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Klaman SL, Godino JG, Northrup A, Lewis SV, Tam A, Carrillo C, Lewis R, Matthews E, Mendez B, Reyes L, Rojas S, Ramers C. Does a simplified algorithm and integrated HCV care model improve linkage to care, retention, and cure among people who inject drugs? A pragmatic quality improvement randomized controlled trial protocol. BMC Infect Dis 2024; 24:105. [PMID: 38238686 PMCID: PMC10797714 DOI: 10.1186/s12879-024-08982-1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND As many as 2.4 million Americans are affected by chronic Hepatitis C Virus (HCV) in the United States.In 2018, the estimated number of adults with a history of HCV infection in San Diego County was 55,354 (95% CI: 25,411-93,329). This corresponded to a seroprevalence of 2.1% (95% CI: 2.1-3.4%). One-third of infections were among PWID. Published research has demonstrated that direct-acting antivirals (DAAs) have high efficacy and can now be used by primary care providers to treat HCV. In addition, limited evidence exists to support the effectiveness of simplified algorithms in clinical trial and real-world settings. Even with expanded access to HCV treatment in primary care settings, there are still groups, especially people who inject drugs (PWID) and people experiencing homelessness, who experience treatment disparities due to access and treatment barriers. The current study extends the simplified algorithm with a streetside 'one-stop-shop' approach with integrated care (including the offer of buprenorphine prescriptions and abscess care) using a mobile clinic situated adjacent to a syringe service program serving many homeless populations. Rates of HCV treatment initiation and retention will be compared between patients offered HCV care in a mobile clinic adjacent to a syringe services program (SSP) and homeless encampment versus those who are linked to a community clinic's current practice of usual care, which includes comprehensive patient navigation. METHODS A quasi-experimental, prospective, interventional, comparative effectiveness trial with allocation of approximately 200 patients who inject drugs and have chronic HCV to the "simplified care" pathway (intervention group) or the "usual care" pathway (control group). Block randomization will be performed with a 1:1 randomization. DISCUSSION Previous research has demonstrated acceptable outcomes for patients treated using simplified algorithms for DAAs and point-of-care testing in mobile medical clinics; however, there are opportunities to explore how these new, innovative systems of care impact treatment initiation rates or other HCV care cascade outcomes among PWID. TRIAL REGISTRATION We have registered our study with ClinicalTrials.gov, a resource of the United States National Library of Medicine. This database contains research studies from United States and other countries around the world. Our study has not been previously published. The ClinicalTrials.gov registration identifier is NCT04741750.
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Affiliation(s)
- Stacey L Klaman
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
| | - Job G Godino
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA.
| | - Adam Northrup
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
| | - Sydney V Lewis
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
| | - Aaron Tam
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
| | - Carolina Carrillo
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
| | - Robert Lewis
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
| | - Eva Matthews
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
| | - Blanca Mendez
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
| | - Letty Reyes
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
| | - Sarah Rojas
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
| | - Christian Ramers
- Laura Rodriguez Research Institute - Family Health Centers of San Diego, 1750 Fifth Avenue, San Deigo, CA, 92101, USA
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Bridi L, Albahsahli B, Bencheikh N, Baker DA, Godino JG, O'Laughlin KN, Al-Rousan T. Barriers and facilitators to self-measured blood pressure monitoring among US-resettled Arab refugees with hypertension: a qualitative study. BMC Prim Care 2023; 24:256. [PMID: 38036967 PMCID: PMC10687832 DOI: 10.1186/s12875-023-02215-1] [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] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Minoritized communities including refugees are at an increased risk of poorly controlled hypertension. Evidence indicates that self-measured blood pressure monitoring (SMBP) is an effective method to improve blood pressure control in patients with hypertension. However, it has not been studied among refugee populations. The objective of this study is to examine barriers and facilitators to SMBP among Arab refugees resettled in the United States (US) with diagnosed hypertension. METHODS A total of 109 participants were recruited through a Federally Qualified Health Center system that is a major provider of healthcare to refugees in San Diego, California. Participants completed a questionnaire and were interviewed using in-depth, semi-structured interviews. Interviews were transcribed and translated, and data were coded using inductive thematic analysis and organized based on the theory of care-seeking behavior. RESULTS Several barriers to engaging in effective SMBP monitoring were identified. Clinical and sociodemographic barriers included reliance on public monitors and poor hypertension literacy. Psychosocial barriers of affect, norms, and habits included fear and anxiety from hypertension, cultural stigma of illness, and conditional SMBP with symptoms, respectively. Utility psychosocial barriers included lack of SMBP prioritization in treatment and perceived inaccuracy of home monitors. Family members' support with home monitoring served as an important facilitator to SMBP. CONCLUSIONS There are several barriers to effective SMBP among the US-resettled Arab refugee population that may reflect unique cultural and care-seeking behaviors. Tailored public health and clinical interventions are needed to support refugee patients and providers to improve hypertension self-management behaviors for this unique population.
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Affiliation(s)
- Lana Bridi
- School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Behnan Albahsahli
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
| | - Nissma Bencheikh
- School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Dania Abu Baker
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
- School of Social Work, San Diego State University, San Diego, CA, USA
| | - Job G Godino
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, USA
| | - Kelli N O'Laughlin
- Departments of Emergency Medicine and Global Health, University of Washington, Seattle, WA, USA
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA.
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Sanchez-Trigo H, Maher C, Godino JG, Sañudo B. Effects of an mHealth physical activity intervention to prevent osteoporosis in premenopausal women. A randomized controlled trial. J Sci Med Sport 2023; 26:545-552. [PMID: 37739855 DOI: 10.1016/j.jsams.2023.09.004] [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: 02/18/2023] [Revised: 07/31/2023] [Accepted: 09/02/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES It is critical to develop prevention strategies for osteoporosis that reduce the burden fractures place on individuals and health systems. This study evaluated the effects of an mHealth intervention that delivered and monitored a non-supervised exercise program on bone mineral density (BMD). DESIGN Randomized controlled trial. METHODS 60 premenopausal women aged 35-50 years were divided into an intervention group (IG) and a control group (CG). The IG followed a 6-month intervention aimed at increasing osteogenic physical activity, guided by two daily goals: walking at least 10,000 steps and completing 60 impacts over 4 g of acceleration. These goals were monitored using a wearable accelerometer linked to an mHealth app. The CG maintained their regular lifestyle and wore the accelerometer without feedback. BMD was estimated using dual-energy X-ray absorptiometry (DXA) scans at baseline and after 6 months, with group-by-time analyses conducted using ANCOVA. The intervention's impact on physical fitness and activity habits was also evaluated. RESULTS 46 participants completed the study (IG = 24; CG = 22). The IG showed significant improvements compared to the CG in femoral neck BMD (IG: +0.003 ± 0.029 g/cm2 vs CG: -0.027 ± 0.031 g/cm2), trochanter BMD (IG: +0.004 ± 0.023 g/cm2 vs CG: -0.026 ± 0.030 g/cm2), and total hip BMD (IG: +0.006 ± 0.043 g/cm2 vs CG: -0.040 ± 0.048 g/cm2). The IG also demonstrated significant improvements in physical fitness measures, including peak torque and power at various speeds and positions. No adverse events related to the intervention were reported. CONCLUSIONS This non-supervised physical activity intervention delivered by wearable-technology and an mHealth app was effective in improving BMD, suggesting its potential for osteoporosis prevention.
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Affiliation(s)
| | - Carol Maher
- Allied Health and Human Performance, University of South Australia, Australia; Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Australia
| | - Job G Godino
- Herbert Wertheim School of Public Health and Longevity Science, University of California, USA; Exercise and Physical Activity Resource Center, University of California, USA; Laura Rodriguez Research Institute, Family Health Centers of San Diego, USA
| | - Borja Sañudo
- Physical Education and Sports Department, University of Seville, Spain
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Godino JG, Samaniego JC, Sharp SP, Taren D, Zuber A, Armistad AJ, Dezan AM, Leyba AJ, Friedly JL, Bunnell AE, Matthews E, Miller MJ, Unger ER, Bertolli J, Hinckley A, Lin JMS, Scott JD, Struminger BB, Ramers C. A technology-enabled multi-disciplinary team-based care model for the management of Long COVID and other fatiguing illnesses within a federally qualified health center: protocol for a two-arm, single-blind, pragmatic, quality improvement professional cluster randomized controlled trial. Trials 2023; 24:524. [PMID: 37573421 PMCID: PMC10423413 DOI: 10.1186/s13063-023-07550-3] [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: 05/31/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND The clinical burden of Long COVID, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and other post-infectious fatiguing illnesses (PIFI) is increasing. There is a critical need to advance understanding of the effectiveness and sustainability of innovative approaches to clinical care of patients having these conditions. METHODS We aim to assess the effectiveness of a Long COVID and Fatiguing Illness Recovery Program (LC&FIRP) in a two-arm, single-blind, pragmatic, quality improvement, professional cluster, randomized controlled trial in which 20 consenting clinicians across primary care clinics in a Federally Qualified Health Center system in San Diego, CA, will be randomized at a ratio of 1:1 to either participate in (1) weekly multi-disciplinary team-based case consultation and peer-to-peer sharing of emerging best practices (i.e., teleECHO (Extension for Community Healthcare Outcomes)) with monthly interactive webinars and quarterly short courses or (2) monthly interactive webinars and quarterly short courses alone (a control group); 856 patients will be assigned to participating clinicians (42 patients per clinician). Patient outcomes will be evaluated according to the study arm of their respective clinicians. Quantitative and qualitative outcomes will be measured at 3- and 6-months post-baseline for clinicians and every 3-months post assignment to a participating clinician for patients. The primary patient outcome is change in physical function measured using the Patient-Reported Outcomes Measurement Information System (PROMIS)-29. Analyses of differences in outcomes at both the patient and clinician levels will include a linear mixed model to compare change in outcomes from baseline to each post-baseline assessment between the randomized study arms. A concurrent prospective cohort study will compare the LC&FIRP patient population to the population enrolled in a university health system. Longitudinal data analysis approaches will allow us to examine differences in outcomes between cohorts. DISCUSSION We hypothesize that weekly teleECHO sessions with monthly interactive webinars and quarterly short courses will significantly improve clinician- and patient-level outcomes compared to the control group. This study will provide much needed evidence on the effectiveness of a technology-enabled multi-disciplinary team-based care model for the management of Long COVID, ME/CFS, and other PIFI within a federally qualified health center. TRIAL REGISTRATION ClinicalTrials.gov, NCT05167227 . Registered on December 22, 2021.
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Affiliation(s)
- Job G Godino
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, 1750 5Th Ave, San Diego, CA, 92101, USA.
- Center for Wireless and Population Health Systems, UC San Diego, 9500 Gilman Drive, Dept. 0811, La Jolla, CA, 92093, USA.
- Herbert Wertheim School of Public Health and Longevity Science, UC San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
- Exercise and Physical Activity Resource Center, UC San Diego, 9500 Gilman Drive, Dept. 0811, La Jolla, CA, 92093, USA.
| | - Jane C Samaniego
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, 1750 5Th Ave, San Diego, CA, 92101, USA
| | - Sydney P Sharp
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, 1750 5Th Ave, San Diego, CA, 92101, USA
- Exercise and Physical Activity Resource Center, UC San Diego, 9500 Gilman Drive, Dept. 0811, La Jolla, CA, 92093, USA
| | - Douglas Taren
- Department of Pediatrics and Nutrition, University of Colorado, 13001 East 17Th Place, Aurora, CO, 80045, USA
| | - Alexandra Zuber
- Ata Health Strategies, LLC, 1537 D Street NE, Washington, DC, 20002, USA
| | - Amy J Armistad
- Project ECHO, University of New Mexico Health Sciences Center, 1650 University Blvd NE, Albuquerque, NM, 87102, USA
| | - Amanda M Dezan
- Project ECHO, University of New Mexico Health Sciences Center, 1650 University Blvd NE, Albuquerque, NM, 87102, USA
| | - Azure J Leyba
- Project ECHO, University of New Mexico Health Sciences Center, 1650 University Blvd NE, Albuquerque, NM, 87102, USA
| | - Janna L Friedly
- Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
- Rehabilitation Clinic, Harborview Medical Center, 410 9Th Ave, Seattle, WA, 98104, USA
| | - Aaron E Bunnell
- Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
- Rehabilitation Clinic, Harborview Medical Center, 410 9Th Ave, Seattle, WA, 98104, USA
| | - Eva Matthews
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, 1750 5Th Ave, San Diego, CA, 92101, USA
| | - Maureen J Miller
- National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Elizabeth R Unger
- National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Jeanne Bertolli
- National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Alison Hinckley
- National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - Jin-Mann S Lin
- National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA
| | - John D Scott
- Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
- Rehabilitation Clinic, Harborview Medical Center, 410 9Th Ave, Seattle, WA, 98104, USA
| | - Bruce B Struminger
- Project ECHO, University of New Mexico Health Sciences Center, 1650 University Blvd NE, Albuquerque, NM, 87102, USA
| | - Christian Ramers
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, 1750 5Th Ave, San Diego, CA, 92101, USA
- School of Medicine, UC San Diego, 9500 Gilman Drive, Dept. 0606, La Jolla, CA, 92093, USA
- School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA
- Global Hepatitis Program, Clinton Health Access Initiative, 383 Dorchester Ave, Boston, MA, 02127, USA
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Albahsahli B, Bridi L, Aljenabi R, Abu-Baker D, Kaki DA, Godino JG, Al-Rousan T. Impact of United States refugee ban and discrimination on the mental health of hypertensive Arabic-speaking refugees. Front Psychiatry 2023; 14:1083353. [PMID: 37636820 PMCID: PMC10449266 DOI: 10.3389/fpsyt.2023.1083353] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 07/21/2023] [Indexed: 08/29/2023] Open
Abstract
Background Hypertension is a global leading cause of death which disproportionately affects refugees. This chronic disease increases the risk of heart disease, stroke, brain, and other end-organ disease, if left uncontrolled. The 2017 United States travel or "Muslim" ban prevented immigrants and refugees from seven Muslim-majority countries from entering the United States, including Syria and Iraq; two major contributors to the global refugee population. As of 2020, the United States has admitted more than 133,000 and 22,000 Iraqi and Syrian refugees, respectively. Studies on the health effects of this policy on refugees are lacking. This study qualitatively explores the impact of the refugee ban on United States resettled Syrian and Iraqi refugees with hypertension. Methods Participants were recruited through a federally qualified health center system that is the largest healthcare provider for refugees in San Diego, CA. All participants were Arabic-speaking refugees diagnosed with hypertension from Syria and Iraq. In-depth interviews took place between April 2021 and April 2022. Inductive thematic analysis was used to analyze data from semi-structured interviews. Results Participants (N = 109) include 53 women and 56 men (23 Syrian, 86 Iraqi). The average age was 61.3 years (SD: 9.7) and stay in the United States was 9.5 years (SD 5.92). Four themes emerged linking the travel ban's impact on health, in line with the society to cells framework: (1) family factors: the refugee ban resulted in family separation; (2) physiological factors: the refugee ban worsened participants' mental health, exacerbating hypertension and perceived health outcomes; (3) community factors: perpetuation of Islamophobia, xenophobia, and perceived discrimination were structural barriers with links to poorer health; and (4) individual factors: trickle down consequences led to worsened participant self-image and self-perception within their host community. Discussion The refugee ban negatively impacted the mental and physical health of United States resettled Arabic-speaking refugees through perceived discrimination, stress, and poor social integration. It continues to have long-lasting effects years after the ban was instated. Centering family reunification within the United States Refugee Admissions Program and tailoring interventions through the healthcare and public health systems are warranted to reduce hypertension disparities in this growing and overlooked population.
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Affiliation(s)
- Behnan Albahsahli
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
| | - Lana Bridi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
- School of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Raghad Aljenabi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
| | - Dania Abu-Baker
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
- School of Social Work, San Diego State University, San Diego, CA, United States
| | - Dahlia A Kaki
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Job G Godino
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
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Wing D, Eyler LT, Lenze EJ, Wetherell JL, Nichols JF, Meeusen R, Godino JG, Shimony JS, Snyder AZ, Nishino T, Nicol GE, Nagels G, Roelands B. Fatness, fitness and the aging brain: A cross sectional study of the associations between a physiological estimate of brain age and physical fitness, activity, sleep, and body composition. Neuroimage Rep 2022; 2:100146. [PMID: 36743444 PMCID: PMC9894084 DOI: 10.1016/j.ynirp.2022.100146] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction Changes in brain structure and function occur with aging. However, there is substantial heterogeneity both in terms of when these changes begin, and the rate at which they progress. Understanding the mechanisms and/or behaviors underlying this heterogeneity may allow us to act to target and slow negative changes associated with aging. Methods Using T1 weighted MRI images, we applied a novel algorithm to determine the physiological age of the brain (brain-predicted age) and the predicted age difference between this physiologically based estimate and chronological age (BrainPAD) to 551 sedentary adults aged 65 to 84 with self-reported cognitive complaint measured at baseline as part of a larger study. We also assessed maximal aerobic capacity with a graded exercise test, physical activity and sleep with accelerometers, and body composition with dual energy x-ray absorptiometry. Associations were explored both linearly and logistically using categorical groupings. Results Visceral Adipose Tissue (VAT), Total Sleep Time (TST) and maximal aerobic capacity all showed significant associations with BrainPAD. Greater VAT was associated with higher (i.e,. older than chronological) BrainPAD (r = 0.149 p = 0.001)Greater TST was associated with higher BrainPAD (r = 0.087 p = 0.042) and greater aerobic capacity was associated with lower BrainPAD (r = - 0.088 p = 0.040). With linear regression, both VAT and TST remained significant (p = 0.036 and 0.008 respectively). Each kg of VAT predicted a 0.741 year increase in BrainPAD, and each hour of increased TST predicted a 0.735 year increase in BrainPAD. Maximal aerobic capacity did not retain statistical significance in fully adjusted linear models. Discussion Accumulation of visceral adipose tissue and greater total sleep time, but not aerobic capacity, total daily physical activity, or sleep quantity and/or quality are associated with brains that are physiologically older than would be expected based upon chronological age alone (BrainPAD).
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Affiliation(s)
- David Wing
- Herbert Wertheim School of Public Health and Human Longevity, University of California, San Diego, United States
- Exercise and Physical Activity Resource Center (EPARC), University of California, San Diego, United States
| | - Lisa T. Eyler
- Department of Psychiatry, University of California, San Diego, United States
- San Diego Veterans Administration Health Care System, San Diego, United States
| | - Eric J. Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Julie Loebach Wetherell
- Mental Health Service, VA San Diego Healthcare System, United States
- Department of Psychiatry, University of California, San Diego, United States
| | - Jeanne F. Nichols
- Herbert Wertheim School of Public Health and Human Longevity, University of California, San Diego, United States
- Exercise and Physical Activity Resource Center (EPARC), University of California, San Diego, United States
| | - Romain Meeusen
- Human Physiology & Sports Physiotherapy Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Job G. Godino
- Herbert Wertheim School of Public Health and Human Longevity, University of California, San Diego, United States
- Exercise and Physical Activity Resource Center (EPARC), University of California, San Diego, United States
| | - Joshua S. Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Abraham Z. Snyder
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Tomoyuki Nishino
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Ginger E. Nicol
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Guy Nagels
- Department of Neurology, UZ Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Bart Roelands
- Human Physiology & Sports Physiotherapy Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
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Wing D, Godino JG, Baker FC, Yang R, Chevance G, Thompson WK, Reuter C, Bartsch H, Wilbur A, Straub LK, Castro N, Higgins M, Colrain IM, de Zambotti M, Wade NE, Lisdahl KM, Squeglia LM, Ortigara J, Fuemmeler B, Patrick K, Mason MJ, Tapert SF, Bagot KS. Recommendations for Identifying Valid Wear for Consumer-Level Wrist-Worn Activity Trackers and Acceptability of Extended Device Deployment in Children. Sensors (Basel) 2022; 22:9189. [PMID: 36501894 PMCID: PMC9738818 DOI: 10.3390/s22239189] [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] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/16/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Self-reported physical activity is often inaccurate. Wearable devices utilizing multiple sensors are now widespread. The aim of this study was to determine acceptability of Fitbit Charge HR for children and their families, and to determine best practices for processing its objective data. METHODS Data were collected via Fitbit Charge HR continuously over the course of 3 weeks. Questionnaires were given to each child and their parent/guardian to determine the perceived usability of the device. Patterns of data were evaluated and best practice inclusion criteria recommended. RESULTS Best practices were established to extract, filter, and process data to evaluate device wear, r and establish minimum wear time to evaluate behavioral patterns. This resulted in usable data available from 137 (89%) of the sample. CONCLUSIONS Activity trackers are highly acceptable in the target population and can provide objective data over longer periods of wear. Best practice inclusion protocols that reflect physical activity in youth are provided.
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Grants
- U01DA041048 NIH HHS
- U01DA050989 NIH HHS
- U01DA051016 NIH HHS
- U01DA041022 NIH HHS
- U01DA051018, U01DA051037, U01DA050987, U01DA041174, U01DA041106, U01DA041117, U01DA041028, U01DA041134, U01DA050988, U01DA051039, U01DA041156, U01DA041025, U01DA041120, U01DA051038, U01DA041148, U01DA041093, U01DA041089, U24DA041123, U24DA041147. NIH HHS
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Affiliation(s)
- David Wing
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA 92093, USA
| | - Job G. Godino
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA 92093, USA
| | - Fiona C. Baker
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA
| | - Rongguang Yang
- Department of Radiology, University of California, San Diego, CA 92093, USA
| | | | | | - Chase Reuter
- Department of Radiology, University of California, San Diego, CA 92093, USA
| | - Hauke Bartsch
- Department of Computer Science, University of Bergen, 5007 Bergen, Norway
| | - Aimee Wilbur
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA
| | - Lisa K. Straub
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Norma Castro
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
| | - Michael Higgins
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA 92093, USA
| | - Ian M. Colrain
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA
| | | | - Natasha E. Wade
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
| | - Krista M. Lisdahl
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
| | - Lindsay M. Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29208, USA
| | - Joseph Ortigara
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA 92093, USA
| | - Bernard Fuemmeler
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Kevin Patrick
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA 92093, USA
| | - Michael J. Mason
- Center for Behavioral Health Research, University of Tennessee, Knoxville, TN 37996, USA
| | - Susan F. Tapert
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
| | - Kara S. Bagot
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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8
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Seaton M, Wing D, Shen J, Rauh MJ, Kado D, Godino JG, Nichols JF. Associations Of Lean Mass And Muscular Strength With Trabecular Bone Score In Older Adults. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000875512.54241.9f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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9
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Chevance G, Golaszewski NM, Tipton E, Hekler EB, Buman M, Welk GJ, Patrick K, Godino JG. Accuracy and Precision of Energy Expenditure, Heart Rate, and Steps Measured by Combined-Sensing Fitbits Against Reference Measures: Systematic Review and Meta-analysis. JMIR Mhealth Uhealth 2022; 10:e35626. [PMID: 35416777 PMCID: PMC9047731 DOI: 10.2196/35626] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/27/2022] [Accepted: 02/10/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Although it is widely recognized that physical activity is an important determinant of health, assessing this complex behavior is a considerable challenge. OBJECTIVE The purpose of this systematic review and meta-analysis is to examine, quantify, and report the current state of evidence for the validity of energy expenditure, heart rate, and steps measured by recent combined-sensing Fitbits. METHODS We conducted a systematic review and Bland-Altman meta-analysis of validation studies of combined-sensing Fitbits against reference measures of energy expenditure, heart rate, and steps. RESULTS A total of 52 studies were included in the systematic review. Among the 52 studies, 41 (79%) were included in the meta-analysis, representing 203 individual comparisons between Fitbit devices and a criterion measure (ie, n=117, 57.6% for heart rate; n=49, 24.1% for energy expenditure; and n=37, 18.2% for steps). Overall, most authors of the included studies concluded that recent Fitbit models underestimate heart rate, energy expenditure, and steps compared with criterion measures. These independent conclusions aligned with the results of the pooled meta-analyses showing an average underestimation of -2.99 beats per minute (k comparison=74), -2.77 kcal per minute (k comparison=29), and -3.11 steps per minute (k comparison=19), respectively, of the Fitbit compared with the criterion measure (results obtained after removing the high risk of bias studies; population limit of agreements for heart rate, energy expenditure, and steps: -23.99 to 18.01, -12.75 to 7.41, and -13.07 to 6.86, respectively). CONCLUSIONS Fitbit devices are likely to underestimate heart rate, energy expenditure, and steps. The estimation of these measurements varied by the quality of the study, age of the participants, type of activities, and the model of Fitbit. The qualitative conclusions of most studies aligned with the results of the meta-analysis. Although the expected level of accuracy might vary from one context to another, this underestimation can be acceptable, on average, for steps and heart rate. However, the measurement of energy expenditure may be inaccurate for some research purposes.
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Affiliation(s)
| | - Natalie M Golaszewski
- Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla, CA, United States
- Center for Wireless & Population Health Systems, University of California, San Diego, La Jolla, CA, United States
| | - Elizabeth Tipton
- Department of Statistics, Northwestern University, Evanston, IL, United States
| | - Eric B Hekler
- Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla, CA, United States
- Center for Wireless & Population Health Systems, University of California, San Diego, La Jolla, CA, United States
- Exercise and Physical Activity Resource Center, University of California, San Diego, La Jolla, CA, United States
| | - Matthew Buman
- School of Nutrition & Health Promotion, Arizona State University, Phoenix, AZ, United States
| | - Gregory J Welk
- Department of Kinesiology, Iowa State University, Ames, IA, United States
| | - Kevin Patrick
- Center for Wireless & Population Health Systems, University of California, San Diego, La Jolla, CA, United States
| | - Job G Godino
- Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla, CA, United States
- Center for Wireless & Population Health Systems, University of California, San Diego, La Jolla, CA, United States
- Exercise and Physical Activity Resource Center, University of California, San Diego, La Jolla, CA, United States
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA, United States
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10
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Golaszewski NM, LaCroix AZ, Godino JG, Allison MA, Manson JE, King JJ, Weitlauf JC, Bea JW, Garcia L, Kroenke CH, Saquib N, Cannell B, Nguyen S, Bellettiere J. Evaluation of Social Isolation, Loneliness, and Cardiovascular Disease Among Older Women in the US. JAMA Netw Open 2022; 5:e2146461. [PMID: 35107574 PMCID: PMC8811637 DOI: 10.1001/jamanetworkopen.2021.46461] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
IMPORTANCE Social isolation and loneliness are increasing public health concerns and have been associated with increased risk of cardiovascular disease (CVD) among older adults. OBJECTIVE To examine the associations of social isolation and loneliness with incident CVD in a large cohort of postmenopausal women and whether social support moderated these associations. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study, conducted from March 2011 through March 2019, included community-living US women aged 65 to 99 years from the Women's Health Initiative Extension Study II who had no history of myocardial infarction, stroke, or coronary heart disease. EXPOSURES Social isolation and loneliness were ascertained using validated questionnaires. MAIN OUTCOMES AND MEASURES The main outcome was major CVD, which was physician adjudicated using medical records and included coronary heart disease, stroke, and death from CVD. Continuous scores of social isolation and loneliness were analyzed. Hazard ratios (HRs) and 95% CIs for CVD were calculated for women with high social isolation and loneliness scores (midpoint of the upper half of the distribution) vs those with low scores (midpoint of the lower half of the distribution) using multivariable Cox proportional hazards regression models adjusting for age, race and ethnicity, educational level, and depression and then adding relevant health behavior and health status variables. Questionnaire-assessed social support was tested as a potential effect modifier. RESULTS Among 57 825 women (mean [SD] age, 79.0 [6.1] years; 89.1% White), 1599 major CVD events occurred over 186 762 person-years. The HR for the association of high vs low social isolation scores with CVD was 1.18 (95% CI, 1.13-1.23), and the HR for the association of high vs low loneliness scores with CVD was 1.14 (95% CI, 1.10-1.18). The HRs after additional adjustment for health behaviors and health status were 1.08 (95% CI, 1.03-1.12; 8.0% higher risk) for social isolation and 1.05 (95% CI, 1.01-1.09; 5.0% higher risk) for loneliness. Women with both high social isolation and high loneliness scores had a 13.0% to 27.0% higher risk of incident CVD than did women with low social isolation and low loneliness scores. Social support was not a significant effect modifier of the associations (social isolation × social support: r, -0.18; P = .86; loneliness × social support: r, 0.78; P = .48). CONCLUSIONS AND RELEVANCE In this cohort study, social isolation and loneliness were independently associated with modestly higher risk of CVD among postmenopausal women in the US, and women with both social isolation and loneliness had greater CVD risk than did those with either exposure alone. The findings suggest that these prevalent psychosocial processes merit increased attention for prevention of CVD in older women, particularly in the era of COVID-19.
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Affiliation(s)
- Natalie M. Golaszewski
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego
| | - Andrea Z. LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego
| | - Job G. Godino
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego
- Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, California
- Center for Wireless and Population Health Systems, University of California, San Diego
- Exercise and Physical Activity Resource Center, University of California, San Diego
| | - Matthew A. Allison
- Division of Preventive Medicine, Department of Family Medicine, University of California, San Diego
| | - JoAnn E. Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jennifer J. King
- Department of Health Promotion Sciences, University of Arizona Cancer Center, Tucson, Arizona
| | - Julie C. Weitlauf
- Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, Stanford, California
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Jennifer W. Bea
- Department of Health Promotion Sciences, University of Arizona Cancer Center, Tucson, Arizona
| | - Lorena Garcia
- University of California Davis School of Medicine, Davis
| | | | - Nazmus Saquib
- Department of Clinical Sciences, College of Medicine, Sulaiman Al Rajhi University, Al Bukayriyah, Saudi Arabia
| | - Brad Cannell
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston School of Public Health–Dallas Campus
| | - Steve Nguyen
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego
| | - John Bellettiere
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego
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11
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Philis-Tsimikas A, Fortmann AL, Godino JG, Schultz J, Roesch SC, Gilmer TP, Farcas E, Sandoval H, Savin KL, Clark T, Chichmarenko M, Jones JA, Gallo LC. Dulce Digital-Me: protocol for a randomized controlled trial of an adaptive mHealth intervention for underserved Hispanics with diabetes. Trials 2022; 23:80. [PMID: 35090520 PMCID: PMC8796443 DOI: 10.1186/s13063-021-05899-x] [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: 07/12/2021] [Accepted: 11/30/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND By 2034, the number of US individuals with diabetes is predicted to increase from 23.7 to 44.1 million, and annual diabetes-related spending is expected to grow from $113 to $336 billion. Up to 55% of US Hispanics born in the year 2000 are expected to develop diabetes during their lifetime. Poor healthcare access and cultural barriers prevent optimal care, adherence, and clinical benefit, placing Hispanics at disproportionate risk for costly diabetes complications. Mobile technology is increasingly prevalent in all populations and can circumvent such barriers. Our group developed Dulce Digital, an educational text messaging program that improved glycemic control relative to usual care. Dulce Digital-Me (DD-Me) has been tailored to a participant's individual needs with a greater focus on health behavior change. METHODS This is a three-arm, parallel group, randomized trial with equal allocation ratio enrolling Hispanic adults with low income and poorly managed type 2 diabetes (N = 414) from a San Diego County Federally Qualified Health Center. Participants are randomized to receive Dulce Digital, Dulce Digital-Me-Automated, or Dulce Digital-Me-Telephonic. The DD-Me groups include Dulce Digital components plus personalized goal-setting and feedback delivered via algorithm-driven automated text messaging (DD-Me-Automated) or by the care team health coach (DD-Me-Telephonic) over a 12-month follow-up period. The study will examine the comparative effectiveness of the three groups in improving diabetes clinical control [HbA1c, primary outcome; low-density lipoprotein cholesterol (LDL-C), and systolic blood pressure (SBP)] and patient-provider communication and patient adherence (i.e., medication, self-management tasks) over 12 months and will examine cost-effectiveness of the three interventions. DISCUSSION Our comparative evaluation of three mHealth approaches will elucidate how technology can be integrated most effectively and efficiently within primary care-based chronic care model approaches to reduce diabetes disparities in Hispanics and will assess two modes of personalized messaging delivery (i.e., automated messaging vs. telephonic by health coach) to inform cost and acceptability. TRIAL REGISTRATION NCT03130699-All items from the WHO Trial Registration data set are available in https://clinicaltrials.gov/ct2/show/study/NCT03130699 .
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Affiliation(s)
- Athena Philis-Tsimikas
- grid.288434.10000 0001 1541 3236Scripps Whittier Diabetes Institute, Scripps Health, San Diego, USA
| | - Addie L. Fortmann
- grid.288434.10000 0001 1541 3236Scripps Whittier Diabetes Institute, Scripps Health, San Diego, USA
| | - Job G. Godino
- grid.421317.20000 0004 0497 8794Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, USA ,grid.266100.30000 0001 2107 4242Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, USA
| | | | - Scott C. Roesch
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, USA ,grid.263081.e0000 0001 0790 1491Department of Psychology, San Diego State University, San Diego, USA
| | - Todd P. Gilmer
- grid.266100.30000 0001 2107 4242Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, USA
| | - Emilia Farcas
- grid.266100.30000 0001 2107 4242Qualcomm Institute, University of California, San Diego, USA
| | - Haley Sandoval
- grid.288434.10000 0001 1541 3236Scripps Whittier Diabetes Institute, Scripps Health, San Diego, USA
| | - Kimberly L. Savin
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, USA
| | - Taylor Clark
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, USA
| | - Mariya Chichmarenko
- grid.288434.10000 0001 1541 3236Scripps Whittier Diabetes Institute, Scripps Health, San Diego, USA
| | - Jennifer A. Jones
- grid.288434.10000 0001 1541 3236Scripps Whittier Diabetes Institute, Scripps Health, San Diego, USA
| | - Linda C. Gallo
- grid.263081.e0000 0001 0790 1491Department of Psychology, San Diego State University, San Diego, USA
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12
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Lawhun Costello V, Chevance G, Wing D, Mansour-Assi SJ, Sharp S, Golaszewski NM, Young EA, Higgins M, Ibarra A, Larsen B, Godino JG. Impact of the COVID-19 Pandemic on Objectively Measured Physical Activity and Sedentary Behavior Among Overweight Young Adults: Yearlong Longitudinal Analysis. JMIR Public Health Surveill 2021; 7:e28317. [PMID: 34665759 PMCID: PMC8614391 DOI: 10.2196/28317] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 08/18/2021] [Accepted: 10/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has impacted multiple aspects of daily living, including behaviors associated with occupation, transportation, and health. It is unclear how these changes to daily living have impacted physical activity and sedentary behavior. OBJECTIVE In this study, we add to the growing body of research on the health impact of the COVID-19 pandemic by examining longitudinal changes in objectively measured daily physical activity and sedentary behavior among overweight or obese young adults participating in an ongoing weight loss trial in San Diego, California. METHODS Data were collected from 315 overweight or obese (BMI: range 25.0-39.9 kg/m2) participants aged from 18 to 35 years between November 1, 2019, and October 30, 2020, by using the Fitbit Charge 3 (Fitbit LLC). After conducting strict filtering to find valid data on consistent wear (>10 hours per day for ≥250 days), data from 97 participants were analyzed to detect multiple structural changes in time series of physical activity and sedentary behavior. An algorithm was designed to detect multiple structural changes. This allowed for the automatic identification and dating of these changes in linear regression models with CIs. The number of breakpoints in regression models was estimated by using the Bayesian information criterion and residual sum of squares; the optimal segmentation corresponded to the lowest Bayesian information criterion and residual sum of squares. To quantify the changes in each outcome during the periods identified, linear mixed effects analyses were conducted. In terms of key demographic characteristics, the 97 participants included in our analyses did not differ from the 210 participants who were excluded. RESULTS After the initiation of the shelter-in-place order in California on March 19, 2021, there were significant decreases in step counts (-2872 steps per day; 95% CI -2734 to -3010), light physical activity times (-41.9 minutes; 95% CI -39.5 to -44.3), and moderate-to-vigorous physical activity times (-12.2 minutes; 95% CI -10.6 to -13.8), as well as significant increases in sedentary behavior times (+52.8 minutes; 95% CI 47.0-58.5). The decreases were greater than the expected declines observed during winter holidays, and as of October 30, 2020, they have not returned to the levels observed prior to the initiation of shelter-in-place orders. CONCLUSIONS Among overweight or obese young adults, physical activity times decreased and sedentary behavior times increased concurrently with the implementation of COVID-19 mitigation strategies. The health conditions associated with a sedentary lifestyle may be additional, unintended results of the COVID-19 pandemic.
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Affiliation(s)
- Victoria Lawhun Costello
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States
| | - Guillaume Chevance
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, United States.,Barcelona Institute for Global Health, Barcelona, Spain
| | - David Wing
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States.,Exercise and Physical Activity Resource Center, University of California, San Diego, La Jolla, CA, United States
| | - Shadia J Mansour-Assi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States.,Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, United States
| | - Sydney Sharp
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States
| | - Natalie M Golaszewski
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States.,Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, United States
| | - Elizabeth A Young
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States.,Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, United States
| | - Michael Higgins
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, United States.,Exercise and Physical Activity Resource Center, University of California, San Diego, La Jolla, CA, United States
| | - Anahi Ibarra
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States
| | - Britta Larsen
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States
| | - Job G Godino
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States.,Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, United States.,Exercise and Physical Activity Resource Center, University of California, San Diego, La Jolla, CA, United States
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13
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Chevance G, Baretta D, Romain AJ, Godino JG, Bernard P. Day-to-day associations between sleep and physical activity: a set of person-specific analyses in adults with overweight and obesity. J Behav Med 2021; 45:14-27. [PMID: 34427820 PMCID: PMC8382675 DOI: 10.1007/s10865-021-00254-6] [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: 02/18/2021] [Accepted: 08/09/2021] [Indexed: 12/16/2022]
Abstract
The objective of the present study was to estimate whether physical activity on one day was associated with both sleep quality and quantity the following night and to examine to what extent sleep on one night was associated with physical activity the next day. We collected data from 33 young adults who were overweight or obese and consistently wore a Fitbit Charge 3. A total of 7094 days and nights were analyzed. Person-specific models were conducted to test the bi-directional associations for each participant separately. Results suggest an absence of association between steps and sleep efficiency in the two directions. More heterogeneous results were observed for the association between steps and total sleep time, with 19 participants (58%) showing a negative association between total sleep time and next day steps, and 9 (27%) showing a negative association between steps and next day total sleep time. Taken together, these results suggest a potential conflicting association between total sleep time and physical activity for some participants. Pre- and post-print doi: https://doi.org/10.31236/osf.io/nfjqv ; supplemental material: https://osf.io/y7nxg/ .
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Affiliation(s)
- Guillaume Chevance
- ISGlobal, Barcelona Institute for Global Health, Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain.
| | | | - Ahmed Jérôme Romain
- École de Kinésiologie Et Des Sciences de L'activité Physique, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada.,Research Center, University Institute of Mental Health At Montreal, Montréal, QC, Canada
| | - Job G Godino
- Center for Wireless & Population Health Systems, University of California, San Diego, USA.,Exercise and Physical Activity Resource Center, University of California, San Diego, USA.,Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, USA
| | - Paquito Bernard
- Research Center, University Institute of Mental Health At Montreal, Montréal, QC, Canada.,Department of Physical Activity Sciences, Université du Québec À Montréal, Montréal, Québec, Canada
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14
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Wing D, Godino JG, Vo A, Moran R, Graham S, Nichols JF. Quantification of Scan Analysis Errors in GE Lunar DXA Visceral Adiposity in Adults. J Clin Densitom 2021; 24:287-293. [PMID: 32709552 DOI: 10.1016/j.jocd.2020.06.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/25/2022]
Abstract
Utilization of dual-energy X-ray absorptiometry is increasing in clinical settings and the fitness industry as a viable tool to assess total and regional body composition, including visceral adiposity. Previous research using small samples (<50) has described several pitfalls in patient positioning, scan acquisition, and/or analysis that alter regional body composition values. Our aim was to quantify the largest probable error in measures of total, android, gynoid, and visceral fat caused by incorrect placement of the head cut-line, in a large sample of adults. Total body images (N = 436) from 196 women and 67 men (20-85 years) scanned on a GE Lunar Prodigy densitometer were analyzed using enCORE software in 2 ways: (1) placing the head cut-line just beneath the bony protuberance of the chin according to manufacturer recommendation (correct method); (2) placing the head cut-line at the lowest point below the chin and just above the soft tissue at the shoulders (incorrect method). All other cut-lines were fixed. Mean differences in adiposity were examined using Lin's concordance correlation coefficient; equality of means and variances were evaluated using Bradley-Blackwood F-tests. The limits of agreement were displayed as Bland-Altman plots and calculated as the mean difference ±1.96 times the standard deviation of the difference. Correlation coefficients for paired comparisons of adiposity for correct vs incorrect cut-line placement ranged from 0.983-0.999 for all variables (all p < 0.001). Significant mean differences were 172 ± 130, 201 ± 168, 65 ± 122, and -143 ± 336 g for android, gynoid, visceral, and total fat mass, respectively (all p < 0.0001). These differences exceeded our site's least significant change in 66%, 37%, 29%, and 4% of participant scans for android, gynoid, visceral, and total fat mass, respectively. Our findings underscore the importance of careful review of the manufacturer's auto analysis and consistency in conducting serial scans to ensure accurate and precise measures of regional body fat.
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Affiliation(s)
- David Wing
- Exercise and Physical Activity Resource Center (EPARC), Department of Family Medicine and Public Health, University of California, San Diego (UCSD), La Jolla, CA, USA; UCSD Bone Densitometry School, La Jolla, CA, USA
| | - Job G Godino
- Exercise and Physical Activity Resource Center (EPARC), Department of Family Medicine and Public Health, University of California, San Diego (UCSD), La Jolla, CA, USA
| | - Anh Vo
- Exercise and Physical Activity Resource Center (EPARC), Department of Family Medicine and Public Health, University of California, San Diego (UCSD), La Jolla, CA, USA
| | - Ryan Moran
- Exercise and Physical Activity Resource Center (EPARC), Department of Family Medicine and Public Health, University of California, San Diego (UCSD), La Jolla, CA, USA; UCSD Bone Densitometry School, La Jolla, CA, USA
| | - Sarah Graham
- Exercise and Physical Activity Resource Center (EPARC), Department of Family Medicine and Public Health, University of California, San Diego (UCSD), La Jolla, CA, USA; Department of Psychiatry, UCSD, La Jolla, CA, USA; Sam and Rose Stein Institute for Research on Aging, UCSD, La Jolla, CA, USA
| | - Jeanne F Nichols
- Exercise and Physical Activity Resource Center (EPARC), Department of Family Medicine and Public Health, University of California, San Diego (UCSD), La Jolla, CA, USA; UCSD Bone Densitometry School, La Jolla, CA, USA.
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15
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Rojas SA, Godino JG, Northrup A, Khasira M, Tam A, Asmus L, Frenette C, Ramers CB. Effectiveness of a Decentralized Hub and Spoke Model for the Treatment of Hepatitis C Virus in a Federally Qualified Health Center. Hepatol Commun 2021; 5:412-423. [PMID: 33681676 PMCID: PMC7917265 DOI: 10.1002/hep4.1617] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/18/2020] [Accepted: 09/13/2020] [Indexed: 12/22/2022] Open
Abstract
Hepatitis C virus (HCV) is a major cause of cirrhosis, liver cancer, and mortality in the United States. We assessed the effectiveness of decentralized HCV treatment delivered by nurse practitioners (NPs), primary care physicians (PMDs), or an infectious disease physician (ID MD) using direct-acting antivirals in a Federally Qualified Health Center (FQHC) in urban San Diego, CA. We conducted a cross-sectional analysis of 1,261 patients who received treatment from six NPs, 10 PMDs, and one ID MD practicing in 10 clinics between January 2014 and January 2020. Care was delivered based on the Extension for Community Healthcare Outcomes (Project ECHO) model with one hub and nine spokes. HCV was deemed cured if a patient had a sustained virologic response (SVR) after 12 weeks of treatment (SVR12). We evaluated differences in the prevalence of cure between provider types and hub or spoke status using Poisson regression. Patients were 34% Latino, 16% black, 63% were aged >50 years, and 59% were homeless; 53% had advanced fibrosis, 69% had genotype 1, and 5% were coinfected with human immunodeficiency virus. A total of 943 patients achieved SVR12 (96% per protocol and 73% intention to treat). Even after adjustment for demographics, resources, and disease characteristics, the prevalence of cure did not differ between the ID MD and PMDs (prevalence ratio [PR], 1.00; 95% confidence interval [CI], 0.95-1.04) or NPs (PR, 1.01; 95% CI, 0.96-1.05). Similarly, there were no differences between the hub and spokes (PR, 1.01; 95% CI, 0.98-1.04). Conclusion: Among a low-income and majority homeless cohort of patients at urban FQHC clinics, HCV treatment administered by nonspecialist providers was not inferior to that provided by a specialist.
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Affiliation(s)
- Sarah A. Rojas
- Laura Rodriguez Research InstituteFamily Health Centers of San DiegoSan DiegoCA
- Institute of Public HealthSan Diego State University Research FoundationSan DiegoCA
| | - Job G. Godino
- Laura Rodriguez Research InstituteFamily Health Centers of San DiegoSan DiegoCA
- Center for Wireless and Population Health SystemsUniversity of California San DiegoLa JollaCA
| | - Adam Northrup
- Laura Rodriguez Research InstituteFamily Health Centers of San DiegoSan DiegoCA
| | - Maureen Khasira
- Laura Rodriguez Research InstituteFamily Health Centers of San DiegoSan DiegoCA
| | - Aaron Tam
- Laura Rodriguez Research InstituteFamily Health Centers of San DiegoSan DiegoCA
| | - Lisa Asmus
- Institute of Public HealthSan Diego State University Research FoundationSan DiegoCA
| | | | - Christian B. Ramers
- Laura Rodriguez Research InstituteFamily Health Centers of San DiegoSan DiegoCA
- Division of Infectious DiseasesDepartment of MedicineUniversity of California San DiegoLa JollaCA
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16
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Godino JG, Wing D, de Zambotti M, Baker FC, Bagot K, Inkelis S, Pautz C, Higgins M, Nichols J, Brumback T, Chevance G, Colrain IM, Patrick K, Tapert SF. Performance of a commercial multi-sensor wearable (Fitbit Charge HR) in measuring physical activity and sleep in healthy children. PLoS One 2020; 15:e0237719. [PMID: 32886714 PMCID: PMC7473549 DOI: 10.1371/journal.pone.0237719] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/31/2020] [Indexed: 12/26/2022] Open
Abstract
PURPOSE This study sought to assess the performance of the Fitbit Charge HR, a consumer-level multi-sensor activity tracker, to measure physical activity and sleep in children. METHODS 59 healthy boys and girls aged 9-11 years old wore a Fitbit Charge HR, and accuracy of physical activity measures were evaluated relative to research-grade measures taken during a combination of 14 standardized laboratory- and field-based assessments of sitting, stationary cycling, treadmill walking or jogging, stair walking, outdoor walking, and agility drills. Accuracy of sleep measures were evaluated relative to polysomnography (PSG) in 26 boys and girls during an at-home unattended PSG overnight recording. The primary analyses included assessment of the agreement (biases) between measures using the Bland-Altman method, and epoch-by-epoch (EBE) analyses on a minute-by-minute basis. RESULTS Fitbit Charge HR underestimated steps (~11.8 steps per minute), heart rate (~3.58 bpm), and metabolic equivalents (~0.55 METs per minute) and overestimated energy expenditure (~0.34 kcal per minute) relative to research-grade measures (p< 0.05). The device showed an overall accuracy of 84.8% for classifying moderate and vigorous physical activity (MVPA) and sedentary and light physical activity (SLPA) (sensitivity MVPA: 85.4%; specificity SLPA: 83.1%). Mean estimates of bias for measuring total sleep time, wake after sleep onset, and heart rate during sleep were 14 min, 9 min, and 1.06 bpm, respectively, with 95.8% sensitivity in classifying sleep and 56.3% specificity in classifying wake epochs. CONCLUSIONS Fitbit Charge HR had adequate sensitivity in classifying moderate and vigorous intensity physical activity and sleep, but had limitations in detecting wake, and was more accurate in detecting heart rate during sleep than during exercise, in healthy children. Further research is needed to understand potential challenges and limitations of these consumer devices.
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Affiliation(s)
- Job G. Godino
- Exercise and Physical Activity Resource Center, University of California, San Diego, La Jolla, California, United States of America
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, California, United States of America
| | - David Wing
- Exercise and Physical Activity Resource Center, University of California, San Diego, La Jolla, California, United States of America
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, California, United States of America
| | | | - Fiona C. Baker
- Center for Health Sciences, SRI International, Menlo Park, California, United States of America
| | - Kara Bagot
- Department of Psychiatry, University of California, San Diego, La Jolla, California, United States of America
| | - Sarah Inkelis
- Department of Psychiatry, University of California, San Diego, La Jolla, California, United States of America
| | - Carina Pautz
- Exercise and Physical Activity Resource Center, University of California, San Diego, La Jolla, California, United States of America
| | - Michael Higgins
- Exercise and Physical Activity Resource Center, University of California, San Diego, La Jolla, California, United States of America
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, California, United States of America
| | - Jeanne Nichols
- Exercise and Physical Activity Resource Center, University of California, San Diego, La Jolla, California, United States of America
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, California, United States of America
| | - Ty Brumback
- Department of Psychological Science, Northern Kentucky University, Highland Heights, Kentucky, United States of America
| | - Guillaume Chevance
- Exercise and Physical Activity Resource Center, University of California, San Diego, La Jolla, California, United States of America
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, California, United States of America
| | - Ian M. Colrain
- Center for Health Sciences, SRI International, Menlo Park, California, United States of America
| | - Kevin Patrick
- Exercise and Physical Activity Resource Center, University of California, San Diego, La Jolla, California, United States of America
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, California, United States of America
| | - Susan F. Tapert
- Department of Psychiatry, University of California, San Diego, La Jolla, California, United States of America
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17
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Allman-Farinelli M, Chen J, Chevance G, Partridge SR, Gemming L, Patrick K, Godino JG. The efficacy of electronic health interventions targeting improved sleep for achieving prevention of weight gain in adolescents and young to middle-aged adults: A systematic review. Obes Rev 2020; 21:e13006. [PMID: 32037672 DOI: 10.1111/obr.13006] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/21/2019] [Accepted: 01/15/2020] [Indexed: 12/24/2022]
Abstract
Sleep is emerging as a modifiable risk factor in counteracting harmful weight gain. Electronic and mobile devices offer a channel for wide-reaching intervention delivery. This systematic review aimed to determine the efficacy of interventions that included sleep behaviour as part of health promotion for preventing weight gain. Seven databases were searched from 1 January 2000 until 28 June 2019. Eligible studies were controlled trials of weight gain prevention programs that addressed sleep in healthy participants aged 13 to 44 years of age. The primary outcome was change in measured or self-reported weight. From 824 publications located, only six eligible trials with a total of 3,277 participants were identified and all addressed multiple behaviours. One study demonstrated a decrease in weight for the intervention group, and two other studies showed a decreased prevalence of overweight and obesity. Only one trial showed improved sleep duration but failed to show differences in weight. No definitive conclusions concerning the efficacy of electronic weight gain prevention interventions that include sleep can be made, but future trials should provide more detail about intervention techniques used, employ objective sleep and physical activity measures and undertake mediation analysis to judge the contributions of changes in sleep to study outcomes. PROSPERO REGISTRATION: CRD42019121879.
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Affiliation(s)
| | - Juliana Chen
- Charles Perkins Centre, The University of Sydney, Camperdown, Australia
| | - Guillaume Chevance
- Center for Wireless and Population Health Systems, The University of California San Diego, San Diego, California, USA
| | | | - Luke Gemming
- Charles Perkins Centre, The University of Sydney, Camperdown, Australia
| | - Kevin Patrick
- Center for Wireless and Population Health Systems, The University of California San Diego, San Diego, California, USA
| | - Job G Godino
- Center for Wireless and Population Health Systems, The University of California San Diego, San Diego, California, USA
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18
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Abstract
Purpose Cardiorespiratory fitness (CRF), broadly defined as the body’s ability to utilize oxygen, is a well-established prognostic marker of health, but it is not routinely measured. This may be due to the difficulty of acquiring high-quality CRF measures. The purpose of this study was to independently determine the validity of the Fitbit Charge 2’s measure of CRF (Fitbit CRF). Methods Sixty-five healthy adults between the ages of 18 and 45 yr (55% female, 45% male) were recruited to undergo gold standard V˙O2max testing and wear a Fitbit Charge 2 continuously for 1 wk during which they were instructed to complete a qualifying outdoor run to derive the Fitbit CRF (units: mL·kg−1·min−1). This measure was compared with V˙O2max measures (units: mL·kg−1·min−1) epoched at 15 and 60 s. Results Bland–Altman analyses revealed that Fitbit CRF had a positive bias of 1.59 mL·kg−1·min−1 compared with laboratory data epoched at 15 s and 0.30 mL·kg−1·min−1 compared with data epoched at 60 s (n = 60). F statistics (2.09; 0.08) and P values (0.133; 0.926) from Bradley–Blackwood tests for the concordance of Fitbit CRF with 15- and 60-s laboratory data, respectively, support the null hypothesis of equal means and variances, indicating there is concordance between the two measures. Mean absolute percentage error was less than 10% for each comparison. Conclusions The Fitbit Charge 2 provides an acceptable level of validity when measuring CRF in young, healthy, and fit adults who are able to run. Further research is required to determine if it is a potentially useful tool in clinical practice and epidemiological research to quantify, categorize, and longitudinally track risk for adverse outcomes.
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Affiliation(s)
- Katharine Klepin
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA
| | - David Wing
- Exercise and Physical Activity Resource Center, University of California, San Diego, San Diego, CA
| | - Michael Higgins
- Exercise and Physical Activity Resource Center, University of California, San Diego, San Diego, CA
| | - Jeanne Nichols
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA.,Exercise and Physical Activity Resource Center, University of California, San Diego, San Diego, CA
| | - Job G Godino
- Exercise and Physical Activity Resource Center, University of California, San Diego, San Diego, CA.,Center for Wireless and Population Health Systems, University of California, San Diego, San Diego, CA
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19
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Goldsack JC, Coravos A, Bakker JP, Bent B, Dowling AV, Fitzer-Attas C, Godfrey A, Godino JG, Gujar N, Izmailova E, Manta C, Peterson B, Vandendriessche B, Wood WA, Wang KW, Dunn J. Verification, analytical validation, and clinical validation (V3): the foundation of determining fit-for-purpose for Biometric Monitoring Technologies (BioMeTs). NPJ Digit Med 2020; 3:55. [PMID: 32337371 PMCID: PMC7156507 DOI: 10.1038/s41746-020-0260-4] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 03/12/2020] [Indexed: 12/30/2022] Open
Abstract
Digital medicine is an interdisciplinary field, drawing together stakeholders with expertize in engineering, manufacturing, clinical science, data science, biostatistics, regulatory science, ethics, patient advocacy, and healthcare policy, to name a few. Although this diversity is undoubtedly valuable, it can lead to confusion regarding terminology and best practices. There are many instances, as we detail in this paper, where a single term is used by different groups to mean different things, as well as cases where multiple terms are used to describe essentially the same concept. Our intent is to clarify core terminology and best practices for the evaluation of Biometric Monitoring Technologies (BioMeTs), without unnecessarily introducing new terms. We focus on the evaluation of BioMeTs as fit-for-purpose for use in clinical trials. However, our intent is for this framework to be instructional to all users of digital measurement tools, regardless of setting or intended use. We propose and describe a three-component framework intended to provide a foundational evaluation framework for BioMeTs. This framework includes (1) verification, (2) analytical validation, and (3) clinical validation. We aim for this common vocabulary to enable more effective communication and collaboration, generate a common and meaningful evidence base for BioMeTs, and improve the accessibility of the digital medicine field.
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Affiliation(s)
| | - Andrea Coravos
- Digital Medicine Society (DiMe), Boston, MA USA
- Elektra Labs, Boston, MA USA
- Harvard-MIT Center for Regulatory Science, Boston, MA USA
| | - Jessie P. Bakker
- Digital Medicine Society (DiMe), Boston, MA USA
- Philips, Monroeville, PA USA
| | - Brinnae Bent
- Biomedical Engineering Department, Duke University, Durham, NC USA
| | | | | | - Alan Godfrey
- Computer and Information Sciences Department, Northumbria University, Newcastle-upon-Tyne, UK
| | - Job G. Godino
- Center for Wireless and Population Health Systems, University of California, San Diego, CA USA
| | - Ninad Gujar
- Samsung Neurologica, Danvers, MA USA
- Curis Advisors, Cambridge, MA USA
| | - Elena Izmailova
- Digital Medicine Society (DiMe), Boston, MA USA
- Koneksa Health, New York, USA
| | - Christine Manta
- Digital Medicine Society (DiMe), Boston, MA USA
- Elektra Labs, Boston, MA USA
| | | | - Benjamin Vandendriessche
- Byteflies, Antwerp, Belgium
- Department of Electrical, Computer and Systems Engineering, Case Western Reserve University, Cleveland, OH USA
| | - William A. Wood
- Department of Medicine, University of North Carolina at Chapel Hill; Lineberger Comprehensive Cancer Center, Chapel Hill, NC USA
| | - Ke Will Wang
- Biomedical Engineering Department, Duke University, Durham, NC USA
| | - Jessilyn Dunn
- Biomedical Engineering Department, Duke University, Durham, NC USA
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC USA
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20
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Grega LM, Assi SJ, Hekler EB, Weibel N, Golaszewski NM, Godino JG. SMART 2.0: A Multimodal Weight Loss Intervention for Young Adults. Ext Abstr Hum Factors Computing Syst 2019; 2019. [PMID: 33033808 DOI: 10.1145/3290607.3312940] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A significant number of young Americans are vulnerable to excess weight gain, especially during the college years. While technology-based weight loss interventions have the potential to be very engaging, short-term approaches showed limited success. In our work we aim to better understand the impact of long-term, multimodal, technology-based weight loss interventions, and study their potential for greater effect among college students. In this paper we lay the basis for our approach towards a multimodal health intervention for young adults: we present formative work based on interviews and a design workshop with 26 young adults. We discuss our intervention at the intersection of user feedback, empirical evidence from previous work, and behavior change theory.
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21
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Cameron N, Godino JG, Skipper T, Dillon L, Waalen J, Hill L, Patrick K. Associations between reliable changes in depression and changes in BMI, total body fatness and visceral adiposity during a 12-month weight loss trial. Int J Obes (Lond) 2018; 43:1859-1862. [PMID: 30538278 PMCID: PMC6559873 DOI: 10.1038/s41366-018-0272-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/15/2018] [Accepted: 10/28/2018] [Indexed: 11/09/2022]
Abstract
We investigated associations between changes in depression and body composition over a 12-month weight loss trial. Of the 298 adults (BMI > 27 m/kg2), 219 with complete depression and body composition data were included. A 10-item Center for Epidemiologic Studies Depression Scale measured depression; dual-energy x-ray absorptiometry measured body composition. Multinomial logistic regression predicted reliable changes in depression by BMI, body fat (BF) and visceral adiposity (VAT). Multiplicative interaction terms tested modification by sex and ethnicity. Participants with increases in body composition were less likely to experience improvements in depression (BMI: RRR = 0.79 (0.68 – 0.91), p < 0.01; BF: RRR = 0.97 (0.94 – 0.99), p = 0.01; VAT: RRR = 0.99 (0.98 – 1.00), p = 0.02), but not worsening of depression (BMI: RRR= 1.29 (0.96 – 1.73), p = 0.10; BF: RRR = 1.04 (0.99 – 1.09), p = 0.15; VAT: RRR = 1.01 (1.00 – 1.03), p = 0.18). Sex and ethnicity interaction terms were not significant. However, the relationship was only significant among females, among non-Latinos for BMI and BF, and among Latinos for VAT. Our study supports the association between depression and obesity and highlights the need for longitudinal studies investigating VAT and depression in diverse ethnic groups.
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Affiliation(s)
- Natalie Cameron
- University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Job G Godino
- Center for Wireless and Population Health Systems, 9500 Gilman Drive, La Jolla, CA, 92093, USA.,Department of Family Medicine and Public Health UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Tricia Skipper
- Department of Family Medicine and Public Health UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Lindsay Dillon
- Center for Wireless and Population Health Systems, 9500 Gilman Drive, La Jolla, CA, 92093, USA.,Department of Family Medicine and Public Health UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Jill Waalen
- Department of Family Medicine and Public Health UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Linda Hill
- Center for Wireless and Population Health Systems, 9500 Gilman Drive, La Jolla, CA, 92093, USA.,Department of Family Medicine and Public Health UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Kevin Patrick
- Department of Family Medicine and Public Health UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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22
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Muse ED, Godino JG, Netting JF, Alexander JF, Moran HJ, Topol EJ. From second to hundredth opinion in medicine: A global consultation platform for physicians. NPJ Digit Med 2018; 1:55. [PMID: 31304334 PMCID: PMC6550165 DOI: 10.1038/s41746-018-0064-y] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/17/2018] [Accepted: 09/19/2018] [Indexed: 11/19/2022] Open
Abstract
Serious medical diagnostic errors lead to adverse patient outcomes and increased healthcare costs. The use of virtual online consultation platforms may lead to better-informed physicians and reduce the incidence of diagnostic errors. Our aim was to assess the usage characteristics of an online, physician-to-physician, no-cost, medical consultation platform, Medscape Consult, from November 2015 through October 2017. Physicians creating original content were noted as “presenters” and those following up as “responders”. During the study period, 37,706 physician users generated a combined 117,346 presentations and responses. The physicians had an average age of 56 years and were from 171 countries on every continent. Over 90% of all presentations received responses with the median time to first response of 1.5 h. Overall, computer- and device-based medical consultation has the capacity to rapidly reach a global medical community and may play a role in the reduction of diagnostic errors.
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Affiliation(s)
- Evan D Muse
- 1Scripps Research Translational Institute, The Scripps Research Institute, La Jolla, CA USA.,2Division of Cardiovascular Disease, Scripps Clinic-Scripps Health, La Jolla, CA USA
| | - Job G Godino
- 1Scripps Research Translational Institute, The Scripps Research Institute, La Jolla, CA USA.,3University of California San Diego, La Jolla, CA USA
| | | | | | | | - Eric J Topol
- 1Scripps Research Translational Institute, The Scripps Research Institute, La Jolla, CA USA.,2Division of Cardiovascular Disease, Scripps Clinic-Scripps Health, La Jolla, CA USA
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23
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Liu J, Godino JG, Norman GJ, Hill L, Calfas K, Sallis JF, Arredondo E, Rock CL, Criqui M, Zhu SH, Griffiths K, Covin J, Dillon L, Patrick K. Planned care for obesity and cardiovascular risk reduction using a stepped-down approach: A randomized-controlled trial. Prev Med 2018; 114:223-231. [PMID: 30055199 PMCID: PMC6130909 DOI: 10.1016/j.ypmed.2018.07.015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 07/21/2018] [Accepted: 07/24/2018] [Indexed: 11/29/2022]
Abstract
UNLABELLED Primary care-based approaches to address concurrent obesity and cardiovascular disease risk factors (CVDRFs) that begin with a high intensity intervention that is subsequently decreased (i.e., stepped-down) if weight loss is achieved have not been rigorously examined. Our study is a 20-month, single-blind randomized controlled trial at five primary care clinics in San Diego, CA, in 2013, where 262 obese adults (aged 25-70 years; 32.1% male; 59.2% white) with at least one CVDRF were enrolled into planned care for obesity and risk reduction (PCORR) using a stepped-down approach or enhanced usual care (EUC). All patients received physician recommendations for weight loss and CVDRFs. EUC patients (n = 132) received an individual session with a health educator every 4 months. PCORR patients (n = 130) received individual and group sessions (in-person, mail, telephone, and email) in three steps, characterized by less contact if success was achieved. At 20 months, 40.7%, 23.8%, and 15.4% of PCORR patients were in steps 1, 2, and 3, respectively (25.2% were lost to follow-up). PCORR resulted in a between-group difference in reduction in body weight of 6.1% [95% CI, 5.3 to 6.9] compared to EUC 2.8% [95% CI, 2.0 to 3.6] p = 0.007, with a greater reduction in BMI (35.2 [95% CI, 34.4 to 35.9] to 33.7 [95% CI, 32.9 to 34.5] kg/m2) than EUC (36.0 [95% CI, 35.3 to 36.8] to 35.1 [95% CI, 34.3 to 35.9] kg/m2), as indicated by a significant treatment by time interaction (p = 0.009). PCORR resulted in greater weight loss over 20 months than EUC. TRIAL REGISTRATION ClinicalTrials.gov, NCT01134029.
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Affiliation(s)
- Jie Liu
- School of Medicine, University of California, San Diego, La Jolla, CA, United States of America
| | - Job G Godino
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States of America; Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, United States of America
| | - Gregory J Norman
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States of America; Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, United States of America
| | - Linda Hill
- School of Medicine, University of California, San Diego, La Jolla, CA, United States of America; Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States of America
| | - Karen Calfas
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States of America
| | - James F Sallis
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States of America
| | - Elva Arredondo
- Graduate School of Public Health, San Diego State University, San Diego, CA, United States of America
| | - Cheryl L Rock
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States of America
| | - Michael Criqui
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States of America
| | - Shu-Hong Zhu
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States of America
| | - Kenneth Griffiths
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States of America
| | - Jennifer Covin
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States of America
| | - Lindsay Dillon
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, United States of America
| | - Kevin Patrick
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States of America; Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, United States of America.
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24
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Cameron NA, Shen J, Rusk K, Parker R, Godino JG, Nichols JF. Longitudinal Decline in Cardiorespiratory Fitness With Age Among Male Firefighters in San Diego, California, 2005-2015. Am J Public Health 2018; 108:1388-1393. [PMID: 30138059 DOI: 10.2105/ajph.2018.304591] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine age-associated changes in cardiorespiratory fitness (CRF) among firefighters. METHODS Male firefighters (n = 1169) underwent annual evaluations from 2005 to 2015 in San Diego, California. We assessed CRF, the ability to deliver and use oxygen, during a maximal graded exercise test and recorded it in metabolic equivalents (METs; 1 MET = 3.5 ml/kg/min). We investigated differences in baseline CRF among 10-year age groups and patterns of change over follow-up using cross-sectional and longitudinal analyses, respectively. RESULTS Both analyses support an inverse relationship between CRF and age. Mean baseline CRF decreased from 15.7 ±1.7 to 11.7 ±1.9 METs in the younger than 30 years and 50 years and older age groups, respectively. There was no interaction between body fat and age in predicting CRF (Page × body fat = .09). Longitudinally, there was a nonlinear decrease in CRF, which differed across age groups: the youngest age group demonstrated the greatest decrease in CRF. CONCLUSIONS Results support a negative, nonlinear association between age and CRF without modification by body fatness. Public Health Implications. Fire departments should recognize the health and safety risks of declining CRF and institutionalize programs to promote firefighter fitness.
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Affiliation(s)
- Natalie Avella Cameron
- At the time of the study, Natalie Avella Cameron was with the University of California San Diego School of Medicine, La Jolla. Jian Shen and Jeanne F. Nichols are with the Department of Family Medicine and Public Health, University of California San Diego. Kathleen Rusk and Richard Parker are with the San Diego Firefighters' Regional Fire Wellness Program, San Diego Sports Medicine and Family Health Center, San Diego. Job G. Godino is with the Exercise and Physical Activity Resource Center, Center for Wireless and Population Health Systems, University of California San Diego
| | - Jian Shen
- At the time of the study, Natalie Avella Cameron was with the University of California San Diego School of Medicine, La Jolla. Jian Shen and Jeanne F. Nichols are with the Department of Family Medicine and Public Health, University of California San Diego. Kathleen Rusk and Richard Parker are with the San Diego Firefighters' Regional Fire Wellness Program, San Diego Sports Medicine and Family Health Center, San Diego. Job G. Godino is with the Exercise and Physical Activity Resource Center, Center for Wireless and Population Health Systems, University of California San Diego
| | - Kathleen Rusk
- At the time of the study, Natalie Avella Cameron was with the University of California San Diego School of Medicine, La Jolla. Jian Shen and Jeanne F. Nichols are with the Department of Family Medicine and Public Health, University of California San Diego. Kathleen Rusk and Richard Parker are with the San Diego Firefighters' Regional Fire Wellness Program, San Diego Sports Medicine and Family Health Center, San Diego. Job G. Godino is with the Exercise and Physical Activity Resource Center, Center for Wireless and Population Health Systems, University of California San Diego
| | - Richard Parker
- At the time of the study, Natalie Avella Cameron was with the University of California San Diego School of Medicine, La Jolla. Jian Shen and Jeanne F. Nichols are with the Department of Family Medicine and Public Health, University of California San Diego. Kathleen Rusk and Richard Parker are with the San Diego Firefighters' Regional Fire Wellness Program, San Diego Sports Medicine and Family Health Center, San Diego. Job G. Godino is with the Exercise and Physical Activity Resource Center, Center for Wireless and Population Health Systems, University of California San Diego
| | - Job G Godino
- At the time of the study, Natalie Avella Cameron was with the University of California San Diego School of Medicine, La Jolla. Jian Shen and Jeanne F. Nichols are with the Department of Family Medicine and Public Health, University of California San Diego. Kathleen Rusk and Richard Parker are with the San Diego Firefighters' Regional Fire Wellness Program, San Diego Sports Medicine and Family Health Center, San Diego. Job G. Godino is with the Exercise and Physical Activity Resource Center, Center for Wireless and Population Health Systems, University of California San Diego
| | - Jeanne F Nichols
- At the time of the study, Natalie Avella Cameron was with the University of California San Diego School of Medicine, La Jolla. Jian Shen and Jeanne F. Nichols are with the Department of Family Medicine and Public Health, University of California San Diego. Kathleen Rusk and Richard Parker are with the San Diego Firefighters' Regional Fire Wellness Program, San Diego Sports Medicine and Family Health Center, San Diego. Job G. Godino is with the Exercise and Physical Activity Resource Center, Center for Wireless and Population Health Systems, University of California San Diego
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Silarova B, Douglas FE, Usher-Smith JA, Godino JG, Griffin SJ. Risk accuracy of type 2 diabetes in middle aged adults: Associations with sociodemographic, clinical, psychological and behavioural factors. Patient Educ Couns 2018; 101:43-51. [PMID: 28757303 PMCID: PMC6086332 DOI: 10.1016/j.pec.2017.07.023] [Citation(s) in RCA: 7] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To identify the proportion of individuals with an accurate perception of their risk of type 2 diabetes (T2D) prior to, immediately after and eight weeks after receiving a personalised risk estimate. Additionally, we aimed to explore what factors are associated with underestimation and overestimation immediately post-intervention. METHODS Cohort study based on the data collected in the Diabetes Risk Communication Trial. We included 379 participants (mean age 48.9 (SD 7.4) years; 55.1% women) who received a genotypic or phenotypic risk estimate for T2D. RESULTS While only 1.3% of participants perceived their risk accurately at baseline, this increased to 24.7% immediately after receiving a risk estimate and then dropped to 7.3% at eight weeks. Those who overestimated their risk at baseline continued to overestimate it, whereas those who underestimated their risk at baseline improved their risk accuracy. We did not identify any other characteristics associated with underestimation or overestimation immediately after receiving a risk estimate. CONCLUSION Understanding a received risk estimate is challenging for most participants with many continuing to have inaccurate risk perception after receiving the estimate. PRACTICE IMPLICATIONS Individuals who overestimate or underestimate their T2D risk before receiving risk information might require different approaches for altering their risk perception.
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Affiliation(s)
- Barbora Silarova
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge, CB2 0QQ, UK.
| | - Fiona E Douglas
- School of Clinical Medicine, University of Cambridge, Box 111 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK.
| | - Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Wort's Causeway, Cambridge, CB1 8RN, UK.
| | - Job G Godino
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge, CB2 0QQ, UK; Center for Wireless and Population Health Systems, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0811, USA.
| | - Simon J Griffin
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge, CB2 0QQ, UK; The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Wort's Causeway, Cambridge, CB1 8RN, UK.
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Abstract
BACKGROUND Improved understanding of sedentary time's impact on cardiometabolic health can help prioritize intervention targets. OBJECTIVE We investigated cross-sectional and longitudinal relations of reported screen time and objectively measured total percent of time spent sedentary with cardiometabolic health in obese youth. METHODS Participants were 106 obese adolescents age 11-13 (N = 106, 51% girls, and 82% Hispanic) recruited from primary care clinics in southern California. Main predictor measures were child-reported screen time and objectively assessed sedentary time. Outcome measures were body mass index (BMI), waist and hip circumference, body fat, blood pressure, glucose, triglycerides, insulin, cholesterol, aspartate aminotransferase (AST), and serum alanine aminotransferase (ALT). RESULTS Total percent sedentary time was not associated with the cardiometabolic health markers after adjusting for moderate-to-vigorous physical activity (MVPA). However, screen time was positively associated with BMI and diastolic blood pressure at baseline, and positive longitudinal associations were found with BMI, triglycerides, low-density lipoprotein, AST, and ALT. CONCLUSIONS Reported screen time, but not total sedentary time, was related to multiple cardiometabolic health markers in obese adolescents, independent of MVPA. The findings suggest that limiting and replacing screen time, which was more than 3 hours per day on average in this sample, is likely an important behavior change strategy for interventions treating childhood obesity and comorbidities. The associations with screen time were strongest with AST and ALT, suggesting that this form of sedentary behavior may impact liver health.
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Affiliation(s)
- Gregory J. Norman
- University of California San Diego, School of Medicine, La Jolla, CA
- West Health Institute, La Jolla, CA
| | - Jordan A. Carlson
- University of California San Diego, School of Medicine, La Jolla, CA
- Children's Mercy Hospital, Kansas City, MO
| | - Kevin Patrick
- University of California San Diego, School of Medicine, La Jolla, CA
| | | | - Job G. Godino
- University of California San Diego, School of Medicine, La Jolla, CA
| | - Jeannie Huang
- University of California San Diego, School of Medicine, La Jolla, CA
| | - John Thyfault
- University of Kansas Medical Center, Kansas City, MO
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Godino JG, Appel LJ, Gross AL, Schrack JA, Parrinello CM, Kalyani RR, Windham BG, Pankow JS, Kritchevsky SB, Bandeen-Roche K, Selvin E. Diabetes, hyperglycemia, and the burden of functional disability among older adults in a community-based study. J Diabetes 2017; 9:76-84. [PMID: 26847713 PMCID: PMC4975681 DOI: 10.1111/1753-0407.12386] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 12/08/2015] [Accepted: 01/27/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND There is a need for continued surveillance of diabetes-related functional disability. In the present study, we examined associations between diabetes, hyperglycemia, and the burden of functional disability in a community-based population. METHODS A cross-sectional analysis was conducted of 5035 participants who attended Visit 5 (2011-13) of the Atherosclerosis Risk in Communities study. Functional disability was dichotomously defined by any self-reported difficulty performing 12 tasks essential to independent living grouped into four functional domains. Associations of diagnosed diabetes (via self-report) and undiagnosed diabetes and prediabetes (via HbA1c) with functional disability were evaluated using Poisson regression. RESULTS Participants had a mean age of 75 years, 42 % were male, 22 % were Black, and 31 % had diagnosed diabetes. Those with diagnosed diabetes had a significantly greater burden of functional disability than those without diabetes, even after adjustment for demographics, health behaviors, and comorbidities: prevalence ratios (95 % confidence intervals) were 1.24 (1.15, 1.34) for lower extremity mobility, 1.14 (1.07, 1.21) for general physical activities, 1.33 (1.16, 1.52) for instrumental activities of daily living (ADL), and 1.46 (1.24, 1.73) for ADL (all P < 0.05). The associations of undiagnosed diabetes and prediabetes with disability were not statistically significant (all P > 0.05). CONCLUSIONS Among older adults, the burden of functional disability associated with diabetes was not entirely explained by known risk factors, including comorbidities. Hyperglycemia below the threshold for the diagnosis of diabetes was not associated with disability. Research into effective strategies for the prevention of functional disability among older adults with diabetes is needed.
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Affiliation(s)
- Job G Godino
- Departments of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- The Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alden L Gross
- Departments of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- The Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer A Schrack
- Departments of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- The Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Christina M Parrinello
- Departments of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rita R Kalyani
- The Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Beverly Gwen Windham
- Division of Geriatric Medicine, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - James S Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Karen Bandeen-Roche
- The Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth Selvin
- Departments of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
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Ballew SH, Chen Y, Daya NR, Godino JG, Windham BG, McAdams-DeMarco M, Coresh J, Selvin E, Grams ME. Frailty, Kidney Function, and Polypharmacy: The Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis 2016; 69:228-236. [PMID: 27884475 DOI: 10.1053/j.ajkd.2016.08.034] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/10/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Frail individuals are at increased risk for poor outcomes, including adverse drug events. Kidney function is often compromised in frailty and is a key consideration in medication choice and dosing; however, creatinine-based measures of kidney function may be biased in frail individuals. STUDY DESIGN Observational study. SETTING & PARTICIPANTS 4,987 community-dwelling older men and women with complete data who participated in visit 5 of the Atherosclerosis Risk in Communities (ARIC) Study (2011-2013). PREDICTORS Kidney measures included glomerular filtration rate (GFR) estimated using serum creatinine (eGFRcr) and serum cystatin C level (eGFRcys) and urine albumin-creatinine ratio. OUTCOME Frailty, defined using established criteria of 3 or more frailty characteristics (weight loss, slowness, exhaustion, weakness, and low physical activity). RESULTS 341 (7%) participants were classified as frail, 1,475 (30%) had eGFRcr<60mL/min/1.73m2, 2,480 (50%) had eGFRcys<60mL/min/1.73m2, and 1,006 (20%) had albuminuria with albumin excretion ≥ 30mg/g. Among frail participants, prevalences of eGFRcr and eGFRcys<60mL/min/1.73m2 were 45% and 77%, respectively. Adjusted for covariates, frailty showed a moderate association with eGFRcr and a strong association with eGFRcys and albumin-creatinine ratio. Frail individuals with eGFRcr of 60 to <75mL/min/1.73m2 were frequently reclassified to lower eGFR categories using eGFRcys (49% to 45-<60, 32% to 30-<45, and 3% to <30mL/min/1.73m2). Hyperpolypharmacy (taking ≥10 classes of medications) was more common in frail individuals (54% vs 38% of nonfrail), including classes requiring kidney clearance (eg, digoxin) and associated with falls and subsequent complications (eg, hypnotic/sedatives and anticoagulants). LIMITATIONS Cross-sectional study design. CONCLUSIONS Frail individuals had a high prevalence of reduced kidney function, with large discrepancies when reduced kidney function was classified by eGFRcys versus eGFRcr. Given the substantial medication burden and uncertainty in chronic kidney disease classification, confirmation of kidney function with alternative biomarkers may be warranted to ensure careful prescribing practices in this vulnerable population.
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Affiliation(s)
- Shoshana H Ballew
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Yan Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Natalie R Daya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Job G Godino
- Center for Wireless and Population Health Systems, Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA
| | - B Gwen Windham
- Division of Geriatrics, Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Mara McAdams-DeMarco
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD
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Godino JG, van Sluijs EMF, Marteau TM, Sutton S, Sharp SJ, Griffin SJ. Lifestyle Advice Combined with Personalized Estimates of Genetic or Phenotypic Risk of Type 2 Diabetes, and Objectively Measured Physical Activity: A Randomized Controlled Trial. PLoS Med 2016; 13:e1002185. [PMID: 27898672 PMCID: PMC5127499 DOI: 10.1371/journal.pmed.1002185] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/21/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Information about genetic and phenotypic risk of type 2 diabetes is now widely available and is being incorporated into disease prevention programs. Whether such information motivates behavior change or has adverse effects is uncertain. We examined the effect of communicating an estimate of genetic or phenotypic risk of type 2 diabetes in a parallel group, open, randomized controlled trial. METHODS AND FINDINGS We recruited 569 healthy middle-aged adults from the Fenland Study, an ongoing population-based, observational study in the east of England (Cambridgeshire, UK). We used a computer-generated random list to assign participants in blocks of six to receive either standard lifestyle advice alone (control group, n = 190) or in combination with a genetic (n = 189) or a phenotypic (n = 190) risk estimate for type 2 diabetes (intervention groups). After 8 wk, we measured the primary outcome, objectively measured physical activity (kJ/kg/day), and also measured several secondary outcomes (including self-reported diet, self-reported weight, worry, anxiety, and perceived risk). The study was powered to detect a between-group difference of 4.1 kJ/kg/d at follow-up. 557 (98%) participants completed the trial. There were no significant intervention effects on physical activity (difference in adjusted mean change from baseline: genetic risk group versus control group 0.85 kJ/kg/d (95% CI -2.07 to 3.77, p = 0.57); phenotypic risk group versus control group 1.32 (95% CI -1.61 to 4.25, p = 0.38); and genetic risk group versus phenotypic risk group -0.47 (95% CI -3.40 to 2.46, p = 0.75). No significant differences in self-reported diet, self-reported weight, worry, and anxiety were observed between trial groups. Estimates of perceived risk were significantly more accurate among those who received risk information than among those who did not. Key limitations include the recruitment of a sample that may not be representative of the UK population, use of self-reported secondary outcome measures, and a short follow-up period. CONCLUSIONS In this study, we did not observe short-term changes in behavior associated with the communication of an estimate of genetic or phenotypic risk of type 2 diabetes. We also did not observe changes in worry or anxiety in the study population. Additional research is needed to investigate the conditions under which risk information might enhance preventive strategies. (Current Controlled Trials ISRCTN09650496; Date applied: April 4, 2011; Date assigned: June 10, 2011). TRIAL REGISTRATION The trial is registered with Current Controlled Trials, ISRCTN09650496.
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Affiliation(s)
- Job G. Godino
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Center for Wireless and Population Health Systems, Department of Family Medicine and Public Health and Calit2’s Qualcomm Institute, University of California, San Diego, La Jolla, California, United States of America
- * E-mail:
| | - Esther M. F. van Sluijs
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, University of Cambridge School of Clinical Medicine, Institute of Public Health, Cambridge, United Kingdom
| | - Stephen Sutton
- Behavioural Science Group, University of Cambridge School of Clinical Medicine, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Stephen J. Sharp
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Simon J. Griffin
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Primary Care Unit, University of Cambridge School of Clinical Medicine, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
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Wang H, Blanco E, Algarín C, Peirano P, Burrows R, Reyes M, Wing D, Godino JG, Gahagan S. Weight Status and Physical Activity: Combined Influence on Cardiometabolic Risk Factors Among Adolescents, Santiago, Chile. Glob Pediatr Health 2016; 3:2333794X16674561. [PMID: 27803943 PMCID: PMC5077069 DOI: 10.1177/2333794x16674561] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 12/26/2022] Open
Abstract
We tested the independent and combined influence of overweight/obesity and meeting moderate to vigorous physical activity (MVPA) guidelines (≥60 minutes per day) on cardiometabolic risk factors among healthy adolescents. We measured anthropometry, blood pressure, fasting lipids, and activity by accelerometer in 223 adolescents. They were categorized as overweight/obese versus normal weight and meeting the World Health Organization guidelines for MVPA per day. Adolescents were 16.8 years, 41% overweight/obese, 30% met MVPA guidelines, 50% low high-density lipoprotein, 22% high triglycerides, 12% high blood pressure, and 6% high fasting glucose. Controlling for sex, overweight/obese adolescents who did not meet MVPA guidelines had 4.0 and 11.9 increased odds for elevated triglycerides and systolic blood pressure, respectively, compared to normal weight adolescents who met MVPA guidelines. Overweight/obese and normal weight adolescents who met MVPA guidelines did not differ in cardiometabolic risk factors. Among overweight/obese adolescents, being physically active attenuated the likelihood of high triglycerides and systolic blood pressure.
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Affiliation(s)
- Helen Wang
- University of California San Diego, La Jolla, CA, USA
| | - Estela Blanco
- University of California San Diego, La Jolla, CA, USA
| | | | | | | | | | - David Wing
- University of California San Diego, La Jolla, CA, USA
| | - Job G Godino
- University of California San Diego, La Jolla, CA, USA
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de Zambotti M, Godino JG, Baker FC, Cheung J, Patrick K, Colrain IM. The Boom in Wearable Technology: Cause for Alarm or Just What is Needed to Better Understand Sleep? Sleep 2016; 39:1761-2. [PMID: 27397564 DOI: 10.5665/sleep.6108] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/25/2016] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Job G Godino
- Center for Wireless and Population Health Systems, Qualcomm Institute of Calit2, San Diego, CA.,Department of Family Medicine and Public Health, University of California, San Diego, CA
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA
| | - Joseph Cheung
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
| | - Kevin Patrick
- Center for Wireless and Population Health Systems, Qualcomm Institute of Calit2, San Diego, CA.,Department of Family Medicine and Public Health, University of California, San Diego, CA
| | - Ian M Colrain
- Center for Health Sciences, SRI International, Menlo Park, CA
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Godino JG, Merchant G, Norman GJ, Donohue MC, Marshall SJ, Fowler JH, Calfas KJ, Huang JS, Rock CL, Griswold WG, Gupta A, Raab F, Fogg BJ, Robinson TN, Patrick K. Using social and mobile tools for weight loss in overweight and obese young adults (Project SMART): a 2 year, parallel-group, randomised, controlled trial. Lancet Diabetes Endocrinol 2016; 4:747-755. [PMID: 27426247 PMCID: PMC5005009 DOI: 10.1016/s2213-8587(16)30105-x] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/21/2016] [Accepted: 05/24/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND 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). METHODS 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. FINDINGS 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. INTERPRETATION Social and mobile technologies did not facilitate sustained reductions in weight among young adults, although these approaches might facilitate limited short-term weight loss. FUNDING The National Heart, Lung, and Blood Institute of the National Institutes of Health (U01 HL096715).
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Affiliation(s)
- Job G Godino
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA; Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Gina Merchant
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA; Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Gregory J Norman
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA; Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Michael C Donohue
- Department of Neurology, University of Southern California, Los Angeles, CA, USA
| | - Simon J Marshall
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA; Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - James H Fowler
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA; Division of Global Public Health, University of California, San Diego, La Jolla, CA, USA; Department of Political Science, University of California, San Diego, La Jolla, CA, USA
| | - Karen J Calfas
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA; Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Jeannie S Huang
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA; Division of Pediatric Gastroenterology, University of California, San Diego, La Jolla, CA, USA
| | - Cheryl L Rock
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - William G Griswold
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA
| | - Anjali Gupta
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA; Department of Development, Aging, and Regeneration, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Fredric Raab
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA
| | - B J Fogg
- Behavior Design Laboratory, Human Sciences and Technologies Advanced Research Institute, Stanford University, Stanford, CA, USA
| | - Thomas N Robinson
- Stanford Solutions Science Laboratory, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Kevin Patrick
- Center for Wireless and Population Health Systems, University of California, San Diego, La Jolla, CA, USA; Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA.
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Bietz MJ, Bloss CS, Calvert S, Godino JG, Gregory J, Claffey MP, Sheehan J, Patrick K. Opportunities and challenges in the use of personal health data for health research. J Am Med Inform Assoc 2016; 23:e42-8. [PMID: 26335984 PMCID: PMC4954630 DOI: 10.1093/jamia/ocv118] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [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: 05/01/2015] [Revised: 06/08/2015] [Accepted: 06/26/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Understand barriers to the use of personal health data (PHD) in research from the perspective of three stakeholder groups: early adopter individuals who track data about their health, researchers who may use PHD as part of their research, and companies that market self-tracking devices, apps or services, and aggregate and manage the data that are generated. MATERIALS AND METHODS A targeted convenience sample of 465 individuals and 134 researchers completed an extensive online survey. Thirty-five hour-long semi-structured qualitative interviews were conducted with a subset of 11 individuals and 9 researchers, as well as 15 company/key informants. RESULTS Challenges to the use of PHD for research were identified in six areas: data ownership; data access for research; privacy; informed consent and ethics; research methods and data quality; and the unpredictable nature of the rapidly evolving ecosystem of devices, apps, and other services that leave "digital footprints." Individuals reported willingness to anonymously share PHD if it would be used to advance research for the good of the public. Researchers were enthusiastic about using PHD for research, but noted barriers related to intellectual property, licensing, and the need for legal agreements with companies. Companies were interested in research but stressed that their first priority was maintaining customer relationships. CONCLUSION Although challenges exist in leveraging PHD for research, there are many opportunities for stakeholder engagement, and experimentation with these data is already taking place. These early examples foreshadow a much larger set of activities with the potential to positively transform how health research is conducted.
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Affiliation(s)
- Matthew J Bietz
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, California, USA Center for Wireless and Population Health Systems, Calit2, University of California, San Diego, California, USA
| | - Cinnamon S Bloss
- Center for Wireless and Population Health Systems, Calit2, University of California, San Diego, California, USA Department of Psychiatry, School of Medicine, University of California, San Diego, California, USA Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, California, USA
| | - Scout Calvert
- Louise M. Darling Biomedical Library, University of California, Los Angeles, California, USA
| | - Job G Godino
- Center for Wireless and Population Health Systems, Calit2, University of California, San Diego, California, USA Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, California, USA
| | - Judith Gregory
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, California, USA
| | - Michael P Claffey
- Department of Psychology, University of California, San Diego, California, USA
| | - Jerry Sheehan
- Information Technology Center, Montana State University, Bozeman, Montana, USA
| | - Kevin Patrick
- Center for Wireless and Population Health Systems, Calit2, University of California, San Diego, California, USA Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, California, USA
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Cobb LK, Godino JG, Selvin E, Kucharska-Newton A, Coresh J, Koton S. Spousal Influence on Physical Activity in Middle-Aged and Older Adults: The ARIC Study. Am J Epidemiol 2016; 183:444-51. [PMID: 26337074 DOI: 10.1093/aje/kwv104] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 04/14/2015] [Indexed: 12/14/2022] Open
Abstract
Low physical activity levels are a public health concern. Few studies have assessed the concordance of physical activity change among spouses. We studied this concordance during a 6-year period (baseline: 1987-1989; follow-up: 1993-1995) in 3,261 spousal pairs from the US-based Atherosclerosis Risk in Communities (ARIC) Study. Linear regression was used to examine the association between change in individuals' sport/exercise and leisure physical activity indices (ranging from 1 (low) to 5 (high)) and change in his or her spouse's indices. The association between individual and spousal changes in meeting physical activity recommendations was assessed with logistic regression. Individual changes in the sport/exercise and leisure indices were positively associated with spousal changes. For every standard deviation increase in their wives' sport/exercise index, men's exercise index increased by 0.09 (95% confidence interval: 0.05, 0.12) standard deviation; for every standard deviation increase in their wives' leisure index, men's leisure index increased by 0.08 standard deviation. Results were similar for women. Individuals had higher odds of meeting physical activity recommendations if their spouse met recommendations at both visits or just follow-up. In conclusion, changes in an individual's physical activity are positively associated with changes in his or her spouse's physical activity. Physical activity promotion efforts should consider targeting couples.
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Parrinello CM, Rastegar I, Godino JG, Miedema MD, Matsushita K, Selvin E. Prevalence of and Racial Disparities in Risk Factor Control in Older Adults With Diabetes: The Atherosclerosis Risk in Communities Study. Diabetes Care 2015; 38:1290-8. [PMID: 25852205 PMCID: PMC4477331 DOI: 10.2337/dc15-0016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/13/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Controversy surrounds appropriate risk factor targets in older adults with diabetes. We evaluated the proportion of older adults with diabetes meeting different targets, focusing on possible differences by race, and assessed whether demographic and clinical characteristics explained disparities. RESEARCH DESIGN AND METHODS We conducted a cross-sectional study of 5,018 participants aged 67-90 years (1,574 with and 3,444 without diagnosed diabetes) who attended visit 5 of the Atherosclerosis Risk in Communities (ARIC) study (2011-2013). Risk factor targets were defined using both stringent (and less stringent) goals: hemoglobin A1c (HbA1c) <7%, <53 mmol/mol (<8%, <64 mmol/mol); LDL cholesterol (LDL-c) <100 mg/dL (<130 mg/dL); and blood pressure (BP) <140/90 mmHg (<150/90 mmHg). We used Poisson regression to obtain prevalence ratios (PRs). RESULTS Most older adults with diabetes met stringent (and less stringent) targets: 72% (90%) for HbA1c, 63% (86%) for LDL-c, and 73% (87%) for BP; but only 35% (68%) met all three. A higher proportion of whites than blacks met targets, however defined. Among people treated for risk factors, racial disparities in prevalence of meeting stringent targets persisted even after adjustment: PRs (whites vs. blacks) were 1.03 (95% CI 0.91, 1.17) for HbA1c, 1.21 (1.09, 1.35) for LDL-c, 1.10 (1.00, 1.21) for BP, and 1.28 (0.99, 1.66) for all three. Results were similar but slightly attenuated using less stringent goals. Black women were less likely than white women to meet targets for BP and all three risk factors; this disparity was not observed in men. CONCLUSIONS Black-white disparities in risk factor control in older adults with diabetes were not fully explained by demographic or clinical characteristics and were greater in women than men. Further study of determinants of these disparities is important.
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Affiliation(s)
- Christina M Parrinello
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ina Rastegar
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Baltimore Polytechnic Institute, Baltimore, MD
| | - Job G Godino
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Department of Epidemiology and the Center on Aging and Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN
| | - Kunihiro Matsushita
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
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Godino JG, van Sluijs EMF, Sutton S, Griffin SJ. Understanding perceived risk of type 2 diabetes in healthy middle-aged adults: a cross-sectional study of associations with modelled risk, clinical risk factors, and psychological factors. Diabetes Res Clin Pract 2014; 106:412-9. [PMID: 25467619 PMCID: PMC4337811 DOI: 10.1016/j.diabres.2014.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 02/05/2014] [Revised: 09/23/2014] [Accepted: 10/17/2014] [Indexed: 02/04/2023]
Abstract
AIMS To determine the perceived risk of type 2 diabetes in a sample of healthy middle-aged adults and examine the association between perceived risk and modelled risk, clinical risk factors, and psychological factors theorised to be antecedents of behaviour change. METHODS An exploratory, cross-sectional analysis of perceived risk of type 2 diabetes (framed according to time and in comparison with peers) was conducted using baseline data collected from 569 participants of the Diabetes Risk Communication Trial (Cambridgeshire, UK). Type 2 diabetes risk factors were measured during a health assessment and the Framingham Offspring Diabetes Risk Score was used to model risk. Questionnaires assessed psychological factors including anxiety, diabetes-related worry, behavioural intentions, and other theory-based antecedents of behaviour change. Multivariable regression analyses were used to examine associations between perceived risk and potential correlates. RESULTS Participants with a high perceived risk were at higher risk according to the Framingham Offspring Diabetes Risk Score (p<0.001). Higher perceived risk was observed in those with a higher body fat percentage, lower self-rated health, higher diabetes-related worry, and lower self-efficacy for adhering to governmental recommendations for physical activity (all p<0.001). The framing of perceived risk according to time and in comparison with peers did not influence these results. CONCLUSIONS High perceived risk of type 2 diabetes is associated with higher risk of developing the disease, and a decreased likelihood of engagement in risk-reducing health behaviours. Risk communication interventions should target high-risk individuals with messages about the effectiveness of prevention strategies.
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Affiliation(s)
- Job G Godino
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Box 285, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom
| | - Esther M F van Sluijs
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Box 285, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom
| | - Stephen Sutton
- Behavioural Science Group, Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0SR, United Kingdom
| | - Simon J Griffin
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Box 285, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom.
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Wijndaele K, DE Bourdeaudhuij I, Godino JG, Lynch BM, Griffin SJ, Westgate K, Brage S. Reliability and validity of a domain-specific last 7-d sedentary time questionnaire. Med Sci Sports Exerc 2014; 46:1248-60. [PMID: 24492633 PMCID: PMC4047320 DOI: 10.1249/mss.0000000000000214] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [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: 12/19/2022]
Abstract
PURPOSE The objective of this study is to examine test-retest reliability, criterion validity, and absolute agreement of a self-report, last 7-d sedentary behavior questionnaire (SIT-Q-7d), which assesses total daily sedentary time as an aggregate of sitting/lying down in five domains (meals, transportation, occupation, nonoccupational screen time, and other sedentary time). Dutch (DQ) and English (EQ) versions of the questionnaire were examined. METHODS Fifty-one Flemish adults (ages 39.4 ± 11.1 yr) wore a thigh accelerometer (activPAL3™) and simultaneously kept a domain log for 7 d. The DQ was subsequently completed twice (median test-retest interval: 3.3 wk). Thigh-acceleration sedentary time was log annotated to create comparable domain-specific and total sedentary time variables. Four hundred two English adults (ages 49.6 ± 7.3 yr) wore a combined accelerometer and HR monitor (Actiheart) for 6 d to objectively measure total sedentary time. The EQ was subsequently completed twice (median test-retest interval: 3.4 wk). In both samples, the questionnaire reference frame overlapped with the criterion measure administration period. All participants had five or more valid days of criterion data, including one or more weekend day. RESULTS Test-retest reliability (intraclass correlation coefficient (95% CI)) was fair to good for total sedentary time (DQ: 0.68 (0.50-0.81); EQ: 0.53 (0.44-0.62)) and poor to excellent for domain-specific sedentary time (DQ: from 0.36 (0.10-0.57) (meals) to 0.66 (0.46-0.79) (occupation); EQ: from 0.45 (0.35-0.54) (other sedentary time) to 0.76 (0.71-0.81) (meals)). For criterion validity (Spearman rho), significant correlations were found for total sedentary time (DQ: 0.52; EQ: 0.22; all P <0.001). Compared with domain-specific criterion variables (DQ), modest-to-strong correlations were found for domain-specific sedentary time (from 0.21 (meals) to 0.76 (P < 0.001) (screen time)). The questionnaire generally overestimated sedentary time compared with criterion measures. CONCLUSION The SIT-Q-7d appears to be a useful tool for ranking individuals in large-scale observational studies examining total and domain-specific sitting.
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Affiliation(s)
- Katrien Wijndaele
- 1MRC Epidemiology Unit, University of Cambridge, Cambridge, England, UNITED KINGDOM; 2Department of Movement and Sport Sciences, Ghent University, Ghent, BELGIUM; 3Physical Activity Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, AUSTRALIA; 4Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, AUSTRALIA
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Godino JG, Watkinson C, Corder K, Sutton S, Griffin SJ, van Sluijs EMF. Awareness of physical activity in healthy middle-aged adults: a cross-sectional study of associations with sociodemographic, biological, behavioural, and psychological factors. BMC Public Health 2014; 14:421. [PMID: 24886612 PMCID: PMC4012086 DOI: 10.1186/1471-2458-14-421] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [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] [Received: 02/05/2014] [Accepted: 04/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interventions to promote physical activity have had limited success. One reason may be that inactive adults are unaware that their level of physical activity is inadequate and do not perceive a need to change their behaviour. We aimed to assess awareness of physical activity, defined as the agreement between self-rated and objective physical activity, and to investigate associations with sociodemographic, biological, behavioural, and psychological factors. METHODS We conducted an exploratory, cross-sectional analysis of awareness of physical activity using baseline data collected from 453 participants of the Feedback, Awareness and Behaviour study (Cambridgeshire, UK). Self-rated physical activity was measured dichotomously by asking participants if they believed they were achieving the recommended level of physical activity. Responses were compared to objective physical activity, measured using a combined accelerometer and heart rate monitor (Actiheart®). Four awareness groups were created: overestimators, realistic inactives, underestimators, and realistic actives. Logistic regression was used to assess associations between awareness group and potential correlates. RESULTS The mean (standard deviation) age of participants was 47.0 (6.9) years, 44.4% were male, and 65.1% were overweight (body mass index ≥ 25). Of the 258 (57.0%) who were objectively classified as inactive, 130 (50.4%) misperceived their physical activity by incorrectly stating that they were meeting the guidelines (overestimators). In a multivariable logistic regression model adjusted for age and sex, those with a lower body mass index (Odds Ratio (OR) = 0.95, 95% Confidence Interval (CI) = 0.90 to 1.00), higher physical activity energy expenditure (OR = 1.03, 95% CI = 1.00 to 1.06) and self-reported physical activity (OR = 1.13, 95% CI = 1.07 to 1.19), and lower intention to increase physical activity (OR = 0.69, 95% CI = 0.48 to 0.99) and response efficacy (OR = 0.53, 95% CI = 0.31 to 0.91) were more likely to overestimate their physical activity. CONCLUSIONS Overestimators have more favourable health characteristics than those who are realistic about their inactivity, and their psychological characteristics suggest that they are less likely to change their behaviour. Personalised feedback about physical activity may be an important first step to behaviour change.
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Affiliation(s)
- Job G Godino
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Box 285, Hills Road, Cambridge CB2 0QQ, United Kingdom
| | - Clare Watkinson
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Box 285, Hills Road, Cambridge CB2 0QQ, United Kingdom
| | - Kirsten Corder
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Box 285, Hills Road, Cambridge CB2 0QQ, United Kingdom
- UKCRC Centre for Diet and Activity Research (CEDAR), Institute of Public Health, University of Cambridge, Box 296, Forvie Site, Robinson Way, Cambridge CB2 0SR, United Kingdom
| | - Stephen Sutton
- Behavioural Science Group, Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0SR, United Kingdom
| | - Simon J Griffin
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Box 285, Hills Road, Cambridge CB2 0QQ, United Kingdom
- UKCRC Centre for Diet and Activity Research (CEDAR), Institute of Public Health, University of Cambridge, Box 296, Forvie Site, Robinson Way, Cambridge CB2 0SR, United Kingdom
| | - Esther MF van Sluijs
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Box 285, Hills Road, Cambridge CB2 0QQ, United Kingdom
- UKCRC Centre for Diet and Activity Research (CEDAR), Institute of Public Health, University of Cambridge, Box 296, Forvie Site, Robinson Way, Cambridge CB2 0SR, United Kingdom
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Godino JG, van Sluijs EMF, Marteau TM, Sutton S, Sharp SJ, Griffin SJ. Effect of communicating genetic and phenotypic risk for type 2 diabetes in combination with lifestyle advice on objectively measured physical activity: protocol of a randomised controlled trial. BMC Public Health 2012; 12:444. [PMID: 22708638 PMCID: PMC3490832 DOI: 10.1186/1471-2458-12-444] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [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: 05/29/2012] [Accepted: 06/18/2012] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is associated with increased risk of morbidity and premature mortality. Among those at high risk, incidence can be halved through healthy changes in behaviour. Information about genetic and phenotypic risk of T2D is now widely available. Whether such information motivates behaviour change is unknown. We aim to assess the effects of communicating genetic and phenotypic risk of T2D on risk-reducing health behaviours, anxiety, and other cognitive and emotional theory-based antecedents of behaviour change. METHODS In a parallel group, open randomised controlled trial, approximately 580 adults born between 1950 and 1975 will be recruited from the on-going population-based, observational Fenland Study (Cambridgeshire, UK). Eligible participants will have undergone clinical, anthropometric, and psychosocial measurements, been genotyped for 23 single-nucleotide polymorphisms associated with T2D, and worn a combined heart rate monitor and accelerometer (Actiheart(®)) continuously for six days and nights to assess physical activity. Participants are randomised to receive either standard lifestyle advice alone (control group), or in combination with a genetic or a phenotypic risk estimate for T2D (intervention groups). The primary outcome is objectively measured physical activity. Secondary outcomes include self-reported diet, self-reported weight, intention to be physically active and to engage in a healthy diet, anxiety, diabetes-related worry, self-rated health, and other cognitive and emotional outcomes. Follow-up occurs eight weeks post-intervention. Values at follow-up, adjusted for baseline, will be compared between randomised groups. DISCUSSION This study will provide much needed evidence on the effects of providing information about the genetic and phenotypic risk of T2D. Importantly, it will be among the first to examine the impact of genetic risk information using a randomised controlled trial design, a population-based sample, and an objectively measured behavioural outcome. Results of this trial, along with recent evidence syntheses of similar studies, should inform policy concerning the availability and use of genetic risk information.
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Affiliation(s)
- Job G Godino
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Hills Road, Box 285, CB2 0QQ, Cambridge, UK
| | - Esther MF van Sluijs
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Hills Road, Box 285, CB2 0QQ, Cambridge, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK
| | - Stephen Sutton
- Behavioural Science Group, Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Hills Road, Box 285, CB2 0QQ, Cambridge, UK
| | - Simon J Griffin
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Hills Road, Box 285, CB2 0QQ, Cambridge, UK
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Abstract
This study examined the relation between misperception of healthy weight and obesity, as well as moderators of this relation, in a sample of middle-aged black men. Survey data from 404 mostly immigrant, black males living in greater New York City were collected as part of a larger randomized controlled trial. Data included measures of health status, BMI, perceived healthy weight, and misperception of healthy weight. Misperception of healthy weight was more frequent among obese men (90.2%) than nonobese men (48.7%) (P < 0.001). Mean level of misperception was also significantly higher in obese men than nonobese men (P < 0.001). Health status moderated the relation between misperception of healthy weight and obesity: obese men who felt healthy or who had fewer comorbid conditions had greater misperception of healthy weight than obese men who felt unhealthy or had relatively more comorbid conditions (P < 0.01). Our findings demonstrate that misperception of healthy weight discriminates between obese and nonobese black men, and the magnitude of this relation is exacerbated in obese men who are relatively healthy. Future studies should determine the prevalence of misperception of healthy weight in more diverse populations and identify potential mediators of the relation between misperception of healthy weight and obesity.
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Affiliation(s)
- Job G. Godino
- Department of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - Stephen J. Lepore
- Department of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - Stefanie Rassnick
- Johnson & Johnson Research & Development, Spring House, Pennsylvania, USA
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