Managing obesity through mobile phone applications: a state-of-the-art review from a user-centred design perspective

Evidence has shown that the trend of increasing obesity rates has continued in the last decade. Mobile phone applications, benefiting from their ubiquity, have been increasingly used to address this issue. In order to increase the applications’ acceptance and success, a design and development process that focuses on users, such as User-Centred Design, is necessary. This paper reviews reported studies that concern the design and development of mobile phone applications to prevent obesity, and analyses them from a User-Centred Design perspective. Based on the review results, strengths and weaknesses of the existing studies were identified. Identified strengths included: evidence of the inclusion of multidisciplinary skills and perspectives; user involvement in studies; and the adoption of iterative design practices. Weaknesses included the lack of specificity in the selection of end-users and inconsistent evaluation protocols. The review was concluded by outlining issues and research areas that need to be addressed in the future, including: greater understanding of the effectiveness of sharing data between peers; privacy; and guidelines for designing for behavioural change through mobile phone applications

Promotion of a healthy lifestyle among 5-year-old overweight children: Health behavior outcomes of the 'Be active, eat right' study

Background: This study evaluates the effects of an intervention performed by youth health care professionals on child health behaviors. The intervention consisted of offering healthy lifestyle counseling to parents of overweight (not obese) 5-year-old children. Effects of the intervention on the child having breakfast, drinking sweet beverages, watching television and playing outside were evaluated. Methods. Data were collected with the 'Be active, eat right' study, a cluster randomized controlled trial among nine youth health care centers in the Netherlands. Parents of overweight children received lifestyle counseling according to the intervention protocol in the intervention condition (n = 349) and usual care in the control condition (n = 288). Parents completed questionnaires regarding demographic characteristics, health behaviors and the home environment at baseline and at 2-year follow-up. Cluster adjusted regression models were applied; interaction terms were explored. Results: The population for analysis consisted of 38.1% boys; mean age 5.8 [sd 0.4] years; mean BMI SDS 1.9 [sd 0.4]. There were no significant differences in the number of minutes of outside play or television viewing a day between children in the intervention and the control condition. Also, the odds ratio for having breakfast daily or drinking two or less glasses of sweet beverages a day showed no significant differences between the two conditions. Additional analyses showed that the odds ratio for drinking less than two glasses of sweet beverages at follow-up compared with baseline was significantly higher for children in both the intervention (p < 0.001) and the control condition (p = 0.029). Conclusions: Comparison of the children in the two conditions showed that the intervention does not contribute to a change in health behaviors. Further studies are needed to investigate opportunities to adjust the intervention protocol, such as integration of elements in the regular well-child visit. The intervention protocol for youth health care may become part of a broader approach to tackle childhood overweight and obesity. Trial registration. Current Controlled Trials ISRCTN04965410

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

A census of baryons in the Universe from localized fast radio bursts

More than three quarters of the baryonic content of the Universe resides in a highly diffuse state that is difficult to observe, with only a small fraction directly observed in galaxies and galaxy clusters. Censuses of the nearby Universe have used absorption line spectroscopy to observe these invisible baryons, but these measurements rely on large and uncertain corrections and are insensitive to the majority of the volume, and likely mass. Specifically, quasar spectroscopy is sensitive either to only the very trace amounts of Hydrogen that exists in the atomic state, or highly ionized and enriched gas in denser regions near galaxies. Sunyaev-Zel'dovich analyses provide evidence of some of the gas in filamentary structures and studies of X-ray emission are most sensitive to gas near galaxy clusters. Here we report the direct measurement of the baryon content of the Universe using the dispersion of a sample of localized fast radio bursts (FRBs), thus utilizing an effect that measures the electron column density along each sight line and accounts for every ionised baryon. We augment the sample of published arcsecond-localized FRBs with a further four new localizations to host galaxies which have measured redshifts of 0.291, 0.118, 0.378 and 0.522, completing a sample sufficiently large to account for dispersion variations along the line of sight and in the host galaxy environment to derive a cosmic baryon density of $\Omega_{b} = 0.051_{-0.025}^{+0.021} \, h_{70}^{-1}$ (95% confidence). This independent measurement is consistent with Cosmic Microwave Background and Big Bang Nucleosynthesis values.Comment: Published online in Nature 27 May, 202

Quasar Sightline and Galaxy Evolution (QSAGE) - III. The mass-metallicity and fundamental metallicity relation of z ≈ 2.2 galaxies

We present analysis of the mass-metallicity relation (MZR) for a sample of 67 [O iii]-selected star-forming (SF) galaxies at a redshift range of z = 1.99-2.32 (zmed = 2.16) using Hubble Space Telescope Wide Field Camera 3 grism spectroscopy from the Quasar Sightline and Galaxy Evolution survey. Metallicities were determined using empirical gas-phase metallicity calibrations based on the strong emission lines [O ii]3727, 3729, [O iii]4959, 5007 and Hβ. SF galaxies were identified, and distinguished from active-galactic nuclei, via Mass-Excitation diagrams. Using z ∼0 metallicity calibrations, we observe a negative offset in the z = 2.2 MZR of ≈-0.51 dex in metallicity when compared to locally derived relationships, in agreement with previous literature analysis. A similar offset of ≈-0.46 dex in metallicity is found when using empirical metallicity calibrations that are suitable out to z ∼5, though our z = 2.2 MZR, in this case, has a shallower slope. We find agreement between our MZR and those predicted from various galaxy evolution models and simulations. Additionally, we explore the extended fundamental metallicity relation (FMR) which includes an additional dependence on star formation rate. Our results consistently support the existence of the FMR, as well as revealing an offset of 0.28 ± 0.04 dex in metallicity compared to locally derived relationships, consistent with previous studies at similar redshifts. We interpret the negative correlation with SFR at fixed mass, inferred from an FMR existing for our sample, as being caused by the efficient accretion of metal-poor gas fuelling SFR at cosmic noon

Being questioned and receiving advice about alcohol and smoking in health care: Associations with patients' characteristics, health behavior, and reported stage of change

<p>Abstract</p> <p>Background</p> <p>Alcohol habits are more rarely addressed than other health behavior topics in Swedish health care. This study examined whether differences between topics could be explained by their different associations with patient characteristics or by the differences in the prevalence of the disadvantageous health behavior, i.e., excessive alcohol use and smoking. The study moreover examined whether simply being asked questions about behavior, i.e., alcohol use or smoking, was associated with reported change.</p> <p>Methods</p> <p>The study was based on a cross-sectional postal survey (n = 4 238, response rate 56.5 percent) representative of the adult population in Stockholm County in 2003. Retrospective self-reports were used to assess health care visits during the past 12 months, the questions and advice received there, patients characteristics, health behavior, and the present stage of change. Logistic regression analysis was used to estimate the associations among the 68 percent who had visited health care.</p> <p>Results</p> <p>Among the health care visitors, 23 percent reported being asked about their alcohol habits, and 3 percent reported receiving advice or/and support to modify their alcohol use - fewer than for smoking, physical exercise, or diet. When regression models adjusted for patient characteristics, the differences between health behaviors in the extent of questioning and advice remained. However, when the models also adjusted for smoking and alcohol consumption there was no difference between smoking and alcohol-related advice. In fact one-third of the present smokers and two-fifths of the persons dependent on alcohol reported having receiving advice the previous 12 months. Those who reported being asked questions or receiving advice more often reported a decreased alcohol use and similarly intended to cease smoking within 6 months. Questions about alcohol use were moreover related to a later stage of stage of change independently of advice among women but not among men.</p> <p>Conclusions</p> <p>While most patients are never addressed, many in the target groups seem to be reached anyway. Besides advice, already addressing alcohol habits appears to be associated with change. The results also indicate that gender possibly plays a role in the relationship between advice and the stage of change.</p

Optimizing diffusion of an online computer tailored lifestyle program: a study protocol

ABSTRACT: Background Although the Internet is a promising medium to offer lifestyle interventions to large amounts of people at relatively low costs and effort, actual exposure rates of these interventions fail to meet the high expectations. Since public health impact of interventions is determined by intervention efficacy and level of exposure to the intervention, it is imperative to put effort in optimal dissemination. The present project attempts to optimize the dissemination process of a new online computer tailored generic lifestyle program by carefully studying the adoption process and developing a strategy to achieve sustained use of the program. Methods/Design A prospective study will be conducted to yield relevant information concerning the adoption process by studying the level of adoption of the program, determinants involved in adoption and characteristics of adopters and non-adopters as well as satisfied and unsatisfied users. Furthermore, a randomized control trial will be conducted to the test the effectiveness of a proactive strategy using periodic e-mail prompts in optimizing sustained use of the new program. Discussion Closely mapping the adoption process will gain insight in characteristics of adopters and non-adopters and satisfied and unsatisfied users. This insight can be used to further optimize the program by making it more suitable for a wider range of users, or to develop adjusted interventions to attract subgroups of users that are not reached or satisfied with the initial intervention. Furthermore, by studying the effect of a proactive strategy using period prompts compared to a reactive strategy to stimulate sustained use of the intervention and, possibly, behaviour change, specific recommendations on the use and the application of prompts in online lifestyle interventions can be developed. Trial registration Dutch Trial Register (NTR1786) and Medical Ethics Committee of Maastricht University and the University Hospital Maastricht (NL2723506809/MEC0903016)

Assessing hospitals' clinical risk management: Development of a monitoring instrument

<p>Abstract</p> <p>Background</p> <p>Clinical risk management (CRM) plays a crucial role in enabling hospitals to identify, contain, and manage risks related to patient safety. So far, no instruments are available to measure and monitor the level of implementation of CRM. Therefore, our objective was to develop an instrument for assessing CRM in hospitals.</p> <p>Methods</p> <p>The instrument was developed based on a literature review, which identified key elements of CRM. These elements were then discussed with a panel of patient safety experts. A theoretical model was used to describe the level to which CRM elements have been implemented within the organization. Interviews with CRM practitioners and a pilot evaluation were conducted to revise the instrument. The first nationwide application of the instrument (138 participating Swiss hospitals) was complemented by in-depth interviews with 25 CRM practitioners in selected hospitals, for validation purposes.</p> <p>Results</p> <p>The monitoring instrument consists of 28 main questions organized in three sections: 1) Implementation and organizational integration of CRM, 2) Strategic objectives and operational implementation of CRM at hospital level, and 3) Overview of CRM in different services. The instrument is available in four languages (English, German, French, and Italian). It allows hospitals to gather comprehensive and systematic data on their CRM practice and to identify areas for further improvement.</p> <p>Conclusions</p> <p>We have developed an instrument for assessing development stages of CRM in hospitals that should be feasible for a continuous monitoring of developments in this important area of patient safety.</p

Defining the effect and mediators of two knowledge translation strategies designed to alter knowledge, intent and clinical utilization of rehabilitation outcome measures: a study protocol [NCT00298727]

BACKGROUND: A substantial number of valid outcome measures have been developed to measure health in adult musculoskeletal and childhood disability. Regrettably, national initiatives have merely resulted in changes in attitude, while utilization remains unacceptably low. This study will compare the effectiveness and mediators of two different knowledge transfer (KT) interventions in terms of their impact on changing knowledge and behavior (utilization and clinical reasoning) related to health outcome measures. METHOD/DESIGN: Physical and occupational therapists (n = 144) will be recruited in partnership with the national professional associations to evaluate two different KT interventions with the same curriculum: 1) Stakeholder-Hosted Interactive Problem-Based Seminar (SHIPS), and 2) Online Problem-Based course (e-PBL). SHIPS will consist of face-to-face problem-based learning (PBL) for 2 1/2 days with outcome measure developers as facilitators, using six problems generated in consultation with participants. The e-PBL will consist of a 6-week web-based course with six generic problems developed by content experts. SHIPS will be conducted in three urban centers in Canada. Participants will be block-allocated by a minimization procedure to either of the two interventions to minimize any prognostic differences. Trained evaluators at each site will conduct chart audits and chart-stimulated recall. Trained interviewers will conduct semi-structured interviews focused on identifying critical elements in KT and implementing practice changes. Interviews will be transcribed verbatim. Baseline predictors including demographics, knowledge, attitudes/barriers regarding outcome measures, and Readiness to Change will be assessed by self-report. Immediately post-intervention and 6 months later, these will be re-administered. Primary qualitative and quantitative evaluations will be conducted 6-months post-intervention to assess the relative effectiveness of KT interventions and to identify elements that contribute to changing clinical behavior. Chart audits will determine the utilization of outcome measures (counts). Incorporation of outcome measures into clinical reasoning will be assessed using an innovative technique: chart-stimulated recall. DISCUSSION: A strategy for optimal transfer of health outcome measures into practice will be developed and shared with multiple disciplines involved in primary and specialty management of musculoskeletal and childhood disability