A 12-week commercial web-based weight-loss program for overweight and obese adults: randomized controlled trial comparing basic versus enhanced features

Background

The development and use of Web-based programs for weight loss is increasing rapidly, yet they have rarely been evaluated using randomized controlled trials (RCTs). Interestingly, most people who attempt weight loss use commercially available programs, yet it is very uncommon for commercial programs to be evaluated independently or rigorously.

Objective

To compare the efficacy of a standard commercial Web-based weight-loss program (basic) versus an enhanced version of this Web program that provided additional personalized e-feedback and contact from the provider (enhanced) versus a wait-list control group (control) on weight outcomes in overweight and obese adults.

Methods

This purely Web-based trial using a closed online user group was an assessor-blinded RCT with participants randomly allocated to the basic or enhanced 12-week Web-based program, based on social cognitive theory, or the control, with body mass index (BMI) as the primary outcome.

Results

We enrolled 309 adults (129/309, 41.8% male, BMI mean 32.3, SD 4 kg/m²) with 84.1% (260/309) retention at 12 weeks. Intention-to-treat analysis showed that both intervention groups reduced their BMI compared with the controls (basic: –0.72, SD 1.1 kg/m², enhanced: –1.0, SD 1.4, control: 0.15, SD 0.82; P < .001) and lost significant weight (basic: –2.1, SD 3.3 kg, enhanced: –3.0, SD 4.1, control: 0.4, SD 2.3; P < .001) with changes in waist circumference (basic: –2.0, SD 3.5 cm, enhanced: –3.2, SD 4.7, control: 0.5, SD 3.0; P < .001) and waist-to-height ratio (basic: –0.01, SD 0.02, enhanced: –0.02, SD 0.03, control: 0.0, SD 0.02; P < .001), but no differences were observed between the basic and enhanced groups. The addition of personalized e-feedback and contact provided limited additional benefits compared with the basic program.

Conclusions

A commercial Web-based weight-loss program can be efficacious across a range of weight-related outcomes and lifestyle behaviors and achieve clinically important weight loss. Although the provision of additional personalized feedback did not facilitate greater weight loss after 12 weeks, the impact of superior participant retention on longer-term outcomes requires further study. Further research is required to determine the optimal mix of program features that lead to the biggest treatment impact over time.

Trial Registration

Australian New Zealand Clinical Trials Registry (ANZCTR): 12610000197033; http://www.anzctr.org.au/trial_view.aspx?id=335159 (Archived by WebCite at http://www.webcitation.org/66Wq0Yb7U)     

A novel, self-guided, home-based intervention to promote condom use among young men: a pilot study

Background

Current HIV prevention programs are often expensive to implement and require significant commitment on the part of participants and staff. These factors limit widespread implementation. Thus, there is an increasingly recognized need to develop and test brief interventions designed to promote safer sex.

Methods

This study tested the potential efficacy of a brief, self-guided, home-based intervention to promote consistent and correct condom use among young men by focusing on condom use skill, enjoyment, and self-efficacy. The central focus of The Kinsey Institute^®Homework Intervention Strategy (KIHIS) is that men practice applying, using, and removing condoms alone (a “low pressure” situation) trying various condoms and lubricants. A repeated measures evaluation compared 2-week, 6-week (n = 28) and 4-month (n = 17) follow-up evaluations to baseline (pre-intervention).

Results

Despite the limited sample size, significant post-intervention improvement was found for condom use experiences, confidence in the ability to use condoms, self-efficacy for condom use, and condom comfort as well as a reduction in breakage and erection problems.

Conclusion

Our findings suggest that the KIHIS, with its inherent potential for easy translation to public health sexually transmitted infection (STI) clinics (requiring very little clinic resources), may have lasting and positive effects on subsequent condom use attitudes, skills, and behaviors.     

清洁手术预防性应用抗菌药物干预效果分析

目的评价陕西省汉中市中心医院清洁手术切口抗菌药物使用现状,通过干预措施促进抗菌药物在外科围术期的合理应用。方法以本院308例在骨科、普外科、神经外科和胸外科实施的清洁手术病例为研究对象,随机分为对照组(124例)和干预组(184例),对照组根据以往的临床经验用药,干预组根据《抗菌药物临床应用指导原则》中的相关规定用药。观察两组患者在围术期的用药情况,并进行比较。结果我院在围术期的清洁手术患者抗菌药物的应用方面存在不合理现象,经干预后,术前对照组用药率为30.65%,干预组为68.48%;术后药物联用对照组为38.71%,干预组为27.72%,差异有统计学意义(P<0.01)。结论由于抗菌药物的不合理应用现象持续时间较长,导致管理工作的难度较大,在教育和管理方面需加强,并广泛宣传,取得患者及其家属的理解和支持,最终达到抗菌药物合理应用的目的。     

阴道超声引导下注射氨甲蝶呤治疗输卵管妊娠22例临床分析

目的探讨阴道超声介入治疗输卵管妊娠的适应证及治疗效果。方法阴道超声引导下,以COOK穿刺针抽吸输卵管内妊娠物,并注入氨甲蝶呤50mg／kg,监测血HCG—p值及附件区包块变化情况。结果22例输卵管妊娠患者经此治疗成功2l例,失败1例。结论阴道超声介入治疗输卵管妊娠是一种有效治疗方法,扩大了输卵管妊娠保守治疗的适应证,保留了女性的生育功能。     

糖调节受损对冠状动脉介入治疗患者预后的影响

目的研究冠心病(包括不稳定性心绞痛、稳定性心绞痛、急性ST段抬高型心肌梗死、急性非ST段抬高型心肌梗死患者)合并糖调节受损及糖尿病患者,在行冠状动脉介入(PCI)治疗后6个月发生的心血管事件。方法将2008年9月—2010年9月行PCI治疗的患者206例,随机分成4组,糖尿病组(A组)70例、空腹血糖受损组(B组)36例、糖耐量减低组(C组)35例、非糖调节受损组或正常血糖组(D组)65例。对4组冠状动脉造影结果进行比较;部分患者复查冠状动脉造影等,对近期预后进行评估。结果冠状动脉造影结果比较,A、B、C组冠状动脉三支病变、左主干病变、C型病变均多于D组(P<0.05);心功能方面,6个月时心脏超声测EF值,结果示:A、B、C、D组之间比较无差异(P>0.05)。对有心绞痛症状的患者进行运动试验初步筛选,A、B、C组运动试验结果阳性发生率与D组比较有差异(P<0.05),而A、B、C组之间比较无差异(P>0.05)。4组患者中对运动试验阳性的患者复查冠状动脉造影,A、B、C组支架内再狭窄发生率高于D组(P<0.05);A、B、C组新出现其他血管病变的发生率高于D组(P<0.05)。A、B、C组HbA_(1c)高于D组,差异有统计学意义(P<0.05)。结论糖调节受损与2型糖尿病有类似血管损害,早期发现血糖异常、尽早干预血糖对PCI患者预后非常重要。     

经桡动脉途径行冠状动脉介入诊疗72例临床对照研究

目的:探讨经桡动脉途径进行冠心病诊断和治疗的临床效果,提高冠心病介入治疗效率。方法:回顾性分析经桡动脉途径进行诊断和治疗的72例冠心病患者的临床资料,并以同期采用经股动脉途径进行介入治疗的72例冠心病患者为对照组,比较两组患者治疗效果、住院时间、并发症发生率、治疗费用。结果:两组患者治疗成功率比较,差异无统计学意义(P>0.05),观察组患者并发症发生率,住院时间和住院费用低于对照组,组间比较,差异有统计学意义(P<0.05)。结论:经桡动脉途径诊断治疗冠心病疗效确切,并发症发生率低,患者术后住院时间短,可有效降低治疗费用,值得临床推广。     

产后抑郁干预效果分析

目的:可以对产妇实施针对产后抑郁的干预措施并对效果进行分析。方法:选取400名符合条件的产妇,随机分为干预组和对照组各200人。对照组接受常规产后护理,干预组产妇在此基础上还接受产后行为健康教育,其内容包括产后抑郁危险因素或行为的识别以及社会支持、自我效能和管理的强化。利用爱丁堡产后抑郁量表,在随机分组前、分娩后3周、3个月和6个月分别对产妇进行评估。结果:干预组产后抑郁发生率明显低于对照组,产后3次调查结果分别为:8.6%vs16.3%,8.2%vs15.7%,8.8%vs16.1%(P<0.05)。多因素Logistic回归分析显示,行为健康教育能降低产妇产后抑郁发生的危险性,产后3周、3个月和6个月的OR值分别为:0.35、0.44、0.52。结论:行为健康教育能有效降低产妇产后抑郁的发生。     

手术室护理中人性化护理应用效果观察

目的:探讨手术室护理中提供人性化护理的应用效果,寻求增加患者满意度,加强医院竞争力的途径.方法:选取2010年1月至2011年6月在我院278名择期手术患者随机分为对照组和试验组,每组各139人,对照组实行常规的护理,实验组在术前、术中、术后实施一系列的人性化护理.结果:试验组在经过人性化护理干预后其焦虑水平较对照组低(P＜0.05),对护理工作的满意度较对照组高(P＜0.05).结论:对手术病人实行人性化护理有助于降低患者焦虑水平,提高对手术成功的信心,提高患者对护理工作的满意程度.     

Factors Related to the Improvement of Quality of Life at 6 Months after Discharge for Myocardial Infarction Patients Treated with Percutaneous Coronary Intervention

Objective: The purpose of this study was to evaluate the relationship between improvement of health-related quality of life (QOL) and participation in self-care activities and coronary risk factor management at 6 months after discharge for acute myocardial infarction (AMI) patients treated with percutaneous coronary intervention (PCI).Methods: A total of 118 patients were asked to complete the MOS 36-Item Short-Form Health Survey (SF-36) questionnaire at discharge and 6 months after discharge. The SF-36 consists of eight subscales: Physical Functioning (PF), Role Physical (RP), Bodily Pain (BP), General Health Perception (GH), Vitality (VT), Social Functioning (SF), Role Emotional (RE) and Mental Health (MH). We examined self-care activities and coronary risk factor management and related factors from SF-36 scores to measure quality of life (QOL) at discharge and 6 months after discharge.Results: The PF and BP scores at 6 months after discharge were significantly higher than those at discharge. Increasing PF and BP scores indicated improvement in ability to perform physical activities and absence of intense bodily pain that would interfere with activities of daily living or work. Improvement of PF in AMI patients treated with PCI was related to performing exercise after discharge and absence of diabetes mellitus. However, there were no related factors for BP.Conclusion: Our results indicated that exercise, as a self-care activity after discharge, for AMI patients treated with PCI may be related to the improvement of QOL.