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McMullen B, Duncanson K, Collins C, MacDonald-Wicks L. A systematic review of the mechanisms influencing engagement in diabetes prevention programmes for people with pre-diabetes. Diabet Med 2024; 41:e15323. [PMID: 38829966 DOI: 10.1111/dme.15323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/02/2024] [Accepted: 03/20/2024] [Indexed: 06/05/2024]
Abstract
AIMS To identify barriers and enablers that influence engagement in and acceptability of diabetes prevention programmes for people with pre-diabetes. The results will provide insights for developing strategies and recommendations to improve design and delivery of diabetes prevention programmes with enhanced engagement and acceptability for people with pre-diabetes. METHODS This review used a critical realist approach to examine context and mechanisms of diabetes prevention programmes. Medline, Embase, PsycInfo, Cinahl, Web of Science, Scopus and Pre-Medline were searched for English language studies published between 2000 and 2023. A quality assessment was conducted using Joanna Briggs Institute critical appraisal tools. RESULTS A total of 90 papers met inclusion criteria. The included studies used a variety of quantitative and qualitative methodologies. Data extracted focused on barriers and enablers to engagement in and acceptability of diabetes prevention programmes, with seven key mechanisms identified. These included financial, environmental, personal, healthcare, social and cultural, demographic and programme mechanisms. Findings highlighted diverse factors that influenced engagement in preventive programmes and the importance of considering these factors when planning, developing and implementing future diabetes prevention programmes. CONCLUSIONS Mechanisms identified in this review can inform design and development of diabetes prevention programmes for people with pre-diabetes and provide guidance for healthcare professionals and policymakers. This will facilitate increased participation and engagement in preventive programmes, potentially reducing progression and/or incidence of pre-diabetes to type 2 diabetes and improving health outcomes.
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Affiliation(s)
- Britney McMullen
- Mid North Coast Local Health District, University of Newcastle, Coffs Harbour, Australia
| | - Kerith Duncanson
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Clare Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Lesley MacDonald-Wicks
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
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2
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Gómez-Gómez I, Rodero-Cosano ML, Bellón JÁ, Zabaleta-Del-Olmo E, Maderuelo-Fernandez JA, Moreno-Peral P, Magallón-Botaya R, Oliván-Blázquez B, Casajuana-Closas M, López-Jiménez T, Bolíbar B, Llobera J, Clavería A, Sanchez-Perez A, Motrico E. Examining the influence of mental health and structural determinants of health on the stage of motivational readiness for health behaviour changes: A path analysis study. J Health Psychol 2024:13591053241241015. [PMID: 38605575 DOI: 10.1177/13591053241241015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
This study explores the influence of mental health and structural determinants of health on motivational readiness for health behaviour change in 1462 Spanish primary healthcare users. Chi-square test and structural equation modelling were performed. Results showed that depression and anxiety were negatively associated with being in the action stages of motivational readiness for a healthy diet and physical activity. This association was statistically significant only for motivational readiness for a healthy diet and depression (β = - 0 . 076 ; p = 0 . 046 ). Furthermore, women and workers were more likely to be in the action stages of motivational readiness for a healthy diet while older adults and adults with higher health-related quality of life were more likely to be in the action stages of motivational readiness for physical activity. The present study suggests that structural (being older, being a woman and being employed) and intermediary (suffering from depression and higher health-related quality of life) determinants of health influence motivational readiness for health behaviour changes.
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Affiliation(s)
- Irene Gómez-Gómez
- Universidad Loyola Andalucía, Spain
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
| | | | - Juan Á Bellón
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Biomedical Research Institute of Málaga (IBIMA), Spain
- Andalusian Health Service (SAS), Spain
- University of Málaga, Spain
| | - Edurne Zabaleta-Del-Olmo
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Institut Català de la Salut, Spain
- Universitat de Girona, Spain
| | - José A Maderuelo-Fernandez
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Spain
- Instituto de investigación Biomédica de Salamanca (IBSAL), Spain
- Gerencia de Atención Primaria de Salamanca, Spain
- Gerencia Regional de salud de Castilla y León (SACyL), Spain
| | - Patricia Moreno-Peral
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Biomedical Research Institute of Málaga (IBIMA), Spain
| | - Rosa Magallón-Botaya
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Universidad de Zaragoza, Spain
- Institute for Health Research Aragón (IISA), Spain
| | - Bárbara Oliván-Blázquez
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Universidad de Zaragoza, Spain
- Institute for Health Research Aragón (IISA), Spain
| | - Marc Casajuana-Closas
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Spain
| | - Tomàs López-Jiménez
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Spain
| | - Bonaventura Bolíbar
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Spain
| | - Joan Llobera
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Servei de Salut de les Illes Balears, Spain
| | - Ana Clavería
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Área de Vigo, SERGAS, Spain
- Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Spain
| | - Alvaro Sanchez-Perez
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- BioCruces Bizkaia Health Research Institute, Basque Healthcare Service - Osakidetza, Spain
| | - Emma Motrico
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III, Spain
- Instituto de Investigaciones Biomédicas de Sevilla, IBIS (Universidad de Sevilla, HUVR, Junta de Andalucía, CSIC), Sevilla, Spain
- Departamento de Psicología Evolutiva y de la Educación, Universidad de Sevilla, Spain
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Huttunen-Lenz M, Hansen S, Raben A, Westerterp-Plantenga M, Adam T, Macdonald I, Stratton G, Swindell N, Martinez JA, Navas-Carretero S, Handjieva-Darlenska T, Handjiev S, Poppitt SD, Silvestre MP, Larsen TM, Vestentoft PS, Fogelholm M, Jalo E, Brand-Miller J, Muirhead R, Schlicht W. Hybrid Evaluation of a Lifestyle Change Program to Prevent the Development of Type 2 Diabetes Among Individuals With Prediabetes: Intended and Observed Changes in Intervening Mechanisms. J Prim Care Community Health 2024; 15:21501319241248223. [PMID: 38916158 DOI: 10.1177/21501319241248223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Lifestyle interventions can prevent type 2 diabetes (T2D) by successfully inducing behavioral changes (eg, avoiding physical inactivity and sedentariness, increasing physical activity and/or healthy eating) that reduce body weight and normalize metabolic levels (eg, HbA1c). For interventions to be successful, it is important to influence "behavioral mechanisms" such as self-efficacy, which motivate behavioral changes. Theory-based expectations of how self-efficacy, chronic stress, and mood changed over time were investigated through a group-based behavior change intervention (PREMIT). At 8 intervention sites, PREMIT was offered by trained primary care providers in 18 group-sessions over a period of 36 months, divided into 4 intervention phases. Adherence to the intervention protocol was assessed. METHOD Participants (n = 962) with overweight and prediabetes who had achieved ≥8% weight loss during a diet reduction period and completed the intervention were categorized into 3 groups: infrequent, frequent, or very frequent group sessions attendance. The interactions between participation in the group sessions and changes in self-efficacy, stress, and mood were multivariate tested. Intervention sites were regularly asked where and how they deviated from the intervention protocol. RESULTS There was no increase in the participants' self-efficacy in any group. However, the level of self-efficacy was maintained among those who attended the group sessions frequently, while it decreased in the other groups. For all participants, chronic stress and the frequency of attending group sessions were inversely related. Significant differences in mood were found for all groups. All intervention centers reported specific activities, additional to intervention protocol, to promote participation in the group sessions. CONCLUSIONS The results suggest that the behavioral changes sought by trained primary care providers are related to attendance frequency and follow complex trajectories. The findings also suggest that group-based interventions in naturalistic primary care settings aimed at preventing T2D require formats and strategies that encourage participants to attend group sessions regularly.
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Affiliation(s)
| | | | - Anne Raben
- University of Copenhagen, Frederiksberg, Denmark
- Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | - Tanja Adam
- Maastricht University, Maastricht, The Netherlands
| | - Ian Macdonald
- University of Nottingham, Nottingham, UK
- Nestle Research, Lausanne, Switzerland
| | | | | | - J Alfredo Martinez
- University of Navarra, Pamplona, Spain
- Instituto de Salud Carlos III, Madrid, Spain
- IMDEAfood Madrid, Madrid, Spain
- IDISNA Navarra, Pamplona, Spain
| | - Santiago Navas-Carretero
- University of Navarra, Pamplona, Spain
- Instituto de Salud Carlos III, Madrid, Spain
- Navarra Institute for Health Research, Pamplona, Spain
| | | | | | | | - Marta P Silvestre
- University of Auckland, Auckland, New Zealand
- NOVA University of Lisbon, Lisbon, Portugal
| | | | | | | | - Elli Jalo
- University of Helsinki, Helsinki, Finland
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Ringenbach SDR, Arnold NE, Tucker K, Rand MK, Studenka BE, Ringenbach SB, Chen CC. Assisted Cycle Therapy (ACT) Improved Self-Efficacy and Exercise Perception in Middle-Age Adults with Down Syndrome. Brain Sci 2023; 13:1719. [PMID: 38137167 PMCID: PMC10741653 DOI: 10.3390/brainsci13121719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/30/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Alzheimer's disease is prevalent in persons with Down syndrome (DS) as early as their 30s and presents as decreased social interaction, coordination, and physical activity. Therefore, changing attitudes and beliefs about exercise is key to increasing motivation for physical activity especially in middle-age adults with DS. The aim of this study was to examine the effects of Assisted Cycle Therapy (ACT) on self-efficacy and exercise perception in middle-age adults with Down syndrome (DS) following an exercise intervention three times a week for 8 weeks. Twelve participants were in the ACT group in which a motor assisted their cycling to be performed at least 30% faster than voluntary cycling (VC), 10 participants were in the voluntary cycling group, and two participants were in the no cycling (NC) group. The results showed that both exercise groups (i.e., ACT and VC) improved in their self-efficacy after the 8-week intervention. In addition, exercise perception improved following ACT, but not VC or NC. Our results are discussed with respect to their future implications for exercise in the DS population. The results can be attributed to differences in effort required by each intervention group as well as the neurotrophic factors that occur when muscle contractions create synaptic connections resulting in improvement in cognition and feelings of satisfaction.
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Affiliation(s)
- Shannon D. R. Ringenbach
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA; (N.E.A.); (K.T.); (M.K.R.); (S.B.R.)
| | - Nathaniel E. Arnold
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA; (N.E.A.); (K.T.); (M.K.R.); (S.B.R.)
| | - Kori Tucker
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA; (N.E.A.); (K.T.); (M.K.R.); (S.B.R.)
| | - Miya K. Rand
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA; (N.E.A.); (K.T.); (M.K.R.); (S.B.R.)
| | - Breanna E. Studenka
- Department of Kinesiology and Health Science, Utah State University, Logan, UT 84322, USA;
| | - Stockton B. Ringenbach
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA; (N.E.A.); (K.T.); (M.K.R.); (S.B.R.)
| | - Chih-Chia Chen
- Department of Kinesiology, Mississippi State University, Starkville, MS 39762, USA;
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5
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Dang K, Ritvo P, Katz J, Gratzer D, Knyahnytska Y, Ortiz A, Walters C, Attia M, Gonzalez-Torres C, Lustig A, Daskalakis Z. The Role of Daily Steps in the Treatment of Major Depressive Disorder: Secondary Analysis of a Randomized Controlled Trial of a 6-Month Internet-Based, Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth. Interact J Med Res 2023; 12:e46419. [PMID: 38064262 PMCID: PMC10746981 DOI: 10.2196/46419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/15/2023] [Accepted: 08/28/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Current evidence supports physical activity (PA) as an adjunctive treatment for major depressive disorder (MDD). Few studies, however, have examined the relationship between objectively measured PA and MDD treatment outcomes using prospective data. OBJECTIVE This study is a secondary analysis of data from a 24-week internet-based, mindfulness-based cognitive behavioral therapy program for MDD. The purpose of this analysis was twofold: (1) to examine average daily step counts in relation to MDD symptom improvement, and whether pain moderated this relationship; and (2) to examine whether changes in step activity (ie, step trajectories) during treatment were associated with baseline symptoms and symptom improvement. METHODS Patients from the Centre for Addiction and Mental Health were part of a randomized controlled trial evaluating the effects of internet-based, mindfulness-based cognitive behavioral therapy for young adults (aged 18-30 years old) with MDD. Data from 20 participants who had completed the intervention were analyzed. PA, in the form of objectively measured steps, was measured using the Fitbit-HR Charge 2 (Fitbit Inc), and self-reported depression severity was measured with the Beck Depression Inventory-II (BDI-II). Linear regression analysis was used to test PA's relationship with depression improvement and the moderating effect of pain severity and pain interference. Growth curve and multivariable regression models were used to test longitudinal associations. RESULTS Participants walked an average of 8269 steps per day, and each additional +1000-step difference between participants was significantly associated with a 2.66-point greater improvement (reduction) in BDI-II, controlling for anxiety, pain interference, and adherence to Fitbit monitoring (P=.02). Pain severity appeared to moderate (reduce) the positive effect of average daily steps on BDI-II improvement (P=.03). Higher baseline depression and anxiety symptoms predicted less positive step trajectories throughout treatment (Ps≤.001), and more positive step trajectories early in the trial predicted greater MDD improvement at the end of the trial (Ps<.04). However, step trajectories across the full duration of the trial did not significantly predict MDD improvement (Ps=.40). CONCLUSIONS This study used objective measurements to demonstrate positive associations between PA and depression improvement in the context of cognitive behavioral treatment. Pain appeared to moderate this relationship, and baseline symptoms of anxiety and depression predicted PA trajectories. The findings inform future interventions for major depression. Future research with larger samples should consider additional moderators of PA-related treatment success and the extent to which outcomes are related to PA change in multimodal interventions. TRIAL REGISTRATION Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/11591.
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Affiliation(s)
- Kevin Dang
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada
| | - Paul Ritvo
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| | - Joel Katz
- School of Kinesiology and Health Sciences, York University, Toronto, ON, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| | - David Gratzer
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yuliya Knyahnytska
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Abigail Ortiz
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Mohamed Attia
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Christina Gonzalez-Torres
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andrew Lustig
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Zafiris Daskalakis
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
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Miller CK, King D, Nagaraja HN, Fujita K, Cheavens J, Focht BC. Impact of an augmented intervention on self-regulatory, dietary and physical activity outcomes in a diabetes prevention trial among adults with prediabetes. J Behav Med 2023; 46:770-780. [PMID: 36933057 PMCID: PMC10024518 DOI: 10.1007/s10865-023-00406-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023]
Abstract
Self-regulation can facilitate modifications in lifestyle to promote behavioral change. However, little is known about whether adaptive interventions promote improvement in self-regulatory, dietary, and physical activity outcomes among slow treatment responders. A stratified design with an adaptive intervention for slow responders was implemented and evaluated. Adults ≥ 21 years old with prediabetes were stratified to the standard Group Lifestyle Balance intervention (GLB; n = 79) or the adaptive GLB Plus intervention (GLB + ; n = 105) based on first-month treatment response. Intake of total fat was the only study measure that significantly differed between groups at baseline (P = 0.0071). GLB reported greater improvement in self-efficacy for lifestyle behaviors, goal satisfaction with weight loss, and very active minutes of activity than GLB + (all P < 0.01) at 4-months. Both groups reported significant improvement in self-regulatory outcomes and reduction in energy and fat intake (all P < 0.01). An adaptive intervention can improve self-regulation and dietary intake when tailored to early slow treatment responders.
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Affiliation(s)
- Carla K Miller
- School of Public Health-Bloomington, Indiana University, 1025 East 7Th Street, Bloomington, IN, 47405, USA.
| | - Danielle King
- Department of Human Sciences, Human Nutrition, Ohio State University, Columbus, OH, USA
| | - Haikady N Nagaraja
- College of Public Health, Division of Biostatistics, Ohio State University, Columbus, OH, USA
| | - Kentaro Fujita
- Department of Psychology, Ohio State University, Columbus, OH, USA
| | | | - Brian C Focht
- Department of Human Sciences, Kinesiology, Ohio State University, Columbus, OH, USA
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7
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COVID-19-specific worries among people with type 2 diabetes following the continuation of the pandemic and occurrence of multiple waves of COVID -19 in Iran. J Diabetes Metab Disord 2022; 21:61-68. [PMID: 35036383 PMCID: PMC8753953 DOI: 10.1007/s40200-021-00935-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/08/2021] [Indexed: 12/16/2022]
Abstract
Abstract Purpose To assess COVID-19-specific diabetes worries, and to determine characteristics of people with high levels of these worries among people with type 2 diabetes (T2D) following the continuation of the pandemic and occurrence of multiple waves of COVID-19 in Iran. Methods An interviewer-based, cross-sectional study was conducted using 500 T2D people in a diabetes specialty clinic. The questionnaire package comprised five parts: sociodemographic and clinical characteristics, COVID-19-specific worries, diabetes-related distress, feelings of isolation and changes in diabetes-specific behaviors. Clinical history and serum measurements were collected from electronic medical records. Descriptive statistics and logistic regressions were performed in the study. Results Worries related to COVID-19 pandemic were highly prevalent in T2D people. Around 60% were worried about being severely affected due to diabetes if infected with COVID-19 and being described as a high-risk group for COVID-19, and more than half about being possibly faced with lack of diabetes medications. Logistic regressions demonstrated that being female, higher age, diabetes-related complications, duration of diabetes, insulin use, feeling isolation, diabetes-related distress and having changed self-management behaviors were associated with being more worried about diabetes and COVID-19. Conclusion Diabetes-related worries relating to the COVID-19 were strongly associated with poorer psychosocial status. Findings emphasize the importance of conveying up-to-date information regarding diabetes and COVID-19 that patients want and need to know, also of providing emotional support associated with COVID-19-specific diabetes worries.
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8
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Stromberg SE, Boone DM, Healy A, Feldman M, Grishman EK, Faith MA. Social self-efficacy associated with HbA1c through physical activity and diabetes quality of life: A serial mediation study. Pediatr Diabetes 2021; 22:1081-1091. [PMID: 34455658 DOI: 10.1111/pedi.13261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Type 1 diabetes (T1D) is one of the most common pediatric chronic illnesses and increasing worldwide in prevalence. Physical activity has been positively linked with better glycemic control in youth with T1D. Although not yet studied, children's social self-efficacy may be a parameter related to physical activity in youth with diabetes. The current study investigated associations among social self-efficacy, physical activity, diabetes quality of life, and hemoglobin A1c (HbA1c) among youth with T1D utilizing mediation and serial mediation models. RESEARCH DESIGN AND METHODS Participants were 144 youth (M age = 14.95) with T1D (53.5% girls) and their caregivers. Youth completed the PedsQL Diabetes Module, the Physical Activity Questionnaire for Older Children and Adolescents and the Self-Efficacy Questionnaire for Social Skills for Children. Youths' HbA1c values were also measured. RESULTS Physical activity significantly mediated the relationship between greater youth social self-efficacy and better diabetes quality of life. Diabetes quality of life mediated the relationship between greater physical activity and lower HbA1c. The serial mediation model demonstrated greater social self-efficacy is related to greater physical activity, which in turn is related to better diabetes quality of life and ultimately resulting in lower HbA1c. CONCLUSIONS Physical activity, social self-efficacy, and diabetes-related quality of life may be modifiable factors related to HbA1c for youth with T1D. Findings indicate a need for healthcare providers to consider youth physical activity, quality of life, and social self-efficacy when evaluating and intervening in youth diabetes treatment adherence.
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Affiliation(s)
| | - Dianna M Boone
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Ashly Healy
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Marissa Feldman
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Ellen K Grishman
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Melissa A Faith
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
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9
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Mitchell ES, Yang Q, Behr H, Ho A, DeLuca L, May CN, Michaelides A. Psychosocial Characteristics by Weight Loss and Engagement in a Digital Intervention Supporting Self-Management of Weight. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041712. [PMID: 33578975 PMCID: PMC7916717 DOI: 10.3390/ijerph18041712] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 01/01/2023]
Abstract
There is substantial variability in weight loss outcomes. Psychosocial characteristics underlying outcomes require better understanding, particularly on self-managed digital programs. This cross-sectional study examines differences in psychosocial characteristics by weight loss and engagement outcome, and which characteristics are most associated with weight loss, on a self-managed digital weight loss program. Some underexplored psychosocial characteristics are included, such as flourishing, or a sense of meaning and purpose in life. A questionnaire was emailed to a random sample of 10,000 current users at week 5 in the program and 10,000 current users at week 17. The questionnaire was completed by 2225 users, and their self-reported weight and recorded program engagement data were extracted from the program’s database. Multiple comparison tests indicated that mental health quality of life, depression, anxiety, work-life balance, and flourishing differed by weight loss outcome at program end (week 17; ≥5%, 2–5%, below 2%) and by engagement tertile at program beginning and end (weeks 5 and 17). Only anxiety was associated with weight loss in a backward stepwise regression controlling for engagement and sociodemographic characteristics. Flourishing did not predict weight loss overall but predicted the weight loss outcome group. Our findings have implications for creating more effective interventions for individuals based on psychosocial characteristics and highlight the potential importance of anxiety in underexplored self-managed digital programs.
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Affiliation(s)
- Ellen S. Mitchell
- Academic Research, Noom, 229 W 28th St., New York, NY 10001, USA; (Q.Y.); (H.B.); (A.H.); (L.D.); (C.N.M.); (A.M.)
- Correspondence:
| | - Qiuchen Yang
- Academic Research, Noom, 229 W 28th St., New York, NY 10001, USA; (Q.Y.); (H.B.); (A.H.); (L.D.); (C.N.M.); (A.M.)
| | - Heather Behr
- Academic Research, Noom, 229 W 28th St., New York, NY 10001, USA; (Q.Y.); (H.B.); (A.H.); (L.D.); (C.N.M.); (A.M.)
- Department of Integrative Health, Saybrook University, 55 W Eureka St, Pasadena, CA 91103, USA
| | - Annabell Ho
- Academic Research, Noom, 229 W 28th St., New York, NY 10001, USA; (Q.Y.); (H.B.); (A.H.); (L.D.); (C.N.M.); (A.M.)
| | - Laura DeLuca
- Academic Research, Noom, 229 W 28th St., New York, NY 10001, USA; (Q.Y.); (H.B.); (A.H.); (L.D.); (C.N.M.); (A.M.)
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave, Bronx, NY 10461, USA
| | - Christine N. May
- Academic Research, Noom, 229 W 28th St., New York, NY 10001, USA; (Q.Y.); (H.B.); (A.H.); (L.D.); (C.N.M.); (A.M.)
| | - Andreas Michaelides
- Academic Research, Noom, 229 W 28th St., New York, NY 10001, USA; (Q.Y.); (H.B.); (A.H.); (L.D.); (C.N.M.); (A.M.)
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10
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Joachim-Célestin M, Gamboa-Maldonado T, Dos Santos H, Montgomery SB. A Qualitative Study on the Perspectives of Latinas Enrolled in a Diabetes Prevention Program: Is the Cost of Prevention Too High? J Prim Care Community Health 2020; 11:2150132720945423. [PMID: 32755275 PMCID: PMC7543125 DOI: 10.1177/2150132720945423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Latinas are among the groups most affected by diabetes health disparities, yet they often benefit less from diabetes interventions even when these are culturally adapted. The purpose of this qualitative study was to explore readiness of Latinas enrolled in a diabetes prevention program to adopt recommended preventive behaviors, and to identify factors associated with the adoption and maintenance of these recommended lifestyle changes. Insights gained will be used to inform future efforts at reducing diabetes disparities and the burden of chronic diseases among Latinas. Methods: Nine focus group discussions (FGDs) and 3 key informant interviews (KIIs) were conducted after the completion of a culturally adapted diabetes prevention program led by Latino community health workers. A grounded theory approach by Charmaz informed by the transtheoretical model guided the questions. Discussions and interviews were audio-taped with participants’ permission, transcribed, coded, and themed. Results: Forty low-income Latinas contributed to FGDs and KIIs. Baseline readiness to engage in new behaviors varied. Negative personal and family health events and physician referral impacted most readiness to enroll and to adopt preventive behaviors. Built environment, financial constraints, and threat of social alienation constituted major barriers to behavior adoption and maintenance, while physician involvement, awareness of diabetes complications, and social support partially mitigated these impediments. Conclusions: Our results suggest that timing of enrollment, physician-patient dynamics, and the emotional personal/family cost of behavior modification should all be considered when planning diabetes prevention programs for low-income Latinas. Besides appropriately timing referrals to accessible culturally informed prevention programs, health educators and health care providers should be aware of the potentially negative impact of behavior modification on family dynamics and be prepared to address resulting repercussions. Future research on Latinas should also include and report data on physician involvement, family context, and social determinants of health for more consistent program comparisons.
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11
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Exploring the role of goal setting in weight loss for adults recently diagnosed with pre-diabetes. BMC Nurs 2020; 19:67. [PMID: 32684841 PMCID: PMC7362527 DOI: 10.1186/s12912-020-00462-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 07/12/2020] [Indexed: 11/25/2022] Open
Abstract
Background The management of prediabetes in the community setting is a global priority. We evaluated the feasibility of a 6-month multilevel practice nurse-led prediabetes dietary intervention which involved goal setting. The aim of this paper is to explore the weight loss goals and strategies reported by participants to achieve their weight loss goals as recorded by practice nurses, and report on factors that influenced dietary behaviours. Methods This study used a convergent mixed-methods design. A six-month pragmatic non-randomised pilot study with a qualitative process evaluation was conducted in two neighbouring provincial cities in New Zealand. A structured dietary intervention delivered by practice nurses was implemented in four practices in 2014–2016. Content analysis of the text and descriptive statistics were used to analyse the data. Results One hundred and fifty seven people with prediabetes were enrolled (85 intervention, 72 control). The intervention group lost a mean 1.3 kg more than the control group (p < .0.001). The majority of the intervention group indicated either a high level of readiness (n = 42, 53%) or some readiness (n = 31, 39%) to make food changes. The majority of weight loss goals aligned with clinical guidelines (between 5 and 10% of body weight). While just over half (n = 47, 55%) demonstrated weight loss at the end of the six month period, the majority of participants did not achieve their predetermined weight loss goal (n = 78, 83%). Gender, ethnicity and budget were not related to weight loss at six months. Readiness to change and reported challenges to making dietary changes were related to weight loss at six months. Negative factors or set-backs included sporadic adherence to diet due to other health problems, change in context or environment and coping with ill health, most notably stress and low mood. Conclusions The data relating to weight loss and dietary goals provided insight into the challenges that people faced in making dietary changes for weight loss across a six month period. Simplifying goal setting to those goals with the greatest potential clinical impact or the greatest significance to the person, in a socially supportive environment, may increase the success of goal achievement. Trial registration ANZCTR ACTRN1261500080656. Registered 3 August 2015 (Retrospectively registered). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366560&isReview=true
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12
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Booth JE, Benham JL, Schinbein LE, McGinley SK, Rabi DM, Sigal RJ. Long-Term Physical Activity Levels After the End of a Structured Exercise Intervention in Adults With Type 2 Diabetes and Prediabetes: A Systematic Review. Can J Diabetes 2020; 44:680-687.e2. [PMID: 32654972 DOI: 10.1016/j.jcjd.2020.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 03/01/2020] [Accepted: 03/25/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Randomized, controlled trials have shown that exercise interventions reduce the incidence of type 2 diabetes in people with impaired glucose tolerance, and improve glycemic control, body composition and cardiorespiratory fitness in people with type 2 diabetes. We undertook the present systematic review to determine the extent to which participants in structured exercise trials continue to be physically active after the end of the interventions. METHODS We systematically searched MEDLINE, EMBASE, CINAHL, SPORTDiscus and Cochrane Central Register of Controlled Trials for randomized, controlled trials that reported objective or self-reported physical activity levels in people with type 2 diabetes or prediabetes a minimum of 3 months after the end of a structured exercise intervention. This systematic review was registered on PROSPERO (PROSPERO CRD42018089468). RESULTS Of 14,649 articles retrieved, 5 randomized, controlled trials (including 549 participants) were included in this systematic review. One study revealed significant improvements in self-reported physical activity levels in the intervention group compared with the control group 1, 3 and 5 years after baseline assessments, and decreased waist circumference, weight and body mass index at 1 year, but not 3 or 5 years. The 4 remaining studies did not find between-group differences at follow-up timepoints between 6 months and 3 years. CONCLUSIONS Future research should report physical activity levels at follow up to determine whether participation in a structured exercise intervention results in sustained increased physical activity levels. In addition, interventions should be evaluated for their effectiveness in improving adherence to long-term physical activity.
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Affiliation(s)
- Jane E Booth
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jamie L Benham
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Laura E Schinbein
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Samantha K McGinley
- Department of Family Medicine, University of British Columbia, Victoria, British Columbia, Canada
| | - Doreen M Rabi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ronald J Sigal
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
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13
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Joensen LE, Madsen KP, Holm L, Nielsen KA, Rod MH, Petersen AA, Rod NH, Willaing I. Diabetes and COVID-19: psychosocial consequences of the COVID-19 pandemic in people with diabetes in Denmark-what characterizes people with high levels of COVID-19-related worries? Diabet Med 2020; 37:1146-1154. [PMID: 32392380 PMCID: PMC7273071 DOI: 10.1111/dme.14319] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2020] [Indexed: 12/17/2022]
Abstract
AIM To map COVID-19-specific worries and overall psychosocial health among people with diabetes in the initial phase of the COVID-19 pandemic in Denmark, and to explore characteristics of people with diabetes and high levels of worries related to the COVID-19 pandemic. METHODS A cross-sectional survey was conducted by distributing online questionnaires to 2430 adult members (> 18 years) of two user panels consisting of people with diabetes who have volunteered to share information about their life with diabetes. The questionnaire included items on COVID-19-specific worries as well as such worries related to diabetes, sociodemographic and health status, social relations, diabetes-specific social support, diabetes distress and changes in diabetes-specific behaviours. Responses were analysed with descriptive statistics and logistic regressions. RESULTS People with diabetes have COVID-19-specific worries related to their diabetes. More than half were worried about being overly affected due to diabetes if infected with COVID-19, about one-third about being characterized as a risk group due to diabetes and not being able to manage diabetes if infected. Logistic regressions showed that being female, having type 1 diabetes, diabetes complications and diabetes distress, feeling isolated and lonely, and having changed diabetes behaviours were associated with being more worried about COVID-19 and diabetes. CONCLUSION People with diabetes have COVID-19-specific worries related to their diabetes which is associated with poorer psychosocial health. These worries should be addressed through support targeting specific questions and needs of individuals with diabetes as well as frequent updates on new knowledge regarding COVID-19 and diabetes.
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Affiliation(s)
| | | | - L. Holm
- Steno Diabetes Center CopenhagenGentofteDenmark
| | | | - M. H. Rod
- Steno Diabetes Center CopenhagenGentofteDenmark
| | | | - N. H. Rod
- Section of EpidemiologyDepartment of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - I. Willaing
- Steno Diabetes Center CopenhagenGentofteDenmark
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14
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Hendryx M, Dinh P, Chow A, Kroenke CH, Hingle M, Shadyab AH, Garcia L, Howard BV, Luo J. Lifestyle and Psychosocial Patterns and Diabetes Incidence Among Women with and Without Obesity: a Prospective Latent Class Analysis. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 21:850-860. [PMID: 32405807 DOI: 10.1007/s11121-020-01130-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We conducted latent class analyses to identify women with homogeneous combinations of lifestyle and behavioral variables and tested whether latent classes were prospectively associated with diabetes incidence for women with or without baseline obesity. A total of 64,710 postmenopausal women aged 50-79 years without prevalent diabetes at baseline (years 1993-1998) were followed until 2018 with a mean follow-up of 14.6 years (sd = 6.4). Lifestyle variables included smoking, diet quality, physical activity, and sleep quality. Psychosocial variables included social support, depression, and optimism. Multivariable Cox proportional hazards regression models tested associations between latent classes and diabetes incidence controlling for age, race/ethnicity, and education. During follow-up, 8076 (12.4%) women developed diabetes. For women without baseline obesity, five latent classes were identified. Compared with a lower risk referent, diabetes incidence was higher in classes characterized by high probability of multiple lifestyle and psychosocial risks (HR = 1.45; 95% CI 1.28, 1.64), poor diet and exercise (HR = 1.23; 95% CI 1.13, 1.33), and psychosocial risks alone (HR = 1.20; 95% CI 1.12, 1.29). For women with baseline obesity, four latent classes were identified. Compared with a lower risk referent, diabetes incidence was higher for women with obesity in classes characterized by high probability of multiple lifestyle and psychosocial risks (HR = 1.48; 95% CI 1.32, 1.66), poor diet and exercise (HR = 1.32; 95% CI 1.19, 1.47), and intermediate probabilities of multiple risks (HR = 1.17; 95% CI 1.05, 1.30). Diabetes prevention efforts that focus on diet and exercise may benefit from attention to how lifestyle behaviors interact with psychosocial variables to increase diabetes risks, and conversely, how psychological or social resources may be leveraged with lifestyle changes to reduce the risk for women with and without obesity.
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Affiliation(s)
- Michael Hendryx
- Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, IN, 47405, USA.
| | - Paul Dinh
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Angela Chow
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Candyce H Kroenke
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Melanie Hingle
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Lorena Garcia
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
| | | | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA
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15
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Stühmann LM, Paprott R, Heidemann C, Ziese T, Hansen S, Zahn D, Scheidt-Nave C, Gellert P. Psychometric properties of a nationwide survey for adults with and without diabetes: the "disease knowledge and information needs - diabetes mellitus (2017)" survey. BMC Public Health 2020; 20:192. [PMID: 32028928 PMCID: PMC7006078 DOI: 10.1186/s12889-020-8296-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In order to close existing information gaps on diabetes-related health perceptions, diabetes knowledge, and information-seeking behaviors among adults in Germany, a representative population-based survey targeting the German-speaking population 18 years and older with and without diabetes was conducted. The aim of the present work was to analyze the psychometric properties of the multi-item scales, applied in the survey in order to provide guidance for decisions on the use of these measurements for future research. METHODS Based on data from participants who completed the final survey (N = 1479 with known diabetes; N = 2327 without known diabetes) reliability and unidimensionality of multi-item scales were tested using Cronbach's Alpha and confirmatory factor analysis (CFA). RESULTS Psychometric properties and model fit varied across scales. Cronbach's alpha values ranged from very good to unacceptable. Model fit indices suggested evidence of a single underlying factor in some but not all scales. Adequate reliability and at least mediocre model fit were found for diabetes distress and patient-provider-relationship in people with diabetes and for perceived level of information in individuals without diabetes. Scales revealing inacceptable reliability values or not suggesting unidimensionality were e.g. diabetes-related stigmatization in both individuals with and without diabetes, self-efficacy in individuals with diabetes, and perceived personal control in those without diabetes. CONCLUSION Based on results of the current study, some of the scales applied in the survey can be recommended for present and future analyses of the survey data and for future surveys (e.g. diabetes distress, patient-provider-relationship in people with diabetes). Other scales should be interpreted and used with caution (e.g. depressive symptoms in people with diabetes) while others should be reformulated, interpreted only as single items, or need further investigation (e.g. diabetes-related stigmatization in people with and without diabetes). Findings provide researchers the opportunity to evaluate diabetes-specific scales in population-based studies of adults with and without diabetes.
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Affiliation(s)
- Lena M Stühmann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Institute for Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Rebecca Paprott
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Thomas Ziese
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Sylvia Hansen
- Ceres - Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health, Cologne, Germany
| | - Daniela Zahn
- Federal Centre for Health Education (BZgA), Office for National Education and Communication on Diabetes Mellitus, Cologne, Germany
- Preventive Cardiology and Medical Prevention, Department of Cardiology, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Paul Gellert
- Charité - Universitätsmedizin Berlin, Institute for Medical Sociology and Rehabilitation Science, Berlin, Germany.
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16
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Avila-Garcia P, Hernandez-Ramos R, Nouri SS, Cemballi A, Sarkar U, Lyles CR, Aguilera A. Engaging users in the design of an mHealth, text message-based intervention to increase physical activity at a safety-net health care system. JAMIA Open 2019; 2:489-497. [PMID: 32025646 PMCID: PMC6994014 DOI: 10.1093/jamiaopen/ooz049] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 08/19/2019] [Accepted: 09/25/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Text-messaging interventions are a promising approach to increasing physical activity in vulnerable populations. To better inform the development of a text-messaging intervention, we sought to identify barriers and facilitators to using text messaging and engaging in physical activity among patients with diabetes and comorbid depression. MATERIALS AND METHODS We conducted interviews with primary care patients at a safety-net health care system (N = 26). Data were collected at 3 stages, including a focus group (stage 1), and individual interviews (stage 2 and 3). Patients in stage 1 and 2 previously participated in a text-messaging intervention as part of depression treatment. Discussions focused on participant experience of previously using a text-messaging intervention, influences and perceptions of physical activity, and mobile phone use. We analyzed all transcripts for emerging themes. RESULTS Participants were 56.2 years (±9.7); 69.2% were female, 65.4% identified as Hispanic/Latino(a), and 46.2% reported having less than a high school education. All had depression and 61.5% had diabetes. Specific barriers that emerged included low literacy and only basic use of mobile phones in everyday life, in combination with a high prevalence of comorbid health conditions and limited mobility. These were each addressed with a specific content or intervention delivery change in the overall intervention design. CONCLUSIONS Conducting a focus group and individual interviews with end users of an mHealth intervention under development has implications for tailoring and modifying components of the content and format to ensure that the final intervention will engage end users most effectively.
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Affiliation(s)
- Patricia Avila-Garcia
- School of Social Welfare, University of California, Berkeley, Berkeley, California, USA
- Department of Psychiatry, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Rosa Hernandez-Ramos
- School of Social Welfare, University of California, Berkeley, Berkeley, California, USA
- Department of Psychiatry, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
| | - Sarah S Nouri
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Anupama Cemballi
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Urmimala Sarkar
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Courtney R Lyles
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Adrian Aguilera
- School of Social Welfare, University of California, Berkeley, Berkeley, California, USA
- Department of Psychiatry, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA
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17
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Hafez D, Heisler M, Choi H, Ankuda CK, Winkelman T, Kullgren JT. Association Between Purpose in Life and Glucose Control Among Older Adults. Ann Behav Med 2019; 52:309-318. [PMID: 30084896 DOI: 10.1093/abm/kax012] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Greater purpose in life is associated with lower rates of certain chronic diseases. Whether purpose in life can protect against development of prediabetes or type 2 diabetes is unknown. Purpose To examine the association between purpose in life and blood glucose control among adults ≥50 years. Methods We conducted a longitudinal cohort study of 3,907 participants of the Health and Retirement Study who at baseline did not have type 2 diabetes or prediabetes. Baseline purpose in life was measured using the Ryff and Keyes' Scales of Psychological Well-Being and grouped into tertiles (high, medium, and low). We used multivariable linear regression to examine the association between baseline purpose in life and HbA1c over 4 years. Multivariable logistic regression was used to examine the association between baseline purpose and incident prediabetes or type 2 diabetes over the same period. Results After adjusting for sociodemographic factors, body mass index, physical activity, and physical and mental health factors, HbA1c was 0.07 percentage points lower among participants with high purpose than those with low purpose (95% confidence interval [CI] -0.12 to -0.02; p = .011). Participants with high purpose had lower odds of developing prediabetes or type 2 diabetes than those with low purpose (adjusted odds ratio 0.78; 95% CI 0.62 to 0.98; p = .037). Conclusions Among older adults, greater purpose in life is associated with a lower incidence of prediabetes or type 2 diabetes. Strategies to promote greater purpose in life should be tested as a part of type 2 diabetes prevention efforts.
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Affiliation(s)
- Dina Hafez
- Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI, USA.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,University of Michigan Medical School, Ann Arbor, MI, USA.,University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Michele Heisler
- Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI, USA.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,University of Michigan Medical School, Ann Arbor, MI, USA.,University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - HwaJung Choi
- Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI, USA.,University of Michigan Medical School, Ann Arbor, MI, USA.,University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Claire K Ankuda
- Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI, USA.,University of Michigan Medical School, Ann Arbor, MI, USA.,University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Tyler Winkelman
- Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI, USA.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,University of Michigan Medical School, Ann Arbor, MI, USA.,University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Jeffrey T Kullgren
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,University of Michigan Medical School, Ann Arbor, MI, USA.,University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
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18
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Yates T, Gray LJ, Henson J, Edwardson CL, Khunti K, Davies MJ. Impact of Depression and Anxiety on Change to Physical Activity Following a Pragmatic Diabetes Prevention Program Within Primary Care: Pooled Analysis From Two Randomized Controlled Trials. Diabetes Care 2019; 42:1847-1853. [PMID: 31399440 DOI: 10.2337/dc19-0400] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/06/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The impact of major affective disorders on the effectiveness of diabetes prevention programs at promoting health behaviors has not been established. We investigated whether depression modifies the effectiveness of two pragmatic diabetes prevention programs at promoting increased physical activity. RESEARCH DESIGN AND METHODS This study pooled data from two cluster randomized controlled trials (Walking Away from Type 2 Diabetes and Let's Prevent Type 2 Diabetes) that included individuals at high risk of type 2 diabetes who were recruited from primary care. The trials used very similar intervention methods to promote physical activity and had annual follow-up over a 36-month period. Depressive symptoms were measured by the Hospital Anxiety and Depression Scale, and physical activity was measured by a piezoelectric pedometer (Let's Prevent Type 2 Diabetes) or an accelerometer (Walking Away from Type 2 Diabetes) and expressed as steps per day. RESULTS This analysis included 1,163 individuals (571 control, 592 intervention) who had concurrent baseline and follow-up data for ambulatory activity, depression, and anxiety. The median depression score was 3 at baseline; 11% of individuals were classified as having mild to severe depression. Those with no depressive symptoms at baseline or during follow-up increased their ambulatory activity by 592 steps per day (P < 0.001); this effect decayed by 88 steps per day (95% CI 21, 155) for every additional depressive symptom score at baseline, and each increase in the depressive symptom score between baseline and follow-up further attenuated the intervention effect by 99 steps per day (95% CI 2, 196). CONCLUSIONS Both depressive symptom burden at baseline and change in this burden are associated with a graded reduction in the effectiveness of diabetes prevention programs at increasing physical activity in primary care.
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Affiliation(s)
- Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, U.K. .,NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, U.K
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester, Leicester, U.K.,NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester, U.K.,NIHR Leicester Biomedical Research Centre, Leicester, U.K
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, U.K.,NIHR Collaborations for Leadership in Applied Health Research and Care East Midlands, Leicester, U.K
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, U.K.,NIHR Leicester Biomedical Research Centre, Leicester, U.K
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19
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Bray GA, Krauss RM, Sacks FM, Qi L. Lessons Learned from the POUNDS Lost Study: Genetic, Metabolic, and Behavioral Factors Affecting Changes in Body Weight, Body Composition, and Cardiometabolic Risk. Curr Obes Rep 2019; 8:262-283. [PMID: 31214942 DOI: 10.1007/s13679-019-00353-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This paper reviews the genetic and non-genetic factors that provided predictions of, or were associated with, weight loss and other metabolic changes in the POUNDS Lost clinical trial of weight loss. This trial randomized 811 individuals who were overweight or obese to one of four diets that contained either 15% or 25% protein and 20% or 40% fat in a 2 × 2 factorial design. A standard behavioral weight loss program was available for all participants who were followed for 2 years with an 80% completion rate. RECENT FINDINGS Nineteen genes and five genetic risk scores were used along with demographic, behavioral, endocrine, and metabolic measurements. Genetic variations in most of the genes were associated with weight loss, but this association often varied with the dietary assignment. A number of demographic and behavioral factors, including attendance at behavioral sessions and food cravings were predictive of weight changes. A high baseline level of free triiodothyronine or free thyroxine predicted the magnitude of weight loss. Several perfluoroakyl compounds predicted more rapid weight regain. Genetic evidence from POUNDS Lost provides guidance toward selection of a personalized weight loss diet and improvement in metabolic profile. There is still room for additional research into the predictors of weight loss.
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Affiliation(s)
- George A Bray
- Pennington Biomedical Research Center Baton Rouge, Baton Rouge, LA, USA.
- Children's Hospital Oakland Research Institute, Oakland, CA, USA.
| | - Ronald M Krauss
- Children's Hospital Oakland Research Institute, Oakland, CA, USA
| | - Frank M Sacks
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lu Qi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Tulane University School of Public Health, New Orleans, LA, USA
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Karsten MDA, van Oers AM, Groen H, Mutsaerts MAQ, van Poppel MNM, Geelen A, van de Beek C, Painter RC, Mol BWJ, Roseboom TJ, Hoek A. Determinants of successful lifestyle change during a 6-month preconception lifestyle intervention in women with obesity and infertility. Eur J Nutr 2019; 58:2463-2475. [PMID: 30076459 PMCID: PMC6689274 DOI: 10.1007/s00394-018-1798-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 07/26/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE To identify demographic, (bio)physical, behavioral, and psychological determinants of successful lifestyle change and program completion by performing a secondary analysis of the intervention arm of a randomized-controlled trial, investigating a preconception lifestyle intervention. METHODS The 6-month lifestyle intervention consisted of dietary counseling, physical activity, and behavioral modification, and was aimed at 5-10% weight loss. We operationalized successful lifestyle change as successful weight loss (≥ 5% weight/BMI ≤ 29 kg/m2), weight loss in kilograms, a reduction in energy intake, and an increase in physical activity during the intervention program. We performed logistic and mixed-effect regression analyses to identify baseline factors that were associated with successful change or program completion. RESULTS Women with higher external eating behavior scores had higher odds of successful weight loss (OR 1.10, 95% CI 1.05-1.16). Women with the previous dietetic support lost 0.94 kg less during the intervention period (95% CI 0.01-1.87 kg). Women with higher self-efficacy reduced energy intake more than women with lower self-efficacy (p < 0.01). Women with an older partner had an increased energy intake (6 kcal/year older, 95% CI 3-13). A high stage of change towards physical activity was associated with a higher number of daily steps (p = 0.03). A high stage of change towards weight loss was associated with completion of the intervention (p = 0.04). CONCLUSIONS Determinants of lifestyle change and program completion were: higher external eating behavior, not having received previous dietetic support, high stage of change. This knowledge can be used to identify women likely to benefit from lifestyle interventions and develop new interventions for women requiring alternative support. TRIAL REGISTRATION The LIFEstyle study was registered at the Dutch trial registry (NTR 1530; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1530 ).
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Affiliation(s)
- Matty D A Karsten
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Anne M van Oers
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Obstetrics and Gynecology, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ, Enschede, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Meike A Q Mutsaerts
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Mireille N M van Poppel
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- Institute of Sport Science, University of Graz, Mozartgasse 14, 8010, Graz, Austria
| | - Anouk Geelen
- Division of Human Nutrition, Wageningen University and Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - Cornelieke van de Beek
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Rebecca C Painter
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Ben W J Mol
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, School of Medicine, Monash University, Clayton Road, Melbourne, Australia
| | - Tessa J Roseboom
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Annemieke Hoek
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Ritchie ND, Carroll JK, Holtrop JS, Havranek EP. Effects of physical activity goal attainment on engagement and outcomes in the National Diabetes Prevention Program. Transl Behav Med 2019; 8:932-937. [PMID: 29669050 DOI: 10.1093/tbm/ibx021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The National Diabetes Prevention Program (NDPP) is the most widely available behavioral intervention to prevent diabetes, but attrition is a concern and strategies are needed to make the program more engaging. Previous evidence suggests that the 150-min weekly physical activity goal in NDPP is hard for many to achieve. Further study of the impact of this protocol recommendation may improve understanding for NDPP reach and effectiveness in reducing diabetes risk. We conducted an observational study of relationships between physical activity goal attainment and retention and weight loss among 391 NDPP participants between March 2013 and May 2016. Average percent of self-reported weekly physical activity goal attainment was 52.7% (SD = 35.1). Goal attainment was related to percent of sessions attended, β = 0.21 (p < .01) and program completion (OR 0.47; p < .05; 95% CI 0.24-0.90). Each occurrence of goal failure was associated with a 25% lower likelihood of attending the next session (OR 0.75; p < .001; 95% CI 0.64-0.87). Goal attainment was also related to total percent weight loss, β = -0.14 (p < .05) and achieving ≥5% weight loss (OR 0.39; p < .01; 95% CI 0.19-0.76), but there was no effect of goal attainment on weight change per session attended. Failing to attain physical activity goals may deter retention in the NDPP. Yet, goal attainment did not affect the rate of weight loss per session attended. It may be important to encourage continued engagement among individuals who struggle to achieve physical activity goals. Moreover, it may be necessary to modify physical activity recommendations to meet individual needs.
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Affiliation(s)
- Natalie D Ritchie
- Denver Health and Hospital Authority, Denver, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | - Edward P Havranek
- Denver Health and Hospital Authority, Denver, CO, USA.,University of Colorado School of Medicine, Aurora, CO, USA
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22
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Understanding Correlates of Physical Activity in American Indian Families: The Healthy Children Strong Families-2 Study. J Phys Act Health 2018; 15:866-873. [PMID: 30336717 DOI: 10.1123/jpah.2017-0584] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Little is known about factors contributing to physical activity (PA) in American Indian (AI) populations. Addressing this gap is paramount as sedentary activity and obesity continue to increase in this population. The purpose of this study was to determine factors associated with PA among AI families with young children. METHODS Height and weight of both adult (n = 423) and child (n = 390) were measured, and surveys assessed demographics, PA, stress (adult only), sleep, and screen time. Separate multivariate logistic regression models were constructed for adults and children (reported as adjusted odds ratios, aORs). RESULTS For adults, age (aOR = 0.952; P ≤ .001), television viewing (aOR = 0.997; P = .01), and computer use (aOR = 0.996; P = .003) decreased the odds of being active. For children, high adult activity (aOR = 1.795; P ≤ .01), longer weekday sleep (aOR = 1.004; P = .01), and family income >$35,000 (aOR = 2.772; P = .01) increased the odds of being active. We found no association between adult PA with stress or adult sleep or between child PA with body mass index and screen time. CONCLUSIONS Given the complexity of the factors contributing to obesity among AI families, multigenerational interventions focused on healthy lifestyle change such as decreasing adult screen time and increasing child sleep time may be needed to increase PA within AI families.
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Huttunen-Lenz M, Hansen S, Christensen P, Meinert Larsen T, Sandø-Pedersen F, Drummen M, Adam TC, Macdonald IA, Taylor MA, Martinez JA, Navas-Carretero S, Handjiev S, Poppitt SD, Silvestre MP, Fogelholm M, Pietiläinen KH, Brand-Miller J, Berendsen AA, Raben A, Schlicht W. PREVIEW study-influence of a behavior modification intervention (PREMIT) in over 2300 people with pre-diabetes: intention, self-efficacy and outcome expectancies during the early phase of a lifestyle intervention. Psychol Res Behav Manag 2018; 11:383-394. [PMID: 30254498 PMCID: PMC6143124 DOI: 10.2147/prbm.s160355] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Onset of type 2 diabetes (T2D) is often gradual and preceded by impaired glucose homeostasis. Lifestyle interventions including weight loss and physical activity may reduce the risk of developing T2D, but adherence to a lifestyle change is challenging. As part of an international T2D prevention trial (PREVIEW), a behavior change intervention supported participants in achieving a healthier diet and physically active lifestyle. Here, our aim was to explore the influence of this behavioral program (PREMIT) on social-cognitive variables during an 8-week weight loss phase. METHODS PREVIEW consisted of an initial weight loss, Phase I, followed by a weight- maintenance, Phase II, for those achieving the 8-week weight loss target of ≥ 8% from initial bodyweight. Overweight and obese (BMI ≥25 kg/m2) individuals aged 25 to 70 years with confirmed pre-diabetes were enrolled. Uni- and multivariate statistical methods were deployed to explore differences in intentions, self-efficacy, and outcome expectancies between those who achieved the target weight loss ("achievers") and those who did not ("non-achievers"). RESULTS At the beginning of Phase I, no significant differences in intentions, self-efficacy and outcome expectancies between "achievers" (1,857) and "non-achievers" (163) were found. "Non-achievers" tended to be younger, live with child/ren, and attended the PREMIT sessions less frequently. At the end of Phase I, "achievers" reported higher intentions (healthy eating χ2(1)=2.57; P <0.008, exercising χ2(1)=0.66; P <0.008), self-efficacy (F(2; 1970)=10.27, P <0.005), and were more positive about the expected outcomes (F(4; 1968)=11.22, P <0.005). CONCLUSION Although statistically significant, effect sizes observed between the two groups were small. Behavior change, however, is multi-determined. Over a period of time, even small differences may make a cumulative effect. Being successful in behavior change requires that the "new" behavior is implemented time after time until it becomes a habit. Therefore, having even slightly higher self-efficacy, positive outcome expectancies and intentions may over time result in considerably improved chances to achieve long-term lifestyle changes.
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Affiliation(s)
- Maija Huttunen-Lenz
- Department of Exercise and Health Sciences, University of Stuttgart, Stuttgart, Germany,
| | - Sylvia Hansen
- Department of Exercise and Health Sciences, University of Stuttgart, Stuttgart, Germany,
| | - Pia Christensen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Meinert Larsen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Finn Sandø-Pedersen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Mathijs Drummen
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands
| | - Tanja C Adam
- Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands
| | - Ian A Macdonald
- MRC/ARUK Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Life Sciences, University of Nottingham, Nottingham, UK
- School of Life Sciences, University of Nottingham Medical School, Nottingham, UK
| | - Moira A Taylor
- School of Life Sciences, University of Nottingham Medical School, Nottingham, UK
| | - J Alfredo Martinez
- Center for Nutrition Research at the University of Navarra, Pamplona, Spain
- Madrid Institute of Advanced Studies (IMDEA Food), Madrid, Spain
- Biomedical Research Centre Network in Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Institute, Madrid, Spain
| | - Santiago Navas-Carretero
- Center for Nutrition Research at the University of Navarra, Pamplona, Spain
- Madrid Institute of Advanced Studies (IMDEA Food), Madrid, Spain
- Biomedical Research Centre Network in Physiopathology of Obesity and Nutrition (CIBERobn), Carlos III Institute, Madrid, Spain
| | - Svetoslav Handjiev
- Department of Pharmacology and Toxicology, Medical University - Sofia, Sofia, Bulgaria
| | - Sally D Poppitt
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Marta P Silvestre
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Mikael Fogelholm
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Kirsi H Pietiläinen
- Obesity Research Unit, Research Program Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
- Abdominal Center, Endocrinology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | - Jennie Brand-Miller
- Charles Perkins Centre and School of Life and Environmental Biosciences, University of Sydney, Camperdown, NSW, Australia
| | - Agnes Am Berendsen
- Division of Human Nutrition & Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Wolfgang Schlicht
- Department of Exercise and Health Sciences, University of Stuttgart, Stuttgart, Germany,
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24
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Chang C, Khurana S, Strodel R, Camp A, Magenheimer E, Hawley N. Perceived Barriers to Physical Activity Among Low-Income Latina Women at Risk for Type 2 Diabetes. DIABETES EDUCATOR 2018; 44:444-453. [DOI: 10.1177/0145721718787782] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose The purpose of this study was to examine perceived barriers to physical activity among low-income Latina women who were at risk for type 2 diabetes, as well as the demographic factors that influence these perceived barriers. Methods Recruited in the waiting room of a community health center in a low-income neighborhood (n = 160), Latina women between the ages of 18 and 49 years completed a survey to assess demographic characteristics and perceived barriers to physical inactivity. Descriptive statistics, chi-square tests, and multivariate regression analyses were conducted to identify barriers to physical activity and the associations between demographic factors and perceived barriers. Results The most commonly perceived barriers to physical activity in the study sample were lack of willpower and lack of energy. After adjusting for other characteristics, overweight/obese participants were more likely than women of normal weight to report social influence and fear of injury as important barriers to exercise. In addition, women whose preferred language was Spanish were more likely than women whose preferred language was English to perceive lack of time, and social influence as important barriers. Conclusions The effective encouragement of physical activity among Latina women at risk for type 2 diabetes must address the perceived barriers of lack of willpower and lack of energy. Although all women at risk for type 2 diabetes could benefit from counseling and other strategies to encourage physical activity, these efforts should be targeted toward Spanish-speaking overweight/obese women, who are more likely to perceive barriers to exercise.
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Affiliation(s)
| | | | | | - Anne Camp
- Fair Haven Community Health Center, New Haven, Connecticut, USA
| | | | - Nicola Hawley
- Yale School of Public Health, New Haven, Connecticut, USA
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25
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Theoretical Rationale for How Slimming Garments May Motivate Physical Activity in People with Obesity. PROGRESS IN PREVENTIVE MEDICINE 2018. [DOI: 10.1097/pp9.0000000000000017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Age Differences in Health Behavior and Weight Changes in Japanese Workers: 1-Year Follow-Up Study. J Occup Environ Med 2018; 60:839-846. [PMID: 29787397 DOI: 10.1097/jom.0000000000001354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine 1-year changes in stage of health behavior change and its associations with changes in health behavior and weight in a working population cohort. METHODS Using annual health examination data, 57,431 eligible Japanese workers aged 18 to 64 years were examined for their 1-year changes in stage of change, eating and exercise habits, and weight. RESULTS The stages of change became polarized into the precontemplation and the action/maintenance (ie, post-action) and became stabilized with increasing age. The 1-year change in stage of change was accompanied by changes in eating and exercise habits and weight. CONCLUSIONS The age-dependent tendency towards bipolarization and stabilization of stages of change suggested that workplace health promotion interventions for facilitating health behavior changes should be started at younger ages.
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Xu H, Tang L, Hu Z, Gao F, Yang Y, Qin L, Luo BA. Association between physical activity and health-related quality of life in elderly individuals with pre-diabetes in rural Hunan Province, China: a cross-sectional study. BMJ Open 2018; 8:e019836. [PMID: 29654016 PMCID: PMC5898310 DOI: 10.1136/bmjopen-2017-019836] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES There are few data on the relationship between health-related quality of life (HRQoL) and physical activity among elderly individuals with pre-diabetes. This study aimed to determine if differences existed in HRQoL between individuals with pre-diabetes who were physically active compared with those who were physically inactive in rural China. DESIGN, SETTING AND PARTICIPANTS A cross-sectional survey was conducted among the elderly (≧60 years) in rural communities in Yiyang City of China. Multistage cluster random sampling was carried out to select 42 areas, and interviews were conducted among 434 elderly individuals with pre-diabetes. Pre-diabetes was screened using an oral glucose tolerance test. MAIN OUTCOME MEASURES The Medical Outcomes Study 36-Item Short Form Health Survey questionnaire was used to measure HRQoL. Physical activity was assessed using the International Physical Activity Questionnaire. Multivariate analysis of covariance (MANCOVA) was used to test for differences in HRQoL between the physically active group and the inactive group. RESULTS A total of 434 individuals with pre-diabetes were included in this study. The physical component summary (PCS) score of HRQoL was 42.1±10.2 and the mental component summary score was 46.4±8.9. A median total physical activity of 524 metabolic equivalent-min/week was reported. A significant MANCOVA model (Wilks' λ=0.962, F(2,423)=8.44, P<0.001) indicated that elderly individuals with pre-diabetes who were physically active reported higher PCS scores (Mdiff=5.2, P<0.001, effective size=0.47) compared with those physically inactive after adjusting for the following covariates: age, gender, marital status, education, smoking, chronic disease, body mass index and waist:hip ratio. CONCLUSIONS The HRQoL of elderly individuals with pre-diabetes is poor in rural China. These findings demonstrated that elderly individuals with pre-diabetes who were physically active had higher PCS scores than those who were physically inactive. Furthermore, these results support the rationale for developing a physical activity intervention for HRQoL of individuals with pre-diabetes. TRIAL REGISTRATION NUMBER ChiCTR-IOR-15007033; Results.
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Affiliation(s)
- Huilan Xu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Lu Tang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhao Hu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Fan Gao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yang Yang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Lulu Qin
- Department of Social Medicine and Health Management, School of Medicine, Hunan Normal University, Changsha, China
| | - Bang-an Luo
- Department of Mental Health, Brain Hospital of Hunan Province, Changsha, China
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Alhalel N, Schueller SM, O'Brien MJ. Association of changes in mental health with weight loss during intensive lifestyle intervention: does the timing matter? Obes Sci Pract 2018; 4:153-158. [PMID: 29670753 PMCID: PMC5893461 DOI: 10.1002/osp4.157] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/08/2018] [Accepted: 01/17/2018] [Indexed: 12/31/2022] Open
Abstract
Objective This study examined changes in mental health symptoms and weight during weight loss treatment. It was hypothesized that worsening mental health would negatively impact weight loss. Methods Data were analyzed from a trial of 92 Hispanic women with overweight/obesity and prediabetes, who were randomized to receive intensive lifestyle intervention (ILI), metformin 1,700 mg daily, or standard care. Depression, anxiety and perceived stress were assessed at 0, 6 and 12 months. Six‐ and 12‐month weight change was compared among participants whose symptom scores worsened on any mental health measure (W) vs. improved or remained stable on all three (I/S). Results Among ILI participants, the 12‐month difference in weight loss between I/S and W groups was statistically significant: −5.1 kg (P = 0.001). From baseline to 6 months, ILI participants in I/S and W groups experienced comparable weight loss. However, from 6 to 12 months, W participants regained weight, whereas I/S participants experienced continued weight loss. In the metformin and standard care arms, there was no weight difference between I/S and W groups. Conclusions In ILI, 12‐month improvement or stability in mental health was significantly associated with weight loss. Weight trajectories between I/S and W groups diverged at 6 months.
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Affiliation(s)
- N Alhalel
- Northwestern University Feinberg School of Medicine Chicago IL USA
| | - S M Schueller
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL USA.,Center for Behavioral Intervention Technologies Northwestern University Feinberg School of Medicine Chicago IL USA
| | - M J O'Brien
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL USA.,Division of General Internal Medicine and Geriatrics Northwestern University Feinberg School of Medicine Chicago IL USA.,Center for Community Health, Institute for Public Health and Medicine Northwestern University Feinberg School of Medicine Chicago IL USA
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Castonguay A, Miquelon P, Boudreau F. Self-regulation resources and physical activity participation among adults with type 2 diabetes. Health Psychol Open 2018; 5:2055102917750331. [PMID: 29372066 PMCID: PMC5774733 DOI: 10.1177/2055102917750331] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Physical activity plays a crucial role in the prevention and treatment of type 2 diabetes. Therefore, it is important to understand why so few adults with type 2 diabetes regularly engage in physical activity. The role of self-regulation in the context of health-related behavior adherence, especially in terms of physical activity engagement and adherence, has largely been reviewed based on the strength energy model. Building on this line of research, the aim of this theoretical work was to highlight how self-regulation and ego depletion can influence the lower rate of physical activity participation among adults with type 2 diabetes, compared to adults from the general population.
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30
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Cioffi CE, Ranjani H, Staimez LR, Anjana RM, Mohan V, Weber MB. Self-efficacy and diabetes prevention in overweight South Asians with pre-diabetes. BMJ Open Diabetes Res Care 2018; 6:e000561. [PMID: 30397491 PMCID: PMC6203034 DOI: 10.1136/bmjdrc-2018-000561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/30/2018] [Accepted: 09/05/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE We evaluated the effects of a diabetes prevention itervention on self-efficacy (SE) and the associations between SE and diabetes-related outcomes among overweight Asian Indian adults with pre-diabetes in a randomized controlled translational trial (the Diabetes Community Lifestyle Improvement Program, D-CLIP). RESEARCH DESIGN AND METHODS Data were obtained from 550 adults who were randomized to a diabetes prevention program or standard of care. Dietary and exercise-related SEs were measured at baseline, core intervention completion (4 months), and annually until the end of follow-up (3 years or diabetes diagnosis). Mixed-effects regressions described changes in SE over time by treatment group. Among treatment participants, multivariable-adjusted models described associations of SE at baseline and intervention completion with diabetes incidence and other secondary outcomes (weight, waist circumference (WC), exercise, and energy intake). RESULTS From baseline to 4 months, dietary (β=10.3, p=0.04) and exercise (β=0.49, p=0.04) SE increased significantly in the treatment arm only; however, this increase from baseline was no longer significant at later time points. Among treatment participants, there was no association of dietary or exercise SE with diabetes incidence, but baseline exercise SE was independently associated with improved weight, WC, and exercise at 4 months (p<0.05). Change in exercise SE from baseline to intervention completion also predicted increased exercise at 4, 12, and 24 months (p<0.05). CONCLUSIONS Exposure to D-CLIP resulted in improved SE at treatment completion, but this effect was not sustained over longer follow-up. Several short-term and long-term secondary outcomes, but not diabetes risk, were significantly associated with exercise SE, suggesting this psychosocial trait may facilitate success in achieving certain health goals. TRIAL REGISTRATION NUMBER NCT01283308.
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Affiliation(s)
- Catherine E Cioffi
- Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, USA
| | | | - Lisa R Staimez
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, USA
| | | | | | - Mary Beth Weber
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Emory University, Atlanta, USA
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Baum A, Scarpa J, Bruzelius E, Tamler R, Basu S, Faghmous J. Targeting weight loss interventions to reduce cardiovascular complications of type 2 diabetes: a machine learning-based post-hoc analysis of heterogeneous treatment effects in the Look AHEAD trial. Lancet Diabetes Endocrinol 2017; 5:808-815. [PMID: 28711469 PMCID: PMC5815373 DOI: 10.1016/s2213-8587(17)30176-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/21/2017] [Accepted: 04/27/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND The Action for Health in Diabetes (Look AHEAD) trial investigated whether long-term cardiovascular disease morbidity and mortality could be reduced through a weight loss intervention among people with type 2 diabetes. Despite finding no significant reduction in cardiovascular events on average, it is possible that some subpopulations might have derived benefit. In this post-hoc analysis, we test the hypothesis that the overall neutral average treatment effect in the trial masked important heterogeneous treatment effects (HTEs) from intensive weight loss interventions. METHODS We used causal forest modelling, which identifies HTEs, using a random half of the trial data (the training set). We applied Cox proportional hazards models to test the potential HTEs on the remaining half of the data (the testing set). The analysis was deemed exempt from review by the Columbia University Institutional Review Board, Protocol ID# AAAO3003. FINDINGS Between Aug 22, 2001, and April 30, 2004, 5145 patients with type 2 diabetes were enrolled in the Look AHEAD randomised controlled trial, of whom 4901 were included in the The National Institute of Diabetes and Digestive and Kidney Diseases Repository and included in our analyses: 2450 for model development and 2451 in the testing dataset. Baseline HbA1c and self-reported general health distinguished participants who differentially benefited from the intervention. Cox models for the primary composite cardiovascular outcome revealed a number needed to treat of 28·9 to prevent 1 event over 9·6 years among participants with HbA1c 6·8% or higher, or both HbA1c less than 6·8% and Short Form Health Survey (SF-36) general health score of 48 or more (2101 [86%] of 2451 participants in the testing dataset; 167 [16%] of 1046 primary outcome events for intervention vs 205 [19%] of 1055 for control, absolute risk reduction of 3·46%, 95% CI 0·21-6·73%, p=0·038) By contrast, participants with HbA1c less than 6·8% and baseline SF-36 general health score of less than 48 (350 [14%] of 2451 participants in the testing data; 27 [16%] of 171 primary outcome events for intervention vs 15 [8%] of 179 primary outcome events for control) had an absolute risk increase of the primary outcome of 7·41% (0·60 to 14·22, p=0·003). INTERPRETATION Look AHEAD participants with moderately or poorly controlled diabetes (HbA1c 6·8% or higher) and subjects with well controlled diabetes (HbA1c less than 6·8%) and good self-reported health (85% of the overall study population) averted cardiovascular events from a behavioural intervention aimed at weight loss. However, 15% of participants with well controlled diabetes and poor self-reported general health experienced negative effects that rendered the overall study outcome neutral. HbA1c and a short questionnaire on general health might identify people with type 2 diabetes likely to derive benefit from an intensive lifestyle intervention aimed at weight loss. FUNDING None.
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Affiliation(s)
- Aaron Baum
- Department of Health System Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Joseph Scarpa
- Department of Health System Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emilie Bruzelius
- Department of Health System Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Epidemiology, Joseph L Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ronald Tamler
- Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sanjay Basu
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - James Faghmous
- Department of Health System Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Mikkelsen K, Stojanovska L, Polenakovic M, Bosevski M, Apostolopoulos V. Exercise and mental health. Maturitas 2017; 106:48-56. [PMID: 29150166 DOI: 10.1016/j.maturitas.2017.09.003] [Citation(s) in RCA: 390] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/04/2017] [Accepted: 09/06/2017] [Indexed: 02/06/2023]
Abstract
There is a growing body of literature that recognizes the positive effects of exercise on mood states such as anxiety, stress and depression, through physiological and biochemical mechanisms, including endorphins, mitochondria, mammalian target of rapamycin, neurotransmitters and the hypothalamic-pituitary-adrenal axis, and via the thermogenic hypothesis. In addition, psychological mechanisms influence the effects of exercise on mood states, as suggested by both the distraction hypothesis and the self-efficacy hypothesis. Exercise has also been shown to reduce inflammation via several different processes (inflammation, cytokines, toll-like receptors, adipose tissue and via the vagal tone), which can contribute to better health outcomes in people suffering from mood disorders.
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Affiliation(s)
- Kathleen Mikkelsen
- Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Lily Stojanovska
- Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | | | | | - Vasso Apostolopoulos
- Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, Melbourne, Australia.
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Burgess E, Hassmén P, Pumpa KL. Determinants of adherence to lifestyle intervention in adults with obesity: a systematic review. Clin Obes 2017; 7:123-135. [PMID: 28296261 DOI: 10.1111/cob.12183] [Citation(s) in RCA: 249] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 12/01/2022]
Abstract
Lifestyle intervention programmes are efficacious in the management of obesity but often report poor attendance and adherence rates that hinder treatment effectiveness and health outcomes. The aim of this systematic review is to identify (i) barriers to behaviour change and (ii) predictors of adherence to lifestyle intervention programmes in adults with obesity. Studies were identified by systematically reviewing the literature within Medline, PsycINFO, CINAHL, SPORTDiscus and Web of Science from inception to August 2016. Barriers to behaviour change include poor motivation; environmental, societal and social pressures; lack of time; health and physical limitations; negative thoughts/moods; socioeconomic constraints; gaps in knowledge/awareness; and lack of enjoyment of exercise. The most prominent predictors of adherence include early weight loss success, lower baseline body mass index (BMI), better baseline mood, being male and older age. The findings within this review provide novel insight to clinicians working in obesity and have important implications for lifestyle intervention programme design. Barriers to behaviour change need to be addressed early in treatment, with lifestyle intervention individualized accordingly. Predictors of adherence should also be taken into careful consideration, with negative moods and unrealistic weight loss expectations discussed at the outset. If adherence is improved, treatment effectiveness, health outcomes and the ultimate burden of chronic diseases could also be improved.
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Affiliation(s)
- E Burgess
- University of Canberra Research Institute for Sport and Exercise, Canberra, Australia
| | - P Hassmén
- University of Canberra Research Institute for Sport and Exercise, Canberra, Australia
- School of Health and Human Sciences, Southern Cross University, Lismore, Australia
| | - K L Pumpa
- University of Canberra Research Institute for Sport and Exercise, Canberra, Australia
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, Australia
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Strauss SM, McCarthy M. Arthritis-Related Limitations Predict Insufficient Physical Activity in Adults With Prediabetes Identified in the NHANES 2011-2014. DIABETES EDUCATOR 2017; 43:163-170. [PMID: 28169593 DOI: 10.1177/0145721717691849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Purpose The purpose of the study was to determine the extent to which arthritis-related limitations are salient in predicting less than the recommended amount of time for adults with prediabetes to spend on moderate or vigorous physical activity. Methods Data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) in the United States were used to identify the predictors of insufficient physical activity in a large sample of adults with prediabetes 20 years of age and older (n = 2536). Results When extrapolated to more than 45 million adults in the United States at least 20 years of age with prediabetes, 42.7% had insufficient physical activity. Having arthritis-related functional limitations was a significant predictor of insufficient physical activity, even after accounting for the statistically significant contributions of female sex, older age, lower education level, higher body mass index, and depression. Conclusion When educating and counseling adults with prediabetes, diabetes educators should assess for arthritis-related functional limitations when examining factors that may affect prediabetes progression. Recommendations for physical activity for those with mobility and other limitations need to be individualized within a tailored exercise program to accommodate their specific limitations.
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Affiliation(s)
- Shiela M Strauss
- New York University Rory Meyers College of Nursing, New York, NY, USA (Dr Strauss, Dr McCarthy)
| | - Margaret McCarthy
- New York University Rory Meyers College of Nursing, New York, NY, USA (Dr Strauss, Dr McCarthy)
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Matsui N, Washida K, Shoji M, Nakaizumi D, Kitagawa T, Terada S, Uchiyama K. Decrease in Self-Efficacy for Exercise at 12 Weeks after Exercise Education in Diabetic Patients. Health (London) 2017. [DOI: 10.4236/health.2017.94046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Contribution of Psychosocial Factors to Physical Activity in Women of Color in the Saving Lives Staying Active (SALSA) Study. J Aging Phys Act 2016; 25:351-359. [PMID: 27834574 DOI: 10.1123/japa.2015-0239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Culturally appropriate, innovative strategies to increase physical activity (PA) in women of color are needed. This study examined whether participation in SALSA, an 8-week randomized, crossover pilot study to promote PA, led to improved psychosocial outcomes and whether these changes were associated with changes in PA over time. Women of color (N = 50) completed Internet-based questionnaires on PA, exercise self-efficacy, motivational readiness, stress, and social support at three time points. Women reported high socioeconomic status, decreases in exercise self-efficacy, and increases in motivational readiness for exercise and a number of stressful events (p < .05); changes in motivational readiness for exercise varied by group (p = .043). Changes in psychosocial factors were associated with increases in PA. Latin dance improved motivational readiness for PA. Future studies are needed to determine whether Latin dance improves other psychological measures and quality of life in women of color in an effort to increase PA and reduce health disparities.
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Lucke-Wold B, Shawley S, Ingels JS, Stewart J, Misra R. A Critical Examination of the Use of Trained Health Coaches to Decrease the Metabolic Syndrome for Participants of a Community-Based Diabetes Prevention and Management Program. JOURNAL OF HEALTHCARE COMMUNICATIONS 2016; 1. [PMID: 27857997 PMCID: PMC5110146 DOI: 10.4172/2472-1654.100038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The epidemic of obesity and diabetes in the United States poses major challenge to the prevention and management of chronic diseases. Furthermore, when this is viewed in other components of the metabolic syndrome (i.e., the burden of high cholesterol and hypertension), the prevalence of the metabolic syndrome continues to rise in the USA continued challenge is how to deal with this epidemic from a medical and public health standpoint. Community Based Participatory Research (CBPR) is a unique approach and offers a novel perspective for answering this challenge. A critical set of goals for CBPR is to address health disparities and social inequalities while getting community members engaged in all aspects of the research process. Utilizing the West Virginia Diabetes Prevention and Management Program and trained Health Coaches as a model, we discuss topics of consideration related to CBPR, involving trained health coaches, optimizing early adoption of healthy lifestyle behaviors, and enhancing participation. Through careful project planning and design, questions regarding disparities increasing susceptibility and preventive efforts within the community can be addressed successfully. These topics are part of a broader integration of theories such as participatory research, community engagement, and outcomes measurement. The understanding of the pathophysiology and epidemiology of the metabolic syndrome can help frame an appropriate strategy for establishing long-term community-wide changes that promote health. In order to continue to improve investigations for preventing the metabolic syndrome, it will be necessary to have aggressive efforts at the individual and population level for developing culturally sensitive programs that start early and are sustainable in practical environments such as the workplace. In this comprehensive review, we will discuss practical considerations related to project design, implementation, and how to measure effectiveness in regards to reducing the burden of the metabolic syndrome.
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Affiliation(s)
| | | | | | | | - Ranjita Misra
- West Virginia University, Morgantown, West Virginia, USA
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Ivanova E, Burns RJ, Deschênes SS, Knäuper B, Schmitz N. A Longitudinal Investigation of Anxiety and Depressive Symptomatology and Exercise Behaviour Among Adults With Type 2 Diabetes Mellitus. Can J Diabetes 2016; 41:73-81. [PMID: 27697449 DOI: 10.1016/j.jcjd.2016.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 07/08/2016] [Accepted: 07/25/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Evidence suggests that symptoms of depression and anxiety predict lower exercise behaviour and, inversely, that less exercise predicts higher symptomatology. The present longitudinal study examined this reciprocal association in adults with type 2 diabetes mellitus. We predicted that symptoms of anxiety or depression would intensify over time as a consequence of lower exercise frequency and, similarly, that exercise frequency would decrease as a consequence of greater symptoms of anxiety or depression. METHODS We studied 1691 adults with type 2 diabetes who provided baseline measures in 2011 and 2 subsequent annual assessments (Follow-up 1 and Follow-up 2). Symptoms of depression and anxiety were measured using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7, respectively. A single item assessed exercise frequency in the past month (in days). RESULTS Separate 3-wave cross-lagged path models for symptoms of anxiety and depression tested the reciprocal associations. Contrary to our hypotheses, the reciprocal associations were not supported and, by extension, the predicted secondary associations were not tested. In sum, only depressive symptoms negatively predicted subsequent exercise frequency (Follow-up 1 and Follow-up 2). CONCLUSIONS Symptoms of depression were prospectively associated with lower exercise frequency, which is consistent with evidence from population-based studies that identify depressive symptoms as a barrier to exercise participation.
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Affiliation(s)
- Elena Ivanova
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Rachel J Burns
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Sonya S Deschênes
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Bärbel Knäuper
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Norbert Schmitz
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada; Montreal Diabetes Research Centre, Montreal, Quebec, Canada.
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Edwards ES, Sackett SC. Psychosocial Variables Related to Why Women are Less Active than Men and Related Health Implications. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2016; 9:47-56. [PMID: 27398045 PMCID: PMC4933535 DOI: 10.4137/cmwh.s34668] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/12/2016] [Accepted: 05/15/2016] [Indexed: 12/22/2022]
Abstract
This article reviews psychosocial influences on women’s participation in physical activity as they differ from men and how associated activity differences impact women’s risk for a number of chronic diseases. This topic directly aligns with the mission of this special edition related to disparities in women’s health as the typically lower level of physical activity in females directly impacts their health. On average, females participate in physical activity at lower rates than their male counterparts. These lower rates of physical activity are directly related to both incidence of and outcomes from cardiovascular disease, type 2 diabetes, and breast and gynecological cancers. The relationship between psychosocial factors that are understood to affect physical activity differs between men and women. Specifically, self-efficacy, social support, and motivation are empirically substantiated factors that found to impact physical activity participation among women differently than men. Understanding these relationships is integral to designing effective interventions to target physical activity participation in women so that the related health risks are adequately addressed.
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Affiliation(s)
| | - Sarah Carson Sackett
- Department of Kinesiology, James Madison University, Morrison Bruce Center, Harrisonburg, VA, USA
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Miller CK, Weinhold KR, Nagaraja HN. Impact of a Worksite Diabetes Prevention Intervention on Diet Quality and Social Cognitive Influences of Health Behavior: A Randomized Controlled Trial. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2016; 48:160-9.e1. [PMID: 26787601 PMCID: PMC4788518 DOI: 10.1016/j.jneb.2015.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/02/2015] [Accepted: 12/04/2015] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the impact of a worksite diabetes prevention intervention on secondary outcomes regarding the change in diet quality and components of the Health Action Process Approach (HAPA) theoretical framework. DESIGN Pretest-posttest control group design with 3-month follow-up. SETTING University worksite. PARTICIPANTS Employees aged 18-65 years with prediabetes (n = 68). INTERVENTION A 16-week group-based intervention adapted from the Diabetes Prevention Program. MAIN OUTCOME MEASURES Diet quality was assessed using the Alternative Healthy Eating Index 2010; HAPA components were assessed via written questionnaire. ANALYSIS Repeated-measures ANOVA compared the between- and within-group change in outcomes across time. RESULTS Significant difference occurred between groups for the change in consumption of nuts/legumes and red/processed meats postintervention and for fruits at 3-month follow-up (all P < .05); a significant increase in total Alternative Healthy Eating Index 2010 score occurred postintervention in the experimental group (P = .002). The changes in action planning, action self-efficacy, and coping self-efficacy from HAPA were significantly different between groups after the intervention; the change in outcome expectancies was significantly different between groups at 3-month follow-up (all P < .05). CONCLUSIONS AND IMPLICATIONS The worksite intervention facilitated improvement in diet quality and in planning and efficacious beliefs regarding diabetes prevention. Further research is needed to evaluate the long-term impact of the intervention.
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Affiliation(s)
- Carla K. Miller
- Professor, Department of Human Sciences, Human Nutrition, , 614-292-1391
| | - Kellie R. Weinhold
- Graduate Research Assistant, Department of Human Sciences, Human Nutrition,
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Borkoles E, Carroll S, Clough P, Polman RC. Effect of a non-dieting lifestyle randomised control trial on psychological well-being and weight management in morbidly obese pre-menopausal women. Maturitas 2016; 83:51-8. [DOI: 10.1016/j.maturitas.2015.09.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 09/15/2015] [Accepted: 09/28/2015] [Indexed: 12/17/2022]
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Jimenez DE, Reynolds CF, Alegría M, Harvey P, Bartels SJ. The Happy Older Latinos are Active (HOLA) health promotion and prevention study: study protocol for a pilot randomized controlled trial. Trials 2015; 16:579. [PMID: 26683695 PMCID: PMC4683729 DOI: 10.1186/s13063-015-1113-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/09/2015] [Indexed: 11/25/2022] Open
Abstract
Background Results of previous studies attest to the greater illness burden of common mental disorders (anxiety and depression) in older Latinos and the need for developing preventive interventions that are effective, acceptable, and scalable. Happy Older Latinos are Active (HOLA) is a newly developed intervention that uses a community health worker (CHW) to lead a health promotion program in order to prevent common mental disorders among at-risk older Latinos. This pilot study tests the feasibility and acceptability of delivering HOLA to older, at-risk Latinos. Methods/Design HOLA is a multi-component, health promotion intervention funded by the National Institute of Mental Health (NIMH). This prevention approach will be tested against a fotonovela, an enhanced psychoeducation control condition, in a sample of Latino elderly with minor or subthreshold depression or anxiety. A total of 60 older Latinos (aged 60+) will be randomized to receive HOLA or the fotonovela. The primary outcomes of interest are recruitment, adherence, retention, and acceptability. Data will also be collected on: preemption of incident and recurrent major depression, generalized anxiety, and social phobia; reduction in depression and anxiety symptom severity; physical functioning; sedentary behaviors; social engagement; and self-efficacy. Discussion The results of this study could have implications for other high-risk, highly disadvantaged populations. The development of a health promotion intervention designed to prevent common mental disorders could be a means of addressing multiple disparities (for example, mental health outcomes, mental health service use, stigma) among racial/ethnic minority elderly. ClinicalTrials.gov Identifier NCT02371954. Date of registration: 21 January 2015.
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Affiliation(s)
- Daniel E Jimenez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1695 NW 9th Ave., Suite 3208, Miami, FL, 33136, USA.
| | - Charles F Reynolds
- NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, PA, USA.
| | - Margarita Alegría
- Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA.
| | - Philip Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1695 NW 9th Ave., Suite 3208, Miami, FL, 33136, USA.
| | - Stephen J Bartels
- Dartmouth Centers for Health and Aging, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. Stephen.j.bartels.@dartmouth.edu
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Weber MB, Ranjani H, Anjana RM, Mohan V, Narayan KMV, Gazmararian JA. Behavioral and psychosocial correlates of adiposity and healthy lifestyle in Asian Indians. Prim Care Diabetes 2015; 9:418-425. [PMID: 25733342 DOI: 10.1016/j.pcd.2015.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 01/23/2015] [Accepted: 01/31/2015] [Indexed: 11/22/2022]
Abstract
AIMS Adiposity is an important diabetes risk factor, and Asian Indians have elevated diabetes risk. This analysis assessed the relationship between behavioral and psychosocial factors and adiposity among Asian Indians to better understand factors driving elevated weight/waist circumference in this population. METHODS This study used screening data (N=1285) from the D-CLIP study, a randomized controlled diabetes prevention trial in Chennai, India. Correlation tests and linear regression models were done to describe relationships among exposure variables (weight loss/exercise self-efficacy, fruit/vegetable intake, weekly exercise, past weight loss experience) and between these exposures and BMI or waist circumference. RESULTS Exercise and weight loss self-efficacy were positively correlated with average minutes per week exercising (R=0.26, p<0.0001) and fruit (R=0.07, p<0.05) and vegetable intake (R=0.12, p<0.0001). Weekly fruit consumption, past weight loss experience, and weight loss self-efficacy, along with sex, age, and marital status, explained 13.6% and 25.9% in the variation in BMI and waist circumference, respectively. CONCLUSIONS Low fruit consumption, unsuccessful past weight loss attempts, and low self-efficacy for weight loss are associated with higher BMI and waist circumference in this population. Understanding factors related to adiposity is important for preventing and treating weight gain.
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Affiliation(s)
- Mary Beth Weber
- Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Harish Ranjani
- Madras Diabetes Research Foundation, 6B Conran Smith Road, Gopalapuram, Chennai 600 086, India.
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation, 6B Conran Smith Road, Gopalapuram, Chennai 600 086, India.
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation, 6B Conran Smith Road, Gopalapuram, Chennai 600 086, India.
| | - K M Venkat Narayan
- Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Julie A Gazmararian
- Department of Epidemiology, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
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Does the effect of walkable built environments vary by neighborhood socioeconomic status? Prev Med 2015; 81:262-7. [PMID: 26400637 DOI: 10.1016/j.ypmed.2015.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 09/10/2015] [Accepted: 09/12/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine socioeconomic status as a moderator of the relationship between the built environment and active transportation such as walking or cycling using measures of built environment exposure derived from individuals transport trips. METHODS The 2008 Montreal Origin-destination (OD) survey provided origin-destination coordinates for a sample of 156,700 participants. We selected participants from this survey that had traveled within the census metropolitan area of Montreal the day preceding the interview, and that were between 18-65 years of age. Measures of connectivity, land-use mix, and density of business and services were collected using 400-m buffers of the trip routes. Logistic regression was used to model the relationship between built environment variables and active transportation. RESULTS Trip routes in the 2nd, 3rd, and 4th quartile of density of business and services or connectivity translated into greater odds of taking AT (compared to a trip in the lowest quartile). Trip routes in the 2nd, 3rd, and 4th quartile of land-use mix translated into lower odds of taking AT. Trips in the highest quartiles of connectivity and density of business and services were found to have a weaker association with active transportation if the individual undergoing the trip was from a low SES neighborhood. CONCLUSION Our results suggest that previous studies finding no effect modification may have been due to the limitation of measurements of exposures to the residential neighborhood.
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Alsenany S, Al Saif A. Incidence of diabetes mellitus type 2 complications among Saudi adult patients at primary health care center. J Phys Ther Sci 2015; 27:1727-30. [PMID: 26180307 PMCID: PMC4499970 DOI: 10.1589/jpts.27.1727] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 02/14/2015] [Indexed: 01/22/2023] Open
Abstract
[Purpose] This study analyzed type 2 diabetes and its role in complications among adult Saudi patients. [Subjects] Patients attending four primary health care centers in Jeddah were enrolled. [Methods] A cross-sectional design study among Saudi patients attending Ministry of Health primary health care centers in Jeddah was selected for use by the Primary Health Care administration. Patients were interviewed with structured questionnaires to determine the presence of diabetes and risk factors using questions about the history of any disease. [Results] Diabetes mellitus was present in 234 subjects during the data collection period (March-June 2014). Mean patient age was 58 years; diabetes prevalence was 42% in males and 58% in females. The mean age for diabetes onset in males and females was 34 and 39 years, respectively. There was a higher incidence of obesity (75%) associated with a sedentary lifestyle (body mass index ≥25) in females (N= 96; 40%) compared with males (N= 87; 36%). In this study, >44% of individuals aged 55 or older had severe to uncontrolled diabetes with long-term complications. The age-adjusted incidence of hypertension and coronary heart disease was 38% and 24%, respectively, showing a clear incidence of diabetes associated with cardiovascular disease in Saudi Arabia. [Conclusion] This study found that a multifactorial approach to managing diabetes complication risks is needed.
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Affiliation(s)
- Samira Alsenany
- Public Health Department, Faculty of Nursing, King Abdulaziz University, Saudi Arabia
| | - Amer Al Saif
- Physical Therapy Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Saudi Arabia
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Miller CK, Weinhold KR, Marrero DG, Nagaraja HN, Focht BC. A Translational Worksite Diabetes Prevention Trial Improves Psychosocial Status, Dietary Intake, and Step Counts among Employees with Prediabetes: A Randomized Controlled Trial. Prev Med Rep 2015; 2:118-126. [PMID: 25798374 PMCID: PMC4363734 DOI: 10.1016/j.pmedr.2015.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Few worksite trials have examined the impact of diabetes prevention interventions on psychological and behavioral outcomes. Thus, the impact of a worksite lifestyle intervention on psychosocial outcomes, food group intake, and step counts for physical activity (PA) was evaluated. METHOD A randomized pretest/posttest control group design with 3-month follow-up was employed from October 2012 to May 2014 at a U.S. university worksite among employees with prediabetes. The experimental group (n=35) received a 16-week group-based intervention while the control group received usual care (n=33). Repeated measures analysis of variance compared the change in outcomes between groups across time. RESULTS A significant difference occurred between groups post-intervention for self-efficacy associated with eating and PA; goal commitment and difficulty; satisfaction with weight loss and physical fitness; peer social support for healthful eating; generation of alternatives for problem solving; and intake of fruits, meat, fish, poultry, nuts, and seeds (all ps < .05). The experimental group significantly increased step counts post-intervention (p = .0279) and were significantly more likely to report completing their work at study end (p = .0231). CONCLUSION The worksite trial facilitated improvement in modifiable psychosocial outcomes, dietary patterns, and step counts; the long-term impact on diabetes prevention warrants further investigation. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01682954.
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Affiliation(s)
- Carla K. Miller
- Department of Human Sciences, Human Nutrition, Ohio State University, 1787 Neil Ave., 325 Campbell Hall, Columbus, OH 43210, USA
| | - Kellie R. Weinhold
- Department of Human Sciences, Human Nutrition, Ohio State University, Columbus, OH, USA
| | - David G. Marrero
- Indiana University School of Medicine, 410 W. 10th Street, Room 1140, Indianapolis, IN 46202, USA
| | - Haikady N. Nagaraja
- Division of Biostatistics, College of Public Health, Ohio State University, Columbus, OH, USA
| | - Brian C. Focht
- Department of Human Sciences, Kinesiology, Ohio State University, Columbus, OH, USA
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Nessen T, Demmelmaier I, Nordgren B, Opava CH. The Swedish Exercise Self-Efficacy Scale (ESES-S): reliability and validity in a rheumatoid arthritis population. Disabil Rehabil 2015; 37:2130-4. [PMID: 25572319 PMCID: PMC4720053 DOI: 10.3109/09638288.2014.998780] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: The aim of the present study was to investigate aspects of reliability and validity of the Exercise Self-Efficacy Scale (ESES-S) in a rheumatoid arthritis (RA) population. Methods: A total of 244 people with RA participating in a physical activity stkudy were included. The six-item ESES-S, exploring confidence in performing exercise, was assessed for test–retest reliability over 4–6 months, and for internal consistency. Construct validity investigated correlation with similar and other constructs. Results: An intraclass correlation coefficient (ICC) of 0.59 (95% CI 0.37–0.73) was found for 84 participants with stable health perceptions between measurement occasions. Cronbach’s alpha coefficients of 0.87 and 0.89 were found at the first and second measurements. Corrected item-total correlation single ESES-S items ranged between 0.53 and 0.73. Construct convergent validity for the ESES-S was partly confirmed by correlations with health-enhancing physical activity and outcome expectations respectively (Pearson’s r = 0.18, p < 0.01). Construct divergent validity was confirmed by the absence of correlations with age or gender. No floor or ceiling effects were found for ESES-S. Conclusions: The results indicate that the ESES-S has moderate test–retest reliability and respectable internal consistency in people with RA. Construct validity was partially supported in the present sample. Further research on construct validity of the ESES-S is recommended.Implications for Rehabilitation Physical exercise is crucial for management of symptoms and co-morbidity in rheumatoid arthritis. Self-efficacy for exercise is important to address in rehabilitation as it regulates exercise motivation and behavior. Measurement properties of self-efficacy scales need to be assessed in specific populations and different languages.
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Affiliation(s)
- Thomas Nessen
- a Division of Physiotherapy, Department of Neurobiology , Care Sciences and Society, Karolinska Institutet , Stockholm , Sweden and
| | - Ingrid Demmelmaier
- a Division of Physiotherapy, Department of Neurobiology , Care Sciences and Society, Karolinska Institutet , Stockholm , Sweden and
| | - Birgitta Nordgren
- a Division of Physiotherapy, Department of Neurobiology , Care Sciences and Society, Karolinska Institutet , Stockholm , Sweden and
| | - Christina H Opava
- a Division of Physiotherapy, Department of Neurobiology , Care Sciences and Society, Karolinska Institutet , Stockholm , Sweden and.,b Department of Rheumatology , Karolinska University Hospital , Stockholm , Sweden
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Mama SK, Diamond PM, McCurdy SA, Evans AE, McNeill LH, Lee RE. Individual, social and environmental correlates of physical activity in overweight and obese African American and Hispanic women: A structural equation model analysis. Prev Med Rep 2015; 2:57-64. [PMID: 25692093 PMCID: PMC4327909 DOI: 10.1016/j.pmedr.2015.01.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective Ecologic frameworks account for multilevel factors related to physical activity (PA) and may be used to develop effective interventions for women. The purpose of this study was to examine the influence of individual, social and environmental factors on PA among African American and Hispanic women using structural equation modeling. Methods Overweight and obese women (N = 164, 65.9% African American) completed a 7-day accelerometer protocol, a physical assessment, and questionnaires on body image, self-efficacy, motivational readiness, social support, home environment for physical activity and perceived environment. Trained assessors evaluated each participant's neighborhood and collected objective measures of physical activity resources and the pedestrian environment. Assessments were completed between 2006 and 2008. Results Structural model fit was acceptable (RMSEA = .030). Body composition and image was negatively associated with PA, and motivational readiness had an indirect effect on PA through body composition and image. PA resources and the pedestrian environment operated through the perceived environment to positively influence neighborhood cohesion, which was positively associated with body composition and image. Conclusion PA is more heavily influenced by intrapersonal factors related to weight. Improving intrapersonal factors related to weight and perceptions of the environment may lead to increased PA in African American and Hispanic women. Physical inactivity contributes to health disparities among ethnic minority women. Individual factors directly and indirectly influence physical activity. The physical environment influences individual factors via the social environment.
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Affiliation(s)
- Scherezade K. Mama
- Department of Health Disparities Research, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler St., Unit 1440, Houston, TX 77030, USA
- School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin, 26th Floor, Houston, TX 77030, USA
- Texas Obesity Research Center, Department of Health and Human Performance, University of Houston, 3855 Holman St., Garrison Gym Rm 104, Houston, TX, USA
- Corresponding author at: Department of Health Disparities Research, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler St., Unit 1440 (FCT9.6051), Houston, TX 77030-3906, USA. Fax: + 1 713 792 1152.
| | - Pamela M. Diamond
- School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin, 26th Floor, Houston, TX 77030, USA
| | - Sheryl A. McCurdy
- School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin, 26th Floor, Houston, TX 77030, USA
| | - Alexandra E. Evans
- The University of Texas School of Public Health—Austin Regional Campus, 1616 Guadalupe, Suite 6.300, Austin, TX 78701, USA
| | - Lorna H. McNeill
- Department of Health Disparities Research, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler St., Unit 1440, Houston, TX 77030, USA
| | - Rebecca E. Lee
- College of Nursing and Health Innovation, Arizona State University, 550 N. 3rd Street, Phoenix, AZ 85004, USA
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49
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Huffman JC, DuBois CM, Millstein RA, Celano CM, Wexler D. Positive Psychological Interventions for Patients with Type 2 Diabetes: Rationale, Theoretical Model, and Intervention Development. J Diabetes Res 2015; 2015:428349. [PMID: 26064980 PMCID: PMC4442018 DOI: 10.1155/2015/428349] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/02/2015] [Indexed: 12/21/2022] Open
Abstract
Most patients with type 2 diabetes (T2D) have suboptimal adherence to recommended diet, physical activity, and/or medication. Current approaches to improve health behaviors in T2D have been variably effective, and successful interventions are often complex and intensive. It is therefore vital to develop interventions that are simple, well-accepted, and applicable to a wide range of patients who suffer from T2D. One approach may be to boost positive psychological states, such as positive affect or optimism, as these constructs have been prospectively and independently linked to improvements in health behaviors. Positive psychology (PP) interventions, which utilize systematic exercises to increase optimism, well-being, and positive affect, consistently increase positive states and are easily delivered to patients with chronic illnesses. However, to our knowledge, PP interventions have not been formally tested in T2D. In this paper, we review a theoretical model for the use of PP interventions to target health behaviors in T2D, describe the structure and content of a PP intervention for T2D patients, and describe baseline data from a single-arm proof-of-concept (N = 15) intervention study in T2D patients with or without depression. We also discuss how PP interventions could be combined with motivational interviewing (MI) interventions to provide a blended psychological-behavioral approach.
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Affiliation(s)
- Jeff C. Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- *Jeff C. Huffman:
| | - Christina M. DuBois
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Rachel A. Millstein
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Christopher M. Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Deborah Wexler
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
- MGH Diabetes Center, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
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Clarke J, Proudfoot J, Birch MR, Whitton AE, Parker G, Manicavasagar V, Harrison V, Christensen H, Hadzi-Pavlovic D. Effects of mental health self-efficacy on outcomes of a mobile phone and web intervention for mild-to-moderate depression, anxiety and stress: secondary analysis of a randomised controlled trial. BMC Psychiatry 2014; 14:272. [PMID: 25252853 PMCID: PMC4189737 DOI: 10.1186/s12888-014-0272-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 09/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Online psychotherapy is clinically effective yet why, how, and for whom the effects are greatest remain largely unknown. In the present study, we examined whether mental health self-efficacy (MHSE), a construct derived from Bandura's Social Learning Theory (SLT), influenced symptom and functional outcomes of a new mobile phone and web-based psychotherapy intervention for people with mild-to-moderate depression, anxiety and stress. METHODS STUDY I: Data from 49 people with symptoms of depression, anxiety and/or stress in the mild-to-moderate range were used to examine the reliability and construct validity of a new measure of MHSE, the Mental Health Self-efficacy Scale (MHSES). STUDY II We conducted a secondary analysis of data from a recently completed randomised controlled trial (N = 720) to evaluate whether MHSE effected post-intervention outcomes, as measured by the Depression, Anxiety and Stress Scales (DASS) and Work and Social Adjustment Scale (WSAS), for people with symptoms in the mild-to-moderate range. RESULTS STUDY I: The data established that the MHSES comprised a unitary factor, with acceptable internal reliability (Cronbach's alpha = .89) and construct validity. STUDY II The intervention group showed significantly greater improvement in MHSE at post-intervention relative to the control conditions (p's < = .000). MHSE mediated the effects of the intervention on anxiety and stress symptoms. Furthermore, people with low pre-treatment MHSE reported the greatest post-intervention gains in depression, anxiety and overall distress. No effects were found for MHSE on work and social functioning. CONCLUSION Mental health self-efficacy influences symptom outcomes of a self-guided mobile phone and web-based psychotherapeutic intervention and may itself be a worthwhile target to increase the effectiveness and efficiency of online treatment programs. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12610000625077.
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Affiliation(s)
- Janine Clarke
- Black Dog Institute, Hospital Road, Randwick, NSW 2013 Australia ,School of Psychiatry, UNSW Australia, High Street, Kensington, NSW 2052 Australia
| | - Judith Proudfoot
- Black Dog Institute, Hospital Road, Randwick, NSW 2013 Australia ,School of Psychiatry, UNSW Australia, High Street, Kensington, NSW 2052 Australia
| | - Mary-Rose Birch
- Black Dog Institute, Hospital Road, Randwick, NSW 2013 Australia
| | - Alexis E Whitton
- Black Dog Institute, Hospital Road, Randwick, NSW 2013 Australia
| | - Gordon Parker
- School of Psychiatry, UNSW Australia, High Street, Kensington, NSW 2052 Australia
| | - Vijaya Manicavasagar
- Black Dog Institute, Hospital Road, Randwick, NSW 2013 Australia ,School of Psychiatry, UNSW Australia, High Street, Kensington, NSW 2052 Australia
| | - Virginia Harrison
- Black Dog Institute, Hospital Road, Randwick, NSW 2013 Australia ,School of Psychiatry, UNSW Australia, High Street, Kensington, NSW 2052 Australia
| | | | - Dusan Hadzi-Pavlovic
- Black Dog Institute, Hospital Road, Randwick, NSW 2013 Australia ,School of Psychiatry, UNSW Australia, High Street, Kensington, NSW 2052 Australia
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