Impact of Navigators on First Visit to a Transplant Center, Waitlisting, and Kidney Transplantation: A Randomized, Controlled Trial.

BACKGROUND AND OBJECTIVES: Many patients with ESKD face barriers in completing the steps required to obtain a transplant. These eight sequential steps are medical suitability, interest in transplant, referral to a transplant center, first visit to center, transplant workup, successful candidate, waiting list or identify living donor, and receive transplant. This study sought to determine the effect of navigators on helping patients complete these steps. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Our study was a cluster randomized, controlled trial involving 40 hemodialysis facilities and four transplant centers in Ohio, Kentucky, and Indiana from January 1, 2014 to December 31, 2016. Four trained kidney transplant recipients met regularly with patients on hemodialysis at 20 intervention facilities, determined their step in the transplant process, and provided tailored information and assistance in completing that step and subsequent steps. Patients at 20 control facilities continued to receive usual care. Primary study outcomes were waiting list placement and receipt of a deceased or living donor transplant. An exploratory outcome was first visit to a transplant center. RESULTS: Before the trial, intervention (1041 patients) and control (836 patients) groups were similar in the proportions of patients who made a first visit to a transplant center, were placed on a waiting list, and received a deceased or living donor transplant. At the end of the trial, intervention and control groups were also similar in first visit (16.1% versus 13.8%; difference, 2.3%; 95% confidence interval, -0.8% to 5.5%), waitlisting (16.3% versus 13.8%; difference, 2.5%; 95% confidence interval, -1.2% to 6.1%), deceased donor transplantation (2.8% versus 2.2%; difference, 0.6%; 95% confidence interval, -0.8% to 2.1%), and living donor transplantation (1.2% versus 1.0%; difference, 0.1%; 95% confidence interval, -0.9% to 1.1%). CONCLUSIONS: Use of trained kidney transplant recipients as navigators did not increase first visits to a transplant center, waiting list placement, and receipt of deceased or living donor transplants.

Longitudinal Changes and Seasonal Variation in Body Composition in Professional Australian Football Players.

PURPOSE: To compare development and variations in body composition of early-, mid-, and late-career professional Australian Football (AF) players over 3 successive seasons. METHODS: Regional and total-body composition (body mass [BM], fat mass [FM], fat-free soft-tissue mass [FFSTM], and bone mineral content [BMC]) were assessed 4 times, at the same time of each season-start preseason (SP), end preseason (EP), midseason (MS), and end season (ES)-from 22 professional AF players using pencil-beam dual-energy X-ray absorptiometry. Nutritional intake for each player was evaluated concomitantly using 3-d food diaries. Players were classified according to their age at the beginning of the observational period as either early- (<21 y, n = 8), mid- (21 to 25 y, n = 9), or late- (>25 y, n = 5) career athletes. RESULTS: Early-career players had lower FFSTM, BMC, and BM than mid- and late-career throughout. FM and %FM had greatest variability, particularly in the early-career players. FM reduced and FFSTM increased from SP to EP, while FM and FFSTM decreased from EP to MS. FM increased and FFSTM decreased from MS to ES, while FM and FFSTM increased during the off-season. CONCLUSIONS: Early-career players may benefit from greater emphasis on specific nutrition and resistance-training strategies aimed at increasing FFSTM, while all players should balance training and diet toward the end of season to minimize increases in FM.

Changes in Anthropometry, Upper-Body Strength, and Nutrient Intake in Professional Australian Football Players During a Season.

The purpose of this study was to examine the seasonal changes in body composition, nutrition, and upper-body (UB) strength in professional Australian Football (AF) players. The prospective longitudinal study examined changes in anthropometry (body mass, fat-free soft-tissue mass [FFSTM], and fat mass) via dual-energy X-ray absorptiometry 5 times during an AF season (start preseason, midpreseason, start season, midseason, end season) in 45 professional AF players. Dietary intakes and strength (bench press and bench pull) were also assessed at these time points. Players were categorized as experienced (>4 y experience, n = 23) or inexperienced (<4 y experience, n = 22). Fat mass decreased during the preseason but was stable through the in-season for both groups. %FFSTM was increased during the preseason and remained constant thereafter. UB strength increased during the preseason and was maintained during the in-season. Changes in UB FFSTM were related to changes in UB-strength performance (r = .37-.40). Total energy and carbohydrate intakes were similar between the experienced and inexperienced players during the season, but there was a greater ratio of dietary fat intake at the start-preseason point and an increased alcohol, reduced protein, and increased total energy intake at the end of the season. The inexperienced players consumed more fat at the start of season and less total protein during the season than the experienced players. Coaches should also be aware that it can take >1 y to develop the appropriate levels of FFSTM in young players and take a long-term view when developing the physical and performance abilities of inexperienced players.

Comparison of anthropometry, upper-body strength, and lower-body power characteristics in different levels of Australian football players.

The aim of this study was to compare the anthropometry, upper-body strength, and lower-body power characteristics in elite junior, sub-elite senior, and elite senior Australian Football (AF) players. Nineteen experienced elite senior (≥4 years Australian Football League [AFL] experience), 27 inexperienced elite senior (<4 years AFL experience), 22 sub-elite senior, and 21 elite junior AF players were assessed for anthropometric profile (fat-free soft tissue mass [FFSTM], fat mass, and bone mineral content) with dual-energy x-ray absorptiometry, upper-body strength (bench press and bench pull), and lower-body power (countermovement jump [CMJ] and squat jump with 20 kg). A 1-way analysis of variance assessed differences between the playing levels in these measures, whereas relationships between anthropometry and performance were assessed with Pearson's correlation. The elite senior and sub-elite senior players were older and heavier than the elite junior players (p ≤ 0.05). Both elite playing groups had greater total FFSTM than both the sub-elite and junior elite players; however, there were only appendicular FFSTM differences between the junior elite and elite senior players (p < 0.001). The elite senior playing groups were stronger and had greater CMJ performance than the lower level players. Both whole-body and regional FFSTM were correlated with bench press (r = 0.43-0.64), bench pull (r = 0.58-0.73), and jump squat performance measures (r = 0.33-0.55). Australian Football players' FFSTM are different between playing levels, which are likely because of training and partly explain the observed differences in performance between playing levels highlighting the importance of optimizing FFSTM in young players.

The accuracy and precision of DXA for assessing body composition in team sport athletes.

This study determined the precision of pencil and fan beam dual-energy X-ray absorptiometry (DXA) devices for assessing body composition in professional Australian Football players. Thirty-six professional Australian Football players, in two groups (fan DXA, N = 22; pencil DXA, N = 25), underwent two consecutive DXA scans. A whole body phantom with known values for fat mass, bone mineral content and fat-free soft tissue mass was also used to validate each DXA device. Additionally, the criterion phantom was scanned 20 times by each DXA to assess reliability. Test-retest reliability of DXA anthropometric measures were derived from repeated fan and pencil DXA scans. Fat-free soft tissue mass and bone mineral content from both DXA units showed strong correlations with, and trivial differences to, the criterion phantom values. Fat mass from both DXA showed moderate correlations with criterion measures (pencil: r = 0.64; fan: r = 0.67) and moderate differences with the criterion value. The limits of agreement were similar for both fan beam DXA and pencil beam DXA (fan: fat-free soft tissue mass = -1650 ± 179 g, fat mass = -357 ± 316 g, bone mineral content = 289 ± 122 g; pencil: fat-free soft tissue mass = -1701 ± 257 g, fat mass = -359 ± 326 g, bone mineral content = 177 ± 117 g). DXA also showed excellent precision for bone mineral content (coefficient of variation (%CV) fan = 0.6%; pencil = 1.5%) and fat-free soft tissue mass (%CV fan = 0.3%; pencil = 0.5%) and acceptable reliability for fat measures (%CV fan: fat mass = 2.5%, percent body fat = 2.5%; pencil: fat mass = 5.9%, percent body fat = 5.7%). Both DXA provide precise measures of fat-free soft tissue mass and bone mineral content in lean Australian Football players. DXA-derived fat-free soft tissue mass and bone mineral content are suitable for assessing body composition in lean team sport athletes.

Physiological and behavioural outcomes of a randomised controlled trial of a cognitive behavioural lifestyle intervention for overweight and obese adolescents.

AIM: This study evaluates the efficacy of the Choose Health program, a family-based cognitive behavioural lifestyle program targeting improved eating and activity habits, in improving body composition, cardiovascular fitness, eating and activity behaviours in overweight and obese adolescents. METHOD: The sample comprised 29 male and 34 female overweight (n = 15) or obese (n = 48) adolescents aged 11.5-18.9 years (M = 14.3, SD = 1.9). Participants were randomly allocated to treatment or waitlist control conditions; waitlist condition participants were offered treatment after 6 months. DEXA-derived and anthropometric measures of body composition; laboratory-based cycle ergometer and field-assessed cardiovascular fitness data; objective and self-report physical activity measures; and self-report measures of eating habits and 7-day weighed food diaries were used to assess treatment outcome. Adherence to treatment protocols was high. RESULTS: Treatment resulted in significant (p < .05) and sustained improvements in a range of body composition (body fat, percent body fat, lean mass) and anthropometric measures (weight, BMI, BMI-for-age z-score and percentiles). Minimal improvements were seen in cardiovascular fitness. Similar results were obtained in completer and intention-to-treat analysis. Poor adherence to assessment protocols limits conclusions that can be drawn from physical activity and dietary data. CONCLUSIONS: Participation in the Choose Health program resulted in significant improvement in body composition. Longer-term follow up is required to determine the durability of intervention effects. Alternative approaches to the measurement of diet and physical activity may be required for adolescents.

Does long-term swimming participation have a deleterious effect on the adult female skeleton?

Swimming is a popular activity for Australian women with proven cardiovascular benefits yet lacks the features thought necessary to stimulate positive adaptive changes in bone. Given that peak bone mass is attained close to the end of the second decade, we asked whether swimming was negatively associated with bone mineral density in premenopausal women beyond this age. Bone mass and retrospective physical activity data were gathered from 43 female swimmers and 44 controls (mean ages 40.4 and 43.8 years, respectively). Swimmers were recruited from the Australian Union of Senior Swimmers International while controls were healthy community dwellers with similar lean mass, fat mass, height, weight and body mass index. None of the participants had a history of medical complaints nor use of medications known to affect bone. Dual energy X-ray absorptiometry was used to determine areal bone mineral density at total body, lumbar spine, proximal femur, distal radius and tibia while self-administered questionnaires were used to approximate historical and recent physical activity and calcium intake. Swimmers had averaged over 2 hours of swimming per week for the past 5 years and 1.45 h/week over lifetime with no systematic swimming exposure for controls. Lifetime exposure to weight bearing and impact exercise were similar. There were no intergroup differences for bone mass at any site though controls had higher incidence of low bone mass/osteoporosis. No differences in bone mass were detected between swimmers in the upper and lower quartiles for swim participation for any period. Long-term swim participation did not compromise areal bone mineral density.

Body mass index as an indicator of adiposity among adults with intellectual disability.

BACKGROUND: Body mass index (BMI) has been identified as a key health indicator and determinant of health for people with intellectual disability. Our aim was to examine whether BMI is a useful indicator of adiposity among a sample of adults with intellectual disability. METHOD: Participants were 46 ambulatory community-dwelling volunteers with mild to moderate intellectual disability. Age ranged from 19 to 60 years, 25 were male, and 17 had Down syndrome. Soft tissue composition was determined using a dual-energy X-ray absorptiometer (DXA) and height and weight were directly assessed. RESULTS: Regression equations revealed that BMI accounted for 68% of the variance in percent body fat and 83% of the variance in total body fat. Partial correlations of BMI with fat and lean masses determined by DXA were r = .91 and r = -.12, respectively. A BMI of >or= 30 had excellent specificity for obesity, but less than optimal sensitivity. CONCLUSIONS: BMI appears to be a reasonable indicator of adiposity, although a BMI >or= 30 may misclassify a proportion of individuals assessed by DXA as obese.

Motivational interviewing and cognitive behaviour therapy in the treatment of adolescent overweight and obesity: study design and methodology.

BACKGROUND: Despite the high prevalence and negative physical and psychosocial consequences of overweight and obesity in adolescents, very little research has evaluated treatment in this population. Consequently, clinicians working with overweight and obese adolescents have little empirical research on which to base their practise. Cognitive behavioural therapy has demonstrated efficacy in promoting behaviour change in many treatment resistant disorders. Motivational interviewing has been used to increase motivation for change and improve treatment outcomes. In this paper we describe the rationale and design of a randomised controlled trial testing the efficacy of motivational interviewing and cognitive behaviour therapy in the treatment of overweight and obese adolescents. METHODS: Participants took part in a motivational interview or a standard semi-structured assessment interview and were then randomly allocated to a cognitive behavioural intervention or a wait-list control condition. The cognitive behavioural intervention, the CHOOSE HEALTH Program, consisted of 13 individual treatment sessions (12 face-to-face, 1 phone call) followed by 9 maintenance sessions (7 phone calls, 2 face-to-face). Assessments were conducted prior to participation, after the treatment phase and after the maintenance phase of intervention. Improvement in body composition was the primary outcome; secondary outcomes included improved cardiovascular fitness, eating and physical activity habits, family and psychosocial functioning. CONCLUSION: Despite the demonstrated effectiveness of motivational interviewing and cognitive behavioural therapy in the long-term management of many treatment resistant disorders, these approaches have been under-utilised in adolescent overweight and obesity treatment. This study provides baseline data and a thorough review of the study design and treatment approach to allow for the assessment of the efficacy of motivational interviewing and cognitive behavioural therapy in the treatment of adolescent overweight and obesity. Data obtained in this study will also provide much needed information about the behavioural and psychosocial factors associated with adolescent overweight and obesity.