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Aydınlar A, Mavi A, Kütükçü E, Kırımlı EE, Alış D, Akın A, Altıntaş L. Awareness and level of digital literacy among students receiving health-based education. BMC MEDICAL EDUCATION 2024; 24:38. [PMID: 38191385 PMCID: PMC10773083 DOI: 10.1186/s12909-024-05025-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/03/2024] [Indexed: 01/10/2024]
Abstract
BACKGROUND Being digitally literate allows health-based science students to access reliable, up-to-date information efficiently and expands the capacity for continuous learning. Digital literacy facilitates effective communication and collaboration among other healthcare providers. It helps to navigate the ethical implications of using digital technologies and aids the use of digital tools in managing healthcare processes. Our aim in this study is to determine the digital literacy level and awareness of our students receiving health-based education in our university and to pave the way for supporting the current curriculum with courses on digital literacy when necessary. METHOD Students from Acibadem University who were registered undergraduate education for at least four years of health-based education, School of Medicine, Nutrition and Dietetics, Nursing, Physiotherapy and Rehabilitation, Psychology, Biomedical Engineering, Molecular Biology, and Genetics were included. The questionnaire consisted of 24 queries evaluating digital literacy in 7 fields: software and multimedia, hardware and technical problem solving, network and communication/collaboration, ethics, security, artificial intelligence (A.I.), and interest/knowledge. Two student groups representing all departments were invited for interviews according to the Delphi method. RESULTS The survey was completed by 476 students. Female students had less computer knowledge and previous coding education. Spearman correlation test showed that there were weak positive correlations between the years and the "software and multimedia," "ethics," "interest and knowledge" domains, and the average score. The students from Nursing scored lowest in the query after those from the Nutrition and Dietetics department. The highest scores were obtained by Biomedical Engineering students, followed by the School of Medicine. Participants scored the highest in "network" and "A.I." and lowest in "interest-knowledge" domains. CONCLUSION It is necessary to define the level of computer skills who start health-based education and shape the curriculum by determining which domains are weak. Creating an educational environment that fosters females' digital knowledge is recommended. Elective courses across faculties may be offered to enable students to progress and discuss various digital literacy topics. The extent to which students benefit from the digital literacy-supported curriculum may be evaluated. Thus, health-based university students are encouraged to acquire the computer skills required by today's clinical settings. REGISTRATION This study was approved by Acıbadem University and Acıbadem Healthcare Institutions Medical Research Ethics Committee (ATADEK) (11 November 2022, ATADEK registration: 2022-17-138) All methods were carried out in accordance with relevant guidelines and regulations. Informed consent was obtained from the participants.
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Affiliation(s)
| | - Arda Mavi
- Acibadem University School of Medicine, Istanbul, Türkiye
| | - Ece Kütükçü
- Faculty of Engineering and Natural Sciences, Acibadem University, Istanbul, Türkiye
| | - Elçim Elgün Kırımlı
- Faculty of Engineering and Natural Sciences, Acibadem University, Istanbul, Türkiye
| | - Deniz Alış
- Department of Radiology, Acibadem University School of Medicine, Istanbul, Türkiye
| | - Ata Akın
- Faculty of Engineering and Natural Sciences, Acibadem University, Istanbul, Türkiye
| | - Levent Altıntaş
- Department of Basic Sciences, Acibadem University School of Medicine, Istanbul, Türkiye.
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Bharati R, Kovach KA. Incorporating Lifestyle Medicine Into Primary Care Practice: Perceptions and Practices of Family Physicians. Am J Lifestyle Med 2023; 17:704-716. [PMID: 37711349 PMCID: PMC10498979 DOI: 10.1177/15598276211072506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Introduction: Lifestyle medicine (LM) uses therapeutic lifestyle behavior change to address the root causes of chronic diseases. The purpose of this study was to assess family physicians' perceptions and utilization of LM principles in their primary care practices, as well as identify reported barriers to implementation. Methods: A survey was administered to 5770 family physicians registered with the American Academy of Family Physicians (AAFP). The survey questions assessed the gap between perception and practice of LM core competencies and the 6 domains of LM. Results: The responses from 447 family physicians were included in the study. Respondents' perceived importance and reported practice was higher for clinical skills compared to the community partnerships and advocacy. There was a substantial gap in the reported comfort with and practice of certain LM domains, such as sleep (47%) and relationships (39.4%). However, LM board-certified physicians had a significantly higher frequency of practice in these domains. The majority of participants identified both difficulty with changing patient behavior (89%) and having limited time (81%) as major barriers to incorporate LM into their practice. Conclusion: Lifestyle medicine concepts resonate strongly with family physicians although gaps exist surrounding engaging in community partnerships, advocacy, and certain domains of LM. This study assesses family physicians' perceptions and utilization of LM principles in their primary care practices, and identifies reported barriers to implementation.
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Giacomello L, Bordignon S, Salm D, Donatello N, Belmonte LA, Bobinski F, Tourinho Dos Santos CF, Traebert JL, Piovezan AP, Martins DF. RETRACTED: Effects of the application of a food processing-based classification system in obese women: A randomized controlled pilot study. Nutr Health 2023:2601060231153947. [PMID: 36751033 DOI: 10.1177/02601060231153947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Leandro Giacomello
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina at Palhoça, Palhoca, Santa Catarina, Brazil
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina at Palhoça, Palhoca, Brazil
| | - Silvana Bordignon
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina at Palhoça, Palhoca, Santa Catarina, Brazil
| | - Daiana Salm
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina at Palhoça, Palhoca, Santa Catarina, Brazil
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina at Palhoça, Palhoca, Brazil
| | - Nathalia Donatello
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina at Palhoça, Palhoca, Santa Catarina, Brazil
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina at Palhoça, Palhoca, Brazil
| | - Luiz Augusto Belmonte
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina at Palhoça, Palhoca, Santa Catarina, Brazil
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina at Palhoça, Palhoca, Brazil
| | - Franciane Bobinski
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina at Palhoça, Palhoca, Santa Catarina, Brazil
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina at Palhoça, Palhoca, Brazil
| | | | - Jefferson Luiz Traebert
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina at Palhoça, Palhoca, Brazil
- School of Medicine, University of Southern Santa Catarina at Palhoça, Palhoca, Santa Catarina, Brazil
| | - Anna Paula Piovezan
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina at Palhoça, Palhoca, Santa Catarina, Brazil
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina at Palhoça, Palhoca, Brazil
- School of Medicine, University of Southern Santa Catarina at Palhoça, Palhoca, Santa Catarina, Brazil
- School of Pharmacy, University of Southern Santa Catarina at Palhoça, Palhoca, Santa Catarina, Brazil
| | - Daniel Fernandes Martins
- Experimental Neuroscience Laboratory (LaNEx), University of Southern Santa Catarina at Palhoça, Palhoca, Santa Catarina, Brazil
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina at Palhoça, Palhoca, Brazil
- School of Medicine, University of Southern Santa Catarina at Palhoça, Palhoca, Santa Catarina, Brazil
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Pritchard EK, Kim HC, Nguyen N, van Vreden C, Xia T, Iles R. The effect of weight loss interventions in truck drivers: Systematic review. PLoS One 2022; 17:e0262893. [PMID: 35196317 PMCID: PMC8865692 DOI: 10.1371/journal.pone.0262893] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/09/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Truck driving is the most common vocation among males internationally with a high proportion overweight/obese due to a combination of work and lifestyle factors leading to health complications. With limited studies in this area, this systematic review aimed to identify and describe interventions addressing weight reduction in truck drivers. Methods Five electronic databases were searched, January 2000 to June 2020 (CINAHL, Cochrane Library, Embase, Ovid MEDLINE, Scopus). Inclusion criteria: experimental primary studies, long-distance (≥500 kms) truck drivers, peer reviewed publications in English. Weight loss interventions included physical activity, diet, behavioral therapy, or health promotion/education programs. Exclusions: non-interventional studies, medications or surgical interventions. Two independent researchers completed screening, risk of bias (RoB) and data extraction with discrepancies managed by a third. Study descriptors, intervention details and outcomes were extracted. Results Seven studies (two RCTs, five non-RCTs,) from three countries were included. Six provided either counselling/coaching or motivational interviewing in combination with other components e.g. written resources, online training, provision of exercise equipment. Four studies demonstrated significant effects with a combined approach, however, three had small sample sizes (<29). The effect sizes for 5/7 studies were medium to large size (5/7 studies), indicating likely clinical significance. RoB assessment revealed some concerns (RCTs), and for non-RCTs; one moderate, two serious and two with critical concerns. Based on the small number of RCTs and the biases they contain, the overall level of evidence in this topic is weak. Conclusion Interventions that include a combination of coaching and other resources may provide successful weight reduction for truck drivers and holds clinical significance in guiding the development of future interventions in this industry. However, additional trials across varied contexts with larger sample populations are needed.
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Affiliation(s)
- Elizabeth K. Pritchard
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- * E-mail:
| | - Hyunjin Christina Kim
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nicola Nguyen
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Caryn van Vreden
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ting Xia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ross Iles
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Jennings C, Patterson E, Curtis RG, Mazzacano A, Maher CA. Effectiveness of a Lifestyle Modification Program Delivered under Real-World Conditions in a Rural Setting. Nutrients 2021; 13:nu13114040. [PMID: 34836296 PMCID: PMC8620632 DOI: 10.3390/nu13114040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/13/2022] Open
Abstract
Whilst there is considerable evidence to support the efficacy of physical activity and dietary interventions in disease and death prevention, translation of knowledge into practice remains inadequate. We aimed to examine the uptake, retention, acceptability and effectiveness on physical activity, physical function, sitting time, diet and health outcomes of a Healthy Eating Activity and Lifestyle program (HEALTM) delivered under real-world conditions. The program was delivered to 430 adults living across rural South Australia. Participants of the program attended weekly 2 h healthy lifestyle education and exercise group-based sessions for 8 weeks. A total of 47 programs were delivered in over 15 communities. In total, 548 referrals were received, resulting in 430 participants receiving the intervention (78% uptake). At baseline, 74.6% of participants were female, the mean age of participants was 53.7 years and 11.1% of participants identified as Aboriginal and/or Torres Strait Islander. Follow-up assessments were obtained for 265 participants. Significant improvements were observed for walking, planned physical activity, incidental physical activity, total physical activity, 30 s chair stand, 30 s arm curl, 6 min walk, fruit consumption and vegetable consumption, sitting time and diastolic blood pressure. Positive satisfaction and favourable feedback were reported. The healthy lifestyle program achieved excellent real-world uptake and effectiveness, reasonable intervention attendance and strong program acceptability amongst rural and vulnerable communities.
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Affiliation(s)
- Cally Jennings
- Sonder, Edinburgh North, SA 5113, Australia; (E.P.); (A.M.)
- Correspondence:
| | | | - Rachel G. Curtis
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia; (R.G.C.); (C.A.M.)
| | - Anna Mazzacano
- Sonder, Edinburgh North, SA 5113, Australia; (E.P.); (A.M.)
| | - Carol A. Maher
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia; (R.G.C.); (C.A.M.)
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Sawyer AT, McManus K. Understanding patient experiences in a motivational interviewing intervention to improve whole-person lifestyle among individuals with hypertension or type 2 diabetes: a qualitative focus group study. Int J Qual Stud Health Well-being 2021; 16:1978373. [PMID: 34547985 PMCID: PMC8462931 DOI: 10.1080/17482631.2021.1978373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose This qualitative focus group study aimed to determine how participants responded to a motivational interviewing intervention and to further explore how it impacted whole-person lifestyle of participants with hypertension or type 2 diabetes. Methods Twenty participants attended one of five focus groups. A trained researcher led the one-hour focus groups using a semi-structured question guide. Responses were coded using thematic analysis and were then aggregated into six themes. Results The following six themes emerged most consistently: (1) the importance of a coach who can connect meaningfully with participants; (2) appreciation of the whole-person approach; (3) the power of “choice” in making health behaviour changes; (4) the effectiveness of goal setting and accountability; (5) the desire for increased contact and follow-up; (6) overall positive experience with mixed clinical results. Conclusion Focus group themes highlighted that this intervention may empower individuals to feel confident in their choices and attain their goals during their health and wellness journey.
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Affiliation(s)
| | - Kim McManus
- AdventHealth, Research Institute, Orlando, FL, USA
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Findley PA. Health and nutrition: Social work's role. SOCIAL WORK IN HEALTH CARE 2020; 59:513-524. [PMID: 32787738 DOI: 10.1080/00981389.2020.1804035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/06/2020] [Accepted: 07/28/2020] [Indexed: 06/11/2023]
Abstract
Poor dietary choices can lead to chronic physical illnesses and mental health issues. Nutrition and mental health have gained more attention recently, with a greater focus on complex nutrition at the biological level. Social workers have not traditionally taken an active role in direct discussion of nutrition with clients, but with the need for translation of complicated nutrition information, social workers should gain a broader understanding of nutrition for assessment and intervention.
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Affiliation(s)
- Patricia A Findley
- School of Social Work, Rutgers University , New Brunswick, New Jersey, USA
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Masia TA, Mushaphi LF, Mabapa NS, Mbhenyane XG. Nutrition knowledge and care practices of home-based caregivers in Vhembe District, South Africa. Afr Health Sci 2020; 20:912-922. [PMID: 33163059 PMCID: PMC7609106 DOI: 10.4314/ahs.v20i2.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Home-based care is provided to clients in their homes to promote and maintain good health, hygiene and nutrition. OBJECTIVE This study assessed nutrition knowledge and care practices of home-based caregivers in Vhembe District, South Africa. METHODS The design was cross sectional, descriptive and exploratory using quantitative and qualitative approaches. Multistage sampling was used, with convenient selection of two municipalities from four, eight home-based care agencies randomly selected from 96 agencies, 128 caregivers conveniently selected for interviews, 92 caregivers selected for focus group discussions and 28 caregivers selected for observation during home visits. Demographic characteristics, nutrition knowledge and care practices were evaluated using questionnaires, interview guides and observational checklists. Data were analysed using SPSS 22 and thematic analysis for qualitative data. RESULTS caregivers (99.2%) were women, 68.7% had secondary education and all had received 59-day training and 64.1% had six to ten years of home-based care experience. Only 0.8% had adequate nutrition knowledge, 45.3% satisfactory knowledge and 53.9% limited to no knowledge. Most care practices reported during the focus group discussions were not observed during home visits. CONCLUSION Nutrition knowledge and care practices of HBC in Vhembe District were found to be inadequate. The nutrition content in the training package should be improved.
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Affiliation(s)
- Tirhani A Masia
- University of Venda, School of Health Sciences, Department of Nutrition, P/bag X5050, Thohoyandou, 0950, South Africa; Tel: 015 962 8906, ; ;
| | - Lindelani F Mushaphi
- University of Venda, School of Health Sciences, Department of Nutrition, P/bag X5050, Thohoyandou, 0950, South Africa; Tel: 015 962 8906, ; ;
| | - Ngoako S Mabapa
- University of Venda, School of Health Sciences, Department of Nutrition, P/bag X5050, Thohoyandou, 0950, South Africa; Tel: 015 962 8906, ; ;
| | - Xikombiso G Mbhenyane
- Stellenbosch University, Faculty of Medicine and Health Science, Division of Human Nutrition, P.O.Box 241, Cape Town, 8000, South Africa; , Tel: 021 938 9135
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Sawyer AT, Wheeler J, Jennelle P, Pepe J, Robinson PS. A Randomized Controlled Trial of a Motivational Interviewing Intervention to Improve Whole-Person Lifestyle. J Prim Care Community Health 2020; 11:2150132720922714. [PMID: 32449452 PMCID: PMC7249599 DOI: 10.1177/2150132720922714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The purpose of this randomized controlled trial was to examine the effects of a
motivational interviewing intervention to improve whole-person lifestyle and
reduce cardiovascular disease risk profile. A sample of 111 adults with type 2
diabetes and/or hypertension was recruited from a primary care physician
practice. The intervention was facilitated by a program specialist trained in
motivational interviewing. Outcomes included body mass index, cholesterol,
hemoglobin A1c, blood pressure, waist circumference, wellness scores, and
substance use. Differences in the changes in body mass index and waist
circumference existed between the intervention and control groups after 6
months. In the intervention group, the proportion of high wellness scores
increased after the program. A whole-person lifestyle intervention with
motivational interviewing for patients with metabolic syndrome can improve one’s
health in terms of components in the cardiovascular disease risk profile, as
well as overall wellness. Efforts to improve the health of these patients may
incorporate motivational interviewing to guide goal setting and address mental
and spiritual health in addition to physical health.
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Gadenz SD, Harzheim E, Amaral HG, Drehmer M. Development and Assessment of a Mobile Nutritional Counseling Tool for Primary Care Physicians. Telemed J E Health 2019; 26:805-811. [PMID: 31556810 DOI: 10.1089/tmj.2019.0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Hypertension remains widely undetected, undertreated, and poorly controlled. Appropriate dietary changes can prevent and treat hypertension effectively. Primary care physicians (PCPs) have the opportunity to counsel patients about their diets and are able to facilitate long-term adherence to changes. However, they encounter several barriers to delivery of evidence-based counseling in daily medical practice. m-Health can make important contributions. Objective: To describe the development and assessment of a Brazilian mobile app for nutritional management of hypertension supported by evidence-based. Materials and Methods: App development used a user-centered approach that seeks to solve problems in a collective and collaborative way. The app was developed in Apache Cordova® (Adobe Systems, San Jose, CA) for iOS and Android mobile phone platforms. Beta testing was performed with a sample of Brazilian PCPs (n = 62), who were asked to use the app in routine practice and evaluate it. Results: The process involved researchers, government, PCPs, nutritionists, and designers. Dieta Dash® (Universidade Federal do Rio Grande do Sul-UFRGS, Porto Alegre, Brazil) app was divided into following sections: meal evaluation, Healthy meals, Healthy choices, and a database of Healthy recipes. The mean perceived usefulness and ease-of-use scores were 23.3 and 32.3 out of 42, respectively. Conclusions: It is a great source of up-to-date and summary guidelines, usable, acceptable, and positively impact clinical care. PCPs have identified improvements that could make the user experience better. The Dieta Dash app can be incorporated into Brazilian primary care practice.
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Affiliation(s)
- Sabrina Dalbosco Gadenz
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Telehealth Program, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Erno Harzheim
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Telehealth Program, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Herberth Giuliano Amaral
- Telehealth Program, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Postgraduate Program in Computational Modelling and Systems, Montes Claros State University, Montes Claros, Brazil
| | - Michele Drehmer
- Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Department of Nutrition, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Aldubayan K, Aljuraiban G, Aldisi D. Necessary Knowledge and Skills for Dietitians in Saudi Arabia: A Qualitative Study. Malays J Med Sci 2019; 26:110-118. [PMID: 31303855 PMCID: PMC6613473 DOI: 10.21315/mjms2019.26.3.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/03/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Dietitians play a major role in health promotion and chronic diseases prevention. Graduates from clinical nutrition and dietetics major should be equipped with the necessary knowledge and skills for their role to be more effective. The purpose of this study is to investigate the knowledge and skills needed by current and future graduates in clinical nutrition and dietetics. METHODS In this qualitative study, structured interviews by focus groups were conducted. Dietitians from different governmental and private sectors were invited to participate in the study. Focus groups were stratified based on the participants' gender and years of experience to promote self-disclosure. Abridged transcript of relevant and useful points was performed. The transcripts were coded and cross-validated by two researchers. RESULTS A total of four focus groups were conducted. Two focus groups comprise 9 male participants and the other two comprise 10 females. The age of participants ranged 25-40 years old. Participants were employees in Riyadh city with experience that ranged 3-10 years old. Nine themes of the necessary knowledge and skills were identified. CONCLUSION It is recommended for the Saudi government to create standards specialised for clinical nutrition and dietetics undergraduate and graduate programmes.
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Affiliation(s)
- Khalid Aldubayan
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, Kingdom of Saudi Arabia
| | - Ghadeer Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, Kingdom of Saudi Arabia
| | - Dara Aldisi
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, Kingdom of Saudi Arabia
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The Effects of Dietary Mobile Apps on Nutritional Outcomes in Adults with Chronic Diseases: A Systematic Review and Meta-Analysis. J Acad Nutr Diet 2019; 119:626-651. [DOI: 10.1016/j.jand.2018.11.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 11/12/2018] [Indexed: 01/19/2023]
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Baron R, Martin L, Gitsels-van der Wal JT, Noordman J, Heymans MW, Spelten ER, Brug J, Hutton EK. Health behaviour information provided to clients during midwife-led prenatal booking visits: Findings from video analyses. Midwifery 2017; 54:7-17. [PMID: 28780476 DOI: 10.1016/j.midw.2017.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/09/2017] [Accepted: 07/09/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE to quantify to what extent evidence-based health behaviour topics relevant for pregnancy are discussed with clients during midwife-led prenatal booking visits and to assess the association of client characteristics with the extent of information provided. DESIGN quantitative video analyses. SETTING AND PARTICIPANTS 173 video recordings of prenatal booking visits with primary care midwives and clients in the Netherlands taking place between August 2010 and April 2011. MEASUREMENTS thirteen topics regarding toxic substances, nutrition, maternal weight, supplements, and health promoting activities were categorized as either 'never mentioned', 'briefly mentioned', 'basically explained' or 'extensively explained'. Rates on the extent of information provided were calculated for each topic and relationships between client characteristics and dichotomous outcomes of the extent of information provided were assessed using Generalized Linear Mixed Modelling. FINDINGS our findings showed that women who did not take folic acid supplementation, who smoked, or had a partner who smoked, were usually provided basic and occasionally extensive explanations about these topics. The majority of clients were provided with no information on recommended weight gain (91.9%), fish promotion (90.8%), caffeine limitation (89.6%), vitamin D supplementation (87.3%), physical activity promotion (81.5%) and antenatal class attendance (75.7%) and only brief mention of alcohol (91.3%), smoking (81.5%), folic acid (58.4) and weight at the start of pregnancy (52.0%). The importance of a nutritious diet was generally either never mentioned (38.2%) or briefly mentioned (45.1%). Nulliparous women were typically given more information on most topics than multiparous women. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE although additional information was generally provided about folic acid and smoking, when relevant for their clients, the majority of women were provided with little or no information about the other health behaviours examined in this study. Midwives may be able to improve prenatal health promotion by providing more extensive health behaviour information to their clients during booking visits.
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Affiliation(s)
- Ruth Baron
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG), Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Linda Martin
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG), Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Janneke T Gitsels-van der Wal
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG), Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Janneke Noordman
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN Utrecht, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands; Department of Methodology and Applied Biostatistics, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Evelien R Spelten
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG), Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands; Department of Public Health, Rural Health School, La Trobe University, Melbourne, VIC 3086, Australia
| | - Johannes Brug
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Eileen K Hutton
- Department of Midwifery Science, Midwifery Academy Amsterdam Groningen (AVAG), Amsterdam Public Health Research Institute, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands; Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, MDCL 2210, Hamilton, ON, Canada L8S 4K1
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Harden SM, Ramalingam NS, Wilson KE, Evans-Hoeker E. Informing the development and uptake of a weight management intervention for preconception: a mixed-methods investigation of patient and provider perceptions. BMC OBESITY 2017; 4:8. [PMID: 28191322 PMCID: PMC5295190 DOI: 10.1186/s40608-017-0144-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/27/2017] [Indexed: 11/19/2022]
Abstract
Background It is recommended for women to have a healthy body mass index before conception. However, there is limited research on appropriate preconception interventions for weight loss. Furthermore, there is a lack of knowledge on providers’ willingness to refer to particular behavioral interventions and the degree to which patients would attend those interventions. Methods A cross-section of 67 patients and 21 providers completed surveys related to their demographics and willingness to refer/attend a number of interventions for weight loss. A case study of three patients from the target audience was used to elicit detailed feedback on preconception weight status and weight loss intervention. Results Overall, patients were willing to attend a variety of interventions, regardless of BMI category. Focus group participants shared that weight loss prior to conception would be beneficial for them and their child, but cited barriers such as time, location, and the way providers encourage weight loss. Providers were willing to refer to a number of behavioral interventions, and were less willing to prescribe weight loss medications than other intervention options. Conclusions A number of intervention strategies may be well received by both patients and providers in preconception care to assist with weight loss prior to conception. Future research is needed on intervention effects and sustainability. Electronic supplementary material The online version of this article (doi:10.1186/s40608-017-0144-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samantha M Harden
- Department of Human Nutrition, Virginia Tech Foods, and Exercise, 1981 Kraft Dr, Blacksburg, VA USA.,Department of OBGYN, Virginia Tech Carilion School of Medicine, 1231 S. Jefferson St, Roanoke, VA 24013 USA
| | - NithyaPriya S Ramalingam
- Virginia Tech Translational Biology, Medicine, and Health Program, 1981 Kraft Dr, Blacksburg, VA USA
| | - Kathryn E Wilson
- Department of Human Nutrition, Virginia Tech Foods, and Exercise, 1981 Kraft Dr, Blacksburg, VA USA
| | - Emily Evans-Hoeker
- Department of OBGYN, Virginia Tech Carilion School of Medicine, 1231 S. Jefferson St, Roanoke, VA 24013 USA
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Ashton LM, Morgan PJ, Hutchesson MJ, Rollo ME, Collins CE. Feasibility and preliminary efficacy of the 'HEYMAN' healthy lifestyle program for young men: a pilot randomised controlled trial. Nutr J 2017; 16:2. [PMID: 28086890 PMCID: PMC5237246 DOI: 10.1186/s12937-017-0227-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 01/03/2017] [Indexed: 01/07/2023] Open
Abstract
Background In young men, unhealthy lifestyle behaviours can be detrimental to their physical and/or mental health and set them on a negative health trajectory into adulthood. Despite this, there is a lack of evidence to guide development of effective health behaviour change interventions for young men. This study assessed the feasibility and preliminary efficacy of the ‘HEYMAN’ (Harnessing Ehealth to enhance Young men’s Mental health, Activity and Nutrition) healthy lifestyle program for young men. Methods A pilot RCT with 50 young men aged 18–25 years randomised to the HEYMAN intervention (n = 26) or waitlist control (n = 24). HEYMAN was a 3-month intervention, targeted for young men to improve eating habits, activity levels and well-being. Intervention development was informed by a participatory research model (PRECEDE-PROCEED). Intervention components included eHealth support (website, wearable device, Facebook support group), face-to-face sessions (group and individual), a personalised food and nutrient report, home-based resistance training equipment and a portion control tool. Outcomes included: feasibility of research procedures (recruitment, randomisation, data collection and retention) and of intervention components. Generalized linear mixed models estimated the treatment effect at 3-months for the primary outcomes: pedometer steps/day, diet quality, well-being and several secondary outcomes. Results A 7-week recruitment period was required to enrol 50 young men. A retention rate of 94% was achieved at 3-months post-intervention. Retained intervention participants (n = 24) demonstrated reasonable usage levels for most program components and also reported reasonable levels of program component acceptability for attractiveness, comprehension, usability, support, satisfaction and ability to persuade, with scores ranging from 3.0 to 4.6 (maximum 5). No significant intervention effects were observed for the primary outcomes of steps/day (1012.7, 95% CI = −506.2, 2531.6, p = 0.191, d = 0.36), diet quality score (3.6, 95% CI = −0.4, 7.6, p = 0.081, d = 0.48) or total well-being score (0.4, 95% CI = −1.6, 2.5, p = 0.683, d = 0.11). Significant intervention effects were found for daily vegetable servings, energy-dense, nutrient-poor foods, MVPA, weight, BMI, fat mass, waist circumference and cholesterol (all p < 0.05). Conclusions The HEYMAN program demonstrated feasibility in assisting young men to make some positive lifestyle changes. This provides support for the conduct of a larger, fully-powered RCT, but with minor amendments to research procedures and intervention components required. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12616000350426. Electronic supplementary material The online version of this article (doi:10.1186/s12937-017-0227-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lee M Ashton
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Philip J Morgan
- School of Education, Faculty of Education and Arts, Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Melinda J Hutchesson
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Megan E Rollo
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia.
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Morris HL, Dumenci L, Lafata JE. Development and validation of an instrument to measure collaborative goal setting in the care of patients with diabetes. BMJ Open Diabetes Res Care 2017; 5:e000269. [PMID: 28316793 PMCID: PMC5337731 DOI: 10.1136/bmjdrc-2016-000269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/06/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Despite known benefits of patient-perceived collaborative goal setting, we have a limited ability to monitor this process in practice. We developed the Patient Measure of Collaborative Goal Setting (PM-CGS) to evaluate the use of collaborative goal setting from the patient's perspective. RESEARCH DESIGN AND METHODS A random sample of 400 patients aged 40 years or older, receiving diabetes care from the Virginia Commonwealth University Health System between 8/2012 and 8/2013, were mailed a survey containing potential PM-CGS items (n=44) as well as measures of patient demographics, perceived self-management competence, trust in their physician, and self-management behaviors. Confirmatory factor analysis was used to evaluate construct validity. External validity was evaluated via a structural equation model (SEM) that tested the association of the PM-CGS with self-management behaviors. The direct and two mediated (via trust and self-efficacy) pathways were tested. RESULTS A total of 259 patients responded to the survey (64% response rate), of which 192 were eligible for inclusion. Results from the factor analysis supported a 37-item measure of patient-perceived CGS spanning five domains: listen and learn; share ideas; caring relationship; measurable objective; and goal achievement support (χ=4366.13, p<0.001; RMSEA=0.08). Results from the SEM supported the external validity of the PM-CGS. The relationship between CGS and self-management was partially mediated by perceived competence (p<0.05). The direct effect between the PM-CGS and self-management was significant (p<0.001). CONCLUSIONS CGS can be validly measured by the 37-item PM-CGS. Use of the PM-CGS can help illustrate actionable deficits in goal-setting discussions.
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Affiliation(s)
- Heather L Morris
- Department of Health Outcomes and Policy, University of Florida, Gainesville, Florida, USA
| | - Levent Dumenci
- Virginia Commonwealth University, Richmond, Virginia, USA
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Gretebeck KA, Bailey T, Gretebeck RJ. A Minimal Contact Diet and Physical Activity Intervention for White-Collar Workers. Workplace Health Saf 2016; 65:417-423. [PMID: 27913809 DOI: 10.1177/2165079916674483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Minimal contact lifestyle interventions with multiple components coupled with health screening have the potential to improve worker health. The purpose of this study was to test a minimal contact multiple component lifestyle diet and exercise intervention. The multiple components that were included in this project included a worksite health screening, brief counseling session, emailed newsletter, and a pedometer. In response to the intervention, participants reported an increase in green salad, fruit, and vegetable consumption as well as an increase in self-efficacy for consuming three servings of fruits and vegetables a day. Study participants also demonstrated a significant increase in physical activity as shown by their responses to the question, "During leisure time I walk." A minimal contact multiple component worksite health promotion program with relatively high feasibility and low cost can improve workers' health-related behaviors, and participants can become more aware of their health.
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Quidde J, von Grundherr J, Koch B, Bokemeyer C, Escherich G, Valentini L, Buchholz D, Schilling G, Stein A. Improved nutrition in adolescents and young adults after childhood cancer - INAYA study. BMC Cancer 2016; 16:872. [PMID: 27825320 PMCID: PMC5101649 DOI: 10.1186/s12885-016-2896-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/26/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Multimodality treatment improves the chance of survival but increases the risk for long-term side effects in young cancer survivors, so-called" Adolescents and Young Adults"(AYAs). Compared to the general population AYAs have a 5 to 15-fold increased risk of cardiovascular morbidity. Thus, improving modifiable lifestyle risk factors is of particular importance. METHODS The INAYA trial included AYAs between 18 and 39 years receiving an intensified individual nutrition counseling at four time points in a 3-month period based on a 3-day dietary record. At week 0 and 12 AYAs got a face-to-face counseling, at week 2 and 6 by telephone. Primary endpoint was change in nutritional behavior measured by Healthy Eating Index - European Prospective Investigation into Cancer and Nutrition (HEI-EPIC). RESULTS Twenty-three AYAs (11 female, 12 male, median age 20 years (range 19-23 years), median BMI: 21.4 kg/m2 (range: 19.7-23.9 kg/m2) after completion of cancer treatment for sarcoma (n = 2), carcinoma (n = 2), blastoma (n = 1), hodgkin lymphoma (n = 12), or leukemia (n = 6) were included (median time between diagnosis and study inclusion was 44 month). The primary endpoint was met, with an improvement of 20 points in HEI-EPIC score in 52.2 % (n = 12) of AYAs. At baseline, median HEI-EPIC score was 47.0 points (range from 40.0 to 55.0 points) and a good, moderate and bad nutritional intake was seen in 4.3, 73.9 and 21.7 % of AYAs. At week 12, median HEI-EPIC improved significantly to 65.0 points (range from 55.0 to 76.0 points) (p ≤ 0.001) and a good, moderate and bad nutritional intake was seen in 47.8, 52.2 and 0 % of AYAs. No change was seen in quality of life, waist-hip ratio and blood pressure. CONCLUSION Intensified nutrition counseling is feasible and seem to improve nutritional behavior of AYAs. Further studies will be required to demonstrate long-term sustainability and confirm the results in a randomized design in larger cohorts. TRIAL REGISTRATION Clinical trial identifier DRKS00009883 on DRKS.
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Affiliation(s)
- J Quidde
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumour Center - University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - J von Grundherr
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumour Center - University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - B Koch
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumour Center - University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - C Bokemeyer
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumour Center - University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - G Escherich
- Department of Paediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - L Valentini
- Hochschule Neubrandenburg - University of Applied Sciences, Fachbereich Agrarwirtschaft und Lebensmittelwissenschaften, Brodaer Straße 2, 17033, Neubrandenburg, Germany
| | - D Buchholz
- Hochschule Neubrandenburg - University of Applied Sciences, Fachbereich Agrarwirtschaft und Lebensmittelwissenschaften, Brodaer Straße 2, 17033, Neubrandenburg, Germany
| | - G Schilling
- Hamburger Krebsgesellschaft e.V., Butenfeld 18, 22529, Hamburg, Germany
| | - A Stein
- Department of Oncology, Hematology, BMT with Section Pneumology, Hubertus Wald Tumour Center - University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Curtis SM, Willis MS. "Are you eating healthy?" Nutrition discourse in Midwestern clinics for the underserved. PATIENT EDUCATION AND COUNSELING 2016; 99:1641-1646. [PMID: 27133919 DOI: 10.1016/j.pec.2016.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 04/01/2016] [Accepted: 04/17/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate nutrition information provided and exchanged between patients and health providers in Midwestern clinics for underserved populations. METHODS Forty-six clinic visits were observed to determine content and direction of nutrition information. In-depth data were collected with clinicians and clinic administrators regarding nutrition education provided to patients. RESULTS All patients were diagnosed with multiple obesity-related morbidities. Although women more often posed nutrition questions, few patients asked about dietary intake. Two-thirds of healthcare professionals initiated discussion about dietary intake; however, nutrition education was not provided regardless of clinician's profession. CONCLUSIONS Patients did not appear to link morbidity with diet. Providers did not share comprehensive nutrition knowledge during clinic visits. Dietitians, who specialize in nutrition education, rarely had access to patients. IMPLICATIONS Nutrition education during clinic visits is essential for reducing obesity rates. Nutrition students need clinic experience and could provide important patient education at low cost.
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Hoffman AJ. The Impact of Physical Activity for Cancer Prevention: Implications for Nurses. Semin Oncol Nurs 2016; 32:255-72. [PMID: 27539280 DOI: 10.1016/j.soncn.2016.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To discuss the significant issues surrounding the prescribing of physical activity as a first line of defense against the development of age-associated life-limiting illnesses such as cancer while providing strategic knowledge for clinicians regarding its prescription and management. DATA SOURCES Literature review on physical activity in cancer prevention. CONCLUSION There is growing evidence that reduced physical activity increases the risk of co-morbid conditions such as cancer, yet there is limited clinician education and subsequent prescription of physical activity. IMPLICATIONS FOR NURSING PRACTICE Nurses in partnership with other primary care clinicians have a unique opportunity to effect change of our nation's greatest modifiable public health threat, physical inactivity.
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Murphy KM, Mash R, Malan Z. The case for behavioural change counselling for the prevention of NCDs and improvement of self-management of chronic conditions. S Afr Fam Pract (2004) 2016. [DOI: 10.1080/20786190.2016.1187885] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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van der Pligt P, Olander EK, Ball K, Crawford D, Hesketh KD, Teychenne M, Campbell K. Maternal dietary intake and physical activity habits during the postpartum period: associations with clinician advice in a sample of Australian first time mothers. BMC Pregnancy Childbirth 2016; 16:27. [PMID: 26831724 PMCID: PMC4736124 DOI: 10.1186/s12884-016-0812-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 01/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous health benefits are associated with achieving optimal diet and physical activity behaviours during and after pregnancy. Understanding predictors of these behaviours is an important public health consideration, yet little is known regarding associations between clinician advice and diet and physical activity behaviours in postpartum women. The aims of this study were to compare the frequency of dietary and physical activity advice provided by clinicians during and after pregnancy and assess if this advice is associated with postpartum diet and physical activity behaviours. METHODS First time mothers (n = 448) enrolled in the Melbourne InFANT Extend trial completed the Cancer Council of Australia's Food Frequency Questionnaire when they were three to four months postpartum, which assessed usual fruit and vegetable intake (serves/day). Total physical activity time, time spent walking and time in both moderate and vigorous activity for the previous week (min/week) were assessed using the Active Australia Survey. Advice received during and following pregnancy were assessed by separate survey items, which asked whether a healthcare practitioner had discussed eating a healthy diet and being physically active. Linear and logistic regression assessed associations of advice with dietary intake and physical activity. RESULTS In total, 8.6% of women met guidelines for combined fruit and vegetable intake. Overall, mean total physical activity time was 350.9 ± 281.1 min/week. Time spent walking (251.97 ± 196.78 min/week), was greater than time spent in moderate (36.68 ± 88.58 min/week) or vigorous activity (61.74 ± 109.96 min/week) and 63.2% of women were meeting physical activity recommendations. The majority of women reported they received advice regarding healthy eating (87.1%) and physical activity (82.8%) during pregnancy. Fewer women reported receiving healthy eating (47.5%) and physical activity (51.9%) advice by three months postpartum. There was no significant association found between provision of dietary and/or physical activity advice, and mother's dietary intakes or physical activity levels. CONCLUSIONS Healthy diet and physical activity advice was received less after pregnancy than during pregnancy yet no association between receipt of advice and behaviour was observed. More intensive approaches than provision of advice may be required to promote healthy diet and physical activity behaviours in new mothers. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ( ACTRN12611000386932 13/04/2011).
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Affiliation(s)
- Paige van der Pligt
- />Centre for Physical activity and Nutrition Research (C-PAN), Deakin University, Burwood Campus, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Ellinor K Olander
- />Centre for Maternal and Child Health Research, City University London, London, UK
| | - Kylie Ball
- />Centre for Physical activity and Nutrition Research (C-PAN), Deakin University, Burwood Campus, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - David Crawford
- />Centre for Physical activity and Nutrition Research (C-PAN), Deakin University, Burwood Campus, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Kylie D Hesketh
- />Centre for Physical activity and Nutrition Research (C-PAN), Deakin University, Burwood Campus, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Megan Teychenne
- />Centre for Physical activity and Nutrition Research (C-PAN), Deakin University, Burwood Campus, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Karen Campbell
- />Centre for Physical activity and Nutrition Research (C-PAN), Deakin University, Burwood Campus, 221 Burwood Highway, Burwood, VIC 3125 Australia
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Forsyth A, Deane FP, Williams P. A lifestyle intervention for primary care patients with depression and anxiety: A randomised controlled trial. Psychiatry Res 2015; 230:537-44. [PMID: 26453120 DOI: 10.1016/j.psychres.2015.10.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 08/10/2015] [Accepted: 10/01/2015] [Indexed: 11/28/2022]
Abstract
This study aimed to evaluate the efficacy of a diet and exercise lifestyle intervention on mental health outcomes for patients currently being treated for depression and/or anxiety in primary care. Patients (n=119) referred by general practitioners to the 12-week randomised controlled trial were assigned to either an intervention of six visits to a dual qualified dietitian/exercise physiologist (DEP) where motivational interviewing and activity scheduling were used to engage patients in individually-tailored lifestyle change (focussed on diet and physical activity), or an attention control with scheduled telephone contact. Assessments conducted at baseline (n=94) and 12 weeks (n=60) were analysed with an intent-to-treat approach using linear mixed modelling. Significant improvement was found for both groups on Depression, Anxiety and Stress Scale (DASS) scores, measures of nutrient intake and total Australian modified Healthy Eating Index (Aust-HEI) scores. Significant differences between groups over time were found only for iron intake and body mass index. Patients participating in individual consultations with a dietitian were more likely to maintain or improve diet quality than those participating in an attention control. This study provides initial evidence to support the role of dietitians in the management of patients with depression and/or anxiety.
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Affiliation(s)
- Adrienne Forsyth
- School of Health Sciences, University of Wollongong, Wollongong, NSW, Australia.
| | - Frank P Deane
- Illawarra Institute for Mental Health and School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Peter Williams
- School of Health Sciences, University of Wollongong, Wollongong, NSW, Australia
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Ancker JS, Witteman HO, Hafeez B, Provencher T, Van de Graaf M, Wei E. "You Get Reminded You're a Sick Person": Personal Data Tracking and Patients With Multiple Chronic Conditions. J Med Internet Res 2015; 17:e202. [PMID: 26290186 PMCID: PMC4642375 DOI: 10.2196/jmir.4209] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 06/03/2015] [Accepted: 07/24/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Consumer health information technologies (HIT) that encourage self-tracking, such as diet and fitness tracking apps and disease journals, are attracting widespread interest among technology-oriented consumers (such as "quantified self" advocates), entrepreneurs, and the health care industry. Such electronic technologies could potentially benefit the growing population of patients with multiple chronic conditions (MCC). However, MCC is predominantly a condition of the elderly and disproportionately affects the less affluent, so it also seems possible that the barriers to use of consumer HIT would be particularly severe for this patient population. OBJECTIVE Our aim was to explore the perspectives of individuals with MCC using a semistructured interview study. Our research questions were (1) How do individuals with MCC track their own health and medical data? and (2) How do patients and providers perceive and use patient-tracked data? METHODS We used semistructured interviews with patients with multiple chronic diseases and providers with experience caring for such patients, as well as participation in a diabetes education group to triangulate emerging themes. Data were analyzed using grounded theory and thematic analysis. Recruitment and analysis took place iteratively until thematic saturation was reached. RESULTS Interviews were conducted with 22 patients and 7 health care providers. The patients had an average of 3.5 chronic conditions, including type 2 diabetes, heart disease, chronic pain, and depression, and had regular relationships with an average of 5 providers. Four major themes arose from the interviews: (1) tracking this data feels like work for many patients, (2) personal medical data for individuals with chronic conditions are not simply objective facts, but instead provoke strong positive and negative emotions, value judgments, and diverse interpretations, (3) patients track for different purposes, ranging from sense-making to self-management to reporting to the doctor, and (4) patients often notice that physicians trust technologically measured data such as lab reports over patients' self-tracked data. CONCLUSIONS Developers of consumer health information technologies for data tracking (such as diet and exercise apps or blood glucose logs) often assume patients have unlimited enthusiasm for tracking their own health data via technology. However, our findings potentially explain relatively low adoption of consumer HIT, as they suggest that patients with multiple chronic illnesses consider it work to track their own data, that the data can be emotionally charged, and that they may perceive that providers do not welcome it. Similar themes have been found in some individual chronic diseases but appeared more complex because patients often encountered "illness work" connected to multiple diseases simultaneously and frequently faced additional challenges from aging or difficult comorbidities such as chronic pain, depression, and anxiety. We suggest that to make a public health impact, consumer HIT developers should engage creatively with these pragmatic and emotional issues to reach an audience that is broader than technologically sophisticated early adopters. Novel technologies are likely to be successful only if they clearly reduce patient inconvenience and burden, helping them to accomplish their "illness work" more efficiently and effectively.
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Affiliation(s)
- Jessica S Ancker
- Weill Cornell Medical College, Department of Healthcare Policy and Research, Division of Health Informatics, New York, NY, United States.
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Zapata LB, Tregear SJ, Curtis KM, Tiller M, Pazol K, Mautone-Smith N, Gavin LE. Impact of Contraceptive Counseling in Clinical Settings: A Systematic Review. Am J Prev Med 2015; 49:S31-45. [PMID: 26190845 PMCID: PMC4608447 DOI: 10.1016/j.amepre.2015.03.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/23/2015] [Accepted: 03/23/2015] [Indexed: 01/26/2023]
Abstract
CONTEXT This systematic review evaluated the evidence on the impact of contraceptive counseling provided in clinical settings on reproductive health outcomes to provide information to guide national recommendations on quality family planning services. EVIDENCE ACQUISITION Multiple databases were searched during 2010-2011 for peer-reviewed articles published in English from January 1985 through February 2011 describing studies that evaluated contraceptive counseling interventions in clinical settings. Studies were excluded if they focused primarily on prevention of HIV or sexually transmitted infections, focused solely on men, or were conducted outside the U.S., Canada, Europe, Australia, or New Zealand. EVIDENCE SYNTHESIS The initial search identified 12,327 articles, of which 22 studies (from 23 articles) met the inclusion criteria. Six studies examined the impact of contraceptive counseling among adolescents, with four finding a significant positive impact on at least one outcome of interest. Sixteen studies examined the impact of counseling among adults or mixed populations (adults and adolescents), with 11 finding a significant positive impact on at least one outcome of interest. CONCLUSIONS Promising components of contraceptive counseling were identified despite the diversity of interventions and inability to compare the relative effectiveness of one approach versus another. The evidence base would be strengthened by improved documentation of counseling procedures; assessment of intervention implementation and fidelity to put study findings into context; and development and inclusion of more RCTs, studies conducted among general samples of women, and studies with sample sizes sufficient to detect important behavioral outcomes at least 12 months post-intervention.
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Affiliation(s)
| | | | | | | | - Karen Pazol
- Division of Reproductive Health, CDC, Atlanta, Georgia
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Zabaleta-del-Olmo E, Bolibar B, García-Ortíz L, García-Campayo J, Llobera J, Bellón JÁ, Ramos R. Building interventions in primary health care for long-term effectiveness in health promotion and disease prevention. A focus on complex and multi-risk interventions. Prev Med 2015; 76 Suppl:S1-4. [PMID: 25778858 DOI: 10.1016/j.ypmed.2015.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 03/08/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Edurne Zabaleta-del-Olmo
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Gran Via Corts Catalanes 587 àtic, 08007 Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain; Department of Nursing, Universitat de Girona, c/Emili Grahit 77, 17071 Girona, Spain.
| | - Bonaventura Bolibar
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Gran Via Corts Catalanes 587 àtic, 08007 Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Luis García-Ortíz
- Primary Care Research Unit, The Alamedilla Health Center, Salamanca Institute for Biomedical Research (IBSAL), Av. Comuneros 27-31, 37003 Salamanca, Spain; Department of Biomedical Sciences and Diagnostics, University of Salamanca, Miguel de Unamuno Campus, Calle Alfonso X El Sabio s/n, 37007 Salamanca, Spain
| | - Javier García-Campayo
- Department of Psychiatry, Miguel Servet University Hospital, University of Zaragoza, redIAPP, Isabel la Católica 1-3, 50009 Zaragoza, Spain
| | - Joan Llobera
- Research Unit, Primary Care Department of Mallorca, Ib-Salut Balears, IdISPa, Govern de les Illes Balear, C/Reina Esclaramunda 9, 07003 Palma, Spain
| | - Juan Ángel Bellón
- El Palo Health Centre, Avenida Salvador Allende 159, 20018 Málaga, Spain; Research Unit of Málaga Primary Care District, c/Sevilla 23, 3ª planta, 29009 Málaga, Spain; Department of Preventive Medicine and Public Health, University of Málaga, School of Medicine, Campus de Teatinos, 29071 Málaga, Spain; Málaga Biomedical Research Institute (IBIMA), Av. Jorge Luis Borges 15, Bl.3 Pl.3, 29010 Málaga, Spain
| | - Rafel Ramos
- Girona Research Unit, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/Maluquer Salvador 11, 17002 Girona, Spain; Department of Medical Sciences, School of Medicine, University of Girona, c/Emili Grahit, 77, 17071 Girona, Spain
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Maderuelo-Fernandez JA, Recio-Rodríguez JI, Patino-Alonso MC, Pérez-Arechaederra D, Rodriguez-Sanchez E, Gomez-Marcos MA, García-Ortiz L. Effectiveness of interventions applicable to primary health care settings to promote Mediterranean diet or healthy eating adherence in adults: A systematic review. Prev Med 2015; 76 Suppl:S39-55. [PMID: 25524613 DOI: 10.1016/j.ypmed.2014.12.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 11/07/2014] [Accepted: 12/08/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the effects on healthy eating or the Mediterranean diet adherence achieved by interventions suitable for implementation in primary care settings. METHODS Medline (PubMed) and The Cochrane Library bibliographic searches retrieved randomized controlled trials published in English or Spanish, January 1990-January 2013. The inclusion criteria were adult population, >3 months follow-up, and interventions suitable for primary care settings. Exclusion resulted if studies focused exclusively on weight loss or did not analyze food intake (fats, fruits and vegetables--F&V, fiber) or Mediterranean diet adherence. Validity (risk of bias) was independently evaluated by two researchers; discrepancies were reviewed until a consensus was reached. RESULTS Of the 15 included articles (14 studies), only 3 studies surpassed 12-months follow-up. Ten interventions emphasized healthy nutrition (n = 9948); 4 added activity levels (n = 3816). Six trials included participants with cardiovascular risk; 7 were community-based; 1 focused on women with cancer. Eleven studies showed 9.7% to 59.3% increased F&V intake with counseling interventions, compared to baseline (-13.3% to 27.8% in controls). Seven studies reported significant differences between intervention and control groups. CONCLUSION Nutritional counseling moderately improves nutrition, increases intake of fiber, F&V, reduces dietary saturated fats, and increases physical activity. Studies with longer follow-up are needed to determine long-term effects, cardiovascular morbidity, and mortality.
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Affiliation(s)
- José A Maderuelo-Fernandez
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL.
| | - José I Recio-Rodríguez
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL.
| | - Maria C Patino-Alonso
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL; Statistics Department, University of Salamanca, Salamanca, Spain.
| | - Diana Pérez-Arechaederra
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL.
| | - Emiliano Rodriguez-Sanchez
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL; Medicine Department, University of Salamanca, Salamanca, Spain.
| | - Manuel A Gomez-Marcos
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL; Medicine Department, University of Salamanca, Salamanca, Spain.
| | - Luis García-Ortiz
- Primary Care Research Unit, The Alamedilla Health Center, Castilla and León Health Service, SACYL, Salamanca, Spain. REDIAPP. IBSAL; Medicine Department, University of Salamanca, Salamanca, Spain.
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Moldovan-Johnson M, Martinez L, Lewis N, Freres D, Hornik RC. The role of patient-clinician information engagement and information seeking from nonmedical channels in fruit and vegetable intake among cancer patients. JOURNAL OF HEALTH COMMUNICATION 2014; 19:1359-76. [PMID: 24875456 PMCID: PMC4250474 DOI: 10.1080/10810730.2014.906521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Previous research suggests positive effects of health information seeking on prevention behaviors such as diet, exercise, and fruit and vegetable consumption. The present study builds upon this research and strengthens causal claims from it by examining the lagged effect of patient-clinician information engagement on fruit and vegetable consumption as well as the indirect effect on the outcome through seeking information from nonmedical channels. The results are based on data collected from a randomly drawn sample of breast, prostate, and colorectal cancer patients from the Pennsylvania Cancer Registry who completed mail surveys in the Fall of 2006 and 2007. There was a 65% response rate for baseline subjects (resulting n = 2,013); of those, 1,293 were interviewed 1 year later, and 1,257 were available for our analyses. Results show a positive lagged main effect of patient-clinician information engagement at baseline on fruit and vegetable consumption at follow-up (B = 0.26, SE = 0.10, p = .01). The mediation analysis shows that patient-clinician information engagement leads to increased fruit and vegetable consumption among cancer patients, in part through patients' information seeking from nonmedical channels. Implications of these findings for the cancer patient population and for physicians are discussed.
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Wright JA, Quintiliani LM, Turner-McGrievy GM, Migneault JP, Heeren T, Friedman RH. Comparison of two theory-based, fully automated telephone interventions designed to maintain dietary change in healthy adults: study protocol of a three-arm randomized controlled trial. JMIR Res Protoc 2014; 3:e62. [PMID: 25387065 PMCID: PMC4260007 DOI: 10.2196/resprot.3367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 06/13/2014] [Accepted: 07/18/2014] [Indexed: 11/21/2022] Open
Abstract
Background Health behavior change interventions have focused on obtaining short-term intervention effects; few studies have evaluated mid-term and long-term outcomes, and even fewer have evaluated interventions that are designed to maintain and enhance initial intervention effects. Moreover, behavior theory has not been developed for maintenance or applied to maintenance intervention design to the degree that it has for behavior change initiation. Objective The objective of this paper is to describe a study that compared two theory-based interventions (social cognitive theory [SCT] vs goal systems theory [GST]) designed to maintain previously achieved improvements in fruit and vegetable (F&V) consumption. Methods The interventions used tailored, interactive conversations delivered by a fully automated telephony system (Telephone-Linked Care [TLC]) over a 6-month period. TLC maintenance intervention based on SCT used a skills-based approach to build self-efficacy. It assessed confidence in and barriers to eating F&V, provided feedback on how to overcome barriers, plan ahead, and set goals. The TLC maintenance intervention based on GST used a cognitive-based approach. Conversations trained participants in goal management to help them integrate their newly acquired dietary behavior into their hierarchical system of goals. Content included goal facilitation, conflict, shielding, and redundancy, and reflection on personal goals and priorities. To evaluate and compare the two approaches, a sample of adults whose F&V consumption was below public health goal levels were recruited from a large urban area to participate in a fully automated telephony intervention (TLC-EAT) for 3-6 months. Participants who increase their daily intake of F&V by ≥1 serving/day will be eligible for the three-arm randomized controlled trial. A sample of 405 participants will be randomized to one of three arms: (1) an assessment-only control, (2) TLC-SCT, and (3) TLC-GST. The maintenance interventions are 6 months. All 405 participants who qualify for the trial will complete surveys administered by blinded interviewers at baseline (randomization), 6, 12, 18, and 24 months. Results Data analysis is not yet complete, but we hypothesize that (1) TLC-GST > TLC-SCT > control at all follow-up time points for F&V consumption, and (2) intervention effects will be mediated by the theoretical constructs (eg, self-efficacy, goal pursuit, conflict, shielding, and facilitation). Conclusions This study used a novel study design to initiate and then promote the maintenance of dietary behavior change through the use of an evidence-based fully automated telephony intervention. After the first 6 months (the acquisition phase), we will examine whether two telephony interventions built using different underlying behavioral theories were more successful than an assessment-only control group in helping participants maintain their newly acquired health behavior change. Trial Registration Clinicaltrials.gov NCT00148525; http://clinicaltrials.gov/ct2/show/NCT00148525 (Archived by Webcite at http://www.webcitation.org/6TiRriJOs).
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Affiliation(s)
- Julie A Wright
- Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, MA, United States.
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Van den Berg VL, Abera BMM, Nel M, Walsh CM. Nutritional status of undergraduate healthcare students at the University of the Free State. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2013.10874394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- VL Van den Berg
- Department of Nutrition and Dietetics, School of Allied Health Professions, Faculty of Health Sciences, University of the Free State
| | - BMM Abera
- Department of Nutrition and Dietetics, School of Allied Health Professions, Faculty of Health Sciences, University of the Free State
| | - M Nel
- Department of Biostatistics, Faculty of Health Sciences, University of the Free State, Bloemfontein
| | - CM Walsh
- Department of Nutrition and Dietetics, School for Allied Health Professions
- Faculty of Health Sciences, University of the Free State, Bloemfontein
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Levy MD, Loy L, Zatz LY. Policy approach to nutrition and physical activity education in health care professional training. Am J Clin Nutr 2014; 99:1194S-201S. [PMID: 24646822 PMCID: PMC3985221 DOI: 10.3945/ajcn.113.073544] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Nutrition and physical activity are key risk factors for a host of today's most prevalent and costly chronic conditions, such as obesity and diabetes; yet, health care providers are not adequately trained to educate patients on the components of a healthy lifestyle. The purpose of this article is to underscore the need for improved nutrition and physical activity training among health care professionals and to explore opportunities for how policy can help support a shift in training. We first identify key barriers to sufficient training in nutrition and physical activity. Then, we provide an overview of how recent changes in the government and institutional policy environment are supporting a shift toward prevention in our health care system and creating an even greater need for improved training of health care professionals in nutrition and physical activity. Last, we outline recommendations for additional policy changes that could drive enhanced training for health care professionals and recommend future directions in research.
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Affiliation(s)
- Matthew D Levy
- Division of Community Pediatrics, Department of Pediatrics, Medstar Georgetown University Hospital, Washington, DC (MDL), and the Bipartisan Policy Center, Washington, DC (LL and LYZ)
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Lara J, Hobbs N, Moynihan PJ, Meyer TD, Adamson AJ, Errington L, Rochester L, Sniehotta FF, White M, Mathers JC. Effectiveness of dietary interventions among adults of retirement age: a systematic review and meta-analysis of randomized controlled trials. BMC Med 2014; 12:60. [PMID: 24712557 PMCID: PMC4021978 DOI: 10.1186/1741-7015-12-60] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 03/13/2014] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Retirement from work involves significant lifestyle changes and may represent an opportunity to promote healthier eating patterns in later life. However, the effectiveness of dietary interventions during this period has not been evaluated. METHODS We undertook a systematic review of dietary interventions among adults of retirement transition age (54 to 70 years). Twelve electronic databases were searched for randomized controlled trials evaluating the promotion of a healthy dietary pattern, or its constituent food groups, with three or more months of follow-up and reporting intake of specific food groups. Random-effects models were used to determine the pooled effect sizes. Subgroup analysis and meta-regression were used to assess sources of heterogeneity. RESULTS Out of 9,048 publications identified, 68 publications reporting 24 studies fulfilled inclusion criteria. Twenty-two studies, characterized by predominantly overweight and obese participants, were included in the meta-analysis. Overall, interventions increased fruit and vegetable (F&V) intake by 87.5 g/day (P <0.00001), with similar results in the short-to-medium (that is, 4 to 12 months; 85.6 g/day) and long-term (that is, 13 to 58 months; 87.0 g/day) and for body mass index (BMI) stratification. Interventions produced slightly higher intakes of fruit (mean 54.0 g/day) than of vegetables (mean 44.6 g/day), and significant increases in fish (7 g/day, P = 0.03) and decreases in meat intake (9 g/day, P <0.00001). CONCLUSIONS Increases in F&V intakes were positively associated with the number of participant intervention contacts. Dietary interventions delivered during the retirement transition are therefore effective, sustainable in the longer term and likely to be of public health significance.
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Affiliation(s)
- Jose Lara
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Hobbs
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Paula J Moynihan
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
| | - Thomas D Meyer
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Ashley J Adamson
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Linda Errington
- Walton Library, Newcastle University, Newcastle upon Tyne, UK
| | - Lynn Rochester
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Falko F Sniehotta
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Martin White
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - John C Mathers
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne NE4 5PL, UK
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
- Centre for Brain Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
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Moderators of health behavior initiation and maintenance in a randomized telephone counseling trial. Prev Med 2014; 61:34-41. [PMID: 24412896 DOI: 10.1016/j.ypmed.2014.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/27/2013] [Accepted: 01/01/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study compares moderators of initiation and maintenance of health behavior changes. METHODS Data come from a cluster-randomized, 12-month telephone counseling intervention for physical activity and diet, targeting type 2 diabetes or hypertension patients (n=434, Australia,2005-2007). Demographic and health-related characteristics, theoretical constructs, and baseline behavioral outcomes were considered as moderators. Mixed models, adjusting for baseline values, assessed moderation of intervention effects for trial outcomes (physical activity, intakes of fat, saturated fat, fiber, fruit, vegetables) at end-of-intervention (12 months/initiation) and maintenance follow-up (18 months), and compared moderation between these periods. RESULTS Social support for physical activity and baseline physical activity were significant (p<0.05) moderators of physical activity at 12 months. Gender, marital status, social support for healthy eating, BMI, and number of chronic conditions were significant moderators of dietary changes at 12- and/or 18 months. Instances of moderation differing significantly between 12- and 18 months were: baseline physical activity for physical activity (initiation) and marital status for fat intake (maintenance). CONCLUSIONS This exploratory study showed that moderation of physical activity and diet effects sometimes differed between initiation and maintenance. To identify unique moderators for initiation and/or maintenance of behavior changes, future studies need to report on and statistically test for such differences.
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Modelling the impact of compliance with dietary recommendations on cancer and cardiovascular disease mortality in Canada. Public Health 2014; 128:222-30. [PMID: 24612957 DOI: 10.1016/j.puhe.2013.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 11/01/2013] [Accepted: 11/05/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Despite strong evidence indicating that unbalanced diets relate to chronic diseases and mortality, most adults do not comply with dietary recommendations. To help determine which recommendations could yield the most benefits, the number of deaths attributable to cardiovascular diseases and cancer that could be delayed or averted in Canada if adults changed their diet to adhere to recommendations were estimated. STUDY DESIGN Macrosimulation based on national population-based survey and vital statistics data. METHODS A macrosimulation model was used to draw age- and sex-specific changes in relative risks based on the results of meta-analyses of relationship between food components and risk of cardiovascular disease and diet-related cancers. Inputs in the model included Canadian recommendations (fruit and vegetable, fibre, salt, and total-, monounsaturated-, polyunsaturated-, saturated-, and trans-fats), average dietary intake (from 35,107 participants with 24-h recall), and mortality from specific causes (from Canadian Vital Statistics). Monte Carlo analyses were used to compute 95% credible intervals (CI). RESULTS The estimates of this study suggest that 30,540 deaths (95% CI: 24,953, 34,989) per year could be averted or delayed if Canadians adhered to their dietary recommendations. By itself, the recommendation for fruit and vegetable intake could save as many as 72% (55-87%) of these deaths. It is followed by recommendations for fibres (29%, 13-43%) and salt (10%, 9-12%). CONCLUSIONS A considerable number of lives could be saved if Canadians adhered to the national dietary intake recommendations. Given the scarce resources available to promote guideline adhesion, priority should be given to recommendations for fruit and vegetable intake.
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Lam W, Chan EA, Yeung KSS. Implications for school nursing through interprofessional education and practice. J Clin Nurs 2014; 22:1988-2001. [PMID: 23745646 DOI: 10.1111/jocn.12163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2012] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To explore the interprofessional collaboration between nursing and social work professionals in their delivery of health services for schoolchildren. BACKGROUND Interprofessional education has long been recommended as a way to meet the need for effective collaboration in school health service with a view to improving the quality of health care. No local study in Hong Kong has looked specifically at how nursing and social work professionals carry out school health services through interprofessional education and practice. Therefore, an examination was conducted of collaboration on a community-based school caring project. DESIGN A qualitative design was employed, using semi-structured interviews, field observation and field debriefing. METHODS Seven nursing students and five social work students were recruited and interviewed in 2011. The transcripts were analysed using qualitative content analysis. RESULTS Three themes were identified: (1) early identification of children's needs through interprofessional collaboration for health promotion, (2) prompt referral for schoolchildren in need, and (3) comprehensive planning and implementation of school health service. CONCLUSION The strength of collaborative work between nursing and social work professionals is that it helps to identify and address these complex health needs of children. Healthcare providers are hence able to develop a fuller understanding of children's problems, which in turn enables them to provide appropriate and effective health promotion interventions. RELEVANCE TO CLINICAL PRACTICE The development of interprofessional education for school health services should be envisaged by the local higher educational institute and policy makers to reduce children's risk-taking behaviours and promote their health and well-being. Health educators and health policy makers can better understand how interprofessional education and collaboration can promote children health service for regional and national policy and practice.
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Affiliation(s)
- Winsome Lam
- The School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
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Tantalaki E, Piperi C, Livadas S, Kollias A, Adamopoulos C, Koulouri A, Christakou C, Diamanti-Kandarakis E. Impact of dietary modification of advanced glycation end products (AGEs) on the hormonal and metabolic profile of women with polycystic ovary syndrome (PCOS). Hormones (Athens) 2014; 13:65-73. [PMID: 24722128 DOI: 10.1007/bf03401321] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the impact of dietary intervention on Advanced Glycation End products (AGEs) intake on the hormonal and metabolic profile in women with polycystic ovary syndrome (PCOS). METHODS After baseline evaluation, 23 women with PCOS [mean ± SD, age: 23.4 ± 5.7 years; body mass index (BMI): 26 ± 5.7 kg/m2] underwent the following consecutive 2-month dietary regimens: a hypocaloric diet with ad-libitum AGEs content (Hypo), an isocaloric diet with high AGEs (HA) and an isocaloric diet with low AGEs (LA). Metabolic, hormonal and oxidative stress status was assessed and AGEs levels were determined in all subjects after the completion of each dietary intervention. RESULTS Serum levels of AGEs, testosterone, oxidative stress, insulin and HOMA-IR index were significantly increased on the HA compared to the Hypo diet and subsequently decreased on the LA diet (compared to HA) (p<0.05 for all parameters). BMI remained unaltered throughout the HA and LA periods compared to the Hypo period. Serum AGEs were strongly correlated with insulin, as well as with HOMA, during the LA dietary period (r=0.53, p=0.02 and r=0.51, p=0.03, respectively). For the same period, dietary AGEs were correlated with insulin levels (rho=0.49, p=0.04). CONCLUSIONS Modifications of dietary AGEs intake are associated with parallel changes in serum AGEs, metabolic, hormonal and oxidative stress biomarkers in women with PCOS. These novel findings support recommendations for a low AGEs dietary content along with lifestyle changes in women with PCOS.
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Affiliation(s)
- Evangelia Tantalaki
- Endocrine Unit, Third Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Greece
| | - Christina Piperi
- Department of Biological Chemistry, University of Athens Medical School; Athens, Greece
| | - Sarantis Livadas
- Endocrine Unit, Third Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Greece
| | - Anastasios Kollias
- Endocrine Unit, Third Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Greece
| | - Christos Adamopoulos
- Department of Biological Chemistry, University of Athens Medical School; Athens, Greece
| | - Aikaterini Koulouri
- Endocrine Unit, Third Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Greece
| | - Charikleia Christakou
- Endocrine Unit, Third Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Greece
| | - Evanthia Diamanti-Kandarakis
- Endocrine Unit, Third Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Greece
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Goode A, Reeves M, Owen N, Eakin E. Results from the dissemination of an evidence-based telephone-delivered intervention for healthy lifestyle and weight loss: the Optimal Health Program. Transl Behav Med 2013; 3:340-50. [PMID: 24294322 DOI: 10.1007/s13142-013-0210-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Despite proven efficacy, there are few published evaluations of telephone-delivered interventions targeting physical activity, healthy eating, and weight loss in community dissemination contexts. This study aims to evaluate participant and program outcomes from the Optimal Health Program, a telephone-delivered healthy lifestyle and weight loss program provided by a primary health care organization. Dissemination study used a single-group, repeated measures design; outcomes were assessed at 6-month (mid-program; n = 166) and 12-month (end of program; n = 88) using paired analyses. The program reached a representative sample of at-risk, primary care patients, with 56 % withdrawing before program completion. Among completers, a statistically significant improvement between baseline and end of program was observed for weight [mean change (SE) -5.4 (7.0) kg] and waist circumference [-4.8 (9.7) cm], underpinned by significant physical activity and dietary change. Findings suggest that telephone-delivered weight loss and healthy lifestyle programs can provide an effective model for use in primary care settings, but participant retention remains a challenge.
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Affiliation(s)
- Ana Goode
- Cancer Prevention Research Centre, School of Population Health, The University of Queensland, Herston Rd., Herston, Queensland 4006 Australia
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Bodde AE, Shippee ND, May CR, Mair FS, Erwin PJ, Murad MH, Montori VM. Examining health promotion interventions for patients with chronic conditions using a novel patient-centered complexity model: protocol for a systematic review and meta-analysis. Syst Rev 2013; 2:29. [PMID: 23663259 PMCID: PMC3655854 DOI: 10.1186/2046-4053-2-29] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 04/24/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Successful chronic care self-management requires adherence to healthy lifestyle behaviors, but many healthcare-based health promotion interventions have resulted in small and unsustainable changes in patient behavior. Patients with chronic conditions may already be overwhelmed by burdensome illnesses and treatments, and not have the capacity to respond well to the additional work required of behavior modifications. To explore this phenomenon, we will apply the cumulative complexity model (CCM), a patient-centered model of patient complexity, to a systematic review and meta-analysis of healthcare-based health behavior interventions. METHODS/DESIGN This systematic review will include randomized trials published between 2002 and 2012 that compared healthcare-based interventions aimed at improving healthy diet and physical activity in community dwelling adult patients with chronic conditions. After extracting study and risk of bias features from each trial, we will classify the interventions according to the conceptual model. We will then use meta-analysis and subgroup analysis to test hypotheses based on the conceptual model. DISCUSSION Healthcare providers need evidence of successful health promoting interventions for patients with chronic conditions who display common behavioral risk factors. To better understand how patients respond to interventions, we will apply the CCM, which accounts for both the capacity of patients with chronic conditions and their treatment-related workload, and posits that a balance between capacity and workload predicts successful enactment of self-care. Analysis will also include whether patients with multiple chronic conditions respond differently to interventions compared to those with single chronic conditions. The results of this review will provide insights as to how patients with chronic conditions respond to health-promoting interventions. REVIEW REGISTRATION PROSPERO registration number: CRD42012003428.
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Affiliation(s)
- Amy E Bodde
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA
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Harris MF, Chan BC, Laws RA, Williams AM, Davies GP, Jayasinghe UW, Fanaian M, Orr N, Milat A. The impact of a brief lifestyle intervention delivered by generalist community nurses (CN SNAP trial). BMC Public Health 2013; 13:375. [PMID: 23607755 PMCID: PMC3653785 DOI: 10.1186/1471-2458-13-375] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 04/16/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The risk factors for chronic disease, smoking, poor nutrition, hazardous alcohol consumption, physical inactivity and weight (SNAPW) are common in primary health care (PHC) affording opportunity for preventive interventions. Community nurses are an important component of PHC in Australia. However there has been little research evaluating the effectiveness of lifestyle interventions in routine community nursing practice. This study aimed to address this gap in our knowledge. METHODS The study was a quasi-experimental trial involving four generalist community nursing (CN) services in New South Wales, Australia. Two services were randomly allocated to an 'early intervention' and two to a 'late intervention' group. Nurses in the early intervention group received training and support in identifying risk factors and offering brief lifestyle intervention for clients. Those in the late intervention group provided usual care for the first 6 months and then received training. Clients aged 30-80 years who were referred to the services between September 2009 and September 2010 were recruited prior to being seen by the nurse and baseline self-reported data collected. Data on their SNAPW risk factors, readiness to change these behaviours and advice and referral received about their risk factors in the previous 3 months were collected at baseline, 3 and 6 months. Analysis compared changes using univariate and multilevel regression techniques. RESULTS 804 participants were recruited from 2361 (34.1%) eligible clients. The proportion of clients who recalled receiving dietary or physical activity advice increased between baseline and 3 months in the early intervention group (from 12.9 to 23.3% and 12.3 to 19.1% respectively) as did the proportion who recalled being referred for dietary or physical activity interventions (from 9.5 to 15.6% and 5.8 to 21.0% respectively). There was no change in the late intervention group. There a shift towards greater readiness to change in those who were physically inactive in the early but not the comparison group. Clients in both groups reported being more physically active and eating more fruit and vegetables but there were no significant differences between groups at 6 months. CONCLUSION The study demonstrated that although the intervention was associated with increases in advice and referral for diet or physical activity and readiness for change in physical activity, this did not translate into significant changes in lifestyle behaviours or weight. This suggests a need to facilitate referral to more intensive long-term interventions for clients with risk factors identified by primary health care nurses. TRIAL REGISTRATION ACTRN12609001081202.
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Affiliation(s)
- Mark F Harris
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Bibiana C Chan
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Rachel A Laws
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Anna M Williams
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Gawaine Powell Davies
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Upali W Jayasinghe
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Mahnaz Fanaian
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Neil Orr
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Andrew Milat
- Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
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Chan BC, Jayasinghe UW, Christl B, Laws RA, Orr N, Williams A, Partington K, Harris MF. The impact of a team-based intervention on the lifestyle risk factor management practices of community nurses: outcomes of the community nursing SNAP trial. BMC Health Serv Res 2013; 13:54. [PMID: 23394573 PMCID: PMC3599701 DOI: 10.1186/1472-6963-13-54] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 01/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lifestyle risk factors like smoking, nutrition, alcohol consumption, and physical inactivity (SNAP) are the main behavioural risk factors for chronic disease. Primary health care is an appropriate setting to address these risk factors in individuals. Generalist community health nurses (GCHNs) are uniquely placed to provide lifestyle interventions as they see clients in their homes over a period of time. The aim of the paper is to examine the impact of a service-level intervention on the risk factor management practices of GCHNs. METHODS The trial used a quasi-experimental design involving four generalist community nursing services in NSW, Australia. The services were randomly allocated to either an intervention group or control group. Nurses in the intervention group were provided with training and support in the provision of brief lifestyle assessments and interventions. The control group provided usual care. A sample of 129 GCHNs completed surveys at baseline, 6 and 12 months to examine changes in their practices and levels of confidence related to the management of SNAP risk factors. Six semi-structured interviews and four focus groups were conducted among the intervention group to explore the feasibility of incorporating the intervention into everyday practice. RESULTS Nurses in the intervention group became more confident in assessment and intervention over the three time points compared to their control group peers. Nurses in the intervention group reported assessing physical activity, weight and nutrition more frequently, as well as providing more brief interventions for physical activity, weight management and smoking cessation. There was little change in referral rates except for an improvement in weight management related referrals. Nurses' perception of the importance of 'client and system-related' barriers to risk factor management diminished over time. CONCLUSIONS This study shows that the intervention was associated with positive changes in self-reported lifestyle risk factor management practices of GCHNs. Barriers to referral remained. The service model needs to be adapted to sustain these changes and enhance referral. TRIAL REGISTRATION ACTRN12609001081202.
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Affiliation(s)
- Bibiana C Chan
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Upali W Jayasinghe
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Bettina Christl
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Rachel A Laws
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne, Australia
| | - Neil Orr
- Centre for Epidemiology and Evidence, New South Wales Ministry of Health, Sydney, Australia
| | - Anna Williams
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | | | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Ilmonen J, Isolauri E, Laitinen K. Nutrition education and counselling practices in mother and child health clinics: study amongst nurses. J Clin Nurs 2012; 21:2985-94. [DOI: 10.1111/j.1365-2702.2012.04232.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Logue E, Sutton K, Jarjoura D, Smucker W, Baughman K, Capers C. Transtheoretical Model-Chronic Disease Care for Obesity in Primary Care: A Randomized Trial. ACTA ACUST UNITED AC 2012; 13:917-27. [PMID: 15919846 DOI: 10.1038/oby.2005.106] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare health benefits achieved in a transtheoretical model-chronic disease (TM-CD) minimal intervention for obesity vs. augmented usual care (AUC). RESEARCH METHOD AND PROCEDURES This was a 2-year, randomized clinical trial with overweight or obese men and women from 15 primary care sites. AUC (n = 336) included dietary and exercise advice, prescriptions, and three 24-hour dietary recalls every 6 months. TM-CD care (n = 329) included AUC elements plus "stage of change" (SOC) assessments for five target behaviors every other month, mailed SOC and target behavior-matched workbooks, and monthly telephone calls from a weight-loss advisor. Weight change was the primary outcome. RESULTS Repeated measures models under the missing at random assumption yielded nonsignificant adjusted differences between the AUC and TM-CD groups for weight change, waist circumference, energy intake or expenditure, blood pressure, and blood lipids. The pattern of change over time suggested that TM-CD participants were trying harder to impact target behaviors during the first 6 to 12 months of the trial but relapsed afterward. Sixty percent of trial participants maintained their baseline weights for 18 to 24 months. DISCUSSION A combination of mailed patient materials and monthly telephone calls based on the transtheoretical model and some elements of chronic disease care is not powerful enough, relative to AUC, to alter target behaviors among overweight primary care patients in an obesogenic environment. AUC may be sufficient to maintain weights among at-risk primary care patients.
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Affiliation(s)
- Everett Logue
- Department of Family Practice, Summa Health System, 525 East Market Street, Suite 290, Akron, OH 44309-2090, USA.
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Lin JJ, Mann DM. Application of persuasion and health behavior theories for behavior change counseling: design of the ADAPT (Avoiding Diabetes Thru Action Plan Targeting) program. PATIENT EDUCATION AND COUNSELING 2012; 88:460-6. [PMID: 22770813 PMCID: PMC3417073 DOI: 10.1016/j.pec.2012.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 06/09/2012] [Accepted: 06/14/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Diabetes incidence is increasing worldwide and providers often do not feel they can effectively counsel about preventive lifestyle changes. The goal of this paper is to describe the development and initial feasibility testing of the Avoiding Diabetes Thru Action Plan Targeting (ADAPT) program to enhance counseling about behavior change for patients with pre-diabetes. METHODS Primary care providers and patients were interviewed about their perspectives on lifestyle changes to prevent diabetes. A multidisciplinary design team incorporated this data to translate elements from behavior change theories to create the ADAPT program. The ADAPT program was pilot tested to evaluate feasibility. RESULTS Leveraging elements from health behavior theories and persuasion literature, the ADAPT program comprises a shared goal-setting module, implementation intentions exercise, and tailored reminders to encourage behavior change. Feasibility data demonstrate that patients were able to use the program to achieve their behavior change goals. CONCLUSION Initial findings show that the ADAPT program is feasible for helping improve primary care providers' counseling for behavior change in patients with pre-diabetes. PRACTICE IMPLICATIONS If successful, the ADAPT program may represent an adaptable and scalable behavior change tool for providers to encourage lifestyle changes to prevent diabetes.
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Affiliation(s)
- Jenny J Lin
- Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA.
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Ahn S, Smith ML, Ory MG. Physicians' discussions about body weight, healthy diet, and physical activity with overweight or obese elderly patients. J Aging Health 2012; 24:1179-202. [PMID: 22918131 DOI: 10.1177/0898264312454573] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the correlates of physician-patient discussions about body weight, healthy diet, and physical activity. METHOD Subjects were 635 adults (≥65 years; mean 72.8 years) who had an increased body mass index (BMI≥25 kg/m2) and participated in a self-administered community survey. Logistic regression analyses were performed. RESULTS While approximately half of study participants reported having discussed healthy diets (51%) and physical activity (52%) with their physician, only 42% of those who were overweight or obese reported being recognized as such by their physician. Being moderately or severely obese, more chronic conditions, and more frequent physician visits increased the likelihood of being recognized as overweight or obese and reporting lifestyle discussions. DISCUSSION The health care provider is important in recognizing older patient's weight problems and discussing practical lifestyle changes. Tools for more proactive screening and implementation of follow-up behavioral counseling can help the health care providers better address obesity prevention in clinical practice.
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Affiliation(s)
- SangNam Ahn
- School of Public Health, University of Memphis, Memphis, TN 38152-3530, USA.
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Body weight, eating practices and nutritional knowledge amongst university nursing students, Eastern Cape, South Africa. Afr J Prim Health Care Fam Med 2012. [PMCID: PMC4565438 DOI: 10.4102/phcfm.v4i1.323] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Health care workers need to be equipped to deal with the increasing obesity and obesity-related morbidity occurring in developing countries. Objectives To assess weight status, eating practices and nutritional knowledge amongst nursing students at the University of Fort Hare, Eastern Cape. Method A cross-sectional descriptive survey was conducted on 161 undergraduate (51 male and 110 female) students of the Department of Nursing Sciences at the University of Fort Hare. Body mass index, waist and hip circumferences and waist hip ratio were determined. Nutritional knowledge and eating practices were investigated by structured interviewer-administered questionnaires. Results Statically, 49.7% were overweight or obese (58.2% of the females; 31.4% of the males) and 65.2% had waist circumferences putting them at risk for non-communicable diseases. Most did not meet the recommendations for intakes from the vegetable group (97.5% ate <3 servings per day), the fruit group (42.2% ate <2 servings per day), and the dairy group (92.6% ate <2 servings per day); whilst 78.3% ate ≥4 serving per day of sugar or sweets. Most consumed margarine, oil or fat (68.3%), sugar (59.0%) and bread (55.9%) daily, but few reported daily intakes of vegetables (12.4%), fruit (23.6%), fruit juice (21.2%) and milk (15.6%). Fewer than 50% knew the recommended intakes for vegetables, fruit, dairy, starchy foods and meat or meat alternatives. Conclusions These nursing students had a high prevalence of overweight and obesity, poor eating habits and inadequate knowledge on key nutrition issues, which may impact negatively on their efficacy as future health ambassadors to the public.
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Goode AD, Owen N, Reeves MM, Eakin EG. Translation from research to practice: community dissemination of a telephone-delivered physical activity and dietary behavior change intervention. Am J Health Promot 2012; 26:253-9. [PMID: 22375577 DOI: 10.4278/ajhp.100401-qual-99] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe the process of translating an evidence-based, telephone-delivered physical activity and dietary behavior change intervention from research into practice. DESIGN Descriptive case study. SETTING/SUBJECTS Nongovernment, primary medical care-based community health organization. INTERVENTION Telephone-delivered intervention targeting physical activity and diet in primary medical care patients. MEASURES/ANALYSIS Systematic documentation of process outcomes related to intervention adoption and adaptation. RESULTS Research-community partnerships were critical in facilitating translation, including (1) an initial competitive advantage within a State Health Department-funded preventive health initiative; (2) advocacy to ensure the adoption of the intervention, (3) subsequent support for the adaptation of program elements to ensure fit of the program with the community organization's objectives and capacities, while maintaining feasible elements of fidelity with the original evidence-based program; (4) the integration of program management and evaluation systems within the community organization; and (5) ongoing support for staff members responsible for program delivery and evaluation. Preliminary process evaluation of the Optimal Health Program supports the acceptability and feasibility of the program within community practice. CONCLUSIONS INTERVENTION characteristics central to adoption can be influenced by research-community partnerships. It is likely that evidence-based interventions will need to be adapted for delivery within the real world. Researchers should endeavor to provide training and support to ensure, as much as possible, fidelity with the original program, and that the relevant adaptations are evidence based.
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Affiliation(s)
- Ana D Goode
- Cancer Prevention Research Centre, School of Population Health, The University of Queensland, Brisbane, Queensland, Australia.
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Kumanyika SK, Fassbender JE, Sarwer DB, Phipps E, Allison KC, Localio R, Morales KH, Wesby L, Harralson T, Kessler R, Tan-Torres S, Han X, Tsai AG, Wadden TA. One-year results of the Think Health! study of weight management in primary care practices. Obesity (Silver Spring) 2012; 20:1249-57. [PMID: 22051940 DOI: 10.1038/oby.2011.329] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Think Health! study evaluated a behavioral weight loss program adapted from the Diabetes Prevention Program (DPP) lifestyle intervention to assist primary care providers (PCPs) and auxiliary staff acting as lifestyle coaches (LCs) in offering weight loss counseling to their patients. In a randomized trial conducted at five clinical sites, study participants were randomly assigned in a 1:1 ratio within each site to either "Basic Plus" (n = 137), which offered PCP counseling every 4 months plus monthly LC visits during the first year of treatment, or "Basic" (n = 124), which offered only PCP counseling every 4 months. Participants were primarily (84%) female, 65% African American, 16% Hispanic American, and 19% white. In the 72% of participants in each treatment group with a 12-month weight measurement, mean (95% CI) 1-year weight changes (kg) were -1.61 (-2.68, -0.53) in Basic Plus and -0.62 (-1.45, 0.20) in Basic (difference: 0.98 (-0.36, 2.33); P = 0.15). Results were similar in model-based estimates using all available weight data for randomized participants, adjusting for potential confounders. More Basic Plus (22.5%) than Basic (10.2%) participants lost ≥ 5% of their baseline weight (P = 0.022). In a descriptive, nonrandomized analysis that also considered incomplete visit attendance, mean weight change was -3.3 kg in Basic Plus participants who attended ≥ 5 LC visits vs. + 0.53 kg in those attending <5 LC visits. We conclude that the Basic Plus approach of moderate-intensity counseling by PCPs and their staff can facilitate modest weight loss, with clinically significant weight loss in high program attenders.
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Affiliation(s)
- Shiriki K Kumanyika
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
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Abstract
With the changing health care environment, prevalence of chronic health conditions, and burgeoning challenges of health literacy, obesity, and homelessness, self-management support provides an opportunity for clinicians to enhance effectiveness and, at the same time, to engage patients to participate in managing their own personal care. This article reviews the differences between patient education and self-management and describes easy-to-use strategies that foster patient self-management and can be used by health care providers in the medical setting. It also highlights the importance of linking patients to nonmedical programs and services in the community.
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Affiliation(s)
- Patrick T McGowan
- Centre on Aging, University of Victoria, Victoria, British Columbia, Canada.
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Sonntag U, Wiesner J, Fahrenkrog S, Renneberg B, Braun V, Heintze C. Motivational interviewing and shared decision making in primary care. PATIENT EDUCATION AND COUNSELING 2012; 87:62-66. [PMID: 21873018 DOI: 10.1016/j.pec.2011.07.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 07/28/2011] [Accepted: 07/29/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The aim of this study was to assess general practitioners' (GP) readiness to involve obese patients in therapy decision making and to determine whether they integrate motivational interviewing techniques. METHODS Fifty-eight preventive Check-up 35 encounters with overweight and obese patients in primary care were audio recorded in 12 GP practices. The use of motivational interviewing techniques was rated with the Behavior Change Counseling Index (BECCI). The involvement in medical decisions was rated with the Observing Patient Involvement Scale (OPTION). RESULTS OPTION and BECCI scores were low (means=0.71 and 1.65), indicating minimal implementation of shared decision making and motivational interviewing in preventive encounters with these patients. GPs used more motivational interviewing for patients with a BMI>30 kg/m(2) than for those with a BMI<30 kg/m(2). Female GPs had significantly higher shared decision making scores, indicating that they prefer to involve patients in medical decisions. GPs differed significantly in their use of both approaches. CONCLUSIONS Shared decision making and motivational interviewing, though known to be successful strategies in lifestyle counseling, are rarely used during obesity encounters in our sample of German GPs. PRACTICE IMPLICATIONS GPs should be sensitized and trained in the application of these methods.
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Affiliation(s)
- Ulrike Sonntag
- Institute for General Practice and Family Medicine, Charité Universitätsmedizin, Berlin, Germany.
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Bock C, Diehl K, Schneider S, Diehm C, Litaker D. Behavioral Counseling for Cardiovascular Disease Prevention in Primary Care Settings. Med Care Res Rev 2012; 69:495-518. [PMID: 22457269 DOI: 10.1177/1077558712441084] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiovascular disease carries a substantial public health burden. Physician advice on modifying behavioral risk factors is effective, yet the practice of and factors associated with behavioral counseling in primary care have not been systematically investigated. The authors conducted a systematic review that identified 18 studies providing data on 6,338 physicians. The provision of preventive services differed by patients’ individual risk. Physicians’ counseling on smoking cessation was most commonly reported. The proportions of physicians counseling about nutrition and physical activity were notably lower and few physicians took further action by using more intensive counseling approaches. As studies were mainly based on self-reports, current delivery of preventive services may be overestimated. There is a need to increase the frequency of behavioral counseling in primary care settings, particularly for nutrition and physical activity, and to emphasize that counseling may also benefit individuals without cardiovascular disease risk factors.
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Affiliation(s)
- Christina Bock
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Katharina Diehl
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Sven Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Curt Diehm
- Department of Internal Medicine, Clinical Center and Academic Hospital of the University of Heidelberg, Karlsbad-Langensteinbach, Germany
| | - David Litaker
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Germany
- Departments of Medicine, Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA
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