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1.
Artigo em Inglês | MEDLINE | ID: mdl-32437055

RESUMO

OBJECTIVE: This study aimed to investigate the roles of frequency and consistency of self-weighing in promoting weight-loss maintenance. METHODS: Participants were 74 adults who completed a 3-month internet-based weight-loss program followed by a 9-month no-intervention maintenance period. Frequency of self-weighing was defined as the number of days that participants self-weighed during the maintenance period via a study-provided smart scale. Consistency was defined as the number of weeks that participants self-weighed at a certain frequency, with multiple minimum thresholds examined. Hierarchical regression analyses were used to assess associations among frequency, consistency, and weight change during the maintenance period. RESULTS: Greater consistency was significantly associated with less weight regain when defined as the number of weeks that participants self-weighed on ≥6 d/wk or 7 d/wk (P values < 0.05). Contrary to hypotheses, frequency was not associated with weight change (P = 0.141), and there was not a significant interaction between frequency and consistency. CONCLUSIONS: Results demonstrate that consistency of self-weighing may be more important than total frequency for preventing weight regain after the end of a weight-loss program. Further, results suggest that a high level of consistency (self-weighing for ≥6 d/wk or 7 d/wk) may be necessary to promote successful weight-loss maintenance.

2.
Artigo em Inglês | MEDLINE | ID: mdl-32339394

RESUMO

With the COVID-19 pandemic, clinicians and researchers have been suddenly confronted with the difficulty of treatment provision and continuation of clinical trials without face-to-face contact. This predicament has resulted in the rapid adoption of telehealth methodologies.1 Clinicians and researchers focused on obesity management have an additional need-- a remote way to measure weight. In this piece, we will describe electronic scales (e-scales) and provide guidance on how clinicians/researchers might best implement e-scales in their clinical practice or research studies to remotely measure weight.

3.
J Behav Med ; 43(2): 246-253, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32130566

RESUMO

Research has suggested that there may be a bidirectional association between stress and physical activity; however, much of this work has been conducted in athletes or adults with normal weight. The current study investigated the bidirectional association between stress and physical activity in adults with overweight and obesity. For a full year, during and after a 12-week, Internet-based weight loss program, 74 participants (BMI = 31.2 kg/m2) were asked to report stress and minutes of physical activity each week. An increase in stress was associated with less physical activity during the same week and predicted fewer minutes of physical activity the following week. Finally, each 1 h increase in physical activity on a given week was associated with a small decrease in stress ratings the following week. Results confirmed the bidirectional association between stress and physical activity in a sample of adults with overweight/obesity, and supported results highlighting stress as a barrier to physical activity. Future studies should investigate whether adding intervention components to decrease stress or to reinforce physical activity can improve physical activity engagement in this population.

4.
Am J Health Promot ; : 890117120905709, 2020 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-32077301

RESUMO

PURPOSE: To determine characteristics of weight gain prevention programs that facilitate engagement. DESIGN: Randomized factorial experiment (5 × 2). SETTING: Recruited nationally online. PARTICIPANTS: Adults aged 18 to 75 with body mass index ≥25 who decline a behavioral weight loss intervention (n = 498). MEASURES: Participants were randomly presented with one of 10 possible descriptions of hypothetical, free weight gain prevention programs that were all low dose and technology-based but differed in regard to 5 behavior change targets (self-weighing only; diet only; physical activity only; combined diet, physical activity, and self-weighing; or choice between diet, physical activity, and self-weighing targets) crossed with 2 financial incentive conditions (presence or absence of incentives for self-monitoring). Participants reported willingness to join the programs, perceived program effectiveness, and reasons for declining enrollment. ANALYSIS: Logistic regression and linear regression to test effects of program characteristics offered on willingness to initiate programs and programs' perceived effectiveness, respectively. Content analyses for open-ended text responses. RESULTS: Participants offered the self-weighing-only programs were more willing to initiate than those offered the programs targeting all 3 behaviors combined (50% vs 36%; odds ratio [OR] = 1.79; 95% confidence interval [CI], 1.01-3.13). Participants offered the programs with financial incentives were more willing to initiate (50% vs 33%; OR = 2.08; 95% CI, 1.44-2.99) and anticipated greater intervention effectiveness (ß = .34, P = .02) than those offered no financial incentives. Reasons for declining to initiate included specific program features, behavior targets, social aspects, and benefits. CONCLUSION: Targeting self-weighing and providing financial incentives for self-monitoring may result in greater uptake of weight gain prevention programs. STUDY PREREGISTRATION: https://osf.io/b9zfh , June 19, 2018.

5.
Nutr Diabetes ; 10(1): 3, 2020 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-32066659

RESUMO

Diabetes is a complex and multifactorial disease affecting more than 415 million people worldwide. Excess adiposity and modifiable lifestyle factors, such as unhealthy dietary patterns and physical inactivity, can play a significant role in the development of type 2 diabetes. Interventions that implement changes to lifestyle behaviors, in addition to pharmacological treatment, may attenuate the development and worsening of diabetes. This narrative review delineates how standard behavioral interventions (SBTs), based in "first wave" behavioral therapies and "second wave" cognitive behavioral therapies, serve as the foundation of diabetes treatment by supporting effective lifestyle changes, including improving adherence to healthful behaviors, medication, and self-monitoring regimens. Moreover, "third wave" "acceptance-based therapies" (ABTs), which integrate techniques from acceptance and commitment therapy, are proposed as a potential novel treatment option for diabetes management. Further research and long-term, randomized controlled trials will clarify the feasibility, acceptability, and effectiveness of ABT for improving glucose control via enhancing medication adherence and promoting effective lifestyle changes in people with diabetes.

6.
Circ Cardiovasc Qual Outcomes ; 12(11): e006073, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31707825

RESUMO

BACKGROUND: Recent court decisions have thrown into question the Food and Drug Administration's rules limiting manufacturer promotion of prescription drugs for unapproved uses. We assessed how providing pro forma disclosures or more descriptive evidence context about the data supporting an off-label claim affected physicians' beliefs about drug efficacy. METHODS AND RESULTS: In online and mailed surveys, we randomized national samples of board-certified, clinically active cardiologists, internists, and endocrinologists to receive 1 of 3 information scenarios about a hypothetical drug derived verbatim from excerpts on the website for Vascepa, a prescription fish oil for which Food and Drug Administration specially permitted off-label promotion after a manufacturer lawsuit. The scenarios presented information about the approved on-label indication (severe hypertriglyceridemia), off-label claim + pro forma disclaimers (suggestive but not conclusive evidence for use as an add-on to a statin for patients reaching low-density lipoprotein goal but with persistent moderate hypertriglyceridemia), and off-label claim + evidence context (eg, reports on 3 trials failing to demonstrate cardiovascular benefit of other triglyceride-lowering drugs for such patients). Among 686 respondents (48% response rate), 29% reported receiving off-label information about Vascepa (ie, use as an add-on to a statin) from the manufacturer, and 16% had prescribed it off-label for this purpose. Off-label prescribing was 5 times higher among physicians who received such off-label information (38% versus 7%, P<0.001). For the hypothetical drug, the proportion of physicians endorsing the unproven claim that the drug reduced cardiovascular risk was similar among those randomized to the on-label and off-label claim + pro forma disclaimers scenarios (35% versus 37% [95% CI, -6% to 11%]), but substantially lower among those randomized to the off-label claim + evidence context scenario (21% [95% CI, -24% to 7%]). CONCLUSIONS: Physicians who received company information about the unapproved use of Vascepa were more likely to report prescribing it off-label. Supplementing off-label claims with evidence context improved the prescribers' knowledge and reduced enthusiasm for the unproven, off-label indication of reducing cardiovascular risk.

7.
Health Psychol ; 38(12): 1150-1158, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31566400

RESUMO

OBJECTIVES: Despite increased interest in the development of individually tailored weight management programs, little is known about what factors proximally predict weight change. METHOD: The current study investigated proximal (week-to-week) predictors of weight loss and regain in 74 adults during a 3-month, Internet-based behavioral weight loss program followed by a 9-month "maintenance" period (during which no additional intervention was provided). Participants were asked to self-weigh daily using scales that transmitted weight via the cellular network and to answer a brief questionnaire each week querying mood, behaviors, and cognitions hypothesized to be associated with weight loss and regain. RESULTS: Longitudinal multilevel models demonstrated that weight loss during initial intervention was proximally predicted by (a) greater frequency of self-monitoring weight and caloric intake, consistency between eating choices and weight loss goals, and importance of "staying on track" with these goals and (b) less negative mood, boredom with weight control efforts, hunger, and temptation to eat foods "not on plan" (ps < .05). Greater weight regain after intervention was also proximally predicted by these factors (with effects in the opposite direction) and additionally by less physical activity, less positive mood, more stress, greater temptation to skip planned physical activity, and higher ratings of the amount of effort required to stay on track (ps < .05). CONCLUSIONS: Results confirmed the importance of self-monitoring for weight loss and maintenance and identified other key week-to-week predictors of weight change. Results also supported efforts to develop intervention approaches specifically focused on weight loss maintenance. Future research should investigate whether using identified predictors to tailor intervention content and timing can improve weight outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Obesidade/psicologia , Perda de Peso/fisiologia , Programas de Redução de Peso/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
8.
J Manag Care Spec Pharm ; 25(11): 1210-1224, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31663459

RESUMO

BACKGROUND: Step therapy policies that require prescribers to follow an ordered protocol for drug choices are widely used by public and private insurers to manage medication costs; however, the perceptions of prescribing physicians regarding these policies have not been studied. OBJECTIVE: To determine physician attitudes toward step therapy policies and the correlation of these beliefs with physician characteristics. METHODS: A sample of clinically active physicians specializing in internal medicine, cardiology, or endocrinology received a survey administered online or via mail. Five-point Likert scale questions assessed physicians' opinions of clinical, economic, and implementation elements of prior authorization policies; physician demographic characteristics; and the extent of their interactions with the pharmaceutical industry. RESULTS: 686 physicians (48%) responded to the survey, which was evenly divided among primary care physicians, endocrinologists, and cardiologists. Many respondents (70%) had interactions with industry, including receipt of meals or gifts and use of medication samples. Physicians reported that step therapy policies could improve the affordability of medication use (55% agree vs. 26% disagree) and its clinical appropriateness (59% agree vs. 19% disagree). By similar margins, however, physicians stated that step therapy policies were implemented inefficiently and inflexibly and often did not incorporate relevant patient-specific information. Physicians in subspecialties, especially endocrinology, and those who had interactions with the pharmaceutical industry were more likely to hold negative views of step therapy policies. CONCLUSIONS: Most physicians recognize the potential of step therapy to improve the quality and cost-effectiveness of prescribing, although interactions with industry may affect these opinions. Physician perception of ineffective implementation of these policies, however, undermines their acceptability. DISCLOSURES: The American Board of Internal Medicine (ABIM) funded the survey used in this study. The ABIM had no role in the design and conduct of the study or development and preparation of the manuscript. Survey honoraria was provided by the Consumers Union. Kesselheim and Avorn's work is funded by the Laura and John Arnold Foundation. Kesselheim is also supported by the Harvard-MIT Center for Regulatory Science, Arnold Ventures, and the Engelberg Foundation. Ross is employed by the ABIM. Fischer, Lu, and Tessema have nothing to disclose.

9.
Transl Behav Med ; 2019 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-31228199

RESUMO

Residents of rural communities generally have limited access to preventive health services such as lifestyle programs for weight management. In 2009, the U.S. Congress authorized the Centers for Disease Control and Prevention (CDC) to partner with local community organizations to disseminate the Diabetes Prevention Program (DPP), an evidence-based lifestyle intervention for weight management. Given that the National DPP (NDPP) was designed to broaden nationwide access to weight-loss treatment for adults at high risk for developing diabetes, the present study examined the implementation of the NDPP in rural and urban counties across the USA. The names and locations of NDPP community partnership sites were collected from the CDC website and cross-referenced with the U.S. Census Bureau's classification of counties as rural versus urban. Results showed that overall 27.9% of the 3,142 counties in the USA contained one or more NDPP partnership sites. However, significantly fewer rural counties had access to a NDPP site compared with urban counties (14.6% vs. 48.4%, respectively, p < .001). This disparity was evident across all types of partnership sites (ps < .001). These findings indicate that implementation of the NDPP has expanded the overall availability of evidence-based weight-management programs across the USA. However, this increase has been disproportionately greater for urban counties versus rural counties, thereby widening the rural/urban disparity in access to preventive health services. Alternative dissemination strategies that address the special barriers to implementation faced by rural communities are needed to increase access to the NDPP.

10.
BMJ Open Diabetes Res Care ; 7(1): e000653, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31245006

RESUMO

Objective: This study examined the effects of three doses of behavioral weight loss treatment, compared with a nutrition education control group, on changes in glycemic control in individuals with obesity and prediabetes. Research design and methods: The study included 287 adults (77% female, 81% White; mean (SD) age=54.1 (10.5) years, body mass index=36.3 (3.9) kg/m2, and hemoglobin A1c (HbA1c)=5.9 (0.2%)). Participants were randomized to one of three behavioral treatment doses (high=24 sessions, moderate=16 sessions, or low=8 sessions) or to an education group (control=8 sessions). Changes in HbA1c, fasting glucose, and body weight were assessed from baseline to 6 months. Results: Mean (99.2% credible interval (CI)) reductions in HbA1c were 0.11% (0.07% to 0.16%), 0.08% (0.03% to 0.13%), 0.03% (-0.01% to 0.07%), and 0.02% (-0.02% to 0.07%), for the high, moderate, low, and control conditions, respectively. Mean (CI) reductions in fasting blood glucose were 0.26 mmol/L (0.14 to 0.39), 0.09 mmol/L (0 to 0.19), 0.01 mmol/L (-0.07 to 0.09), and 0.04 mmol/L (-0.03 to 0.12) for the high, moderate, low, and control conditions, respectively. The high-dose treatment produced significantly greater reductions in HbA1c and fasting blood glucose than the low-dose and control conditions (posterior probabilities (pp)<0.001); no other significant between-group differences were observed. Mean (CI) reductions in body weight were 10.91 kg (9.30 to 12.64), 10.08 kg (8.38 to 11.72), 6.35 kg (5.19 to 7.69), and 3.82 kg (3.04 to 4.54) for the high, moderate, low, and control conditions, respectively. All between-group differences in 6-month weight change were significant (pps<0.001) except for the high-dose versus moderate-dose comparison. Conclusion: For adults with obesity and prediabetes a high dose of behavioral treatment involving 24 sessions over 6 months may be needed to optimize improvements in glycemic control. Trial registration number: NCT00912652.

11.
Obesity (Silver Spring) ; 27(3): 385-390, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30703282

RESUMO

OBJECTIVE: Greater frequency of self-weighing has been associated with greater weight loss in weight management interventions, but little is known regarding the accuracy of self-reported weight data. METHODS: Agreement between objective smart-scale and self-reported weight data was assessed in 74 adults (age = 50.7 years; BMI = 31.2 kg/m2 ) enrolled in a 12-week, Internet-based weight management program. Participants were asked to self-weight daily using a study-provided smart scale and to self-report weights via the study website. RESULTS: There was strong agreement between smart-scale and self-reported weight values (intraclass correlation = 0.982) but only moderate agreement regarding frequency of self-weighing assessed via each method (κ = 0.491; P < 0.0001). Greater self-weighing frequency was associated with greater weight loss across measures (all P < 0.001). Compared with days when participants did both, weights were 0.66 kg higher on days when participants self-weighed via the smart scale but did not self-report weight (8% of days) and 0.58 kg higher on days when they self-reported weight but did not self-weigh via the smart scale (4% of days; all P < 0.0001). CONCLUSIONS: Results suggest that self-reported weight values are similar to smart-scale measurements; however, either method alone may underestimate self-weighing frequency. Furthermore, missing self-weighing data should not be treated as ignorable because weights may be higher than those observed on nonmissing days.


Assuntos
Manutenção do Peso Corporal/fisiologia , Obesidade/terapia , Perda de Peso/fisiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Fatores de Tempo , Adulto Jovem
13.
Contemp Clin Trials ; 76: 55-63, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30408606

RESUMO

Obesity is a major contributor to the greater prevalence of chronic disease morbidity and mortality observed in rural versus nonrural areas of the U.S. Nonetheless, little research attention has been given to modifying this important driver of rural/urban disparities in health outcomes. Although lifestyle treatments produce weight reductions of sufficient magnitude to improve health, the existing research is limited with respect to the long-term maintenance of treatment effects and the dissemination of services to underserved populations. Recent studies have demonstrated the feasibility of delivering lifestyle programs through the infrastructure of the U.S. Cooperative Extension Service (CES), which has >2900 offices nationwide and whose mission includes nutrition education and health promotion. In addition, several randomized trials have shown that supplementing lifestyle treatment with extended-care programs consisting of either face-to-face sessions or individual telephone counseling can improve the maintenance of weight loss. However, both options entail relatively high costs that inhibit adoption in rural communities. The delivery of extended care via group-based telephone intervention may represent a promising, cost-effective alternative that is well suited to rural residents who tend to be isolated, have heightened concerns about privacy, and report lower quality of life. The Rural Lifestyle Eating and Activity Program (Rural LEAP) is a randomized trial, conducted via CES offices in rural communities, targeted to adults with obesity (n = 528), and designed to evaluate the effectiveness and cost-effectiveness of extended-care programs delivered via group or individual telephone counseling compared to an education control condition on long-term changes in body weight.

15.
J Behav Med ; 41(1): 130-137, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29080115

RESUMO

Research has suggested that memories of mood, emotions, and behaviors are not purely unbiased retrieval, but more similar to reconstructions based on current opinions, positive or negative experiences associated with the memory, and how a person believes they would have felt, thought, or acted. We investigated this memory bias in 66 adult participants with overweight/obesity who rated their mood, emotions, and behaviors during a 12-week, Internet-based behavioral weight loss program and later recalled these ratings at Month 3 (immediate post-test) and Month 12 (follow-up). At Month 3, participants recalled the intervention more positively than reported previously, p = .010, but reported remembering the intervention more negatively at the Month 12 follow-up, p = .004. Memory bias was associated with initial weight loss and regain, ps < .05, such that participants who lost more weight at Month 3 remembered their mood, emotions, and behaviors during intervention more positively, and those who regained more weight at Month 12, more negatively. Future research should investigate whether this bias is associated with willingness to re-engage with intervention.


Assuntos
Afeto , Rememoração Mental , Obesidade/psicologia , Sobrepeso/psicologia , Perda de Peso , Programas de Redução de Peso , Adulto , Cultura , Emoções , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Obesidade/terapia , Sobrepeso/terapia
16.
Obesity (Silver Spring) ; 26(2): 318-323, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29239141

RESUMO

OBJECTIVE: Although the trajectory of weight change during and/or after behavioral weight management interventions is believed to include a period of weight loss followed by maintenance and later regain, the sparse data produced by existing study designs (conducting assessments at 3- to 6-month intervals) have limited investigation into the precise pattern. METHODS: Seventy-five adults were asked to self-weigh daily via "smart" scales during a 12-week, Internet-based weight loss program and for an additional 9 months with no further intervention. Longitudinal change-point mixed-effect models were used to characterize overall weight change patterns and identify when individuals moved from weight loss to maintenance/regain. RESULTS: Analyses suggested a three-phase model. During the first phase, participants lost weight at a (mean ± SE) rate of -0.46 ± 0.04 kg/wk; after 77.66 ± 3.96 days, they transitioned to regain (0.07 ± 0.02 kg/wk). The next transition occurred at 222.55 ± 7.23 days, after which the rate of regain decreased slightly (0.06 ± 0.02 kg/wk). Exploratory analyses identified baseline/demographic factors predicting the timing of transition points and slope of weight change within phases. CONCLUSIONS: In contrast to the hypothesized trajectory, results demonstrated that participants transitioned immediately from weight loss to regain (with no "maintenance" period) and later to a slower rate of regain. Future studies should investigate whether extended-care programs change or merely delay this pattern.


Assuntos
Internet/estatística & dados numéricos , Obesidade/terapia , Ganho de Peso/fisiologia , Perda de Peso/fisiologia , Programas de Redução de Peso/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos de Pesquisa , Adulto Jovem
17.
J Behav Med ; 40(1): 99-111, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27783259

RESUMO

Obesity is a prevalent health care issue associated with disability, premature morality, and high costs. Behavioral weight management interventions lead to clinically significant weight losses in overweight and obese individuals; however, many individuals are not able to participate in these face-to-face treatments due to limited access, cost, and/or time constraints. Technological advances such as widespread access to the Internet, increased use of smartphones, and newer behavioral self-monitoring tools have resulted in the development of a variety of eHealth weight management programs. In the present paper, a summary of the most current literature is provided along with potential solutions to methodological challenges (e.g., high attrition, minimal participant racial/ethnic diversity, heterogeneity of technology delivery modes). Dissemination and policy implications will be highlighted as future directions for the field of eHealth weight management.


Assuntos
Terapia Comportamental/organização & administração , Promoção da Saúde/organização & administração , Obesidade/prevenção & controle , Telemedicina/estatística & dados numéricos , Medicina Baseada em Evidências , Humanos , Internet , Obesidade/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Perda de Peso
18.
Obesity (Silver Spring) ; 24(12): 2509-2514, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27804255

RESUMO

OBJECTIVE: To determine whether an acceptance-based behavioral intervention (ABBI) produces better weight losses than standard behavioral treatment (SBT) among individuals reporting high internal disinhibition. METHODS: Participants were 162 adults with overweight or obesity (mean BMI 37.6 kg/m2 ) randomly assigned to ABBI or SBT. Both interventions provided the same calorie intake target, exercise goal, and self-monitoring skills training. SBT incorporated current best practice interventions for addressing problematic thoughts and emotions. ABBI utilized acceptance-based techniques based on Acceptance and Commitment Therapy. ABBI and SBT were compared on weight change and internal disinhibition change over 24 months. RESULTS: Mixed models analysis showed mean weight loss at 24 months was -4.1% (SE = 0.88) for ABBI and -2.4% (SE = 0.87) for SBT (P = 0.204). Secondary analyses showed that the ABBI group regained less weight from the end of treatment to the final follow-up (4.6 vs. 7.1 kg; P = 0.005), and that a significantly higher proportion of ABBI participants achieved a 5% weight loss (38% vs. 25%; P = 0.038) at 24 months. CONCLUSIONS: Results suggest that ABBI could be helpful for improving the maintenance of weight loss for individuals who report high internal disinhibition.


Assuntos
Terapia Comportamental/métodos , Comportamento , Sobrepeso/psicologia , Sobrepeso/terapia , Perda de Peso , Adulto , Ingestão de Energia , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/psicologia , Obesidade/terapia , Resultado do Tratamento
19.
PLoS One ; 11(10): e0163339, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27768700

RESUMO

BACKGROUND: Generic drugs are cost-effective versions of brand-name drugs approved by the Food and Drug Administration (FDA) following proof of pharmaceutical equivalence and bioequivalence. Generic drugs are widely prescribed by physicians, although there is disagreement over the clinical comparability of generic drugs to brand-name drugs within the physician community. The objective of this survey was to assess physicians' perceptions of generic drugs and the generic drug approval process. METHODS AND FINDINGS: A survey was administered to a national sample of primary care internists and specialists between August 2014 and January 2015. In total, 1,152 physicians comprising of internists with no reported specialty certification and those with specialty certification in hematology, infectious diseases, and endocrinology were surveyed. The survey assessed physicians' perceptions of the FDA's generic drug approval process, as well as their experiences prescribing six generic drugs approved between 2008 and 2012 using product-specific approval pathways and selected comparator drugs. Among 718 respondents (62% response rate), a majority were comfortable with the FDA's process in ensuring the safety and effectiveness of generic drugs overall (91%) and with letting the FDA determine which tests were necessary to determine bioequivalence in a particular drug (92%). A minority (13-26%) still reported being uncomfortable prescribing generic drugs approved using product-specific pathways. Overall, few physicians heard reports of concerns about generic versions of the study drugs or their comparators, with no differences between the two groups. Physicians tended to hear about concerns about the safety or effectiveness of generic drugs from patients, pharmacists, and physician colleagues. CONCLUSIONS: Physicians hold largely positive views of the FDA's generic drug approval process even when some questioned the performance of certain generic drugs in comparison to brand-name drugs. Better education about the generic drug approval process and standards may alleviate concerns among the physician community and support the delivery of cost-effective health care.


Assuntos
Aprovação de Drogas/legislação & jurisprudência , Medicamentos Genéricos , Médicos/psicologia , Confiança , United States Food and Drug Administration , Humanos , Inquéritos e Questionários , Estados Unidos
20.
Obesity (Silver Spring) ; 24(11): 2341-2343, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27619935

RESUMO

OBJECTIVE: Daily self-weighing is an effective weight loss strategy. Little is known about "micro" factors influencing nonadherence to self-weighing (e.g., daily overeating). It was hypothesized that increased caloric intake on a given day would increase odds of not self-weighing the following day. METHODS: Daily self-reports of weight and caloric intake were collected from 74 adults with overweight and obesity (mean BMI = 31.2 ± 4.5 kg/m2 , age = 50.6 ± 10 years, 69% female, 87% Caucasian) throughout a 12-week Internet-based weight management intervention. Multilevel logistic regression investigated odds of nonadherence to self-weighing on a given day based on the previous day's caloric intake. RESULTS: Self-monitoring adherence was high (weights: 87%; calories: 85%); adherence was associated with greater 12-week weight loss (weighing: r = -0.24, P = 0.04; calories: r = -0.26, P = 0.04). Increased caloric intake on a given day, relative to the individual's average intake, was associated with increased odds of nonadherence to self-weighing the next day (F(1,5106) = 12.66, P = 0.0004, ß = 0.001). For example, following a day of eating 300 calories more than usual, odds of not self-weighing increased by 1.33. CONCLUSIONS: Odds of nonadherence to self-weighing increased following a day with higher-than-usual caloric intake. Weight management interventions collecting daily self-monitoring data could provide support to participants who report increased caloric intake to prevent self-weighing nonadherence.


Assuntos
Hiperfagia/psicologia , Obesidade/psicologia , Cooperação do Paciente/psicologia , Autocuidado/psicologia , Programas de Redução de Peso/métodos , Adulto , Peso Corporal , Ingestão de Energia , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Obesidade/terapia , Sobrepeso/psicologia , Sobrepeso/terapia , Autocuidado/métodos , Pesos e Medidas
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