Development and evaluation of a short instrument to estimate usual dietary intake of percentage energy from fat.
ABSTRACT To describe the data-based development of a short dietary assessment instrument, a 16-item screener; and to evaluate the performance of the screener, comparing its performance with a complete 120-item food frequency questionnaire (FFQ) in assessing percentage energy from fat intake.
A subsample (n=404) of participants in the National Institutes of Health-AARP Diet and Health Study, who had completed an FFQ and two 24-hour dietary recalls, also completed the fat screener. Percentage energy from fat from the screener and from the FFQ were compared with estimated true usual intake using a measurement error model.
For men, the mean percentage energy from fat estimates for the different methods were: recalls, 30.1%, screener, 29.9%; FFQ, 30.4%. For women, the results were: recalls, 31.3%, screener, 28.4%, FFQ, 30.0%. Estimated correlations between true intake and screener were 0.64 and 0.58 for men and women, respectively, and between true intake and FFQ were 0.67 for men and 0.72 for women. Estimated attenuation coefficients for the screener were 1.29 (men) and 0.98 (women) and for the FFQ were 0.56 (men) and 0.57 (women).
The percentage energy from fat screener, when used in conjunction with external reference data, may be useful to compare mean intakes of fat for different population subgroups, and to examine relationships between fat intake and other factors.
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ABSTRACT: Inhibitory control training has been shown to influence eating behaviour in the laboratory; however, the reliability of these effects is not yet established outside the laboratory, nor are the mechanisms responsible for change in behaviour. Two online Stop-Signal Task training interventions were conducted to address these points. In Study 1, 72 participants completed baseline and follow-up measures of inhibitory control, self-regulatory depletion, fat intake and body-mass index. Participants were randomly assigned to complete one of three Stop-Signal Tasks daily for ten days: food-specific inhibition- inhibition in response to unhealthy food stimuli only, general inhibition- inhibition was not contingent on type of stimuli, and control- no inhibition. While fat intake did not decrease, body-mass index decreased in the food-specific condition and change in this outcome was mediated by changes in vulnerability to depletion. In Study 2, the reliability and longevity of these effects were tested by replicating the intervention with a third measurement time-point. Seventy participants completed baseline, post-intervention and follow-up measures. While inhibitory control and vulnerability to depletion improved in both training conditions post-intervention, eating behaviour and body-mass index did not. Further, improvements in self-regulatory outcomes were not maintained at follow-up. It appears that while the training paradigm employed in the current studies may improve self-regulatory outcomes, it may not necessarily improve health outcomes. It is suggested that this may be due to the task parameters, and that a training paradigm that utilises a higher proportion of stop-signals may be necessary to change behaviour. In addition, improvements in self-regulation do not appear to persist over time. These findings further current conceptualisations of the nature of self-regulation and have implications for the efficacy of online interventions designed to improve eating behaviour. Copyright © 2015. Published by Elsevier Ltd.Appetite 02/2015; 89. DOI:10.1016/j.appet.2015.02.022 · 2.52 Impact Factor
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ABSTRACT: Black and Hispanic stroke survivors experience higher rates of recurrent stroke than whites. This disparity is partly explained by disproportionately higher rates of uncontrolled hypertension in these populations. Home blood pressure telemonitoring (HBPTM) and nurse case management (NCM) have proven efficacy in addressing the multilevel barriers to blood pressure (BP) control and reducing BP. However, the effectiveness of these interventions has not been evaluated in stroke patients. This study is designed to evaluate the comparative effectiveness, cost-effectiveness and sustainability of these two telehealth interventions in reducing BP and recurrent stroke among high-risk Black and Hispanic stroke survivors with uncontrolled hypertension. A total of 450 Black and Hispanic patients with recent nondisabling stroke and uncontrolled hypertension are randomly assigned to one of two 12-month interventions: 1) HBPTM with wireless feedback to primary care providers or 2) HBPTM plus individualized, culturally-tailored, telephone-based NCM. Patients are recruited from stroke centers and primary care practices within the Health and Hospital Corporations (HHC) Network in New York City. Study visits occur at baseline, 6, 12 and 24 months. The primary outcomes are within-patient change in systolic BP at 12 months, and the rate of stroke recurrence at 24 months. The secondary outcome is the comparative cost-effectiveness of the interventions at 12 and 24 months; and exploratory outcomes include changes in stroke risk factors, health behaviors and treatment intensification. Recruitment for the stroke telemonitoring hypertension trial is currently ongoing. The combination of two established and effective interventions along with the utilization of health information technology supports the sustainability of the HBPTM + NCM intervention and feasibility of its widespread implementation. Results of this trial will provide strong empirical evidence to inform clinical guidelines for management of stroke in minority stroke survivors with uncontrolled hypertension. If effective among Black and Hispanic stroke survivors, these interventions have the potential to substantially mitigate racial and ethnic disparities in stroke recurrence. ClinicalTrials.gov NCT02011685 . Registered 10 December 2013.Trials 12/2015; 16(1):605. DOI:10.1186/s13063-015-0605-5 · 2.12 Impact Factor
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ABSTRACT: Cancer patients face a myriad of psychosocial and practical issues. Especially challenging is the time from an initial diagnosis to the onset of treatment and patient navigation services are important to guide patients, especially underserved populations, through this maze of uncertainty. Here we report on the Pennsylvania Patient Navigator Demonstration Project (PaPND) designed to evaluate the acceptability, feasibility, and impact of a culturally and linguistically appropriate non-clinical navigator program. The development of the project, based on behavioral theory and community-based participatory research principles, is described. Forty-four cancer patients from diverse backgrounds participated, which included a baseline assessment, navigation services, and a four week and twelve week follow-up assessment. On average, participants experienced 1.8 barriers with transportation and insurance issues the most common barriers. The majority (56%) of the barriers required more than an hour of the navigator's time to address, with insurance, transportation and caregiver/support issues requiring the most time. Overall patients were fairly satisfied with the navigation services. The findings showed improvement patient's stress-related thoughts, cognition (understanding of their disease), expectancies and beliefs or values/goals, as well as self-efficacy of managing cancer related issues from the baseline to follow-up assessments. The evaluation results suggest that providing and connecting cancer patients to appropriate information to improve their understanding of their diagnosis and recommended treatments needs to be addressed, and where the integration of non-clinical and clinical navigation is essential. In addition, more attention to the assessment of psychosocial issues, such as the patients' emotional worries, and more comprehensive training in these areas would enhance navigation programs.