Impact of implementing a competency-based job framework for clinical research professionals on employee turnover.

INTRODUCTION: A new competency-based job framework was implemented for clinical research professionals at a large, clinical research-intensive academic medical center. This study evaluates the rates of turnover before and after implementation of the new framework. Turnover in this workforce (as with most) is costly; it contributes to wasted dollars and lost productivity since these are highly specialized positions requiring extensive training, regardless of experience in the field. METHODS: Trends in employee turnover for 3 years prior to and after the implementation of competency-based job framework for clinical research positions were studied using human resources data. Employee demographics, turnover rates, and comparisons to national statistics are summarized. RESULTS: Employee turnover within the clinical research professional jobs has decreased from 23% to 16%, a 45% reduction, since the implementation of competency-based job framework. CONCLUSION: The new jobs and career ladders, both of which are centered on a competency-based framework, have decreased the overall turnover rate in this employee population. Since little is known about the rates of turnover in clinical research, especially in the academic medical setting, the results of this analysis can provide important insights to other academic medical centers on both employee turnover rate in general and the potential impact of implementing large-scale competency-based job changes.

Steps to Health employee weight management randomized control trial: short-term follow-up results.

OBJECTIVE: To present the short-term follow-up findings of the Steps to Health study, a randomized trial to evaluate the effectiveness of two employee weight management programs offered within Duke University and the Health System. METHODS: A total of 550 obese (body mass index, ≥30 kg/m2) employees were randomized 1:1 between January 2011 and June 2012 to the education-based Weight Management (WM) or the WM+ arm, which focused on behavior modification. Employees were contacted to complete a follow-up visit approximately 14 months after baseline. RESULTS: There were no clinically, or statistically, meaningful differences between arms, but there were modest reductions in body mass index, and positive, meaningful changes in diet and physical activity for both arms. CONCLUSIONS: The modest positive effects observed in this study may suggest that to achieve weight loss through the workplace more intensive interventions may be required.

Diet quality of overweight and obese mothers and their preschool children.

BACKGROUND: Children of obese parents are more likely to become obese than children of normal-weight parents. However, there is little information regarding the diet intakes of children of obese parents. OBJECTIVE: Our objective was to determine the diet quality of preschoolers and their overweight/obese mothers, whether maternal and child diet quality were correlated, and predictors of child's diet quality. DESIGN: Results are from baseline measurements from a randomized controlled behavioral intervention. PARTICIPANTS: Participants were English-literate, postpartum mothers and their preschoolers (n=177 mother-child dyads) in North Carolina. Visits took place in the Triangle and Triad regions of North Carolina between September 2007 and November 2009. MAIN OUTCOME MEASURES: We measured diet quality of mothers and preschoolers using the Healthy Eating Index-2005. STATISTICAL ANALYSES PERFORMED: Descriptive statistics, χ(2), analysis of variance, Pearson correlations, and stepwise regression models were used. RESULTS: Only 11% of children and 7% of mothers had Healthy Eating Index-2005 scores ≥80. Most children did not meet recommendations for fruits, vegetables, whole grains, meat and beans, sodium, saturated fat, and energy from solid fat and added sugars. Child diet quality was correlated with maternal diet quality (r=0.44; P<0.001). However, children and mothers differed in the proportion that met food-group recommendations: children vs mothers: total fruit (50% vs 14%), whole fruit (46% vs 28%), total vegetables (6% vs 18%), dark green and orange vegetables and legumes (7% vs 19%), total grains (57% vs 71%), milk (63% vs 22%), and meat and beans (33% vs 60%). Maternal diet quality and household income were positively correlated with child diet quality. CONCLUSIONS: The diets of children of overweight/obese mothers need improvement in several areas. Mother's diet quality and household income are important contributors to child's diet quality and should be considered in efforts to improve the diets of these children.

Changes in physical activity among postpartum overweight and obese women: results from the KAN-DO Study.

Few studies have assessed physical activity at multiple time points in the postpartum period or used both self-reported and objective measures of assessment. The purpose of this study was to describe physical activity and sedentary behavior at two time points in a cohort of overweight or obese postpartum women using both self-reported and objective measures. In total, 132 women completed physical activity assessments at a median of 24 weeks postpartum and again approximately 10 months later. At both time points, women wore an Actical accelerometer for one week and completed the Kaiser Physical Activity Survey. Adjusted Poisson regression models were used to determine whether physical activity changed over time for the cohort. Overall counts per minute and moderate to vigorous physical activity increased from baseline to 10 months later, although the absolute levels were modest (median 6.9 to 8.8 minutes/day). A median of 64%-71% at baseline and 63%-67% at follow-up of their monitored times were sedentary. More intensive interventions are needed to help postpartum women integrate physical activity and reduce sedentary behavior. [Supplementary material is available for this article. Go to the publisher's online edition of Women & Health for the following resource: three figures that show the distribution of physical activity and sedentary behavior by study periods among control participants].

The steps to health employee weight management randomized control trial: rationale, design and baseline characteristics.

BACKGROUND: The workplace can be an important setting for addressing obesity. An increasing number of employers offer weight management programs. PURPOSE: Present the design, rationale and baseline characteristics of the Steps to Health study (STH), a randomized trial to evaluate the effectiveness of two preexisting employee weight management programs offered at Duke University and Medical Center. METHODS: 550 obese (BMI ≥30) employee volunteers were randomized 1:1 to two programs. Baseline data, collected between January 2011 and July 2012, included height/weight, accelerometry, workplace injuries, health care utilization, and questionnaires querying socio-cognitive factors, perceptions of health climate, physical activity, and dietary intake. In secondary analyses participants in the two programs will also be compared to a non-randomized observational control group of obese employees. RESULTS: At baseline, the mean age was 45 years, 83% were female, 41% white, and 53% black. Mean BMI was 37.2. Participants consumed a mean of 2.37 servings of fruits and vegetables per day (in the past week), participated in 11.5 min of moderate-to-vigorous physical activity, and spent 620 min being sedentary. CONCLUSION: STH addresses the need for evaluation of worksite interventions to promote healthy weight. In addition to having direct positive effects on workers' health, worksite programs have the potential to increase productivity and reduce health care costs.

Diet quality and weight change among overweight and obese postpartum women enrolled in a behavioral intervention program.

BACKGROUND: Postpartum weight retention is a risk factor for long-term weight gain. Encouraging new mothers to consume a healthy diet may result in weight loss. OBJECTIVE: To assess predictors of diet quality during the early postpartum period; to determine whether diet quality, energy intake, and lactation status predicted weight change from 5 to 15 months postpartum; and to determine whether an intervention improved diet quality, reduced energy intake, and achieved greater weight loss compared with usual care. DESIGN: Randomized clinical trial (KAN-DO: Kids and Adults Now-Defeat Obesity), a family- and home-based, 10-month, behavioral intervention to prevent childhood obesity, with secondary aims to improve diet and physical activity habits of mothers to promote postpartum weight loss. PARTICIPANTS: Overweight/obese, postpartum women (n=400), recruited from 14 counties in the Piedmont region of North Carolina. INTERVENTION: Eight education kits, each mailed monthly; motivational counseling; and one group class. METHODS: Anthropometric measurements and 24-hour dietary recalls collected at baseline (approximately 5 months postpartum) and follow-up (approximately 10 months later). Diet quality was determined using the Healthy Eating Index-2005 (HEI-2005). STATISTICAL ANALYSES: Descriptive statistics, χ(2), analysis of variance, bi- and multivariate analyses were used. RESULTS: At baseline, mothers consumed a low-quality diet (HEI-2005 score=64.4 ± 11.4). Breastfeeding and income were positive, significant predictors of diet quality, whereas body mass index was a negative predictor. Diet quality did not predict weight change. However, total energy intake, not working outside of the home, and breastfeeding duration/intensity were negative predictors of weight loss. There were no significant differences in changes in diet quality, decreases in energy intake, or weight loss between the intervention (2.3 ± 5.4 kg) and control (1.5 ± 4.7 kg) arms. CONCLUSIONS: The family-based intervention did not promote postpartum weight loss. Reducing energy intake, rather than improving diet quality, should be the focus of weight-loss interventions for overweight/obese postpartum women.

Parent-focused change to prevent obesity in preschoolers: results from the KAN-DO study.

OBJECTIVE: The study presents the immediate post-intervention results of Kids and Adults Now - Defeat Obesity!, a randomized controlled trial to enhance healthy lifestyle behaviors in mother-preschooler (2-5 years old) dyads in North Carolina (2007-2011). The outcomes include change from baseline in the child's diet, physical activity and weight, and in the mother's parenting behaviors, diet, physical activity, and weight. METHOD: The intervention targeted parenting through maternal emotion regulation, home environment, feeding practices, and modeling of healthy behaviors. 400 mother-child dyads were randomized. RESULTS: Mothers in the intervention arm, compared to the control arm, reduced instrumental feeding (-0.24 vs. 0.01, p<0.001) and TV snacks (-.069 vs. -0.24, p=0.001). There were also improvements in emotional feeding (p=0.03), mother's sugary beverage (p=0.03) and fruit/vegetable (p=0.04) intake, and dinners eaten in front of TV (p=0.01); these differences were not significant after adjustment for multiple comparisons. CONCLUSION: KAN-DO, designed to maximize the capacity of mothers as agents of change, improved several channels of maternal influence. There were no group differences in the primary outcomes, but differences were observed in the parenting and maternal outcomes and there were trends toward improvement in the preschoolers' diets. Long-term follow-up will address whether these short-term trends ultimately improve weight status.

Predictors of and health services utilization related to depressive symptoms among elderly Koreans.

While the prevalence, comorbidity, risk profile and health care utilization for late-life depression have been described for many Western countries, much less is known about the recent epidemiology of late-life depression in East Asian countries such as Korea. We investigated predictors for depressive symptoms and the association between depressive symptoms and the utilization of both medical care and preventive services in elderly Koreans. Data were obtained from a nationally representative sample of Koreans aged 60 and above (2226 men, 2911 women) who participated in the 2008 wave of the Korean Longitudinal Study of Ageing. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression scale. Risk factors considered included sociodemographics, health behaviors, chronic diseases, and physical function. Health care utilization factors included hospitalization, outpatient clinic use and basic medical checkup. Being female, being unmarried, and having less education, lower household income, physical inactivity and lower weight were associated with depressive symptoms. Presence of chronic diseases and limited physical function also showed a significant association with depressive symptoms. Depressive symptoms were associated with increased odds of hospitalization and outpatient visits, but decreased the odds of utilization of basic medical checkup after controlling for potential confounders. Findings on most risk factors, except lower weight, were consistent with reports from Western countries. It is important to recognize the burden of depressive symptoms in the elderly. The interaction of such symptoms with chronic diseases should be acknowledged and considered in the clinical setting as well as in health care planning and policymaking.

Unmet social support for healthy behaviors among overweight and obese postpartum women: results from the Active Mothers Postpartum Study.

BACKGROUND: In the United States, about two thirds of women of reproductive age are overweight or obese. Postpartum is a transitional period. Life changes during this time can put mothers under high levels of stress when interpersonal support is inadequate. This study sought to explore predictors of unmet social support (support inadequacy) for healthy behaviors among postpartum women who were overweight or obese before pregnancy. METHODS: Potential predictors of unmet social support for healthy behaviors were derived from baseline and 6-month postpartum data from the Active Mothers Postpartum (AMP) study. The Postpartum Support Questionnaire queried three dimensions of social support: (1) informational support, (2) emotional support, and (3) instrumental support. The main outcome, the overall Unmet Social Support Score (USSS), was the sum of the differences between the perceived need of support and perceived receipt of support in all three dimensions. Subscores were defined for each of the three support dimensions. RESULTS: One hundred ninety women completed the 6-month Postpartum Support Questionnaire. Depression (p=0.018), unmarried status (p=0.049), and postpartum weight gain (p=0.003) were crude predictors for the overall USSS. After controlling for covariates, depression (p=0.009) and living with a spouse (p=0.040) were significant predictors for overall USSS. In adjusted analysis, depression remained a significant predictor for unmet emotional (p=0.035) and instrumental (p=0.001) social support. CONCLUSIONS: Certain psychosocial factors predict support inadequacy expectations among postpartum women. Targeting the factors related to unmet social support may be a helpful way to promote healthy behaviors among overweight postpartum women.

Kids and adults now! Defeat Obesity (KAN-DO): rationale, design and baseline characteristics.

BACKGROUND: Prevention of childhood obesity is a public health priority. Parents influence a child's weight by modeling healthy behaviors, controlling food availability and activity opportunities, and appropriate feeding practices. Thus interventions should target education and behavioral change in the parent, and positive, mutually reinforcing behaviors within the family. METHODS: This paper presents the design, rationale and baseline characteristics of Kids and Adults Now! - Defeat Obesity (KAN-DO), a randomized controlled behavioral intervention trial targeting weight maintenance in children of healthy weight, and weight reduction in overweight children. 400 children aged 2-5 and their overweight or obese mothers in the Triangle and Triad regions of North Carolina are randomized equally to control or the KAN-DO intervention, consisting of mailed family kits encouraging healthy lifestyle change. Eight (monthly) kits are supported by motivational counseling calls and a single group session. Mothers are targeted during a hypothesized "teachable moment" for health behavior change (the birth of a new baby), and intervention content addresses: parenting skills ((e.g., emotional regulation, authoritative parenting), healthy eating, and physical activity. RESULTS: The 400 mother-child dyads randomized to trial are 75% white and 22% black; 19% have a household income of $30,000 or below. At baseline, 15% of children are overweight (85th-95th percentile for body mass index) and 9% are obese (≥ 95th percentile). CONCLUSION: This intervention addresses childhood obesity prevention by using a family-based, synergistic approach, targeting at-risk children and their mothers during key transitional periods, and enhancing maternal self-regulation and responsive parenting as a foundation for health behavior change.

Comparison of dietary intake of overweight postpartum mothers practicing breastfeeding or formula feeding.

BACKGROUND: Weight gain in the postpartum period is a risk factor for long-term obesity. Investigations of dietary intake among lactating and nonlactating overweight women might identify nutritional concerns specific to this population. OBJECTIVE: To compare nutrient, meal, and snack intakes, food-group servings and prevalence of dieting among fully breastfeeding (BF), mixed breast and formula feeding (MF), and formula feeding (FF) overweight and obese women. The second aim was to compare nutrient intakes and food-group servings to the Dietary Reference Intake and MyPyramid recommendations, respectively. DESIGN: Data were collected from September 2004 through April 2006 in Durham, NC. Infant feeding practices and dietary information were collected on 450 women between 6 and 9 weeks postpartum. Two 24-hour dietary recalls were completed by phone, using Nutrition Data Systems for Research. Analysis of covariance was used to compare infant feeding groups in dietary quality (nutrient intake per 1,000 kcal) and food-group servings, controlling for prepregnancy body mass index, race, age, education, income, and marital status. χ² analysis was performed to determine differences in meal and snack intake and dieting among infant feeding groups. RESULTS: BF women consumed more energy (2,107 ± 50 kcal) than MF (1,866 ± 56 kcal) or FF (1,657 ± 50 kcal) women (P < 0.001). Adjusted nutrient intake did not differ between groups. All groups were at risk for inadequate intakes of vitamins A, E, C, and folate and did not meet recommended servings of all food groups. BF women consumed lunch and snacks more frequently, were less likely to diet, and reported higher intakes of grains and desserts than MF and FF women. CONCLUSIONS: To help increase intakes of nutrients lacking in the diet and prevent postpartum weight gain, overweight women should be encouraged to increase fruits, vegetables, low-fat dairy, whole grains, legumes, and healthy types of fat, while decreasing refined grains, regular soda, sweetened beverages, and desserts.

Smoking prevalence in early pregnancy: comparison of self-report and anonymous urine cotinine testing.

OBJECTIVE: Societal pressures against smoking during pregnancy may lead to a reduction in disclosure of smoking status. The objective of this study was to compare prevalence of smoking at prenatal intake by self-report with anonymous biochemical validation. METHODS: Women receiving care at the Duke Obstetrics Clinic from February 2005 through January 2006 were eligible for evaluation. Self-reported smoking and urine samples were obtained anonymously at prenatal intake. The NicCheck™ I semi-quantitative dipstick was used to detect urinary nicotine, cotinine, and 3-hydroxycotinine. The difference, with 95% confidence interval, between the proportions of smokers by self-report and urine testing was calculated for (1) high-positive vs. low-positive and negative results combined and (2) any positive vs. negative results. RESULTS: Among 297 subjects, self-reported smoking was 18.2 vs. 14.8% for low-positive and negative results combined with an absolute difference of 3.4%, [-2.9%, 9.6%]. When comparing self-report with any positive result (43.1%), the absolute difference was 24.9%, [17.4%, 32.1%]. CONCLUSIONS: Our findings suggest that most pregnant women disclose their smoking and many nonsmokers may have significant second-hand exposure. Universal urinary cotinine screening of pregnant women could aid in appropriately counseling women about second-hand exposure as well as monitoring women at high risk for adverse pregnancy outcomes.

Active Mothers Postpartum: a randomized controlled weight-loss intervention trial.

BACKGROUND: Pregnancy may contribute to overweight and obesity. PURPOSE: The primary objective of Active Mothers Postpartum was to promote a reduction in BMI through 24-months postpartum via sustainable lifestyle changes. DESIGN: Behavioral intervention RCT to enhance postpartum weight loss. SETTING/PARTICIPANTS: A total of 450 overweight or obese women, enrolled 6-weeks postpartum, were recruited through obstetrics clinics and community posters in the Durham NC area. INTERVENTION: Intervention participants were offered eight healthy-eating classes, ten physical-activity classes, and six telephone-counseling sessions over 9 months. MAIN OUTCOME MEASURES: Changes from baseline (6-weeks postpartum) to 1-month post-intervention (12-months postpartum) in: (1) diet (caloric intake, calories from fat, intake of certain foods); (2) physical activity (self-reported physical activity, television time); and (3) weight (collected 2004-2007, analyzed 2007-2008). RESULTS: Mean weight loss was 0.90 kg (+/-5.1 kg) in the intervention group and 0.36 kg (+/-4.9 kg) in the control group; this difference was not significant. There were also no significant group differences in improvement of diet or increased physical activity. In secondary analyses, there was a positive bivariate relationship between classes attended and weight loss (p=0.01). CONCLUSIONS: There were no significant differences among the arms in diet, physical activity, or weight change. Home-based interventions via mail, telephone, or Internet/e-mail may be more feasible and successful in this population. The postpartum period is an important phase in women's lives with regard to weight retention, but engaging them during this busy period remains a challenge. TRIAL REGISTRATION: NCT00212251.

Active Mothers Postpartum (AMP): rationale, design, and baseline characteristics.

BACKGROUND: Pregnancy and the postpartum period have been suggested as important contributors to overweight and obesity among women. This paper presents the design, rationale, and baseline participant characteristics of a randomized controlled intervention trial to enhance weight loss in postpartum women who entered pregnancy overweight or obese. METHODS: Active Mothers Postpartum (AMP) is based on the rationale that the birth of a child can be a teachable moment. AMP's primary objectives are to promote and sustain a reduction in body mass index (BMI) up to 2 years postpartum via changes in diet and exercise behavior, with a secondary aim to assess racial differences in these outcomes. Women in the intervention arm participate in ten physical activity group sessions, eight healthy eating classes, and six telephone counseling sessions over a 9-month period. They also receive motivational tools, including a workbook with recipes and exercises, a pedometer, and a sport stroller. RESULTS: Four hundred fifty women aged > or =18 (mean 30.9), with a BMI > or = 25 kg/m(2) (mean 33.0) at baseline (6 weeks postpartum) were enrolled; 45% of the final sample are black and 53% are white. Baseline characteristics by study arm and by race are presented. CONCLUSIONS: Our intervention is designed to be disseminated broadly to benefit the public health. Behavior change interventions based on principles of social cognitive theory, stage of readiness, and other models that coincide with a teachable moment, such as the birth of a child, could be important motivators for postpartum weight loss.