Estimating activity energy expenditure: how valid are physical activity questionnaires?

Activity energy expenditure (AEE) is the modifiable component of total energy expenditure (TEE) derived from all activities, both volitional and nonvolitional. Because AEE may affect health, there is interest in its estimation in free-living people. Physical activity questionnaires (PAQs) could be a feasible approach to AEE estimation in large populations, but it is unclear whether or not any PAQ is valid for this purpose. Our aim was to explore the validity of existing PAQs for estimating usual AEE in adults, using doubly labeled water (DLW) as a criterion measure. We reviewed 20 publications that described PAQ-to-DLW comparisons, summarized study design factors, and appraised criterion validity using mean differences (AEE(PAQ) - AEE(DLW), or TEE(PAQ) - TEE(DLW)), 95% limits of agreement, and correlation coefficients (AEE(PAQ) versus AEE(DLW) or TEE(PAQ) versus TEE(DLW)). Only 2 of 23 PAQs assessed most types of activity over the past year and indicated acceptable criterion validity, with mean differences (TEE(PAQ) - TEE(DLW)) of 10% and 2% and correlation coefficients of 0.62 and 0.63, respectively. At the group level, neither overreporting nor underreporting was more prevalent across studies. We speculate that, aside from reporting error, discrepancies between PAQ and DLW estimates may be partly attributable to 1) PAQs not including key activities related to AEE, 2) PAQs and DLW ascertaining different time periods, or 3) inaccurate assignment of metabolic equivalents to self-reported activities. Small sample sizes, use of correlation coefficients, and limited information on individual validity were problematic. Future research should address these issues to clarify the true validity of PAQs for estimating AEE.     

Low literacy Chinese patients: how are they affected and how do they cope with health matters? A qualitative study

Background  

Low literacy is common in Hong Kong and China, especially among the females and the elderly. These are often the patients with the greatest health care needs. However little is known about how low literacy affects the ability of patients to obtain adequate medical care and comply with the recommendations of health professionals.     

How do patients with cancer pain view community pharmacy services? An interview study

Pain experienced by many patients with advanced cancer is often not well controlled and community pharmacists are potentially well placed to provide support. The study objective was to explore the views and experiences of patients with advanced cancer about community pharmacies, their services and attitudes towards having a community pharmacist pain medicines consultation. Purposive sampling of GP clinical information systems was used to recruit patients with advanced cancer, living in the community and receiving opioid analgesics in one area of England, UK between January 2015 and July 2016. Thirteen patients had a semi‐structured interview which was audio‐recorded and transcribed verbatim. Data were analysed deductively and inductively using Framework analysis and incorporating new themes as they emerged. The framework comprised Pain management, Experiences and expectations, Access to care and Communication. All patients reported using one regular community pharmacy citing convenience, service and staff friendliness as influential factors. The idea of a community pharmacy medicines consultation was acceptable to most patients. The idea of telephone consultations was positively received but electronic media such as Skype was not feasible or acceptable for most. Patients perceived a hierarchy of health professionals with specialist palliative care nurses at the top (due to their combined knowledge of their condition and medicines) followed by GPs then pharmacists. Patients receiving specialist palliative care described pain that was better controlled than those who were not. They thought medicines consultations with a pharmacist could be useful for patients before referral for palliative care. There is a need for pain medicines support for patients with advanced cancer, and unmet need appears greater for those not under the care of specialist services. Medicines consultations, in principle, are acceptable to patients both in person and by telephone, and the latter was perceived to be of particular benefit to patients less able to leave the house.     

Anaphylaxis: how do you live with it?

This article reports on a study of the needs of families coping with life-threatening allergies in a child. Due to the scarcity of publications on the psychosocial dimensions of anaphylaxis, the authors draw on selected literature on family coping with chronic illness, asthma, and allergy to provide a conceptual context for the research and discussion of findings. Using qualitative methodology, parents from 17 families were interviewed about their experiences adjusting to a diagnosis of anaphylaxis in a child. From participants' responses about the nature and sources of information and support, parenting dilemmas, family activities, anxieties, challenges, and coping strategies, the authors identify patterns in the adaptive processes related to predictable developmental and episodic events that increase anxiety and support needs. Social work clinicians and other family-serving professionals can help families maintain an optimal balance between protective and debilitating anxiety. Potential interventions in community and health settings are suggested.     

The evolution of physical activity recommendations: how much is enough?

Physical inactivity is a major public health problem, and compelling evidence suggests that it is a contributing factor in several chronic diseases and conditions. Recognition of the health and functional hazards of a sedentary way of life has led numerous groups to promulgate public health recommendations for physical activity. In this report, we review the evolution of physical activity recommendations, discuss reasons for differences in the recommendations, and provide a summary recommendation in an attempt to harmonize existing differences. Current public health recommendations for physical activity are for 30 min of moderate-intensity activity each day, which provides substantial benefits across a broad range of health outcomes for sedentary adults. This dose of exercise may be insufficient to prevent unhealthful weight gain for some persons who may need additional exercise or caloric restriction to minimize the likelihood of further weight gain. Persons who get 30 min of moderate-intensity exercise per day are likely to achieve additional health benefits if they exercise more. In addition to aerobic exercise, people should engage in resistance training and flexibility exercises at least twice a week, which will promote the maintenance of lean body mass, improvements in muscular strength and endurance, and preservation of function, all of which enable long-term participation in regular physical activity and promote quality of life.     

Can a self-administered questionnaire identify workers with chronic or recurring low back pain?

To verify if the Nordic Musculoskeletal Questionnaire (NMQ), Visual Analogue Scale (VAS),Roland-Morris Disability Questionnaire (RDQ) and physical examination of the lumbar spinecan identify workers with chronic or recurring low back pain, using health history forreference. Fifty office workers of both sexes, aged between 19 and 55 yr, were evaluatedusing a standardized physical examination and the NMQ, VAS and RDQ. Discriminant analysiswas performed to determine the discriminant properties of these instruments. A highersuccess rate (94%) was observed in the model including only the NMQ and in the modelincluding the NMQ and the physical examination. The lowest success rate (82%) was observedin the model including the NMQ, RDQ and VAS. The NMQ was able to detect subjects withchronic or recurring low back pain with 100% sensitivity and 88% specificity. The NMQappears to be the best instrument for identifying subjects with chronic or recurring lowback pain. Thus, this self-reported questionnaire is suitable for screening workers forchronic or recurring low back pain in occupational settings.     

How are we doing with physical activity?

An estimated 60% of U.S. adults are inactive or underactive, and nearly half of America's youth (aged 12 to 21 years) are not vigorously active on a regular basis. Downstream interventions provide individual strategies that effectively increase short-term participation in physical activity by 10% to 25%. Downstream and midstream approaches tailored to individual preferences have greater success. Packaging and disseminating physical activity programs for community, worksite, and health care settings are not as far along as for other areas, although inactivity prevalence is about twice that of smoking, and both risk factors have substantial morbidity and mortality. Less is known about effectiveness of upstream approaches, which have potential for the greatest public health impact. Suggestions include continued promotion of moderate-intensity physical activity, greater dissemination of successful programs, and investigation of physical environment influences.     

Lowering cholesterol: how low is low enough?

The mean cholesterol level of the civilized modern humans is above the one considered "physiological", and a biological gradient exists between serum cholesterol level and cardiovascular events. Clinical studies on cholesterol lowering revealed that cardiovascular risk can be lowered in parallel along this gradient, and the "lower is better" rule appears to be supported by the current evidence. LDL cholesterol level should minimally be reduced on average by 50% to approach the "physiological" cholesterol concentration in order to halt the progression of atherosclerosis. Using the initial doses of hydroxymethylglutaryl coenzyme A reductase inhibitors (statins), the first-line lipid lowering drugs, this goal cannot be reached. On the other hand, high doses of statins increase the frequency of adverse events, which should contribute to the common failure of putting patients to their lipid targets in a real-world setting. Consequently, the combination of low dose statins and another cholesterol lowering agent with a mechanism of action different than synthesis inhibition (such as ezetimibe) may be the optimal clinical approach to avoid the dose-dependent adverse events. The ongoing large head-to-head clinical trials will clarify the efficacy and safety of cholesterol lowering combination therapy relative to statins in the reduction of cardiovascular risk.