PubMed · 10577889
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R I Hector. 1999. A flawed study design?. https://pubmed.ncbi.nlm.nih.gov/10577889/
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The effectiveness of behavioral interventions for pediatric feedings problems has been well documented. However, the application of these procedures in the real world is often more complex and difficult than research reports reveal. Multiple factors such as the child's medical condition and history, medical monitoring requirements, and the need to adjust treatment procedures as intervention progresses make it difficult to follow the best-laid plans developed from reading structured and highly controlled experimental applications. This article details factors to be considered in the actual clinical-based application of behavioral procedures in the treatment of pediatric feeding problems. A description of how referrals are generated and initial assessment is conducted, and a model for inpatient treatment is presented. In addition, the need for efficient and effective treatment in the real world is stressed.
Hot flashes are the most common symptom of the climacteric and occur in about 75% of perimenopausal and postmenopausal women in Western societies. Although hot flashes accompany the withdrawal of estrogen at menopause, the decline in estrogen levels is not sufficient to explain their occurrence. Elevated sympathetic activation acting through central alpha(2)-adrenergic receptors contributes to the initiation of hot flashes, possibly by narrowing the thermoneutral zone in symptomatic women. Hot flashes are then triggered by small elevations in core body temperature acting within this narrowed zone. A relaxation-based method, paced respiration, has been shown in 3 controlled investigations to significantly reduce objectively measured hot flash occurrence by about 50% with no adverse effects. In 6 studies of physical exercise, however, investigators did not find positive effects on hot flashes, possibly because exercise raises core body temperature, thereby triggering hot flashes. Although many epidemiologic studies have found increased reports of sleep disturbance during the menopausal transition, recent laboratory investigations have not found this effect, nor have they found that hot flashes produce disturbed sleep. Therefore, sleep complaints in women at midlife should not routinely be attributed to hot flashes or to menopause.
BACKGROUND: The treatment of obesity, marked by a high rate of recidivism, lacks strategies that sustain the improved lifestyle behaviors that led to the weight loss. Self-monitoring, a behavioral strategy to increase awareness of one's behavior, is the cornerstone of behavioral treatment in weight loss management. However, adherence to self-monitoring is less than ideal. The actual patterns of self-monitoring of eating behaviors in weight loss treatment programs have not been studied previously; if done, these data could provide information on how self-monitoring patterns affect weight loss and if interventions can be developed that address deficits in self-monitoring. Technology now permits an instrumented paper-and-pencil diary to record the real time of individuals' self-monitoring behaviors (invivodata, inc.), thus providing more information about self-reported behaviors. This technology differs from PDA based products (ex. e-diary, e-trials, logpad, PICS) because, to the user, it is no different from a standard paper-and-pencil diary. METHODS: The purposes of this ancillary study are: (1) to describe the electronically recorded patterns of self-monitoring of eating behaviors by weight-loss study participants; (2) compare reported vs. electronically recorded self-monitoring; and (3) examine the relationship between the electronically validated adherence to self-monitoring goals and success in weight loss in a sub-sample of participants in the PREFER study. This paper describes the design, methods and preliminary 6-month results. RESULTS: Preliminary results reveal that participants frequently report recording their eating behavior during times when the binder was not opened. Two examples of data are shown that demonstrate the lack of concordance between the self-reported and the electronically recorded data. CONCLUSIONS: These unobtrusively collected electronic data can lead to the development of strategies that can promote improved adherence to self-monitoring.