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Tan X, Xie H, Wang D. Nutrition and Physical Activity Counseling by General Practitioners in China. Risk Manag Healthc Policy 2023; 16:2151-2162. [PMID: 37868022 PMCID: PMC10588712 DOI: 10.2147/rmhp.s427481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction To reduce unhealthy lifestyles in China, it is critical to implement effective strategies. Counseling provided by physicians is important for assisting patients in improving their lifestyles, and general practitioners (GPs) are the main providers of lifestyle counseling to patients. However, few studies have focused on the lifestyle counseling practices by GPs in China, particularly in regard to nutrition and physical activity. Objective The aims of this study are: (i) to examine the current practice of Chinese GPs in counseling patients regarding nutrition and physical activity; (ii) to understand the common barriers to such counseling by Chinese GPs; and (iii) to study the association between GPs' personal lifestyle choices and their practices in lifestyle counseling. Methods A cross-sectional, self-reported online questionnaire was conducted among GPs in Hunan province, China. A total of 198 GPs completed the questionnaire. Results The majority of GPs provide nutrition and physical activity counseling to less than 40% of their patients, spending less than three minutes per counseling session. The main reported barriers to counseling on nutrition and physical activity are inadequate time and a lack of knowledge or experience. GPs primarily acquire knowledge through medical books and journals, followed by science popularization. Furthermore, GPs who maintain healthier lifestyle habits, possess a better understanding of lifestyle guidelines, conduct longer office visits, and exhibit higher self-efficacy are more likely to provide counseling to patients. Conclusion This study highlights the need for improvement in nutrition and physical activity counseling among Chinese GPs. GPs' personal nutrition and physical activity habits may measurably influence their counseling practice. We recommend that GPs themselves adopt healthier lifestyle habits to potentially improve their counseling practice. Moreover, proactive measures should be taken to assist GPs in overcoming barriers encountered with lifestyle counseling.
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Affiliation(s)
- Xian Tan
- Hengyang Medical School, University of South China, Hengyang, Hunan, People's Republic of China
- Institute for Future Sciences, University of South China, Changsha, Hunan, People's Republic of China
| | - Hebin Xie
- The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, People's Republic of China
| | - Danling Wang
- Hengyang Medical School, University of South China, Hengyang, Hunan, People's Republic of China
- Institute for Future Sciences, University of South China, Changsha, Hunan, People's Republic of China
- The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan, People's Republic of China
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Alamri AS, Al-Otaibi FS, Alzahrani AO, Alharthi AS, Alfaran RM, Alzahrani AS. Lifestyle Assessment of Primary Healthcare Physicians in Taif, Saudi Arabia in the Year 2022. Cureus 2023; 15:e37323. [PMID: 37182051 PMCID: PMC10167881 DOI: 10.7759/cureus.37323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
Objective This study aims to evaluate primary healthcare physicians' lifestyles to promote their well-being and improve care quality for the general population. Methods This cross-sectional quantitative study was conducted on primary healthcare physicians in Taif, Kingdom of Saudi Arabia (KSA), using self-administered questionnaires. Results We included 206 participants aged 26-66. Most participants were 35 years old or younger (67%), male (62.1%), and residents (52.4%). Of all participants, 49.5% held a Bachelor's degree, 40.8% had completed their board certificate or Ph.D., and 69.9% had at least 10 years of experience. Of all participants, 16.5% and less than 9% reported having hypercholesterolemia and other comorbidities, respectively. More than 50% were physically inactive, 26.2% were moderately inactive, and 17.4% were moderately active or active individuals. Physical activity was significantly associated with job titles (p < 0.018). The qualification was associated with dietary score (p = 0.034), and 42.7% of participants were in need of diet change. About a quarter (25.2%) were smokers, and 92.3% of them smoked daily. Male participants were associated with a greater likelihood of smoking (p < 0.001). Overall, 41.7% were overweight, and 25.7% were obese. Increased BMI was associated with older age and male gender (p < 0.001 and p < 0.002, respectively), as well as the title of the physician and years of experience (p < 0.001 and p < 0.002, respectively). Conclusion Participants' unhealthy lifestyles indicate the need to establish measures to promote healthy lifestyles among physicians.
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Affiliation(s)
- Abdullah S Alamri
- Department of Preventive Medicine, Prince Mansour Military Hospital, Taif, SAU
| | - Fawaz S Al-Otaibi
- Department of Family Medicine, Alhada Armed Forces Hospital, Taif, SAU
| | - Ali O Alzahrani
- Department of Family Medicine, Alhada Armed Forces Hospital, Taif, SAU
| | | | - Raed M Alfaran
- Department of Family Medicine, Prince Mansour Military Hospital, Taif, SAU
| | - Ahmed S Alzahrani
- Department of Preventive Medicine, Prince Mansour Military Hospital, Taif, SAU
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Drost JM, Lucas PH, Patchett DC, Hatley MR, Johnson DC, Scales R. Introducing Lifestyle Medicine Within the Mayo Clinic Alix School of Medicine in Arizona. Am J Lifestyle Med 2021; 15:612-618. [PMID: 34916881 PMCID: PMC8669907 DOI: 10.1177/15598276211007824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 03/17/2021] [Indexed: 01/15/2023] Open
Abstract
Purpose: High-value care is becoming increasingly important as the United States shifts toward a more sustainable health care system. Lifestyle medicine (LM) may be the highest-value model of care. Surprisingly, however, it is taught in a minority of medical schools. In this article, we describe a pilot project of introducing a brief LM course taught within the Mayo Clinic Alix School of Medicine in Arizona. The main purpose of the course was to introduce the students to LM as a specialty practice and to provide students with foundational knowledge of the pillars of LM. Results: Students reported improved personal health habits and increased confidence in LM competencies.
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Affiliation(s)
| | - Pauline H. Lucas
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Arizona, Phoenix, Arizona
| | - David C. Patchett
- Department of Family Medicine, Mayo Clinic Arizona, Phoenix, Arizona
| | - Melissa R. Hatley
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Arizona, Phoenix, Arizona
| | | | - Robert Scales
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona
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Zollinger JM, Katuli SD. Knowledge, Attitude, and Practice of Orthopedic Manual Physical Therapists Toward Lifestyle Screening and Education: A Descriptive Study. Am J Lifestyle Med 2021. [DOI: 10.1177/15598276211028557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction. Lifestyle-focused rehabilitation plans need to become part of the standard system of care for the treatment of chronic diseases. To achieve this goal, the KAP of rehabilitation professionals toward lifestyle medicine needs to be understood. This study investigated the niche of orthopedic manual physical therapy and is purposed as a foundational model for continued research. Method. A survey instrument was designed to investigate the KAP of orthopedic manual physical therapists toward lifestyle screening and education. Results. There were 155 participants of which 58.1-72.3% reported frequently talking to their patients about lifestyle topics, while 78.1-80.6% felt highly confident and competent while doing so. Additionally, 92.9-94.8% thought that lifestyle screening and education was important and that physical therapists should be doing it. Participants discussed exercise most frequently with their patients (96.1%) and alcohol the least (12.9%). Participants with advanced degrees (ie, PhD or DSc) had significantly higher Practice (MΔ= −3.755, P = .001) and Knowledge (MΔ= −4.14904, P = .020) ratings than those with entry-level physical therapy degrees. Conclusion. There was strong acceptance of lifestyle screening and education in orthopedic manual physical therapy with an emphasis on exercise. This study provides a foundational basis for continued research.
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Affiliation(s)
- Jillian M. Zollinger
- From the School of Rehabilitation Sciences, Andrews University, Berrien Springs (JMZ, SDK), Michigan
| | - Sozina D. Katuli
- From the School of Rehabilitation Sciences, Andrews University, Berrien Springs (JMZ, SDK), Michigan
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Boka BC, Traore F, Niamkey EJT, Ekou KA, Coulibaly I, Dah C. [Prescribing habits of physical activity by cardiac physicians in Côte d'Ivoire]. Ann Cardiol Angeiol (Paris) 2021; 70:25-32. [PMID: 32778386 DOI: 10.1016/j.ancard.2020.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/18/2020] [Accepted: 03/30/2020] [Indexed: 06/11/2023]
Abstract
Regular physical activity (PA) has multiple health benefits that contribute to the prevention and management of many non-communicable diseases such as cardiovascular disease. However, a large proportion of the world's population is not active enough to benefit its health. Despite the potential of physicians to increase the level of PA practice in both primary and secondary prevention, there appears to be little intervention in this direction during medical consultations. What is the situation in Côte d'Ivoire? We conducted a prospective study that focused on the description and analysis of the practice of PA awareness and prescribing of Côte d'Ivoire cardiologist physicians and to examine the extent to which their socio-cultural characteristicsdemographics, their personal PA practices, barriers and needs influenced their PA prescribing in primary or secondary prevention settings. The results showed a high rate of overweight and obesity (64 %) and a low level of PA (40 %). We noted a high rate of locating (90 %) and advising AP (92 %). High blood pressure (98 %) and obesity (94 %) were the major conditions for which physicians prescribed PA. They were mainly about walking (94 %) and through oral counselling (80 %). Among the brakes identified were mainly the lack of knowledge about PA prescribing, lack of consultation time and lack of motivation of patients in 48 %, 44 % and 34 % of cases respectively. In terms of the needs expressed to promote the prescription of PA, it was mainly the personal conviction of the physician of the interest of prescribing an PA (80 %), of the organization of training on the prescription of PA (78 %) and completion of patient handouts (56 %).
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Affiliation(s)
- B C Boka
- Institut de cardiologie d'Abidjan, Abidjan, Cote d'Ivoire.
| | - F Traore
- Institut de cardiologie d'Abidjan, Abidjan, Cote d'Ivoire
| | - E J T Niamkey
- Institut de cardiologie d'Abidjan, Abidjan, Cote d'Ivoire
| | - K A Ekou
- Institut de cardiologie d'Abidjan, Abidjan, Cote d'Ivoire
| | - I Coulibaly
- Institut de cardiologie d'Abidjan, Abidjan, Cote d'Ivoire
| | - C Dah
- Laboratoire de physiologie, médecine du sport, CHU de Cocody, Cocody, Cote d'Ivoire
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Aggarwal M, Singh Ospina N, Kazory A, Joseph I, Zaidi Z, Ataya A, Agito M, Bubb M, Hahn P, Sattari M. The Mismatch of Nutrition and Lifestyle Beliefs and Actions Among Physicians: A Wake-Up Call. Am J Lifestyle Med 2019; 14:304-315. [PMID: 32477033 DOI: 10.1177/1559827619883603] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background. There is a notable lack of education on nutrition and physical activity guidelines in medical schools and postgraduate training. The purpose of this study is to assess the nutrition and exercise knowledge and personal health behaviors of physicians in the Department of Medicine at a large academic center. Methods. We conducted a survey study in the Department of Medicine at the University of Florida in 2018. The survey instrument included questions on demographics, medical comorbidities, baseline perception of health and fitness, and knowledge of nutrition concepts. The Duke Activity Status Index assessed activity/functional capacity and the validated 14-point Mediterranean Diet Survey evaluated dietary preferences. Data were analyzed using descriptive statistics and the χ2 test was used to perform comparisons between groups. Statistical significance was determined at P < .05. Results. Out of 331 eligible physicians, 303 (92%) participated in the study. While all respondents agreed that eating well is important for health, less than a fourth followed facets of a plant-based Mediterranean diet. Only 25% correctly identified the American Heart Association recommended number of fruit and vegetable servings per day and fewer still (20%) were aware of the recommended daily added sugar limit for adults. Forty-six percent knew the American Heart Association physical activity recommendations and 52% reported more than 3 hours of personal weekly exercise. Reported fruit and vegetable consumption correlated with perceived level of importance of nutrition as well as nutrition knowledge. Forty percent of physicians (102/253) who considered nutrition at least somewhat important reported a minimum of 2 vegetable and 3 fruit servings per day, compared with 7% (3/44) of those who considered nutrition less important ("neutral," "not important," or "important, but I don't have the time to focus on it right now"; P < .0001). Conclusions. This study highlights the need for significant improvement in education of physicians about nutrition and physical activity and need for physicians to focus on good personal health behaviors, which may potentially improve with better education.
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Affiliation(s)
- Monica Aggarwal
- Division of Cardiology, University of Florida, Gainesville, Florida
| | | | - Amir Kazory
- Division of Cardiology, University of Florida, Gainesville, Florida
| | - Islande Joseph
- Division of Cardiology, University of Florida, Gainesville, Florida
| | - Zareen Zaidi
- Division of Cardiology, University of Florida, Gainesville, Florida
| | - Ali Ataya
- Division of Cardiology, University of Florida, Gainesville, Florida
| | - Markus Agito
- Division of Cardiology, University of Florida, Gainesville, Florida
| | - Michael Bubb
- Division of Cardiology, University of Florida, Gainesville, Florida
| | - Paulette Hahn
- Division of Cardiology, University of Florida, Gainesville, Florida
| | - Maryam Sattari
- Division of Cardiology, University of Florida, Gainesville, Florida
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Ozanne E, Karliner LS, Tice JA, Haas JS, Livaudais-Toman J, Pasick RJ, Kaplan CP. An Intervention Tool to Increase Patient-Physician Discussion of Lifestyle Risk Factors for Breast Cancer. J Womens Health (Larchmt) 2019; 28:1468-1475. [PMID: 30222505 PMCID: PMC7207052 DOI: 10.1089/jwh.2018.7026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Risk assessment and discussion of lifestyle in primary care are crucial elements of breast cancer prevention and risk reduction. Our objective was to evaluate the impact of a breast cancer risk assessment and education tool on patient-physician discussion of behaviors and breast cancer risk. Materials and Methods: We conducted a randomized controlled trial with an ethnically and linguistically diverse sample of women, ages 40-74, from two primary care practices. Intervention participants completed a tablet computer-based Breast Cancer Risk Assessment and Education (BreastCARE) intervention in the waiting room before a scheduled visit. Both patients and physicians received an individualized risk report to discuss during the visit. Control patients underwent usual care. Telephone surveys assessed patient-physician discussion of weight, exercise, and alcohol use 1 week following the visit. Results: Among the 1235 participants, 27.7% (161/580) intervention and 22.3% (146/655) usual-care patients were high risk for breast cancer. Adjusting for clustering by physician, the intervention increased discussions of regular exercise (odds ratios [OR] = 1.94, 1.50-2.51) and weight (OR = 1.56, 1.23-1.96). There was no effect of the intervention on discussion of alcohol. Women with some college education were more likely to discuss their weight than those with high school education or less (OR = 1.75, 1.03-2.96). Similarly, non-English speakers were more likely to discuss their weight compared with English speakers (OR = 2.33, 1.04-5.22). Conclusions: BreastCARE is a feasible risk assessment tool that can successfully promote discussions about modifiable breast cancer risk factors between patients and primary care physicians.
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Affiliation(s)
- Elissa Ozanne
- Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Leah S. Karliner
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
- Multi-Ethnic Health Equity Research Center, University of California San Francisco, San Francisco, California
| | - Jeffrey A. Tice
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Jennifer S. Haas
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer Livaudais-Toman
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Rena J. Pasick
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Celia P. Kaplan
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
- Multi-Ethnic Health Equity Research Center, University of California San Francisco, San Francisco, California
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8
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Hsu DP, Hansen SL, Roberts TA, Murray CK, Mysliwiec V. Predictors of Wellness Behaviors in U.S. Army Physicians. Mil Med 2018; 183:e641-e648. [DOI: 10.1093/milmed/usy059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/20/2018] [Indexed: 01/11/2023] Open
Affiliation(s)
- Daniel P Hsu
- Department of Pediatrics, San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX
- Department of Sleep Medicine, Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Dr. Ste 1, JBSA Lackland AFB, TX
| | - Shana L Hansen
- Department of Pediatrics, San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX
- Department of Sleep Medicine, Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Dr. Ste 1, JBSA Lackland AFB, TX
| | - Timothy A Roberts
- Department of Pediatrics, San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX
| | - Clinton K Murray
- 1st Area Medical Laboratory, 44th Medical Bde, 5116 Bel Air St, Aberdeen Proving Grounds, MD
| | - Vincent Mysliwiec
- Department of Sleep Medicine, Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Dr. Ste 1, JBSA Lackland AFB, TX
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Nutrition Counselling Practices among General Practitioners in Croatia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121499. [PMID: 29207514 PMCID: PMC5750917 DOI: 10.3390/ijerph14121499] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/16/2017] [Accepted: 11/29/2017] [Indexed: 01/07/2023]
Abstract
Chronic non-communicable diseases are a significant public health problem and imbalanced nutrition is one of the most significant risk factor for them. The objective of this study was to examine Croatia’s general practitioners’ nutrition counselling practice and determine the factors that influence such practice. A cross-sectional study was conducted among 444 (17.0%) randomly selected general practitioners (GPs) in Croatia from May to July 2013 via a 32-item anonymous questionnaire. Study showed that 77.0% of participants had provided nutrition counselling exclusively to patients with specific health risks; 18.7% participants had provided nutrition counselling for all patients, regardless of their individual risks, while 4.3% had not provide nutrition counselling. As the most significant stimulating factor for implementing nutrition counselling in their daily work with patients, 55.6% of the participants identified personal interest regarding nutrition and the effects it has on health. The latter factor was more frequently emphasized among female general practitioners (p < 0.001) and general practitioners without chronic diseases (p < 0.001). The most significant barrier for nutrition counselling was lack of time (81.6%). It is necessary to make additional efforts to increase the frequency of nutrition counselling provided by general practitioners in Croatia. The majority of Croatian general practitioners could increase their nutrition counselling practice in order to promote balanced nutrition and improve the overall health status of their patients.
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Obeidat NA, Habashneh MA, Shihab RA, Hawari FI. Are Jordanian primary healthcare practitioners fulfilling their potential in cancer prevention and community health? Findings from a cross-sectional survey. BMJ Open 2017; 7:e015269. [PMID: 28389495 PMCID: PMC5558813 DOI: 10.1136/bmjopen-2016-015269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Primary healthcare practitioners (PHCPs) can contribute to the control of cancer by promoting healthy lifestyles to patients. Given the scarcity of data in the Middle East on this subject, we sought to determine, through a cross-sectional survey, the status of healthy lifestyle promotion by PHCPs (physicians, nurses, midwives, nurse aids) in Jordan. METHODS Building on published studies, an Arabic questionnaire was developed to measure knowledge, perceptions and practices of Jordanian PHCPs with regard to healthy lifestyle counselling. A purposive sample of 20 clinics covering the main regions of Jordan was selected and all PHCPs were asked to complete the questionnaire. RESULTS 322 practitioners (32.3% physicians) responded (a 75.1% response rate). 24.4% of PHCPs were current cigarette smokers (physicians 44.2%). Roughly 58% of physicians and 50% of non-physicians reported advising the majority of patients to quit tobacco, but proportions were lower for providing other services (eg, asking about frequency of tobacco use, inquiring about diet and exercise, providing evidence-based guidance on quitting tobacco or improving diet and activity). Only 8% of the sample reported collectively asking the majority of patients about smoking status, exercise and diet; and providing evidence-based tips to improve these. Among physicians and non-physicians, 14.2% and 40.4% were able to identify the lifestyle-related risk factors associated with breast, colorectal and lung cancer. In multivariable analyses, confidence was the only significant variable associated with provision of counselling on healthy lifestyles. CONCLUSIONS Among Jordanian PHCPs, primary prevention services are underprovided, and data suggest ample room to improve PHCPs' skills and practices.
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Affiliation(s)
- N A Obeidat
- Cancer Control Office, King Hussein Cancer Center, Amman, Jordan
| | - M A Habashneh
- Awareness and Communication Health Directorate, Ministry of Health, Amman, Jordan
| | - R A Shihab
- Cancer Control Office, King Hussein Cancer Center, Amman, Jordan
| | - F I Hawari
- Cancer Control Office, King Hussein Cancer Center, Amman, Jordan
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Fathi A, Ahari SS, Amani F, Nikneghad MR. Study Frequency of Hypertension and Obesity and their Relationship with Lifestyle Factors (Nutritional Habits, Physical Activity, Cigarette Consumption) in Ardabil City Physicians, 2012-13. Indian J Community Med 2016; 41:268-272. [PMID: 27890976 PMCID: PMC5112967 DOI: 10.4103/0970-0218.193332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background and Objective: Few studies have been done on lifestyle of Iranian physicians. As physicians have important role in health promotion, the main goal of the study was to assess the lifestyle of this influential group. Materials and Methods: A cross-sectional descriptive study was conducted on lifestyle of all registered physicians of Ardabil hospitals, Iran, 2012–13. In this research, 225 physicians were selected, by using simple random sampling. Demographic and lifestyle data were obtained by self-report using standard questionnaires, physical activity by official Iranian short-version of the international physical activity questionnaire, and dietary intake by food frequency questionnaire. Weight and height was performed according to standard protocols by using standardized and zero calibrated instruments. Data were analyzed by inferential statistics using Statistical Package for the Social Sciences. 16 software. Results: Findings showed that 8% of participants were hypertensive, 21.3% smoker, 40%–47% inactive, 51.1% overweight, and 18.2% obese. There was a significant relationship between blood pressure and self-reported lifestyle habits (P < 0.05). And 70.7% of males and 74.1% of females had regular 10-min walking each day and moderate activity of males was significantly higher than females (P < 0.05). Food frequency weekly consumption of overweight and obese physicians were significantly higher than normal weight physicians (P < 0.05). Conclusion: Few doctors follow a healthy lifestyle; this may have a negative effect on society attitude about health.
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Affiliation(s)
- Afshin Fathi
- Department of Pediatrics, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Saeid Sadeghieh Ahari
- Department of Community medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Firouz Amani
- Department of Basic Science, Ardabil University of Medical Sciences, Ardabil, Iran
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Track: A randomized controlled trial of a digital health obesity treatment intervention for medically vulnerable primary care patients. Contemp Clin Trials 2016; 48:12-20. [PMID: 26995281 DOI: 10.1016/j.cct.2016.03.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/09/2016] [Accepted: 03/14/2016] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Obesity continues to disproportionately affect medically vulnerable populations. Digital health interventions may be effective for delivering obesity treatment in low-resource primary care settings. METHODS Track is a 12-month randomized controlled trial of a digital health weight loss intervention in a community health center system. Participants are 351 obese men and women aged 21 to 65years with an obesity-related comorbidity. Track participants are randomized to usual primary care or to a 12-month intervention consisting of algorithm-generated tailored behavior change goals, self-monitoring via mobile technologies, daily self-weighing using a network-connected scale, skills training materials, 18 counseling phone calls with a Track coach, and primary care provider counseling. Participants are followed over 12months, with study visits at baseline, 6, and 12months. Anthropometric data, blood pressure, fasting lipids, glucose and HbA1C and self-administered surveys are collected. Follow-up data will be collected from the medical record at 24months. RESULTS Participants are 68% female and on average 50.7years old with a mean BMI of 35.9kg/m(2). Participants are mainly black (54%) or white (33%); 12.5% are Hispanic. Participants are mostly employed and low-income. Over 20% of the sample has hypertension, diabetes and hyperlipidemia. Almost 27% of participants currently smoke and almost 20% score above the clinical threshold for depression. CONCLUSIONS Track utilizes an innovative, digital health approach to reduce obesity and chronic disease risk among medically vulnerable adults in the primary care setting. Baseline characteristics reflect a socioeconomically disadvantaged, high-risk patient population in need of evidence-based obesity treatment.
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Lobelo F, de Quevedo IG. The Evidence in Support of Physicians and Health Care Providers as Physical Activity Role Models. Am J Lifestyle Med 2016; 10:36-52. [PMID: 26213523 PMCID: PMC4511730 DOI: 10.1177/1559827613520120] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 11/05/2013] [Accepted: 11/15/2013] [Indexed: 11/15/2022] Open
Abstract
Physical inactivity constitutes the fourth leading cause of death worldwide. Health care providers (HCPs) should play a key role in counseling and appropriately referring their patients to adopt physical activity (PA). Previous reports suggest that active HCPs are more likely to provide better, more credible, and motivating preventive counseling to their patients. This review summarizes the available evidence on the association between HCPs' personal PA habits and their related PA counseling practices. Based on relevant studies, a snowball search strategy identified, out of 196 studies screened, a total of 47 pertinent articles published between 1979 and 2012. Of those, 23 described HCPs' PA habits and/or their counseling practices and 24 analytic studies evaluated the association between HCPs' personal PA habits and their PA counseling practices. The majority of studies came from the United States (n = 33), and 9 studies included nonphysicians (nurses, pharmacists, and other HCPs). PA levels were mostly self-reported, and counseling was typically assessed as self-reported frequency or perceived self-efficacy in clinical practice. Most (19 out of 24) analytic studies reported a significant positive association between HCPs' PA habits and counseling frequency, with odds ratios ranging between 1.4 and 5.7 (P < .05), in 6 studies allowing direct comparison. This review found consistent evidence supporting the notion that physically active physicians and other HCPs are more likely to provide PA counseling to their patients and can indeed become powerful PA role models. This evidence appears sufficient to justify randomized trials to determine if adding interventions to promote PA among HCPs, also results in improvements in the frequency and quality of PA preventive counseling and referrals, delivered by HCPs, to patients in primary care settings. Future studies should also aim at objectively quantifying the effect of HCPs' PA role-modeling and how it influences patients' PA levels. More evidence from low-to-middle income countries is needed, where 80% of the deaths due to inactivity and related noncommunicable diseases already occur.
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Affiliation(s)
- Felipe Lobelo
- Global Health Promotion Office, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Isabel Garcia de Quevedo
- Global Health Promotion Office, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Stanton R, Rosenbaum S, Kalucy M, Reaburn P, Happell B. A call to action: exercise as treatment for patients with mental illness. Aust J Prim Health 2015; 21:120-5. [DOI: 10.1071/py14054] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 07/01/2014] [Indexed: 12/17/2022]
Abstract
Mental illness affects the lives of a significant number of Australians. In addition to pharmacological and psychological interventions, exercise has demonstrated benefits for people with mental illness including symptom reduction, improved cardiovascular risk profile and improved physical capacity. Unfortunately, evidence shows that clinician-delivered exercise advice is not routinely offered. This is despite patient acceptability for exercise. This article summarises the recent evidence supporting the prescription of exercise for people with mental illness and offers a model incorporating basic exercise prescription, and referral pathways for specialised advice. Current exercise prescription patterns for people with mental illness may not meet patient expectations; therefore, clinicians should consider exercise referral schemes to increase the accessibility of interventions for people with a mental illness.
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Boothe-LaRoche A, Belay B, Sharma AJ. Pregnancy and Postpartum Related Weight Counseling Practices of U.S. Obstetrician-Gynecologists: Results from the Doc Styles Survey, 2010. ACTA ACUST UNITED AC 2014; 3:208. [PMID: 26251763 DOI: 10.4172/2167-0420.1000208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe factors and provider characteristics associated with weight-related counseling practices among U.S. obstetrician-gynecologists (OB/GYNs). METHODS Data were from a 2010 cross-sectional survey of 250 OB/GYNs. The OB/GYNs were asked how often they used pre-pregnancy body mass index (BMI) to determine the appropriate range of gestational weight gain (GWG), counseled pregnant patients on appropriate rate of GWG, and counseled postpartum patients on weight loss or maintenance. They were also asked how often they counseled pregnant and postpartum patients on five weight-related behaviors [consumption of Fruits and Vegetables (FV), Sugar-Sweetened Beverages (SSB), or high-fat or sugary foods, breastfeeding, and Physical Activity (PA)]. RESULTS Less than half of providers reported "always" using BMI to determine appropriate GWG (42%); however 65% reported "always" counseling about appropriate GWG rate. About one-third of providers reported counseling about postpartum weight loss or maintenance (38%).Providers reported counseling pregnant and postpartum patients on all weight-related behaviors only 58% and 27% of the time, respectively. Providers with normal BMI had a greater odds of counseling pregnant patients on FV consumption (adjusted odds ratio (aOR): 3.2; 95% confidence interval (CI): 1.5-7.0) and postpartum patients on FV (aOR: 1.9; 95% CI: 1.1-3.6) compared to overweight/obese providers. Providers who exercised regularly had a greater odds of counseling pregnant and postpartum patients on SSB (aOR: 2.2; 95% CI: 1.1-4.8, and aOR: 2.6; 95% CI: 1.4-4.9, respectively) compared to those providers not exercising regularly. Providers who used podcasts for continuing medical education(CME) had a greater odds of providing counseling on several behaviors, including postpartum patients on FV consumption (aOR: 3.1; 95% CI: 1.3-7.2). CONCLUSIONS Improvements can be made in weight-related counseling practices of OB/GYNs for both pregnant and postpartum patients. Strategies to improve counseling practices, such as podcasts for CME, could be investigated further.
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Affiliation(s)
| | - Brook Belay
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention, USA
| | - Andrea J Sharma
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, USA ; U.S. Public Health Service Commissioned Corps, USA
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Silva SM, Facchini LA, Tomasi E, Piccini R, Thumé E, Silveira DSD, Siqueira FV, Dilélio AS, Nunes BP, Saes MDO. Advice for salt, sugar and fat intake habits among adults: a national-based study. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2013; 16:995-1004. [DOI: 10.1590/s1415-790x2013000400019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 10/28/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION : A healthy diet is recognized as an important strategy for promoting health as an essential part of non-pharmacological therapy of various health problems. OBJECTIVE : To analyze the reported advice for the intake of salt, sugar and fat for the Brazilian adults living in urban areas. METHODOLOGY : National-based cross-sectional study with 12,402 adults interviewed in 100 Brazilian cities. RESULTS : The most prevalent advice was to low fat intake (38%), followed by the advice to low salt and sugar intake (36%) and sugar (29%). The percentage of receiving different advice was similar and more common among women, older people, those with a partner, higher economic class, former smokers, active and in person with physician diagnoses of hypertension, diabetes and overweight. People with white skin color received more advice to eat healthy food, except for the orientation to low salt intake. CONCLUSION : The results show a low prevalence of advice, which configures a missed opportunity to prevent health problems. Although dietary counseling should not be understood only as the transmission of advice regarding some nutrients, it is important to develop actions in order to qualify services and health professionals, allowing the population to have access to qualified information about the benefits of having healthy lifestyles.
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Vuori IM, Lavie CJ, Blair SN. Physical activity promotion in the health care system. Mayo Clin Proc 2013; 88:1446-61. [PMID: 24290119 DOI: 10.1016/j.mayocp.2013.08.020] [Citation(s) in RCA: 171] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/29/2013] [Accepted: 08/27/2013] [Indexed: 12/17/2022]
Abstract
Physical activity (PA) and exercise training (ET) have great potential in the prevention, management, and rehabilitation of a variety of diseases, but this potential has not been fully realized in clinical practice. The health care system (HCS) could do much more to support patients in increasing their PA and ET. However, counseling on ET is not used widely by the HCS owing partly to attitudes but mainly to practical obstacles. Extensive searches of MEDLINE, the Cochrane Library, the Database of Abstracts of Reviews of Effects, and ScienceDirect for literature published between January 1, 2000, and January 31, 2013, provided data to assess the critical characteristics of ET counseling. The evidence reveals that especially brief ET counseling is an efficient, effective, and cost-effective means to increase PA and ET and to bring considerable clinical benefits to various patient groups. Furthermore, it can be practiced as part of the routine work of the HCS. However, there is a need and feasible means to increase the use and improve the quality of ET counseling. To include PA and ET promotion as important means of comprehensive health care and disease management, a fundamental change is needed. Because exercise is medicine, it should be seen and dealt with in the same ways as pharmaceuticals and other medical interventions regarding the basic and continuing education and training of health care personnel and processes to assess its needs and to prescribe and deliver it, to reimburse the services related to it, and to fund research on its efficacy, effectiveness, feasibility, and interactions and comparability with other preventive, therapeutic, and rehabilitative modalities. This change requires credible, strong, and skillful advocacy inside the medical community and the HCS.
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Stanford FC, Durkin MW, Stallworth JR, Blair SN. Comparison of physical activity levels in physicians and medical students with the general adult population of the United States. PHYSICIAN SPORTSMED 2013; 41:86-92. [PMID: 24231600 PMCID: PMC9908370 DOI: 10.3810/psm.2013.11.2039] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Physicians who are physically fit have a higher likelihood of counseling their patients about physical activity. We sought to determine if the amount of physical activity in physicians and medical students differs from the general adult population of the United States and if geographic differences in physical activity levels exist. METHODS A cross-sectional survey was distributed to physicians and medical students throughout the United States to determine their level of physical activity according to US Department of Health and Human Services (DHHS) 2008 guidelines; data were collected from participants from June 2009 through January 2010. Our data set was compared with physical activity data from the Centers for Disease Control and Prevention (CDC) and we used geographic regions defined by the US Census Bureau. RESULTS Our survey respondents contained 631 attending physicians, 159 fellow physicians, 897 resident physicians, and 262 medical students. Only 64.5% of the general US adult population meets DHHS guidelines for physical activity, but 78% of the survey participants fulfilled the guidelines. The percentage of US adults who do not engage in leisure-time physical activity is 25.4% compared with 5.8% of survey participants. Survey respondents in the southern region had the lowest physical activity levels and participants in the western region had the highest levels. CONCLUSION Physicians and medical students engage in more physical activity than the general US adult population. Regional differences in the general population's physical activity also persisted in physicians and medical students. Therefore, physicians who complete less physical activity may be less likely to encourage patients to engage in physical activity in geographic areas where the adult population is less active.
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Affiliation(s)
- Fatima Cody Stanford
- Obesity Medicine and Nutrition Clinical and Research Fellow, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | | | - James Rast Stallworth
- Palmetto Health Richland, University of South Carolina School of Medicine, Columbia, SC
| | - Steven N. Blair
- Departments of Exercise Science and Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
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20
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Hung OY, Keenan NL, Fang J. Physicians' health habits are associated with lifestyle counseling for hypertensive patients. Am J Hypertens 2013; 26:201-8. [PMID: 23382404 DOI: 10.1093/ajh/hps022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) recommended lifestyle interventions, either with or without pharmacologic treatment, for all patients with high blood pressure. The objective of this study is to determine the association of physicians' personal habits with their attitudes and behaviors regarding JNC VII lifestyle modification guidelines. METHODS One thousand primary care physicians completed DocStyles 2010, a voluntary web-based survey designed to provide insight into physician attitudes and behaviors regarding various health issues. RESULTS The respondents' average age was 45.3 years, and 68% were male. In regards to physician behavior, 4.0% smoked at least once a week, 38.6% ate ≥5 cups of fruits and/or vegetables ≥5 days/week, and 27.4% exercised ≥5 days/week. When asked about specific types of advice offered to their hypertensive patients, physicians reported recommending that their patients eat a healthy diet (92.2%), or cut down on salt (96.1%), or attain or maintain a healthy weight (94.8%), or limit the use of alcohol (75.4%), or be physically active (94.4%). Collectively, 66.5% made all 5 lifestyle modification recommendations. Nonsmoking physicians were more likely to recommend each lifestyle intervention to their hypertensive patients. Those who exercised at least 1 day per week were more likely to recommend limiting alcohol use. CONCLUSIONS The probability of recommending all 5 JNC VII interventions was greater for physicians who were nonsmoking and who exercised at least 1 day a week.
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Affiliation(s)
- Olivia Y Hung
- Emory University School of Medicine Internal Medicine Residency Program, Atlanta, GA, USA
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21
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Personal health behaviors and role-modeling attitudes of physical therapists and physical therapist students: a cross-sectional study. Phys Ther 2012; 92:1419-36. [PMID: 22822236 DOI: 10.2522/ptj.20110037] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Physical therapists have been encouraged to engage in health promotion practice. Health professionals who engage in healthy behaviors themselves are more apt to recommend those behaviors, and patients are more motivated to change their behaviors when their health care provider is a credible role model. OBJECTIVE The purpose of this study was to describe the health behaviors and role-modeling attitudes of physical therapists and physical therapist students. DESIGN This study was a descriptive cross-sectional survey. METHODS A national sample of 405 physical therapists and 329 physical therapist students participated in the survey. Participants' attitudes toward role modeling and behaviors related to physical activity, fruit and vegetable consumption, abstention from smoking, and maintenance of a healthy weight were measured. Wilcoxon rank sum tests were used to examine differences in attitudes and behaviors between physical therapists and physical therapist students. RESULTS A majority of the participants reported that they engage in regular physical activity (80.8%), eat fruits and vegetables (60.3%), do not smoke (99.4%), and maintain a healthy weight (78.7%). Although there were no differences in behaviors, physical therapist students were more likely to believe that role modeling is a powerful teaching tool, physical therapist professionals should "practice what they preach," physical activity is a desirable behavior, and physical therapist professionals should be role models for nonsmoking and maintaining a healthy weight. LIMITATIONS Limitations of this study include the potential for response bias and social desirability bias. CONCLUSIONS Physical therapists and physical therapist students engage in health-promoting behaviors at similarly high rates but differ in role-modeling attitudes.
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22
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Use of the internet in the treatment of obesity and prevention of type 2 diabetes in primary care. Proc Nutr Soc 2012; 72:98-108. [PMID: 23098133 DOI: 10.1017/s0029665112002777] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cardiovascular prevention, including emphasising healthy diet and physical activity patterns for weight loss and diabetes prevention, is an important focus of primary care medicine, yet provision of intensive lifestyle counselling in the primary care setting remains uncommon. Online approaches for providing lifestyle counselling are emerging as a new avenue for bringing support to outpatient patient populations. Features of successful programmes include the use of a structured behavioural programme, electronic counselling support and feedback, and uncomplicated user interfaces. Online tools may be used independently or to complement in-person approaches. Limited data also suggest that the internet can be used to support the maintenance of weight loss. In addition, the internet may help overcome various clinical barriers to lifestyle support, including significant time limitations, a need to prioritise acute care and maintain clinical workflow, and the high cost of counselling. Furthermore, the continuity of the primary care patient-provider(s) relationship provides an established source of long-term support which has been difficult to create in other community settings. As the field of online lifestyle counselling matures, nutrition and physical activity experts will face new challenges in providing asynchronous counselling without the assistance of traditional non-verbal communication cues. However, the potential for reaching a wider population in a convenient and accessible manner also creates unique opportunities for providing lifestyle support.
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McTigue KM, Conroy MB, Bigi L, Murphy C, McNeil M. Weight loss through living well: translating an effective lifestyle intervention into clinical practice. DIABETES EDUCATOR 2009; 35:199-204, 208. [PMID: 19321806 DOI: 10.1177/0145721709332815] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To translate the Diabetes Prevention Program (DPP) lifestyle intervention into a clinical setting and evaluate its effectiveness. METHODS The authors implemented a group-based version of the DPP lifestyle curriculum in a large academic medicine practice. It is delivered by a nurse educator over 12 weekly sessions with optional reenrollment, available on a self-pay basis, and implemented using existing clinical resources (eg, electronic medical record referrals, scheduling, conference rooms, communication technology). The program was evaluated using a controlled before-after design, including all patients referred between April 1, 2005, and February 1, 2007. Patients with a body mass index (BMI) >or=25 kg/m(2) were eligible if their primary care providers felt the program was medically appropriate and safe. Change in weight (kg) and frequency of achieving >or=7% weight loss were examined. RESULTS Referred patients were primarily female (84%), with an average age of 49.91 years (SE, 1.46) and average BMI of 39.65 kg/m(2) (SE, 0.73). Among eligible patients, 93% of enrollees and 80% of nonenrollees had follow-up weights recorded within the evaluation window. Over 1 year, mean weight change was -5.19 kg (95% confidence interval [CI], -7.71 to -2.68) among enrollees and +0.21 kg (CI, -1.0 to 1.93) among nonenrollees (P < .001). A >or=7% loss was found for 27% of enrollees and 6% of nonenrollees (P = .001). CONCLUSIONS An evidence-based lifestyle intervention can be effectively translated into the clinical setting. Use of existing resources may facilitate patient flow and minimize cost. This provider-integrated preventive care approach may provide a model for incorporating knowledge from behavioral science into clinical care.
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Affiliation(s)
- Kathleen M McTigue
- The University of Pittsburgh, Department of Medicine, Pittsburgh, Pennsylvania
| | - Molly B Conroy
- The University of Pittsburgh, Department of Medicine, Pittsburgh, Pennsylvania
| | - Lori Bigi
- The University of Pittsburgh, Department of Medicine, Pittsburgh, Pennsylvania
| | - Cynthia Murphy
- The University of Pittsburgh, Department of Medicine, Pittsburgh, Pennsylvania
| | - Melissa McNeil
- The University of Pittsburgh, Department of Medicine, Pittsburgh, Pennsylvania
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Endevelt R, Werner P, Karpati T, Ami LB. Which physicians are best prepared to advise seniors about nutrition? A pilot survey in Israel. JOURNAL OF NUTRITION FOR THE ELDERLY 2009; 28:96-104. [PMID: 19234998 DOI: 10.1080/01639360802634100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Physicians' knowledge and attitudes can profoundly impact the quality of nutritional care provided to older patients. We assessed physicians' knowledge and attitudes concerning nutritional care for older adults and its correlates. Questionnaires were mailed to 898 physicians in the second largest HMO in Israel: the response rate was 26.5%. Questionnaires assessed aspects of geriatric nutrition, such as food choices, functioning, and medical conditions. Results indicated highest knowledge of nutritional issues for family physicians and for those who were younger (<50 age) and female. Although 68% believed it is important for physicians to explain nutritional issues to older patients, this role was also deemed important for dietitians (83%) and nurses (59%). A variety of factors influencing geriatric nutrition, especially functional and medical conditions, were identified; likewise, nutrition was perceived as influencing various health conditions. Although the low response rate limits generalizability, it appears that physicians in this survey recognized the impact of proper nutrition health and take responsibility for explaining nutrition to their older patients.
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Affiliation(s)
- Ronit Endevelt
- Department of Public Health, University of Haifa, Haifa, Israel.
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25
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Terre L. Health Risk Reduction in Women. Am J Lifestyle Med 2008. [DOI: 10.1177/1559827608314179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This review discusses evidence-based perspectives on health risk reduction in women and the implications for gender-informed research, clinical best practices, and public policy.
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Affiliation(s)
- Lisa Terre
- Department of Psychology, University of Missouri-Kansas City,
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Bopp M, Fallon E. Community-based interventions to promote increased physical activity: a primer. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2008; 6:173-187. [PMID: 19382818 DOI: 10.1007/bf03256132] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Current recommendations, based on an abundance of empirical data documenting the impact of physical activity (PA) on preventing morbidity and mortality associated with common chronic diseases, indicate that adults should accumulate 30 minutes of moderate-intensity PA > or =5 days per week. However, worldwide rates of PA remain low, indicating a great need for large-scale implementation of evidence-based PA interventions. We briefly present practical aspects of intervention planning, implementation and evaluation within common community settings. The first stage of intervention planning is formative research, which allows for a better understanding of the elements needed for a successful intervention. Partnering with community settings (schools, worksites, faith-based organizations and healthcare organizations) offers many benefits and the opportunity to reach specific populations. Setting-based approaches allow for multilevel strategies, ranging from individual-based programmes and educational initiatives to physical and social environmental changes. Various settings such as healthcare, worksite, and school- and community-based settings are discussed. Intervention delivery methods and strategies can range, depending on the population and setting targeted, from small-group approaches to mediated methods (e.g. print, telephone, electronic). The final phase of intervention planning and implementation is evaluation. Several objective and subjective methods of PA assessment are available to determine the effectiveness of the intervention. We have highlighted the need for process evaluation of intervention implementation to provide valuable information for the dissemination and sustainability of successful interventions. Although there are numerous considerations for the design, implementation, assessment and evaluation of PA interventions, the potential for positive impact on the overall health of the public indicates the necessity for programmes designed to increase PA.
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Affiliation(s)
- Melissa Bopp
- Department of Kinesiology, Kansas State University, Manhattan, Kansas 66506, USA.
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Gilbert MJ, Fleming MF. Use of enhanced body mass index charts during the pediatric health supervision visit increases physician recognition of overweight patients. Clin Pediatr (Phila) 2007; 46:689-97. [PMID: 17579096 DOI: 10.1177/0009922807300744] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The American Academy of Pediatrics recommends counseling about obesity-specific topics and measuring body mass index (BMI) at all health supervision visits. The authors compared the rates of overweight diagnosis and physician counseling at 2 clinics, one using color-coded BMI charts. The authors interviewed patients and reviewed their charts for differences in diagnosis and counseling rates. They also retrospectively compared age- and physician-matched charts pre- and postintervention, reviewing them for diagnosis of overweight. Intervention patients were more likely to have their BMI discussed (53/77 vs 3/70, P < .0001) and be identified as overweight both prospectively (8/10 vs 1/8, P = .015) and in the authors' matched chart review (8/10 vs 1/10, P = .005). Discussion rates of obesity-related topics such as nutrition, physical activity, and media time did not differ. BMI charts increase overweight patient identification by pediatricians. Further research is needed on the benefits of earlier overweight identification and best counseling methods for promoting healthy weight.
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Karliner LS, Napoles-Springer A, Kerlikowske K, Haas JS, Gregorich SE, Kaplan CP. Missed opportunities: family history and behavioral risk factors in breast cancer risk assessment among a multiethnic group of women. J Gen Intern Med 2007; 22:308-14. [PMID: 17356960 PMCID: PMC1824768 DOI: 10.1007/s11606-006-0087-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Clinician's knowledge of a woman's cancer family history (CFH) and counseling about health-related behaviors (HRB) is necessary for appropriate breast cancer care. OBJECTIVE To evaluate whether clinicians solicit CFH and counsel women on HRB; to assess relationship of well visits and patient risk perception or worry with clinician's behavior. DESIGN Cross-sectional population-based telephone survey. PARTICIPANTS Multiethnic sample; 1,700 women from San Francisco Mammography Registry with a screening mammogram in 2001-2002. PREDICTORS well visit in prior year, self-perception of 10-year breast cancer risk, worry scale. OUTCOMES Patient report of clinician asking about CFH in prior year, or ever counseling about HRB in relation to breast cancer risk. Multivariate models included age, ethnicity, education, language of interview, insurance/mammography facility, well visit, ever having a breast biopsy/follow-up mammography, Gail-Model risk, Jewish heritage, and body mass index. RESULTS 58% reported clinicians asked about CFH; 33% reported clinicians ever discussed HRB. In multivariate analysis, regardless of actual risk, perceived risk, or level of worry, having had a well visit in prior year was associated with increased odds (OR = 2.3; 95% CI 1.6, 3.3) that a clinician asked about CFH. Regardless of actual risk of breast cancer, a higher level of worry (OR = 1.9; 95% CI 1.4, 2.6) was associated with increased odds that a clinician ever discussed HRB. CONCLUSIONS Clinicians are missing opportunities to elicit family cancer histories and counsel about health-related behaviors and breast cancer risk. Preventive health visits offer opportunities for clinicians to address family history, risk behaviors, and patients' worries about breast cancer.
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Affiliation(s)
- Leah S. Karliner
- Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, California USA
| | - Anna Napoles-Springer
- Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, California USA
- UCSF Comprehensive Cancer Center, University of California, San Francisco, California USA
| | - Karla Kerlikowske
- General Internal Medicine Section, Department of Veterans’ Affairs, University of California, San Francisco, California USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA USA
- Department of Medicine, University of California, San Francisco, California USA
| | - Jennifer S. Haas
- Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts USA
| | - Steven E. Gregorich
- Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, California USA
| | - Celia Patricia Kaplan
- Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, California USA
- UCSF Comprehensive Cancer Center, University of California, San Francisco, California USA
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Nicholson WK, Asao K, Brancati F, Coresh J, Pankow JS, Powe NR. Parity and risk of type 2 diabetes: the Atherosclerosis Risk in Communities Study. Diabetes Care 2006; 29:2349-54. [PMID: 17065666 DOI: 10.2337/dc06-0825] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE While high parity is hypothesized to be associated with insulin resistance and type 2 diabetes, few studies have examined this association in diverse racial samples or geographical areas. Our objectives were to estimate the magnitude of association between parity and diabetes and to determine if higher parity is predictive of future risk of diabetes. RESEARCH DESIGN AND METHODS This was a population-based, prospective cohort study of 7,024 Caucasian and African-American women from the Atherosclerosis Risk in Communities study, a prospective epidemiological study of men and women aged 45-64 years, with 9 years of follow-up. Incident diabetes was defined by the 1997 American Diabetes Association diagnostic criteria. Parity was defined as the number of live births (no live births [nulliparity], one to two live births, three to four live births, and five or more live births [grandmultiparity]). Parity and risk of diabetes was estimated for 754 incident cases of diabetes with Cox proportional hazard regression models, adjusting for sociodemographic, clinical, and lifestyle factors and inflammatory markers. RESULTS Incidence rates were highest among women with five or more live births (23/1,000 person-years [95% CI 20.3-26.7]) and lowest among women with one to two live births (11/1,000 person-years [9.6-12.5]). Adjustment indicated that much of the risk was due to sociodemographic factors and higher obesity, but after adjustment for all covariates, grandmultiparity (five or more) was still associated with a 27% increased risk for diabetes (hazard ratio 1.27 [95% CI 1.02-1.57]). CONCLUSIONS Grandmultiparity is predictive of future risk of diabetes after adjustment for confounders.
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Affiliation(s)
- Wanda K Nicholson
- Johns Hopkins School of Medicine, 600 N. Wolfe St., Phipps 247, Baltimore, MD 21287, USA.
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