Attrition and Retention in Multidisciplinary Weight Management Interventions for Adults with Obesity: A Systematic Review

Background High rates of attrition undermine the success of weight management interventions (WMIs), but a comprehensive understanding of the factors that increase dropout risk remains absent. This is partly explained by heterogeneity of intervention design, and the absence of a universal definition of attrition. This systematic review aimed to identify the factors related to- and predictive of attrition and retention in multidisciplinary WMIs for adults with obesity. Methods The systematic literature search, conducted in Cochrane, Medline, PsycInfo, and Scopus, aimed to identify original research articles published between February 2008 and December 2019. Articles investigating attrition or retention in multidisciplinary WMIs were eligible for inclusion if interventions were for adults (≥18) with obesity identified by body mass index ≥30kg/M2 and lasted ≥6 months. Multidisciplinary was defined as ≥2 interventionist disciplines or professions, for the purpose of this review. Data was synthesised narratively. Results The literature search resulted in seventeen studies which satisfied the inclusion criteria. Attrition rates ranged from 10% at 3-months to 81% at 3-years. The sociodemographic factors associated with reduced risk of attrition included older age, living in less deprived areas, higher levels of education, and female gender. Poor mental health, low social support, high weight loss goals and poor or unsatisfactory results may increase the likelihood of participant dropout, but evidence was limited and inconclusive because of different methodologies, and only a small number of studies investigating some of the variables. Conclusions The scope for targeted retention strategies is limited because few variables were consistently associated with attrition. Until a comprehensive understanding of attrition emerges, WMIs should seek to reduce social inequities in the benefit of WMI provision. Future research should consider factors reported qualitatively, such as intervention expectations and satisfaction, social support, patient-clinician relationships, and logistical barriers. Adopting a universal definition of attrition and de-homogenising participant dropouts would advance future research. As qualitative evidence is limited, exploring participant experiences of WMIs would help understand how attrition rates can be reduced, and in-turn improve WMI effectiveness.

Systematic review and meta-analysis of clinical effectiveness of self-management interventions in Parkinson’s disease

Background Parkinson’s disease is a complex neurodegenerative condition with significant impact on quality of life (QoL), wellbeing and function. The objective of this review is to evaluate the clinical effectiveness of self-management interventions for people with Parkinson’s disease, taking a broad view of self-management and considering effects on QoL, wellbeing and function. Methods Systematic searches of four databases (MEDLINE, Embase, PsycINFO, Web of Science) were conducted for studies evaluating self-management interventions for people with Parkinson’s disease published up to 16th November 2020. Original quantitative studies of adults with idiopathic Parkinson’s disease were included, whilst studies of atypical Parkinsonism were excluded. Full-text articles were independently assessed by two reviewers, with data extracted by one reviewer and reliability checked by a second reviewer, then synthesised through a narrative approach and, for sufficiently similar studies, a meta-analysis of effect size was conducted (using a random-effects meta-analysis with restricted maximum likelihood method pooled estimate). Interventions were subdivided into self-management components according to PRISMS Taxonomy. Risk of bias was examined with the Cochrane Risk of Bias 2 (RoB2) tool or ROBIN-I tool as appropriate. Results Thirty-six studies were included, evaluating a diverse array of interventions and encompassing a range of study designs (RCT n = 19; non-randomised CT n = five; within subject pre- and post-intervention comparisons n = 12). A total of 2884 participants were assessed in studies across ten countries, with greatest output from North America (14 studies) and UK (six studies). Risk of bias was moderate to high for the majority of studies, mostly due to lack of participant blinding, which is not often practical for interventions of this nature. Only four studies reported statistically significant improvements in QoL, wellbeing or functional outcomes for the intervention compared to controls. These interventions were group-based self-management education and training programmes, either alone, combined with multi-disciplinary rehabilitation, or combined with Cognitive Behaviour Therapy; and a self-guided community-based exercise programme. Four of the RCTs evaluated sufficiently similar interventions and outcomes for meta-analysis: these were studies of self-management education and training programmes evaluating QoL (n = 478). Meta-analysis demonstrated no significant difference between the self-management and the control groups with a standardised mean difference (Hedges g) of − 0.17 (− 0.56, 0.21) p = 0.38. By the GRADE approach, the quality of this evidence was deemed “very low” and the effect of the intervention is therefore uncertain. Components more frequently observed in effective interventions, as per PRISMS taxonomy analysis, were: information about resources; training or rehearsing psychological strategies; social support; and lifestyle advice and support. The applicability of these findings is weakened by the ambiguous and at times overlapping nature of self-management components. Conclusion Approaches and outcomes to self-management interventions in Parkinson’s disease are heterogenous. There are insufficient high quality RCTs in this field to show effectiveness of self-management interventions in Parkinson’s disease. Whilst it is not possible to draw conclusions on specific intervention components that convey effectiveness, there are promising findings from some studies, which could be targeted in future evaluations.

Potential distribution of fall armyworm in Africa and beyond, considering climate change and irrigation patterns

The fall armyworm, Spodoptera frugiperda (FAW), first invaded Africa in 2016 and has since become established in many areas across the continent where it poses a serious threat to food and nutrition security. We re-parameterized the existing CLIMEX model to assess the FAW global invasion threat, emphasizing the risk of transient and permanent population establishment in Africa under current and projected future climates, considering irrigation patterns. FAW can establish itself in almost all countries in eastern and central Africa and a large part of western Africa under the current climate. Climatic barriers, such as heat and dry stresses, may limit the spread of FAW to North and South Africa. Future projections suggest that FAW invasive range will retract from both northern and southern regions towards the equator. However, a large area in eastern and central Africa is projected to have an optimal climate for FAW persistence. These areas will serve as FAW ‘hotspots’ from where it may migrate to the north and south during favorable seasons and then pose an economic threat. Our projections can be used to identify countries at risk for permanent and transient FAW-population establishment and inform timely integrated pest management interventions under present and future climate in Africa.

Seasonal pattern of food habits of large herbivores in riverine alluvial grasslands of Brahmaputra floodplains, Assam

Jarman–Bell (1974) hypothesized that in the dry savanna of Africa, small-bodied herbivores tend to browse more on forage with high protein and low fibre content. This implies browsing on high nutritive forage by meso-herbivores, and grazing and mixed feeding on coarse forage by mega-herbivores. We tested this hypothesis in the riverine alluvial grasslands of the Kaziranga National Park (KNP), where seasonal flood and fire play an important role in shaping the vegetation structure. We analyzed the feeding habits and quality of major forage species consumed by three mega-herbivores, viz. greater one-horned rhino, Asian elephant, and Asiatic wild buffalo, and three meso-herbivores, viz. swamp deer, hog deer, and sambar. We found that both mega and meso-herbivores were grazers and mixed feeders. Overall, 25 forage plants constituted more than 70% of their diet. Among monocots, family Poaceae with Saccharum spp. (contributing > 9% of the diet), and, among dicots, family Rhamnaceae with Ziziphus jujuba (contributing > 4% of the diet) fulfilled the dietary needs. In the dry season, the concentration of crude protein, neutral detergent fibre, calcium, sodium, and phosphorous varied significantly between monocots and dicots, whereas only calcium and sodium concentrations varied significantly in the wet season. Dicots were found to be more nutritious throughout the year. Compared to the dry season, the monocots, viz. Alpinia nigra, Carex vesicaria, Cynodon dactylon, Echinochloa crus-galli, Hemarthria compressa, Imperata cylindrica, and Saccharum spp., with their significantly high crude protein, were more nutritious during the wet season. Possibly due to the availability of higher quality monocots in the wet season, both mega and meso-herbivores consume it in high proportion. We concluded that the Jarman–Bell principle does not apply to riverine alluvial grasslands as body size did not explain the interspecific dietary patterns of the mega and meso-herbivores. This can be attributed to seasonal floods, habitat and forage availability, predation risk, and management practices such as controlled burning of the grasslands. The ongoing succession and invasion processes, anthropogenic pressures, and lack of grassland conservation policy are expected to affect the availability of the principal forage and suitable habitat of large herbivores in the Brahmaputra floodplains, which necessitates wet grassland-based management interventions for the continued co-existence of large herbivores in such habitats.

Outcome reporting in randomized controlled trials (RCTs) on the pharmacological management of idiopathic overactive bladder (OAB) in women; a systematic review for the development of core outcome sets (COS)

Introduction and hypothesis Evidence on OAB management remains suboptimal and methodological limitations in randomized control trials (RCTs) affect their comparability. High quality meta-analyses are lacking. This study aimed to compare selection and reporting of outcomes and outcome measures across RCTs as well as evaluate methodological quality and outcome reporting quality as a first stage in the process of developing core outcome sets (COS). Methods RCTs were searched using Pubmed, EMBASE, Medline, Cochrane, ICTRP and Clinicaltrials.gov from inception to January 2020, in English language, on adult women. Pharmacological management, interventions, sample size, journal type and commercial funding were documented. Methodological and outcome reporting quality were evaluated using JADAD and MOMENT scores. Results Thirty-eight trials (18,316 women) were included. Sixty-nine outcomes were reported, using 62 outcome measures. The most commonly reported outcome domains were efficacy (86.8%), safety (73.7%) and QoL (60.5%). The most commonly reported outcomes in each domain were urgency urinary incontinence episodes (UUI) (52.6%), antimuscarinic side effects (76.3%) and change in validated questionnaire scores (36.8%). A statistically significant correlation was found between JADAD and MOMENT (Spearman’s rho = 0.548, p < 0.05) scores. This indicates that higher methodological quality is associated with higher outcome reporting quality. Conclusions Development of COS and core outcome measure sets will address variations and lead to higher quality evidence. We recommend the most commonly reported outcomes in each domain, as interim COS. For efficacy we recommend: UUI episodes, urgency and nocturia episodes; for safety: antimuscarinic adverse events, other adverse events and discontinuation rates; for QoL: OAB-q, PPBC and IIQ scores.

Exploring Health Professionals’ Perceptions of Chemotherapy and Radiation Therapy-Related Oral Mucositis

Purpose Determine health professionals’ (HPs’) perceptions of oral mucositis (OM), including clinical presentation of chemotherapy (CT)-induced vs radiation therapy (RT)-induced OM, its assessment and management. Methods HPs involved in the care of head and neck cancer (HNC) patients receiving RT to the oral cavity/oropharynx and haematopoietic stem cell transplantation (HSCT) patients receiving mucositis-inducing CT regimens were invited to participate in a customised 20-question survey. Themes included OM presentation, assessment and management. Results Survey response rate was 81.4%. Most were nurses (33%) and specialist doctors/dentists (25%). Majority (45%) identified as part of the haematology service, followed by radiation oncology (32%). Most haematology and radiation oncology HPs (89% and 70%, respectively) agreed/strongly agreed that OM impacted patients’ ability to complete treatment. There was a significant association (p<0.01) between HPs’ specialty and their perceptions of OM manifestations. Most radiation oncology (85%) and all oral medicine HPs agreed/strongly agreed that clinical manifestations of CT-induced OM and RT-induced OM were different, whereas haematology HPs varied in their perceptions (11% disagreed, 41% were neutral and 48% agreed/strongly agreed). There was uncertainty regarding differences in management of CT vs RT-induced OM: 30% of haematology HPs and 45% of radiation oncology HPs agreed/strongly agreed but most (52% and 45%, respectively in each group) responded “neutral.” Conclusion OM was recognised to adversely impact HSCT and HNC RT patients’ ability to complete treatment. There were differences in HPs’ perceived understanding of OM manifestations and management. Interventions to address these may reduce unwanted variations in patient care and outcomes.

The European Turtle Dove in the ecotone between woodland and farmland: multi-scale habitat associations and implications for the design of management interventions

The European Turtle Dove (turtle dove) is globally threatened after undergoing a sustained and generalised decline across its breeding range, with habitat loss suggested as the main driver. Here, we reviewed the scientific literature on habitat associations across its European breeding range, in relation to distribution, breeding numbers, nesting substrates, food and foraging habitats, to identify optimal habitat management measures. Large-scale distribution seemed related to the availability, but not dominance, of woodland landscapes; abundance was generally higher in woodland than on farmland. However, abundance in woodland increased with additional structural diversity and proximity to farmland, and abundance on farmland increased with greater availability of non-farmland features. Nesting occurred most frequently on trees (secondarily on bushes) but we found geographical differences in the type of nesting substrate, with thorny bushes being used more frequently in the north, and open canopy trees in the south. Turtle doves fed on a wide spectrum of seeds with a predominance of wild, particularly early-flowering, plants; but we could not identify a single plant species whose abundance determined turtle dove numbers. Across the distribution range, a shift from wild to cultivated seeds occurred as the season progressed. However, interventions should favour the availability and access to wild seeds. Efficient management interventions depend on the dominant habitat; overall, interventions should seek to augment landscape heterogeneity by increasing the mixing of farmland and woodland. Combined forestry and agricultural policies must provide the right conditions for ecotone species like the Turtle dove.

Dog Ecology and Demographics in Several Areas in the Philippines and Its Application to Anti-Rabies Vaccination Programs

Understanding dog population dynamics plays a vital role in planning both rabies and dog management interventions. Establishing a human to dog ratio and an understanding how the urban/rural nature of the community might affect the overall dog population estimate provides an easy-to-use reference to estimate approximate dog populations in a range of communities. A total of 10,664 households were interviewed in 10 locations in the Philippines (2017 and 2018) to understand the dog population variations among the urban, semi-urban and rural areas. Epicollect5 and OSM tracker applications were used to conduct household interviews using a predesigned fixed set of questions. All answers were recorded directly using mobile phone applications. The survey results showed that for every 1000 humans, there are 256.3 dogs in rural areas, 213.8 dogs in semi-rural areas, 208.7 dogs in urban areas and 170.0 dogs on small islands of the Philippines. We estimate a total dog population in the Philippines of 23.29 million dogs (CI 95%, 22.51–24.07 million). Based on the survey findings from Quezon City and Cebu City, targets, resources allocations and vaccination approach were adjusted for the anti-rabies vaccination program at two locations in 2018, which lead to a 3- to 4-fold increase in the total number of dogs vaccinated in each city compared to previous years.