Prevalence of multiple behavioral risk factors for chronic diseases in adults aged 50+, from eleven European countries - the SHARE study (2004)

Exploring the Implementation of Shared Decision-Making Involving Health Coaches for Diabetes and Hypertension Self-Management: Qualitative Study

BACKGROUND

An emerging focus on person-centered care has prompted the need to understand how shared decision-making (SDM) and health coaching could support self-management of diabetes and hypertension.

OBJECTIVE

This study aims to explore preferences for the scope of involvement of health coaches and health care professionals (HCPs) in SDM and the factors that may influence optimal implementation of SDM from the perspectives of patients and HCPs.

METHODS

We conducted focus group discussions with 39 patients with diabetes and hypertension and 45 HCPs involved in their care. The main topics discussed included the roles of health coaches and HCPs in self-management, views toward health coaching and SDM, and factors that should be considered for optimal implementation of SDM that involves health coaches. All focus group discussions were audio recorded, transcribed verbatim, and analyzed using thematic analysis.

RESULTS

Participants agreed that the main responsibility of HCPs should be identifying the patient's stage of change and medication education, while health coaches should focus on lifestyle education, monitoring, and motivational conversation. The health coach was seen to be more effective in engaging patients in lifestyle education and designing goal management plans as health coaches have more time available to spend with patients. The importance of a health coach's personal attributes (eg, sufficient knowledge of both medical and psychosocial management of disease conditions) and credentials (eg, openness, patience, and empathy) was commonly emphasized. Participants viewed that addressing the following five elements would be necessary for the optimal implementation of SDM: (1) target population (newly diagnosed and less stable patients), (2) commitment of all stakeholders (discrepancy on targeted times and modality), (3) continuity of care (familiar faces), (4) philosophy of care (person-centered communication), and (5) faces of legitimacy (physician as the ultimate authority).

CONCLUSIONS

The findings shed light on the appropriate roles of health coaches vis-à-vis HCPs in SDM as perceived by patients and HCPs. Findings from this study also contribute to the understanding of SDM on self-management strategies for patients with diabetes and hypertension and highlight potential opportunities for integrating health coaches into the routine care process.

Identifying Clusters of Health Behaviors in a Japanese Working Population at Risk for Non-Communicable Diseases: A Latent Class Analysis of 12,168 Individuals

Introduction

Noncommunicable diseases (NCDs) have become a significant global problem. Health behaviors are associated with NCDs, and characterizing populations using a public health approach can help provide specific interventions according to their characteristics. This study aims to examine the formation of clusters of health behavior combinations in the Japanese working population at risk of NCDs, taking into account the influences of age and gender, using latent class analysis.

Methods

Participants were individuals at risk for NCDs but had not previously been diagnosed with any. Latent class analysis (LCA) was used to study clustering based on basic characteristics and health behaviors. All statistical analyses were conducted using R (Version 4.0.4) and the "poLCA" package (Version 1.6.0).

Results

This study included 12,168 participants. LCA compared models with one to six latent classes. The five-class model was determined to be the most appropriate based on Bayesian Information Criterion, Akaike Information Criterion, and G^2 values, as well as distinguishable cluster characteristics. Cluster 1: "having healthy lifestyles but disliking hospitals"; Cluster 2: "women with healthy lifestyle behaviors"; Cluster 3: "general population"; Cluster 4: "middle-aged group in need of lifestyle improvement"; Cluster 5: "a group receiving treatment for lifestyle-related diseases."

Conclusions

This study reveals discernible health behavior patterns in a sample of the Japanese population using large real-world data, suggesting the effectiveness of distinct approaches when considering a population approach to public health.

In person versus remote cognitive rehabilitation in patients with subjective cognitive decline or neurocognitive disorders: what factors drive patient's preference?

Background

To date, there is still a lack of consensus for identifying the ideal candidate for cognitive telerehabilitation (TR). The main goal of the present study is to identify the factors associated to the preference for either TR or in-person cognitive training (CT) programs in older adults at risk of dementia or with early cognitive impairment.

Methods

A sample of 56 participants with subjective cognitive decline or neurocognitive disorders eligible for CT were enrolled at the Dementia Research Center and Neurorehabilitation Unit of IRCCS Mondino Foundation. All individuals underwent a baseline assessment to capture their complete profile, including cognitive reserve and lifestyle habits, sociodemographic characteristics, cognitive functioning, and mental health. Patients were then asked their preference for TR or in-person CT, before being randomized to either treatment as per protocol procedures. Statistical analyses included explorative descriptive approach, logistic regression, and non-parametric models to explore the overall contribution of each variable.

Results

The two (TR and in-person) preference groups were similar for cognitive functioning and mental health status. Socio-demographic and lifestyle profiles seem to be the most important factors to influence the preference in terms of the area under the curve (AUC) of the models. The two preference groups differed in terms of socio-demographic characteristics (e.g., level of technological skills, age, and distance from the clinic). Furthermore, participants who selected the TR modality of CT had significantly higher levels of cognitive reserve and adopted more protective lifestyle habits (e.g., regular physical activity, Mediterranean diet) when compared to those who preferred in-person CT.

Discussion

These findings highlight that the preference to receive CT delivered by TR or in person is a complex issue and is influenced by a variety of factors, mostly related to lifestyle habits and sociodemographic characteristics. Availability of profiles of patients that may be more attracted to one or the other modality of TR may help promote shared decision-making to enhance patient experience and outcomes.

Longitudinal patterns of lifestyle risk behaviours among UK adults with established cardiovascular disease: a latent transition analysis

Background

People with cardiovascular disease (CVD) need to engage in healthy lifestyle behaviours. However, there is a gap in identifying longitudinal patterns of change in lifestyle behaviours among people with CVD. This study aimed to identify clustering of lifestyle risk behaviours and their 4 ± year changes among UK adults with CVD, and to determine the associated factors.

Methods

We used the UK Biobank data collected at two time points (2006-2010/baseline data = T0 and 2014+/third visit data = T4). Six key lifestyle risk behaviours were assessed: smoking, high alcohol intake, poor fruit and vegetable consumption, physical inactivity, poor sleep balance (<7 or >8 h/night) and prolonged sitting. A random intercept latent transition analysis was performed to identify patterns of lifestyle risk behaviours at T0 and their changes from T0 to T4.

Results

We included 5,304 participants with CVD whose data on lifestyle risk behaviours were collected at two-time points. Alcohol intake and current smoking were 75.7% and 5.4% at baseline, respectively, and 67.4% and 3.0% at follow-up. Three latent classes emerged: Latent class (LC) 1-"high alcohol intake, poor sleep balance and poor fruit and vegetable intake", LC2-"high alcohol intake and poor fruit and vegetable intake", and LC3-"high alcohol intake". Most adults remained in the same LC over the 4 + years (range: 83.9%-100.0%). After 4 + years, 3.5% from LC3 and 10.4% from LC2 at baseline moved into LC1. The odds of transitioning to LC2 relative to staying in LC1 and LC3 were 2.22 and 4.13 times higher for males than for females, respectively. A single-year increase in participants' age was associated with a 1.16 times increase in the odds of moving to LC1 relative to staying in LC2.

Conclusion

People with CVD did not show improvement in lifestyle risk behaviours, and interventions targeting multiple lifestyle risk behaviours are needed to improve CVD.

Effects of age on non-communicable disease risk factors among Nepalese adults

The growing burden of non-communicable diseases (NCDs) and an increase in the prevalence of the underlying risk factors are creating a challenge to health systems in low- and middle-income countries (LMICs). In Nepal, deaths attributable to NCDs have been increasing, as has life expectancy. This poses questions with regards to how age and various risk factors interact in affecting NCDs. We analyzed the effects of age on NCD risk factors, using data from the Nepalese STEPs survey 2019, a nationally representative cross-sectional study. Six sociodemographic determinants, four behavioral risk factors, and four biological risk factors were examined. Age effects were analyzed among three age groups: below 35 years (young), 35-59 years (middle aged) and 60 years and above (elderly). The prevalence of selected behavioral risk factors for NCDs, notably smoking, alcohol consumption and insufficient physical activity, and some biological risk factors (hypertension, hyperlipidemia) increases with age. The prevalence of most behavioral risk factors was highest among men and women aged 60 years and above. The prevalence of hypertension and hyperlipidemia was highest among the elderly, but the prevalence of diabetes and overweight/obesity was highest among the middle aged for both sexes. Age interactions in the association between behaviors and biological risk factors were surprisingly weak. However, age interactions were significant in the association between alcohol consumption and -hypertension, -overweight/obesity and -hyperlipidemia among women. While the prevalence of NCD risk factors tends to be higher among elders, the interaction between age and risk factors is complex. Most NCD risk factors are related to behaviors, which originate in young adulthood. It is necessary to diagnose and treat biological risk factors, in younger age groups before they manifest as NCDs. Similarly, behavior change interventions need to target these younger age groups to reduce the risk of NCDs later in life.

Proactive automatised lifestyle intervention (PAL) in general hospital patients: study protocol of a single-group trial

INTRODUCTION

The co-occurrence of health risk behaviours (HRBs, ie, tobacco smoking, at-risk alcohol use, insufficient physical activity and unhealthy diet) increases the risks of cancer, other chronic diseases and mortality more than additively; and applies to more than half of adult general populations. However, preventive measures that target all four HRBs and that reach the majority of the target populations, particularly those persons most in need and hard to reach are scarce. Electronic interventions may help to efficiently address multiple HRBs in healthcare patients. The aim is to investigate the acceptance of a proactive and brief electronic multiple behaviour change intervention among general hospital patients with regard to reach, retention, equity in reach and retention, satisfaction and changes in behaviour change motivation, HRBs and health.

METHODS AND ANALYSIS

A pre-post intervention study with four time points is conducted at a general hospital in Germany. All patients, aged 18-64 years, admitted to participating wards of five medical departments (internal medicine A and B, general surgery, trauma surgery, ear, nose and throat medicine) are systematically approached and invited to participate. Based on behaviour change theory and individual HRB profile, 175 participants receive individualised and motivation-enhancing computer-generated feedback at months 0, 1 and 3. Intervention reach and retention are determined by the proportion of participants among eligible patients and of participants who continue participation, respectively. Equity in reach and retention are measured with regard to school education and other sociodemographics. To investigate satisfaction with the intervention and subsequent changes, a 6-month follow-up is conducted. Descriptive statistics, multivariate regressions and latent growth modelling are applied.

ETHICS AND DISSEMINATION

The local ethics commission and data safety appointee approved the study procedures. Results will be disseminated via publication in international scientific journals and presentations on scientific conferences.

TRIAL REGISTRATION NUMBER

NCT05365269.

Behavioral Health Risk Factors and Motivation to Change among Cardiovascular General Hospital Patients Aged 50 to 79 Years

Little is known about the (co-)occurrence of smoking, alcohol at-risk drinking, physical inactivity and overweight, and the motivation to change these behavioral health risk factors (HRFs) in older general hospital patients with cardiovascular disease. Between October and December 2016, all consecutively admitted patients aged 50 to 79 years were proactively recruited on 3 cardiology wards and asked to participate in a survey on HRFs and behavior change motivation. Of the eligible patients, 80.4% participated in the survey (n = 328). The mean age was 66.5 years (standard deviation 9.0), and 65.5% were male. At least 1 HRF was present in 91.8% (n = 280), at least 2 HRFs in 54.4% (n = 166), and 3 or 4 HRFs in 12.1% (n = 37) of participants. The proportion of older adults who contemplated or were changing or planning to change their behavior to meet health behavior recommendations ranged between 66.0% (smoking) and 93.2% (alcohol consumption). The results indicate a notable co-occurrence of behavioral HRFs in older patients with cardiovascular disease. The majority of older adults were at least considering changing the respective behavior. To prevent and treat diseases efficiently, hospitalization may be a suitable moment for systematic multiple HRF screening and intervention.

Emergency hospital admissions among older adults living alone in the community

Background

Among older adults, living alone is often associated with higher risk of Emergency Department (ED) admissions. However, older adults living alone are very heterogeneous in terms of health. As more older adults choose to live independently, it remains unclear if the association between living alone and ED admissions is moderated by health status. We studied the association between living alone and ED admission outcomes (number of admissions, inpatient days and inpatient costs) among older adults with and without multimorbidity.

Methods

We used data from 16,785 individuals of the third follow-up of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese (mean age: 73(61-96) years). Participants were interviewed face-to-face from 2014 to 2016 for sociodemographic/health factors and followed-up for one year on ED admission outcomes using Singapore Ministry of Health’s Mediclaim Database. We first applied multivariable logistic regression and two-part models to test if living alone is a risk factor for ED admission outcomes. We then ran stratified and joint effect analysis to examine if the associations between living alone and ED admission outcomes were moderated by multimorbidity.

Results

Compared to living with others, living alone was associated with higher odds of ED admission [Odds Ratio (OR) 1.28, 95 % Confidence Interval(CI) 1.08-1.51)], longer inpatient days (+0.61, 95 %CI 0.25-0.97) and higher inpatient costs (+322 USD, 95 %CI 54-591). The interaction effects of living arrangement and multimorbidity on ED admissions and inpatient costs were not statistically different, whereas the interaction between living arrangements and multimorbidity on inpatient days was borderline significant (p-value for interaction=0.050). Compared to those living with others and without multimorbidity, the relative mean increase was 1.13 inpatient days (95 %CI 0.39-1.86) for those living alone without multimorbidity, and 0.73 inpatient days ( 95 %CI 0.29-1.17) for those living alone with multimorbidity.

Conclusions

Older adults living alone were at higher risk of ED admission and higher inpatient costs regardless of multimorbidity, while those living alone without multimorbidity had the longest average inpatient days. To enable aging in place while avoiding ED admissions, interventions could provide instrumental support and regular health monitoring to older adults living alone, regardless of their health status.

Understanding the influence of socioeconomic status on the association between combinations of lifestyle factors and adverse health outcomes: a systematic review protocol

INTRODUCTION

Combinations of unhealthy lifestyle factors are strongly associated with mortality, cardiovascular disease (CVD) and cancer. It is unclear how socioeconomic status (SES) affects those associations. Lower SES groups may be disproportionately vulnerable to the effects of unhealthy lifestyle factors compared with higher SES groups via interactions with other factors associated with low SES (eg, stress) or via accelerated biological ageing. This systematic review aims to synthesise studies that examine how SES moderates the association between lifestyle factor combinations and adverse health outcomes. Greater understanding of how lifestyle risk varies across socioeconomic spectra could reduce adverse health by (1) identifying novel high-risk groups or targets for future interventions and (2) informing research, policy and interventions that aim to support healthy lifestyles in socioeconomically deprived communities.

METHODS AND ANALYSIS

Three databases will be searched (PubMed, EMBASE, CINAHL) from inception to March 2020. Reference lists, citations and grey literature will also be searched. Inclusion criteria are: (1) prospective cohort studies; (2) investigations of two key exposures: (a) lifestyle factor combinations of at least three lifestyle factors (eg, smoking, physical activity and diet) and (b) SES (eg, income, education or poverty index); (3) an assessment of the impact of SES on the association between combinations of unhealthy lifestyle factors and health outcomes; (4) at least one outcome from-mortality (all cause, CVD and cancer), CVD or cancer incidence. Two independent reviewers will screen titles, abstracts and full texts of included studies. Data extraction will focus on cohort characteristics, exposures, direction and magnitude of SES effects, methods and quality (via Newcastle-Ottawa Scale). If appropriate, a meta-analysis, pooling the effects of SES, will be performed. Alternatively, a synthesis without meta-analysis will be conducted.

ETHICS AND DISSEMINATION

Ethical approval is not required. Results will be disseminated via peer-reviewed publication, professional networks, social media and conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42020172588.

The influence of resistance training on neuromuscular function in middle-aged and older adults: A systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Deterioration of neuromuscular function is a major mechanism of age-related strength loss. Resistance training (RT) improves muscle strength and mass. However, the effects of RT on neuromuscular adaptations in middle-aged and older adults are unclear.

METHODS

Randomised controlled RT interventions (≥2 weeks) involving adults aged ≥50 years were identified. Primary outcome measures were voluntary activation (VA), electromyographic (EMG) activity during maximal voluntary contraction (MVC), and antagonist coactivation. Data were pooled using a weighted random-effect model. Sub-analyses were conducted by muscle or muscle group and health status of participants. Sensitivity analysis was based on study quality. P < 0.05 indicated statistical significance.

RESULTS

Twenty-seven studies were included. An effect was found for VA (standardised mean difference [SMD] 0.54, 0.01 to 1.07, P = 0.04), This result remained significant following sensitivity analysis involving only studies that were low risk of bias. Subgroup analyses showed an effect for plantar flexor VA (SMD 1.13, 0.20 to 2.06, P = 0.02) and VA in healthy participants (SMD 1.04, 0.32 to 1.76, P = 0.004). There was no effect for EMG activity or antagonist coactivation of any muscle group (P > 0.05).

DISCUSSION

Resistance training did not alter EMG activity or antagonist coactivation in older adults. Sensitivity analysis resulted in the effect for VA remaining significant, indicating that this finding was not dependent on study quality. Studies predominantly involved healthy older adults (78%), limiting the generalisability of these findings to clinical cohorts. Future research should determine the effects of RT on neuromuscular function in people with sarcopenia and age-related syndromes.

Improvement of Working Memory is a Mechanism for Reductions in Delay Discounting Among Mid-Age Individuals in an Urban Medically Underserved Area

BACKGROUND

Delay discounting, or the tendency to devalue rewards as a function of their delayed receipt, is associated with myriad negative health behaviors. Individuals from medically underserved areas are disproportionately at risk for chronic health problems. The higher rates of delay discounting and consequent adverse outcomes evidenced among low-resource and unstable environments suggest this may be an important pathway to explain health disparities among this population.

PURPOSE

The current study examined the effectiveness of a computerized working memory training program to decrease rates of delay discounting among residents of a traditionally underserved region.

METHODS

Participants (N = 123) were recruited from a community center serving low income and homeless individuals. Subjects completed measures of delay discounting and working memory and then took part in either an active or control working memory training.

RESULTS

Analyses indicated that participants in the active condition demonstrated significant improvement in working memory and that this improvement mediated the relation between treatment condition and reductions in delay discounting.

CONCLUSIONS

Results suggest that a computerized intervention targeting working memory may be effective in decreasing rates of delay discounting in adults from medically underserved areas (ClinicalTrials.gov number NCT03501706).

Association between Food Label Unawareness and Loss of Renal Function in Diabetes: A Cross-Sectional Study in South Korea

Objectives: To examine sex differences in the association between food label unawareness and loss of renal function among South Korean diabetic patients aged ≥30 year and determine whether reading food labels when choosing which food products to consume plays a potential role in slowing the progression of renal disease. Methods: Data from the 2016–2017 Korea National Health and Nutrition Examination Survey were used for the analysis. Renal function was determined by the Modification of Diet in Renal Disease estimated glomerular filtration rate, and food label unawareness was defined as being unaware of the food label when choosing a food product for consumption. Multiple regression analysis was used to investigate the association between food label unawareness and loss of renal function among South Korean diabetic patients. Results: Four hundred and eighty-seven diabetic patients (men: 274; women: 213) were enrolled. Loss of renal function was associated with food label unawareness in only male diabetic patients (men: β = –10.01, standard error (SE) = 5.08, p = 0.0506; women: β = –0.30, SE = 5.14, p = 0.9528). A strong association was found between loss of renal function and food label unawareness among socially isolated male diabetic patients who lived in a one-generational household, did not have a spouse, and ate alone. Conclusion: Cultivating habits of reading food labels and inducing social facilitation may play a potential role in managing loss of renal function among male diabetic patients.

Association of behavioral risk factors with self-reported and symptom or measured chronic diseases among adult population (18-69 years) in India: evidence from SAGE study

BACKGROUND

The objective is to analyze the behavioral risk factors among the adult population and to identify the determinants of and their association with self-reported and symptom or measured chronic diseases in India.

METHODS

The study utilized data from the Study on Global Aging and Adult Health (SAGE), Wave 1 (2007). Logistic regression was applied to examine the association of self-reported and symptom or measured chronic diseases with behavioral risk factors and socioeconomic-demographic covariates.

RESULTS

The results show that the prevalence of the symptom or measured chronic diseases was higher (41.9%) than that of the self-reported chronic diseases (24.1%). The moderate and vigorous physical activity was less likely to be associated with self-reported depression, arthritis, and stroke, but more likely to be associated with the symptom or measured based arthritis and asthma compared to physical inactivity. Adequate intake of fruits and vegetables was significantly less likely to be associated with angina, COPD, and asthma; however, it was more than three times more likely to be associated (OR: 3.45; 95% CI: 1.99-5.97) with self-reported depression. Infrequent moderate alcohol drinking was statistically two times more associated (OR: 1.83; 95% CI: 1.04-3.21) with the symptom or measured based COPD than non-drinking. Likewise, any type of tobacco use was found to be about four times more associated (OR: 3.59; 95% CI: 1.07-12.13) with self-reported stroke. Both self-reported and symptom or measured hypertension, arthritis, and diabetes were associated with overweight, while hypertension was associated with obesity. Females and increased age came out as significant predictors of both self-reported and symptom or measured chronic diseases.

CONCLUSION

The prevalence of chronic diseases and their association with BRFs and socioeconomic and demographic covariates differ markedly when assessed against self-reported criteria versus symptom or measured criteria. Adequate intake of fruits and vegetables is a crucial behavior that controls and delays the onset of chronic diseases. The study suggests that the National Program should remain focused on behavioral risk factors for maximum returns on health outcomes and that proper awareness and knowledge must be spread about healthy lifestyle behaviors throughout the country.

Widowhood and Alcohol, Tobacco, and Other Drug Use Among Older Adults in India

Objective

We sought to assess how widowhood among older adults in India was associated with alcohol consumption, smoking, and use of chewing tobacco or other drugs.

Method

Data were collected in 2011 from 9,852 adults aged 60 and older from seven regionally diverse states in India. Regression analyses provided estimates of the relationship between widowhood and having smoked cigarettes, consumed alcohol, or used chewed tobacco or other drugs in the past month among men, adjusting for demographic and socioeconomic factors. We also estimated the relationship between widowhood and past-month substance use among women.

Results

Recently widowed men (within 0-4 years) were 1.76 times (95% confidence interval [CI] 1.01-3.09, p < .05) more likely to have consumed alcohol and 1.62 times (95% CI 1.01-2.59, p < .05) more likely to have used chewing tobacco or other drugs as compared with married men. Women widowed for any length of time were 1.37 times (95% CI 1.11-1.69, p < .01) more likely to have used chewing tobacco or other drugs.

Discussion

Interventions aimed at reducing use of chewing tobacco or other drugs among older adults in India should consider focusing on recently widowed men and women widowed for any amount of time.

Physicians' lifestyle advice on primary and secondary cardiovascular disease prevention in Germany: A comparison between the STAAB cohort study and the German subset of EUROASPIRE IV

Background

We assessed prevalence and determinants in appropriate physician-led lifestyle advice (PLA) in a population-based sample of individuals without cardiovascular disease (CVD) compared with a sample of CVD patients.

Methods

PLA was assessed via questionnaire in a subsample of the population-based Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort free of CVD (primary prevention sample) and the German subset of the fourth EUROASPIRE survey (EUROASPIRE-IV) comprising CVD patients (secondary prevention sample). PLA was fulfilled if the participant reported having ever been told by a physician to: stop smoking (current/former smokers), reduce weight (overweight/obese participants), increase physical activity (physically inactive participants) or keep to a healthy diet (all participants). Factors associated with receiving at least 50% of the PLA were identified using logistic regression.

Results

Information on PLA was available in 665 STAAB participants (55 ± 11; 55% females) and in 536 EUROASPIRE-IV patients (67 ± 9; 18% females). Except for smoking, appropriate PLA was more frequently given in the secondary compared with the primary prevention sample. Determinants associated with appropriate PLA in primary prevention were: diabetes mellitus (odds ratio (OR) 4.54; 95% confidence interval (CI) 1.88–10.95), hyperlipidaemia (OR 3.12; 95% CI 2.06–4.73) and hypertension (OR 1.74; 95% CI 1.15–2.62); in secondary prevention: age (OR per year 0.96; 95% CI 0.93–0.98) and diabetes mellitus (OR 2.33; 95% CI 1.20–4.54).

Conclusions

In primary prevention, PLA was mainly determined by the presence of vascular risk factors, whereas in secondary prevention the level of PLA was higher in general, but the association between CVD risk factors and PLA was less pronounced.

Health Risk Behavior Patterns in a National Adult Population Survey

Background: The aim of this paper is to analyze the co-occurrence of health risk behaviors (HRBs), namely, tobacco smoking, alcohol risk drinking, overeating, and physical inactivity, as well as their 16 combinations (patterns), which are stratified by age and gender. Methods: The data of 19,294 study participants, from a telephone survey among the adult general population of Germany that was conducted in 2012, were analyzed. Results: In adults, two or more of the four HBRs were found among 51.5% of females and 61.9% of males. The single most prevalent HRB pattern among all of the female (20.7, 19.6–21.8%) and male participants (18.2, 17.1–19.3%) was being overweight combined with a lack of physical activity, and its prevalence increased by 4% with each year of life. A multinomial regression analysis revealed that education was inversely associated with 11 of the 15 HRB patterns. The risk of having four, compared to zero, HRBs was 3.3 (2.5–4.4) for males relative to females. Conclusion: Similar to the findings from other western countries, the majority of the participants in this adult national sample from Germany had two or more HRBs. The most common of all possible HRB patterns was overweight and inactivity. The data confirm inverse relations between education and most HRB patterns.

Lifestyle for Brain Health (LIBRA): a new model for dementia prevention

OBJECTIVE

Modifiable risk factors for dementia were recently identified and compiled in a systematic review. The 'Lifestyle for Brain Health' (LIBRA) score, reflecting someone's potential for dementia prevention, was studied in a large longitudinal population-based sample with respect to predicting cognitive change over an observation period of up to 16 years.

METHODS

Lifestyle for Brain Health was calculated at baseline for 949 participants aged 50-81 years from the Maastricht Ageing Study. The predictive value of LIBRA for incident dementia and cognitive impairment was examined by using Cox proportional hazard models and by testing its relation with cognitive decline.

RESULTS

Lifestyle for Brain Health predicted future risk of dementia, as well as risk of cognitive impairment. A one-point increase in LIBRA score related to 19% higher risk for dementia and 9% higher risk for cognitive impairment. LIBRA predicted rate of decline in processing speed, but not memory or executive functioning.

CONCLUSIONS

Lifestyle for Brain Health (LIBRA) may help in identifying and monitoring risk status in dementia-prevention programmes, by targeting modifiable, lifestyle-related risk factors. Copyright © 2017 John Wiley & Sons, Ltd.

Smoking Prevalence Among Users of Primary Healthcare Units in Brazil: The Role of Religiosity

The objective of this cross-sectional study is to examine the association between religious involvement and tobacco use in a large representative sample of users of primary healthcare units of Ribeirão Preto, Southeast Brazil. Current and past smoking habits were determined among 1055 users of primary healthcare units. Participants' religiosity was measured using the DUREL questionnaire. The prevalence of smoking among men was 16.8% [95% confidence interval (CI) 12.0-22.5] and among women was 12.6% (95% CI 10.4-15.0). Among the current smokers, 40.9% were light smokers, 24.6% were moderate smokers, and 34.5% were heavy smokers. The mean number of cigarettes smoked per day was 13.5. Respondents who have a religion had a lower smoking prevalence than people who had no religion. Current smoking prevalence tended to be higher among people who do not practice their religion than people who practice their religion. Smoking status is also associated with self-reported religiosity, organizational religious activity and some aspects of intrinsic religiosity. Religiosity is an important factor in influencing the smoking behavior in Brazilian users of the public health services.

The clustering of health-related behaviours in a British population sample: Testing for cohort differences

Research findings indicate that health-related behaviours (HRBs) do not co-occur within individuals by chance and therefore cluster. This study uses Latent Profile Analysis (LPA), to identify the clustered patterns and prevalence of four HRBs: smoking, alcohol, diet, physical activity. We used data, collected from participants in their early 30s, from two British cohorts born in 1958 and 1970 (N=21,019). Multi-group LPA models were run separately by gender testing for cohort differences in HRB cluster patterns. For both genders three clusters emerged: 'Risky' (1-9%), 'Moderate Smokers' (20-30%) and 'Mainstream' (68-77%). HRBs amongst members of the 'Mainstream' cluster were more beneficial than HRBs amongst members of the other two clusters, characterised as not smoking, frequent fruit and vegetable consumption, less frequent consumption of chips and fried food and being more physically active. Nevertheless, frequent consumption of sweet foods was common in the 'Mainstream' cluster. There was a large shift in membership to the 'Mainstream' cluster for men and women born in 1970. Amongst women members of the 'Mainstream' cluster, a higher proportion of those born in 1970 appeared to have drunk alcohol above the contemporaneous UK recommended limits but consumed sweet foods less frequently, than those born in 1958. In summary our findings provide additional evidence of HRB clustering, identifying largely consistent HRBs cluster patterns across cohort and gender groups, with some differences in prevalence. This evidence of HRB clustering across time and by gender provides a person-centred understanding that can inform interventions to improve HRBs.

The burden of behavioral risk factors for cardiovascular disease in Europe. A significant prevention deficit

OBJECTIVE

The study objective was to assess the burden of major cardiovascular disease (CVD) behavioral risk factors (BRFs) (i.e., smoking, excess body weight, physical inactivity, risky alcohol consumption) among individuals in the community with and without CVD history.

METHODS

For the current study, a subset of the data from the Survey of Health, Ageing and Retirement in Europe (SHARE) was analyzed, which were collected from 26,743 individuals aged 50+ years old, during the 1st wave of SHARE in 2004/05 in eleven European countries.

RESULTS

Among those with CVD, there is a statistically significant higher percentage of inactive individuals (81.4% vs. 69.5 among those without CVD), and of individuals with excess body weight (64.3%) or obese (21.6%). Patients with CVD had a lower prevalence of smoking and risky alcohol consumption in most countries, whereas the prevalence of high body weight and physical inactivity was higher in CVD patients compared to individuals without CVD in almost all countries. More than half of the population has at least two BRFs, with a significantly higher prevalence of multiple BRFs among those diagnosed with CVD.

CONCLUSION

Study findings suggest that a significant burden of behavioral risk factors for CVD remains in the population overall but also among patients diagnosed with CVD. Given the significant prevalence of BRFs, the prevention benefits would be immense for all stakeholders involved and negligence would be perilous.

Reducing dementia risk by targeting modifiable risk factors in mid-life: study protocol for the Innovative Midlife Intervention for Dementia Deterrence (In-MINDD) randomised controlled feasibility trial

Background

Dementia prevalence is increasing as populations live longer, with no cure and the costs of caring exceeding many other conditions. There is increasing evidence for modifiable risk factors which, if addressed in mid-life, can reduce the risk of developing dementia in later life. These include physical inactivity, low cognitive activity, mid-life obesity, high blood pressure, and high cholesterol. This study aims to assess the acceptability and feasibility and impact of giving those in mid-life, aged between 40 and 60 years, an individualised dementia risk modification score and profile and access to personalised on-line health information and goal setting in order to support the behaviour change required to reduce such dementia risk. A secondary aim is to understand participants’ and practitioners’ views of dementia prevention and explore the acceptability and integration of the Innovative Midlife Intervention for Dementia Deterrence (In-MINDD) intervention into daily life and routine practice.

Methods/design

In-MINDD is a multi-centre, primary care-based, single-blinded randomised controlled feasibility trial currently being conducted in four European countries (France, Ireland, the Netherlands and the UK). Participants are being recruited from participating general practices. Inclusion criteria will include age between 40 and 60 years; at least one modifiable risk factor for dementia risk (including diabetes, hypertension, obesity, renal dysfunction, current smoker, raised cholesterol, coronary heart disease, current or previous history of depression, self-reported sedentary lifestyle, and self-reported low cognitive activity) access to the Internet. Primary outcome measure will be a change in dementia risk modification score over the timescale of the trial (6 months). A qualitative process evaluation will interview a sample of participants and practitioners about their views on the acceptability and feasibility of the trial and the links between modifiable risk factors and dementia prevention. This work will be underpinned by Normalisation Process Theory.

Discussion

This study will explore the feasibility and acceptability of a risk profiler and on-line support environment to help individuals in mid-life assess their risk of developing dementia in later life and to take steps to alleviate that risk by tackling health-related behaviour change. Testing the intervention in a robust and theoretically informed manner will inform the development of a future, full-scale randomised controlled trial.

Trial registration

ISRCTN Registry: ISRCTN 98553005 (DOI: 10.1186/ISRCTN98553005).

Electronic supplementary material

The online version of this article (doi:10.1186/s40814-015-0035-x) contains supplementary material, which is available to authorized users.

Impact of a primary-based telemonitoring programme in HRQOL, satisfaction and usefulness in a sample of older adults with chronic diseases in Valencia (Spain)

BACKGROUND

Chronic patients are frequent users of healthcare services and are prone to hospital admissions. In Valencia (Spain) the Valcronic programme aims to manage chronic patients through different levels of telemonitoring and telecare. This paper examines the impact of the Valcronic programme on self-perceived HRQOL in a one-year period and on perceptions of satisfaction and usefulness in a sample of older adults with chronic diseases.

METHODS

The sample (n=74) was randomly selected from Valcronic users and was stratified considering different variables. HRQOL was assessed using the EQ-5D questionnaire at two points in time: before the beginning of the Valcronic programme and after a one-year follow-up. Satisfaction and usefulness were evaluated one year after users' inclusion.

RESULTS

The whole sample experienced improvement, although not significant, of its HRQOL; patients over 75 showed impairment. Patients with at least one problem in the EQ-5D dimensions decreased after one year (82.43% vs. 74.32%). Users' perceptions of satisfaction and usefulness were highly positive.

CONCLUSIONS

Our sample benefited from the Valcronic programme, experiencing an improvement in their HRQOL, a decreased use of health resources or high satisfaction levels.

IMPLICATIONS

Further adjustments are needed to address a comprehensive response to the needs of the global population of reference.

Association of Behavioral Risk Factors for Chronic Diseases With Physical and Mental Health in European Adults Aged 50 Years or Older, 2004-2005

INTRODUCTION

Noncommunicable diseases are the leading cause of illness and death worldwide; behavioral risk factors (BRFs) contribute to these diseases. We assessed the presence of multiple BRFs among European adults according to their physical and mental health status.

METHODS

We used data from 26,026 adults aged 50 years or older from 11 countries that participated in the Survey of Health, Ageing and Retirement in Europe (2004-2005). BRFs (overweight or obesity, smoking, physical inactivity, and risky alcohol consumption) were assessed according to physical health (ie, presence of chronic diseases, disease symptoms, or limitations in activities of daily living) and mental health (depression) through multiple regression estimations.

RESULTS

Overweight or obesity in men and physical inactivity in women were the most prevalent BRFs. Compared with physically active adults, physically inactive adults had a higher mean number of chronic diseases (1.33 vs 1.26) and chronic disease symptoms (1.55 vs 1.47). Risky alcohol consumption (≥4 servings of an alcohol beverage ≥3 times a week) was associated with a higher mean depression score (2.84 vs 2.47). Compared with adults with 0 or 1 BRF, adults with 2 or more BRFs had significantly higher odds of having 1 or more chronic diseases (men: 1.52; women: 1.73) and functional limitations (men: 1.65; women: 1.79) and higher prevalence of high blood pressure (37.8% vs 28.2). Belgian adults with BRFs had the highest mean number of chronic diseases or functional limitations among those who were overweight or obese and the highest mean number of chronic diseases and disease symptoms among those who smoked and were physically inactive.

CONCLUSION

We found revealed significant positive associations between BRFs and poor health among middle-aged and older European adults. Primary health care intervention programs should focus on developing ways to reduce BRF prevalence in this population.

Co-occurrence of behavioral risk factors of common non-communicable diseases among urban slum dwellers in Nairobi, Kenya

BACKGROUND

The four common non-communicable diseases (NCDs) account for 80% of NCD-related deaths worldwide. The four NCDs share four common risk factors. As most of the existing evidence on the common NCD risk factors is based on analysis of a single factor at a time, there is a need to investigate the co-occurrence of the common NCD risk factors, particularly in an urban slum setting in sub-Saharan Africa.

OBJECTIVE

To determine the prevalence of co-occurrence of the four common NCDs risk factors among urban slum dwellers in Nairobi, Kenya.

DESIGN

This analysis was based on the data collected as part of a cross-sectional survey to assess linkages among socio-economic status, perceived personal risk, and risk factors for cardiovascular and NCDs in a population of slum dwellers in Nairobi, Kenya, in 2008-2009. A total of 5,190 study subjects were included in the analysis. After selecting relevant variables for common NCD risk factors, we computed the prevalence of all possible combinations of the four common NCD risk factors. The analysis was disaggregated by relevant background variables.

RESULTS

The weighted prevalences of unhealthy diet, insufficient physical activity, harmful use of alcohol, and tobacco use were found to be 57.2, 14.4, 10.1, and 12.4%, respectively. Nearly 72% of the study participants had at least one of the four NCD risk factors. About 52% of the study population had any one of the four NCD risk factors. About one-fifth (19.8%) had co-occurrence of NCD risk factors. Close to one in six individuals (17.6%) had two NCD risk factors, while only 2.2% had three or four NCD risk factors.

CONCLUSIONS

One out of five of people in the urban slum settings of Nairobi had co-occurrence of NCD risk factors. Both comprehensive and differentiated approaches are needed for effective NCD prevention and control in these settings.

Spirometric obstruction and tobacco exposure among male Turkish nursing home residents

Spirometric obstruction is a prevalent problem in older adults and related to life-style risk factors. Symptoms related to chronic-obstructive-pulmonary-disease (COPD) are also prevalent symptoms with diverse etiologies - not limited to pulmonary obstruction. Older adults may have unrecognized airway obstruction due to functional limitations or symptoms mis-attributed to age/other co-morbidities. Therefore, spirometric obstruction may clinically be over/under diagnosed. Over last few decades, the burden of smoking-related diseases has increased in older adults. Additional evidence regarding older adults is required. We aimed to study frequency of spirometric obstruction, its over/under diagnosis and tobacco exposure in a group of male nursing-home residents. For spirometric obstruction diagnosis, two different thresholds [(fixed value: 0.70) versus (age-corrected value: 0.65 in residents >65 years of age)] were compared for better clinical practice. One hundred and three residents with 71.4 ± 6.3 years-of-age included. Spirometric obstruction prevalences were 39.8 and 29.1% with fixed and age-corrected FEV1/FVC thresholds, respectively. Age-corrected FEV1/FVC threshold underdiagnosed COPD in 1.9% while fixed threshold overdiagnosed spirometric obstruction in 8.7%. Active smokers were 64.1%, ex-smokers 23.3% and non-smokers 12.6%. Our study suggests high prevalences of spirometric obstruction and smoking in male nursing-home residents in Turkey. We suggest the use of age-corrected FEV1/FVC threshold practicing better than the use of fixed FEV1/FVC threshold in this patient group.

[Inequalities in physical inactivity according educational level in Spain, 1987 and 2007]

Objetivo

Comparar la magnitud de las desigualdades en la frecuencia de inactividad física en España en 1987 y 2007.

Diseño

Estudio descriptivo, diseño transversal, nivel nacional.

Participantes

Datos de la Encuesta Nacional de Salud de 1987 y 2007, población adulta de 25 a 64 años. Tamaño muestral 30.000 sujetos (1987) y 29.478 (2006/7).

Mediciones principales

Variable principal de resultados, inactividad física en tiempo libre. Factor de exposición, nivel educativo. Análisis de prevalencias y asociación a través de odds ratio (OR). Ajuste por variables socioeconómicas: edad en decenios, estado civil, situación laboral, clase social del cabeza de familia e ingresos del hogar.

Resultados

Descenso de la prevalencia de inactividad física en tiempo libre en 2007 respecto a 1987, tanto en mujeres como hombres. Mayores descensos observados entre los sujetos con estudios universitarios. La magnitud de las desigualdades en salud ha aumentado con el tiempo. Así ocurrió por ejemplo con el grupo de varones de 45 a 64 años, con OR de 2,43 (1,91-3,09) en 1987, a OR de 2,77 (2,17-3,54) en 2007, ajustadas por todas las variables socioeconómicas), en el caso de sujetos con peor nivel de estudios.

Conclusiones

La prevalencia de inactividad física descendió entre 1987 y 2007, y los mayores descensos fueron en sujetos con estudios universitarios. La brecha de las diferencias en prevalencias y OR de inactividad física en tiempo libre, ha aumentado con el tiempo. Parece necesario contribuir, desde estrategias de Educación para la Salud y promoción de la equidad, a la reducción de las desigualdades en conductas de riesgo.

Patterns of smoking prevalence among the elderly in Europe

Scant information is available on determinants of smoking prevalence in the vulnerable population of the elderly, particularly in Europe. Therefore, we analyzed smoking patterns among older adults (≥65 years old), using data from a representative survey based on 3,071 elderly, conducted in 17 European countries in 2010, within the Pricing Policies And Control of Tobacco in Europe (PPACTE) project. Overall smoking prevalence in 17 European countries was 11.5% (15.3% in men and 8.6% in women). An inverse relation with level of education was observed among men, while no specific pattern was evident among women. Smoking prevalence was highest in eastern/central Europe for men (20.3%) and northern Europe for women (13.1%). In both sexes combined, smokers were more frequent in countries with low implementation of tobacco control activities (14.9%). Anti-tobacco campaigns and smoking cessation interventions specifically targeted to the elderly are urgently needed in Europe.