A systematic review of measures of self-reported adherence to unsupervised home-based rehabilitation exercise programmes, and their psychometric properties

BACKGROUND: Adherence is an important factor contributing to the effectiveness of exercise-based rehabilitation. However, there appears to be a lack of reliable, validated measures to assess self-reported adherence to prescribed but unsupervised home-based rehabilitation exercises. OBJECTIVES: A systematic review was conducted to establish what measures were available and to evaluate their psychometric properties. DATA SOURCES: MEDLINE, EMBASE, PsycINFO CINAHL (June 2013) and the Cochrane library were searched (September 2013). Reference lists from articles meeting the inclusion criteria were checked to ensure all relevant papers were included. STUDY SELECTION: To be included articles had to be available in English; use a self-report measure of adherence in relation to a prescribed but unsupervised home-based exercise or physical rehabilitation programme; involve participants over the age of 18. All health conditions and clinical populations were included. DATA EXTRACTION: Descriptive data reported were collated on a data extraction sheet. The measures were evaluated in terms of eight psychometric quality criteria. RESULTS: 58 studies were included, reporting 61 different measures including 29 questionnaires, 29 logs, two visual analogue scales and one tally counter. Only two measures scored positively for one psychometric property (content validity). The majority of measures had no reported validity or reliability testing. CONCLUSIONS: The results expose a gap in the literature for well-developed measures that capture self-reported adherence to prescribed but unsupervised home-based rehabilitation exercises

Hypnotherapy is more effective than nicotine replacement therapy for smoking cessation: Results of a randomized controlled trial

The efficacy of pharmacotherapy for smoking cessation is well documented. However, due to relapse rates and side effects, hypnotherapy is gaining attention as an alternative treatment option. The aim of this one-center randomized study was to compare the efficacy of hypnotherapy alone, as well as hypnotherapy with nicotine replacement therapy (NRT), to conventional NRT in patients hospitalized with a cardiac or pulmonary illness. METHODS: We evaluated self-reported and biochemically verified 7-day prevalence smoking abstinence rates at 12 and 26 weeks post-hospitalization. Patients (n=164) were randomized into one of three counseling-based treatment groups: NRT for 30 days (NRT; n=41), a 90-min hypnotherapy session (H; n=39), and NRT with hypnotherapy (HNRT; n=37). Treatment groups were compared to a self-quit group of 35 patients who refused intervention. RESULTS: Hypnotherapy patients were more likely than NRT patients to be nonsmokers at 12 weeks (43.9% vs. 28.2%; p=0.14) and 26 weeks after hospitalization (36.6% vs. 18.0%; p=0.06). Smoking abstinence rates in the HNRT group were similar to the H group. There was no difference in smoking abstinence rates at 26 weeks between self quit and participants in any of the treatment groups. In multivariable regression analysis adjusting for diagnosis and demographic characteristics, H and HNRT were over three times more likely than NRT participants to abstain at 26-weeks post-discharge (RR=3.6; p=0.03 and RR=3.2; p=0.04, respectively). CONCLUSION: Hypnotherapy is more effective than NRT in improving smoking abstinence in patients hospitalized for a smoking-related illness, and could be an asset to post-discharge smoking cessation programs

Fun and fit: Evaluation of a pediatric exercise program

While the components of effective pediatric exercise interventions have been identified in structured research settings, recent reviews have highlighted the need for translating these interventions into accessible programs. In this paper we evaluate a behavioral intervention-based exercise program designed to serve community children and teens at risk for adult obesity. Measures of weight, strength, cardiovascular fitness, and exercise intensity improved significantly over the course of this program, and qualitative assessments indicated that attitudes towards exercise also improved. Our experiences suggest that structured, protocol-driven exercise interventions can be successfully translated into effective programs accessible to children of different ages and socioeconomic levels

Determinants of peak bone mass in young premenopausal women

Peak bone mass is defined as the highest level of bone mass attained during life through normal growth, and small increases in peak bone mass may prevent osteoporotic fractures later in life. Non-modifiable genetic factors account for as much as 50-70% of the variation in peak bone mass, but to achieve full genetic potential an individual must work to optimize the modifiable environmental and lifestyle factors that also contribute to the variation in peak bone mass. Thus, understanding these modifiable factors affecting peak bone mass is important for osteoporosis prevention. The first paper of this dissertation examines the association between peak bone mass and body composition. Previous studies of this association are based on size-dependent bone mass measures, so the true association between body composition and peak bone mass has remained unclear. In size-adjusted analyses, we found that lean mass was positively associated peak bone mass, while fat mass measures were inversely associated with peak bone mass. This analysis clarifies that lean mass, and not fat mass, is important to peak bone mass in young premenopausal women. Women in this group should maintain a healthy body fat percentage to ensure attainment and maintenance of optimum peak bone mass. The second paper of this dissertation examines the association between overall diet quality and peak bone mass using established indices of diet quality. We found no association between these established diet quality scores and bone mass, suggesting these scores may not be appropriate for use in studies related to bone. Because scores measuring overall diet are important for epidemiologic research, a score specifically tailored to reflect bone-specific dietary components would benefit future research. The third paper of this dissertation evaluates the relative contribution of bone-related clinical and lifestyle factors to peak bone mass. We found that waist circumference explained the most variation in peak bone mass, and that physical activity measures, dietary factors, and age at menarche were also important. These findings inform osteoporosis prevention, and factors identified in this analysis are appropriate for use in a clinical setting as part of a prescreening tool for low peak bone mass

The association of lean mass and fat mass with peak bone mass in young premenopausal women

Total body mass is a major determinant of bone mass, but studies of the relative contributions of lean mass (LM) and fat mass (FM) to bone mass have yielded conflicting results. This is likely because of the use of bone measures that are not adequately adjusted for body size and, therefore, not appropriate for analyses related to body composition, which is also correlated with body size. We examined the relationship between body composition and peak bone mass in premenopausal women aged 18-30 yr using both size-dependent and size-adjusted measures of bone density and body composition, as well as statistical models adjusted for size-related factors. We measured total bone mass and areal bone density using dual-energy X-ray absorptiometry, and used established formulas to calculate estimates of volumetric (size-adjusted) bone density. LM tended to be positively associated with bone both before and after adjustment for size-related factors. FM and body fat percentage, however, were positively associated with size-dependent bone measures, but adjusting for size removed or reversed this association. These findings suggest that the association between bone mass and body composition, especially FM, is dependent on the bone measures analyzed, and that determining the most appropriate size-adjustment techniques is critical for understanding this relationship. Copyright © 2010 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved

Household chemical exposures and the risk of canine malignant lymphoma, a model for human non-Hodgkin\u27s lymphoma

BACKGROUND: Epidemiologic studies of companion animals offer an important opportunity to identify risk factors for cancers in animals and humans. Canine malignant lymphoma (CML) has been established as a model for non-Hodgkin\u27s lymphoma (NHL). Previous studies have suggested that exposure to environmental chemicals may relate to development of CML. METHODS: We assessed the relation of exposure to flea and tick control products and lawn-care products and risk of CML in a case-control study of dogs presented to a tertiary-care veterinary hospital (2000-2006). Cases were 263 dogs with biopsy-confirmed CML. Controls included 240 dogs with benign tumors and 230 dogs undergoing surgeries unrelated to cancer. Dog owners completed a 10-page questionnaire measuring demographic, environmental, and medical factors. RESULTS: After adjustment for age, weight, and other factors, use of specific lawn care products was associated with greater risk of CML. Specifically, the use of professionally applied pesticides was associated with a significant 70% higher risk of CML (odds ratio(OR)=1.7; 95% confidence interval (CI)=1.1-2.7). Risk was also higher in those reporting use of self-applied insect growth regulators (OR=2.7; 95% CI=1.1-6.8). The use of flea and tick control products was unrelated to risk of CML. CONCLUSIONS: Results suggest that use of some lawn care chemicals may increase the risk of CML. Additional analyses are needed to evaluate whether specific chemicals in these products may be related to risk of CML, and perhaps to human NHL as well. Copyright © 2011 Elsevier Inc. All rights reserved

Dietary vitamin D intake, 25-hydroxyvitamin D3 levels and premenstrual syndrome in a college-aged population

High dietary intake of vitamin D may reduce the risk of premenstrual syndrome (PMS), perhaps by affecting calcium levels, cyclic sex steroid hormone fluctuations, and/or neurotransmitter function. Only a small number of previous studies have evaluated this relationship and none have focused on young women. We assessed this relationship in a cross-sectional analysis within the UMass Vitamin D Status Study. Between 2006 and 2008, 186 women aged 18-30 (mean age=21.6 years) completed a validated food frequency questionnaire, additional questionnaires to assess menstrual symptoms and other health and lifestyle factors, and provided a fasting blood sample collected during the late luteal phase of their menstrual cycle. Among all study participants, results suggested the possibility of an inverse association between intake of vitamin D from food sources and overall menstrual symptom severity, though were not statistically significant; mean intakes in women reporting menstrual symptom severity of none/minimal, mild, and moderate/severe were 253, 214, and 194 IU/day, respectively (P=0.18). From among all study participants, 44 women meeting standard criteria for PMS and 46 women meeting control criteria were included in additional case-control analyses. In these women, after adjustment for age, body mass index, smoking status and total calcium intake, higher intake of vitamin D from foods was associated with a significant lower prevalence of PMS. Women reporting vitamin D intake from food sources of \u3eor=100 IU/day had a prevalence odds ratio of 0.31 compared to those reporting\u3c100 IU/day (95% confidence interval=0.10-0.98). Late luteal phase 25-hydroxyvitamin D3 levels were not associated with prevalent PMS. Results from this pilot study suggest that a relationship between vitamin D and PMS is possible, though larger studies are needed to further evaluate this relationship and to investigate whether 25-hydroxyvitamin D3 levels in the follicular or early luteal phases of the menstrual cycle may be related to PMS risk. Copyright (c) 2010 Elsevier Ltd. All rights reserved