Heidi Enwald

Inhibitor of apoptosis 2 and TAK1-binding protein are components of the Drosophila Imd pathway

The Imd signaling cascade, similar to the mammalian TNF‐receptor pathway, controls antimicrobial peptide expression in Drosophila. We performed a large‐scale RNAi screen to identify novel components of the Imd pathway in Drosophila S2 cells. In all, 6713 dsRNAs from an S2 cell‐derived cDNA library were analyzed for their effect on Attacin promoter activity in response to Escherichia coli. We identified seven gene products required for the Attacin response in vitro, including two novel Imd pathway components: inhibitor of apoptosis 2 (Iap2) and transforming growth factor‐activated kinase 1 (TAK1)‐binding protein (TAB). Iap2 is required for antimicrobial peptide response also by the fat body in vivo. Both these factors function downstream of Imd. Neither TAB nor Iap2 is required for Relish cleavage, but may be involved in Relish nuclear localization in vitro, suggesting a novel mode of regulation of the Imd pathway. Our results show that an RNAi‐based approach is suitable to identify genes in conserved signaling cascades.

Preventing the Obesity Epidemic by Second Generation Tailored Health Communication: An Interdisciplinary Review

Background The prevention of obesity and health concerns related to obesity are major challenges worldwide. The use of eHealth communication and the tailoring of information delivered via the Internet at the individual level may increase the effectiveness of interventions. Mastering behaviors related to nutrition, physical activity, and weight management are the main issues in preventing obesity, and the need for interdisciplinary knowledge within this area is obvious. Objective The objectives were to review the literature on tailored health communication and to present an interdisciplinary analysis of studies on “second” generation tailored interventions aimed at behavior change in nutrition, physical activity, or weight management. Methods A literature search was conducted of the main electronic information sources on health communication. Selection criteria were defined, and 23 intervention studies were selected. The content analysis focused on the following: study designs, objectives of behavior change, target groups, sample sizes, study lengths, attrition rates, theories applied, intervention designs, computer-based channels used, statistically significant outcomes from the perspective of tailoring, and possible biases of the studies. However, this was not a structured meta-analysis and cannot be replicated as such. Results Of the 23 studies, 21 were randomized controlled trials, and all focused on behavior change: 10 studies focused on behavior change in nutrition, 7 on physical activity, 2 on nutrition and physical activity, and 4 on weight management. The target groups and the number of participants varied: 8 studies included more than 500 participants, and 6 studies included less than 100. Most studies were short; the duration of 20 studies was 6 months or less. The Transtheoretical Model was applied in 14 of the 23 studies, and feedback as a tailoring mechanism was used in addition to an Internet site (or program) in 15 studies and in addition to email in 11 studies. Self-reporting was used in 15 studies, and 14 studies did not have a no-information control group. Tailoring was more effective in nutrition interventions than in physical activity and weight management interventions. The outcomes were mixed or negative in 4 studies of physical activity interventions and in 3 studies of weight management. The use of a no-information control group seemed to have been linked to statistically significant between-group effects in measuring physical activity. This bias effect related to intervention design may explain the differences in the outcomes of the physical activity studies. Conclusions Tailoring was shown to have been an effective method in nutrition interventions, but the results for physical activity were mixed, which is in line with previous studies. Nevertheless, the effect of possible biases, such as relying solely on self-reports and on intervention design without a no-information control group, should not be underestimated. Thus, the issue of bias merits more attention in planning interventions and in future meta-analyses.

Everyday health information literacy among young men compared with adults with high risk for metabolic syndrome - a cross-sectional population-based study

This cross-sectional population-based study aims at identifying differences in the aspects of everyday health information literacy among young healthy men and adults with an increased risk for metabolic syndrome. Data were collected with a self-assessment-based 10-item screening tool administered at the Finnish Defence Force’s call-ups (n=2507, response rate 59%) and at health intervention study (n=571, response rate 98%). Adults with increased risk for metabolic syndrome seemed to value health information but had more difficulty in knowing who to believe in health issues and understanding the terminology used. The difficulties applied especially to respondents 35 years old or over. Men, and especially young men, had lower motivation than women to seek health information. Although the results are indicative, the everyday health information literacy screening tool seems to be useful in revealing areas that health communication should be focused on among different populations.

Effect of tailored, gamified, mobile physical activity intervention on life satisfaction and self-rated health in young adolescent men

BackgroundOnline behavior-change programs may increase physical activity in adolescents, but their effects on subjective health and wellbeing are not well known. PurposeWe investigated the effects of a mobile physical activity intervention on life satisfaction and self-rated health among young adolescent men. MethodsIn this population-based study, 496 men (17.8y, SD 0.6y) participated in a 6-month trial. They were randomized into an intervention (n=250) and a control group (n=246). Only the intervention group had access to a tailored mobile service. Life satisfaction and self-rated health were inquired about at baseline and at the end of the trial. ResultsLife satisfaction improved in the intervention (p<0.001) and control group (p=0.01). Life satisfaction was most likely to improve among men with low baseline satisfaction (OR 13.8; 95% CI 3.751.8) and mood-related exercise motive (2.5 (1.15.6)). There were no statistically significant changes in self-rated health, but those who reported poor health at baseline (OR 9.6; 95% CI 3.724.9) and improved self-rated fitness during the trial (4.2 (1.511.9)) were more likely to gain improvements in self-rated health. ConclusionIn this mobile physical activity intervention, improvements in self-rated health and life satisfaction were associated with low life satisfaction and poor self-rated health at baseline within the intervention group. Trial registrationThis randomized controlled trial is registered to the clinical trials register NCT01376986. A population-based, large sample size and a randomized controlled design.Effectiveness of a novel intervention on subjective wellbeing among adolescent men.Life satisfaction increased similarly regardless of the group allocation.Low baseline subjective wellbeing was associated with positive changes.

Individual factors affecting preferences for feedback message tactics in the contexts of physical activity.

Tailored feedback on personal physical activity behavior has been used to inform individuals and promote physical activity among different populations. This study aimed to increase the understanding of factors associated with young mens preferences for feedback message tactics in the context of physical activity and exercise. How preferences vary was analyzed in terms of the self-reported physical activity, stage of exercise behavior change, exercise self-efficacy, objectively measured physical health status, and sociodemographic characteristics of young Finnish men. Population-based survey data, including physiological measurements (n = 525), were collected at the Finnish Defence Forces’ call-ups in the city of Oulu, Finland, in September 2011. The results indicate that the stage of exercise behavior change, exercise self-efficacy, physical health status, and educational level are associated with a preference for normative and ipsative comparison. Multivariate logistic regression models show that an advanced stage of exercise behavior change and education in the academic track of an upper secondary school are independent predictors of preferring ipsative and normative physical activity feedback among young men. The study provides new insights into how the stage of behavior change influences health information behavior and is in line with studies emphasizing social factors—including education—as being important in shaping health-related behavior. These factors could form the basis for tailoring information when designing health promotion.

eHealth Literacy Research – Quo vadis?

ABSTRACT The concept of electronic health (eHealth) literacy evolved from the social and information sciences and describes competencies necessary to use electronic health services. As it is a rather new topic, and as there is no current overview of the state of the art in research, it is not possible to identify research gaps. Therefore, the objective of this viewpoint article is to increase knowledge on the current state of the art of research in eHealth literacy and to identify gaps in scientific research which should be focused on by the research community in the future. The article provides a current viewpoint of the concept of eHealth literacy and related research. Gaps can be found in terms of a missing “gold standard” regarding both the definition and the measurement of eHealth literacy. Furthermore, there is a need for identifying the implications on eHealth developers, which evolve from the measurement of eHealth literacy in eHealth users. Finally, a stronger inclusion of health professionals, both in the evolving concept and in the measurement of eHealth literacy, is needed in the future.

Gamified Persuasion: User Experiences of Online Activation Service

The authors have empirically examined the persuasive properties of digital games from a multidisciplinary perspective. Besides the relevant cultural and psychological theories related to the game phenomenon, the authors have included a case study where a persuasive online activation service was tested among young men N=280, average 17.9 year old in the promotion of physical and social activity. The emphasis of the article is on qualitative material, which is based on in-depth interviews of 10 individuals, as well as participant observation considering the user experiences regarding the activation service and gaming in general. The authors have concluded that games contain persuasive characteristics based on human culture and psychology and that these characteristics could effectively be utilized in physically and socially activating games.

Everyday Health Information Literacy in Counselling on Healthy Eating. The Case of PrevMetSyn

The use of a screening tool for assessing everyday health information literacy (EHIL) is examined in counselling on healthy eating and lifestyle in the intervention study Improved Methods of Lifestyle Modification for Patients at High Risk for Metabolic Syndrome (PrevMetSyn) ongoing in Finland from 2013 to 2016. A case study with quantitative methods is used. The participants in a controlled intervention trial (based on a population-based sample of 560 subjects) were randomized into three groups: (1) intensive face-to-face counselling, (2) low-intensive face-to-face counselling, and (3) a control group, and further into users or non-users of a web-based ICT-programme. All participants’ EHIL was screened at the beginning. The analyses indicated the distributions of the EHIL scores. Accordingly, one visit was targeted on the perceived ability to assess the quality of health information in intensive face-to-face counselling. Applying the EHIL tool together with cognitive behavioral therapy is a novel counselling approach.

Feasibility of Gamified Mobile Service Aimed at Physical Activation in Young Men: Population-Based Randomized Controlled Study (MOPO)

Background The majority of young people do not meet the recommendations on physical activity for health. New innovative ways to motivate young people to adopt a physically active lifestyle are needed. Objective The study aimed to study the feasibility of an automated, gamified, tailored Web-based mobile service aimed at physical and social activation among young men. Methods A population-based sample of 496 young men (mean age 17.8 years [standard deviation 0.6]) participated in a 6-month randomized controlled trial (MOPO study). Participants were randomized to an intervention (n=250) and a control group (n=246). The intervention group was given a wrist-worn physical activity monitor (Polar Active) with physical activity feedback and access to a gamified Web-based mobile service, providing fitness guidelines, tailored health information, advice of youth services, social networking, and feedback on physical activity. Through the trial, the physical activity of the men in the control group was measured continuously with an otherwise similar monitor but providing only the time of day and no feedback. The primary outcome was the feasibility of the service based on log data and questionnaires. Among completers, we also analyzed the change in anthropometry and fitness between baseline and 6 months and the change over time in weekly time spent in moderate to vigorous physical activity. Results Mobile service users considered the various functionalities related to physical activity important. However, compliance of the service was limited, with 161 (64.4%, 161/250) participants visiting the service, 118 (47.2%, 118/250) logging in more than once, and 41 (16.4%, 41/250) more than 5 times. Baseline sedentary time was higher in those who uploaded physical activity data until the end of the trial (P=.02). A total of 187 (74.8%, 187/250) participants in the intervention and 167 (67.9%, 167/246) in the control group participated in the final measurements. There were no differences in the change in anthropometry and fitness from baseline between the groups, whereas waist circumference was reduced in the most inactive men within the intervention group (P=.01). Among completers with valid physical activity data (n=167), there was a borderline difference in the change in mean daily time spent in moderate to vigorous physical activity between the groups (11.9 min vs −9.1 min, P=.055, linear mixed model). Within the intervention group (n=87), baseline vigorous physical activity was inversely associated with change in moderate to vigorous physical activity during the trial (R=−.382, P=.01). Conclusions The various functionalities related to physical activity of the gamified tailored mobile service were considered important. However, the compliance was limited. Within the current setup, the mobile service had no effect on anthropometry or fitness, except reduced waist circumference in the most inactive men. Among completers with valid physical activity data, the trial had a borderline positive effect on moderate to vigorous physical activity. Further development is needed to improve the feasibility and adherence of an integrated multifunctional service. Trial registration Clinicaltrials.gov NCT01376986; http://clinicaltrials.gov/ct2/show/NCT01376986 (Archived by WebCite at http://www.webcitation.org/6tjdmIroA)

Perceived loneliness among home-dwelling older adults with and without memory disorder: A population-based study

The aim of this population-based cross-sectional study was to describe and compare the prevalence and features of perceived loneliness among home-dwelling older adults with (n = 129) and without (n = 244) memory disorder. The latter group was randomly resampled from 789 respondents stratified by age to obtain a standardized control group. Loneliness was assessed using the six-item De Jong Gierveld Loneliness Scale, and perceived stress using Cohen, Kamarck and Mermelstein’s 10-item Perceived Stress Scale. Results show that severe loneliness was common among the home-dwelling older adults, especially those with memory disorder, who also perceived stress more frequently than those without memory disorder. Both groups, but again more frequently those with memory disorder, were more likely to be emotionally than socially lonely. Thus, when planning social and healthcare services and interventions to mitigate loneliness among older adults living at home, memory problems and emotional loneliness require particular consideration.