Publications by authors named "Wen You"

68 Publications

From Bright Bodies to Choose: Using a CBPR Approach to Develop Childhood Obesity Intervention Materials for Rural Virginia.

Sage Open 2019 Jan 21;9(1):1-14. Epub 2019 Mar 21.

University of Nebraska Medical Center, Omaha, USA.

This community-based participatory research (CBPR) project used a collaborative process to develop a culturally relevant workbook for parents of overweight children. We followed a mixed methods iterative process to assess clear communication using a CBPR approach. Materials were evaluated using readability tests, the Clear Communication Index (CCI), and the Suitability Assessment of Materials (SAM). In addition, we used surveys and focus groups to investigate parents' perceptions and gather feedback from delivery staff using the workbook. While workbook materials maintained adequate grade reading levels, our iterative process and the use of CCI and SAM led to significant improvements in (a) clearly communicating the objectives of the program, (b) being culturally relevant, and (c) reaching a high satisfaction among users. These findings suggest that evaluative measures for written materials should move beyond readability and need to account for level of clarity and cultural appropriateness of messages. Furthermore, we found that that an iterative process to intervention's material development using clear communication strategies while involving community members, parents, and research partners can lead to workbook materials that are culturally relevant to the target audience, and better communicate program objectives. Finally, this is a potentially generalizable process for improving clear communication of written health information materials.
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http://dx.doi.org/10.1177/2158244019837313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8291387PMC
January 2019

Design and fault diagnosis of DCS sintering furnace's temperature control system for edge computing.

Authors:
Na Qu Wen You

PLoS One 2021 6;16(7):e0253246. Epub 2021 Jul 6.

Department of Mechanical and Electrical Engineering, Changchun University of Technology, Changchun City, China.

Under the background of modern industrial processing and production, the sintering furnace's temperature control system is researched to achieve intelligent smelting and reduce energy consumption. First, the specific application and implementation of edge computing in industrial processing and production are analyzed. The industrial processing and production intelligent equipment based on edge computing includes the equipment layer, the edge layer, and the cloud platform layer. This architecture improves the operating efficiency of the intelligent control system. Then, the sintering furnace in the metallurgical industry is taken as an example. The sintering furnace connects powder material particles at high temperatures; thus, the core temperature control system is investigated. Under the actual sintering furnace engineering design, the Distributed Control System (DCS) is used as the basis of sintering furnace temperature control, and the Programmable Logic Controller (PLC) is adopted to reduce the electrical wiring and switch contacts. The hardware circuit of DCS is designed; on this basis, an embedded operating system with excellent performance is transplanted according to functional requirements. The final DCS-based temperature control system is applied to actual monitoring. The real-time temperature of the upper, middle, and lower currents of 1# sintering furnace at a particular point is measured to be 56.95°C, 56.58°C, and 57.2°C, respectively. The real-time temperature of the upper, middle, and lower currents of 2# sintering furnaces at a particular point is measured to be 144.7°C, 143.8°C, and 144.0°C, respectively. Overall, the temperature control deviation of the three currents of the two sintering furnaces stays in the controllable range. An expert system based on fuzzy logic in the fault diagnosis system can comprehensively predict the situation of the sintering furnaces. The prediction results of the sintering furnace's faults are closer to the actual situation compared with the fault diagnosis method based on the Backpropagation (BP) neural network. The designed system makes up for the shortcomings of the sintering furnace's traditional temperature control systems and can control the temperature of the sintering furnace intelligently and scientifically. Besides, it can diagnose equipment faults timely and efficiently, thereby improving the sintering efficiency.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0253246PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8259965PMC
July 2021

Hamartomatous polyposis syndrome associated malignancies: Risk, pathogenesis and endoscopic surveillance.

J Dig Dis 2021 Jun 18. Epub 2021 Jun 18.

Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.

Hamartomatous polyposis syndromes (HPS) are a heterogeneous spectrum of diseases that are characterized by diffuse hamartomatous polyps lining the gastrointestinal (GI) tract together with extra-GI manifestations. Classical HPS includes juvenile polyposis syndrome, Peutz-Jeghers syndrome, PTEN hamartoma tumor syndrome and hereditary mixed polyposis syndrome. Patients with HPS have a higher risk of GI and extra-GI malignancies than the general population, although the underlying mechanisms remain unclear and are obviously different from the carcinogenesis of classical adenocarcinoma and colitis-associated malignancy. In this review we aimed to clarify the risks, possible mechanism and endoscopic surveillance of HPS-associated GI malignancies.
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http://dx.doi.org/10.1111/1751-2980.13029DOI Listing
June 2021

Low Health Literacy Is Associated With Energy-Balance-Related Behaviors, Quality of Life, and BMI Among Rural Appalachian Middle School Students: A Cross-Sectional Study.

J Sch Health 2021 Aug 6;91(8):608-616. Epub 2021 Jun 6.

Professor, School of Medicine, Department of Public Health Sciences, University of Virginia, 16 E. Main Street, Christiansburg, VA, 24073., USA.

Background: Many studies document associations between low health literacy (HL) and poor health behaviors and outcomes. Yet, HL is understudied among adolescents, particularly from underserved, rural communities. We targeted rural adolescents in this cross-sectional study and explored relationships between HL and (1) energy-balance-related health behaviors and (2) body mass index (BMI) and quality of life (QOL).

Methods: Surveys were administered to 7th graders across 8 middle schools in rural Appalachia. HL was assessed using the Newest Vital Sign. Energy-balance-related behaviors and QOL were assessed using validated instruments. Height and weight were objectively measured. Analyses were conducted using the Hodges-Lehmann nonparametric median difference test.

Results: Of the 854 adolescent students (mean age = 12; 55% female), 47% had limited HL. Relative to students with higher HL, students with lower HL reported significantly lower frequency of health-promoting behaviors (water, fruit and vegetable intake, physical activity, sleep), higher frequency of risky health behaviors (sugar-sweetened beverages, junk food, screen time), and had higher BMI percentiles and lower QOL (all p < .05).

Conclusions: Low HL is associated with energy-balance-related behaviors, BMI, and QOL among rural, Appalachian adolescents. Findings underscore the relevance of HL among rural middle school students and highlight implications for school health.
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http://dx.doi.org/10.1111/josh.13051DOI Listing
August 2021

A Systematic Review of the Cost-Utility of Spinal Cord Stimulation for Persistent Low Back Pain in Patients With Failed Back Surgery Syndrome.

Global Spine J 2021 Apr;11(1_suppl):66S-72S

Department of Neurosurgery, UVA School of Medicine, Charlottesville, VA, USA.

Study Design: Systematic Review.

Objectives: To review the literature surrounding the cost-effectiveness of implanting spinal cord stimulators for failed back surgery syndrome.

Methods: A systematic review was conducted inclusive of all publications in the Medline database and Cochrane CENTRAL trials register within the last 10 years (English language only) assessing the cost-effectiveness of Spinal Cord Stimulator device implantation (SCSdi) in patients with previous lumbar fusion surgery.

Results: The majority of reviewed publications that analyzed cost-effectiveness of SCSdi compared to conventional medical management (CMM) or re-operation in patients with failed back surgery syndrome (FBSS) showed an overall increase in direct medical costs; these increased costs were found in nearly all cases to be offset by significant improvements in patient quality of life. The cost required to achieve these increases in quality adjusted life years (QALY) falls well below $25 000/QALY, a conservative estimate of willingness to pay.

Conclusions: The data suggest that SCSdi provides both superior outcomes and a lower incremental cost: effectiveness ratio (ICER) compared to CMM and/or re-operation in patients with FBSS. These findings are in spite of the fact that the majority of studies reviewed were agnostic to the type of device or innervation utilized in SCSdi. Newer devices utilizing burst or higher frequency stimulation have demonstrated their superiority over traditional SCSdi via randomized clinical trials and may provide lower ICERs.
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http://dx.doi.org/10.1177/2192568220970163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076810PMC
April 2021

Surface doping of non-fullerene photoactive layer by soluble polyoxometalate for printable organic solar cells.

Chem Commun (Camb) 2021 Mar;57(21):2689-2692

Wuhan National Laboratory for Optoelectronics, School of Optical and Electronic Information, Huazhong University of Science and Technology, Wuhan 430074, China.

The non-fullerene photoactive layer (PTB7-Th:IEICO-4F) film is first immersed into a PMA solution to induce an effective surface p-type doping. An improved hole-collection and a high PCE of 11.37% was obtained, although the non-fullerene OSCs were without a commonly evaporated MoO3. This surface doping technique is an effective and feasible strategy for the printable electronics technology.
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http://dx.doi.org/10.1039/d1cc00032bDOI Listing
March 2021

Applying the socio-ecological model to understand factors associated with sugar-sweetened beverage behaviours among rural Appalachian adolescents.

Public Health Nutr 2021 Aug 11;24(11):3242-3252. Epub 2021 Jan 11.

Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, University of Virginia, 16 East Main Street, Christiansburg, VA24073, USA.

Objective: The objective of the current study was to identify factors across the socio-ecological model (SEM) associated with adolescents' sugar-sweetened beverage (SSB) intake.

Design: This cross-sectional study surveyed adolescents using previously validated instruments. Analyses included descriptive statistics, ANOVA tests and stepwise nonlinear regression models (i.e., two-part models) adjusted to be cluster robust. Guided by SEM, a four-step model was used to identify factors associated with adolescent SSB intake - step 1: demographics (i.e., age, gender), step 2: intrapersonal (i.e., theory of planned behaviour (attitudes, subjective norms, perceived behavioural control, behavioural intentions), health literacy, media literacy, public health literacy), step 3: interpersonal (i.e., caregiver's SSB behaviours, caregiver's SSB rules) and step 4: environmental (i.e., home SSB availability) level variables.

Setting: Eight middle schools across four rural southwest Virginia counties in Appalachia.

Participants: Seven hundred ninety seventh grade students (55·4 % female, 44·6 % males, mean age 12 (sd 0·5) years).

Results: Mean SSB intake was 36·3 (sd 42·5) fluid ounces or 433·4 (sd 493·6) calories per day. In the final step of the regression model, seven variables significantly explained adolescent's SSB consumption: behavioural intention (P < 0·05), affective attitude (P < 0·05), perceived behavioural control (P < 0·05), health literacy (P < 0·001), caregiver behaviours (P < 0·05), caregiver rules (P < 0·05) and home availability (P < 0·001).

Conclusions: SSB intake among adolescents in rural Appalachia was nearly three times above national mean. Home environment was the strongest predictor of adolescent SSB intake, followed by caregiver rules, caregiver behaviours and health literacy. Future interventions targeting these factors may provide the greatest opportunity to improve adolescent SSB intake.
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http://dx.doi.org/10.1017/S1368980021000069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8272722PMC
August 2021

Epidemiological and Economic Impact of COVID-19 in the US.

medRxiv 2020 Nov 30. Epub 2020 Nov 30.

This research measures the epidemiological and economic impact of COVID-19 spread in the US under different mitigation scenarios, comprising of non-pharmaceutical interventions. A detailed disease model of COVID-19 is combined with a model of the US economy to estimate the direct impact of labor supply shock to each sector arising from morbidity, mortality, and lock down, as well as the indirect impact caused by the interdependencies between sectors. During a lockdown, estimates of jobs that are workable from home in each sector are used to modify the shock to labor supply. Results show trade-offs between economic losses, and lives saved and infections averted are non-linear in compliance to social distancing and the duration of lockdown. Sectors that are worst hit are not the labor-intensive sectors such as Agriculture and Construction, but the ones with high valued jobs such as Professional Services, even after the teleworkability of jobs is accounted for. Additionally, the findings show that a low compliance to interventions can be overcome by a longer shutdown period and vice versa to arrive at similar epidemiological impact but their net effect on economic loss depends on the interplay between the marginal gains from averting infections and deaths, versus the marginal loss from having healthy workers stay at home during the shutdown.
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http://dx.doi.org/10.1101/2020.11.28.20239517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709183PMC
November 2020

Beyond the supermarket: analyzing household shopping trip patterns that include food at home and away from home retailers.

BMC Public Health 2020 Nov 19;20(1):1747. Epub 2020 Nov 19.

Department of Epidemiology, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198, USA.

Background: Modifying a household's food environment by targeting a single retailer type, like supermarkets, has a limited impact on dietary outcomes. This may be because the food environment has a limited impact on shopping behaviors, or because households are not as reliant on supermarkets as we assume. However, our understanding of how households shop for food, especially when considering the use of both food at home (FAH) retailers, such as supermarkets, and away from home retailers (FAFH), such as restaurants, is limited. Thus, understanding how households shop for food is a necessary first step when developing programs to modify food purchasing behavior.

Methods: K-means cluster analysis was used to identify weekly food shopping trip patterns based on the percentage of trips to FAH and FAFH retailers in the 2013 Food Acquisition and Purchase Survey (FoodAPS) dataset (n = 4665 households). Multinomial logistic regression was used to examine the relationship between shopping trip patterns, household and food environment characteristics.

Results: Three patterns emerged: primarily supermarket, primarily supercenter, or mix (i.e. no dominant retailer type, but high FAFH use). Households with incomes below 185% of the federal poverty line were evenly divided between patterns that rely primarily on FAH retailers, and the mix pattern. While nearly 70% of households with incomes above 185% of the federal poverty line are in the mix cluster. Supermarket and superstore availability significantly influenced the likelihood of belonging to those clusters respectively, while having a child, higher income, and attitudes towards healthy meal preparation time or taste significantly influenced the likelihood of belonging to the mix cluster.

Conclusion: Although lower-income households are more likely to rely primarily on FAH retailers, household's, regardless of income, that primarily utilize FAH retailers show a strong preference for either superstores or supermarkets suggesting a need for interventions to reach both retailer types. However, altering the food environment alone may not be sufficient to discourage use of FAFH retailers as households relying on FAFH retailers are significantly influenced by meal preparation time and healthy food taste.
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http://dx.doi.org/10.1186/s12889-020-09882-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678129PMC
November 2020

Medical costs of keeping the US economy open during COVID-19.

Sci Rep 2020 10 28;10(1):18422. Epub 2020 Oct 28.

Network Systems Science and Advanced Computing Division, Biocomplexity Institute, University of Virginia, Charlottesville, VA, 22904, USA.

We use an individual based model and national level epidemic simulations to estimate the medical costs of keeping the US economy open during COVID-19 pandemic under different counterfactual scenarios. We model an unmitigated scenario and 12 mitigation scenarios which differ in compliance behavior to social distancing strategies and in the duration of the stay-home order. Under each scenario we estimate the number of people who are likely to get infected and require medical attention, hospitalization, and ventilators. Given the per capita medical cost for each of these health states, we compute the total medical costs for each scenario and show the tradeoffs between deaths, costs, infections, compliance and the duration of stay-home order. We also consider the hospital bed capacity of each Hospital Referral Region (HRR) in the US to estimate the deficit in beds each HRR will likely encounter given the demand for hospital beds. We consider a case where HRRs share hospital beds among the neighboring HRRs during a surge in demand beyond the available beds and the impact it has in controlling additional deaths.
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http://dx.doi.org/10.1038/s41598-020-75280-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7595181PMC
October 2020

Sustaining the reach of a scalable weight loss intervention through financial incentives- a pragmatic, feasibility, online randomized trial protocol.

Contemp Clin Trials 2020 11 10;98:106142. Epub 2020 Sep 10.

Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.

Background: High attrition following initial enrollment in evidence-based weight loss programs is a common, challenging, and under-studied issue. A behavioral economics approach consisting of modest monetary incentives may help to engage participants beyond enrollment to close the initial attrition gap.

Purpose: To describe the methods and design of a pragmatic, online randomized controlled trial (RCT) of an incentivized, technology-facilitated weight loss program through an innovative research-practice partnership involving primary care, health promotion researchers, and a small business.

Methods: This study is a four-arm (1:1:1:1) RCT that compares the efficacy of outcome-based (weight loss), process-based (weighing in), a combination of outcome- and process-based, or choice-based incentives on sustaining program reach after initial enrollment for an evidence-based weight loss program. The multicomponent weight loss program includes a website, social cognitive theory-based daily health coaching, tailored messaging delivered via email and text messaging, access to online health coaches, and objective weight assessment through a community kiosk. The study will enroll 400 individuals aged 19 and older who have a body mass index ≥25 kg/m, and have reliable access to the Internet or a smart phone. Participants will be followed for 3, 6, 9, and 12 months to assess program reach and representativeness, and continued participation after enrollment. The secondary outcomes include weight loss and program implementation costs. We will conduct participant focus groups to understand the barriers and facilitators of participation and key informant interviews focusing on clinic managers and care providers to explore the potential for future adoption and implementation of the evidence-based program.

Discussion: This study possesses the potential to close the attrition gap after initial enrollment in a web-based digital weight loss intervention in the primary care and community settings. Clinicaltrials.gov registration: NCT04225234.
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http://dx.doi.org/10.1016/j.cct.2020.106142DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040949PMC
November 2020

Medical Costs of Keeping the US Economy Open During COVID-19.

medRxiv 2020 Jul 19. Epub 2020 Jul 19.

We use an individual based model and national level epidemic simulations to estimate the medical costs of keeping the US economy open during COVID-19 pandemic under different counterfactual scenarios. We model an unmitigated scenario and 12 mitigation scenarios which differ in compliance behavior to social distancing strategies and to the duration of the stay-home order. Under each scenario we estimate the number of people who are likely to get infected and require medical attention, hospitalization, and ventilators. Given the per capita medical cost for each of these health states, we compute the total medical costs for each scenario and show the tradeoffs between deaths, costs, infections, compliance and the duration of stay-home order. We also consider the hospital bed capacity of each Hospital Referral Region (HRR) in the US to estimate the deficit in beds each HRR will likely encounter given the demand for hospital beds. We consider a case where HRRs share hospital beds among the neighboring HRRs during a surge in demand beyond the available beds and the impact it has in controlling additional deaths.
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http://dx.doi.org/10.1101/2020.07.17.20156232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7388489PMC
July 2020

Effects of Seasonal Vitamin D3 Supplementation on Strength, Power, and Body Composition in College Swimmers.

Int J Sport Nutr Exerc Metab 2020 Feb 4:1-9. Epub 2020 Feb 4.

Virginia Tech.

The purpose of this study was to evaluate the impact of fall season vitamin D3 supplementation on strength/power, body composition, and anabolic hormones in swimmers with optimal vitamin D status at summer's end. Male and female National Collegiate Athletic Association Division I swimmers (N = 19) with optimal 25-hydroxyvitamin D [25(OH)D] randomly received 5,000 IU of vitamin D3 (VITD) or placebo (PLA) daily for 12 weeks while participating in swimming and strength and conditioning training (August-November). Before and after the intervention, the participants underwent blood sampling for analysis of serum 25(OH)D, parathyroid hormone, total testosterone, free testosterone, sex hormone-binding globulin, and insulin-like growth factor 1, dual-energy X-ray absorptiometry, and strength/power testing (bench press, squat, dead lift, standing broad jump, vertical jump, and dips and pull-ups). Sex was used as a covariate for analyses. The 25(OH)D was decreased by 44% in PLA (p < .05) and increased by 8% in VITD over the 12 weeks. Fat-free mass increased in VITD (56.4-59.1 kg; p < .05), but not PLA (59.4-59.7 kg; p < .01). Significant Group × Time interaction effects were observed for dead lift (F = 21.577, p < .01) and vertical jump (F = 11.219, p < .01), but no other strength/power tests. Total testosterone decreased similarly in both groups, but free testosterone decreased and sex hormone-binding globulin increased only in PLA (p < .01). There were no group differences or changes in insulin-like growth factor 1 with the intervention. The findings suggest that vitamin D supplementation is an efficacious strategy to maintain 25(OH)D during the fall season training and to enhance some aspects of strength/power and fat-free mass in swimmers. Further research on the relationship between vitamin D and anabolic hormones is needed.
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http://dx.doi.org/10.1123/ijsnem.2019-0250DOI Listing
February 2020

Factors influencing high respiratory mortality in coal-mining counties: a repeated cross-sectional study.

BMC Public Health 2019 Nov 8;19(1):1484. Epub 2019 Nov 8.

Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198, USA.

Background: Previous studies have associated elevated mortality risk in central Appalachia with coal-mining activities, but few have explored how different non-coal factors influence the association within each county. Consequently, there is a knowledge gap in identifying effective ways to address health disparities in coal-mining counties. To specifically address this knowledge gap, this study estimated the effect of living in a coal-mining county on non-malignant respiratory diseases (NMRD) mortality, and defined this as "coal-county effect." We also investigated what factors may accentuate or attenuate the coal-county effect.

Methods: An ecological epidemiology protocol was designed to observe the characteristics of three populations and to identify the effects of coal-mining on community health. Records for seven coal-mining counties (n = 19,692) were obtained with approvals from the Virginia Department of Health Office of Vital Statistics for the years 2005 to 2012. Also requested were records from three adjacent coal counties (n = 10,425) to provide a geographic comparison. For a baseline comparison, records were requested for eleven tobacco-producing counties (n = 27,800). We analyzed the association of 57,917 individual mortality records in Virginia with coal-mining county residency, county-level socioeconomic status, health access, behavioral risk factors, and coal production. The development of a two-level hierarchical model allowed the coal-county effect to vary by county-level characteristics. Wald tests detected sets of significant factors explaining the variation of impacts across counties. Furthermore, to illustrate how the model estimations help explain health disparities, two coal-mining county case studies were presented.

Results: The main result revealed that coal-mining county residency increased the probability of dying from NMRD. The coal-county effect was accentuated by surface coal mining, high smoking rates, decreasing health insurance coverage, and a shortage of doctors. In Virginia coal-mining regions, the average coal-county effect increased by 147% (p-value< 0.01) when one doctor per 1000 left, and the effect increased by 68% (p-value< 0.01) with a 1% reduction of health insurance rates, holding other factors fixed.

Conclusions: This study showed a high mortality risk of NMRD associated with residents living in Virginia coal-mining counties. Our results also revealed the critical role of health access in reducing health disparities related to coal exposure.
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http://dx.doi.org/10.1186/s12889-019-7858-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6839055PMC
November 2019

[Spatial structure characteristics of the main tree species in a mixed broadleaved Korean pine (Pinus koraiensis)forest in a mountainous area of eastern Liaoning Province, China].

Ying Yong Sheng Tai Xue Bao 2019 Sep;30(9):2933-2940

Liaoning Institute of Economic Forestry, Dalian 116031, Liaoning, China.

Maintaining forest structural diversity is generally considered as an effective way to preserve forest stability and biodiversity. The spatial structure characteristics of the dominant tree species in a climax community were investigated in a primary mixed broadleaved Korean pine (Pinus koraiensis) forest in a mountainous area of eastern Liaoning. Stand spatial structure parameters were determined based on the relationships among neighboring trees. The climax communities were used as a theoretical reference for optimizing the spatial structure of a low-quality secondary forest and monoculture plantation. The diameter distribution of the trees in the pine forest exhibited an inverse J-shape, indicating that understory regeneration was relatively good and with certain proportion of large-diameter trees. The main tree species were randomly distributed across the whole plot (=0.507) and in an intensively mixed state (=0.82). An average DBH comparison of trees in the stand indicated that they were at a intermediate status (=0.506). There was a differentiation among different dominances along the high intensity mixed dimension in the stand, indicating an optimal distribution of understory trees and the rational utilization of resources. Trees in the small diameter category were at a state of complete compression, while canopy trees were at a state of complete dominance in terms of their vertical space. Individuals of each dominant tree species were randomly scattered, with a random pattern of individuals throughout the climax community.
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http://dx.doi.org/10.13287/j.1001-9332.201909.021DOI Listing
September 2019

The Adoption of the Healthy Eating Standards in Local Afterschool Programs Does Not Improve Quality of Snacks.

J Sch Health 2019 10 9;89(10):809-817. Epub 2019 Aug 9.

University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198.

Objectives: In 2011, the National Afterschool Association adopted the Healthy Eating and Physical Activity (HEPA) standards to address snack quality and physical activity in afterschool programs. Although research has indicated promise in the adoption of these policies by national organizations, less is known about local adoption, implementation, and effectiveness. In this study, we aimed to compare the quality of snacks served at program sites pre- and post-adoption and to determine the quality of non-program snacks compared to program snacks.

Methods: An interrupted time series design was used to measure snack quality and consumption at 3 policy adopting sites and 2 non-policy adopting sites that served as a comparison control. Trained research staff collected snack type, brand, and amount consumed using a modified quarter-waste method. Analysis on nutrient content of snacks was completed using Nutrition Data System for Research software.

Results: Adoption of the HEPA standards among policy adopting sites did not result in significantly better snack quality. Across all sites, program snacks were healthier than non-program snacks.

Conclusion: Pursuing additional components of the HEPA standards related to implementation may be necessary to significantly improve snack quality. Environmental supports such as limiting the amount of non-program snacks available onsite may improve snack quality.
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http://dx.doi.org/10.1111/josh.12822DOI Listing
October 2019

A comparative effectiveness trial of two family-based childhood obesity treatment programs in a medically underserved region: Rationale, design & methods.

Contemp Clin Trials 2019 09 28;84:105801. Epub 2019 Jun 28.

Department of Health Promotion, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075, USA.

While there is a large body of literature documenting the efficacy of family-based childhood obesity (FBCO) treatment interventions, there is little evidence that these interventions have been systematically translated into regular practice - particularly in health disparate regions. To address this research-practice gap, this project was guided by a community advisory board (CAB) and the RE-AIM planning and evaluation framework within a systems-based and community-based participatory research approach. Families with overweight or obese children between 5 and 12 years old, in the medically-underserved Dan River Region, were randomly assigned to one of two FBCO treatment programs (iChoose vs. Family Connections) delivered by local Parks & Recreation staff. Both programs have previously demonstrated clinically meaningful child BMI z-score reductions, but vary in intensity, structure, and implementation demands. Two clinical CAB partners embedded recruitment methods into their regional healthcare organization, using procedures representative to what could be used if either program was taken to scale. The primary effectiveness outcome is child BMI z-scores at 6-months, with additional assessments at 3-months and at 12-months. Secondary goals are to determine: (1) reach into the intended audience; (2) effectiveness on secondary child and parent outcomes; (3) intervention adoption by organizations and staff; (4) fidelity, cost, and capacity for intervention implementation; and (5) maintenance of individual-level changes and organizational-level sustainability. This research addresses literature gaps related to the features within clinical and community settings that could improve both child weight status and the translation of FBCO interventions into typical practice in medically-underserved communities. IDENTIFIERS: Clincialtrials.gov: NCT03245775.
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http://dx.doi.org/10.1016/j.cct.2019.06.015DOI Listing
September 2019

Kids SIPsmartER, a cluster randomized controlled trial and multi-level intervention to improve sugar-sweetened beverages behaviors among Appalachian middle-school students: Rationale, design & methods.

Contemp Clin Trials 2019 08 21;83:64-80. Epub 2019 Jun 21.

University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA.

The intake of sugar-sweetened beverages (SSB) is disproportionately high in Appalachia, including among adolescents whose intake is more than double the national average and more than four times the recommended daily amount. Unfortunately, there is insufficient evidence for effective strategies targeting SSB behaviors among Appalachian youth in real-world settings, including rural schools. Kids SIPsmartER is a 6-month, school-based, behavior and health literacy program aimed at improving SSB behaviors among middle school students. The program also integrates a two-way short message service (SMS) strategy to engage caregivers in SSB role modeling and supporting home SSB environment changes. Kids SIPsmartER is grounded by the Theory of Planned Behavior and health literacy, media literacy, numeracy, and public health literacy concepts. Guided by the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance), this type 1 hybrid design and cluster randomized controlled trial targets 12 Appalachian middle schools in southwest Virginia. The primary aim evaluates changes in SSB behaviors at 7-months among 7th grade students at schools receiving Kids SIPsmartER, as compared to control schools. Secondary outcomes include other changes in students (e.g., BMI, quality of life, theory-related variables) and caregivers (e.g., SSB behaviors, home SSB environment), and 19-month maintenance of these outcomes. Reach is assessed, along with mixed-methods strategies (e.g., interviews, surveys, observation) to determine how teachers implement Kids SIPsmartER and the potential for institutionalization within schools. This paper discusses the rationale for implementing and evaluating a type 1 hybrid design and multi-level intervention addressing pervasive SSB behaviors in Appalachia. Clincialtrials.gov: NCT03740113.
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http://dx.doi.org/10.1016/j.cct.2019.06.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6713199PMC
August 2019

Participatory development and pilot testing of iChoose: an adaptation of an evidence-based paediatric weight management program for community implementation.

BMC Public Health 2019 Jan 29;19(1):122. Epub 2019 Jan 29.

Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE, 68198-6075, USA.

Background: To describe the identification, adaptation, and testing of an evidence-based pediatric weight management program for a health disparate community.

Methods: A community advisory board (CAB) of decision-makers and staff from local health care, public health, and recreation organizations engaged with academic partners to select an evidence-based program (EBP) for local implementation. Three EBPs were identified (Traffic Light, Bright Bodies, Golan and colleagues Home Environmental Model) and each EBP was rated on program characteristics, implementation and adaptation, and adoptability. Following selection of the EBP that was rated highest, the POPS-CAB made adaptations based on the program principles described in peer-reviewed publications. The adapted intervention, iChoose, was then pilot tested in 3 iterative phases delivered initially by research partners, then co-delivered by research and community partners, then delivered by community partners. The RE-AIM framework was used to plan and evaluate the iChoose intervention across all waves with assessments at baseline, post program (3 months), and follow-up (6 months).

Results: Bright Bodies rated highest on program characteristics and adoptability (p's < 0.05), while Home Environmental Model rated highest on implementation factors (p < 0.05). Qualitatively, the selection focused on important program characteristics and on matching those characteristics to the potential to fit within the community partner services. The adapted program-iChoose-had 18% reach and with participants that were representative of the target population on age, gender, ethnicity, and race. Effectiveness was demonstrated by modest, but significant reductions in BMI z-scores at post-program compared to baseline (M = - 0.047; t = - 2.11, p = 0.046). This decrease returned to values similar to baseline 3 months (M = 0.009) after the program was completed. Implementation fidelity was high and implementation fidelity did not differ between community or research delivery agents.

Conclusion: The process to help organizations identify and select evidence-based programs appropriate for their community led to consensus on a single EBP. While iChoose was successful in initiating changes in BMI z-scores, could be implemented in a low resource community with fidelity, it was insufficient to lead to sustained child BMI z-scores. In response to these data, maintenance of program effects and delivery are the current focus of the CBPR team.
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http://dx.doi.org/10.1186/s12889-019-6450-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352451PMC
January 2019

The reach and effectiveness of SIPsmartER when implemented by rural public health departments: a pilot dissemination and implementation trial to reduce sugar-sweetened beverages.

Transl Behav Med 2020 08;10(3):676-684

LENOWISCO and Cumberland Plateau Health District, Virginia Department of Health, Wise, VA, USA.

SIPsmartER is a theory-based, 6-month, multi-component health literacy intervention shown to improve sugar-sweetened beverages (SSB) behaviors among adults in rural, southwest Virginia. The objective of this pilot trial was to understand the reach and effectiveness of SIPsmartER when delivered by existing staff in public health practice settings. This pre-post research design was conducted in partnership with four medically underserved southwest Virginia Department of Health (VDH) districts. Validated measures and standardized data collection techniques were used. Analyses included descriptive statistics and multilevel mixed-effects linear regressions models. Of 928 individuals screened, 586 (63%) were eligible and 117 (20% of eligible) enrolled in SIPsmartER (79% retained). The sample was majority female (71%) and white (94%) and had ≤high school education (59%) and an annual income of approximately $12,500. Relative to the county population, the enrolled study sample was representative for age and race, yet underrepresented for men and overrepresented for low income and low educational attainment. Significant improvements from baseline to 6 months were observed for the primary SSB outcome (-403 [confidence interval [CI] = -528, -278] SSB kcals/day) (p < .001). SSB-related attitudes, perceived behavioral control, behavioral intentions, and media literacy also significantly improved (all p < .05). SIPsmartER appears to be promising for VDH and potentially other health departments in medically underserved areas. When compared to the previous effectiveness trial, existing VDH staff achieved similar reach and effectiveness for some, but not all, outcomes. Future work is needed on methods to support health departments in developing strategies to reach new participants and to integrate SIPsmartER into sustained practice.
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http://dx.doi.org/10.1093/tbm/ibz003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413190PMC
August 2020

Effectiveness of DVD vs. group-initiated diabetes prevention on information uptake for high & low health literacy participants.

Patient Educ Couns 2019 05 23;102(5):968-975. Epub 2018 Dec 23.

University of Nebraska Medical Center, United States.

Objective: This study evaluates the effectiveness of technology versus in-person, group-initiated diabetes prevention to enhance comprehension of learning objectives between patients with differing health literacy (HL).

Methods: Evidence-based content through either a DVD (n = 217) or in-person, group class (n = 225) to initiate the intervention. A teach-back call was used to assess comprehension of, and reinforce, learning objectives. Chi-squared was used to determine differences between conditions (DVD vs Class) and HL levels (High n = 361 vs. Low n = 81) and regression analyses were used to examine relationships.

Results: DVD participants performed significantly better across teach back questions (15.4 ± 2.5 v. 14.8 ± 2.6, p < 0.01), demonstrated comprehension in fewer teach-back rounds (1.9 ± 0.7 v. 2.1 ± 0.7, p < 0.01), and answered more questions correctly on the first try (4.2 ± 1.6 v. 3.4 ± 1.8, p < 0.01). Models for HL levels and modality by HL level were statistically significant (p < 0.01) favoring the DVD.

Conclusion: Initiating a diabetes prevention program with the use of a DVD appears to be a superior option to in-person, class sessions. Teach-back and teach-to-goal strategies enables participants of both high and low health literacy levels to receive and confirm mastery of diabetes prevention objectives.

Practice Implications: A teach-back call may improve information uptake increasing the likelihood of health behavior uptake.
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http://dx.doi.org/10.1016/j.pec.2018.12.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7477788PMC
May 2019

[Removal of Humic Acid from Water by Magnetic Chitosan-Grafted Polyacrylamide].

Huan Jing Ke Xue 2018 Dec;39(12):5532-5540

Ministry of Education, Key Laboratory of Integrated Regulation and Resource Development on Shallow Lakes, Hohai University, Nanjing 210098, China.

For high-efficiency removal of humic acid (HA), a natural organic matter in the water source, an adsorbent named magnetically modified chitosan-grafted polyacrylamide (MC-g-PAM) was developed by using an coprecipitation method. Analytical instruments, such as a Fourier transform infrared (FTIR) spectroscope, scanning electron microscope (SEM), vibrating sample magnetometer (VSM), and specific surface area tester (BET), were used to characterize and analyze this material. With the aid of batch tests, the removal efficiency and mechanism of humic acid in water samples were investigated. The results show that the specific surface area and specific saturation magnetization values of the prepared MC-g-PAM are 27.065 m·g and 9.63 emu·g, respectively. The adsorption of humic acid by MC-g-PAM is an endothermic process and the Langmuir isotherm model and the pseudo-second-order kinetic equation fit the adsorption process well. At 25℃, the equilibrium adsorption capacity of MC-g-PAM to humic acid reaches 120.77 mg·g.
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http://dx.doi.org/10.13227/j.hjkx.201803074DOI Listing
December 2018

Supporting maintenance of sugar-sweetened beverage reduction using automated versus live telephone support: findings from a randomized control trial.

Int J Behav Nutr Phys Act 2018 10 4;15(1):97. Epub 2018 Oct 4.

Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24061, USA.

Background: Although reducing sugar-sweetened beverage (SSB) intake is an important behavioral strategy to improve health, no known SSB-focused behavioral trial has examined maintenance of SSB behaviors after an initial reduction. Guided by the RE-AIM framework, this study examines 6-18 month and 0-18 month individual-level maintenance outcomes from an SSB reduction trial conducted in a medically-underserved, rural Appalachia region of Virginia. Reach and implementation indicators are also reported.

Methods: Following completion of a 6-month, multi-component, behavioral RCT to reduce SSB intake (SIPsmartER condition vs. comparison condition), participants were further randomized to one of three 12-month maintenance conditions. Each condition included monthly telephone calls, but varied in mode and content: 1) interactive voice response (IVR) behavior support, 2) human-delivered behavior support, or 3) IVR control condition. Assessments included the Beverage Intake Questionnaire (BEVQ-15), weight, BMI, and quality of life. Call completion rates and costs were tracked. Analysis included descriptive statistics and multilevel mixed-effects linear regression models using intent-to-treat procedures.

Results: Of 301 subjects enrolled in the 6-month RCT, 242 (80%) were randomized into the maintenance phase and 235 (78%) included in the analyses. SIPsmartER participants maintained significant 0-18 month decreases in SSB. For SSB, weight, BMI and quality of life, there were no significant 6-18 month changes among SIPsmartER participants, indicating post-program maintenance. The IVR-behavior participants reported greater reductions in SSB kcals/day during the 6-18 month maintenance phase, compared to the IVR control participants (- 98 SSB kcals/day, 95% CI = - 196, - 0.55, p < 0.05); yet the human-delivered behavior condition was not significantly different from either the IVR-behavior condition (27 SSB kcals/day, 95% CI = - 69, 125) or IVR control condition (- 70 SSB kcals/day, 95% CI = - 209, 64). Call completion rates were similar across maintenance conditions (4.2-4.6 out of 11 calls); however, loss to follow-up was greatest in the IVR control condition. Approximated costs of IVR and human-delivered calls were remarkably similar (i.e., $3.15/participant/month or $38/participant total for the 12-month maintenance phase), yet implications for scalability and sustainability differ.

Conclusion: Overall, SIPsmartER participants maintained improvements in SSB behaviors. Using IVR to support SSB behaviors is effective and may offer advantages as a scalable maintenance strategy for real-world systems in rural regions to address excessive SSB consumption.

Trial Registry: Clinicaltrials.gov; NCT02193009 ; Registered 11 July 2014. Retrospectively registered.
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http://dx.doi.org/10.1186/s12966-018-0728-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6172826PMC
October 2018

MicroRNA-106 attenuates hyperglycemia-induced vascular endothelial cell dysfunction by targeting HMGB1.

Gene 2018 Nov 25;677:142-148. Epub 2018 Jul 25.

Department of Central Laboratory, Shanghai Gongli Hospital, The Second Military Medical University, Shanghai 200135, PR China. Electronic address:

Chronic wounds are a common surgical problem exacerbated by diabetes. A hyperglycemic microenvironment induces inflammation and apoptosis, and plays an important role in vascular endothelial cell dysfunction in diabetes. Increasing evidence shows that high mobility group box 1 (HMGB1) expression is related to inflammation and apoptosis. The aim of this study was to determine the function of HMGB1 in hyperglycemia-induced vascular endothelial cell dysfunction. The results showed that the expression of HMGB1 was increased in human umbilical vein endothelial cells (HUVECs) after exposure to high glucose (25 mM). Downregulation of HMGB1 attenuated the high glucose-induced antiangiogenesis of HUVECs, and the decrease expression of HMGB1 inhibiting HUVEC apoptosis and inflammatory factor expression. In addition, miR-106 expression in HUVECs was decreased under high glucose conditions. Increased miR-106 significantly reversed the high glucose-induced vascular endothelial cell dysfunction by inhibition of HUVEC apoptosis and inflammatory factor expression. However, HMGB1 overexpression attenuated the protective effect of miR-106 on HUVECs in high glucose conditions. This suggested that miR-106 suppressed hyperglycemia-induced vascular endothelial cell dysfunction by targeting HMGB1. Double fluorescent reporter assays confirmed that miR-106 interacted with the 3'-UTR of HMGB1 and inhibited HMGB1 expression. Taken together, these data collectively suggested that miR-106 was a potential molecular target for inhibiting high glucose-induced inflammation and apoptosis by targeting HMGB1.
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http://dx.doi.org/10.1016/j.gene.2018.07.063DOI Listing
November 2018

[Effect of Volume Loading Rate (VLR) on Denitrifying Phosphorus Removal by the ABR-MBR Process].

Huan Jing Ke Xue 2018 Jan;39(1):239-246

School of Environmental Science and Engineering, Suzhou University of Science and Technology, Suzhou 215009, China.

The effect of volume loading rate (VLR) on denitrifying phosphorus removal was investigated in a continuous-flow ABR-MBR combined process treating domestic wastewater to arrive at optimum process parameters. In the experiment, the VLR of the ABR was set at 0.76, 1.01, 1.51, and 2.27 kg·(m·d). The removal of carbon, nitrogen, and phosphorus in the system and the effect of the VLR in the MBR on nitrification performance were observed for each VLR of the ABR. The results showed that under the condition when the VLR of the ABR was 1.51 kg·(m·d), the amount of COD removal in the A2 chamber was the largest, and shortcut nitrification was achieved in the MBR when the VLR of the MBR was 1.51 kg·(m·d). Meanwhile, the removal efficiency of NH-N and TN reached more than 90% and 72%, respectively, the anaerobic P-release and anoxic P-uptake were 7.41 mg·Land 15.42 mg·L, respectively, and the concentration of PO-P in effluent was lower than 0.5 mg·L, which indicated that the shortcut nitrification was more conducive to strengthening the performance of denitrifying phosphorus removal in the ABR-MBR system.
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http://dx.doi.org/10.13227/j.hjkx.201707072DOI Listing
January 2018

[Effect of NO-N Recycling Ratio on Denitrifying Phosphorus Removal Efficiency in the ABR-MBR Combined Process].

Huan Jing Ke Xue 2018 Mar;39(3):1309-1315

School of Environmental Science and Engineering, Suzhou University of Science and Technology, Suzhou 215009, China.

Based on the coupling of the ABR process and the MBR process, a novel combined ABR-MBR process, including biophase separation, liquid circulation, and functional linkage, was developed to achieve simultaneous carbon, nutrient, and phosphorus removal when treating domestic wastewater with low carbon/nitrogen ratio and to obtain the best combination of ABR, providing a quality carbon source, and MBR, achieving shortcut nitrification by optimizing hydraulic retention time (HRT). The influence of NO-N recycling ratio on nitrogen and phosphorus removal was investigated at NO-N recycling ratios of 100%, 200%, 300%, and 400%, respectively. The experimental results under different conditions showed that the efficiency of denitrifying phosphorus removal in the ABR was found to increase with increasing NO-N recycling ratio from 100% to 300% but decreased when the NO-N recycling ratio was 400%. Shortcut nitrification was achieved by controlling the low dissolved oxygen (DO) concentration ranges from 0.3 to 1.0 mg·L with the short HRT of 3 h in the MBR reactor. The nitrite accumulation ratio was above 60%, when the NO-N recycling ratio was 300%. Meanwhile, shortcut denitrifying phosphorus removal (where NO-N mainly acted as the electron acceptor for denitrifying phosphorus removal) was achieved and played the dominant role in phosphorus removal.
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http://dx.doi.org/10.13227/j.hjkx.201707197DOI Listing
March 2018

[Realization of Shortcut Nitrification in the ABR-MBR Process Treating Domestic Wastewater].

Huan Jing Ke Xue 2017 Dec;38(12):5154-5161

School of Environmental Science and Engineering, Suzhou University of Science and Technology, Suzhou 215009, China.

The operational control conditions for realizing shortcut nitrification in the membrane bioreactor (MBR) process was investigated in a lab-scale anaerobic baffled reactor (ABR)-MBR combined system, which laid the foundation for further research on the performance of denitrification phosphorus removal in the system. The experimental results under different conditions showed that shortcut nitrification in the MBR was achieved by controlling the dissolved oxygen (DO) concentration to low levels (0.5-1.0 mg·L to 0.3-0.7 mg·L) and changing the effective volume of the MBR to control hydraulic retention time (HRT), with the HRT in the ABR equal to 6 h, sludge reflux ratio of 100%, NO-N reflux ratio of 300%, and temperature of 30℃±2℃. Finally, the shortcut nitrification deteriorated as the HRT in the MBR increased from 3 h to 5 h, with nitrite accumulation rate dramatically dropping from 60% to 15%. The analysis of the influencing factors of shortcut nitrification showed that maintaining low DO concentration (0.3-0.7 mg·L) and gradually shortening HRT were the key factors. The pH, free ammonia (FA), free nitrous acid (FNA), temperature, and sludge retention time (SRT) had a slightly positive effect on shortcut nitrification. During the period of shortcut nitrification, a stable and high efficiency removal of COD and NH-N were achieved, and the average concentration of the effluent of COD and NH-N, whose removal rates were above 90%, were below 50 mg·L and 2 mg·L, respectively, and the removal efficiency of total nitrogen (TN) reached 72%.
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http://dx.doi.org/10.13227/j.hjkx.201706153DOI Listing
December 2017

The Relationship Between the Stanford Leisure-Time Activity Categorical Item and the Godin Leisure-Time Exercise Questionnaire Among Rural Intervention Participants of Varying Health Literacy Status.

J Phys Act Health 2018 04 9;15(4):269-278. Epub 2018 Feb 9.

Background: A pragmatic, self-reported physical activity measure is needed for individuals of varying health literacy status.

Methods: This study is a secondary analysis of a 6-month behavioral intervention for rural Appalachian adults developed using health literacy strategies. We examined the relationship and responsiveness of the Stanford Leisure-Time Activity Categorical Item (L-Cat) and adapted Godin Leisure-Time Exercise Questionnaire (GLTEQ) and determined if baseline health literacy status moderates intervention effects.

Results: Of 301 enrolled participants, 289 completed the L-Cat at baseline and 212 at 6 months. Approximately 33% were low health literate and 43% reported annual income of ≤$14,999. There was high agreement (84.1%) between the L-Cat and adapted GLTEQ for classifying individuals as meeting physical activity recommendations with little differences by health literacy level (low literacy 80.4% and high literacy 85.9%). The primary source of incongruent classification was the adapted GLTEQ classified almost 20% of individuals as meeting recommendations, whereas the L-Cat classified them as not meeting recommendations. There were differences in responsiveness between measures, but baseline health literacy status did not moderate change in any L-Cat or adapted GLTEQ measures.

Conclusion: Implications and recommendations for using the L-Cat 2.3 and GLTEQ among individuals of varying health literacy status are discussed.
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http://dx.doi.org/10.1123/jpah.2017-0284DOI Listing
April 2018

Cost effectiveness and return on investment of a scalable community weight loss intervention.

Prev Med 2017 Dec 5;105:295-303. Epub 2017 Oct 5.

Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.

This study assessed the lifetime health and economic consequences of an efficacious scalable community weight loss program for overweight and obese adults. We applied a state-transition Markov model to project lifetime economic outcome (US dollar) and the degree of disease averted as a result of a weight loss intervention, compared with no intervention, from a payer perspective. Effect sizes of the intervention on weight loss, by sex, race and ethnicity, and body mass index (BMI) of participants, were derived from a 12-month community program. Relative risk of diseases across BMI levels and other parameters were informed by the literature. A return on investment (ROI) analysis was conducted to present the overall cost-benefit of the program. Simulation results showed that among 33,656 participants and at a cost of $2.88 million, the program was predicted to avert (with a corresponding estimated medical costs saved of) 78 cases of coronary heart disease ($28 million), 9 cases of strokes ($971,832), 92 cases of type 2 diabetes ($24 million), 1 case of colorectal cancer ($357,022), and 3 cases of breast cancer ($483,259) over the participant lifetime. The estimated medical costs saved per participant was $1403 ($1077 of African American men and $1532 of Hispanic men), and the ROI was $16.7 ($12.8 for African American men and $18.3 for Hispanic men) for every $1 invested. We concluded that a scalable efficacious community weight loss program provides a cost-effective approach with significant ROI, which will assist informed decisions for future adoption and dissemination.
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http://dx.doi.org/10.1016/j.ypmed.2017.10.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5918290PMC
December 2017

The Influence of Parental Health Literacy Status on Reach, Attendance, Retention, and Outcomes in a Family-Based Childhood Obesity Treatment Program, Virginia, 2013-2015.

Prev Chronic Dis 2017 09 28;14:E87. Epub 2017 Sep 28.

Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska.

Introduction: Few interventions have evaluated the influence of parent health literacy (HL) status on weight-related child outcomes. This study explores how parent HL affects the reach, attendance, and retention of and outcomes in a 3-month multicomponent family-based program to treat childhood obesity (iChoose).

Methods: This pre-post, quasiexperimental trial occurred in the Dan River Region, a federally designated medically underserved area. iChoose research protocol and intervention strategies were designed using an HL universal precautions approach. We used validated measures, standardized data collection techniques, and generalized linear mixed-effect parametric models to determine the moderation effect of parent HL on outcomes.

Results: No significant difference in HL scores were found between parents who enrolled their child in the study and those who did not. Of 94 enrolled parents, 34% were low HL, 49% had an annual household income of less than $25,000, and 39% had a high school education or less. Of 101 enrolled children, 60% were black, and the mean age was 9.8 (standard deviation, 1.3) years. Children of parents with both low and high HL attended and were retained at similar rates. Likewise, parent HL status did not significantly influence improvements in effectiveness outcomes (eg, child body mass index [BMI] z scores, parent BMI, diet and physical activity behaviors, quality of life), with the exception of child video game/computer screen time; low HL decreased and high HL increased screen time (coefficient = 0.52, standard error, 0.11, P < .001).

Conclusion: By incorporating design features that attended to the HL needs of parents, children of parents with low HL engaged in and benefited from a family-based childhood obesity treatment program similar to children of parents with high HL.
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http://dx.doi.org/10.5888/pcd14.160421DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5621521PMC
September 2017
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