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Boumans J, van de Mheen D, Crutzen R, Dupont H, Bovens R, Rozema A. Understanding How and Why Alcohol Interventions Prevent and Reduce Problematic Alcohol Consumption among Older Adults: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063188. [PMID: 35328875 PMCID: PMC8953167 DOI: 10.3390/ijerph19063188] [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: 01/17/2022] [Revised: 03/05/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022]
Abstract
Problematic alcohol use has been increasing in older adults (55+) in recent decades. Many of the effective interventions that are available to prevent or reduce the negative effects of alcohol consumption are aimed at adults in general. It is unclear whether these interventions also work for older adults. The objective of this review was to understand how (i.e., which elements), in which context, and why (which mechanisms) interventions are successful in preventing or reducing (problematic) alcohol consumption among older adults. A systematic review of articles published between 2000 and 2022 was performed using PubMed, PsycINFO, Web of Science and CHINAHL. Realist evaluation was used to analyze the data. We found 61 studies on interventions aimed at preventing or reducing problematic alcohol use. Most of the interventions were not specifically designed for older adults but also included older adults. The findings of the current study highlight three major effective elements of interventions: (1) providing information on the consequences of alcohol consumption; (2) being in contact with others and communicating with them about (alcohol) problems; and (3) personalized feedback about drinking behavior. Two of these elements were also used in the interventions especially designed for older adults. Being in contact with others and communicating with them about (alcohol) problems is an important element to pay attention to for developers of alcohol interventions for older adults because loneliness is a problem for this age group and there is a relationship between the use of alcohol and loneliness.
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Affiliation(s)
- Jogé Boumans
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands; (D.v.d.M.); (R.B.); (A.R.)
- Correspondence:
| | - Dike van de Mheen
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands; (D.v.d.M.); (R.B.); (A.R.)
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands; (R.C.); (H.D.)
| | - Hans Dupont
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands; (R.C.); (H.D.)
| | - Rob Bovens
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands; (D.v.d.M.); (R.B.); (A.R.)
| | - Andrea Rozema
- Tranzo Scientific Center for Care and Wellbeing, School of Social and Behavioral Sciences, Tilburg University, 5000 LE Tilburg, The Netherlands; (D.v.d.M.); (R.B.); (A.R.)
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Borisevich D, Schnurr TM, Engelbrechtsen L, Rakitko A, Ängquist L, Ilinsky V, Aadahl M, Grarup N, Pedersen O, Sørensen TIA, Hansen T. Non-linear interaction between physical activity and polygenic risk score of body mass index in Danish and Russian populations. PLoS One 2021; 16:e0258748. [PMID: 34662357 PMCID: PMC8523041 DOI: 10.1371/journal.pone.0258748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/04/2021] [Indexed: 11/19/2022] Open
Abstract
Body mass index (BMI) is a highly heritable polygenic trait. It is also affected by various environmental and behavioral risk factors. We used a BMI polygenic risk score (PRS) to study the interplay between the genetic and environmental factors defining BMI. First, we generated a BMI PRS that explained more variance than a BMI genetic risk score (GRS), which was using only genome-wide significant BMI-associated variants (R2 = 13.1% compared to 6.1%). Second, we analyzed interactions between BMI PRS and seven environmental factors. We found a significant interaction between physical activity and BMI PRS, even when the well-known effect of the FTO region was excluded from the PRS, using a small dataset of 6,179 samples. Third, we stratified the study population into two risk groups using BMI PRS. The top 22% of the studied populations were included in a high PRS risk group. Engagement in self-reported physical activity was associated with a 1.66 kg/m2 decrease in BMI in this group, compared to a 0.84 kg/m2 decrease in BMI in the rest of the population. Our results (i) confirm that genetic background strongly affects adult BMI in the general population, (ii) show a non-linear interaction between BMI genetics and physical activity, and (iii) provide a standardized framework for future gene-environment interaction analyses.
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Affiliation(s)
- Dmitrii Borisevich
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Theresia M. Schnurr
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Line Engelbrechtsen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Gynecology and Obstetrics, Herlev Hospital, Herlev, Denmark
| | | | - Lars Ängquist
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Mette Aadahl
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Grarup
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Oluf Pedersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thorkild I. A. Sørensen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Rasmussen M, Hovhannisyan K, Adami J, Tønnesen H. Characteristics of Patients in Treatment for Alcohol and Drug Addiction Who Succeed in Changing Smoking, Weight, and Physical Activity: A Secondary Analysis of an RCT on Combined Lifestyle Interventions. Eur Addict Res 2021; 27:123-130. [PMID: 33080594 PMCID: PMC8006577 DOI: 10.1159/000510608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 07/07/2020] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Patients addicted to alcohol or drug often have additional unhealthy lifestyles, adding to the high mortality and morbidity in this patient group. Therefore, it is important to consider lifestyle interventions as part of the usual addiction treatment. OBJECTIVE The aim was to identify predictors of successful changes in lifestyle risk factors among patients in treatment for alcohol or drug addiction. METHODS We conducted a secondary analysis of a trial using a 6-week intensive integrated lifestyle intervention: The very integrated program (VIP). Patients were recruited in Addiction Centres Malmö and Psychiatry Skåne, Sweden. The primary outcome was successful changes in lifestyle, measured as quitting tobacco, exercising 30 min per day, and not being over- or underweight after 6 weeks and 12 months. RESULTS A total of 212 patients were included in the RCT, and 128 were included in this secondary analysis: 108 at 6 weeks and 89 at 12 months of follow-up. A total of 69 patients were respondents at both follow-ups. The follow-up rates were 51 and 42%, respectively. More education, having at least 2 lifestyle risk factors and having a high quality of life were predictors of a successful change in lifestyle after 6 weeks. After 12 months, the predictors for a successful outcome were having 3 or more risk factors, while an education level up to 3 years was a negative predictor. CONCLUSIONS Having several unhealthy lifestyles in addition to alcohol and drug addiction was a significant predictor of successful lifestyle changes in the short- and long term after the VIP for lifestyle interventions. Likewise, education was significant. The results should be considered in future development and research among this vulnerable group of patients.
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Affiliation(s)
- Mette Rasmussen
- Department of Health Sciences, Clinical Health Promotion Centre, WHO-CC, Lund University, Lund, Sweden,Clinical Health Promotion Centre, WHO-CC, The Parker Institute, University of Copenhagen, Copenhagen, Denmark,*Mette Rasmussen, Department of Health Sciences, Clinical Health Promotion Unit, WHO-CC, Lund University, Södra Förstadsgatan 35, SE–20502 Malmö (Sweden),
| | - Karen Hovhannisyan
- Clinical Health Promotion Centre, WHO-CC, The Parker Institute, University of Copenhagen, Copenhagen, Denmark
| | | | - Hanne Tønnesen
- Department of Health Sciences, Clinical Health Promotion Centre, WHO-CC, Lund University, Lund, Sweden,Clinical Health Promotion Centre, WHO-CC, The Parker Institute, University of Copenhagen, Copenhagen, Denmark
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Bernstorff M, Deichgræber P, Bruun NH, Dalsgaard EM, Fenger-Grøn M, Lauritzen T. A Randomised Trial Examining Cardiovascular Morbidity and All-Cause Mortality 24 years Following General Health Checks: the Ebeltoft Health Promotion Project (EHPP). BMJ Open 2019; 9:e030400. [PMID: 31662372 PMCID: PMC6830618 DOI: 10.1136/bmjopen-2019-030400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/06/2019] [Accepted: 10/07/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Global prevalence of risk factors for cardiovascular disease (CVD) and all-cause mortality is increasing. Treatments are available but can only be implemented if individuals at risk are identified. General health checks have been suggested to facilitate this process. OBJECTIVES To examine the long-term effect of population-based general health checks on CVD and all-cause mortality. DESIGN AND SETTING The Ebeltoft Health Promotion Project (EHPP) is a parallel randomised controlled trial in a Danish primary care setting. PARTICIPANTS The EHPP enrolled individuals registered in the Civil Registration System as (1) inhabitants of Ebeltoft municipality, (2) registered with a general practitioner (GP) participating in the study and (3) aged 30-49 on 1 January 1991. A total of 3464 individuals were randomised as invitees (n=2000) or non-invitees (n=1464). Of the invitees, 493 declined. As an external control group, we included 1 511 498 Danes living outside the municipality of Ebeltoft. INTERVENTIONS Invitees were offered a general health check and, if test-results were abnormal, recommended a 15-45 min consultation with their GP. Non-invitees in Ebeltoft received a questionnaire at baseline and were offered a general health check at year 5. The external control group, that is, the remaining Danish population, received routine care only. OUTCOME MEASURES HRs for CVD and all-cause mortality. RESULTS Every individual randomised was analysed. When comparing invitees to non-invitees within the municipality of Ebeltoft, we found no significant effect of general health checks on CVD (HR=1.11 (0.88; 1.41)) or all-cause mortality (HR=0.93 (0.75; 1.16)). When comparing invitees to the remaining Danish population, we found similar results for CVD (adjusted HR=0.99 (0.86; 1.13)) and all-cause mortality (adjusted HR=0.96 (0.85; 1.09)). CONCLUSION We found no effect of general health checks offered to the general population on CVD or all-cause mortality. TRIAL REGISTRATION NUMBER NCT00145782; 2015-57-0002; 62908, 187.
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Affiliation(s)
- Martin Bernstorff
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Pia Deichgræber
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Henrik Bruun
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Else-Marie Dalsgaard
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Morten Fenger-Grøn
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Torsten Lauritzen
- Department of Public Health, Research Unit for General Practice, Aarhus University, Aarhus, Denmark
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Factors influencing doctors' counselling on patients' lifestyle habits: a cohort study. BJGP Open 2018; 2:bjgpopen18X101607. [PMID: 30564740 PMCID: PMC6202006 DOI: 10.3399/bjgpopen18x101607] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 06/10/2018] [Indexed: 02/07/2023] Open
Abstract
Background Lifestyle changes are important for prevention and treatment of many common diseases, and doctors have an important role in the lifestyle counselling of patients. It is important to know more about factors influencing lifestyle counselling. Aim To investigate the frequency of counselling about physical activity compared to that about alcohol habits; the impact of doctors' own physical activity and alcohol habits on patient counselling about these lifestyle dimensions; and whether perceived mastery of clinical work or vulnerable personality have a confounding or moderating effect on these associations. Design & setting In this nationwide cohort survey, a total of 978 doctors in Norway were surveyed by postal questionnaires in 1993/94 and 2014. The response rate was 562/978 (57%). Method The outcome variables were questions on frequency of asking about alcohol and exercise habits. Explanatory variables were questions on doctors' own exercise habits, drinking habits (using Alcohol Use Disorders Identification Test [AUDIT]), perceived mastery of clinical work, vulnerable personality, and specialty. Associations were studied by linear regression analysis. Results Of the 526 responders, 307 (58%) reported asking usually/often about exercise habits, while n = 140/524 (27%) usually/often asked about alcohol habits. A doctor's own physical activity level was associated with frequency of asking about physical activity (unstandardised regression coefficient [B] = 0.07; 95% confidence intervals [CI] = 0.01 to 0.13). There were no significant associations between doctors' own lifestyle habits and counselling on alcohol habits. Doctors with low levels of vulnerability asked more frequently about physical activity, regardless of their own physical activity habits (F = 2.41, P = 0.048). Conclusion Doctors' own lifestyles influenced their preventive counselling about physical activity, but not about alcohol. Vulnerability moderated these effects, indicating the importance of early interventions to help doctors with a vulnerable personality to handle negative criticism from patients.
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Ryan JM, Allen E, Gormley J, Hurvitz EA, Peterson MD. The risk, burden, and management of non-communicable diseases in cerebral palsy: a scoping review. Dev Med Child Neurol 2018; 60:753-764. [PMID: 29572812 DOI: 10.1111/dmcn.13737] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2018] [Indexed: 12/26/2022]
Abstract
AIM To examine the risk, burden, and management of non-communicable diseases (NCDs) among people with cerebral palsy (CP). METHOD Databases (Ovid MEDLINE, Embase Ovid, CINAHL Plus) were systematically searched up to August 2017. Data on the prevalence of risk factors for, and the burden and management of, cardiovascular diseases, diabetes, cancers, and respiratory diseases were extracted. RESULTS Thirty-six studies that examined the prevalence of risk factors among people with CP were identified. There was inconsistent evidence that people with CP had higher prevalence of metabolic risk factors such as hypertension, hyperlipidaemia, and obesity, but strong evidence that they participated in low levels of physical activity, compared with people without CP. Seven studies reported on the burden of NCDs. Adults with CP had a higher risk of NCDs, including stroke, chronic obstructive pulmonary disease, and other heart conditions, and death due to NCDs, including cancers, chronic obstructive pulmonary disease, stroke, and ischaemic heart disease, compared with the general population. Only one study reported on the management of NCD, specifically the uptake of breast cancer screening among females. INTERPRETATION The burden of NCDs is higher among adults with CP compared with the general population. Further research is required to determine the prevalence of metabolic risk factors and management of NCDs among people with CP. WHAT THIS PAPER ADDS Adults with cerebral palsy (CP) have an increased risk of non-communicable diseases (NCDs) and increased risk of death because of NCDs. Evidence is inconsistent about the elevated prevalence of metabolic risk factors for NCDs. Evidence is consistent that people with CP participate in reduced physical activity. Only one study reported on management of NCD among people with CP. Available evidence suggests people with CP are less likely to receive preventive medicine.
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Affiliation(s)
- Jennifer M Ryan
- College of Health and Life Sciences, Brunel University, London, UK.,Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - John Gormley
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Edward A Hurvitz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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Kaner EFS, Beyer FR, Muirhead C, Campbell F, Pienaar ED, Bertholet N, Daeppen JB, Saunders JB, Burnand B. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2018; 2:CD004148. [PMID: 29476653 PMCID: PMC6491186 DOI: 10.1002/14651858.cd004148.pub4] [Citation(s) in RCA: 259] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Excessive drinking is a significant cause of mortality, morbidity and social problems in many countries. Brief interventions aim to reduce alcohol consumption and related harm in hazardous and harmful drinkers who are not actively seeking help for alcohol problems. Interventions usually take the form of a conversation with a primary care provider and may include feedback on the person's alcohol use, information about potential harms and benefits of reducing intake, and advice on how to reduce consumption. Discussion informs the development of a personal plan to help reduce consumption. Brief interventions can also include behaviour change or motivationally-focused counselling.This is an update of a Cochrane Review published in 2007. OBJECTIVES To assess the effectiveness of screening and brief alcohol intervention to reduce excessive alcohol consumption in hazardous or harmful drinkers in general practice or emergency care settings. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and 12 other bibliographic databases to September 2017. We searched Alcohol and Alcohol Problems Science Database (to December 2003, after which the database was discontinued), trials registries, and websites. We carried out handsearching and checked reference lists of included studies and relevant reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) of brief interventions to reduce hazardous or harmful alcohol consumption in people attending general practice, emergency care or other primary care settings for reasons other than alcohol treatment. The comparison group was no or minimal intervention, where a measure of alcohol consumption was reported. 'Brief intervention' was defined as a conversation comprising five or fewer sessions of brief advice or brief lifestyle counselling and a total duration of less than 60 minutes. Any more was considered an extended intervention. Digital interventions were not included in this review. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We carried out subgroup analyses where possible to investigate the impact of factors such as gender, age, setting (general practice versus emergency care), treatment exposure and baseline consumption. MAIN RESULTS We included 69 studies that randomised a total of 33,642 participants. Of these, 42 studies were added for this update (24,057 participants). Most interventions were delivered in general practice (38 studies, 55%) or emergency care (27 studies, 39%) settings. Most studies (61 studies, 88%) compared brief intervention to minimal or no intervention. Extended interventions were compared with brief (4 studies, 6%), minimal or no intervention (7 studies, 10%). Few studies targeted particular age groups: adolescents or young adults (6 studies, 9%) and older adults (4 studies, 6%). Mean baseline alcohol consumption was 244 g/week (30.5 standard UK units) among the studies that reported these data. Main sources of bias were attrition and lack of provider or participant blinding. The primary meta-analysis included 34 studies (15,197 participants) and provided moderate-quality evidence that participants who received brief intervention consumed less alcohol than minimal or no intervention participants after one year (mean difference (MD) -20 g/week, 95% confidence interval (CI) -28 to -12). There was substantial heterogeneity among studies (I² = 73%). A subgroup analysis by gender demonstrated that both men and women reduced alcohol consumption after receiving a brief intervention.We found moderate-quality evidence that brief alcohol interventions have little impact on frequency of binges per week (MD -0.08, 95% CI -0.14 to -0.02; 15 studies, 6946 participants); drinking days per week (MD -0.13, 95% CI -0.23 to -0.04; 11 studies, 5469 participants); or drinking intensity (-0.2 g/drinking day, 95% CI -3.1 to 2.7; 10 studies, 3128 participants).We found moderate-quality evidence of little difference in quantity of alcohol consumed when extended and no or minimal interventions were compared (-14 g/week, 95% CI -37 to 9; 6 studies, 1296 participants). There was little difference in binges per week (-0.08, 95% CI -0.28 to 0.12; 2 studies, 456 participants; moderate-quality evidence) or difference in days drinking per week (-0.45, 95% CI -0.81 to -0.09; 2 studies, 319 participants; moderate-quality evidence). Extended versus no or minimal intervention provided little impact on drinking intensity (9 g/drinking day, 95% CI -26 to 9; 1 study, 158 participants; low-quality evidence).Extended intervention had no greater impact than brief intervention on alcohol consumption, although findings were imprecise (MD 2 g/week, 95% CI -42 to 45; 3 studies, 552 participants; low-quality evidence). Numbers of binges were not reported for this comparison, but one trial suggested a possible drop in days drinking per week (-0.5, 95% CI -1.2 to 0.2; 147 participants; low-quality evidence). Results from this trial also suggested very little impact on drinking intensity (-1.7 g/drinking day, 95% CI -18.9 to 15.5; 147 participants; very low-quality evidence).Only five studies reported adverse effects (very low-quality evidence). No participants experienced any adverse effects in two studies; one study reported that the intervention increased binge drinking for women and two studies reported adverse events related to driving outcomes but concluded they were equivalent in both study arms.Sources of funding were reported by 67 studies (87%). With two exceptions, studies were funded by government institutes, research bodies or charitable foundations. One study was partly funded by a pharmaceutical company and a brewers association, another by a company developing diagnostic testing equipment. AUTHORS' CONCLUSIONS We found moderate-quality evidence that brief interventions can reduce alcohol consumption in hazardous and harmful drinkers compared to minimal or no intervention. Longer counselling duration probably has little additional effect. Future studies should focus on identifying the components of interventions which are most closely associated with effectiveness.
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Affiliation(s)
- Eileen FS Kaner
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Fiona R Beyer
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Colin Muirhead
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Fiona Campbell
- The University of SheffieldSchool of Health and Related ResearchRegent StreetSheffieldUKS1 4DA
| | - Elizabeth D Pienaar
- South African Medical Research CouncilCochrane South AfricaPO Box 19070TygerbergCape TownSouth Africa7505
| | - Nicolas Bertholet
- Lausanne University HospitalAlcohol Treatment Center, Department of Community Medicine and HealthLausanneSwitzerland
| | - Jean B Daeppen
- Lausanne University HospitalAlcohol Treatment Center, Department of Community Medicine and HealthLausanneSwitzerland
| | - John B Saunders
- Royal Brisbane and Women's HospitalDepartment of PsychiatryCentre for Drug & Alcohol StudiesSchool of MedicineUniversity of Queensland/Royal Brisbane HospitalQueenslandAustralia4029
| | - Bernard Burnand
- Lausanne University HospitalCochrane Switzerland, Institute of Social and Preventive MedicineBiopôle 2Route de la Corniche 10LausanneVaudSwitzerlandCH‐1010
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Baumann S, Toft U, Aadahl M, Jørgensen T, Pisinger C. The long-term effect of a population-based life-style intervention on smoking and alcohol consumption. The Inter99 Study--a randomized controlled trial. Addiction 2015; 110:1853-60. [PMID: 26173928 DOI: 10.1111/add.13052] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/02/2015] [Accepted: 07/03/2015] [Indexed: 11/30/2022]
Abstract
AIMS To examine whether improvements in smoking and alcohol consumption throughout the 5-year course of a population-based multi-factorial life-style intervention were sustained 5 years after its discontinuation. DESIGN Population-based randomized controlled trial. SETTING Suburbs of Copenhagen, Denmark. PARTICIPANTS A total of 9415 people aged 30-60 years were randomized to an intervention group (n = 6091) and an assessment-only control group (n = 3324). INTERVENTION All participants in the intervention group received screening, risk assessment and individual life-style counselling; participants at high risk of ischaemic heart disease-according to pre-specified criteria-were also offered group-based counselling. MEASUREMENTS Self-reported point abstinence from smoking as well as changes in the average alcohol consumption per week and binge drinking in the past week from baseline to 10-year follow-up were investigated using random-effects modelling. FINDINGS At 10-year follow up, people in the intervention group reported a higher smoking abstinence rate [odds ratio (OR) = 1.84, 95% confidence interval (CI) = 1.02-3.33, P = 0.043] and a greater reduction in binge drinking (net change = -0.08 days with binge drinking in the last week, 95% CI = -0.16 to -0.01, P = 0.028) than in the control group. There were no detectable long-term intervention effects on the average alcohol consumption per week. CONCLUSIONS A population-based multi-factorial life-style intervention of 5 years' duration in Denmark had sustained beneficial effects on smoking abstinence and binge drinking 5 years after its discontinuation.
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Affiliation(s)
- Sophie Baumann
- University Medicine Greifswald, Institute of Social Medicine and Prevention, Greifswald, Germany.,Research Centre for Prevention and Health, Glostrup Hospital, Building 84/85, Glostrup, Denmark
| | - Ulla Toft
- Research Centre for Prevention and Health, Glostrup Hospital, Building 84/85, Glostrup, Denmark
| | - Mette Aadahl
- Research Centre for Prevention and Health, Glostrup Hospital, Building 84/85, Glostrup, Denmark.,Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Glostrup Hospital, Building 84/85, Glostrup, Denmark.,Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark.,Faculty of Medicine, University of Aalborg, Aalborg, Denmark
| | - Charlotta Pisinger
- Research Centre for Prevention and Health, Glostrup Hospital, Building 84/85, Glostrup, Denmark.,Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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9
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Watson JM, Fairhurst C, Li J, Tober G, Crosby H, Lloyd C, Godfrey C, Mdege ND, Dale V, Toner P, Parrott S, Raistrick D. ADAPTA: A pilot randomised controlled trial of an alcohol-focused intervention versus a healthy living intervention for problem drinkers identified in a general hospital setting. Drug Alcohol Depend 2015; 154. [PMID: 26194955 PMCID: PMC4545229 DOI: 10.1016/j.drugalcdep.2015.06.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM To examine the relative feasibility, acceptability, applicability, effectiveness and explore cost-effectiveness of a healthy living focused intervention (HL) compared to an alcohol-focused intervention (AF) for problem drinkers identified in hospital. METHODS A pragmatic, randomised, controlled, open pilot trial. Feasibility and acceptability were measured by recruitment, attrition, follow-up rates and number of treatment sessions attended. Effectiveness was measured using the Alcohol Use Disorders Identification Test score at six months. Additional economic and secondary outcome measures were collected. RESULTS Eighty-six participants were randomised and 72% (n=62) were retained in full participation. Forty-one participants attended at least one treatment session (48%). A greater proportion in the HL group attended all four treatment sessions (33% vs 19%). Follow-up rates were 29% at six months and 22% at twelve months. There was no evidence of a difference in AUDIT score between treatment groups at six months. Mean cost of health care and social services, policing and the criminal justice system use decreased while EQ-5D scores indicated minor improvement in both arms. However, this pilot trial was not powered to detect differences in either measure between groups. CONCLUSIONS While no treatment effect was observed, this study demonstrated a potential to engage patients drinking at harmful or dependent levels in a healthy living intervention. However, recruitment proved challenging and follow-up rates were poor. Better ways need to be found to help these patients recognise the harms associated with their drinking and overcome the evident barriers to their engagement with specialist treatment.
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Affiliation(s)
- Judith M. Watson
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom
| | - Caroline Fairhurst
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Jinshuo Li
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Gillian Tober
- Leeds Addiction Unit, 19 Springfield Mount, Leeds LS2 9NG, United Kingdom.
| | - Helen Crosby
- Leeds Addiction Unit, 19 Springfield Mount, Leeds LS2 9NG, United Kingdom.
| | - Charlie Lloyd
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Christine Godfrey
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Noreen D. Mdege
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom
| | - Veronica Dale
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Paul Toner
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Steve Parrott
- University of York, Department of Health Sciences, Heslington, York YO10 5DD, United Kingdom.
| | - Duncan Raistrick
- Leeds Addiction Unit, 19 Springfield Mount, Leeds LS2 9NG, United Kingdom.
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10
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Jørgensen T, Jacobsen RK, Toft U, Aadahl M, Glümer C, Pisinger C. Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population: Inter99 randomised trial. BMJ 2014; 348:g3617. [PMID: 24912589 PMCID: PMC4049194 DOI: 10.1136/bmj.g3617] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate the effect of systematic screening for risk factors for ischaemic heart disease followed by repeated lifestyle counselling on the 10 year development of ischaemic heart disease at a population level. DESIGN Randomised controlled community based trial. SETTING Suburbs of Copenhagen, Denmark. PARTICIPANTS 59,616 people aged 30-60 years randomised with different age and sex randomisation ratios to an intervention group (n = 11,629) and a control group (n = 47,987). INTERVENTION The intervention group was invited for screening, risk assessment, and lifestyle counselling up to four times over a five year period. All participants with an unhealthy lifestyle had individually tailored lifestyle counselling at all visits (at baseline and after one and three years); those at high risk of ischaemic heart disease, according to predefined criteria, were furthermore offered six sessions of group based lifestyle counselling on smoking cessation, diet, and physical activity. After five years all were invited for a final counselling session. Participants were referred to their general practitioner for medical treatment, if relevant. The control group was not invited for screening. MAIN OUTCOME MEASURES The primary outcome measure was incidence of ischaemic heart disease in the intervention group compared with the control group. Secondary outcome measures were stroke, combined events (ischaemic heart disease, stroke, or both), and mortality. RESULTS 6091 (52.4%) people in the intervention group participated at baseline. Among 5978 people eligible at five year follow-up (59 died and 54 emigrated), 4028 (67.4%) attended. A total of 3163 people died in the 10 year follow-up period. Among 58,308 without a history of ischaemic heart disease at baseline, 2782 developed ischaemic heart disease. Among 58,940 without a history of stroke at baseline, 1726 developed stroke. No significant difference was seen between the intervention and control groups in the primary end point (hazard ratio for ischaemic heart disease 1.03, 95% confidence interval 0.94 to 1.13) or in the secondary endpoints (stroke 0.98, 0.87 to 1.11; combined endpoint 1.01, 0.93 to 1.09; total mortality 1.00, 0.91 to 1.09). CONCLUSION A community based, individually tailored intervention programme with screening for risk of ischaemic heart disease and repeated lifestyle intervention over five years had no effect on ischaemic heart disease, stroke, or mortality at the population level after 10 years.Trial registration Clinical trials NCT00289237.
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Affiliation(s)
- Torben Jørgensen
- Research Centre for Prevention and Health, Building 84/85, Glostrup Hospital, DK-2600 Glostrup, Denmark Faculty of Health Science, University of Copenhagen, Denmark Faculty of Medicine, University of Aalborg, Denmark
| | - Rikke Kart Jacobsen
- Research Centre for Prevention and Health, Building 84/85, Glostrup Hospital, DK-2600 Glostrup, Denmark
| | - Ulla Toft
- Research Centre for Prevention and Health, Building 84/85, Glostrup Hospital, DK-2600 Glostrup, Denmark
| | - Mette Aadahl
- Research Centre for Prevention and Health, Building 84/85, Glostrup Hospital, DK-2600 Glostrup, Denmark
| | - Charlotte Glümer
- Research Centre for Prevention and Health, Building 84/85, Glostrup Hospital, DK-2600 Glostrup, Denmark Faculty of Medicine, University of Aalborg, Denmark
| | - Charlotta Pisinger
- Research Centre for Prevention and Health, Building 84/85, Glostrup Hospital, DK-2600 Glostrup, Denmark Faculty of Health Science, University of Copenhagen, Denmark
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11
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Diderichsen F, Andersen I, Manuel C, Andersen AMN, Bach E, Baadsgaard M, Brønnum-Hansen H, Hansen FK, Jeune B, Jørgensen T, Søgaard J. Health Inequality - determinants and policies. Scand J Public Health 2012; 40:12-105. [DOI: 10.1177/1403494812457734] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Finn Diderichsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ingelise Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Celie Manuel
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Elsa Bach
- The National Research Centre for the Working Environment
| | | | | | | | | | | | - Jes Søgaard
- The Danish Institute for Health Services Research
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