Few weight loss interventions are evaluated for longer than a year, and even fewer employ social and mobile technologies commonly used among young adults. We assessed the efficacy of a 2 year, ...theory-based, weight loss intervention that was remotely and adaptively delivered via integrated user experiences with Facebook, mobile apps, text messaging, emails, a website, and technology-mediated communication with a health coach (the SMART intervention).
In this parallel-group, randomised, controlled trial, we enrolled overweight or obese college students (aged 18-35 years) from three universities in San Diego, CA, USA. Participants were randomly assigned (1:1) to receive either the intervention (SMART intervention group) or general information about health and wellness (control group). We used computer-based permuted-block randomisation with block sizes of four, stratified by sex, ethnicity, and college. Participants, study staff, and investigators were masked until the intervention was assigned. The primary outcome was objectively measured weight in kg at 24 months. Differences between groups were evaluated using linear mixed-effects regression within an intention-to-treat framework. Objectively measured weight at 6, 12, and 18 months was included as a secondary outcome. The trial is registered with ClinicalTrials.gov, number NCT01200459.
Between May 18, 2011, and May 17, 2012, 404 individuals were randomly assigned to the intervention (n=202) or control (n=202). Participants' mean (SD) age was 22·7 (3·8) years. 284 (70%) participants were female and 125 (31%) were Hispanic. Mean (SD) body-mass index at baseline was 29·0 (2·8) kg/m(2). At 24 months, weight was assessed in 341 (84%) participants, but all 404 were included in analyses. Weight, adjusted for sex, ethnicity, and college, was not significantly different between the groups at 24 months (-0·79 kg 95% CI -2·02 to 0·43, p=0·204). However, weight was significantly less in the intervention group compared with the control group at 6 months (-1·33 kg 95% CI -2·36 to -0·30, p=0·011) and 12 months (-1·33 kg -2·30 to -0·35, p=0·008), but not 18 months (-0·67 kg 95% CI -1·69 to 0·35, p=0·200). One serious adverse event in the intervention group (gallstones) could be attributable to rapid and excessive weight loss.
Social and mobile technologies did not facilitate sustained reductions in weight among young adults, although these approaches might facilitate limited short-term weight loss.
The National Heart, Lung, and Blood Institute of the National Institutes of Health (U01 HL096715).
Background Biopsy surveillance protocols for the assessment of Barrett's esophagus can be subject to sampling errors, resulting in diagnostic uncertainty. Optical coherence tomography is a ...cross-sectional imaging technique that can be used to conduct volumetric laser endomicroscopy (VLE) of the entire distal esophagus. We have developed a biopsy guidance platform that places endoscopically visible marks at VLE-determined biopsy sites. Objective The objective of this study was to demonstrate in human participants the safety and feasibility of VLE-guided biopsy in vivo. Design A pilot feasibility study. Setting Massachusetts General Hospital. Patients A total of 22 participants were enrolled from January 2011 to June 2012 with a prior diagnosis of Barrett's esophagus. Twelve participants were used to optimize the laser marking parameters and the system platform. A total of 30 target sites were selected and marked in real-time by using the VLE-guided biopsy platform in the remaining 10 participants. Intervention Volumetric laser endomicroscopy. Main Outcome Measurements Endoscopic and VLE visibility, and accuracy of VLE diagnosis of the tissue between the laser cautery marks. Results There were no adverse events of VLE and laser marking. The optimal laser marking parameters were determined to be 2 seconds at 410 mW, with a mark separation of 6 mm. All marks made with these parameters were visible on endoscopy and VLE. The accuracies for diagnosing tissue in between the laser cautery marks by independent blinded readers for endoscopy were 67% (95% confidence interval CI, 47%-83%), for VLE intent-to-biopsy images 93% (95% CI, 78%-99%), and for corrected VLE post-marking images 100% when compared with histopathology interpretations. Limitations This is a single-center feasibility study with a limited number of patients. Conclusion Our results demonstrate that VLE-guided biopsy of the esophagus is safe and can be used to guide biopsy site selection based on the acquired volumetric optical coherence tomography imaging data. (Clinical trial registration number: NCT01439633 .)
Background Optical coherence tomography (OCT) is a cross-sectional, high-resolution imaging modality that has been shown to accurately differentiate esophageal specialized intestinal metaplasia (SIM) ...from gastric cardia at the squamocolumnar junction (SCJ) and diagnose high-grade dysplasia and intramucosal carcinoma in patients with SIM. The clinical utility of OCT has been limited, however, by its inability to acquire images over large areas. Objective The aim of this study was to use recently developed high-speed OCT technology, termed optical frequency domain imaging (OFDI), and a new balloon-centering catheter (2.5 cm diameter) to demonstrate the feasibility of large area, comprehensive optical microscopy of the entire distal esophagus (∼6.0 cm) in patients. Design A pilot feasibility study. Setting Massachusetts General Hospital. Patients Twelve patients undergoing routine EGD. Results Comprehensive microscopy of the distal esophagus was successfully performed in 10 patients with the OFDI system and balloon catheter. There were no complications resulting from the imaging procedure. Volumetric data sets were acquired in less than 2 minutes. OFDI images at the SCJ showed a variety of microscopic features that were consistent with histopathologic findings, including squamous mucosa, cardia, SIM with and without dysplasia, and esophageal erosion. Limitations Inability to obtain direct correlation of OFDI data and histopathologic diagnoses. Conclusions Comprehensive volumetric microscopy of the human distal esophagus was successfully demonstrated with OFDI and a balloon-centering catheter, providing a wealth of detailed information about the structure of the esophageal wall. This technique will support future studies to compare OFDI image information with histopathologic diagnoses.
Background Knowledge of the prevalence, clustering, and correlates of multiple adolescent health behaviors can inform the design of health promotion interventions. Methods A cross-sectional design ...was used to assess 878 adolescents aged 11 to 15 years (53.6% girls, 58% non-Hispanic white) recruited in primary care clinics in 2001–2002. Adolescent physical activity (assessed with accelerometers), television viewing time (reported), percent calories from fat, and servings of fruits and vegetables (assessed with multiple 24-hour recalls) were dichotomized into meeting or not meeting national guidelines. Parent health behaviors were assessed with self-reported measures. Analyses were conducted in 2006. Results Fifty-five percent of adolescents did not meet the physical activity guideline, and 30% exceeded 2 hours daily of television viewing time, with boys more active and less sedentary than girls ( p <0.01). The majority of the adolescents did not meet dietary guidelines. Nearly 80% had multiple risk behaviors and only 2% met all four guidelines. The number of risk behaviors was associated with being older and being at risk for overweight or being overweight, for boys and girls ( p <0.05). Two parent health behaviors—history of smoking and failure to meet the fruits and vegetables guideline—were significantly associated with a higher number of risk behaviors for girls ( p <0.05). Conclusions Eight of ten adolescents in this sample failed to meet guidelines for two or more diet, physical activity, and sedentary risk behaviors. Some parent health behaviors, along with the adolescent’s weight status and age, were associated with a higher number of adolescent health risk behaviors.
Background Random biopsy esophageal surveillance can be subject to sampling errors, resulting in diagnostic uncertainty. Optical frequency domain imaging (OFDI) is a high-speed, 3-dimensional ...endoscopic microscopy technique. When deployed through a balloon-centering catheter, OFDI can automatically image the entire distal esophagus (6.0 cm length) in approximately 2 minutes. Objective To test a new platform for guided biopsy that allows the operator to select target regions of interest on an OFDI dataset, and then use a laser to mark the esophagus at corresponding locations. The specific goals include determining the optimal laser parameters, testing the accuracy of the laser marking process, evaluating the endoscopic visibility of the laser marks, and assessing the amount of mucosal damage produced by the laser. Design Experimental study conducted in 5 swine in vivo. Setting Massachusetts General Hospital. Main Outcome Measurements Success rate, including endoscopic visibility of laser marks and accuracy of the laser marking process for selected target sites, and extent of the thermal damage caused by the laser marks. Results All of the laser-induced marks were visible by endoscopy. Target locations were correctly marked with a success rate of 97.07% (95% confidence interval, 89.8%-99.7%). Thermal damage was limited to the superficial layers of the mucosa and was observed to partially heal within 2 days. Limitations An animal study with artificially placed targets to simulate pathology. Conclusions The study demonstrates that laser marking of esophageal sites identified in comprehensive OFDI datasets is feasible and can be performed with sufficient accuracy, precision, and visibility to guide biopsy in vivo.
Objective To review eHealth intervention studies for adults and children that targeted behavior change for physical activity, healthy eating, or both behaviors. Data Sources Systematic literature ...searches were performed using five databases: MEDLINE, PsychInfo, CINAHL, ERIC, and the Cochrane Library to retrieve articles. Study Inclusion and Exclusion Criteria Articles published in scientific journals were included if they evaluated an intervention for physical activity and/or dietary behaviors, or focused on weight loss, used randomized or quasi-experimental designs, measured outcomes at baseline and a follow-up period, and included an intervention where participants interacted with some type of electronic technology either as the main intervention or an adjunct component. All studies were published between 2000 and 2005. Results Eighty-six publications were initially identified, of which 49 met the inclusion criteria (13 physical activity publications, 16 dietary behaviors publications, and 20 weight loss or both physical activity and diet publications), and represented 47 different studies. Studies were described on multiple dimensions, including sample characteristics, design, intervention, measures, and results. eHealth interventions were superior to comparison groups for 21 of 41 (51%) studies (3 physical activity, 7 diet, 11 weight loss/physical activity and diet). Twenty-four studies had indeterminate results, and in four studies the comparison conditions outperformed eHealth interventions. Conclusions Published studies of eHealth interventions for physical activity and dietary behavior change are in their infancy. Results indicated mixed findings related to the effectiveness of eHealth interventions. Interventions that feature interactive technologies need to be refined and more rigorously evaluated to fully determine their potential as tools to facilitate health behavior change.
Abstract Objectives To determine (1) reliability of new food environment measures; (2) association between home food environment and fruit and vegetable (FV) intake; and (3) association between ...community and home food environment. Methods In 2005, a cross-sectional survey was conducted with readministration to assess test-retest reliability. Adolescents, parents of adolescents, and parents of children (n = 458) were surveyed in San Diego, Boston, and Cincinnati. Results Most subscales had acceptable reliability. Fruit and vegetable intake was positively associated with availability of healthful food ( r = 0.15-0.27), FV ( r = 0.22-0.34), and ratio of more-healthful/less-healthful food in the home ( r = 0.23-0.31) and was negatively associated with less-healthful food in the home ( r = -0.17 to -0.18). Home food environment was associated with household income but not with community food environment. Conclusions and Implications A more healthful home food environment was related to youth FV intake. Higher income households had more healthful food in the home. The potential influence of neighborhood food outlets warrants further study.
Background Spectrally encoded confocal microscopy (SECM) is a high-speed reflectance confocal microscopy technique that has the potential to be used for acquiring comprehensive images of the entire ...distal esophagus endoscopically with subcellular resolution. Objective The goal of this study was to demonstrate large-area SECM in upper GI tissues and to determine whether the images contain microstructural information that is useful for pathologic diagnosis. Design A feasibility study. Setting Gastrointestinal Unit, Massachusetts General Hospital. Patients Fifty biopsy samples from 36 patients undergoing routine EGD were imaged by SECM, in their entirety, immediately after their removal. Results The microstructure seen in the SECM images was similar to that seen by histopathology. Gastric cardia mucosa was clearly differentiated from squamous mucosa. Gastric fundic/body type mucosa showed more tightly packed glands than gastric cardia mucosa. Fundic gland polyps showed cystically dilated glands lined with cuboidal epithelium. The presence of intraepithelial eosinophils was detected with the cells demonstrating a characteristic bilobed nucleus. Specialized intestinal metaplasia was identified by columnar epithelium and the presence of goblet cells. Barrett's esophagus (BE) with dysplasia was differentiated from specialized intestinal metaplasia by the loss of nuclear polarity and disorganized glandular architecture. Limitations Ex vivo, descriptive study. Conclusions Large-area SECM images of gastroesophageal biopsy samples enabled the visualization of both subcellular and architectural features of various upper GI mucosal types and were similar to the corresponding histopathologic slides. These results suggest that the development of an endoscopic SECM probe is merited.
Sun-Protection Behaviors Among African Americans Pichon, Latrice C., PhD; Corral, Irma, PhD; Landrine, Hope, PhD ...
American journal of preventive medicine,
03/2010, Letnik:
38, Številka:
3
Journal Article
Recenzirano
Background Data suggest that the prevalence of sun-protection behaviors is low (44%) among African Americans; the samples in such studies, however, tended to be small or nonrepresentative. Purpose ...This article aims to examine the prevalence and correlates of sun-protection behaviors among a large, random, statewide sample of African-American adults living in California to ascertain behavioral patterns and highlight directions for targeted interventions. Methods From September 2006 through May 2008, an anonymous health survey collected data on sunscreen, sunglasses, and wide-brim hat use among a random sample of 2187 African-American adults, and assessed demographic, regional, skin type, and other potential correlates of these behaviors. The analysis was conducted in 2009. Results Only 31% engaged in at least one sun-protection behavior; of the three behaviors, sunscreen use was the least prevalent, with 63% never using sunscreen. Multivariate logistic regressions revealed that gender, SES, and skin type were significant predictors of sun-protection behaviors. Conclusions Tailored interventions to increase sun-protection behaviors among African Americans (men in particular) are needed.
Abstract Background There is no consensus as to whether low dietary intakes of saturated fat or cholesterol, or high intakes of dietary fiber are related to a lower prevalence of metabolic syndrome ...(MetS) in adolescent children. Objective To determine whether a fiber-rich diet as measured by a fiber index (grams fiber/1,000 kcal) is associated with lower rates of MetS among adolescents vs a diet low in saturated fat or cholesterol as measured by a saturated fat index (grams saturated fat/1,000 kcal) and a cholesterol index (milligrams cholesterol/1,000 kcal), respectively. Design/participants/setting Cross-sectional analysis of 12- to 19-year-old boys and girls (N=2,128) who participated in the National Health and Nutrition Examination Survey 1999-2002. Outcomes and statistical analyses The prevalence of MetS (abnormal values of three or more of the following: waist circumference, blood pressure, fasting serum high-density lipoprotein cholesterol, triglycerides, and glucose) was compared across quintiles of the dietary indexes (fiber index, saturated fat index, and cholesterol index) derived from 24-hour recalls. χ2 tests determined the prevalence across dietary quintiles, and multivariate logistic regression evaluated the association of the dietary indexes with MetS. Weighted analyses were used controlling for sex, age, ethnicity, and family income. Significance was set at P ≤0.05. Results The overall prevalence of MetS was 6.4% (n=138). There was a graded inverse association between the fiber index and MetS ( P <0.001) with a threefold difference between the lowest and highest quintiles (9.2% vs 3.1%). Each quintile increase in the fiber index was associated with a ∼20% decrease in MetS (adjusted odds ratio 0.83, 95% confidence interval 0.68-1.00; P ≤0.043). Neither the saturated fat index ( P =0.87) nor the cholesterol index ( P =0.22) was significantly associated with MetS. Conclusions Higher intakes of dietary fiber, but not low intakes of saturated fat or cholesterol are related to the MetS in adolescents. These findings suggest that to reduce the risks for MetS in adolescents, it is more important to emphasize a paradigm that promotes the inclusion of fiber-rich, nutrient-dense, plant-based foods vs what foods to restrict or exclude as is commonly done when the focus is on total fat, cholesterol, or saturated fat intake.
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