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1.
Health Psychol ; 2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34370494

RESUMO

OBJECTIVE: The biomedical research community has long recognized that much of the basic research being conducted, whether in the biological, behavioral or social sciences, is not readily translated into clinical and public health applications. This translational gap is due in part to challenges inherent in moving research findings from basic or discovery research to applied research that addresses clinical or public health problems. In the behavioral and social sciences, research designs typically used in the early phases of translational research are small, underpowered "pilot" studies that may lack sufficient statistical power to test the research question of interest. While this approach is discouraged, these studies are often employed to estimate effect sizes before embarking on a larger trial with adequate statistical power to test the research hypothesis. The goal of this paper is to provide an alternative approach to early phase studies using single case designs (SCDs). METHOD: Review basic principles of SCDs; provide a series of hypothetical SCD replication experiments to illustrate (1) how data from SCDs can be analyzed to test the effects of an intervention on behavioral and biological outcomes and (2) how sample sizes can be derived for larger randomized controlled trials (RCTs) based on clinically meaningful effects from SCDs; and review feedback between SCDs and RCTs. RESULTS: The paper illustrates the use of SCD reversal and multiple baseline designs for early phase translational research. CONCLUSION: SCDs provide a flexible and efficient platform for the use of experimental methods in early phase translational research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

2.
J Natl Cancer Inst ; 2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34240206

RESUMO

It is estimated that behaviors such as poor diet, alcohol consumption, tobacco use, sedentary behavior, and excessive ultraviolet exposure account for nearly half of all cancer morbidity and mortality. Accordingly, the behavioral, social, and communication sciences have been important contributors to cancer prevention and control research, with methodological advances and implementation science helping to produce optimally effective interventions. To sustain these contributions, it is vital to adapt to the contemporary context. Efforts must consider ancillary effects of the 2019 coronavirus disease pandemic, profound changes in the information environment and public understanding of and trust in science, renewed attention to structural racism and social determinants of health, and the rapidly increasing population of cancer survivors. Within this context, it is essential to accelerate reductions in tobacco use across all population subgroups; consider new models of energy balance (diet, physical activity, sedentary behavior); increase awareness of alcohol as a risk factor for cancer, and identify better communication practices in the context of cancer-related decisions such as screening and genetic testing. Successful integration of behavioral research and cancer prevention depends on working globally and seamlessly across disciplines, taking a multilevel approach where possible. Methodological and analytic approaches should be emphasized in research training programs and should employ new and underutilized data sources and technologies. As the leadership core of the National Cancer Institute's Behavioral Research Program, we reflect on these challenges and opportunities and consider implications for the next phase of behavioral research in cancer prevention and control.

4.
Adv Nutr ; 12(2): 325-333, 2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33463673

RESUMO

A growing body of literature examines the potential benefits of a time-based diet strategy referred to as time-restricted eating (TRE). TRE, a type of intermittent fasting, restricts the time of eating to a window of 4-12 h/d but allows ad libitum intake during eating windows. Although TRE diets do not overtly attempt to reduce energy intake, preliminary evidence from small studies suggests that TRE can lead to concomitant reduction in total energy, improvements in metabolic health, and weight loss. Unique features of the TRE diet strategy may facilitate adherence and long-term weight loss maintenance. In this Perspective, we explore the potential multilevel (i.e., biological, behavioral, psychosocial, environmental) facilitators and barriers of TRE for long-term weight loss maintenance in comparison with the more commonly used diet strategy, caloric restriction (CR). Compared with CR, TRE may facilitate weight loss maintenance by counteracting physiological adaptations to weight loss (biological), allowing for usual dietary preferences to be maintained (behavioral), preserving executive functioning (psychosocial), and enabling individuals to withstand situational pressures to overeat (environmental). However, TRE may also pose unique barriers to weight loss maintenance, particularly for individuals with poor baseline diet quality, internal or social pressures to eat outside selected windows (e.g., grazers), and competing demands that interfere with the scheduling of eating. Future studies of TRE in free-living individuals should consider the multiple levels of influence impacting long-term adherence and weight loss maintenance. Ultimately, TRE could be one strategy in a toolkit of tailored diet strategies to support metabolic health and weight loss maintenance.


Assuntos
Restrição Calórica , Perda de Peso , Ingestão de Energia , Jejum , Humanos , Obesidade
6.
J Behav Med ; 42(1): 34-51, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30825087

RESUMO

The National Institutes of Health (NIH) has played a major role in promoting behavioral medicine research over the past 40 years through funding, review, and priority-setting activities and programs including scientific conferences, meetings, workgroups, intramural research, and training opportunities. In this review of NIH activities in support of behavioral medicine over the past four decades, we highlight key events, programs, projects, and milestones that demonstrate the many ways in which the NIH has supported behavioral and social sciences research and advanced the public health while contributing to the evolution of behavioral medicine as a scientific field.


Assuntos
Medicina do Comportamento/história , National Institutes of Health (U.S.)/história , Saúde Pública/história , Pesquisa Comportamental/história , História do Século XX , História do Século XXI , Humanos , Ciências Sociais/história , Estados Unidos
7.
J Clin Epidemiol ; 110: 74-81, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30826377

RESUMO

OBJECTIVES: To provide recommendations for the selection of comparators for randomized controlled trials of health-related behavioral interventions. STUDY DESIGN AND SETTING: The National Institutes of Health Office of Behavioral and Social Science Research convened an expert panel to critically review the literature on control or comparison groups for behavioral trials and to develop strategies for improving comparator choices and for resolving controversies and disagreements about comparators. RESULTS: The panel developed a Pragmatic Model for Comparator Selection in Health-Related Behavioral Trials. The model indicates that the optimal comparator is the one that best serves the primary purpose of the trial but that the optimal comparator's limitations and barriers to its use must also be taken into account. CONCLUSION: We developed best practice recommendations for the selection of comparators for health-related behavioral trials. Use of the Pragmatic Model for Comparator Selection in Health-Related Behavioral Trials can improve the comparator selection process and help resolve disagreements about comparator choices.


Assuntos
Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , National Institutes of Health (U.S.)/normas , Guias de Prática Clínica como Assunto , Feminino , Humanos , Masculino , Seleção de Pacientes , Psicoterapia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Estados Unidos
8.
J Obstet Gynecol Neonatal Nurs ; 48(2): 197-204, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30790528

RESUMO

Researchers may find it difficult to transition from conducting descriptive, mechanistic, and associational studies to developing interventions based on those findings because little guidance is available. In this article, we present the Obesity-Related Behavioral Intervention Trials (ORBIT) model and describe its applicability in designing behaviorally oriented interventions for women. Adapted from drug development research on the translation of basic laboratory research to clinical practice, the ORBIT model emphasizes the pre-efficacy testing phases of intervention development. Phase I is focused on the definition and refinement of the intervention and incorporates various study designs, including experimental, observational, qualitative, and adaptive design. Phase II involves the use of single-group proof-of-concept, feasibility, and preliminary efficacy studies to show the feasibility and capacity of the intervention to produce change in an intermediate endpoint. Phase III involves the use of randomized controlled trials to test the efficacy of the intervention. We illustrate how the ORBIT model could be applied in a hypothetical intervention to increase a woman's sense of control of her life before behavioral weight loss efforts in the postpartum period.


Assuntos
Terapia Comportamental/métodos , Pesquisa Metodológica em Enfermagem/métodos , Obesidade , Pesquisa Médica Translacional/métodos , Saúde da Mulher , Feminino , Educação em Saúde/métodos , Humanos , Obesidade/prevenção & controle , Obesidade/psicologia , Obesidade/terapia , Serviços Preventivos de Saúde/métodos , Projetos de Pesquisa
9.
Am Psychol ; 73(8): 949-954, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30394774

RESUMO

Although deaths due to cardiovascular diseases have declined significantly since the 1970s, they remain the most common cause of morbidity and mortality in the United States. A large number of cardiovascular risk factors, such as smoking, obesity, and sedentary lifestyle, are modifiable. Psychologists and other behavioral scientists and practitioners are engaged in not only understanding the mechanistic links between behaviors and cardiovascular health but also developing effective interventions for improving health. The purpose of this special issue is to highlight some of the more innovative psychological research in cardiovascular health promotion, disease prevention, and management. Articles included in this issue focus on 2 primary areas. First, cutting-edge research on the current state of knowledge of modifiable health behaviors and their impact on cardiovascular health include articles on e-cigarette use as a putative risk factor, psychological factors involved in adherence to medications, the role of sleep in cardiovascular health, and innovative approaches to enhancing the treatment and recovery of patients with cardiovascular diseases. Second, outstanding research identifying the mechanisms by which psychological factors such as stress, depression, and anxiety impact cardiovascular disease include an overview of the current state of science examining psychological comorbidities that can accompany cardiovascular disease and influence outcomes, discussion of the neurocognitive processes that connect stress appraisal with biological functioning and diseases processes, and the role of genetics on behavioral interventions and clinical decision-making in the context of behavioral weight loss treatments. Our goal with these innovative articles is to stimulate additional advances in cardiovascular behavioral medicine. (PsycINFO Database Record (c) 2018 APA, all rights reserved).


Assuntos
Medicina do Comportamento , Doenças Cardiovasculares/psicologia , Doenças Cardiovasculares/terapia , Humanos
10.
Am Psychol ; 73(8): 968-980, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30394776

RESUMO

Poor adherence to cardiovascular disease medications carries significant psychological, physical, and economic costs, including failure to achieve therapeutic goals, high rates of hospitalization and health care costs, and incidence of death. Despite much effort to design and evaluate adherence interventions, rates of adherence to cardiovascular-related medications have remained relatively stagnant. We identify two major reasons for this: First, interventions have not addressed the time-varying reasons for nonadherence, and 2nd, interventions have not explicitly targeted the self-regulatory processes involved in adherence behavior. Inclusion of basic and applied psychological science in intervention development may improve the efficacy and effectiveness of behavioral interventions to improve adherence. In this article, we use a taxonomy of time-based phases of adherence-including initiation, implementation, and discontinuation-as context within which to review illustrative studies of barriers to adherence, interventions to improve adherence, and self-regulatory processes involved in adherence. Finally, we suggest a framework to translate basic psychological science regarding self-regulation into multicomponent interventions that can address multiple and time-varying barriers to nonadherence across the three adherence phases. The field of psychology is essential to improving medication adherence and associated health outcomes, and concrete steps need to be taken to implement this knowledge in future interventions. (PsycINFO Database Record (c) 2018 APA, all rights reserved).


Assuntos
Terapia Comportamental/métodos , Medicina do Comportamento/métodos , Doenças Cardiovasculares/tratamento farmacológico , Adesão à Medicação/psicologia , Autocontrole/psicologia , Humanos
11.
Health Psychol ; 37(12): 1081-1091, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30307270

RESUMO

OBJECTIVE: Improving diet, activity level, and medication adherence and controlling tobacco and other substance use have all been shown to produce measurable, cost-effective improvements in health outcomes. However, many individuals do not respond to available treatments, and efficacious interventions are often not brought to scale. Developing and implementing more potent behavioral treatments in diverse populations to ultimately improve public health involves a focus on behavioral intervention research across the translational spectrum. There has been little attention paid to designs, methods, and analytic techniques for early phase trials. METHOD: The National Institutes of Health sponsored a cross-institute, 2-day Workshop on Innovative Study Designs and Methods for Developing, Testing and Implementing Behavioral Interventions to Improve Health to review, evaluate, and disseminate a selection of innovative designs and analytic strategies for use in behavioral intervention studies. RESULTS: The workshop was organized to reflect methods appropriate for use across the translational spectrum. Because of the historical attention paid to the randomized clinical trial, the workshop placed particular emphasis on the designing and preliminary testing of behavioral interventions, the optimization of interventions, and the later effectiveness and implementation of trials. CONCLUSIONS: This article provides a summary of the methods discussed at the workshop, with recommendations for their use to improve the impact, reach, and cost-effectiveness of behavioral intervention research across the translational spectrum. (PsycINFO Database Record (c) 2018 APA, all rights reserved).


Assuntos
Terapia Comportamental/métodos , Projetos de Pesquisa/tendências , Humanos
12.
Transl Behav Med ; 8(5): 808-814, 2018 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-29617926

RESUMO

The prevention and effective treatment of many chronic diseases such as cardiovascular disease, cancer and diabetes are dependent on behaviors such as not smoking, adopting a physically-active lifestyle, eating a healthy diet, and adhering to prescribed medical and behavioral regimens. Yet adoption and maintenance of these behaviors pose major challenges for individuals, their families and communities, as well as clinicians and health care systems. These challenges can best be met through the integration of the biomedical and behavioral sciences that is achieved by the formation of strategic partnerships between researchers and practitioners in these disciplines to address pressing clinical and public health problems. The National Institutes of Health has supported a number of clinical trials and research initiatives that demonstrate the value of biomedical and behavioral science partnerships in translating fundamental discoveries into significant improvements in health outcomes. We review several such examples of collaborations between biomedical and behavioral researchers, describe key initiatives focused on advancing a transdisciplinary translational perspective, and outline areas which require insights, tools and findings from both the biomedical and behavioral sciences to advance the public's health.


Assuntos
Pesquisa Comportamental , Pesquisa Biomédica , Doença Crônica/prevenção & controle , Colaboração Intersetorial , National Institutes of Health (U.S.) , Saúde Pública , Pesquisa Médica Translacional , Humanos , Estados Unidos
13.
Obesity (Silver Spring) ; 26 Suppl 2: S6-S15, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29575780

RESUMO

BACKGROUND: Individual variability in response to multiple modalities of obesity treatment is well documented, yet our understanding of why some individuals respond while others do not is limited. The etiology of this variability is multifactorial; however, at present, we lack a comprehensive evidence base to identify which factors or combination of factors influence treatment response. OBJECTIVES: This paper provides an overview and rationale of the Accumulating Data to Optimally Predict obesity Treatment (ADOPT) Core Measures Project, which aims to advance the understanding of individual variability in response to adult obesity treatment. This project provides an integrated model for how factors in the behavioral, biological, environmental, and psychosocial domains may influence obesity treatment responses and identify a core set of measures to be used consistently across adult weight-loss trials. This paper provides the foundation for four companion papers that describe the core measures in detail. SIGNIFICANCE: The accumulation of data on factors across the four ADOPT domains can inform the design and delivery of effective, tailored obesity treatments. ADOPT provides a framework for how obesity researchers can collectively generate this evidence base and is a first step in an ongoing process that can be refined as the science advances.


Assuntos
Obesidade/terapia , Humanos , Comunicação Interdisciplinar , Projetos de Pesquisa
14.
Obesity (Silver Spring) ; 26 Suppl 2: S45-S54, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29575781

RESUMO

BACKGROUND: Within the Accumulating Data to Optimally Predict obesity Treatment (ADOPT) Core Measures Project, the psychosocial domain addresses how psychosocial processes underlie the influence of obesity treatment strategies on weight loss and weight maintenance. The subgroup for the psychosocial domain identified an initial list of high-priority constructs and measures that ranged from relatively stable characteristics about the person (cognitive function, personality) to dynamic characteristics that may change over time (motivation, affect). OBJECTIVES: This paper describes (a) how the psychosocial domain fits into the broader model of weight loss and weight maintenance as conceptualized by ADOPT; (b) the guiding principles used to select constructs and measures for recommendation; (c) the high-priority constructs recommended for inclusion; (d) domain-specific issues for advancing the science; and (e) recommendations for future research. SIGNIFICANCE: The inclusion of similar measures across trials will help to better identify how psychosocial factors mediate and moderate the weight loss and weight maintenance process, facilitate research into dynamic interactions with factors in the other ADOPT domains, and ultimately improve the design and delivery of effective interventions.


Assuntos
Obesidade/psicologia , Humanos , Motivação , Obesidade/terapia , Psicologia , Pesquisa , Perda de Peso
15.
Transl Behav Med ; 6(2): 244-59, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27356995

RESUMO

The National Heart, Lung, and Blood Institute and the National Institutes of Health Office of Disease Prevention convened a meeting on August 29-30, 2013 entitled "Obesity Intervention Taxonomy and Pooled Analysis." The overarching goals of the meeting were to understand how to decompose interventions targeting behavior change, and in particular, those that focus on obesity and to combine data from groups of related intervention studies to supplement what can be learned from the individual studies. This paper summarizes the workshop recommendations and provides an overview of the two other papers that originated from the workshop and that address decomposition of behavioral change interventions and pooling of data across diverse studies within a consortium.


Assuntos
Terapia Comportamental/classificação , Obesidade/prevenção & controle , Centers for Disease Control and Prevention, U.S. , Comportamentos Relacionados com a Saúde , Humanos , National Heart, Lung, and Blood Institute (U.S.) , Estados Unidos
16.
Pediatr Clin North Am ; 63(3): 389-99, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27261541

RESUMO

Pediatric obesity increases the risk of later-life obesity and chronic diseases. Basic research to better understand factors associated with excessive weight gain in early life and studies translating research findings into preventive and therapeutic strategies are essential to our ability to better prevent and treat childhood obesity. This overview describes several National Institutes of Health efforts designed to stimulate basic and translational research in childhood obesity prevention and treatment. These examples demonstrate the value of research in early phase translational pediatric obesity research and highlight some promising directions for this important area of research.


Assuntos
Terapia Comportamental/organização & administração , Educação em Saúde/organização & administração , Promoção da Saúde/organização & administração , Educação de Pacientes como Assunto/organização & administração , Obesidade Pediátrica/prevenção & controle , Pesquisa Comportamental/tendências , Criança , Proteção da Criança/tendências , Feminino , Humanos , Masculino , National Institutes of Health (U.S.) , Obesidade Pediátrica/terapia , Comportamento de Redução do Risco , Estados Unidos
18.
Transl Behav Med ; 6(1): 32-43, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27012251

RESUMO

The translation of basic behavioral science discoveries into practical strategies represents a promising approach to developing more effective preventive interventions to improve health. Since translational research inevitably involves making use of diverse perspectives from multiple disciplines, it is best conducted as a transdisciplinary enterprise. In this paper, we discuss current strategies used by NIH to support transdisciplinary translational behavioral (TDTB) research, summarize successful efforts, and highlight challenges encountered in conducting such work (ranging from conceptual to organizational to methodological). Using examples from NIH-funded projects we illustrate the potential benefits of, and barriers to, pursuing this type of research and discuss next steps and potential future directions for NIH-supported TDTB research.


Assuntos
Pesquisa Comportamental/métodos , National Institutes of Health (U.S.) , Pesquisa Médica Translacional/métodos , Pesquisa Comportamental/economia , Pesquisa Comportamental/educação , Cultura , Humanos , Revisão da Pesquisa por Pares , Projetos de Pesquisa , Pesquisa Médica Translacional/economia , Pesquisa Médica Translacional/educação , Estados Unidos
19.
Health Psychol ; 34(10): 971-82, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25642841

RESUMO

OBJECTIVE: Given the critical role of behavior in preventing and treating chronic diseases, it is important to accelerate the development of behavioral treatments that can improve chronic disease prevention and outcomes. Findings from basic behavioral and social sciences research hold great promise for addressing behaviorally based clinical health problems, yet there is currently no established pathway for translating fundamental behavioral science discoveries into health-related treatments ready for Phase III efficacy testing. This article provides a systematic framework for developing behavioral treatments for preventing and treating chronic diseases. METHOD: The Obesity-Related Behavioral Intervention Trials (ORBIT) model for behavioral treatment development features a flexible and progressive process, prespecified clinically significant milestones for forward movement, and return to earlier stages for refinement and optimization. RESULTS: This article presents the background and rationale for the ORBIT model, a summary of key questions for each phase, a selection of study designs and methodologies well-suited to answering these questions, and prespecified milestones for forward or backward movement across phases. CONCLUSIONS: The ORBIT model provides a progressive, clinically relevant approach to increasing the number of evidence-based behavioral treatments available to prevent and treat chronic diseases. (PsycINFO Database Record


Assuntos
Terapia Comportamental/métodos , Doença Crônica/terapia , Pesquisa Biomédica , Humanos
20.
Am Heart J ; 162(3): 412-24, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21884856

RESUMO

Poor adherence to efficacious cardiovascular-related medications has led to considerable morbidity, mortality, and avoidable health care costs. This article provides results of a recent think-tank meeting in which various stakeholder groups representing key experts from consumers, community health providers, the academic community, decision-making government officials (Food and Drug Administration, National Institutes of Health, etc), and industry scientists met to evaluate the current status of medication adherence and provide recommendations for improving outcomes. Below, we review the magnitude of the problem of medication adherence, prevalence, impact, and cost. We then summarize proven effective approaches and conclude with a discussion of recommendations to address this growing and significant public health issue of medication nonadherence.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , Serviços de Saúde Comunitária/métodos , Serviços Comunitários de Farmácia/organização & administração , Adesão à Medicação/estatística & dados numéricos , Fármacos Cardiovasculares/economia , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/epidemiologia , Custos de Medicamentos , Honorários Farmacêuticos/tendências , Humanos , Morbidade/tendências , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
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