A Digitally Enabled Combined Lifestyle Intervention for Weight Loss: Pilot Study in a Dutch General Population Cohort

BACKGROUND

Overweight and obesity rates among the general population of the Netherlands keep increasing. Combined lifestyle interventions (CLIs) focused on physical activity, nutrition, sleep, and stress management can be effective in reducing weight and improving health behaviors. Currently available CLIs for weight loss (CLI-WLs) in the Netherlands consist of face-to-face and community-based sessions, which face scalability challenges. A digitally enabled CLI-WL with digital and human components may provide a solution for this challenge; however, the feasibility of such an intervention has not yet been assessed in the Netherlands.

OBJECTIVE

The aim of this study was two-fold: (1) to determine how weight and other secondary cardiometabolic outcomes (lipids and blood pressure) change over time in a Dutch population with overweight or obesity and cardiometabolic risk participating in a pilot digitally enabled CLI-WL and (2) to collect feedback from participants to guide the further development of future iterations of the intervention.

METHODS

Participants followed a 16-week digitally enabled lifestyle coaching program rooted in the Fogg Behavior Model, focused on nutrition, physical activity, and other health behaviors, from January 2020 to December 2021. Participants could access the digital app to register and track health behaviors, weight, and anthropometrics data at any time. We retrospectively analyzed changes in weight, blood pressure, and lipids for remeasured users. Surveys and semistructured interviews were conducted to assess critical positive and improvement points reported by participants and health care professionals.

RESULTS

Of the 420 participants evaluated at baseline, 53 participated in the pilot. Of these, 37 (70%) were classified as overweight and 16 (30%) had obesity. Mean weight loss of 4.2% occurred at a median of 10 months postintervention. The subpopulation with obesity (n=16) showed a 5.6% weight loss on average. Total cholesterol decreased by 10.2% and low-density lipoprotein cholesterol decreased by 12.9% on average. Systolic and diastolic blood pressure decreased by 3.5% and 7.5%, respectively. Participants identified the possibility of setting clear action plans to work toward and the multiple weekly touch points with coaches as two of the most positive and distinctive components of the digitally enabled intervention. Surveys and interviews demonstrated that the digital implementation of a CLI-WL is feasible and well-received by both participants and health care professionals.

CONCLUSIONS

Albeit preliminary, these findings suggest that a behavioral lifestyle program with a digital component can achieve greater weight loss than reported for currently available offline CLI-WLs. Thus, a digitally enabled CLI-WL is feasible and may be a scalable alternative to offline CLI-WL programs. Evidence from future studies in a Dutch population may help elucidate the mechanisms behind the effectiveness of a digitally enabled CLI-WL.

Spectroscopic and structural studies, thermal characterization, optical proprieties and theoretical investigation of 2-aminobenzimidazolium tetrachlorocobaltate(II)

In this study we present the crystal structure, spectroscopic and thermal behavior, Hirshfeld surface analysis, and DFT calculations of a new organic-inorganic hybrid compound (C₇H₈N₃)₂[CoCl₄]. This compound crystallizes in the centrosymmetric space group P1¯. Single-crystal X-ray diffraction analysis indicates that structure consists of a succession of mixed layers formed by organic cations and inorganic anions parallel to the (001) plane and propagate according to the c-axis. Layers further are assembled into a 3D supramolecular architecture through N-H^…Cl hydrogen bonds and π^…π interactions. The peak positions of the experimental PXRD pattern are in agreement with the simulated ones from the crystal structure, indicating phase purity of the title compound. The presence of the different functional groups and the nature of their vibrations were identified by ATR-FTIR and FT-Raman spectroscopies. The tetrahedral environment of Co²⁺ was confirmed by UV-visible spectroscopy, where the spectrum shows three weak absorption bands in the visible range due to d-d electronic transitions ⁴A₂(F) → ⁴T₂(F), ⁴A₂(F) → ⁴T₁(F) and ⁴A₂(F) → ⁴T₁(P) typical of Co(II) coordination compounds. The direct and indirect optical band gap values were determined by Tauc method. The optimized structure and calculated vibrational frequencies were obtained by density functional theory (DFT) using B3LYP functional. TGA and DSC coupled to mass spectrometry (MS) experiments under argon atmosphere in the temperature range (25-950 °C) were carried out in order to determine the thermal stability of the title compound.

Seasonal drivers of tuberculosis: evidence from over 100 years of notifications in Cape Town

BACKGROUND: Tuberculosis incidence varies seasonally in many settings. However, the role of seasonal variation in reactivation vs. transmission is unclear.METHODS: We reviewed data on TB notifications in Cape Town, South Africa, from 1903 to 2017 (exclusive of 1995-2002, which were unavailable). Data from 2003 onward were stratified by HIV status, age and notification status (new vs. retreatment). We performed seasonal decomposition and time-dependent spectral analysis using wavelets to assess periodicity over time. We estimated monthly peak-to-peak seasonal amplitude of notifications as a percentage of the annual notification rate.RESULTS: A seasonal trend was intermittently detected between 1904 and 1994, particularly during periods of high notification rates, but was consistently and strongly evident between 2003 and 2017, with peaks in September through November, following winter. Among young children, a second, higher seasonal peak was observed in March. Seasonal variation was greater in children (<5 years, 54%, 95% CI 47-61; 5-14 years, 63%, 95% CI 58-69) than in adults (36%, 95% CI 33-39).CONCLUSIONS: Stronger seasonal effects were seen in children, in whom progression following recent infection is known to be the predominant driver of disease. These findings may support increased transmission in the winter as an important driver of TB in Cape Town.

Exploring the applicability of the CAM18sl brightness prediction

Recently, a color appearance model, CAM18sl, has been published. The model can predict the color perception (hue, colorfulness, brightness) of self-luminous stimuli seen against neutral backgrounds varying in luminance. In this paper, the applicability of CAM18sl to situations different from the one for which it was originally developed is explored. The brightness perception predicted by this model (expressed in "bright") is compared with the outcome of the CIE Unified Glare Rating (UGR) for luminaires, the limiting luminance values for Variable Message Signs as indicated in the European standard for outdoor situations, the visual gloss (VG) formula to characterize the gloss of objects, the CIE grey-scale calculation for self-luminous devices, and the predicted brightness value of illuminated objects according to CIECAM02. Although the application domains mentioned above are very distinct, it appears that the predicted brightness perception of the CAM18sl model correlates well with the outcome of the particular and dedicated metrics. It seems that, for brightness perception, CAM18sl can be considered as a general model applicable for a wide range of applications. This could lead to a reduction of a number of application-specific metrics.

Color appearance model for self-luminous stimuli

A model for brightness and hue perception of self-luminous stimuli surrounded by a self-luminous achromatic background has been developed based on a series of visual experiments. In the model, only the absolute spectral radiance values of the stimulus and background are used as input. Normalized cone excitations are calculated using the 10° Commission Internationale de l'Éclairage (CIE) 2006 cone fundamentals. A von Kries chromatic adaptation transform applied in the CIE 2006 cone space is adopted, and luminance compression and adaptation due to the self-luminous background are included by using a Michaelis-Menten function. Model parameters are determined by fitting the model to the experimental visual data obtained for brightness, hue, and the amount of color versus neutral. The model is validated with additional experimental data. An absolute brightness scale expressed in "bright" is proposed.

An integrated community TB-HIV adherence model provides an alternative to DOT for tuberculosis patients in Cape Town

SETTING

Cape Town, South Africa.

OBJECTIVE

To evaluate anti-tuberculosis treatment outcomes and rate of antiretroviral therapy (ART) initiation using weekly community-based adherence support compared to daily directly observed therapy (DOT).

METHODS

This was a retrospective analysis comparing two cohorts treated for tuberculosis (TB) in 70 TB clinics during 6-month periods before and after the introduction of a new adherence model comprising treatment literacy sessions during 2 weeks of DOT, followed by weekly home visits by community care workers to eligible patients managing their own treatment. Odds ratios (ORs) of treatment success and ART initiation were calculated using multivariable random effects logistic regression models. Hazard ratios (HRs) of default and death were calculated using multivariable random effects Cox regression models.

RESULTS

The pre-intervention cohort comprised 11 896 patients with TB and the post-intervention cohort 11 314. There was no difference in pre- and post-intervention anti-tuberculosis treatment success rates (respectively 82.8% and 82.5%, adjusted OR [aOR] 1.02, 95%CI 0.89-1.17, P = 0.76) nor an increased hazard of death (adjusted HR [aHR] 0.98, 95%CI 0.80-1.21, P = 0.87) or default (aHR 0.97, 95%CI 0.81-1.15, P = 0.69). The ART initiation rate increased from 67% to 74% (aOR 1.43; 95%CI 1.01-1.85, P < 0.01).

CONCLUSION

Weekly community-based adherence support was a viable alternative to daily DOT, with no deterioration in anti-tuberculosis treatment outcomes and an increase in ART initiation.

Low incidence of the immune reconstitution inflammatory syndrome among HIV-infected patients starting antiretroviral therapy in Gabon: a prospective cohort study

There is a paucity of data on the immune reconstitution inflammatory syndrome (IRIS) in the Central African region. We followed ART-naive HIV-infected patients initiating antiretroviral therapy in an HIV clinic in Gabon, for 6 months. Among 101 patients, IRIS was diagnosed in five. All IRIS cases were mucocutaneous manifestations. There were no cases of tuberculosis (TB) IRIS, but active TB (n = 20) was associated with developing other forms of IRIS (p = 0.02). Six patients died. The incidence of IRIS is low in Gabon, with mild, mucocutaneous manifestations.