Preventing weight regain can only be achieved by sustained changes in energy balance-related behaviors that are associated with weight, such as diet and physical activity. Changes in motivation and ...self-regulatory skills can support long-term behavioral changes in the context of weight loss maintenance. We propose that experiencing a supportive climate care is associated with enhanced satisfaction of basic psychological needs, intrinsic goals, and autonomous motivation. These factors are expected to be associate with the utilization of self-regulation skills, leading to more sustained behavior changes and ultimately preventing weight regain. This hypothesis was tested in this ancillary analysis of the NoHoW trial, where the study arms were pooled and followed for 12 months. The NoHoW was a three-center, large-scale weight regain prevention full factorial trial. In this longitudinal study, data were collected in adults who lost > 5% weight in the past year (N = 870, complete data only, 68.7% female, 44.10 + or - 11.86 years, 84.47 + or - 17.03 kg) during their participation in a 12-month digital behavior change intervention. Weight and validated measures of motivational- and self-regulatory skills-related variables were collected at baseline, six- and 12 months. Change variables were used in Mplus' path analytical models informed by NoHoW's logic model. The bivariate correlations confirmed key mediators' potential effect on weight outcomes in the expected causal direction. The primary analysis showed that a quarter of the variance (r2 = 23.5%) of weight regain prevention was achieved via the mechanisms of action predicted in the logic model. Specifically, our results show that supportive climate care is associated with needs satisfaction and intrinsic goal content leading to better weight regain prevention via improvements in self-regulatory skills and exercise-controlled motivation. The secondary analysis showed that more mechanisms of action are significant in participants who regained or maintained their weight. These results contribute to a better understanding of the mechanisms of action leading to behavior change in weight regain prevention. The most successful participants used only a few intrinsic motivation-related mechanisms of action, suggesting that habits may have been learned. While developing a digital behavior change intervention, researchers and practitioners should consider creating supportive climate care to improve needs satisfaction and intrinsic goal contents.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Accurate solutions for the estimation of physical activity and energy expenditure at scale are needed for a range of medical and health research fields. Machine learning techniques show promise in ...research-grade accelerometers, and some evidence indicates that these techniques can be applied to more scalable commercial devices.
This study aims to test the validity and out-of-sample generalizability of algorithms for the prediction of energy expenditure in several wearables (ie, Fitbit Charge 2, ActiGraph GT3-x, SenseWear Armband Mini, and Polar H7) using two laboratory data sets comprising different activities.
Two laboratory studies (study 1: n=59, age 44.4 years, weight 75.7 kg; study 2: n=30, age=31.9 years, weight=70.6 kg), in which adult participants performed a sequential lab-based activity protocol consisting of resting, household, ambulatory, and nonambulatory tasks, were combined in this study. In both studies, accelerometer and physiological data were collected from the wearables alongside energy expenditure using indirect calorimetry. Three regression algorithms were used to predict metabolic equivalents (METs; ie, random forest, gradient boosting, and neural networks), and five classification algorithms (ie, k-nearest neighbor, support vector machine, random forest, gradient boosting, and neural networks) were used for physical activity intensity classification as sedentary, light, or moderate to vigorous. Algorithms were evaluated using leave-one-subject-out cross-validations and out-of-sample validations.
The root mean square error (RMSE) was lowest for gradient boosting applied to SenseWear and Polar H7 data (0.91 METs), and in the classification task, gradient boost applied to SenseWear and Polar H7 was the most accurate (85.5%). Fitbit models achieved an RMSE of 1.36 METs and 78.2% accuracy for classification. Errors tended to increase in out-of-sample validations with the SenseWear neural network achieving RMSE values of 1.22 METs in the regression tasks and the SenseWear gradient boost and random forest achieving an accuracy of 80% in classification tasks.
Algorithms trained on combined data sets demonstrated high predictive accuracy, with a tendency for superior performance of random forests and gradient boosting for most but not all wearable devices. Predictions were poorer in the between-study validations, which creates uncertainty regarding the generalizability of the tested algorithms.
Many weight loss programs show short-term effectiveness, but subsequent weight loss maintenance is difficult to achieve. Digital technologies offer a promising means of delivering behavior change ...approaches at low costs and on a wide scale. The Navigating to a Healthy Weight (NoHoW) project, which was funded by the European Union's Horizon 2020 research and innovation program, aimed to develop, test, and evaluate a digital toolkit designed to promote successful long-term weight management. The toolkit was tested in an 18-month, large-scale, international, 2×2 factorial (motivation and self-regulation vs emotion regulation) randomized controlled trial that was conducted on adults with overweight or obesity who lost ≥5% of their body weight in the preceding 12 months before enrollment into the intervention.
This paper aims to describe the development of the NoHoW Toolkit, focusing on the logic models, content, and specifications, as well as the results from user testing.
The toolkit was developed by using a systematic approach, which included the development of the theory-based logic models, the selection of behavior change techniques, the translation of these techniques into a web-based app (NoHoW Toolkit components), technical development, and the user evaluation and refinement of the toolkit.
The toolkit included a set of web-based tools and inputs from digital tracking devices (smart scales and activity trackers) and modules that targeted weight, physical activity, and dietary behaviors. The final toolkit comprised 34 sessions that were distributed through 15 modules and provided active content over a 4-month period. The motivation and self-regulation arm consisted of 8 modules (17 sessions), the emotion regulation arm was presented with 7 modules (17 sessions), and the combined arm received the full toolkit (15 modules; 34 sessions). The sessions included a range of implementations, such as videos, testimonies, and questionnaires. Furthermore, the toolkit contained 5 specific data tiles for monitoring weight, steps, healthy eating, mood, and sleep.
A systematic approach to the development of digital solutions based on theory, evidence, and user testing may significantly contribute to the advancement of the science of behavior change and improve current solutions for sustained weight management. Testing the toolkit by using a 2×2 design provided a unique opportunity to examine the effect of motivation and self-regulation and emotion regulation separately, as well as the effect of their interaction in weight loss maintenance.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Purpose
To investigate whether higher dietary inflammatory index (DII
®
) scores were associated with higher prevalence of radiographic symptomatic knee osteoarthritis in a large cohort of North ...American people from the Osteoarthritis Initiative database.
Methods
A total of 4358 community-dwelling participants (2527 females; mean age 61.2 years) from the Osteoarthritis Initiative were identified. DII
®
scores were calculated using the validated Block Brief 2000 Food-Frequency Questionnaire and scores were categorized into quartiles. Knee radiographic symptomatic osteoarthritis was diagnosed clinically and radiologically. The strength of association between divided into quartiles (DII
®
) and knee osteoarthritis was investigated through a logistic regression analysis, which adjusted for potential confounders, and results were reported as odds ratios (ORs) with 95% confidence intervals (CIs).
Results
Participants with a higher DII
®
score, indicating a more pro-inflammatory diet, had a significantly higher prevalence of radiographic symptomatic knee osteoarthritis compared to those with lower DII
®
score (quartile 4: 35.4% vs. quartile 1: 24.0%;
p
< 0.0001). Using a logistic regression analysis, adjusting for 11 potential confounders, participants with the highest DII
®
score (quartile 4) had a significantly higher probability of experiencing radiographic symptomatic knee osteoarthritis (OR 1.40; 95% CI 1.14–1.72;
p
= 0.002) compared to participants with the lowest DII
®
score (quartile 1).
Conclusions
Higher DII
®
values are associated with higher prevalence of radiographic symptomatic knee osteoarthritis.
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DOBA, EMUNI, FIS, FSPLJ, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
Objective estimates of activity patterns and energy expenditure (EE) are important for the measurement of energy balance. The Intelligent Device for Energy Expenditure and Activity (IDEEA) can ...estimate EE from the thirty-five postures and activities it can identify and record. The present study evaluated the IDEEA system's estimation of EE using whole-body indirect calorimetry over 24 h, and in free-living subjects using doubly-labelled water (DLW) over 14 d. EE was calculated from the IDEEA data using calibration values for RMR and EE while sitting and standing, both as estimated by the IDEEA system (IDEEAest) and measured by indirect calorimetry (IDEEAmeas). Subjects were seven females and seven males, mean age 38·1 and 39·7 years, mean BMI 25·2 and 26·2 kg/m2, respectively. The IDEEAest method produced a similar estimate of EE to the calorimeter (10·8 and 10·8 MJ, NS), while the IDEEAmeas method underestimated EE (9·9 MJ, P < 0·001). After removing data from static cycling, which the IDEEA was unable to identify as an activity, both the IDEEAest and IDEEAmeas methods overestimated EE compared to the calorimeter (9·9 MJ, P < 0·001; 9·1 MJ, P < 0·05 and 8·6 MJ, respectively). Similarly, the IDEEA system overestimated EE compared to DLW over 14 d; 12·7 MJ/d (P < 0·01), 11·5 MJ/d (P < 0·01) and 9·5 MJ/d for the IDEEAest, IDEEAmeas and DLW, respectively. The IDEEA system overestimated EE both in the controlled laboratory and free-living environments. Using measured EE values for RMR, sitting and standing reduced, but did not eliminate, the error in estimated EE.
The platelet collection and distribution system, based on volunteer nonremunerated donors, apheresis platelet collections, and primarily 1-directional distribution of platelets for up to 5-day room ...temperature storage at hospitals, typically performs well and provides therapeutic support for hundreds of thousands of patients annually. However, direct and indirect effects of the coronavirus disease 2019 pandemic, particularly during the Omicron wave, produced dramatic systemic failures and severe shortages. We propose 4 initiatives to reinforce the existing platelet pipeline and buffer the platelet supply against future unexpected disruptions.
Background
Although the safety and therapeutic efficacy of COVID‐19 convalescent plasma (CCP) has been extensively evaluated, the safety of CCP donation has not been explored in a multi‐institutional ...context.
Study design and methods
Nine blood collection organizations (BCOs) participated in a multi‐institutional donor hemovigilance effort to assess the safety of CCP donation. Donor adverse events (DAEs) were defined according to the Standard for Surveillance of Complications Related to Blood Donation, and severity was assessed using the severity grading tool. Multivariate analysis was performed to determine attributes associated with DAE severity.
Results
The overall DAE rate was 37.7 per 1000 donations. Repeat apheresis and apheresis‐naïve donors experienced adverse event rates of 19.9 and 49.8 per 1000 donations, respectively. Female donors contributed 51.9% of CCP donations with a DAE rate of 49.4 per 1000 donations. The DAE rate for male donors was 27.4 per 1000 donations. Vasovagal reactions accounted for over half of all reported DAEs (51.1%). After adjustment, volume of CCP donated was associated with vasovagal reaction severity (odds ratio OR 6.5, 95% confidence interval CI 2.5–17.1). Donor age and donation history were also associated with DAE severity. Considerable differences in DAE types and rates were observed across the participating BCOs despite the use of standardized hemovigilance definitions.
Conclusion
The safety of CCP donation appears comparable to that of conventional apheresis plasma donation with similar associated risk factors for DAE types and severity.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
To assess changes in inpatient transfusion utilization and patient outcomes with implementation of a comprehensive patient blood management (PBM) program at a large US medical center.
This is an ...observational study of graduated PBM implementation for hospitalized adults (age ≥18 years) from January 1, 2010, through December 31, 2017, at two integrated hospital campuses at a major academic US medical center. Allogeneic transfusion utilization and clinical outcomes were assessed over time through segmented regression with multivariable adjustment comparing observed outcomes against projected outcomes in the absence of PBM activities.
In total, 400,998 admissions were included. Total allogeneic transfusions per 1000 admissions decreased from 607 to 405 over the study time frame, corresponding to an absolute risk reduction for transfusion of 6.0% (95% confidence interval CI: 3.6%, 8.3%; P<.001) and a 22% (95% CI: 6%, 37%; P=.006) decrease in the rate of transfusions over projected. The risk of transfusion decreased for all blood components except cryoprecipitate. Transfusion reductions were experienced for all major surgery types except liver transplantation, which remained stable over time. Hospital length of stay (multiplicative increase in geometric mean 0.85 95% CI: 0.81, 0.89; P<.001) and incident in-hospital adverse events (absolute risk reduction: 1.5% 95% CI: 0.1%, 3.0%; P=.04) were lower than projected at the end of the study time frame.
Patient blood management implementation for hospitalized patients in a large academic center was associated with substantial reductions in transfusion utilization and improved clinical outcomes. Broad-scale implementation of PBM in US hospitals is feasible without signal for patient harm.
Whether self-regulation of food intake in weight loss maintenance (WLM) differs between being a short-term maintainer (having maintained without regaining less than 12 months) and a long-term ...maintainer (having maintained without regaining at least 12 months) is under-researched.
The aim of this study was to explore the self-regulatory strategies and self-efficacy beliefs applied by short- and long-term maintainers to the complex set of behaviours comprising food intake in WLM, and to obtain a better understanding of their challenges in the various food-intake processes in WLM.
Individual interviews (14 female/4 male) were conducted with nine Danish short- and nine long-term weight loss maintainers. The Health Action Process Approach (HAPA) was applied post-hoc to organise data and support analyses, since the approach focuses on both the cognitions (e.g., self-efficacy, the nature of which differs depending on the phase of behaviour change) and self-regulatory strategies (e.g., action planning and coping planning) involved in behaviour change.
Self-regulatory strategies and self-efficacy beliefs varied between the food-related behaviours and between short- and long-term maintainers. Consistent with the progression suggested by HAPA, with repeated use of action and coping planning, long-term maintainers had formed habitual routines, not only allowing them more flexibility, but also providing them stronger self-control in the behaviours related to WLM such as buying and storing food, and eating at social gatherings. The short-term maintainers often displayed a ‘weight loss mind-set.’ The short-term maintainers focused on the avoidance of certain behaviours, showed less self-regulatory flexibility, and exhibited more detailed action planning, but their interviews also inferred that they had ambitions to build strong WLM-habits, maintenance, and recovery self-efficacy.
The contribution of this study is a more comprehensive view on food intake as an outcome of a set of complex behaviours, revealing insights into the differences in cognitions and strategies applied to the task of WLM, between short- and long-term maintainers.
•Food intake should be viewed as an outcome of a complex set of behaviours.•Self-regulatory strategies differ between short- and long-term weight loss maintainers.•Short-term maintainers plan more and are less self-regulatory flexible.•Long-term maintainers are more flexible and good at coping planning.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
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