Five years of lifestyle intervention improved self-reported mental and physical health in a general population: the Inter99 study

Key lifestyles and interim health outcomes for effective interventions in general populations: A network analysis of a large international observational study

Background

The interconnected nature of lifestyles and interim health outcomes implies the presence of the central lifestyle, central interim health outcome and bridge lifestyle, which are yet to be determined. Modifying these factors holds immense potential for substantial positive changes across all aspects of health and lifestyles. We aimed to identify these factors from a pool of 18 lifestyle factors and 13 interim health outcomes while investigating potential gender and occupation differences.

Methods

An international cross-sectional study was conducted in 30 countries across six World Health Organization regions from July 2020 to August 2021, with 16 512 adults self-reporting changes in 18 lifestyle factors and 13 interim health outcomes since the pandemic.

Results

Three networks were computed and tested. The central variables decided by the expected influence centrality were consumption of fruits and vegetables (centrality = 0.98) jointly with less sugary drinks (centrality = 0.93) in the lifestyles network; and quality of life (centrality = 1.00) co-dominant (centrality = 1.00) with less emotional distress in the interim health outcomes network. The overall amount of exercise had the highest bridge expected influence centrality in the bridge network (centrality = 0.51). No significant differences were found in the network global strength or the centrality of the aforementioned key variables within each network between males and females or health workers and non-health workers (all P-values >0.05 after Holm-Bonferroni correction).

Conclusions

Consumption of fruits and vegetables, sugary drinks, quality of life, emotional distress, and the overall amount of exercise are key intervention components for improving overall lifestyle, overall health and overall health via lifestyle in the general population, respectively. Although modifications are needed for all aspects of lifestyle and interim health outcomes, a larger allocation of resources and more intensive interventions were recommended for these key variables to produce the most cost-effective improvements in lifestyles and health, regardless of gender or occupation.

Behavior-related health risk factors, mental disorders and mortality after 20 years in a working aged general population sample

Mortality is predicted by the sum of behavior-related health risk factors (BRFs: tobacco smoking, alcohol drinking, body overweight, and physical inactivity). We analyzed degrees and combinations of BRFs in their relation to mortality and adjusted for mental disorders. In a random sample of the general population in northern Germany aged 18-64, BRFs and mental disorders had been assessed in 1996-1997 by the Munich Composite International Diagnostic Interview. A sum score including eight ranks of the behavior-related health risk factors was built. Death and its causes were ascertained 2017-2018 using residents' registration files and death certificates. Relations of the sum score and combinations of the BRFs at baseline with all-cause, cancer, and cardiovascular mortality 20 years later were analyzed. The sum score and combinations predicted all-cause, cardiovascular and cancer mortality. The odds ratio of the sum score was 1.38 (95% confidence interval 1.31-1.46) after adjustment for age, gender, and mental disorder. In addition to the BRFs, mood, anxiety or somatoform disorders were not related to mortality. We concluded that the sum score and combinations of behavior-related health risk factors predicted mortality, even after adjustment for mental disorders.

Interrelationships between self reported physical health and health behaviors among healthy US adults: From the NHANES 2009-2016

Objectives

Individuals who engage in regular physical activity, consume a healthy diet, have a normal body mass index (BMI), as well as avoid smoking and heavy alcohol consumption have lower risks of morbidity and mortality. While self-reported health is a strong predictor of morbidity and mortality, data are sparse about the interrelationship of concurrent healthy behaviors and self-reported health.

Study design

Cross-sectional study design.

Methods

The sample included 7,267 individuals aged 30-50 years without diabetes, heart failure, cancer, myocardial infarction, stroke and emphysema from 2009 to 2016 of the National Health and Nutrition Examination Survey (NHANES). We used latent class analyses to identify concurrent healthy behaviors and explore interrelationships of class membership with self-reported health after adjusting for covariates using SAS® 9.4 software.

Results

Two mutually exclusive classes were found, "fewer healthy behaviors" and "more healthy behaviors". "Fewer healthy behaviors" class members were less adherent to healthy guidelines while "more healthy behaviors" class members were more adherent. The two classes varied by smoking status, diet, and physical activity but not by BMI or alcohol consumption. Individuals in the "more healthy behaviors" class were associated with self-assessments of good (OR: 2.08; 95% CI: 1.15-3.79), very good (OR: 3.22; 95% CI: 1.78-3.79) and excellent (OR: 4.09; 95% CI: 2.11-7.94) health compared to those in the "fewer healthy behavior" class.

Conclusions

We revealed two mutual exclusive classes with differing patterns of healthy behavior adherence. The class of individuals with more concurrent healthy behavior recommendations were more likely to self-assess their health more favorably.

General Health Checks in Adult Primary Care: A Review

IMPORTANCE

General health checks, also known as general medical examinations, periodic health evaluations, checkups, routine visits, or wellness visits, are commonly performed in adult primary care to identify and prevent disease. Although general health checks are often expected and advocated by patients, clinicians, insurers, and health systems, others question their value.

OBSERVATIONS

Randomized trials and observational studies with control groups reported in prior systematic reviews and an updated literature review through March 2021 were included. Among 19 randomized trials (906 to 59 616 participants; follow-up, 1 to 30 years), 5 evaluated a single general health check, 7 evaluated annual health checks, 1 evaluated biannual checks, and 6 evaluated health checks delivered at other frequencies. Twelve of 13 observational studies (240 to 471 415 participants; follow-up, cross-sectional to 5 years) evaluated a single general health check. General health checks were generally not associated with decreased mortality, cardiovascular events, or cardiovascular disease incidence. For example, in the South-East London Screening Study (n = 7229), adults aged 40 to 64 years who were invited to 2 health checks over 2 years, compared with adults not invited to screening, experienced no 8-year mortality benefit (6% vs 5%). General health checks were associated with increased detection of chronic diseases, such as depression and hypertension; moderate improvements in controlling risk factors, such as blood pressure and cholesterol; increased clinical preventive service uptake, such as colorectal and cervical cancer screening; and improvements in patient-reported outcomes, such as quality of life and self-rated health. In the Danish Check-In Study (n = 1104), more patients randomized to receive to a single health check, compared with those randomized to receive usual care, received a new antidepressant prescription over 1 year (5% vs 2%; P = .007). In a propensity score-matched analysis (n = 8917), a higher percentage of patients who attended a Medicare Annual Wellness Visit, compared with those who did not, underwent colorectal cancer screening (69% vs 60%; P < .01). General health checks were sometimes associated with modest improvements in health behaviors such as physical activity and diet. In the OXCHECK trial (n = 4121), fewer patients randomized to receive annual health checks, compared with those not randomized to receive health checks, exercised less than once per month (68% vs 71%; difference, 3.3% [95% CI, 0.5%-6.1%]). Potential adverse effects in individual studies included an increased risk of stroke and increased mortality attributed to increased completion of advance directives.

CONCLUSIONS AND RELEVANCE

General health checks were not associated with reduced mortality or cardiovascular events, but were associated with increased chronic disease recognition and treatment, risk factor control, preventive service uptake, and improved patient-reported outcomes. Primary care teams may reasonably offer general health checks, especially for groups at high risk of overdue preventive services, uncontrolled risk factors, low self-rated health, or poor connection or inadequate access to primary care.

Changes in Health-Risk Behavior, Body Mass Index, Mental Well-Being, and Risk Status Following Participation in a Stepwise Web-Based and Face-to-Face Intervention for Prevention of Lifestyle-Related Diseases: Nonrandomized Follow-Up Cohort Study

BACKGROUND

Recent evidence suggests the effectiveness of stepwise, targeted approaches for the prevention of lifestyle-related diseases with combinations of web-based and face-to-face interventions showing promising results.

OBJECTIVE

This paper reports on 1-year changes in health-risk behaviors, BMI, self-rated health, mental well-being, and risk of disease at 1-year follow-up after participation in a stepwise intervention that targeted persons at high risk of disease and persons with health-risk behavior. To this end, we distinguish between participants who took up the full intervention (web-based plus face-to-face) and those who received only the web-based intervention.

METHODS

The Early Detection and Prevention (Danish acronym: TOF) pilot study was conducted as a nonrandomized, 1-year follow-up intervention study in two municipalities in the Region of Southern Denmark. A total of 9400 citizens born between 1957 and 1986 (aged 29 to 60 years) were randomly sampled from participating general practitioner (GP) patient-list systems and were invited to take part in the study. Participants were subsequently stratified into risk groups based on their responses to a questionnaire on health-risk behavior and data from their GP's electronic patient record (EPR) system. All participants received a digital personal health profile with individualized information on current health-risk behavior and targeted advice on relevant health-risk behavior changes. In addition, patients at high risk of disease, as indicated by their digital health profile, were offered a targeted intervention at their GP. Patients who were not deemed at high risk of disease but who exhibited health-risk behaviors were offered a targeted intervention at their municipal health center (MHC). At 1-year follow-up, health-risk behaviors, self-rated health, BMI, and mental well-being were reassessed by questionnaire, and current information on diagnoses and medical treatment was retrieved from the EPRs.

RESULTS

Of 598 patients at high risk of disease or with health-risk behavior, 135 took up the targeted intervention at their GP or MHC and 463 received the personal health profile only. From baseline to 1-year follow-up, the number of patients with unhealthy eating habits decreased, mean mental well-being increased, and smoking prevalence decreased in patients who had received the digital personal health profile alone. Among patients who took up the targeted intervention, unhealthy eating habits and sedentary lifestyles decreased and significant reductions in mean BMI were observed. At 1-year follow up, no health-risk behaviors were detected among 17.4% of patients who at baseline had exhibited health-risk behaviors or high risk of disease.

CONCLUSIONS

A stepwise targeted preventive approach using web-based and face-to-face elements may lead to favorable lifestyle changes. Specifically, a web-based approach may improve smoking and eating habits and mental well-being, whereas supplementary face-to-face interventions may be necessary to improve exercise habits and BMI.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02797392; https://clinicaltrials.gov/ct2/show/NCT02797392.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12875-018-0820-8.

A Randomised Trial Examining Cardiovascular Morbidity and All-Cause Mortality 24 years Following General Health Checks: the Ebeltoft Health Promotion Project (EHPP)

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.

General health checks in adults for reducing morbidity and mortality from disease

BACKGROUND

General health checks are common elements of health care in some countries. They aim to detect disease and risk factors for disease with the purpose of reducing morbidity and mortality. Most of the commonly used individual screening tests offered in general health checks have been incompletely studied. Also, screening leads to increased use of diagnostic and therapeutic interventions, which can be harmful as well as beneficial. It is therefore important to assess whether general health checks do more good than harm. This is the first update of the review published in 2012.

OBJECTIVES

To quantify the benefits and harms of general health checks.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, two other databases and two trials registers on 31 January 2018. Two review authors independently screened titles and abstracts, assessed papers for eligibility and read reference lists. One review author used citation tracking (Web of Knowledge) and asked trial authors about additional studies.

SELECTION CRITERIA

We included randomised trials comparing health checks with no health checks in adults unselected for disease or risk factors. We did not include geriatric trials. We defined health checks as screening for more than one disease or risk factor in more than one organ system.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed the risk of bias in the trials. We contacted trial authors for additional outcomes or trial details when necessary. When possible, we analysed the results with a random-effects model meta-analysis; otherwise, we did a narrative synthesis.

MAIN RESULTS

We included 17 trials, 15 of which reported outcome data (251,891 participants). Risk of bias was generally low for our primary outcomes. Health checks have little or no effect on total mortality (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.97 to 1.03; 11 trials; 233,298 participants and 21,535 deaths; high-certainty evidence, I² = 0%), or cancer mortality (RR 1.01, 95% CI 0.92 to 1.12; 8 trials; 139,290 participants and 3663 deaths; high-certainty evidence, I² = 33%), and probably have little or no effect on cardiovascular mortality (RR 1.05, 95% CI 0.94 to 1.16; 9 trials; 170,227 participants and 6237 deaths; moderate-certainty evidence; I² = 65%). Health checks have little or no effect on fatal and non-fatal ischaemic heart disease (RR 0.98, 95% CI 0.94 to 1.03; 4 trials; 164,881 persons, 10,325 events; high-certainty evidence; I² = 11%), and probably have little or no effect on fatal and non-fatal stroke (RR 1.05 95% CI 0.95 to 1.17; 3 trials; 107,421 persons, 4543 events; moderate-certainty evidence, I² = 53%).

AUTHORS' CONCLUSIONS

General health checks are unlikely to be beneficial.

Effects of invitation to participate in health surveys on the incidence of cardiovascular disease: a randomized general population study

Background

The effects of health checks on reducing cardiovascular disease morbidity and mortality in the general population have been questioned. There are few randomized studies with long-term follow-up. We used a cohort randomly selected from a general population as a randomized trial to study the effect of repeated general health checks on the 30-year incidence of ischaemic heart disease (IHD), stroke and all-cause mortality.

Methods

The study included all persons ( n = 17 845) aged 30, 40, 50 and 60 years living in 11 municipalities in Copenhagen, the capital of Denmark. An age- and gender-stratified random sample ( n = 4789) was invited to up to three health checks, from 1982 to 1994 (intervention group). The remaining 12 994 persons were defined as the control group. Complete follow-up on mortality, emigration and fatal and non-fatal IHD and stroke until 31 December 2012 was obtained by linkage to registries.

Results

There were 3209 and 2190 incident cases of IHD and stroke, respectively, and a total of 6432 deaths during follow-up (mean = 25.2 years). The hazard ratios (HRs) (95% confidence intervals, CIs) for persons in the intervention group versus persons in the control group were as follows: IHD (HR: 0.99, 95% CI: 0.92, 1.07), stroke (HR: 1.14, 95% CI: 1.04, 1.25) and all-cause mortality (HR: 1.03, 95% CI: 0.98, 1.09).

Conclusions

Repeated general health checks offered to the general population had no beneficial effects on the development of IHD, stroke or all-cause mortality during 30 years of follow-up. An increased incidence of stroke was observed in the group offered health checks.

The association between alcohol drinking and self-reported mental and physical functioning: a prospective cohort study among City of Helsinki employees

OBJECTIVES

Alcohol drinking is associated with ill health but less is known about its contribution to overall functioning. We aimed to examine whether alcohol drinking predicts self-reported mental and physical functioning 5-7 years later.

DESIGN

A prospective cohort study.

SETTING

Helsinki, Finland.

PARTICIPANTS

40-year-old to 60-year-old employees of the City of Helsinki (5301 women and 1230 men) who participated in a postal survey in 2000-2002 and a follow-up survey in 2007.

PRIMARY AND SECONDARY OUTCOME MEASURES

Mental and physical functioning measured by the Short Form 36 Health Survey.

RESULTS

Alcohol drinking was differently associated with mental and physical functioning. Heavy average drinking, binge drinking and problem drinking were all associated with subsequent poor mental functioning except for heavy average drinking among men, whereas only problem drinking was associated with poor physical functioning. Also, non-drinking was associated with poor physical functioning. Problem drinking was the drinking habit showing most widespread and strongest associations with health functioning. The associations between problem drinking and poor mental functioning and with poor physical functioning among women remained after adjusting for baseline mental functioning, sociodemographic factors, working conditions and other health behaviours.

CONCLUSIONS

Alcohol drinking is associated especially with poor mental functioning. Problem drinking was the drinking habit strongest associated with poor health functioning. The results call for early recognition and prevention of alcohol problems in order to improve health functioning among employees.

Honest Labor Bears a Lovely Face: Will Late-Life Unemployment Impact Health and Satisfaction in Retirement?

OBJECTIVE

Unemployment among older adults during recessionary cycles has been tied to early retirement decisions and negative health outcomes. This study explored episodes of unemployment experienced between age 50 and retirement as predictors of retirement age and health outcomes.

METHODS

A total of 1540 participants from the U.S. Health and Retirement Study aged 50 years and older who transitioned from workforce to retirement were analyzed with descriptive statistics and multiple regression controlling for unemployment, demographics, and health status.

RESULTS

Late-life unemployment significantly related to earlier retirement age and lowered life satisfaction, independent of income effects. We found no main effect for late-life unemployment on physical health status.

CONCLUSIONS

Potential improvements in future life satisfaction might be gained if job search obstacles are removed for older unemployed adults, reducing reliance on involuntary early retirement as an income source.

The relationship between family support; pain and depression in elderly with arthritis

The prevalence and chronic nature of arthritis make it the most common cause of disability among U.S.A adults. Family support reduces the negative impact of chronic conditions generally but its role in pain and depression for arthritic conditions is not well understood. A total of 844 males (35.0%) and 1567 females (65.0%) with arthritic conditions (n = 2411) were drawn from the 2012 Health and Retirement Study to examine the effect of family support on pain and depressive symptoms. Using regression analysis and controlling for age, ethnicity, gender, marital/educational status and employment/income, physical function/disability status, pain and antidepressant medications, and other clinical indicators of chronic health conditions, we examined the effects of family support (spouse, children, other) on pain and depression levels. Results indicated that depressive symptoms decreased significantly with strong family and spousal support (p < .05). Pain decreased as support levels increased, but was non-statistically significant. This study provides new insights into the relationship between family support, pain, and depression for individuals with arthritis. Future longitudinal studies are needed to evaluate family support and relationships over a wider spectrum of demographics.

Psychological consequences of screening for cardiovascular risk factors in an un-selected general population: Results from the Inter99 randomised intervention study

Background: Concerns that general health checks, including screening for risk factors to ischemic heart disease (IHD), have negative psychological consequences seem widely unfounded; however, previous studies are only based on self-reports from participants. Aim: To investigate if risk factor screening in healthy adults leads to mental distress in the study population, independent of participation. Methods: The Inter99 study (1999 – 2006) was a randomised intervention in the general population, aiming to prevent IHD by a healthier lifestyle. We included the whole study population, independent of participation ( n = 60,915). We merged data with information on the use of psychotropic medication and/or hospitalisation due to psychiatric diagnoses, as retrieved from national registers in Denmark, 4 years before and 5 years after the study began. We conducted analyses using generalised estimating equations. Results: There was no significant difference between the intervention and control groups in their use of antipsychotics, hypnotics/sedatives, antidepressants or anxiolytics. As regards admission to the hospital with mental disorders, no significant difference was seen. These findings were true based on a yearly basis, and when investigating both short-term and a long-term effects of the intervention. There was no interaction with socioeconomic status. Of the 918 persons with a psychiatric diagnosis before the study start, 303 (33%) were re-admitted in the intervention period. Pre-screening of psychological status did not influence the psychological impact of screening. Conclusions: This large, randomised intervention study supports that screening for risk factors to IHD does not increase mental distress, not even in the mentally or socioeconomically most vulnerable persons. This study included the whole Inter99 study population (not only study participants).

General health checks in adults for reducing morbidity and mortality from disease

BACKGROUND

General health checks are common elements of health care in some countries. These aim to detect disease and risk factors for disease with the purpose of reducing morbidity and mortality. Most of the commonly used screening tests offered in general health checks have been incompletely studied. Also, screening leads to increased use of diagnostic and therapeutic interventions, which can be harmful as well as beneficial. It is, therefore, important to assess whether general health checks do more good than harm.

OBJECTIVES

We aimed to quantify the benefits and harms of general health checks with an emphasis on patient-relevant outcomes such as morbidity and mortality rather than on surrogate outcomes such as blood pressure and serum cholesterol levels.

SEARCH METHODS

We searched The Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, MEDLINE, EMBASE, Healthstar, CINAHL, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) to July 2012. Two authors screened titles and abstracts, assessed papers for eligibility and read reference lists. One author used citation tracking (Web of Knowledge) and asked trialists about additional studies.

SELECTION CRITERIA

We included randomised trials comparing health checks with no health checks in adults unselected for disease or risk factors. We did not include geriatric trials. We defined health checks as screening general populations for more than one disease or risk factor in more than one organ system.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data and assessed the risk of bias in the trials. We contacted authors for additional outcomes or trial details when necessary. For mortality outcomes we analysed the results with random-effects model meta-analysis, and for other outcomes we did a qualitative synthesis as meta-analysis was not feasible.

MAIN RESULTS

We included 16 trials, 14 of which had available outcome data (182,880 participants). Nine trials provided data on total mortality (155,899 participants, 11,940 deaths), median follow-up time nine years, giving a risk ratio of 0.99 (95% confidence interval (CI) 0.95 to 1.03). Eight trials provided data on cardiovascular mortality (152,435 participants, 4567 deaths), risk ratio 1.03 (95% CI 0.91 to 1.17) and eight trials on cancer mortality (139,290 participants, 3663 deaths), risk ratio 1.01 (95% CI 0.92 to 1.12). Subgroup and sensitivity analyses did not alter these findings.We did not find an effect on clinical events or other measures of morbidity but one trial found an increased occurrence of hypertension and hypercholesterolaemia with screening and one trial found an increased occurence of self-reported chronic disease. One trial found a 20% increase in the total number of new diagnoses per participant over six years compared to the control group. No trials compared the total number of prescriptions, but two out of four trials found an increased number of people using antihypertensive drugs. Two out of four trials found small beneficial effects on self-reported health, but this could be due to reporting bias as the trials were not blinded. We did not find an effect on admission to hospital, disability, worry, additional visits to the physician, or absence from work, but most of these outcomes were poorly studied. We did not find useful results on the number of referrals to specialists, the number of follow-up tests after positive screening results, or the amount of surgery.

AUTHORS' CONCLUSIONS

General health checks did not reduce morbidity or mortality, neither overall nor for cardiovascular or cancer causes, although the number of new diagnoses was increased. Important harmful outcomes, such as the number of follow-up diagnostic procedures or short term psychological effects, were often not studied or reported and many trials had methodological problems. With the large number of participants and deaths included, the long follow-up periods used, and considering that cardiovascular and cancer mortality were not reduced, general health checks are unlikely to be beneficial.

Diversity and ambivalence in general practitioners' attitudes towards preventive health checks - a qualitative study

Background

Systematic preventive health checks in primary care have been introduced in several countries. The Danish Health Service does not provide this service, but health checks are nevertheless being conducted unsystematically. Very little is known about the GPs’ experience with this service.

The purpose of our study is to describe GPs’ attitudes towards and concerns about providing preventive health checks and to describe their experiences with the health checks that they provide in daily practice.

Methods

A qualitative descriptive study was conducted based on three semi-structured focus group interviews with 16 GPs from Central Region, Denmark. The focus group interviews took place at the Department of Public Health, Section for General Practice, Aarhus University in November 2010.

Results

We found that the participating GPs all conducted some kind of preventive health checks, but also that there was great diversity in the content. The GPs were somewhat ambivalent towards health checks. Many GPs found the service beneficial for the patients. Concurrently, they had reservations about promoting ill-health, they questioned whether the health checks were a core mission of primary care, and they were concerned whether the health checks would benefit the “right” patients. The GPs felt a need for further documentation of the benefits for the patients before a possible future implementation of systematic health checks. Some GPs found that health checks could be performed in other settings than general practice.

Conclusions

Our study revealed that health checks are performed differently. Their quality differs, and the GPs perform the health check based on their personal attitude towards this service and prevention in general. Our analysis suggests that the doctors are basically uncertain about the best approach. Our study also uncovers the GPs’ reservations about inducing negative psychological reactions and decreased well-being among the health check participants. Further studies are needed to disclose where these concerns emerge.

The association between sleep problems and perceived health status: a Japanese nationwide general population survey

OBJECTIVE

Sleep problems in humans have been reported to impact seriously on daily function and to have a close association with well-being. To examine the effects of individual sleep problems on physical and mental health, we conducted a nationwide epidemiological survey and examined the associations between sleep problems and perceived health status.

METHODS

Cross-sectional surveys with a face-to-face interview were conducted in August and September, 2009, as part of the Nihon University Sleep and Mental Health Epidemiology Project (NUSMEP). Data from 2559 people aged 20 years or older were analyzed (response rate 54.0%). Participants completed a questionnaire on perceived physical and mental health statuses, and sleep problems including the presence or absence of insomnia symptoms (i.e., difficulty initiating sleep [DIS], difficulty maintaining sleep [DMS], and early morning awakening [EMA]), excessive daytime sleepiness (EDS), poor sleep quality (PSQ), short sleep duration (SSD), and long sleep duration (LSD).

RESULTS

The prevalence of DIS, DMS, and EMA was 14.9%, 26.6%, and 11.7%, respectively, and 32.7% of the sample reported at least one of them. At the complaint level, the prevalence of EDS, PSQ, SSD, and LSD was 1.4%, 21.7%, 4.0%, and 3.2%, respectively. Multiple logistic regression analyses revealed that DMS, PSQ, SSD, and LSD were independently associated with poor perceived physical health status; DIS, EDS, and PSQ were independently associated with poor perceived mental health status.

CONCLUSIONS

This study has demonstrated that sleep problems have individual significance with regard to perceived physical or mental health status.

Long-term outcome of multidisciplinary intervention of chronic non-cancer pain patients in a private setting

Background and aim

The present study reports on chronic non-cancer patients who were referred to a private pain clinic, according to a waiting time guarantee and treated within one month from referral. Based on evaluation by members of the multidisciplinary staff at our pain clinic a pain management program could be offered individually or as group therapy.

Methods

Health related quality of life, psychometric tests, use of pain medication; socio-economic status and number of consultations in general practice were recorded at referral to the clinic and by postal questionnaires at follow-up 21 months later. The primary treatment outcome (treatment success) was defined as an improvement of at least 40 points in the physical component and/or the mental component of SF-36 from baseline to follow-up. Secondary outcome measures were changes in Beck’s Anxiety Inventory and Beck’s Depression Inventory, use of analgesics, work status and transfer income and number of consultations at the GP’s office due to the chronic pain condition.

Results

A total of 306 patients were included: 141 were treated individually and 165 were treated in groups. At follow-up, data were obtained from 189 patients (62%). Comparing baseline to follow-up data, 62% of group treated patients were treated successfully, compared with 41% of individually treated patients. Anxiety and depression were significantly improved in group treated patients but not in those treated individually. significantly more patients had work income (and less patients transfer income) among group treated, compared with individually treated. At follow-up use of antidepressants and anticonvulsants was increased whereas use of tranquilizers and strong opioids was decreased in all patients. Number of consultations at their GPs due to chronic pain was significantly reduced in all patients.

Conclusions

Multidisciplinary treatment in a private pain clinic seems to have a long-term effect in relation to biological, psychological and social aspects of the chronic pain condition. Treatments based on group therapy may offer better results than individual treatment courses.

Implications

The effect of group therapy should be explored further.

Lifestyle behaviours and quality-adjusted life years in middle and older age

OBJECTIVE

to examine the relationship between combined lifestyle behaviours and quality-adjusted life years (QALYs) in a general population.

METHODS

a population-based study was conducted in 13,358 men and women who participated in the European Prospective Investigation into Cancer (EPIC)-Norfolk (baseline 1993-97). A score of 1 was given to each of non-smoking, physically not inactive, moderate alcohol consumption (1-14 units) and consumption of at least five portions of fruit and vegetables (vitamin C level ≥50 µmol/l). Short-Form Six-Dimension (SF-6D) health utility index scores were derived from the SF-36. QALYs were estimated up to follow-up (July 2007).

RESULTS

a total of 13,358 men and women were eligible to be included in the study (aged 40-79 years at baseline). A total of 12,921 people were alive at follow-up (117, 784 person-years). Mean follow-up period was ∼11.5 years. 437 (4.4% of men and 2.4% of women) died. The death rate was 6.5 times higher in people with health behaviour score 0 compared with those who scored 4 (8.4 versus 1.3%). People with higher scores had significantly higher QALYs.

CONCLUSION

our findings support the view that modifiable lifestyle factors are an important component in health improvement.

[Lifestyle medicine: the importance of considering all the causes of disease]

The enormous potential effects of health behavior change on mortality, morbidity, and health care costs provide ample motivation for the concept of lifestyle medicine. Lifestyle medicine involves the therapeutic use of lifestyle interventions on health and quality of life, and considers not only risk factors and markers, but also a range of antecedent factors from all levels of causality. Treatment would ultimate employ a combination of clinical (patient-centered) and public-health interventions. Examples of target patient behaviors include, but are not limited to, eliminating tobacco use, moderating alcohol consumption, increasing physical activity, improving diet, sleep, and emotional and mental well-being. The effective implementation of lifestyle medicine should be a priority within the necessary changes in current healthcare systems and public health policies.