Empowerment for behaviour change through social connections: a qualitative exploration of women's preferences in preconception health promotion in the state of Victoria, Australia.

BACKGROUND: Health behaviours in the preconception period have the potential to impact on fertility and pregnancy outcomes, and the health of all women regardless of pregnancy intention. Public awareness of this is low and interventions that promote behaviour change have not been integrated into real-world settings. Aims were to explore women's understandings of health and health behaviours and what supports are important to promote behaviour change in the preconception period. METHODS: This qualitative study is the first phase of a broader co-design project set in the state of Victoria, Australia. Over 3 months, a series of in-depth interviews were conducted with female participants who were intending to become pregnant in the next 2 years (n = 6) and participants who were not intending to become pregnant in the next 2 years (n = 6). Community advisors (n = 8) aged 18-45 years provided feedback throughout the process. Coding of transcripts from interviews and meetings was undertaken by two researchers before a deductive process identified themes mapped to the COM-B framework. RESULTS: Nine themes and eight sub-themes were identified. Participants had a holistic view of health with nutrition, physical activity and sleep being most valued. Social connections were considered as being important for overall health and wellbeing and for promoting health behaviours. The only difference between groups was that pregnancy was an additional motivator for women who were planning to become pregnant in the next 2 years. A range of health information is available from health professionals and other sources. Unlimited access to information was empowering but sometimes overwhelming. Being listened to and shared experiences were aspects of social connections that validated participants and guided them in their decision-making. CONCLUSIONS: Women valued their health and had a holistic view that includes physical, mental and social dimensions. Women viewed social connections with others as an opportunity to be listened to and to gain support that empowers behaviour change. Future interventions to promote behaviour change in preconception women should consider the importance all women placed on social connections and leverage off existing resources to connect women.

Deep learning-based automated speech detection as a marker of social functioning in late-life depression.

BACKGROUND: Late-life depression (LLD) is associated with poor social functioning. However, previous research uses bias-prone self-report scales to measure social functioning and a more objective measure is lacking. We tested a novel wearable device to measure speech that participants encounter as an indicator of social interaction. METHODS: Twenty nine participants with LLD and 29 age-matched controls wore a wrist-worn device continuously for seven days, which recorded their acoustic environment. Acoustic data were automatically analysed using deep learning models that had been developed and validated on an independent speech dataset. Total speech activity and the proportion of speech produced by the device wearer were both detected whilst maintaining participants' privacy. Participants underwent a neuropsychological test battery and clinical and self-report scales to measure severity of depression, general and social functioning. RESULTS: Compared to controls, participants with LLD showed poorer self-reported social and general functioning. Total speech activity was much lower for participants with LLD than controls, with no overlap between groups. The proportion of speech produced by the participants was smaller for LLD than controls. In LLD, both speech measures correlated with attention and psychomotor speed performance but not with depression severity or self-reported social functioning. CONCLUSIONS: Using this device, LLD was associated with lower levels of speech than controls and speech activity was related to psychomotor retardation. We have demonstrated that speech activity measured by wearable technology differentiated LLD from controls with high precision and, in this study, provided an objective measure of an aspect of real-world social functioning in LLD.

Progressive 24-Hour Recall: Usability Study of Short Retention Intervals in Web-Based Dietary Assessment Surveys.

BACKGROUND: Under-reporting because of the limitations of human memory is one of the key challenges in dietary assessment surveys that use the multiple-pass 24-hour recall. Research indicates that shortening a retention interval (ie, the time between the eating event and recall) reduces the burden on memory and may increase the accuracy of the assessment. OBJECTIVE: This study aimed to explore the accuracy and acceptability of Web-based dietary assessment surveys based on a progressive recall, where a respondent is asked to record multiple recalls throughout a 24-hour period using the multiple-pass protocol and portion size estimation methods of the 24-hour recall. METHODS: The experiment was conducted with a dietary assessment system, Intake24, that typically implements the multiple-pass 24-hour recall method where respondents record all meals they had for the previous day on a single occasion. We modified the system to allow respondents to add multiple recalls throughout the day using the multiple-pass protocol and portion size estimation methods of the 24-hour recall (progressive recall). We conducted a dietary assessment survey with 33 participants, where they were asked to record dietary intake using both 24-hour and progressive recall methods for weekdays only. We compared mean retention intervals (ie, the time between eating event and recall) for the 2 methods. To examine accuracy, we compared mean energy estimates and the mean number of reported foods. Of these participants, 23 were interviewed to examine the acceptability of the progressive recall. RESULTS: Retention intervals were found to be, on average, 15.2 hours (SD 7.8) shorter during progressive recalls than those during 24-hour recalls. We found that the mean number of foods reported for evening meals for progressive recalls (5.2 foods) was significantly higher (P=.001) than that for 24-hour recalls (4.2 foods). The number of foods and the amount of energy reported for other meals remained similar across the 2 methods. In interviews, 65% (15/23) of participants said that the 24-hour recall is more convenient in terms of fitting in with their daily lifestyles, and 65% (15/23) of respondents indicated that they remembered meal content and portion sizes better with the progressive recall. CONCLUSIONS: The analysis of interviews and data from our study indicate that progressive recalls provide minor improvements to the accuracy of dietary assessment in Intake24. Additional work is needed to improve the acceptability of progressive recalls in this system.

Integrating Health Technologies in Health Services for Syrian Refugees in Lebanon: Qualitative Study.

BACKGROUND: Lebanon currently hosts around one million Syrian refugees. There has been an increasing interest in integrating eHealth and mHealth technologies into the provision of primary health care to refugees and Lebanese citizens. OBJECTIVE: We aimed to gain a deeper understanding of the potential for technology integration in primary health care provision in the context of the protracted Syrian refugee crisis in Lebanon. METHODS: A total of 17 face-to-face semistructured interviews were conducted with key informants (n=8) and health care providers (n=9) involved in the provision of health care to the Syrian refugee population in Lebanon. Interviews were audio recorded and directly translated and transcribed from Arabic to English. Thematic analysis was conducted. RESULTS: Study participants indicated that varying resources, primarily time and the availability of technologies at primary health care centers, were the main challenges for integrating technologies for the provision of health care services for refugees. This challenge is compounded by refugees being viewed by participants as a mobile population thus making primary health care centers less willing to invest in refugee health technologies. Lastly, participant views regarding the health and technology literacies of refugees varied and that was considered to be a challenge that needs to be addressed for the successful integration of refugee health technologies. CONCLUSIONS: Our findings indicate that in the context of integrating technology into the provision of health care for refugees in a low or middle income country such as Lebanon, some barriers for technology integration related to the availability of resources are similar to those found elsewhere. However, we identified participant views of refugees' health and technology literacies to be a challenge specific to the context of this refugee crisis. These challenges need to be addressed when considering refugee health technologies. This could be done by increasing the visibility of refugee capabilities and configuring refugee health technologies so that they may create spaces in which refugees are empowered within the health care system and can work toward debunking the views discovered in this study.

Behavioural intervention for weight loss maintenance versus standard weight advice in adults with obesity: A randomised controlled trial in the UK (NULevel Trial).

BACKGROUND: Scalable weight loss maintenance (WLM) interventions for adults with obesity are lacking but vital for the health and economic benefits of weight loss to be fully realised. We examined the effectiveness and cost-effectiveness of a low-intensity technology-mediated behavioural intervention to support WLM in adults with obesity after clinically significant weight loss (≥5%) compared to standard lifestyle advice. METHODS AND FINDINGS: The NULevel trial was an open-label randomised controlled superiority trial in 288 adults recruited April 2014 to May 2015 with weight loss of ≥5% within the previous 12 months, from a pre-weight loss BMI of ≥30 kg/m2. Participants were self-selected, and the majority self-certified previous weight loss. We used a web-based randomisation system to assign participants to either standard lifestyle advice via newsletter (control arm) or a technology-mediated low-intensity behavioural WLM programme (intervention arm). The intervention comprised a single face-to-face goal-setting meeting, self-monitoring, and remote feedback on weight, diet, and physical activity via links embedded in short message service (SMS). All participants were provided with wirelessly connected weighing scales, but only participants in the intervention arm were instructed to weigh themselves daily and told that they would receive feedback on their weight. After 12 months, we measured the primary outcome, weight (kilograms), as well as frequency of self-weighing, objective physical activity (via accelerometry), psychological variables, and cost-effectiveness. The study was powered to detect a between-group weight difference of ±2.5 kg at follow-up. Overall, 264 participants (92%) completed the trial. Mean weight gain from baseline to 12 months was 1.8 kg (95% CI 0.5-3.1) in the intervention group (n = 131) and 1.8 kg (95% CI 0.6-3.0) in the control group (n = 133). There was no evidence of an effect on weight at 12 months (difference in adjusted mean weight change from baseline: -0.07 [95% CI 1.7 to -1.9], p = 0.9). Intervention participants weighed themselves more frequently than control participants and were more physically active. Intervention participants reported greater satisfaction with weight outcomes, more planning for dietary and physical activity goals and for managing lapses, and greater confidence for healthy eating, weight loss, and WLM. Potential limitations, such as the use of connected weighing study in both trial arms, the absence of a measurement of energy intake, and the recruitment from one region of the United Kingdom, are discussed. CONCLUSIONS: There was no difference in the WLM of participants who received the NULevel intervention compared to participants who received standard lifestyle advice via newsletter. The intervention affected some, but not all, process-related secondary outcomes of the trial. TRIAL REGISTRATION: This trial is registered with the ISRCTN registry (ISRCTN 14657176; registration date 20 March 2014).

Estimating energy expenditure from wrist and thigh accelerometry in free-living adults: a doubly labelled water study.

BACKGROUND: Many large studies have implemented wrist or thigh accelerometry to capture physical activity, but the accuracy of these measurements to infer activity energy expenditure (AEE) and consequently total energy expenditure (TEE) has not been demonstrated. The purpose of this study was to assess the validity of acceleration intensity at wrist and thigh sites as estimates of AEE and TEE under free-living conditions using a gold-standard criterion. METHODS: Measurements for 193 UK adults (105 men, 88 women, aged 40-66 years, BMI 20.4-36.6 kg m-2) were collected with triaxial accelerometers worn on the dominant wrist, non-dominant wrist and thigh in free-living conditions for 9-14 days. In a subsample (50 men, 50 women) TEE was simultaneously assessed with doubly labelled water (DLW). AEE was estimated from non-dominant wrist using an established estimation model, and novel models were derived for dominant wrist and thigh in the non-DLW subsample. Agreement with both AEE and TEE from DLW was evaluated by mean bias, root mean squared error (RMSE), and Pearson correlation. RESULTS: Mean TEE and AEE derived from DLW were 11.6 (2.3) MJ day-1 and 49.8 (16.3) kJ day-1 kg-1. Dominant and non-dominant wrist acceleration were highly correlated in free-living (r = 0.93), but less so with thigh (r = 0.73 and 0.66, respectively). Estimates of AEE were 48.6 (11.8) kJ day-1 kg-1 from dominant wrist, 48.6 (12.3) from non-dominant wrist, and 46.0 (10.1) from thigh; these agreed strongly with AEE (RMSE ~12.2 kJ day-1 kg-1, r ~ 0.71) with small mean biases at the population level (~6%). Only the thigh estimate was statistically significantly different from the criterion. When combining these AEE estimates with estimated REE, agreement was stronger with the criterion (RMSE ~1.0 MJ day-1, r ~ 0.90). CONCLUSIONS: In UK adults, acceleration measured at either wrist or thigh can be used to estimate population levels of AEE and TEE in free-living conditions with high precision.

Feasibility of parent communication training with remote coaching using smartphone apps.

BACKGROUND: Communication training for parents of young children with neurodisability is often delivered in groups and includes video coaching. Group teaching is problematic when there is wide variation in the characteristics and needs amongst participants. AIMS: To assess the potential feasibility and acceptability of delivering one-to-one parent training supported by remote coaching using smartphone apps and of conducting further trials of the intervention. METHODS & PROCEDURES: We aimed to recruit eight children aged 12-48 months with motor disorders and communication difficulties and to provide families with individual parent training in six weekly home visits supplemented by remote coaching via smartphone apps. For outcome measurement, parents recorded their interaction with their child thrice weekly during baseline (3 weeks), intervention, post-intervention (3 weeks) and follow-up (1 week). Measures comprised parent responsiveness and counts of children's communication and vocalization. Research design feasibility was measured through rates of recruitment, attrition, outcome measure completion and agreement between raters on outcome measurement. Intervention feasibility was assessed through the proportion of therapy sessions received, the number of videos and text messages shared using the apps in remote coaching, and message content. Parents were interviewed about the acceptability of the intervention and trial design. Interviews were transcribed and analyzed using inductive thematic analysis. OUTCOMES & RESULTS: Nine children were recruited over 16 weeks. All fitted the inclusion criteria. Four families withdrew from the study. Five families completed the intervention. No family submitted the target number of video recordings for outcome measurement. Interrater agreement was moderate for child communication (K = 0.46) and vocalization (K = 0.60) and high for The Responsive Augmentative and Alternative Communication Style scale (RAACS) (rs = 0.96). Parents who completed the intervention reported positive experiences of the programme and remote coaching via the apps. Therapist messages via the app contained comments on parent and child behaviour and requests for parental reflection/action; parental messages contained reflections on children's communication. CONCLUSIONS & IMPLICATIONS: The intervention and study design demanded high levels of parental involvement and was not suitable for all families. Recording shorter periods of interaction via mobile phones or using alternative methods of data collection may increase feasibility of outcome measurement.

Retraining function in people with Parkinson's disease using the Microsoft kinect: game design and pilot testing.

BACKGROUND: Computer based gaming systems, such as the Microsoft Kinect (Kinect), can facilitate complex task practice, enhance sensory feedback and action observation in novel, relevant and motivating modes of exercise which can be difficult to achieve with standard physiotherapy for people with Parkinson's disease (PD). However, there is a current need for safe, feasible and effective exercise games that are appropriate for PD rehabilitation. The aims of this study were to i) develop a computer game to rehabilitate dynamic postural control for people with PD using the Kinect; and ii) pilot test the game's safety and feasibility in a group of people with PD. METHODS: A rehabilitation game aimed at training dynamic postural control was developed through an iterative process with input from a design workshop of people with PD. The game trains dynamic postural control through multi-directional reaching and stepping tasks, with increasing complexity across 12 levels of difficulty. Nine people with PD pilot tested the game for one session. Participant feedback to identify issues relating to safety and feasibility were collected using semi-structured interviews. RESULTS: Participants reported that they felt safe whilst playing the game. In addition, there were no adverse events whilst playing. In general, the participants stated that they enjoyed the game and seven of the nine participants said they could imagine themselves using the game at home, especially if they felt it would improve their balance. The Flow State Scale indicated participants were immersed in the gameplay and enjoyed the experience. However, some participants reported that they found it difficult to discriminate between different types and orientations of visual objects in the game and some also had difficulty with the stepping tasks, especially when performed at the same time as the reaching tasks. CONCLUSION: Computer-based rehabilitation games using the Kinect are safe and feasible for people with PD although intervention trials are needed to test their safety, feasibility and efficacy in the home.

Modifiable parental factors associated with the mental health of youth from immigrant families in high-income countries: A systematic review and meta-analysis.

Parental factors play a major role in youth mental health and many youth in high-income countries have at least one overseas-born parent. It is, hence, important to understand how immigrant parenting is associated with youth mental health in high-income countries. Following PRISMA guidelines, this review sought to identify modifiable parental factors to inform parenting interventions to prevent mental health problems in youth aged 0-18 years whose parents migrated voluntarily for economic reasons from low and middle-income countries to high-income countries. Sixteen parental factors were identified from 56 studies that were associated with five outcomes - youth self-esteem (k = 17), general stress (k = 4), acculturative stress (k = 4), anxiety symptoms (k = 9), and depressive symptoms (k = 41). A sound evidence base was found for one or more of these outcomes associated with protective factors - caring and supportive parenting and parental monitoring; and risk factors - parent-youth acculturative and general conflict, parental withdrawal, interparental conflict, and parent mental health problems. This systematic review and meta-analysis identified immigrant parental factors that have robust associations with youth mental health outcomes. These findings can be used to inform parenting interventions and support immigrant parents in preventing youth mental health problems.

Small Fish Big Impact: Improving Nutrition during Pregnancy and Lactation, and Empowerment for Marginalized Women.

Undernutrition and micronutrient deficiencies such as anemia are considered significant public health challenges in Bangladesh, which enhancing fish consumption is a well-established food-based intervention to address these. This paper documents the establishment of community-based fish chutney production and reports the impact of its consumption on mid-upper arm circumference (MUAC) and hemoglobin (Hb) levels among targeted 150 pregnant and lactating women (PLW) in rural Bangladesh. A fish chutney was developed using locally available ingredients followed by a series of laboratory tests, including nutrient composition, shelf-life and food safety. A community-based fish chutney production process was designed to: (1) supply locally available ingredients for processing; (2) establish two fish drying sites; (3) initiate a community-based production site; and (4) distribute fish chutney to PLW for one year by six women nutrition field facilitators. Then a pre- and post-intervention study was designed for a selected 150 PLW to receive 30 g of fish chutney daily for 12 months. Differences in mean MUAC and Hb levels pre- and post-consumption were analyzed using one-way analysis of variance. Consumption of 30 g of fish-chutney resulted in significant increases of the mean values of Hb levels and MUAC among the targeted PLW.

How effective are interventions in optimizing workplace mental health and well-being? A scoping review of reviews and evidence map.

OBJECTIVES: Mental well-being is critical to quality of life. Workplace mental well-being is crucial to ensure employee health, satisfaction, and performance. Mental ill-health is a global challenge, costing workplaces $17 billion per year. Workplaces have realized the need for investment in interventions to promote mental health and well-being in their workforce. However, given their limited resources, workplace personnel responsible for program implementation need evidence-based guidance on which interventions influence which outcomes. METHODS: This study employed a scoping review methodology in order to produce an evidence map and includes reviews of workplace mental well-being interventions. The search strategy focused on peer-reviewed articles with the primary aim of investigating workplace mental health interventions. Reviews were assessed for quality using AMSTAR 2. The evidence map includes interventions (rows) and outcomes (columns), with the relative size of the reviews underpinning each intersection represented by circles and the direction of evidence represented by color. RESULTS: Eighty reviews were deemed eligible from 4795 citations. The resulting evidence map includes 17 intervention types designed to influence 12 outcomes. Interventions with the highest quality evidence were mindfulness, education and information provision, and individual psychological therapies. The most common outcomes were burnout / stress reduction and mental well-being. Interventions tended to focus on individual level factors rather than organizational or system-level factors. CONCLUSION: The evidence-base for workplace mental health interventions is broad and extensive. There is an apparent knowledge-to-practice gap, presenting challenges to implementing workplace mental health programs (ie, what interventions have the highest quality evidence). This study aims to fill the gap by providing an interactive evidence-map. Future research should look to fill the gaps within the map including the lack of organization and system level factors and especially economic evaluations.

Understanding Preconception Women's Needs and Preferences for Digital Health Resources: Qualitative Study.

BACKGROUND: Improving preconception health can benefit all women, their children, and their families regardless of their individual pregnancy intentions. Rapidly increasing access to information technology and online engagement have created opportunities to use digital health resources to engage with preconception women regarding lifestyle behaviors. OBJECTIVE: This study explores how preconception women engage with digital health resources and online platforms to inform the design and development of a digital health resource to support women to make positive behavior change for their preconception health. METHODS: This codesign research followed the Double Diamond process, which focuses on contextualization and explorative processes in phase 1 and ideation and development processes in phase 2. Phase 1 is reported on in this study and was undertaken via a series of 1-on-1 in-depth interviews with female participants (N=12) aged 18-45 years over 3 months. Interviews were designed to explore participants' lived experiences in relation to their health and desired supports for healthy lifestyle behaviors. The first interview focused on participants' perceptions of health and health behaviors, the second interview focused on social connections for health, and the third interview focused on digital health information and supports. Conversations from the first interview informed the development of the second interview, and conversations from the second interview informed the development of the third interview. Community advisors (N=8) met to provide feedback and advice to the researchers throughout the interview process. Qualitative analyses of transcripts from interviews were undertaken by 2 researchers before a deductive process identified themes mapped to the capability, opportunity, motivation, and behavior (COM-B) framework. RESULTS: In total, 9 themes and 8 subthemes were identified from 124 codes. In relation to digital health resources, specifically, participants were already engaging with a range of digital health resources and had high expectations of these. Digital health resources needed to be easy to access, make women's busy lives easier, be evidence based, and be reputable. Social connectedness was also highly important to our participants, with information and advice from peers with similar experiences being preferred over yet more online health information. Online communities facilitated these social interactions. Participants were open to the idea of chatbots and virtual assistants but acknowledged that they would not replace authentic social interactions. CONCLUSIONS: Codesigned digital health resources should be evidence based, reputable, and easy to access. Social connections were considered highly important to women, and designers of digital health resources should consider how they can increase opportunities for women to connect and learn from each other to promote health behaviors.

Collective Action for Wellness in the Malaysian Workplace: Protocol for a Feasibility Study.

BACKGROUND: Chronic diseases and the associated risk factors are preventable with lifestyle changes such as eating a healthier diet and being more physically active. In Malaysia, the prevalence of chronic diseases, including diabetes, hypertension, and heart diseases, has risen. In the present study, we explore the potential of co-designing and implementing a digital wellness intervention to promote socially-driven health knowledge and practices in the workplace in Malaysia, drawing on social cognitive theory, social impact theory, and social influence theory. OBJECTIVE: This study aims to co-design and assess the feasibility of a socially-driven digital health intervention to promote healthy behavior and prevent chronic diseases in a workplace in Malaysia. METHODS: This study involves two phases: (i) identifying the barriers and facilitators to healthy behaviors at work and co-designing the intervention activities with the employees, (ii) implementing and evaluating the intervention's feasibility. Phase 1 will involve qualitative data collection and analysis through semi-structured, in-depth interviews and co-design workshops with the employees, while Phase 2 will consist of a feasibility study employing quantitative measurements of health behaviors through accelerometers and questionnaires. RESULTS: This study was funded in June 2021 and ethics approval for Phase 1 was obtained from the Monash University Human Research Ethics Committee in January 2022. As of August 2022, qualitative interviews with 12 employees have been completed and the data has been transcribed and analyzed. These results will be published in a future paper with results from all Phase 1 activities. CONCLUSIONS: The study will help us to better understand the mechanisms through which digital technologies can promote socially-driven health knowledge and behaviors. This research will also result in a scalable wellness intervention that could be further tailored and expanded to other employers and social groups across the region. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/39238.

Place of patient-reported outcomes & experiences measurements (PROMS/PREMS) in the assessment and pricing of Health technologies in France.

In the context of health technologies assessment, patient-reported outcome measures (PROMs) have become assessment criteria that are expected by evaluation agencies along with the other usual clinical criteria. PROMs instruments measure all aspects of patient experience in connection with their health: symptoms, activities of daily living (physical function, sleep, etc.), various aspects of health-related quality of life (QoL), compliance, global impression of change in wellbeing. PROMs are useful both as 1) a primary or secondary efficacy endpoints, and 2) a tolerability criterion to supplement vigilance data reported by clinicians. Measurement of PROMs must be subject to methodological rigor that is identical to that of other assessment criteria measured by an observer. Scales must be validated, suitable for the objective, and where possible specific to a disease. In addition to standard measures of quality of life, PROMs are taken into consideration in the assessments performed by the HAS, even if their impact on the conclusions is difficult to isolate, as assessments are multifactorial and take into account all data available with regard to the medical context. The CEPS will indirectly take into account PROMs in the fixing of the price or tariff only if they have contributed to the award of the ASA/ASMR by the ad hoc committee of the HAS. The working group has formulated three recommendations which aim to further the implementation of patient-reported outcome measures: (1) Better information for all parties involved in a dossier for technology assessment, (2) Systematization of the collection of PROMs for evaluation of health products, (3) Improved quality of dossiers thanks to the use of relevant and validated tools.

N-backer: an auditory n-back task with automatic scoring of spoken responses.

The n-back task is commonly used to load working memory (WM) in dual-task and neuroimaging experiments. However, it typically involves visual presentation and buttonpress responses, making it unsuitable for combination with primary tasks that involve vision and action, such as sequential object use and other tasks of daily living. The N-backer software presented here will automatically present and score auditory-verbal n-back sequences utilising the standard speech synthesis and recognition facilities that come with Microsoft Windows. Data are presented from an experiment in which 12 student participants carried out three tasks from the Naturalistic Action Test (NAT) while their attention was divided between the primary task and a continuous auditory-verbal 2-back secondary task. The participants' 2-back performance was scored in two ways: by hand, from video recordings, and automatically, using the software, allowing us to evaluate the accuracy of N-backer. There was an extremely high correlation between these scores (.933). The videos were also used to obtain a comprehensive error score for the NAT. Significantly more errors were made in the more complex NAT tasks when participants were 2-backing, as compared with when they were not, showing that the auditory-verbal n-back task can be used to disrupt sequential object use. This dual-task method may simulate the attentional deficits of patients with brain injury, providing insights into the difficulties they face in tasks of daily living.

The feasibility and acceptability of using a novel wrist worn cueing device to self-manage drooling problems in people with Parkinson's disease: A pilot study.

INTRODUCTION: Daytime drooling is experienced by around 50% of Parkinson's patients, who fail to swallow saliva in sufficient volume or regularity, despite normal production. This research explored the feasibility and acceptability of using a cueing device, to improve drooling. METHODS: During a four-week intervention, 28 participants were asked to use a cueing device for 1 h per day. During this time, the device vibrated once-per-minute, reminding the participant to swallow their saliva. A daily diary was used to collect self-report around swallowing severity, frequency, and duration. This was filled out by participants for one week before, four weeks during and for one week immediately after intervention. Diaries were also collected for one week during a follow up, carried out four weeks after intervention finished. RESULTS: Participants self-reported benefits in drooling severity (p = 0.031), frequency (p ≤ 0.001), and duration (p = 0.001) after using the device. Improvements were maintained at follow up. Twenty-two participants explicitly reported a positive benefit to their drooling during exit interview. All felt the intervention and device were acceptable and usable. CONCLUSIONS: Using a cueing device for one month had perceived benefit to drooling severity, frequency and duration in patients with Parkinson's. Participants accepted the device and treatment protocol.

Validity and reliability of an online self-report 24-h dietary recall method (Intake24): a doubly labelled water study and repeated-measures analysis.

Online self-reported 24-h dietary recall systems promise increased feasibility of dietary assessment. Comparison against interviewer-led recalls established their convergent validity; however, reliability and criterion-validity information is lacking. The validity of energy intakes (EI) reported using Intake24, an online 24-h recall system, was assessed against concurrent measurement of total energy expenditure (TEE) using doubly labelled water in ninety-eight UK adults (40-65 years). Accuracy and precision of EI were assessed using correlation and Bland-Altman analysis. Test-retest reliability of energy and nutrient intakes was assessed using data from three further UK studies where participants (11-88 years) completed Intake24 at least four times; reliability was assessed using intra-class correlations (ICC). Compared with TEE, participants under-reported EI by 25 % (95 % limits of agreement -73 % to +68 %) in the first recall, 22 % (-61 % to +41 %) for average of first two, and 25 % (-60 % to +28 %) for first three recalls. Correlations between EI and TEE were 0·31 (first), 0·47 (first two) and 0·39 (first three recalls), respectively. ICC for a single recall was 0·35 for EI and ranged from 0·31 for Fe to 0·43 for non-milk extrinsic sugars (NMES). Considering pairs of recalls (first two v. third and fourth recalls), ICC was 0·52 for EI and ranged from 0·37 for fat to 0·63 for NMES. EI reported with Intake24 was moderately correlated with objectively measured TEE and underestimated on average to the same extent as seen with interviewer-led 24-h recalls and estimated weight food diaries. Online 24-h recall systems may offer low-cost, low-burden alternatives for collecting dietary information.