"Talking Takes Off": A System-wide Approach to Prioritize Children's Speech, Language, and Communication Needs.

BACKGROUND: "Talking Takes Off" is a local government program designed to improve speech, language and communication (SLC) outcomes in the early years, as supported by a system-wide approach. The overall aims of this study were to assess the progress that the program made in its first year, especially in relation to its integration with the wider practice and its impact on the various stakeholders. OBJECTIVES: To investigate whether the training and resources offered to the workforce were effectively integrated into practice during its first year. To explore professionals' and parents' views and experiences of the program regarding their prioritization, knowledge and skills concerning SLC needs. METHODS: A mixed methods design was used. A pre and post training survey was sent out to the workforce (n = 398), followed by a 3-month follow-up survey (n = 54). Semistructured interviews with strategic and political leaders (n = 4), early years practitioners (n = 8), and parents (n = 6) were conducted and analysed using Thematic and Framework analysis. FINDINGS: A prioritization of SLC development was demonstrated, as were enhanced levels of confidence and skills regarding the identification and support of needs. CONCLUSIONS: The findings are promising and suggest that Talking Takes Off has started to make a positive impact on parents' and professionals' priorities, knowledge and skills. Moving forward, Talking Takes Off need to sustain a strong foundation for continuing to implement their system-wide approach, addressing SLC needs across their capture area.

Identification of Complex Health Interventions Suitable for Evaluation: Development and Validation of the 8-Step Scoping Framework.

BACKGROUND: There is extensive literature on the methodology of evaluation research and the development and evaluation of complex interventions but little guidance on the formative stages before evaluation and how to work with partner organizations that wish to have their provision evaluated. It is important to be able to identify suitable projects for evaluation from a range of provision and describe the steps required, often with academic institutions working in partnership with external organizations, in order to set up an evaluation. However, research evaluating programs or interventions rarely discusses these stages. OBJECTIVE: This study aimed to extend work on evaluability assessment and pre-evaluation planning by proposing an 8-Step Scoping Framework to enable the appraisal of multiple programs in order to identify interventions suitable for evaluation. We aimed to add to the literature on evaluability assessment and more recent evaluation guidance by describing the processes involved in working with partner organizations. METHODS: This paper documents the steps required to identify multiple complex interventions suitable for process and outcome evaluation. The steps were developed using an iterative approach by working alongside staff in a local government organization, to build an evidence base to demonstrate which interventions improve children's outcomes. The process of identifying suitable programs for evaluation, thereby establishing the pre-evaluation steps, was tested using all Flying Start provision. RESULTS: The 8-Step Scoping Framework was described using the example of the local government organization Flying Start to illustrate how each step contributes to finding projects suitable for process and outcome evaluation: (1) formulating overarching key questions that encompass all programs offered by an organization, (2) gaining an in-depth understanding of the work and provision of an organization and engaging staff, (3) completing a data template per project/program offered, (4) assessing the robustness/validity of data across all programs, (5) deciding on projects suitable for evaluation and those requiring additional data, (6) negotiating with chosen project leads, both within and outside the organization, (7) developing individual project evaluation protocols, and (8) applying for ethical approval from the university and partner organization. CONCLUSIONS: This paper describes the processes involved in identifying suitable projects for evaluation. It adds to the existing literature on the assessment of specific programs suitable for evaluation and guidance for conducting evaluations by establishing the formative steps required to identify suitable programs from a range of provision. This scoping framework particularly relates to academic partners and organizations tasked with delivering evidence-based services designed to meet local needs. The steps identified have been described in the context of early years provision but can be applied to a range of community-based evaluations, or more generally, to cases where an academic partner is working with external stakeholders to identify projects suitable for academic evaluation.

Quasi-causal associations of physical activity and neighborhood walkability with body mass index: a twin study.

OBJECTIVE: Physical activity, neighborhood walkability, and body mass index (BMI, kg/m(2)) associations were tested using quasi-experimental twin methods. We hypothesized that physical activity and walkability were independently associated with BMI within twin pairs, controlling for genetic and environmental background shared between them. METHODS: Data were from 6376 (64% female; 58% identical) same-sex pairs, University of Washington Twin Registry, 2008-2013. Neighborhood walking, moderate-to-vigorous physical activity (MVPA), and BMI were self-reported. Residential address was used to calculate walkability. Phenotypic (non-genetically informed) and biometric (genetically informed) regression was employed, controlling for age, sex, and race. RESULTS: Walking and MVPA were associated with BMI in phenotypic analyses; associations were attenuated but significant in biometric analyses (Ps<0.05). Walkability was not associated with BMI, however, was associated with walking (but not MVPA) in both phenotypic and biometric analyses (Ps<0.05), with no attenuation accounting for shared genetic and environmental background. CONCLUSIONS: The association between activity and BMI is largely due to shared genetic and environmental factors, but a significant causal relationship remains accounting for shared background. Although walkability is not associated with BMI, it is associated with neighborhood walking (but not MVPA) accounting for shared background, suggesting a causal relationship between them.

Recent physical activity in relation to DNA damage and repair using the comet assay.

BACKGROUND: Limited evidence suggests that very high-intensity exercise is positively associated with DNA damage but moderate exercise may be associated with DNA repair. METHODS: Participants were 220 healthy, Washington State 50- to 76-year-olds in the validity/biomarker substudy of the VITamins And Lifestyle (VITAL) cohort, who provided blood samples and completed questionnaires assessing recent physical activity and demographic and health factors. Measures included nested activity subsets: total activity, moderate- plus high-intensity activity, and high-intensity activity. DNA damage (n = 122) and repair (n = 99) were measured using the comet assay. Multivariate linear regression was used to estimate regression coefficients and associated 95% confidence intervals (CIs) for relationships between MET-hours per week of activity and each DNA outcome (damage, and 15- and 60-minute repair capacities). RESULTS: DNA damage was not associated with any measure of activity. However, 60-minute DNA repair was positively associated with both total activity (ß = 0.21, 95% CI: 0.0057-0.412; P = .044) and high-intensity activity (ß = 0.31, 95% CI: 0.20-0.60; P = .036), adjusting for age, sex, BMI, and current multivitamin use. CONCLUSIONS: This study is the first to assess broad ranges of activity intensity levels related to DNA damage and repair. Physical activity was unrelated to DNA damage but was associated with increased repair.

Increases in physical activity may affect quality of life differently in men and women: the PACE project.

PURPOSE: Obesity is associated with impaired quality of life (QoL), but less is known about physical activity. We investigated how decreases in body mass index (BMI) and increases in activity affect obesity-specific QoL and potential gender differences in associations. METHODS: In a large worksite randomized trial of a multilevel intervention on diet and physical activity behaviors, we conducted a cohort analysis at two years of follow-up. Self-reported activity and Obesity and Weight Loss Quality of Life (OWLQOL) were analyzed for individual-level associations using linear mixed models accounting for random worksite effects. RESULTS: Gender modified the BMI-OWLQOL relationship, so analyses were conducted for males and females separately. Adjusting for demographic confounders, baseline OWLQOL, and several worksite-level variables including intervention arm, a 1.9 unit decrease in BMI (the interquartile range) was associated with an OWLQOL increase of 1.7 (95 % CI: 1.2, 2.2) in males and 3.6 (95 % CI: 3.2, 4.0) in females. Similarly, a 23 unit increase in physical activity score was associated with an OWLQOL increase of 0.9 (95 % CI: 0.5, 1.4) in males and 1.6 (95 % CI: 1.0, 2.3) in females. Physical activity associations were attenuated when adjusting for change in BMI, but remained significant for women (mean BMI 27.8 kg/m(2)). CONCLUSIONS: This is the first study to demonstrate that increasing physical activity may improve obesity-specific QoL to a greater extent in women, particularly among overweight women, independent of BMI. Results may inform the design of interventions tailored to women targeting well-being through messages of increasing physical activity.

Recreational physical activity and risk of papillary thyroid cancer among women in the California Teachers Study.

PURPOSE: Little is known about the relationship between physical activity and thyroid cancer risk, and few cohort data on this association exist. Thus, the present study aimed to prospectively examine long-term activity and risk of papillary thyroid cancer among women. METHODS: 116,939 women in the California Teachers Study, aged 22-79 years with no history of thyroid cancer at cohort entry, were followed from 1995-1996 through 2009; 275 were diagnosed with invasive papillary thyroid cancer. Cox proportional-hazards regression provided relative risk (RR) estimates and 95% confidence intervals (CI) for associations between thyroid cancer and combined strenuous and moderate recreational physical activity both in the long-term (high school through age 54 years or current age if younger than 54 years) and recently (during the three years prior to joining the cohort). RESULTS: Overall, women whose long-term recreational physical activity averaged at least 5.5 MET-hours/week (i.e. were active) had a non-significant 23% lower risk of papillary thyroid cancer than inactive women (RR = 0.77, 95% CI: 0.57, 1.04). RR estimates were stronger among normal weight or underweight women (body mass index, BMI<25.0 kg/m(2), trend p = 0.03) than among overweight or obese women (trend p = 0.35; homogeneity-of-trends p = 0.03). A similar pattern of risk was observed for recent activity (BMI<25 kg/m(2), trend p = 0.11; BMI≥25 kg/m(2), trend p = 0.16; homogeneity-of-trends p = 0.04). Associations for long-term activity did not appear to be driven by activity in any particular life period (e.g. youth, adulthood). CONCLUSIONS: Long-term physical activity may reduce papillary thyroid cancer risk among normal weight and underweight women.

Dietary and physical activity behaviours related to obesity-specific quality of life and work productivity: baseline results from a worksite trial.

Obesity is associated with impaired health-related quality of life (QOL) and reduced productivity; less is known about the effect of dietary factors. The present study investigated how dietary behaviours, physical activity and BMI relate to weight-specific QOL and work productivity. The study was conducted in thirty-one small blue-collar and service industry worksites in Seattle. Participants were 747 employees (33·5 % non-White). Measures included self-reported servings of fruits and vegetables, dietary behaviours such as fast food consumption, Godin free-time physical activity scores, measured height and weight, Obesity and Weight-Loss QOL (OWLQOL) scores, and Work Limitations Questionnaire scores. Baseline data were analysed using linear mixed models separately for men (n 348) and women (n 399), since sex modified the effects. BMI was negatively associated with OWLQOL in both women (P < 0·001) and men (P < 0·001). The linear effect estimate for OWLQOL scores associated with a one-category increase in BMI was 30 (95 % CI 25, 44) % for women and 14 (95 % CI 10, 17) % for men. BMI was positively associated with productivity loss only in women (exp(slope) = 1·46, 95 % CI 1·02, 2·11, P = 0·04). Eating while doing another activity was negatively associated with OWLQOL scores in men (P = 0·0006, independent of BMI) and with productivity in women (P = 0·04, although the effect diminished when adjusting for BMI). Fast-food meals were associated with decreased productivity in men (P = 0·038, independent of BMI). The results suggest that obesogenic dietary behaviours and higher BMI are associated with decreased QOL and productivity to different degrees in women and men.