The influence of three short-term weight loss interventions on self-efficacy, decisional balance, and processes of change in obese adults

Motivational and psychosocial outcomes have not been reported in behavioral weight loss programs utilizing the SenseWear Pro armband (SWA) and motivational interviewing; making it difficult to identify motivational components that may be related to weight loss. The Transtheoretical Model (TTM) is one model used to help explain motivation and behavior change through the constructs of decisional balance (DB), diet and physical activity self-efficacy (SE), and cognitive and behavioral processes of change (C-POC, B-POC). The purpose of this study was to assess the changes in TTM constructs of DB, SE, and both C-POC and B-POC in a randomized trial evaluating three different weight loss interventions in obese adults. Seventy-eight subjects (32 males and 46 females) completed one of three 8-week weight loss interventions with guidance from a health coach and the utilization of motivational interviewing techniques. Group 1 (n = 26) received a behaviorally guided weight loss program (GWLP), Group 2 (n = 26) received a self-monitoring tool called the SenseWear Pro Armband (SWA) with Weight management system (WMS) and Group 3 (n = 26) received both programming options (GWLP + SWA). Weight change and changes in TTM constructs of SE, DB (pros vs. cons), and C-POC and B-POC were assessed at baseline and at the completion of the intervention. Changes in variables across time and condition were assessed using multivariate ANOVAs and the magnitude of effects were reported using effect sizes. All interventions produced significant weight loss, with no significant differences between groups. Significant changes in TTM constructs were observed over time and some differences were evident between groups. Large effect sizes were found for improvements in SE in groups that received the GWLP (Groups 1 and 3), while slight improvements were seen in the SWA group (Group 2). Decisional balance improved significantly (p \u3c 0.05) in the combined GWLP + SWA intervention (Group 3). Significant improvements (p \u3c 0.001) over time were evident for specific B-POC: counterconditioning, interpersonal systems control, reinforcement management, self-liberation, and stimulus control. The results of this study support previous evidence showing improvements in self-efficacy directly after an active intervention, but warrants further examination for identifying which processes of change are influenced via self-monitoring techniques and the use of motivational interviewing techniques on motivational and behavioral outcomes. Longer-term studies are needed to determine if these factors may influence maintenance of weight loss

Using Community Structure Networks to Model Heterogeneous Mixing in Epidemics, and a Potential Application to HIV in Washington, D.C.

Using models, mathematicians can better understand and analyze the factors that influence the dynamic spread of infectious disease through a population. The most fundamental epidemiological model is the SIR model, originally proposed by Kermack and McKendrick. In this model individuals in a population are categorized as Susceptible (S), Infected (I), or Removed (R), and differential equations are used to analyze the flow of people from one compartment to another. Many epidemiological models use the SIR model as a foundation, building complexities into it. Modeling HIV, for example, is complex because not all people in a population are at equal risk for infection. Many SIR-like models assume that each member of a population is equally likely to interact with any other member of the population. However, in reality, there are many factors such as race, neighborhood, profession, socio-economic status, religion, education, and more that impact how likely one person is to interact with another. One increasingly popular way to analyze the effects of heterogeneous mixing is by using networks. Inspired by data suggesting that HIV incidence in Washington, D.C. is skewed by race and neighborhood, this paper explores the effects of community structure in networks on transmission dynamics

Dual-energy X-ray absorptiometry, skinfold thickness and waist circumference for assessing body composition in ambulant and non-ambulant wheelchair games players

Field based assessments provide a cost effective and accessible alternative to dual energy X ray absorptiometry (DXA) for practitioners determining body composition in athletic populations. It remains unclear how the range of physical impairments classifiable in wheelchair sports may affect the utility of field based body composition techniques. The present study assessed body composition using DXA in 14 wheelchair games players who were either wheelchair dependent (non walkers; n=7) or relied on a wheelchair for sports participation only (walkers; n=7). Anthropometric measurements were used to predict body fat percentage with existing regression equations established for able bodied persons by Sloan & Weir, Durnin & Womersley, Lean et al, Gallagher et al and Pongchaiyakul et al. In addition, linear regression analysis was performed to calculate the association between body fat percentage and BMI, waist circumference, sum of 6 skinfold thickness and sum of 8 skinfold thickness. Results showed that non- walkers had significantly lower total lean tissue mass (46.2±=6.6 kg vs. 59.4±8.2 kg, P =.006) and total body mass (65.8±4.2 kg vs. 79.4 ± 14.9kg; P=0.05) than walkers. Body fat percentage calculated from most existing regression equations was significantly lower than that from DXA, by 2 to 9% in walkers and 8 to 14% in non- walkers. Of the anthropometric measurements, the sum of 8 skinfold thickness had the lowest standard error of estimation in predicting body fat content. In conclusion, existing anthropometric equations developed in able- bodied populations substantially underestimated body fat content in wheelchair athletes, particularly non-walkers. Impairment specific equations may be needed in wheelchair athletes

Dual-energy X-ray absorptiometry, skinfold thickness and waist circumference for assessing body composition in ambulant and non-ambulant wheelchair games players

Field based assessments provide a cost effective and accessible alternative to dual energy X ray absorptiometry (DXA) for practitioners determining body composition in athletic populations. It remains unclear how the range of physical impairments classifiable in wheelchair sports may affect the utility of field based body composition techniques. The present study assessed body composition using DXA in 14 wheelchair games players who were either wheelchair dependent (non walkers; n=7) or relied on a wheelchair for sports participation only (walkers; n=7). Anthropometric measurements were used to predict body fat percentage with existing regression equations established for able bodied persons by Sloan & Weir, Durnin & Womersley, Lean et al, Gallagher et al and Pongchaiyakul et al. In addition, linear regression analysis was performed to calculate the association between body fat percentage and BMI, waist circumference, sum of 6 skinfold thickness and sum of 8 skinfold thickness. Results showed that non- walkers had significantly lower total lean tissue mass (46.2±=6.6 kg vs. 59.4±8.2 kg, P =.006) and total body mass (65.8±4.2 kg vs. 79.4 ± 14.9kg; P=0.05) than walkers. Body fat percentage calculated from most existing regression equations was significantly lower than that from DXA, by 2 to 9% in walkers and 8 to 14% in non- walkers. Of the anthropometric measurements, the sum of 8 skinfold thickness had the lowest standard error of estimation in predicting body fat content. In conclusion, existing anthropometric equations developed in able- bodied populations substantially underestimated body fat content in wheelchair athletes, particularly non-walkers. Impairment specific equations may be needed in wheelchair athletes

Global, Regional, and National Progress Towards Sustainable Development Goal 3.2 for Neonatal and Child Health: All-Cause and Cause-Specific Mortality Findings From the Global Burden of Disease Study 2019

Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3–74·0) in 2000 to 37·1 (33·2–41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8–29·5) in 2000 to 17·9 (16·3–19·8) in 2019. In 2019, 136 (67%) of 204 countries had a U5MR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030, 154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9·65 million (95% UI 9·05–10·30) in 2000 and 5·05 million (4·27–6·02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3·76 million [95% UI 3·53–4·02]) in 2000 to 48% (2·42 million; 2·06–2·86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0·80 (95% UI 0·71–0·86) deaths per 1000 livebirths and U5MR to 1·44 (95% UI 1·27–1·58) deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million (95% UI 1·35–2·58; 37% [95% UI 32–43]) of 5·05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress

Assessment of body composition in spinal cord injury: A scoping review.

The objective of this scoping review was to map the evidence on measurement properties of body composition tools to assess whole-body and regional fat and fat-free mass in adults with SCI, and to identify research gaps in order to set future research priorities. Electronic databases of PubMed, EMBASE and the Cochrane library were searched up to April 2020. Included studies employed assessments related to whole-body or regional fat and/or fat-free mass and provided data to quantify measurement properties that involved adults with SCI. All searches and data extractions were conducted by two independent reviewers. The scoping review was designed and conducted together with an expert panel (n = 8) that represented research, clinical, nutritional and lived SCI experience. The panel collaboratively determined the scope and design of the review and interpreted its findings. Additionally, the expert panel reached out to their professional networks to gain further stakeholder feedback via interactive practitioner surveys and workshops with people with SCI. The research gaps identified by the review, together with discussions among the expert panel including consideration of the survey and workshop feedback, informed the formulation of future research priorities. A total of 42 eligible articles were identified (1,011 males and 143 females). The only tool supported by studies showing both acceptable test-retest reliability and convergent validity was whole-body dual-energy x-ray absorptiometry (DXA). The survey/workshop participants considered the measurement burden of DXA acceptable as long as it was reliable, valid and would do no harm (e.g. radiation, skin damage). Practitioners considered cost and accessibility of DXA major barriers in applied settings. The survey/workshop participants expressed a preference towards simple tools if they could be confident in their reliability and validity. This review suggests that future research should prioritize reliability and validity studies on: (1) DXA as a surrogate 'gold standard' tool to assess whole-body composition, regional fat and fat-free mass; and (2) skinfold thickness and waist circumference as practical low-cost tools to assess regional fat mass in persons with SCI, and (3) females to explore potential sex differences of body composition assessment tools. Registration review protocol: CRD42018090187 (PROSPERO)

Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background Previous attempts to characterise the burden of chronic respiratory diseases have focused only on specific disease conditions, such as chronic obstructive pulmonary disease (COPD) or asthma. In this study, we aimed to characterise the burden of chronic respiratory diseases globally, providing a comprehensive and up-to-date analysis on geographical and time trends from 1990 to 2017. Methods Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we estimated the prevalence, morbidity, and mortality attributable to chronic respiratory diseases through an analysis of deaths, disability-adjusted life-years (DALYs), and years of life lost (YLL) by GBD super-region, from 1990 to 2017, stratified by age and sex. Specific diseases analysed included asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, pneumoconiosis, and other chronic respiratory diseases. We also assessed the contribution of risk factors (smoking, second-hand smoke, ambient particulate matter and ozone pollution, household air pollution from solid fuels, and occupational risks) to chronic respiratory disease-attributable DALYs. Findings In 2017, 544·9 million people (95% uncertainty interval [UI] 506·9–584·8) worldwide had a chronic respiratory disease, representing an increase of 39·8% compared with 1990. Chronic respiratory disease prevalence showed wide variability across GBD super-regions, with the highest prevalence among both males and females in high-income regions, and the lowest prevalence in sub-Saharan Africa and south Asia. The age-sex-specific prevalence of each chronic respiratory disease in 2017 was also highly variable geographically. Chronic respiratory diseases were the third leading cause of death in 2017 (7·0% [95% UI 6·8–7·2] of all deaths), behind cardiovascular diseases and neoplasms. Deaths due to chronic respiratory diseases numbered 3 914 196 (95% UI 3 790 578–4 044 819) in 2017, an increase of 18·0% since 1990, while total DALYs increased by 13·3%. However, when accounting for ageing and population growth, declines were observed in age-standardised prevalence (14·3% decrease), agestandardised death rates (42·6%), and age-standardised DALY rates (38·2%). In males and females, most chronic respiratory disease-attributable deaths and DALYs were due to COPD. In regional analyses, mortality rates from chronic respiratory diseases were greatest in south Asia and lowest in sub-Saharan Africa, also across both sexes. Notably, although absolute prevalence was lower in south Asia than in most other super-regions, YLLs due to chronic respiratory diseases across the subcontinent were the highest in the world. Death rates due to interstitial lung disease and pulmonary sarcoidosis were greater than those due to pneumoconiosis in all super-regions. Smoking was the leading risk factor for chronic respiratory disease-related disability across all regions for men. Among women, household air pollution from solid fuels was the predominant risk factor for chronic respiratory diseases in south Asia and sub-Saharan Africa, while ambient particulate matter represented the leading risk factor in southeast Asia, east Asia, and Oceania, and in the Middle East and north Africa super-region. Interpretation Our study shows that chronic respiratory diseases remain a leading cause of death and disability worldwide, with growth in absolute numbers but sharp declines in several age-standardised estimators since 1990. Premature mortality from chronic respiratory diseases seems to be highest in regions with less-resourced health systems on a per-capita basis

Lewy Body Dementia Association\u27s Research Centers of Excellence Program: Inaugural Meeting Proceedings.

The first Lewy Body Dementia Association (LBDA) Research Centers of Excellence (RCOE) Investigator\u27s meeting was held on December 14, 2017, in New Orleans. The program was established to increase patient access to clinical experts on Lewy body dementia (LBD), which includes dementia with Lewy bodies (DLB) and Parkinson\u27s disease dementia (PDD), and to create a clinical trials-ready network. Four working groups (WG) were created to pursue the LBDA RCOE aims: (1) increase access to high-quality clinical care, (2) increase access to support for people living with LBD and their caregivers, (3) increase knowledge of LBD among medical and allied (or other) professionals, and (4) create infrastructure for a clinical trials-ready network as well as resources to advance the study of new therapeutics

Securing Our Economic Future

The American economy is in the midst of a wrenching crisis, one caused by the COVID-19 pandemic and aggravated further by a series of climate-driven natural disasters. While the economy has made some steps towards recovery, the pandemic has laid bare the reality that too many Americans are unable to meet many of their urgent and basic needs. At the same time, it has become painfully clear that American society is not equipped to deal with the risks emerging from our changing climate. This book is a contribution towards policy options for addressing these challenges. Although it was largely written before the pandemic crises beset our country, the analyses, diagnoses, and prescriptions contained within all shed new light on the underlying fragilities that have since been exposed. The volume is composed of nine commissioned chapters and is divided into three sections, covering the 'Economics of the American Middle Class'; the 'Geographic Disparities in Economic Opportunity'; and the 'Geopolitics of the Climate and Energy Challenge and the US Policy Response.' Part I focuses on the economic wellbeing of the American middle class and the chapters in this section evaluate the prevailing narrative of its decline. The chapters in part II investigate the large variation in income and economic opportunities across places, and include a specific policy proposal for emergency rental assistance. Part III is devoted to the global climate crisis. The chapters in this final section emphasize the mounting social and economic costs of inaction and discuss potential policy approaches for tackling the climate challenge

Lewy Body Dementia Association\u27s Research Centers of Excellence Program: Inaugural Meeting Proceedings

The first Lewy Body Dementia Association (LBDA) Research Centers of Excellence (RCOE) Investigator\u27s meeting was held on December 14, 2017, in New Orleans. The program was established to increase patient access to clinical experts on Lewy body dementia (LBD), which includes dementia with Lewy bodies (DLB) and Parkinson\u27s disease dementia (PDD), and to create a clinical trials-ready network. Four working groups (WG) were created to pursue the LBDA RCOE aims: (1) increase access to high-quality clinical care, (2) increase access to support for people living with LBD and their caregivers, (3) increase knowledge of LBD among medical and allied (or other) professionals, and (4) create infrastructure for a clinical trials-ready network as well as resources to advance the study of new therapeutics