Measuring success: program fidelity of Queensland's child health home visiting services. A document analysis.

BACKGROUND: The Family CA.R.E. (Community-based Assistance Resourcing and Education) program was introduced in Queensland two decades ago. It aimed to redress health inequalities for infants from families experiencing specific social stressors. The program has been locally adapted over time and has not been evaluated against the original program. This study assessed the extent to which selected hospital and health services in Queensland, Australia have modified the original Family C.A.R.E. METHODS: Altheide's model was used to facilitate a critical document analysis of policies and guidelines for adapted Family C.A.R.E. home visiting programs in use by hospital and health services (target n =7). RESULTS: Five of seven eligible services provided service model documentation. There was low alignment with the original Family C.A.R.E. program across four of the five participating services. While the program delivered within Service 4 was highly aligned to the structure and intent of the original model, variation to the program was still evident. Importantly, four of the five participating programs were not collecting evaluation measures. CONCLUSIONS: Health services have adapted the original Family C.A.R.E program format to 'fit' the local service environment but have largely failed to collect data to facilitate evaluation. Inability to evaluate the program leads to uncertainty about program success and benefits as well as any unintended consequences for families engaging in unevaluated home visiting programs. This study highlights the importance of monitoring program fidelity and evaluating success given the potential ramifications for this vulnerable cohort and for health service delivery.

Asynchronous Remote Assessment for Cognitive Impairment: Reliability Verification of the Neurotrack Cognitive Battery.

BACKGROUND: As evidenced by the further reduction in access to testing during the COVID-19 pandemic, there is an urgent, growing need for remote cognitive assessment for individuals with cognitive impairment. The Neurotrack Cognitive Battery (NCB), our response to this need, was evaluated for its temporal reliability and stability as part of ongoing validation testing. OBJECTIVE: The aim of this study is to assess the temporal reliability of the NCB tests (5 total) across a 1-week period and to determine the temporal stability of these measures across 3 consecutive administrations in a single day. METHODS: For test-retest reliability, a range of 29-66 cognitively healthy participants (ages 18-68 years) completed each cognitive assessment twice, 1 week apart. In a separate study, temporal stability was assessed using data collected from 31 different cognitively healthy participants at 3 consecutive timepoints in a single day. RESULTS: Correlations for the assessments were between 0.72 and 0.83, exceeding the standard acceptable threshold of 0.70 for temporal reliability. Intraclass correlations ranged from 0.60 to 0.84, indicating moderate to good temporal stability. CONCLUSIONS: These results highlight the NCB as a brief, easy-to-administer, and reliable assessment for remote cognitive testing. Additional validation research is underway to determine the full magnitude of the clinical utility of the NCB.

A short digital eye-tracking assessment predicts cognitive status among adults.

Current cognitive assessments suffer from limited scalability and high user burden. This study aimed to (1) examine the relationship between a brief eye-tracking-based visual paired-comparison (VPC) and gold standard cognitive assessments, (2) examine longitudinal stability of the VPC task, (3) determine the ability of the VPC task to differentiate between cognitively normal (CN) individuals and individuals with mild cognitive impairment (MCI). Fifty-five adults (n = 44 CN, n = 11 MCI; 56.4 ± 26.7 years) were tested on two occasions, separated by at least 14 days. Visit 1 included VPC, Montreal Cognitive Assessment (MoCA), Digit Symbol Coding test (DSC), and NIH Toolbox Cognitive Battery (NIHTB-CB). Visit 2 included VPC, DSC, NIHTB-CB, and dual-task (DT). Significant differences existed between baseline VPC scores for CN and MCI groups (p < .001). VPC scores remained stable over time in both groups (p < .05). Significant associations existed between VPC and MoCA (p < .01), DSC (p < .001), and various NIHTB-CB subtests at both time points. The VPC test significantly predicts cognitive outcomes (p < .05), with age and VPC being the only significant predictors. Additionally, area under the curve (receiver operator characteristic = 0.80) for VPC scores demonstrated good classification accuracy. VPC reliably predicted cognitive status while remaining stable over time and displayed significant associations with gold standard cognitive assessments. VPC is a less burdensome and more scalable assessment than traditional tests, enabling longitudinal monitoring of cognitive status in resource-limited environments.

Engagement With a Digital Platform for Multimodal Cognitive Assessment and Multidomain Intervention in a Japanese Population: Pilot, Quasi-Experimental, Longitudinal Study.

BACKGROUND: As the global prevalence of dementia continues to rise, multidomain lifestyle interventions that address modifiable risk factors associated with pathological cognitive decline are increasing. Although some digital options have been developed to increase the reach and scalability of these programs, because of cultural differences, the efficacy of the programs in one population cannot easily be generalized to populations in other countries. OBJECTIVE: This investigation aimed to examine the usability and engagement of a digitally delivered multidomain cognitive lifestyle intervention developed in the United States for a Japanese population. METHODS: This feasibility investigation utilized a quasi-experimental, single-arm, nonrandomized, longitudinal design where participants engaged in the behavioral intervention on a smartphone. Of the 559 participants that initially enrolled (age: mean 51 years, SD 7.5 years; 51.7% female [289/559]), 242 completed the final testing trial. Participants enrolled in a multidomain lifestyle program that consisted of (1) psychoeducational material, (2) physical activity tracker, (3) nutrition tracker, (4) audio-based meditations, and (5) health coaching. Engagement with the program was assessed through the total number of app sessions and the use of the exercise, diet, and meditation tracking features within the app. The total number of minutes exercised was collected through subjective user inputs, and nutrition was quantified by the Mediterranean-DASH Intervention for Neurodegenerative Delay diet adherence score. RESULTS: Significant relationships existed between overall nutrition score and frequency of nutrition tracking (r=0.18), frequency of physical activity tracking (r=0.19), and the total number of minutes exercised (r=0.22). Total minutes exercised was significantly correlated with total app sessions (r=0.57), frequency of physical activity tracking (r=0.85), frequency of nutrition tracking (r=0.64), number of times participants meditated (r=0.46), and total lessons read (r=0.36). The number of completed lessons was significantly related to frequency of physical activity tracking (r=0.40), frequency of nutrition tracking (r=0.43), the total number of times participants meditated (r=0.35), and total minutes exercised (r=0.33). Dividing the cohort into two groups based on lesson completion (<10 lessons completed vs ≥10 lessons completed), significant differences were observed between the total minutes exercised, frequency of physical activity tracking, frequency of nutrition tracking, and total number of times participants meditated (all P values <.01). CONCLUSIONS: Overall, this cross-cultural feasibility study in Japanese users demonstrated that the various engagement metrics were significantly correlated, and greater engagement was related to improved nutrition scores and increased time exercising. In addition, the relationships between lesson completion and other engagement metrics suggest that there may be value in exploring mechanisms that enhance lesson completion. Future research should examine the program in randomized control trials to more rigorously evaluate program efficacy.

Barriers to and delays in accessing breast cancer care among New Zealand women: disparities by ethnicity.

BACKGROUND: Unequal access to health care contributes to disparities in cancer outcomes. We examined the ethnic disparity in barriers to accessing primary and specialist health care experienced by New Zealand women with breast cancer. METHODS: Women diagnosed with a primary invasive breast cancer between 2005 and 2007 were eligible. There were 1,799 respondents, n = 302 Maori (the indigenous population of NZ), n = 70 Pacific and n = 1,427 non-Maori/non-Pacific women. Participants completed a questionnaire listing 12 barriers grouped into three domains for analysis: personal; practical; and health care process factors, and reported the number of days between seeing a primary and a specialist care provider. Chi-squared, Fisher exact tests and logistic regression were used to assess uni- and multivariable differences in prevalence between ethnic groupings. RESULTS: The prevalence of reporting three or more barriers was 18% among Pacific, 10% among Maori and 3% among non-Maori/non-Pacific women (P <0.001). The most commonly reported barriers were fear (Maori women) and cost (Pacific and non-Maori/non-Pacific women). Ethnic differences in reported barriers were not explained by deprivation or diabetes prevalence. Women with diabetes reported a two-fold higher risk of experiencing barriers to care compared to those without diabetes (odds ratio [OR]: 2.06, 95%CI 1.20 to 3.57). Maori and Pacific women were more likely to face delays (median 14 days) in seeing a specialist than non-Maori/non-Pacific women (median 7 days); these differences were not explained by the reported barriers. CONCLUSIONS: Patterns of reported barriers to care differed according to ethnicity and were not explained by deprivation, or presence of co-morbidity. Maori and Pacific women are more likely to experience barriers to breast cancer care compared to non- Maori/non-Pacific women. We identified two key barriers affecting care for Maori and Pacific women; (a) delays in follow-up, and (b) the impact of co-morbid conditions. Future New Zealand work needs to focus attention on health care process factors and improving the interface between primary and secondary care to ensure quality health care is realised for all women with breast cancer.

Breakfasts Higher in Protein Increase Postprandial Energy Expenditure, Increase Fat Oxidation, and Reduce Hunger in Overweight Children from 8 to 12 Years of Age.

BACKGROUND: Currently 1 in every 3 children aged 2-19 y is overweight or obese. Breakfast is a key component of a healthy diet and has the potential to affect children's health. OBJECTIVE: The objective of this study was to determine whether consumption of a protein-based breakfast (PRO) increases postprandial energy metabolism and substrate oxidation, reduces hunger, and reduces food intake at lunch compared with a carbohydrate-based breakfast (CHO) in normal weight (NW) vs. overweight/obese (OW) children. METHODS: A randomized, crossover-design study was conducted in NW (n = 16; 33 ± 1 kg) and OW (n = 13; 46 ± 2 kg) children (10 ± 1 y). Participants were served either a PRO [344 kcal, 21% protein (18 g), 52% carbohydrate, and 27% fat] or CHO [327 kcal, 4% protein (3 g), 67% carbohydrate, and 29% fat]. Energy expenditure (EE), substrate oxidation, appetite, and blood glucose were measured over a 4 h period. Four hour postprandial participants were provided with access to a lunch buffet and food intake was recorded. RESULTS: After breakfast, OW children in the PRO group had higher (P < 0.0001) EEs and fat oxidation over the 4 h period than did the NW children in the CHO and PRO groups. There was no difference in postprandial EE or carbohydrate oxidation between the CHO and PRO groups over the 4 h period; however, fat oxidation was 16% higher (P < 0.05) after the PRO than the CHO and postprandial carbohydrate oxidation at 4 h was 32% higher after the PRO than the CHO (P < 0.01), independent of weight group. All participants had decreased feelings of hunger (-14%; P < 0.01) and increased fullness (+32%; P < 0.05) after the PRO than the CHO. Finally, there was no difference in food intake within the NW and OW groups. CONCLUSION: This study indicates that breakfast macronutrient composition affects postprandial responses in both NW and OW children. A PRO increases postprandial EE and fat oxidation, reduces hunger, and increases satiety when compared with a carbohydrate-based breakfast.

Thermic effect of food, exercise, and total energy expenditure in active females.

OBJECTIVES: Exercise and the thermic effect of food contribute to total energy expenditure and overall maintenance of health. The aim of this study was to determine the interaction between TEF and exercise on TEE based on meal protein content. DESIGN: A randomized, repeated measures study. METHODS: Ten active females, of normal body weight, participated. Preliminary maximal aerobic capacity (VO2max) was determined. Three additional testing sessions consisted of performing a 30-min bout of exercise at 60% VO2max after consumption of a high (45% total kcal) or low (15% total kcal) protein meal, or fasted. RESULTS: Repeated measures ANOVA indicated a significant main effect for the feeding protocols (α=.05). The high protein meal elicited a 30.39% and 98.15% greater increase in TEF compared to the low protein meal (p=.006) and fasted state (p<.001), respectively. The low protein meal resulted in 94.34% greater TEF compared to fasted (p<.001). Combined with exercise, high protein meal TEF was significantly greater compared to fasted (p=.010) but was not significantly greater than the low protein meal (p=.122). Significant differences were not found between the low protein meals with exercise compared to fasted conditions (p=.094). CONCLUSIONS: Findings of this study provide insight on increased TEE under acute high protein feeding conditions as compared to a low protein meal and fasted state. Combined with exercise, potential for further increases in TEE exists as a result of TEF.