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In sub-Saharan Africa, theory and evidenced-based interventions that are systematically designed and using sound evaluation methods to report on effectiveness are limited. A sex education programme called SPEEK was developed, implemented and evaluated in Ghana using the Intervention Mapping approach. SPEEK aimed at delaying sexual initiation, reducing sexually transmitted infections (STIs) and preventing pregnancy, targeting junior high school students in a West African rural setting. The final programme included 11 (interactive) lessons using a diverse range of theory-based methods. In this article, we report on the effect evaluation of the programme. Participating schools were randomized to the intervention (N = 10 schools) and a waiting-list control group (N = 11 schools). The students completed survey questionnaires at baseline (N = 1822), at direct post-test (N = 1805) and at six months follow-up (N = 1959), measuring cognitive and affective psychosocial determinants of sexual delay, condom use and STI testing. Mixed regression models showed that at direct post-test, students having received the SPEEK programme scored significantly more positively on knowledge on condom use, pregnancy and STIs testing; attitude toward exercising sexual rights, condom availability and condom use; perceived behavioural control toward sexual delay, condom use and sexual intercourse; and perceived risk toward STIs (P ’s < 0.002). The results suggest that the programme may improve adolescent sexual health in Ghana or in similar cultures, but would need further study that include behavioural measures and a longer follow-up to make this assertion with more confidence. [ABSTRACT FROM AUTHOR]

Background. Diastasis recti abdominis (DrA) is associated with negative body image, musculoskeletal pain and dysfunction, and perhaps urogynecological complaints. The severity of DrA has traditionally been determined by measuring the interrectus distance (IRD); however, the relationship between IRD and symptoms in women with DrA is unclear. Objective. The objective of the study was to investigate the relationship between IRD and symptom severity in women with DrA in the early postpartum period. Design. This study used a cross-sectional design. Methods. Thirty-two women with DrA were assessed at 3 weeks postpartum. The IRD was measured using ultrasound imaging. Symptom severity was assessed using the Multidimensional Body-Self Relations Questionnaire subscales (body image), visual analog scales (abdominal, low back, and pelvic pain intensity), the Modified Oswestry Index (disability due to low back pain), and the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire (urogynecological dysfunction). Spearman correlation coefficients (p) between IRD and each outcome were calculated and tested using 1-tailed significance (adjusted α = .009). Results. The group median IRD was 2.97 cm (interquartile range = 1.65 cm), with the largest IRD in the sample being 7.97 cm. The IRD was significantly correlated with worst abdominal pain in the last 24 hours (p = 0.45, P = .005) and with overall body image (p = -0.44, P = .006) but not with the other outcomes. Limitations. Women in the sample were primiparous, were in the early (3 weeks) postpartum period, had relatively low body mass indexes (mean = 25.0 kg/m²) considering that they had recently given birth, were all breast-feeding, and had a narrow age range (27-35 years old). These factors limited the generalizability of our results to all women with DrA. Conclusions. This preliminary work suggests that, in the early postpartum period, IRD as a measure of DrA severity is meaningful for body image. [ABSTRACT FROM AUTHOR]

Background. Soft tissue massage and exercise are commonly used to treat episodes of shoulder pain. Objective. The study objective was to compare the effects of soft tissue massage and exercise with those of exercise alone on pain, disability, and range of motion in people with nonspecific shoulder pain. Design. This was a randomized controlled trial. Setting. The study was conducted in public hospital physical therapy clinics in Sydney, New South Wales, Australia. Participants. The study participants were 80 people with an average age of 62.6 years (SD=12.2) who were referred to physical therapists for treatment of nonspecific shoulder pain. Intervention. Participants were randomly assigned to either a group that received soft tissue massage around the shoulder and exercises (n=40) or a group that received exercise only (n=40) for 4 weeks. Measurements. The primary outcome was improvement in pain, as measured on a 100-mm visual analog scale, 1 week after the cessation of treatment. Secondary outcomes were disability and active flexion, abduction, and hand-behind-back range of motion. Measurements were obtained at baseline, 1 week after the cessation of treatment, and 12 "weeks after the cessation of treatment. Results. The between-group difference in pain scores from the baseline to 12 weeks after the cessation of treatment demonstrated a small significant difference in favor of the group receiving exercise only (mean difference= 14.7 mm). There were no significant differences between groups in any other variable. Limitations. It was not possible to mask therapists or participants to group allocation. Diagnostic tests were not used on participants to determine specific shoulder pathology. Conclusions. The addition of soft tissue massage to an exercise program for the shoulder conferred no additional benefit for improving pain, disability, or range of motion in people with nonspecific shoulder pain. [ABSTRACT FROM AUTHOR]

The effectiveness of methods to prevent stroke recurrence and of education focusing on learners’ needs has not been fully explored. The aims of this study were to assess the effects of such interventions among stroke patients and their primary caregivers and to evaluate the feasibility of a web-based stroke education program. The participants were 36 patients with a clinical diagnosis of ischemic stroke within 12 months post-stroke and their primary caregivers. The participants were randomly assigned to either an experimental or a control group. The primary measures included blood chemistry, self-reported health behaviors, sense of control, and health motivation for stroke patients, and caregiver mastery for caregivers. To test the feasibility of the intervention program, the rates of participation and occurrence of technical problems were calculated. The experimental group tended to improve significantly more than the control group in terms of exercise, diet, sense of control and health motivation for the stroke patients and in terms of caregiver mastery for the primary caregivers. The rate of participation in the web-based program was 63.1%. This program, which focuses on recurrence prevention in stroke patients and caregivers, has the potential to improve health behaviors for stroke patients. [ABSTRACT FROM PUBLISHER]

In this study, we compared the relationships of body mass index (BMI) and body adiposity index (BAI) with body fat percentage (BF%) in a Caucasian, European population. BF% was measured by dual-energy x-ray absorptiometry in a population-based cross-sectional study of 5,193 middle-aged (47–49 years) and elderly (71–74 years) men and women from the Hordaland Health Study in western Norway from 1997 to 1999. In the total population, the correlation between BAI and BF% was stronger (r = 0.78) than the correlation between BMI and BF% (r = 0.56) with similar results in the middle-aged and elderly groups. However, in men and women separately, BMI was a better correlate of BF% (for men, r = 0.76; for women, r = 0.81) than was BAI (for men, r = 0.57; for women, r = 0.72). BMI was also a better correlate of BF% than was BAI assessed by partial correlations adjusted for sex (for BMI-BF%, r = 0.79; for BAI-BF%, r = 0.67). Bland-Altman plots and BF%-stratified analyses showed that BAI tended to overestimate BF% in lean subjects and to underestimate it in those with higher proportions of body fat, but that it predicted BF% well for those whose BMI was in a normal range. At the individual level and in population studies adjusted for sex, BMI outperforms BAI as a predictor of BF%. [ABSTRACT FROM PUBLISHER]

Hookah tobacco smoking is increasing among US college students, including those who would not otherwise use tobacco. Part of hookah’s appeal is attributed to the perception that hookah is less harmful than cigarettes. The aims of this study were to assess knowledge of harmful exposures associated with hookah smoking relative to cigarette smoking and to determine associations between this knowledge and hookah smoking outcomes. Students (N = 852) at the University of Florida were randomly sampled via e-mail to obtain information on demographics, hookah smoking behavior and knowledge of five exposures (e.g. tar and nicotine). Multivariable logistic regression models assessed independent associations between knowledge and hookah smoking outcomes. Of the five factual knowledge items asked, 475 (55.8%) of the respondents answered none correctly. In multivariable models, correct responses to any knowledge items were not associated with lower odds of hookah smoking or susceptibility to hookah smoking in the future. Although college students are largely unaware of the toxicant exposures associated with hookah smoking, there is little association between knowledge and hookah smoking behavior. [ABSTRACT FROM PUBLISHER]

The integrated discrimination improvement (IDI) index is a popular tool for evaluating the capacity of a marker to predict a binary outcome of interest. Recent reports have proposed that the IDI is more sensitive than other metrics for identifying useful predictive markers. In this article, the authors use simulated data sets and theoretical analysis to investigate the statistical properties of the IDI. The authors consider the common situation in which a risk model is fitted to a data set with and without the new, candidate predictor(s). Results demonstrate that the published method of estimating the standard error of an IDI estimate tends to underestimate the error. The z test proposed in the literature for IDI-based testing of a new biomarker is not valid, because the null distribution of the test statistic is not standard normal, even in large samples. If a test for the incremental value of a marker is desired, the authors recommend the test based on the model. For investigators who find the IDI to be a useful measure, bootstrap methods may offer a reasonable option for inference when evaluating new predictors, as long as the added predictive capacity is large. [ABSTRACT FROM AUTHOR]

Background. The Stair Climb Power Test (SCPT) is a functional test associated with leg muscle power in older people. Objective. The purposes of this study were to compare the results of the SCPT in people with chronic obstructive pulmonary disease (COPD) and people who were healthy and to explore associations of the SCPT with muscle strength (force-generating capacity) and functional performance. Design. The study was a cross-sectional investigation. Methods. Twenty-one people with COPD and a predicted mean (SD) percentage of forced expiratory volume in 1 second of 47.2 (12.9) and 21 people who were healthy and matched for age, sex, and body mass were tested with the SCPT. Knee extensor and flexor muscle torque was assessed with an isokinetic dynamometer. Functional performance was assessed with the Timed "Up & Go" Test (TUG) and the Six-Minute Walk Test (6MWT). Results. People with COPD showed lower values on the SCPT (28%) and all torque measures (~ 32%), except for eccentric knee flexor muscle torque. In people with COPD, performance on the TUG and 6MWT was lower by 23% and 28%, respectively. In people with COPD, the SCPT was moderately associated with knee extensor muscle isometric and eccentric torque (≥r .46) and strongly associated (r = .68) with the 6MWT. In people who were healthy, the association of the SCPT with knee extensor muscle torque tended to be stronger (r≥.66); however, no significant relationship between the SCPT and measures of functional performance was found. Limitations. The observational design of the study and the use of a relatively small convenience sample limit the generalizability of the findings. Conclusions. The SCPT is a simple and safe test associated with measures of functional performance in people with COPD. People with COPD show deficits on the SCPT. However, the SCPT is only moderately associated with muscle torque and thus cannot be used as a simple surrogate for muscle strength in people with COPD. [ABSTRACT FROM AUTHOR]

We consider a very general class of empirical discrepancy statistics that includes the Cressie–Read discrepancy statistics and, in particular, the empirical likelihood ratio statistic. Higher-order asymptotics for expected lengths of associated confidence intervals are investigated. An explicit formula is worked out and its use for comparative purposes is discussed. It is seen that the empirical likelihood ratio statistic, which enjoys interesting second-order power properties, loses much of its edge under the present criterion. [ABSTRACT FROM AUTHOR]

In this paper we discuss several statistical techniques which may be used to test the validity of a possibly non-linear and multivariate regression model, using the information provided by estimating one or more alternative models on the same set of data. We first exposit, from a different perspective, the tests proposed by us in Davidson and MacKinnon (1981a), and discuss modified versions of these tests and extensions of them to the multivariate case. We then prove that all these tests, and also the tests previously proposed by Pesaran (1974) and Pesaran and Deaton (1978), based on the work of Cox (1961, 1962), are asymptotically equivalent under certain conditions. Finally, we present the results of a sampling experiment which shows that different tests can behave quite differently in small samples. [ABSTRACT FROM AUTHOR]

Test statistics from the weighted log-rank class are commonly used to compare treatment with control when there is right censoring. This paper uses saddlepoint methods to determine mid-p-values from the null permutation distributions of tests from the weighted log-rank class. Analytical saddlepoint computations replace the permutation simulations and provide mid-p-values that are virtually exact for all practical purposes. The speed of these saddlepoint computations makes it practicable to invert the weighted log-rank tests to determine nominal 95% confidence intervals for the treatment effect with right-censored data. Such analytical inversions lead to permutation confidence intervals that are easily computed and virtually identical to the exact intervals that would normally require massive amounts of simulation. [ABSTRACT FROM AUTHOR]