Publications by authors named "Brian C Helsel"

8 Publications

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The Family Nutrition and Physical Activity Survey: Comparisons with Obesity and Physical Activity in Adolescents with Autism Spectrum Disorder.

J Autism Dev Disord 2022 Jan 4. Epub 2022 Jan 4.

Division of Physical Activity and Weight Management, Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.

Adolescents with autism spectrum disorder (ASD) are at a heightened risk for obesity. Family-level measures of nutrition and physical activity may help explain factors contributing to disproportionate rates of weight gain. Twenty adolescents with ASD participated in baseline testing for a study to assess the feasibility of remotely-delivered yoga. Parents completed the Family Nutrition and Physical Activity (FNPA) survey and anthropometrics and physical activity were assessed in the adolescents. A median split was applied to the FNPA score to create high and low obesogenic environments and nonparametric O'Brien's multiple endpoint tests were used to evaluate the differences. Between-group differences were found in anthropometrics (p = 0.01) but not physical activity (p = 0.72). Implications for a multifaceted family-based approach to obesity prevention are discussed.
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http://dx.doi.org/10.1007/s10803-021-05415-9DOI Listing
January 2022

A comparison of accelerometer cut-points for measuring physical activity and sedentary time in adolescents with Down syndrome.

Res Dev Disabil 2022 Jan 24;120:104126. Epub 2021 Nov 24.

Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.

Background: No cut-points have been developed for youth with Down syndrome; there is concern that altered gait patterns, decreased energy expenditure and exercise capacity of individuals with Down syndrome may produce inaccurate physical activity data if accelerometer data are analyzed using cut-points from populations with typical development and other IDD diagnoses.

Aim: To compare physical activity and sedentary time across existing accelerometer cut-point methods in adolescents with Down syndrome.

Methods: In this cross-sectional analysis, participants diagnosed with Down syndrome (n = 37; 15.5 ± 1.9 years; 57 % female) wore an accelerometer on their non-dominant hip for seven-days. Data were analyzed and compared across four physical activity intensity cut-points: Evenson, Freedson 4-MET, McGarty, and Romanizi.

Outcomes & Results: Differences in time spent in each intensity across cut-point methods were evident for sedentary (448-615 min/day), light (72-303 min/day) and moderate-to-vigorous (12-77 min/day) activities. Between 0.0-67.6 % of the sample met the physical activity guidelines, depending on the cut-point method selected.

Conclusions & Implications: This study presents the wide variation of accumulated physical activity minutes when different cut-points are applied to individuals with Down syndrome. There is a critical need to establish Down syndrome-specific measures of physical activity assessment rather than applying methods developed for their peers with typical development.

What This Paper Adds: This paper highlights concerns over the application of objective measurements of physical activity in youth with Down syndrome from measurement methods derived from populations with typical development. This is the first manuscript to examine this issue in a sample comprised solely of youth with Down syndrome. Results demonstrate the large variation in time spent in each activity intensity that arise due to the application of different cut-point methods.
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http://dx.doi.org/10.1016/j.ridd.2021.104126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8724392PMC
January 2022

Weight Loss Interventions for Adolescents With Intellectual Disabilities: An RCT.

Pediatrics 2021 09 19;148(3). Epub 2021 Aug 19.

Departments of Internal Medicine.

Objectives: In this randomized trial, we compared the effectiveness of 2 diets (enhanced stop light diet [eSLD] versus conventional meal plan diet [CD]) and 2 delivery strategies (face-to-face [FTF] versus remote delivery [RD]) on weight loss across 6 months in adolescents with intellectual and developmental disabilities who were overweight or obese.

Methods: Participants were randomly assigned to 1 of 3 arms (FTF/CD, RD/CD, or RD/eSLD) and asked to attend one-on-one sessions with a health educator every 2 weeks to aid in maintaining compliance with recommendations for a reduced-energy diet and increased physical activity. The CD followed the US dietary guidelines. The eSLD used the stop light guide and was enhanced with portion-controlled meals. The FTF arm was delivered during in-person home visits. The RD arms were delivered by using video conferencing.

Results: A total of 110 adolescents with intellectual and developmental disabilities (aged ∼16 years, 53% female, BMI 33) were randomly assigned to the FTF/CD ( = 36), RD/CD ( = 39), or RD/eSLD ( = 35) group. Body weight at 6 months was obtained from 97%, 100%, and 86% of participants in the FTF/CD, RD/CD, and RD/eSLD arms, respectively. The eSLD elicited significantly greater weight loss than the CD: RD/eSLD (-5.0 ± 5.9 kg; -6.4%) versus RD/CD (-1.8 ± 4.0 kg; -2.4%) ( = .01). However, weight loss did not differ by delivery strategy: FTF/CD (-0.3 ± 5.0 kg; -0.2%) versus RD/CD (-1.8 ± 4.0 kg; -2.4%) ( = .20).

Conclusions: The eSLD elicited significantly greater 6-month weight loss compared with a CD when both interventions were delivered remotely. Minimal 6-month weight loss, which did not differ significantly between FTF delivery and RD, was observed with a CD.
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http://dx.doi.org/10.1542/peds.2021-050261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8477713PMC
September 2021

Diabetes Patient Surveillance in the Emergency Department: Proof of Concept and Opportunities.

West J Emerg Med 2021 Apr 2;22(3):636-643. Epub 2021 Apr 2.

Clemson University, Department of Public Health Sciences, Clemson, South Carolina.

Introduction: The purpose of this study was to characterize the at-risk diabetes and prediabetes patient population visiting emergency department (ED) and urgent care (UC) centers in upstate South Carolina.

Methods: We conducted this retrospective study at the largest non-profit healthcare system in South Carolina, using electronic health record (EHR) data of patients who had an ED or UC visit between February 2, 2016-July 31, 2018. Key variables including International Classification of Diseases, 10th Revision codes, laboratory test results, family history, medication, and demographic characteristics were used to classify the patients as healthy, having prediabetes, having diabetes, being at-risk for prediabetes, or being at-risk for diabetes. Patients who were known to have diabetes were classified further as having controlled diabetes, management challenged, or uncontrolled diabetes. Population analysis was stratified by the patient's annual number of ED/UC visits.

Results: The risk stratification revealed 4.58% unique patients with unrecognized diabetes and 10.34% of the known patients with diabetes considered to be suboptimally controlled. Patients identified as diabetes management challenged had more ED/UC visits. Of note, 33.95% of the patients had unrecognized prediabetes/diabetes risk factors identified during their ED/UC with 87.95% having some form of healthcare insurance.

Conclusion: This study supports the idea that a single ED/UC unscheduled visit can identify individuals with unrecognized diabetes and an at-risk prediabetes population using EHR data. A patient's ED/UC visit, regardless of their primary reason for seeking care, may be an opportunity to provide early identification and diabetes disease management enrollment to augment the medical care of our community.
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http://dx.doi.org/10.5811/westjem.2020.12.49171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202983PMC
April 2021

Multidimensional risk score to stratify community-dwelling older adults by future fall risk using the Stopping Elderly Accidents, Deaths and Injuries (STEADI) framework.

Inj Prev 2021 10 22;27(5):461-466. Epub 2020 Dec 22.

Parks, Recreation and Tourism Management, Clemson University, Clemson, South Carolina, USA.

Background: The Stopping Elderly Accidents, Deaths and Injuries (STEADI) screening algorithm aligns with current fall prevention guidelines and is easy to administer within clinical practice. However, the stratification into low, moderate and high risk categories limits the meaningful interpretation of the fall-related risk factors.

Methods: Baseline measures from a modified STEADI were used to predict self-reported falls over 4 years in 3170 respondents who participated in the 2011-2015 National Health and Aging Trends Study. A point method was then applied to find coefficient-based integers and 4-year fall risk estimates from the predictive model. Sensitivity and specificity estimates from the point method and the combined moderate and high fall risk STEADI categories were compared.

Results: There were 886 (27.95%) and 387 (12.21%) respondents who were classified as moderate and high risk, respectively, when applying the stratification method. Falls in the past year (OR: 2.16; 95% CI: 1.61 to 2.89), multiple falls (OR: 2.94; 95% CI: 1.89 to 4.55) and a fear of falling (OR: 1.77; 95% CI: 1.45 to 2.16) were among the significant predictors of 4-year falls in older adults. The point method revealed integers that ranged from 0 (risk: 27.21%) to 44 (risk: 99.71%) and a score of 10 points had comparable discriminatory capacity to the combined moderate and high STEADI categories.

Conclusion: Coefficient-based integers and their risk estimates can provide an alternative interpretation of a predictive model that may be useful in determining fall risk within a clinical setting, tracking changes longitudinally and defining the effectiveness of an intervention.
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http://dx.doi.org/10.1136/injuryprev-2020-044014DOI Listing
October 2021

A dyadic approach for a remote physical activity intervention in adults with Alzheimer's disease and their caregivers: Rationale and design for an 18-month randomized trial.

Contemp Clin Trials 2020 11 23;98:106158. Epub 2020 Sep 23.

Department of Internal Medicine, The University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA. Electronic address:

Adults with Alzheimer's disease and related dementia (ADRD) and their caregivers represent a sizeable and underserved segment of the population with low levels of moderate physical activity (MPA). Options for increasing MPA in community dwelling adults with ADRD and their caregivers are limited. A home-based physical activity intervention delivered remotely via video conferencing to groups of adults with ADRD and their caregivers (RGV), represents a potentially effective approach for increasing MPA in this group. We will conduct an 18-month randomized trial (6 mos. Active intervention, 6 mos. Maintenance, 6 mos. no contact) to compare the effectiveness of the RGV approach with usual care, enhanced with caregiver support (EUC), for increasing MPA in 100 community dwelling adults with ADRD and their caregiver. The primary aim is to compare MPA (min/wk.), assessed by accelerometer, across the 6-mo. active intervention in adults with ADRD randomized to RGV or EUC. Secondarily, we will compare adults with ADRD and their caregivers randomized to RGV or ECU on the following outcomes across 18 mos.: MPA (min/wk.), sedentary time (min/wk.), percentage meeting 150 min/wk. MPA goal, functional fitness, activities of daily living, quality of life, residential transitions, cognitive function, and caregiver burden. Additionally, we will evaluate the influence of age, sex, BMI, attendance (exercise/support sessions), use of recorded sessions, self-monitoring, peer interactions during group sessions, caregiver support, type and quality of dyadic relationship, and number of caregivers on changes in MPA in adults with ADRD and their caregiver across 18 mos.
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http://dx.doi.org/10.1016/j.cct.2020.106158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686020PMC
November 2020

Family and Friend Influences on Fruit and Vegetable Intake in Elementary Aged Children.

J Community Health 2019 10;44(5):932-940

Department of Public Health Sciences, Clemson University, P.O. Box 340745, Clemson, SC, 29634-0745, USA.

The purpose of this study was to investigate the eating behaviors and social cognitive factors that affect fruit and vegetable consumption. Strategies to change, pros & cons, enjoyment, family support, and peer influence were measured in children ages 8-10 years both pre- and post- Zest Quest® program (pre: n = 82; post: n = 80). Children for a comparison group were selected from comparable elementary schools and pre- and post- measures were evaluated (pre: n = 92; post: n = 87). Chi-squared analyses were conducted on individual measures and Spearman correlations & linear regression were used for composite variables with fruit and vegetable consumption as the dependent variable. Results from the study demonstrated significant moderate correlations for fruit change strategies pre- (r = 0.39) and post-intervention (r = 0.33) and vegetable change strategies pre-intervention (r = 0.42) in the Zest Quest® group. Peer influence (r = 0.33) and enjoyment (r = 0.38) showed significant moderate correlations with fruit intake in the comparison group. The regression analysis showed pros (β = 0.24, p value 0.05) and cons (β = 0.14, p value 0.05) to be significant predictors for fruit intake post-intervention in the Zest Quest® group. Prior to the intervention, strategies to change (β = 0.10, p value 0.02) was a significant predictor for fruit intake and cons (β = 0.15, p value = 0.03) for vegetable intake in this group. Family support and peer influence were not significant in the regression models, but demonstrated significance in the crude model. Eating behaviors and social cognitive factors may have an effect on fruit and vegetable consumption, but these measures are difficult to capture. Future research should continue exploring the impact of family support and peer influence on fruit and vegetable intake.
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http://dx.doi.org/10.1007/s10900-019-00640-xDOI Listing
October 2019

Telemedicine and Mobile Health Technology Are Effective in the Management of Digestive Diseases: A Systematic Review.

Dig Dis Sci 2018 Jun 16;63(6):1392-1408. Epub 2018 Apr 16.

Department of Pediatric Gastroenterology, Greenville Health System, Greenville, SC, USA.

Background: Mobile applications and interactive websites are an increasingly used method of telemedicine, but their use lacks evidence in digestive diseases.

Aim: This study aims to explore digestive disease studies that use telemedicine to effectively manage disease activity, help monitor symptoms, improve compliance to the treatment protocol, increase patient satisfaction, and enhance the patient-to-provider communication.

Methods: EBSCO, PubMed, and Web of Science databases were searched using Medical Subject Headings and other keywords to identify studies that utilized telemedicine in patients with digestive disease. The PRISMA guidelines were used to identify 20 research articles that had data aligning with 4 common overlapping themes including, patient compliance (n = 13), patient satisfaction (n = 11), disease activity (n = 15), and quality of life (n = 13). The studies focused on digestive diseases including inflammatory bowel disease (n = 7), ulcerative colitis (n = 4), Crohn's Disease (n = 1), irritable bowel syndrome (n = 6), and colorectal cancer (n = 2).

Results: From the studies included in this systematic review, patient compliance and patient satisfaction ranged between 25.7-100% and 74-100%, respectively. Disease activity, measured by symptom severity scales and physiological biomarkers, showed improvements following telemedicine interventions in several, but not all, studies. Similar to disease activity, general and disease-specific quality of life showed improvements following telemedicine interventions in as little as 12 weeks in some studies.

Conclusion: Telemedicine and mobile health technology may be effective in managing disease activity and improving quality of life in digestive diseases. Future studies should explore both gastrointestinal and gastroesophageal diseases using these types of interventions.
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http://dx.doi.org/10.1007/s10620-018-5054-zDOI Listing
June 2018
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