Nutrition and physical activity interventions to reduce cardiovascular disease risk in health care settings: a quantitative review with a focus on women

What is the effect of a brief intervention to promote physical activity when delivered in a health care setting? A systematic review

ISSUE ADDRESSED

What are the effects of a brief intervention to promote physical activity (PA) delivered in a health care setting other than primary care?

METHODS

MEDLINE, EMBASE, CINAHL and PsycINFO were used to identify randomised controlled trials which evaluated the effect of brief interventions to increase PA, delivered in a health care setting. Review outcomes included subjectively or objectively measured PA, adherence to prescribed interventions, adverse events, health-related quality of life, self-efficacy and stage of change in relation to PA. Where possible, clinically homogenous studies were combined in a meta-analysis.

RESULTS

Twenty-five eligible papers were included. Brief counselling interventions were associated with increased PA compared to control, for both self-reported PA (mean difference 34 minutes/week, 95% confidence intervals [95% CI] 9-60 minutes), and pedometer (MD 1541 steps/day, 95% CI 433-2649) at medium term follow up.

CONCLUSION

Our findings suggest that some brief interventions to increase PA, delivered in the health care setting, are effective at increasing PA in the medium term. There is limited evidence for the long-term efficacy of such interventions. The wide variation in types of interventions makes it difficult to determine which intervention features optimize outcomes. SO WHAT?: Brief counselling interventions delivered in a health care setting may support improved PA. Clinicians working in health care settings should consider the implementation of brief interventions to increase PA in vulnerable patient groups, including older adults and those with chronic illness.

A Comparison of Strategies to Improve Population Diets: Government Policy versus Education and Advice

Different strategies have been utilized in order to improve the healthiness of the population diet. Many interventions employ education, advice, and encouragement (EAE). Those interventions have been carried out in diverse settings and may achieve modest success; the estimated risk of cardiovascular disease is lowered by about 5–15%. An alternative strategy is action policies carried out by the governments. The removal of trans-fatty acids from food is a model for a successful action policy. Other action policies include requiring a substantial reduction in the amount of salt added to processed foods and ordering schools to cease supplying unhealthy food to students. Taxes and subsidies can be used to increase the price of unhealthy foods, such as sugar-rich foods, and reduce the price of healthy foods, such as fruit and vegetables. It is very probable that action policies are more effective than those based on EAE. They are also much more cost-effective.

What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol

INTRODUCTION

Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles. Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels. Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease, disability and higher mortality rates.

METHODS AND ANALYSIS

Systematic searches will be conducted on all relevant databases (eg, PubMed, Scopus, CINAHL, PsycINFO). Studies will be included if they assess interventions aimed at changing physical activity or sedentary behaviour levels in adults (over 18) who are inactive and do not suffer from chronic conditions. Studies must also be randomised controlled trials (RCTs), have a primary outcome of physical activity or sedentary behaviour, and measure outcomes at least 6 months after intervention completion. Studies will be coded using the Behaviour Change Technique (BCT) taxonomy v1 and Template for Intervention Description and Replication (TIDieR) guidelines. 2 reviewers will independently screen full-text articles and extract data on study characteristics, participants, BCTs, intervention features and outcome measures. Study quality will also be assessed independently by 2 reviewers using the Cochrane risk of bias tool. A meta-analysis will be considered if there is sufficient homogeneity across outcomes. GRADE criteria will be used to assess quality of evidence.

DISSEMINATION

This will be the first review to systematically appraise interventions aimed at changing the physical activity or sedentary behaviour of inactive individuals using RCT designs with a 6-month follow-up post-intervention. This review will better inform intervention designers targeting inactive populations and inform the design of a future complex intervention.

REVIEW REGISTRATION NUMBER

This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 17 October 2014 (registration number: CRD42014014321).

The Role of Nutrition and Physical Activity in Cholesterol and Aging

Cholesterol is a precursor of several substances with important biologic activities; however, it is common to associate this molecule only with bad outcomes. This article reviews the cholesterol metabolism, its functions in the human body, its pathogenicity, and its elimination. The modifications in biochemical paths of cholesterol in aging are highlighted. Finally, the role of diet, physical activity, and exercise in cholesterol management is discussed.

Strategic nutrition: a vision for the twenty-first century

It is now widely accepted that poor nutrition plays a major role in the epidemic of various diseases, including obesity, type 2 diabetes and CVD. There has also been much research regarding the role of related factors such as advertising and food prices. Many intervention studies have been carried out where attempts have been made to persuade people to modify their behaviour, such as by making dietary changes, in order to enhance health (health promotion). There has also been much debate on the potential of government policy as a tool for achieving these goals. Various proposals have been made, such as a tax on sugary drinks, the redirection of food subsidies and how the salt content of food can be reduced. However, the great majority of previous papers have considered only single aspects of the topics discussed here. The present paper reviews strategies for improving public health, both health promotion interventions and the use of government policy approaches. Topics discussed include providing advice for the general population and the design of food guides and food labels. This leads to the conclusion that we need an overall strategy that integrates this diverse body of information and formulates a comprehensive action plan. I propose the term ‘strategic nutrition’. The implementation of this plan opens up a path to a major advance in public health.

Methodological quality of meta-analyses on the blood pressure response to exercise: a review

Numerous meta-analyses have been conducted to summarize the growing numbers of trials addressing the effects of exercise on blood pressure (BP), yet it is unclear how well they have satisfied contemporary methodological standards. We applied an augmented version of the Assessment of Multiple Systematic Reviews (AMSTARExBP) scale to 33 meta-analyses retrieved from searches of electronic databases. Qualifying reports used meta-analytic procedures; examined controlled exercise training trials; had BP as a primary outcome; and had exercise or physical activity interventions independently or combined with other lifestyle interventions. AMSTARExBP scores averaged near the middle of the scale (Mean = 56.0% ± 21.4% of total items possible); co-authored and more recent meta-analyses had higher quality scores. Common deficits were failures to disclose full search details (30% did), gauge the quality of included trials (48% did), use duplicate study selection and data extraction (55% did), or incorporate study quality in formulating results (35% did). Nearly all (91%) meta-analyses observed that exercise significantly lowered BP; fewer (58%) found that such effects depended on exercise or patient characteristics but these patterns often conflicted. Meta-analyses are often pillars of clinical recommendations and guidelines, yet only 58% addressed the clinical translations of their findings. In sum, meta-analyses have contributed less than ideally to our understanding of how exercise may impact BP, or how these BP effects may be moderated by patient or exercise characteristics. Future meta-analyses that better satisfy contemporary standards offer considerable promise to understand how and for whom exercise impacts BP.

Intrapersonal, social and physical environmental determinants of moderate-to-vigorous physical activity in working-age women: a systematic review protocol

BACKGROUND

The majority of North American adult females do not meet current physical activity recommendations (150 min of moderate-to-vigorous intensity physical activity (MVPA) per week accrued in ≥10 min bouts) ultimately placing themselves at increased risk of morbidity and mortality. Working-age females face particular challenges in meeting physical activity recommendations as they have multiple demands, including occupational, family and social demands. To develop effective interventions to increase MVPA among working-age females, it is necessary to identify and understand the strongest modifiable determinants influencing these behaviours. Therefore, the objective of this systematic review is to examine the available evidence to identify intrapersonal, social and environmental determinants of MVPA among working-age females.

METHODS/DESIGN

Six electronic databases will be searched to identify all prospective cohort studies that report on intrapersonal, social and/or environmental determinants of MVPA in working-age females. Grey literature sources including theses, published conference abstracts and websites from relevant organizations will also be included. Articles that report on intrapersonal (e.g. health status, self-efficacy, socio-economic status (SES), stress, depression), social environmental (e.g. crime, safety, area SES, social support, climate and capital, policies), and environmental (e.g. weather, workplace, home, neighbourhood, recreation environment, active transportation) determinants of MVPA in a working-age (mean age 18-65 years) female population will be included. Risk of bias will be assessed within and across all included studies using the Tool to Assess Risk of Bias in Cohort Studies and the Grades of Recommendation, Assessment, Development and Evaluation approach. Harvest plots will be used to synthesize results across all determinants, and meta-analyses will be conducted where possible among studies with sufficient homogeneity.

DISCUSSION

This review will provide a comprehensive examination of evidence in this field and will serve to highlight gaps for future research on the determinants of MVPA in working-age females and ultimately inform intervention design.

SYSTEMATIC REVIEW REGISTRATION PROSPERO

CRD42014009750.

Results of the Heart Healthy and Ethnically Relevant Lifestyle trial: a cardiovascular risk reduction intervention for African American women attending community health centers

OBJECTIVES

We evaluated a theory-based lifestyle intervention targeting physical activity and dietary fat intake among African American women at high risk for cardiovascular disease.

METHODS

The Heart Healthy and Ethnically Relevant Lifestyle trial (2005-2008) randomly assigned 266 low-income African American women aged 35 years and older who were patients of South Carolina community health care centers into comprehensive or standard care interventions. Comprehensive participants received standard care (stage-matched provider counseling and assisted goal setting) plus 12 months of telephone counseling and tailored newsletters. Primary outcomes were 6- and 12-month self-reported physical activity and dietary fat intake.

RESULTS

Comprehensive participants were more likely than were standard care participants to decrease total physical activity (odds ratio [OR] = 3.13; 95% confidence interval [CI] = 1.18, 8.25) and increase leisure-time physical activity (OR = 3.82; 95% CI = 1.41, 10.3) at 6 months (no 12-month differences). Mean reductions in Dietary Risk Assessment score occurred in both groups but were greater among comprehensive participants than among standard care participants (6 months, -8.50 vs -5.34; 12 months, -7.16 vs -3.37; P < .001).

CONCLUSIONS

The comprehensive intervention improved women's leisure-time physical activity and dietary fat intake, highlighting a replicable model to help primary care providers implement lifestyle counseling.

Posthospital Heart-Healthy Behaviors in Adults With Comorbid Diabetes

The purpose of these secondary analyses was to examine relationships between patient factors and patient-provider decision-making style (PDM) on heart-healthy behavior changes in 142 adults with diabetes after hospitalization for an acute coronary syndrome (ACS). A clinical trial randomized adults to either control or a telephone coaching intervention. Generalized estimating equations were used to analyze the relationship between patient factors and PDM style on longitudinal postdischarge changes in three heart-healthy behaviors, avoiding high fat foods, weight loss, and increased physical activity. Neither PDM style nor telephone coaching intervention affected heart-healthy behaviors in this population. Although adults with diabetes preferred collaborative patient-provider decision-making, present levels of provider engagement were not sufficient to support behavior change. Results suggest the need for sustained and tailored nursing interventions to facilitate heart-healthy behavior changes in adults with diabetes after ACS hospitalization.

How to promote healthy behaviours in patients? An overview of evidence for behaviour change techniques

To identify the evidence for the effectiveness of behaviour change techniques, when used by health-care professionals, in accomplishing health-promoting behaviours in patients. Reviews were used to extract data at a study level. A taxonomy was used to classify behaviour change techniques. We included 23 systematic reviews: 14 on smoking cessation, 6 on physical exercise, and 2 on healthy diets and 1 on both exercise and diets. None of the behaviour change techniques demonstrated clear effects in a convincing majority of the studies in which they were evaluated. Techniques targeting knowledge (n = 210 studies) and facilitation of behaviour (n = 172) were evaluated most frequently. However, self-monitoring of behaviour (positive effects in 56% of the studies), risk communication (52%) and use of social support (50%) were most often identified as effective. Insufficient insight into appropriateness of technique choice and quality of technique delivery hinder precise conclusions. Relatively, however, self-monitoring of behaviour, risk communication and use of social support are most effective. Health professionals should avoid thinking that providing knowledge, materials and professional support will be sufficient for patients to accomplish change and consider alternative strategies which may be more effective.

Adoption and implementation of physical activity and dietary counseling by community health center providers and nurses

BACKGROUND

Primary care providers are expected to provide lifestyle counseling, yet many barriers exist. Few studies report on adoption and implementation in routine practice. This study reports training, adoption, and implementation of an intervention to promote physical activity (PA) and dietary counseling in community health centers.

METHODS

Providers (n = 30) and nurses (n = 28) from 9 clinics were invited to participate. Adopters completed CD-ROM training in stage-matched, patient-centered counseling and goal setting. Encounters were audio recorded. A subsample was coded for fidelity.

RESULTS

Fifty-seven percent of providers and nurses adopted the program. Provider counseling was seen in 66% and nurse goal setting in 58% of participant (N = 266) encounters, although audio recordings were lower. Duration of provider counseling and nurse goal setting was 4.9 ± 4.5 and 7.3 ± 3.8 minutes, respectively. Most PA (80%) and diet (94%) goals were stage-appropriate. Although most providers discussed at least 1 behavioral topic, some topics (eg, self-efficacy, social support) were rarely covered.

CONCLUSIONS

A sizeable percentage of providers and nurses completed training, rated it favorably, and delivered lifestyle counseling, although with variable fidelity. With low implementation cost and limited office time required, this model has the potential to be disseminated to improve counseling rates in primary care.

Seven-year follow-up of a multiple-health-behavior diabetes intervention

OBJECTIVE

To examine the long-term effects of multiple health-behavior changes from the Mediterranean Lifestyle Program.

METHODS

The randomized trial targeted postmenopausal women with type 2 diabetes (N = 279) at high risk for heart disease. The intervention featured a weekend retreat followed by regular meetings over 24 months to enhance healthful eating, physical activity (PA), stress management, and support behaviors.

RESULTS

Long-term analyses indicated that significant improvements made in the targeted behaviors during the active treatment phase of the study (at 6, 12, and 24 months) were partially maintained during the nontreatment phase of the study, through 5 years postintervention contact for dietary behavior and stress management, and 1-year posttreatment for PA.

CONCLUSIONS

This moderate-intensity group-based intervention produced health behavior changes that tended to plateau or return to baseline levels 1 to 5 years after treatment.

Heart Healthy and Ethnically Relevant (HHER) Lifestyle trial for improving diet and physical activity in underserved African American women

BACKGROUND

African American women are at increased risk for CVD morbidity and mortality relative to white women. Physical inactivity and poor dietary habits are modifiable health behaviors shown to reduce CVD risk. Community health centers have the potential to reach large numbers of African Americans to modify their risk for CVD, yet few lifestyle counseling interventions have been conducted in this setting.

METHODS

The HHER Lifestyle trial is a randomized controlled trial to compare the effects of a standard care intervention (provider counseling, nurse goal setting, and educational materials) to a comprehensive intervention (standard care intervention plus 12 months of telephone counseling and tailored print materials) on changes in physical activity and dietary fat consumption in financially disadvantaged African American women at 6 and 12 months. Secondary outcomes are body mass index, central adiposity, and total cholesterol. Potential mediators of outcome are self-efficacy for overcoming barriers, social support, and decisional balance.

RESULTS

African American women (N=266; 130 standard care, 136 comprehensive intervention) 35 years and older from nine clinics within two community health centers were enrolled. Most participants were overweight or obese with existing chronic health conditions.

CONCLUSION

The HHER Lifestyle trial is unique in that it targets financially disadvantaged African American women from community health centers, incorporates a standard care intervention into a routine clinical appointment, and includes a comprehensive process evaluation. The design will permit further research examining the added effect of regular telephone counseling and tailored print materials to a primary care provider and nurse intervention.

Overweight and obesity in postpartum Hispanic women

Overweight and obesity vary in prevalence among particular groups, and are especially problematic for childbearing Hispanic women. The complex interaction between physical changes associated with pregnancy, role changes accompanying birth, and family and cultural values related to childbearing are superimposed upon the underlying mechanisms that create or perpetuate obesity. In this article we review biological and behavioral research on obesity in postpartum Hispanic women to identify critical components for intervention studies focused on weight management. Recommendations are offered for health care providers and researchers.

A randomized trial of sequential and simultaneous multiple behavior change interventions for physical activity and fat intake

BACKGROUND

Major questions remain unanswered about how best to accomplish multiple behavior change. The purpose of this study was to evaluate whether there are differences in successfully changing multiple behaviors in computer-tailored sequential and simultaneous interventions for physical activity (PA) promotion and fat intake (FI) reduction.

METHODS

Participants (N=567) were randomly assigned to receive an intervention for PA and FI simultaneously; PA at baseline and FI at 3 months; or FI at baseline and PA at 3 months. Successful behavior change at 6 months was defined as: >60 min PA increase and/or 5% FI reduction. Using multinomial logistic regression the odds ratios of successful behaviors change (none, PA only, FI only, or both) were determined for intervention mode, gender, age, BMI and education.

RESULTS

Overall drop-out was 26%. There was no behavior change for 20.2% of participants; 30.5% successfully decreased FI; 15.8% successfully increased PA; 33.5% successfully changed both behaviors. Intervention mode, gender and age were not associated with successful behavior change. Compared to those that did not change any behaviors: participants that successfully changed FI were more likely to be overweight/obese (OR=1.85); and participants that successfully changed both behaviors were more likely to be overweight/obese (OR=2.13) and have lower education (OR=2.46).

CONCLUSIONS

Success in changing multiple behaviors was not associated with intervention mode; both simultaneous and sequential interventions can be applied. Being overweight might be an extra motivator to change health behaviors.

Community-based interventions to promote increased physical activity: a primer

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.

Environment and active living: the roles of health risk and economic factors

PURPOSE

This study examines the associations that a neighborhood ' physical and social environments have with transportation and recreation physical activities, with an emphasis on the roles of health risk and economic factors.

DESIGN

It is a cross-sectional study with a hypothesis-testing approach. Setting. The study was conducted within the city of Seattle, Washington. Subjects. The subjects included 438 able-bodied, randomly selected adults.

MEASURES

Physical activity and sociodemographic data came from a telephone survey (34 % response rate). Environmental variables were measured subjectively as people's perceptions and objectively using the Geographic Information System. Bivariate analyses and the Structural Equation Model were used to test the overall theoretic framework and the relationships among latent and observed variables.

RESULTS

Lower-income populations lived in areas with more routine destinations and higher densities and were more active for transportation than higher-income populations. People with higher health risks were less active for both transportation and recreation purposes. The social environment-perception of people walking and biking in the neighborhood-was more strongly associated with recreational physical activities, while the physical environment was more strongly associated with transportation physical activities.

CONCLUSION

Further investigation of different subpopulations and explicit distinction among different purposes of physical activities are needed in future research and interventions. This study is limited to urban areas and cross-sectional data.

Which food-related behaviours are associated with healthier intakes of fruits and vegetables among women?

OBJECTIVE

To examine associations between shopping, food preparation, meal and eating behaviours and fruit and vegetable intake among women.

DESIGN

Cross-sectional survey.

SETTING

Community-based sample from metropolitan Melbourne, Australia.

SUBJECTS

A sample of 1136 women aged 18-65 years, randomly selected from the electoral roll.

RESULTS

Food-related behaviours reflecting organisation and forward-planning, as well as enjoyment of and high perceived value of meal shopping, preparation and consumption were associated with healthier intakes of fruits and vegetables. For example, women who more frequently planned meals before they went shopping, wrote a shopping list, enjoyed food shopping, planned in the morning what they will eat for dinner that night, planned what they will eat for lunch, reported they enjoy cooking, liked trying new recipes and who reported they sometimes prepare dishes ahead of time were more likely to consume two or more servings of vegetables daily. Conversely, women who frequently found cooking a chore, spent less than 15 minutes preparing dinner, decided on the night what they will eat for dinner, ate in a fast-food restaurant, ate takeaway meals from a fast-food restaurant, ate dinner and snacks while watching television and who frequently ate on the run were less likely to eat two or more servings of vegetables daily.

CONCLUSIONS

Practical strategies based on these behavioural characteristics could be trialled in interventions aimed at promoting fruit and vegetable consumption among women.

Lifestyle interventions in cancer survivors: designing programs that meet the needs of this vulnerable and growing population

In the world today, there are roughly 25 million cancer survivors. Although the increasing numbers of survivors testifies to the success of early detection and treatment, there is a downside. Cancer survivors are at increased risk for second cancers, other forms of comorbidity (e.g., cardiovascular disease, diabetes, osteoporosis), and functional decline. Lifestyle factors, such as a healthy diet, regular exercise, and smoking cessation may prevent these conditions and improve survivors' quality of life. Data also are accumulating to suggest that healthful lifestyle practices and successful weight management may prevent progressive or recurrent disease. Previous surveys conducted among both adult and pediatric cancer survivors indicate that most survivors have high levels of interest in diet and exercise interventions. Additionally, survivors who smoke report high levels of interest in interventions aimed at smoking cessation. Many factors, such as intervention timing and duration and channels of delivery, must be carefully considered in developing interventions that best meet the needs of this vulnerable population. Total transparency also is necessary in reporting the results of trials to ensure the inclusion of information regarding proportional accrual, attrition, and study sample sociodemographic characteristics to move toward the development of interventions most likely to gain broad-scale acceptance and adherence. Home-based interventions that rely on telephone counseling, mailed materials, or computer-assisted approaches offer promising means of reaching the geographically dispersed population of cancer survivors. More research is necessary to develop interventions that can reach and effectively promote long-term behavior change in this ever-increasing population.

Creating a robust public health infrastructure for physical activity promotion

The essential role of physical activity both as an independent protective factor against numerous common chronic diseases and as a means to maintain a healthy weight is gaining increasing scientific recognition. Although the science of physical activity promotion is advancing rapidly, the practice of promoting physical activity at a population level is in its infancy. The virtual absence of a public health practice infrastructure for the promotion of physical activity at the local level presents a critical challenge to control policy for chronic disease, and particularly obesity. To translate the increasing evidence of the value of physical activity into practice will require systemic, multilevel, and multisectoral intervention approaches that build individual capability and organizational capacity for behavior change, create new social norms, and promote policy and environmental changes that support higher levels of energy expenditure across the population. This paper highlights societal changes contributing to inactivity; describes the evolution and current status of population-based public health physical activity promotion efforts in research and practice settings; suggests strategies for engaging decision makers, stakeholders, and the general public in building the necessary infrastructure to effectively promote physical activity; and identifies specific recommendations to spur the creation of a robust public health infrastructure for physical activity.

Efficacy of sequential or simultaneous interactive computer-tailored interventions for increasing physical activity and decreasing fat intake

BACKGROUND

Little evidence exists about the effectiveness of "interactive" computer-tailored interventions and about the combined effectiveness of tailored interventions on physical activity and diet. Furthermore, it is unknown whether they should be executed sequentially or simultaneously.

PURPOSE

The purpose of this study was to examine (a) the effectiveness of interactive computer-tailored interventions for increasing physical activity and decreasing fat intake and (b) which intervening mode, sequential or simultaneous, is most effective in behavior change.

METHODS

Participants (N = 771) were randomly assigned to receive (a) the physical activity and fat intake interventions simultaneously at baseline, (b) the physical activity intervention at baseline and the fat intake intervention 3 months later, (c) the fat intake intervention at baseline and the physical activity intervention 3 months later, or (d) a place in the control group.

RESULTS

Six months postbaseline, the results showed that the tailored interventions produced significantly higher physical activity scores, F(2, 573) = 11.4, p < .001, and lower fat intake scores, F(2, 565) = 31.4, p < .001, in the experimental groups when compared to the control group.

CONCLUSIONS

For both behaviors, the sequential and simultaneous intervening modes showed to be effective; however, for the fat intake intervention and for the participants who did not meet the recommendation in the physical activity intervention, the simultaneous mode appeared to work better than the sequential mode.

Quantitative assessment model for gastric cancer screening

AIM: To set up a mathematic model for gastric cancer screening and to evaluate its function in mass screening for gastric cancer.

METHODS: A case control study was carried on in 66 patients and 198 normal people, then the risk and protective factors of gastric cancer were determined, including heavy manual work, foods such as small yellow-fin tuna, dried small shrimps, squills, crabs, mothers suffering from gastric diseases, spouse alive, use of refrigerators and hot food, etc. According to some principles and methods of probability and fuzzy mathematics, a quantitative assessment model was established as follows: first, we selected some factors significant in statistics, and calculated weight coefficient for each one by two different methods; second, population space was divided into gastric cancer fuzzy subset and non gastric cancer fuzzy subset, then a mathematic model for each subset was established, we got a mathematic expression of attribute degree (AD).

RESULTS: Based on the data of 63 patients and 693 normal people, AD of each subject was calculated. Considering the sensitivity and specificity, the thresholds of AD values calculated were configured with 0.20 and 0.17, respectively. According to these thresholds, the sensitivity and specificity of the quantitative model were about 69% and 63%. Moreover, statistical test showed that the identification outcomes of these two different calculation methods were identical (P>0.05).

CONCLUSION: The validity of this method is satisfactory. It is convenient, feasible, economic and can be used to determine individual and population risks of gastric cancer.

A Systematic Review of Studies Evaluating Diffusion and Dissemination of Selected Cancer Control Interventions

With this review, the authors sought to determine what strategies have been evaluated (including the outcomes assessed) to disseminate cancer control interventions that promote the uptake of behavior change. Five topic areas along the cancer care continuum (smoking cessation, healthy diet, mammography, cervical cancer screening, and control of cancer pain) were selected to be representative. A systematic review was conducted of primary studies evaluating dissemination of a cancer control intervention. Thirty-one studies were identified that evaluated dissemination strategies in the 5 topic areas. No strong evidence currently exists to recommend any one dissemination strategy as effective in promoting the uptake of cancer control interventions. The authors conclude that there is a strong need for more research into dissemination of cancer control interventions. Future research should consider methodological issues such as the most appropriate study design and outcomes to be evaluated.

The influence of pretreatment on cure rates of Helicobacter pylori eradication

BACKGROUND

Many patients treated for H. pylori infection have been taking a proton pump inhibitor beforehand. There is conflicting evidence whether pretreatment influences the efficacy of H. pylori eradication. The aim of this study was to investigate the influence of pretreatment on cure rates of H. pylori eradication.

METHODS

Patients with H. pylori positive peptic ulcer disease or functional dyspepsia were treated with two-day quadruple therapy (lansoprazole 30 mg twice daily, and colloidal bismuth subcitrate 120 mg, tetracycline 250 mg and metronidazole 250 mg, all eight times a day). Patients were randomised to receive either three-day pretreatment with lansoprazole 30 mg twice daily or no pretreatment. H. pylori was diagnosed using CLO, histology and culture.

RESULTS

Twenty-five (66%) of 38 patients with pretreatment and 32 (84%) of 38 patients without pretreatment were cured (p=0.06). After adjustment for diagnosis, smoking status and metronidazole resistance the influence of pretreatment became slightly less pronounced (OR 0.44, 95% CI 0.1-1.7). Nonsmokers and patients with peptic ulcer disease were more likely to achieve H. pylori eradication than smokers and patients with functional dyspepsia, respectively (adjusted odds ratios: 4.79 (1.2-19) and 4.32 (1.0-18)).

CONCLUSIONS

This two-day quadruple therapy reached an overall cure rate of 75%. Nonsmokers and patients with peptic ulcer disease were more likely to achieve H. pylori eradication. Three-day pretreatment with a proton pump inhibitor may decrease cure rates of this two-day quadruple therapy.

A Replicable Process for Redesigning Ethnically Relevant Educational Materials

BACKGROUND

To serve the populations targeted by Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) effectively, healthcare providers need educational materials that are evidence based and ethnically relevant and can be easily incorporated into busy clinic settings. We describe a replicable process used to redesign and tailor physical activity and diet education materials for African American women in the southeastern United States.

METHODS

The process consists of seven phases. Quantitative and qualitative analyses were used on data gathered in 2000 from two expert panels and eight focus groups.

RESULTS

Expert panelists preferred materials perceived to be high quality, easy to understand, organized to facilitate use by healthcare providers, and with content relevant to African American women. Focus group participants were mostly concerned with the visual appeal and content of educational materials. They liked high-quality materials that are brief; avoid jargon and use simple language, bright colors, and photographs; and provide useful information that acknowledges the context of their lives, including their family roles.

CONCLUSIONS

The redesign process can produce ethnically and culturally appropriate educational materials for use by WISEWOMAN providers and other healthcare providers in conjunction with cardiovascular (CVD) risk reduction and behavioral counseling. To be effective, materials must address the needs and concerns of both providers and patients.

Expanding the Evidence for Health Promotion: Developing Best Practices for WISEWOMAN

Implementing effective programs to prevent chronic disease holds the promise of reducing morbidity and mortality, reducing health disparities, and promoting health. Yet many programs have demonstrated success only in highly controlled research settings and few address the needs of low-income, uninsured, minority women. Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN), a demonstration program funded by the Centers for Disease Control and Prevention (CDC), that provides chronic disease risk factor screening and lifestyle interventions for low-income, 40-64-year-old women is learning from our own successful programs but is also charting new territory. As the CDC, state health departments, tribal organizations, and other WISEWOMAN partners approach the end of the first decade of WISEWOMAN demonstration projects, we are seeking to understand what has worked and what has not. This paper describes the rationale and proposed methodology for assessing best practices in the WISEWOMAN program through a participatory process that will examine scientific evidence and quantitative and qualitative program data. By emphasizing practicality in addition to scientific rigor, we are expanding the base of evidence considered to identify effective approaches for reducing cardiovascular disease (CVD) risk in financially disadvantaged, ethnically diverse women. Results of the 3-year project will be disseminated in a format intended to encourage programs to select and adapt those strategies best suited to their particular contexts.

Nutrition-related issues for the breast cancer survivor

Nutritional status and dietary intake play a significant role in the prognosis of breast cancer patients and may modify the progression of disease, as well as influence risk for comorbid conditions, such as osteoporosis and cardiovascular disease. A critical review of relevant clinical and epidemiological studies identified through MEDLINE and CINAHL searches was undertaken to provide the clinician with a summary of evidence that could form the appropriate guidance of women diagnosed with breast cancer who seek to reduce their risk of progressive or recurrent disease, and improve their overall health. Currently, healthy weight control with an emphasis on exercise to preserve or increase both lean body and bone masses, and plant-based diets that include ample amounts of nutrient-dense, low-energy density foods, particularly vegetables, can be recommended. Furthermore, diets high in vegetables, fruit, whole grains, and low-fat dairy foods, and low in saturated fat, may help to lower overall disease risk in this population.