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1.
Clin Cardiol ; 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32378265

RESUMO

BACKGROUND: Previous studies examining the use of direct oral anticoagulants (DOACs) in atrial fibrillation (AF) have largely focused on patients newly initiating therapy. Little is known about the prevalence/patterns of switching to DOACs among AF patients initially treated with warfarin. HYPOTHESIS: To examine patterns of anticoagulation among patients chronically managed with warfarin upon the availability of DOACs and identify patient/practice-level factors associated with switching from chronic warfarin therapy to a DOAC. METHODS: Prospective cohort study of AF patients in the NCDR PINNACLE registry prescribed warfarin between May 1, 2008 and May 1, 2015. Patients were followed at least 1 year (median length of follow-up 375 days, IQR 154-375) through May 1, 2016 and stratified as follows: continued warfarin, switched to DOAC, or discontinued anticoagulation. To identify significant predictors of switching, a three-level multivariable hierarchical regression was developed. RESULTS: Among 383 008 AF patients initially prescribed warfarin, 16.3% (n = 62 620) switched to DOACs, 68.8% (n = 263 609) continued warfarin, and 14.8% (n = 56 779) discontinued anticoagulation. Among those switched, 37.6% received dabigatran, 37.0% rivaroxaban, 24.4% apixaban, and 1.0% edoxaban. Switched patients were more likely to be younger, women, white, and have private insurance (all P < .001). Switching was less likely with increased stroke risk (OR, 0.92; 95%CI, 0.91-0.93 per 1-point increase CHA2 DS2 -VASc), but more likely with increased bleeding risk (OR, 1.12; 95%CI, 1.10-1.13 per 1-point increase HAS-BLED). There was substantial variation at the practice-level (MOR, 2.33; 95%CI, 2.12-2.58) and among providers within the same practice (MOR, 1.46; 95%CI, 1.43-1.49). CONCLUSIONS: Among AF patients treated with warfarin between October 1, 2010 and May 1, 2016, one in six were switched to DOACs, with differences across sociodemographic/clinical characteristics and substantial practice-level variation. In the context of current guidelines which favor DOACs over warfarin, these findings help benchmark performance and identify areas of improvement.

2.
Proc Natl Acad Sci U S A ; 117(19): 10565-10574, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32345721

RESUMO

Numerous mutations that impair retrograde membrane trafficking between endosomes and the Golgi apparatus lead to neurodegenerative diseases. For example, mutations in the endosomal retromer complex are implicated in Alzheimer's and Parkinson's diseases, and mutations of the Golgi-associated retrograde protein (GARP) complex cause progressive cerebello-cerebral atrophy type 2 (PCCA2). However, how these mutations cause neurodegeneration is unknown. GARP mutations in yeast, including one causing PCCA2, result in sphingolipid abnormalities and impaired cell growth that are corrected by treatment with myriocin, a sphingolipid synthesis inhibitor, suggesting that alterations in sphingolipid metabolism contribute to cell dysfunction and death. Here we tested this hypothesis in wobbler mice, a murine model with a homozygous partial loss-of-function mutation in Vps54 (GARP protein) that causes motor neuron disease. Cytotoxic sphingoid long-chain bases accumulated in embryonic fibroblasts and spinal cords from wobbler mice. Remarkably, chronic treatment of wobbler mice with myriocin markedly improved their wellness scores, grip strength, neuropathology, and survival. Proteomic analyses of wobbler fibroblasts revealed extensive missorting of lysosomal proteins, including sphingolipid catabolism enzymes, to the Golgi compartment, which may contribute to the sphingolipid abnormalities. Our findings establish that altered sphingolipid metabolism due to GARP mutations contributes to neurodegeneration and suggest that inhibiting sphingolipid synthesis might provide a useful strategy for treating these disorders.

3.
AIDS Behav ; 2020 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-32170508

RESUMO

Men who have sex with men (MSM) are disproportionately affected by HIV and may avoid disclosing their sexual preferences to others. With heightened attention on immigrant status in the United States, foreign-born MSM may be particularly concerned about disclosing their sexual orientation. We sought to examine how immigrant status is associated with sexual orientation disclosure among MSM and to assess the impact of disclosure on HIV/STD prevention outcomes stratified by nativity. We analyzed data from the 2014 and 2017 Seattle-area surveys of MSM from the National HIV Behavioral Surveillance (NHBS) system. Foreign-born MSM were less likely than U.S.-born MSM to have disclosed their sexuality to friends who are not gay, lesbian, or bisexual (85.0% vs. 95.5%; p < .001) or to family members (80.5% vs. 91.3%; p < .001). Further, disclosure to one's health care provider significantly increased the likelihood of having tested for HIV in the past 12 months among foreign-born and U.S.-born MSM. Findings highlight the need to better understand the risks and benefits of disclosure among foreign-born MSM. Future research may explore how responses and reactions to disclosure among foreign-born MSM shape pathways to HIV risk and prevention.

4.
J Am Coll Cardiol ; 75(1): 93-112, 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31918838

RESUMO

The National Cardiovascular Data Registry PINNACLE (Practice Innovation and Clinical Excellence) Registry is the largest outpatient cardiovascular practice registry in the world. It tracks real-world management and quality of 4 common cardiovascular conditions: heart failure, coronary artery disease, atrial fibrillation, and hypertension. In 2013, the PINNACLE Registry contained information on 2,898,505 patients, cared for by 4,859 providers in 431 practices. By 2017, the registry contained information on 6,040,996 patients, cared for by 8,853 providers in 724 practices. During this time period, care processes for PINNACLE patients generally improved. Among patients with heart failure, combined beta-blocker and renin-angiotensin antagonist medication rates increased from 60.7% to 72.8%. Among patients with coronary artery disease, statin medication rates increased from 66% to 80.1%. Among patients with atrial fibrillation, oral anticoagulation rates increased from 52.7% to 65.2%. In contrast, blood pressure control rates among patients with hypertension were largely stable. PINNACLE data also fueled a variety of quality measurement programs and 51 peer-reviewed publications.

5.
Behav Med ; : 1-11, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31039086

RESUMO

Posttraumatic stress, low academic performance, and future orientation as pathways from community violence exposure to sexual risk-taking behavior were examined among 753 African American youth in a large urban school district, ranging from ages of 13 to 24 years. Youth completed a self-report instrument. Youth completed a self-report instrument of Exposure to Violence Probe, University of California at Los Angeles' PTSD Reaction Index Adolescent Version, and Coopersmith's Self-Esteem Scale. Structural equation modeling was performed to examine relationships among the major study variables. Results indicated that community violence exposure was not directly associated with sexual risk behavior. However, community violence exposure had a significantly positive impact on posttraumatic stress, which was associated with low future orientation and sexual risk behavior. Findings suggest that targeted interventions need to consider variables that mediate the association between violence exposure and sexual risk behavior, which can reduce poor sexual health outcomes among urban youth who are exposed to violence in their community.

7.
Birth Defects Res ; 111(14): 967-981, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-30989821

RESUMO

OBJECTIVES: Mothers need a nutrient-rich diet for healthy neural tube development. Neural tube defect risk can be reduced through fortifying grain products with folic acid and taking folic acid supplements. Fortification is not required in Bangladesh. Maternal supplement use rates are low, similar to other countries. This study evaluates maternal dietary intake during pregnancy to identify possible interventions. METHODS: A food frequency questionnaire (FFQ) assessed maternal diet. The primary aim compared dietary intake (calories, fat, carbohydrate, protein, fiber, vitamins, and minerals) between mothers of infants with myelomeningocele (cases) and mothers of controls. Secondary aims included (i) comparing foods consumed and (ii) evaluating if rice intake correlated with arsenic exposure. Paired t-tests, Wilcoxon signed rank tests, McNemar's chi-squared test, and linear regression were used. RESULTS: This study included 110 matched mother-infant pairs (55 cases/55 controls). Mothers of cases and mothers of controls had similar caloric intake [median 2406 kcal/day vs. 2196 kcal/day (p = 0.071)]. Mothers in both groups consumed less than half the daily recommended 600 µg of folate. Diets were potentially deficient in vitamins A, D, E, potassium, sodium, and iron. Steamed rice was the primary food consumed for both groups, and this rice intake was not associated with toenail arsenic. CONCLUSIONS: Dietary interventions should increase folate, vitamins A, D, E, potassium, sodium, and iron intake in Bangladeshi mothers. Folic acid fortification of grain products maybe the only viable strategy to achieve adequate folate intake for mothers. Given the central role of rice to the Bangladeshi diet, fortifying rice may be a viable option.

8.
AIDS Behav ; 23(2): 336-346, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30109457

RESUMO

Latino immigrants in the United States are at elevated risk for HIV infection and delayed HIV diagnosis. Immigration documentation status and its contribution to fears are important barriers to accessing health services including HIV testing. A currently changing political climate within the United States may have increased the complexity of the intersection of documentation status and health care access. This study used an anonymous survey conducted in March and April 2017 in New York City to compare: sociodemographic characteristics, HIV testing behaviors, HIV risk behaviors, and perceptions of fear around HIV testing among documented and undocumented Latino immigrants (N = 301). We found that undocumented immigrants reported lower levels of education, income, and health insurance than did documented immigrants. However, groups did not differ in having tested for HIV in the last 12 months, in future intentions to test for HIV, or in emotional/cognitive perceptions of fear around HIV testing. Undocumented immigrants reported lower rates of having ever tested for HIV in their lifetime (68.6%) than documented immigrants (80.5%) (p = 0.027). In conclusion, we found that despite sociodemographic challenges, undocumented immigrants had similar HIV testing behaviors as their documented counterparts in our study community. Further understanding of the mitigating factors that resulted in seemingly equal access to HIV testing in this community for undocumented immigrants is warranted.


Assuntos
Emigrantes e Imigrantes/psicologia , Medo , Infecções por HIV/diagnóstico , Hispano-Americanos/psicologia , Imigrantes Indocumentados/psicologia , Adolescente , Adulto , Preservativos/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Infecções por HIV/prevenção & controle , Acesso aos Serviços de Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Renda , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Percepção , Assunção de Riscos , Sexo Seguro/estatística & dados numéricos , Trabalho Sexual/estatística & dados numéricos , Fatores Socioeconômicos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Inquéritos e Questionários , Imigrantes Indocumentados/estatística & dados numéricos , Estados Unidos , Sexo sem Proteção/estatística & dados numéricos , Adulto Jovem
9.
AIDS Care ; 31(2): 141-152, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30309240

RESUMO

Asians have the highest rate of undiagnosed HIV in the United States. Limited research on factors implicated in HIV testing among this population presents a barrier to monitoring and addressing HIV testing disparities. To examine predictors of HIV testing among Asians in the United States, a systematic search of articles published from January 1997 to December 2017 was conducted using four electronic databases, including Medline, PubMed, PsycINFO, and Web of Science. Twenty-two articles were included according to predefined inclusion criteria: peer-reviewed, published in English, took place in the United States, included participants at least 18 years of age, reported data specifically on Asians or Asian subgroups, and assessed HIV testing. Included studies were assessed by methodological quality scoring. Individual-level factors such as HIV knowledge and HIV risk perceptions were commonly reported facilitators of HIV testing. Studies placed less attention on community, institutional, or structural level factors predicting HIV testing. Sorely warranted are high quality, longitudinal studies that examine HIV testing among Asians in the United States. Multi-level theoretical frameworks that examine HIV testing among Asians with attention to ethnic subgroups are needed to improve understanding of HIV testing and to develop targeted testing interventions.


Assuntos
Americanos Asiáticos , Infecções por HIV/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Testes Sorológicos , Estados Unidos
10.
West J Nurs Res ; 41(6): 798-815, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30178715

RESUMO

African American youths, especially those in low resource communities, are vulnerable to peer victimization, which can increase risk of sexually transmitted infections. However, few studies explored the relationship between these two health concerns and the pathways that may link them. The present study aimed to address this gap. We used descriptive statistics, correlation coefficients, and structural equation modeling to analyze data collected from 277 adolescents ages 13 to 24 years in Chicago. Primary results indicated that peer victimization was not directly related to acquisition of sexually transmitted infections. However, peer victimization was negatively associated with condom use, and condom use was negatively associated with sexually transmitted infections. Furthermore, affiliation with sexually active peers was positively associated with substance use. These findings have implications for bullying and sexual risk prevention and intervention of low-income youths. Attention to treatment approaches and interventions that are holistic and culturally feasible is recommended for practitioners working with urban youth.


Assuntos
Afro-Americanos/estatística & dados numéricos , Vítimas de Crime , Grupo Associado , Doenças Sexualmente Transmissíveis/prevenção & controle , Adolescente , Comportamento do Adolescente , Adulto , Chicago , Feminino , Humanos , Masculino , Pobreza , Comportamento Sexual , Adulto Jovem
11.
J Immigr Minor Health ; 21(4): 844-852, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29961164

RESUMO

Immigrants are at increased risk for late HIV testing; however, there is limited understanding of how migration to the United States shapes HIV testing behaviors. This study examined the relationship between the migration process and HIV testing among Latino immigrants. Semi-structured, in-depth interviews were conducted in March and April 2017 with 34 Latino immigrants in New York City. Grounded theory guided analysis of the qualitative data. Results indicated that Latino immigrants experienced cumulative stress and trauma throughout the migration process that contributed to significant emotional and psychological consequences. Stress and trauma accumulated from the migration process posed barriers to HIV testing as Latino immigrants sought to avoid activities perceived as stressful, including learning one's HIV status. Targeted interventions that ameliorate the stressful effects of migration may facilitate preventive health behaviors among Latino immigrants.


Assuntos
Emigrantes e Imigrantes/psicologia , Infecções por HIV/prevenção & controle , Hispano-Americanos/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Teoria Fundamentada , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Pesquisa Qualitativa , Estados Unidos
14.
Int J Epidemiol ; 2018 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-30452641

RESUMO

The overall effect of an exposure on an outcome, in the presence of a mediator with which the exposure may interact, can be decomposed into four components that correspond to the portion of the effect that is due: (i) to neither mediation nor interaction; (ii) to just interaction (but not mediation); (iii) to both mediation and interaction; and (iv) to just mediation (but not interaction). This four-way decomposition unifies methods to attribute effects to interactions and methods that assess mediation. We introduce the Stata command med4way to estimate the causal contrasts that arise in this decomposition. Med4way is implemented as a Stata stand-alone command requiring Stata version 10 or higher (StataCorp, College Station, TX, USA), and allows estimating the four-way decomposition using parametric regression models. Med4way can be used when the outcome is continuous, dichotomous, count or survival time, and the mediator is continuous or binary. The command accommodates cohort and case-control designs. We present two examples of application of the command to gain insight on important public health problems. In the first application, we employ med4way to investigate the role of birth outcomes in explaining the effect of maternal exposure to manganese on child neurodevelopment. In the second application, we investigate the role of stage at diagnosis in explaining income disparities in colorectal cancer survival. The command is freely available on GitHub [https://github.com/anddis/med4way] and has been published under General Public License (GPL) version 3.

15.
J Interv Card Electrophysiol ; 52(3): 315-322, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29936634

RESUMO

Aortic stenosis is the most common valvular heart disease in industrialized countries and the most common cause of left ventricular outflow tract (LVOT) obstruction. Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement for intermediate to high-risk surgical candidates with symptomatic severe aortic stenosis. Conduction system abnormalities, including atrioventricular (AV) and intraventricular (IV) block, are the most common complication of TAVR. In this review, we aim to explore the anatomical issues relevant to atrioventricular block, the relevant clinical and procedural aspects, and the management and long-term implications of AV and IV block.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/terapia , Bloqueio de Ramo/terapia , Estimulação Cardíaca Artificial/métodos , Substituição da Valva Aórtica Transcateter/ética , Animais , Estenose da Valva Aórtica/diagnóstico por imagem , Bloqueio Atrioventricular/diagnóstico por imagem , Bloqueio Atrioventricular/etiologia , Bloqueio Atrioventricular/mortalidade , Bloqueio de Ramo/diagnóstico por imagem , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/mortalidade , Ecocardiografia Doppler/métodos , Eletrocardiografia/métodos , Humanos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , Prognóstico , Medição de Risco , Taxa de Sobrevida , Substituição da Valva Aórtica Transcateter/métodos , Resultado do Tratamento
16.
Int J Epidemiol ; 47(4): 1169-1179, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29733356

RESUMO

Background: Our previous study demonstrated that prenatal manganese exposure is associated with cognitive test scores among a cohort of 2- to 3-year-old Bangladeshi children. This study tested the hypothesis that the adverse effects of manganese are mediated through poor prenatal growth. Methods: Pregnant mothers were enrolled in a birth cohort in Bangladesh between 2008 and 2011, and children were followed at birth and age 20-40 months. Manganese concentration was measured in umbilical cord blood. Anthropometric measurements (weight, length, head circumference) were assessed at delivery. Children's cognitive development was assessed at age 20-40 months using the Bayley Scales of Infant and Toddler Development-Third Edition. Using recently developed statistical approaches that estimate mediation and interaction effects simultaneously, we evaluated whether the association between cord blood manganese and cognitive score was mediated through anthropometric measures at birth. Results: This analysis included 764 mother-child pairs. Higher manganese concentration was associated with lower cognitive score [ß=-0.61, standard error (SE)=0.23, p = 0.009]. Among the birth measures, we found a significant indirect effect only through birth length (ß =-0.10, SE = 0.03, p = 0.001). We also found evidence of mediated interaction (both mediation and interaction, ß =-0.03, SE = 0.01, p = 0.01) with birth length in the association between cord blood manganese and cognitive score. The overall proportion mediated by birth length was 33% (p = 0.02) and the proportion attributed to interaction was 11% (p = 0.04). We did not find evidence of a mediating effect through birth weight or head circumference. Conclusions: Our findings confirm that prenatal growth, particularly birth length, contributes to the overall effect of environmental manganese exposure on a child's cognitive development.


Assuntos
Desenvolvimento Infantil/efeitos dos fármacos , Cognição , Exposição Ambiental/efeitos adversos , Sangue Fetal/química , Manganês/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal , Adulto , Antropometria , Bangladesh , Pré-Escolar , Estudos de Coortes , Feminino , Sangue Fetal/efeitos dos fármacos , Humanos , Lactente , Masculino , Manganês/sangue , Testes Neuropsicológicos , Gravidez , Adulto Jovem
17.
Am J Med ; 131(6): 684-692.e12, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29518370

RESUMO

BACKGROUND: We examined the associations among 8 different fat depots accumulated in various anatomic regions and the relationship between these fat depots and multiple cardiometabolic risk factors. METHODS: Participants were from the Framingham Heart Study Offspring and Third Generation who also participated in the multidetector computed tomography substudy in 2002-2005. Exposures were multidetector computed tomography-derived fat depots, including abdominal subcutaneous adipose tissue, abdominal visceral adipose tissue, intramuscular fat, intrathoracic fat, pericardial fat, thoracic periaortic fat, intrahepatic fat, and renal sinus fat. Multivariable-adjusted regression analyses with a forward selection procedure were performed to identify the most predictive fat depots. RESULTS: Of 2529 participants, 51.9% were women (mean age, 51.1 years). Visceral adipose tissue had the strongest correlations with each of the other fat measures (range, 0.26-0.77) and with various cardiometabolic risk factors (range, -0.34 to 0.39). As determined by the selection models, visceral adipose tissue was the only fat depot that was associated with all cardiometabolic risk factors evaluated in this study (all P<.05). Selection models also showed that subcutaneous adipose tissue and intrahepatic fat were associated with cardiometabolic risk factors related to the traits of dysglycemia, dyslipidemia, and hypertension (all P<.05). However, only associations with visceral adipose tissue and intrahepatic fat persisted after further adjustment for body mass index and waist circumference. CONCLUSIONS: Visceral adipose tissue and intrahepatic fat were consistent correlates of cardiometabolic risk factors, above and beyond standard anthropometric indices. Our data provide important insights for understanding the associations between variations in fat distribution and cardiometabolic abnormalities.


Assuntos
Tecido Adiposo/fisiologia , Composição Corporal , Distribuição da Gordura Corporal , Doenças Cardiovasculares/etiologia , Estudos Longitudinais , Doenças Metabólicas/etiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
18.
Am J Cardiol ; 121(2): 162-167, 2018 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-29146023

RESUMO

Cross-sectional studies have shown that pericardial fat is associated with atherosclerotic burden above and beyond generalized and central adiposity. Whether pericardial fat is longitudinally associated with coronary artery calcium (CAC) has not been firmly established. We examined the associations between cardiac ectopic fat including pericardial and intrathoracic fat with CAC progression and incidence in a community-based study setting. Study participants were from the Framingham Heart Study Offspring and Third Generation Cohorts who underwent multidetector computed tomography at 2 consecutive examinations (2002 to 2005 and 2008 to 2011) for the assessment of CAC. Multivariable-adjusted regression models were used to evaluate the associations between cardiac ectopic fat with CAC. Nonlinear associations were also examined. We included 1,732 participants (49.6% women, mean age 49.9 years). Of the 1,024 participants with a CAC score = 0 at baseline, 197 individuals developed a CAC score > 0 (19.2%) during 6.1 years of follow-up. The remaining 708 participants with a CAC score > 0 at baseline were eligible for CAC progression analysis. We identified nonlinear association between pericardial fat and CAC progression. Higher pericardial fat was associated with higher CAC progression only for those participants with pericardial fat higher than the median value (ß = 56.0, p = 0.04). Intrathoracic fat was linearly associated with CAC progression (ß = 23.0, p = 0.02). However, all of these associations did not persist after additional adjustment for body mass index, abdominal visceral adipose tissue, or waist circumference (all p ≥ 0.14). Neither pericardial nor intrathoracic fat were associated with CAC incidence (all p ≥ 0.33). Overall, both of the cardiac ectopic fat measures were longitudinally associated with CAC progression.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Pericárdio/diagnóstico por imagem , Tórax/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Adulto , Doença da Artéria Coronariana/epidemiologia , Progressão da Doença , Feminino , Humanos , Gordura Intra-Abdominal/diagnóstico por imagem , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Dinâmica não Linear , Calcificação Vascular/epidemiologia
19.
JAMA Intern Med ; 177(11): 1586-1593, 2017 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-28973115

RESUMO

Importance: Gamification, the application of game design elements such as points and levels in nongame contexts, is often used in digital health interventions, but evidence on its effectiveness is limited. Objective: To test the effectiveness of a gamification intervention designed using insights from behavioral economics to enhance social incentives within families to increase physical activity. Design, Setting, and Participants: The Behavioral Economics Framingham Incentive Trial (BE FIT) was a randomized clinical trial with a 12-week intervention period and a 12-week follow-up period. The investigation was a community-based study between December 7, 2015, and August 14, 2016. Participants in the modified intent-to-treat analysis were adults enrolled in the Framingham Heart Study, a long-standing cohort of families. Interventions: All participants tracked daily step counts using a wearable device or a smartphone, established a baseline, selected a step goal increase, and received daily individual feedback on goal performance by text message or email for 24 weeks. Families in the gamification arm could earn points and progress through levels based on physical activity goal achievement during the 12-week intervention. The game design was meant to enhance collaboration, accountability, and peer support. Main Outcomes and Measures: The primary outcome was the proportion of participant-days that step goals were achieved during the intervention period. Secondary outcomes included the proportion of participant-days that step goals were achieved during the follow-up period and the change in the mean daily steps during the intervention and follow-up periods. Results: Among 200 adults comprising 94 families, the mean age was 55.4 years, and 56.0% (n = 112) were female. During the intervention period, participants in the gamification arm achieved step goals on a significantly greater proportion of participant-days (0.53 vs 0.32; adjusted difference, 0.27; 95% CI, 0.20-0.33; P < .001) and had a significantly greater increase in the mean daily steps compared with baseline (1661 vs 636; adjusted difference, 953; 95% CI, 505-1401; P < .001) than the control arm. During the follow-up period, physical activity in the gamification arm declined but remained significantly greater than that in the control arm for the proportion of participant-days achieving step goals (0.44 vs 0.33; adjusted difference, 0.12; 95% CI, 0.05-0.19; P < .001) and the mean daily steps compared with baseline (1385 vs 798; adjusted difference, 494; 95% CI, 170-818; P < .01). Conclusions and Relevance: Gamification designed to leverage insights from behavioral economics to enhance social incentives significantly increased physical activity among families in the community. Trial Registration: clinicaltrials.gov Identifier: NCT02531763.


Assuntos
Exercício Físico , Saúde da Família , Jogos Experimentais , Motivação , Caminhada/fisiologia , Feminino , Objetivos , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial
20.
Sci Total Environ ; 607-608: 475-482, 2017 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-28704672

RESUMO

Among a cohort of children located in rural areas of Bangladesh affected by high levels of exposure to environmental metals, we investigated the associations between anthropometric measures, growth trajectory, and neurodevelopment at age 20-40months. Our study population included mothers and their children who participated in a longitudinal birth cohort study that took in place in the Pabna and Sirajdikhan areas of Bangladesh. Anthropometric measures including weight, length, and head circumference were measured at birth, age 12months, and age 20-40months. Neurodevelopment was assessed using Bayley Scales of Infant and Toddler Development Third Edition (BSID-III) multi-scale at age 20-40months. A total of 777 mother-child pairs were included. Higher anthropometric measures at 20-40months were associated with higher cognitive, language, and motor scores on BSID-III. For example, a 1-kg increment in birthweight was associated with an increase of 2.11 for cognitive score (p<0.0001), 1.63 for language score (p=0.006), and 0.89 for motor scores (p=0.03). Greater positive changes in growth parameters, or growth trajectory, between birth and 20-40months were also associated with higher BSID-III scores. These associations remained significant after adjusting for potential confounders and prenatal exposure to environmental metals. These findings suggest that even when taking into account high environmental metal exposures, prenatal and early childhood growth have strong associations with neurodevelopmental test scores in early childhood.


Assuntos
Antropometria , Desenvolvimento Infantil , Exposição Ambiental/análise , Metais Pesados/análise , Bangladesh , Peso ao Nascer , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Desenvolvimento da Linguagem , Estudos Longitudinais , Destreza Motora
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