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Yoong SL, Turon H, Wong CK, Bayles L, Finch M, Barnes C, Doherty E, Wolfenden L. An audit of the dissemination strategies and plan included in international food-based dietary guidelines. Public Health Nutr 2023; 26:2586-2594. [PMID: 37565494 DOI: 10.1017/s1368980023001714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Food-based dietary guidelines (FBDG) are an important resource to improve population health; however, little is known about the types of strategies to disseminate them. This study sought to describe dissemination strategies and content of dissemination plans that were available for FBDG. DESIGN A cross-sectional audit of FBDG with a published English-language version sourced from the United Nations FAO repository. We searched for publicly available dissemination strategies and any corresponding plans available in English language. Two authors extracted data on strategies, which were grouped according to the Model for Dissemination Research Framework (including source, audience, channel and message). For guidelines with a dissemination plan, we described goals, audience, strategies and expertise and resources according to the Canadian Institute for Health Research guidance. SETTING FBDG from fifty-three countries mostly from high-income (n 28, 52·8 %), and upper-middle income (n 18, 34 %) areas were included. PARTICIPANTS n/a. RESULTS The source of guidelines was most frequently health departments (79·2 %). The message included quantities and types of foods, physical activity recommendations and 88·7 % included summarised versions of main messages. The most common channels were infographics and information booklets, and the main end-users were the public. For twelve countries (22·6 %), we were able to source an English-language dissemination plan, where none met all recommendations outlined by the Canadian Institute for Health Research. CONCLUSIONS The public was the most frequently identified end-user and thus most dissemination strategies and plans focused on this group. Few FBDG had formal dissemination plans and of those there was limited detailed provided.
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Affiliation(s)
- Sze Lin Yoong
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute, Population Health Research Program, New Lambton, NSW, Australia
| | - Heidi Turon
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Population Health Research Program, New Lambton, NSW, Australia
| | - Carrie K Wong
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Lyndal Bayles
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Meghan Finch
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute, Population Health Research Program, New Lambton, NSW, Australia
| | - Courtney Barnes
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute, Population Health Research Program, New Lambton, NSW, Australia
| | - Emma Doherty
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute, Population Health Research Program, New Lambton, NSW, Australia
| | - Luke Wolfenden
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute, Population Health Research Program, New Lambton, NSW, Australia
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van Leuven L, Engelbrektsson J, Forster M. Reach and predictors of effects during nation-wide dissemination of the universal parenting program All Children in Focus. BMC Public Health 2023; 23:2027. [PMID: 37853429 PMCID: PMC10583325 DOI: 10.1186/s12889-023-16823-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/23/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Parenting programs have the potential to improve population health, if widely disseminated. However, wide-scale dissemination is challenging. Also, more knowledge is needed of whether parenting programs are effective for the variability of families in the general population. METHODS This study aimed to investigate who the universal parenting program All Children in Focus (ABC) reaches when offered in routine care in Sweden. A second aim was to investigate if the outcomes were predicted by factors related to family background, group leader experience, and homework completion. Questionnaires were collected before and after ABC from 1420 parents. Hierarchical regression analyses were performed to examine predictors of disruptive child behavior, parenting practices, and satisfaction. RESULTS ABC was available in about 40% of Swedish municipalities and reached a fairly representative population sample, with the exception that fewer fathers than mothers participated. The examined predictors explained a small proportion of the variance in the outcomes (2.5, 3.5 and 14.7%, respectively). Still, the effect on disruptive child behavior was statistically significantly larger for parents born in Sweden, with higher education, and older children. The effect on parenting practices was also larger for parents born in Sweden, for mothers, and for those practicing homework more frequently. Most examined predictors showed no statistically significant association with child and parenting outcomes. Parents were generally satisfied with ABC and the significant predictors of satisfaction had little practical meaning. CONCLUSIONS A fairly representative group of parents across Sweden were reached by ABC. Background variables, homework completion, and group leaders' experience explained a small proportion of variance in the outcomes. Meanwhile, the slightly lower intervention effects found for preschool children and parents born abroad calls for further investigation, since even small differences in effects can have an impact at a population level. The study also points to the importance of stressing homework completion and to increase the reach of universal parenting interventions to some underrepresented groups.
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Affiliation(s)
- Livia van Leuven
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels Väg 9, 171 65, Solna, Sweden.
| | - Johanna Engelbrektsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels Väg 9, 171 65, Solna, Sweden
| | - Martin Forster
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels Väg 9, 171 65, Solna, Sweden
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Dopp AR, Hunter SB, Godley MD, González I, Bongard M, Han B, Cantor J, Hindmarch G, Lindquist K, Wright B, Schlang D, Passetti LL, Wright KL, Kilmer B, Aarons GA, Purtle J. Comparing organization-focused and state-focused financing strategies on provider-level reach of a youth substance use treatment model: a mixed-method study. Implement Sci 2023; 18:50. [PMID: 37828518 PMCID: PMC10571404 DOI: 10.1186/s13012-023-01305-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Financial barriers in substance use disorder service systems have limited the widespread adoption-i.e., provider-level reach-of evidence-based practices (EBPs) for youth substance use disorders. Reach is essential to maximizing the population-level impact of EBPs. One promising, but rarely studied, type of implementation strategy for overcoming barriers to EBP reach is financing strategies, which direct financial resources in various ways to support implementation. We evaluated financing strategies for the Adolescent Community Reinforcement Approach (A-CRA) EBP by comparing two US federal grant mechanisms, organization-focused and state-focused grants, on organization-level A-CRA reach outcomes. METHOD A-CRA implementation took place through organization-focused and state-focused grantee cohorts from 2006 to 2021. We used a quasi-experimental, mixed-method design to compare reach between treatment organizations funded by organization-focused versus state-focused grants (164 organizations, 35 states). Using administrative training records, we calculated reach as the per-organization proportion of trained individuals who received certification in A-CRA clinical delivery and/or supervision by the end of grant funding. We tested differences in certification rate by grant type using multivariable linear regression models that controlled for key covariates (e.g., time), and tested threats to internal validity from our quasi-experimental design through a series of sensitivity analyses. We also drew on interviews and surveys collected from the treatment organizations and (when relevant) interviews with state administrators to identify factors that influenced reach. RESULTS The overall certification rates were 27 percentage points lower in state-focused versus organization-focused grants (p = .01). Sensitivity analyses suggested these findings were not explained by confounding temporal trends nor by organizational or state characteristics. We did not identify significant quantitative moderators of reach outcomes, but qualitative findings suggested certain facilitating factors were more influential for organization-focused grants (e.g., strategic planning) and certain barrier factors were more impactful for state-focused grants (e.g., states finding it difficult to execute grant activities). DISCUSSION As the first published comparison of EBP reach outcomes between financing strategies, our findings can help guide state and federal policy related to financing strategies for implementing EBPs that reduce youth substance use. Future work should explore contextual conditions under which different financing strategies can support the widespread implementation of EBPs for substance use disorder treatment.
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Affiliation(s)
- Alex R Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Mark D Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | | | - Michelle Bongard
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Bing Han
- Department of Research and Evaluation, Division of Biostatistics Research, Kaiser Permanente Southern California, 100 South Los Robles Avenue 2nd Floor, Pasadena, CA, 91101, USA
| | - Jonathan Cantor
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Grace Hindmarch
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Kerry Lindquist
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Blanche Wright
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
- Department of Health Policy and Management, University of California Los Angeles, 650 Charles Young Dr. S., 31-269 CHS Box 951772, Los Angeles, CA, 90095, USA
| | - Danielle Schlang
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Lora L Passetti
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Kelli L Wright
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Beau Kilmer
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Gregory A Aarons
- Department of Psychiatry and Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, 9500 Gilman Dr. (0812), La Jolla, San Diego, CA, 92093, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management and Global Center for Implementation Science, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
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Oluwoye O, Lissau A, Stokes S, Selloni AT, James N, Amiri S, McDonell MG, Anglin DM. Study protocol for a multi-level cross-sectional study on the equitable reach and implementation of coordinated specialty care for early psychosis. Implement Sci Commun 2023; 4:90. [PMID: 37553719 PMCID: PMC10410783 DOI: 10.1186/s43058-023-00476-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Approximately 115,000 young adults will experience their first episode of psychosis (FEP) each year in the USA. Coordinated specialty care (CSC) for early psychosis is an evidence-based early intervention model that has demonstrated effectiveness by improving quality of life and reducing psychiatric symptoms for many individuals. Over the last decade, there has significant increase in the implementation of CSC programs throughout the USA. However, prior research has revealed difficulties among individuals and their family members accessing CSC. Research has also shown that CSC programs often report the limited reach of their program to underserved populations and communities (e.g., ethnoracial minorities, rural and low socioeconomic neighborhoods). Dissemination and implementation research focused on the equitable reach and implementation of CSC is needed to address disparities at the individual level. METHODS The proposed study will create a novel integrative multi-level geospatial database of CSC programs implemented throughout the USA that will include program-level data (e.g., geocoded location, capacity, setting, role availability), provider-level data (race, ethnicity, professional credentials), and neighborhood-level census data (e.g., residential segregation, ethnic density, area deprivation, rural-urban continua, public transit time). This database will be used to characterize variations in CSC programs by geographical location and examine the overall reach CSC programs to specific communities. The quantitative data will be combined with qualitative data from state administrators, providers, and service users that will inform the development of dissemination tools, such as an interactive dashboard, that can aid decision making. DISCUSSION Findings from this study will highlight the impact of outer contextual determinants on implementation and reach of mental health services, and will serve to inform the future implementation of CSC programs with a primary focus on equity.
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Affiliation(s)
- Oladunni Oluwoye
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99210-1495, USA.
| | - Ari Lissau
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99210-1495, USA
| | - Sheldon Stokes
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99210-1495, USA
| | - Alexandria T Selloni
- Department of Psychology, City College of New York, City University of New York, New York, USA
| | - Najé James
- Department of Psychology, City College of New York, City University of New York, New York, USA
| | - Solmaz Amiri
- Department of Medical Education and Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA
| | - Michael G McDonell
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99210-1495, USA
| | - Deidre M Anglin
- Department of Psychology, City College of New York, City University of New York, New York, USA
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Brandes M, Brandes B, Sell L, Sacheck JM, Chinapaw M, Lubans DR, Woll A, Schipperijn J, Jago R, Busse H. How to select interventions for promoting physical activity in schools? Combining preferences of stakeholders and scientists. Int J Behav Nutr Phys Act 2023; 20:48. [PMID: 37098620 PMCID: PMC10127415 DOI: 10.1186/s12966-023-01452-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/12/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND The failure to scale-up and implement physical activity (PA) interventions in real world contexts, which were previously successful under controlled conditions, may be attributed to the different criteria of stakeholders and scientists in the selection process of available interventions. Therefore, the aim of our study was to investigate and compare the criteria applied by local stakeholders and scientists for selecting amongst suitable school-based PA interventions for implementation. METHODS We conducted a three-round repeated survey Delphi study with local stakeholders (n = 7; Bremen, Germany) and international scientific PA experts (n = 6). Independently for both panels, two rounds were utilized to develop a list of criteria and the definitions of criteria, followed by a prioritization of the criteria in the third round. For each panel, a narrative analysis was used to rank-order unique criteria, list the number of scorers for the unique criteria and synthesize criteria into overarching categories. RESULTS The stakeholders developed a list of 53 unique criteria, synthesized into 11 categories with top-ranked criteria being 'free of costs', 'longevity' and 'integration into everyday school life'. The scientists listed 35 unique criteria, synthesized into 7 categories with the top-ranked criteria being 'efficacy', 'potential for reach' and 'feasibility'. The top ranked unique criteria in the stakeholder panel were distributed over many categories, whereas four out of the top six criteria in the scientist panel were related to 'evidence'. CONCLUSIONS Although stakeholders and scientists identified similar criteria, major differences were disclosed in the prioritization of the criteria. We recommend an early collaboration of stakeholders and scientists in the design, implementation, and evaluation of PA interventions.
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Affiliation(s)
- Mirko Brandes
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany.
| | - Berit Brandes
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Louisa Sell
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Jennifer M Sacheck
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, D.C., USA
| | - Mai Chinapaw
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - David R Lubans
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, Australia
| | - Alexander Woll
- Institute of Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Jasper Schipperijn
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Russell Jago
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Heide Busse
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
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Hoft G, Forseth B, Trofimoff A, Bangash M, Davis AM. Barriers to Participation in a Telemedicine-based, Family-based Behavioral Group Treatment Program for Pediatric Obesity: Qualitative findings from Rural Caregivers. Child Health Care 2023; 53:60-75. [PMID: 38239336 PMCID: PMC10794019 DOI: 10.1080/02739615.2023.2189116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
This study examined factors influencing rural caregivers' decision to decline participation in a healthy lifestyle intervention. Eligible caregivers of rural children who declined participation in a healthy lifestyle intervention were interviewed regarding reasons for declining. Inductive thematic analyses were conducted for responses. Caregiver interviews (n=16) resulted in 5 saturated themes: (1) rural families' household schedules prohibit participation, (2) preference for diverse treatment approaches, (3) desire for information across multimedia platforms, and more communication with a point-of-contact, (4) support for an inclusive approach integrated with existing school practices, and (5) caregivers had an understanding of behaviors that promote health.
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Affiliation(s)
- Galen Hoft
- Center for Children’s Healthy Lifestyles & Nutrition – Department of Pediatrics - University of Kansas Medical Center - Kansas City, Kansas
- Kansas City University of Medicine and Biosciences – Kansas City, Missouri
| | - Bethany Forseth
- Center for Children’s Healthy Lifestyles & Nutrition – Department of Pediatrics - University of Kansas Medical Center - Kansas City, Kansas
| | - Anna Trofimoff
- Center for Children’s Healthy Lifestyles & Nutrition – Department of Pediatrics - University of Kansas Medical Center - Kansas City, Kansas
| | - Maheen Bangash
- Center for Children’s Healthy Lifestyles & Nutrition – Department of Pediatrics - University of Kansas Medical Center - Kansas City, Kansas
| | - Ann M. Davis
- Center for Children’s Healthy Lifestyles & Nutrition – Department of Pediatrics - University of Kansas Medical Center - Kansas City, Kansas
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Bartels SJ, Aschbrenner KA, Pratt SI, Zubkoff L, Jue K, Williams G, Godfrey MM, Cohen MJ, Banerjee S, Xie H, Wolfe R, Naslund JA, Bond GR. Virtual Learning Collaborative Compared to Technical Assistance as a Strategy for Implementing Health Promotion in Routine Mental Health Settings: A Hybrid Type 3 Cluster Randomized Trial. Adm Policy Ment Health 2022; 49:1031-46. [PMID: 35987829 DOI: 10.1007/s10488-022-01215-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 08/03/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Despite widespread use of learning collaboratives, few randomized trials have evaluated their effectiveness as a strategy for implementing evidence based practices. This randomized trial evaluated the effectiveness of a virtual learning collaborative (VLC) in the implementation of a health promotion program for persons with serious mental illness (SMI) aimed at reducing cardiovascular risk reduction in routine mental health settings, compared to routine technical assistance (TA). METHODS Fifty-five mental health provider organizations were recruited to participate in a Hybrid Type 3 cluster randomized implementation-effectiveness trial of the InSHAPE health promotion program for persons with SMI. Sites were stratified by size and randomized prior to implementation to an 18-month group-based VLC with monthly learning sessions or individual site TA with four scheduled conference calls over 18 months. Primary implementation and service outcomes were InSHAPE program fidelity, participation, and reach. Primary clinical outcomes were weight loss, cardiorespiratory fitness, and cardiovascular risk reduction (≥ 5% weight loss or > 50 m increase on the 6-Minute Walk Test). Program fidelity was assessed at 6, 12, and 24 months; program participation and participant-level outcomes were assessed at 3, 6, 9, and 12 months. RESULTS VLC (N = 27) and TA (N = 28) sites were similar in organizational characteristics (all p > 0.05). At 12-month follow-up mean program fidelity score was higher in VLC compared to TA (90.5 vs. 79.1; p = 0.002), with over double the proportion with good fidelity (VLC = 73.9% vs. TA = 34.8%; p = 0.009). Over half of individuals in both VLC and TA achieved cardiovascular risk-reduction at 6-month follow-up (VLC: 51.0%; TA: 53.5%; p = 0.517) and at 12-month follow-up (62% VLC and TA; p = 0.912). At 12-month follow-up VLC compared to TA was associated with greater participation (VLC 69.5% vs. TA 56.4% attending at least 50% of sessions, p = 0.002); larger caseloads (VLC = 16 vs. TA = 11; p = 0.024); greater reach consisting of 45% greater number of participants receiving InSHAPE (VLC = 368 vs. TA = 253), and 58% greater number of participants achieving cardiovascular risk reduction (VLC = 150 vs. TA = 95). CONCLUSION Virtual learning collaboratives compared to routine technical assistance as an implementation strategy for evidence-based health promotion promote greater intervention fidelity, greater levels of intervention participation, greater reach, and a greater number of participants achieving clinically significant risk reduction outcomes, while achieving similarly high levels of intervention effectiveness for participants who completed at least 6 months of the program.
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Michaud TL, Estabrooks PA, You W, Ern J, Scoggins D, Gonzales K, King KM, Dai H, Su D. Effectiveness of incentives to improve the reach of health promotion programs- a systematic review and meta-analysis. Prev Med 2022; 162:107141. [PMID: 35809822 DOI: 10.1016/j.ypmed.2022.107141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/31/2022] [Accepted: 07/02/2022] [Indexed: 10/17/2022]
Abstract
The reach (i.e., enrollment, engagement, and retention) of health promotion evidence-based programs (EBPs) at the participant level has been challenging. Incentives based on behavioral economics may be used to improve EBP reach. We aimed to systematically review and synthesize the evidence of the effectiveness of incentives as a dissemination strategy to increase EBP reach. We conducted a literature search in PubMed, SCOPUS, EMBASE, Cochrane Review and Cochrane CENTRAL for articles published between January 2000 and March 2020 to identify incentive strategies used to increase program reach among health promotion EBPs. Inclusion criteria included studies published in English, experimental or quasi-experimental designs, comparison of incentive to non-incentive or control strategies, and reported on reach (n = 35 health promotion studies). Monetary incentives using cash and a fixed schedule of reinforcement were the most used incentive schemes (71%). Incentives alone or combined with other strategies as a multicomponent approach were effective in improving program enrollment, engagement, and retention. Specifically, incentive strategies were associated with higher odds of program enrollment (odds ratio [OR], 2.78; 95% confidence interval [CI], 1.82-4.24; n = 10) and retention (OR, 2.54, 95% CI, 1.34-4.85; n = 9) with considerable heterogeneity (I2 = 94% and 91%, respectively). Incentives are a promising individual-level dissemination strategy to improve the reach of health promotion EBPs. However, understanding the optimal amount, type, frequency, and target of incentives, and how incentives fit in a multicomponent approach in different contexts requires further research.
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Affiliation(s)
- Tzeyu L Michaud
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Paul A Estabrooks
- Department of Health and Kinesiology, College of Health, University of Utah, Salt Lake City, UT, USA
| | - Wen You
- Department of Public Health Sciences, University of Virginia, University of Virginia Cancer Center, Charlottesville, VA, USA
| | - Jessica Ern
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dylan Scoggins
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kelly Gonzales
- College of Nursing, Omaha Division, University of Nebraska Medical Center, Omaha, NE, USA
| | - Keyonna M King
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Hongying Dai
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dejun Su
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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Czwikla J, Herzberg A, Kapp S, Kloep S, Rothgang H, Nitschke I, Haffner C, Hoffmann F. Generalizability and reach of a randomized controlled trial to improve oral health among home care recipients: comparing participants and nonparticipants at baseline and during follow-up. Trials 2022; 23:560. [PMID: 35804423 PMCID: PMC9264743 DOI: 10.1186/s13063-022-06470-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background The generalizability of randomized controlled trials (RCTs) with a low response can be limited by systematic differences between participants and nonparticipants. This participation bias, however, is rarely investigated because data on nonparticipants is usually not available. The purpose of this article is to compare all participants and nonparticipants of a RCT to improve oral health among home care recipients at baseline and during follow-up using claims data. Methods Seven German statutory health and long-term care insurance funds invited 9656 home care recipients to participate in the RCT MundPflege. Claims data for all participants (n = 527, 5.5% response) and nonparticipants (n = 9129) were analyzed. Associations between trial participation and sex, age, care dependency, number of Elixhauser diseases, and dementia, as well as nursing, medical, and dental care utilization at baseline, were investigated using multivariable logistic regression. Associations between trial participation and the probability of (a) moving into a nursing home, (b) being hospitalized, and (c) death during 1 year of follow-up were examined via Cox proportional hazards regressions, controlling for baseline variables. Results At baseline, trial participation was positively associated with male sex (odds ratio 1.29 [95% confidence interval 1.08–1.54]), high (vs. low 1.46 [1.15–1.86]) care dependency, receiving occasional in-kind benefits to relieve caring relatives (1.45 [1.15–1.84]), having a referral by a general practitioner to a medical specialist (1.62 [1.21–2.18]), and dental care utilization (2.02 [1.67–2.45]). It was negatively associated with being 75–84 (vs. < 60 0.67 [0.50–0.90]) and 85 + (0.50 [0.37–0.69]) years old. For morbidity, hospitalizations, and formal, respite, short-term, and day or night care, no associations were found. During follow-up, participants were less likely to move into a nursing home than nonparticipants (hazard ratio 0.50 [0.32–0.79]). For hospitalizations and mortality, no associations were found. Conclusions For half of the comparisons, differences between participants and nonparticipants were observed. The RCT’s generalizability is limited, but to a smaller extent than one would expect because of the low response. Routine data provide a valuable source for investigating potential differences between trial participants and nonparticipants, which might be used by future RCTs to evaluate the generalizability of their findings. Trial registration German Clinical Trials Register DRKS00013517. Retrospectively registered on June 11, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06470-y.
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Affiliation(s)
- Jonas Czwikla
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany. .,Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany. .,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany.
| | - Alexandra Herzberg
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
| | - Sonja Kapp
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
| | - Stephan Kloep
- High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany.,Competence Center for Clinical Trials, University of Bremen, Linzer Straße 4, 28359, Bremen, Germany
| | - Heinz Rothgang
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
| | - Ina Nitschke
- Division of Gerodontology, Clinic of Prosthetic Dentistry and Dental Materials Science, University Medical Center, Liebigstraße 10-14, 04103, Leipzig, Germany.,Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Plattenstraße 11, CH-8032, Zurich, Switzerland
| | - Cornelius Haffner
- Special Care- and Geriatric Dentistry, Städtisches Klinikum Harlaching München, Sanatoriumsplatz 2, 81545, Munich, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany
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10
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Ezenwankwo EF, Nnate DA, Usoro GD, Onyeso CP, Anieto IB, Ibeneme SC, Albertus Y, Lambert VE, Ezeukwu AO, Abaraogu UO, Shamley D. A scoping review examining the integration of exercise services in clinical oncology settings. BMC Health Serv Res 2022; 22:236. [PMID: 35189864 PMCID: PMC8859567 DOI: 10.1186/s12913-022-07598-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/04/2022] [Indexed: 12/11/2022] Open
Abstract
Background Addressing questions surrounding the feasibility of embedding exercise service units in clinical oncology settings is imperative for developing a sustainable exercise-oncology clinical pathway. We examined available literature and offered practical recommendations to support evidence-based practice, policymaking, and further investigations. Methods Four thousand eight hundred sixty-three unique records identified in Embase, CINAHL, MEDLINE, Web of Science Core Collection, and ProQuest (Health and Medicine) were screened for studies that recruited cancer patients, assessed the co-location of exercise service and cancer treatment units, and reported findings on service implementation. Evidence from six studies providing data from over 30 programs was integrated using narrative synthesis. Results Service implementation was relatively modest across the included studies. Exercise services were delivered by physiotherapists, exercise physiologists, and kinesiologists and funded mainly through grants and private donations, with staff salaries accruing as the major expense. Service penetration, adoption, and acceptability were generally low. However, studies recorded high clinician/patient satisfaction. Major barriers to service integration were limited funding, lack of detailed implementation plan, and low organizational buy-in. Common reasons for non-utilization, missed sessions, and dropouts were lack of interest, unwellness, hospital readmission, disease progression, and adverse skeletal events. Conclusion Implementing exercise services in clinical oncology settings seems an effective approach for increasing access to exercise-based rehabilitation for individuals on cancer treatment. While this model appears feasible for patients/clinicians, efforts are required to optimize service integration both in the short and long term. Key priorities include seeking [local] actions to address issues relating to funding and organizational buy-in. Important considerations may include developing an implementation plan to guide the implementation process, expanding the patient core management team to include staff from the exercise rehabilitation unit, and exploring the role of patient feedback in increasing clinician participation (e.g., treating oncologists and nurses) in the referral process. Future research should consider effective strategies to promote patients’ sense of self-efficacy and behavioral control and, further, the place of audit and feedback in improving exercise service delivery and overall service implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07598-y.
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Affiliation(s)
- Elochukwu F Ezenwankwo
- Centre for Health Through Physical Activity, Lifestyle and Sports (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. .,Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Anzio Road, ObservatoryCape Town, 7925, South Africa.
| | - Daniel A Nnate
- Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Countess of Chester Hospital NHS Foundation Trust, Health Park, Liverpool Road, Chester, CH2 1UL, UK
| | - Godspower D Usoro
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Chimdimma P Onyeso
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Ijeoma B Anieto
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Sam C Ibeneme
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.,Department of Physiotherapy, Faculty of Health Sciences, School of Therapeuitc Studies, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.,Department of Physiotherapy, Faculty of Health Sciences and Technology, King David University of Medical Sciences, Ebonyi State, Uburu, Nigeria
| | - Yumna Albertus
- Centre for Health Through Physical Activity, Lifestyle and Sports (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Victoria E Lambert
- Centre for Health Through Physical Activity, Lifestyle and Sports (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Antoninus O Ezeukwu
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Ukachukwu O Abaraogu
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.,Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Delva Shamley
- Centre for Health Through Physical Activity, Lifestyle and Sports (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Clinical Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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11
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Richardson RT, Russo SA, Chafetz RS, Warshauer S, Nice E, Kozin SH, Zlotolow DA, Richards JG. Reachable workspace with real-time motion capture feedback to quantify upper extremity function: A study on children with brachial plexus birth injury. J Biomech 2021; 132:110939. [PMID: 34998183 DOI: 10.1016/j.jbiomech.2021.110939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 10/19/2022]
Abstract
Clinical upper extremity (UE) functional assessments and motion capture measures are limited to a set of postures and/or motions that may provide an incomplete evaluation of UE functionality. Reachable workspace analysis offers a more global assessment of UE function, but is reliant on patient compliance with instructions and may result in underestimates of a patient's true UE function. This study evaluated a clinical tool that incorporates real-time visual feedback with motion capture to provide an innovative means of engaging patients to ensure a 'best effort' quantification of their available UE workspace. Reachable workspace for 10 children with brachial plexus birth injury was collected with and without real-time feedback on the affected and unaffected limbs. Real-time feedback consisted of subjects reaching for virtual targets surrounding their physical space using a virtual cursor controlled by the real-time location of their hand. Real-time feedback resulted in significantly greater workspace in multiple regions on both the affected (3/6 octants; mean differences 10.8%-20.0%) and unaffected (6/6 octants; mean differences 24.3%-40.0%) limbs. Use of real-time feedback also yielded significant interlimb differences in workspace across more regions (4/6 octants; mean differences 29.0%-39.9% vs. 1/6 octants; mean difference 17%). Finally, real-time feedback resulted in significant interlimb differences in median reach distance across more regions (4/6 octants; mean differences 7.5%-44.8% vs. 1/6 octants; mean difference 11.2%). A reachable workspace tool with real-time feedback results in more workspace and UE function recorded and offers a highly visual and intuitive depiction of a patient's UE abilities.
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Affiliation(s)
| | | | | | | | - Emily Nice
- Shriners Hospital for Children, Philadelphia, PA, USA
| | - Scott H Kozin
- Shriners Hospital for Children, Philadelphia, PA, USA
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12
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Michaud TL, Wilson K, Silva F, Almeida F, Katula J, Estabrooks P. Costing a population health management approach for participant recruitment to a diabetes prevention study. Transl Behav Med 2021; 11:1864-1874. [PMID: 33963855 PMCID: PMC8541699 DOI: 10.1093/tbm/ibab054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Limited research has reported the economic feasibility-from both a research and practice perspective-of efforts to recruit and enroll an intended audience in evidence-based approaches for disease prevention. We aimed to retrospectively assess and estimate the costs of a population health management (PHM) approach to identify, engage, and enroll patients in a Type 1 Hybrid Effectiveness-Implementation (HEI), diabetes-prevention trial. We used activity-based costing to estimate the recruitment costs of a PHM approach integrated within an HEI trial. We took the perspective of a healthcare system that may adopt, and possibly sustain, the strategy in the typical practice. We also estimated replication costs based on how the strategy could be applied in healthcare systems interested in referring patients to a local diabetes prevention program from a payer perspective. The total recruitment and enrollment costs were $360,424 to accrue 599 participants over approximately 15 months. The average cost per screened and enrolled participant was $263 and $620, respectively. Translating to the typical settings, total recruitment costs for replication were estimated as $193,971 (range: $43,827-$210,721). Sensitivity and scenario analysis results indicated replication costs would be approximately $283-$444 per patient enrolled if glucose testing was necessary, based on the Medicare-covered services. From a private payer perspective, and without glucose testing, per-participant assessed costs were estimated at $31. A PHM approach can be used to accrue a large number of participants in a short period of time for an HEI trial, at a comparable cost per participant.
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Affiliation(s)
- Tzeyu L Michaud
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kathryn Wilson
- Department of Kinesiology and Health, College of Education & Human Development, Georgia State University, Atlanta, GA, USA
- Center for the Study of Stress, Trauma, and Resilience, College of Education and Human Development, Georgia State University, Atlanta, GA, USA
| | - Fabiana Silva
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Fabio Almeida
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jeff Katula
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Paul Estabrooks
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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13
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Sutherland R, Campbell E, McLaughlin M, Nathan N, Wolfenden L, Lubans DR, Morgan PJ, Gillham K, Oldmeadow C, Searles A, Reeves P, Williams M, Evans N, Bailey A, Boyer J, Lecathelinais C, Davies L, McKenzie T, Robertson K, Wiggers J. Scale-up of the Physical Activity 4 Everyone (PA4E1) intervention in secondary schools: 24-month implementation and cost outcomes from a cluster randomised controlled trial. Int J Behav Nutr Phys Act 2021; 18:137. [PMID: 34688281 PMCID: PMC8542325 DOI: 10.1186/s12966-021-01206-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/29/2021] [Indexed: 11/15/2022] Open
Abstract
Background Physical Activity 4 Everyone (PA4E1) is an evidence-based program effective at increasing adolescent physical activity (PA) and improving weight status. This study aimed to determine a) the effectiveness of an adapted implementation intervention to scale-up PA4E1 at 24-month follow-up, b) fidelity and reach, and c) the cost and cost-effectiveness of the implementation support intervention. Methods A cluster randomised controlled trial using a type III hybrid implementation-effectiveness design in 49 lower socio-economic secondary schools, randomised to a program (n = 24) or control group (n = 25). An adapted implementation intervention consisting of seven strategies was developed to support schools to implement PA4E1 over 24-months. The primary outcome was the proportion of schools implementing at least four of the 7 PA practices, assessed via computer assisted telephone interviews (CATI) with Head Physical Education Teachers. Secondary outcomes included the mean number of PA practices implemented, fidelity and reach, cost and cost-effectiveness. Logistic regression models assessed program effects. Results At baseline, no schools implemented four of the 7 PA practices. At 24-months, significantly more schools in the program group (16/23, 69.6%) implemented at least four of the 7 PA practices than the control group (0/25, 0%) (p < 0.001). At 24-months, program schools were implementing an average of 3.6 more practices than control schools (4.1 (1.7) vs. 0.5 (0.8), respectively) (P < 0.001). Fidelity and reach of the implementation intervention were high (> 75%). The total cost of the program was $415,112 AUD (2018) ($17,296 per school; $117.30 per student). Conclusions The adapted implementation intervention provides policy makers and researchers with an effective and potentially cost-effective model for scaling-up the delivery of PA4E1 in secondary schools. Further assessment of sustainability is warranted. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12617000681358 prospectively registered 12th May 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01206-8.
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Affiliation(s)
- Rachel Sutherland
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Matthew McLaughlin
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. .,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia. .,Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Nicole Nathan
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - David R Lubans
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Philip J Morgan
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Karen Gillham
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Chris Oldmeadow
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Penny Reeves
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Mandy Williams
- South Western Sydney Local Health District, Locked Mail Bag, 7279, BC1871, Liverpool, NSW, Australia
| | - Nicole Evans
- Central Coast Local Health District, 4-6 Watt Street, Gosford, NSW, 2250, Australia
| | - Andrew Bailey
- Mid North Coast Local Health District, P.O. Box 126, Port Macquarie, NSW, Australia
| | - James Boyer
- New South Wales Department of Education, School Sports Unit, Level 3, 1 Oxford Street, Darlinghurst, NSW, 2010, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Lynda Davies
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Tom McKenzie
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Katie Robertson
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - John Wiggers
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
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14
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Rosen LJ, Galili T, Kott J, Rees V. Beyond "Safe and Effective": The urgent need for high-impact smoking cessation medications. Prev Med 2021; 150:106567. [PMID: 33957153 DOI: 10.1016/j.ypmed.2021.106567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
Smoking cessation medications (SCMs) are an evidence-based cornerstone of comprehensive tobacco control programs globally. However, the impact of SCMs on population smoking prevalence is controversial, with inconsistencies between randomized controlled trials (RCTs) and population-based observational studies. We estimated SCM impact on permanent cessation and population smoking prevalence by extrapolating efficacy estimates from meta-analyses of RCTs, using the standard population impact formula: efficacy*reach. We calculated the potential SCM impact under a range of assumptions for permanent cessation (20%,14%), behavioral support (yes/no), reach (40%-2%), and underlying smoking prevalence. Assuming behavioral support for all, depending on reach, 8%-0.3% of smokers are expected to quit permanently. Without behavioral support, permanent cessation is estimated to be 6.4%-0.2%. Assuming an underlying population smoking prevalence of 14%, (current U.S. prevalence), the maximum impact on population smoking prevalence is 1.12%. Impact on prevalence increases with increasing underlying country-specific levels of prevalence. With current U.S. levels of reach, behavioral support and smoking prevalence, we estimate that, based on a single course of treatment, 2.3% of smokers would quit permanently, contributing to a 0.3% decrease in population level smoking prevalence. Even under ideal conditions, the potential of current first-line SCMs to increase cessation in a substantial proportion of smokers, and reduce population smoking prevalence, is limited. In order to avert the predicted billion tobacco-caused deaths in this century, "safe and effective" medications are not sufficient: SCMs with high population impact are urgently needed. Policies to ensure the availability and accessibility of highly efficacious SCMs, with behavioral support, are crucial.
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Affiliation(s)
- Laura J Rosen
- Dept. of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel; Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T. Chan School of Public Health, Boston, MA, USA.
| | - Tal Galili
- Department of Statistics and Operations Research, The Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv 69978, Ramat-Aviv, Israel.
| | | | - Vaughan Rees
- Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T. Chan School of Public Health, Boston, MA, USA
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15
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Miech EJ, Freitag MB, Evans RR, Burns JA, Wiitala WL, Annis A, Raffa SD, Spohr SA, Damschroder LJ. Facility-level conditions leading to higher reach: a configurational analysis of national VA weight management programming. BMC Health Serv Res 2021; 21:797. [PMID: 34380495 PMCID: PMC8359110 DOI: 10.1186/s12913-021-06774-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background While the Veterans Health Administration (VHA) MOVE! weight management program is effective in helping patients lose weight and is available at every VHA medical center across the United States, reaching patients to engage them in treatment remains a challenge. Facility-based MOVE! programs vary in structures, processes of programming, and levels of reach, with no single factor explaining variation in reach. Configurational analysis, based on Boolean algebra and set theory, represents a mathematical approach to data analysis well-suited for discerning how conditions interact and identifying multiple pathways leading to the same outcome. We applied configurational analysis to identify facility-level obesity treatment program arrangements that directly linked to higher reach. Methods A national survey was fielded in March 2017 to elicit information about more than 75 different components of obesity treatment programming in all VHA medical centers. This survey data was linked to reach scores available through administrative data. Reach scores were calculated by dividing the total number of Veterans who are candidates for obesity treatment by the number of “new” MOVE! visits in 2017 for each program and then multiplied by 1000. Programs with the top 40 % highest reach scores (n = 51) were compared to those in the lowest 40 % (n = 51). Configurational analysis was applied to identify specific combinations of conditions linked to reach rates. Results One hundred twenty-seven MOVE! program representatives responded to the survey and had complete reach data. The final solution consisted of 5 distinct pathways comprising combinations of program components related to pharmacotherapy, bariatric surgery, and comprehensive lifestyle intervention; 3 of the 5 pathways depended on the size/complexity of medical center. The 5 pathways explained 78 % (40/51) of the facilities in the higher-reach group with 85 % consistency (40/47). Conclusions Specific combinations of facility-level conditions identified through configurational analysis uniquely distinguished facilities with higher reach from those with lower reach. Solutions demonstrated the importance of how local context plus specific program components linked together to account for a key implementation outcome. These findings will guide system recommendations about optimal program structures to maximize reach to patients who would benefit from obesity treatment such as the MOVE! program. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06774-w.
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Affiliation(s)
- Edward J Miech
- Veterans Affairs Center for Health Information & Communication, VA EXTEND QUERI, Roudebush VA Medical Center, Indianapolis, USA.
| | - Michelle B Freitag
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Michigan, Ann Arbor, USA
| | - Richard R Evans
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Michigan, Ann Arbor, USA
| | - Jennifer A Burns
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Michigan, Ann Arbor, USA
| | - Wyndy L Wiitala
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Michigan, Ann Arbor, USA
| | - Ann Annis
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Michigan, Ann Arbor, USA
| | - Susan D Raffa
- National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, North Carolina, USA.,Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Stephanie A Spohr
- National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, North Carolina, USA
| | - Laura J Damschroder
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, Michigan, Ann Arbor, USA
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16
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Eckland CB, Vasavada A, Catena RD. Shoulder and elbow requirements during sagittal reach as a result of changing anthropometry throughout pregnancy. Appl Ergon 2021; 94:103411. [PMID: 33725557 DOI: 10.1016/j.apergo.2021.103411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
During pregnancy, anthropometric and physiological changes can result in difficulty reaching for and lifting everyday objects. The aims of this study were to determine the changes in sagittal plane anterior reach space (SPARS) and shoulder/elbow strength requirements throughout pregnancy. Seventeen participants were tested through a longitudinal observational cohort study between 16 and 36 weeks gestation in four-week intervals. A 25% decrease in SPARS was observed at the L3-4 torso height. Combined with arm mass increases, shoulder and elbow moment requirements at the minimum and maximum static reach distances significantly increased. However, inverse dynamics analysis determined that mass gains in the arm alone only minimally impact dynamic shoulder moments. Additionally, torso flexion increases throughout pregnancy demonstrates that women are attempting to compensate for decreased SPARS, possibly indicating the additional perceptual importance of reach space in accommodations for pregnant workers.
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Affiliation(s)
- Chantel B Eckland
- Washington State University, 19 Smith Gym, Pullman, WA, 99164-1410, USA.
| | - Anita Vasavada
- Washington State University, 205 Wegner Hall, Pullman, WA, 99164-1565, USA.
| | - Robert D Catena
- Washington State University, 113F Smith Gym, Pullman, WA, 99164-1410, USA.
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17
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Berenfeld C, Harvey J, Hoffmann M, Shankar K. Estimating the Reach of a Manifold via its Convexity Defect Function. Discrete Comput Geom 2021; 67:403-438. [PMID: 35221405 PMCID: PMC8827210 DOI: 10.1007/s00454-021-00290-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 10/10/2020] [Accepted: 02/14/2021] [Indexed: 06/14/2023]
Abstract
The reach of a submanifold is a crucial regularity parameter for manifold learning and geometric inference from point clouds. This paper relates the reach of a submanifold to its convexity defect function. Using the stability properties of convexity defect functions, along with some new bounds and the recent submanifold estimator of Aamari and Levrard (Ann. Statist. 47(1), 177-204 (2019)), an estimator for the reach is given. A uniform expected loss bound over a C k model is found. Lower bounds for the minimax rate for estimating the reach over these models are also provided. The estimator almost achieves these rates in the C 3 and C 4 cases, with a gap given by a logarithmic factor.
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Affiliation(s)
- Clément Berenfeld
- Université Paris-Dauphine PSL, CEREMADE, Place du Maréchal de Lattre de Tassigny, 75016 Paris, France
| | - John Harvey
- Department of Mathematics, Swansea University, Fabian Way, Swansea, SA1 8EN UK
| | - Marc Hoffmann
- Université Paris-Dauphine PSL, CEREMADE, Place du Maréchal de Lattre de Tassigny, 75016 Paris, France
| | - Krishnan Shankar
- National Science Foundation, 2415 Eisenhower Avenue, Alexandria, VA 22314 USA
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18
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Lantagne DD, Mrotek LA, Slick R, Beardsley SA, Thomas DG, Scheidt RA. Contributions of implicit and explicit memories to sensorimotor adaptation of movement extent during goal-directed reaching. Exp Brain Res 2021; 239:2445-2459. [PMID: 34106298 PMCID: PMC8354879 DOI: 10.1007/s00221-021-06134-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 05/05/2021] [Indexed: 12/01/2022]
Abstract
We examined how implicit and explicit memories contribute to sensorimotor adaptation of movement extent during goal-directed reaching. Twenty subjects grasped the handle of a horizontal planar robot that rendered spring-like resistance to movement. Subjects made rapid “out-and-back” reaches to capture a remembered visual target at the point of maximal reach extent. The robot’s resistance changed unpredictably between reaches, inducing target capture errors that subjects attempted to correct from one trial to the next. Each subject performed over 400 goal-directed reaching trials. Some trials were performed without concurrent visual cursor feedback of hand motion. Some trials required self-assessment of performance between trials, whereby subjects reported peak reach extent on the most recent trial. This was done by either moving a cursor on a horizontal display (visual self-assessment), or by moving the robot’s handle back to the recalled location (proprioceptive self-assessment). Control condition trials performed either without or with concurrent visual cursor feedback of hand motion did not require self-assessments. We used step-wise linear regression analyses to quantify the extent to which prior reach errors and explicit memories of reach extent contribute to subsequent reach performance. Consistent with prior reports, providing concurrent visual feedback of hand motion increased reach accuracy and reduced the impact of past performance errors on future performance, relative to the corresponding no-vision control condition. By contrast, we found no impact of interposed self-assessment on subsequent reach performance or on how prior target capture errors influence subsequent reach performance. Self-assessments were biased toward the remembered target location and they spanned a compressed range of values relative to actual reach extents, demonstrating that declarative memories of reach performance systematically differed from actual performances. We found that multilinear regression could best account for observed data variability when the regression model included only implicit memories of prior reach performance; including explicit memories (self-assessments) in the model did not improve its predictive accuracy. We conclude therefore that explicit memories of prior reach performance do not contribute to implicit sensorimotor adaptation of movement extent during goal-directed reaching under conditions of environmental uncertainty.
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Affiliation(s)
- Devon D Lantagne
- Biomedical Engineering, Marquette University and Medical College of Wisconsin, Olin Engineering Center Rm 206, 1515 W. Wisconsin Ave, Milwaukee, WI, 53233, USA
| | - Leigh Ann Mrotek
- Biomedical Engineering, Marquette University and Medical College of Wisconsin, Olin Engineering Center Rm 206, 1515 W. Wisconsin Ave, Milwaukee, WI, 53233, USA
| | - Rebecca Slick
- Biomedical Engineering, Marquette University and Medical College of Wisconsin, Olin Engineering Center Rm 206, 1515 W. Wisconsin Ave, Milwaukee, WI, 53233, USA
| | - Scott A Beardsley
- Biomedical Engineering, Marquette University and Medical College of Wisconsin, Olin Engineering Center Rm 206, 1515 W. Wisconsin Ave, Milwaukee, WI, 53233, USA
- Clinical Translational Science Institute, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Danny G Thomas
- Pediatrics, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Robert A Scheidt
- Biomedical Engineering, Marquette University and Medical College of Wisconsin, Olin Engineering Center Rm 206, 1515 W. Wisconsin Ave, Milwaukee, WI, 53233, USA.
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
- Division of Civil, Mechanical and Manufacturing Innovation, National Science Foundation, Alexandria, VA, 22314, USA.
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19
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Morsø L, Bogh SB, Ris I, Kongsted A. Mind the gap - Evaluation of the promotion initiatives for implementation of the GLA:D® back clinician courses. Musculoskelet Sci Pract 2021; 53:102373. [PMID: 33823485 DOI: 10.1016/j.msksp.2021.102373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/06/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Translation of research into practice is a methodological challenge. The GLA:D® Back program was initiated to implement evidence-based care for people with low back pain inspired by GLA:D® (Good Life with osteoArthritis in Denmark) that has succeeded in implementing evidence-based care for knee and hip osteoarthritis. This study evaluates the spread and reach of promotion initiatives for GLA:D® Back clinician courses, and the adoption of the GLA:D® Back intervention in clinical practice. METHODS Pre-defined success criteria addressed; i) spread; achievement of intended promotion activities (e.g. social media), ii) reach; recruitment of clinicians with certain profiles (e.g. gender balance). Adoption was defined as patient enrollment in the GLA:D® Back registry by course participants. Univariate and multivariate logistic regression was used to investigate associations between adoption and clinician characteristics. RESULTS Most clinicians signed up based on information from colleagues (22%). Pre-defined goals for reach, except one, was obtained. 23% (140) of clinicians initiated the GLA:D® Back program in clinical practice within <90 days of course participation; mainly physiotherapists (p < 0.001). The odds ratio for starting GLA:D® Back patient care in a chiropractic setting was 7.4 [2.5; 21.4], indicating that physiotherapists employed by chiropractors mostly handled the intervention. CONCLUSION Future promotion strategies should recognize the influence of colleagues and professional networks. Converting clinician courses into patient care was mostly adopted physiotherapists. Although, evaluation processes were less useful in this study, future evaluation of health care processes has potential to inform the implementation of new models in future studies.
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Affiliation(s)
- Lars Morsø
- Open Patient Explorative Network (OPEN), Region of Suothern Denmark, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Søren Bie Bogh
- Open Patient Explorative Network (OPEN), Region of Suothern Denmark, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Inge Ris
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Nordic Institute of Chiropractic and Clinical Biomechanics (NIKKB), Odense, Denmark
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20
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Pineda R, Roussin J, Kwon J, Heiny E, Colditz G, Smith J. Applying the RE-AIM framework to evaluate the implementation of the Supporting and Enhancing NICU Sensory Experiences (SENSE) program. BMC Pediatr 2021; 21:137. [PMID: 33752619 PMCID: PMC7983273 DOI: 10.1186/s12887-021-02594-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/02/2021] [Indexed: 02/07/2023] Open
Abstract
Background To maximize the benefit of parent-directed, positive sensory exposures in the NICU, a structured sensory-based program titled the Supporting and Enhancing NICU Sensory Experiences (SENSE) program was developed that includes specific doses and targeted timing of evidence-based sensory exposures. Methods The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was used to systematically evaluate the SENSE program as an implementation strategy. One-hundred preterm infants ≤32 weeks gestation were studied (61 receiving the SENSE program and 39 standard-of-care). Parent education time and infant sensory exposures were tracked, and parents completed a questionnaire that probed their perceptions about the SENSE program. Results One-hundered thirty-one families were recruited, and 100 (76%) enrolled. The SENSE program was initiated at an average postmenstrual age of 29.8 (±2.4) weeks; 4.9 (±5.6) days after birth. The average number of education sessions with families was 4.8 (±3.7) amounting to 72.3 (±37.4) total minutes over hospitalization. The total time of logged tactile and auditory exposures among SENSE recipients over the length of hospitalization was a median (IQ range) of 9325 (5295-15,694) minutes over an average of 10.1 (±7.6) weeks of hospitalization. There were differences in the proportion of tactile and auditory exposure targets received by the infant among those receiving the SENSE program compared to standard-of-care (91% compared to 48%; p < 0.0001). Ninety-five percent of infants tolerated the SENSE program as defined, with 5% of infants requiring intermittent adaptations or the interventions being stopped for a period that typically lasted 1–2 weeks. Earlier parent education was related to more parent participation in SENSE program interventions (p = 0.04). Eighty-five percent of participants receiving the SENSE program had most of the sensory interventions completed by parents, as opposed to the medical or sensory support team. Seventy-two percent of infants had at least 100% of the auditory and tactile doses conducted over the length of stay. Parents reported acceptability. Conclusion The SENSE program had good reach, was effective and acceptable with minimal cost, was adopted, and had good fidelity. Insights from implementation of the SENSE program (within a research study) informed future strategies to aid maintenance during dissemination.
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Affiliation(s)
- Roberta Pineda
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA. .,Department of Pediatrics, Keck School of Medicine, Los Angeles, CA, USA. .,Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, USA.
| | - Jessica Roussin
- Program in Occupational Therapy, Washington University, St. Louis, MO, USA.,Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Jenny Kwon
- Program in Occupational Therapy, Washington University, St. Louis, MO, USA
| | - Elizabeth Heiny
- Program in Occupational Therapy, Washington University, St. Louis, MO, USA.,Department of Therapy Services, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Graham Colditz
- Department of Surgery, Washington University, St. Louis, MO, USA
| | - Joan Smith
- Department of Quality, Safety, and Practice Excellence, St. Louis Children's Hospital, St. Louis, MO, USA
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21
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Norman SL, Maresca D, Christopoulos VN, Griggs WS, Demene C, Tanter M, Shapiro MG, Andersen RA. Single-trial decoding of movement intentions using functional ultrasound neuroimaging. Neuron 2021; 109:1554-1566.e4. [PMID: 33756104 DOI: 10.1016/j.neuron.2021.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/29/2020] [Accepted: 03/01/2021] [Indexed: 12/18/2022]
Abstract
New technologies are key to understanding the dynamic activity of neural circuits and systems in the brain. Here, we show that a minimally invasive approach based on ultrasound can be used to detect the neural correlates of movement planning, including directions and effectors. While non-human primates (NHPs) performed memory-guided movements, we used functional ultrasound (fUS) neuroimaging to record changes in cerebral blood volume with 100 μm resolution. We recorded from outside the dura above the posterior parietal cortex, a brain area important for spatial perception, multisensory integration, and movement planning. We then used fUS signals from the delay period before movement to decode the animals' intended direction and effector. Single-trial decoding is a prerequisite to brain-machine interfaces, a key application that could benefit from this technology. These results are a critical step in the development of neuro-recording and brain interface tools that are less invasive, high resolution, and scalable.
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Affiliation(s)
- Sumner L Norman
- Biology & Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - David Maresca
- Chemistry & Chemical Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Vassilios N Christopoulos
- Biology & Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA; T&C Chen Brain-Machine Interface Center, California Institute of Technology, Pasadena, CA 91125, USA
| | - Whitney S Griggs
- Biology & Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA
| | - Charlie Demene
- Physics for Medicine Paris, INSERM, CNRS, ESPCI Paris, PSL Research University, 75012 Paris, France; INSERM Technology Research Accelerator in Biomedical Ultrasound, Paris, France
| | - Mickael Tanter
- Physics for Medicine Paris, INSERM, CNRS, ESPCI Paris, PSL Research University, 75012 Paris, France; INSERM Technology Research Accelerator in Biomedical Ultrasound, Paris, France
| | - Mikhail G Shapiro
- Chemistry & Chemical Engineering, California Institute of Technology, Pasadena, CA 91125, USA.
| | - Richard A Andersen
- Biology & Biological Engineering, California Institute of Technology, Pasadena, CA 91125, USA; T&C Chen Brain-Machine Interface Center, California Institute of Technology, Pasadena, CA 91125, USA.
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22
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Yang CL, Gad A, Creath RA, Magder L, Rogers MW, Waller SM. Effects of transcranial direct current stimulation (tDCS) on posture, movement planning, and execution during standing voluntary reach following stroke. J Neuroeng Rehabil 2021; 18:5. [PMID: 33413441 PMCID: PMC7791870 DOI: 10.1186/s12984-020-00799-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/09/2020] [Indexed: 11/26/2022] Open
Abstract
Background Impaired movement preparation of both anticipatory postural adjustments and goal directed movement as shown by a marked reduction in the incidence of StartReact responses during a standing reaching task was reported in individuals with stroke. We tested how transcranial direct current stimulation (tDCS) applied over the region of premotor areas (PMAs) and primary motor area (M1) affect movement planning and preparation of a standing reaching task in individuals with stroke. Methods Each subject performed two sessions of tDCS over the lesioned hemisphere on two different days: cathodal tDCS over PMAs and anodal tDCS over M1. Movement planning and preparation of anticipatory postural adjustment-reach sequence was examined by startReact responses elicited by a loud acoustic stimulus of 123 dB. Kinetic, kinematic, and electromyography data were recorded to characterize anticipatory postural adjustment-reach movement response. Results Anodal tDCS over M1 led to significant increase of startReact responses incidence at loud acoustic stimulus time point − 500 ms. Increased trunk involvement during movement execution was found after anodal M1 stimulation compared to PMAs stimulation. Conclusions The findings provide novel evidence that impairments in movement planning and preparation as measured by startReact responses for a standing reaching task can be mitigated in individuals with stroke by the application of anodal tDCS over lesioned M1 but not cathodal tDCS over PMAs. This is the first study to show that stroke-related deficits in movement planning and preparation can be improved by application of anodal tDCS over lesioned M1. Trial registration ClinicalTrial.gov, NCT04308629, Registered 16 March 2020—Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/NCT04308629
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Affiliation(s)
- Chieh-Ling Yang
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, 100 Penn Street, Baltimore, MD, 21201, USA. .,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, 4255 Laurel Street, Vancouver, BC, V5Z2G9, Canada. .,Department of Physical Therapy, University of British Columbia, Vancouver, BC, V6T1Z3, Canada.
| | - Alon Gad
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, 100 Penn Street, Baltimore, MD, 21201, USA
| | - Robert A Creath
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, 100 Penn Street, Baltimore, MD, 21201, USA.,Lewis Human Performance Lab, Department of Exercise Science, Lebanon Valley College, Annville, PA, 17003, USA
| | - Laurence Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, 100 Penn Street, Baltimore, MD, 21201, USA
| | - Sandy McCombe Waller
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, 100 Penn Street, Baltimore, MD, 21201, USA.,Division of Health, Business, Technology and Science, Frederick Community College, 7932 Oppossumtown Pike, Frederick, MD, 21702, USA
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23
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Spahrkäs SS, Looijmans A, Sanderman R, Hagedoorn M. Recruiting participants for an international mHealth study via Facebook Ads: Experiences from the Untire App RCT. Internet Interv 2021; 23:100362. [PMID: 33489782 PMCID: PMC7811041 DOI: 10.1016/j.invent.2021.100362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/23/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Social media recruitment via Facebook Ads seems to be a promising method for large-scale international trials examining the effectiveness of mHealth interventions. However, little is known about this method in terms of strategy, reach, and costs in the context of psycho-oncology. This paper presents the results of the recruitment strategy that was applied in the Untire app study and shows how many participants could be reached using advertisements (i.e., Ads) on Facebook, who participated, and what it cost. METHOD The Untire app study is a randomized controlled trial targeted at cancer patients and survivors across four English-speaking countries (i.e., Australia, Canada, the U.K., and the U.S.A.). Reach was assessed by the number of people who were shown the Ads, who clicked on the Ads, and completed study assessments. Demographic characteristics were gathered from Facebook Ads Manager and from online study assessments to describe who was reached. Costs were assessed by the budget spent and the cost per click for Ads, for reaching the study's landing page, and for completing study assessments. To conduct a powered RCT, we needed 164 12-weeks assessments in both the intervention and the control group. RESULTS From March till October 2018, we used 76 Ads, which were presented to 1.2 million people. 37.376 persons clicked on the study link in the Ads, resulting in 755 baseline completers. Most participants were female (92%), middle-aged (55.5 ± 9.79), and came from the U.K. (72%). The total Facebook advertisement costs from March till October 2018 were €17 k, resulting in an average cost of €0.45 per click on the Ads, €5.55 on average for a person reaching the study's landing page, and €14.89 on average per eligible participant. The costs for every baseline and 12-weeks completer were €22.42 and €47.69, respectively. DISCUSSION Reaching participants for international mHealth studies in psycho-oncology via Facebook Ads has potential but is costly. The key to reducing costs lies in constant optimization and testing of Ads and refinement of target audience characteristics.
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Affiliation(s)
- Simon S. Spahrkäs
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, the Netherlands,Corresponding author at: Department of Health Psychology, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, POB 196, 9700AD Groningen, the Netherlands.
| | - Anne Looijmans
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Robbert Sanderman
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, the Netherlands,Department of Psychology, Health & Technology, University of Twente, the Netherlands
| | - Mariët Hagedoorn
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, the Netherlands
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24
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Abstract
Dexterous forelimb movements like reaching, grasping, and manipulating objects are fundamental building blocks of the mammalian motor repertoire. These behaviors are essential to everyday activities, and their elaboration underlies incredible accomplishments by human beings in art and sport. Moreover, the susceptibility of these behaviors to damage and disease of the nervous system can lead to debilitating deficits, highlighting a need for a better understanding of function and dysfunction in sensorimotor control. The cerebellum is central to coordinating limb movements, as defined in large part by Joseph Babinski and Gordon Holmes describing motor impairment in patients with cerebellar lesions over 100 years ago (Babinski, 1902; Holmes, 1917), and supported by many important human and animal studies that have been conducted since. Here, with a focus on output pathways of the cerebellar nuclei across mammalian species, we describe forelimb movement deficits observed when cerebellar circuits are perturbed, the mechanisms through which these circuits influence motor output, and key challenges in defining how the cerebellum refines limb movement.
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Affiliation(s)
- Ayesha R Thanawalla
- Molecular Neurobiology Laboratory, Salk Institute for Biological Studies, 10010 N. Torrey Pines Road, La Jolla, CA 92037, USA
| | - Albert I Chen
- Nanyang Technological University (NTU), School of Biological Sciences, 11 Mandalay Road, Singapore 308232, Singapore; A*STAR, Institute of Molecular and Cell Biology, 61 Biopolis Drive, Singapore 308232, Singapore.
| | - Eiman Azim
- Molecular Neurobiology Laboratory, Salk Institute for Biological Studies, 10010 N. Torrey Pines Road, La Jolla, CA 92037, USA.
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25
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Lang AE, Milosavljevic S, Dickerson CR, Kim SY. Examining assessment methods of scapular motion: Comparing results from planar elevations and functional task performance. Clin Biomech (Bristol, Avon) 2020; 80:105203. [PMID: 33127188 DOI: 10.1016/j.clinbiomech.2020.105203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/01/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Scapular kinematics of breast cancer survivors are most often evaluated during arm elevation. However, known compensations exist during functional task performance. The purpose of this study was to determine if scapular kinematics of breast cancer survivors during arm elevation are related to scapular kinematics during functional task performance. METHODS Scapular kinematics of 25 non-cancer controls and 25 breast cancer survivors (split by presence of impingement pain) during arm elevation in 3 planes and 3 reaching and lifting functional tasks were measured. Scapular upward rotation and scapulohumeral rhythm (SHR) at 30° increments of arm elevation were calculated. Between-group differences of upward rotation during arm elevation were evaluated with one-way ANOVAs (p < 0.05). The association of upward rotation angle and SHR during arm elevation and functional tasks was tested with Pearson correlations (p < 0.05). FINDINGS Scapular upward rotation was reduced for the breast cancer survivor with pain at lower levels of arm elevation in each plane by up to 7.1° (p = .014 to 0.049). This is inconsistent with functional task results, in which upward rotation decrements occurred at higher levels of arm elevation. Upward rotation angles and SHR during arm elevation had an overall weak-to-moderate relationship (r = 0.003 to 0.970, p = .001 to 0.048) to values from functional tasks. Arm elevation during sagittal plane elevation demonstrated scapular upward rotation that was most closely associated to upward rotation during functional task performance. INTERPRETATION Inconsistent relationships suggests that clinical evaluations should adopt basic functional movements for scapular motion assessment to complement simple arm elevations.
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Affiliation(s)
- Angelica E Lang
- Department of Health Sciences, College of Medicine, University of Saskatchewan, Canada
| | - Stephan Milosavljevic
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Canada
| | - Clark R Dickerson
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Canada
| | - Soo Y Kim
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Canada.
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26
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Friedman RM, Chehade NG, Roe AW, Gharbawie OA. Optical imaging reveals functional domains in primate sensorimotor cortex. Neuroimage 2020; 221:117188. [PMID: 32711067 DOI: 10.1016/j.neuroimage.2020.117188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 07/19/2020] [Indexed: 12/03/2022] Open
Abstract
Motor cortex (M1) and somatosensory cortex (S1) are central to arm and hand control. Efforts to understand encoding in M1 and S1 have focused on temporal relationships between neural activity and movement features. However, it remains unclear how the neural activity is spatially organized within M1 and S1. Optical imaging methods are well-suited for revealing the spatio-temporal organization of cortical activity, but their application is sparse in monkey sensorimotor cortex. Here, we investigate the effectiveness of intrinsic signal optical imaging (ISOI) for measuring cortical activity that supports arm and hand control in a macaque monkey. ISOI revealed spatial domains that were active in M1 and S1 in response to instructed reaching and grasping. The lateral M1 domains overlapped the hand representation and contained a population of neurons with peak firing during grasping. In contrast, the medial M1 domain overlapped the arm representation and a population of neurons with peak firing during reaching. The S1 domain overlapped the hand representations of areas 1 and 2 and a population of neurons with peak firing upon hand contact with the target. Our single unit recordings indicate that ISOI domains report the locations of spatial clusters of functionally related neurons. ISOI is therefore an effective tool for surveilling the neocortex for “hot zones” of activity that supports movement. Combining the strengths of ISOI with other imaging modalities (e.g., fMRI, 2-photon) and with electrophysiological methods can open new frontiers in understanding the spatio-temporal organization of cortical signals involved in movement control.
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Yi JC, Sullivan B, Leisenring WM, Majhail NS, Jim H, Loren A, Uberti J, Whalen V, Flowers MED, Lee SJ, Maynard K, Syrjala KL. Who Enrolls in an Online Cancer Survivorship Program? Reach of the INSPIRE Randomized Controlled Trial for Hematopoietic Cell Transplantation Survivors. Biol Blood Marrow Transplant 2020; 26:1948-1954. [PMID: 32599215 DOI: 10.1016/j.bbmt.2020.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/10/2020] [Accepted: 06/19/2020] [Indexed: 12/17/2022]
Abstract
The internet can be a valuable tool in delivering survivorship care to hematopoietic cell transplantation (HCT) cancer survivors. We describe the reach of INSPIRE, an Internet and social media-based randomized controlled trial, to address healthcare and psychosocial needs of HCT survivors. All survivors 2-10 years after HCT for hematologic malignancy or myelodysplasia from 6 transplantation centers in the US were approached by mail and follow-up calls. Eligible participants had access to the Internet, an email address, and did not have active disease in the past 2 years. We used logistic regression to determine characteristics of eligible survivors who were more or less likely to enroll. Of 2578 eligible HCT survivors, 1065 (41%) enrolled in the study. The mean age of enrollees was 56.3 ± 12.6 years (range, 19 to 89 years), 52% were male, and 94% were white. Survivors less likely to enroll included those who were male, age <40 years, and who received an autologous transplant (all P < .001). Compared with white survivors, African Americans were less likely to enroll (P < .001), whereas Native Americans/Alaska Natives were more likely to join the study (P = .03). The reach of the INSPIRE program was broad, including to survivors who traditionally have less access to resources, such as Native Americans/Alaskan Natives and rural residents. Strategies are still needed to improve the enrollment of online studies of survivorship resources for males, young adults, African American, and autologous HCT survivors because their use may improve outcomes.
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Affiliation(s)
- Jean C Yi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Brie Sullivan
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Wendy M Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Navneet S Majhail
- Cleveland Clinic, Blood and Marrow Transplant Program, Cleveland, Ohio
| | | | - Alison Loren
- University of Pennsylvania, Blood & Marrow Transplant, Cell Therapy & Transplant Program, Philadelphia, Pennsylvania
| | - Joseph Uberti
- Barbara Ann Karmanos Cancer Institute, Detroit, Michigan
| | - Victoria Whalen
- University of Nebraska, Blood & Marrow Stem Cell Transplant Program, Omaha, Nebraska
| | - Mary E D Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington School of Medicine, Seattle, Washington
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington School of Medicine, Seattle, Washington
| | - Katie Maynard
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington School of Medicine, Seattle, Washington
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Nalugya R, Tanton C, Hytti L, Kansiime C, Nakuya K, Namirembe P, Nakalema S, Neema S, Alezuyo C, Namuli Musoke S, Torondel B, Francis SC, Ross DA, Bonell C, Seeley J, Weiss HA. Assessing the effectiveness of a comprehensive menstrual health intervention program in Ugandan schools (MENISCUS): process evaluation of a pilot intervention study. Pilot Feasibility Stud 2020; 6:51. [PMID: 32346485 DOI: 10.1186/s40814-020-00585-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 03/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background Poor menstrual health and hygiene (MHH) is a globally recognised public health challenge. A pilot study of an MHH intervention was conducted in two secondary schools in Entebbe, Uganda, over 9 months. The intervention included five components delivered by the implementing partner (WoMena Uganda) and the research team: (i) training teachers to implement government guidelines for puberty education, (ii) a drama skit to reduce stigma about menstruation, (iii) training in use of a menstrual kit (including re-usable pads), (iv) guidance on pain relief methods including provision of analgesics and (v) improvements to school water, sanitation and hygiene (WASH) facilities. The aim of the process evaluation was to examine implementation, context and possible causal pathways. Methods We collected information on fidelity, dose, reach, acceptability, context and mechanisms of impact using (i) quantitative survey data collected from female and male students in year 2 of secondary school (ages 13–21; 450 at the baseline and 369 at endline); (ii) qualitative data from 40 in-depth interviews with parents, teachers and female students, and four focus group discussions with students, stratified by gender; (iii) data from unannounced visits checking on WASH facilities throughout the study; and (iv) routine data collected as part of the implementation. Quantitative data were used primarily to assess fidelity, dose and reach. Qualitative data were used primarily to assess acceptability, context and possible mechanisms. Results Both schools received all intervention elements that were delivered by the research team and implementing partner. The drama skit, menstrual kit and pain management intervention components were delivered with fidelity. Intervention components that relied on school ownership (puberty education training and WASH improvements) were not fully delivered. Overall, the intervention was acceptable to participants. Multilevel contextual factors including schools’ social and physical environment, and family, cultural and social factors influenced the acceptability of the intervention in the school setting. The intervention components reinforced one another, as suggested in our theoretical framework. Conclusion The intervention was feasible to deliver and acceptable to the schools and students. We propose a full-scale cluster-randomised trial to evaluate the intervention, adding a school-based MHH leadership group to address issues with school ownership. Trial registration ClinicalTrials.gov NCT04064736. Registered August 22, 2019, retrospectively registered.
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Schliemann D, Paramasivam D, Dahlui M, Cardwell CR, Somasundaram S, Ibrahim Tamin NSB, Donnelly C, Su TT, Donnelly M. Change in public awareness of colorectal cancer symptoms following the Be Cancer Alert Campaign in the multi-ethnic population of Malaysia. BMC Cancer 2020; 20:252. [PMID: 32213173 PMCID: PMC7093961 DOI: 10.1186/s12885-020-06742-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/12/2020] [Indexed: 12/12/2022] Open
Abstract
Background Colorectal cancer (CRC) cases are detected late in Malaysia similar to most Asian countries. The Be Cancer Alert Campaign (BCAC) was a culturally adapted mass media campaign designed to improve CRC awareness and reduce late detection in Malaysia. The evaluation of the BCAC-CRC aimed to assess campaign reach, campaign impact and health service use. Methods Participants aged ≥40 years (n = 730) from randomly selected households in Selangor State Malaysia, completed interview-based assessments. Campaign reach was assessed in terms of responses to an adapted questionnaire that was used in evaluations in other countries. The impact of the campaign was assessed in terms of awareness, confidence to detect symptoms and self-efficacy to discuss symptoms with a doctor as captured by the Cancer Awareness Measure (CAM). CAM was administered before-and-after campaign implementation and responses by BCAC recognisers (i.e. participants who recognised one or more of the BCAC television, radio or print advertisements when prompted) and non-recognisers (i.e. participants who did not recognise any of the BCAC advertisements) were compared analytically. Logistic regression analysed comparative differences in cancer awareness by socio-demographic characteristics and recognition of the BCAC materials. Results Over 65% of participants (n = 484) recognised the BCAC-CRC. Campaign-recognisers were significantly more likely to be aware of each CRC symptom at follow-up and were more confident about noticing symptoms (46.9% vs 34.9%, p = 0.018) compared to non-recognisers. There was no difference between groups in terms of self-efficacy to see a doctor about symptoms. Improved symptoms awareness at follow-up was lower for Indians compared to Malays (adjusted odds ratio (OR) 0.53, 95% Confidence Interval (CI): 0.34, 0.83, p = 0.005). Health service use data did not indicate an increase in screening activity during or immediately after the campaign months. Conclusion Overall, the findings of the evaluation indicated that the culturally adapted, evidence-based mass media intervention improved CRC symptom awareness among the Malaysian population; and that impact is more likely when a campaign operates a differentiated approach that matches modes of communication to the ethnic and social diversity in a population.
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Affiliation(s)
- Désirée Schliemann
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK.
| | - Darishiani Paramasivam
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maznah Dahlui
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Facultas Public Health, University Airlangga, Surabaya, Indonesia
| | - Christopher R Cardwell
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | | | | | | | - Tin Tin Su
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia.,South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Michael Donnelly
- Centre for Public Health and UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
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Befort CA, Kurz D, VanWormer JJ, Ellerbeck EF. Recruitment and reach in a pragmatic behavioral weight loss randomized controlled trial: implications for real-world primary care practice. BMC Fam Pract 2020; 21:47. [PMID: 32126987 PMCID: PMC7055122 DOI: 10.1186/s12875-020-01117-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Obesity is a major risk factor behind some of the most common problems encountered in primary care. Although effective models for obesity treatment have been developed, the 'reach' of these interventions is poor and only a small fraction of primary care patients receive evidence-based treatment. The purpose of this study is to identify factors that impact the uptake (reach) of an evidence-based obesity treatment program within the context of a pragmatic cluster randomized controlled trial comparing three models of care delivery. METHODS Recruitment and reach were evaluated by the following measures: 1) mailing response rates, 2) referral sources among participants contacting the study team, 3) eligibility rates, 4) participation rates, and 5) representativeness based on demographics, co-morbid conditions, and healthcare utilization of 1432 enrolled participants compared to > 17,000 non-participants from the clinic-based patient populations. Referral sources and participation rates were compared across study arms and level of clinic engagement. RESULTS The response rate to clinic-based mailings was 13.2% and accounted for 66% of overall program recruitment. An additional 22% of recruitment came from direct clinic referrals and 11% from media, family, or friends. Of those screened, 87% were eligible; among those eligible, 86% enrolled in the trial. Participation rates did not vary across the three care delivery arms, but were higher at clinics with high compared to low provider involvement. In addition, clinics with high provider involvement had a higher rate of in clinic referrals (33% versus 16%) and a more representative sample with regards to BMI, rurality, and months since last clinic visit. However, across clinics, enrolled participants compared to non-participants were older, more likely to be female, more likely to have had a joint replacement but less likely to have CVD or smoke, and had fewer hospitalizations. CONCLUSIONS A combination of direct patient mailings and in-clinic referrals may enhance the reach of primary care behavioral weight loss interventions, although more proactive outreach is likely necessary for men, younger patients, and those at greater medial risk. Strategies are needed to enhance provider engagement in referring patients to behavioral weight loss programs. TRIAL REGISTRATION clnicialtrials.gov NCT02456636. Registered May 28, 2015, https://www.clinicaltrials.gov/ct2/results?cond=&term=RE-POWER&cntry=&state=&city=&dist=.
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Affiliation(s)
- Christie A Befort
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1008, Kansas City, KS, 66160, USA.
| | - Danny Kurz
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1008, Kansas City, KS, 66160, USA
| | - Jeffrey J VanWormer
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, 1000 North Oak Ave (ML2), Marshfield, WI, 54449, USA
| | - Edward F Ellerbeck
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1008, Kansas City, KS, 66160, USA
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Darling WG, Pizzimenti MA, Rotella DL, Ge J, Stilwell-Morecraft KS, Morecraft RJ. Changes in ipsilesional hand motor function differ after unilateral injury to frontal versus frontoparietal cortices in Macaca mulatta. Exp Brain Res 2019; 238:205-220. [PMID: 31834452 DOI: 10.1007/s00221-019-05690-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/07/2019] [Indexed: 01/29/2023]
Abstract
We tested the hypothesis that injury to frontoparietal sensorimotor areas causes greater initial impairments in performance and poorer recovery of ipsilesional dexterous hand/finger movements than lesions limited to frontal motor areas in rhesus monkeys. Reaching and grasping/manipulation of small targets with the ipsilesional hand were assessed for 6-12 months post-injury using two motor tests. Initial post-lesion motor skill and long-term recovery of motor skill were compared in two groups of monkeys: (1) F2 group-five cases with lesions of arm areas of primary motor cortex (M1) and lateral premotor cortex (LPMC) and (2) F2P2 group-five cases with F2 lesions + lesions of arm areas of primary somatosensory cortex and the anterior portion of area 5. Initial post-lesion reach and manipulation skills were similar to or better than pre-lesion skills in most F2 lesion cases in a difficult fine motor task but worse than pre-lesion skill in most F2P2 lesion cases in all tasks. Subsequently, reaching and manipulation skills improved over the post-lesion period to higher than pre-lesion skills in both groups, but improvements were greater in the F2 lesion group, perhaps due to additional task practice and greater ipsilesional limb use for daily activities. Poorer and slower post-lesion improvement of ipsilesional upper limb motor skill in the F2P2 cases may be due to impaired somatosensory processing. The persistent ipsilesional upper limb motor deficits frequently observed in humans after stroke are probably caused by greater subcortical white and gray matter damage than in the localized surgical injuries studied here.
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Affiliation(s)
- Warren G Darling
- Motor Control Laboratory, Department of Health and Human Physiology, The University of Iowa, Iowa City, IA, 52242, USA.
| | - Marc A Pizzimenti
- Department of Anatomy and Cell Biology, Carver College of Medicine, The University of Iowa, Iowa City, IA, 52242, USA
| | - Diane L Rotella
- Motor Control Laboratory, Department of Health and Human Physiology, The University of Iowa, Iowa City, IA, 52242, USA
| | - Jizhi Ge
- Laboratory of Neurological Sciences, Division of Basic Biomedical Sciences, Sanford School of Medicine, The University of South Dakota, Vermillion, SD, 57069, USA
| | - Kimberly S Stilwell-Morecraft
- Laboratory of Neurological Sciences, Division of Basic Biomedical Sciences, Sanford School of Medicine, The University of South Dakota, Vermillion, SD, 57069, USA
| | - Robert J Morecraft
- Laboratory of Neurological Sciences, Division of Basic Biomedical Sciences, Sanford School of Medicine, The University of South Dakota, Vermillion, SD, 57069, USA
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Askeland E, Forgatch MS, Apeland A, Reer M, Grønlie AA. Scaling up an Empirically Supported Intervention with Long-Term Outcomes: the Nationwide Implementation of GenerationPMTO in Norway. Prev Sci 2019; 20:1189-1199. [PMID: 31440944 PMCID: PMC6881263 DOI: 10.1007/s11121-019-01047-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Effective implementation outcomes are necessary preconditions for effective service and positive treatment outcomes for children with behavioral problems. The aim of this study is to assess outcomes of the transfer of the empirically supported intervention GenerationPMTO from the developer in the USA to a nationwide implementation in Norway. Adoption, sustainability, reach, and fidelity are tested across seven generations of therapists in Norway. Participants in the study were 521 therapists who began training in the program. The developer's team trained the first generation (G1) and the Norwegian team trained the next six generations (G2-G7). The mean rate of certification was 94.2% (n = 491). Intervention fidelity was assessed from 1964 video recordings of intervention sessions submitted for certification evaluation using the observation-based measure Fidelity of Implementation Rating System (FIMP). A small but significant drop in fidelity scores was previously observed from G1 to G2; however, fidelity scores recovered at or above G1 scores for G3 Forgatch and DeGarmo (Prevention Science 12, 235-246, 2011). Twenty years since the inception of implementation, 314 certified therapists practice the model today, a retention rate of 64%. The outcomes show sustained fidelity scores across seven generations, increasing heterogeneity among therapists trained, and a shift of focus in the target population from clinical to primary services. The present study contributes to the field with the systematic evaluation of outcomes for the full transfer implementation approach with continuing adoption and sustainability, increasing reach and sustained intervention fidelity across several generations of practitioners.
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Affiliation(s)
- Elisabeth Askeland
- The Norwegian Center for Child Behavioral Development, NUBU, Postbox 7053 Majorstuen, 0306, Oslo, Norway.
| | - Marion S Forgatch
- Implementation Sciences International, Inc. & Oregon Social Learning Center, Eugene, OR, 97401, USA
| | - Anett Apeland
- The Norwegian Center for Child Behavioral Development, NUBU, Postbox 7053 Majorstuen, 0306, Oslo, Norway
| | - Marit Reer
- The Norwegian Center for Child Behavioral Development, NUBU, Postbox 7053 Majorstuen, 0306, Oslo, Norway
| | - Anette A Grønlie
- The Norwegian Center for Child Behavioral Development, NUBU, Postbox 7053 Majorstuen, 0306, Oslo, Norway
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Karl JM, Slack BM, Wilson AM, Wilson CA, Bertoli ME. Increasing task precision demands reveals that the reach and grasp remain subject to different perception-action constraints in 12-month-old human infants. Infant Behav Dev 2019; 57:101382. [PMID: 31580995 DOI: 10.1016/j.infbeh.2019.101382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/29/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022]
Abstract
The reach and grasp follow different developmental trajectories, but are often considered to have achieved nearly adult-like precision and integration by 12 months of age. This study used frame-by-frame video analysis to investigate whether increasing precision demands, by placing small reaching targets on a narrow pedestal rather than on a flat table, would influence the reach and grasp movements of 12-month-old infants in a complementary or differential fashion. The results reveal that placing the target atop a pedestal impaired the infants's ability to direct an appropriate digit towards the small target, but did not produce a corresponding decrease in the frequency with which they used an index-thumb pincer grip to grasp the target. This was due to the fact that, although infants were more likely to contact the target with a suboptimal part of the hand in the pedestal condition, a greater proportion of these suboptimal contacts ultimately transitioned to a successful index-thumb pincer grip. Thus, increasing task precision demands impaired reach accuracy, but facilitated index-thumb grip formation, in 12-month-old infants. The differential response of the reach and grasp to the increased precision demands of the pedestal condition suggests that the two movements are not fully integrated and, when precision demands are great, remain sensitive to different perception-action constraints in 12-month-old infants.
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Affiliation(s)
- Jenni M Karl
- Department of Psychology, Thompson Rivers University, Kamloops, BC, Canada.
| | - Braydon M Slack
- Department of Psychology, Thompson Rivers University, Kamloops, BC, Canada
| | - Alexis M Wilson
- Department of Psychology, Thompson Rivers University, Kamloops, BC, Canada
| | | | - Marisa E Bertoli
- Department of Psychology, Thompson Rivers University, Kamloops, BC, Canada
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Teoh JYC, Mackenzie G, Tortolero L, Rivas JG. Social Media Analytics: What You Need to Know as a Urologist. Eur Urol Focus 2019; 6:434-436. [PMID: 31471218 DOI: 10.1016/j.euf.2019.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 07/28/2019] [Accepted: 08/15/2019] [Indexed: 11/30/2022]
Abstract
In this digital era there has been increasing use of social media in the field of urology. Although we can often feel the impact of social media in our daily encounters, we need more quantifiable measures to evaluate and monitor social media activities. By gathering and analyzing data from different social media platforms, we will be able to understand how we can engage our audience more successfully in the dissemination of urological information. In this mini-review we discuss the fundamentals of social media analytics with a special focus on social media metrics and social network analysis. We also discuss the implications of social media analytics with the aim of fostering a better understanding of this important aspect of social media. PATIENT SUMMARY: By gathering and analyzing data from social media platforms, we will be able to understand how we can engage our audience more successfully in the dissemination of urological information.
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Affiliation(s)
- Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
| | | | | | - Juan Gomez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain
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Boissonnat JD, Lieutier A, Wintraecken M. The reach, metric distortion, geodesic convexity and the variation of tangent spaces. ACTA ACUST UNITED AC 2019; 3:29-58. [PMID: 31633006 DOI: 10.1007/s41468-019-00029-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 06/27/2019] [Indexed: 10/28/2022]
Abstract
In this paper we discuss three results. The first two concern general sets of positive reach: we first characterize the reach of a closed set by means of a bound on the metric distortion between the distance measured in the ambient Euclidean space and the shortest path distance measured in the set. Secondly, we prove that the intersection of a ball with radius less than the reach with the set is geodesically convex, meaning that the shortest path between any two points in the intersection lies itself in the intersection. For our third result we focus on manifolds with positive reach and give a bound on the angle between tangent spaces at two different points in terms of the reach and the distance between the two points.
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Machado LR, Heathcock J, Carvalho RP, Pereira ND, Tudella E. Kinematic characteristics of arm and trunk when drinking from a glass in children with and without cerebral palsy. Clin Biomech (Bristol, Avon) 2019; 63:201-206. [PMID: 30925379 DOI: 10.1016/j.clinbiomech.2019.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 02/12/2019] [Accepted: 03/18/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Children with cerebral palsy (CP) often have difficulty with activities that require the upper extremities secondary to deficits in strength and range of motion, spasticity, and poor timing and coordination of movement. This study aimed to identify and compare timing and coordination of the trunk and upper extremity in children with and without CP during a functional task. METHODS Eighteen children, N = 9 with CP and N = 9 with typical development were enrolled. Participants were seated in a standard chair and instructed to drink from a glass placed at a distance of 75% of available arm length. The task was divided into 3 Phases: 1) reaching to the glass, 2) transporting the glass to the mouth, and 3) returning the glass to the table. The spatiotemporal and angular variables were analyzed with 3D kinematics of movement using a 4-camera Qualysis Motion System. FINDINGS Children with CP demonstrated poor upper extremity timing and coordination. Despite significant trunk displacement used as a compensation in Phase 1, children with CP demonstrated a significantly lower mean velocity and velocity peak during Phases 2 and 3; and demonstrated less straight motion which required more time and movement units in all phases. INTERPRETATION Children with CP demonstrated poor upper extremity timing and coordination when drinking (even when they successfully completed the task) measured by more trunk displacement, slower, less straight movements, and more movement units. Current rehabilitation strategies could consider training speed and use functional tasks that require different strategies across multiple phases.
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Affiliation(s)
- L R Machado
- Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luís, São Carlos, Brazil.
| | - J Heathcock
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA.
| | - R P Carvalho
- Department of Human Movement Sciences, Federal University of São Paulo, Edifício Central - R. Silva Jardim, 136, Vila Matias, Santos, Brazil
| | - N D Pereira
- Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luís, São Carlos, Brazil
| | - E Tudella
- Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luís, São Carlos, Brazil
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Hoersch J, Hoffmann-Doerr S, Keller D. Derivation of an inhalation TTC for the workplace based on DNEL values reported under REACH. Toxicol Lett 2018; 290:110-115. [PMID: 29596887 DOI: 10.1016/j.toxlet.2018.03.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/01/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
The Threshold of Toxicological Concern (TTC) concept defines a generic tolerable exposure for chemicals of unknown toxicity below which the risk of adverse health effects is considered very small. The original concept was refined and extended over the years, based either on differentiated structural classes or on additional information on certain toxicological endpoints. Initially, the focus of the TTC application was only on systemic toxic effects after repeated oral intake and consisted of one value. However, under well-defined boundary conditions, a long-term systemic inhalation TTC could also serve as a cut-off criterion for occupational exposure in those cases where workers are exposed to very low levels of chemicals by inhalation contact and could therefore reduce the need to perform animal tests. Within the scope of the European REACH legislation, several thousand systemic long-term inhalation Derived No Effect Levels (DNELs) for workers have been published. By statistical evaluation of the DNEL distribution of 1876 chemicals and the resulting 99th percentiles, we propose an inhalation workplace TTC for systemic effects in the region of 50 μg/m3 (7 μg/kg body weight/day). Specific exclusion criteria apply for the discussed concept.
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Affiliation(s)
- Johanna Hoersch
- Henkel AG & Co. KGaA, Henkelstr. 67, 40589 Düsseldorf, Germany.
| | | | - Detlef Keller
- Henkel AG & Co. KGaA, Henkelstr. 67, 40589 Düsseldorf, Germany
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Abstract
Temporal-spatial reach parameters are revealing of upper-limb function in children with motor impairments, but have not been quantified in a toddler population. This work quantitatively characterizes temporal-spatial reach in typically-developing (TD) and very-low-birth-weight (VLBW) preterm toddlers, who are at increased risk of motor impairment. 47 children born VLBW (<1500 g birth-weight; ≤32 weeks gestation) and 22 TD children completed a reaching assessment at 18-22 months of age, adjusted for prematurity. Inertial sensors containing accelerometers, gyroscopes and magnetometers were fixed to toddlers' wrists while they reached for a cube. Reach time, path length, velocity at contact, peak velocity magnitude and timing, acceleration at contact, and peak acceleration were derived from inertial-sensor and high-speed video data. Preterm children also received the Bayley Scales of Infant Development-3rd Edition (BSID-III). Compared to TD toddlers, preterm toddlers had significantly different reach path length, velocity at contact, peak velocity magnitude and timing, acceleration at contact, and peak acceleration. Among preterm toddlers, decreased reach time (rho = -.346, p = .018), decreased time to peak velocity (r = -.390, p = .007), and increased peak acceleration (r = .298, p = .044) correlated to higher BSID-III fine motor scores. Toddlers with below-average fine motor scores had significantly higher peak and contact velocity. Preterm toddlers demonstrated substantial differences in temporal-spatial reach parameters compared to TD toddlers, and evidence indicated several reach parameters were revealing of function and may be useful as a clinical assessment.
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Affiliation(s)
- Katelyn Cahill-Rowley
- Department of Bioengineering, Stanford University, Stanford, CA, USA; Motion & Gait Analysis Laboratory, Lucile Packard Children's Hospital, Palo Alto, CA, USA; Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jessica Rose
- Motion & Gait Analysis Laboratory, Lucile Packard Children's Hospital, Palo Alto, CA, USA; Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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Ball K, Abbott G, Wilson M, Chisholm M, Sahlqvist S. How to get a nation walking: reach, retention, participant characteristics and program implications of Heart Foundation Walking, a nationwide Australian community-based walking program. Int J Behav Nutr Phys Act 2017; 14:161. [PMID: 29162125 PMCID: PMC5698941 DOI: 10.1186/s12966-017-0617-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/14/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Community-based walking programs represent a low-cost, accessible approach to increasing physical activity among inactive adults. However, recruiting participants from vulnerable and hard-to-reach groups remains a challenge. This study examined the reach, retention, sociodemographic and health characteristics, physical activity levels and motivators of participants in Heart Foundation Walking, a nationwide Australian community-based walking program. METHODS Descriptive cross-sectional analyses were undertaken with data from 22,416 participants aged 15+ years in the Heart Foundation Walking registration database in December 2015, and from four surveys of participants in 2010 (n = 2400), 2011 (n = 3274), 2012 (n = 4158) and 2015 (n = 1890). RESULTS Heart Foundation Walking reached participants in every geographic region of Australia, including remote and sparsely populated regions, and engaged sizeable proportions of the following at-risk participants: older than 60 years (>70%); with very low incomes (17-25%); who were overweight or obese (around 60%); and with one or more chronic disease or disease risk factors (57-81%). For all demographic groups, one-year retention rates were at least 75%. Seventy percent of participants met physical activity recommendations. Over 75% reported joining the program for health and fitness reasons while the most cited motivator for continuing was the social aspect (57-73%). CONCLUSIONS Volunteer-run, group-based walking programs can have substantial reach and retention, in particular among those at risk for physical inactivity. The provision of opportunities for social interaction appears to be a key program element in promoting long-term participation, including among high-risk groups.
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Affiliation(s)
- Kylie Ball
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Melbourne Burwood Campus, 221 Burwood Hwy, Burwood, VIC 3125 Australia
| | - Gavin Abbott
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Melbourne Burwood Campus, 221 Burwood Hwy, Burwood, VIC 3125 Australia
| | - Michelle Wilson
- Heart Foundation, 155-159 Hutt St, Adelaide, SA 5000 Australia
| | - Melanie Chisholm
- North Western Melbourne PHN, 369 Royal Parade, Parkville, VIC 3052 Australia
| | - Shannon Sahlqvist
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Melbourne Burwood Campus, 221 Burwood Hwy, Burwood, VIC 3125 Australia
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Lee RE, Reese-Smith JY, Mama SK, Medina AV, Wolfe KL, Estabrooks PA. Reach and representativeness of ethnic minority women in the Health Is Power Study: a longitudinal analysis. Transl Behav Med 2017; 7:106-114. [PMID: 27256575 DOI: 10.1007/s13142-016-0385-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Reach is a key factor in translating research to practical application. This study examined reach and representativeness of a multi-city, randomized controlled community health trial in African American (AA) and Hispanic or Latina (HL) women. Participants completed measures of demographics, body mass index (BMI), percent body fat, resting heart rate, and blood pressure followed by a run-in procedure and a randomization meeting. AA were more likely to be screened out initially; HL were more likely to drop out. Participation did not differ by city or recruitment method. Women who completed the post-intervention assessment were more likely to be AA, older, and have higher socioeconomic status (p values < .05). This study showed moderate levels of reach but overrepresented higher educated, wealthier, and older women at the completion of the study. Representativeness can change over the course of the study and impact the practicality of translating research to practice.
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Affiliation(s)
- Rebecca E Lee
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, 550 N 3rd St, Phoenix, AZ, 85004, USA.
| | - Jacqueline Y Reese-Smith
- Department of Psychology, Jackson State University, 1400 J.R. Lynch Street, LIB Rm 232, Jackson, MS, 39217, USA
| | - Scherezade K Mama
- Department of Kinesiology, The Pennsylvania State University, 268J Recreation Building, University Park, PA, 16802, USA
| | - Ashley V Medina
- Texas Obesity Research Center, Department of Health and Human Performance, University of Houston, 3855 Holman Street, Garrison Gym Rm 104, Houston, TX, 77204-6015, USA
| | - Kristin L Wolfe
- Texas Obesity Research Center, Department of Health and Human Performance, University of Houston, 3855 Holman Street, Garrison Gym Rm 104, Houston, TX, 77204-6015, USA
| | - Paul A Estabrooks
- Department of Health Promotion, Social & Behavioral Health, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198, USA
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Butensky SD, Sloan AP, Meyers E, Carmel JB. Dexterity: A MATLAB-based analysis software suite for processing and visualizing data from tasks that measure arm or forelimb function. J Neurosci Methods 2017; 286:114-124. [PMID: 28583476 DOI: 10.1016/j.jneumeth.2017.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hand function is critical for independence, and neurological injury often impairs dexterity. To measure hand function in people or forelimb function in animals, sensors are employed to quantify manipulation. These sensors make assessment easier and more quantitative and allow automation of these tasks. While automated tasks improve objectivity and throughput, they also produce large amounts of data that can be burdensome to analyze. We created software called Dexterity that simplifies data analysis of automated reaching tasks. NEW METHOD Dexterity is MATLAB software that enables quick analysis of data from forelimb tasks. Through a graphical user interface, files are loaded and data are identified and analyzed. These data can be annotated or graphed directly. Analysis is saved, and the graph and corresponding data can be exported. For additional analysis, Dexterity provides access to custom scripts created by other users. RESULTS To determine the utility of Dexterity, we performed a study to evaluate the effects of task difficulty on the degree of impairment after injury. Dexterity analyzed two months of data and allowed new users to annotate the experiment, visualize results, and save and export data easily. COMPARISON WITH EXISTING METHOD(S) Previous analysis of tasks was performed with custom data analysis, requiring expertise with analysis software. Dexterity made the tools required to analyze, visualize and annotate data easy to use by investigators without data science experience. CONCLUSIONS Dexterity increases accessibility to automated tasks that measure dexterity by making analysis of large data intuitive, robust, and efficient.
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Affiliation(s)
| | - Andrew P Sloan
- Texas Biomedical Center, The University of Texas at Dallas, Richardson, TX, 75080, USA; Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX, 75080, USA.
| | - Eric Meyers
- Texas Biomedical Center, The University of Texas at Dallas, Richardson, TX, 75080, USA; Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX, 75080, USA.
| | - Jason B Carmel
- Burke Medical Research Institute, White Plains, NY, 10605, USA; Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, 10065, USA; Departments of Neurology and Pediatrics, Weill Cornell Medical College, New York, NY, USA.
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Goedendorp MM, Kuiper D, Reijneveld SA, Sanderman R, Steverink N. Sustaining program effectiveness after implementation: The case of the self-management of well-being group intervention for older adults. Patient Educ Couns 2017; 100:1177-1184. [PMID: 28089311 DOI: 10.1016/j.pec.2017.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 01/05/2017] [Accepted: 01/09/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The Self-Management of Well-being (SMW) group intervention for older women was implemented in health and social care. Our aim was to assess whether effects of the SMW intervention were comparable with the original randomized controlled trial (RCT). Furthermore, we investigated threats to effectiveness, such as participant adherence, group reached, and program fidelity. METHODS In the implementation study (IMP) 287 and RCT 142 women participated. We compared scores on self-management ability and well-being of the IMP and RCT. For adherence, drop-out rates and session attendance were compared. Regarding reach, we compared participants' baseline characteristics. Professionals completed questions regarding program fidelity. RESULTS No significant differences were found on effect outcomes and adherence between IMP and RCT (all p≥0.135). Intervention effect sizes were equal (0.47-0.59). IMP participants were significantly less lonely and more likely to be married, but had lower well-being. Most professionals followed the protocol, with only minimal deviations. CONCLUSION The effectiveness of the SMW group intervention was reproduced after implementation, with similar participant adherence, minimal changes in the group reached, and high program fidelity. PRACTICE IMPLICATIONS The SMW group intervention can be transferred to health and social care without loss of effectiveness. Implementation at a larger scale is warranted.
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Affiliation(s)
- Martine M Goedendorp
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Daphne Kuiper
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Clinical Research Office, UMC staff, University Medical Center Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, (Community & Occupational Medicine,) University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robbert Sanderman
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | - Nardi Steverink
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Sociology, University of Groningen, Groningen, The Netherlands
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Yu X, Ren J, Zhang Q, Liu Q, Liu H. Modeling study of seated reach envelopes based on spherical harmonics with consideration of the difficulty ratings. Appl Ergon 2017; 60:220-230. [PMID: 28166881 DOI: 10.1016/j.apergo.2016.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 11/28/2016] [Accepted: 12/03/2016] [Indexed: 06/06/2023]
Abstract
Reach envelopes are very useful for the design and layout of controls. In building reach envelopes, one of the key problems is to represent the reach limits accurately and conveniently. Spherical harmonics are proved to be accurate and convenient method for fitting of the reach capability envelopes. However, extensive study are required on what components of spherical harmonics are needed in fitting the envelope surfaces. For applications in the vehicle industry, an inevitable issue is to construct reach limit surfaces with consideration of the seating positions of the drivers, and it is desirable to use population envelopes rather than individual envelopes. However, it is relatively inconvenient to acquire reach envelopes via a test considering the seating positions of the drivers. In addition, the acquired envelopes are usually unsuitable for use with other vehicle models because they are dependent on the current cab packaging parameters. Therefore, it is of great significance to construct reach envelopes for real vehicle conditions based on individual capability data considering seating positions. Moreover, traditional reach envelopes provide little information regarding the assessment of reach difficulty. The application of reach envelopes will improve design quality by providing difficulty-rating information about reach operations. In this paper, using the laboratory data of seated reach with consideration of the subjective difficulty ratings, the method of modeling reach envelopes is studied based on spherical harmonics. The surface fitting using spherical harmonics is conducted for circumstances both with and without seat adjustments. For use with adjustable seat, the seating position model is introduced to re-locate the test data. The surface fitting is conducted for both population and individual reach envelopes, as well as for boundary envelopes. Comparison of the envelopes of adjustable seat and the SAE J287 control reach envelope shows that the latter is nearly at the middle difficulty level. It is also found that the abilities of reach envelope models in expressing the shape of the reach limits based on spherical harmonics depends both on the terms in the model expression and on the data used to fit the envelope surfaces.
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Affiliation(s)
- Xiaozhi Yu
- State Key Lab of Automotive Simulation and Control, Jilin University, Changchun 130022, China
| | - Jindong Ren
- State Key Lab of Automotive Simulation and Control, Jilin University, Changchun 130022, China.
| | - Qian Zhang
- State Key Lab of Automotive Simulation and Control, Jilin University, Changchun 130022, China
| | - Qun Liu
- State Key Lab of Automotive Simulation and Control, Jilin University, Changchun 130022, China
| | - Honghao Liu
- State Key Lab of Automotive Simulation and Control, Jilin University, Changchun 130022, China
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Liu Q, Ren J, Zhang Q, Hua M. Seated reach capabilities for ergonomic design and evaluation with consideration of reach difficulties. Appl Ergon 2017; 59:357-363. [PMID: 27890148 DOI: 10.1016/j.apergo.2016.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 09/18/2016] [Accepted: 09/26/2016] [Indexed: 06/06/2023]
Abstract
This paper aimed to identify the reach capabilities of 26 seated subjects considering the reach difficulty, orientation and other potential factors, and to find a method to model the minimum reach capability surfaces for fixed and adjustable seats. The reach capability radius was used as a measure of the reach capability and theoretically modeled. Based on the test data of seated reach, the distribution of the reach capability radius was analyzed. The strategy to select the minimum reach envelopes was constructed to accommodate a sufficient percentage of the target population for both fixed and adjustable seats. For adjustable seats, a method was developed to derive the reach capability data from the tested individual reach capability data by introducing seating position models to re-position the individual reach capability data. An application case was realized based on the cab packaging data of a mini-van, and the minimum reach envelopes of different difficulties were created and validated to accommodate 90% of the target population.
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Affiliation(s)
- Qun Liu
- College of Automotive Engineering, Jilin University, Changchun 130022, China
| | - Jindong Ren
- College of Automotive Engineering, Jilin University, Changchun 130022, China.
| | - Qian Zhang
- College of Automotive Engineering, Jilin University, Changchun 130022, China
| | - Meng Hua
- College of Automotive Engineering, Jilin University, Changchun 130022, China
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Estabrooks P, You W, Hedrick V, Reinholt M, Dohm E, Zoellner J. A pragmatic examination of active and passive recruitment methods to improve the reach of community lifestyle programs: The Talking Health Trial. Int J Behav Nutr Phys Act 2017; 14:7. [PMID: 28103935 PMCID: PMC5248490 DOI: 10.1186/s12966-017-0462-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 01/05/2017] [Indexed: 01/30/2023] Open
Abstract
Background A primary challenge for behavior change strategies is ensuring that interventions can be effective while also attracting a broad and representative sample of the target population. The purpose of this case-study was to report on (1) the reach of a randomized controlled trial targeting reduced sugary beverages, (2) potential participant characteristic differences based on active versus passive recruitment strategies, and (3) recruitment strategy cost. Methods Demographic and recruitment information was obtained for 8 counties and for individuals screened for participation. Personnel activities and time were tracked. Costs were calculated and compared by active versus passive recruitment. Results Six-hundred and twenty, of 1,056 screened, individuals were eligible and 301enrolled (77% women; 90% white; mean income $21,981 ± 16,443). Eighty-two and 44% of those responding to passive and active methods, respectively, enrolled in the trial. However, active recruitment strategies yielded considerably more enrolled (active = 199; passive = 102) individuals. Passive recruitment strategies yielded a less representative sample in terms of gender (more women), education (higher), and income (higher; p’s <0.05). The average cost of an actively recruited and enrolled participant was $278 compared to $117 for a passively recruited and enrolled participant. Conclusions Though passive recruitment is more cost efficient it may reduce the reach of sugary drink reduction strategies in lower educated and economic residents in rural communities. Trial registration Clinicaltrials.gov; ID: NCT02193009, July 2014, retrospectively registered.
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Affiliation(s)
- Paul Estabrooks
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198-4365, USA.
| | - Wen You
- Department of Applied and Agricultural Economics, Virginia Tech, 304 Hutcheson Hall, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Valisa Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 335A Wallace Hall, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Margaret Reinholt
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1981 Kraft Drive, 1031 ILSB, Blacksburg, VA, 24060, USA
| | - Erin Dohm
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1981 Kraft Drive, 1031 ILSB, Blacksburg, VA, 24060, USA
| | - Jamie Zoellner
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1981 Kraft Drive, 1031 ILSB, Blacksburg, VA, 24060, USA
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Bukman AJ, Teuscher D, Ben Meftah J, Groenenberg I, Crone MR, van Dijk S, Bos MB, Feskens EJM. Exploring strategies to reach individuals of Turkish and Moroccan origin for health checks and lifestyle advice: a mixed-methods study. BMC Fam Pract 2016; 17:85. [PMID: 27439610 PMCID: PMC4955164 DOI: 10.1186/s12875-016-0476-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 07/06/2016] [Indexed: 11/10/2022]
Abstract
Background Low participation rates among ethnic minorities in preventive healthcare services are worrisome and not well understood. The objective of this study was to explore how adults of Turkish and Moroccan origin living in the Netherlands, aged 45 years and older, can be reached to participate in health checks for cardio-metabolic diseases and follow-up (lifestyle) advice. Methods This mixed-methods study used a convergent parallel design, to combine data of one quantitative study and three qualitative studies. Questionnaire data were included of 310 respondents, and interview data from 22 focus groups and four individual interviews. Participants were recruited via a research database, general practitioners and key figures. Quantitative data were analysed descriptively and qualitative data were analysed using a thematic approach. Results Regarding health checks, 50 % (95 % CI 41;59) of the Turkish questionnaire respondents and 66 % (95 % CI 57;76) of the Moroccan questionnaire respondents preferred an invitation from their general practitioner. The preferred location to fill out the health check questionnaire was for both ethnic groups the general practitioner’s office or at home, on paper. Regarding advice, both groups preferred to receive advice at individual level rather than in a group, via either a physician or a specialised healthcare professional. It was emphasised that the person who gives lifestyle advice should be familiar with the (eating) habits of the targeted individual. Sixty-one percent (95 % CI 53;69) of the Turkish respondents preferred to receive information in their native language compared to 37 % (95 % CI 29;45) of the Moroccan respondents. Several participants mentioned a low proficiency in the local language as an explanation for their preference to fill out the health check questionnaire at home, to receive advice from an ethnic-matched professional, and to receive information in their native language. Conclusions The general practitioner is considered as a promising contact to reach adults of Turkish and Moroccan origin for health checks or (lifestyle) advice. It might be necessary to provide information in individuals’ native language to overcome language barriers. In addition, (lifestyle) advice must be tailored. The obtained insight into preferences of Turkish and Moroccan adults regarding reach for preventive healthcare services could help professionals to successfully target these groups.
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Affiliation(s)
- Andrea J Bukman
- Division of Human Nutrition, Wageningen University, P.O Box 8129, 6700 EV, Wageningen, The Netherlands.
| | - Dorit Teuscher
- Department of Human Biology, Maastricht University Medical Centre+, NUTRIM School for Nutrition, Toxicology and Metabolism, P.O Box 616, 6200 MD, Maastricht, The Netherlands
| | - Jamila Ben Meftah
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2300 RC, Leiden, The Netherlands
| | - Iris Groenenberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2300 RC, Leiden, The Netherlands
| | - Mathilde R Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2300 RC, Leiden, The Netherlands
| | - Sandra van Dijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2300 RC, Leiden, The Netherlands.,Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioral Sciences, Leiden University, P.O Box 9555, 2300 RB, Leiden, The Netherlands
| | - Marieke B Bos
- Dutch Heart Foundation, P.O Box 300, 2501 CH, The Hague, The Netherlands
| | - Edith J M Feskens
- Division of Human Nutrition, Wageningen University, P.O Box 8129, 6700 EV, Wageningen, The Netherlands
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Scherr CL, Augusto B, Ali K, Malo TL, Vadaparampil ST. Provider-reported acceptance and use of the Centers for Disease Control and Prevention messages and materials to support HPV vaccine recommendation for adolescent males. Vaccine 2016; 34:4229-4234. [PMID: 27340095 DOI: 10.1016/j.vaccine.2016.06.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE We evaluated Florida-based physicians' awareness and use of the Centers for Disease Control and Prevention's (CDC) "You are the Key" campaign website, including messages to support physicians' human papillomavirus (HPV) vaccine recommendations. METHODS Using closed-ended and free-text survey items, physicians' (n=355) practices related to HPV vaccination recommendations for males and use of the CDC's materials were assessed. Descriptive statistics were calculated for closed-ended questions, and thematic analysis was conducted on free-text responses. RESULTS Over half of physicians were aware of the CDC's website (n=186; 57.9%); of those aware, fewer than half reported using the website (n=86; 46.2%). Slightly more than half reported awareness of the CDC's messages (n=178; 55.3%); however, less than one-third of those aware reported using them (n=56; 31.5%). Physicians' comments on the CDC's messages were favorable; 78.6-93.2% said they would use a message in clinic. CONCLUSION Additional research is needed to identify the best mechanisms for resource dissemination and to understand why physicians do not use these messages, despite favorable attitudes.
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Affiliation(s)
- C L Scherr
- Northwestern University, School of Communication, Department of Communication Studies, Center for Communication and Health, 710 North Lake Shore Drive 15th Floor, Chicago, IL 60611, USA
| | - B Augusto
- Moffitt Cancer Center, Health Outcomes and Behavior, 120902 Magnolia Drive, MRCCANCONT, Tampa, FL 33612, USA
| | - K Ali
- Moffitt Cancer Center, Health Outcomes and Behavior, 120902 Magnolia Drive, MRCCANCONT, Tampa, FL 33612, USA
| | - T L Malo
- University of North Carolina, Lineberger Comprehensive Cancer Center and Department of Health Behavior, 324 Rosenau Hall CB# 7440, Chapel Hill, NC 27599, USA
| | - S T Vadaparampil
- Moffitt Cancer Center, Health Outcomes and Behavior, 120902 Magnolia Drive, MRCCANCONT, Tampa, FL 33612, USA.
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Dusing SC, Thacker LR, Galloway JC. Infant born preterm have delayed development of adaptive postural control in the first 5 months of life. Infant Behav Dev 2016; 44:49-58. [PMID: 27285202 DOI: 10.1016/j.infbeh.2016.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 12/23/2015] [Accepted: 05/12/2016] [Indexed: 12/14/2022]
Abstract
UNLABELLED Infants born preterm are at increased risk of developmental disabilities, that may be attributed to their early experiences and ability to learn. The purpose of this paper was to evaluate the ability of infants born preterm to adapt their postural control to changing task demands. METHODS This study included 18 infants born at 32 weeks of gestation or less whose posture was compared in supine under 2 conditions, with and without a visual stimulus presented. The postural variability, measured with root mean squared displacement of the center of pressure, and postural complexity, measured with the approximate entropy of the center of pressure displacement were measured longitudinally from 2.5 to 5 months of age. RESULTS AND DISCUSSION The infants looked at the toys in midline for several months prior to adapting their postural variability in a manner similar to full term infants. Only after postural variability was reduced in both the caudal cephalic and medial lateral direction in the toy condition did the infants learn to reach for the toy. Postural complexity did not vary between conditions. These findings suggest that infants used a variety of strategies to control their posture. In contrast to research with infants born full term, the infants born preterm in this study did not identify the successful strategy of reducing movement of the center of pressure until months after showing interest in the toy. This delayed adaptation may impact the infants ability to learn over time.
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Affiliation(s)
- Stacey C Dusing
- Motor Development Lab, Department of Physical Therapy, Department of Pediatrics, Virginia Commonwealth University, United States.
| | - Leroy R Thacker
- School of Nursing, Virginia Commonwealth University, United States.
| | - James C Galloway
- Department of Physical Therapy, Biomechanics and Movement Sciences Program, University of Delaware, United States.
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Westlake KP, Johnson BP, Creath RA, Neff RM, Rogers MW. Influence of non-spatial working memory demands on reach-grasp responses to loss of balance: Effects of age and fall risk. Gait Posture 2016; 45:51-5. [PMID: 26979883 PMCID: PMC4794637 DOI: 10.1016/j.gaitpost.2016.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 11/18/2015] [Accepted: 01/05/2016] [Indexed: 02/02/2023]
Abstract
Reactive balance recovery strategies following an unexpected loss of balance are crucial to the prevention of falls, head trauma and other major injuries in older adults. While a longstanding focus has been on understanding lower limb recovery responses, the upper limbs also play a critical role. However, when a fall occurs, little is known about the role of memory and attention shifting on the reach to grasp recovery strategy and what factors determine the speed and precision of this response beyond simple reaction time. The objective of this study was to compare response time and accuracy of a stabilizing grasp following a balance perturbation in older adult fallers compared to non-fallers and younger adults while loading the processing demands of non-spatial, verbal working memory. Working memory was engaged with a progressively challenging verb-generation task that was interrupted by an unexpected sideways platform perturbation and a pre-instructed reach to grasp response. Results revealed that the older adults, particularly those at high fall risk, demonstrated significantly increased movement time to handrail contact and grasping errors during conditions in which non-spatial memory was actively engaged. These findings provide preliminary evidence of the cognitive deficit in attention shifting away from an ongoing working memory task that underlies delayed and inaccurate protective reach to grasp responses in older adult fallers.
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Affiliation(s)
- Kelly P Westlake
- Department of Physical Therapy & Rehabilitation Science, The University of Maryland, School of Medicine, 100 Penn Street, Baltimore, MD, United States.
| | - Brian P Johnson
- Department of Physical Therapy & Rehabilitation Science, The University of Maryland, School of Medicine, 100 Penn Street, Baltimore, MD, United States
| | - Robert A Creath
- Department of Physical Therapy & Rehabilitation Science, The University of Maryland, School of Medicine, 100 Penn Street, Baltimore, MD, United States
| | - Rachel M Neff
- Department of Physical Therapy & Rehabilitation Science, The University of Maryland, School of Medicine, 100 Penn Street, Baltimore, MD, United States
| | - Mark W Rogers
- Department of Physical Therapy & Rehabilitation Science, The University of Maryland, School of Medicine, 100 Penn Street, Baltimore, MD, United States
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Wong CC, Ramanathan DS, Gulati T, Won SJ, Ganguly K. An automated behavioral box to assess forelimb function in rats. J Neurosci Methods 2015; 246:30-7. [PMID: 25769277 DOI: 10.1016/j.jneumeth.2015.03.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 02/26/2015] [Accepted: 03/03/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Rodent forelimb reaching behaviors are commonly assessed using a single-pellet reach-to-grasp task. While the task is widely recognized as a very sensitive measure of distal limb function, it is also known to be very labor-intensive, both for initial training and the daily assessment of function. NEW METHOD Using components developed by open-source electronics platforms, we have designed and tested a low-cost automated behavioral box to measure forelimb function in rats. Our apparatus, made primarily of acrylic, was equipped with multiple sensors to control the duration and difficulty of the task, detect reach outcomes, and dispense pellets. Our control software, developed in MATLAB, was also used to control a camera in order to capture and process video during reaches. Importantly, such processing could monitor task performance in near real-time. RESULTS We further demonstrate that the automated apparatus can be used to expedite skill acquisition, thereby increasing throughput as well as facilitating studies of early versus late motor learning. The setup is also readily compatible with chronic electrophysiological monitoring. COMPARISON WITH EXISTING METHODS Compared to a previous version of this task, our setup provides a more efficient method to train and test rodents for studies of motor learning and recovery of function after stroke. The unbiased delivery of behavioral cues and outcomes also facilitates electrophysiological studies. CONCLUSIONS In summary, our automated behavioral box will allow high-throughput and efficient monitoring of rat forelimb function in both healthy and injured animals.
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Affiliation(s)
- Chelsea C Wong
- Neurology & Rehabilitation Service, San Francisco VA Medical Center, San Francisco, CA, United States; Department of Neurology, University of California, San Francisco, CA, United States
| | - Dhakshin S Ramanathan
- Neurology & Rehabilitation Service, San Francisco VA Medical Center, San Francisco, CA, United States; Psychiatry Service, San Francisco VA Medical Center, San Francisco, CA, United States; Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Tanuj Gulati
- Neurology & Rehabilitation Service, San Francisco VA Medical Center, San Francisco, CA, United States; Department of Neurology, University of California, San Francisco, CA, United States
| | - Seok Joon Won
- Neurology & Rehabilitation Service, San Francisco VA Medical Center, San Francisco, CA, United States; Department of Neurology, University of California, San Francisco, CA, United States
| | - Karunesh Ganguly
- Neurology & Rehabilitation Service, San Francisco VA Medical Center, San Francisco, CA, United States; Department of Neurology, University of California, San Francisco, CA, United States.
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