Low-caloric formula diets can improve hemodynamic parameters of patients with type 2 diabetes. We, therefore, hypothesized that persons with overweight or obesity can benefit from a high-protein, ...low-glycemic but moderate-caloric formula diet. This post-hoc analysis of the Almased Concept against Overweight and Obesity and Related Health Risk- (ACOORH) trial investigated the impact of a lifestyle intervention combined with a formula diet (INT, n = 308) compared to a control group with lifestyle intervention alone (CON, n = 155) on hemodynamic parameters (systolic and diastolic blood pressure (SBP, DBP), resting heart rate (HR), and pulse wave velocity (PWV)) in high-risk individuals with prehypertension or hypertension. INT replaced meals during the first 6 months (1 week: 3 meals/day; 2−4 weeks: 2 meals/day; 5−26 weeks: 1 meal/day). Study duration was 12 months. From the starting cohort, 304 (68.3%, INT: n = 216; CON: n = 101) participants had a complete dataset. Compared to CON, INT significantly reduced more SBP (−7.3 mmHg 95% CI −9.2; −5.3 vs. −3.3 mmHg −5.9; −0.8, p < 0.049) and DBP (−3.7 mmHg −4.9; −2.5 vs. −1.4 mmHg −3.1; 0.2, p < 0.028) after 12 months. Compared to CON, INT showed a pronounced reduction in resting HR and PWV after 6 months but both lost significance after 12 months. Changes in SBP, DBP, and PWV were significantly associated positively with changes in body weight and fat mass (all p < 0.05) and resting HR correlated positively with fasting insulin (p < 0.001) after 12 months. Combining a lifestyle intervention with a high-protein and low-glycemic formula diet improves hemodynamic parameters to a greater extent than lifestyle intervention alone in high-risk individuals with overweight and obesity.
Objective: To determine if similar levels of performance on the Overall Test Battery Mean (OTBM) occur at different forced choice test (FCT) p-value score failures. Second, to determine the OTBM ...levels that are associated with failures at above chance on various performance validity (PVT) tests. Method: OTBMs were computed from archival data obtained from four practices. We calculated each examinee's Estimated Premorbid Global Ability (EPGA) and OTBM. The sample size was 5,103 examinees with 282 (5.5%) of these scoring below chance at p ≤ .20 on at least one FCT. Results: The OTBM associated with a failure at p ≤ .20 was equivalent to the OTBM that was associated with failing 6 or more PVTs at above-chance cutoffs. The mean OTBMs relative to increasingly strict FCT p cutoffs were similar (T scores in the 30s). As expected, there was an inverse relationship between the number of PVTs failed and examinees' OTBMs. Conclusions: The data support the use of p ≤ .20 as the probability level for testing the significance of below chance performance on FCTs. The OTBM can be used to index the influence of invalid performance on outcomes, especially when an examinee scores below chance.
Lifestyle interventions are indicated as first-line therapy to fight obesity focusing on various aspects of a healthy lifestyle. However, as most of these lifestyle programs only include single ...components, we designed a multifactorial, telemedical and group-based seminar program to improve weight loss in overweight individuals.
Overweight volunteers (BMI ≥25 kg/m2) were randomized into a starting intervention group (SI, n=15) or a waiting list control group (WL, n=15). The multicomponent intervention consisted of a (1) group-based seminar program addressing low-carbohydrate nutrition, physical activity, and the carbohydrate-blood glucose-insulin relationship. Further components used were (2) low-carbohydrate formula diet, (3) flash-glucose-monitoring devices and (4) telemedical supervision. Both groups received telemedical devices at baseline. After the 12-weeks intervention phase of SI, WL started with the same intervention. Participants received monthly calls by coaches until week 26. Data were recorded before and after 12, 26 and 52 weeks of follow-up.
After 12 weeks of intervention, SI demonstrated a stronger reduction in weight compared to WL (-7.8 kg vs. -1.5 kg; P<0.001). The estimated treatment difference between both groups was -6.3 kg with 95% confidence interval (95% CI) -7.4; -4.5 (P<0.001). Compared to WL, fat mass and eating behavior improved in SI as well (all P<0.01). Furthermore, SI improved fasting blood glucose, HbA1c, quality of life (all P<0.05), fasting insulin, blood pressure (both P<0.01), and eating behavior (P<0.001) in the within-group analysis, while WL did not show any changes. After 26 and 52 weeks of follow-up, weight reduction could be maintained in the SI-group by -9.7 kg 95% CI: -16.1; -3.2 (P<0.001) and -7.8 kg 95% CI: -15.4; -0.9 (P<0.05), respectively.
A multifactorial program leads to long-term clinically relevant weight reductions and improvements in cardiovascular risk factors in overweight individuals.
Disclosure
M. Röhling: None. K. Martin: None. S. Ellinger: None. S. Martin: Consultant; Self; Almased Wellness GmbH, AstraZeneca, Lilly Diabetes. K. Kempf: Speaker's Bureau; Self; cognomed, Kirchheim Verlag.
The meta-analytic findings of Binder et al. (1997) and Frencham et al. (2005) showed that the neuropsychological effect of mild traumatic brain injury (mTBI) was negligible in adults by 3 months post ...injury. Pertab et al. (2009) reported that verbal paired associates, coding tasks, and digit span yielded significant differences between mTBI and control groups. We re-analyzed data from the 25 studies used in the prior meta-analyses, correcting statistical and methodological limitations of previous efforts, and analyzed the chronicity data by discrete epochs. Three months post injury the effect size of −0.07 was not statistically different from zero and similar to that which has been found in several other meta-analyses (Belanger et al., 2005; Schretlen & Shapiro, 2003). The effect size 7 days post injury was −0.39. The effect of mTBI immediately post injury was largest on Verbal and Visual Memory domains. However, 3 months post injury all domains improved to show non-significant effect sizes. These findings indicate that mTBI has an initial small effect on neuropsychological functioning that dissipates quickly. The evidence of recovery in the present meta-analysis is consistent with previous conclusions of both Binder et al. and Frencham et al. Our findings may not apply to people with a history of multiple concussions or complicated mTBIs.
As formula diets have demonstrated to be effective in reducing weight, we hypothesised that in patients with overweight or obesity and accompanied cardiovascular risk factors, combining a liquid ...formula diet with a lifestyle intervention is superior in reducing weight and improving cardiovascular risk factors than lifestyle intervention alone.
In this multicenter RCT 463 participants with overweight or obesity (BMI: 27-35 kg/m²; at least one additional co-morbidity of the metabolic syndrome) were randomised (1:2) into either a control group with lifestyle intervention only (CON, n = 155) or a lifestyle intervention group including a liquid meal replacement (INT, n = 308). Both groups used telemonitoring devices (scales and pedometers), received information on healthy diet and were instructed to increase physical activity. Telemonitoring devices automatically transferred data into a personalised online portal and acquired data were discussed. INT obtained a liquid meal replacement substituting three meals/day (~1200 kcal) within the first week. During weeks 2-4, participants replaced two meals/day and during weeks 5-26 only one meal/day was substituted (1300-1500 kcal/day). Follow-up was conducted after 52 weeks. Intention-to-treat analyses were performed. Primary outcome was weight change. Secondary outcomes comprised changes in cardiometabolic risk factors including body composition and laboratory parameters.
From the starting cohort 360 (78%, INT: n = 244; CON: n = 116) and 317 (68%, INT: n = 216; CON: n = 101) participants completed the 26-weeks intervention phase and the 52-weeks follow-up. The estimated treatment difference (ETD) between both groups was -3.2 kg -4.0; -2.5 (P < 0.001) after 12 weeks and -1.8 kg -2.8; -0.8 (P < 0.001) after 52 weeks.
A low-intensity lifestyle intervention combined with a liquid meal replacement is superior regarding weight reduction and improvement of cardiovascular risk factors than lifestyle intervention alone.
ObjectivesWe examined the effect of a telemedical coaching (TMC) programme accompanied with or without telemonitoring on weight loss in an occupational healthcare setting with a three-armed ...randomised controlled trial (NCT01837134 ’Pre-results').MethodsOverweight employees (n=104, body mass index BMI ≥25 kg/m2) were invited by their medical corporate department and randomised into either a TMC group (n=34) or in one of the two control groups (C1, n=34; C2, n=36). TMC and C1 were equipped with telemonitoring devices (scales and pedometers) at baseline, and C2 after 6 months. Telemonitoring devices automatically transferred data into a personalised online portal. TMC was coached with weekly care calls in months 3–6 and monthly calls from months 7 to 12. C2 had a short coaching phase in months 6–9. C1 received no further support. After the 12-month intervention phase, participants could take advantage of further company health promotion offers. Follow-up data were determined after 12 months of intervention and per-protocol (PP) and intention-to-treat (ITT) analyses were performed. Weight change was followed up after 36 months. Estimated treatment difference (ETD) was calculated for weight reduction.ResultsETD from TMC to C1 (−3.6 kg 95% CI −7.40 to −0.1, p=0.047) and to C2 (−4.2 kg −7.90 to −0.5, p=0.026) was significantly different at the 12 months follow-up in the PP-analysis, but lost significance in the ITT analysis. All groups reduced weight after 12 months (−3.3 to −8.4 kg 5.5–10.3 kg, all p<0.01) and sustained it during the 36 months follow-up (−4.8 to −7.8 kg 5.6–12.8 kg, all p<0.01). ETD analyses revealed no difference between all groups neither in the PP nor in the ITT analysis at the 3 years follow-up. All groups reduced BMI, systolic and diastolic blood pressure and improved eating behaviour in the PP or ITT analyses.ConclusionsTMC and/or telemonitoring support long-term weight reduction in overweight employees. The combination of both interventions points towards an additional effect.Trial registration number NCT01837134.
The emergence of a closer relationship between cloud service providers in the cloud computing market is the inevitable consequence of the computing as utility concept. The closer cooperation creates ...competitive advantages for providers and users of cloud services as well. Capacities and services can be used in a collaborative and flexible way. Despite the numerous potentials of composite cloud services, trust, policy and privacy are the major challenges resulting from the distributed and flexible data handling. The paper derives requirements and solutions in the field of inter-cloud service communication with a special focus on security. The proposed architecture is evaluated with a sample collaborative business process of inter-cloud service interaction.
The current study utilizes five decades of data to demonstrate cohort differences in gender representation in governance, speaking at conferences, serving on editorial boards, and in scholarly ...productivity in clinical neuropsychology. Broadly examining gender disparities across domains of professional attainment helps illuminate the areas in which inequity in clinical neuropsychology is most pronounced and in need of ameliorative resources.
Data from 1967 to 2017 were coded from publicly available information from the four major professional associations for clinical neuropsychology in the U.S. (i.e. INS, AACN, NAN, & SCN). Gender differences were examined in (1) speaking at a national conference, (2) holding an office in a professional organization, (3) serving on the editorial team for a journal affiliated with a professional organization, and (4) scholarly activity as coded from Google Scholar.
The percentage of men in the field significantly declined across time, whereas the percentage of women significantly increased; the number of women exceeded the number of men in approximately 1992. Gender differences in conference speakers, editorial board members, and research citations were greater in the earlier than in more recent cohorts of clinical neuropsychologists but gender inequity in conference speaking and editorial activities is evident in the most recent cohorts.
Gender differences in conference speakers, editorial board members, and in earning research citations have diminished over time, but early career women still face disadvantages in speaking at conferences and serving on editorial boards. We provide strategies to increase and sustain women's participation in leadership in neuropsychology.
Background. Lifestyle interventions have shown to be effective when continuous personal support was provided. However, there is lack of knowledge whether a telemedical-approach with personal coaching ...contributes to long-term weight losses in overweight employees. We, therefore, tested the hypothesis that telemedical-based lifestyle interventions accompanied with telemedical coaching lead to larger weight losses in overweight persons in an occupational health care setting. Methods. Overweight employees (n=180) with a body mass index (BMI) of >27 kg/m2 were randomized into either a telemedical (TM) group (n=61), a telemedical coaching (TMC) group (n=58), or a control group (n=61). Both intervention groups were equipped with scales and pedometers automatically transferring the data into a personalized online portal, which could be monitored from participants and coaches. Participants of the TMC group received additionally one motivational care call per week by mental coaches to discuss the current data (current weight and steps) and achieving goals such as a healthy lifestyle or weight reduction. The control group remained in routine care. Clinical and anthropometric data were determined after the 12-week intervention. Additionally, weight change was followed up after 12 months. Results. Participants of TMC (-3.1 ± 4.8 kg, p<0.0001) and TM group (-1.9 ± 4.0 kg; p=0.0012) significantly reduced weight and sustained it during the 1-year follow-up, while the control group showed no change. Compared to the control group only weight loss in the TMC group was significantly different (p<0.001) after 12 months. TMC and TM group also reduced BMI, waist circumference, and LDL cholesterol. Moreover, TMC group improved additionally systolic and diastolic blood pressure, total cholesterol, HDL cholesterol, and HbA1c. Conclusions. Telemedical devices in combination with telemedical coaching lead to significant long-term weight reductions in overweight persons in an occupational health care setting. This study is registered with NCT01868763, ClinicalTrials.gov.
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