Feasibility of tuberculosis treatment monitoring by video directly observed therapy: a binational pilot study.

BACKGROUND: Although directly observed therapy (DOT) is recommended worldwide for monitoring anti-tuberculosis treatment, transportation and personnel requirements limit its use. OBJECTIVE: To evaluate the feasibility and acceptability of 'video DOT' (VDOT), which allows patients to record and transmit medication ingestion via videos watched remotely by health care providers to document adherence. METHODS: We conducted a single-arm trial among tuberculosis (TB) patients in San Diego, California, USA, (n = 43) and Tijuana, Mexico (n = 9) to represent high- and low-resource settings. Pre-/post-treatment interviews assessed participant characteristics and experiences. Adherence was defined as the proportion of observed doses to expected doses. RESULTS: The mean age was 37 years (range 18-86), 50% were male, and 88% were non-Caucasian. The mean duration of VDOT use was 5.5 months (range 1-11). Adherence was similar in San Diego (93%) and Tijuana (96%). Compared to time on in-person DOT, 92% preferred VDOT, 81% thought VDOT was more confidential, 89% never/rarely had problems recording videos, and 100% would recommend VDOT to others. Seven (13%) participants were returned to in-person DOT and six (12%) additional participants had their phones lost, broken or stolen. CONCLUSIONS: VDOT was feasible and acceptable, with high adherence in both high- and low-resource settings. Efficacy and cost-effectiveness studies are needed.

Parental education and physical activity in pre-school children.

BACKGROUND: The purpose of this study was to objectively assess pre-school children's total physical activity (TPA) patterns and compliance with guidelines and to examine differences relative to parental education. METHODS: The sample consisted on 509 healthy pre-school children, aged 3-6 years recruited from kindergartens located in the metropolitan area of Porto, Portugal. The PA was assessed for 7 consecutive days by accelerometry. For TPA, we followed the guidelines of the National Association for Sport and Physical Education (NASPE) (children who spent at least >120 min per day in active play). For TPA, we calculated the proportion of children who spent at least >120 min per day in active play and moderate-to-vigorous physical activity (MVPA), we calculated the proportion of children who spent at least >60 min per day in active play. Parental education was analysed according to the Portuguese education system. RESULTS: Children with parents in the highest education level were less active than children from low and middle education level (P ≤ 0.001) in all patterns of PA (week and weekend). Regarding TPA during the week we found that the majority of children from low and middle parental education meet the NASPE guidelines. On the other hand, more than half the children from high parental education did not meet these recommendations (P ≤ 0.001) and MVPA recommendations (P ≤ 0.05). In both recommendations, children from low parental education were twice more likely to meet the recommendations compared with children belonging to high parental education. CONCLUSION: Parent education was negatively associated with children's daily physical activity patterns and compliance with guidelines.

Clustering of physical inactivity in leisure, work, commuting and household domains among Brazilian adults.

OBJECTIVES: To identify the clustering of physical inactivity in leisure, work, commuting and household contexts, and the sociodemographic factors associated with the clustering of inactive behaviour in different domains among Brazilian adults. STUDY DESIGN: Cross-sectional population-based study. METHODS: The study was performed in Florianopolis, capital of Santa Catarina, one of the southern states of Brazil, from September 2009 to January 2010. Adults aged 20-59 years were interviewed. Physical inactivity in each domain was defined as non-participation in specific physical activities, using a validated Brazilian questionnaire. Clustering of physical inactivity was identified by the ratio between observed prevalence and expected prevalence of 16 different combinations. Multinomial logistic regression was used in the analysis of sociodemographic factors associated with clustering of physical inactivity. RESULTS: Of the 1720 interviewees, the greatest differences between the observed and expected proportions were observed in simultaneous physical inactivity in the leisure and household domains for men, and physical inactivity in the leisure domain alone for women (59% and 88%, respectively); these differences were higher than expected if the behaviours were independent. Physical inactivity in two or more domains was observed more frequently in men and in individuals with a higher per-capita family income. Ageing was associated with physical inactivity in three or four domains. CONCLUSIONS: Physical inactivity was observed in different domains according to gender. Men and older individuals with a higher per-capita family income were more likely to exhibit physical inactivity when all domains were considered together.

Concurrent validation of estimated activity energy expenditure using a 3-day diary and accelerometry in adolescents.

Estimates of daily energy expenditure are important to studies of physical activity and energy balance. Objective measures are not always feasible and further research is needed to validate survey instruments and diaries. The study validates estimated activity energy expenditure (AEE) based on a 3-day diary protocol relative to AEE derived from uniaxial accelerometry in adolescents, 265 girls and 227 boys (12.5-16.4 years). Participants completed the diary and wore a GT1M Actigraph accelerometer on the same days. Height and weight were measured. Correlations between protocols were significant (P<0.001) but moderate, r=0.65 in males and r=0.69 in females. The highest correlation occurred among males on Friday, r=0.74 (P<0.01). Controlling for body mass, partial correlations between protocols decreased to 0.44 and 0.35 in males and females, respectively. About 97% of the cases fell within the limits of agreement in a Bland-Altman plot. The criterion of inclusion for the accelerometer excluded 18% of the initial sample. In summary, the 3-day diary was completed without any major problems and provided a reasonably valid alternative for assessing AEE. Concordance between methods was slightly lower for individuals with higher values of AEE.