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A primary care-based, multicomponent lifestyle intervention for overweight adolescent females.

ABSTRACT: Most clinic-based weight control treatments for youth have been designed for preadolescent children by using family-based care. However, as adolescents become more autonomous and less motivated by parental influence, this strategy may be less appropriate. This study evaluated a primary care-based, multicomponent lifestyle intervention specifically tailored for overweight adolescent females.Adolescent girls (N = 208) 12 to 17 years of age (mean ± SD: 14.1 ± 1.4 years), with a mean ± SD BMI percentile of 97.09 ± 2.27, were assigned randomly to the intervention or usual care control group. The gender and developmentally tailored intervention included a focus on adoptable healthy lifestyle behaviors and was reinforced by ongoing feedback from the teen's primary care physician. Of those randomized, 195 (94%) completed the 6-month posttreatment assessment, and 173 (83%) completed the 12-month follow-up. The primary outcome was reduction in BMI z score.The decrease in BMI z score over time was significantly greater for intervention participants compared with usual care participants (-0.15 in BMI z score among intervention participants compared with -0.08 among usual care participants; P = .012). The 2 groups did not differ in secondary metabolic or psychosocial outcomes. Compared with usual care, intervention participants reported less reduction in frequency of family meals and less fast-food intake.A 5-month, medium-intensity, primary care-based, multicomponent behavioral intervention was associated with significant and sustained decreases in BMI z scores among obese adolescent girls compared with those receiving usual care.

SUBMITTER: DeBar LL

PROVIDER: S-EPMC3289521 | biostudies-literature | 2012 Mar

REPOSITORIES: biostudies-literature

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A primary care-based, multicomponent lifestyle intervention for overweight adolescent females.

DeBar Lynn L LL Stevens Victor J VJ Perrin Nancy N Wu Philip P Pearson John J Yarborough Bobbi Jo BJ Dickerson John J Lynch Frances F

Pediatrics 20120213 3

<h4>Background and objective</h4>Most clinic-based weight control treatments for youth have been designed for preadolescent children by using family-based care. However, as adolescents become more autonomous and less motivated by parental influence, this strategy may be less appropriate. This study evaluated a primary care-based, multicomponent lifestyle intervention specifically tailored for overweight adolescent females.<h4>Methods</h4>Adolescent girls (N = 208) 12 to 17 years of age (mean ± S ...[more]

PMID: 22331335

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Project description:BackgroundThe SingHypertension primary care clinic intervention, which consisted of clinician training in hypertension management, subsidized single-pill combination medications, nurse-delivered motivational conversations and telephone follow-ups, improved blood pressure control and cardiovascular disease (CVD) risk scores relative to usual care among patients with uncontrolled hypertension in Singapore. This study quantified the incremental cost-effectiveness, in terms of incremental cost per unit reduction disability-adjusted life years, of SingHypertension relative to usual care for patients with hypertension from the health system perspective.Methods and resultsWe developed a Markov model to simulate CVD events and associated outcomes for a hypothetical cohort of patients over a 10-year period. Costs were measured in US dollars, and effectiveness was measured in disability-adjusted life years averted. We present base-case results and conducted deterministic and probabilistic sensitivity analyses. Based on a willingness-to-pay threshold of US $55 500 per DALY averted, SingHypertension was cost-effective for patients with hypertension (incremental cost-effectiveness ratio: US $24 765 per disability-adjusted life year averted) relative to usual care. This result held even if risk reduction was assumed to decline linearly to 0 over 10 years but not sooner than 7 years. Incremental cost-effectiveness ratios were most sensitive to the magnitude of the reduction in CVD risk; at least a 0.13% to 0.16% point reduction in 10-year CVD risk is required for cost-effectiveness. Probabilistic sensitivity analysis indicates that SingHypertension has a 78% chance of being cost-effective at the willingness-to-pay threshold.ConclusionsSingHypertension represents good value for the money for reducing CVD incidence, morbidity, and mortality and should be considered for wide-scale implementation in Singapore and possibly other countries.Registration informationREGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02972619.

Project description:BACKGROUND:Adult immunization rates are below Healthy People 2020 targets. Our objective was to evaluate the effectiveness of a multicomponent intervention to improve adult immunization rates. METHODS:This prospective interventional before-and-after non-randomized study was conducted through the American Academy of Family Physicians National Research Network with 43 primary care physicians from a large multi-specialty healthcare organization (multicomponent intervention group n?=?23; comparator group n?=?20) in the United States. The multicomponent intervention included provider reminders, quarterly provider-level performance reports, provider education, patient visual aid materials, and standing orders on adult pneumococcal, influenza, and zoster immunizations. We assessed individual and comparative provider-level vaccination rates and missed opportunities detailing concordance with targets established by Healthy People 2020 for pneumococcal, influenza, and zoster immunizations. RESULTS:Vaccination rates increased after 12?months in intervention and comparator groups respectively for: a). influenza from 44.4?±?16.7 to 51.3%?±?12.9% (by 6.9 percentage points, p?=?0.001) and from 35.1?±?19.1 to 41.3%?±?14.2%, (by 6.2 percentage points, p?=?0.01); b). pneumococcal vaccinations in older adults from 62.8?±?17.6 to 81.4%?±?16.6% (by 18.6 percentage points, for p?<?0.0001) and from 55.9?±?20.0 to 72.7%?±?18.4% (by 16.7 percentage points, p?<?0.0001); and c). zoster from 37.1?±?13.4 to 41.9%?±?13.1% (by 4.8 percentage points, p?<?0.0001) and from 35.0?±?18.7 to 42.3%?±?20.9% (7.3 percentage points, p?=?0.001). Pneumococcal vaccinations in adults at risk did not change from baseline in intervention group (35.7?±?19.6 to 34.5%?±?19.0%, p?=?0.3) and improved slightly in comparator group (24.3?±?20.1 to 28.2%?±?20.0%, p?=?0.003). Missed opportunities reduced after 12?months, most noticeably, for: a). for influenza from 57.7 to 48.6% (by 9.1 percentage points, p?<?0.0001) and from 69.7 to 59.6% (by 10.1 percentage points, p?<?0.0001); b). pneumococcal vaccinations in older adults from 18.1 to 11.5% (by 6.6 percentage points p?<?0.0001) and from 24.6 to 20.4% (by 4.3 percentage points, p?<?0.0001) in intervention and comparator groups respectively. CONCLUSIONS:Multicomponent interventions show promise in improving vaccination rates and reducing missed opportunities in older adults for pneumococcal and zoster vaccines and vaccination against influenza. Provider reminders remain the most effective strategy when delivered either as a component of these interventions or alone.

Project description:ObjectiveTo evaluate the feasibility of a randomized controlled pilot study with lifestyle-promoting text messages as a treatment for hypertension in primary care.DesignRandomized controlled pilot trial.SettingThree primary health care centers in southern Sweden.SubjectsSixty patients aged 40-80 years with hypertension were included.Main outcome measuresFeasibility of the pilot study, i.e. recruitment rate, dropout rate and eligibility criteria. Secondary outcomes were change in blood pressure and other cardiovascular risk factors.MethodsThirty participants were randomized to the intervention group with four lifestyle-promoting text messages sent every week for six months. The control group received usual care. The baseline and follow-up visits for all 60 patients included measurements of blood pressure, anthropometrics, blood tests and a self-reported questionnaire.ResultsAll feasibility criteria (recruitment rate (≥55%), dropout rate (≤15%) and eligibility (60 eligible patients during the four-month inclusion period) for the pilot study were fulfilled. This means that a larger study with a similar design may be conducted. After six months, there were no significant improvements in cardiovascular risk factors. However, we found favorable trends for all secondary outcomes in the intervention group as compared to the control group.ConclusionLifestyle modification in patients with hypertension is important to reduce cardiovascular risk. However, primary healthcare has limited resources to work with modifying lifestyle habits. This is the first pilot study to test the feasibility of text message-based lifestyle intervention in patients with hypertension in Swedish primary healthcare. Whether significant improvement in cardiovascular risk factors may be achieved in a larger study population remains to be evaluated. Key points This pilot randomized controlled trial (RCT) is the first study to evaluate the feasibility of text message-based lifestyle advice to patients with hypertension in Swedish primary healthcare. •All feasibility criteria for the pilot study were fulfilled. This outcome means that a larger study with a similar design may be conducted. •The study was not powered to find significant changes in cardiovascular risk factors. Nevertheless, after six months we found favorable trends for all secondary outcomes in the intervention group compared to control. •If a future larger study can show significant results, this intervention could serve as a useful tool in everyday primary healthcare.

Project description:Introduction: Exercise and consumption of dairy foods have been shown to improve bone mineralization. However, little is known about the magnitude and timing of their synergistic effects on markers and regulators of bone metabolism in response to acute exercise in adolescent females with obesity, a population susceptible to altered bone metabolism and mineral properties. This study examined the influence of twelve weeks of exercise training and nutritional counselling on the bone biochemical marker response to acute exercise and whether higher dairy consumption could further influence the response. Methods: Thirty adolescent females (14.3 ± 2.0 years) with overweight/obesity (OW/OB) completed a 12-week lifestyle modification intervention involving exercise training and nutritional counselling. Participants were randomized into two groups: higher dairy intake (RDa; 4 servings/day; n = 14) or low dairy intake (LDa; 0-2 servings/d; n = 16). Participants performed one bout of plyometric exercise (5 circuits; 120 jumps) both pre- and post-intervention. Blood samples were taken at rest, 5 min and 1 h post-exercise. Serum sclerostin, osteocalcin (OC), osteoprotegerin (OPG), receptor activator nuclear factor kappa B ligand (RANKL), and C-terminal telopeptide of type 1 collagen (βCTX) concentrations were measured. Results: While there was an overall increase in sclerostin pre-intervention from pre to 5 min post-exercise (+11% p = 0.04), this response was significantly decreased post-intervention (-25%, p = 0.03) independent of dairy intake. The OPG:RANKL ratio was unresponsive to acute exercise pre-intervention but increased 1 h post-exercise (+2.6 AU; p < 0.001) post-intervention. Dairy intake did not further influence these absolute responses. However, after the 12-week intervention, the RDa group showed a decrease in the relative RANKL post-exercise response (-21.9%; p < 0.01), leading to a consistent increase in the relative OPG:RANKL ratio response, which was not the case in the LDa group. There was no influence of the intervention or dairy product intake on OC, OPG, or βCTX responses to acute exercise (p > 0.05). Conclusion: A lifestyle modification intervention involving exercise training blunts the increase in sclerostin and can augment the increase in OPG:RANKL ratio to acute exercise in adolescent females with OW/OB, while dairy product consumption did not further influence these responses.

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A primary care-based, multicomponent lifestyle intervention for overweight adolescent females.

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A primary care-based, multicomponent lifestyle intervention for overweight adolescent females.

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