Peer coaching through mHealth targeting physical activity in people with Parkinson disease: feasibility study

BACKGROUND: Long-term engagement in exercise and physical activity mitigates the progression of disability and increases quality of life in people with Parkinson disease (PD). Despite this, the vast majority of individuals with PD are sedentary. There is a critical need for a feasible, safe, acceptable, and effective method to assist those with PD to engage in active lifestyles. Peer coaching through mobile health (mHealth) may be a viable approach. OBJECTIVE: The purpose of this study was to develop a PD-specific peer coach training program and a remote peer-mentored walking program using mHealth technology with the goal of increasing physical activity in persons with PD. We set out to examine the feasibility, safety, and acceptability of the programs along with preliminary evidence of individual-level changes in walking activity, self-efficacy, and disability in the peer mentees. METHODS: A peer coach training program and a remote peer-mentored walking program using mHealth was developed and tested in 10 individuals with PD. We matched physically active persons with PD (peer coaches) with sedentary persons with PD (peer mentees), resulting in 5 dyads. Using both Web-based and in-person delivery methods, we trained the peer coaches in basic knowledge of PD, exercise, active listening, and motivational interviewing. Peer coaches and mentees wore FitBit Zip activity trackers and participated in daily walking over 8 weeks. Peer dyads interacted daily via the FitBit friends mobile app and weekly via telephone calls. Feasibility was determined by examining recruitment, participation, and retention rates. Safety was assessed by monitoring adverse events during the study period. Acceptability was assessed via satisfaction surveys. Individual-level changes in physical activity were examined relative to clinically important differences. RESULTS: Four out of the 5 peer pairs used the FitBit activity tracker and friends function without difficulty. A total of 4 of the 5 pairs completed the 8 weekly phone conversations. There were no adverse events over the course of the study. All peer coaches were "satisfied" or "very satisfied" with the training program, and all participants were "satisfied" or "very satisfied" with the peer-mentored walking program. All participants would recommend this program to others with PD. Increases in average steps per day exceeding the clinically important difference occurred in 4 out of the 5 mentees. CONCLUSIONS: Remote peer coaching using mHealth is feasible, safe, and acceptable for persons with PD. Peer coaching using mHealth technology may be a viable method to increase physical activity in individuals with PD. Larger controlled trials are necessary to examine the effectiveness of this approach.This study is supported by Boston Roybal Center for Active Lifestyle Interventions (RALI Boston), Grant #P30 AG048785, and the American Parkinson Disease Association, Massachusetts chapter. The authors would like to thank Nicole Sullivan, SOT, for her assistance with data management and data collection and Nick Wendel, DPT, for his assistance with data collection. Additionally, the authors would like to thank the participants in this study for their time, effort, and insights. (P30 AG048785 - Boston Roybal Center for Active Lifestyle Interventions (RALI Boston); American Parkinson Disease Association, Massachusetts chapter)Accepted manuscrip

Il ruolo delle banche locali e del relationship lending in scenari economici in profondo cambiamento

Lo scopo di questo lavoro \ue8 quello di esaminare la relazione tra banca locale e impresa in un contesto economico in profondo cambiamento. L\u2019obiettivo \ue8 comprendere se e come l\u2019orientamento all\u2019attivit\ue0 di finanziamento delle banche locali (pi\uf9 radicate nel territorio e pi\uf9 vicine ai principi del relationship lending) sia cambiato in seguito allo scoppio della crisi finanziaria

The role of attitude, control and intention to explain fruit and vegetable intake among racial/ethnic minority women with low socioeconomic status

OBJECTIVE: Fruit and Vegetable (FV) intake-a modi able risk factor for chronic diseases-is lower among racial/ethnic minorities and low Socio- Economic Status (SES) groups when compared to other populations. The Theory of Planned Behavior (TPB) is one theoretical model studied to explain and in uence individual health behaviors, including FV intake, in middle class populations, but not exclusively in diverse, low SES groups. This cross-sectional study evaluated the utility of select TPB variables to explain intention to consume and intake of FV in this population. DESIGN: Demographics, BMI, select TPB variables, and FV intake were measured via survey. Bivariate analyses were conducted to explore relationships between variables. Hierarchical regression analyses were used to t two models: one to explain intention and one to explain behavior with regard to FV vegetable intake. RESULTS: Participants (n=114) age 25-69 years and were mostly African American/Black and Hispanic (21.9% and 73%, respectively). The TPB variable perceived behavioral control was the only signi cant predictor of intention to consume FV (OR=2.55, 95% CI OR: 1.23, 5.27), and with BMI, FV intake (R2=0.08; F [2,130] =5.72, p=0.0042). CONCLUSION: Perceived behavioral control and BMI are the most signi cant predictors of FV intake but explain only 8% of the variability in intake in our cohort. Our results support prior research which suggests an attenuation of the intention-behavior relationship by SES, and may question the utility of the TPB as it is currently operationalized as a foundational model for future health behavior change research and programs in low SES racial/ethnic minorities

Pilot and feasibility test of an implementation intention intervention to improve fruit and vegetable intake among women with low socioeconomic status

Fruit and vegetable intake (FVI), a modifiable risk factor for chronic diseases, is lower in low socioeconomic status (SES) populations. Implementation intentions (a specific type of planning that extends the Theory of Planned Behavior) has been studied to improve FVI, but not exclusively with low SES groups. Using mixed methods, we evaluated the feasibility, acceptability, and preliminary efficacy of an implementation intention intervention (versus a general plan) to increase FVI in women with low SES. For the pilot randomized controlled trial, demographics, body mass index, attitude, perceived behavioral control, goal intention strength, and FVI were measured at baseline and FVI again 1-month following the intervention. Feasibility data were collected for recruitment, randomization, retention, and assessment procedures and compared to predetermined targets. Semi-structured interview data was analyzed for emergent themes regarding acceptability of the trial. Preliminary efficacy of the intervention to improve FVI was analyzed descriptively. Feasibility targets were met for randomization (100% vs. ≥80% target), retention (93.5% vs. ≥70% target) and the assessment metrics missing data points (2% vs. ≤10% target) and days from intervention to follow up (mean=69.2, sd=42.6 vs.days). Targets for recruitment were not met with the exception of participants giving informed consent (100% vs. ≥70% target). Participants described the intervention as enjoyable and reported behavioral constructs outside of those measured as important to improve FVI. Limited efficacy analysis suggested that both groups increased their FVI (experimental: +0.17 servings per day, 95% CI: -0.85, 1.20; control: +0.50 servings per day, 95% CI: -0.56, 1.58). Further research which examines interventions based upon behavior change models to improve dietary health behaviors in marginalized groups is needed

Perturbation theory and the two-level approximation:A corollary and critique

This analysis addresses the use of a two-level approximation to simplify expressions derived from perturbation theory. It is shown that the limitations of validity for the emergent results are more stringent than is commonly understood, being equivalent in effect to the adoption of a more extensive approximation - one that significantly undermines the perturbative origin of those expressions. Effectively truncating the completeness relation, a series of interconnected operator relations comes into play, some with physically untenable consequences. A new theorem on the expectation values of operator functions highlights additional constraints upon any molecule modelled as a two-level system. © 2010 Elsevier B.V. All rights reserved