Text messaging and brief phone calls for weight loss in overweight and obese English- and Spanish-speaking adults: A 1-year, parallel-group, randomized controlled trial.

BACKGROUND: Weight loss interventions based solely on text messaging (short message service [SMS]) have been shown to be modestly effective for short periods of time and in some populations, but limited evidence is available for positive longer-term outcomes and for efficacy in Hispanic populations. Also, little is known about the comparative efficacy of weight loss interventions that use SMS coupled with brief, technology-mediated contact with health coaches, an important issue when considering the scalability and cost of interventions. We examined the efficacy of a 1-year intervention designed to reduce weight among overweight and obese English- and Spanish-speaking adults via SMS alone (ConTxt) or in combination with brief, monthly health-coaching calls. ConTxt offered 2-4 SMS/day that were personalized, tailored, and interactive. Content was theory- and evidence-based and focused on reducing energy intake and increasing energy expenditure. Monthly health-coaching calls (5-10 minutes' duration) focused on goal-setting, identifying barriers to achieving goals, and self-monitoring. METHODS AND FINDINGS: English- and Spanish-speaking adults were recruited from October 2011 to March 2013. A total of 298 overweight (body mass index [BMI] 27.0 to 39.9 kg/m2) adults (aged 21-60 years; 77% female; 41% Hispanic; 21% primarily Spanish speaking; 44% college graduates or higher; 22% unemployed) were randomly assigned (1:1) to receive either ConTxt only (n = 101), ConTxt plus health-coaching calls (n = 96), or standard print materials on weight reduction (control group, n = 101). We used computer-based permuted-block randomization with block sizes of three or six, stratified by sex and Spanish-speaking status. Participants, study staff, and investigators were masked until the intervention was assigned. The primary outcome was objectively measured percent of weight loss from baseline at 12 months. Differences between groups were evaluated using linear mixed-effects regression within an intention-to-treat framework. A total of 261 (87.2%) and 253 (84.9%) participants completed 6- and 12-month visits, respectively. Loss to follow-up did not differ by study group. Mean (95% confidence intervals [CIs]) percent weight loss at 12 months was -0.61 (-1.99 to 0.77) in the control group, -1.68 (-3.08 to -0.27) in ConTxt only, and -3.63 (-5.05 to -2.81) in ConTxt plus health-coaching calls. At 12 months, mean (95% CI) percent weight loss, adjusted for baseline BMI, was significantly different between ConTxt plus health-coaching calls and the control group (-3.0 [-4.99 to -1.04], p = 0.003) but not between the ConTxt-only and the control group (-1.07 [-3.05 to 0.92], p = 0.291). Differences between ConTxt plus health-coaching calls and ConTxt only were not significant (-1.95 [-3.96 to 0.06], p = 0.057). These findings were consistent across other weight-related secondary outcomes, including changes in absolute weight, BMI, and percent body fat at 12 months. Exploratory subgroup analyses suggested that Spanish speakers responded more favorably to ConTxt plus health-coaching calls than English speakers (Spanish contrast: -7.90 [-11.94 to -3.86], p < 0.001; English contrast: -1.82 [-4.03 to 0.39], p = 0.107). Limitations include the unblinded delivery of the intervention and recruitment of a predominantly female sample from a single site. CONCLUSIONS: A 1-year intervention that delivered theory- and evidence-based weight loss content via daily personalized, tailored, and interactive SMS was most effective when combined with brief, monthly phone calls. TRIAL REGISTRATION: ClinicalTrials.gov NCT01171586.

Assessment of the Effects of 6 Standard Rodent Diets on Binge-Like and Voluntary Ethanol Consumption in Male C57BL/6J Mice.

BACKGROUND: In recent years, much attention has been given to the lack of reproducibility in biomedical research, particularly in preclinical animal studies. This is a problem that also plagues the alcohol research field, particularly in consistent consumption in animal models of alcohol use disorders. One often overlooked factor that could affect reproducibility is the maintenance diet used in preclinical studies. METHODS: Herein, 2 well-established models of alcohol consumption, the "drinking in the dark" (DID) procedure and the continuous 2-bottle choice (C2BC) paradigm, were employed to determine the effects of diet on ethanol (EtOH) consumption. Male C57BL/6J mice were given 1 of 6 standard rodent chow diets obtained from Purina LabDiet(®) , Inc. (Prolab(®) RMH 3000) or Harlan(®) Laboratories, Inc. (Teklad Diets T.2916, T.2918, T.2920X, T.7912, or T.8940). A separate group of animals were used to test dietary effects on EtOH pharmacokinetics and behavioral measures following intraperitoneal (IP) injections of various doses of EtOH. RESULTS: Mice eating Harlan diets T.2916 (H2916) and T.2920X (H2920) consumed significantly less EtOH and exhibited lower blood EtOH concentrations (BECs) during DID; however, during C2BC, animals maintained on Harlan T.7912 (H7912) consumed more EtOH and had a higher EtOH preference than the other diet groups. EtOH consumption levels did not stem from changes in alcohol pharmacokinetics, as a separate group of animals administered EtOH IP showed no difference in BECs. However, animals on Harlan diet T.2920X (H2920) were more sensitive to alcohol-induced locomotor activity in an open-field task. No diet-dependent differences were seen in alcohol-induced sedation as measured with loss of righting reflex. CONCLUSIONS: Although these data do not identify a specific mechanism, together, they clearly show that the maintenance diet impacts EtOH consumption. It is incumbent upon the research community to consider the importance of describing nutritional information in methods, which may help decrease interlaboratory reproducibility issues.

Patterns of Weekday and Weekend Sedentary Behavior Among Older Adults.

The purpose of this study was to compare estimates of sedentary time on weekdays vs. weekend days in older adults and determine if these patterns vary by measurement method. Older adults (N = 230, M = 83.5, SD = 6.5 years) living in retirement communities completed a questionnaire about sedentary behavior and wore an ActiGraph accelerometer for seven days. Participants engaged in 9.4 (SD = 1.5) hr per day of accelerometer-measured sedentary time, but self-reported engaging in 11.4 (SD = 4.9) hr per day. Men and older participants had more accelerometer-measured sedentary time than their counterparts. The difference between accelerometer-measured weekday and weekend sedentary time was nonsignificant. However, participants self-reported 1.1 hr per day more sedentary time on weekdays compared with weekend days. Findings suggest self-reported but not accelerometer-measured sedentary time should be investigated separately for weekdays and weekend days, and that self-reports may overestimate sedentary time in older adults.

Are health behavior change interventions that use online social networks effective? A systematic review.

BACKGROUND: The dramatic growth of Web 2.0 technologies and online social networks offers immense potential for the delivery of health behavior change campaigns. However, it is currently unclear how online social networks may best be harnessed to achieve health behavior change. OBJECTIVE: The intent of the study was to systematically review the current level of evidence regarding the effectiveness of online social network health behavior interventions. METHODS: Eight databases (Scopus, CINAHL, Medline, ProQuest, EMBASE, PsycINFO, Cochrane, Web of Science and Communication & Mass Media Complete) were searched from 2000 to present using a comprehensive search strategy. Study eligibility criteria were based on the PICOS format, where "population" included child or adult populations, including healthy and disease populations; "intervention" involved behavior change interventions targeting key modifiable health behaviors (tobacco and alcohol consumption, dietary intake, physical activity, and sedentary behavior) delivered either wholly or in part using online social networks; "comparator" was either a control group or within subject in the case of pre-post study designs; "outcomes" included health behavior change and closely related variables (such as theorized mediators of health behavior change, eg, self-efficacy); and "study design" included experimental studies reported in full-length peer-reviewed sources. Reports of intervention effectiveness were summarized and effect sizes (Cohen's d and 95% confidence intervals) were calculated wherever possible. Attrition (percentage of people who completed the study), engagement (actual usage), and fidelity (actual usage/intended usage) with the social networking component of the interventions were scrutinized. RESULTS: A total of 2040 studies were identified from the database searches following removal of duplicates, of which 10 met inclusion criteria. The studies involved a total of 113,988 participants (ranging from n=10 to n=107,907). Interventions included commercial online health social network websites (n=2), research health social network websites (n=3), and multi-component interventions delivered in part via pre-existing popular online social network websites (Facebook n=4 and Twitter n=1). Nine of the 10 included studies reported significant improvements in some aspect of health behavior change or outcomes related to behavior change. Effect sizes for behavior change ranged widely from -0.05 (95% CI 0.45-0.35) to 0.84 (95% CI 0.49-1.19), but in general were small in magnitude and statistically non-significant. Participant attrition ranged from 0-84%. Engagement and fidelity were relatively low, with most studies achieving 5-15% fidelity (with one exception, which achieved 105% fidelity). CONCLUSIONS: To date there is very modest evidence that interventions incorporating online social networks may be effective; however, this field of research is in its infancy. Further research is needed to determine how to maximize retention and engagement, whether behavior change can be sustained in the longer term, and to determine how to exploit online social networks to achieve mass dissemination. Specific recommendations for future research are provided.

Click "like" to change your behavior: a mixed methods study of college students' exposure to and engagement with Facebook content designed for weight loss.

BACKGROUND: Overweight or obesity is prevalent among college students and many gain weight during this time. Traditional face-to-face weight loss interventions have not worked well in this population. Facebook is an attractive tool for delivering weight loss interventions for college students because of its popularity, potential to deliver strategies found in successful weight loss interventions, and ability to support ongoing adaptation of intervention content. OBJECTIVE: The objective of this study was to describe participant exposure to a Facebook page designed to deliver content to overweight/obese college students in a weight loss randomized controlled trial (N=404) and examine participant engagement with behavior change campaigns for weight loss delivered via Facebook. METHODS: The basis of the intervention campaign model were 5 self-regulatory techniques: intention formation, action planning, feedback, goal review, and self-monitoring. Participants were encouraged to engage their existing social network to meet their weight loss goals. A health coach moderated the page and modified content based on usage patterns and user feedback. Quantitative analyses were conducted at the Facebook post- and participant-level of analysis. Participant engagement was quantified by Facebook post type (eg, status update) and interaction (eg, like) and stratified by weight loss campaign (sequenced vs nonsequenced). A subset of participants were interviewed to evaluate the presence of passive online engagement or "lurking." RESULTS: The health coach posted 1816 unique messages to the study's Facebook page over 21 months, averaging 3.45 posts per day (SD 1.96, range 1-13). In all, 72.96% (1325/1816) of the posts were interacted with at least once (eg, liked). Of these, approximately 24.75% (328/1325) had 1-2 interactions, 23.39% (310/1325) had 3-5 interactions, 25.13% (333/1325) had 6-8 interactions, and 41 posts had 20 or more interactions (3.09%, 41/1325). There was significant variability among quantifiable (ie, visible) engagement. Of 199 participants in the final intervention sample, 32 (16.1%) were highly active users and 62 (31.2%) never visibly engaged with the intervention on Facebook. Polls were the most popular type of post followed by photos, with 97.5% (79/81) and 80.3% (386/481) interacted with at least once. Participants visibly engaged less with posts over time (partial r=-.33; P<.001). Approximately 40% of the participants interviewed (12/29, 41%) reported passively engaging with the Facebook posts by reading but not visibly interacting with them. CONCLUSIONS: Facebook can be used to remotely deliver weight loss intervention content to college students with the help of a health coach who can iteratively tailor content and interact with participants. However, visible engagement with the study's Facebook page was highly variable and declined over time. Whether the level of observed engagement is meaningful in terms of influencing changes in weight behaviors and outcomes will be evaluated at the completion of the overall study.

Shadows of quantum machine learning.

Quantum machine learning is often highlighted as one of the most promising practical applications for which quantum computers could provide a computational advantage. However, a major obstacle to the widespread use of quantum machine learning models in practice is that these models, even once trained, still require access to a quantum computer in order to be evaluated on new data. To solve this issue, we introduce a class of quantum models where quantum resources are only required during training, while the deployment of the trained model is classical. Specifically, the training phase of our models ends with the generation of a 'shadow model' from which the classical deployment becomes possible. We prove that: (i) this class of models is universal for classically-deployed quantum machine learning; (ii) it does have restricted learning capacities compared to 'fully quantum' models, but nonetheless (iii) it achieves a provable learning advantage over fully classical learners, contingent on widely believed assumptions in complexity theory. These results provide compelling evidence that quantum machine learning can confer learning advantages across a substantially broader range of scenarios, where quantum computers are exclusively employed during the training phase. By enabling classical deployment, our approach facilitates the implementation of quantum machine learning models in various practical contexts.

Using wearable cameras to categorise type and context of accelerometer-identified episodes of physical activity.

BACKGROUND: Accelerometers can identify certain physical activity behaviours, but not the context in which they take place. This study investigates the feasibility of wearable cameras to objectively categorise the behaviour type and context of participants' accelerometer-identified episodes of activity. METHODS: Adults were given an Actical hip-mounted accelerometer and a SenseCam wearable camera (worn via lanyard). The onboard clocks on both devices were time-synchronised. Participants engaged in free-living activities for 3 days. Actical data were cleaned and episodes of sedentary, lifestyle-light, lifestyle-moderate, and moderate-to-vigorous physical activity (MVPA) were identified. Actical episodes were categorised according to their social and environmental context and Physical Activity (PA) compendium category as identified from time-matched SenseCam images. RESULTS: There were 212 days considered from 49 participants from whom SenseCam images and associated Actical data were captured. Using SenseCam images, behaviour type and context attributes were annotated for 386 (out of 3017) randomly selected episodes (such as walking/transportation, social/not-social, domestic/leisure). Across the episodes, 12 categories that aligned with the PA Compendium were identified, and 114 subcategory types were identified. Nineteen percent of episodes could not have their behaviour type and context categorized; 59% were outdoors versus 39% indoors; 33% of episodes were recorded as leisure time activities, with 33% transport, 18% domestic, and 15% occupational. 33% of the randomly selected episodes contained direct social interaction and 22% were in social situations where the participant wasn't involved in direct engagement. CONCLUSION: Wearable camera images offer an objective method to capture a spectrum of activity behaviour types and context across 81% of accelerometer-identified episodes of activity. Wearable cameras represent the best objective method currently available to categorise the social and environmental context of accelerometer-defined episodes of activity in free-living conditions.

Fruit and vegetable intake and eating behaviors mediate the effect of a randomized text-message based weight loss program.

INTRODUCTION: We hypothesized that fruit/vegetable intake and eating behaviors mediate the relationship between experimental condition and weight loss in a randomized trial evaluating a text-message based weight loss program. METHODS: Overweight/obese individuals from San Diego, CA (N = 52 with complete data) were randomly assigned in 2007 into one of two groups for four months: 1) the intervention group that received 2-5 weight management text-messages p/day; 2) the usual-care comparison group. Three 24-hour recalls assessed fruit/vegetable intake change and the eating behavior inventory (EBI) measured change in eating behaviors. Regression path models tested intervention mediation. RESULTS: Direct effects of the intervention were found for change in body weight (b = -3.84, R(2) = 0.074), fruit/vegetable intake (b = 2.00, R(2) = 0.083), and EBI scores (b = 7.15, R(2) = 0.229) (ps < 0.05). The treatment group to weight change path was not statistically significant (b = -0.673, R(2) = 0.208) when fruit/vegetable intake change and EBI score change were specified as intervention mediators in the model. The total indirect effect was 3.17 lb indicating that the indirect paths explained 82.6% of the total effect on weight change. DISCUSSION: Fruit/vegetable intake and eating behaviors mediated the intervention's effect on weight change. The findings suggest that sending text-messages that promote healthy eating strategies resulted in moderate short-term weight loss.

Utility of passive photography to objectively audit built environment features of active transport journeys: an observational study.

BACKGROUND: Active transport can contribute to physical activity accumulation and improved health in adults. The built environment is an established associate of active transport behaviours; however, assessment of environmental features encountered during journeys remains challenging. The purpose of this study was to examine the utility of wearable cameras to objectively audit and quantify environmental features along work-related walking and cycling routes. METHODS: A convenience sample of employed adults was recruited in New Zealand, in June 2011. Participants wore a SenseCam for all journeys over three weekdays and completed travel diaries and demographic questionnaires. SenseCam images for work-related active transport journeys were coded for presence of environmental features hypothesised to be related to active transport. Differences in presence of features by transport mode and in participant-reported and SenseCam-derived journey duration were determined using two-sample tests of proportion and an independent samples t-test, respectively. RESULTS: Fifteen adults participated in the study, yielding 1749 SenseCam images from 30 work-related active transport journeys for coding. Significant differences in presence of features were found between walking and cycling journeys. Almost a quarter of images were uncodeable due to being too dark to determine features. There was a non-significant tendency for respondents to under-report their journey duration. CONCLUSION: This study provides proof of concept for the use of the SenseCam to capture built environment data in real time that may be related to active transportation. Further work is required to test and refine coding methodologies across a range of settings, travel behaviours, and demographic groups.

Is television viewing a suitable marker of sedentary behavior in young people?

BACKGROUND: Television (TV) viewing is a highly prevalent sedentary behavior in young people and has played a significant role in the assessment of sedentary behaviors. An important question to be addressed is to what extent TV viewing is a suitable indicator, or marker, of overall levels of sedentary behavior in children and adolescents. This has not yet been attempted in youth, but has already been attempted in Australian adults. PURPOSE: This study was conducted to test whether TV viewing in UK teenagers is a marker of sedentary behavior more broadly and to see if the results mirror those of Australian adults. METHODS: Ecological momentary assessment time-use diaries were completed by 561 boys and 923 girls (mean age 14.67 years) in which weekday and weekend out-of-school time behaviors were recorded every 15 min. RESULTS: TV viewing was negatively associated with other leisure-time sedentary behaviors for both boys and girls for weekdays and weekends. Higher levels of TV viewing were associated with less time in other key sedentary behaviors, such as computer use in boys and motorized transport in girls. CONCLUSIONS: TV viewing appears not to reflect additional time in other sedentary behaviors in British teenagers, in contrast to data from Australian women. Studies of sedentary behavior should encompass as wide a range of behaviors as possible.

Family circumstance, sedentary behaviour and physical activity in adolescents living in England: Project STIL.

BACKGROUND: Identification of non-modifiable correlates of physical activity and sedentary behaviour in youth contributes to the development of effective targeted intervention strategies. The purpose of this research was to examine the relationships between family circumstances (e.g. socio-economic status, single vs. dual parent household, presence/absence of siblings) and leisure-time physical activity and sedentary behaviours in adolescents. METHODS: A total of 1171 adolescents (40% male; mean age 14.8 years) completed ecological momentary assessment diaries every 15 minutes for 3 weekdays outside of school hours and 1 weekend day. Analysed behaviours were sports/exercise, active travel, TV viewing, computer use, sedentary socialising (hanging-out, using the telephone, sitting and talking) and total sedentary behaviour. Linear regression was employed to estimate levels of association between individual family circumstance variables and each behaviour. RESULTS: Compared to girls from higher socioeconomic status (SES) groups, girls from low SES groups reported higher weekend TV viewing and higher weekday total sedentary behaviour. For boys, single parent status was associated with greater total sedentary behaviour compared to those from dual parent households. Boys and girls from low socio-economic neighbourhoods reported lower participation in sports/exercise compared to those living in higher socio-economic neighbourhoods. CONCLUSION: Associations were not consistent across behaviours or between genders. Overall, findings indicate that boys from single parent households and girls from low socio-economic families may be at increased risk of high sedentary behaviour. Those living in low socioeconomic neighbourhoods may be at increased risk of reduced participation in sports and exercise.

The prevalence of sedentary behavior and physical activity in leisure time: A study of Scottish adolescents using ecological momentary assessment.

OBJECTIVE: To report time and prevalence of leisure time sedentary and active behaviors in adolescents. METHOD: Cross-sectional, stratified, random sample from schools in 14 districts in Scotland, 2002-03, using ecological momentary assessment (n=385 boys, 606 girls; mean age 14.1 years; range 12.6-16.7 years). This is a method of capturing current behavioral episodes. We used 15 min time intervals. RESULTS: Television viewing occupied the most leisure time. The five most time consuming sedentary activities occupied 228 min per weekday and 396 min per weekend day for boys, and 244 min per weekday and 400 min per weekend day for girls, with TV occupying one-third to one-half of this time. In contrast, 62 min was occupied by active transport and sports/exercise per weekday and 91 min per weekend day for boys, with 55 min per weekday and 47 min per weekend day for girls. A minority watched more than 4 h of TV per day, with more at weekends. Other main sedentary behaviors for boys were homework, playing computer/video games, and motorised transport and, for girls, homework, motorised transport, and sitting and talking. CONCLUSION: Scottish adolescents engage in a variety of sedentary and active behaviors. Research into sedentary behavior must assess multiple behaviors and not rely solely on TV viewing.

Temporal and environmental patterns of sedentary and active behaviors during adolescents' leisure time.

BACKGROUND: There is great interest in young people's overweight and obesity. Few data, however, describe when sedentary and physically active behaviors are likely to occur during the day or how these behaviors are related to location. PURPOSE: The purpose of this study was to describe sedentary and active leisure-time behaviors of adolescents across the day and setting. METHOD: Adolescents (male n = 579, female n = 967; aged 13-16 years) completed time-use diaries for three weekdays and one weekend day. At 15 min intervals, participants recorded what they were doing and where they were. RESULTS: TV viewing and sports/exercise peaked at different times in the day, although TV viewing was two to three times more likely to occur than sports/exercise. TV viewing was most likely to occur during the middle to late evening. The playing of computer games was low, particularly for girls. Weekend data showed TV viewing was the most reported activity throughout the day. For boys, "being in the garden" was highly predictive of engaging in sports/exercise, but this declined rapidly with age. Motorized travel to school was reported twice as often as active travel. CONCLUSION: Momentary assessments of behavior, in conjunction with contemporaneous reports of environmental factors, describe important patterns of leisure-time active and sedentary behaviors in youth.

Race/ethnicity, social class, and leisure-time physical inactivity.

PURPOSE: The aims of this study were to determine 1) prevalence of leisure-time physical inactivity in a nationally representative sample of non-Hispanic white, non-Hispanic black, and Hispanic men and women; 2) prevalence of leisure-time inactivity by racial/ethnic group across social class indicators; and 3) the relationship between leisure-time inactivity and occupational physical activity, independent of other social class indicators. METHODS: The National Physical Activity and Weight Loss Survey was a telephone survey of noninstitutionalized U.S. adults (4695 men, 6516 women) conducted by random digit dialing between September and December 2002. Self-reported physical activity was assessed using questions from the 2001 Behavioral Risk Factor Surveillance System. Respondents who reported no moderate- or vigorous-intensity physical activity during leisure time in a usual week were classified as inactive. Indicators of social class were education, family income, employment status, and marital status. RESULTS: Age-adjusted prevalence of leisure-time inactivity was 9.9% +/- 0.6 SE (standard error) and 12.0 +/- 0.6 for white men and women, respectively; 19.0 +/- 2.5 and 25.2 +/- 2.1 for non-Hispanic black men and women, and 20.9 +/- 2.1 and 27.3 +/- 2.5 for Hispanic men and women. Within each racial/ethnic group, prevalence of leisure-time inactivity was highest among participants of lower social class. Differences in inactivity by racial/ethnic group were less evident after adjustment for social class. Odds of inactivity were similar across quartiles of occupational physical activity after adjustment for age, sex, and social class. CONCLUSIONS: Non-Hispanic blacks and Hispanics were more inactive during their leisure time than were non-Hispanic whites. Social class but not occupational physical activity seems to moderate the relationship between race/ethnicity and leisure-time physical inactivity.

Medical evacuations in the oil and gas industry: a retrospective review with implications for future evacuation and preventative strategies.

Background: Businesses increasingly conduct operations in remote areas where medical evacuation [Medevac(s)] carries more risk. Royal Dutch Shell developed a remote healthcare strategy whereby enhanced remote healthcare is made available to the patient through use of telemedicine and telemetry. To evaluate that strategy, a review of Medevacs of Shell International employees [i.e. expatriate employees (EEs) and frequent business travellers (FBTs)] was undertaken. Method: A retrospective review of Medevac data (period 2008-12) that were similar in operational constraints and population profile was conducted. Employee records and Human Resource data were used as a denominator for the population. Analogous Medevac data from specific locations were used to compare patterns of diagnoses. Results: A total of 130 Medevacs were conducted during the study period, resulting in a Medevac rate of 4 per 1000 of population with 16 per 1000 for females and 3 per 1000 for males, respectively. The youngest and oldest age-groups required Medevacs in larger proportions. The evacuation rates were highest for countries classified as 'high' or 'extreme risk'. The most frequent diagnostic categories for Medevac were: trauma, digestive, musculoskeletal, cardiac and neurological. In 9% of the total, a strong to moderate link could be made between the pre-existing medical condition and diagnosis leading to Medevac. Conclusion: This study uniquely provides a benchmark Medevac rate (4 per 1000) for EEs and FBTs and demonstrates that Medevac rates are highest from countries identified as 'high risk'; there is an age and gender bias, and pre-existing medical conditions are of notable relevance. It confirms a change in the trend from injury to illness as a reason for Medevac in the oil and gas industry and demonstrates that diagnoses of a digestive and traumatic nature are the most frequent. A holistic approach to health (as opposed to a predominant focus on fitness to work), more attention to female travellers, and the application of modern technology and communication will reduce the need for Medevacs.

Tackling the obesity pandemic: a call for sedentary behaviour research.

An emerging threat to public health is seen in the dramatic rise in obesity status of Canadians, especially among young people. In addressing the possible factors responsible for these dramatic increases, this paper outlines the importance of understanding sedentariness as an important health behaviour, distinct from physical activity, and identifying the modifiable determinants of sedentary behaviours.

Prior Binge Ethanol Exposure Potentiates the Microglial Response in a Model of Alcohol-Induced Neurodegeneration.

Excessive alcohol consumption results in neurodegeneration which some hypothesize is caused by neuroinflammation. One characteristic of neuroinflammation is microglial activation, but it is now well accepted that microglial activation may be pro- or anti-inflammatory. Recent work indicates that the Majchrowicz model of alcohol-induced neurodegeneration results in anti-inflammatory microglia, while intermittent exposure models with lower doses and blood alcohol levels produce microglia with a pro-inflammatory phenotype. To determine the effect of a repeated binge alcohol exposure, rats received two cycles of the four-day Majchrowicz model. One hemisphere was then used to assess microglia via immunohistochemistry and while the other was used for ELISAs of cytokines and growth factors. A single binge ethanol exposure resulted in low-level of microglial activation; however, a second binge potentiated the microglial response. Specifically, double binge rats had greater OX-42 immunoreactivity, increased ionized calcium-binding adapter molecule 1 (Iba-1+) cells, and upregulated tumor necrosis factor-α (TNF-α) compared with the single binge ethanol group. These data indicate that prior ethanol exposure potentiates a subsequent microglia response, which suggests that the initial exposure to alcohol primes microglia. In summary, repeated ethanol exposure, independent of other immune modulatory events, potentiates microglial activity.

The Role of Stress in Understanding Differences in Sedentary Behavior in Hispanic/Latino Adults: Results From the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study.

BACKGROUND: Chronic stress and/or lifetime traumatic stress can create a self-reinforcing cycle of unhealthy behaviors, such as overeating and sedentary behavior, that can lead to further increases in stress. This study examined the relationship between stress and sedentary behavior in a sample of Hispanic/Latino adults (N = 4244) from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. METHODS: Stress was measured as the number of ongoing difficulties lasting 6 months or more and as lifetime exposure to traumatic events. Sedentary behavior was measured by self-report and with accelerometer. Multivariable regression models examined associations of stress measures with time spent in sedentary behaviors adjusting by potential confounders. RESULTS: Those who reported more than one chronic stressor spent, on average, 8 to 10 additional minutes per day in objectively measured sedentary activities (P < .05), whereas those with more than one lifetime traumatic stressor spent (after we adjusted for confounders) 10 to 14 additional minutes in sedentary activities (P < .01) compared with those who did not report any stressors. Statistical interactions between the 2 stress measures and age or sex were not significant. CONCLUSION: Interventions aimed at reducing sedentary behaviors might consider incorporating stress reduction into their approaches.

Using social and mobile tools for weight loss in overweight and obese young adults (Project SMART): a 2 year, parallel-group, randomised, controlled trial.

BACKGROUND: Few weight loss interventions are evaluated for longer than a year, and even fewer employ social and mobile technologies commonly used among young adults. We assessed the efficacy of a 2 year, theory-based, weight loss intervention that was remotely and adaptively delivered via integrated user experiences with Facebook, mobile apps, text messaging, emails, a website, and technology-mediated communication with a health coach (the SMART intervention). METHODS: In this parallel-group, randomised, controlled trial, we enrolled overweight or obese college students (aged 18-35 years) from three universities in San Diego, CA, USA. Participants were randomly assigned (1:1) to receive either the intervention (SMART intervention group) or general information about health and wellness (control group). We used computer-based permuted-block randomisation with block sizes of four, stratified by sex, ethnicity, and college. Participants, study staff, and investigators were masked until the intervention was assigned. The primary outcome was objectively measured weight in kg at 24 months. Differences between groups were evaluated using linear mixed-effects regression within an intention-to-treat framework. Objectively measured weight at 6, 12, and 18 months was included as a secondary outcome. The trial is registered with ClinicalTrials.gov, number NCT01200459. FINDINGS: Between May 18, 2011, and May 17, 2012, 404 individuals were randomly assigned to the intervention (n=202) or control (n=202). Participants' mean (SD) age was 22·7 (3·8) years. 284 (70%) participants were female and 125 (31%) were Hispanic. Mean (SD) body-mass index at baseline was 29·0 (2·8) kg/m(2). At 24 months, weight was assessed in 341 (84%) participants, but all 404 were included in analyses. Weight, adjusted for sex, ethnicity, and college, was not significantly different between the groups at 24 months (-0·79 kg [95% CI -2·02 to 0·43], p=0·204). However, weight was significantly less in the intervention group compared with the control group at 6 months (-1·33 kg [95% CI -2·36 to -0·30], p=0·011) and 12 months (-1·33 kg [-2·30 to -0·35], p=0·008), but not 18 months (-0·67 kg [95% CI -1·69 to 0·35], p=0·200). One serious adverse event in the intervention group (gallstones) could be attributable to rapid and excessive weight loss. INTERPRETATION: Social and mobile technologies did not facilitate sustained reductions in weight among young adults, although these approaches might facilitate limited short-term weight loss. FUNDING: The National Heart, Lung, and Blood Institute of the National Institutes of Health (U01 HL096715).

Accelerometer adherence and performance in a cohort study of US Hispanic adults.

PURPOSE: This study described participant adherence to wearing the accelerometer and accelerometer performance in a cohort study of adults. METHODS: From 2008 to 2011, 16,415 US Hispanic/Latino adults age 18-74 yr enrolled in the Hispanic Community Health Study/Study of Latinos. Immediately after the baseline visit, participants wore an Actical accelerometer for 1 wk. This study explored correlates of accelerometer participation and adherence, defined as wearing it for at least three of a possible six days for ≥10 h·d. Accelerometer performance was assessed by exploring the number of different values of accelerometer counts per minute for each participant. RESULTS: Overall, 92.3% (n = 15,153) had at least 1 d with accelerometer data and 77.7% (n = 12,750) were adherent. Both accelerometer participation and adherence were higher among participants who were married or partnered, reported a higher household income, were first-generation immigrants, or reported lower sitting time. Participation was also higher among those with no stair limitations. Adherence was higher among participants who were male, older, employed or retired, not US born, preferred Spanish over English, reported higher work activity or lower recreational activity, and with a lower body mass index. Among the sample that met the adherence definition, the maximum recorded count per minute was 12,000, and there were a total of 5846 different counts per minute. On average, participants had 112.5 different counts per minute over 6 d (median, 106; interquartile range, 91-122). The number of different counts per minute was higher among men, younger ages, normal weight, and those with higher accelerometer-assessed physical activity. CONCLUSION: Several correlates differed between accelerometer participation and adherence. These characteristics could be targeted in future studies to improve accelerometer wear. The performance of the accelerometer provided insight into creating a more accurate nonwear algorithm.