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Article ; Online: The range of outcomes and outcome measurement instruments collected in multisectoral community-based obesity prevention interventions in children: A systematic review.

Sultana, Marufa / Nichols, Melanie / Jacobs, Jane / Karacabeyli, Derin / Allender, Steven / Novotny, Rachel / Brown, Vicki

Obesity reviews : an official journal of the International Association for the Study of Obesity

2024 Volume 25, Issue 6, Page(s) e13731

Abstract: Multicomponent and multisectoral community-based interventions (CBIs) have proven potential in preventing overweight and obesity in children. Synthesizing evidence on the outcomes collected and reported in such CBIs is critical for the evidence of ... ...

Abstract	Multicomponent and multisectoral community-based interventions (CBIs) have proven potential in preventing overweight and obesity in children. Synthesizing evidence on the outcomes collected and reported in such CBIs is critical for the evidence of effectiveness and cost-effectiveness. This systematic review aimed to identify the range of outcomes and outcome measurement instruments collected and reported in multisectoral and multicomponent CBIs for obesity prevention in children. A systematic search updated an existing review and extended the search to 11 academic databases (2017-2023) and gray literature. Outcomes were classified into outcome domains, and common measurement instruments were summarized. Seventeen outcome domains from 140 unique outcomes were identified from 45 included interventions reported in 120 studies. The most frequently collected outcome domains included anthropometry and body composition (91% of included interventions), physical activity (84%), dietary intake (71%), environmental (71%), and sedentary behavior (62%). The most frequently collected outcomes from each of these domains included body mass index (89%), physical activity (73%), fruit and vegetable intake (58%), school environment (42%), and screen time (58%). Outcome measurement instruments varied, particularly for behavioral outcomes. Standardization of reported outcomes and measurement instruments is recommended to facilitate data harmonization and support quantifying broader benefits of CBIs for obesity prevention.
MeSH term(s)	Humans ; Pediatric Obesity/prevention & control ; Child ; Exercise ; Outcome Assessment, Health Care ; Health Promotion/methods
Language	English
Publishing date	2024-03-03
Publishing country	England
Document type	Systematic Review ; Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2147980-X
ISSN	1467-789X ; 1467-7881
ISSN (online)	1467-789X
ISSN	1467-7881
DOI	10.1111/obr.13731
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Article ; Online: Prevalence and socio-demographic distributions of meeting RMI Guidelines for Healthy Living among elementary school children in Majuro, Republic of Marshall Islands: a cross-sectional population-based survey.

Smith, Tanner / Chong, Kar Hau / Cross, Penny / Ipil, Maybelline / Eliou, Pranson / Novotny, Rachel / Okely, Anthony D

The Lancet regional health. Western Pacific

2023 Volume 37, Page(s) 100783

Abstract: Background: Childhood obesity is high in Republic of Marshall Islands (RMI). We report the prevalence and socio-demographic distribution of selected obesity-related risk factors among children in Majuro, RMI.: Methods: Sixteen elementary schools were ...

Abstract	Background: Childhood obesity is high in Republic of Marshall Islands (RMI). We report the prevalence and socio-demographic distribution of selected obesity-related risk factors among children in Majuro, RMI. Methods: Sixteen elementary schools were approached and students and parents in Grades 1, 3, and 5 invited to participate in this cross-sectional population-based survey. Accelerometry and a questionnaire were used to collect data on children's physical activity (PA), sleep, screen time and dietary behaviours. Descriptive statistics and mixed-effects logistic regression were used to examine differences in the proportions of children meeting selected RMI Healthy Living Guidelines by sex, school grade and school sector. Findings: Thirteen schools and 958 children were recruited, of which 892 (52.2% girls; mean age 9.3 ± 1.8 years) provided useable data. Around 90% met the PA, 29% screen time, 13% sleep, 69% sugar-sweetened beverage and 56% highly processed food guidelines. The proportion meeting individual guidelines was higher among children in Grade 1 compared with Grade 5. Being a girl (0.27; 95% CI 0.16, 0.46) was associated with lower odds of meeting the PA recommendation. Compared with children from Grade 1, those in Grade 5 had lower odds of meeting the PA (0.28; 95% CI 0.15, 0.55), screen time (0.60; 95% CI 0.40, 0.89), sleep duration (0.33; 95% CI 0.18, 0.59), sugar-sweetened beverage (0.35; 95% CI 0.23, 0.53), and consumption of highly processed foods recommendations (0.49; 95% CI 0.33, 0.72). Interpretation: While most children in RMI are adequately active, resources are needed to promote healthier levels of screen time, sleep, sugar-sweetened beverage and highly processed food consumption, especially among older children. Funding: This study was funded by World Diabetes Foundation; Canvasback Missions, RMI; NHMRC Australia (APP1176858); Pacific Community.
Language	English
Publishing date	2023-05-03
Publishing country	England
Document type	Journal Article
ISSN	2666-6065
ISSN (online)	2666-6065
DOI	10.1016/j.lanwpc.2023.100783
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Article ; Online: Diet and Acanthosis Nigricans over a Two-Year Period in Children of the Pacific Region.

Taren, Douglas / Alaofè, Halimatou / Yamanaka, Ashley B / Coleman, Patricia / Fleming, Travis / Aflague, Tanisha / Shallcross, Leslie / Wilkens, Lynne / Novotny, Rachel

Nutrients

2023 Volume 15, Issue 12

Abstract: Background: The impact that dietary carbohydrates have on children developing type 2 diabetes remains controversial. Furthermore, there are limited pediatric longitudinal studies on changes in body mass index (BMI) and diet related to the development of ...

Abstract	Background: The impact that dietary carbohydrates have on children developing type 2 diabetes remains controversial. Furthermore, there are limited pediatric longitudinal studies on changes in body mass index (BMI) and diet related to the development of acanthosis nigricans (AN), a risk factor associated with type 2 diabetes. Methods: Two 24 h dietary records were collected for 558 children, 2-8 years of age, at baseline and at a 2-year follow-up. Data on age, sex, BMI, and the presence of AN were also collected at each time point from the Children's Healthy Living Program. Logistic regression was used to determine factors associated with the presence of AN at follow-up. Multinominal regression was used to determine factors associated with changes in AN status. Linear regression was used to measure the associations between changes in dietary intake and in the Burke Score for AN. Results: AN was present in 28 children at baseline and 34 children at follow-up. Adjusting for the presence of AN at baseline, age, sex, study group, baseline BMI, change in BMI z-score, time between assessments, and baseline intake, an increase from baseline for each teaspoon of sugar and serving of carbohydrate-rich food increased the risk for having AN at follow-up by 9% and 8%, respectively ( Conclusions: Added sugar and foods rich in starch were independently associated with the occurrence of AN, suggesting the type of carbohydrates consumed is a factor in AN occurrence.
MeSH term(s)	Humans ; Child ; Diabetes Mellitus, Type 2 ; Acanthosis Nigricans/epidemiology ; Acanthosis Nigricans/etiology ; Diet ; Body Mass Index ; Dietary Carbohydrates ; Starch ; Sugars ; Energy Intake
Chemical Substances	Dietary Carbohydrates ; Starch (9005-25-8) ; Sugars
Language	English
Publishing date	2023-06-12
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2518386-2
ISSN	2072-6643 ; 2072-6643
ISSN (online)	2072-6643
ISSN	2072-6643
DOI	10.3390/nu15122718
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Article ; Online: Food Insecurity and Blood Pressure in a Multiethnic Population.

Ing, Claire Townsend / Clemens, Brettany / Ahn, Hyeong Jun / Kaholokula, Joseph Keawe'aimoku / Hovmand, Peter S / Seto, Todd B / Novotny, Rachel

International journal of environmental research and public health

2023 Volume 20, Issue 13

Abstract: Food insecurity is a social determinant of health and is increasingly recognized as a risk factor for hypertension. Native Hawaiians bear a disproportionate burden of hypertension and known risk factors. Despite this, the relative effects of food ... ...

Abstract	Food insecurity is a social determinant of health and is increasingly recognized as a risk factor for hypertension. Native Hawaiians bear a disproportionate burden of hypertension and known risk factors. Despite this, the relative effects of food insecurity and financial instability on blood pressure have yet to be investigated in this population. This study examines the relative effects of food insecurity and financial instability on blood pressure, controlling for potential confounders in a multiethnic sample. Participants (
MeSH term(s)	Child ; Humans ; Female ; Blood Pressure ; Food Supply ; Diet ; Food Insecurity ; Hypertension/epidemiology
Language	English
Publishing date	2023-06-28
Publishing country	Switzerland
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph20136242
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Article ; Online: Social determinants of health literacy among parents and caregivers in the US-Affiliated Pacific.

Dela Cruz, Rica / Galbreath, Jennifer / Butel, Jean / Yamanaka, Ashley B / Wilkens, Lynne R / Aflague, Tanisha / Coleman, Patricia / Shallcross, Leslie / McFall, Pauline / Novotny, Rachel

Health promotion international

2024 Volume 39, Issue 1

Abstract: Health literacy is understudied in the US-Affiliated Pacific (USAP), where local populations have historically experienced social marginalization and disproportionate health inequities caused by the social determinants of health (SDOH). This cross- ... ...

Abstract	Health literacy is understudied in the US-Affiliated Pacific (USAP), where local populations have historically experienced social marginalization and disproportionate health inequities caused by the social determinants of health (SDOH). This cross-sectional study analyzed several SDOH indicators-acculturation, use of food assistance programs and demographic characteristics (race and ethnicity, household income, primary language spoken at home and educational attainment)-and their relationship to health literacy among 1305 parents/caregivers of young children ages 2-8 years old who participated in the Children's Healthy Living (CHL) program in Alaska, American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Guam, and Hawai'i. Significantly increased odds of low health literacy were found among parents/caregivers with households where a language other than English was the primary language compared to English-only households (OR = 1.86, 95% CI = 1.22, 2.82), household income of <$35 000 compared to ≥$35 000 (OR = 2.15, 95% CI = 1.13, 4.07), parents/caregivers of Asian children compared to parents/caregivers of White children (OR = 2.68, 95% CI = 1.05, 6.84), parent/caregivers with less than or some high school education compared to high school completion (1st- to 8th-grade OR = 4.46, 95% CI = 2.09, 9.52; 9th- to 11th-grade OR 1.87, 95% CI = 1.06, 3.30) and parent/caregivers with acculturation status defined as marginalized as compared to integrated (OR = 2.31, 95% CI = 1.09, 4.86). This study indicates that some USAP parents/caregivers may lack the capacity to acquire health information, utilize health resources, and navigate health decision making. Future efforts to understand and improve health literacy in the USAP should be population specific, thoroughly assess personal and organizational health literacy, and inventory community health care capacity.
MeSH term(s)	Child ; Humans ; Child, Preschool ; Cross-Sectional Studies ; Caregivers/education ; Social Determinants of Health ; Health Literacy ; Parents
Language	English
Publishing date	2024-01-27
Publishing country	England
Document type	Journal Article
ZDB-ID	1027448-0
ISSN	1460-2245 ; 0957-4824
ISSN (online)	1460-2245
ISSN	0957-4824
DOI	10.1093/heapro/daae002
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Article ; Online: Acculturation and Health Status in the Children's Healthy Living Program in the Pacific Region.

Sparks, Kalanikiekie S / Fialkowski, Marie K / Dela Cruz, Rica / Grandinetti, Andrew / Wilkens, Lynne / Banna, Jinan C / Bersamin, Andrea / Paulino, Yvette / Aflague, Tanisha / Coleman, Patricia / Deenik, Jonathan / Fleming, Travis / Novotny, Rachel

International journal of environmental research and public health

2024 Volume 21, Issue 4

Abstract: Acculturation/enculturation has been found to impact childhood health and obesity status. The objective of this study is to use cross-sectional data to examine the association between proxies of adult/caregiver acculturation/enculturation and child ... ...

Abstract	Acculturation/enculturation has been found to impact childhood health and obesity status. The objective of this study is to use cross-sectional data to examine the association between proxies of adult/caregiver acculturation/enculturation and child health status (Body Mass Index [BMI], waist circumference [WC], and acanthosis nigricans [AN]) in the U.S.-Affiliated Pacific Islands (USAPI), Alaska, and Hawai'i. Study participants were from the Children's Healthy Living (CHL) Program, an environmental intervention trial and obesity prevalence survey. Anthropometric data from 2-8 year olds and parent/caregiver questionnaires were used in this analysis. The results of this study (n = 4121) saw that those parents/caregivers who identified as traditional had children who were protected against overweight/obesity (OWOB) status and WC > 75th percentile (compared to the integrated culture identity) when adjusted for significant variables from the descriptive analysis. AN did not have a significant association with cultural classification. Future interventions in the USAPI, Alaska, and Hawai'i may want to focus efforts on parents/caregivers who associated with an integrated cultural group as an opportunity to improve health and reduce child OWOB prevalence.
MeSH term(s)	Humans ; Child ; Female ; Acculturation ; Male ; Cross-Sectional Studies ; Child, Preschool ; Health Status ; Hawaii/epidemiology ; Child Health ; Adult ; Body Mass Index ; Pacific Islands/epidemiology ; Pediatric Obesity/epidemiology ; Pediatric Obesity/ethnology
Language	English
Publishing date	2024-04-06
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph21040448
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Article ; Online: Proportion and Correlates of Children in the US-Affiliated Pacific Region Meeting Sleep, Screen Time, and Physical Activity Guidelines.

Ryan, Sarah T / Okely, Anthony D / Chong, Kar Hau / Stanley, Rebecca M / Randle, Melanie / Waqa, Gade / Yamanaka, Ashley B / Guerrero, Rachael Leon / Coleman, Patricia / Shallcross, Leslie / Wilkens, Lynne R / Deenik, Jonathan L / Novotny, Rachel

Journal of physical activity & health

2024 , Page(s) 1

Abstract: Introduction: Limited data on 24-hour movement behaviors of children aged 5-8 years exist globally. We describe the prevalence and sociodemographic associations of meeting physical activity (PA), sedentary recreational screen time (ST), and sleep ... ...

Abstract	Introduction: Limited data on 24-hour movement behaviors of children aged 5-8 years exist globally. We describe the prevalence and sociodemographic associations of meeting physical activity (PA), sedentary recreational screen time (ST), and sleep guidelines among children from 11 jurisdictions in the US-Affiliated Pacific region. Methods: Cross-sectional representative data from 1192 children aged 5-8 years living in the US-Affiliated Pacific region were drawn from the baseline 2012-2014 Children's Healthy Living Program. Sleep and moderate- to vigorous-intensity PA were calculated from accelerometry. ST and sociodemographic data were collected from caregiver surveys. The percentage of children meeting the Asia-Pacific 24-hour movement guidelines for PA (≥60 min/d of moderate- to vigorous-intensity PA), sleep (≥9 and ≤ 11 h/d) and ST (≤2 h/d) were calculated. Generalized linear mixed models were used to examine associations with adiposity and sociodemographic variables. Results: Twenty-seven percent (95% confidence interval, 24.6-30.0) of children met integrated guidelines; 98% (96.2-98.0) met PA, 78% (75.4-80.0) met sleep, and 35% (32.6-38.0) met ST guidelines. Females (adjusted odds ratio = 1.40 [95% confidence interval, 1.03-1.91]) and those living in lower-middle-income jurisdictions (2.29 [1.49-3.54]) were more likely to meet ST guidelines. Overweight children (0.62 [0.40-0.96]), those aged 8 years (0.39 [0.22-0.69]), and children with caregivers of an education level of high school or beyond (0.44 [0.29-0.68]) were less likely to achieve ST guidelines. Children from midrange annual household incomes were less likely to meet combined guidelines (0.60 [0.39-0.92]). Conclusions: Three-quarters of children are not meeting integrated Asia-Pacific 24-hour movement guidelines. Future strategies for reducing ST and increasing integrated guidelines compliance are needed.
Language	English
Publishing date	2024-03-26
Publishing country	United States
Document type	Journal Article
ISSN	1543-5474
ISSN (online)	1543-5474
DOI	10.1123/jpah.2023-0463
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Article: Associations between Cultural Identity, Household Membership and Diet Quality among Native Hawaiian, Pacific Islander, and Filipino Infants in Hawai'i.

Kai, Jessie / Chen, John J / Braun, Kathryn L / Kaholokula, Joseph Keaweʻaimoku / Novotny, Rachel / Boushey, Carol J / Fialkowski, Marie K

Children (Basel, Switzerland)

2022 Volume 9, Issue 1

Abstract: Public health efforts to reduce diet-related health disparities experienced by indigenous peoples could be enhanced by efforts to improve complementary infant feeding practices. The latter is possible through interventions informed by cultural ... ...

Abstract	Public health efforts to reduce diet-related health disparities experienced by indigenous peoples could be enhanced by efforts to improve complementary infant feeding practices. The latter is possible through interventions informed by cultural determinants. This cross-sectional secondary analysis explored possible determinants of the complementary feeding practices of Native Hawaiian, Pacific Islander, and/or Filipino infants (NHPIF) in Hawai'i, ages 3-12 months. The objective was to determine the association between caregiver cultural identity and infant household membership with indicators of infant diet healthfulness. The cultural identities, infant household memberships, early infant feeding practices and additional demographic information (infant age and sex, household income) were assessed via an online questionnaire. Surrogate reporting of the infants' diets over four days was evaluated using an image-based mobile food record (mFR). Data collected by the mFR were evaluated to derive the World Health Organization's minimum dietary diversity (MDD) indicator and food group consumption. Data were summarized by descriptive statistics and analyzed using multivariate linear and logistic regressions. Seventy infant participants, ages 3-12 months, and their primary caregivers completed the study. Of these, there were 56 infant participants between the age of 6-12 months. Approximately 10% of infants, ages 6-12 months, met MDD for all four days. Meeting MDD and the number of food groups consumed were significantly associated with age. Caregiver cultural identity, infant household membership and infant sex had non-significant associations with indicators of infant diet quality. Findings inform the influences shaping dietary patterns of Native Hawaiian, Pacific Islander and Filipino infants in Hawai'i.
Language	English
Publishing date	2022-01-02
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2732685-8
ISSN	2227-9067
ISSN	2227-9067
DOI	10.3390/children9010048
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Article ; Online: Prediction of breast cancer risk among women of the Mariana Islands: the BRISK retrospective case-control study.

Shvetsov, Yurii B / Wilkens, Lynne R / White, Kami K / Chong, Marie / Buyum, Arielle / Badowski, Grazyna / Leon Guerrero, Rachael T / Novotny, Rachel

BMJ open

2022 Volume 12, Issue 12, Page(s) e061205

Abstract: Objectives: To develop a breast cancer risk prediction model for Chamorro and Filipino women of the Mariana Islands and compare its performance to that of the Breast Cancer Risk Assessment Tool (BCRAT).: Design: Case-control study.: Setting: ... ...

Abstract	Objectives: To develop a breast cancer risk prediction model for Chamorro and Filipino women of the Mariana Islands and compare its performance to that of the Breast Cancer Risk Assessment Tool (BCRAT). Design: Case-control study. Setting: Clinics/facilities and other community-based settings on Guam and Saipan (Northern Mariana Islands). Participants: 245 women (87 breast cancer cases and 158 controls) of Chamorro or Filipino ethnicity, age 25-80 years, with no prior history of cancer (other than skin cancer), residing on Guam or Saipan for at least 5 years. Primary and secondary outcome measures: Breast cancer risk models were constructed using combinations of exposures previously identified to affect breast cancer risk in this population, population breast cancer incidence rates and all-cause mortality rates for Guam. Results: Models using ethnic-specific relative risks performed better than those with relative risks estimated from all women. The model with the best performance among both ethnicities (the Breast Cancer Risk Model (BRISK) model; area under the receiver operating characteristic curve (AUC): 0.64 and 0.67 among Chamorros and Filipinos, respectively) included age at menarche, age at first live birth, number of relatives with breast cancer and waist circumference. The 10-year breast cancer risk predicted by the BRISK model was 1.28% for Chamorros and 0.89% for Filipinos. Performance of the BCRAT was modest among both Chamorros (AUC: 0.60) and Filipinos (AUC: 0.55), possibly due to incomplete information on BCRAT risk factors. Conclusions: The ability to develop breast cancer risk models for Mariana Islands women is constrained by the small population size and limited availability of health services and data. Nonetheless, we have demonstrated that breast cancer risk prediction models with adequate discriminatory performance can be built for small populations such as in the Mariana Islands. Anthropometry, in particular waist circumference, was important for estimating breast cancer risk in this population.
MeSH term(s)	Female ; Humans ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Risk ; Breast Neoplasms/epidemiology ; Case-Control Studies ; Retrospective Studies ; Micronesia/epidemiology ; Risk Factors ; Risk Assessment
Language	English
Publishing date	2022-12-09
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-061205
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Article ; Online: Growth in bone and body size among Asian and white girls in the Female Adolescent Maturation (FAM) study.

Novotny, Rachel / Davis, James

Archives of osteoporosis

2015 Volume 10, Page(s) 31

Abstract: Rationale: This study intends to identify differences in growth of Asian and White girls.: Main result: Asian girls gained bone at similar rates to White girls. Physical activity was important to bone growth. Ethnic differences remained after ... ...

Abstract	Rationale: This study intends to identify differences in growth of Asian and White girls. Main result: Asian girls gained bone at similar rates to White girls. Physical activity was important to bone growth. Ethnic differences remained after adjusting for physical activity, demographics, and diet. Significance: Physical activity can improve bone gain. Purpose: The purpose of this study is to examine differences in body size and bone growth of Asian, White, and Asian-White Mixed girls. Methods: Three prospective examinations of 99 Asian, 73 White, and 63 Mixed Asian and White girls, with a mean age of 11.0 years at enrollment were performed. Calcaneal bone mass, skeletal breadths, and body fat were measured. Physical activity, diet, and birth size were reported. The analyses examined the extent that body dimensions and bone size changed over time by demographic, diet, physical activity, body, and bone size parameters. Results: White children were the most physically active yet had lower calcaneal ultrasound values for speed of sound (SOS). Based on regression models, bone mass, and subscapular skinfold thickness were greater in Asian girls compared to White and Asian-White Mixed girls at age 10 years. Asian-White Mixed girls had greater BMI compared to Asian or White girls. Asian girls gained body size more slowly than White girls, but changes in bone parameters did not differ significantly; Asian-White Mixed girls gained abdomen, hip, and weight more slowly than White girls. Among all girls, SOS and broadband ultrasound attenuation (BUA) increased significantly by level of physical activity before 12 years, but not after. Conclusions: Asian girls had more upper body (subscapular) fat at age 10 years and gained height and hip and abdomen circumferences more slowly than Asian-White and White girls. Asian girls had greater bone SOS and BUA at age 10 years but gained bone at similar rates to White girls. Physical activity was especially important to bone growth before age 12 years. However, ethnic differences remained after adjusting for physical activity, demographic, and dietary factors.
MeSH term(s)	Adipose Tissue/growth & development ; Adolescent ; Aging/ethnology ; Anthropometry ; Asian Continental Ancestry Group/statistics & numerical data ; Body Size/physiology ; Body Weight/physiology ; Bone Density ; Bone Development/physiology ; Calcaneus/diagnostic imaging ; Child ; Child Nutritional Physiological Phenomena/ethnology ; Child, Preschool ; Diet/ethnology ; European Continental Ancestry Group/statistics & numerical data ; Feeding Behavior/ethnology ; Female ; Humans ; Motor Activity/physiology ; Prospective Studies ; Ultrasonography
Language	English
Publishing date	2015
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2253231-6
ISSN	1862-3514 ; 1862-3522
ISSN (online)	1862-3514
ISSN	1862-3522
DOI	10.1007/s11657-015-0234-3
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