women (mean 7.96, 4.77, and 5.24 respectively). HSV-2 antibodies were significantly correlated with the number of lifetime partners in both men and women, with the odds of being HSV-2 positive increasing by 0.6% (p < 0.01) and 2.7% (p < 0.01) for men and women respectively. HSV-2 antibodies increased with age, even after adjustment for lifetime partners (p < 0.01). Being obese (HSV-2 prevalence 15.9 and 34.9% for men and women respectively) or overweight (HSV-2 prevalence 16.7 and 29.3 for men and women respectively) was not associated with HSV-2 antibodies (HSV-2 prevalence for normal BMI: 15.6 and 23.2% respectively), independent of whether the association was adjusted for life time sexual partners or not. There was evidence of substantial misreporting of sexual behaviour.

Conclusion

Obese and overweight individuals, especially men, self report fewer sex partners than individuals of normal weight, but surprisingly this is not reflected in their risk of HSV-2 infection. HSV-2 antibodies provide information not contained in self-reported number of partners and may better estimate sexual risk than self-reported behaviour.