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Huntriss R, Salimgaraev R, Nikogosov D, Powell J, Varady KA. The effectiveness of mobile app usage in facilitating weight loss: An observational study. Obes Sci Pract 2024; 10:e757. [PMID: 38745944 PMCID: PMC11091450 DOI: 10.1002/osp4.757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/26/2024] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
Aim With increasing rates of global obesity and associated health issues, there is an ever-increasing need for weight management solutions to be more accessible. Mobile applications offer accessible support systems and have the potential to offer a viable and effective weight management solution as an alternative to traditional healthcare models. Objective To evaluate the effectiveness of the SIMPLE mobile application for time-restricted eating in achieving weight loss (WL). Methods User data were analyzed between January 2021 and January 2023. In-app activity was calculated as the proportion of active days over 12, 26 and 52 weeks. A day is considered active if it contains at least one in-app action (e.g., logging weight, food, fasting, or physical activity). Users were categorized into four in-app activity levels: inactive (in-app activity <33%), medium activity (33%-66%), high activity (66%-99%), and maximal activity (100%). Weight change among in-app activity groups was assessed at 12, 26, and 52 weeks. Results Out of 53,482 users, a positive association was found between the use of the SIMPLE app and WL. Active app users lost more weight than their less active counterparts. Active users had a median WL of 4.20%, 5.04%, and 3.86% at 12, 26, and 52 weeks, respectively. A larger percentage of active users-up to 50.26%-achieved clinically significant WL (≥5%) when compared to inactive users. A dose-response relationship between WL and app usage was found after adjusting for gender, age, and initial Body Mass Index; a 10% increase in app activity correlated with increased WL by 0.43, 0.66 and 0.69 kg at 12, 26, and 52 weeks, respectively. Conclusions The study demonstrates that the SIMPLE app enables effective WL directly associated with the level of app engagement. Mobile health applications offer an accessible and effective weight management solution and should be considered when supporting adults to lose weight.
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Affiliation(s)
| | | | | | - John Powell
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordOxfordshireUK
| | - Krista A. Varady
- Department of Kinesiology and NutritionUniversity of IllinoisChicagoIllinoisUSA
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Yudkin JS, Allicock MA, Atem FD, Galeener CA, Messiah SE, Barlow SE. Efficacy of a Primary Care eHealth Obesity Treatment Pilot Intervention Developed for Vulnerable Pediatric Patients. Child Obes 2024; 20:75-86. [PMID: 36893214 PMCID: PMC11071101 DOI: 10.1089/chi.2022.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Background: Challenges to treat excess weight in primary care settings include time constraints during encounters and barriers to multiple visits for patient families, especially those from vulnerable backgrounds. Dynamo Kids! (DK), a bilingual (English/Spanish) e-health intervention, was created to address these system-level challenges. This pilot study assessed the effect of DK use on parent-reported healthy habits and child BMI. Methods: In this 3-month, quasi-experimental cohort design, DK was offered to parents with children aged 6-12 years with BMI ≥85th percentile in three public primary care sites in Dallas, Texas. DK included three educational modules, one tracking tool, recipes, and links to internet resources. Parents completed an online survey before and after 3 months. Pre-post changes in family nutrition and physical activity (FNPA) scores, clinic-measured child %BMIp95, and self-reported parent BMI were assessed using mixed-effects linear regression modeling. Results: A total of 73 families (mean child age = 9.3 years; 87% Hispanic, 12% non-Hispanic Black, and 77% Spanish-speaking families) completed the baseline survey (participants) and 46 (63%) used the DK site (users). Among users, pre-post changes (mean [standard deviation]) showed an increase in FNPA scores (3.0 [6.3], p = 0.01); decrease in child %BMIp95 (-1.03% [5.79], p = 0.22); and decrease in parent BMI (-0.69 [1.76], p = 0.04). Adjusted models showed -0.02% [95% confidence interval: -0.03 to -0.01] change in child %BMIp95 for each minute spent on the DK website. Conclusions: DK demonstrated a significant increase in parent FNPA scores and decrease in self-reported parent BMI. e-Health interventions may overcome barriers and require a lower dosage than in-person interventions.
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Affiliation(s)
- Joshua S. Yudkin
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Campus, Dallas, TX, USA
| | - Marlyn A. Allicock
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Campus, Dallas, TX, USA
| | - Folefac D. Atem
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Campus, Dallas, TX, USA
| | - Carol A. Galeener
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Campus, Dallas, TX, USA
| | - Sarah E. Messiah
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Campus, Dallas, TX, USA
- Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Campus, Dallas, TX, USA
| | - Sarah E. Barlow
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children's Health, Dallas, TX, USA
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Zhao X, Zheng J, Wang J, Li B, Huang W. Inhibition of Hyperglycemia and Hyperlipidemia by Blocking Toll-like Receptor 4: Comparison of Wild-Type and Toll-like Receptor 4 Gene Knockout Mice on Obesity and Diabetes Modeling. BIOLOGY 2024; 13:63. [PMID: 38275739 PMCID: PMC10813444 DOI: 10.3390/biology13010063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/05/2024] [Accepted: 01/20/2024] [Indexed: 01/27/2024]
Abstract
Innate immune receptor TLR4 plays an important role in glycolipid metabolism. The objective of this study is to investigate the inhibitory effects of blocking TLR4 on hyperglycemia and hyperlipidemia by comparing WT and TLR4-/- mice in obesity and diabetes modeling. The knockout of the TLR4 gene could prevent weight gain induced by a high-fat diet (HFD)/high-sugar and high-fat diet (HSHFD), and the differences in the responses existed between the sexes. It extends the time required to reach the obesity criteria. However, when mice were injected with intraperitoneal streptozotocin (STZ) after being fed by HSHFD for two months, TLR4-/- mice exhibited less weight loss than WT. Blocking TLR4 alleviated the changes in body weight and blood glucose, consequently reducing the efficiency of diabetes modeling, especially for male mice. Additionally, male TLR4-/- obese mice exhibit lower total cholesterol (TC) and low-density lipoprotein (LDL) levels in serum and less formation of fat droplets in the liver compared to WT. On the other hand, the knockout of TLR4 significantly increased the high-density lipoprotein (HDL) of male mice. This study should provide new insights into the role of TLR4, as well as opportunities to target novel approaches to the prevention and treatment of metabolic diseases like obesity and diabetes.
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Affiliation(s)
- Xingyu Zhao
- Institute of Agro-Product Processing, Jiangsu Academy of Agricultural Sciences, Nanjing 210014, China;
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China;
| | - Jiawei Zheng
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China;
| | - Jing Wang
- College of Chemical Engineering, Nanjing Forestry University, Nanjing 210037, China;
| | - Bin Li
- College of Food Science, Shenyang Agricultural University, Shenyang 110866, China;
| | - Wuyang Huang
- Institute of Agro-Product Processing, Jiangsu Academy of Agricultural Sciences, Nanjing 210014, China;
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang 212013, China;
- College of Chemical Engineering, Nanjing Forestry University, Nanjing 210037, China;
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4
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Braxton ME, Nwabichie E, Diaz M, Lish E, Ayers SL, Williams AN, Tornel M, McKim P, Treichel J, Knowler WC, Olson ML, Shaibi GQ. Preventing diabetes in Latino families: A protocol for a randomized control trial. Contemp Clin Trials 2023; 135:107361. [PMID: 37852533 PMCID: PMC10790650 DOI: 10.1016/j.cct.2023.107361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/18/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Latino families are disproportionately affected by type 2 diabetes (T2D) and lifestyle intervention is the first-line approach for preventing T2D. The purpose of this study is to test the efficacy of a culturally-grounded lifestyle intervention that prioritizes health promotion and diabetes prevention for Latino families. The intervention is guided by a novel Family Diabetes Prevention Model, leveraging the family processes of engagement, empowerment, resilience, and cohesion to orient the family system towards health. METHOD Latino families (N = 132) will be recruited and assessed for glucose tolerance as measured by an Oral Glucose Tolerance Test (OGTT) and General and Weight-Specific Quality of Life (QoL) at baseline, four months, and 12 months. All members of the household age 10 and over will be invited to participate. Families will be randomized to the intervention group or a control group (2:1). The 16-week intervention includes weekly nutrition and wellness classes delivered by bilingual, bicultural Registered Dietitians and community health educators at a local YMCA along with two days/week of supervised physical activity classes and a third day of unsupervised physical activity. Control families will meet with a physician and a Registered Dietitian to discuss the results of their metabolic testing and recommend lifestyle changes. We will test the efficacy of a family-focused diabetes prevention intervention for improving glucose tolerance and increasing QoL and test for mediators and moderators of long-term changes. CONCLUSION This study will provide much needed data on the efficacy of a family-focused Diabetes Prevention Program among high-risk Latino families.
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Affiliation(s)
- Morgan E Braxton
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA
| | - Eucharia Nwabichie
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA
| | - Monica Diaz
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA; Ivy Center for Family Wellness, The Society of St Vincent de Paul, USA
| | - Elvia Lish
- Ivy Center for Family Wellness, The Society of St Vincent de Paul, USA
| | - Stephanie L Ayers
- Southwest Interdisciplinary Research Center, Arizona State University, USA
| | - Allison N Williams
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA
| | - Mayra Tornel
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA
| | | | | | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, USA
| | - Micah L Olson
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA; Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, USA; Southwest Interdisciplinary Research Center, Arizona State University, USA; Division of Pediatric Endocrinology and Diabetes, Phoenix Children's Hospital, USA.
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5
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Bielka W, Przezak A, Pawlik A. Follistatin and follistatin-like 3 in metabolic disorders. Prostaglandins Other Lipid Mediat 2023; 169:106785. [PMID: 37739334 DOI: 10.1016/j.prostaglandins.2023.106785] [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: 05/03/2023] [Revised: 09/02/2023] [Accepted: 09/16/2023] [Indexed: 09/24/2023]
Abstract
Follistatin (FST) is a glycoprotein which main role is antagonizing activity of transforming growth factor β superfamily members. Folistatin-related proteins such as follistatin-like 3 (FSTL3) also reveal these properties. The exact function of them has still not been established, but it can be bound to the pathogenesis of metabolic disorders. So far, there were performed a few studies about their role in type 2 diabetes, obesity or gestational diabetes and even less in type 1 diabetes. The outcomes are contradictory and do not allow to draw exact conclusions. In this article we summarize the available information about connections between follistatin, as well as follistatin-like 3, and metabolic disorders. We also emphasize the strong need of performing further research to explain their exact role, especially in the pathogenesis of diabetes and obesity.
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Affiliation(s)
- Weronika Bielka
- Department of Rheumatology and Internal Medicine, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland
| | - Agnieszka Przezak
- Department of Rheumatology and Internal Medicine, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland
| | - Andrzej Pawlik
- Department of Physiology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland.
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6
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Bosdijk A, Nieboer AP, Cramm JM. The development of an integrated neighborhood approach for health promotion and prevention: a qualitative exploration of stakeholders' views. Health Res Policy Syst 2023; 21:125. [PMID: 38017576 PMCID: PMC10683097 DOI: 10.1186/s12961-023-01077-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Although the promise of integrated neighborhood approaches, including the essential roles of communities and collaboration between the medical and social domains, has been widely acknowledged, the realization of such approaches in practice often remains difficult. To gain insight into the development of integrated neighborhood approaches, this case study describes the experiences of stakeholders involved in such an approach for health promotion and prevention in Rotterdam. METHODS Interviews with 18 stakeholders (including health and social care professionals, health insurance employees, and policymakers) were conducted, and stakeholders' statements were analyzed thematically. RESULTS The results reveal a lack of alignment among the professional, organizational, and system levels. Elements needed for collaboration between health and social care professionals are not supported at the organizational and system levels. The lack of integration at the policy and organizational levels encourages competition and self-interest instead of stimulating collaboration. CONCLUSIONS Intersectoral collaboration and coordination must take place not only between professionals, but also at the organizational and policy levels. As long as integration at the organizational and system levels is lacking, professionals' ability to collaborate and provide coordinated support to neighborhood residents will be compromised.
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Affiliation(s)
- Anniek Bosdijk
- Department of Socio-Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Anna Petra Nieboer
- Department of Socio-Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Jane Murray Cramm
- Department of Socio-Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
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7
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Tucker K, Ingram M, Doubleday K, Piper R, Sander A, Flores R, Martinez D, Carvajal S. Results From La Vida Buena (The Good Life): A Quasi-Experimental Intervention of a Community Health Worker-Led Family-Based Childhood Obesity Program for Latino Children 5-8 Years of Age on the U.S.-Mexico Border. Health Promot Pract 2023; 24:1196-1205. [PMID: 36468422 DOI: 10.1177/15248399221112691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of the 8-week, community health worker (CHW)-led La Vida Buena childhood obesity program among Latino children 5 to 8 years old in a rural county along the U.S.-Mexico border. METHODS This quasi-experimental study used a community-based participatory research approach to compare the effectiveness of the La Vida Buena (The Good Life) curriculum as compared with a single educational session. We took anthropomorphic measures and administered parent-reported nutrition and physical activity surveys at baseline, 3 months, and 6 months. The study took place between 2017 and 2020 in Santa Cruz County, Arizona. RESULTS Change in body mass index (BMI) z-score was negligible for both groups. The parent-reported behavior indicated a shift toward healthier family behaviors and environment in the intervention group. IMPLICATIONS FOR PRACTICE This study adds to the growing literature of CHW-led childhood obesity interventions. The engagement of the CHWs in all aspects of the intervention helped to facilitate important behavior changes. Future interventions should emphasize health and wellness rather than BMI z-score and include community, socioeconomic, and systems-level interventions to promote healthy environments.
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Affiliation(s)
- Kathryn Tucker
- The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Maia Ingram
- The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Kevin Doubleday
- The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Rosie Piper
- Mariposa Community Health Center, Nogales, AZ, USA
| | | | | | | | - Scott Carvajal
- The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
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8
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Oshman L, Othman A, Furst W, Heisler M, Kraftson A, Zouani Y, Hershey C, Cho TC, Guetterman T, Piatt G, Griauzde DH. Primary care providers' perceived barriers to obesity treatment and opportunities for improvement: A mixed methods study. PLoS One 2023; 18:e0284474. [PMID: 37071660 PMCID: PMC10112804 DOI: 10.1371/journal.pone.0284474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/31/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Primary care patients with obesity seldom receive effective weight management treatment in primary care settings. This study aims to understand PCPs' perspectives on obesity treatment barriers and opportunities to overcome them. STUDY DESIGN This is an explanatory sequential mixed methods study in which survey data was collected and used to inform subsequent qualitative interviews. SETTINGS AND PARTICIPANTS PCPs who provide care to adult patients in an academic medical center in the Midwestern US. METHODOLOGY PCPs (n = 350) were invited by email to participate in an online survey. PCPs were subsequently invited to participate in semi-structured interviews to further explore survey domains. ANALYTIC APPROACH Survey data were analyzed using descriptive statistics. Interviews were analyzed using directed content analysis. RESULTS Among 107 survey respondents, less than 10% (n = 8) used evidence-based guidelines to inform obesity treatment decisions. PCPs' identified opportunities to improve obesity treatment including (1) education on local obesity treatment resources (n = 78, 73%), evidence-based dietary counseling strategies (n = 67, 63%), and effective self-help resources (n = 75, 70%) and (2) enhanced team-based care with support from clinic staff (n = 53, 46%), peers trained in obesity medicine (n = 47, 44%), and dietitians (n = 58, 54%). PCPs also desired increased reimbursement for obesity treatment. While 40% (n = 39) of survey respondents expressed interest in obesity medicine training and certification through the American Board of Obesity Medicine, qualitative interviewees felt that pursuing training would require dedicated time (i.e., reduced clinical effort) and financial support. CONCLUSIONS Opportunities to improve obesity treatment in primary care settings include educational initiatives, use of team-based care models, and policy changes to incentivize obesity treatment. Primary care clinics or health systems should be encouraged to identify PCPs with specific interests in obesity medicine and support their training and certification through ABOM by reimbursing training costs and reducing clinical effort to allow for study and board examination.
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Affiliation(s)
- Lauren Oshman
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Amal Othman
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Wendy Furst
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, United States of America
| | - Andrew Kraftson
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Yousra Zouani
- College of Engineering, Wayne State University, Detroit, Michigan, United States of America
| | - Cheryl Hershey
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Tsai-Chin Cho
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Timothy Guetterman
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Gretchen Piatt
- Department of Learning Health Sciences, Ann Arbor, Michigan, United States of America
| | - Dina H. Griauzde
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, United States of America
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Skinner AC, Staiano AE, Armstrong SC, Barkin SL, Hassink SG, Moore JE, Savage JS, Vilme H, Weedn AE, Liebhart J, Lindros J, Reilly EM. Appraisal of Clinical Care Practices for Child Obesity Treatment. Part I: Interventions. Pediatrics 2023; 151:190447. [PMID: 36622110 DOI: 10.1542/peds.2022-060642] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
Abstract
The objective of this technical report is to provide clinicians with evidence-based, actionable information upon which to make assessment and treatment decisions for children and adolescents with obesity. In addition, this report will provide an evidence base to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) "What are clinically based, effective treatments for obesity?" and (KQ2) "What is the risk of comorbidities among children with obesity?" See Appendix 1 for the conceptual framework and a priori key questions.
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Affiliation(s)
- Asheley C Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Amanda E Staiano
- Louisiana State University Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Sarah C Armstrong
- Departments of Pediatrics and Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Shari L Barkin
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Sandra G Hassink
- Medical Director, American Academy of Pediatrics, Institute for Healthy Childhood Weight, Wilmington, Delaware
| | - Jennifer E Moore
- Institute for Medicaid Innovation, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jennifer S Savage
- Center for Childhood Obesity Research, Pennsylvania State University, Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania
| | - Helene Vilme
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Ashley E Weedn
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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10
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Barlow SE, Yudkin J, Nelson V, Allicock MA. Dynamo Kids!/¡Niños Dinámicos! A Web Site for Pediatric Primary Care Providers to Offer Parents of Children 6-12 Years Old With Overweight and Obesity: Web Site Development and Protocol for Pilot Study. J Pediatr Health Care 2023; 37:17-24. [PMID: 36184375 PMCID: PMC10584016 DOI: 10.1016/j.pedhc.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/07/2022] [Accepted: 09/03/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION A self-guided web site offered by pediatric primary care providers could help parents implement healthy behaviors. METHOD The Dynamo Kids/¡Niños Dinámicos program was developed with input from parents and health care professionals, creating a bilingual site for parents to learn why and how to implement healthy behavior changes for their children. A single-arm pilot will enroll parents with children 6-12 years with body mass index (BMI) ≥ 85th percentile seen in safety-net practices. Electronic health record modifications alert providers to eligible children at well-child encounters. Consented parents complete online surveys before accessing the site. At 3 months, the providers see children in weight-focused encounters. Outcomes include change in Family Nutrition and Physical Activity parent survey score (primary) and change in child relative BMI (secondary). Additional data include time spent on site, provider surveys, and provider and parent interviews. RESULTS Pending implementation. DISCUSSION If program shows promise, a large, controlled study could further evaluate with a goal of broad dissemination.
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Affiliation(s)
- Sarah E Barlow
- Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, TX; Children's Medical Center of Dallas, Dallas, TX.
| | - Joshua Yudkin
- University of Texas Health Science Center at Houston, School of Public Health, Dallas Campus, Dallas, TX
| | | | - Marlyn A Allicock
- University of Texas Health Science Center at Houston, School of Public Health, Dallas Campus, Dallas, TX
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11
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Bailey-Davis L, Pinto AM, Hanna DJ, Rethorst CD, Still CD, Foster GD. Qualitative inquiry with primary care providers and specialists about adult weight management care and referrals. Transl Behav Med 2022; 12:576-584. [PMID: 35195267 PMCID: PMC9132206 DOI: 10.1093/tbm/ibac006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Obesity is a highly prevalent disease and providers are expected to offer or refer patients for weight management yet increasingly fewer clinical visits address obesity. Challenges to offering care are known but less is known about referrals and how specialists who treat obesity-related comorbidities address care and referrals. This study explored perceptions of primary care providers (PCPs) and specialty providers regarding care and referrals for weight management, specifically referrals to programs in the community setting. A qualitative design was used to interview 33 PCPs (mean age 54 years) and 31 specialists (cardiology, gynecology, endocrinology, and orthopedics [mean age 62 years]) in the USA during 2019. Each interview was conducted by telephone, audio-recorded, and transcribed verbatim. Inductive analysis was used and followed the constant comparative method. Four themes emerged from the data including (a) Clinical guidelines and provider discretion influence obesity care; (b) Facilitators and barriers to discussing weight and small step strategies; (c) Informal referrals are made for weight management in community settings; and (d) Opportunities and challenges for integrating clinical and community services for weight management. Facilitating referrals to effective programs, ideally with a feedback loop could coordinate care and enhance accountability, but education, compliance, and cost issues need addressed. Care may be offered but not be well-aligned with clinical guidelines. Knowledge gaps regarding community programs' offerings and efficacy were evident. Referrals could be systematically promoted, facilitated, and tracked to advance weight management objectives.
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Affiliation(s)
- Lisa Bailey-Davis
- Department of Population Health Sciences, Geisinger, Danville, PA 17822, USA
- Obesity Research Institute, Geisinger, Danville, PA 17822, USA
| | | | - David J Hanna
- Obesity Research Institute, Geisinger, Danville, PA 17822, USA
| | | | | | - Gary D Foster
- WW International, Inc., New York, NY 10010, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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12
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Pullyblank K, Brunner W, Wyckoff L, Krupa N, Scribani M, Strogatz D. Implementation of Evidence-Based Disease Self-Management Programs in a Rural Region: Leveraging and Linking Community and Health Care System Assets. HEALTH EDUCATION & BEHAVIOR 2022; 49:10901981221078516. [PMID: 35179055 DOI: 10.1177/10901981221078516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CONTEXT Rural populations experience both a higher prevalence of and risk for premature death from chronic conditions than do their urban counterparts. Yet barriers to implement community-based chronic disease self-management programs persist. PROGRAM The Living Well program, a multi-sector collaboration between a rural health care system and a network of community-based organizations, has offered the 6-week evidence-based Chronic Disease Self-Management and Diabetes Self-Management workshops since 2017. The program was a response to a quality improvement initiative to improve hypertension and diabetes outcomes throughout the health care system. IMPLEMENTATION Using the rapid cycling quality improvement process, Living Well developed a self-management program recruitment, referral, and coordinating office for a six-county region. Through continuous capacity-building efforts with community partners, as well as leveraging key health care system assets such as the electronic health record and provider detailing, program reach and adoption was increased. EVALUATION The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework was used for the process evaluation. During 3 years, more than 750 individuals engaged with the program, with nearly 600 completing a workshop. The region saw increased engagement by primary care clinicians to refer, and structural changes were embedded into the health care system to facilitate clinic-community partnerships. DISCUSSION A coordinated, multi-sector approach is necessary to develop solutions to complex, chronic health problems. A regional coordinating hub is an effective strategy for implementing community-based programs in rural areas. However, low health care system engagement and fragmented funding remain as barriers to optimal implementation.
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Gertel-Rosenberg A, Viveiros J, Koster A, Thompson G, Taylor B, Blackburn KB, Bo C. Moving the needle on health inequities: principles and tactics for effective cross-sector population health networks. Curr Opin Pediatr 2022; 34:27-32. [PMID: 34840251 PMCID: PMC8728679 DOI: 10.1097/mop.0000000000001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To summarize elements of cross-sector population health networks to support systems and policy change to achieve equitable access to health services and healthy development opportunities for young children and families, allowing everyone to have a fair and just opportunity to be as healthy as possible. RECENT FINDINGS The principles and tactics of Equity and Inclusion, Readiness, Joint Planning, Governance, and Data can guide cross-sector networks in effectively supporting communities in addressing health inequities. These principles are not linear or siloed, but rather, they overlap and reinforce each other. The principles require equity and the participation of community members to be central in all aspects of cross-sector network work. SUMMARY By building strong relationships among community partners, cross-sector population health networks can ensure the network is not a short-term, transactional one-time project, but rather, a sustained collaboration through enduring processes and infrastructure. Networks can gain a fuller understanding of the needs and assets of a community through engagement and leadership by community members than they could gather from data and surveys alone. This approach to serving a community by making members equal partners in the effort helps to place equity at the center of a network's focus, as does embedding equity-related decision-making tools and processes into daily operations of the network. If cross-sector networks build resilient, inclusive structures and procedures, they can utilize them to quickly pivot and adjust to emerging needs or respond to crisis.
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14
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Zhang L, Wang X, He Y, Cao J, Wang K, Lin H, Qu C, Miao J. Regulatory Effects of Functional Soluble Dietary Fiber from Saccharina japonica Byproduct on the Liver of Obese Mice with Type 2 Diabetes Mellitus. Mar Drugs 2022; 20:91. [PMID: 35200621 PMCID: PMC8877147 DOI: 10.3390/md20020091] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 02/01/2023] Open
Abstract
Though the relationship between dietary fiber and physical health has been investigated widely, the use of dietary fiber from marine plants has been investigated relatively rarely. The Saccharina japonica byproducts after the production of algin contain a large amount of insoluble polysaccharide, which will cause a waste of resources if ignored. Soluble dietary fiber (SDF)prepared from waste byproducts of Saccharina japonica by alkaline hydrolysis method for the first time had a wrinkled microscopic surface and low crystallinity, which not only significantly reduced liver index, serum levels of aspartate aminotransferase (AST) and alanine amiotransferase (ALT), and liver fat accumulation damage to the livers of obese diabetic mice, but also activated the PI3K/AKT signaling pathway to increase liver glycogen synthesis and glycolysis. By LC-MS/MS employing a Nexera UPLC tandem QE high-resolution mass spectrometer, the 6 potential biomarker metabolites were screened, namely glycerophosphocholine (GPC), phosphocholine (PCho), pantothenic acid, glutathione (GSH), oxidized glutathione (GSSG), and betaine; several pathways of these metabolites were associated with lipid metabolism, glycogen metabolism, and amino acid metabolism in the liver were observed. This study further provided a detailed insight into the mechanisms of SDF from Saccharina japonica byproducts in regulating the livers of obese mice with type 2 diabetes and laid a reliable foundation for the further development and utilization of Saccharina japonica.
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Affiliation(s)
- Liping Zhang
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao 266071, China;
| | - Xixi Wang
- Key Laboratory of Marine Eco-Environmental Science and Technology, First Institute of Oceanography, Ministry of Natural Resource, Qingdao 266061, China; (X.W.); (Y.H.); (J.C.); (K.W.); (H.L.)
| | - Yingying He
- Key Laboratory of Marine Eco-Environmental Science and Technology, First Institute of Oceanography, Ministry of Natural Resource, Qingdao 266061, China; (X.W.); (Y.H.); (J.C.); (K.W.); (H.L.)
| | - Junhan Cao
- Key Laboratory of Marine Eco-Environmental Science and Technology, First Institute of Oceanography, Ministry of Natural Resource, Qingdao 266061, China; (X.W.); (Y.H.); (J.C.); (K.W.); (H.L.)
| | - Kai Wang
- Key Laboratory of Marine Eco-Environmental Science and Technology, First Institute of Oceanography, Ministry of Natural Resource, Qingdao 266061, China; (X.W.); (Y.H.); (J.C.); (K.W.); (H.L.)
| | - Huan Lin
- Key Laboratory of Marine Eco-Environmental Science and Technology, First Institute of Oceanography, Ministry of Natural Resource, Qingdao 266061, China; (X.W.); (Y.H.); (J.C.); (K.W.); (H.L.)
| | - Changfeng Qu
- Key Laboratory of Marine Eco-Environmental Science and Technology, First Institute of Oceanography, Ministry of Natural Resource, Qingdao 266061, China; (X.W.); (Y.H.); (J.C.); (K.W.); (H.L.)
- Laboratory for Marine Drugs and Bioproducts, Qingdao Pilot National Laboratory for Marine Science and Technology, Qingdao 266237, China
| | - Jinlai Miao
- Key Laboratory of Marine Eco-Environmental Science and Technology, First Institute of Oceanography, Ministry of Natural Resource, Qingdao 266061, China; (X.W.); (Y.H.); (J.C.); (K.W.); (H.L.)
- Laboratory for Marine Drugs and Bioproducts, Qingdao Pilot National Laboratory for Marine Science and Technology, Qingdao 266237, China
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15
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Allison K, Jones S, Hinman RS, Briggs AM, Sumithran P, Quicke J, Holden M, Chiavaroli N, Crofts S, George E, Foster N, Bennell K. Effects of an Online Education Program on Physical Therapists' Confidence in Weight Management for People With Osteoarthritis: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2021; 75:835-847. [PMID: 34931477 DOI: 10.1002/acr.24828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/20/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate effects of an online education program about weight management for osteoarthritis on physical therapists' self-reported confidence in knowledge and skills in weight management and attitudes toward obesity. METHODS In a 2-group randomized controlled trial, 80 physical therapists (58 female physical therapists) were randomized to education or control groups. The theoretically informed and evidence-informed online self-directed training program covered biopsychosocial elements of obesity and weight management. The primary outcome was self-reported confidence in knowledge in weight management using a customized validated tool (scale 14-70, higher scores indicating higher confidence) assessed at baseline and 6 weeks. Secondary measures included confidence in nutrition care, clinical skills in weight management, and weight stigma. Process measures evaluated participant experience. Differences in change between groups were compared using linear regression models adjusted for baseline scores and stratifying variables (clinical setting; confidence in weight management). Moderation analysis was performed using an interaction approach in a linear regression model and multivariable fractional polynomial interaction approach. RESULTS A total of 79 participants (99%) completed outcome measures at 6 weeks. The education group demonstrated greater improvement in confidence in knowledge than the control group (adjusted mean difference 22.6 units, 95% confidence interval 19.6, 25.5). Greater improvement in knowledge was associated with lower baseline values (interaction P = 0.002). Secondary outcomes showed greater improvements in confidence in skills and nutrition care and in weight stigma domains favoring the education group. Over 90% of participants would recommend the program to peers. CONCLUSION An online education program improves physical therapists' short-term confidence in knowledge and skills in weight management for people with osteoarthritis and reduces weight-stigmatized attitudes.
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Affiliation(s)
- Kim Allison
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Jones
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew M Briggs
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | | | - Jonathan Quicke
- Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Melanie Holden
- Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Neville Chiavaroli
- Australian Council for Educational Research, Camberwell, Victoria, Australia
| | - Sam Crofts
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elena George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Nadine Foster
- Primary Care Centre Versus Arthritis, Keele University, Keele, UK, and Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Herston, Queensland, Australia
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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16
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Tompkins NO, Wright J, Giacobbi P, Alelaiwat B, Vance J, Gregory M, Bromley C, Ross M. Maximizing the Potential of Mini-Grants to Promote Policy, Systems, and Environmental Changes: Outcomes and Challenges. Health Promot Pract 2021; 23:445-452. [PMID: 34551602 DOI: 10.1177/15248399211039788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE AND OBJECTIVES This article describes the implementation and evaluation of a chronic disease mini-grant initiative, coordinated by a state health department in collaboration with multiple stakeholders. Braided funding from federal and state sources was used to build and implement the initiative. INTERVENTION APPROACH Mini-grants, facilitated by five different facilitating organizations, were funded to promote implementation of policy, systems, and environmental (PSE) changes at the local level. Grant recipients represented a variety of sectors, including education, government, and nonprofit organizations. EVALUATION METHODS Primary (surveys) and secondary (final reports) data documented achievement of PSE changes. RESULTS A total of $196,369 was dispersed to 65 organizations; 126 PSE changes in the areas of physical activity, nutrition, and tobacco were reported. Challenges in implementing and evaluating mini-grants were identified, including the heterogeneity of the sectors/settings involved and associated variability of proposed activities, time lines, measurement, and evaluation activities. COVID-19 (coronavirus disease 2019) also disrupted the plans for many projects. IMPLICATIONS FOR PUBLIC HEALTH The success of this initiative can be attributed to four main elements: (1) the use of intermediary organizations to facilitate the mini-grants; (2) a participatory evaluation process, combined with early and ongoing communication among all stakeholders; (3) a braided funding strategy; and (4) a multisector approach that engaged both traditional and nontraditional public health organizations. The processes and outcomes, including challenges, can inform other state health departments' efforts in braiding funding and engaging intermediary organizations to expand the reach of PSE changes at the local level.
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Affiliation(s)
| | - Jessica Wright
- West Virginia Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, WV, USA
| | | | | | - James Vance
- West Virginia Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, WV, USA
| | | | - Craig Bromley
- West Virginia Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, WV, USA
| | - Megan Ross
- West Virginia Bureau for Public Health, West Virginia Department of Health and Human Resources, Charleston, WV, USA
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17
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Trofholz A, Shanafelt A, Adamek M, Grannon K, Loth K, Caspi C, Berge JM. Integration as a Tool for Interprofessional Work: A Synthesis of the Literature Regarding How to Use Integrative Strategies to Address Complex Public Health Problems. ACTA ACUST UNITED AC 2021; 21. [PMID: 34485708 DOI: 10.1016/j.xjep.2020.100383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background and Purpose There has been limited success addressing complex public health problems using "siloed" approaches. A next important step in addressing persistent public health problems is adopting an "integrative" approach-intentional collaboration across the domains of research, clinical practice, community, and policy. This synthesis of the literature aggregates and synthesizes the diffuse and multi-disciplinary integration literature base to describe key concepts, aspects of praxis, and challenges and successes to help guide interprofessional practice. Methods A three-step approach was used: 1) a wide-ranging search for articles on integration theory/praxis; 2) a more focused search in the health literature bases; 3) a snowball strategy to identify additional studies. Discussion/Conclusions Identified themes included elements of successful integration; characteristics of an effective integrator; and dynamics between stakeholders in integration praxis. Results of this synthesis of the integration literature provide a deeper understanding of integration and points to clear and exciting next steps for integration praxis and inquiry.
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Affiliation(s)
- Amanda Trofholz
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis
| | - Amy Shanafelt
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis
| | | | - Katherine Grannon
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis
| | - Katie Loth
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis
| | - Caitlin Caspi
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis
| | - Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis
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18
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Tucker S, Bramante C, Conroy M, Fitch A, Gilden A, Wittleder S, Jay M. The Most Undertreated Chronic Disease: Addressing Obesity in Primary Care Settings. Curr Obes Rep 2021; 10:396-408. [PMID: 34297343 PMCID: PMC8300078 DOI: 10.1007/s13679-021-00444-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW While obesity-related comorbidities are frequently addressed and treated in primary care (PC), obesity itself is undertreated. We review the current treatments for obesity and provide potential provider and system-level strategies for integrating weight management and improving longer term obesity care within PC settings. RECENT FINDINGS We now understand that the body develops multiple mechanisms to resist weight loss and promote weight regain, making both weight loss and weight loss maintenance challenging. Therefore, weight management often requires medically supervised interventions and should be treated on a long-term basis. However, there are multiple barriers to improving obesity care within PC settings. Clinically, utilizing strategies such as a shared decision-making approach and the 5As to discuss treatment options can facilitate formulating an obesity treatment plan. Utilizing telehealth, a team-based approach, and community partnering can increase patient access to intensive behavioral interventions. Future studies should evaluate other cost-effective methods to implement obesity care into the PC setting.
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Affiliation(s)
- Shanna Tucker
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Carolyn Bramante
- Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Molly Conroy
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Angela Fitch
- Departments of Medicine and Surgery, Massachusetts General Hospital Weight Center, Harvard Medical School, Boston, MA, USA
| | - Adam Gilden
- Kaiser Permanente Colorado, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Sandra Wittleder
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Melanie Jay
- Departments of Medicine and Population Health, NYU Grossman School of Medicine, New York, NY, USA.
- New York Harbor Veterans Affairs, New York, NY, USA.
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19
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Safaei M, Sundararajan EA, Driss M, Boulila W, Shapi'i A. A systematic literature review on obesity: Understanding the causes & consequences of obesity and reviewing various machine learning approaches used to predict obesity. Comput Biol Med 2021; 136:104754. [PMID: 34426171 DOI: 10.1016/j.compbiomed.2021.104754] [Citation(s) in RCA: 155] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 01/02/2023]
Abstract
Obesity is considered a principal public health concern and ranked as the fifth foremost reason for death globally. Overweight and obesity are one of the main lifestyle illnesses that leads to further health concerns and contributes to numerous chronic diseases, including cancers, diabetes, metabolic syndrome, and cardiovascular diseases. The World Health Organization also predicted that 30% of death in the world will be initiated with lifestyle diseases in 2030 and can be stopped through the suitable identification and addressing of associated risk factors and behavioral involvement policies. Thus, detecting and diagnosing obesity as early as possible is crucial. Therefore, the machine learning approach is a promising solution to early predictions of obesity and the risk of overweight because it can offer quick, immediate, and accurate identification of risk factors and condition likelihoods. The present study conducted a systematic literature review to examine obesity research and machine learning techniques for the prevention and treatment of obesity from 2010 to 2020. Accordingly, 93 papers are identified from the review articles as primary studies from an initial pool of over 700 papers addressing obesity. Consequently, this study initially recognized the significant potential factors that influence and cause adult obesity. Next, the main diseases and health consequences of obesity and overweight are investigated. Ultimately, this study recognized the machine learning methods that can be used for the prediction of obesity. Finally, this study seeks to support decision-makers looking to understand the impact of obesity on health in the general population and identify outcomes that can be used to guide health authorities and public health to further mitigate threats and effectively guide obese people globally.
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Affiliation(s)
- Mahmood Safaei
- Centre for Software Technology and Management, Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia (UKM), Bangi, 43600, Selangor, Malaysia
| | - Elankovan A Sundararajan
- Centre for Software Technology and Management, Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia (UKM), Bangi, 43600, Selangor, Malaysia.
| | - Maha Driss
- RIADI Laboratory, University of Manouba, Manouba, Tunisia; College of Computer Science and Engineering, Taibah University, Medina, Saudi Arabia
| | - Wadii Boulila
- RIADI Laboratory, University of Manouba, Manouba, Tunisia; College of Computer Science and Engineering, Taibah University, Medina, Saudi Arabia
| | - Azrulhizam Shapi'i
- Center for Artificial Intelligence Technology, Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia (UKM), Bangi, 43600, Selangor, Malaysia
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20
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Lee RE, Parker NH, Hallett AM, Kao D, Modelska MJ, Rifai HS, Soltero EG, O'Connor DP. Stakeholder perspectives and sustainability of an integrated care model for the prevention and management of obesity: the Childhood Obesity Research Demonstration (CORD) project. Transl Behav Med 2021; 11:393-407. [PMID: 32667038 DOI: 10.1093/tbm/ibaa058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although reliable strategies exist to promote healthy habits that reduce childhood obesity, the sustainability of these strategies remains an ongoing public health challenge. This study aimed to identify factors experienced in a large, multisite project aimed at reducing childhood obesity that might contribute to project sustainability. Hypothesized constructs underpinning sustainability included replicability, continuation of benefits, institutionalization, and community capacity. Key informants (n = 27) completed 60 min, in-depth interviews, which were audio recorded and transcribed. Transcripts were first coded using a combined deductive and inductive approach. Four major themes emerged (with numerous subthemes): developing partnerships, challenges to the sustainability of implemented programming, the importance of intervening in multiple settings, and ongoing implementation and evaluation strategies. Replicability of complex childhood obesity interventions is possible when there are strong partnerships. Benefits can continue to be conferred from programming, particularly when evidence-based strategies are used that employ best practices. Implementation is facilitated by institutionalization and policies that buffer challenges, such as staffing or leadership changes. Community capacity both enhances the sustainability of interventions and develops as a result of strengthening partnerships and policies that support childhood obesity programming.
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Affiliation(s)
- Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Nathan H Parker
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Allen M Hallett
- Department of Epidemiology, Human Genetics and Environmental Sciences, Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX, USA
| | - Dennis Kao
- School of Social Work, Carleton University, Ottawa, Ontario, Canada
| | - Maria J Modelska
- Department of Civil and Environmental Engineering, Cullen College of Engineering, University of Houston, Houston, TX, USA
| | - Hanadi S Rifai
- Department of Civil and Environmental Engineering, Cullen College of Engineering, University of Houston, Houston, TX, USA
| | - Erica G Soltero
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA
| | - Daniel P O'Connor
- Department of Health and Human Performance, HEALTH Research Institute, University of Houston, Houston, TX, USA
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21
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Simione M, Farrar-Muir H, Mini FN, Perkins ME, Luo M, Frost H, Orav EJ, Metlay J, Zai AH, Kistin CJ, Sease K, Hambidge SJ, Taveras EM. Implementation of the Connect for Health pediatric weight management program: study protocol and baseline characteristics. J Comp Eff Res 2021; 10:881-892. [PMID: 34024120 PMCID: PMC8411392 DOI: 10.2217/cer-2021-0076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We are implementing Connect for Health, a primary care-based intervention to improve family-centered outcomes for children, ages 2–12 years, in organizations that care for low-income children. We will use the ‘Reach-Effectiveness-Adoption-Implementation-Maintenance’ framework to guide our mixed-methods evaluation to examine the effectiveness of stakeholder-informed strategies in supporting program adoption and child outcomes. We also describe characteristics of children, ages 2–12 years with a BMI ≥85th percentile and obesity-related care practices. During the period prior to implementation, 26,161 children with a BMI ≥85th percentile were seen for a primary care visit and a majority lacked recommended diagnosis codes, referrals and laboratory evaluations. The findings suggest the need to augment current approaches to increase uptake of proven-effective weight management programs. Clinical trial registration number: NCT04042493(Clinicaltrials.gov), Registered on 2 August 2019; https://clinicaltrials.gov/ct2/show/NCT04042493.
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Affiliation(s)
- Meg Simione
- Division of General Pediatrics, MassGeneral Hospital for Children, Boston, MA 02114, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Haley Farrar-Muir
- Division of General Pediatrics, MassGeneral Hospital for Children, Boston, MA 02114, USA
| | - Fernanda Neri Mini
- Division of General Pediatrics, MassGeneral Hospital for Children, Boston, MA 02114, USA
| | - Meghan E Perkins
- Division of General Pediatrics, MassGeneral Hospital for Children, Boston, MA 02114, USA
| | - Man Luo
- Division of General Pediatrics, MassGeneral Hospital for Children, Boston, MA 02114, USA
| | - Holly Frost
- Primary Care - Pediatric Service, Denver Health, Denver, CO 80204, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - E John Orav
- Department of Medicine, Brigham & Women's Hospital, Boston, MA 02114, USA
| | - Joshua Metlay
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Adrian H Zai
- Laboratory of Computer Science, Massachusetts General Hospital, MA 02114, USA
| | - Caroline J Kistin
- Department of Pediatrics, Boston University School of Medicine, Boston, MA 02118, USA.,Department of Pediatrics, Prisma Health, Greenville, SC 29605, USA
| | - Kerry Sease
- Prisma Health, Greenville, SC 29605, USA.,Department of Pediatrics, University of South Carolina School of Medicine, Greenville, SC 29605, USA
| | - Simon J Hambidge
- Primary Care - Pediatric Service, Denver Health, Denver, CO 80204, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Elsie M Taveras
- Division of General Pediatrics, MassGeneral Hospital for Children, Boston, MA 02114, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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22
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Halpern B, Louzada MLDC, Aschner P, Gerchman F, Brajkovich I, Faria-Neto JR, Polanco FE, Montero J, Juliá SMM, Lotufo PA, Franco OH. Obesity and COVID-19 in Latin America: A tragedy of two pandemics-Official document of the Latin American Federation of Obesity Societies. Obes Rev 2021; 22:e13165. [PMID: 33230898 PMCID: PMC7753730 DOI: 10.1111/obr.13165] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/12/2020] [Indexed: 12/25/2022]
Abstract
In May 2020, Latin America became the epicenter of the COVID-19 pandemic, a region already afflicted by social disparities, poor healthcare access, inadequate nutrition and a large prevalence of noncommunicable chronic diseases. Obesity and its comorbidities are increasingly prevalent in Latin America, with a more rapid growth in individuals with lower income, and currently a disease associated with COVID-19 severity, complications and death. In this document, the Latin American Association of Obesity Societies and collaborators present a review of the burden of two pandemics in Latin America, discuss possible mechanisms that explain their relationship with each other and provide public health and individual recommendations, as well as questions for future studies.
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Affiliation(s)
- Bruno Halpern
- Executive Committee, Latin American Federation of Obesity Societies (FLASO), Executive Committee, Santo Domingo, Dominican Republic.,Obesity Group, Department of Endocrinology, University of São Paulo, São Paulo, Brazil.,Weight Control Center, Hospital 9 de Julho, São Paulo, Brazil
| | - Maria Laura da Costa Louzada
- School of Public Health, University of São Paulo, São Paulo, Brazil.,Center of Epidemiology Research on Nutrition and Health, University of São Paulo, São Paulo, Brazil
| | - Pablo Aschner
- Javeriana University School of Medicine, San Ignacio University Hospital, Bogotá, Colombia
| | - Fernando Gerchman
- Internal Medicine Department, Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul. Endocrine and Metabolism Division, Hospital de Clínicas, Porto Alegre, Brazil
| | - Imperia Brajkovich
- Department of Internal Medicine B-School of Medicine "Luis Razetti", University Hospital of Caracas-Universidad Central de Venezuela, Caracas, Venezuela
| | - José Rocha Faria-Neto
- Center for Clinical and Epidemiological Research (EpiCenter), School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Felix Escaño Polanco
- Executive Committee, Latin American Federation of Obesity Societies (FLASO), Executive Committee, Santo Domingo, Dominican Republic
| | - Julio Montero
- Executive Committee, Latin American Federation of Obesity Societies (FLASO), Executive Committee, Santo Domingo, Dominican Republic.,Executive Committee, Argentinian Society of Obesity and Alimentary Disorders, Buenos Aires, Argentina
| | - Silvia María Marín Juliá
- Executive Committee, Latin American Federation of Obesity Societies (FLASO), Executive Committee, Santo Domingo, Dominican Republic.,Obesity Group, Universidad de Ciencias Médicas de La Habana, Havana, Cuba
| | - Paulo Andrade Lotufo
- Department of Internal Medicine, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Oscar H Franco
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Wang L, Shang C, Pan H, Yang H, Zhu H, Gong F. MicroRNA Expression Profiles in the Subcutaneous Adipose Tissues of Morbidly Obese Chinese Women. Obes Facts 2021; 14:1-15. [PMID: 33550286 PMCID: PMC7983571 DOI: 10.1159/000511772] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/20/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Obesity is a main global health issue and an outstanding cause of morbidity and mortality. Exploring miRNA profiling may help further studies on obesity. METHODS Three morbidly obese and 5 normal-weight Chinese women were enrolled in the microarray testing group. Abdominal subcutaneous adipose tissue (SAT) samples were excised. Total RNAs including miRNAs were extracted. Affymetrix GeneChip miRNA 4.0 Array was used to compare the expression profiles of miRNAs between the 2 groups. Two algorithms, miRanda and TargetScan, were used to predict target messenger RNAs (mRNAs). Bioinformatics analysis was then done based on the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) databases. The sample sizes were further expanded to 8 morbidly obese and 9 normal-weight subjects, and quantitative real-time PCR (qRT-PCR) was utilized to verify the expression of differential miRNAs and target genes. RESULTS As per the microarray assay, 58 miRNAs were differentially expressed in the SAT from the morbidly obese and normal-weight groups (Fold >4, p < 0.01, FDR <0.05); 54 of these were downregulated and 4 were upregulated in morbidly obese subjects. A total of 1,333 target genes were jointly predicted by miRanda and TargetScan. Further bioinformatics analysis showed that the differential miRNAs were involved in 269 significant biological functions and 89 significant signaling pathways. The validation experiment by qRT-PCR showed that the expression levels of miRNA-143-5p, miRNA-143-3p, miRNA-145-5p, and let-7a-5p were downregulated in morbidly obese subjects, consistent with the microarray detection. High-mobility group A2 (HMGA2), a target gene of the downregulated miRNA let-7a-5p, was first found to be upregulated 3.19-fold in the SAT of morbidly obese Chinese women when compared to normal-weight controls. CONCLUSIONS MiRNA downregulation is a hallmark of intact SAT in a morbidly obese state. Transcription (DNA-dependent), small-molecule metabolic processes, the MAPK signaling pathway, and cancer-related pathways may play important roles in the occurrence and development of obesity. For the first time, we proved that HMGA2, a target gene of let-7a-5p, is upregulated in the SAT of morbidly obese Chinese women.
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Affiliation(s)
- Linjie Wang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Chen Shang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hui Pan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hongbo Yang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Fengying Gong
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China,
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Pearce C, Rychetnik L, Wilson A. The obesity paradigm and the role of health services in obesity prevention: a grounded theory approach. BMC Health Serv Res 2021; 21:111. [PMID: 33526017 PMCID: PMC7851945 DOI: 10.1186/s12913-021-06089-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 01/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background Health services have a clear role in the treatment of obesity and diseases linked to obesity but a less well-established role in prevention, particularly in hospital and community-based health services. Methods The aim of this research was to examine whether and how hospital and community-based health services incorporate adult obesity prevention into policy and practice. The case study setting was an Australian based health service. Grounded theory informed all aspects of the research including participant recruitment, data collection and data analysis. A systems approach guided the analysis of diverse perspectives, relationships and interconnections within the study context. Results The prevailing paradigm within the health service is that obesity is a matter of choice. This dominant perspective combined with a disease focused medical model overly simplifies the complex issue of obesity and reinforces the paradigm which treats obesity as a matter of individual responsibility. A focus on individual change hinders health services from playing an effective role in obesity prevention and leads to unintended consequences, including increasing stigma. Conclusions Health service responses to obesity and its prevention compound the negative elements associated with obesity for individuals and are ineffective in creating positive change at individual or a societal level. An alternative systems-level approach is needed to align health service responses with contemporary approaches that address obesity prevention as a complex problem.
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Affiliation(s)
- Claire Pearce
- Canberra Health Services, Canberra, Australia. .,The Australian Prevention Partnership Centre, Sydney, Australia. .,Menzies Centre for Health Policy, University of Sydney, Sydney, Australia.
| | - Lucie Rychetnik
- The Australian Prevention Partnership Centre, Sydney, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Andrew Wilson
- The Australian Prevention Partnership Centre, Sydney, Australia.,Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
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25
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Kling SM, Harris HA, Marini M, Cook A, Hess LB, Lutcher S, Mowery J, Bell S, Hassink S, Hayward SB, Johnson G, Franceschelli Hosterman J, Paul IM, Seiler C, Sword S, Savage JS, Bailey-Davis L. Advanced Health Information Technologies to Engage Parents, Clinicians, and Community Nutritionists in Coordinating Responsive Parenting Care: Descriptive Case Series of the Women, Infants, and Children Enhancements to Early Healthy Lifestyles for Baby (WEE Baby) Care Randomized Controlled Trial. JMIR Pediatr Parent 2020; 3:e22121. [PMID: 33231559 PMCID: PMC7723742 DOI: 10.2196/22121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/08/2020] [Accepted: 10/25/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Socioeconomically disadvantaged newborns receive care from primary care providers (PCPs) and Women, Infants, and Children (WIC) nutritionists. However, care is not coordinated between these settings, which can result in conflicting messages. Stakeholders support an integrated approach that coordinates services between settings with care tailored to patient-centered needs. OBJECTIVE This analysis describes the usability of advanced health information technologies aiming to engage parents in self-reporting parenting practices, integrate data into electronic health records to inform and facilitate documentation of provided responsive parenting (RP) care, and share data between settings to create opportunities to coordinate care between PCPs and WIC nutritionists. METHODS Parents and newborns (dyads) who were eligible for WIC care and received pediatric care in a single health system were recruited and randomized to a RP intervention or control group. For the 6-month intervention, electronic systems were created to facilitate documentation, data sharing, and coordination of provided RP care. Prior to PCP visits, parents were prompted to respond to the Early Healthy Lifestyles (EHL) self-assessment tool to capture current RP practices. Responses were integrated into the electronic health record and shared with WIC. Documentation of RP care and an 80-character, free-text comment were shared between WIC and PCPs. A care coordination opportunity existed when the dyad attended a WIC visit and these data were available from the PCP, and vice versa. Care coordination was demonstrated when WIC or PCPs interacted with data and documented RP care provided at the visit. RESULTS Dyads (N=131) attended 459 PCP (3.5, SD 1.0 per dyad) and 296 WIC (2.3, SD 1.0 per dyad) visits. Parents completed the EHL tool prior to 53.2% (244/459) of PCP visits (1.9, SD 1.2 per dyad), PCPs documented provided RP care at 35.3% (162/459) of visits, and data were shared with WIC following 100% (459/459) of PCP visits. A WIC visit followed a PCP visit 50.3% (231/459) of the time; thus, there were 1.8 (SD 0.8 per dyad) PCP to WIC care coordination opportunities. WIC coordinated care by documenting RP care at 66.7% (154/231) of opportunities (1.2, SD 0.9 per dyad). WIC visits were followed by a PCP visit 58.9% (116/197) of the time; thus, there were 0.9 (SD 0.8 per dyad) WIC to PCP care coordination opportunities. PCPs coordinated care by documenting RP care at 44.0% (51/116) of opportunities (0.4, SD 0.6 per dyad). CONCLUSIONS Results support the usability of advanced health information technology strategies to collect patient-reported data and share these data between multiple providers. Although PCPs and WIC shared data, WIC nutritionists were more likely to use data and document RP care to coordinate care than PCPs. Variability in timing, sequence, and frequency of visits underscores the need for flexibility in pragmatic studies. TRIAL REGISTRATION ClinicalTrials.gov NCT03482908; https://clinicaltrials.gov/ct2/show/NCT03482908. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12887-018-1263-z.
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Affiliation(s)
- Samantha Mr Kling
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, United States
- Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States
- Geisinger Obesity Institute, Geisinger, Danville, PA, United States
| | - Holly A Harris
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, United States
- Erasmus Medical Center, Generation R Study, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Michele Marini
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, United States
| | - Adam Cook
- Geisinger Obesity Institute, Geisinger, Danville, PA, United States
| | - Lindsey B Hess
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, United States
| | - Shawnee Lutcher
- Geisinger Obesity Institute, Geisinger, Danville, PA, United States
| | - Jacob Mowery
- Geisinger Obesity Institute, Geisinger, Danville, PA, United States
| | - Scott Bell
- Bureau of Women, Infants, and Children, Pennsylvania Department of Health, Harrisburg, PA, United States
| | - Sandra Hassink
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Wilmington, DE, United States
| | - Shannon B Hayward
- Maternal and Family Health Services, Wilkes-Barre, PA, United States
| | - Greg Johnson
- Bureau of Women, Infants, and Children, Pennsylvania Department of Health, Harrisburg, PA, United States
| | | | - Ian M Paul
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | | | - Shirley Sword
- Bureau of Women, Infants, and Children, Pennsylvania Department of Health, Harrisburg, PA, United States
| | - Jennifer S Savage
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, United States
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Lisa Bailey-Davis
- Geisinger Obesity Institute, Geisinger, Danville, PA, United States
- Department of Population Health Sciences, Geisinger, Danville, PA, United States
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Sullivan P, Kincaid Z. Obesity as a chronic care challenge: new opportunities for social work practice. SOCIAL WORK IN HEALTH CARE 2020; 59:470-484. [PMID: 32643595 DOI: 10.1080/00981389.2020.1790079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/12/2020] [Accepted: 06/27/2020] [Indexed: 06/11/2023]
Abstract
While perhaps not garnering the attention of conditions like cancer or heart disease, or behavioral health conditions such as addiction and mental illness, obesity is emerging as a major health concern across the globe. While statistics vary, reports indicate that upwards of 2/3 of Americans can be considered overweight, while more than 30% can be labeled as obese. In recent years, obesity has become increasingly characterized as a chronic health condition, and as such, it is important to take a comprehensive, and long-term approach to care. Social workers should play a central role in reconfigured models of obesity care and given a growing recognition of this as an emerging social problem, such involvement is both needed, and appropriate.
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Affiliation(s)
| | - Zoraida Kincaid
- Social Work, Indiana University , Indianapolis, Indiana, USA
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27
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Jané-Llopis E, Anderson P, Piazza M, O'Donnell A, Gual A, Schulte B, Pérez Gómez A, de Vries H, Natera Rey G, Kokole D, V Bustamante I, Braddick F, Mejía Trujillo J, Solovei A, Pérez De León A, Kaner EF, Matrai S, Manthey J, Mercken L, López-Pelayo H, Rowlands G, Schmidt C, Rehm J. Implementing primary healthcare-based measurement, advice and treatment for heavy drinking and comorbid depression at the municipal level in three Latin American countries: final protocol for a quasiexperimental study (SCALA study). BMJ Open 2020; 10:e038226. [PMID: 32723746 PMCID: PMC7390229 DOI: 10.1136/bmjopen-2020-038226] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Eva Jané-Llopis
- ESADE Business School, Ramon Llull University, Barcelona, Catalunya, Spain
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, CAMH, Toronto, Ontario, Canada
| | - Peter Anderson
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Marina Piazza
- Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Antoni Gual
- Addiction Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Red de Trastornos Adictivos, Instituto Carlos III, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Bernd Schulte
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | | | - Hein de Vries
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Guillermina Natera Rey
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico, DF, Mexico
| | - Daša Kokole
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Ines V Bustamante
- Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Fleur Braddick
- Addiction Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | | | - Adriana Solovei
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Alexandra Pérez De León
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico, DF, Mexico
| | - Eileen Fs Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Silvia Matrai
- Addiction Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
| | - Jakob Manthey
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Liesbeth Mercken
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Hugo López-Pelayo
- Addiction Unit, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain
- Red de Trastornos Adictivos, Instituto Carlos III, Madrid, Spain
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Gillian Rowlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christiane Schmidt
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, CAMH, Toronto, Ontario, Canada
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
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A community-based positive psychology group intervention to promote physical activity among people with metabolic syndrome: Proof of concept results to inform a pilot randomized controlled trial protocol. Contemp Clin Trials Commun 2020; 19:100626. [PMID: 32715153 PMCID: PMC7363607 DOI: 10.1016/j.conctc.2020.100626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/06/2020] [Accepted: 07/13/2020] [Indexed: 01/10/2023] Open
Abstract
Background Community-based physical activity interventions can offset the burden of developing chronic diseases. Positive psychology (PP) interventions may improve health behaviors, but little is known about their effectiveness in community-based prevention settings. A multilevel PP-based intervention has never been studied in people at risk for chronic diseases. Purpose The aim of the trial is to demonstrate feasibility, acceptability, and improve physical activity. The purpose is to describe the theory, design, and rationale of the randomized controlled trial (RCT) phase of an iteratively developed physical activity intervention for metabolic syndrome. The feasibility results of the proof-of-concept phase are presented. Methods Participants are adult primary care patients at community health centers with metabolic syndrome and low physical activity (target n = 64). The 8-week group intervention consists of weekly physical activity goal-setting and self-monitoring, positive psychology activities, and neighborhood walks. Participants rate feasibility and acceptability of sessions. Pre-post-intervention, and 24 weeks later, participants complete accelerometers, questionnaires, and biometrics. Feasibility results Eight participants enrolled and seven completed. The median number of group sessions attended was 7 out of 8. Average ease and usefulness of sessions were rated as 7.0 (±0.5)/10 and 8.1 (±1.0)/10, respectively, indicating feasibility and acceptability. Average pre-post physical activity increased by 2152 steps and 29.25 min of MVPA/week. Discussion This proof-of-concept trial demonstrated high feasibility and acceptability, with increased physical activity. These positive findings suggest that the RCT phase will show high feasibility, acceptability, and initial impact on physical activity.
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Treatment burden as a predictor of self-management adherence within the primary care population. Appl Nurs Res 2020; 54:151301. [PMID: 32650885 DOI: 10.1016/j.apnr.2020.151301] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE We aimed to (1) describe the amount of treatment burden experienced in the primary care population diagnosed with chronic conditions and (2) examine if cumulative and task-specific treatment burden were predictors of medication, exercise, and dietary adherence in patients diagnosed with chronic conditions. DESIGN We conducted a prospective, descriptive, cross-sectional study. METHODS We enrolled 149 men and women from a single primary care clinic. Participants completed self-report surveys with data collected between September 2019 and December 2019. Our primary statistical analyses consisted of multivariate regression modeling. RESULTS The sample experience a moderate amount of treatment burden (M = 38.22; SD = 31.83). We found strong, negative correlations between both cumulative and task-specific burden in relation to medication, exercise, and dietary adherence (p < .001). Significant multivariate models (p < .001), controlling for sample demographics, demonstrated cumulative treatment burden predicted medication adherence, whereas task-specific burden predicted medication, exercise, and dietary adherence outcomes, with model effect sizes ranging from moderate (0.20) to large (0.54). CONCLUSIONS Results demonstrate higher levels of cumulative and task-specific treatment burden predict medication, exercise, and dietary adherence within a sample diagnosed with various chronic conditions. These findings indicate the potential for using treatment burden screening in the clinical setting to identify individuals at risk for poor self-management adherence. Treatment burden screening also enables the provider to determine areas of high burden affecting self-management adherence in order to design an effective treatment plan using targeted interventions, resources, or education to reduce patient burden in order to improve adherence.
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LeRouge CM, Hah H, Deckard GJ, Jiang H. Designing for the Co-Use of Consumer Health Technology in Self-Management of Adolescent Overweight and Obesity: Mixed Methods Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e18391. [PMID: 32597788 PMCID: PMC7367539 DOI: 10.2196/18391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/05/2020] [Accepted: 05/14/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Overweight and obesity in adolescents has reached epidemic proportions in the United States. Consumer health technology (CHT) can serve as a behavioral and social support tool for the management of overweight in adolescence. Recognizing CHT as a social support tool during design enables input from multiple stakeholders who engage in shared co-use to reinforce and empower adolescents in their self-management efforts. OBJECTIVE This study aimed to explore design requirements and enabling factors for the use of CHT as a social support tool for patients (as primary users) and parents and health care providers (as co-users). Our model incorporates key components of the unified theory of acceptance and use of technology (UTAUT) within the framework of the obesity care model (OCM) by recognizing patient self-management as the central process with the influence of their care support network on CHT use and outcomes. METHODS This study was part of a larger two-staged usability study combining focus group, semistructured interviews, and usability walkthroughs of CHT mockups from adolescents (BMI in the 85th-99th percentile range), parents, and physicians. In phase 1, 48 adolescents between the ages of 12 and 17 years, 10 of their parents, and 6 health care providers participated in identifying design requirements and enabling factors for the use of a potential CHT. In phase 2, 70 adolescents and 10 health care providers evaluated the CHT mockups and indicated enabling factors and willingness to use the proposed CHT. RESULTS Our qualitative analysis identified adolescents' intention for the use of CHT in alignment with UTAUT elements of performance expectancy, effort expectancy, and facilitating conditions. Our reconceptualization of social influence identified the expectations and envisioned roles of parents and health care providers as co-users and influencing factors on the co-use of CHT in managing overweight in adolescence. Parents were expected to monitor, to provide guidance and motivation, and to suggest modifications in daily habits, for example, recipes and meals, whereas health care providers were expected to encourage and monitor progress in a clinical setting. These expected roles and co-use patterns were congruent among all 3 stakeholders; the co-use of CHT was desired to be minimally invasive for parents and health care providers and controlled by the adolescents. CONCLUSIONS Our study integrates and extends the perspectives of 2 seminal models to explore design features and social influence roles for the successful user-centered design of CHT for weight self-management in adolescents. Although the co-users (ie, adolescents, parents, health care providers) suggested differing features consistent with their roles, role definitions were congruent. All users recognized the adolescent as the primary user with differential, supportive use from parents and health care providers. This multistakeholder approach can guide successful CHT design that reinforces the collective perspective of self-management.
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Affiliation(s)
- Cynthia M LeRouge
- Department of Information Systems and Business Analytics, Florida International University, Miami, FL, United States
| | - Hyeyoung Hah
- Department of Information Systems and Business Analytics, Florida International University, Miami, FL, United States
| | - Gloria J Deckard
- Department of Information Systems and Business Analytics, Florida International University, Miami, FL, United States
| | - Haoqiang Jiang
- College of Informatics, Northern Kentucky University, Highland Heights, KY, United States
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Power T, Kelly R, Usher K, East L, Travaglia J, Robertson H, Wong A, Jackson D. Living with diabetes and disadvantage: A qualitative, geographical case study. J Clin Nurs 2020; 29:2710-2722. [PMID: 32298498 DOI: 10.1111/jocn.15295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 02/22/2020] [Accepted: 04/07/2020] [Indexed: 12/29/2022]
Abstract
AIMS AND OBJECTIVES To elucidate the experiences of people living with diabetes, residing in an urban diabetogenic area. BACKGROUND Community-level social and environmental factors have a role to play in the development of type 2 diabetes mellitus. Socio-economic deprivation; high obesity rates; high access to fast foods; and multiculturalism contribute to higher rates of diabetes in some geographical areas. However, there is a lack of research examining people's experiences of living with diabetes in diabetogenic areas. The word diabetogenic implies that the phenomenon of interest contributes to the development of diabetes. DESIGN Qualitative, geographical case study approach. METHODS A convenience sample of 17 people living with diabetes in a diabetogenic, low-socio-economic urban area participated in face-to-face, semi-structured interviews. Interviews were audio-recorded, transcribed and analysed thematically. This paper adheres to the COREQ guidelines. FINDINGS Four main themes were identified: 1. Diabetes fatalism: Inevitability and inertia; 2. Living with Inequity: Literacy and intersectionality; 3. Impersonal services: Intimidating and overwhelming; and, 4. Education in the community: Access and anecdotes. CONCLUSIONS This study has highlighted the need to develop local solutions for local problems. In this geographical area, solutions need to address generally lower health literacy, how the community would prefer to receive diabetes education and the issue of diabetes fatalism. RELEVANCE TO CLINICAL PRACTICE Findings from this study have highlighted a need to re-examine how diabetes education is delivered in communities that are already experiencing multiple disadvantages. There are research and practice connotations for how fatalism is positioned for people at high risk of developing diabetes.
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Affiliation(s)
- Tamara Power
- Faculty of Health, University of Technology Sydney (UTS), Broadway, NSW, Australia
| | - Ray Kelly
- Faculty of Health, University of Technology Sydney (UTS), Broadway, NSW, Australia
| | - Kim Usher
- School of Health, University of New England, Armidale, NSW, Australia
| | - Leah East
- School of Health, University of New England, Armidale, NSW, Australia
| | - Jo Travaglia
- Faculty of Health, University of Technology Sydney (UTS), Broadway, NSW, Australia
| | - Hamish Robertson
- Faculty of Health, University of Technology Sydney (UTS), Broadway, NSW, Australia
| | - Ann Wong
- Faculty of Health, University of Technology Sydney (UTS), Broadway, NSW, Australia
| | - Debra Jackson
- Faculty of Health, University of Technology Sydney (UTS), Broadway, NSW, Australia
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Lee RE, Kao D, Parker NH, Hallett AM, Kochi CY, Modelska MJ, Rifai HS, O'Connor DP. Evaluating sustainability in the Childhood Obesity Research Demonstration project: the model and process. ACTA ACUST UNITED AC 2020; 78:13. [PMID: 32082567 PMCID: PMC7017491 DOI: 10.1186/s13690-020-0397-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/30/2020] [Indexed: 02/08/2023]
Abstract
Background In the context of health-related interventions, sustainability is the capacity to maintain the changes resulting from the intervention. These can be improved policies, practices or trends intended to improve population health. The Childhood Obesity Research Demonstration (CORD) project was a multi-site, multi-intervention collaboration testing the Obesity Chronic Care Model with interventions for childhood obesity prevention and management. We present the model, definitions and methodology used for the cross-site sustainability evaluation of CORD. Methods We applied the Ecologic Model of Obesity to childhood obesity interventions to operationalize four sustainability constructs: replicability, continuation of benefits, institutionalization, and community capacity. We used a triangulation approach and employed mixed methods to assess sustainability constructs at each level of the Ecologic Model of Obesity: Micro, Meso, Exo and Macro. We constructed checklists to count and code intervention activities, use of evidence-based practices among providers, and environmental factors and policies hypothesized to influence intervention sustainability. We developed in-depth interviews for principal investigators and project leads. We applied the Wilder Collaboration Factors Inventory with key stakeholders. Results Lessons learned suggested that sustainability constructs should be clearly identified and operationalized a priori. Constructs must be flexible to account for differences between intervention plans and implementation to obtain robust and informative data. Conclusion Strong links are needed among researchers, program implementers and communities to accomplish consistent, robust and valuable data collection efforts to assure sustainable and healthy communities.
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Affiliation(s)
- Rebecca E Lee
- 1Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 N. 3rd St, Phoenix, AZ 85004 USA
| | - Dennis Kao
- 2School of Social Work, Carleton University, 509 Dunton Tower, 1125 Colonel By Drive, Ottawa, ON K1S 5B6 Canada
| | - Nathan H Parker
- 3Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Unit 1330, CPB3.3278, PO Box 301439, Houston, TX 77230 USA
| | - Allen M Hallett
- 4Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, 1616 Guadalupe St, Ste 6.300, Austin, TX 78701 USA
| | - Camila Y Kochi
- 5Department of Pharmacological & Pharmaceutical Sciences, University of Houston, 4849 Calhoun Rd. #5007A, Houston, TX 77204 USA
| | - Maria J Modelska
- 6Department of Civil and Environmental Engineering, Cullen College of Engineering, University of Houston, 4726 Calhoun, N107 Engineering Bldg 1, Houston, TX 77204 USA
| | - Hanadi S Rifai
- 6Department of Civil and Environmental Engineering, Cullen College of Engineering, University of Houston, 4726 Calhoun, N107 Engineering Bldg 1, Houston, TX 77204 USA
| | - Daniel P O'Connor
- 7Department of Health and Human Performance, HEALTH Research Institute, University of Houston, 3875 Holman St. Rm. 104 Garrison, Houston, TX 77204 USA
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Kokkvoll AS, Grimsgaard S, Flægstad T, Andersen LB, Ball GDC, Wilsgaard T, Njølstad I. No additional long-term effect of group vs individual family intervention in the treatment of childhood obesity-A randomised trial. Acta Paediatr 2020; 109:183-192. [PMID: 31240752 DOI: 10.1111/apa.14916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 06/14/2019] [Accepted: 06/24/2019] [Indexed: 12/29/2022]
Abstract
AIM Long-term evaluations of childhood obesity treatments are needed. We examined changes in weight and cardiometabolic risk 1 year after children completed individual family or group-based weight management interventions. METHODS In 2009-2010, 6- to 12-year-old children with overweight or obesity from Finnmark and Troms (Norway) were recruited after media coverage and randomised to 24 months of individual family (n = 49) or group intervention (n = 48). Individual family intervention included counselling by a paediatric hospital team and a public health nurse in the local community. Group intervention included meetings with other families and a multidisciplinary hospital team, weekly physical activity sessions and a family camp. The primary outcome body mass index (BMI) and cardiometabolic risk factors were analysed 12 months after intervention. RESULTS From baseline to 36 months, children's BMI increased 3.0 kg/m2 in individual family and 2.1 kg/m2 in group intervention (between-group -0.9kg/m2 , P = 0.096). Data were available from 62 children (64%). Between-group differences in C peptide (P = 0.01) were detected in favour of group intervention. Pooled data from both treatment groups showed continued decrease in BMI standard deviation score (P < 0.001). CONCLUSION No between-group difference in BMI was observed 12 months after intervention. Both groups combined showed sustained decrease in BMI standard deviation score.
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Affiliation(s)
- Ane Sofie Kokkvoll
- Department of Paediatrics Finnmark Hospital Trust Hammerfest Norway
- Paediatric Research Group, Faculty of Health Sciences UiT The Arctic University of Norway Tromsø Norway
| | - Sameline Grimsgaard
- Department of Community Medicine, Faculty of Health Sciences UiT The Arctic University of Norway Tromsø Norway
| | - Trond Flægstad
- Paediatric Research Group, Faculty of Health Sciences UiT The Arctic University of Norway Tromsø Norway
- Department of Paediatrics University Hospital of North Norway Tromsø Norway
| | - Lars Bo Andersen
- Faculty of Education, Arts and Sport Campus Sogndal Western Norway University of Applied Sciences Sogndal Norway
- Department of Sports Medicine Norwegian School of Sport Sciences Oslo Norway
| | - Geoff D. C. Ball
- Department of Paediatrics, Faculty of Medicine and Dentistry University of Alberta Edmonton Alberta Canada
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences UiT The Arctic University of Norway Tromsø Norway
| | - Inger Njølstad
- Department of Community Medicine, Faculty of Health Sciences UiT The Arctic University of Norway Tromsø Norway
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Hendryx M, Chojenta C, Byles JE. Obesity Risk Among Young Australian Women: A Prospective Latent Class Analysis. Obesity (Silver Spring) 2020; 28:154-160. [PMID: 31755240 DOI: 10.1002/oby.22646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/13/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Prospective studies on obesity incidence specifically among young adults have not been reported. This study examined risks of obesity incidence over 19 years among young women without obesity at baseline. METHODS Women aged 18 to 23 years at baseline (N = 8,177) were followed up every 2 to 3 years to ages 37 to 42 using the Australian Longitudinal Study on Women's Health. A latent class analysis identified obesity-risk classes based on time-dependent measures of income, education, physical activity, sleep quality, dietary behavior, depression, stressful events, and social functioning. Cox proportional hazards regression models examined associations between incident obesity and latent classes, controlling for covariates. RESULTS Four latent classes were identified, including a lower-risk referent class and classes characterized by poor exercise and diet, stress and low income, and multiple intermediate-level risks. Compared with the referent, all three risk classes had significantly higher obesity risk, with the highest risk in the stress and low-income group (hazard ratio = 2.22; 95% CI: 1.92-2.56). Individual risks associated with obesity included lower education, stressful life events, and lower vigorous physical activity. CONCLUSIONS Young women without baseline obesity were at risk of developing obesity when they experienced co-occurring behavioral, socioeconomic, and psychosocial risks. Both latent classes and individual risk indicators offer insights into prevention strategies.
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Affiliation(s)
- Michael Hendryx
- Department of Environmental and Occupational Health, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Catherine Chojenta
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, New South Wales, Australia
| | - Julie E Byles
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, New South Wales, Australia
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Community engagement and pediatric obesity: Incorporating social determinants of health into treatment. J Clin Transl Sci 2019; 4:279-285. [PMID: 33244407 PMCID: PMC7681165 DOI: 10.1017/cts.2019.447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Childhood obesity is a complex and multi-faceted problem, with contributors ranging from individual health behaviors to public policy. For clinicians who treat pediatric obesity, environmental factors that impact this condition in a child or family can be difficult to address in a clinical setting. Community-clinic partnerships are one method to address places and policies that influence a person’s weight and health; however, such partnerships are typically geared toward community-located health behavior change rather than the deeper social determinants of health (SDH), limiting effective behavioral change. Community-engaged research offers a framework for developing community-clinic partnerships to address SDH germane to obesity treatment. In this paper, we discuss the relationship between SDH and pediatric obesity treatment, use of community-clinic partnerships to address SDH in obesity treatment, and how community engagement can be a framework for creating and harnessing these partnerships. We present examples of programs begun by one pediatric obesity clinic using community-engagement principles to address obesity.
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Wolfenden L, Ezzati M, Larijani B, Dietz W. The challenge for global health systems in preventing and managing obesity. Obes Rev 2019; 20 Suppl 2:185-193. [PMID: 31317659 DOI: 10.1111/obr.12872] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/05/2019] [Accepted: 04/06/2019] [Indexed: 12/12/2022]
Abstract
Few health crises have been as predictable as the unfolding obesity pandemic. Clinical and public health services remain the front line of efforts to reduce the burden of obesity. While a range of clinical practice guidelines exist, the need for clinical interventions exceeds the capacity of health systems to provide care for those affected with obesity, and routine clinical practices fall far short of guidelines recommendations even in high-income countries. In this manuscript, we discuss current recommendations regarding obesity interventions and key challenges facing global health systems in managing the health needs of people with obesity. Improving the provision of obesity-related health care is a considerable challenge and will require changing existing perceptions of obesity as a matter of personal failure to its recognition as a disease, innovative approaches to health system reform, clinician capacity building and implementation support, a focus on prevention, and wise resource allocation. Leadership from governments, the medical profession, and patient and community groups to address the issues raised in this manuscript is urgently needed to address the growing health concern.
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Affiliation(s)
- Luke Wolfenden
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Local Health District, Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.,MRC-PHE Centre for Environment and Health, Imperial College London, London, UK.,WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK
| | - Bagher Larijani
- Diabetes Research Centre, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Centre, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - William Dietz
- Redstone Global Centre for Prevention and Wellness, George Washington University, Washington, DC, US
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Sharma AM, Bélanger A, Carson V, Krah J, Langlois M, Lawlor D, Lepage S, Liu A, Macklin DA, MacKay N, Pakseresht A, Pedersen SD, Ramos Salas X, Vallis M. Perceptions of barriers to effective obesity management in Canada: Results from the ACTION study. Clin Obes 2019; 9:e12329. [PMID: 31294535 PMCID: PMC6771494 DOI: 10.1111/cob.12329] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/28/2019] [Accepted: 06/03/2019] [Indexed: 12/24/2022]
Abstract
Obesity is a chronic disease with a significant and growing impact on Canadians. The "Awareness, Care and Treatment In Obesity MaNagement" (ACTION) Study investigated perceptions, attitudes and perceived barriers to obesity management among Canadian people with obesity (PwO), healthcare providers (HCPs) and employers. In this study adult PwO (body mass index ≥30 kg/m2 , based on self-reported height/weight), HCPs (physicians and allied HCPs managing PwO) and employers (≥20 employees; offering health insurance), completed online surveys between 3 August and 11 October 2017 in a cross-sectional design. Survey respondents (N = 2545) included 2000 PwO, 395 HCPs and 150 employers. Obesity was viewed as a "chronic medical condition" by most PwO (60%), HCPs (94%) and employers (71%) and deemed to have a large impact on overall health (74%, 78%, 81%, respectively). Many PwO (74%) believed weight management was their own responsibility. While PwO (55%) reportedly knew how to manage their weight, only 10% reported maintaining ≥10% weight reduction for >1 year. Despite low success rates, the most commonly reported effective long-term weight loss methods tried and/or recommended were "improvements in eating habits" (PwO 38%; HCP 63%) and "being more active" (PwO 39%; HCP 54%). PwO and HCPs reported very different perceptions of the quality and content of their interaction during obesity management discussions. These findings highlight the communication gaps and misunderstanding between PwO, HCPs and employers. This underscores the importance of, and need for, evidence-based management of obesity and a collaborative approach and understanding of the complex nature of this chronic disease.
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Affiliation(s)
- Arya M. Sharma
- Department of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada
| | - André Bélanger
- Le Groupe de Médecine Familiale ValcartierCourceietteQuebecCanada
| | | | - Jodi Krah
- Obesity CanadaNiagara RegionOntarioCanada
| | | | - Diana Lawlor
- Obesity and Bariatric SurgeryHalifaxNova ScotiaCanada
| | | | - Aiden Liu
- Novo Nordisk Canada Inc.MississaugaOntarioCanada
| | | | | | | | - Sue D. Pedersen
- C‐ENDO Diabetes and Endocrinology ClinicCalgaryAlbertaCanada
| | | | - Michael Vallis
- Department of Family MedicineDalhousie UniversityHalifaxNova ScotiaCanada
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Magliano DJ, Islam RM, Barr ELM, Gregg EW, Pavkov ME, Harding JL, Tabesh M, Koye DN, Shaw JE. Trends in incidence of total or type 2 diabetes: systematic review. BMJ 2019; 366:l5003. [PMID: 31511236 PMCID: PMC6737490 DOI: 10.1136/bmj.l5003] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess what proportions of studies reported increasing, stable, or declining trends in the incidence of diagnosed diabetes. DESIGN Systematic review of studies reporting trends of diabetes incidence in adults from 1980 to 2017 according to PRISMA guidelines. DATA SOURCES Medline, Embase, CINAHL, and reference lists of relevant publications. ELIGIBILITY CRITERIA Studies of open population based cohorts, diabetes registries, and administrative and health insurance databases on secular trends in the incidence of total diabetes or type 2 diabetes in adults were included. Poisson regression was used to model data by age group and year. RESULTS Among the 22 833 screened abstracts, 47 studies were included, providing data on 121 separate sex specific or ethnicity specific populations; 42 (89%) of the included studies reported on diagnosed diabetes. In 1960-89, 36% (8/22) of the populations studied had increasing trends in incidence of diabetes, 55% (12/22) had stable trends, and 9% (2/22) had decreasing trends. In 1990-2005, diabetes incidence increased in 66% (33/50) of populations, was stable in 32% (16/50), and decreased in 2% (1/50). In 2006-14, increasing trends were reported in only 33% (11/33) of populations, whereas 30% (10/33) and 36% (12/33) had stable or declining incidence, respectively. CONCLUSIONS The incidence of clinically diagnosed diabetes has continued to rise in only a minority of populations studied since 2006, with over a third of populations having a fall in incidence in this time period. Preventive strategies could have contributed to the fall in diabetes incidence in recent years. Data are limited in low and middle income countries, where trends in diabetes incidence could be different. SYSTEMATIC REVIEW REGISTRATION Prospero CRD42018092287.
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Affiliation(s)
- Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Rakibul M Islam
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | | | - Edward W Gregg
- Centres for Diseases Control and Prevention, Division of Diabetes Translation, Atlanta, GA, USA
- School of Public Health, Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Meda E Pavkov
- Centres for Diseases Control and Prevention, Division of Diabetes Translation, Atlanta, GA, USA
| | - Jessica L Harding
- Centres for Diseases Control and Prevention, Division of Diabetes Translation, Atlanta, GA, USA
| | - Maryam Tabesh
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Digsu N Koye
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
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Pearce C, Rychetnik L, Wutzke S, Wilson A. Obesity prevention and the role of hospital and community-based health services: a scoping review. BMC Health Serv Res 2019; 19:453. [PMID: 31277640 PMCID: PMC6612151 DOI: 10.1186/s12913-019-4262-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/14/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Control of obesity is an important priority to reduce the burden of chronic disease. Clinical guidelines focus on the role of primary healthcare in obesity prevention. The purpose of this scoping review is to examine what the published literature indicates about the role of hospital and community based health services in adult obesity prevention in order to map the evidence and identify gaps in existing research. METHODS Databases were searched for articles published in English between 2006 and 2016 and screened against inclusion and exclusion criteria. Further papers were highlighted through a manual search of the reference lists. Included papers evaluated interventions aimed at preventing overweight and obesity in adults that were implemented within and/or by hospital and community health services; were an empirical description of obesity prevention within a health setting or reported health staff perceptions of obesity and obesity prevention. RESULTS The evidence supports screening for obesity of all healthcare patients, combined with referral to appropriate intervention services but indicates that health professionals do not typically adopt this practice. As well as practical issues such as time and resourcing, implementation is impacted by health professionals' views about the causes of obesity and doubts about the benefits of the health sector intervening once someone is already obese. As well as lacking confidence or knowledge about how to integrate prevention into clinical care, health professional judgements about who might benefit from prevention and negative views about effectiveness of prevention hinder the implementation of practice guidelines. This is compounded by an often prevailing view that preventing obesity is a matter of personal responsibility and choice. CONCLUSIONS This review highlights that whilst a population health approach is important to address the complexity of obesity, it is important that the remit of health services is extended beyond medical treatment to incorporate obesity prevention through screening and referral. Further research into the role of health services in obesity prevention should take a systems approach to examine how health service structures, policy and practice interrelationships, and service delivery boundaries, processes and perspectives impact on changing models of care.
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Affiliation(s)
- Claire Pearce
- The Australian Prevention Partnership Centre, Sydney, NSW Australia
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW Australia
- Canberra Health Services, Canberra, ACT Australia
| | - Lucie Rychetnik
- The Australian Prevention Partnership Centre, Sydney, NSW Australia
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW Australia
- School of Medicine, University of Notre Dame, Sydney, Australia
| | - Sonia Wutzke
- The Australian Prevention Partnership Centre, Sydney, NSW Australia
| | - Andrew Wilson
- The Australian Prevention Partnership Centre, Sydney, NSW Australia
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW Australia
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Tucker KM, Ingram M, Doubleday K, Piper R, Carvajal SC. La Vida Buena (The Good Life) evaluation: a quasi experimental intervention of a community health worker-led family-based childhood obesity program for Latino children 5-8 years of age on the US-Mexico border. BMC Public Health 2019; 19:759. [PMID: 31200685 PMCID: PMC6570830 DOI: 10.1186/s12889-019-7081-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/31/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Due to multiple and interacting factors, Latino children are disproportionately at risk for overweight and obesity in the United States. Childhood obesity increases the risk for adverse physical and psychosocial outcomes throughout the lifespan. Intensive behavioral interventions recommended in primary care settings may not conform to current practices, and the most vulnerable populations are often unable to access these services. Community Health Workers (CHWs) offer a promising approach to bridging the gap between vulnerable communities and culturally competent services. La Vida Buena (The Good Life) is an 8-week family-focused intervention for Latino children 5-8 years old and their parents or caregivers who are patients at a Federally-Qualified Community Health Center (FQHC). It is a culturally and linguistically appropriate curriculum, facilitated by CHWs, that targets family behaviors to foster a healthy lifestyle in order to prevent and mitigate childhood overweight and obesity. METHODS The primary objective is to test the effectiveness of the La Vida Buena (LVB) childhood obesity program among Latino children 5-8 years old and their families as compared with a single educational session. This study uses a parallel two-arm quasi-experimental design. The intervention group receives the 8-week La Vida Buena intervention and the comparison group receives a single educational session. The primary outcome is the change in the child's BMI z-score from baseline to 6 months. DISCUSSION The implementation and evaluation of La Vida Buena may inform research and practice for linking Latino patients in FQHCs to culturally responsive community-based childhood obesity interventions. It will also contribute to the literature about CHWs as facilitators of behavior change for families underserved by health services and preventive programs. La Vida Buena can serve as a culturally and linguistically appropriate early intervention curriculum that will foster a healthy home environment for childhood obesity mitigation and prevention. TRIAL REGISTRATION The trial was retrospectively registered on December 18, 2018. The ClinicalTrials.gov Identifier is NCT03781856.
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Affiliation(s)
- Kathryn M. Tucker
- University of Arizona Prevention Research Center, 1295 N Martin Ave, Tucson, AZ USA
| | - Maia Ingram
- University of Arizona Prevention Research Center, 1295 N Martin Ave, Tucson, AZ USA
| | - Kevin Doubleday
- University of Arizona Prevention Research Center, 1295 N Martin Ave, Tucson, AZ USA
| | - Rosie Piper
- Mariposa Community Health Center, 1710 N Mastick Way, Nogales, AZ USA
| | - Scott C. Carvajal
- University of Arizona Prevention Research Center, 1295 N Martin Ave, Tucson, AZ USA
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Fastenau J, Kolotkin RL, Fujioka K, Alba M, Canovatchel W, Traina S. A call to action to inform patient-centred approaches to obesity management: Development of a disease-illness model. Clin Obes 2019; 9:e12309. [PMID: 30977293 PMCID: PMC6594134 DOI: 10.1111/cob.12309] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/25/2019] [Accepted: 03/12/2019] [Indexed: 02/06/2023]
Abstract
Patient-centred care is an essential component of high-quality health care, shown to improve clinical outcomes and patient satisfaction, and reduce costs. While there are several authoritative models of obesity pathophysiology and treatment algorithms, a truly patient-centred model is lacking. We describe the development of a patient-centric obesity model. A disease-illness framework was selected because it emphasizes each patient's unique experience while capturing biomedical aspects of the disease. Model input was obtained from an accumulation of research including contributions from experts in obesity and patient-reported outcomes, qualitative research with adults living in the United States, and two targeted literature searches. The model places the patient with obesity at its core and links pathologic imbalances of energy intake and expenditure to environmental, sociodemographic, psychological, behavioural, physiological and medical health determinants. It highlights relationships between obesity signs and symptoms, comorbid conditions, impacts on health-related quality of life, and some barriers to obesity management that must be considered to attain better outcomes. Providers need to evaluate patients holistically, understand what changes each patient is motivated to make, and recognize what challenges might impede weight reduction, improvements in comorbid conditions, signs and symptoms, and health-related quality of life before pursuing individualized treatment goals. Patients living with obesity who do lose weight perceive benefits beyond weight loss. Ideally, this model will increase awareness of the complex, heterogeneous impacts of obesity on patients' well-being and recognition of obesity as a chronic disease, and prompt a call to action among stakeholders to improve quality of care.
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Affiliation(s)
- John Fastenau
- Janssen Research & Development, LLCRaritanNew Jersey
| | - Ronette L. Kolotkin
- Quality of Life Consulting, PLLCDurhamNorth Carolina
- Department of Family Medicine and Community HealthDuke University School of MedicineDurhamNorth Carolina
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesFørdeNorway
- Centre of Health ResearchFørde Hospital TrustFørdeNorway
- Morbid Obesity CentreVestfold Hospital TrustTønsbergNorway
| | - Ken Fujioka
- Department of Diabetes and EndocrineScripps ClinicSan DiegoCalifornia
| | - Maria Alba
- Janssen Research & Development, LLCRaritanNew Jersey
| | | | - Shana Traina
- Janssen Research & Development, LLCRaritanNew Jersey
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Dietz WH. We Need a New Approach to Prevent Obesity in Low-Income Minority Populations. Pediatrics 2019; 143:peds.2019-0839. [PMID: 31126970 DOI: 10.1542/peds.2019-0839] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- William H Dietz
- Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
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Sherzai D, Sherzai A. Preventing Alzheimer's: Our Most Urgent Health Care Priority. Am J Lifestyle Med 2019; 13:451-461. [PMID: 31523210 DOI: 10.1177/1559827619843465] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Dementia is the fastest growing epidemic in the developed nations, and if not curtailed, it will single handedly collapse our health care system. The prevalence of dementia is 1 in 10 individuals older than 65 years and increases to 50% of all individuals older than 85 years. The prevalence of Alzheimer's dementia (AD), the most common form of dementia, has been increasing rapidly and is projected to reach 16 million individuals by the year 2050. Several prevailing myths about the science of dementia are discussed, such as that AD is inevitable and that it is exclusively a genetic disease. The fact is that AD is dependent on a multitude of genetic, epigenetic, and environmental factors that interact with one another. In fact, 4 core drivers represent 90% of what determines disease progression in AD. These are (1) glucose or energy dysregulation, (2) lipid dysregulation, (3) inflammation, and (4) oxidation. Lifestyle change can significantly alter the course of AD. The authors have created an acronym-NEURO-to help lifestyle practitioners and the public remember the most important lifestyle elements in the treatment and prevention of AD based on the evidence. "N" is for Nutrition, "E" for Exercise, "U" for Unwind (stress management), "R" for Restorative Sleep, and "O" for Optimizing mental and social activity. The evidence base for each of the components is reviewed.
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Affiliation(s)
- Dean Sherzai
- Department of Neurology, Alzheimer's Prevention Program, Loma Linda University Health, California
| | - Ayesha Sherzai
- Department of Neurology, Alzheimer's Prevention Program, Loma Linda University Health, California
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Haire-Joshu D, Hill-Briggs F. The Next Generation of Diabetes Translation: A Path to Health Equity. Annu Rev Public Health 2019; 40:391-410. [PMID: 30601723 DOI: 10.1146/annurev-publhealth-040218-044158] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Disparities in diabetes burden exist in large part because of the social determinants of health (SDOH). Translation research and practice addressing health equity in diabetes have generally focused on changing individual behavior or providing supportive approaches to compensate for, rather than directly target, SDOH. The purpose of this article is to propose a pathway for addressing SDOH as root causes of diabetes disparities and as an essential target for the next generation of interventions needed to achieve health equity in diabetes prevention and treatment. This review describes ( a) the current burden of diabetes disparities, ( b) the influence of SDOH on diabetes disparities, ( c) gaps in and implications of current translation research, and ( d) approaches to achieving health equity in the next generation of diabetes translation.
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Affiliation(s)
- Debra Haire-Joshu
- Public Health and Medicine, Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA;
| | - Felicia Hill-Briggs
- Departments of Medicine; Health, Behavior and Society; and Acute and Chronic Care; and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA;
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Arslanian S, Bacha F, Grey M, Marcus MD, White NH, Zeitler P. Evaluation and Management of Youth-Onset Type 2 Diabetes: A Position Statement by the American Diabetes Association. Diabetes Care 2018; 41:2648-2668. [PMID: 30425094 PMCID: PMC7732108 DOI: 10.2337/dci18-0052] [Citation(s) in RCA: 196] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Silva Arslanian
- Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, University of Pittsburgh, Pittsburgh, PA
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Fida Bacha
- Children's Nutrition Research Center, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Margaret Grey
- Yale School of Nursing, New Haven, CT
- Yale School of Medicine, New Haven, CT
| | | | - Neil H White
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Philip Zeitler
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO
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Affiliation(s)
- Debra Haire-Joshu
- The Brown School, Center for Obesity Prevention and Policy Research, Washington University in St Louis, St Louis, Missouri.,Department of Medicine, The School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Felicia Hill-Briggs
- Department of Medicine, Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Health, Behavior, and Society, Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Acute and Chronic Care, Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Kelly AS, Marcus MD, Yanovski JA, Yanovski SZ, Osganian SK. Working toward precision medicine approaches to treat severe obesity in adolescents: report of an NIH workshop. Int J Obes (Lond) 2018; 42:1834-1844. [PMID: 30283078 PMCID: PMC6461397 DOI: 10.1038/s41366-018-0231-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/16/2018] [Accepted: 09/11/2018] [Indexed: 02/06/2023]
Abstract
Adolescent severe obesity is a prevalent, chronic, and serious disease with few effective and safe treatment options. To address this issue, a National Institutes of Health-sponsored workshop entitled "Developing Precision Medicine Approaches to the Treatment of Severe Obesity in Adolescents," was convened, bringing together a multidisciplinary group of experts to review the current state of the science and identify (1) what is known regarding the epidemiology and biopsychosocial determinants of severe obesity in adolescents, (2) what is known regarding effectiveness of treatments for severe obesity in adolescents and predictors of response, and (3) gaps and opportunities for future research to develop more effective and targeted treatments for adolescents with severe obesity. Major topical areas discussed at the workshop included: appropriate BMI metrics, valid measures of phenotypes and predictors, mechanisms associated with the development of severe obesity, novel treatments informed by biologically and psychosocially plausible mechanisms, biopsychosocial phenotypes predicting treatment response, standardization of outcome measures and results reporting in research, and improving clinical care. Substantial gaps in knowledge were identified regarding the basic behavioral, psychosocial, and biological mechanisms driving the development of severe obesity and the influence of these factors on treatment response. Additional exploratory and observational studies are needed to better understand the heterogeneous etiology of severe obesity and explain the high degree of variability observed with interventions. Tailored treatment strategies that may be developed by achieving a better understanding of individual differences in genetic endowment, clinical, metabolic, psychological, and behavioral phenotypes, and response to environmental exposures need to be tested. It is anticipated that these recommendations for future research, including strategies to enhance methodological rigor, will advance precision medicine approaches to treat severe obesity in adolescents more effectively.
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Affiliation(s)
- Aaron S Kelly
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Marsha D Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jack A Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Susan Z Yanovski
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Stavroula K Osganian
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
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Wilfley DE, Hayes JF, Balantekin KN, Van Buren DJ, Epstein LH. Behavioral interventions for obesity in children and adults: Evidence base, novel approaches, and translation into practice. AMERICAN PSYCHOLOGIST 2018; 73:981-993. [PMID: 30394777 PMCID: PMC6220709 DOI: 10.1037/amp0000293] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Obesity in adults has nearly doubled in the past 30 years and has risen similarly in children and adolescents. Obesity affects all systems of the body, and the serious health consequences of obesity include an increased risk for cardiovascular disease, such as Type 2 diabetes or high blood pressure, which are occurring at ever younger ages. The present article introduces traditional behavioral weight loss strategies designed to change energy-balance behaviors (i.e., dietary and physical activity behaviors) and the contexts within which these interventions have typically been delivered. The applicability of findings from behavioral economics, cognitive processing, and clinical research that may lead to more potent weight loss and weight loss maintenance interventions are also considered. Given the pervasiveness of obesity, this article concludes with a discussion of efforts toward wider scale dissemination and implementation of behavioral treatments designed to address obesity and to reduce the risk of cardiovascular disease. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine
| | - Jacqueline F Hayes
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | | | | | - Leonard H Epstein
- Division of Behavioral Medicine, Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo
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Christison AL, Vaidya S, Tinajero-Deck L, Hampl SE. Application of the Medical Neighborhood to Children with Severe Obesity. Child Obes 2018; 14:461-467. [PMID: 30109953 DOI: 10.1089/chi.2017.0342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Growth in the prevalence of severe pediatric obesity and tertiary care pediatric weight management programs supports the application of chronic disease management models to the care of children with severe obesity. One such model, the medical neighborhood, aims to optimize care coordination between primary and tertiary care by applying principles of the Patient-Centered Medical Home to all providers. METHODS An exploration of the literature was performed describing effective programs, approaches, and coordinated care models applied to pediatric weight management and other chronic conditions. RESULTS Though there was a paucity of literature discovered with applications specific to pediatric weight management, relevant disease management and care coordination approaches were found. Proposed applications to the care of children with severe obesity can be made. CONCLUSION The application of the medical neighborhood framework, with its inclusion of healthcare and community partners, may optimize the management of children with severe obesity.
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Affiliation(s)
- Amy L Christison
- 1 Department of Pediatrics, University of Illinois College of Medicine at Peoria , Peoria, IL
| | - Susma Vaidya
- 2 Department of Pediatrics, Children's National Medical Center , Washington, DC
| | | | - Sarah E Hampl
- 4 Department of Pediatrics, Children's Mercy Hospital , Kansas City, MO
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Ludwig DS, Ebbeling CB. 90th Anniversary Commentary: Obesity among Offspring of US Immigrants: After 20 Years, a Need to Safeguard Children from the Obesogenic Environment. J Nutr 2018; 148:1674-1677. [PMID: 30281107 PMCID: PMC6669943 DOI: 10.1093/jn/nxy152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 06/03/2018] [Accepted: 06/26/2018] [Indexed: 01/03/2023] Open
Affiliation(s)
- David S Ludwig
- New Balance Foundation Obesity Prevention Center at Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Cara B Ebbeling
- New Balance Foundation Obesity Prevention Center at Boston Children's Hospital and Harvard Medical School, Boston, MA
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