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BackgroundWearable trackers are an increasingly popular tool among healthy adults and are used to facilitate self-monitoring of physical activity. ObjectiveWe aimed to systematically review the effectiveness of wearable trackers for improving physical activity and weight reduction among healthy adults. MethodsThis review used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology and reporting criteria. English-language randomized controlled trials with more than 20 participants from MEDLINE, CINAHL, Cochrane Library, Web of Science, PubMed, and Scopus (2000-2017) were identified. Studies were eligible for inclusion if they reported an intervention group using wearable trackers, reporting steps per day, total moderate-to-vigorous physical activity, activity, physical activity, energy expenditure, and weight reduction. ResultsTwelve eligible studies with a total of 1693 participants met the inclusion criteria. The weighted average age was 40.7 years (95% CI 31.1-50.3), with 64.4% women. The mean intervention duration was 21.4 weeks (95% CI 6.1-36.7). The usage of wearable trackers was associated with increased physical activity (standardized mean difference 0.449, 95% CI 0.10-0.80; P=.01). In the subgroup analyses, however, wearable trackers demonstrated no clear benefit for physical activity or weight reduction. ConclusionsThese data suggest that the use of wearable trackers in healthy adults may be associated with modest short-term increases in physical activity. Further data are required to determine if a sustained benefit is associated with wearable tracker usage.

Textbook content has the ability to influence mathematical learning. This study compares how linear functions are presented in two textbooks, one of South African and the other of German origin. These two textbooks are used in different language-based streams in a school in Gauteng, South Africa. A qualitative content analysis on how the topic of linear functions is presented in these two textbooks was done. The interplay between procedural and conceptual knowledge, the integration of the multiple representations of functions, and the links created to other mathematical content areas and the real world were considered. It was found that the German textbook included a higher percentage of content that promoted the development of conceptual knowledge. This was especially due to the level of cognitive demand of tasks included in the analysed textbook chapters. Also, while the South African textbook presented a wider range of opportunities to interact with the different representations of functions, the German textbook, on the other hand, included more links to the real world. Both textbooks linked 'functions' to other mathematical content areas, although the German textbook included a wider range of linked topics. It was concluded that learners from the two streams are thus exposed to different affordances to learn mathematics by their textbooks.

AimsHeart failure (HF) patients are taught to identify a rapid 5 lb body-weight gain for early detection of cardiac decompensation. Few data support this common advice. The study aim was to determine whether a 5 lb weight gain in 1 week and signs and symptoms of HF increased risk for unplanned physician or emergency department (ED) visits or hospital admission in rural HF patients.Methods and resultsThis was a secondary analysis of a randomized trial. Patients tracked body weight and HF symptoms using diaries. We included patients adherent to daily diaries >50% over 24 months (N = 119). Mean age was 69 ± 11 years; 77% (65) were male, and 67% completed diaries. A weight gain of 5 lb over 7 days was associated with a greater risk for ED visits but not hospital admission [hazard ratio (HR) 1.06, 95% confidence interval (CI) 1.04, 1.08; P

BackgroundAttention to symptoms of weight gain and dyspnea are central tenets of patient education in heart failure (HF). However, it is not known whether diary use improves patient outcomes. The aims of this study were to compare mortality among rural patients with HF who completed versus did not complete a daily diary of weight and symptom self-assessment and to identify predictors of diary use.Methods and resultsThis is a secondary analysis of a 3-arm randomized controlled trial on HF education of self-care with 2 intervention groups versus control who were given diaries for 24 months to track daily weight, HF symptoms, and response to symptom changes. Mean age was 66±13, 58% were men, and 67% completed diaries (n=393). We formed 5 groups (no use, low, medium, high, and very high) based on the first 3 months of diary use and then analyzed time to event (cardiac mortality, all-cause mortality, and HF-related readmission) starting at 3 months. Compared with patients with no diary use, high and very high diary users were less likely to experience all-cause mortality (P=0.02 and P=0.01, respectively). Self-reported sedentary lifestyle was associated with less diary use in an adjusted model (odds ratio, 0.66; 95% confidence interval, 0.46-0.95; P=0.03). Depression and sex were not significant predictors of diary use in the adjusted model.ConclusionsIn this study of 393 rural patients with HF, we found that greater diary use was associated with longer survival. These findings suggest that greater engagement in self-care behaviors is associated with better HF outcomes.Clinical trial registrationURL: https://www.clinicaltrials.gov. Unique Identifier: NCT00415545.

Introduction: Involvement in cardiac rehabilitation programmes reduces death and reoccurring cardiac events, but cardiac rehabilitation attendance is suboptimal globally. The aim of the present project was to evaluate the effectiveness of a co-designed, interactive, web-based cardiac rehabilitation programme as an alternative mode of delivery, as a means of improving access and attendance. Methods: This study reports on the outcomes from the implementation process evaluation using a descriptive observational prospective study design, guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Results: A total of 828 rural patients were enrolled in cardiac rehabilitation, with 50 choosing the web-based cardiac rehabilitation programme. The web-based cohort's mean age was 60 years (SD ± 11.9) and included 17 (34%) men and 33 (66%) women. The rate of programme completion was higher for usual care than for the web-based cohort (17, 34% vs 553, 71.4%, p=<0.001). The web-based cohort reported a positive overall experience (77.8%). Clinicians reported the web-based programme to be high-quality (71.4%). The fidelity of entry of self-reported data for the web-based cohort was high, with all patients completing a pre-assessment. Web-based programme enrolment was associated with a lower chance of cardiac rehabilitation completion (odds ratio 0.19; 95% confidence interval: 0.10, 0.37; P<0.001) after adjusting for age and gender. Conclusions: The web-based programme provides an alternative and more flexible mode of cardiac rehabilitation. It has been integrated and successfully used by patients and clinicians, capturing a cohort that may be unable to attend an in-person cardiac rehabilitation programme. Strategies for improving the rate of completion of web-based programmes need further investigation. [ABSTRACT FROM AUTHOR]

Characterizing how physical and psychological symptoms interact in heart transplant recipients may lead to advances in therapeutic options. This study examined associations between pain and major depression.MethodA cross-sectional study was conducted with adult heart transplant recipients. Pain was measured with the bodily pain domain of the Short Form-36 Health Survey and psychological distress with the Kessler Psychological Distress Scale (K-10). The Mini International Neuropsychiatric Interview, version 6.0, was used to identify participants meeting the criteria for major depression. Hierarchical linear regression was used to determine if there was an association between pain and major depression, controlling for pharmacological treatment of depression, severity of psychological distress, and clinical characteristics including immunosuppression medication which may induce pain as a side effect.ResultsAverage pain score of the 48 heart transplant recipients was 43 ( SD ± 10, range 0-100, lower scores indicate worse pain), with moderate pain reported by 39% ( n = 19). Major depression was associated with worse pain ( R2 change = 36%, β = -16, 95% confidence interval [CI] = [-30, -4], p = .012). Pharmacological treatment for depression was associated with better pain scores ( R2 change = 1.5%, β = 13, 95% CI [4, 23], p = .006).ConclusionsHeart transplant recipients with major depression had worse pain after controlling for pharmacological treatment of depression, severity of psychological distress, and clinical characteristics. Thus, it is imperative that clinicians devising a treatment regimen for pain in heart transplant recipients take into account co-occurring depression and vice versa.

BackgroundHispanics constitute the largest US ethnic group and have been shown to have more frequent heart failure (HF) hospitalizations than non-Hispanic whites. Disease management programs can reduce HF hospitalizations and mortality by increasing patient self-care, but most programs are limited to patients who speak English. Therefore, we hypothesize that Project Fluido, a culturally appropriate self-care education intervention, will improve self-care behaviors and knowledge in Hispanic patients with HF compared with usual care (UC).MethodsProject Fluido (N = 42) was a randomized controlled pilot trial over 3 months. Patients in the experimental group (n = 22) received individualized education in Spanish using the "teach-back" method on the following: high salt foods, when to call the physician, when to report weight gain and the use of diuretics. They also received a nurse-initiated phone call every 2 weeks, a script for calling their physician with increased symptoms, a weight scale and a daily diary to complete. The UC group (n = 20) received a scale and written information. Self-care was measured using the self-care heart failure index and knowledge using teach-back scores. Four knowledge topics were included when using teach-back.ResultsParticipants' mean age was 57 ± 14 years, 57% (24) were male, 64% (27) had hypertension, 86% (36) were New York Heart Association Class I-III and 65% (26) had HF with reduced ejection fraction. Participant health literacy scores showed poor health literacy in 31% (n = 13) and 67% (n = 28) spoke Spanish only. Household income was reported as < $20,000 in 93% (n = 39). Self-care and knowledge scores significantly improved (P < 0.04 and P < 0.02, respectively) in the intervention group compared to UC.ConclusionThe intervention utilized in Project Fluido was a remarkably effective method to improve self-care and HF knowledge in a group of Spanish-speaking HF patients. This improvement is in spite of low physical function, health literacy, acculturation and economic challenges. In addition, teach-back was an effective teaching strategy to improve HF knowledge. Future work is needed to investigate the relationship between increased self-care knowledge, readmissions, and mortality in Spanish-speaking patients with HF.

Background: Although guidelines recommend guideline‐directed medical therapy (GDMT) for patients with acute coronary syndrome (ACS), implementation is limited in clinical practice. Aim: To assess the level of GDMT in ACS patients after discharge who attended cardiac rehabilitation (CR) programs and association with clinical outcomes. Method: A cross‐sectional study was conducted in 13 rural and 10 metropolitan CR programs via all modes of delivery (face‐to‐face, telephone, or general practice‐hybrid) operating in South Australia, Australia. ACS patients were included if they were ≥18 years of age and were referred and attended CR programs with medication details recorded in their hospital discharge summary. GDMT was assessed according to the Australian clinical guidelines for the management of acute coronary syndromes 2016. Prescription of all the four recommended medication classes was considered optimal. Logistic regression and χ2 test were used for association. Ethical approval was granted by the South Australian Department for Health and Wellbeing Human Research Ethics Committee (Reference No. HREC/15/SAH/63) and the Northern Territory Department of Health Human Research Ethics Committee (Reference No. HREC 2015‐2484) which included a waiver of consent per the National Statement on Ethical Conduct in Human Research and the study conforms with the Good Clinical Practice Guidelines. Results: Of the 1229 patients included, 74.6% were male and 41.1% had acute myocardial infarction. Only 39.7% of patients received optimal prescription. Prescription of any three or two medication class combinations occurred for 78.3% and 94.1% of patients, respectively. Optimal GDMT was associated with fewer hospital admissions (odds ratio = 0.647, 95% confidence interval 0.424–0.987, p = 0.043) with no significant gender association. Women were less likely to be prescribed angiotensin converting enzyme inhibitors (p = 0.003), angiotensin receptor blockers (p = 0.007), statins (p = 0.005), and any two (p < 0.001) and three combinations (p = 0.023) of medication classes. Conclusion: GDMT prescription was suboptimal in patients with ACS before attendance at CR. Primary care and CR clinicians have missed an opportunity to implement best practice guideline recommendations, particularly for women. [ABSTRACT FROM AUTHOR]