Baseline Responding Research Articles

How food cues can enhance and inhibit motivation to obtain and consume food

Learning may play an important role in over-eating. One example is Pavlovian-to-instrumental transfer (PIT), whereby reward cues facilitate responding to obtain that reward. Whilst there is increasing research indicating PIT for food in humans, these studies have exclusively tested PIT under instrumental extinction (i.e. when the food is no longer available), which may reduce their ecological validity. To address this, we conducted two experiments exploring PIT for food in humans when tested under instrumental reinforcement. Participants first underwent Pavlovian discrimination training with an auditory cue paired with a chocolate reward (CS+) and another auditory cue unpaired (CS−). In instrumental training participants learnt to press a button to receive the chocolate reward on a VR10 schedule. In the test phase, each CS was presented whilst participants maintained the opportunity to press the button to receive chocolate. In Experiment 1, the PIT test was implemented after up to 20 min of instrumental training (satiation) whereas in Experiment 2 it was implemented after only 4 min of instrumental training. In both experiments there was evidence for differential PIT, but the pattern differed according to the rate of responding at the time of the PIT test. In low baseline responders the CS+ facilitated both button press responding and consumption, whereas in high baseline responders the CS− suppressed responding. These findings suggest that both excitatory and inhibitory associations may be learnt during PIT training and that the expression of these associations depends on motivation levels at the time the cues are encountered. Particularly concerning is that a food-paired cue can elicit increased motivation to obtain and consume food even when the participant is highly satiated and no longer actively seeking food, as this may be one mechanism by which over-consumption is maintained.

Re-evaluating the PCP challenge as a pre-clinical model of impaired cognitive flexibility in schizophrenia

NMDA-R antagonists are a popular translational pharmacological challenge to induce cognitive deficits associated with schizophrenia. Amongst their many cognitive and non-cognitive effects is an ability to impair cognitive flexibility in general, and reversal learning in particular. Here, we test the hypothesis that the NMDA-R antagonist phencyclidine when given acutely selectively effects reversal learning by simultaneously measuring reversal learning and baseline responding, or acquisition and baseline responding, under identical conditions. Animals were trained to simultaneously perform two different visual discriminations in a touch-screen equipped operant box. Accordingly the reward contingencies associated with one pair could be altered, while the second pair acted as an experimental control. As such, the effect of a manipulation on reversal learning, stimuli acquisition, or baseline responding can be more accurately evaluated through the use of a double visual discrimination. A similar approach was also used to investigate the influence of sub-chronic phencyclidine administration on cognitive flexibility. Phencyclidine (1mg/kg) given before testing caused a slowing in acquisition and reversal learning, while having a minimal effect on secondary measures. Sub-chronic phencyclidine administration had no significant effect on any of the measures used within this study. While acute phencyclidine impairs reversal learning, it is clear from these results that other aspects of cognition (learning/relearning) are also impaired, potentially questioning the specificity of acute phencyclidine in conjunction with reversal learning paradigms as a model of impaired cognitive flexibility.

Change in health status in long-term conditions over a one year period: a cohort survey using patient-reported outcome measures.

BackgroundEnhancing quality of life for people with long-term conditions by monitoring patient-reported outcome measure scores is a key domain of health care policy. This study investigated the responsiveness of patient-reported outcome measures for long-term conditions.MethodsA cohort survey was conducted in 33 primary care practices and 4485 patients (1334 asthma, 567 chronic obstructive pulmonary disease, 1121 diabetes, 525 epilepsy, 520 heart failure and 418 stroke) were sent a baseline survey containing a generic (EQ-5D) and a disease-specific measure. Baseline respondents were sent a follow-up after 1 year. Differences in scores for each long-term condition were assessed by paired t-tests. The relationship between scores and self-reported ‘change in health’ was assessed by analysis of variance.ResultsThe baseline achieved a 38.4% response rate and the follow-up 71.5%. The only significant difference for the EQ-5D was found for the Visual Analogue Scale in heart failure between baseline and follow-up, and for change in health. Significant differences between baseline and follow-up scores were found on the disease-specific measures for 1 asthma dimension and 1 stroke dimension. No significant differences were found for other conditions. Significant differences between self-reported change in health and the disease-specific measures were found for 4 asthma dimensions and 2 stroke dimensions.ConclusionsFew significant differences were found between the baseline and follow up or between ‘change in health’ and PROMs scores. This could be explained by the time frame of one year being too short for change to occur or by the PROMs not being responsive enough to change in a primary care sample. The latter is unlikely as the PROMs were in part chosen for their responsiveness to change. The baseline response rates may mean that the sample is not representative, and stable patients may have been more likely to participate. If PROMs are to be used routinely to monitor outcomes in LTCs, further research is needed to maximize response rates, to ensure that the PROMs used are reliable, valid and sensitive enough to detect change and that the time frame for data collection is appropriate.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-014-0123-2) contains supplementary material, which is available to authorized users.

What-Where-When memory in the rodent Odor Span Task

While the Odor Span Task (OST) was developed to assess working memory in rodents, it appears that odor (“What”) and time since an odor was last reinforced (“When”) jointly control responding in the OST. The OST uses an incrementing non-match to sample procedure such that the number of stimuli to remember increases during the session; the rodent is trained to remember stimuli within a session but not between sessions. We used a variation of the OST to add a “Where” dimension to the task to examine whether rodents could learn to respond to scents based on contextual cues as well. In Experiment 1, six rats well-trained on the OST procedure were exposed to four target scents in a holding cage before the OST session began [What-Where-When (WWW) condition]. When these target scents appeared in the OST, rats treated them as novel scents despite their being previously encountered that day; WWW responding was comparable to baseline (BL) responding. Controls were implemented to account for relative familiarity: frequency of target presentation and time since the target odor was presented. On both types of control probes, rats typically responded to target scents less than during WWW or BL conditions, took longer to make a response, and visited more comparison stimuli. In Experiment 2, the study was replicated adding reinforcement delivery for responding to pre-session presentation of target stimuli. Subjects were the same six rats plus two additional rats also well-trained on the OST. Results were similar to those from Experiment 1. These data indicate that the variables controlling performance on the OST task include What stimulus is presented, Where (i.e., in which location) it was presented, and When it was presented. Thus, the OST-probe methodology may provide a useful vehicle for the study of episodic-like memory processes in non-humans.

Frailty as a predictor of all-cause mortality in older men and women

To investigate the modifying effect of sex on the association between frailty and all-cause mortality, and to determine the effects of changes in frailty status on mortality. This population-based study comprised 654 persons aged 76-100 years (mean age 82 ± 4.6 years). Frailty status was assessed at baseline in 2005, and reassessed in 2007 (n=546) using the Cardiovascular Health Study criteria. Death dates were received from the official register until the end of 2009. The associations between frailty, changes in frailty and mortality were investigated using Cox regression models. At baseline, 93 (14%) participants were classified as frail, and 311 (48%) as pre-frail. Over the 4-year follow up, 173 (27%) baseline respondents died. The mortality risk for participants who were frail at baseline was 2.7 (95% CI 1.6-4.5) compared with the robust. In the fully adjusted model, the association was significant for women (HR 2.8, 95% CI 1.5-5.3), and of borderline significance for men (HR 2.4, 95% CI 1.0-5.9). In men, pre-frailty and frailty were both associated with increased mortality risk only in the age-adjusted model (pre-frailty HR 2.3, 95% CI 1.2-4.5; frailty HR 4.0, 95% CI 1.9-8.9). Decline in frailty status during the 2-year follow-up period also markedly increased the risk for mortality over the succeeding 2 years. Frailty is strongly associated with higher mortality, especially among women. Among men, the association was explained by baseline functional capacity, comorbidity and lifestyle factors. Changes in frailty status should also be taken into consideration when planning geriatric care, as such changes could indicate a more rapid decline in health.

EPA-0993 – Health utility scores in children and adolescents with attention-deficit/hyperactivity disorder: response to stimulant treatment

The Health Utilities Index-Mark 2 (HUI2), a generic instrument for assessing health status, is an important effectiveness input for pharmacoeconomic modelling. It has not previously been used in patients with attention deficit/hyperactivity disorder (ADHD). To use HUI2 to assess health utility in patients aged 6–17 years with ADHD receiving the prodrug stimulant lisdexamfetamine dimesylate (LDX). SPD489-325 was a 7-week, randomized, double-blind, placebo-controlled trial of LDX, with osmotic-release oral system methylphenidate (OROSMPH) as a reference treatment. Patients’ parents or guardians completed HUI2 questionnaires at baseline and weeks 4 and 7. Utilities were estimated for treatment responders and non-responders, with response defined as a Clinical Global Impressions-Improvement (CGI-I) score of 1 or 2, or a ≥25% or ≥30% reduction in ADHD Rating Scale IV (ADHD-RS-IV) total score. Of 336 patients randomized, 317 were included in the full analysis set (LDX, n=104; OROS-MPH, n=107; placebo, n=106) and 196 completed the study. At endpoint, mean HUI2 utility scores across all treatment groups were higher for responders than non-responders when response was based on CGI-I score (responders: 0.896 [SD, 0.0990]; non-responders: 0.838 [0.1421]), on a ≥25% reduction in ADHD-RS-IV score from baseline (responders, 0.899 [0.0969]; non-responders, 0.809 [0.1474]), or on a ≥30% reduction in ADHD-RS-IV score from baseline (responders, 0.902 [0.0938]; non-responders 0.814 [0.1477]). The HUI2 instrument is sensitive to treatment response in the child and adolescent ADHD patient population. Health utilities generated using HUI2 are therefore suitable for cost effectiveness evaluations of ADHD medications. Supported by funding from Shire

Assessing fatigue in ankylosing spondylitis: the importance of frequency and severity

The aim of this study was to explore the value of assessing fatigue frequency and its relationship with fatigue severity in a UK cohort of AS patients. Single items from the Evaluation of AS Quality of Life and BASDAI were used to measure fatigue frequency and severity, respectively. Items were included in a questionnaire containing AS-specific and generic measures, completed by participants in a postal survey at baseline and 6 months. Respondents were categorized at baseline into four groups according to fatigue frequency and severity and compared on other measures of health status. Of baseline responders who experienced fatigue (n = 451, 74%), 75% reported it to be frequent and severe, 15% frequent not severe and 10% severe not frequent. There was no difference between groups on gender, age or years with AS. Patients reporting frequent and severe fatigue had worse scores than other groups across all other health status measures. Patients reporting only frequent fatigue had similar scores to those reporting only severe fatigue, but worse than those without fatigue. Eighty-one per cent of non-fatigued patients and 79% of those with frequent and severe fatigue at baseline did not change their level of fatigue at 6 months. However, 80% of patients with frequent or severe fatigue at baseline changed, mainly to no fatigue (43%) or both frequent and severe fatigue (30%). Routinely assessing both the frequency and severity of fatigue is important in understanding the impact of fatigue and its change over time. Not assessing frequency could result in the failure to identify patients with significant fatigue. However, the multidimensional nature of fatigue should be further explored.

Recruiting Women for a Study on Perceived Risk of Cancer: Influence of Survey Topic Salience and Early Versus Late Response

IntroductionUnderstanding the characteristics of early and late survey responders has implications for recruitment efforts and for informing potential response bias. The main objective of this analysis was to examine survey responder status (ie, early vs late response) by sociodemographic characteristics and by salience of study variables among respondents.MethodsWe analyzed data from a survey on family cancer history and perceived cancer risk among women at a large managed health-care organization. For baseline and 12-month follow-up surveys, we defined early versus late responder status according to the 95th percentile of the number of days it took to obtain completed interviews.ResultsWe found no significant associations between responder status and sociodemographic characteristics at baseline or follow-up. At baseline, early responders were significantly more likely than late responders to have a personal history of breast cancer (5.2% vs 3.4%, P = .04) and to have been referred for genetic counseling (4.6% vs 2.0%, P = .004). The association between personal history of breast cancer and responder status persisted at follow-up; only 3.5% of late responders at baseline were also late responders at follow-up. Follow-up survey nonresponse rates did not vary by baseline responder status.ConclusionSurvey topic salience is associated with early response and is important for recruitment. However, once recruited, late responders do not remain late responders at follow-up, suggesting that extra efforts made to recruit late responders are worthwhile. Health-related agencies that conduct surveys should consider survey salience in survey administration and recruitment strategies.

Multiple socioeconomic determinants of weight gain: the Helsinki Health Study

BackgroundSocioeconomic differences in weight gain have been found, but several socioeconomic determinants have not been simultaneously studied using a longitudinal design. The aim of this study was to examine multiple socioeconomic determinants of weight gain.MethodsMail surveys were conducted in 2000–2002 among 40 to 60-year old employees of the City of Helsinki, Finland (n = 8 960, response rate 67%). A follow-up survey was conducted among the baseline respondents in 2007 with a mean follow-up of 5 to 7 years (n = 7 332, response rate 83%). The outcome measure was weight gain of 5 kg or more over the follow-up. Socioeconomic position was measured by parental education, childhood economic difficulties, own education, occupational class, household income, home ownership and current economic difficulties. Multivariable logistic regression models were fitted adjusting simultaneously for all covariates in the final model.ResultsOf women 27% and of men 24% gained 5 kg or more in weight over the follow-up. Among women, after adjusting for age, baseline weight and all socioeconomic determinants, those with basic (OR 1.40 95% CI 1.11-1.76) or intermediate education (OR 1.43 95% CI 1.08-1.90), renters (OR 1.18 95% CI 1.03-1.36) and those with occasional (OR 1.19 95% CI 1.03-1.38) or frequent (OR 1.50 95% CI 1.26-1.79) economic difficulties had increased risk of weight gain. Among men, after full adjustment, having current frequent economic difficulties (OR 1.70 95% CI 1.15-2.49) remained associated with weight gain.ConclusionsCurrent economic difficulties among both women and men, and among women low education and renting, were associated with weight gain. Prevention of weight gain among ageing people would benefit from focusing in particular on those with economic difficulties.

Netilmicin/dexamethasone fixed combination in the treatment of conjunctival inflammation

PurposeTo compare the efficacy and safety of 0.1% dexamethasone/0.3% netilmicin (Netildex), with that of 0.1% dexamethasone/0.3% tobramycin (Tobradex) in the treatment of external ocular inflammation requiring antibiotic therapy.MethodsIn this randomized, double-blind study, 139 subjects with conjunctival inflammation associated with signs of ocular infection were treated with Netildex (n = 71) or Tobradex (n = 68) four times daily for 6 days. The primary efficacy analysis was based on the percentage of patients with at least a 50% decrease in conjunctival hyperemia at the endpoint visit (Day 6 [± 1]) with respect to baseline (responder rate). An equivalence margin of 20% was set for this study. A follow-up visit was performed at Day 14 (± 1). Other efficacy parameters were: conjunctival edema, conjunctival discharge, lid hyperemia, lid edema, presence of ocular infection, and symptoms of ocular discomfort. Safety evaluations included intraocular pressure, visual acuity, and adverse events.ResultsAt Day 6, a decrease of conjunctival hyperemia was observed in 87.3% and 90.9% of the patients treated with Netildex and Tobradex, respectively. The 95% confidence interval for the difference between groups (−15.3 ÷ 8.0) satisfied the equivalence hypothesis. Subjects treated with Netildex had a better control of lid hyperemia (P = 0.016), tearing (P = 0.001), burning (P = 0.007), and stinging (P = 0.004). No adverse reactions were observed during the study except one case of keratitis in the Tobradex group.ConclusionNetildex was as effective and safe as Tobradex in reducing signs and symptoms in patients with conjunctival inflammation when ocular infection was suspected.

The effect of VMAT2 inhibitor GZ-793A on the reinstatement of methamphetamine-seeking in rats

The vesicular monoamine transporter 2 (VMAT2) has been identified as a potential target for the treatment of methamphetamine (METH) abuse. GZ-793A is a potent and selective VMAT2 inhibitor that has been shown to block the primary and conditioned reinforcing effects of METH, while demonstrating no abuse liability when given alone. The aim of the current study was to determine if GZ-793A attenuates METH- or cue-induced reinstatement of METH-seeking after a period of extinction. The effect of acute GZ-793A on locomotor activity also was assessed. After a period of extinction, rats were administered GZ-793A (15mg/kg, s.c.) 15min prior to a priming injection of METH or re-exposure to cues associated with METH infusions. GZ-793A also was administered 20min prior to an injection of METH (0.5mg/kg, s.c.) or saline to determine its effect on locomotor behavior. Pretreatment with GZ-793A (15mg/kg) decreased cue-induced reinstatement, without demonstrating any response suppressive effects when administered in the absence of reinstating stimuli. GZ-793A also decreased methamphetamine-induced reinstatement; however, response suppressant effects of GZ-793A were obtained when the compound was presented alone. In this latter experiment, GZ-793A may have reduced responding for the conditioned reinforcing effects of the contingently available cues rather than having nonspecific effects on baseline responding. GZ-793A had no effect on locomotor activity when administered alone or with METH. GZ-793A and related VMAT2 inhibitors may be promising leads for reducing the risk of relapse to METH use following exposure to drug-associated cues.

Increased variability in tacting under a lag 3 schedule of reinforcement.

Research has shown that variability may be an operant dimension of behavior. One method of reinforcing response variability is to use a lag schedule of reinforcement (Page & Neuringer, 1985). Several studies have shown that a Lag 1 schedule is effective in increasing variable responding with human participants (e.g., Esch, Esch, & Love, 2009; Lee, McComas, & Jawor, 2002). In these arrangements, however, the return to baseline responding during reversal phases suggests that the resulting behavior change may not be maintained following intervention. The purpose of the present study was to investigate the effects of a Lag 3 schedule on increasing and maintaining variability of tacts in 2 children diagnosed with developmental disabilities. Results demonstrated increased variability in tacting for both participants and maintenance in variable responding after a 3-week follow-up.

Health, work, and personal-related predictors of time to return to work among employees with mental health problems

Purpose: To identify health-, personal- and work-related factors predictive of return to work (RTW) in employees sick-listed due to common mental health problems, such as, stress, depression, burnout, and anxiety. Methods: We distributed a baseline questionnaire to employees applying for sickness absence benefits at a large Danish welfare Department (n = 721). A total of 298 employees returned the questionnaire containing information on possible predictors of RTW. We followed up all baseline responders for a maximum of one year in a national registry of social transfer payments, including sickness absence benefits. Results: At baseline, about 9% of respondents had quit their job, 10% were dismissed and the remaining 82% were still working for the same employer. The mean time to RTW, measured from the first day of absence, was 25 weeks (median = 21) and at the end of follow-up (52 weeks) 85% had returned to work. In the fitted Cox model we found that fulfilling the DSM-IV criteria for depression predicted a longer time to RTW (HR: 0.61, CI: 0.45–0.84), whereas a better self-rated health predicted a shorter time to RTW (HR: 1.18, CI: 1.03–1.34). Employees working in the municipal (HR: 0.62, CI: 0.41–0.94) and private sector (HR: 0.65, CI: 0.44–0.96) returned to work slower compared to employees working in the governmental sector. Gender, education, cohabitation, size of workplace, low-back and upper-neck pain and employment at baseline did not predict RTW. Conclusion: Our results indicate that time to RTW is determined by both health- and work-related factors.Implications for RehabilitationCommon mental health problems are one of the leading causes for sickness absence and work disabilityReturn to work after sickness absence is not solely determined by improvements in health but is also affect by individual and work related factorsThis study showed that self-rated health, occupational sector and depression are predictors of time to return to work in employees with mental health problems

Mifepristone in the Central Nucleus of the Amygdala Reduces Yohimbine Stress-Induced Reinstatement of Ethanol-Seeking

Chronic ethanol exposure leads to dysregulation of the hypothalamic-pituitary-adrenal axis, leading to changes in glucocorticoid release and function that have been proposed to maintain pathological alcohol consumption and increase vulnerability to relapse during abstinence. The objective of this study was to determine whether mifepristone, a glucocorticoid receptor antagonist, plays a role in ethanol self-administration and reinstatement. Male, Long-Evans rats were trained to self-administer either ethanol or sucrose in daily 30 min operant self-administration sessions using a fixed ratio 3 schedule of reinforcement. Following establishment of stable baseline responding, we examined the effects of mifepristone on maintained responding and yohimbine-induced increases in responding for ethanol and sucrose. Lever responding was extinguished in separate groups of rats and animals were tested for yohimbine-induced reinstatement and corticosterone release. We also investigated the effects of local mifepristone infusions into the central amygdala (CeA) on yohimbine-induced reinstatement of ethanol- and sucrose-seeking. In addition, we infused mifepristone into the basolateral amygdala (BLA) in ethanol-seeking animals as an anatomical control. We show that both systemic and intra-CeA (but not BLA) mifepristone administration suppressed yohimbine-induced reinstatement of ethanol-seeking, while only systemic injections attenuated sucrose-seeking. In contrast, baseline consumption, yohimbine-induced increases in responding, and circulating CORT levels were unaffected. The data indicate that the CeA plays an important role in the effects of mifepristone on yohimbine-induced reinstatement of ethanol-seeking. Mifepristone may be a valuable pharmacotherapeutic strategy for preventing relapse to alcohol use disorders and, as it is FDA approved, may be a candidate for clinical trials in the near future.

Sensitization of food reinforcement is related to weight status and baseline food reinforcement

Food reinforcement is an empirical index of motivation to obtain food. Higher levels of food reinforcement are associated with increased energy intake and increased body weight. Food reinforcement can vary over repeated food presentations, as people may show reduced reinforcing value if they satiate to repeated reinforcers, or they may show sensitization, or an increase in reinforcing value with repeated presentations. Over the past few years, our laboratory has been studying the impact of repeated administration of large portions of high energy density snack foods on food reinforcement. We have shown in three separate studies that the majority of non-obese individuals become satiated after 2 weeks of the same snack food administration, but that a subset of obese individuals sensitize after this same manipulation. The purpose of the study presented here was to identify predictors of reinforcer satiation or sensitization. For the analyses presented here, we combined data sets from three previous studies for a total of 67 adult participants. We found that higher body mass index (BMI) and higher baseline motivation to eat predicted sensitization, and baseline motivation to eat moderated the effects of BMI, such that higher baseline responding for food predicted sensitization in obese individuals, but satiation in non-obese individuals. These data suggest that repeated exposure to high energy density snack foods may result in sensitization to those foods, with similar effects as drugs of abuse in susceptible individuals, and that an individual's BMI and baseline responding act as predictors of this response.

Trajectory and predictors of depression in a 12-month prospective study after the Madrid March 11 terrorist attacks

BackgroundFew longitudinal studies have examined the trajectory of and the risk factors for depression in a representative sample of the population exposed to terrorism. A 12 month prospective study was conducted among a sample of Madrid city residents after the March 11, 2004 terrorist attacks. We aimed to document the trajectories of depressive symptoms and determine the risk factors associated with these trajectories. MethodsWe conducted telephone surveys among a representative sample of Madrid citizens (N = 1589) to recruit baseline respondents approximately 1 month after the March 11 terrorist attacks. Participants were re-contacted at 6 and 12 months after baseline for further telephone interviews. ResultsFindings reveal heterogeneity in the longitudinal trajectories of depression ranging from the absence of depressive symptoms over time, to transient or chronic depression. Life and recent stressors, experiencing direct exposure to the attacks, personality traits, poor physical health and other psychological disorders were principally associated with a worse trajectory of depression after this event. ConclusionsConsistent with a stress diathesis model, ongoing stressors and intense event exposure are key drivers of a chronic depression trajectory after a mass traumatic event.

Changes in leisure-time physical activity after transition to retirement: a follow-up study

BackgroundRetirement is a major life change that is likely to affect lifestyles. The aim of this study was to examine changes in leisure-time physical activity of moderate and vigorous intensity among ageing employees facing transition to retirement over a follow-up of 5-7 years.MethodsThe baseline data were collected by questionnaire surveys in 2000-2002 among 40-60-year-old employees of the City of Helsinki. A follow-up survey was conducted among the baseline respondents in 2007 (n = 7332, response rate 83%). Those who were on disability retirement at the follow-up were distinguished from old-age retirees. Leisure-time physical activity was measured using similar questions in both surveys.ResultsOld-age retirees increased significantly their time spent in moderate-intensity physical activity: women 31 minutes per week and men 42 minutes per week on average. Such changes were not found among disability retirees or those remaining employed. There were no changes in vigorous activity. Leisure-time physical inactivity at follow-up was lower among old-age retirees compared with employees of nearly the same age. Adjustments made for potential baseline covariates had no effects on these findings.ConclusionsTransition to old-age retirement was associated with an increase in moderate-intensity leisure-time physical activity and a decrease in the proportion of inactive. Encouraging people to leisure-time physical activity after retirement is worthwhile as the increase in free time brings new possibilities for it.

Changes in occupational class differences in leisure-time physical activity: a follow-up study

BackgroundPhysical activity is known to have health benefits across population groups. However, less is known about changes over time in socioeconomic differences in leisure-time physical activity and the reasons for the changes. We hypothesised that class differences in leisure-time physical activity would widen over time due to declining physical activity among the lower occupational classes. We examined whether occupational class differences in leisure-time physical activity change over time in a cohort of Finnish middle-aged women and men. We also examined whether a set of selected covariates could account for the observed changes.MethodsThe data were derived from the Helsinki Health Study cohort mail surveys; the respondents were 40-60-year-old employees of the City of Helsinki at baseline in 2000-2002 (n = 8960, response rate 67%). Follow-up questionnaires were sent to the baseline respondents in 2007 (n = 7332, response rate 83%). The outcome measure was leisure-time physical activity, including commuting, converted to metabolic equivalent tasks (MET). Socioeconomic position was measured by occupational class (professionals, semi-professionals, routine non-manual employees and manual workers). The covariates included baseline age, marital status, limiting long-lasting illness, common mental disorders, job strain, physical and mental health functioning, smoking, body mass index, and employment status at follow-up. Firstly the analyses focused on changes over time in age adjusted prevalence of leisure-time physical activity. Secondly, logistic regression analysis was used to adjust for covariates of changes in occupational class differences in leisure-time physical activity.ResultsAt baseline there were no occupational class differences in leisure-time physical activity. Over the follow-up leisure-time physical activity increased among those in the higher classes and decreased among manual workers, suggesting the emergence of occupational class differences at follow-up. Women in routine non-manual and manual classes and men in the manual class tended to be more often physically inactive in their leisure-time (<14 MET hours/week) and to be less often active (>30 MET hours/week) than those in the top two classes. Adjustment for the covariates did not substantially affect the observed occupational class differences in leisure-time physical activity at follow-up.ConclusionsOccupational class differences in leisure-time physical activity emerged over the follow-up period among both women and men. Leisure-time physical activity needs to be promoted among ageing employees, especially among manual workers.

Internet use leads cancer patients to be active health care consumers

Objective This study examines whether cancer patients’ Internet use leads them to prefer a more active role in medical decision making and whether the effects of Internet use on active participation preferences vary according to patients’ education levels. Methods Randomly drawn sample ( N = 2013) from the Pennsylvania Cancer Registry, comprised of breast, prostate, and colon cancer patients, completed mail surveys in the fall of 2006 (overall response rate = 64%). Of 2013 baseline respondents, 85% agreed to participate in follow-up survey ( N = 1703). Of those who agreed, 76% ( N = 1293) completed follow-up surveys in the fall of 2007. Results Cancer patients’ Internet use for health information at wave one led them to want to be more active participants in medical decision making at wave two ( β = .06, p < .05). This applied to all cancer patients regardless of their education levels. Conclusion Higher levels of Internet use among cancer patients may lead patients to want to be more actively involved in medical decision making. Practice Implications Considering the beneficial effects of patients’ active participation in medical decision making, it will be worthwhile for health educators to recommend Internet use to cancer patients.

Protocol for population testing of an Internet-based Personalised Decision Support system for colorectal cancer screening

BackgroundAustralia has a comparatively high incidence of colorectal (bowel) cancer; however, population screening uptake using faecal occult blood test (FOBT) remains low. This study will determine the impact on screening participation of a novel, Internet-based Personalised Decision Support (PDS) package. The PDS is designed to measure attitudes and cognitive concerns and provide people with individually tailored information, in real time, that will assist them with making a decision to screen. The hypothesis is that exposure to (tailored) PDS will result in greater participation in screening than participation following exposure to non-tailored PDS or resulting from the current non-tailored, paper-based approach.Methods/designA randomised parallel trial comprising three arms will be conducted. Men and women aged 50-74 years (N = 3240) will be recruited. They must have access to the Internet; have not had an FOBT within the previous 12 months, or sigmoidoscopy or colonoscopy within the previous 5 years; have had no clinical diagnosis of bowel cancer. Groups 1 and 2 (PDS arms) will access a website and complete a baseline survey measuring decision-to-screen stage, attitudes and cognitive concerns and will receive immediate feedback; Group 1 will receive information 'tailored' to their responses in the baseline survey and group 2 will received 'non-tailored' bowel cancer information. Respondents in both groups will subsequently receive an FOBT kit. Group 3 (usual practice arm) will complete a paper-based version of the baseline survey and respondents will subsequently receive 'non-tailored' paper-based bowel cancer information with accompanying FOBT kit. Following despatch of FOBTs, all respondents will be requested to complete an endpoint survey. Main outcome measures are (1) completion of FOBT and (2) change in decision-to-screen stage. Secondary outcomes include satisfaction with decision and change in attitudinal scores from baseline to endpoint. Analyses will be performed using Chi-square tests, analysis of variance and log binomial generalized linear models as appropriate.DiscussionIt is necessary to restrict participants to Internet users to provide an appropriately controlled evaluation of PDS. Once efficacy of the approach has been established, it will be important to evaluate effectiveness in the wider at-risk population, and to identify barriers to its implementation in those settings.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12610000095066