Screening for obstructive sleep apnea on the internet: randomized trial.

BACKGROUND: Obstructive sleep apnea is underdiagnosed. We conducted a pilot randomized controlled trial of an online intervention to promote obstructive sleep apnea screening among members of an Internet weight-loss community. METHODS: Members of an Internet weight-loss community who have never been diagnosed with obstructive sleep apnea or discussed the condition with their healthcare provider were randomized to intervention (online risk assessment+feedback) or control. The primary outcome was discussing obstructive sleep apnea with a healthcare provider at 12 weeks. RESULTS: Of 4700 members who were sent e-mail study announcements, 168 (97% were female, age 39.5 years [standard deviation 11.7], body mass index 30.3 [standard deviation 7.8]) were randomized to intervention (n=84) or control (n=84). Of 82 intervention subjects who completed the risk assessment, 50 (61%) were low risk and 32 (39%) were high risk for obstructive sleep apnea. Intervention subjects were more likely than control subjects to discuss obstructive sleep apnea with their healthcare provider within 12 weeks (11% [9/84] vs 2% [2/84]; P=.02; relative risk=4.50; 95% confidence interval, 1.002-20.21). The number needed to treat was 12. High-risk intervention subjects were more likely than control subjects to discuss obstructive sleep apnea with their healthcare provider (19% [6/32] vs 2% [2/84]; P=.004; relative risk=7.88; 95% confidence interval, 1.68-37.02). One high-risk intervention subject started treatment for obstructive sleep apnea. CONCLUSION: An online screening intervention is feasible and likely effective in encouraging members of an Internet weight-loss community to discuss obstructive sleep apnea with their healthcare provider

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This study evaluated the effectiveness of nondieting versus dieting treatments for overweight, bingeeating women. Participants (N = 219) were randomly assigned to 1 of 3 groups: diet treatment (DT), nondiet treatment (NDT), or wait-list control (WLC). DT received a balanced-deficit diet reinforced with behavioral strategies. NDT received therapy designed to help participants break out of their dieting cycles. Treatment in both conditions was administered in weekly groups for 6 months, followed by 26 biweekly maintenance meetings, for a total of 18 months of contact. At 6 months posttreatment, DT lost 0.6 kg while NDT gained 1.3 kg. Both treatment groups reduced their Binge Eating Scale scores significantly more than WLC. At 18-month follow-up, both treatment groups experienced weight gain but maintained similar reductions in binge eating. Results indicate that neither intervention was successful in producing short-or long-term weight loss. Therapist biases, which may have affected treatment integrity, and other methodological issues are discussed in relation to the small weight losses achieved. Estimates of binge eating among obese patients range from 20% to 50%, depending on the criteria used and the study population (Bruce & Wilfiey, 1996; It is unclear whether or not binge-eating obese patients experience greater difficulty in treatment programs as a result of these liabilities. Obese binge eaters have been found to respond to weight loss programs similarly to nonbingers, and experience similar or lower attrition rates This research was supported by National Institute of Diabetes and Digestive and Kidney Diseases Grant DK43109 and by a Minority Scientist Development Award from the American Heart Association and its Puerto Rican Affiliate. Correspondence concerning this article should be addressed to G. Ken Goodrick, Behavioral Medicine Research Center, Baylor College of Medicine, 6535 Fannin, Mailstop F-700, Houston, Texas 77030. outcomes Several nondieting therapeutic approaches have been developed for the treatment of obesity The purpose of this prospective, randomized, controlled study was to evaluate the effectiveness of this nondieting approach in the treatment of obese, binge-eating women, compared with a standardized, behavioral dieting treatment and a control group. Method Participants The mean age of participants was 40 years (SD = 6.3, range = 25 to 50 years). Participants' mean pretreatment weight was 88 kg (SD = 9.6, range = 66 to 110 kg). The mean body mass index (BMI) was 33 kg/m 2 (SD = 3.4), with a range of 26 to 43 kg/m 2. The ethnic-racial composition of the sample was 85% White, 8% Black, and 7% Hispanic. Of the total participants, 62% were married, 21% were single or divorced, and 17% were never married. Twenty-four percent of the participants had a college degree, 65% had some college, and 11% had a high school diploma or less. Sixty-nine percent were employed full time, and 9% part time. Procedure Female participants were recruited from Houston and the surrounding area using print and electronic media to publicize the study. Those 36

Behavioral intention and health behavior

Within the context of Fishbeln's theory of behavioral intention, verbal measures of expectancy and value of perceived outcomes regarding health behaviors were used to predict intention to make a preventive visit to a dentist and to attend a smoker's clinic. The results provided only weak support for the theory. This was explained in terms of the limitations of the theory. In particular, the conditions for assuming rationality and intentionality are defined. It was concluded that verbal measures will reflect rationality and intention only for routine behaviors which the subject can easily predict. Health behaviors such as dental visits and the cessation of cigarette smoking do not fall in this category, and thus intentions and behavior may be inconsistent. If rationality and intentionality cannot be assumed, then verbal measures can be treated as indicants of motivational factors related to the referents of the verbalizations. The relationships among verbal responses and between verbal and behavioral responses lead to the generation of hypotheses concerning the motivational factors antecedent to behavior.Psychology, Department o

Becoming physically fit : behavioral intention and behavioral intervention

Psychology, Department o

Body image treatment within an inpatient program for anorexia nervosa: The role of mirror exposure in the desensitization process

Objective: This pilot study examined the role of mirror confrontation in the desensitization process of a body image treatment within an inpatient program for anorexia nervosa. Method: A within-subjects design was used. It compared the impact of two modes of group body image treatment on body dissatisfaction, anxiety, and avoidance behaviors. Both treatments followed a set format of exposure exercises and homework, but the modified treatment also included mirror confrontation as an exposure exercise. Results: Standard treatment did not produce any significant changes. Modified treatment produced a significant and sustained improvement in body dissatisfaction and a significant reduction in body anxiety and avoidance behaviors. Discussion: Mirror confrontation is a more effective form of exposure because of the strong emotional response it elicits. Patients' pronounced emotional response to this exercise allowed easier identification of the affective and behavioral components of body dissatisfaction and more cogent links into a developmental body image timeline

Effect of financial incentives on improvement in medical quality indicators for primary care

PURPOSE: The efficacy of rewarding physicians financially for preventive services is unproven. The objective of this study was to evaluate the effect of a physician pay-for-performance program similar to the Medicare Physician Quality Reporting Initiative program on quality of preventive care in a network of community health centers. METHODS: A retrospective review of administrative data was done to evaluate a natural quasi-experiment in a network of publicly funded primary care clinics. Physicians in 6 of 11 clinics were given a financial incentive twice the size of the current Centers for Medicare and Medicaid Services\u27 incentive for achieving group targets in preventive care that included cervical cancer screening, mammography, and pediatric immunization. They also received productivity incentives. Six years of performance indicators were compared between incentivized and nonincentivized clinics. We also surveyed the incentivized clinicians about their perception of the incentive program. RESULTS: Although some performance indicators improved for all measures and all clinics, there were no clinically significant differences between clinics that had incentives and those that did not. A linear trend test approached conventional significance levels for Papanicolaou smears (P = .08) but was of very modest magnitude compared with observed nonlinear variations; there was no suggestion of a linear trend for mammography or pediatric immunizations. The survey revealed that most physicians felt the incentives were not very effective in improving quality of care. CONCLUSION: We found no evidence for a clinically significant effect of financial incentives on performance of preventive care in these community health centers. Based on our findings and others, we believe there is great need for more research with strong research designs to determine the effects, both positive and negative, of financial incentives on clinical quality indicators in primary care

Negative stress and the outcome of treatment for binge eating

This study investigated the ability of negatively versus positively perceived stress to predict outcome of treatment for binge eating disorder (BED). Participants were 62 obese women satisfying the DSMIV research criteria for BED. Stress was measured using an instrument based on the Recent Life Change Questionnaire (RLCQ). Participants experiencing high negative stress during the study period reported a binge eating frequency three times greater than that reported by subjects experiencing low negative stress (2.14 vs. 0.65 binge-days/week). Negative stress predicted how fast an individual would reduce binge eating and demonstrated more predictive power than positive stress