Web‐based Weight Management Programs in an Integrated Health Care Setting: A Randomized, Controlled Trial

Objective : To assess the efficacy of a Web‐based tailored behavioral weight management program compared with Web‐based information‐only weight management materials. Research Methods and Procedures : Participants, 2862 eligible overweight and obese (BMI = 27 to 40 kg/m 2 ) members from four regions of Kaiser Permanente's integrated health care delivery system, were randomized to receive either a tailored expert system or information‐only Web‐based weight management materials. Weight change and program satisfaction were assessed by self‐report through an Internet‐based survey at 3‐ and 6‐month follow‐up periods. Results : Significantly greater weight loss at follow‐up was found among participants assigned to the tailored expert system than among those assigned to the information‐only condition. Subjects in the tailored expert system lost a mean of 3 ± 0.3% of their baseline weight, whereas subjects in the information‐only condition lost a mean of 1.2 ± 0.4% ( p < 0.0004). Participants were also more likely to report that the tailored expert system was personally relevant, helpful, and easy to understand. Notably, 36% of enrollees were African‐American, with enrollment rates higher than the general proportion of African Americans in any of the study regions. Discussion : The results of this large, randomized control trial show the potential benefit of the Web‐based tailored expert system for weight management compared with a Web‐based information‐only weight management program.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93691/1/oby.2006.34.pd

Coordinate and redox interactions of epinephrine with ferric and ferrous iron at physiological pH

Coordinate and redox interactions of epinephrine (Epi) with iron at physiological pH are essential for understanding two very different phenomena - the detrimental effects of chronic stress on the cardiovascular system and the cross-linking of catecholamine-rich biopolymers and frameworks. Here we show that Epi and Fe3+ form stable high-spin complexes in the 1:1 or 3:1 stoichiometry, depending on the Epi/Fe3+ concentration ratio (low or high). Oxygen atoms on the catechol ring represent the sites of coordinate bond formation within physiologically relevant bidentate 1:1 complex. Redox properties of Epi are slightly impacted by Fe3+. On the other hand, Epi and Fe2+ form a complex that acts as a strong reducing agent, which leads to the production of hydrogen peroxide via O-2 reduction, and to a facilitated formation of the Epi-Fe3+ complexes. Epi is not oxidized in this process, i.e. Fe2+ is not an electron shuttle, but the electron donor. Epi-catalyzed oxidation of Fe2+ represents a plausible chemical basis of stress-related damage to heart cells. In addition, our results support the previous findings on the interactions of catecholamine moieties in polymers with iron and provide a novel strategy for improving the efficiency of cross-linking.Supplementary material: [http://cherry.chem.bg.ac.rs/handle/123456789/3040

Determining the chemical composition of cloud condensation nuclei

This second progress report describes the status of the project one and one-half years after the start. The goal of the project is to develop the instrumentation to collect cloud condensation nuclei (CCN) in sufficient amounts to determine their chemical composition, and to survey the CCN composition in different climates through a series of field measurements. Our approach to CCN collection is to first form droplets on the nuclei under simulated cloud humidity conditions, which is the only known method of identifying CCN from the background aerosol. Under cloud chamber conditions, the droplets formed become larger than the surrounding aerosol, and can then be removed by inertial impaction. The residue of the evaporated droplets represents the sample to be chemically analyzed. Two size functions of CCN particles are collected by first forming droplets on the large particles are collected by first forming droplets on the large CCN in a haze chamber at 100% relative humidity, and then activating the remaining CCN at 1% supersaturation in a cloud chamber. The experimental apparatus is a serious flow arrangement consisting of an impactor to remove the large aerosol particles, a haze chamber to form droplets on the remaining larger CCN, another impactor to remove the haze droplets containing the larger CCN particles for chemical analysis, a continuous flow diffusion (CFD) cloud chamber to form droplets on the remaining smaller CCN, and a third impactor to remove the droplets for the small CCN sample. Progress is documented here on the development of each of the major components of the flow system. Chemical results are reported on tests to determine suitable wicking material for the different plates. Results of computer modeling of various impactor flows are discussed

Protocol for a randomised controlled trial of a decision aid for the management of pain in labour and childbirth [ISRCTN52287533]

BACKGROUND: Women report fear of pain in childbirth and often lack complete information on analgesic options prior to labour. Preferences for pain relief should be discussed before labour begins. A woman's antepartum decision to use pain relief is likely influenced by her cultural background, friends, family, the media, literature and her antenatal caregivers. Pregnant women report that information about analgesia was most commonly derived from hearsay and least commonly from health professionals. Decision aids are emerging as a promising tool to assist practitioners and their patients in evidence-based decision making. Decision aids are designed to assist patients and their doctors in making informed decisions using information that is unbiased and based on high quality research evidence. Decision aids are non-directive in the sense that they do not aim to steer the user towards any one option, but rather to support decision making which is informed and consistent with personal values. METHODS/DESIGN: We aim to evaluate the effectiveness of a Pain Relief for Labour decision aid, with and without an audio-component, compared to a pamphlet in a three-arm randomised controlled trial. Approximately 600 women expecting their first baby and planning a vaginal birth will be recruited for the trial. The primary outcomes of the study are decisional conflict (uncertainty about a course of action), knowledge, anxiety and satisfaction with decision-making and will be assessed using self-administered questionnaires. The decision aid is not intended to influence the type of analgesia used during labour, however we will monitor health service utilisation rates and maternal and perinatal outcomes. This study is funded by a competitive peer-reviewed grant from the Australian National Health and Medical Research Council (No. 253635). DISCUSSION: The Pain Relief for Labour decision aid was developed using the Ottawa Decision Support Framework and systematic reviews of the evidence about the benefits and risks of the non-pharmacological and pharmacological methods of pain relief for labour. It comprises a workbook and worksheet and has been developed in two forms – with and without an audio-component (compact disc). The format allows women to take the decision aid home and discuss it with their partner

Impact of physical disability on pursuit of gardening activities in mid-aged women

Research on horticultural therapy approaches suggest that its positive impact on clients may extend beyond direct rehabilitation or vocational gains to more generally improved well-being. Persons in rehabilitation programs may relate to gardening as a previously enjoyed past time, or as a new activity for either leisure or employment purposes. While gardening is a popular leisure activity in many countries, few studies have looked at what specific gardening activities community-based populations pursue. As part of a larger mail-out survey looking at gardening interests of mid-aged women, a sub-sample of physically disabled women was compared to healthy age-matched women on gardening activities and interests. Physical and psychological functioning and well-being were also sampled. Both groups completed the SF-36 Health Survey for Australia/New Zealand, the Symptom Checklist-90-Revised, and a gardening questionnaire tapping gardening activities and hours per month on these activities, as well as the reasons for pursuing gardening. Group differences emerged on physical and psychological functioning variables, but for virtually all gardening variables, group differences were minimal. Overall findings suggest that for this sample of mid-aged women, the presence of physical disability or limitation did not adversely affect their access to and enjoyment of gardening activities

Coaching and guidance with patient decision aids : A review of theoretical and empirical evidence

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly citedCoaching and guidance are structured approaches that can be used within or alongside patient decision aids (PtDAs) to facilitate the process of decision making. Coaching is provided by an individual, and guidance is embedded within the decision support materials. The purpose of this paper is to: a) present updated definitions of the concepts “coaching” and “guidance”; b) present an updated summary of current theoretical and empirical insights into the roles played by coaching/guidance in the context of PtDAs; and c) highlight emerging issues and research opportunities in this aspect of PtDA designPeer reviewedFinal Published versio