Predictors of Successful Weight Control: Cross-Cultural Moderators of Treatment Outcomes

Given the heterogeneity of effect sizes within the population for any treatment, identifying moderators of outcomes is critical [1]. In weight management programs, there is a high individual variability in terms of weight loss and an overall modest success [2]. Some people will adopt and sustain attitudes and behaviors associated with weight loss, while others won’t [3]. To predict weight loss outcome just from the subject’s baseline information would be very valuable [4,5]. It would allow to: - Better match between treatments and individuals - Identify the participants with less probability of success (or potential dropouts) in a given treatment and direct them to alternative therapies - Target limited resources to those most likely to succeed - Increase cost-effectiveness and improve success rates of the programs Few studies have been dedicated to describe baseline predictors of treatment success. The Healthy Weight for Life (USA) study is one of the few. Its findings are now being cross-validated in Portuguese samples. This paper describes these cross-cultural comparisons.

Analysis of mediation and reciprocal effects of changes in weight, self-esteem, and exercise in a behavioral weight loss treatment

Improving the treatment of obesity remains a critical challenge. Several health behaviour change models, often based on a social-cognitive framework, have been used to design weight management interventions (Baranowski et al., 2003). However, most interventions have only produced modest weight reductions (Wadden et al., 2002) and socialcognitive variables have shown limited power to predict weight outcomes (Palmeira et al., 2007). Other predictors, and possibl alte nati e e planatory models, are needed to better understand the mechanisms by which weight loss and other obesity treatment-outcomes are brought about (Baranowski, 2006). Self-esteem is one of these possible mechanisms, because is commonly reported to change during the treatment, although these changes are not necessarily associated with weight loss (Blaine et al., 2007; Maciejewski et al., 2005). This possibility should be more evident if the program integrates regular exercise, as it promotes improvements in subjective well-being (Biddle & Mutrie, 2001), with possible influences on long-term behavioral adherence (e.g. diet, exercise). Following the reciprocal effects model tenets (Marsh & Craven, 2006), we expect that the influences between changes in weight, selfesteem and exercise to be reciprocal and might present one of the mechanisms by which obesity treatments can be improved.

Indicadores da individualização de cuidados para o curso de licenciatura em enfermagem

RESUMO: A individualização dos cuidados de enfermagem tem sido associada a uma evolução clínica mais favorável, representando um importante parâmetro de avaliação e de desenvolvimento dos serviços de saúde. A tónica atribuída a esta problemática não só é evidenciada por diversos autores, como se enquadra nas metas de modernização do Sistema Nacional de Saúde e é destaque em vários códigos normativos da profissão nacionais e internacionais, como uma obrigação moral e deontológica. Assim, pretende-se mediante os ganhos em saúde sensíveis às intervenções de enfermagem, identificar quais indicadores do cuidado individualizado, para se efectivar a sua incorporação na formação inicial em enfermagem. Para tal efeito, construiu-se uma bateria de indicadores mediante análise de duas revisões sistemáticas da literatura, que teve por base o Modelo da Eficácia do Papel de Enfermagem, desenvolvido por Irvine et al. (1998). Para à adaptação à realidade portuguesa recorreu-se à técnica de Delphi, com duas rondas, que incluiu respectivamente, 12 e 10 peritos de enfermagem. Na análise de dados utilizou-se o nível de concordância superior ou igual a 90%, na última ronda. Na segunda fase do estudo, aplicou-se um inquérito por questionário (α de Cronbach = 0,919) para testar a sua aplicabilidade dos indicadores, a 156 enfermeiros, do mesmo hospital da área da grande Lisboa, no Serviço de Medicina e Cirurgia. Recorreu-se ao SPSS, versão 19 e realizou-se análise univariada e estatística analítica. Na bateria final de indicadores foram incorporados aqueles com ponderação positiva (≥51%). Os dados qualitativos obtidos foram submetidos a análise de conteúdo. Dos 58 indicadores iniciais, consolidaram-se 8 categorias: cuidado à pessoa em fim de vida e família, toque terapêutico, educação para a auto-gestão da saúde, cuidados de proximidade, gestão de casos, empoderamento/ literacia para a saúde, linha telefónica de apoio permanente/ tele-assistência e apoio psico-emocional, com valorização de 28 indicadores. O tempo de experiência profissional, tipo de serviço e tempo de permanência no mesmo serviço influenciou a percepção dos enfermeiros, confirmando os pressupostos de Irvine et al. (1998) e Benner (2001). A correlação total dos indicadores, no questionário, variou entre 0,248 e 0,650, para p<0,01. O facto de todas as correlações serem positivas significa que provavelmente estão associados à problemática da individualização, pelo que se sugere a sua transposição para o ensino de enfermagem. ABSTRACT: The individualization of nursing care has been associated with a more favorable clinical evolution, an important parameter for the evaluation and development of health services. The emphasis given to this problem is not only evidenced by several authors, as fits the goals of modernizing the National Health System and is featured in several normative codes of the profession nationally and internationally, as a moral and ethical obligation. Thus, it is intended by the gains in health sensitive to nursing interventions, identify indicators of individualized care and give effect to its incorporation into the initial training in nursing. For this purpose, we constructed a series of indicators by analyzing two systematic reviews of literature, which was based on the The Nursing Role Effectiveness Model developed by Irvine et al. (1998). For the adaptation to the Portuguese appealed to the Delphi technique with two rounds, which included, respectively, 10 and 12 nursing experts. In data analysis we used the level of agreement greater than or equal to 90% in the last round. In the second phase of the study, we applied a questionnaire (Cronbach's α = 0.919) to test the applicability of the indicators, the 156 nurses in the same hospital in the Greater Lisbon area, the Department of Medicine and Surgery. Done using the SPSS, version 19 and conducted a univariate analysis and analytical statistics. In the final heat of indicators were incorporated into those with positive weight (≥ 51%). Qualitative data were subjected to content analysis. Of the initial 58 indicators, eight were consolidated categories: care to the person and family life, therapeutic touch education for self-management of health care outreach, case management, empowerment / literacy to health, a telephone line permanent support / tele-assistance and psycho-emotional, with an appreciation of 28 indicators. The length of professional experience, type of service and length of stay in the same service influenced the perception of nurses, confirming the assumptions of Irvine et al. (1998) and Benner (2001). The total correlation of the indicators in the questionnaire ranged between 0.248 and 0.650, p <0.01. The fact that all correlations are positive means that are probably associated with the problem of individuation, which is suggested by its implementation in nursing education.