ABSTRACT
Background: Evidenced-based pediatric obesity treatment requires frequent, in-person visits at specialized clinics. This intervention delivery modality is marked by high attrition, with up to 50% of youth who prematurely drop-out. Mobile health (mHealth) interventions may provide a promising alternative to in-person care in addressing some of the barriers interfering with treatment adherence and engagement. This randomized clinical trial tests the effectiveness of an app-based weight-loss intervention, with and without coaching, among adolescents with obesity. Method(s): Adolescents (n=161;63% completion rate, body mass index >=95th percentile, mean age 16 +/- 2.5 years;47% Hispanic, 65% female, 57% annual household income <=$50,000, 59% publicly insured) were recruited from four clinical centers in Los Angeles County and randomized to: (1) app (AppAlone: Total hours: app = 11, in-person = 3, coach = 4), (2) app intervention + coaching (AppCoach: Total hours: app = 11, in-person = 3, coach = 4) or (3) inperson, monthly, multidisciplinary intervention (Control: in-person = 18) for a 24-week period. The primary outcome was change in the BMI as a percentage of the 95th percentile (%BMIp95) from baseline to post-intervention. Mixed-effects linear regression model was used to assess the association between change in %BMIp95 and demographic data, mood, and eating behaviors. Result(s): Participants across all groups showed a decrease in %BMIp95 at week 12 (% change: -0.78, 95th%CI: -1.31 to -0.24, p=0.004) and 24 (% BMIp95 change -1.29, 95th%CI: -1.82 to -0.76, p<0.0001) compared to baseline, with no significant difference between group (p=0.3). Girls had a greater decrease in %BMIp95 than boys (% BMIp95 change females compared to males: -10.39, 95th%CI: -16.54 to -3.80, p=0.002). At baseline, a higher perceived stress scores (% BMIp95 change: 4.1, 95th%CI: 0.45 to 7.81, p=0.03) and binge eating behaviors (% BMIp95 change: 3.3, 95th%CI: 1.4 to 5.2, p=0.001) were associated with an increase in %BMIp95 over the intervention period. There was no association between ethnicity, mood, and timing of intervention in relation to the COVID-19 pandemic with change in %BMIp95. Conclusion(s): Our results demonstrate the potential of a mHealth app alone or with a coach as a comparable, alternative approach to an inperson, multidisciplinary treatment in adolescents with obesity.
ABSTRACT
Importance: The benefit of routine screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in patients with cancer before cancer-directed therapies is unclear. Herein, we characterize the outcomes of a cohort of cancer patients diagnosed with Coronavirus Disease 2019 (COVID-19) by routine screening in comparison with those diagnosed based on clinical suspicion or exposure history (non-routine screening). Objective: To describe and compare the outcomes of cancer patients diagnosed with COVID-19 on routine screening vs. non-routine screening at a multi-site tertiary cancer center. To identify risk factors for COVID-19-related hospital admission. Design: A multi-site prospective observational study was conducted between March 18 and July 31, 2020. Setting: Three major and 5 satellite campuses of the Mayo Clinic Cancer Center. Participants: Adult patients diagnosed with active cancer within the past five years and confirmed SARS-CoV-2 infection were included. Primary Outcomes and Measures: Clinical and laboratory data were assessed as independent variables. The primary outcome was COVID-19- related hospital admission. Secondary outcomes included intensive care unit (ICU) admissions and all-cause mortality. Results: Between March 18 and July 31, 2020, 5452 patients underwent routine screening in the outpatient setting, 44 (0.81%) were diagnosed with COVID-19. Routine screening detected additional 19 patients from inpatient and pre-procedural settings;161 patients were diagnosed with COVID-19 based on non-routine screening. The median age of the entire cohort at diagnosis was 54 years, and 95 patients (42.2%) were female. COVID-19 related- hospitalization rate (17.5% vs. 26.7%, p=0.14), ICU admission (1.6% vs. 5.6%, p=0.19), and mortality (4.8% vs. 3.7%, p=0.72) were not significantly different between routine screening and non-routine screening groups. In the multivariable analysis, age ≥ 60 years (odds ratio: 4.4, p=0.023) and an absolute lymphocyte count ≤1.4 × 109 /L (odds ratio: 9.2, p=0.002) were independent predictors of COVID-19-related hospital admission. Conclusions and Relevance: The COVID-19 positivity rate was low based on routine screening. Comparing the outcome with the non-routine screening cohort, there was no significant difference. These results led to an important practice change at our cancer center. We currently follow a testing strategy based on symptoms, exposure, risk factors, and clinical judgment.
ABSTRACT
Objectives: Cardiac rehabilitation (CR) exercise classes in Singapore were either cancelled or suspended due to the ongoing COVID-19 pandemic. In response, a hybrid CR programme utilising telehealth was created to reduce reliance on in-person sessions. Our study aimed to assess early patients' impressions of this novel CR delivery method. Methods: Each hybrid CR programme comprises: (a) one CR orientation session via the Zoom video conferencing platform where patients interact with CR nurses and physiotherapists, (b) two 6-minute walk test fitness assessments (at baseline and upon completion), (c) five in-person supervised exercise classes and (d) two teleconsultation sessions (scheduled after exercise sessions 2 and 4) where CR physiotherapists review symptoms and discuss exercise prescriptions with patients over the phone. Upon programme completion, patients filled 2 anonymous online questionnaires - one assessing the videoconferencing component and another assessing the teleconsultation component and overall programme. Results: Seven patients underwent the hybrid CR programme. The majority were male (n=6, 86%), aged between 51 to 65 years (n=4, 57%) and had previously used a wide range of mobile applications (n=6, 86%). 100% of patients either agreed or strongly agreed that both videoconferencing and teleconsultation were: (a) easy to use, (b) as valuable as in-person sessions, (c) saved time and (d) had lower infection risk compared to in-person sessions (Figure). The overall ratings for videoconferencing, teleconsultation and the hybrid programme were 9.3, 9.6 and 9.6 (out of 10) respectively. All patients would definitely recommend the programme to others. Conclusion: Responses by participants of a novel hybrid CR programme utilising telehealth are highly encouraging. From a patient perspective, incorporation of telehealth to enable remote CR is feasible, acceptable and should be considered as an alternative CR delivery method.