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Noh S, Choo J. Gender-Specific Clustering of Lifestyle Behaviors and Its Impacts on Cardiovascular Health. J Cardiovasc Nurs 2023:00005082-990000000-00098. [PMID: 37249529 DOI: 10.1097/jcn.0000000000001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Unhealthy lifestyle behaviors associated with cardiovascular risk manifest a clustering pattern. OBJECTIVE Our aim was to identify behavioral clusters by using 5 unhealthy lifestyle behaviors among the Korean population and examine the impacts of identified behavioral clusters on cardiovascular health (CVH). METHODS A cross-sectional study was conducted using data from the sixth Korea National Health and Nutrition Examination Survey. The participants were 7898, aged 19 to 64 years. The cluster analysis was performed using the behaviors of current smoking, binge drinking, physical inactivity, insufficient fruit intake, and sugar-sweetened beverage drinking. Cardiovascular health was defined as a composite modified z score calculated using biophysical factors. RESULTS Men manifested 4 clusters (ie, risky binge drinkers, dominant smokers, dominant sugar-sweetened beverage drinkers, and nonsubstance/low-fruit eaters) characterized predominantly by substance use; women had 4 clusters (ie, substance users, physically inactive/low-fruit eaters, physically inactive/fruit eaters, and active adherers) characterized predominantly by physical inactivity. Among men, the clusters of dominant smokers and risky binge drinkers had significantly lower CVH scores than those with poor eating behaviors. Among women, the clusters of substance users and physically inactive/low-fruit eaters had significantly lower CVH scores than the active adherers. All the clusters in men had lower CVH scores than the worst cluster in women. CONCLUSIONS There was a gender difference in the clustering pattern. The clusters with smoking and binge drinking in men and women were associated with negative impacts on CVH. Healthcare professionals should pay attention to the clustering pattern to design an efficient lifestyle intervention for cardiovascular disease prevention.
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Sun Z, Imano H, Eguchi E, Hayashi F, Ohira T, Cui R, Yasumura S, Sakai A, Shimabukuro M, Ohto H, Kamiya K, Iso H. The Associations between Evacuation Status and Lifestyle-Related Diseases in Fukushima after the Great East Japan Earthquake: The Fukushima Health Management Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095661. [PMID: 35565055 PMCID: PMC9105675 DOI: 10.3390/ijerph19095661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 02/05/2023]
Abstract
Background: This study aimed to investigate the association between evacuation status and lifestyle-related disease risks among Fukushima residents following the Great East Japan earthquake. Methods: Fukushima health management survey respondents were classified into non-evacuees, returnees, evacuees in lifted areas, and evacuees in banned areas. During a seven-year follow-up, 22,234 men and 31,158 women were included. Those with a history of diabetes, hypertension, or dyslipidemia at baseline were excluded. The odds ratios of risk factors (ORs) and 95% confidence intervals (CIs) for diabetes, hypertension, and dyslipidemia were calculated using a logistic regression model. Spatial autocorrelation of the prevalence of these diseases in the Fukushima area in 2017, was calculated to detect the disease prevalence status. Results: The risks of diabetes, hypertension, and dyslipidemia were higher in evacuees in banned areas than in non-evacuees; the multivariable ORs were 1.32 (95% CI: 1.19–1.46), 1.15 (1.06–1.25), and 1.20 (1.11–1.30) for diabetes, hypertension, and dyslipidemia, respectively. Returnees and evacuees in lifted areas had no increased risk of diseases. The area analyzed had a non-uniform spatial distribution of diabetes, hypertension, and hyperlipidemia, with clusters around Fukushima and Koriyama. Conclusion: Our findings imply the need for continuous support for evacuees in banned areas.
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Affiliation(s)
- Zhichao Sun
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan; (Z.S.); (H.I.)
- Health Town Development Science Center, Yao City Health Center, Osaka 581-0006, Japan
| | - Hironori Imano
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan; (Z.S.); (H.I.)
- Department of Public Health, Kindai University Faculty of Medicine, Osakasayama 589-8511, Japan
| | - Eri Eguchi
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (E.E.); (F.H.); (T.O.)
| | - Fumikazu Hayashi
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (E.E.); (F.H.); (T.O.)
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (S.Y.); (A.S.); (M.S.); (H.O.); (K.K.)
| | - Tetsuya Ohira
- Department of Epidemiology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; (E.E.); (F.H.); (T.O.)
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (S.Y.); (A.S.); (M.S.); (H.O.); (K.K.)
| | - Renzhe Cui
- Department of Internal Medicine, Okanami General Hospital, Iga 518-0842, Japan;
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (S.Y.); (A.S.); (M.S.); (H.O.); (K.K.)
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Akira Sakai
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (S.Y.); (A.S.); (M.S.); (H.O.); (K.K.)
- Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Michio Shimabukuro
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (S.Y.); (A.S.); (M.S.); (H.O.); (K.K.)
- Department of Diabetes, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hitoshi Ohto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (S.Y.); (A.S.); (M.S.); (H.O.); (K.K.)
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima 960-1295, Japan; (S.Y.); (A.S.); (M.S.); (H.O.); (K.K.)
- Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8553, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan; (Z.S.); (H.I.)
- Institute for Global Health Policy Research, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
- Correspondence: ; Tel.: +81-6-6879-3911
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Schepens Niemiec SL, Vigen CLP, Martínez J, Blanchard J, Carlson M. Long-Term Follow-Up of a Lifestyle Intervention for Late-Midlife, Rural-Dwelling Latinos in Primary Care. Am J Occup Ther 2021; 75:7502205020p1-7502205020p11. [PMID: 33657344 PMCID: PMC7929605 DOI: 10.5014/ajot.2021.042861] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Importance: Rural-dwelling Latinos are an underresourced population in need of accessible and effective wellness programs. Objective: To evaluate patients’ long-term health-related outcomes after lifestyle intervention. Design: An uncontrolled pilot trial assessing change in health from pretreatment to long-term follow-up (12 mo after intervention completion, no contact) and from posttreatment to long-term follow-up. Setting: Rural, community-based primary care. Participants: Latino and Hispanic safety-net primary care patients, ages 50 to 64 yr. Intervention: A culturally tailored, 4-mo lifestyle intervention co-led by occupational therapy practitioners and Latino community health workers that features telehealth and in-home sessions covering topics such as healthy eating and navigating health care. Outcomes and Measures: Self-reported and physiological outcomes: symptom–well-being (primary), stress, sleep disturbance, social satisfaction, physical activity, patient activation, blood pressure, and weight. Exit interviews addressed health experiences and intervention impact on participants’ lives. Results: Participants (N = 27) demonstrated clinically significant pretreatment to long-term follow-up benefits in all symptom–well-being dimensions (Cohen’s d ≥ 0.8, p ≤ .004), with additional gains from posttreatment to long-term follow-up (d ≥ 0.4, p ≤ .05). Significant improvements from pre- to posttreatment in systolic blood pressure, stress, and social role and activity satisfaction were maintained at long-term follow-up. No changes were observed in weight, physical activity, or diastolic blood pressure. Participants described the intervention’s sustained positive effect on their wellness. Conclusions and Relevance: A lifestyle intervention led by occupational therapy practitioners and community health workers in a primary care context has potential to achieve long-term health benefits in rural-dwelling, late-midlife Latinos. What This Article Adds: This study reveals that rural, late-midlife Latinos showed long-lasting improvements in psychological and physical health after finishing a program that helped them make healthy lifestyle choices. This finding supports the unique contribution of occupational therapy in primary care settings.
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Affiliation(s)
- Stacey L Schepens Niemiec
- Stacey L. Schepens Niemiec, PhD, OTR/L, is Associate Professor of Research, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles;
| | - Cheryl L P Vigen
- Cheryl L. P. Vigen, PhD, is Associate Professor of Research, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Jenny Martínez
- Jenny Martínez, OTD, OTR/L, BCG, is Associate Professor, Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA
| | - Jeanine Blanchard
- Jeanine Blanchard, PhD, OTR/L, is Project Manager, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Mike Carlson
- Mike Carlson, PhD, is Professor of Research, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
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van Dammen L, Bush NR, de Rooij S, Mol BW, Mutsaerts M, van Oers A, Groen H, Hoek A, Roseboom T. A lifestyle intervention randomized controlled trial in obese women with infertility improved body composition among those who experienced childhood adversity. Stress Health 2021; 37:93-102. [PMID: 32761731 PMCID: PMC7983922 DOI: 10.1002/smi.2976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/20/2020] [Accepted: 07/28/2020] [Indexed: 01/06/2023]
Abstract
Previous research indicates that tailoring lifestyle interventions to participant characteristics optimizes intervention effectiveness. Our objective was to assess whether the effects of a preconception lifestyle intervention in obese infertile women depended on women's exposure to adversity in childhood. A follow-up of a preconception lifestyle intervention randomized controlled trial (the LIFEstyle study) was conducted in the Netherlands among 577 infertile women (age 18-39 years) with a body mass index (BMI) ≥29 kg/m2 at time of randomization; N = 110 (19%) consented to the follow-up assessment, 6 years later. A 6-month preconception lifestyle intervention aimed weight loss through improving diet and increasing physical activity. The control group received care as usual. Outcome measures included weight, BMI, waist and hip circumference, body fat percentage, blood pressure and metabolic syndrome. The potential moderator, childhood adversity, was assessed with the Life Events Checklist-5 questionnaire. Among the 110 women in our follow-up study, n = 65 (59%) reported no childhood adverse events, n = 28 (25.5%) reported 1 type of childhood adverse events and n = 17 (15.5%) reported ≥2 types of childhood adverse events. Regression models showed significant interactions between childhood adversity and effects of lifestyle intervention at the 6-year follow-up. Among women who experienced childhood adversity, the intervention significantly reduced weight (-10.0 [95% CI -18.5 to -1.5] kg, p = 0.02), BMI (-3.2 [-6.1 to -0.2] kg/m2 , p = 0.04) and body fat percentage (-4.5 [95% CI -7.2 to -1.9] p < 0.01). Among women without childhood adversity, the intervention did not affect these outcomes (2.7 [-3.9 to 9.4] kg, p = 0.42), (0.9 [-1.4 to 3.3] kg/m2 , p = 0.42) and (1.7 [95% CI -0.3 to 3.7] p = 0.10), respectively. Having a history of childhood adversity modified the effect of a preconception lifestyle intervention on women's body composition. If replicated, it may be important to consider childhood adversity as a determinant of lifestyle intervention effectiveness.
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Affiliation(s)
- Lotte van Dammen
- Department of Human Development & Family StudiesIowa State UniversityAmesIowaUSA,Department of Obstetrics and GynaecologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands,Department of EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Nicole R. Bush
- Departments of Psychiatry and PediatricsCenter for Health and CommunityDivision of Developmental MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Susanne de Rooij
- Department of Clinical EpidemiologyBiostatistics and BioinformaticsAmsterdam UMCLocation AMCAmsterdamThe Netherlands
| | - Ben Willem Mol
- Department of Obstetrics and GynaecologyMonash UniversityClaytonVictoriaAustralia
| | - Meike Mutsaerts
- Department of Obstetrics and GynaecologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Anne van Oers
- Department of Obstetrics and GynaecologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands,Department of Obstetrics and GynaecologyMedisch Spectrum TwenteEnschedeThe Netherlands
| | - Henk Groen
- Department of EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Annemieke Hoek
- Department of Obstetrics and GynaecologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Tessa Roseboom
- Department of Clinical EpidemiologyBiostatistics and BioinformaticsAmsterdam UMCLocation AMCAmsterdamThe Netherlands,Department of Obstetrics and GynaecologyAmsterdam UMC at the University of AmsterdamAmsterdamThe Netherlands
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Minian N, Corrin T, Lingam M, deRuiter WK, Rodak T, Taylor VH, Manson H, Dragonetti R, Zawertailo L, Melamed OC, Hahn M, Selby P. Identifying contexts and mechanisms in multiple behavior change interventions affecting smoking cessation success: a rapid realist review. BMC Public Health 2020; 20:918. [PMID: 32532233 PMCID: PMC7291527 DOI: 10.1186/s12889-020-08973-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 05/24/2020] [Indexed: 11/17/2022] Open
Abstract
Background Smoking continues to be a leading cause of preventable chronic disease-related morbidity and mortality, excess healthcare expenditure, and lost work productivity. Tobacco users are disproportionately more likely to be engaging in other modifiable risk behaviours such as excess alcohol consumption, physical inactivity, and poor diet. While hundreds of interventions addressing the clustering of smoking and other modifiable risk behaviours have been conducted worldwide, there is insufficient information available about the context and mechanisms in these interventions that promote successful smoking cessation. The aim of this rapid realist review was to identify possible contexts and mechanisms used in multiple health behaviour change interventions (targeting tobacco and two or more additional risk behaviours) that are associated with improving smoking cessation outcome. Methods This realist review method incorporated the following steps: (1) clarifying the scope, (2) searching for relevant evidence, (3) relevance confirmation, data extraction, and quality assessment, (4) data analysis and synthesis. Results Of the 20,423 articles screened, 138 articles were included in this realist review. Following Michie et al.’s behavior change model (the COM-B model), capability, opportunity, and motivation were used to identify the mechanisms of behaviour change. Universally, increasing opportunities (i.e. factors that lie outside the individual that prompt the behaviour or make it possible) for participants to engage in healthy behaviours was associated with smoking cessation success. However, increasing participant’s capability or motivation to make a behaviour change was only successful within certain contexts. Conclusion In order to address multiple health behaviours and assist individuals in quitting smoking, public health promotion interventions need to shift away from ‘individualistic epidemiology’ and invest resources into modifying factors that are external from the individual (i.e. creating a supportive environment). Trial registration PROSPERO registration number: CRD42017064430
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Affiliation(s)
- Nadia Minian
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada
| | - Tricia Corrin
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada
| | - Mathangee Lingam
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada
| | - Wayne K deRuiter
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada
| | - Terri Rodak
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, 1403 - 29 Street NW, Calgary, Alberta, T2N 2T9, Canada
| | - Heather Manson
- Public Health Ontario, 480 University Avenue, Toronto, Ontario, M5G 1V2, Canada
| | - Rosa Dragonetti
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada
| | - Laurie Zawertailo
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada.,Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada
| | - Osnat C Melamed
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada
| | - Margaret Hahn
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada. .,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
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6
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Pascual V, Perez Martinez P, Fernández JM, Solá R, Pallarés V, Romero Secín A, Pérez Jiménez F, Ros E. [SEA/SEMERGEN consensus document 2019: Dietary recommendations in the prevention of cardiovascular disease]. Semergen 2019; 45:333-348. [PMID: 31164311 DOI: 10.1016/j.semerg.2019.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 02/14/2019] [Indexed: 12/12/2022]
Abstract
The current paradigm in the nutrition sciences states that the basic nutritional unit is not the nutrients, but the foods that contain them (oils, nuts, dairy products, eggs, red or processed meats, etc.). These act as a food matrix in which the different nutrients synergistically or antagonistically modulate their effects on the various metabolic pathways determining health and disease. Food is not based on nutrients or isolated foods but on complex mixtures of one and the other that are part of a specific food pattern, a concept that has been targeted as the most pertinent to evaluate the associations between nutrition and health or disease. This document presents a summary of the available evidence on the relationship between different foods and cardiovascular health, and offers simple recommendations to be implemented in the dietary advice offered by the health professional.
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Affiliation(s)
- Vicente Pascual
- Centro de Salud Palleter, Castellón, España; Grupo de Trabajo Nutrición y Estilo de Vida, Sociedad Española de Arteriosclerosis (SEA); Grupo de Trabajo Nutrición de SEMERGEN; Universidad CEU-Cardenal Herrera, Castellón, España.
| | - Pablo Perez Martinez
- Unidad de Lípidos y Arterioesclerosis, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Grupo de Trabajo Nutrición y Estilo de Vida, Sociedad Española de Arteriosclerosis (SEA)
| | - José Manuel Fernández
- Centro de Salud de Valga, Valga, Pontevedra, España; Grupo de Trabajo Nutrición de SEMERGEN
| | - Rosa Solá
- Functional Nutrition, Oxidation and Cardiovascular Diseases Group (NFOC-Salut), Hospital Universitario Sant Joan, EURECAT-Technological Center of Nutrition and Health (CTNS), Facultad de Medicina y Ciencias de la Salud, Universidad Rovira i Virgili, Reus, Tarragona, España; Grupo de Trabajo Nutrición y Estilo de Vida, Sociedad Española de Arteriosclerosis (SEA)
| | - Vicente Pallarés
- Unidad de Vigilancia de la Salud, Unión de Mutuas, Castellón, España; Grupo de Trabajo de Hipertensión Arterial y Enfermedad Cardiovascular de SEMERGEN; Departamento de Medicina, Universitat Jaume I, Castellón, España
| | - Anny Romero Secín
- Centro de Salud de Tineo, Tineo, Asturias, España; Grupo de Trabajo Nutrición de SEMERGEN
| | - Francisco Pérez Jiménez
- Unidad de Lípidos y Arterioesclerosis, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Grupo de Trabajo Nutrición y Estilo de Vida, Sociedad Española de Arteriosclerosis (SEA)
| | - Emilio Ros
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, España; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universidad de Barcelona, Barcelona, España; Unidad de Lípidos, Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, España; Grupo de Trabajo Nutrición y Estilo de Vida, Sociedad Española de Arteriosclerosis (SEA)
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SEA/SEMERGEN consensus document 2019: Dietary recommendations in the prevention of cardiovascular disease. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2019; 31:186-201. [PMID: 30910237 DOI: 10.1016/j.arteri.2019.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/14/2019] [Indexed: 01/15/2023]
Abstract
The current paradigm in the nutrition sciences states that the basic nutritional unit is not the nutrients, but the foods that contain them (oils, nuts, dairy products, eggs, red or processed meats, etc.). These act as a food matrix in which the different nutrients synergistically or antagonistically modulate their effects on the various metabolic pathways determining health and disease. Food is not based on nutrients or isolated foods but on complex mixtures of one and the other that are part of a specific food pattern, a concept that has been targeted as the most pertinent to evaluate the associations between nutrition and health or disease. This document presents a summary of the available evidence on the relationship between different foods and cardiovascular health, and offers simple recommendations to be implemented in the dietary advice offered by the health professional.
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8
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Sisti LG, Dajko M, Campanella P, Shkurti E, Ricciardi W, de Waure C. The effect of multifactorial lifestyle interventions on cardiovascular risk factors: a systematic review and meta-analysis of trials conducted in the general population and high risk groups. Prev Med 2018; 109:82-97. [PMID: 29291422 DOI: 10.1016/j.ypmed.2017.12.027] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/21/2017] [Accepted: 12/24/2017] [Indexed: 01/31/2023]
Abstract
Cardiovascular diseases (CVDs) are the leading cause of premature mortality and disability accounting for one third of all deaths worldwide with considerable impacts on economics and on the quality of life. The evidence suggests that a multifactorial lifestyle intervention might have a role in the CVDs risk reduction, especially in the risk populations, nonetheless the effects on modifiable CVDs risk factors have not been completely explored. Our work aimed at evaluating the impact of multifactorial lifestyle interventions on cardiovascular risk modification, both in the general and risk population. A systematic review and meta-analysis of the randomized controlled trials (RCTs) were performed by including articles published up to April 16th, 2016. RCTs were selected if they had investigated the impact of multifactorial lifestyle interventions on lipids, blood pressure, BMI and waist circumference, smoking and physical activity. Changes in the level of modifiable risk factors from baseline were evaluated. Search resulted in 19,847 studies, of which 36 were included in the analysis. Compared to a usual care, the multifactorial lifestyle intervention is able to lower the blood pressure, total cholesterol, BMI and waist circumference, at both 6 and 12months, and to increase physical activity at 12months. Better results were obtained in primary prevention and in moderate and high risk groups. Multifactorial lifestyle interventions clearly represent a valid tool for reducing the cardiovascular risk factors and should be implemented in the risk groups and in primary prevention.
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Affiliation(s)
- L G Sisti
- Institute of Public Health, Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy.
| | - M Dajko
- Institute of Public Health, Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
| | - P Campanella
- Institute of Public Health, Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
| | - E Shkurti
- University of Medicine, Tirana, Albania
| | - W Ricciardi
- President - Italian National Institute of Health, Rome, Italy
| | - C de Waure
- Institute of Public Health, Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
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Albarracín D, Wilson K, Sally Chan MP, Durantini M, Sanchez F. Action and inaction in multi-behaviour recommendations: a meta-analysis of lifestyle interventions. Health Psychol Rev 2018; 12:1-24. [PMID: 28831848 PMCID: PMC7069597 DOI: 10.1080/17437199.2017.1369140] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This meta-analysis examined theoretical predictions about the effects of different combinations of action (e.g., start an exercise regime) and of inaction (e.g., reduce screen time, rest in between weight lifting series) recommendations in smoking, diet, and physical activity multiple-domain interventions. The synthesis included 150 research reports of interventions promoting multiple behaviour domain change and measuring change at the most immediate follow-up. The main outcome measure was an indicator of overall change that combined behavioural and clinical effects. There were two main findings. First, as predicted, interventions produced the highest level of change when they included a predominance of recommendations along one behavioural dimension (i.e., predominantly inaction or predominantly action). Unexpectedly, within interventions with predominant action or inaction recommendations, those including predominantly inaction recommendations had greater efficacy than those including predominantly action recommendations. This effect, however, was limited to interventions in the diet and exercise domains, but reversed (greater efficacy for interventions with predominant action vs. inaction recommendations) in the smoking domain. These findings provide important insights on how to best combine recommendations when interventions target clusters of health behaviours.
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Iwasaki Y, Honda S, Kaneko S, Kurishima K, Honda A, Kakinuma A, Jahng D. Exercise Self-Efficacy as a Mediator between Goal-Setting and Physical Activity: Developing the Workplace as a Setting for Promoting Physical Activity. Saf Health Work 2016; 8:94-98. [PMID: 28344847 PMCID: PMC5355533 DOI: 10.1016/j.shaw.2016.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 08/01/2016] [Accepted: 08/31/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Physical activity (PA) is ranked as a leading health indicator and the workplace is a key setting to promote PA. The purpose of this study was to examine how goal-setting and exercise self-efficacy (SE) during a health promotion program influenced PA level among Japanese workers. METHODS Using a cross-sectional study design, we surveyed 281 employees. The short version of the International Physical Activity Questionnaire was used to assess PA level. Exercise SE was assessed using a partially modified version of Oka's exercise SE scale. Personal goals were assessed as the total numbers of "yes" responses to five items regarding "details of personal goals to perform PA". A mediational model was used to examine whether exercise SE mediates between the number of personal goals and PA level. RESULTS The mean age of the participants was 46.3 years, 76.2% were men, and the most common occupational category was software engineer (30.6%). The average PA level per week exceeded the recommended level in 127 participants (45.2%). One hundred and eighty-four participants (65.5%) set some form of concrete personal goal to perform PA. The relationship between the number of personal goals and PA level was mediated by exercise SE. CONCLUSION Our study showed that exercise SE mediates goal-setting and increases PA. The results suggest that the components of PA promotion programs should be tailored to enhance participants' confidence in performing PA.
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Affiliation(s)
- Yoshie Iwasaki
- Department of Human Intelligence Systems, Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, Fukuoka, Japan; Department of Health Care, NEC Corporation, Tokyo, Japan
| | - Sumihisa Honda
- Department of Nursing, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Shuji Kaneko
- Department of Human Intelligence Systems, Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, Fukuoka, Japan
| | - Kazuhiro Kurishima
- Department of Human Intelligence Systems, Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, Fukuoka, Japan
| | - Ayumi Honda
- Department of Nursing, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Ayumu Kakinuma
- Department of Health Care, NEC Corporation, Tokyo, Japan
| | - Doosub Jahng
- Department of Human Intelligence Systems, Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, Fukuoka, Japan
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11
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Harting J, van Assema P, van Limpt P, Gorgels T, van Ree J, Ruland E, Vermeer F, de Vries NK. Effects of health counseling on behavioural risk factors in a high-risk cardiology outpatient population: a randomized clinical trial. ACTA ACUST UNITED AC 2016; 13:214-21. [PMID: 16575275 DOI: 10.1097/01.hjr.0000194416.39508.e9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND An evaluation study of an individual lifestyle advice intervention to reduce cardiovascular risk behaviours (high fat consumption, smoking, physical inactivity). METHODS A randomized, controlled trial at the cardiology outpatient clinic of the University Hospital Maastricht. Participants were at high risk of incurring a cardiovascular event. Changes in risk behaviours and behavioural determinants were assessed with self-administered validated questionnaires. RESULTS Questionnaires were completed by 1270 patients at baseline, 1169 after 4 months (92%), and 1032 after 18 months (81.3%). After 4 months, intention-to-treat analyses revealed a decrease in fat consumption (-5.6%, P = 0.000), a reduction in the percentage of smokers [odds ratio (OR) 0.57, 95% confidence intervals (CI) 0.33-0.97] and a trend towards a maintained physical activity level (OR 1.28, 95% CI 0.97-1.70). No long-term effects were found. CONCLUSION The lifestyle advice intervention was potentially effective in changing cardiovascular risk behaviours, but should be further improved to be effective in secondary cardiovascular prevention. The main limitations of the study were related to the randomization procedure and the self-selection of patients and cardiologists.
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Affiliation(s)
- Janneke Harting
- Department of Health Education and Promotion, Maastricht University, Maastricht, The Netherlands.
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12
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James E, Freund M, Booth A, Duncan MJ, Johnson N, Short CE, Wolfenden L, Stacey FG, Kay-Lambkin F, Vandelanotte C. Comparative efficacy of simultaneous versus sequential multiple health behavior change interventions among adults: A systematic review of randomised trials. Prev Med 2016; 89:211-223. [PMID: 27311332 DOI: 10.1016/j.ypmed.2016.06.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 06/02/2016] [Accepted: 06/12/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Growing evidence points to the benefits of addressing multiple health behaviors rather than single behaviors. PURPOSE This review evaluates the relative effectiveness of simultaneous and sequentially delivered multiple health behavior change (MHBC) interventions. Secondary aims were to identify: a) the most effective spacing of sequentially delivered components; b) differences in efficacy of MHBC interventions for adoption/cessation behaviors and lifestyle/addictive behaviors, and; c) differences in trial retention between simultaneously and sequentially delivered interventions. METHODS MHBC intervention trials published up to October 2015 were identified through a systematic search. Eligible trials were randomised controlled trials that directly compared simultaneous and sequential delivery of a MHBC intervention. A narrative synthesis was undertaken. RESULTS Six trials met the inclusion criteria and across these trials the behaviors targeted were smoking, diet, physical activity, and alcohol consumption. Three trials reported a difference in intervention effect between a sequential and simultaneous approach in at least one behavioral outcome. Of these, two trials favoured a sequential approach on smoking. One trial favoured a simultaneous approach on fat intake. There was no difference in retention between sequential and simultaneous approaches. CONCLUSIONS There is limited evidence regarding the relative effectiveness of sequential and simultaneous approaches. Given only three of the six trials observed a difference in intervention effectiveness for one health behavior outcome, and the relatively consistent finding that the sequential and simultaneous approaches were more effective than a usual/minimal care control condition, it appears that both approaches should be considered equally efficacious. PROSPERO registration number: CRD42015027876.
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Affiliation(s)
- Erica James
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Megan Freund
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Angela Booth
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Mitch J Duncan
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Natalie Johnson
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Camille E Short
- Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Fiona G Stacey
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Frances Kay-Lambkin
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Corneel Vandelanotte
- Physical Activity Research Group, The Central Queensland University, North Rockhampton, QLD, Australia
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13
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Sovio U, King V, Miettunen J, Ek E, Laitinen J, Joukamaa M, Veijola J, Järvelin MR. Cloninger’s Temperament Dimensions, Socio-economic and Lifestyle Factors and Metabolic Syndrome Markers at Age 31 Years in the Northern Finland Birth Cohort 1966. J Health Psychol 2016; 12:371-82. [PMID: 17284500 DOI: 10.1177/1359105307074301] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to assess the association between temperament and metabolic syndrome markers. Cloninger’s Temperament and Character Inventory and clinical examination were carried out in 1997 in the Northern Finland Birth Cohort 1966 ( N = 4364 respondents). Novelty seeking was positively associated with waist circumference in both genders. Systolic blood pressure was highest in men with high harm avoidance and low persistence scores and lowest in women with high reward dependence and high persistence scores. Childhood socio-economic status did not confound these associations. Smoking and alcohol consumption were associated with higher novelty seeking. Our results suggest that temperament is associated with metabolic syndrome markers and this association may be partly mediated by lifestyle factors and socio-economic status in adulthood.
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Lynch CP, Williams JS, J. Ruggiero K, G. Knapp R, Egede LE. Tablet-Aided BehavioraL intervention EffecT on Self-management skills (TABLETS) for Diabetes. Trials 2016; 17:157. [PMID: 27005766 PMCID: PMC4804482 DOI: 10.1186/s13063-016-1243-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 02/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple randomized controlled trials (RCTs) show that behavioral lifestyle interventions are effective in improving diabetes management and that comprehensive risk factor management improves cardiovascular disease (CVD) outcomes. The role of technology has been gaining strong support as evidence builds of its potential to improve diabetes management; however, evaluation of its impact in minority populations is limited. This study intends to provide early evidence of a theory-driven intervention, Tablet-Aided BehavioraL intervention EffecT on Self-management skills (TABLETS), using real-time videoconferencing for education and skills training. We examine the potential for TABLETS to improve health risk behaviors and reduce CVD risk outcomes among a low-income African American (AA) population with poorly controlled type 2 diabetes. METHODS The study is a two-arm, pilot controlled trial that randomizes 30 participants to the TABLETS intervention and 30 participants to a usual care group. Blinded outcome assessments will be completed at baseline, 2.5 months (immediate post-intervention), and 6.5 months (follow-up). The TABLETS intervention consists of culturally tailored telephone-delivered diabetes education and skills training delivered via videoconferencing on tablet devices, with two booster sessions delivered via tablet-based videoconferencing at 3 months and 5 months to stimulate ongoing use of the tablet device with access to intervention materials via videoconferencing slides and a manual of supplementary materials. The primary outcomes are physical activity, diet, medication adherence, and self-monitoring behavior, whereas the secondary outcomes are HbA1c, low-density lipoprotein cholesterol (LDL-C), BP, CVD risk, and quality of life. DISCUSSION This study provides a unique opportunity to assess the feasibility and efficacy of a theory-driven, tablet-aided behavioral intervention that utilizes real-time videoconferencing technology for education and skills training on self-management behaviors and quality of life among a high-risk, low-income AA population with an uncontrolled dyad or triad of CVD risk factors (diabetes with or without hypertension or hyperlipidemia). The intervention leverages the use of novel technology for education and skill-building to foster improved diabetes self-management. The findings of this study will inform the process of disseminating the intervention to a broader and larger sample of people and can potentially be refined to align with clinical workflows that target a subsample of patients with poor diabetes self-management. TRIAL REGISTRATION The trial was registered in April 2014 with the United States National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier NCT02128854), available online at: http://clinicaltrials.gov/ct2/show/NCT02128854 .
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Affiliation(s)
- Cheryl P. Lynch
- />Division of General Internal Medicine & Geriatrics, Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, MSC 593, Charleston, SC 29425 USA
- />Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VAMC, 109 Bee Street, Charleston, SC 29401 USA
| | - Joni S. Williams
- />Division of General Internal Medicine & Geriatrics, Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, MSC 593, Charleston, SC 29425 USA
| | - Kenneth J. Ruggiero
- />Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VAMC, 109 Bee Street, Charleston, SC 29401 USA
- />College of Nursing and Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 19 Hagood Avenue, Suite 1002, MSC 160, Charleston, SC 29425 USA
| | - Rebecca G. Knapp
- />Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VAMC, 109 Bee Street, Charleston, SC 29401 USA
- />Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, MSC 835, Charleston, SC 29425-0835 USA
| | - Leonard E. Egede
- />Division of General Internal Medicine & Geriatrics, Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, MSC 593, Charleston, SC 29425 USA
- />Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VAMC, 109 Bee Street, Charleston, SC 29401 USA
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15
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Wosinski J, Cordier SB, Bachmann AO, Gagnon MP, Kiszio B. Effectiveness of nurse-led healthy aging strategies for older adults living in the community: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2016; 14:5-15. [PMID: 27536789 DOI: 10.11124/jbisrir-2016-2191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Jacqueline Wosinski
- 1. Institut et Haute Ecole de Santé La Source, University of Applied Sciences and Arts of Western Switzerland, Switzerland2. Faculté des Sciences Infirmières, Université Laval, Canada3. Bureau d'Echanges des Savoirs pour des praTiques exemplaires de soins (BEST): an Affiliate Center of the Joanna Briggs Institute
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Process Evaluation of the Nationwide Implementation of a Lifestyle Intervention in the Construction Industry. J Occup Environ Med 2015; 58:e6-14. [PMID: 26716860 DOI: 10.1097/jom.0000000000000628] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to monitor the national scale up of the effective lifestyle intervention Health Under Construction in the Dutch construction industry. METHODS Data were collected on seven process indicators, ie, reach, dose delivered, dose received, fidelity, competence, satisfaction, and barriers. RESULTS The intervention reached 2.4% of the target group. Thirty-eight percent of the participants received five to seven consultations and 41% discussed all six intervention components. None of the counselors attained motivational interviewing proficiency. Participants perceived their counselor as competent and were satisfied with the intervention. Counselors were moderately satisfied with the intervention and experienced various barriers. CONCLUSIONS Even though important conditions for scale up were met, the implementation was characterized by a low reach, a high drop-out rate, and a low quality of the counseling technique.
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17
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Kite J, Indig D, Mihrshahi S, Milat A, Bauman A. Assessing the usefulness of systematic reviews for policymakers in public health: A case study of overweight and obesity prevention interventions. Prev Med 2015; 81:99-107. [PMID: 26303371 DOI: 10.1016/j.ypmed.2015.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Systematic reviews (SRs) should include policy-relevant information in order to more readily inform policy and practice. We investigated whether SRs of overweight and obesity prevention interventions are framed in such a way that maximises their usefulness for policymakers. METHOD We conducted a systematic review of SRs of overweight and obesity prevention interventions published in 4 databases any time up to December 2014. We analysed the SRs for their usefulness to policymakers, using a coding frame developed based on literature around what policymakers want and need from systematic reviews. Systematic reviews were assessed for a) policy links and framing; b) quality assessment and conflict of interest statements: and c) discussion of policy implications. RESULTS Of the 153 SRs that met the inclusion criteria, very few (7%) had authors from policy-based organisations, 48% had funding from such organisations, and almost a third (31%) framed their introduction or aims around policy. Most (69%) discussed issues affecting generalisability of the SR findings but only a quarter (24%) discussed cost or cost-effectiveness of the intervention under investigation. Less than a third (29%) of SRs discussed the policy implications of their findings. SRs that were policy-framed were significantly more likely to discuss costs (PR=1.8, 95%CI 1.0-3.0) and policy implications (PR=2.5, 95%CI 1.5-4.0). CONCLUSION SRs should discuss the policy and practice implications of their findings to maximise the influence of SRs on policy making. It is recommended that SR guidelines are updated to include generalisability and discussion of policy and practice implications as a requirement.
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Affiliation(s)
- James Kite
- Prevention Research Collaboration, School of Public Health, University of Sydney, NSW, Australia.
| | - Devon Indig
- Prevention Research Collaboration, School of Public Health, University of Sydney, NSW, Australia.
| | - Seema Mihrshahi
- Prevention Research Collaboration, School of Public Health, University of Sydney, NSW, Australia.
| | - Andrew Milat
- NSW Ministry of Health, 73 Miller St, North Sydney, NSW, Australia.
| | - Adrian Bauman
- Prevention Research Collaboration, School of Public Health, University of Sydney, NSW, Australia.
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18
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Bóveda-Fontán J, Barragán-Brun N, Campiñez-Navarro M, Pérula-de Torres LÁ, Bosch-Fontcuberta JM, Martín-Álvarez R, Arbonies-Ortiz JC, Novo-Rodríguez JM, Criado-Larumbe M, Fernández-García JA, Martín-Rioboó E. Effectiveness of motivational interviewing in patients with dyslipidemia: a randomized cluster trial. BMC FAMILY PRACTICE 2015; 16:151. [PMID: 26498221 PMCID: PMC4620004 DOI: 10.1186/s12875-015-0370-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 10/13/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND It is known that making people change their habits is challenging. It is crucial to identify the most effective approach that general practitioners (GPs) should use to help their patients change unhealthy habits. The objective this study was to assess the efficacy of a multifactorial intervention based on Motivational Interviewing performed by general practitioners to enhance lipid levels in patients with dyslipidemia, as compared to standard care. METHODS A multicenter, controlled, randomized, cluster, two-parallel arm trial with a 12-month follow-up conducted in 25 community health centers of the Spanish. 38 GPs and 227 primary care patients with uncontrolled dyslipidemia were included in the trial. GPs performed an intervention based either on Motivational Interviewing (MI) or standard practice. Lipid levels were measured, and the control degree was analyzed based on the criteria of clinical guidelines. RESULTS 107 were assigned to the Experimental Group (EG) and 120 to the Control Group (CG). An overall improvement was achieved in total cholesterol levels (Mean Difference -MD- = -19.60; 95 % CI: -15.33 at -23.87 mg/dl; p < 0.001), LDL-cholesterol levels (MD = -13.78; 95 % CI: -9.77 at -17.79 mg/dl; p < 0.001) and triglycerides (MD = -19.14; CI 95 %: -11.29 at -26.99 mg/dl; p < 0.001). No differences were found between the two groups. However, when we assessed the degree of lipid control by combining cholesterol <200 mg/dl and LDL-cholesterol < 130 mg/dl parameters, it was observed that a higher percentage of patients achieved target figures in the EG versus CG (13.1 % vs. 5.0 %; adjusted OR = 5.77, 95 % CI: 1.67-19.91). CONCLUSION A Motivational Interviewing-based approach conducted by Primary Care physicians aimed at patients with dyslipidemia, achieved a significant reduction in all lipid parameters, cardiovascular risk, weight reduction and the adherence to the Mediterranean diet, similar to that obtained with the usual intervention and superior in the proportion of patients achieving combined lipid control goals and the level of physical exercise. TRIAL REGISTRATION the trial is registered in ClinicalTrials.gov ( NCT01282190 ; January 21, 2011).
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Affiliation(s)
| | | | | | - Luís Ángel Pérula-de Torres
- Unidad Docente de Medicina Familiar y Comunitaria de Córdoba. Distrito Sanitario Córdoba y Guadalquivir. C/Isla de Lanzarote, Córdoba, Spain.
- Maimónides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofia University Hospital/University of Córdoba, Córdoba, Spain.
| | | | | | | | | | - Margarita Criado-Larumbe
- Health Center Villarrubia (UGC Occidente), Teaching Unit of Family and Community Medicine Cordoba. Sanitary District Cordoba and Guadalquivir. Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Córdoba, Córdoba, Spain.
| | - Jose Angel Fernández-García
- Health Center Villarrubia (UGC Occidente), Teaching Unit of Family and Community Medicine Cordoba. Sanitary District Cordoba and Guadalquivir. Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Córdoba, Córdoba, Spain.
| | - Enrique Martín-Rioboó
- UGC Fuensanta. Teaching Unit of Family and Community Medicine Cordoba. Maimónides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofía University Hospital/University of Cordoba, Córdoba, Spain.
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Rodriguez-Fernandez R, Rahajeng E, Viliani F, Kushadiwijaya H, Amiya RM, Bangs MJ. Non-communicable disease risk factor patterns among mining industry workers in Papua, Indonesia: longitudinal findings from the Cardiovascular Outcomes in a Papuan Population and Estimation of Risk (COPPER) Study. Occup Environ Med 2015; 72:728-35. [PMID: 26231573 PMCID: PMC4602234 DOI: 10.1136/oemed-2014-102664] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 07/13/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Non-communicable diseases (NCDs) constitute an increasing slice of the global burden of disease, with the South-East Asia region projected to see the highest increase in NCD-related deaths over the next decade. Mining industry employees may be exposed to various factors potentially elevating their NCD risk. This study aimed to assess the distribution and 5-year longitudinal trends of key metabolic NCD risk factors in a cohort of copper-gold mining company workers in Papua, Indonesia. METHODS Metabolic indicators of NCD risk were assessed among employees (15 580 at baseline, 6496 prospectively) of a large copper-gold mining operation in Papua, Indonesia, using routinely collected 5-year medical surveillance data. The study cohort comprised individuals aged 18-68 years employed for ≥1 year during 2008-2013. Assessed risk factors were based on repeat measures of cholesterol, blood glucose, blood pressure and body weight, using WHO criteria. RESULTS Metabolic risk indicator rates were markedly high and increased significantly from baseline through 5-year follow-up (p<0.001). Adjusting for gender and age, longer duration of employment (≥10 years) predicted raised cholesterol (adjusted OR (AOR)=1.13, p=0.003), raised blood pressure (AOR=1.16, p=0.009) and overweight/obesity (AOR=1.14, p=0.001) at baseline; and persistent raised cholesterol (AOR=1.26, p=0.003), and both incident (AOR=1.33, p=0.014) and persistent raised blood glucose (AOR=1.62, p=0.044) at 3-year follow-up. CONCLUSIONS Individuals employed for longer periods in a mining operations setting in Papua, Indonesia, may face elevated NCD risk through various routes. Workplace health promotion interventions and policies targeting modifiable lifestyle patterns and environmental exposures present an important opportunity to reduce such susceptibilities and mitigate associated health risks.
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Affiliation(s)
- Rodrigo Rodriguez-Fernandez
- Public Health and Malaria Control, International SOS, Kuala Kencana, Papua, Indonesia NCD Asia Pacific Alliance, Tokyo, Japan
| | - Ekowati Rahajeng
- Non-Communicable Disease Control, Ministry of Health, Jakarta, Indonesia
| | - Francesca Viliani
- Public Health Consulting Services and Community Health, International SOS, Copenhagen, Denmark
| | - Haripurnomo Kushadiwijaya
- Public Health and Malaria Control, International SOS, Kuala Kencana, Papua, Indonesia Faculty of Medicine, Department of Public Health, Gadjah Mada University, Yogyakarta, Indonesia
| | - Rachel M Amiya
- NCD Asia Pacific Alliance, Tokyo, Japan Department of Family Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Michael J Bangs
- Public Health and Malaria Control, International SOS, Kuala Kencana, Papua, Indonesia
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Álvarez-Bueno C, Cavero-Redondo I, Martínez-Andrés M, Arias-Palencia N, Ramos-Blanes R, Salcedo-Aguilar F. Effectiveness of multifactorial interventions in primary health care settings for primary prevention of cardiovascular disease: A systematic review of systematic reviews. Prev Med 2015; 76 Suppl:S68-75. [PMID: 25511466 DOI: 10.1016/j.ypmed.2014.11.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 11/14/2014] [Accepted: 11/29/2014] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of multifactorial interventions carried out in the community setting to decrease cardiovascular risk in healthy patients. METHODS Systematic review of the MEDLINE (via PubMed), Web of Science and Cochrane Library databases from January 1980 to January 2014. Identified for inclusion were systematic reviews of clinical trials that included multifactorial interventions carried out in primary care or community settings, targeting more than one cardiovascular risk factor, and implementing more than one type of intervention. The methodological quality of the included articles was evaluated using the AMSTAR tool. RESULTS Eight systematic reviews were selected, including 219 studies. All of these reviews provided information about the effectiveness of multifactorial interventions in reducing mortality and morbidity due to cardiovascular diseases. Four reviews reported moderate effectiveness and four showed limited effectiveness. CONCLUSION Multifactorial community interventions improve cardiovascular risk factors and have a small but potentially important effect on mortality. These interventions seem to be more effective in the at-risk population and when they are carried out at a high level of intensity.
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Affiliation(s)
- Celia Álvarez-Bueno
- Social and Health Care Research Centre, University of Castilla-La Mancha, Cuenca, Spain.
| | - Iván Cavero-Redondo
- Social and Health Care Research Centre, University of Castilla-La Mancha, Cuenca, Spain.
| | - María Martínez-Andrés
- Social and Health Care Research Centre, University of Castilla-La Mancha, Cuenca, Spain.
| | - Natalia Arias-Palencia
- Social and Health Care Research Centre, University of Castilla-La Mancha, Cuenca, Spain.
| | - Rafael Ramos-Blanes
- Research Unit, Family Medicine, Girona, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol) and Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Spain.
| | - Fernando Salcedo-Aguilar
- Social and Health Care Research Centre, University of Castilla-La Mancha, Cuenca, Spain; Health Centre Cuenca I, Health Service of Castilla-La Mancha (SESCAM), Cuenca, Spain.
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Body brain life: A randomized controlled trial of an online dementia risk reduction intervention in middle-aged adults at risk of Alzheimer's disease. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2015; 1:72-80. [PMID: 29854927 PMCID: PMC5974937 DOI: 10.1016/j.trci.2015.04.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective To examine the efficacy of body brain life (BBL), a 12-week online dementia risk reduction intervention. Methods BBL was evaluated in a randomized controlled trial in 176 middle-aged adults with >2 risk factors and <2 protective factors for Alzheimer's disease (AD) assessed on a brief screening instrument. Participants were randomized to BBL, BBL plus face-to-face group sessions (BBL + FF) or active control (control). Score on the Australian National University-Alzheimer's disease risk index (ANU-ADRI), a validated index of AD risk, was the primary outcome measure assessed at baseline, 12, and 26 weeks. Results A group by time interaction at 26 weeks showed a significant reduction in ANU-ADRI score for BBL compared with control. Planned contrasts showed the BBL and BBL + FF groups had improvement in ANU-ADRI scores at 12 weeks (BBL + FF: z = -0.25; P = .021; BBL: z = -0.25; P = .008) and 26 weeks (BBL + FF: z = -0.48; P < .001; BBL: z = -0.28; P = .004) due to increase in protective factors. Conclusions This short intervention resulted in dementia risk reduction. Online dementia risk reduction interventions show promise for reducing the overall dementia risk in middle-aged adults with multiple risk factors.Clinical Trial Registration: The study is registered under Trial Registration: Reg. # ACTRN12612000147886.
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Johnson HM, Olson AG, LaMantia JN, Kind AJH, Pandhi N, Mendonça EA, Craven M, Smith MA. Documented lifestyle education among young adults with incident hypertension. J Gen Intern Med 2015; 30:556-64. [PMID: 25373831 PMCID: PMC4395591 DOI: 10.1007/s11606-014-3059-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 08/05/2014] [Accepted: 09/26/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Only 38% of young adults with hypertension have controlled blood pressure. Lifestyle education is a critical initial step for hypertension control. Previous studies have not assessed the type and frequency of lifestyle education in young adults with incident hypertension. OBJECTIVE The purpose of this study was to determine patient, provider, and visit predictors of documented lifestyle education among young adults with incident hypertension. DESIGN We conducted a retrospective analysis of manually abstracted electronic health record data. PARTICIPANTS A random selection of adults 18-39 years old (n = 500), managed by a large academic practice from 2008 to 2011 and who met JNC 7 clinical criteria for incident hypertension, participated in the study. MAIN MEASURES The primary outcome was the presence of any documented lifestyle education during one year after meeting criteria for incident hypertension. Abstracted topics included documented patient education for exercise, tobacco cessation, alcohol use, stress management/stress reduction, Dietary Approaches to Stop Hypertension (DASH) diet, and weight loss. Clinic visits were categorized based upon a modified established taxonomy to characterize patients' patterns of outpatient service. We excluded patients with previous hypertension diagnoses, previous antihypertensive medications, or pregnancy. Logistic regression was used to identify predictors of documented education. KEY RESULTS Overall, 55% (n = 275) of patients had documented lifestyle education within one year of incident hypertension. Exercise was the most frequent topic (64%). Young adult males had significantly decreased odds of receiving documented education. Patients with a previous diagnosis of hyperlipidemia or a family history of hypertension or coronary artery disease had increased odds of documented education. Among visit types, chronic disease visits predicted documented lifestyle education, but not acute or other/preventive visits. CONCLUSIONS Among young adults with incident hypertension, only 55% had documented lifestyle education within one year. Knowledge of patient, provider, and visit predictors of education can help better target the development of interventions to improve young adult health education and hypertension control.
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Affiliation(s)
- Heather M Johnson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA,
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Solvang MM, Norekvål TM, Tell GS, Berge LI, Iversen MM. Attempts to improve and confidence in improving health behaviour in 40-49 year olds with and without coronary heart disease: The Hordaland Health Study. Eur J Cardiovasc Nurs 2015; 15:e60-9. [PMID: 25888607 DOI: 10.1177/1474515115583399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/30/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND While the overall incidence of acute myocardial infarction in Norway decreased in 2001-2009, this was not observed for younger adults. Smoking cessation, physical activity and healthy diet are associated with reduced risk of recurrent cardiovascular events and mortality among individuals with established coronary heart disease (CHD). AIMS We investigated whether adults in their 40s with or without CHD had 1) attempted to improve their health behaviour during the previous year, and 2) had confidence in their ability to improve their health behaviour over the next five years. METHODS Study participants were 22,019 40-49 year olds from the Hordaland Health Study. Associations between improvements and intentions regarding health behaviours and prevalent CHD were assessed with logistic regression analyses. RESULTS One hundred and seventy-five (0.8%) participants reported to have CHD. After controlling for demographic, lifestyle and psychosocial variables, attempts to improve health behaviour during the prior year were associated with a threefold increased odds of prevalent CHD (odds ratio 3.07; 95% confidence interval, 1.91-4.95). Confidence in improving health behaviour during the subsequent five years was not associated with increased odds of prevalent CHD. CONCLUSIONS Adults in their 40s with CHD were more likely to have attempted to improve their health behaviour during the past year compared with those without CHD. Healthcare providers should take advantage of these positive attitudes to encourage further positive improvements.
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Affiliation(s)
- Marte M Solvang
- Faculty of Health and Social Sciences, Bergen University College, Norway
| | - Tone M Norekvål
- Faculty of Health and Social Sciences, Bergen University College, Norway Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Line I Berge
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Marjolein M Iversen
- Faculty of Health and Social Sciences, Bergen University College, Norway Department of Endocrinology, Stavanger University Hospital, Norway
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Livingstone KM, Celis-Morales C, Navas-Carretero S, San-Cristobal R, O'Donovan CB, Forster H, Woolhead C, Marsaux CFM, Macready AL, Fallaize R, Kolossa S, Tsirigoti L, Lambrinou CP, Moschonis G, Godlewska M, Surwiłło A, Drevon CA, Manios Y, Traczyk I, Gibney ER, Brennan L, Walsh MC, Lovegrove JA, Alfredo Martinez J, Saris WH, Daniel H, Gibney M, Mathers JC. Profile of European adults interested in internet-based personalised nutrition: the Food4Me study. Eur J Nutr 2015; 55:759-769. [PMID: 25893715 DOI: 10.1007/s00394-015-0897-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/01/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE Personalised interventions may have greater potential for reducing the global burden of non-communicable diseases and for promoting better health and well-being across the lifespan than the conventional "one size fits all" approach. However, the characteristics of individuals interested in personalised nutrition (PN) are unclear. Therefore, the aim of this study was to describe the characteristics of European adults interested in taking part in an internet-based PN study. METHODS Individuals from seven European countries (UK, Ireland, Germany, The Netherlands, Spain, Greece and Poland) were invited to participate in the study via the Food4Me website ( http://www.food4me.org ). Two screening questionnaires were used to collect data on socio-demographic, anthropometric and health-related characteristics as well as dietary intakes. RESULTS A total of 5662 individuals expressed an interest in the study (mean age 40 ± 12.7; range 15-87 years). Of these, 65 % were female and 97 % were Caucasian. Overall, 13 % were smokers and 47 % reported the presence of a clinically diagnosed disease. Furthermore, 47 % were overweight or obese and 35 % were sedentary during leisure time. Assessment of dietary intakes showed that 54 % of individuals reported consuming at least 5 portions of fruit and vegetables per day, 46 % consumed more than 3 servings of wholegrains and 37 % limited their salt intake to <5.75 g per day. CONCLUSIONS Our data indicate that individuals volunteering to participate in an internet-based PN study are broadly representative of the European adult population, most of whom had adequate nutrient intakes but could benefit from improved dietary choices and greater physical activity. Future use of internet-based PN approaches is thus relevant to a wide target audience.
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Affiliation(s)
- Katherine M Livingstone
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Carlos Celis-Morales
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Santiago Navas-Carretero
- Center for Nutrition Research, University of Navarra, Pamplona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Rodrigo San-Cristobal
- Center for Nutrition Research, University of Navarra, Pamplona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Clare B O'Donovan
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Republic of Ireland
| | - Hannah Forster
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Republic of Ireland
| | - Clara Woolhead
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Republic of Ireland
| | - Cyril F M Marsaux
- Department of Human Biology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Anna L Macready
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, University of Reading, Reading, UK
| | - Rosalind Fallaize
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, University of Reading, Reading, UK
| | - Silvia Kolossa
- ZIEL Research Center of Nutrition and Food Sciences, Biochemistry Unit, Technische Universität München, Munich, Germany
| | - Lydia Tsirigoti
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | | | - George Moschonis
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | | | | | - Christian A Drevon
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Iwona Traczyk
- National Food and Nutrition Institute, (IZZ), Warsaw, Poland
| | - Eileen R Gibney
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Republic of Ireland
| | - Lorraine Brennan
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Republic of Ireland
| | - Marianne C Walsh
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Republic of Ireland
| | - Julie A Lovegrove
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, University of Reading, Reading, UK
| | - J Alfredo Martinez
- Center for Nutrition Research, University of Navarra, Pamplona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Wim H Saris
- Department of Human Biology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hannelore Daniel
- ZIEL Research Center of Nutrition and Food Sciences, Biochemistry Unit, Technische Universität München, Munich, Germany
| | - Mike Gibney
- UCD Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Republic of Ireland
| | - John C Mathers
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
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Wilson K, Senay I, Durantini M, Sánchez F, Hennessy M, Spring B, Albarracín D. When it comes to lifestyle recommendations, more is sometimes less: a meta-analysis of theoretical assumptions underlying the effectiveness of interventions promoting multiple behavior domain change. Psychol Bull 2015; 141:474-509. [PMID: 25528345 PMCID: PMC4801324 DOI: 10.1037/a0038295] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A meta-analysis of 150 research reports summarizing the results of multiple behavior domain interventions examined theoretical predictions about the effects of the included number of recommendations on behavioral and clinical change in the domains of smoking, diet, and physical activity. The meta-analysis yielded 3 main conclusions. First, there is a curvilinear relation between the number of behavioral recommendations and improvements in behavioral and clinical measures, with a moderate number of recommendations producing the highest level of change. A moderate number of recommendations is likely to be associated with stronger effects because the intervention ensures the necessary level of motivation to implement the recommended changes, thereby increasing compliance with the goals set by the intervention, without making the intervention excessively demanding. Second, this curve was more pronounced when samples were likely to have low motivation to change, such as when interventions were delivered to nonpatient (vs. patient) populations, were implemented in nonclinic (vs. clinic) settings, used lay community (vs. expert) facilitators, and involved group (vs. individual) delivery formats. Finally, change in behavioral outcomes mediated the effects of number of recommended behaviors on clinical change. These findings provide important insights that can help guide the design of effective multiple behavior domain interventions.
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Tonnon SC, Proper KI, van der Ploeg HP, Westerman MJ, Sijbesma E, van der Beek AJ. A qualitative study of the anticipated barriers and facilitators to the implementation of a lifestyle intervention in the Dutch construction industry. BMC Public Health 2014; 14:1317. [PMID: 25539630 PMCID: PMC4326182 DOI: 10.1186/1471-2458-14-1317] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/16/2014] [Indexed: 11/22/2022] Open
Abstract
Background Lifestyle interventions have proven effective for lowering a cardiovascular risk profile by improving lifestyle behaviors, blood glucose and blood cholesterol levels. However, implementation of lifestyle interventions is often met with barriers. This qualitative study sought to determine anticipated barriers and facilitators to the nationwide implementation of an effective lifestyle intervention in the construction industry in the Netherlands. Methods Prior to implementation, focus groups were held with 8 lifestyle counselors and semi-structured interviews with 20 employees of the construction industry, 4 occupational physicians, 4 medical assistants, and 1 manager of an occupational health service. The transcripts were coded by two coders and analyzed by constant comparison. Results Hypothetical employee willingness to sign up for the intervention was facilitated by a high level of perceived risk, perceived added value of the intervention, and perceived social support. It was hampered by a preference for independence and perceived interference with their work. All professionals named a lack of time as an anticipated barrier to implementation. Lifestyle counselors suggested several strategies to improve the proficiency of their counseling technique, such as training in small groups and a continuous stream of employee referrals. Occupational physicians thought they would be hampered in screening employees and referring them to a lifestyle counselor by the perception that addressing employee lifestyles was not their task, and by a counter-productive relationship with other stakeholders. The manager addressed financial incentives and a good intervention fit with the current approach of the OHS. Conclusion The findings suggest that employees can be motivated to sign up for a lifestyle intervention by tailoring the implementation strategy to various subgroups within the target group. Occupational physicians can be motivated to refer employees for the intervention by making a referral personally and professionally rewarding. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1317) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - K I Proper
- Department of Public and Occupational Health, EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Li M, Wang A, Hu L, Song Z, Zhao Y, Sun Y, Yan L, Li X. Effects of estradiol-drospirenone on menopausal symptoms, lipids and bone turnover in Chinese women. Climacteric 2014; 18:214-8. [PMID: 25362969 DOI: 10.3109/13697137.2014.978753] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the effects of a hormone replacement preparation containing 1 mg estradiol plus 2 mg drospirenone on menopausal symptoms, blood lipids, and bone turnover markers in postmenopausal women. METHODS A prospective, self-controlled trial was conducted in 64 Chinese postmenopausal women aged 45-60 (mean 52.5 ± 3.37) years who were treated with estradiol-drospirenone for at least 6 months. The Kupperman index, blood lipid concentrations, bone mineral density, and bone turnover markers were measured before (baseline) and at 1, 3, and 6 months after treatment. RESULTS In comparison with baseline, the Kupperman index score was significantly improved at 1, 3, and 6 months after estradiol-drospirenone treatment (20.57 ± 6.52 vs. 16.37 ± 5.19, 13.34 ± 4.52, and 12.70 ± 4.42, respectively; all p < 0.01). After 6 months of treatment, concentrations of low density lipoprotein cholesterol, triglycerides, and total cholesterol were significantly decreased, high density lipoprotein cholesterol concentrations were significantly increased (all p < 0.05), and bone mineral densities of the lumbar spine and hip were significantly improved (both p < 0.001 compared with baseline). At both 3 and 6 months after treatment, bone alkaline phosphatase concentrations were significantly decreased compared with baseline (61.14 ± 12.38 IU/l and 58.77 ± 11.35 IU/l, respectively, vs. 65.81 ± 14.75 IU/l; p < 0.05), as were tartrate-resistant acid phosphatase concentrations (5.99 ± 2.98 IU/l and 4.90 ± 2.90 IU/l, respectively, vs. 6.15 ± 3.02 IU/l; p < 0.05). CONCLUSION Estradiol-drospirenone effectively alleviates menopausal symptoms and also has beneficial effects on blood lipids and bone metabolism.
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Affiliation(s)
- M Li
- * Obstetrics and Gynecology Department of Navy General Hospital of Chinese PLA , Beijing
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Concurrent occurrence of multiple positive lifestyle behaviors and depression among adults in the United States. J Affect Disord 2014; 165:126-30. [PMID: 24882189 DOI: 10.1016/j.jad.2014.04.073] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 04/26/2014] [Accepted: 04/26/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND To our knowledge, no studies have examined the dose-response association between concurrent occurrence of multiple positive health behaviors and depression. As a result, the purpose of this study was to examine the dose-response association between concurrent occurrence of lifestyle behaviors (i.e., diet, physical activity, and smoking) on depression symptoms among a national sample of U.S. adults (20-85 yr). METHODS Using data from the 2005-2006 NHANES (n=2574), diet was assessed from the healthy eating index variable; physical activity was assessed via accelerometry; smoking was assessed from cotinine levels; and depression was assessed from the Patient Health Questionnaire 9 (PHQ-9). RESULTS Each lifestyle behavior was independently associated with depression in the expected direction, and there was also evidence of a dose-response relationship. Compared to those having 0 positive lifestyle factors, those with 1, 2, and 3 positive lifestyle factors, respectively, were 15% (p=0.38), 67% (p=0.001), and 82% (p=0.01) less likely to be classifed as having moderate or greater depression symptoms (PHQ-9 ≥10). LIMITATIONS The main limitation of this study was the cross-sectional design. CONCLUSION there is a dose-response relationship between concurrent occurrence of positive lifestyle behaviors and depression symptoms.
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Carrington MJ, Stewart S. Cardiovascular disease prevention via a nurse-facilitated intervention clinic in a regional setting: The Protecting Healthy Hearts Program. Eur J Cardiovasc Nurs 2014; 14:352-61. [DOI: 10.1177/1474515114537022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/29/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Melinda J Carrington
- Centre for Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Australia
| | - Simon Stewart
- Centre for Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Australia
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30
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Prochaska JJ, Fromont SC, Delucchi K, Young-Wolff KC, Benowitz NL, Hall S, Bonas T, Hall SM. Multiple risk-behavior profiles of smokers with serious mental illness and motivation for change. Health Psychol 2014; 33:1518-29. [PMID: 24467257 DOI: 10.1037/a0035164] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Individuals with serious mental illness (SMI) are dying on average 25 years prematurely. The leading causes are chronic preventable diseases. In the context of a tobacco-treatment trial, this exploratory study examined the behavioral risk profiles of adults with SMI to identify broader interventional needs. METHOD Recruited from five acute inpatient psychiatry units, participants were 693 adult smokers (recruitment rate = 76%, 50% male, 45% Caucasian, age M = 39, 49% had income < $10,000) diagnosed with mood disorders (71%), substance-use disorders (63%), posttraumatic stress disorder (39%), psychotic disorders (25%), and attention deficit-hyperactivity disorder (25%). The Staging Health Risk Assessment, the primary measure used in this study, screened for risk status and readiness to change 11 health behaviors, referencing the period prior to acute hospitalization. RESULTS Participants averaged 5.2 (SD = 2.1) risk behaviors, including smoking (100%), high-fat diet (68%), inadequate fruits/vegetables (67%), poor sleep (53%), physical inactivity (52%), and marijuana use (46%). The percent prepared to change ranged from 23% for tobacco and marijuana to 76% for depression management. Latent class analysis differentiated three risk groups: the global higher risk group included patients elevated on all risk behaviors; the global lower risk group was low on all risks; and a mood and metabolic risk group, characterized by inactivity, unhealthy diet, sleep problems, and poor stress and depression management. The global higher risk group (11% of sample) was younger, largely male, and had the greatest number of risk behaviors and mental health diagnoses; had the most severe psychopathologies, addiction-treatment histories, and nicotine dependence; and the lowest confidence for quitting smoking and commitment to abstinence. CONCLUSION Most smokers with SMI engaged in multiple risks. Expanding targets to treat co-occurring risks and personalizing treatment to individuals' multibehavioral profiles may increase intervention relevance, interest, and impact on health.
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Affiliation(s)
- Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University
| | | | - Kevin Delucchi
- Department of Psychiatry, University of California-San Francisco
| | - Kelly C Young-Wolff
- Stanford Prevention Research Center, Department of Medicine, Stanford University
| | - Neal L Benowitz
- Division of Clinical Pharmacology, Departments of Medicine and Bioengineering & Therapeutic Sciences, University of California-San Francisco
| | - Stephen Hall
- Department of Psychiatry, University of California-San Francisco
| | | | - Sharon M Hall
- Department of Psychiatry, University of California-San Francisco
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Williams JS, Cunich M, Byles J. The impact of socioeconomic status on changes in the general and mental health of women over time: evidence from a longitudinal study of Australian women. Int J Equity Health 2013; 12:25. [PMID: 23570377 PMCID: PMC3635960 DOI: 10.1186/1475-9276-12-25] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 03/18/2013] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Generally, men and women of higher socioeconomic status (SES) have better health. Little is known about how socioeconomic factors are associated with changes in health as women progress through mid-life. This study uses data from six survey waves (1996 to 2010) of the Australian Longitudinal Study on Women's Health (ALSWH) to examine associations between SES and changes in the general health and mental health of a cohort of women progressing in years from 45-50 to 59-64. METHODS Participants were 12,709 women (born 1946-51) in the ALSWH. Outcome measures were the general health and mental health subscales of the Medical Outcomes Study Short Form 36 Questionnaire (SF-36). The measure of SES was derived from factor analysis of responses to questions in the ALSWH baseline survey (1996) on school leaving age, highest qualifications, and current or last occupation. Multi-level random coefficient models, adjusted for socio-demographic factors and health behaviors, were used to analyze repeated measures of general health and mental health. Survey year accounted for changes in factors across time. In the first set of analyses we investigated associations between the SES index, used as a "continuous" variable, and general health and mental health changes over time. To illuminate the impact of different levels of SES on health, a second analysis was conducted in which SES scores were grouped into three approximately equal sized categories or "tertiles" as reported in an earlier ALSWH study. The least square means of general and mental health scores from the longitudinal models were plotted for the three SES tertiles. RESULTS The longitudinal analysis showed that, after adjusting for the effects of time and possible confounders, the general (mental) health of this cohort of mid-aged women declined (increased) over time. Higher SES women reported better health than lower SES women, and SES significantly modified the effects of time on both general and mental health in favor of higher SES women. CONCLUSIONS This study contributes to our current understanding of how socioeconomic and demographic factors, health behaviors and time impact on changes in the general and mental health of women progressing in years from 45-50 to 59-64.
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Affiliation(s)
- Jennifer Stewart Williams
- Research Centre for Gender Health & Ageing, Faculty of Health, University of Newcastle, HMRI Building, Callaghan, NSW, 2308, Australia
| | - Michelle Cunich
- Sydney School of Public Health Room 314, A-27 Edward Ford Building University of Sydney, Sydney, NSW, 2006, Australia
| | - Julie Byles
- Research Centre for Gender Health & Ageing, Faculty of Health, University of Newcastle, HMRI Building, Callaghan, NSW, 2308, Australia
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Hardcastle SJ, Taylor AH, Bailey MP, Harley RA, Hagger MS. Effectiveness of a motivational interviewing intervention on weight loss, physical activity and cardiovascular disease risk factors: a randomised controlled trial with a 12-month post-intervention follow-up. Int J Behav Nutr Phys Act 2013; 10:40. [PMID: 23537492 PMCID: PMC3639183 DOI: 10.1186/1479-5868-10-40] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 03/18/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Intensive diet and physical activity interventions have been found to reduce cardiovascular disease (CVD) risk, but are resource intensive. The American Heart Association recently recommended motivational interviewing (MI) as an effective approach for low-intensity interventions to promote health-related outcomes such as weight loss. However, there is limited research evaluating the long-term effectiveness of MI-based interventions on health-related outcomes associated with CVD risk. The current research evaluated the effectiveness of a six-month low-intensity MI intervention in a UK primary-care setting in maintaining reductions in CVD risk factors at12 months post-intervention. METHODS Primary-care patients were randomised to an intervention group that received standard exercise and nutrition information plus up to five face-to-face MI sessions, delivered by a physical activity specialist and registered dietician over a 6-month period, or to a minimal intervention comparison group that received the standard information only. Follow-up measures of behavioural (vigorous and moderate physical activity, walking, physical activity stage-of-change, fruit and vegetable intake, and dietary fat intake) and biomedical (weight, body mass index [BMI], blood pressure, cholesterol) outcomes were taken immediately post-intervention and at a 12-month follow-up occasion. RESULTS Intent-to-treat analyses revealed significant differences between groups for walking and cholesterol. Obese and hypercholesterolemic patients at baseline exhibited significant improvements in BMI and cholesterol respectively among those allocated to the intervention group compared to the comparison group. Post-intervention improvements in other health-related outcomes including blood pressure, weight, and BMI were not maintained. CONCLUSIONS The present study suggests that a low-intensity MI counselling intervention is effective in bringing about long-term changes in some, but not all, health-related outcomes (walking, cholesterol levels) associated with CVD risk. The intervention was particularly effective for patients with elevated levels of CVD risk factors at baseline. Based on these findings future interventions should be conducted in a primary care setting and target patients with high risk of CVD. Future research should investigate how the long-term gains in health-related outcomes brought about by the MI-counselling intervention in the current study could be extended to a wider range of health outcomes.
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Affiliation(s)
- Sarah J Hardcastle
- School of Sport and Service Management, University of Brighton, Denton Road, Eastbourne, ES BN20 7SP, UK
| | - Adrian H Taylor
- Sport, Exercise and Health Sciences, University of Exeter, St. Luke’s Campus, Exeter, Exeter EX1 2LU, UK
| | - Martin P Bailey
- School of Sport and Service Management, University of Brighton, Denton Road, Eastbourne, ES BN20 7SP, UK
| | - Robert A Harley
- School of Sport and Service Management, University of Brighton, Denton Road, Eastbourne, ES BN20 7SP, UK
| | - Martin S Hagger
- Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth WA6845, Australia
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Berks D, Hoedjes M, Raat H, Duvekot JJ, Steegers EAP, Habbema JDF. Risk of cardiovascular disease after pre-eclampsia and the effect of lifestyle interventions: a literature-based study. BJOG 2013; 120:924-31. [PMID: 23530583 DOI: 10.1111/1471-0528.12191] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study addresses the following questions. Do cardiovascular risk factors fully explain the odds ratio of cardiovascular risk after pre-eclampsia? What is the effect of lifestyle interventions (exercise, diet, and smoking cessation) after pre-eclampsia on the risk of cardiovascular disease? DESIGN Literature-based study. SETTING N/A. POPULATION OR SAMPLE N/A. METHODS Data for the calculations were taken from studies identified by PubMed searches. First, the differences in cardiovascular risk factors after pre-eclampsia compared with an uncomplicated pregnancy were estimated. Second, the effects of lifestyle interventions on cardiovascular risk were estimated. Validated risk prediction models were used to translate these results into cardiovascular risk. RESULTS After correction for known cardiovascular risk factors, the odds ratios of pre-eclampsia for ischaemic heart disease and for stroke are 1.89 (IQR 1.76-1.98) and 1.55 (IQR 1.40-1.71), respectively. After pre-eclampsia, lifestyle interventions on exercise, dietary habits, and smoking cessation decrease cardiovascular risk, with an odds ratio of 0.91 (IQR 0.87-0.96). CONCLUSIONS Cardiovascular risk factors do not fully explain the risk of cardiovascular disease after pre-eclampsia. The gap between estimated and observed odds ratios may be explained by an additive risk of cardiovascular disease by pre-eclampsia. Furthermore, lifestyle interventions after pre-eclampsia seem to be effective in decreasing cardiovascular risk. Future research is needed to overcome the numerous assumptions we had to make in our calculations.
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Affiliation(s)
- D Berks
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, the Netherlands.
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Anstey KJ, Bahar-Fuchs A, Herath P, Rebok GW, Cherbuin N. A 12-week multidomain intervention versus active control to reduce risk of Alzheimer's disease: study protocol for a randomized controlled trial. Trials 2013; 14:60. [PMID: 23442574 PMCID: PMC3598396 DOI: 10.1186/1745-6215-14-60] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 02/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disappointing results from clinical trials of disease-modifying interventions for Alzheimer's dementia (AD), along with reliable identification of modifiable risk factors in mid life from epidemiological studies, have contributed to calls to invest in risk-reduction interventions. It is also well known that AD-related pathological processes begin more than a decade before the development of clinical signs. These observations suggest that lifestyle interventions might be most effective when targeting non-symptomatic adults at risk of AD. To date, however, the few dementia risk-reduction programs available have targeted individual risk factors and/or were restricted to clinical settings. The current study describes the development of an evidence-based, theoretically-driven multidomain intervention to reduce AD risk in adults at risk. METHOD The design of Body Brain Life (BBL) is a randomized controlled trial (RCT) to evaluate a 12-week online AD risk-reduction intervention. Eligible participants with several modifiable risk factors on the Australian National University (ANU) AD Risk Index (ANU-ADRI) are randomly allocated to an online only group, an online and face-to-face group, or an active control group. We aim to recruit 180 participants, to undergo a comprehensive cognitive and physical assessment at baseline, post-intervention, and 6-month follow-up assessment. The intervention comprises seven online modules (dementia literacy, risk factor education, engagement in physical, social, and cognitive lifestyles, nutrition, and health monitoring) designed using contemporary models of health behavior change. DISCUSSION The BBL program is a novel online intervention to reduce the risk of AD in middle-aged adults at risk. The trial is currently under way. It is hypothesized that participants in the intervention arms will make lifestyle changes in several domains, and that this will lead to a reduction in their AD risk profile. We also expect to show that health behavior change is underpinned by changes in psychological determinants of behavior. If successful, the findings will contribute to the development of further dementia risk reduction interventions, and thus contribute to the urgent need to lower dementia risk factors in the population to alter future projections of disease prevalence. Longer follow-up of BBL participants and replications using large samples are required to examine whether reduction in AD risk factors will be associated with reduced prevalence. TRIAL REGISTRATION Reg. no. ACTRN12612000147886.
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Affiliation(s)
- Kaarin J Anstey
- Centre for Research on Ageing Health and Wellbeing, The Australian National University, Canberra, Australia.
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Assessing Patterns of Use of Cardio-Protective Polypill Component Medicines in Australian Women. Drugs Aging 2013; 30:193-203. [DOI: 10.1007/s40266-013-0051-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Landsberg L, Aronne LJ, Beilin LJ, Burke V, Igel LI, Lloyd-Jones D, Sowers J. Obesity-related hypertension: pathogenesis, cardiovascular risk, and treatment--a position paper of the The Obesity Society and The American Society of Hypertension. Obesity (Silver Spring) 2013; 21:8-24. [PMID: 23401272 DOI: 10.1002/oby.20181] [Citation(s) in RCA: 165] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 10/18/2012] [Indexed: 01/11/2023]
Abstract
In light of the worldwide epidemic of obesity, and in recognition of hypertension as a major factor in the cardiovascular morbidity and mortality associated with obesity, The Obesity Society and The American Society of Hypertension agreed to jointly sponsor a position paper on obesity-related hypertension to be published jointly in the journals of each society. The purpose is to inform the members of both societies, as well as practicing clinicians, with a timely review of the association between obesity and high blood pressure, the risk that this association entails, and the options for rational, evidenced-based treatment. The position paper is divided into six sections plus a summary as follows: pathophysiology, epidemiology and cardiovascular risk, the metabolic syndrome, lifestyle management in prevention and treatment, pharmacologic treatment of hypertension in the obese, and the medical and surgical treatment of obesity in obese hypertensive patients.
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Affiliation(s)
- Lewis Landsberg
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Landsberg L, Aronne LJ, Beilin LJ, Burke V, Igel LI, Lloyd-Jones D, Sowers J. Obesity-related hypertension: pathogenesis, cardiovascular risk, and treatment: a position paper of The Obesity Society and the American Society of Hypertension. J Clin Hypertens (Greenwich) 2012; 15:14-33. [PMID: 23282121 DOI: 10.1111/jch.12049] [Citation(s) in RCA: 280] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In light of the worldwide epidemic of obesity, and in recognition of hypertension as a major factor in the cardiovascular morbidity and mortality associated with obesity, The Obesity Society and the American Society of Hypertension agreed to jointly sponsor a position paper on obesity-related hypertension to be published jointly in the journals of each society. The purpose is to inform the members of both societies, as well as practicing clinicians, with a timely review of the association between obesity and high blood pressure, the risk that this association entails, and the options for rational, evidenced-based treatment. The position paper is divided into six sections plus a summary as follows: pathophysiology, epidemiology and cardiovascular risk, the metabolic syndrome, lifestyle management in prevention and treatment, pharmacologic treatment of hypertension in the obese, and the medical and surgical treatment of obesity in obese hypertensive patients.
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Affiliation(s)
- Lewis Landsberg
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Ferreira PH, Pinheiro MB, Machado GC, Ferreira ML. Is alcohol intake associated with low back pain? A systematic review of observational studies. ACTA ACUST UNITED AC 2012; 18:183-90. [PMID: 23146385 DOI: 10.1016/j.math.2012.10.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 10/03/2012] [Accepted: 10/09/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND Alcohol intake has been widely reported as a risk factor for low back pain (LBP), however, the literature is inconclusive about this association. OBJECTIVES To determine, in a systematic review, the relationship between alcohol intake and LBP. METHODS A search was conducted in CINAHL, LILACS, Medline, National Research Register and Web of Science to identify studies that investigated the association between alcohol intake and LBP. Quantitative results and its estimators were extracted. When possible, meta-analyses were performed using a random effects model. RESULTS Twenty-six studies were included in this review. Twenty-three studies were retrospective cohorts, two were case-controls, and one employed a longitudinal design. Pooled results from nine studies (two case-controls and seven retrospective cohorts) showed that alcohol consumption is slightly associated with LBP (OR: 1.3; 95% CI: 1.1-1.5). This association appears to be present in studies investigating alcohol as an abuse dependence substance in chronic LBP. Remaining individual studies tended to report no statistical significant association. No dose-response relationship was identified. Only one longitudinal study was identified and even though alcohol consumption was found to be negatively associated with a future episode of LBP (OR: 0.7; 95% CI: 0.5-0.9) this association lost significance for future incidence of LBP in people with no LBP at baseline. CONCLUSIONS Alcohol consumption appears to be associated with complex and chronic LBP only and in people with alcohol consumption dependence. Clinicians in the musculoskeletal field could use this information to design educational strategies for this population.
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Affiliation(s)
- Paulo Henrique Ferreira
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, PO Box 170, Lidcombe, Sydney, NSW 1825, Australia.
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Hee L, Thomas L, Ang X, Yang L, Lo S, Juergens CP, Mussap CJ, Dignan R, French JK. Risk factor modification in diabetic patients following angiographic identification of multi-vessel disease. Int J Cardiol 2012; 167:1276-81. [PMID: 22560944 DOI: 10.1016/j.ijcard.2012.03.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 03/17/2012] [Accepted: 03/19/2012] [Indexed: 12/18/2022]
Abstract
There is little information on whether identification of multi-vessel disease (MVD) in patients with diabetic mellitus (DM) affects risk factor management. From 1125 consecutively screened patients between June 2006 and March 2010, we examined 227 diabetic patients with MVD on coronary angiography. Diabetic control and cholesterol levels were assessed by glycated haemoglobin (HbA1c) and total cholesterol (TC) respectively which were evaluated at baseline and at 1-year follow-up. Patients were grouped by age into <55(n=33), 55-65(n=75), 66-75(n=75) and >75(n=44). Target levels were defined as HbA1c<7% and TC<4.0 mmol/L. Patients <55 years had the highest HbA1c at 9.1[7.6-11.2]% with the lowest proportion of patients (n=3; 11.1%) within target at baseline, while 66-75 years had the best HbA1c at 7.1[6.4-7.8]% with the highest proportion (n=28, 45.2%) reaching target (p<0.0001). At 1-year, the poorest HbA1c control was again observed in the age <55 with fewer patients achieving target compared to the 66-75 age group (HbA1c: 8.5% vs 6.9%; % of patients at target: 20.7% vs 54.5%; p<0.0001). Furthermore, the group <55 years demonstrated the worst TC control at 1-year with a significant increase compared to the baseline TC (p=0.01). Patients with a lower body mass index (BMI) were likely to have an improvement in HbA1c and reach target (p=0.01). Paradoxically, patients who were current smokers demonstrated a beneficial effect on optimal TC control (29.2% vs 15.4%, p=0.027). In younger diabetic patients, risk factor modification at 1-year was poor despite identification of MVD. Developing an effective education and monitoring programme to improve glycaemic control in this high risk group should be a priority.
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Affiliation(s)
- Leia Hee
- Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia
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van Achterberg T, Huisman-de Waal GGJ, Ketelaar NABM, Oostendorp RA, Jacobs JE, Wollersheim HCH. How to promote healthy behaviours in patients? An overview of evidence for behaviour change techniques. Health Promot Int 2011; 26:148-62. [PMID: 20739325 PMCID: PMC3090154 DOI: 10.1093/heapro/daq050] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Theo van Achterberg
- Scientific Institute for Quality of Healthcare (114 IQ healthcare), Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen, The Netherlands.
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Speechly C, Bridges-Webb C, McKenzie S, Zurynski Y, Lucas A. Patient and general practitioner attitudes to healthy lifestyle behaviours and medication following coronary heart disease: an exploratory study. Aust J Prim Health 2011; 16:154-8. [PMID: 21128577 DOI: 10.1071/py09011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patients with coronary heart disease often engage in unhealthy lifestyle behaviours. We explored patients' and general practitioners' (GPs') perceptions about the effectiveness of healthy behaviours and medications for the prevention of further cardiovascular disease. This exploratory study used semi-structured interviews with eight Sydney GPs and 13 of their patients with coronary heart disease. Patients perceived medications to be more effective than healthy behaviours in improving specific aspects of cardiovascular health, such as angina symptoms, cholesterol and blood pressure, whilst GPs perceived that medications were more effective in patients they considered at highest cardiovascular risk, patients with uncontrolled risk factors, or where adherence to healthy behaviours was poor. Among patients we found a negative perception of the effort required to adhere to healthy behaviours and possible underestimation of their future cardiovascular risk. Patients valued support from peers and family. This study opens up avenues for investigation in further research, including whether patient adherence to healthy behaviours may be enhanced by the exploration oftheir perceptions about behaviour effectiveness, barriers and cardiovascular risk and by GP facilitation of practical supports.
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Affiliation(s)
- Catherine Speechly
- Projects, Research and Development Unit, RACGP NSW and ACT Faculty, 12 Mount Street, North Sydney, NSW 2060, Australia.
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Lawler SP, Winkler E, Reeves MM, Owen N, Graves N, Eakin EG. Multiple health behavior changes and co-variation in a telephone counseling trial. Ann Behav Med 2010; 39:250-7. [PMID: 20419359 DOI: 10.1007/s12160-010-9188-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Delivering effective multiple health behavior interventions to large numbers of adults with chronic conditions via primary care settings is a public health priority. PURPOSE Within a 12-month, telephone-delivered diet and physical activity intervention with multiple behavioral outcomes, we examined the extent and co-variation of multiple health behavior change. METHODS A cluster-randomized trial with 434 patients with type 2 diabetes or hypertension were recruited from 10 general practices, which were randomized to receive telephone counseling or usual care. RESULTS Those receiving telephone counseling were significantly more likely than those in usual care to make greater reductions in multiple behaviors after adjusting for baseline risk behaviors (OR 2.42; 95%CI 1.43, 4.11). Controlling for baseline risk and group allocation, making changes to either physical activity, fat, vegetable, or fiber intake was associated with making significantly more improvements in other behaviors. CONCLUSIONS For patients with chronic conditions, telephone counseling can significantly improve multiple health behaviors, with behavioral changes tending to co-vary.
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Pennant M, Davenport C, Bayliss S, Greenheld W, Marshall T, Hyde C. Community programs for the prevention of cardiovascular disease: a systematic review. Am J Epidemiol 2010; 172:501-16. [PMID: 20667932 DOI: 10.1093/aje/kwq171] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this systematic review, the authors aimed to assess the effectiveness of community programs for prevention of cardiovascular disease (CVD). They searched numerous electronic databases (CDSR, DARE, HTA, EED, and CENTRAL via the Cochrane Library, MEDLINE, MEDLINE In Process, EMBASE, CINAHL, PsycINFO, HMIC, and ASSIA) and relevant Web sites from January 1970 to mid-July 2008. Controlled studies of community programs for the primary prevention of CVD were included. Net changes in CVD risk factors were used to generate an overall index for net change in 10-year CVD risk. The authors identified 36 relevant community programs that took place between 1970 and 2008. These programs were multifaceted interventions employing combinations of media, screening, and counseling activities and environmental changes and were primarily evaluated using controlled before-after studies. In 7 studies, investigators reported changes in CVD/total mortality rates, and in 5 they reported net changes. In all cases, these net changes were positive but were largely nonsignificant. In 22 studies, investigators reported changes in physiologic CVD risk factors, and there was a positive trend in the calculated CVD risk score. The average net reduction in 10-year CVD risk was 0.65%. Community programs for CVD prevention appear to have generally achieved favorable changes in overall CVD risk and, with adaptation to current circumstances, deserve continued consideration as possible approaches to preventing CVD.
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Affiliation(s)
- Mary Pennant
- Unit of Public Health, Epidemiology and Biostatistics, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
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Multiple healthy behaviors and optimal self-rated health: findings from the 2007 Behavioral Risk Factor Surveillance System Survey. Prev Med 2010; 51:268-74. [PMID: 20647019 DOI: 10.1016/j.ypmed.2010.07.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 06/21/2010] [Accepted: 07/13/2010] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this study was to examine the association between the number of healthy behaviors (i.e., not currently smoking, not currently drinking excessively, physically active, and consuming fruits and vegetables five or more times per day) and optimal self-rated health (SRH) among U.S. adults or adults with cardiovascular diseases (CVDs) or diabetes. METHODS We estimated the age-standardized prevalence of optimal SRH among a total of 430,912 adults who participated in the 2007 Behavioral Risk Factor Surveillance System (BRFSS). Prevalence ratios were produced with multivariate Cox regression models using number of healthy behaviors as a predictor; status of optimal SRH was used as an outcome variable while controlling for sociodemographic and health risk factors. RESULTS The age-standardized prevalence of reporting optimal SRH was 83.5%, 55.6%, and 56.3% among adults overall, and adults with CVDs or diabetes, respectively. Also in the aforementioned order, adults who reported having four healthy behaviors had 33%, 85%, and 87% increased likelihoods of reporting optimal SRH, when compared to their counterparts who reported none of these behaviors. CONCLUSION The findings of this study indicate that number of healthy behaviors is associated with optimal SRH among adults, especially adults with CVDs or diabetes. These findings reinforce the support for identifying and implementing clinical and population-based intervention strategies that effectively promote multiple healthier lifestyle behaviors among adults.
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Angermayr L, Melchart D, Linde K. Multifactorial Lifestyle Interventions in the Primary and Secondary Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus—A Systematic Review of Randomized Controlled Trials. Ann Behav Med 2010; 40:49-64. [DOI: 10.1007/s12160-010-9206-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Sweet SN, Fortier MS. Improving physical activity and dietary behaviours with single or multiple health behaviour interventions? A synthesis of meta-analyses and reviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:1720-43. [PMID: 20617056 PMCID: PMC2872344 DOI: 10.3390/ijerph7041720] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 04/09/2010] [Accepted: 04/15/2010] [Indexed: 12/13/2022]
Abstract
Since multiple health behaviour interventions have gained popularity, it is important to investigate their effectiveness compared to single health behaviour interventions. This synthesis aims to determine whether single intervention (physical activity or dietary) or multiple interventions (physical activity and dietary) are more effective at increasing these behaviours by synthesizing reviews and meta-analyses. A sub-purpose also explored their impact on weight. Overall, reviews/meta-analyses showed that single health behaviour interventions were more effective at increasing the targeted behaviours, while multiple health behaviour interventions resulted in greater weight loss. This review may assist policies aiming at improving physical activity and nutrition and reversing the obesity epidemic.
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Affiliation(s)
- Shane N Sweet
- School of Psychology, University of Ottawa, 125 University Pr., Montpetit Hall, University of Ottawa, Ottawa, Ontario, K1N 6N5, Canada.
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Kitamura K, Fetters MD, Sano K, Sato J, Ban N. Lifestyle changes of Japanese people on overseas assignment in Michigan, USA. ASIA PACIFIC FAMILY MEDICINE 2009; 8:7. [PMID: 19607688 PMCID: PMC2722578 DOI: 10.1186/1447-056x-8-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 07/16/2009] [Indexed: 05/28/2023]
Abstract
BACKGROUND Temporary work assignments in the United States (US) are widely considered to have negative health outcomes on Asians mostly due to adverse changes in diet and exercise, though there is little research on this phenomenon. This study investigated the impact of lifestyle changes on the biological and psychological health and health behaviours of Japanese people on temporary assignments in the US. METHODS In this cross sectional survey, we distributed a 38 item self-administered questionnaire addressing health habits, mental health function, lifestyle changes and dietary habits to adult Japanese patients presenting for general physicals at a family medicine clinic serving Japanese patients. We conducted simple statistics and regression analysis between length of stay and other health outcomes to determine whether length of residence in the US was predictive of negative lifestyle changes. RESULTS Most participants reported increased caloric intake, weight gain, and less exercise. They also reported increased time with family. More women than men reported physical symptoms and anxiety related to stress. Smoking and alcohol intake were essentially unchanged. No associations were identified between length of residence in the US and health lifestyle habits or other health outcomes. CONCLUSION Negative lifestyle changes occur in diet and exercise for overseas Japanese people, but a positive change in increased family time was found. Women appear to be at a greater risk for somatic disorders than men. As duration of stay does not appear predictive of adverse changes, clinicians should advise patients going abroad of these risks regardless of the term of the work assignment.
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Affiliation(s)
- Kazuya Kitamura
- Kachigawa Family Clinic, 1-3 Matsushin-cho, Kasugai-shi, Aichi 486-0931, Japan
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, USA
| | - Kiyoshi Sano
- Family Practise, American Hospital of Paris, Paris, France
| | - Juichi Sato
- Department of General Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Nobutaro Ban
- Department of General Medicine, Nagoya University Hospital, Nagoya, Japan
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Abstract
Bone mass is maintained when low-dose ethinylestradiol is used in combination with the new progestogen drospirenone as an oral contraceptive, making a regimen of drospirenone combined with 17beta-estradiol an attractive option for hormone replacement therapy (HRT) in postmenopausal women. Drospirenone is a novel progestogen, more closely related to endogenous progesterone in its pharmacological properties than other progestogens available; in combination with estrogen, drospirenone can closely mimic the premenopausal hormonal balance. In a phase II/III double-blind, placebo-controlled, randomized trial, three different doses of drospirenone plus low-dose 17beta-estradiol were compared with placebo, in order to determine their effects on bone density. Of 240 healthy postmenopausal women aged 45-65 years who enrolled, 180 completed the 2-year prospective study. Treatment groups received 1 mg 17beta-estradiol combined with 1, 2 or 3 mg drospirenone daily or placebo. Bone mineral densities at the lumbar spine, hip and total body and markers of bone turnover were measured at 1, 3, 6, 12, 18 and 24 months. In the pooled HRT groups, the bone mineral density at the lumbar spine, hip and total body increased by 7%, 4% and 3%, respectively, compared with placebo (all p < 0.001). Markers of bone turnover in HRT groups all decreased accordingly (serum osteocalcin 52%, serum bone-specific alkaline phosphatase 36%, serum CrossLaps 67% and urinary CrossLaps 75% from baseline; all p < 0.001). The combination of 17beta-estradiol with drospirenone offers a safe and effective medication for decreasing bone turnover and preventing postmenopausal bone loss in postmenopausal women.
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Affiliation(s)
- C Christiansen
- Center for Clinical and Basic Research A/S, Ballerup, Denmark
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Warburton DER, Katzmarzyk PT, Rhodes RE, Shephard RJ. [Evidence-based guidelines for physical activity of adult Canadians]. Appl Physiol Nutr Metab 2009; 32 Suppl 2F:S17-74. [PMID: 19377540 DOI: 10.1139/h07-168] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This review of the literature provides an update on the scientific biological and psychosocial bases for Canada's Physical Activity Guide for Health Active Living, with particular reference to the effect of physical activity on the health of adults aged 20-55 years. Existing physical activity guidelines for adults from around the world are summarized briefly and compared to the Canadian guidelines. The descriptive epidemiology of physical activity and inactivity in Canada is presented, and the strength of the relationship between physical activity and specific health outcomes is evaluated, with particular emphasis on minimal and optimal physical activity requirements. Finally, areas requiring further investigation are highlighted. Summarizing the findings, Canadian and most international physical activity guidelines advocate moderate-intensity physical activity on most days of the week. Physical activity appears to reduce the risk for over 25 chronic conditions, in particular coronary heart disease, stroke, hypertension, breast cancer, colon cancer, type 2 diabetes, and osteoporosis. Current literature suggests that if the entire Canadian population followed current physical activity guidelines, approximately one-third of deaths related to coronary heart disease, one quarter of deaths related to stroke and osteoporosis, 20% of deaths related to colon cancer, hypertension, and type 2 diabetes, and 14% of deaths related to breast cancer could be prevented. It also appears that the prevention of weight gain and the maintenance of weight loss require greater physical activity levels than current recommendations.
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Affiliation(s)
- Darren E R Warburton
- Programme de médecine expérimentale, Centre Osborne, Unité II, 6108, boul. Thunderbird, Laboratoire de physiologie et de réadaptation cardiovasculaires, Université de la Colombie-Britanique, Vancouver, CB V6T 1Z3, Canada.
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Long-term effects of a multimodal behavioral intervention on myocardial perfusion--a randomized controlled trial. Int J Behav Med 2009; 16:219-26. [PMID: 19424808 DOI: 10.1007/s12529-008-9030-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2008] [Indexed: 01/19/2023]
Abstract
BACKGROUND Recent advances in drug therapy question as to the additional impact behavioral interventions may have on the prognosis of patients with clinically stable coronary heart disease (CHD). PURPOSE The aim of the study was to evaluate the effects of a multimodal, behavioral intervention on myocardial perfusion (MP) and cardiac events, compared to standardized cardiologic care, in patients with stable CHD. METHODS Seventy-seven CHD patients (age 54.2 +/- 6.9 years, male 87%) were randomly assigned to a behavioral intervention plus standardized cardiologic care (INT, n = 39) or standardized cardiologic care alone (CO, n = 38). MP was assessed by (201)Thallium MP-scintigrams (SPECT) at baseline, after 2, 3, and 7 years, respectively. Subsequent cardiac events (MI, PCI, CABG) were assessed using the cardiologists' charts. RESULTS Sixty-five patients (84%) completed the study. In all patients, the course of MP was significantly better in INT analysis of variance (ANOVA group x time p = 0.001); this was also true for patients without subsequent PCI/CABG (ANOVA group x time p = 0.002). Incidence of cardiac events was significantly associated with INT (6 vs. 14; log rank test p = .047). CONCLUSION The study suggests additional long-term benefits of a behavioral intervention on myocardial perfusion and cardiac events in patients with stable CHD compared to standardized cardiologic care only.
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