Adherence to a behavioral weight loss treatment program enhances weight loss and improvements in biomarkers

Objectives: To describe participants' adherence to multiple components (attendance, energy intake, fat gram, exercise goals, and self-monitoring eating and exercise behaviors) of a standard behavioral treatment program (SBT) for weight loss and how adherence to these components may influence weight loss and biomarkers (triglycerides, low density lipoproteins [LDL], high density lipoprotein, and insulin) during the intensive and less-intensive intervention phases. Methods: A secondary analysis of a randomized clinical trial consisting of a SBT with either fat-restricted standard or lacto-ovo vegetarian diet. The 12-month intervention was delivered in 33 group sessions. The first six months reflected the intensive phase; the second six months, the less-intensive intervention phase. We conducted the analysis without regard to treatment assignment. Eligible participants included overweight/obese adults (N = 176; mean body mass index = 34.0 kg/m2). The sample was 86.9% female, 70.5% White, and 44.4 ± 8.6 years old. The outcome measures included weight and biomarkers. Results: There was a significant decline in adherence to each treatment component over time (P < 0.0001). In the first six months, adherence to attendance, self-monitoring and the energy goal were significantly associated with greater weight loss (P < 0.05). Adherence to attendance and exercise remained significantly associated with weight loss in the second six months (P < 0.05). Adherence to attendance, self-monitoring and exercise had indirect effects through weight loss on LDL, triglycerides, and insulin (P < 0.05). Conclusions: We observed a decline in adherence to each treatment component as the intervention intensity was reduced. Adherence to multiple treatment components was associated with greater weight loss and improvements in biomarkers. Future research needs to focus on improving and maintaining adherence to all components of the treatment protocol to promote weight loss and maintenance. © 2009 Acharya et al

Assessing the safety attitudes questionnaire (SAQ), German language version in Swiss university hospitals - A validation study

Background: Improving patient safety has become a major focus of clinical care and research over the past two decades. An institution's patient safety climate represents an essential component of ensuring a safe environment and thereby can be vital to the prevention of adverse events. Covering six patient safety related factors, the Safety Attitudes Questionnaire (SAQ) is a validated and widely used instrument to measure the patient safety climate in clinical areas. The objective of this study was to assess the psychometric properties of the German language version of the SAQ. Methods. A survey was carried out in two University Hospitals in Switzerland in autumn 2009 where the SAQ was distributed to a sample of 406 nurses and physicians in medical and surgical wards. Following the American Educational Research Association guidelines, we tested the questionnaire validity by levels of evidence: content validity, internal structure and relations to other variables. Confirmatory factor analysis was used to examine factor structure. Cronbach's alphas and inter-item correlations were calculated to examine internal consistency reliability. Results: A total of 319 questionnaires were completed representing an overall response rate of 78.6%. For three items, the item content validity index was <0.75. Confirmatory factor analysis showed acceptable model fit (RMSEA = 0.045; CFI = 0.944) for the six-factor model. Additional exploratory factor analysis could not identify a better factor model. SAQ factor scores showed positive correlations with the Safety Organizing Scale (r =.56 -.72). The SAQ German version showed moderate to strong internal consistency reliability indices (Cronbach alpha =.65 -.83). Conclusions: The German language version of the SAQ demonstrated acceptable to good psychometric properties and therefore shows promise to be a sound instrument to measure patient safety climate in Swiss hospital wards. However, the low item content validity and large number of missing responses for several items suggest that improvements and adaptations in translation are required for select items, especially within the perception of management scale. Following these revisions, psychometric properties should reassessed in a randomly selected sample and hospitals and departments prior to use in Swiss hospital settings. © 2013 Zimmermann et al.; licensee BioMed Central Ltd

Daytime sleepiness and functional outcomes in older adults with diabetes

Purpose This secondary analysis examined the effect of excessive sleepiness on daytime function in older adults with diabetes from the National Sleep Foundation's Sleep and Aging poll. Methods Respondents were older adults (N = 1506; age range, 55-84 years) evaluated by telephone survey on their sleep duration, sleep disturbances, daytime functional outcomes, and self-reported height, weight, and comorbidities. Results Approximately 16% (n = 244) of the sample acknowledged a diagnosis of diabetes; they were older, had more comorbidities, had a higher body mass index (BMI), and were more likely to be sleepy during the daytime than nondiabetic respondents (all P <.05). Respondents with diabetes who reported frequent daytime sleepiness (n = 50; 20%) had significantly (P <.05) higher BMI, lower self-rated health, and more sleep disturbances than those who were not sleepy (n = 194). Sleepy respondents with diabetes also reported more frequent feelings of depression, decreased pleasure in life, naps, feeling drowsy, or dozing off while driving (all P <.05). Excessive sleepiness was significantly associated (P <.001) with an increased risk for depressive symptoms while controlling for BMI, age, and number of comorbidities. Conclusions These results indicate that sleep disturbances affect not only sleep quality but also daytime function in older adults with diabetes

Symptom clusters in breast cancer across 3 phases of the disease

WOS: 000230076300008PubMed ID: 15915067The purpose of this exploratory, secondary analysis was to compare the prevalence of symptoms attributable to breast cancer or its treatment and to identify and describe symptom clusters across 3 phases of the disease. A pooled analysis was conducted by combining existing symptom data collected at the baseline assessment from 3 independent studies of women with breast cancer. Study I had 40 women with early-stage breast cancer following primary surgery for their disease and prior to the initiation of adjuvant therapy. Study II had 88 women with stage I, II, or III breast cancer who had completed surgery and adjuvant chemotherapy and may have been receiving hormonal therapy. Study III had 26 women with metastatic breast cancer (stage IV). Three symptom clusters were identified corresponding to 3 different phases of the breast cancer experience. Each cluster was composed of symptoms related to fatigue, perceived cognitive impairment, and mood problems. Future studies are needed to prospectively examine whether these symptoms cluster across 3 phases of breast cancer and the effect of these clusters on the functional ability and quality of life in women with breast cancer.NCI NIH HHSUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Cancer Institute (NCI) [R01CA80625

Revisiting the association between cardiovascular risk factors and diabetes: Data from a large population-based study

Purpose: The purpose of this study was to examine the association between cardiovascular risk factors and the presence of diabetes in a large population-level dataset. Methods: A secondary analysis was conducted using data from the 2007 Behavioral Risk Factor Surveillance System, a population-based survey (n = 403,137) conducted in the United States. Results: The majority of the respondents were middle-aged and overweight. Approximately half of the sample reported little or no physical activity. Estimates from a logistic regression model for a weighted sample of white, black, and Hispanic adults revealed that having hypertension or elevated cholesterol was a strong predictor of diabetes even when controlling for age, gender, race, education, income, body mass index, smoking status, and physical activity. Conclusions: The results confirmed the importance of diabetes educators counseling patients with hypertension or hypercholesterolemia about their increased risk for developing diabetes. © 2009 The Author(s)

Improving adherence to a cholesterol-lowering diet: A behavioral intervention study

Less than 50% of US adults follow dietary recommendations. Despite these figures, little research has focused on improving adherence to a therapeutic eating plan. The research utilizing self-efficacy theory has shown promise for improving behavior change and treatment adherence. This study evaluated the efficacy of a telephone-delivered, self-efficacy based intervention designed to improve adherence to a cholesterol-lowering diet among those self-reporting nonadherence. Sixty-five men and women diagnosed with hypercholesterolemia were randomized to usual care or treatment, which consisted of six intervention sessions delivered every 2 weeks by telephone and focused on how to manage eating behavior in challenging situations. There were significant between group differences post intervention in the consumption of saturated fat (P < .001) and cholesterol (P = .040) with the intervention group improving their dietary adherence. Significant change (P = .013) occurred over time in low-density lipoprotein-cholesterol (LDL-C) in the intervention group. No changes were observed in self-efficacy between groups, suggesting that self-efficacy was not a mediator of the improved adherence. The study's findings confirm that the telephone is a useful tool to deliver adherence-enhancing interventions. © 2004 Elsevier Ireland Ltd. All rights reserved

Developing research competence to support Evidence-based practice

This article describes one step in the process that was undertaken to prepare for the introduction of evidence-based practice (EBP) into the curriculum across the Bachelor of Science in Nursing, Master of Science in Nursing, and Doctor of Philosophy programs, as well as the programs that were under development, Clinical Nurse Leader and Doctor of Nursing Practice, at the University of Pittsburgh School of Nursing. Expected research competencies were identified for each level or academic year within each program. Based on these competencies, recommendations on how to modify the curriculum into one that would support students' acquisition and development of the skills necessary to be successful in matriculating through an EBP curriculum were developed. Evaluation mechanisms for the achievement of these competencies vary across the academic programs and will include performance on capstone projects, comprehensive examinations, and program milestones for doctoral students. The establishment of evidence-based competencies provided a foundation for the development of new teaching approaches and the curricular revisions across the three academic programs. Thus, the University of Pittsburgh model of educating for EBP is based on a sequential layering of research competencies throughout the curriculum. © 2005 Elsevier Inc. All rights reserved

Using a Personal Digital Assistant for Self-Monitoring Influences Diet Quality in Comparison to a Standard Paper Record among Overweight/Obese Adults

Self-monitoring has traditionally been done using a paper record, which can be tedious and burdensome. A personal digital assistant (PDA) with dietary software can provide an alternative to a paper record. The study aimed to describe the differences in dietary changes at 6 months between participants randomly assigned to use a paper record or PDA for self-monitoring in a clinical trial of weight-loss treatment. Self-monitoring adherence and changes in weight and diet were assessed between 2006 and 2009. The sample (n=192) was 84% female and 78% white, with a mean age of 49 years and body mass index (calculated as kg/m2) of 34.1. At baseline, the groups did not differ in energy intake, percent calories from fat, and number of servings of the examined food groups. At 6 months, both groups had significant reductions in weight, energy intake, and percent calories from total fat and saturated fatty acids (P<0.001); no between-group differences were found. Compared to the paper record group, the PDA group significantly increased consumption of fruit (P=0.02) and vegetables (P=0.04) and decreased consumption of refined grains (P=0.02). Interactions among self-monitoring and the two groups were found in relation to changes in percent calories from total fat (P=0.02), monounsaturated fatty acids (P=0.002), and trans-fatty acids (P=0.04). Frequent self-monitoring was significantly associated with total sugar (P=0.02) and added sugar (P=0.01) intake in both groups. Our findings suggest that use of a PDA for self-monitoring might improve self-awareness of behavior and dietary changes. © 2011 American Dietetic Association