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Blackburn DF, Yao S, Taylor JG, Alefan Q, Lix LM, Eurich DT, Choudhry NK. Measuring the Influence of Side Effect Expectations, Beliefs, and Incident Side Effects on the Risk for Drug Discontinuation Among Individuals Starting New Medications, a Cross-sectional Study. Patient Prefer Adherence 2024; 18:979-989. [PMID: 38774475 PMCID: PMC11107835 DOI: 10.2147/ppa.s451012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/04/2024] [Indexed: 05/24/2024] Open
Abstract
Purpose To measure the impact of beliefs, expectations, side effects, and their combined effects on the risk for medication nonpersistence. Patients and methods Using a cross-sectional design, individuals from Saskatchewan, Canada who started a new antihypertensive, cholesterol-lowering, or antihyperglycemic medication were surveyed about risk factors for nonpersistence including: (a) beliefs measured by a composite score of three questions asking about the threat of the condition, importance of the drug, and harm of the drug; (b) incident side effects attributed to treatment; and (c) expectations for side effects before starting treatment. Descriptive statistics and logistic regression models were used to quantify the influence of these risk factors on the outcome of nonpersistence. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Results Among 3,029 respondents, 5.8% (n=177) reported nonpersistence within four months after starting the new drug. After adjustment for numerous covariates representing sociodemographics, health-care providers, medication experiences and beliefs, both negative beliefs (OR: 7.26, 95%CI: 4.98-10.59) and incident side effects (OR: 8.00, 95%CI: 5.49-11.68) were associated with the highest odds of nonpersistence with no evidence of interaction. In contrast, expectations for side effects before starting treatment exhibited an important interaction with incident side effects following treatment initiation. Among respondents with incident side effects (n=741, 24.5%), the risk for early nonpersistence was 11.5% if they indicated an expectation for side effects before starting the medication compared to 23.6% if they did not (adjusted OR: 0.38, 95%CI: 0.25-0.60). Conclusion Expectations for side effects may be a previously unrecognized but important marker of the probability to persist with treatment. A high percentage of new medication users appeared unprepared for the possibility of side effects from their new medication making them less resilient if side effects occur.
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Affiliation(s)
- David F Blackburn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Shenzhen Yao
- Public Health Surveillance Unit, Vancouver Coastal Health Authority, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Jeff G Taylor
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Qais Alefan
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Niteesh K Choudhry
- Department of Medicine, Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA
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Naidoo K, Nzimande NP, Morris F. Investigating the socioeconomic impacts of sewage spillages on businesses in the Umhlanga Rocks coastline area. JAMBA (POTCHEFSTROOM, SOUTH AFRICA) 2024; 16:1602. [PMID: 38725876 PMCID: PMC11079421 DOI: 10.4102/jamba.v16i1.1602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/26/2024] [Indexed: 05/12/2024]
Abstract
Sewage spillage is fast becoming a significant concern in South Africa because of the deteriorating infrastructure and substandard service delivery. Thus, this study investigated the socioeconomic impacts of sewage spillages on businesses in the Umhlanga Rocks coastline area. A questionnaire with open and closed-ended questions was used to collect data from business owners in the affected area. One hundred business owners were handed questionnaires to complete, and 95 completed questionnaires were collected. The qualitative data from the questionnaires were analysed using thematic analysis, whereby line-by-line coding was manually completed using Excel. The quantitative data were analysed in R studio using numerous statistical tests, including the Shapiro-Wilk test, the Chi-square test, the Kruskal-Wallis test, Dunn's test, and Cohen's d test. The thematic analysis and statistical testing results showed that sewage spillages disrupted businesses significantly. Results indicated that businesses of different sizes experienced socioeconomic losses differently. Consequently, the results of this study have implications for business owners and communities living in the affected area. Moreover, findings have revealed practical strategies and interventions that may be used by micro- to medium-scale businesses to mitigate the socioeconomic impact of sewage spillages. Contribution The practical strategies revealed in this study contribute to reducing the vulnerability of communities and businesses to sewage spillages. Findings of the study have also been disseminated to the business owners and other relevant stakeholders to provide them with alternative solutions in 'softening the blow' caused by the spillages.
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Affiliation(s)
- Kalin Naidoo
- Department of Geography, Faculty of Humanities, University of KwaZulu-Natal, Durban, South Africa
| | - Ntombifuthi P Nzimande
- Department of Geography, Faculty of Humanities, University of KwaZulu-Natal, Durban, South Africa
| | - Feroza Morris
- Department of Geography, Faculty of Science, University of KwaZulu-Natal, Durban, South Africa
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Lesser IA, Wurz A, Bean C, Culos-Reed N, Lear SA, Jung M. Participant Bias in Community-Based Physical Activity Research: A Consistent Limitation? J Phys Act Health 2024; 21:109-112. [PMID: 37935192 DOI: 10.1123/jpah.2023-0267] [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] [Received: 06/08/2023] [Revised: 08/16/2023] [Accepted: 10/10/2023] [Indexed: 11/09/2023]
Abstract
Physical activity is a beneficial, yet complex, health behavior. To ensure more people experience the benefits of physical activity, we develop and test interventions to promote physical activity and its associated benefits. Nevertheless, we continue to see certain groups of people who choose not to, or are unable to, take part in research, resulting in "recruitment bias." In fact, we (and others) are seemingly missing large segments of people and are doing little to promote physical activity research to equity-deserving populations. So, how can we better address recruitment bias in the physical activity research we conduct? Based on our experience, we have identified 5 broad, interrelated, and applicable strategies to enhance recruitment and engagement within physical activity interventions: (1) gain trust, (2) increase community support and participation, (3) consider alternative approaches and designs, (4) rethink recruitment strategies, and (5) incentivize participants. While we recognize there is still a long way to go, and there are broader community and societal issues underlying recruitment to research, we hope this commentary prompts researchers to consider what they can do to try to address the ever-present limitation of "recruitment bias" and support greater participation among equity-deserving groups.
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Affiliation(s)
- Iris A Lesser
- School of Kinesiology, University of the Fraser Valley, Chilliwack, BC, Canada
| | - Amanda Wurz
- School of Kinesiology, University of the Fraser Valley, Chilliwack, BC, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Corliss Bean
- Department of Recreation & Leisure Studies, Brock University, St. Catharines, ON, Canada
| | - Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, Calgary, AB, Canada
- Department of Psychosocial Resources, Tom Baker Cancer Center, Alberta Health Services, Calgary, AB, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Mary Jung
- School of Health and Exercise Sciences, The University of British Columbia, Vancouver, BC, Canada
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Sugiyama M, Chau HW, Abe T, Kato Y, Jamei E, Veeroja P, Mori K, Sugiyama T. Third Places for Older Adults' Social Engagement: A Scoping Review and Research Agenda. THE GERONTOLOGIST 2023; 63:1149-1161. [PMID: 36512515 DOI: 10.1093/geront/gnac180] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Neighborhood places that facilitate older residents to meet and interact (third places) receive an increasing research interest as studies have consistently shown the benefits of social engagement for older adults' health. This scoping review synthesized the findings of studies examining the role of third places in older adults' social engagement. RESEARCH DESIGN AND METHODS Searching 5 databases (CINAHL, Medline, PsycInfo, Scopus, and Web of Science) in October 2021, this study identified quantitative and qualitative studies that examined the relationships between third places and social engagement (interaction and network) among older adults. RESULTS A total of 32 studies (12 quantitative and 20 qualitative studies) met the eligibility criteria. These studies examined 4 types of third place, namely, community facilities, local businesses, open/green spaces, and transition spaces. More than two thirds of the studies reviewed found that access to community facilities, local businesses, and open/green spaces were related to older adults' social interaction. For the relationships between third places and social networks, the importance of accessible local businesses and the quality of open/green spaces was supported by fewer studies. DISCUSSION AND IMPLICATIONS The findings of quantitative and qualitative studies suggest that local places that are convenient to visit and comfortable to stay in for older adults are likely to enhance their social interaction and network. However, more specific evidence is needed to inform the planning and design of third places. The review discusses future research topics that address the gaps identified in the current literature.
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Affiliation(s)
- Masaaki Sugiyama
- Graduate School of Human Life Science, Osaka Metropolitan University, Osaka, Japan
| | - Hing-Wah Chau
- Institute for Sustainable Industries and Liveable Cities, Victoria University, Melbourne, Australia
| | - Takumi Abe
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Australia
| | - Yusuke Kato
- College of Human Life and Environment, Kinjo Gakuin University, Nagoya, Japan
| | - Elmira Jamei
- Institute for Sustainable Industries and Liveable Cities, Victoria University, Melbourne, Australia
| | - Piret Veeroja
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Australia
| | - Kazuhiko Mori
- Graduate School of Human Life Science, Osaka Metropolitan University, Osaka, Japan
| | - Takemi Sugiyama
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
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Igarashi T, Sugawara I, Inoue T, Nihei M. Research Participant Selection Bias in the Workshop Using Socially Assistive Robots for Older Adults and Its Effect on Population Representativeness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105915. [PMID: 37239641 DOI: 10.3390/ijerph20105915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 05/28/2023]
Abstract
Every research participant has their own personality characteristics. For example, older adults assisted by socially assistive robots (SAR) may have their own unique characteristics and may not be representative of the general population of older adults. In this research, we compared the average personality characteristics of participants in a workshop on robotics recruited directly through posting with those of older Japanese adults to examine participant selection bias and group representativeness for future study of SARs. After a one-week recruitment period, the workshop was attended by 20 older participants (nine males and 11 females) aged between 62 and 86 years. Extroversion among workshop participants was 4.38, 0.40 higher than the average for older adults in Japan. The workshop participants' openness was 4.55, 1.09 higher than the average for the Japanese elderly. Thus, the results indicate a slight selection bias in the personal characteristics of the participants depending on the recruitment method when compared to the Japan national average for older adults. In addition, only one of 20 participants was below the cutoff on the LSNS-6 score and considered to have a tendency toward social isolation. The development and introduction of socially assistive robots is often being considered to support people in social isolation in their daily lives; however, the results of this study showed that it is difficult to recruit people who tend to be socially isolated when gathering research participants by methods such as posting. Therefore, the effectiveness of the method of recruiting participants should be carefully verified in research regarding socially assistive robots.
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Affiliation(s)
- Toshiharu Igarashi
- Department of Human and Engineered Environmental Studies, The University of Tokyo, Kashiwanoha 5-1-5, Chiba 277-8563, Japan
| | - Ikuko Sugawara
- Faculty of Service Management, Bunri University of Hospitality, 311-1, Kashiwabara-shinden, Sainatama 350-1336, Japan
| | - Takenobu Inoue
- Research Institute of National Rehabilitation, Center for the Persons with Disabilities, 1, Namiki 4-chome, Saitama 359-8555, Japan
| | - Misato Nihei
- Institute of Gerontology, The University of Tokyo, 3-1, Hongo 7-chome, Bunkyo-ku, Tokyo 113-8654, Japan
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McNamara R, Davy K, Niranjan V, O'Regan A. Recruitment and characteristics of participants in trials of physical activity for adults aged 45 years and above in general practice: a systematic review. Fam Pract 2022; 40:387-397. [PMID: 36472583 PMCID: PMC10047612 DOI: 10.1093/fampra/cmac128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND General practice is well situated to promote physical activity (PA), but with PA levels declining after 45 years of age, often those who are most likely to benefit from interventions tend to be the least likely recruited to participate in research. AIMS AND RATIONALE The aim of this study was to investigate recruitment and reporting of participant demographics in PA trials for adults aged 45 years and above. Specific objectives were: (i) to examine the reporting of demographics of participants; (ii) to investigate the strategies used to recruit these participants; and, (iii) to examine the efficiency of recruitment strategies. METHODS Seven databases were searched, including: PubMed, CINAHL, the Cochrane Library Register of Controlled Trials, Embase, Scopus, PsycINFO, and Web of Science. Only randomized control trials involving adults 45 years old or older recruited through primary care were included. The PRISMA framework for systematic review was followed, which involved 2 researchers independently conducting title, abstract, and full article screening. Tools for data extraction and synthesis were adapted from previous work on inclusivity in recruitment. RESULTS The searches retrieved 3,491 studies of which 12 were included for review. Sample size of the studies ranged from 31 to 1,366, with a total of 6,042 participants of which 57% were female. Of 101 participating practices, 1 was reported as rural. Reporting of recruitment lacked detail-only 6 studies outlined how practices were recruited. 11/12 studies involved a database or chart review to identify participants that met the inclusion criteria, followed by a letter of invitation sent to those people. The studies with higher recruitment efficiency ratios each employed more than 1 recruitment strategy, e.g. opportunistic invitations and telephone calls. CONCLUSION This systematic review has presented deficits in the reporting of both demographics and recruitment. Future research should aim for a standardized approach to reporting.
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Affiliation(s)
- Richard McNamara
- University of Limerick, Health Research Institute, School of Medicine, Limerick, Ireland
| | - Kimberly Davy
- University of Limerick, Health Research Institute, School of Medicine, Limerick, Ireland
| | - Vikram Niranjan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Andrew O'Regan
- University of Limerick, Health Research Institute, School of Medicine, Limerick, Ireland
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Anderson G, Rega ML, Casasanta D, Graffigna G, Damiani G, Barello S. The association between patient activation and healthcare resources utilization: a systematic review and meta-analysis. Public Health 2022; 210:134-141. [PMID: 35970015 DOI: 10.1016/j.puhe.2022.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/11/2022] [Accepted: 06/19/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To measure the association between patient activation and hospitalization or emergency department (ED) visits among adults with chronic diseases. STUDY DESIGN Systematic review and meta-analysis. METHODS A systematic review of English articles was performed using the following databases: PubMed, Cochrane Library, Web of Science, PsycINFO, and Embase. Articles were searched from 2005 until July 2021. Observational studies that measured the association between patient activation, measured by the Patient Activation Measure (PAM), and hospitalization or ED visits among adults with chronic or multichronic diseases were included. Pairs of reviewers independently screened the studies and extracted data for qualitative and quantitative synthesis. The methodological quality was assessed using the Quality in Prognostic Studies (QUIPS) tool. RESULTS A total of nine observational studies (153,121 participants) were included in the qualitative synthesis, whereas six were pooled in the quantitative synthesis (151,359 participants). High levels of patient activation were significantly associated with a reduced risk for both hospitalizations (RR [95% CI] = 0.69 [0.61; 0.77], I2 = 78%) and ED visits (RR [95% CI] = 0.76 [0.70; 0.84], I2 = 72%). CONCLUSIONS Our findings suggest the existence of an inverse association between patient activation and healthcare resources utilization. Further observational studies are needed to fully comprehend the magnitude of this association.
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Affiliation(s)
- G Anderson
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome, 00133, Italy
| | - M L Rega
- School of Nursing, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, Rome, 00168, Italy
| | - D Casasanta
- Children Hospital Bambino Gesù, Piazza di Sant'Onofrio, 4, 00165, Roma, Italy
| | - G Graffigna
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milan, 20123, Italy; EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Milan, 20123, Italy; Faculty of Agriculture, Food and Environmental Sciences, Università Cattolica del Sacro Cuore, via Milano 24, Cremona, 26100, Italy
| | - G Damiani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, Rome, 00168, Italy; Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, Rome, 00168, Italy
| | - S Barello
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milan, 20123, Italy; EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Milan, 20123, Italy.
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Heffner JL, Coggeshall S, Wheat CL, Krebs P, Feemster LC, Klein DE, Nici L, Johnson H, Zeliadt SB. Receipt of Tobacco Treatment and One-Year Smoking Cessation Rates Following Lung Cancer Screening in the Veterans Health Administration. J Gen Intern Med 2022; 37:1704-1712. [PMID: 34282533 PMCID: PMC9130430 DOI: 10.1007/s11606-021-07011-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Implementation of effective smoking cessation interventions in lung cancer screening has been identified as a high-priority research gap, but knowledge of current practices to guide process improvement is limited due to the slow uptake of screening and dearth of data to assess cessation-related practices and outcomes under real-world conditions. OBJECTIVE To evaluate cessation treatment receipt and 1-year post-screening cessation outcomes within the largest integrated healthcare system in the USA-the Veterans Health Administration (VHA). Design Observational study using administrative data from electronic medical records (EMR). Patients Currently smoking Veterans who received a first lung cancer screening test using low-dose CT (LDCT) between January 2014 and June 2018. Main Outcomes Tobacco treatment received within the window of 30 days before and 30 days after LDCT; 1-year quit rates based on EMR Smoking Health Factors data 6-18 months after LDCT. Key Results Of the 47,609 current smokers screened (95.3% male), 8702 (18.3%) received pharmacotherapy and/or behavioral treatment for smoking cessation; 531 (1.1%) received both. Of those receiving pharmacotherapy, only one in four received one of the most effective medications: varenicline (12.1%) or combination nicotine replacement therapy (14.3%). Overall, 5400 Veterans quit smoking-a rate of 11.3% (missing=smoking) or 13.5% (complete case analysis). Treatment receipt and cessation were associated with numerous sociodemographic, clinical, and screening-related factors. CONCLUSIONS One-year quit rates for Veterans receiving lung cancer screening in VHA are similar to those reported in LDCT clinical trials and cohort studies (i.e., 10-17%). Only 1% of Veterans received the recommended combination of pharmacotherapy and counseling, and the most effective pharmacotherapies were not the most commonly received ones. The value of screening within VHA could be improved by addressing these treatment gaps, as well as the observed disparities in treatment receipt or cessation by race, rurality, and psychiatric conditions.
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Affiliation(s)
- Jaimee L Heffner
- Fred Hutchinson Cancer Research Center, Public Health Sciences, Seattle, WA, USA.
| | - Scott Coggeshall
- VA HSR&D Center of Innovation (COIN) for Veteran Centered and Value-Driven Care, Seattle, WA, USA
| | - Chelle L Wheat
- VA HSR&D Center of Innovation (COIN) for Veteran Centered and Value-Driven Care, Seattle, WA, USA
| | - Paul Krebs
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Laura C Feemster
- VA HSR&D Center of Innovation (COIN) for Veteran Centered and Value-Driven Care, Seattle, WA, USA
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | | | - Linda Nici
- Providence VA Medical Center, Providence, RI, USA
- Brown University, Providence, RI, USA
| | - Hannah Johnson
- VA HSR&D Center of Innovation (COIN) for Veteran Centered and Value-Driven Care, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Steven B Zeliadt
- VA HSR&D Center of Innovation (COIN) for Veteran Centered and Value-Driven Care, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
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Kinsey AW, Phillips J, Desmond R, Gowey M, Jones C, Ard J, Clark JM, Lewis CE, Dutton GR. Factors Associated with Weight Loss Maintenance and Weight Regain Among African American and White Adults Initially Successful at Weight Loss. J Racial Ethn Health Disparities 2022; 9:546-565. [PMID: 33544328 PMCID: PMC8339173 DOI: 10.1007/s40615-021-00985-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Providing ongoing treatment through extended care programs can improve weight loss maintenance (WLM), but the effectiveness of these programs for African Americans (AA) are mixed and may be due to unique cultural factors. PURPOSE To identify, prioritize, and organize factors associated with WLM as experienced by AA and White adults initially successful with weight loss. METHODS Adults identified their greatest amount of lifetime weight loss, and those achieving ≥5% weight loss were classified as maintainers (continued >5% weight reduction for ≥1 year) or regainers (≤5% weight reduction) based on current weight. The nominal group technique was conducted to identify and rank WLM facilitators and barriers. Online card sorting tasks and hierarchical clustering were performed to illustrate conceptual relationships between facilitators (maintainers only) and barriers (regainers only). RESULTS Participants (maintainers, n = 46; regainers, n = 58; 81.7% women, 48.1% AA) identified known factors associated with successful weight management (daily weighing, self-monitoring, regular physical activity, mindful eating). However, the perceived importance of these factors differed between groups (maintainer vs. regainers; AA vs. Whites). Unique factors affecting WLM were also identified (refresher groups recommended by White maintainers and regainers; self-accountability identified by AA maintainers). Salient facilitators and barriers were best represented in 2-3 clusters; each group had ≥1 unique cluster(s) revealing group-specific higher-order domains associated with successful WLM. CONCLUSIONS As lifestyle interventions for WLM (particularly for AA) are developed, attention to the preferences, and lived experiences of these groups is recommended. Strategies targeting physical activity maintenance and autonomy-supportive approaches may improve WLM among AA.
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Affiliation(s)
- Amber W Kinsey
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA
| | - Janice Phillips
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA
| | - Renee Desmond
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA
| | - Marissa Gowey
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Catherine Jones
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jamy Ard
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Jeanne M Clark
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gareth R Dutton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA.
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Benoit JRA, Dursun SM, Greiner R, Cao B, Brown MRG, Lam RW, Greenshaw AJ. Using Machine Learning to Predict Remission in Patients With Major Depressive Disorder Treated With Desvenlafaxine. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:39-47. [PMID: 34379019 PMCID: PMC8808003 DOI: 10.1177/07067437211037141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is a common and burdensome condition that has low rates of treatment success for each individual treatment. This means that many patients require several medication switches to achieve remission; selecting an effective antidepressant is typically a sequential trial-and-error process. Machine learning techniques may be able to learn models that can predict whether a specific patient will respond to a given treatment, before it is administered. This study uses baseline clinical data to create a machine-learned model that accurately predicts remission status for a patient after desvenlafaxine (DVS) treatment. METHODS We applied machine learning algorithms to data from 3,399 MDD patients (90% of the 3,776 subjects in 11 phase-III/IV clinical trials, each described using 92 features), to produce a model that uses 26 of these features to predict symptom remission, defined as an 8-week Hamilton Depression Rating Scale score of 7 or below. We evaluated that learned model on the remaining held-out 10% of the data (n = 377). RESULTS Our resulting classifier, a trained linear support vector machine, had a holdout set accuracy of 69.0%, significantly greater than the probability of classifying a patient correctly by chance. We demonstrate that this learning process is stable by repeatedly sampling part of the training dataset and running the learner on this sample, then evaluating the learned model on the held-out instances of the training set; these runs had an average accuracy of 67.0% ± 1.8%. CONCLUSIONS Our model, based on 26 clinical features, proved sufficient to predict DVS remission significantly better than chance. This may allow more accurate use of DVS without waiting 8 weeks to determine treatment outcome, and may serve as a first step toward changing psychiatric care by incorporating clinical assistive technologies using machine-learned models.
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Affiliation(s)
- James R A Benoit
- Faculty of Nursing, 98623University of Alberta, Edmonton, Alberta
| | - Serdar M Dursun
- Department of Psychiatry, 3158University of Alberta, Edmonton, Alberta
| | - Russell Greiner
- Department of Psychiatry, 3158University of Alberta, Edmonton, Alberta.,Department of Computing Science, 3158University of Alberta, Edmonton, Alberta
| | - Bo Cao
- Department of Psychiatry, 3158University of Alberta, Edmonton, Alberta
| | - Matthew R G Brown
- Department of Computing Science, 3158University of Alberta, Edmonton, Alberta
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
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García Bengoechea E, Clifford AM, Gallagher S, O' Regan A, O'Sullivan N, Casey M, Glynn L, Macken P, Sweeney J, Donnelly A, Murphy A, Woods CB. Juggling with theory, evidence, practice, and real-world circumstances: Development of a complex community intervention to increase physical activity in inactive adults aged 50 years and older - The Move for Life Study. EVALUATION AND PROGRAM PLANNING 2021; 89:101983. [PMID: 34404011 DOI: 10.1016/j.evalprogplan.2021.101983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 06/03/2021] [Accepted: 06/06/2021] [Indexed: 06/13/2023]
Abstract
Despite well-known benefits of physical activity, in Ireland only 38 % of older adults are sufficiently active. Behavioural interventions are rarely developed systematically and, when reported, inadequate description often becomes a barrier for subsequent replication and scalability. In this article, we describe the development and characteristics of Move for Life, an intervention to reach and help inactive adults aged 50 years and older increase their physical activity. It was designed to fit within existing group-based structured physical activity programmes run by Local Sports Partnerships, thus maximising the likelihood of translation into policy and practice. Constructs from social cognitive theory, self-determination theory, and the conceptual model of group cohesion in exercise informed the conceptual model and the development of behavioural skills, social support, and group cohesion intervention strategies. Physical activity instructors supported by peer mentors, who also contributed to sustaining the intervention, implemented these strategies. Moving away from accounts of intervention development as a relatively simple linear process, we illustrate the complex interplay of theory, evidence, practice, and real-world contextual circumstances that shaped the development of Move for Life. Against this backdrop, we discuss issues relevant to the planning and reporting of behavioural and physical activity interventions in public health.
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Affiliation(s)
- Enrique García Bengoechea
- University of Limerick Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education and Sport Sciences, Ireland
| | | | | | - Andrew O' Regan
- University of Limerick School of Medicine and Health Research Institute, Ireland
| | - Nollaig O'Sullivan
- University of Limerick Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education and Sport Sciences, Ireland
| | - Monica Casey
- University of Limerick School of Medicine and Health Research Institute, Ireland
| | - Liam Glynn
- University of Limerick School of Medicine and Health Research Institute, Ireland; HRB Primary Care Clinical Trial Network Ireland, Ireland
| | | | | | - Alan Donnelly
- University of Limerick Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education and Sport Sciences, Ireland
| | - Andrew Murphy
- HRB Primary Care Clinical Trial Network Ireland, Ireland; NUI Galway Department of General Practice, Ireland
| | - Catherine B Woods
- University of Limerick Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education and Sport Sciences, Ireland.
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Characterisation of Temporal Patterns in Step Count Behaviour from Smartphone App Data: An Unsupervised Machine Learning Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111476. [PMID: 34769991 PMCID: PMC8583116 DOI: 10.3390/ijerph182111476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/23/2021] [Accepted: 10/25/2021] [Indexed: 12/23/2022]
Abstract
The increasing ubiquity of smartphone data, with greater spatial and temporal coverage than achieved by traditional study designs, have the potential to provide insight into habitual physical activity patterns. This study implements and evaluates the utility of both K-means clustering and agglomerative hierarchical clustering methods in identifying weekly and yearlong physical activity behaviour trends. Characterising the demographics and choice of activity type within the identified clusters of behaviour. Across all seven clusters of seasonal activity behaviour identified, daylight saving was shown to play a key role in influencing behaviour, with increased activity in summer months. Investigation into weekly behaviours identified six clusters with varied roles, of weekday versus weekend, on the likelihood of meeting physical activity guidelines. Preferred type of physical activity likewise varied between clusters, with gender and age strongly associated with cluster membership. Key relationships are identified between weekly clusters and seasonal activity behaviour clusters, demonstrating how short-term behaviours contribute to longer-term activity patterns. Utilising unsupervised machine learning, this study demonstrates how the volume and richness of secondary app data can allow us to move away from aggregate measures of physical activity to better understand temporal variations in habitual physical activity behaviour.
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13
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Smit E, Leenaars K, Wagemakers A, van der Velden K, Molleman G. How to recruit inactive residents for lifestyle interventions: participants' characteristics based on various recruitment strategies. Health Promot Int 2021; 36:989-999. [PMID: 33270846 PMCID: PMC8521843 DOI: 10.1093/heapro/daaa134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Care Sport Connectors (CSCs) have been appointed to create a connection between primary care and physical activity (PA) sectors to stimulate inactive residents into becoming physically active. Adequate recruitment strategies are necessary to reach the intended target group in order to foster the sustainability of lifestyle interventions. The objective of this study is to explore PA behavior and health characteristics of the target group reached by CSCs and if these characteristics differ between participants when grouped based on how they were recruited. Participants from lifestyle interventions were included between September 2014 and April 2016 using a purposive sampling method. Participants were recruited through CSCs via public relations (n = 135), a personal letter (n = 136), or a referral (n = 98) and compared based on their PA level, health-related quality of life, motivation, self-efficacy, morbidity and health-related fitness. Scores were analyzed with a multi-level (mixed model) analysis measured before the intervention. The three groups were different in PA level (p = 0.002). The outcomes regarding health-related quality of life, motivation, and number of somatic disorders were also significantly different for the three groups, except for the categories of mental health (p = 0.145) and self-efficacy (p = 0.464). For all dimensions, the referral group scored the least favorable. The investment in time and money for an active recruitment strategy like referrals is worthwhile because it provides CSCs the opportunity to reach people who are inactive and at risk of chronic disease. Future studies are necessary to reveal the effect on PA levels and health in the long-term.
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Affiliation(s)
- Eva Smit
- Department of Primary and Community Care, Radboud
University Medical Center, Radboud Institute for Health Sciences,
Nijmegen, P.O. Box 9101 6500 HB. The
Netherlands
| | - Karlijn Leenaars
- Department of Healthy Living, RIVM,
Bilthoven, P.O Box 1, 3720 BA, The Netherlands
| | - Annemarie Wagemakers
- Social Sciences, Group Health & Society,
Wageningen University, Wageningen, P.O. Box 8130, 6700 EW,
The Netherlands
| | - Koos van der Velden
- Department of Primary and Community Care, Radboud
University Medical Center, Radboud Institute for Health Sciences,
Nijmegen, P.O. Box 9101 6500 HB. The
Netherlands
| | - Gerard Molleman
- Department of Primary and Community Care, Radboud
University Medical Center, Radboud Institute for Health Sciences,
Nijmegen, P.O. Box 9101 6500 HB. The
Netherlands
- Research Department, GGD Gelderland
Zuid, Nijmegen, P.O. Box 1120, 6501 BC, The
Netherlands
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A Scoping Review on College Student Physical Activity: How Do Researchers Measure Activity and Examine Inequities? J Phys Act Health 2021; 18:728-736. [PMID: 33979780 DOI: 10.1123/jpah.2020-0370] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of this scoping review was to critically examine the design and quality of contemporary research involving college student physical activity participation, focusing on physical activity measurement, assessment of sociodemographic characteristics, and examination of inequities based on sociodemographic characteristics. METHODS Systematic searches were conducted in 4 electronic databases. RESULTS From 28,951 sources screened, data were extracted from 488 that met the inclusion criteria. The majority of the studies were cross-sectional in design (91.4%) and employed convenience sampling methods (83.0%). Based on the subsample of studies that reported the percentage of students meeting aerobic (n = 158; equivalent of 150 min/wk of moderate physical activity) and muscle-strengthening activity recommendations (n = 8; ≥2 times/wk), 58.7% and 47.8% of students met aerobic and muscle-strengthening recommendations, respectively. With the exception of age and sex, sociodemographic characteristics were rarely assessed, and inequities based upon them were even more scarcely examined-with no apparent increase in reporting over the past decade. CONCLUSIONS College student physical activity levels remain concerningly low. The generalizability of findings from the contemporary literature is limited due to study design, and acknowledgement of the influence that sociodemographic characteristics have on physical activity has largely been overlooked. Recommendations for future research directions and practices are provided.
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15
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Benjenk I, DuGoff EH, Jacobsohn GC, Cayenne N, Jones CMC, Caprio TV, Cushman JT, Green RK, Kind AJH, Lohmeier M, Mi R, Shah MN. Predictors of Older Adult Adherence With Emergency Department Discharge Instructions. Acad Emerg Med 2021; 28:215-225. [PMID: 32767696 DOI: 10.1111/acem.14105] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/13/2020] [Accepted: 07/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Older adults discharged from the emergency department (ED) are at high risk for adverse outcomes. Adherence to ED discharge instructions is necessary to reduce those risks. The objective of this study is to determine the individual-level factors associated with adherence with ED discharge instructions among older adult ED outpatients. METHODS We performed a secondary analysis of data from the control group of a randomized controlled trial testing a care transitions intervention among older adults (age ≥ 60 years) discharged home from the ED in two states. Taking data from patient surveys and chart reviews, we used multivariable logistic regression to identify patient characteristics associated with adherence to printed discharge instructions. Outcomes were patient-reported medication adherence, provider follow-up visit adherence, and knowledge of "red flags" (signs of worsening health requiring further medical attention). RESULTS A total 824 patients were potentially eligible, and 699 had data in at least one pillar. A total of 35% adhered to medication instructions, 76% adhered to follow-up instructions, and 35% recalled at least one red flag. In the multivariate analysis, no factors were significantly associated with failure to adhere to medications. Participants with poor health status (adjusted odds ratio [AOR] = 0.55, 95% confidence interval [CI] = 0.31 to 0.98) were less likely to adhere to follow-up instructions. Participants who were older (AORs trended downward as age category increased) or depressed (AOR = 0.39, 95% CI = 0.17 to 0.85) or had one or more functional limitations (AOR = 0.62, 95% CI = 0.41 to 0.94) were less likely to recall red flags. CONCLUSION Older adults discharged home from the ED have mixed rates of adherence to discharge instructions. Although it is thought that some subgroups may be higher risk than others, given the opportunity to improve ED-to-home transitions, EDs and health systems should consider providing additional care transition support to all older adults discharged home from the ED.
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Affiliation(s)
- Ivy Benjenk
- From the Department of Health Policy and Management School of Public Health University of Maryland College Park MDUSA
| | - Eva H. DuGoff
- From the Department of Health Policy and Management School of Public Health University of Maryland College Park MDUSA
- the Department of Population Health Sciences School of Medicine and Public HealthUniversity of Wisconsin MadisonWIUSA
- the Berkeley Research Group Washington DCUSA
| | - Gwen C. Jacobsohn
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| | - Nia Cayenne
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| | - Courtney M. C. Jones
- the Department of Emergency MedicineUniversity of Rochester Medical Center RochesterNYUSA
| | - Thomas V. Caprio
- the Department of Public Health SciencesUniversity of Rochester Medical Center RochesterNYUSA
- the Department of Medicine Division of Geriatrics University of Rochester Medical Center Rochester NYUSA
| | - Jeremy T. Cushman
- the Department of Emergency MedicineUniversity of Rochester Medical Center RochesterNYUSA
- the Department of Public Health SciencesUniversity of Rochester Medical Center RochesterNYUSA
| | - Rebecca K. Green
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| | - Amy J. H. Kind
- the Division of Geriatrics and Gerontology Department of Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
- and the William S. Middleton Veterans Affairs Geriatrics Research, Education, and Clinical Center Madison WIUSA
| | - Michael Lohmeier
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| | - Ranran Mi
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
| | - Manish N. Shah
- the Department of Population Health Sciences School of Medicine and Public HealthUniversity of Wisconsin MadisonWIUSA
- and the Department of Emergency Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
- the Division of Geriatrics and Gerontology Department of Medicine School of Medicine and Public Health University of Wisconsin Madison WIUSA
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16
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O’Regan A, García Bengoechea E, Clifford AM, Casey M, Gallagher S, Glynn L, Doyle C, Woods C. How to improve recruitment, sustainability and scalability in physical activity programmes for adults aged 50 years and older: A qualitative study of key stakeholder perspectives. PLoS One 2020; 15:e0240974. [PMID: 33119669 PMCID: PMC7595437 DOI: 10.1371/journal.pone.0240974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 10/06/2020] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Physical inactivity among adults aged 50 years and over is a worldwide health concern. The objectives of the study were to investigate the perspectives of those involved with existing physical activity programmes on optimising recruitment, sustainability and scalability of physical activity programmes for adults aged 50 years and over. METHODS The study was conducted in Ireland's Midwest region, where community-based physical activity programmes are delivered to groups by state-funded Local Sports Partnerships. Programme attendees, physical activity professionals and community advocates were recruited. One-to-one interviews and focus groups were conducted in 2018, recorded, transcribed and analysed by an interdisciplinary team experienced in qualitative research. Over a series of meetings, a thematic approach was used to code and analyse the transcripts, categorising data into higher order codes, themes and overarching themes with the purpose of making meaning of the data. Twenty-nine people participated in four focus groups and 18 participated in one-to-one interviews. FINDINGS Data analysis produced three overarching themes. "Age appropriate" explains how communication and the environment should be adapted to the needs of adults aged 50 years and older. "Culture and connection" refer to the interplay of individual and social factors that influence participation, including individual fears and insecurities, group cohesion and added value beyond the physical gains in these programmes. "Roles and partnerships" outlines how key collaborations may be identified and managed and how local ownership is key to success and scalability. CONCLUSION Successful recruitment, sustainability and scalability require an understanding that the target population has unique needs that must be catered for when planning interventions, communicating messages and choosing personnel. The findings of this study can inform the development of community-based programmes to increase physical activity in adults aged 50 years and older.
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Affiliation(s)
- Andrew O’Regan
- Graduate Entry Medical School, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Enrique García Bengoechea
- Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education & Sport Sciences, University of Limerick, Limerick, Ireland
| | - Amanda M. Clifford
- School of Allied Health, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Monica Casey
- Graduate Entry Medical School, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Stephen Gallagher
- Department of Psychology, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Liam Glynn
- Graduate Entry Medical School, Health Research Institute, University of Limerick, Limerick, Ireland
- Health Research Board Primary Care Clinical Trial Network, Galway, Ireland
| | - Ciaran Doyle
- Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education & Sport Sciences, University of Limerick, Limerick, Ireland
| | - Catherine Woods
- Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education & Sport Sciences, University of Limerick, Limerick, Ireland
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Ziesemer K, König LM, Boushey CJ, Villinger K, Wahl DR, Butscher S, Müller J, Reiterer H, Schupp HT, Renner B. Occurrence of and Reasons for "Missing Events" in Mobile Dietary Assessments: Results From Three Event-Based Ecological Momentary Assessment Studies. JMIR Mhealth Uhealth 2020; 8:e15430. [PMID: 33052123 PMCID: PMC7593856 DOI: 10.2196/15430] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/16/2020] [Accepted: 08/03/2020] [Indexed: 01/24/2023] Open
Abstract
Background Establishing a methodology for assessing nutritional behavior comprehensively and accurately poses a great challenge. Mobile technologies such as mobile image-based food recording apps enable eating events to be assessed in the moment in real time, thereby reducing memory biases inherent in retrospective food records. However, users might find it challenging to take images of the food they consume at every eating event over an extended period, which might lead to incomplete records of eating events (missing events). Objective Analyzing data from 3 studies that used mobile image-based food recording apps and varied in their technical enrichment, this study aims to assess how often eating events (meals and snacks) were missed over a period of 8 days in a naturalistic setting by comparing the number of recorded events with the number of normative expected events, over time, and with recollections of missing events. Methods Participants in 3 event-based Ecological Momentary Assessment (EMA) studies using mobile image-based dietary assessments were asked to record all eating events (study 1, N=38, 1070 eating events; study 2, N=35, 934 eating events; study 3, N=110, 3469 eating events). Study 1 used a basic app; study 2 included 1 fixed reminder and the possibility to add meals after the actual eating events occurred instead of in the moment (addendum); and study 3 included 2 fixed reminders, an addendum feature, and the option to record skipped meals. The number of recalled missed events and their reasons were assessed by semistructured interviews after the EMA period (studies 1 and 2) and daily questionnaires (study 3). Results Overall, 183 participants reported 5473 eating events. Although the momentary adherence rate as indexed by a comparison with normative expected events was generally high across all 3 studies, a differential pattern of results emerged with a higher rate of logged meals in the more technically intensive study 3. Multilevel models for the logging trajectories of reported meals in all 3 studies showed a significant, albeit small, decline over time (b=−.11 to −.14, Ps<.001, pseudo-R²=0.04-0.06), mainly because of a drop in reported snacks between days 1 and 2. Intraclass coefficients indicated that 38% or less of the observed variance was because of individual differences. The most common reasons for missing events were competing activities and technical issues, whereas situational barriers were less important. Conclusions Three different indicators (normative, time stability, and recalled missing events) consistently indicated missing events. However, given the intensive nature of diet EMA protocols, the effect sizes were rather small and the logging trajectories over time were remarkably stable. Moreover, the individual’s actual state and context seemed to exert a greater influence on adherence rates than stable individual differences, which emphasizes the need for a more nuanced understanding of the factors that affect momentary adherence.
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Affiliation(s)
- Katrin Ziesemer
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Laura Maria König
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Carol Jo Boushey
- University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI, United States
| | - Karoline Villinger
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Deborah Ronja Wahl
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Simon Butscher
- Human-Computer Interaction Group, Department of Computer and Information Science, University of Konstanz, Konstanz, Germany
| | - Jens Müller
- Human-Computer Interaction Group, Department of Computer and Information Science, University of Konstanz, Konstanz, Germany
| | - Harald Reiterer
- Human-Computer Interaction Group, Department of Computer and Information Science, University of Konstanz, Konstanz, Germany
| | - Harald Thomas Schupp
- General Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Britta Renner
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
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Kuo WC, Stevens JM, Ersig AL, Johnson HM, Tung TH, Bratzke LC. Does 24-h Activity Cycle Influence Plasma PCSK9 Concentration? A Systematic Review and Meta-Analysis. Curr Atheroscler Rep 2020; 22:30. [DOI: 10.1007/s11883-020-00843-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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19
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Arts LPJ, Oerlemans S, Posthuma EFM, Issa DE, Oosterveld M, van der Griend R, Nijziel MR, van de Poll-Franse LV. Web-Based Self-Management for Patients With Lymphoma: Assessment of the Reach of Intervention of a Randomized Controlled Trial. J Med Internet Res 2020; 22:e17018. [PMID: 32406858 PMCID: PMC7256744 DOI: 10.2196/17018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/30/2020] [Accepted: 02/01/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Randomized controlled trials (RCTs) often provide accurate estimates of the internal validity of an intervention but lack information on external validity (generalizability). We conducted an RCT on the effectiveness of a self-management intervention among patients with lymphoma in a population-based setting. OBJECTIVE The objectives of the current study were to describe the proportion of RCT participants compared to all patients invited to participate, and compare sociodemographic and clinical characteristics of RCT participants with all respondents, all patients invited to participate, and all patients selected from the Netherlands Cancer Registry (NCR) to determine the reach of the intervention. An additional objective was to assess differences on RCT outcome variables between RCT and paper respondents. METHODS Patients with lymphoma or chronic lymphocytic leukemia ≥18 years old at diagnosis from 13 hospitals in the Netherlands were selected from the population-based NCR, which routinely collects data on sociodemographic and clinical characteristics. Eligible patients were invited to participate in an RCT and complete a questionnaire. Web-based completion determined RCT enrollment, whereas paper respondents were followed observationally. RESULTS A total of 1193 patients were selected from the NCR, 892 (74.77%) of whom were invited to participate in the trial by their hematologist after verifying eligibility. Among those invited, 25.4% (227/892) completed the web-based questionnaire and were enrolled in the RCT. The RCT participants were younger and there was a higher proportion of men than nonparticipants (P<.001). In addition, 25.7% (229/892) of those invited opted to participate in the paper-based observational follow-up study. Compared with paper respondents, RCT participants were younger (P<.001), with a higher proportion of men (P=.002), and had higher education levels (P=.02). RCT participants more often wanted to receive all available information on their disease (P<.001), whereas paper respondents reported higher levels of emotional distress (P=.009). CONCLUSIONS From a population-based sample of eligible patients, the participation rate in the RCT was approximately 25%. RCT participants may not be representative of the target population because of different sociodemographic and clinical characteristics. Since RCT participants represent a minority of the target population, RCT results should be interpreted with caution as patients in the RCT may be those least in need of a self-management intervention. TRIAL REGISTRATION Netherlands Trial Register NTR5953; https://www.trialregister.nl/trial/5790.
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Affiliation(s)
- Lindy P J Arts
- Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Simone Oerlemans
- Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands.,Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | | | - Djamila E Issa
- Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | - Margriet Oosterveld
- Department of Internal Medicine, Canisius-Wilhelmina Hospital, Nijmegen, Netherlands
| | - René van der Griend
- Department of Internal Medicine, Diakonessenhuis, Utrecht/Zeist, Netherlands
| | - Marten R Nijziel
- Department of Internal Medicine, Catharina Hospital, Eindhoven, Netherlands
| | - Lonneke V van de Poll-Franse
- Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands.,Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
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20
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Daughton AR, Chunara R, Paul MJ. Comparison of Social Media, Syndromic Surveillance, and Microbiologic Acute Respiratory Infection Data: Observational Study. JMIR Public Health Surveill 2020; 6:e14986. [PMID: 32329741 PMCID: PMC7210500 DOI: 10.2196/14986] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/27/2019] [Accepted: 02/09/2020] [Indexed: 11/30/2022] Open
Abstract
Background Internet data can be used to improve infectious disease models. However, the representativeness and individual-level validity of internet-derived measures are largely unexplored as this requires ground truth data for study. Objective This study sought to identify relationships between Web-based behaviors and/or conversation topics and health status using a ground truth, survey-based dataset. Methods This study leveraged a unique dataset of self-reported surveys, microbiological laboratory tests, and social media data from the same individuals toward understanding the validity of individual-level constructs pertaining to influenza-like illness in social media data. Logistic regression models were used to identify illness in Twitter posts using user posting behaviors and topic model features extracted from users’ tweets. Results Of 396 original study participants, only 81 met the inclusion criteria for this study. Of these participants’ tweets, we identified only two instances that were related to health and occurred within 2 weeks (before or after) of a survey indicating symptoms. It was not possible to predict when participants reported symptoms using features derived from topic models (area under the curve [AUC]=0.51; P=.38), though it was possible using behavior features, albeit with a very small effect size (AUC=0.53; P≤.001). Individual symptoms were also generally not predictable either. The study sample and a random sample from Twitter are predictably different on held-out data (AUC=0.67; P≤.001), meaning that the content posted by people who participated in this study was predictably different from that posted by random Twitter users. Individuals in the random sample and the GoViral sample used Twitter with similar frequencies (similar @ mentions, number of tweets, and number of retweets; AUC=0.50; P=.19). Conclusions To our knowledge, this is the first instance of an attempt to use a ground truth dataset to validate infectious disease observations in social media data. The lack of signal, the lack of predictability among behaviors or topics, and the demonstrated volunteer bias in the study population are important findings for the large and growing body of disease surveillance using internet-sourced data.
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Affiliation(s)
- Ashlynn R Daughton
- Analytics, Intelligence and Technology, Los Alamos National Laboratory, Los Alamos, NM, United States
| | - Rumi Chunara
- Biostatistics, School of Global Public Health, New York University, New York, NY, United States.,Computer Science and Engineering, Tandon School of Engineering, New York University, Brooklyn, NY, United States
| | - Michael J Paul
- Information Science Department, University of Colorado Boulder, Boulder, CO, United States
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21
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Cuberek R, Pelclová J, Gába A, Pechová J, Svozilová Z, Přidalová M, Štefelová N, Hron K. Adiposity and changes in movement-related behaviors in older adult women in the context of the built environment: a protocol for a prospective cohort study. BMC Public Health 2019; 19:1522. [PMID: 31727040 PMCID: PMC6857272 DOI: 10.1186/s12889-019-7905-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022] Open
Abstract
Background In older adults, sedentary behaviors increase while physical activity decreases over time following the compositional nature of 24-h behaviors. These changes in movement-related behaviors (MRBs) might be associated with unhealthy weight gain and several health comorbidities. However, information is lacking on how obesity influences longitudinal changes in the composition of MRBs in older adults. Furthermore, the moderating effect of the built environment on prospective associations between obesity and MRBs in older adults is not fully understood. Therefore, using an integrated time-use approach, this study aims to identify prospective associations between obesity and MRBs together with an assessment of the moderating effect of the built environment in elderly women. Methods The study was designed as a prospective 7-year follow-up study. It is based on two previous cross-sectional studies that enable the use of participant data (women aged 60+ years, n = 409) as a baseline dataset in the current study. All methods designed for 7-year follow-up are based on previous studies. The data collection comprises device-based measurement of MRBs (ActiGraph GT1M accelerometer), objective assessment of body adiposity (multi-frequency bioelectrical impedance analysis), subjective assessment of the built environment (NEWS-A questionnaire), and other possible confounding factors. Time spent in sedentary behavior, light physical activity, and moderate-to-vigorous physical activity will be used as three components in a composition reflecting individual MRBs. In linear multiple compositional regression analysis assessing the prospective association between obesity and MRBs, the 7-year follow-up composition of the three mentioned components represents the dependent variable. The 7-year changes in the percentage of body fat (body adiposity), baseline composition of MRBs, and parameters of the built environment represent regressors. Discussion This study will use an integrated time-use approach to explore causality from obesity to device-measured behaviors in older women. The design and respective analysis consider the compositional nature of MRBs data and the potential moderating effects of various factors. A comprehensive assessment of causality may help to develop multilevel interventional models that enhance physical activity in older adults.
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Affiliation(s)
- Roman Cuberek
- Institute of active lifestyle, Faculty of Physical Culture, Palacký University Olomouc, třída Míru 117, 771 11, Olomouc, Czech Republic.
| | - Jana Pelclová
- Institute of active lifestyle, Faculty of Physical Culture, Palacký University Olomouc, třída Míru 117, 771 11, Olomouc, Czech Republic
| | - Aleš Gába
- Institute of active lifestyle, Faculty of Physical Culture, Palacký University Olomouc, třída Míru 117, 771 11, Olomouc, Czech Republic
| | - Jana Pechová
- Institute of active lifestyle, Faculty of Physical Culture, Palacký University Olomouc, třída Míru 117, 771 11, Olomouc, Czech Republic
| | - Zuzana Svozilová
- Institute of active lifestyle, Faculty of Physical Culture, Palacký University Olomouc, třída Míru 117, 771 11, Olomouc, Czech Republic
| | - Miroslava Přidalová
- Institute of active lifestyle, Faculty of Physical Culture, Palacký University Olomouc, třída Míru 117, 771 11, Olomouc, Czech Republic
| | - Nikola Štefelová
- Department of Mathematical Analysis and Applications of Mathematics, Faculty of Science, 17. listopadu 1192/12, 771 46, Olomouc, Czech Republic
| | - Karel Hron
- Department of Mathematical Analysis and Applications of Mathematics, Faculty of Science, 17. listopadu 1192/12, 771 46, Olomouc, Czech Republic
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Goulding D, Wilson MP, MaWhinney S, Jankowski CM, Erlandson KM. A supervised exercise intervention fails to improve depressive symptoms and quality of life among sedentary older adults with HIV infection. AIDS Care 2019; 32:714-721. [PMID: 31238710 DOI: 10.1080/09540121.2019.1634788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Older people living with HIV (PLWH) experience multimorbidity that can negatively impact quality of life (QoL). Exercise can improve physical function, but effects on QoL are not well understood. 32 PLWH and 37 controls aged 50-75 completed 12-weeks of moderate-intensity exercise, then were randomized to moderate or high-intensity for 12 additional weeks. Depressive symptoms (CES-D scores) were significantly greater and QOL (SF-36 mental and physical summary scores) significantly lower among PLWH at baseline (all p < 0.05). PLWH had significantly greater worsening in CES-D scores compared to controls (3.4 [0.7, 6.0]; p = 0.01) between 13and 24 weeks. Mental QoL changed minimally, with no significant difference in changes by serostatus between weeks 0 and 12 or weeks 13 and 24 (p ≤ 0.22). Changes in physical function summary scores were similar by serostatus between 0 and 12 weeks (1.5 [-1.6, 4.6], p = 0.35), but declined significantly more among PLWH between 13 and 24 weeks (-4.1 [-7.2,-1], p = 0.01). Exercise intensity had no significant effect on changes in CES-D or SF-36 summary scores; high-intensity exercise was associated with greater improvements in vitality/fatigue (4.1 [0.8, 7.3], p = 0.02), compared to moderate-intensity. Exercise initiation failed to improve depressive symptoms or QoL among PLWH. Additional interventions may be needed to maximize these patient-reported outcomes among older PLWH initiating an exercise program.
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23
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van Leeuwen N, Lingsma HF, Mooijaart SP, Nieboer D, Trompet S, Steyerberg EW. Regression discontinuity was a valid design for dichotomous outcomes in three randomized trials. J Clin Epidemiol 2018; 98:70-79. [DOI: 10.1016/j.jclinepi.2018.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 02/09/2018] [Accepted: 02/20/2018] [Indexed: 12/01/2022]
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Chatters R, Newbould L, Sprange K, Hind D, Mountain G, Shortland K, Powell L, Gossage-Worrall R, Chater T, Keetharuth A, Lee E, Woods B. Recruitment of older adults to three preventative lifestyle improvement studies. Trials 2018; 19:121. [PMID: 29458392 PMCID: PMC5819193 DOI: 10.1186/s13063-018-2482-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 01/18/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Recruiting isolated older adults to clinical trials is complex, time-consuming and difficult. Previous studies have suggested querying existing databases to identify appropriate potential participants. We aim to compare recruitment techniques (general practitioner (GP) mail-outs, community engagement and clinician referrals) used in three randomised controlled trial (RCT) studies assessing the feasibility or effectiveness of two preventative interventions in isolated older adults (the Lifestyle Matters and Putting Life In Years interventions). METHODS During the three studies (the Lifestyle Matters feasibility study, the Lifestyle Matters RCT, the Putting Life In Years RCT) data were collected about how participants were recruited. The number of letters sent by GP surgeries for each study was recorded. In the Lifestyle Matters RCT, we qualitatively interviewed participants and intervention facilitators at 6 months post randomisation to seek their thoughts on the recruitment process. RESULTS Referrals were planned to be the main source of recruitment in the Lifestyle Matters feasibility study, but due to a lack of engagement from district nurses, community engagement was the main source of recruitment. District nurse referrals and community engagement were also utilised in the Lifestyle Matters and Putting Life In Years RCTs; both mechanisms yielded few participants. GP mail-outs were the main source of recruitment in both the RCTs, but of those contacted, recruiting yield was low (< 3%). Facilitators of the Lifestyle Matters intervention questioned whether the most appropriate individuals had been recruited. Participants recommended that direct contact with health professionals would be the most beneficial way to recruit. CONCLUSIONS Recruitment to the Lifestyle Matters RCT did not mirror recruitment to the feasibility study of the same intervention. Direct district nurse referrals were not effective at recruiting participants. The majority of participants were recruited via GP mail-outs, which may have led to isolated individuals not being recruited to the trials. Further research is required into alternative recruitment techniques, including respondent-driven sampling plus mechanisms which will promote health care professionals to recruit vulnerable populations to research. TRIAL REGISTRATION International Standard Randomised Controlled Trial Registry, ID: ISRCTN28645428 (Putting Life In Years RCT). Registered on 11 April 2012; International Standard Randomised Controlled Trial Registry, ID: ISRCTN67209155 (Lifestyle Matters RCT). Registered on 22 March 2012; ClinicalTrials.gov , ID: NCT03054311 (Lifestyle Matters feasibility study). Registered retrospectively on 19 January 2017.
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Affiliation(s)
- Robin Chatters
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Louise Newbould
- Research Fellow Mental Health and Addiction Research Group Department of Health Sciences ARRC Building University of York, Heslington, York YO10 5DD UK
| | - Kirsty Sprange
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, Nottingham, NG7 2UH UK
| | - Daniel Hind
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Gail Mountain
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Katy Shortland
- Sheffield NIHR Clinical Research Facility, O Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF UK
| | - Lauren Powell
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Rebecca Gossage-Worrall
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Tim Chater
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Anju Keetharuth
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Ellen Lee
- School of Health and Related Research, The University of Sheffield, Regent Court, Regent Street, Sheffield, S1 4DA UK
| | - Bob Woods
- DSDC Wales, Bangor University, Normal Site, Bangor, LL57 2PZ UK
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Regression Discontinuity Design: Simulation and Application in Two Cardiovascular Trials with Continuous Outcomes. Epidemiology 2018; 27:503-11. [PMID: 27031038 DOI: 10.1097/ede.0000000000000486] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In epidemiology, the regression discontinuity design has received increasing attention recently and might be an alternative to randomized controlled trials (RCTs) to evaluate treatment effects. In regression discontinuity, treatment is assigned above a certain threshold of an assignment variable for which the treatment effect is adjusted in the analysis. We performed simulations and a validation study in which we used treatment effect estimates from an RCT as the reference for a prospectively performed regression discontinuity study. We estimated the treatment effect using linear regression adjusting for the assignment variable both as linear terms and restricted cubic spline and using local linear regression models. In the first validation study, the estimated treatment effect from a cardiovascular RCT was -4.0 mmHg blood pressure (95% confidence interval: -5.4, -2.6) at 2 years after inclusion. The estimated effect in regression discontinuity was -5.9 mmHg (95% confidence interval: -10.8, -1.0) with restricted cubic spline adjustment. Regression discontinuity showed different, local effects when analyzed with local linear regression. In the second RCT, regression discontinuity treatment effect estimates on total cholesterol level at 3 months after inclusion were similar to RCT estimates, but at least six times less precise. In conclusion, regression discontinuity may provide similar estimates of treatment effects to RCT estimates, but requires the assumption of a global treatment effect over the range of the assignment variable. In addition to a risk of bias due to wrong assumptions, researchers need to weigh better recruitment against the substantial loss in precision when considering a study with regression discontinuity versus RCT design.
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26
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Li G, Eby DW, Santos R, Mielenz TJ, Molnar LJ, Strogatz D, Betz ME, DiGuiseppi C, Ryan LH, Jones V, Pitts SI, Hill LL, DiMaggio CJ, LeBlanc D, Andrews HF. Longitudinal Research on Aging Drivers (LongROAD): study design and methods. Inj Epidemiol 2017; 4:22. [PMID: 28736796 PMCID: PMC5537138 DOI: 10.1186/s40621-017-0121-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/06/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND As an important indicator of mobility, driving confers a host of social and health benefits to older adults. Despite the importance of safe mobility as the population ages, longitudinal data are lacking about the natural history and determinants of driving safety in older adults. METHODS The Longitudinal Research on Aging Drivers (LongROAD) project is a multisite prospective cohort study designed to generate empirical data for understanding the role of medical, behavioral, environmental and technological factors in driving safety during the process of aging. RESULTS A total of 2990 active drivers aged 65-79 years at baseline have been recruited through primary care clinics or health care systems in five study sites located in California, Colorado, Maryland, Michigan, and New York. Consented participants were assessed at baseline with standardized research protocols and instruments, including vehicle inspection, functional performance tests, and "brown-bag review" of medications. The primary vehicle of each participant was instrumented with a small data collection device that records detailed driving data whenever the vehicle is operating and detects when a participant is driving. Annual follow-up is being conducted for up to three years with a telephone questionnaire at 12 and 36 months and in-person assessment at 24 months. Medical records are reviewed annually to collect information on clinical diagnoses and healthcare utilization. Driving records, including crashes and violations, are collected annually from state motor vehicle departments. Pilot testing was conducted on 56 volunteers during March-May 2015. Recruitment and enrollment were completed between July 2015 and March 2017. CONCLUSIONS Results of the LongROAD project will generate much-needed evidence for formulating public policy and developing intervention programs to maintain safe mobility while ensuring well-being for older adults.
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Affiliation(s)
- Guohua Li
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. .,Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA. .,Center for Injury Epidemiology and Prevention, Columbia University Medical Center, 722 West 168th Street, Room 524, New York, NY, 10032, USA.
| | - David W Eby
- University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor, MI, USA
| | | | - Thelma J Mielenz
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lisa J Molnar
- University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor, MI, USA
| | | | - Marian E Betz
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lindsay H Ryan
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Vanya Jones
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Samantha I Pitts
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Linda L Hill
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA
| | - Charles J DiMaggio
- Division of Trauma, Emergency Surgery and Surgical Critical Care, New York University School of Medicine, New York, NY, USA
| | - David LeBlanc
- University of Michigan Transportation Research Institute and the Center for Advancing Transportation Leadership and Safety (ATLAS Center), Ann Arbor, MI, USA
| | - Howard F Andrews
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
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27
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Chudyk AM, McKay HA, Winters M, Sims-Gould J, Ashe MC. Neighborhood walkability, physical activity, and walking for transportation: A cross-sectional study of older adults living on low income. BMC Geriatr 2017; 17:82. [PMID: 28395672 PMCID: PMC5385598 DOI: 10.1186/s12877-017-0469-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 03/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background Walking, and in particular, outdoor walking, is the most common form of physical activity for older adults. To date, no study investigated the association between the neighborhood built environment and physical activity habits of older adults of low SES. Thus, our overarching aim was to examine the association between the neighborhood built environment and the spectrum of physical activity and walking for transportation in older adults of low socioeconomic status. Methods Cross-sectional data were from the Walk the Talk Study, collected in 2012. Participants (n = 161, mean age = 74 years) were in receipt of a rental subsidy for low income individuals and resided in neighbourhoods across Metro Vancouver, Canada. We used the Street Smart Walk Score to objectively characterize the built environment main effect (walkability), accelerometry for objective physical activity, and the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire to measure walking for transportation. We used regression analyses to examine associations of objectively measured physical activity [total volume, light intensity and moderate intensity physical activity (MVPA)] and self-reported walking for transportation (any, frequency, duration) with walkability. We adjusted analyses for person- and environment-level factors associated with older adult physical activity. Results Neighbourhood walkability was not associated with physical activity volume or intensity and self-reported walking for transportation, with one exception. Each 10-point increase in Street Smart Walk Score was associated with a 45% greater odds of any walking for transportation (compared with none; OR = 1.45, 95% confidence interval = 1.18, 1.78). Sociodemographic, physical function and attitudinal factors were significant predictors of physical activity across our models. Conclusions The lack of associations between most of the explored outcomes may be due to the complexity of the relation between the person and environment. Given that this is the first study to explore these associations specifically in older adults living on low income, this study should be replicated in other settings.
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Affiliation(s)
- Anna M Chudyk
- Centre for Hip Health and Mobility, 7th floor-2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. .,Department of Family Practice, University of British Columbia, 3rd Floor - 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada.
| | - Heather A McKay
- Centre for Hip Health and Mobility, 7th floor-2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.,Department of Family Practice, University of British Columbia, 3rd Floor - 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Meghan Winters
- Centre for Hip Health and Mobility, 7th floor-2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.,Faculty of Health Sciences, Simon Fraser University, 11522 - 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Joanie Sims-Gould
- Centre for Hip Health and Mobility, 7th floor-2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.,Department of Family Practice, University of British Columbia, 3rd Floor - 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Maureen C Ashe
- Centre for Hip Health and Mobility, 7th floor-2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.,Department of Family Practice, University of British Columbia, 3rd Floor - 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
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Abstract
We provide an in-depth description of the mobility (capacity and enacted function, i.e., physical activity and travel behaviour) of community-dwelling older adults of low socioeconomic status. Participants [n = 161, mean age (range) = 74 (65-96) years] completed interviewer-administered questionnaires and objective measures of mobility. Our findings did not generally indicate that older adults of low socioeconomic status have a reduced capacity to be mobile. Participants presented with positive profiles across physical, psychosocial, and social environment domains that influence the capacity to be mobile. They also made a high proportion of trips by foot, although these did not together serve to meet physical activity guidelines for most. We challenge future researchers to focus on innovative strategies to recruit this difficult-to-access population, to consider the influence of socioeconomic status across the lifespan, and the role of behaviour-driven agency when investigating the association between the person, environment, and older adult mobility.
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29
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Matthews L, Mitchell F, Stalker K, McConnachie A, Murray H, Melling C, Mutrie N, Melville C. Process evaluation of the Walk Well study: a cluster-randomised controlled trial of a community based walking programme for adults with intellectual disabilities. BMC Public Health 2016; 16:527. [PMID: 27387203 PMCID: PMC4936049 DOI: 10.1186/s12889-016-3179-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 06/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Walking interventions can be effective in encouraging sedentary populations to become more active; however, limited research has explored the effectiveness of walking interventions for adults with intellectual disabilities. This process evaluation explored the delivery of a community based walking intervention for adults with intellectual disabilities. METHODS Walk Well was a single-blind cluster randomised controlled trial of a 12-week physical activity consultation-led walking intervention. 102 participants were randomised to the Walk Well intervention or a waiting list control group. Participants in the intervention group received three physical activity consultations with a walking advisor at baseline, 6 & 12-weeks. They were encouraged to use a pedometer to set goals and monitor their daily step count. Primary outcome was change in daily step count at 12-weeks. Process evaluation measures included qualitative interviews with key stakeholders (n = 6) and quantifiable data collected as part of the intervention. Additional process data were extracted from a sub-set of qualitative interviews with participants and carers (n = 20). Data were analysed for process information related to context, recruitment and retention, reach, implementation, and fidelity. RESULTS Walk Well was not effective in significantly increasing levels of physical activity. The process evaluation did, however, highlight several important areas for consideration in future studies, including: a successful recruitment and retention strategy reaching a representative sample of adults with intellectual disabilities in the community; feasible and (for most) enjoyable methods of engaging adults with intellectual disabilities in activities to support behaviour change; potential need for greater intervention duration and frequency of contact; advantages and disadvantages of using pedometers as a behaviour change tool; the need for strategies which engage carers in supporting participants; and the complex issue of 'freedom of choice' in relation to lifestyle behaviours and study participation. CONCLUSIONS Walking interventions for adults with intellectual disabilities can be feasibly delivered in the community in relation to reach, recruitment, retention and intervention fidelity. More intensive intervention methods need to be explored as well as strategies to engage and motivate carers in their support of participants. TRIAL REGISTRATION Current Controlled Trials ISRCTN50494254 (3(rd) April 2012).
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Affiliation(s)
- Lynsay Matthews
- Institute of Health and Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland.
| | - Fiona Mitchell
- Department of Physical Activity for Health, University of Strathclyde, Glasgow, Scotland
| | - Kirsten Stalker
- Glasgow School of Social Work, University of Strathclyde, Glasgow, Scotland
| | - Alex McConnachie
- Institute of Health and Wellbeing, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland
| | - Heather Murray
- Institute of Health and Wellbeing, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland
| | - Chris Melling
- Social Work Services, Glasgow City Council, Glasgow, Scotland
| | - Nanette Mutrie
- Institute for Sport, Physical Education and Health Sciences, Moray House School of Education, University of Edinburgh, Edinburgh, Scotland
| | - Craig Melville
- Institute of Health and Wellbeing, Academic Unit for Mental Health & Wellbeing, University of Glasgow, Glasgow, Scotland
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30
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Loring DW, Goldstein FC, Chen C, Drane DL, Lah JJ, Zhao L, Larrabee GJ. False-Positive Error Rates for Reliable Digit Span and Auditory Verbal Learning Test Performance Validity Measures in Amnestic Mild Cognitive Impairment and Early Alzheimer Disease. Arch Clin Neuropsychol 2016; 31:313-31. [PMID: 27084732 DOI: 10.1093/arclin/acw014] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The objective is to examine failure on three embedded performance validity tests [Reliable Digit Span (RDS), Auditory Verbal Learning Test (AVLT) logistic regression, and AVLT recognition memory] in early Alzheimer disease (AD; n = 178), amnestic mild cognitive impairment (MCI; n = 365), and cognitively intact age-matched controls (n = 206). METHOD Neuropsychological tests scores were obtained from subjects participating in the Alzheimer's Disease Neuroimaging Initiative (ADNI). RESULTS RDS failure using a ≤7 RDS threshold was 60/178 (34%) for early AD, 52/365 (14%) for MCI, and 17/206 (8%) for controls. A ≤6 RDS criterion reduced this rate to 24/178 (13%) for early AD, 15/365 (4%) for MCI, and 7/206 (3%) for controls. AVLT logistic regression probability of ≥.76 yielded unacceptably high false-positive rates in both clinical groups [early AD = 149/178 (79%); MCI = 159/365 (44%)] but not cognitively intact controls (13/206, 6%). AVLT recognition criterion of ≤9/15 classified 125/178 (70%) of early AD, 155/365 (42%) of MCI, and 18/206 (9%) of control scores as invalid, which decreased to 66/178 (37%) for early AD, 46/365 (13%) for MCI, and 10/206 (5%) for controls when applying a ≤5/15 criterion. Despite high false-positive rates across individual measures and thresholds, combining RDS ≤ 6 and AVLT recognition ≤9/15 classified only 9/178 (5%) of early AD and 4/365 (1%) of MCI patients as invalid performers. CONCLUSIONS Embedded validity cutoffs derived from mixed clinical groups produce unacceptably high false-positive rates in MCI and early AD. Combining embedded PVT indicators lowers the false-positive rate.
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Affiliation(s)
- David W Loring
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Felicia C Goldstein
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Chuqing Chen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Daniel L Drane
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - James J Lah
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Liping Zhao
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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31
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Bann D, Chen H, Bonell C, Glynn NW, Fielding RA, Manini T, King AC, Pahor M, Mihalko SL, Gill TM. Socioeconomic differences in the benefits of structured physical activity compared with health education on the prevention of major mobility disability in older adults: the LIFE study. J Epidemiol Community Health 2016; 70:930-3. [PMID: 27060177 PMCID: PMC5013156 DOI: 10.1136/jech-2016-207321] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/21/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Evidence is lacking on whether health-benefiting community-based interventions differ in their effectiveness according to socioeconomic characteristics. We evaluated whether the benefit of a structured physical activity intervention on reducing mobility disability in older adults differs by education or income. METHODS The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicentre, randomised trial that compared a structured physical activity programme with a health education programme on the incidence of mobility disability among at-risk community-living older adults (aged 70-89 years; average follow-up of 2.6 years). Education (≤ high school (0-12 years), college (13-17 years) or postgraduate) and annual household income were self-reported (<$24 999, $25 000 to $49 999 and ≥$50 000). The risk of disability (objectively defined as loss of ability to walk 400 m) was compared between the 2 treatment groups using Cox regression, separately by socioeconomic group. Socioeconomic group×intervention interaction terms were tested. RESULTS The effect of reducing the incidence of mobility disability was larger for those with postgraduate education (0.72, 0.51 to 1.03; N=411) compared with lower education (high school or less (0.93, 0.70 to 1.24; N=536). However, the education group×intervention interaction term was not statistically significant (p=0.54). Findings were in the same direction yet less pronounced when household income was used as the socioeconomic indicator. CONCLUSIONS In the largest and longest running trial of physical activity amongst at-risk older adults, intervention effect sizes were largest among those with higher education or income, yet tests of statistical interactions were non-significant, likely due to inadequate power. TRIAL REGISTRATION NUMBER NCT01072500.
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Affiliation(s)
- David Bann
- Centre for Longitudinal Studies, UCL Institute of Education, London, UK
| | - Haiying Chen
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Chris Bonell
- Department of Social and Environmental Health, London School of Hygiene and Tropical, Medicine, UK
| | - Nancy W Glynn
- Center for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts, USA
| | - Todd Manini
- Department of Aging & Geriatric Research, University of Florida, Gainesville, Florida, USA
| | - Abby C King
- Stanford University School of Medicine, Stanford, California, USA
| | - Marco Pahor
- Department of Aging & Geriatric Research, University of Florida, Gainesville, Florida, USA
| | - Shannon L Mihalko
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Thomas M Gill
- Yale School of Medicine, New Haven, Connecticut, USA
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Kharabian Masouleh S, Arélin K, Horstmann A, Lampe L, Kipping JA, Luck T, Riedel-Heller SG, Schroeter ML, Stumvoll M, Villringer A, Witte AV. Higher body mass index in older adults is associated with lower gray matter volume: implications for memory performance. Neurobiol Aging 2016; 40:1-10. [DOI: 10.1016/j.neurobiolaging.2015.12.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 12/28/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
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Factors Associated With Availability of, and Employee Participation in, Comprehensive Workplace Health Promotion in a Large and Diverse Australian Public Sector Setting. J Occup Environ Med 2015; 57:1197-206. [DOI: 10.1097/jom.0000000000000538] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sazlina SG, Browning CJ, Yasin S. Effectiveness of Personalized Feedback Alone or Combined with Peer Support to Improve Physical Activity in Sedentary Older Malays with Type 2 Diabetes: A Randomized Controlled Trial. Front Public Health 2015; 3:178. [PMID: 26217658 PMCID: PMC4500101 DOI: 10.3389/fpubh.2015.00178] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 06/29/2015] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Regular physical activity is an important aspect of self-management among older people with type 2 diabetes but many remain inactive. Interventions to improve physical activity levels have been studied but few studies have evaluated the effects of personalized feedback (PF) or peer support (PS); and there was no study on older people of Asian heritage. Hence, this trial evaluated whether PF only or combined with PS improves physical activity among older Malays with type 2 diabetes (T2DM) compared to usual care only. MATERIALS AND METHODS A three-arm randomized controlled trial was conducted in a primary healthcare clinic in Malaysia. Sixty-nine sedentary Malays aged 60 years and older with T2DM who received usual diabetes care were randomized to PF or PS interventions or as controls for 12 weeks with follow-ups at weeks 24 and 36. Intervention groups performed unsupervised walking activity and received written feedback on physical activity. The PS group also received group and telephone contacts from trained peer mentors. The primary outcome was pedometer steps. Secondary outcomes were self-reported physical activity, cardiovascular risk factors, cardiorespiratory fitness, balance, quality of life, and psychosocial wellbeing. RESULTS Fifty-two (75.4%) completed the 36-week study. The PS group showed greater daily pedometer readings than the PF and controls (p = 0.001). The PS group also had greater improvement in weekly duration (p < 0.001) and frequency (p < 0.001) of moderate intensity physical activity, scores on the Physical Activity Scale for Elderly (p = 0.003), 6-min walk test (p < 0.001), and social support from friends (p = 0.032) than PF and control groups. CONCLUSION The findings suggest that PF combined with PS in older Malays with T2DM improved their physical activity levels, cardiorespiratory fitness, and support from friends. TRIAL REGISTRATION Current Controlled Trials ISRCTN71447000.
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Affiliation(s)
- Shariff-Ghazali Sazlina
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Colette Joy Browning
- Royal District Nursing Service Limited, RDNS Research Institute, St. Kilda, VIC, Australia
| | - Shajahan Yasin
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
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Bassal C, Czellar J, Kaiser S, Dan-Glauser ES. Relationship Between Emotions, Emotion Regulation, and Well-Being of Professional Caregivers of People With Dementia. Res Aging 2015; 38:477-503. [DOI: 10.1177/0164027515591629] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
So far, limited research has been carried out to better understand the interplay between the emotions, the use of emotion regulation strategies, and the well-being of professional caregivers of People with Dementia (PwD). This pilot study ( N = 43 professional caregivers) aimed to (1) describe the type and frequency of emotions experienced at work; (2) analyze the associations between experienced emotions, emotion regulation strategies, and well-being; and (3) test whether the use of specific emotion regulation strategies moderates the relationship between experienced emotions and emotional exhaustion. In the challenging context of professionally caring for PwD, results suggest that (1) caregivers experience positive emotions more frequently than negative emotions; (2) caregivers using relatively inappropriate regulation strategies are more likely to experience negative emotions, less likely to experience positive emotions, and have poorer physical and mental health; and (3) expressive suppression significantly moderates the relationship between positive experienced emotions and emotional exhaustion.
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Affiliation(s)
- Catherine Bassal
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
| | - Judith Czellar
- Unicentre, University of Lausanne, Lausanne, Switzerland
| | - Susanne Kaiser
- Department of Psychology, Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
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Godfrey A, Lara J, Del Din S, Hickey A, Munro CA, Wiuff C, Chowdhury SA, Mathers JC, Rochester L. iCap: Instrumented assessment of physical capability. Maturitas 2015; 82:116-22. [PMID: 25912425 PMCID: PMC4551273 DOI: 10.1016/j.maturitas.2015.04.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/03/2015] [Accepted: 04/05/2015] [Indexed: 11/05/2022]
Abstract
Instrumented testing of five physical capability tasks with a single accelerometer. Evaluated on a large cohort of older adults. iCap provides robust quantitative data about physical capability. iCap captures gait and postural control data known as sensitive to ageing/pathology. Methodology may have practical utility in a wide range of surveys and studies.
Objectives The aims of this study were to (i) investigate instrumented physical capability (iCap) as a valid method during a large study and (ii) determine whether iCap can provide important additional features of postural control and gait to categorise cohorts not previously possible with manual recordings. Study design Cross-sectional analysis involving instrumented testing on 74 adults who were recruited as part of a pilot intervention study; LiveWell. Participants wore a single accelerometer-based monitor (lower back) during standardised physical capability tests so that outcomes could be compared directly with manual recordings (stopwatch and measurement tape) made concurrently. Main outcome measures Time, distance, postural control and gait characteristics. Results Agreement between manual and iCap ranged from moderate to excellent (0.649–0.983) with mean differences between methods low and deemed acceptable. Additionally, iCap successfully quantified (i) postural control characteristics which showed sensitivity to distinguish between 5 variations of the standing balance test and (ii) 14 gait characteristics known to be sensitive to age/pathology. Conclusions Our findings show that iCap can provide robust quantitative data about physical capability during standardised tests while also providing sensitive (age/pathology) postural control and gait characteristics not previously quantifiable with manual recordings. The methodology which we propose may have practical utility in a wide range of clinical and public health surveys and studies, including intervention studies, where assessment could be undertaken within diverse settings. This will need to be tested in further validation studies in a wider range of settings.
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Affiliation(s)
- A Godfrey
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK; Clinical Ageing Research Unit, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - J Lara
- Institute of Cellular Medicine, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK; Human Nutrition Research Centre, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - S Del Din
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK; Clinical Ageing Research Unit, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - A Hickey
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK; Clinical Ageing Research Unit, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - C A Munro
- Institute of Cellular Medicine, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK; Human Nutrition Research Centre, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - C Wiuff
- Institute of Cellular Medicine, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK; Human Nutrition Research Centre, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - S A Chowdhury
- Institute of Cellular Medicine, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK; Human Nutrition Research Centre, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - J C Mathers
- Institute of Cellular Medicine, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK; Human Nutrition Research Centre, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - L Rochester
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK; Clinical Ageing Research Unit, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne, UK.
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Dinglas VD, Huang M, Sepulveda KA, Pinedo M, Hopkins RO, Colantuoni E, Needham DM. Personalized contact strategies and predictors of time to survey completion: analysis of two sequential randomized trials. BMC Med Res Methodol 2015; 15:5. [PMID: 25575599 PMCID: PMC4407535 DOI: 10.1186/1471-2288-15-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 01/02/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Effective strategies for contacting and recruiting study participants are critical in conducting clinical research. In this study, we conducted two sequential randomized controlled trials of mail- and telephone-based strategies for contacting and recruiting participants, and evaluated participant-related variables' association with time to survey completion and survey completion rates. Subjects eligible for this study were survivors of acute lung injury who had been previously enrolled in a 12-month observational follow-up study evaluating their physical, cognitive and mental health outcomes, with their last study visit completed at a median of 34 months previously. METHODS Eligible subjects were contacted to complete a new research survey as part of two randomized trials, initially using a randomized mail-based contact strategy, followed by a randomized telephone-based contact strategy for non-responders to the mail strategy. Both strategies focused on using either a personalized versus a generic approach. In addition, 18 potentially relevant subject-related variables (e.g., demographics, last known physical and mental health status) were evaluated for association with time to survey completion. RESULTS Of 308 eligible subjects, 67% completed the survey with a median (IQR) of 3 (2, 5) contact attempts required. There was no significant difference in the time to survey completion for either randomized trial of mail- or phone-based contact strategy. Among all subject-related variables, age ≤40 years and minority race were independently associated with a longer time to survey completion. CONCLUSION We found that age ≤40 years and minority race were associated with a longer time to survey completion, but personalized versus generic approaches to mail- and telephone-based contact strategies had no significant effect. Repeating both mail and telephone contact attempts was important for increasing survey completion rate. TRIAL REGISTRATION NCT00719446.
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Affiliation(s)
- Victor D Dinglas
- />Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
- />Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
| | - Minxuan Huang
- />Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
- />Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
| | - Kristin A Sepulveda
- />Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
- />Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
| | - Mariela Pinedo
- />Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
- />Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
| | - Ramona O Hopkins
- />Pulmonary and Critical Care Division, Department of Medicine, Intermountain Medical Center, 5121 Cottonwood Street, 84157 Murray, UT USA
- />Psychology Department and Neuroscience Center, Brigham Young University, 84602 Provo, UT USA
| | - Elizabeth Colantuoni
- />Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
- />Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe Street, 21205 Baltimore, MD USA
| | - Dale M Needham
- />Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
- />Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
- />Department of Physical Medicine and Rehabilitation, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
| | - the NIH NHLBI ARDS Network
- />Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
- />Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
- />Pulmonary and Critical Care Division, Department of Medicine, Intermountain Medical Center, 5121 Cottonwood Street, 84157 Murray, UT USA
- />Psychology Department and Neuroscience Center, Brigham Young University, 84602 Provo, UT USA
- />Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe Street, 21205 Baltimore, MD USA
- />Department of Physical Medicine and Rehabilitation, Johns Hopkins University, 1830 E Monument Street, 5th floor, 21205 Baltimore, MD USA
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Sidebottom AC, Johnson PJ, VanWormer JJ, Sillah A, Winden TJ, Boucher JL. Exploring electronic health records as a population health surveillance tool of cardiovascular disease risk factors. Popul Health Manag 2014; 18:79-85. [PMID: 25290223 DOI: 10.1089/pop.2014.0058] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The objective of this study was to examine the utility of using electronic health record (EHR) data for periodic community health surveillance of cardiovascular disease (CVD) risk factors through 2 research questions. First, how many years of EHR data are needed to produce reliable estimates of key population-level CVD health indicators for a community? Second, how comparable are the EHR estimates relative to those from community screenings? The study takes place in the context of the Heart of New Ulm Project, a 10-year population health initiative designed to reduce myocardial infarctions and CVD risk factor burden in a rural community. The community is served by 1 medical center that includes a clinic and hospital. The project screened adult residents of New Ulm for CVD risk factors in 2009. EHR data for 3 years prior to the heart health screenings were extracted for patients from the community. Single- and multiple-year EHR prevalence estimates were compared for individuals ages 40-79 years (N=5918). EHR estimates also were compared to screening estimates (N=3123). Single-year compared with multiyear EHR data prevalence estimates were sufficiently precise for this rural community. EHR and screening prevalence estimates differed significantly-systolic blood pressure (BP) (124.0 vs. 128.9), diastolic BP (73.3 vs. 79.2), total cholesterol (186.0 vs. 201.0), body mass index (30.2 vs. 29.5), and smoking (16.6% vs. 8.2%)-suggesting some selection bias depending on the method used. Despite differences between data sources, EHR data may be a useful source of population health surveillance to inform and evaluate local population health initiatives.
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Mountain GA, Hind D, Gossage-Worrall R, Walters SJ, Duncan R, Newbould L, Rex S, Jones C, Bowling A, Cattan M, Cairns A, Cooper C, Edwards RT, Goyder EC. 'Putting Life in Years' (PLINY) telephone friendship groups research study: pilot randomised controlled trial. Trials 2014; 15:141. [PMID: 24758530 PMCID: PMC4022155 DOI: 10.1186/1745-6215-15-141] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 03/28/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Loneliness in older people is associated with poor health-related quality of life (HRQoL). We undertook a parallel-group randomised controlled trial to evaluate the effectiveness and cost-effectiveness of telephone befriending for the maintenance of HRQoL in older people. An internal pilot tested the feasibility of the trial and intervention. METHODS Participants aged >74 years, with good cognitive function, living independently in one UK city were recruited through general practices and other sources, then randomised to: (1) 6 weeks of short one-to-one telephone calls, followed by 12 weeks of group telephone calls with up to six participants, led by a trained volunteer facilitator; or (2) a control group. The main trial required the recruitment of 248 participants in a 1-year accrual window, of whom 124 were to receive telephone befriending. The pilot specified three success criteria which had to be met in order to progress the main trial to completion: recruitment of 68 participants in 95 days; retention of 80% participants at 6 months; successful delivery of telephone befriending by local franchise of national charity. The primary clinical outcome was the Short Form (36) Health Instrument (SF-36) Mental Health (MH) dimension score collected by telephone 6 months following randomisation. RESULTS We informed 9,579 older people about the study. Seventy consenting participants were randomised to the pilot in 95 days, with 56 (80%) providing valid primary outcome data (26 intervention, 30 control). Twenty-four participants randomly allocated to the research arm actually received telephone befriending due to poor recruitment and retention of volunteer facilitators. The trial was closed early as a result. The mean 6-month SF-36 MH scores were 78 (SD 18) and 71 (SD 21) for the intervention and control groups, respectively (mean difference, 7; 95% CI, -3 to 16). CONCLUSIONS Recruitment and retention of participants to a definitive trial with a recruitment window of 1 year is feasible. For the voluntary sector to recruit sufficient volunteers to match demand for telephone befriending created by trial recruitment would require the study to be run in more than one major population centre, and/or involve dedicated management of volunteers. TRIAL REGISTRATION ISRCTN28645428.
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Affiliation(s)
- Gail A Mountain
- ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Daniel Hind
- Clinical Trials Research Unit, ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Rebecca Gossage-Worrall
- Clinical Trials Research Unit, ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Stephen J Walters
- ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Rosie Duncan
- ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Louise Newbould
- ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Saleema Rex
- Clinical Trials Research Unit, ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Carys Jones
- Institute of Medical and Social Care Research, Bangor University, Bangor, Gwynedd LL57 2DG, UK
| | - Ann Bowling
- School of Health Sciences, Highfield Campus, University Road, Southampton SO17 1BJ, UK
| | - Mima Cattan
- Faculty of Health and Life Sciences, University of Northumbria, Coach Lane Campus, Newcastle Upon Tyne NE7 7XA, UK
| | - Angela Cairns
- Community Network, First Floor, 12-20 Baron Street, London N1 9LL, UK
| | - Cindy Cooper
- Clinical Trials Research Unit, ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Rhiannon Tudor Edwards
- Institute of Medical and Social Care Research, Bangor University, Bangor, Gwynedd LL57 2DG, UK
| | - Elizabeth C Goyder
- ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
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Jordan S, Watkins A, Storey M, Allen SJ, Brooks CJ, Garaiova I, Heaven ML, Jones R, Plummer SF, Russell IT, Thornton CA, Morgan G. Volunteer bias in recruitment, retention, and blood sample donation in a randomised controlled trial involving mothers and their children at six months and two years: a longitudinal analysis. PLoS One 2013; 8:e67912. [PMID: 23874465 PMCID: PMC3706448 DOI: 10.1371/journal.pone.0067912] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 05/22/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The vulnerability of clinical trials to volunteer bias is under-reported. Volunteer bias is systematic error due to differences between those who choose to participate in studies and those who do not. METHODS AND RESULTS This paper extends the applications of the concept of volunteer bias by using data from a trial of probiotic supplementation for childhood atopy in healthy dyads to explore 1) differences between a) trial participants and aggregated data from publicly available databases b) participants and non-participants as the trial progressed 2) impact on trial findings of weighting data according to deprivation (Townsend) fifths in the sample and target populations. 1) a) Recruits (n = 454) were less deprived than the target population, matched for area of residence and delivery dates (n = 6,893) (mean [SD] deprivation scores 0.09[4.21] and 0.79[4.08], t = 3.44, df = 511, p<0.001). b) i) As the trial progressed, representation of the most deprived decreased. These participants and smokers were less likely to be retained at 6 months (n = 430[95%]) (OR 0.29,0.13-0.67 and 0.20,0.09-0.46), and 2 years (n = 380[84%]) (aOR 0.68,0.50-0.93 and 0.55,0.28-1.09), and consent to infant blood sample donation (n = 220[48%]) (aOR 0.72,0.57-0.92 and 0.43,0.22-0.83). ii) Mothers interested in probiotics or research or reporting infants' adverse events or rashes were more likely to attend research clinics and consent to skin-prick testing. Mothers participating to help children were more likely to consent to infant blood sample donation. 2) In one trial outcome, atopic eczema, the intervention had a positive effect only in the over-represented, least deprived group. Here, data weighting attenuated risk reduction from 6.9%(0.9-13.1%) to 4.6%(-1.4-+10.5%), and OR from 0.40(0.18-0.91) to 0.56(0.26-1.21). Other findings were unchanged. CONCLUSIONS Potential for volunteer bias intensified during the trial, due to non-participation of the most deprived and smokers. However, these were not the only predictors of non-participation. Data weighting quantified volunteer bias and modified one important trial outcome. TRIAL REGISTRATION This randomised, double blind, parallel group, placebo controlled trial is registered with the International Standard Randomised Controlled Trials Register, Number (ISRCTN) 26287422. Registered title: Probiotics in the prevention of atopy in infants and children.
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Affiliation(s)
- Sue Jordan
- Department of Nursing, The College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, Wales, United Kingdom.
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Mitchell F, Melville C, Stalker K, Matthews L, McConnachie A, Murray H, Walker A, Mutrie N. Walk Well: a randomised controlled trial of a walking intervention for adults with intellectual disabilities: study protocol. BMC Public Health 2013; 13:620. [PMID: 23816316 PMCID: PMC3733830 DOI: 10.1186/1471-2458-13-620] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 06/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Walking interventions have been shown to have a positive impact on physical activity (PA) levels, health and wellbeing for adult and older adult populations. There has been very little work carried out to explore the effectiveness of walking interventions for adults with intellectual disabilities. This paper will provide details of the Walk Well intervention, designed for adults with intellectual disabilities, and a randomised controlled trial (RCT) to test its effectiveness. METHODS/DESIGN This study will adopt a RCT design, with participants allocated to the walking intervention group or a waiting list control group. The intervention consists of three PA consultations (baseline, six weeks and 12 weeks) and an individualised 12 week walking programme.A range of measures will be completed by participants at baseline, post intervention (three months from baseline) and at follow up (three months post intervention and six months from baseline). All outcome measures will be collected by a researcher who will be blinded to the study groups. The primary outcome will be steps walked per day, measured using accelerometers. Secondary outcome measures will include time spent in PA per day (across various intensity levels), time spent in sedentary behaviour per day, quality of life, self-efficacy and anthropometric measures to monitor weight change. DISCUSSION Since there are currently no published RCTs of walking interventions for adults with intellectual disabilities, this RCT will examine if a walking intervention can successfully increase PA, health and wellbeing of adults with intellectual disabilities. TRIAL REGISTRATION ISRCTN ISRCTN50494254.
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Affiliation(s)
- Fiona Mitchell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Craig Melville
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Kirsten Stalker
- Glasgow School of Social Work, University of Strathclyde, Glasgow, Scotland, UK
| | - Lynsay Matthews
- Physical Activity for Health Research Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, UK
| | - Alex McConnachie
- Institute of Health and Wellbeing, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, UK
| | - Heather Murray
- Institute of Health and Wellbeing, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, UK
| | - Andrew Walker
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, UK
| | - Nanette Mutrie
- Institute for Sport, Physical Education and Health Sciences, Moray House School of Education, University of Edinburgh, Edinburgh, Scotland, UK
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Nivison-Smith I, Simpson JM, Dodds AJ, Ma DDF, Szer J, Bradstock KF. A population-based analysis of the effect of autologous hematopoietic cell transplant in the treatment of multiple myeloma. Leuk Lymphoma 2013; 54:1671-6. [PMID: 23286335 DOI: 10.3109/10428194.2013.763396] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This population registry-based study followed all cases of myeloma diagnosed in New South Wales, Australia, during 2002-2005 and compared survival outcomes of those who proceeded to autologous hematopoietic cell transplant (HCT) with those who did not. Data available consisted of demographic details and survival, and did not include disease details or treatment type or response. Of 708 patients, 270 (38%) had a HCT. The 5-year overall survival (OS) of HCT recipients was significantly better than for those who did not proceed to HCT (62% vs. 54%, p = 0.003). HCT was a significant favorable risk factor for OS, while age over 60 was an adverse risk factor. However, for patients alive at 1 year from diagnosis, there was no significant difference in survival between HCT and non-HCT patients, suggesting that worse disease biology and/or coexisting morbidities were likely to be major reasons for the poorer outcome for non-HCT patients.
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Affiliation(s)
- Ian Nivison-Smith
- Australasian Bone Marrow Transplant Recipient Registry (ABMTRR), Darlinghurst, NSW, Australia.
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Dattalo M, Giovannetti ER, Scharfstein D, Boult C, Wegener S, Wolff JL, Leff B, Frick KD, Reider L, Frey K, Noronha G, Boyd C. Who participates in chronic disease self-management (CDSM) programs? Differences between participants and nonparticipants in a population of multimorbid older adults. Med Care 2012; 50:1071-5. [PMID: 22892650 PMCID: PMC3494793 DOI: 10.1097/mlr.0b013e318268abe7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Self-care management is recognized as a key component of care for multimorbid older adults; however, the characteristics of those most likely to participate in Chronic Disease Self-Management (CDSM) programs and strategies to maximize participation in such programs are unknown. OBJECTIVES To identify individual factors associated with attending CDSM programs in a sample of multimorbid older adults. RESEARCH DESIGN Participants in the intervention arm of a matched-pair cluster-randomized controlled trial of the Guided Care model were invited to attend a 6-session CDSM course. Logistic regression was used to identify factors independently associated with attendance. SUBJECTS All subjects (N = 241) were aged 65 years or older, were at high risk for health care utilization, and were not homebound. MEASURES Baseline information on demographics, health status, health activities, and quality of care was available for CDSM participants and nonparticipants. Participation was defined as attendance at 5 or more CDSM sessions. RESULTS A total of 22.8% of multimorbid older adults who were invited to CDSM courses participated in 5 or more sessions. Having better physical health (odds ratio [95% confidence interval] = 2.3 [1.1-4.8]) and rating one's physician poorly on support for patient activation (odds ratio [95% confidence interval] = 2.8 [1.3-6.0]) were independently associated with attendance. CONCLUSIONS Multimorbid older adults who are in better physical health and who are dissatisfied with their physicians' support for patient activation are more likely to participate in CDSM courses.
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Affiliation(s)
- Melissa Dattalo
- Johns Hopkins Bayview Internal Medicine Residency Program, 4940 Eastern Avenue, Baltimore, MD 21224, P: 630-921-1715, F: 410-550-0491
| | - Erin R. Giovannetti
- 5200 Eastern Ave, Mason F. Lord Building, 7 Floor, Center Tower, Baltimore, MD 21224 P: 410-274-8824, F: 410-550-8701
| | - Daniel Scharfstein
- 615 N. Wolfe Street, E3547, Baltimore, MD 21117, P: 410-955-2420, F: 410-955-0958
| | - Chad Boult
- 624 N. Broadway, Hampton House Room 693, Baltimore, MD 21205, P: 410-955-6546, F: 410-955-0470
| | - Stephen Wegener
- 600 N. Wolfe Street, Phipps 174, Baltimore, MD 21297, P: 410-502-2438, F: 410-502-2419
| | - Jennifer L. Wolff
- 624 N. Broadway, Hampton House, Room 692, Baltimore, MD 21205, P: 410-502-0458, F: 410-955-0470
| | - Bruce Leff
- 5505 Hopkins Bayview Circle, Beacham Center, Baltimore, MD 21224, P: 410-550-2652, F: 410-550-8701
| | - Kevin D. Frick
- 624 N. Broadway, Hampton House, Room 606, Baltimore, MD 21205, P: 410-614-4018, F: 410-955-0470
| | - Lisa Reider
- 624 N. Broadway, Hampton House Room 355, Baltimore, MD 21205, P: 410-502-3962, F: 410-955-0470
| | - Katherine Frey
- 624 N. Broadway, Hampton House Room 350, Baltimore, MD 21205, P: 410-502-9109, F: 410-955-0470
| | - Gary Noronha
- 3100 Wyman Park Dr, Baltimore, MD 21211, P: 410-338-3421, F: 410-338-3498
| | - Cynthia Boyd
- 5200 Eastern Ave, Mason F. Lord Building, 7 Floor, Center Tower, Baltimore, MD 21224, P: 410-550-8676, F: 410-550-8701
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Abstract
Internet psychological interventions are efficacious and may reduce traditional access barriers. No studies have evaluated whether any sampling bias exists in these trials that may limit the translation of the results of these trials into real-world application. We identified 7999 potentially eligible trial participants from a community-based health cohort study and invited them to participate in a randomized controlled trial of an online cognitive behavioural therapy programme for people with depression. We compared those who consented to being assessed for trial inclusion with nonconsenters on demographic, clinical and behavioural indicators captured in the health study. Any potentially biasing factors were then assessed for their association with depression outcome among trial participants to evaluate the existence of sampling bias. Of the 35 health survey variables explored, only 4 were independently associated with higher likelihood of consenting-female sex (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.05-1.19), speaking English at home (OR 1.48, 95% CI 1.15-1.90) higher education (OR 1.67, 95% CI 1.46-1.92) and a prior diagnosis of depression (OR 1.37, 95% CI 1.22-1.55). The multivariate model accounted for limited variance (C-statistic 0.6) in explaining participation. These four factors were not significantly associated with either the primary trial outcome measure or any differential impact by intervention arm. This demonstrates that, among eligible trial participants, few factors were associated with the consent to participate. There was no indication that such self-selection biased the trial results or would limit the generalizability and translation into a public or clinical setting.
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VanWormer JJ, Linde JA, Harnack LJ, Stovitz SD, Jeffery RW. Is baseline physical activity a determinant of participation in worksite walking clubs? Data from the HealthWorks Trial. J Phys Act Health 2012; 9:849-56. [PMID: 21952267 PMCID: PMC3489008 DOI: 10.1123/jpah.9.6.849] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Some evidence suggests that physical activity programs mainly attract employees who are already active. This study examined the degree to which baseline physical activity was associated with enrollment in worksite walking clubs. METHODS All variables were measured at baseline. Walking club participation was measured over 2 years. There were 642 individuals from 3 worksites with complete data available for logistic regression analyses. RESULTS Baseline physical activity [OR (95% CI)=1.00 (0.99, 1.01)] was not a significant predictor of walking club participation. Participants who were older [OR=1.03 (1.01, 1.04)] or indicated more social support for physical activity [OR=1.13 (1.02, 1.25)] had significantly higher odds of participation relative to those who were younger or indicated less social support, respectively. In addition, men [OR=-0.25 (0.18, 0.36)] and employees from the second worksite [OR=-0.41 (0.25, 0.67)] had significantly lower odds of participation relative to women and employees from the first or third worksites, respectively. Sensitivity analyses arrived at similar conclusions. CONCLUSIONS Worksite walking clubs were appealing across varying levels of physical activity. Future research should improve marketing and program design to engage harder-to-reach segments of the workforce, particularly young men and those with limited social support.
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Affiliation(s)
- Jeffrey J VanWormer
- Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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Crain AL, Martinson BC, Sherwood NE, O’Connor PJ. The long and winding road to physical activity maintenance. Am J Health Behav 2010; 34:764-75. [PMID: 20604700 PMCID: PMC3319762 DOI: 10.5993/ajhb.34.6.11] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To build upon state-of-the-art theory and empirical data to estimate the strength of multiple mediators of the efficacious Keep Active Minnesota (KAM) physical activity (PA) maintenance intervention. METHODS The total, direct, and indirect effects through which KAM helped randomized participants (KAM n = 523; UC n = 526) maintain moderate or vigorous PA (MVPA) for up to 2 years were estimated using structural equation modeling. RESULTS Multiple mediators explained half (beta = .052, P = .13) of the effect of KAM on MVPA (beta = .105, P = .004). Self-efficacy was the upstream variable in 2 endogenously mediated effects, and the self-concept mediator emerged as the strongest predictor of MVPA. CONCLUSIONS KAM positively impacted self-efficacy, which was associated with PA enjoyment, integration into the self-concept, and PA maintenance. Successful long-term PA maintenance appears to be influenced by multiple small interrelated mediational pathways. Future research evaluating maintenance models should specify recursive relationships among mediators and outcomes.
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Affiliation(s)
- A. Lauren Crain
- 952-967-5354, HealthPartners Research Foundation, Mail Stop 21111R, PO Box 1524, Minneapolis, MN 55440-1524, fax: 952-967-5022
| | - Brian C. Martinson
- 952-967-5021, HealthPartners Research Foundation, Mail Stop 21111R, PO Box 1524, Minneapolis, MN 55440-1524, fax: 952-967-5022
| | - Nancy E. Sherwood
- 952-967-7303, HealthPartners Research Foundation, Mail Stop 21111R, PO Box 1524, Minneapolis, MN 55440-1524, fax: 952-967-5022
| | - Patrick J. O’Connor
- 952-967-5034, HealthPartners Research Foundation, Mail Stop 21111R, PO Box 1524, Minneapolis, MN 55440-1524, fax: 952-967-5022
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Hart PL, Grindel CG. Illness representations, emotional distress, coping strategies, and coping efficacy as predictors of patient outcomes in type 2 diabetes. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1752-9824.2010.01062.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Martinson BC, Sherwood NE, Crain AL, Hayes MG, King AC, Pronk NP, O'Connor PJ. Maintaining physical activity among older adults: 24-month outcomes of the Keep Active Minnesota randomized controlled trial. Prev Med 2010; 51:37-44. [PMID: 20382179 PMCID: PMC2885533 DOI: 10.1016/j.ypmed.2010.04.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Revised: 03/29/2010] [Accepted: 04/01/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the efficacy at 6-, 12-, and 24-month follow-up of Keep Active Minnesota (KAM), a telephone and mail-based intervention designed to promote physical activity (PA) maintenance among currently active adults age 50 to 70. METHOD Participants who reported having recently increased their MVPA to a minimum of 2d/wk, 30 min/bout, (N=1049) were recruited in 2004 and 2005 from one large managed care organization in Minnesota, and randomly assigned to either treatment (KAM; N=523), or Usual Care (UC; N=526) with PA assessed using the CHAMPS questionnaire, and expressed as kcal/wk energy expenditure. RESULTS We find a sustained, significant benefit of the intervention at 6, 12 and 24 months. kcal/wk expenditure in moderate or vigorous activities was higher at 6 (p<.03, Cohen's d(6m)=.16), 12 (p<.04, d(12 m)=.13) and 24 months (p<.01, d(24 m)=.16) for KAM participants, compared to UC participants. CONCLUSIONS The KAM telephone- and mail-based PA maintenance intervention was effective at maintaining PA in both the short-term (6 months) and longer-term (12 and 24 months) relative to usual care.
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Affiliation(s)
- Brian C Martinson
- HealthPartners Research Foundation, Minneapolis, MN 55440-1524, USA.
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