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Different Lifestyle Interventions in Adults From Underserved Communities: The FAMILIA Trial.

来自服务不足社区的成年人的不同生活方式干预: FAMILIA试验。

  • 影响因子:6.43
  • DOI:10.1016/j.jacc.2019.10.021
  • 作者列表:"Fernandez-Jimenez R","Jaslow R","Bansilal S","Diaz-Munoz R","Fatterpekar M","Santana M","Clarke-Littman A","Latina J","Soto AV","Hill CA","Al-Kazaz M","Samtani R","Vedanthan R","Giannarelli C","Kovacic JC","Bagiella E","Kasarskis A","Fayad ZA","Fuster V
  • 发表时间:2020-01-07
Abstract

BACKGROUND:The current trends of unhealthy lifestyle behaviors in underserved communities are disturbing. Thus, effective health promotion strategies constitute an unmet need. OBJECTIVES:The purpose of this study was to assess the impact of 2 different lifestyle interventions on parents/caregivers of children attending preschools in a socioeconomically disadvantaged community. METHODS:The FAMILIA (Family-Based Approach in a Minority Community Integrating Systems-Biology for Promotion of Health) study is a cluster-randomized trial involving 15 Head Start preschools in Harlem, New York. Schools, and their children's parents/caregivers, were randomized to receive either an "individual-focused" or "peer-to-peer-based" lifestyle intervention program for 12 months or control. The primary outcome was the change from baseline to 12 months in a composite health score related to blood pressure, exercise, weight, alimentation, and tobacco (Fuster-BEWAT Score [FBS]), ranging from 0 to 15 (ideal health = 15). To assess the sustainability of the intervention, this study evaluated the change of FBS at 24 months. Main pre-specified secondary outcomes included changes in FBS subcomponents and the effect of the knowledge of presence of atherosclerosis as assessed by bilateral carotid/femoral vascular ultrasound. Mixed-effects models were used to test for intervention effects. RESULTS:A total of 635 parents/caregivers were enrolled: mean age 38 ± 11 years, 83% women, 57% Hispanic/Latino, 31% African American, and a baseline FBS of 9.3 ± 2.4 points. The mean within-group change in FBS from baseline to 12 months was ∼0.20 points in all groups, with no overall between-group differences. However, high-adherence participants to the intervention exhibited a greater change in FBS than their low-adherence counterparts: 0.30 points (95% confidence interval: 0.03 to 0.57; p = 0.027) versus 0.00 points (95% confidence interval: -0.43 to 0.43; p = 1.0), respectively. Furthermore, the knowledge by the participant of the presence of atherosclerosis significantly boosted the intervention effects. Similar results were sustained at 24 months. CONCLUSIONS:Although overall significant differences were not observed between intervention and control groups, the FAMILIA trial highlights that high adherence rates to lifestyle interventions may improve health outcomes. It also suggests a potential contributory role of the presentation of atherosclerosis pictures, providing helpful information to improve future lifestyle interventions in adults.

摘要

背景: 目前服务不足的社区中不健康生活方式行为的趋势令人不安。因此,有效的健康促进战略构成了未满足的需求。 目的: 本研究的目的是评估两种不同的生活方式干预措施对社会经济弱势社区学龄前儿童的父母/照顾者的影响。 方法: FAMILIA (基于家庭的方法,在少数民族社区整合系统-生物学促进健康) 研究是一项整群随机试验,涉及纽约哈莱姆区的15名学龄前儿童。学校及其子女的父母/照顾者被随机分组,接受为期12个月的 “个人关注” 或 “点对点” 生活方式干预计划或对照。主要结局是与血压、运动、体重、营养和烟草相关的综合健康评分 (Fuster-BEWAT评分 [FBS]) 从基线至12个月的变化,范围为0至15 (理想健康 = 15)。为了评估干预的可持续性,本研究评估了24个月时FBS的变化。主要预先指定的次要结局包括FBS子组分的变化以及通过双侧颈动脉/股动脉血管超声评估的动脉粥样硬化存在知识的影响。采用混合效应模型检验干预效果。 结果: 共纳入635名父母/照顾者: 平均年龄38 ± 11岁,83% 名女性,57% 名西班牙裔/拉丁裔,31% 名非洲裔美国人,基线FBS为9.3 ± 2.4分。所有组中FBS从基线至12个月的平均组内变化为 ∼ 0.20分,没有总体组间差异。然而,对干预的高依从性参与者表现出比低依从性参与者更大的FBS变化: 分别为0.30分 (95% 置信区间: 0.03 ~ 0.57; p = 0.027) 和0.00分 (95% 置信区间: -0.43 ~ 0.43; p = 1.0)。此外,参与者对动脉粥样硬化存在的了解显著提高了干预效果。类似的结果在24个月时持续。 结论: 尽管干预组和对照组之间没有观察到总体显著差异,但FAMILIA试验强调,对生活方式干预的高依从率可能会改善健康结局。它还表明了动脉粥样硬化图片的呈现的潜在贡献作用,为改善成人未来的生活方式干预提供了有用的信息。

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发表时间:2020-04-02
DOI:10.1080/09273948.2019.1569240
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日常生活活动方向

日常生活活动指一个人为了满足日常生活的需要每天所进行的必要活动和功能性移动。

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