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Mehok LE, Walsh KT, Miller MM, Anastas TM, Hirsh AT. Exercise and Dietary Recommendations for Women with Chronic Pain: What's Weight and Race Got To Do with It? THE JOURNAL OF PAIN 2024; 25:104505. [PMID: 38484856 PMCID: PMC11283970 DOI: 10.1016/j.jpain.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 02/08/2024] [Accepted: 03/03/2024] [Indexed: 05/12/2024]
Abstract
Exercise and diet are beneficial for pain, yet many patients do not receive such recommendations from providers. This may be due to biases related to gender, race, and weight. We recruited medical students (N = 90) to view videos of women with chronic back pain performing a functional task; patients varied by weight (overweight/obese) and race (Black/White). For each woman patient, providers rated their likelihood of recommending exercises or dietary changes. Ratings significantly differed across recommendations (F(2.75, 244.72) = 6.19, P < .01) in that providers were more likely to recommend flexibility exercises than aerobic exercises and dietary changes and were more likely to recommend strength exercises than dietary changes. Results also indicated that women with obesity were more likely to receive aerobic (F(1,89) = 17.20, P < .01), strength (F(1,89) = 6.08, P = .02), and dietary recommendations (F(1,89) = 37.56, P < .01) than were women with overweight. Additionally, White women were more likely to receive a recommendation for flexibility exercises (F(1,89) = 4.92, P = .03) than Black women. Collectively, these findings suggest that providers' exercise and dietary recommendations for women with chronic pain are influenced by the weight status and racial identity of the patient. Future studies are needed to identify the reasons underlying these systematic differences, including the stereotypes and attitudes that may be driving these effects. PERSPECTIVE: This article presents results on how patient weight and race impact providers' exercise and diet recommendations for women with chronic back pain. Provider recommendations for these modalities may be systematically biased in a way that impedes care and impacts patient functioning.
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Affiliation(s)
- Lauren E. Mehok
- Behavioral Health Care Line, New Mexico Veterans Affairs Healthcare System, Albuquerque, NM
| | - Kaitlyn T. Walsh
- Department of Psychology, Indiana University Indianapolis (IUI), Indianapolis, IN
| | - Megan M. Miller
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tracy M. Anastas
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Adam T. Hirsh
- Department of Psychology, Indiana University Indianapolis (IUI), Indianapolis, IN
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Lee KM, Ghanei B, Tomiyama AJ. A brief induction of loving kindness meditation to reduce anti-fat bias. PLoS One 2024; 19:e0302039. [PMID: 38900806 PMCID: PMC11189228 DOI: 10.1371/journal.pone.0302039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 03/27/2024] [Indexed: 06/22/2024] Open
Abstract
Weight stigma is highly prevalent. However, existing weight stigma interventions are only modestly effective at reducing anti-fat attitudes. The current research proposes a novel approach using a loving kindness meditation (LKM). Experiment 1 tests whether random assignment to the LKM intervention reduces explicit and implicit anti-fat bias and increases empathy based on the LKM recipient with higher weight (close other vs. stranger). Experiment 2 tests whether LKM outperforms an empathy intervention or control to increase empathy or reduce stigmatizing behavior. Results revealed that the LKM increased empathic care but did not reduce anti-fat bias compared to control; the LKM intervention, but not the empathy intervention, reported greater empathy compared to control in unadjusted analyses; and participants in the LKM and empathy interventions (vs. control) were more likely to engage in stigmatizing behavior. These findings suggest that the LKM may not be effective at reducing weight stigma despite increasing empathy.
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Affiliation(s)
- Kristen M. Lee
- Department of Psychology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Bita Ghanei
- Department of Psychology, University of California Los Angeles, Los Angeles, California, United States of America
| | - A. Janet Tomiyama
- Department of Psychology, University of California Los Angeles, Los Angeles, California, United States of America
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Dannemiller M, Shadiack A, Sineath M, Baird A, Poirier M, Thomas K, Flynn MG. Exercise Is a Vital Sign. HCA HEALTHCARE JOURNAL OF MEDICINE 2024; 5:225-236. [PMID: 39015584 PMCID: PMC11249174 DOI: 10.36518/2689-0216.1829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Description In this review, we argue that exercise (physical activity) be monitored as a vital sign since no other basic sign or symptom provides as much information about a patient's health status. The influence of regular exercise on patient health is indisputable, with strong evidence to show the power of exercise to mitigate chronic disease and improve overall health. Several simple tools, such as Physical Activity as a Vital Sign and Exercise as a Vital Sign are available to assess patient physical activity. When properly applied, there is evidence to support the efficacy of these tools, but there are barriers that prevent broad inclusion in primary care, among which are time and provider knowledge. In our review, we also discussed the value of physician-led lifestyle discussions with patients and found they view these discussions favorably. There is also evidence that physicians who exercise are more likely to have these lifestyle discussions with their patients, but the proportion of physicians who exercise regularly is fairly low. We believe physicians' awareness of their patients' sedentary lifestyles should prompt a prescription to increase physical activity, but additional in-clinic support and community resources need to be in place for patients to get a regular dose.
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Affiliation(s)
| | | | | | | | - Marc Poirier
- Memorial Health University Medical Center, Savannah, GA
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Couser GP, Hagen PT, Swift MD, Newcomb RD, Cowl CT. Physician Health Series Part One: Characteristics of Physicians as Patients. Mayo Clin Proc 2024; 99:836-843. [PMID: 38702130 DOI: 10.1016/j.mayocp.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/25/2023] [Accepted: 08/30/2023] [Indexed: 05/06/2024]
Abstract
This is the first article of a 3-part series about physician health. In this installment, we outline the unique characteristics of physicians as patients, challenges and opportunities presented by physician-patients, and recommendations for treating physicians. Future articles will delve into role clarity, occupational considerations, mental health, and interactions with third parties such as the physician's employer or licensing board. Ultimately, this series will help treating clinicians provide the best care to their physician-patients and successfully navigate the unique challenges that may arise, especially when the diagnosis may have an impact on their ability to practice medicine.
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Affiliation(s)
- Greg P Couser
- Mayo Clinic Physician Health Center, Public Health, Infectious Disease, and Occupational Medicine, Mayo Clinic, Rochester, MN.
| | - Philip T Hagen
- Mayo Clinic Physician Health Center, Public Health, Infectious Disease, and Occupational Medicine, Mayo Clinic, Rochester, MN
| | - Melanie D Swift
- Mayo Clinic Physician Health Center, Public Health, Infectious Disease, and Occupational Medicine, Mayo Clinic, Rochester, MN
| | - Richard D Newcomb
- Mayo Clinic Physician Health Center, Public Health, Infectious Disease, and Occupational Medicine, Mayo Clinic, Rochester, MN
| | - Clayton T Cowl
- Mayo Clinic Physician Health Center, Public Health, Infectious Disease, and Occupational Medicine, Mayo Clinic, Rochester, MN
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McCormick SJ, Smith-Holmquist N, Benton MJ. Personal health behaviors and physical activity and nutrition counseling by nurse practitioners: An online survey. J Am Assoc Nurse Pract 2023; 35:794-801. [PMID: 37584492 DOI: 10.1097/jxx.0000000000000925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/13/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Healthy lifestyle counseling improves nutritional intake and participation in exercise, yet the rate of patient counseling varies and clinicians' personal behaviors can influence counseling practices. PURPOSE This cross-sectional study evaluated lifestyle counseling by nurse practitioners (NPs) and the relationship between their personal behaviors and patient counseling. METHODOLOGY Practicing NPs ( N = 1,220) completed an online survey regarding personal behaviors and counseling for healthy body weight, moderate-vigorous physical activity, muscle strengthening, fruit and vegetable consumption, and dietary protein. RESULTS The majority reported counseling "usually" or "often" for healthy weight (54%), moderate-vigorous physical activity (53%), and fruits/vegetables (57%), whereas only 44% and 17% reported "usually" or "often" counseling for dietary protein and muscle strengthening. When NPs did not personally engage in the behavior, the odds for counseling were significantly reduced: NPs were 21% less likely to counsel for moderate-vigorous physical activity (odds ratio [OR] = 0.79 [0.65-0.97], p = .026), 27% less likely to counsel for muscle strengthening (OR = 0.73 [0.60-0.90], p = .004), 57% less likely to counsel for fruit/vegetable consumption (OR = 0.43 [0.35-0.54], p < .001), and 72% less likely to counsel for dietary protein (OR = 0.28 [0.18-0.45], p < .001). Personal body mass index did not predict counseling for a healthy weight. CONCLUSION Although NPs report regular patient counseling regarding healthy lifestyle behaviors, the odds for counseling are increased approximately 20-75% when they engage in the behaviors themselves. IMPLICATIONS Promotion of healthy behaviors during professional education may have long-term implications for preventive health counseling.
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Affiliation(s)
- Sherry J McCormick
- Department of Nursing, University of Colorado, Colorado Springs, Colorado
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Sugimoto S, Recker D, Halvorson EE, Skelton JA. Are Future Doctors Prepared to Address Patients' Nutritional Needs? Cooking and Nutritional Knowledge and Habits in Medical Students. Am J Lifestyle Med 2023; 17:736-745. [PMID: 38511108 PMCID: PMC10948926 DOI: 10.1177/15598276211018165] [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: 03/22/2024] Open
Abstract
Background. Many diseases are linked to lifestyle in the United States, yet physicians receive little training in nutrition. Medical students' prior knowledge of nutrition and cooking is unknown. Objective. To determine incoming medical students' prior nutrition knowledge, culinary skills, and nutrition habits. Methods. A dual-methods study of first-year medical students. Cross-sectional survey assessing prior knowledge, self-efficacy, and previous education of cooking and nutrition. Interviews of second-year medical students explored cooking and nutrition in greater depth. Results. A total of 142 first-year medical students participated; 16% had taken a nutrition course, with majority (66%) learning outside classroom settings. Students had a mean score of 87% on the Nutritional Knowledge Questionnaire versus comparison group (64.9%). Mean cooking and food skills score were lower than comparison scores. Overall, students did not meet guidelines for fiber, fruit, vegetables, and whole grains. Interviews with second-year students revealed most learned to cook from their families; all believed it important for physicians to have this knowledge. Conclusions. Medical students were knowledgeable about nutrition, but typically self-taught. They were not as confident or skilled in cooking, and mostly learned from their family. They expressed interest in learning more about nutrition and cooking.
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Affiliation(s)
- Sam Sugimoto
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Drew Recker
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Joseph A. Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Savitsky B, Shulman I, Kagan I. Comprehensive Training of Community Diagnosis and the Community-Oriented Primary Health Care Model in Nursing Education: An Evidence-Based Project. Nurse Educ 2023; 48:E178-E182. [PMID: 37130357 DOI: 10.1097/nne.0000000000001437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Community-oriented primary health care is a health promotion model that includes community diagnosis of a targeted community. PURPOSE This educational project aimed to develop and implement an innovative approach of applying the principles of evidence-based practice in the teaching of community diagnosis, where the class of nursing students serves as an example of community. METHODS The method consisted of a lecture and an evidence-based simulation of community diagnosis based on data collection regarding the lifestyle and health behaviors of third-year nursing students from a 4-year academic nursing program (200 students; 90% response rate). RESULTS The data analysis revealed insufficient consumption of fruits, vegetables, and unsweetened fluids; excessive consumption of red and processed meat; insufficient engagement in physical activity; high anxiety level; and sleep deprivation. CONCLUSIONS This educational approach allowed an interactive presentation of community health diagnostic methodology as well as community health problem prioritization applying the principles of an evidence-based approach. The method also improves students' awareness of their health and makes them better ambassadors of promoting a healthy lifestyle.
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Affiliation(s)
- Bella Savitsky
- (Drs Savitsky and Kagan), Department of Nursing, Ashkelon Academic College, Ashkelon, Israel; and (Ms Shulman), Preventive Medicine Branch, Medical Corps, IDF, Ramat Gan, Israel
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Telaak SH, Howe LC, Persky S. Physician weight influences responses to a public health message about the genetics of obesity. PATIENT EDUCATION AND COUNSELING 2023; 115:107853. [PMID: 37542821 DOI: 10.1016/j.pec.2023.107853] [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: 10/31/2022] [Revised: 06/01/2023] [Accepted: 06/12/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE Many patients prefer lean physicians to physicians with obesity and place higher credence in their weight management advice. Because genetic information about weight can be viewed as self-serving for individuals with overweight or obesity, physicians with obesity may be discounted when sharing such information. As provision of genetic information regarding weight becomes increasingly common in public health messaging, could a physician's own weight influence how these messages are received by the public? METHODS In an online survey, 967 participants were randomly assigned a physician profile (lean v. has obesity) with a media interview transcript discussing genetic factors of a common health condition (obesity v. osteoporosis). RESULTS Participants perceived the physician with obesity who discussed genetic factors in obesity as less trustworthy and less credible. Participants were also less likely to anticipate following her advice on weight-related issues. Participants with higher BMI had less negative perceptions of this physician. CONCLUSION Physicians with obesity, when providing public health messaging regarding genetic information about obesity, may be met with distrust and negative attitudes toward the physician. PRACTICAL IMPLICATIONS Future research should investigate health communication strategies that address this form of weight stigma while accurately conveying genetic factors that contribute to weight.
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Affiliation(s)
- Sydney H Telaak
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, USA
| | - Lauren C Howe
- Department of Business Administration, University of Zurich, Switzerland
| | - Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, USA.
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Znyk M, Kaleta D. Healthy lifestyle counseling, and barriers perceived by general practitioners in Poland. Front Public Health 2023; 11:1256505. [PMID: 37829088 PMCID: PMC10565007 DOI: 10.3389/fpubh.2023.1256505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction The aim of the study was to determine the influence of the personal factors, such as body mass index (BMI), of general practitioners (GPs), and their counseling on weight management, healthy lifestyle, and their perceived barriers. Materials and methods The cross-sectional study was conducted from January 2020 to December 2021 among 161 GPs in the city of Lodz. Results Only 3.7% of physicians always advised their patients on diet and physical activity (p < 0.05). Most of the GPs (54%) provide counseling occasionally. GPs gave general advice more often to patients with chronic diseases than to patients who did not. The study showed that the chance of providing advice on eating habits or physical activity was significantly higher for the GPs who practiced physical activity (OR = 2.64; 95%Cl: 1.01-6.91, p < 0.05) and measured patient weight, height, and BMI (OR = 4.86; 95%Cl: 1.86-12.67, p < 0.001). GPs who were overweight (OR = 3.55; 95%Cl: 1.49-8.41, p < 0.01) and measured patient weight, height, and BMI (OR = 3.61; 95%Cl: 1.58-8.25, p < 0.01) were more likely to advise on nutrition or physical activity to "healthy" patients. Doctors who measured patient weight, height, and BMI advised patients with chronic diseases (OR = 6.45; 95%Cl: 2.54-16.34, p < 0.001). Over 40% of GPs believe that they are not effective in counseling. Lack of time turned out to be the main barrier to counseling for 73.3% of GPs, which was associated with heavy workload (>100 visits per week). Conclusion As many GPs doubt their effectiveness, it is recommended that GPs attend more training activities regarding counseling. In addition, organizational changes are needed to reduce patient numbers, and financial incentives are needed to improve counseling and patient measurement.
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Affiliation(s)
- Małgorzata Znyk
- Department of Hygiene and Epidemiology, Medical University of Lodz, Lodz, Poland
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10
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Charles JA, Wood NI, Neary S, Moreno JO, Scierka L, Brink B, Zhao X, Gielissen KA. "Zoom"ing to the Kitchen: A Novel Approach to Virtual Nutrition Education for Medical Trainees. Nutrients 2023; 15:4166. [PMID: 37836450 PMCID: PMC10574391 DOI: 10.3390/nu15194166] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/06/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
While nutritional interventions are first-line therapy for many chronic diseases, most medical trainees receive minimal nutrition education, leaving them unprepared to address nutritional issues with patients. An interactive, single-session, virtual nutrition curriculum was taught online to 80 physician assistant (PA) students. Topics included plant-based nutrition, dietary history-taking and counseling, and culinary medicine. Students were surveyed before, immediately after, and four weeks after the curriculum to assess changes to nutrition-related knowledge, attitudes, confidence, and personal dietary behaviors. Seventy-three PA students (91%) completed the pre-survey, 76 (95%) completed the post-survey, and 42 (52.5%) completed the delayed post-survey. Knowledge scores increased immediately post-intervention (48.9% to 78.9%; p < 0.001) and persisted four weeks later (78.9% to 75.8%; p = 0.54). Post-intervention, students felt more confident in dietary history-taking (55% vs. 95%; p = 0.001) and nutrition counseling (53% vs. 84%; p = 0.003) and agreed that dietary changes alone could reverse type 2 diabetes (74% vs. 97%; p = 0.027) and coronary artery disease (66% vs. 92%; p = 0.039). Curricula using virtual teaching kitchens may be a scalable approach to nutrition education for medical trainees.
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Affiliation(s)
- Justin A. Charles
- Department of Family Medicine and Public Health, UC San Diego Health, San Diego, CA 92093, USA
| | - Nathan I. Wood
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA; (N.I.W.); (J.O.M.); (L.S.)
| | - Stephanie Neary
- Physician Assistant Online Program, Yale University School of Medicine, New Haven, CT 06520, USA;
| | - Jorge O. Moreno
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA; (N.I.W.); (J.O.M.); (L.S.)
| | - Lindsey Scierka
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA; (N.I.W.); (J.O.M.); (L.S.)
| | - Benjamin Brink
- Department of Internal Medicine, Brown University-Rhode Island Hospital, Providence, RI 02912, USA
| | - Xiwen Zhao
- Yale Center for Analytical Sciences, Yale University School of Public Health, New Haven, CT 06511, USA;
| | - Katherine A. Gielissen
- Division of General Internal Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA;
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Andoy-Galvan JA, Sriram S, Kiat TJ, Xin LZ, Shin WJ, Chinna K. Obesogenic Environment in the medical field: First year findings from a five-year cohort study. F1000Res 2023; 12:550. [PMID: 37868299 PMCID: PMC10589624 DOI: 10.12688/f1000research.125203.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 10/24/2023] Open
Abstract
Background: Doctors with a normal BMI and healthy living habits have shown to be more confident and effective in providing realistic guidance and obesity management to their patients. This study investigated obesogenic tendencies of medical students as they progress in their medical studies. Methods: A cohort of forty-nine medical students enrolled in a five-year cohort study and was followed up after one year. At the initiation of the cohort, socio-demography and information on anthropometry, accommodation, eating behavior, stress and sleeping habits of the students had been recorded. Follow-up data was collected using a standardized self-administered questionnaire. Results: Thirty-seven percent of the students in the cohort are either obese or overweight in the one-year period.. A year of follow-up suggests that there is an increase in BMI among the male students (P=0.008) and the changes are associated with changes in accommodation (P=0.016), stress levels (P=0.021), and sleeping habits (P=0.011). Conclusion: Medical education system should seriously consider evaluating this aspect in the curriculum development to help our future medical practitioners practice a healthy lifestyle and be the initiator of change in the worsening prevalence of obesity worldwide.
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Affiliation(s)
- Jo Ann Andoy-Galvan
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, 47500, Malaysia
| | - Shyamkumar Sriram
- School of Health Sciences and Professions, Department of Social and Public Health, Ohio University, Athens, OH, 45701, USA
| | - Tey Jin Kiat
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, 47500, Malaysia
| | - Lim Zig Xin
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, 47500, Malaysia
| | - Wong Jun Shin
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, 47500, Malaysia
| | - Karuthan Chinna
- Faculty of Business and Management, UCSI University, Cheras, Kuala Lumpur, 56100, Malaysia
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Alamri AS, Al-Otaibi FS, Alzahrani AO, Alharthi AS, Alfaran RM, Alzahrani AS. Lifestyle Assessment of Primary Healthcare Physicians in Taif, Saudi Arabia in the Year 2022. Cureus 2023; 15:e37323. [PMID: 37182051 PMCID: PMC10167881 DOI: 10.7759/cureus.37323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
Objective This study aims to evaluate primary healthcare physicians' lifestyles to promote their well-being and improve care quality for the general population. Methods This cross-sectional quantitative study was conducted on primary healthcare physicians in Taif, Kingdom of Saudi Arabia (KSA), using self-administered questionnaires. Results We included 206 participants aged 26-66. Most participants were 35 years old or younger (67%), male (62.1%), and residents (52.4%). Of all participants, 49.5% held a Bachelor's degree, 40.8% had completed their board certificate or Ph.D., and 69.9% had at least 10 years of experience. Of all participants, 16.5% and less than 9% reported having hypercholesterolemia and other comorbidities, respectively. More than 50% were physically inactive, 26.2% were moderately inactive, and 17.4% were moderately active or active individuals. Physical activity was significantly associated with job titles (p < 0.018). The qualification was associated with dietary score (p = 0.034), and 42.7% of participants were in need of diet change. About a quarter (25.2%) were smokers, and 92.3% of them smoked daily. Male participants were associated with a greater likelihood of smoking (p < 0.001). Overall, 41.7% were overweight, and 25.7% were obese. Increased BMI was associated with older age and male gender (p < 0.001 and p < 0.002, respectively), as well as the title of the physician and years of experience (p < 0.001 and p < 0.002, respectively). Conclusion Participants' unhealthy lifestyles indicate the need to establish measures to promote healthy lifestyles among physicians.
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Affiliation(s)
- Abdullah S Alamri
- Department of Preventive Medicine, Prince Mansour Military Hospital, Taif, SAU
| | - Fawaz S Al-Otaibi
- Department of Family Medicine, Alhada Armed Forces Hospital, Taif, SAU
| | - Ali O Alzahrani
- Department of Family Medicine, Alhada Armed Forces Hospital, Taif, SAU
| | | | - Raed M Alfaran
- Department of Family Medicine, Prince Mansour Military Hospital, Taif, SAU
| | - Ahmed S Alzahrani
- Department of Preventive Medicine, Prince Mansour Military Hospital, Taif, SAU
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Bailey-Davis L, Moore AM, Poulsen MN, Dzewaltowski DA, Cummings S, DeCriscio LR, Hosterman JF, Huston D, Kirchner HL, Lutcher S, McCabe C, Welk GJ, Savage JS. Comparing enhancements to well-child visits in the prevention of obesity: ENCIRCLE cluster-randomized controlled trial. BMC Public Health 2022; 22:2429. [PMID: 36572870 PMCID: PMC9792161 DOI: 10.1186/s12889-022-14827-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/06/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Obesity disproportionally impacts rural, lower-income children in the United States. Primary care providers are well-positioned to engage parents in early obesity prevention, yet there is a lack of evidence regarding the most effective care delivery models. The ENCIRCLE study, a pragmatic cluster-randomized controlled trial, will respond to this gap by testing the comparative effectiveness of standard care well-child visits (WCV) versus two enhancements: adding a patient-reported outcome (PRO) measure (PRO WCV) and PRO WCV plus Food Care (telehealth coaching and a grocery store tour). METHODS A total of 2,025 parents and their preschool-aged children (20-60 months of age) will be recruited from 24 Geisinger primary care clinics, where providers are randomized to the standard WCV, PRO WCV, or PRO WCV plus Food Care intervention arms. The PRO WCV includes the standard WCV plus collection of the PRO-the Family Nutrition and Physical Activity (FNPA) risk assessment-from parents. Parents complete the PRO in the patient-portal or in the clinic (own device, tablet, or kiosk), receive real-time feedback, and select priority topics to discuss with the provider. These results are integrated into the child's electronic health record to inform personalized preventive counseling by providers. PRO WCV plus Food Care includes referrals to community health professionals who deliver evidence-based obesity prevention and food resource management interventions via telehealth following the WCV. The primary study outcome is change in child body mass index z-score (BMIz), based on the World Health Organization growth standards, 12 months post-baseline WCV. Additional outcomes include percent of children with overweight and obesity, raw BMI, BMI50, BMIz extended, parent involvement in counseling, health behaviors, food resource management, and implementation process measures. DISCUSSION Study findings will inform health care systems' choices about effective care delivery models to prevent childhood obesity among a high-risk population. Additionally, dissemination will be informed by an evaluation of mediating, moderating, and implementation factors. TRIAL REGISTRATION ClinicalTrials.gov identifier (NCT04406441); Registered May 28, 2020.
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Affiliation(s)
- Lisa Bailey-Davis
- grid.280776.c0000 0004 0394 1447Department of Population Health Sciences, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA ,Center for Obesity & Metabolic Research, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA
| | - Amy M. Moore
- grid.29857.310000 0001 2097 4281Center for Childhood Obesity Research, The Pennsylvania State University, 129 Noll Laboratory, University Park, PA 16802 USA
| | - Melissa N. Poulsen
- grid.280776.c0000 0004 0394 1447Department of Population Health Sciences, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA
| | - David A. Dzewaltowski
- grid.266813.80000 0001 0666 4105College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198 USA
| | - Stacey Cummings
- Department of Pediatrics, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA
| | - Laina R. DeCriscio
- Health and Wellness, Steele Institute, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA
| | - Jennifer Franceschelli Hosterman
- Department of Pediatrics, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA ,Departments of Internal Medicine and Pediatrics, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA
| | - Daniel Huston
- Health and Wellness, Steele Institute, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA
| | - H. Lester Kirchner
- grid.280776.c0000 0004 0394 1447Department of Population Health Sciences, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA
| | - Shawnee Lutcher
- Center for Obesity & Metabolic Research, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA
| | - Carolyn McCabe
- grid.280776.c0000 0004 0394 1447Department of Population Health Sciences, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA ,Center for Obesity & Metabolic Research, Geisinger, 100 N Academy Ave, Danville, PA 17822 USA
| | - Gregory J. Welk
- grid.34421.300000 0004 1936 7312Department of Kinesiology, Iowa State University, 103E Forker, 534 Wallace Rd, Ames, IA 50011 USA
| | - Jennifer S. Savage
- grid.29857.310000 0001 2097 4281Center for Childhood Obesity Research, The Pennsylvania State University, 129 Noll Laboratory, University Park, PA 16802 USA
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Leow SN, Tay CL, Ng WW, Mior Mohammad Jafri MN. Effectiveness of Fit and Trimmed Staffs (FATS) program on weight management among the healthcare providers at Simpang Health Clinic, Perak: A pre-post interventional study. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2022; 17:89-96. [PMID: 36606163 PMCID: PMC9809445 DOI: 10.51866/oa.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Obesity is associated with an increased risk for non-communicable diseases. Local studies have shown that 33.1% of healthcare providers (HCPs) are overweight, while 21.1% are obese. Interventions that consist of diet, physical exercise and cognitive behavioural training have been shown to be successful in reducing weight. METHOD We designed a weight loss programme for our HCPs named the 'Fit and Trimmed Staff programme, which consisted of 3 months of group education on obesity-related health problems led by a doctor, a pharmacist, a nutritionist and an occupational therapist among HCPs. Monthly individual dietary counselling by a nutritionist was also provided for 6 months. We measured the body weight, body mass index, percentage of body fat, visceral fat and percentage of skeletal muscle of the HCPs before and after the intervention. RESULTS Forty-five (56.25%) HCPs at Simpang Health Clinic were either overweight or obese; the majority of them were drivers and administrative clerks (100%), followed by health attendants (69.2%) and medical assistants (63.6%). At 6 months post-intervention, there was a trend towards a non-significant reduction in the fat percentage (median=-0.8%, P=0.423). Approximately 42% (n=19) of the HCPs lost weight, while 58% gained weight. Weight loss was observed more commonly in the male HCPs (>50%) than in the female HCPs. CONCLUSION A weight loss programme solely consisting of health discussion and nutritional advice is inadequate to induce weight reductions. A multimodal approach may be considered in managing weight among HCPs.
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Affiliation(s)
- Shing Ni Leow
- MD (MMA, Russia) , Doctor of Family Medicine (UKM), Klinik Kesihatan Changkat Jering, Changkat Jering, Taiping, Perak, Malaysia.
| | - Chai Li Tay
- MD (UKM), MFamMed (UM), Klinik Kesihatan Simpang, Jalan, Kuala Kangsar, Simpang, Taiping, Perak, Malaysia
| | - Wei Wei Ng
- BSc (Hon) Nutrition (UKM), Klinik Kesihatan Simpang, Jalan, Kuala Kangsar, Simpang 34700, Taiping, Perak, Malaysia
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15
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Xie X, Chen Q, Liu H. Barriers to hospital-based phase 2 cardiac rehabilitation among patients with coronary heart disease in China: a mixed-methods study. BMC Nurs 2022; 21:333. [PMID: 36447215 PMCID: PMC9706833 DOI: 10.1186/s12912-022-01115-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Coronary heart disease (CHD) has become a leading cause of morbidity and premature death worldwide. Cardiac rehabilitation (CR) was proved to have substantial benefits for patients with CHD. The CR was divided into three phases. Phase 2 is the important part of CR which involves hospital-based structured and closely monitored exercises and activities. However, CR utilization is low worldwide. The barriers to hospital-based phase 2 CR in China have not been well identified. AIMS To investigate barriers to hospital-based phase 2 cardiac rehabilitation among coronary heart disease patients in China and to explore the reasons. METHODS This study employed an explanatory sequential mixed-methods design. The study was conducted in a university hospital in China from July 2021 to December 2021. Quantitative data was collected through the Cardiac Rehabilitation Barrier Scale. Qualitative data was collected through unstructured face-to-face interviews. Data analysis included descriptive statistics and inductive qualitative content analysis. RESULTS One hundred and sixty patients completed the Cardiac Rehabilitation Barrier Scale and 17 patients participated in unstructured face-to-face interviews. The main barriers identified were distance (3.29 ± 1.565), transportation (2.99 ± 1.503), cost (2.76 ± 1.425), doing exercise at home (2.69 ± 1.509) and time constraints (2.48 ± 1.496). Six themes were identified; logistical factors, social support, misunderstanding of cardiac rehabilitation, program and health system-level factors, impression of CR team and psychological distress. The first four themes confirmed the quantitative results and provide a deeper explanation for the quantitative results. The last two themes were new information that emerged in the qualitative phase. CONCLUSION This study provides a better understanding of the barriers to hospital-based phase 2 cardiac rehabilitation among coronary heart disease patients in the Chinese context during the Covid-19 pandemic. Innovative programs such as home-based CR, mobile health, and hybrid programs might be considered to overcome some of these barriers. In addition, psychosocial intervention should be included in these programs to mitigate some of the barriers associated with the impression of CR team and psychological distress.
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Affiliation(s)
- Xiaoqi Xie
- Shantou University Medical College, Shantou, Guangdong Province, China
| | - Qiongshan Chen
- Shantou University Medical College, Shantou, Guangdong Province, China
| | - Hui Liu
- Department of Cardiology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
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16
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Cassiano GS, Carvalho-Ferreira JP, Buckland NJ, Ulian MD, da Cunha DT. Are Dietitians With Obesity Perceived as Competent and Warm? Applying the Stereotype Content Model to Weight Stigma in Brazil. Front Nutr 2022; 9:813344. [PMID: 35284459 PMCID: PMC8916106 DOI: 10.3389/fnut.2022.813344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/31/2022] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to understand how dietitians' body size influences perceived competence and warmth, based on the Stereotype Content Model (SCM). Online data were collected from 1,039 Brazilians, who were either laypeople, registered dietitians, or nutrition students. Participants rated the competence and warmth dimensions of three dietitians who differed in sex, body weight, and age. Participants also indicated how likelythey would consult or recommend each dietitian for nutritional advice, and indicated their attitudes toward people with obesity (PWO) [using The Antifat Attitudes Test (AFAT)]. Laypeople attributed less competence and warmth to all profiles compared to dietitians and students (p < 0.001). Three clusters occupied the SCM warmth-by-competence space. However, the clusters were different among groups (laypeople, dietitians, and students). For lay participants, the woman without overweight, the older woman, and the older man were located in the high competence/medium warmth cluster. Meanwhile, the woman with obesity was located in the medium competence/high warmth cluster. The dietitians and students map found the woman with obesity and the older woman in a high competence and warmth cluster. In general, the woman with obesity, the man without obesity, and the older man can be classified as ambivalent stereotypes, the woman being perceived as more warm than competent and the men more competent than warm. Participants with high AFAT scores were less likely to consult or recommend to a family member a dietitian with obesity. This study contributes to identifying ambivalent stereotypes for dietitians. Dietitians with obesity can be seen as warm but less competent. Also, although less intense than laypeople, dietitians, and students exhibited weight stigma. These findings can foster important discussions about weight stigma and emphasize the need to increase population awareness about the causes of obesity.
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Affiliation(s)
- Giovana Santarosa Cassiano
- Multidisciplinary Food and Health Laboratory, School of Applied Sciences, State University of Campinas, Campinas, Brazil
| | | | - Nicola J. Buckland
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Mariana Dimitrov Ulian
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Diogo Thimoteo da Cunha
- Multidisciplinary Food and Health Laboratory, School of Applied Sciences, State University of Campinas, Campinas, Brazil
- *Correspondence: Diogo Thimoteo da Cunha
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17
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Poulton G, Antono A. A Taste of Virtual Culinary Medicine and Lifestyle Medicine-An Online Course for Medical Students. Am J Lifestyle Med 2022; 16:57-60. [PMID: 35185428 PMCID: PMC8848118 DOI: 10.1177/15598276211046558] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
As medical schools work to train the next generation of providers, including robust content in nutrition education is paramount. The National Academy of Sciences sets the benchmark for 25 hours of nutrition education in medical schools, though many schools do not meet this requirement. Usually, nutrition lectures in medical schools are given in the pre-clinical years and focus on biochemistry and micronutrients. During the COVID-19 pandemic, there was a unique opportunity to quickly develop and implement an elective course for 3rd and 4th year medical students at the University of North Carolina School of Medicine. A course was created in lifestyle medicine and culinary medicine, and all were delivered remotely through Zoom. This course would be simple to replicate at other institutions and was very well received. This article will describe more of the resources, methods, and reactions to this course.
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Affiliation(s)
- Ginger Poulton
- Ginger Poulton, MD, Mountain Area Health Education Center and the University of Chapel Hill Medical School, 218 Elkwood Ave, Asheville, NC 28804, USA; e-mail:
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18
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Rempel AML, Barlow PB, Kaldjian LC. Medical Education and the Ethics of Self-Care: A Survey of Medical Students Regarding Professional Challenges and Expectations for Living Healthy Lifestyles. South Med J 2021; 114:783-788. [PMID: 34853855 DOI: 10.14423/smj.0000000000001333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Little is known about medical students' attitudes regarding the healthy lifestyle habits they are taught to recommend to patients and whether they believe they have a professional responsibility to live a healthy lifestyle. Understanding students' attitudes and practices regarding healthy lifestyles may provide insights into the personal and professional challenges that students face as they navigate the ethical tension between obligations to care for others (altruism) and for themselves (self-care). METHODS The authors conducted a cross-sectional, anonymous, online survey of all medical students at the University of Iowa Carver College of Medicine in fall 2019, using descriptive statistics for analysis. RESULTS A total of 351 students participated (response rate, 52.0%). Most agreed that physicians (85.5%) and medical students (77.8%) have a responsibility to try to live a healthy lifestyle; that physicians who practice healthy behaviors are more confident in counseling patients (94.0%), more likely to counsel patients (88.3%), and more likely to have their advice followed (86.9%); that as students they are more likely to counsel patients if they practice the healthy behavior (90.0%); and that their medical school workload resulted in exercise (69.7%), sleeping (69.4%), and eating (60.2%) practices that were less healthy than they should be. CONCLUSIONS Most medical students support the professional responsibility to live a healthy lifestyle and believe doing so increases their effectiveness in counseling patients about healthy lifestyle habits. The medical school workload may limit some students' ability to live healthy lifestyles, however. Medical students need educational opportunities in ethics and professionalism to discuss challenges and expectations for living healthy lifestyles, with an eye toward practical approaches to living the life of a medical student that are professionally responsible and personally realistic.
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Affiliation(s)
- Anne M L Rempel
- From the Department of Internal Medicine, the Office of Consultation and Research in Medical Education, and the Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City
| | - Patrick B Barlow
- From the Department of Internal Medicine, the Office of Consultation and Research in Medical Education, and the Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City
| | - Lauris C Kaldjian
- From the Department of Internal Medicine, the Office of Consultation and Research in Medical Education, and the Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City
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19
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Kahleova H, Berrien-Lopez R, Holtz D, Green A, Sheinberg R, Gujral H, Holubkov R, Barnard ND. Nutrition for Hospital Workers During a Crisis: Effect of a Plant-Based Dietary Intervention on Cardiometabolic Outcomes and Quality of Life in Healthcare Employees During the COVID-19 Pandemic. Am J Lifestyle Med 2021; 16:399-407. [PMID: 35698577 PMCID: PMC9184832 DOI: 10.1177/15598276211050339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The study tested the effects of a vegan diet on cardiometabolic outcomes and quality of
life among healthcare employees during the COVID-19 pandemic. Overweight hospital
employees were enrolled and randomly assigned (in a 1:1 ratio) to an intervention group,
which was asked to follow a low-fat vegan diet, or a control group, asked to make no diet
changes. However, due to COVID-19 disruptions, all participants remained on their usual
diets from March to June (12 weeks), creating a de facto control period, and all (n = 12)
started the vegan diet with online classes in June, which continued for 12 weeks. Nine
participants completed all final assessments. A crossover ANOVA was used for statistical
analysis of differences in cardiovascular health during the control period and during the
intervention. Despite the ongoing crisis, body weight decreased (treatment effect −5.7 kg
[95% CI −9.7 to −1.7]; P = .01); fasting plasma glucose decreased
(−11.4 mg/dL [95% CI −18.8 to −4.1]; P = .007); total and LDL-cholesterol
decreased (−30.7 mg/dL [95% CI −53.8 to −7.5]; P = .02; and −24.6 mg/dL
[−44.8 to −4.3]; P = .02, respectively); diastolic blood pressure
decreased (−8.5 mm Hg [95% CI −16.3 to −.7]; P = .03); and quality of
life increased (P = .005) during the intervention period, compared with
the control period. A vegan diet improved cardiometabolic outcomes and quality of life in
healthcare workers at the height of the COVID-19 pandemic.
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Affiliation(s)
- Hana Kahleova
- Physicians Committee for Responsible Medicine, Washington, DC, USA, (HK, DH, AG, NDB); Adjunct Faculty, George Washington University School of Medicine and Health Sciences, Washington, DC, USA, (NDB); University of Maryland School of Medicine, Baltimore City, MD, USA, (RBL); Sibley Memorial Hospital, Washington, DC, USA, (HG, RS); School of Medicine, University of Utah, Salt Lake City, UT, USA, (RH)
| | - Rickisha Berrien-Lopez
- Physicians Committee for Responsible Medicine, Washington, DC, USA, (HK, DH, AG, NDB); Adjunct Faculty, George Washington University School of Medicine and Health Sciences, Washington, DC, USA, (NDB); University of Maryland School of Medicine, Baltimore City, MD, USA, (RBL); Sibley Memorial Hospital, Washington, DC, USA, (HG, RS); School of Medicine, University of Utah, Salt Lake City, UT, USA, (RH)
| | - Danielle Holtz
- Physicians Committee for Responsible Medicine, Washington, DC, USA, (HK, DH, AG, NDB); Adjunct Faculty, George Washington University School of Medicine and Health Sciences, Washington, DC, USA, (NDB); University of Maryland School of Medicine, Baltimore City, MD, USA, (RBL); Sibley Memorial Hospital, Washington, DC, USA, (HG, RS); School of Medicine, University of Utah, Salt Lake City, UT, USA, (RH)
| | - Amber Green
- Physicians Committee for Responsible Medicine, Washington, DC, USA, (HK, DH, AG, NDB); Adjunct Faculty, George Washington University School of Medicine and Health Sciences, Washington, DC, USA, (NDB); University of Maryland School of Medicine, Baltimore City, MD, USA, (RBL); Sibley Memorial Hospital, Washington, DC, USA, (HG, RS); School of Medicine, University of Utah, Salt Lake City, UT, USA, (RH)
| | - Rosanne Sheinberg
- Physicians Committee for Responsible Medicine, Washington, DC, USA, (HK, DH, AG, NDB); Adjunct Faculty, George Washington University School of Medicine and Health Sciences, Washington, DC, USA, (NDB); University of Maryland School of Medicine, Baltimore City, MD, USA, (RBL); Sibley Memorial Hospital, Washington, DC, USA, (HG, RS); School of Medicine, University of Utah, Salt Lake City, UT, USA, (RH)
| | - Harpreet Gujral
- Physicians Committee for Responsible Medicine, Washington, DC, USA, (HK, DH, AG, NDB); Adjunct Faculty, George Washington University School of Medicine and Health Sciences, Washington, DC, USA, (NDB); University of Maryland School of Medicine, Baltimore City, MD, USA, (RBL); Sibley Memorial Hospital, Washington, DC, USA, (HG, RS); School of Medicine, University of Utah, Salt Lake City, UT, USA, (RH)
| | - Richard Holubkov
- Physicians Committee for Responsible Medicine, Washington, DC, USA, (HK, DH, AG, NDB); Adjunct Faculty, George Washington University School of Medicine and Health Sciences, Washington, DC, USA, (NDB); University of Maryland School of Medicine, Baltimore City, MD, USA, (RBL); Sibley Memorial Hospital, Washington, DC, USA, (HG, RS); School of Medicine, University of Utah, Salt Lake City, UT, USA, (RH)
| | - Neal D. Barnard
- Physicians Committee for Responsible Medicine, Washington, DC, USA, (HK, DH, AG, NDB); Adjunct Faculty, George Washington University School of Medicine and Health Sciences, Washington, DC, USA, (NDB); University of Maryland School of Medicine, Baltimore City, MD, USA, (RBL); Sibley Memorial Hospital, Washington, DC, USA, (HG, RS); School of Medicine, University of Utah, Salt Lake City, UT, USA, (RH)
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20
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Lianov LS, Barron GC, Fredrickson BL, Hashmi S, Klemes A, Krishnaswami J, Lee J, Le Pertel N, Matthews JA, Millstein RA, Phillips EM, Sannidhi D, Purpur de Vries P, Wallace A, Winter SJ. Positive psychology in health care: defining key stakeholders and their roles. Transl Behav Med 2021; 10:637-647. [PMID: 32766868 DOI: 10.1093/tbm/ibz150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Lifestyle-related diseases have common risk factors: physical inactivity, poor diet, inadequate sleep, high stress, substance use, and social isolation. Evidence is mounting for the benefits of incorporating effective methods that promote healthy lifestyle habits into routine health care treatments. Research has established that healthy habits foster psychological and physiological health and that emotional well-being is central to achieving total well-being. The Happiness Science and Positive Health Committee of the American College of Lifestyle Medicine aims to raise awareness about strategies for prioritizing emotional well-being. The Committee advocates for collaborative translational research to adapt the positive psychology and behavioral medicine evidence base into methodologies that address emotional well-being in nonmental health care settings. Another aim is to promote health system changes that integrate evidence-based positive-psychology interventions into health maintenance and treatment plans. Also, the Committee seeks to ameliorate health provider burnout through the application of positive psychology methods for providers' personal health. The American College of Lifestyle Medicine and Dell Medical School held an inaugural Summit on Happiness Science in Health Care in May 2018. The Summit participants recommended research, policy, and practice innovations to promote total well-being via lifestyle changes that bolster emotional well-being. These recommendations urge stakeholder collaboration to facilitate translational research for health care settings and to standardize terms, measures, and clinical approaches for implementing positive psychology interventions. Sample aims of joint collaboration include developing evidence-based, practical, low-cost behavioral and emotional assessment and monitoring tools; grants to encourage dissemination of pilot initiatives; medical record dashboards with emotional well-being and related aspects of mental health as vital signs; clinical best practices for health care teams; and automated behavioral programs to extend clinician time. However, a few simple steps for prioritizing emotional well-being can be implemented by stakeholders in the near-term.
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Affiliation(s)
- Liana S Lianov
- American College of Lifestyle Medicine, Chesterfied, MO, USA
| | - Grace Caroline Barron
- Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Barbara L Fredrickson
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sean Hashmi
- Adult Weight Management, Southern California Kaiser Permanente, Woodland Hills, CA, USA
| | | | | | - Jenny Lee
- Department of Preventive Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Noémie Le Pertel
- Empowered Wellness and Center for Positive Leadership LLC, Primary Care, Columbia University Irving Medical Center, New York, NY, USA
| | - Jessica A Matthews
- Department of Kinesiology, Point Loma Nazarene University, San Diego, CA, USA
| | - Rachel A Millstein
- Behavioral Medicine Program and Cardiac Psychiatry Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Edward M Phillips
- Physical Medicine and Rehabilitation Service, VA Boston Health Care System and Institute of Lifestyle Medicine, Boston, MA, USA
| | - Deepa Sannidhi
- Division of Family Medicine, Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA.,Division of Preventive Medicine, Department of Family Medicine and Public Health, UC San Diego Health, La Jolla, CA, USA
| | | | - Anne Wallace
- Beech Acres Parenting Center, Cincinnati, OH, USA
| | - Sandra J Winter
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
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21
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Pfoh ER, Heinberg LJ, Rothberg MB. Factors Impacting Physician Referral To and Patient Attendance at Weight Management Programs Within a Large Integrated Health System. J Gen Intern Med 2021; 36:2339-2345. [PMID: 33483826 PMCID: PMC8342643 DOI: 10.1007/s11606-020-06520-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/20/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Identifying which patients receive referrals to and which ones attend weight management programs can provide insights into how physicians manage obesity. OBJECTIVE To describe patient factors associated with referrals, which primarily reflect physician priorities, and attendance, which reflects patient priorities. We also examine the influence of the individual physician by comparing adjusted rates of referral and attendance across physicians. DESIGN Retrospective cohort study. PARTICIPANTS Adults with a body mass index (BMI) ≥ 30 kg/m2 who had a primary care visit between 2015 and 2018 at a large integrated health system MAIN MEASURES: Referrals and visits to programs were collected from the EHR in 2019 and analyzed in 2019-2020. Multilevel logistic regression models were used to identify the association between patient characteristics and (1) receiving a referral, and (2) attending a visit after a referral. We compared physicians' adjusted probabilities of referring patients and of their patients attending a visit. KEY RESULTS Our study included 160,163 adults, with a median BMI of 35 kg/m2. Seventeen percent of patients received ≥ 1 referral and 29% of those attended a visit. The adjusted odds of referral increased 57% for patients with a BMI 35-39 (versus 30-34) and 32% for each comorbidity (p < 0.01). Attending a visit was less strongly associated with BMI (aOR 1.18 for 35-39 versus 30-34, 95% CI 1.09-1.27) and not at all with comorbidity. For the physician-level analysis, the adjusted probability of referral had a much wider range (0 to 83%; mean = 19%) than did the adjusted probability of attendance (range 27 to 34%). CONCLUSIONS Few patients attended a weight management program. Physicians vary greatly in their probability of referring patients to programs but not in their patients' probability of attending.
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Affiliation(s)
- Elizabeth R Pfoh
- Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland, OH, USA.
| | - Leslie J Heinberg
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.,Enterprise Weight Management Center, Cleveland Clinic, Cleveland, OH, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic Community Care, Cleveland, OH, USA
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22
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Cepni AB, Hatem C, Ledoux TA, Johnston CA. The Importance of Health Values Among Health Care Providers. Am J Lifestyle Med 2021; 15:224-226. [PMID: 34025310 PMCID: PMC8120612 DOI: 10.1177/1559827621992271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Medical professionals' healthy eating and physical activity behaviors are likely to wane as other life events and everyday pressures increase. This is vital because as health behaviors decrease, the likelihood that this topic is addressed with patients also decreases. Increased training to improve health care providers' knowledge about lifestyle behaviors may be inadequate to actually bring about a healthier lifestyle. The area of personal identity and value formation may shed light on a significant barrier in this area. Developing health care professionals who have values consistent with a healthy diet and physical activity, instead of just being informed about it, would increase the likelihood that healthy behavior changes are discussed with patients. Strategies to encourage value formation around healthy lifestyles among medical professionals are discussed.
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Affiliation(s)
- Aliye B. Cepni
- Department of Health and Human Performance, University of Houston, Houston, Texas
| | - Cherine Hatem
- Department of Health and Human Performance, University of Houston, Houston, Texas
| | - Tracey A. Ledoux
- Department of Health and Human Performance, University of Houston, Houston, Texas
| | - Craig A. Johnston
- Department of Health and Human Performance, University of Houston, Houston, Texas
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23
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Obesity among Health-Care Workers: Which Occupations Are at Higher Risk of Being Obese? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084381. [PMID: 33924182 PMCID: PMC8074354 DOI: 10.3390/ijerph18084381] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/17/2021] [Accepted: 04/18/2021] [Indexed: 11/17/2022]
Abstract
Obesity among health-care workers (HCWs) is an important issue as it can affect both their health condition and their professional capability. Although adult obesity is attributable to occupational factors, few reports are available on Malaysian health-care workers’ obesity and whether different health-care job categories are related to workers’ obesity. This study aimed to determine the prevalence of obesity among HCWs and the association between various HCW job categories and obesity. A cross-sectional study was conducted by analyzing secondary data from the 2019 annual cardiovascular health screening program, which included information regarding all government health-care workers in the east coast region of Peninsular Malaysia. The subject’s body mass index (BMI) was categorized according to WHO criteria. Only 43% of the subjects had a normal BMI, while 33.1% were categorized as overweight, and 21.1% were obese. Different HCWs’ job categories were shown to be significantly associated with their obesity status, with nurses apparently having a higher risk of being obese (Adj OR = 1.91, 95% CI 1.45, 2.53, p-value < 0.001). This study’s results require further exploration of HCWs’ working condition factors and for different job categories that contribute to obesity. Public health intervention programs to combat obesity should be implemented that primarily target HCW groups at the highest risk of obesity.
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24
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Sbraccia P, Busetto L, Santini F, Mancuso M, Nicoziani P, Nicolucci A. Misperceptions and barriers to obesity management: Italian data from the ACTION-IO study. Eat Weight Disord 2021; 26:817-828. [PMID: 32385580 PMCID: PMC8004527 DOI: 10.1007/s40519-020-00907-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/15/2020] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Despite the increasing prevalence of obesity in Italy, it remains largely underdiagnosed and undertreated. We aimed to identify the perceptions, attitudes, behaviours and barriers to effective obesity care among people with obesity (PwO) and healthcare professionals (HCPs) in Italy. METHODS The ACTION-IO study was an online cross-sectional survey conducted in 11 countries from June to October 2018. Findings from the Italian cohort are reported here. RESULTS The survey was completed by 1501 PwO and 302 HCPs in Italy. Most PwO (84%) and HCPs (77%) acknowledged the large impact of obesity on overall health. However, fewer PwO (62%) than HCPs (91%) perceived obesity as a chronic disease. Most PwO (84%) assumed full responsibility for their weight loss. A median of 3 (mean 6) years elapsed between when PwO started struggling with obesity and when they first discussed their weight with an HCP. Many PwO expressed that they liked (80%) or would like (74%) their HCPs to initiate weight management conversations, and only 3% were offended by such a conversation. For 77% of HCPs, perceiving their patients as unmotivated or disinterested in losing weight prevented them from initiating these conversations. Short appointment times were also considered a limiting factor for 40% of HCPs. CONCLUSIONS Most PwO took complete responsibility for their own weight loss and waited considerable time before seeking help from an HCP. There is a need for improved education of both PwO and HCPs and for a more positive attitude from HCPs towards initiating weight discussions with PwO. Trial registration ClinicalTrials.gov: Awareness, Care & Treatment in Obesity Management - an International Observation (ACTION-IO). ClinicalTrials.gov: NCT03584191 LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.
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Affiliation(s)
- Paolo Sbraccia
- Internal Medicine Unit and Obesity Center, Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
| | - Luca Busetto
- Center for the Study and the Integrated Treatment of Obesity, University Hospital of Padua, Padua, Italy
| | - Ferruccio Santini
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | | | | | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
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Reilly J, Burrell D. Educating Trainees to Manage Pregnant Women With Obesity: A Primer. Clin Obstet Gynecol 2021; 64:244-249. [PMID: 33481419 DOI: 10.1097/grf.0000000000000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review is intended to outline essential resources for trainees in order to optimize education on the care of pregnant patients with obesity. Addressing provider biases, exploring ethical considerations of care and streamlining screening and counseling of patients with obesity will provide an excellent framework for our trainees to care for women with obesity from preconception to postpartum care and beyond.
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Affiliation(s)
- Justine Reilly
- Department of Obstetrics & Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, Providence, Rhode Island
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Vázquez‐Velázquez V, Laviada‐Molina H, García‐García E, Sandoval‐Diez E, Mancillas‐Adame L. Perceptions, Attitudes, and Barriers to Obesity Care in Mexico: Data From the ACTION-IO Study. Obesity (Silver Spring) 2021; 29:317-326. [PMID: 33491317 PMCID: PMC7898320 DOI: 10.1002/oby.23077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/06/2020] [Accepted: 11/01/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The Awareness, Care, and Treatment in Obesity Management-International Observation (ACTION-IO) study (ClinicalTrials.gov identifier NCT03584191) aimed to identify perceptions, attitudes, behaviors, and barriers to effective obesity care in people with obesity (PwO) and health care professionals (HCPs). This study presents the results from Mexico. METHODS An online survey was conducted. In Mexico, eligible PwO were ≥18 years of age with BMI ≥30 kg/m2 based on self-reported height and weight. Eligible HCPs had direct patient care. RESULTS The survey was completed by 2,000 PwO and 400 HCPs in Mexico. Many PwO (71%) and HCPs (94%) categorized obesity as a chronic disease. Sixty-three percent of PwO felt motivated to lose weight, but many HCPs perceived that PwO were not interested in losing weight (76%) or motivated to lose weight (69%). Lack of financial means to support weight-loss efforts was a barrier for PwO (34%) to discussing weight with HCPs. Sixty-five percent of PwO had discussed weight with HCPs in the past 5 years. PwO (80%) and HCPs (89%) considered lack of exercise as the main barrier to weight loss. Few PwO (34%) had successfully lost ≥5% of their body mass over the past 3 years. CONCLUSIONS This ACTION-IO study in Mexico identified discrepancies in the perceptions of PwO and HCPs, highlighting opportunities for further education and patient-centered approaches.
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Affiliation(s)
- Verónica Vázquez‐Velázquez
- Obesity and Eating Disorder ClinicInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | | | - Eduardo García‐García
- Obesity and Eating Disorder ClinicInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | | | - Leonardo Mancillas‐Adame
- Endocrinology DivisionUniversity Hospital and Medical SchoolAutonomous University of Nuevo LeónSan Nicolás de los GarzaMexico
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Alnasiri AA, Alruwaili N. Influence of physicians' BMI on counseling practice for obesity in primary health care clinics in Aljouf region, Saudi Arabia. A cross-sectional study. J Family Med Prim Care 2021; 10:4143-4146. [PMID: 35136780 PMCID: PMC8797116 DOI: 10.4103/jfmpc.jfmpc_700_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives: Methods: Results: Conclusion:
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Stuij M, van Maarschalkerweerd PEA, Seidell JC, Halberstadt J, Dedding C. Youth perspectives on weight-related words used by healthcare professionals: A qualitative study. Child Care Health Dev 2020; 46:369-380. [PMID: 32037594 DOI: 10.1111/cch.12760] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/28/2020] [Accepted: 02/03/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although healthcare professionals often consider body weight a sensitive and difficult topic to discuss with children, a contextualized and comprehensive understanding of youth perspectives on weight-related words used in healthcare has yet to be established. This qualitative study aims to explore perspectives of Dutch children on the terminology healthcare professionals use when discussing weight. METHODS Fourteen interviews and one focus group discussion were held with children (age 8-16) who were in care because of their weight. A toolkit with customizable interview techniques was used in order to facilitate reflection and tailor the interview to each respondent. A narrative content analysis was conducted. RESULTS Respondents attached both clear and subtle differences in meanings to (certain) weight-related words. Their perspectives were not unanimous for any single word. Moreover, at times, respondents framed certain words in positive or negative ways or used a word they disliked to describe themselves. This illustrates that meanings of weight-related words are not fixed but context and situation specific. CONCLUSION This study revealed that meanings children assign to weight-related words are shaped by their experiences in the broader social context, especially at school, as well as with (previous) healthcare professionals. It pointed towards the importance of bedside manner, acquaintanceship, and support. Healthcare professionals treating children because of their body weight are advised to invest in a good patient-caregiver relationship, pay attention to children's previous (negative) social weight-related experiences, and reflect critically on their own preconceptions about body weight and the impact these preconceptions might have on their patient-caregiver relationships.
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Affiliation(s)
- Mirjam Stuij
- Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands.,Mulier Institute, Utrecht, The Netherlands
| | - Pomme E A van Maarschalkerweerd
- Faculty of Science, Department of Health Sciences, Section Youth and Lifestyle, VU University Amsterdam, Amsterdam, The Netherlands
| | - Jaap C Seidell
- Faculty of Science, Department of Health Sciences, Section Youth and Lifestyle, VU University Amsterdam, Amsterdam, The Netherlands
| | - Jutka Halberstadt
- Faculty of Science, Department of Health Sciences, Section Youth and Lifestyle, VU University Amsterdam, Amsterdam, The Netherlands
| | - Christine Dedding
- Department of Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands
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Begrambekova YL, Efremushkina AY, Kozhedub YA, Smirnova EA, Terekhovskaya YV, Adonina EV, Petchina IV, Malenkova VY, Fendrikova SV, Skibitsky VV, Lelyavina TA, Kuular IA, Khromov-Borisov NN, Karanadze NA. [Physical training in patients with chronic heart failure: level of involvement, as well as psychosocial, anamnestic and iatrogenic factors that determine the motivation to practice]. ACTA ACUST UNITED AC 2020; 60:18-23. [PMID: 32394852 DOI: 10.18087/cardio.2020.4.n738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/08/2019] [Indexed: 11/18/2022]
Abstract
Introduction Physical exercise (PE) is a necessary part in the treatment of patients with chronic heart failure (CHF), which is stated in the European Society of Cardiology guidelines and the Russian Heart Failure Society guidelines. However, this type of non-drug treatment is still not sufficiently used in HF patients in Russia.Aim To study the current involvement of HF patients in PT and to describe psychosocial factors that influence the patients' willingness to exercise and potential barriers and motivations for PE.Methods This study was designed as an in-moment survey. Patients with CHF who visited clinics in 7 cities of the Russian Federation in 2018 as a part of European Heart Failure Awareness Days were provided with a self-administered questionnaire containing questions about their social and educational status, attitude to PT as a method of treatment, and factors motivating and demotivating them to participation in training sessions. The survey participants were also asked a question about their source of information about exercise in HF. Physicians filled in the items describing HF clinical manifestations (left ventricular ejection fraction (EF) and HF functional class (FC)). Code numbers were used for further identification of the participants and to protect their confidentiality. Statistical analysis was performed with the StatXcat-8 program. Limits of exact confidence intervals (CIs) were provided both for fractions and parameters of polynomial distribution. CI limits for differences and fractions were calculated using MOVER. Age was analyzed using the PAST program.Results The study included 560 patients with HF; 52 % of them were women (mean age, 64; 95 % CI: 63-65 years). Women were 3 years older than men (95 % CI: 1.3-4.9 years). 501 (89.5 %) patients had FC II-III; 265 (49 %) patients had HF with low EF. 350 (62 %) patients had comorbidities: 41.4 % of patients had diabetes mellitus and 25.4 % of patients had arthritis. Only 91 (17 %) patients reported exercising. Patients younger than 65 exercised significantly more frequently than older ones (odds ratio (OR), 1.7, 95 % CI: 1.0-2.7, р<0.001). Patients with higher education had better chances to be involved in PT or were more anxious to start training (OR, 2.7; 95 % CI: 1.6-4.7, р<0.001). The capability for influencing the disease was the major motivation for PT for both sexes. Probability of this answer was 48 % (95 % CI: 33-61) for men and 46 % (95 % CI: 29-63) for women. 62 % of patients indicated poor health as the major barrier for participation in PT. Only 55 % of patients knew that PT could be a method for HF treatment, and only 50 % were informed about that by their physician.Conclusion The factors that positively influence the willingness to exercise include male sex, higher level of education, younger age, and better perception of the own health condition. 62 % of patients indicated poor health as the major barrier for participation in training. On the whole, the awareness of patients about PT benefits for health in HF was low. To our opinion, this was a serious factor of the extremely low involvement of patients in PT. Only 55 % of patients knew that PT could be a method for HF treatment, and, furthermore, only 50 % of patients received this information from their physicians.
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Affiliation(s)
- Yu L Begrambekova
- Medical Scientific and Educational Center of the M.V. Lomonosov Moscow State University
| | - A Yu Efremushkina
- Altay State Medical University Altay Regional Cardiological Dispensary
| | | | | | | | | | | | | | | | | | | | - I A Kuular
- V. A. Almazov National Medical Research Center
| | | | - N A Karanadze
- Medical Scientific and Educational Center of the M.V. Lomonosov Moscow State University
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Carlos S, Rico-Campà A, de la Fuente-Arrillaga C, Echavarri M, Fernandez-Montero A, Gea A, Salazar C, Martínez-González MA. Do healthy doctors deliver better messages of health promotion to their patients?: Data from the SUN cohort study. Eur J Public Health 2020; 30:466-472. [DOI: 10.1093/eurpub/ckaa019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background
Healthy lifestyle adherence is associated with lower chronic disease morbidity/mortality. The role of doctors, as counselors and role models, is essential. Among physicians participating in a prospective cohort, we investigated the behavioral counseling on diet and lifestyle provided to their patients in association with their own personal behaviors.
Methods
We assessed 890 doctors aged ≤65 years participating in the ‘Seguimiento Universidad de Navarra’ (SUN) cohort, who replied to an online questionnaire regarding their practices on behavioral counseling and drug prescription to their patients. Data were combined with previous baseline information on their personal healthy habits.
Results
Among doctors, 31% reported <10 min per visit; 73% counseled 60–100% of their patients on smoking cessation, 58% on physical activity, 54% on weight control, 51% on healthy nutrition, 44% on alcohol avoidance/reduction and 28% recommended alcohol moderate consumption. The percentage of doctors that counseled 100% of their patients about lifestyle was 43% for smoking cessation, 15% for exercise and 13% for weight control and nutrition. Better doctor’s adherence to the Mediterranean dietary pattern was associated with more frequent and longer nutrition counseling. Higher practice of physical activity was associated with longer time on counseling about exercise to their patients. Among doctors both current and former smoking were inversely associated with the frequency and duration of their smoking cessation/avoidance counseling practices.
Conclusions
Personal behavioral changes among doctors and better training of medical doctors on a personal healthy diet and lifestyle are likely to contribute to improve the behavioral counseling given to patients.
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Affiliation(s)
- Silvia Carlos
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain
| | - Anaïs Rico-Campà
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain
- Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
| | - Carmen de la Fuente-Arrillaga
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain
- Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
| | - María Echavarri
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
| | - Alejandro Fernandez-Montero
- IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain
- Department of Occupational Medicine, University of Navarra, Pamplona, Spain
| | - Alfredo Gea
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain
- Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
| | - Camino Salazar
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria, Sanidad de Castilla y Leon (SACYL), Palencia, Spain
| | - Miguel Angel Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain
- Centro de Investigación Biomédica en Red Área de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
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McClure‐Brenchley KJ, Pitpitan EV, Quinn DM. Prejudice against higher‐weight health providers: Implications for patients and providers. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2020. [DOI: 10.1111/jasp.12655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | | | - Diane M. Quinn
- Department of Psychological Sciences University of Connecticut Storrs CT USA
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Ananthakumar T, Jones NR, Hinton L, Aveyard P. Clinical encounters about obesity: Systematic review of patients' perspectives. Clin Obes 2020; 10:e12347. [PMID: 31793217 DOI: 10.1111/cob.12347] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/08/2019] [Accepted: 10/15/2019] [Indexed: 02/06/2023]
Abstract
Guidelines recommend clinicians intervene on obesity but it is unclear how people with overweight react. In this systematic review, we searched 20 online databases for qualitative studies interviewing people with overweight or obesity who had consulted a primary care clinician. Framework synthesis was used to analyse 21 studies to produce a new theoretical understanding. Consultations in which patients discussed their weight were more infrequent than patients would have liked, which some perceived was because they were unworthy of medical time; others that it indicated doctors feel being overweight is not a serious risk. Patients reported that doctors offered banal advice assuming that the patient ate unhealthily or was not trying to address their weight. Patients reported doctors assumed that their symptoms were due to overweight without a proper history or examination, creating concern that serious illness may be missed. Patients responded positively to offers of support for weight loss and active monitoring of weight. Patients with overweight internalize weight stigma sensitizing them to clues that clinicians are judging them negatively, even if weight is not discussed. Patients' negative experiences in consultations relate to perceived snap judgements and flippant advice and negative experiences appear more salient than positive ones.
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Affiliation(s)
- Thanusha Ananthakumar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicholas R Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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ACOG Committee Opinion No. 763: Ethical Considerations for the Care of Patients With Obesity. Obstet Gynecol 2019; 133:e90-e96. [PMID: 30575680 DOI: 10.1097/aog.0000000000003015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Obesity is a medical condition that may be associated with bias among health care professionals, and this bias may result in disrespectful or inadequate care of patients with obesity. Obstetrician-gynecologists regularly care for patients with obesity and play an integral role in advocating for best practices in health care and optimizing health outcomes for patients with obesity. Obstetrician-gynecologists should be prepared to care for their patients with obesity in a nonjudgmental manner, being cognizant of the medical and societal implications of obesity. This Committee Opinion has been updated from its previous version to focus on obesity bias within the medical community and to provide practical guidance using people-first language instead of labels (ie, "patients with obesity" versus "obese patients") to help obstetrician-gynecologists deliver effective, compassionate medical care that meets the needs of patients with obesity.
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Cohen RW, Persky S. Influence of weight etiology information and trainee characteristics on Physician-trainees' clinical and interpersonal communication. PATIENT EDUCATION AND COUNSELING 2019; 102:1644-1649. [PMID: 31003876 PMCID: PMC6660982 DOI: 10.1016/j.pec.2019.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 04/01/2019] [Accepted: 04/05/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This analysis explores the effects of relaying information about the genetic and behavioral causes of obesity (vs. control) on physician trainees' verbal communication behavior with a virtual patient with obesity. Moderation by physician trainees' gender and BMI was also assessed. METHODS 119 physician trainees' verbal responses were recorded and coded using a close-ended content analytic approach. RESULTS Physician trainees in the behavioral and genetic information conditions were more likely to discuss weight (behavioral: AOR = 5.40; genetic: AOR = 6.58,) and provide lifestyle counseling (behavioral: AOR = 10.92; genetic: AOR = 3.50). Those in the behavioral condition were more likely to make assumptions about the patient's lifestyle behavior (AOR = 5.53) and use stigmatizing language (AOR = 4.69). Heavier physician trainees in the genetic condition had shorter interactions (β = -0.53, p < 0.01). CONCLUSION Emphasizing the genetic causes of overweight offers a potential avenue for encouraging clinical communication with patients with obesity, without also increasing prejudice and bias. Additional efforts may be needed to reap the benefits of genetic information for providers with higher weight. PRACTICE IMPLICATIONS For providers, considering genetic factors underlying patient body weight and obesity risk may serve to reduce stigmatizing communication with patients.
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Affiliation(s)
| | - Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute, USA.
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Garrett SL, Pina-Thomas DM, Peterson KA, Benton MJ. Tracking physical activity in baccalaureate nursing students in the United States prior to graduation: A longitudinal study. NURSE EDUCATION TODAY 2019; 80:28-33. [PMID: 31228658 DOI: 10.1016/j.nedt.2019.05.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 03/29/2019] [Accepted: 05/08/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To evaluate changes in physical activity among baccalaureate nursing students over time. DESIGN Longitudinal descriptive study. SETTING Baccalaureate nursing program at a four-year university in the United States. PARTICIPANTS Fifty-two male (n = 4) and female (n = 48) nursing students. METHODS At the beginning and end (weeks 1-2 and 15-16) of the three semesters prior to graduation, students completed the International Physical Activity Questionnaire (IPAQ) and their body mass index (BMI) was calculated. Based on the IPAQ, physical activity was calculated as MET-minutes per week of vigorous, moderate, and walking activities, using metabolic equivalents of 8.0 METS for vigorous, 4.0 METS for moderate, and 3.3 METS for walking. RESULTS At baseline, students were 21.3 ± 1.4 years old with a BMI of 23.5 ± 2.9 kg/m2. BMI increased throughout the study and prior to graduation was 23.9 ± 3.2 kg/m2 (p = 0.039). Overall, students maintained high physical activity levels that did not change statistically. Walking was the predominant activity, followed by vigorous and then moderate activity. Walking and vigorous activity displayed opposing patterns. Vigorous activity decreased over the first three measurement periods (p = 0.029), increased for the fourth period, and then decreased again over the last two periods (p = 0.037 compared to baseline). By comparison, walking increased over the first three measurements (p = 0.002) and then decreased again (p = 0.015). When students were grouped by physical activity level (moderate vs. high), there were significant between-group differences in vigorous activity and walking. At baseline and end of study, the moderate activity group participated in 58% and 49% less vigorous activity, and 83% and 45% less walking than the high activity group. CONCLUSION In this group of baccalaureate nursing students, overall physical activity did not decline with time. Students participated in sufficient physical activity to promote health, and after graduation, they are likely to provide effective patient counselling regarding healthy lifestyles.
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Affiliation(s)
- Susan L Garrett
- Helen & Arthur E. Johnson Beth-El College of Nursing & Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Deborah M Pina-Thomas
- Helen & Arthur E. Johnson Beth-El College of Nursing & Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Kerry A Peterson
- University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO, USA
| | - Melissa J Benton
- Helen & Arthur E. Johnson Beth-El College of Nursing & Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO, USA.
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Montan PD, Sourlas A, Olivero J, Silverio D, Guzman E, Kosmas CE. Pharmacologic therapy of obesity: mechanisms of action and cardiometabolic effects. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:393. [PMID: 31555707 DOI: 10.21037/atm.2019.07.27] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Obesity is a chronic, relapsing, multifactorial disease, which has become a serious threat to public health globally, as the worldwide prevalence of obesity increases exponentially over time. It has been well established that obesity is associated with multiple adverse cardiometabolic effects. Although lifestyle changes are the first line of therapy for obesity, these are often insufficient in attaining weight loss goals. Orlistat, phentermine/topiramate, lorcaserin, naltrexone/bupropion, and liraglutide are agents that have been approved for the treatment of obesity but their effects on cardiometabolic risk factors and outcomes have not been clearly elucidated. Given the detrimental repercussions of obesity on cardiometabolic health, there is a pressing clinical need to fully understand the effects of these agents beyond weight loss alone. Certain previous weight loss drugs have been withdrawn due to safety concerns and this underlines the need for more careful assessment of the effects of the various pharmacologic agents currently used for the treatment of obesity. This review aims to provide an overview of the mechanisms, efficacy, safety and cardiometabolic effects of the currently available pharmacologic agents for weight loss.
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Affiliation(s)
- Peter D Montan
- Cardiology Clinic, Cardiology Unlimited, PC, New York, NY, USA
| | | | - Jiohanna Olivero
- Escuela de Odontología, Universidad Iberoamericana, Santo Domingo, Dominican Republic
| | - Delia Silverio
- Cardiology Clinic, Cardiology Unlimited, PC, New York, NY, USA
| | - Eliscer Guzman
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
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Evans‐Hoeker EA, Ramalingam NS, Harden SM. Weight management perceptions and clinical practices among gynaecology providers caring for reproductive-aged patients. Obes Sci Pract 2019; 5:304-311. [PMID: 31452915 PMCID: PMC6700516 DOI: 10.1002/osp4.338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Research suggests that patient and provider conversations about healthy eating and physical activity behaviours may lead to patients' increased health behaviours, access to dietary and physical activity resources, and weight management. The American College of Obstetrics and Gynecology (ACOG) has a number of weight management intervention options, but it is unclear if providers have conversations about intervention options with their patients who are of reproductive age. The purpose of this work was to evaluate the degree to which gynaecology healthcare providers offer the weight management intervention options as recommended by ACOG. METHODS Cross-sectional study of gynaecology providers in Southwest Virginia utilizing an electronic survey to identify weight management perceptions and current clinical practices. Responses were measured using quantitative methods, and agreeability and frequency responses were measured using a 5-point Likert scale. RESULTS Twenty-three of the 31 eligible providers (74.2%) completed the survey. Providers acknowledge that patients need weight management discussions and they feel comfortable and are willing to have these discussions. While physical activity recommendations were consistent among providers, they did not reflect the complete physical activity recommendations for Americans. Consistency in dietary recommendations was lacking. Although providers make recommendations for physical activity and/or diet at least sometimes, they rarely utilize other methods of weight management as outlined in the ACOG recommendations, such as referrals to other providers, programmes or medications. CONCLUSIONS Areas for improvement in weight management practices include frequency of counselling, consistency in dietary counselling and frequency of utilization of weight loss medications and referrals to ancillary services. These results can be used to aid the development of methods for targeting these deficiencies.
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Affiliation(s)
- E. A. Evans‐Hoeker
- Department of Obstetrics and GynecologyCarilion ClinicRoanokeVirginiaUSA
- Department of Obstetrics and GynecologyVirginia Tech Carilion School of MedicineRoanokeVirginiaUSA
| | - N. S. Ramalingam
- Translational Biology, Medicine and HealthVirginia TechBlacksburgVirginiaUSA
- Department of Human Nutrition, Foods, and ExerciseVirginia TechBlacksburgVirginiaUSA
| | - S. M. Harden
- Department of Obstetrics and GynecologyVirginia Tech Carilion School of MedicineRoanokeVirginiaUSA
- Department of Human Nutrition, Foods, and ExerciseVirginia TechBlacksburgVirginiaUSA
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Affiliation(s)
- Neal D Barnard
- Adjunct Faculty, George Washington University School of Medicine and Health Sciences, Washington, DC.,Physicians Committee for Responsible Medicine, Washington, DC.,Barnard Medical Center, Washington, DC
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Primary care providers’ attitudes and knowledge of bariatric surgery. Surg Endosc 2019; 34:2273-2278. [DOI: 10.1007/s00464-019-07018-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022]
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Fruh SM, Golden A, Graves RJ, Hall HR, Minchew LA, Williams S. Advanced Practice Nursing student knowledge in obesity management: A mixed methods research study. NURSE EDUCATION TODAY 2019; 77:59-64. [PMID: 30954857 PMCID: PMC6564685 DOI: 10.1016/j.nedt.2019.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/06/2019] [Accepted: 03/27/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Obesity, the most prevalent chronic disease affecting multiple systems, is associated with increased mortality and a decreased life expectancy. OBJECTIVES The purpose of this study was to identify Advanced Practice Nursing (APN) students' confidence of obesity management as well as satisfaction of APN curriculum on and curricular recommendations regarding obesity management. DESIGN Modified convergent mixed-methods design. SETTING A university-based college of nursing in the Deep South. PARTICIPANTS Graduate APN Students. METHODS An exploratory mixed methods online survey was administered to APN students. The survey included demographics; confidence in obesity management; knowledge of pharmacological treatment; self-reported height and weight; experiences and challenges related to obesity management; and suggestions of curricular content changes for the treatment of obesity that would increase student expertise and confidence. RESULTS Ninety-nine surveys were completed by 94 female and five male APN students aged 26 to 61 years. The majority (70.7%) were white with BMIs ranging from 19.57 to 51.37 (x̅=27.81). Areas where students were least comfortable were prescribing anti-obesity medications and accurately billing for obesity management. Fourteen percent of APN students reported feeling that their graduate nursing education program did not prepare them well in obesity management, 25.3% reported feeling slightly well prepared, 32% reported feeling moderately well prepared, and 27.8% reported feeling very well or extremely well prepared. Qualitative responses accentuated insecurity in areas such as initiating a discussion on obesity management with patients who have obesity. CONCLUSIONS Overall, APN students requested that their curriculum incorporate more instruction on how to begin the discussion of weight loss and provide clear evidence-based guidelines that include diet, exercise, and medication options. An efficient way to affect the management and treatment of obesity is to ensure that the next generation of providers is thoroughly prepared to implement the best evidence-based obesity management for patients.
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Affiliation(s)
- Sharon M Fruh
- University of South Alabama, College of Nursing, 5721 USA Drive North Room 4080, Mobile, AL 36688, United States of America.
| | - Angela Golden
- 940 Pinewood Boulevard, Munds Park, AZ 86017, United States of America
| | - Rebecca J Graves
- University of South Alabama, College of Nursing, 5721 USA Drive North, Mobile, AL 36688, United States of America.
| | - Heather R Hall
- University of South Alabama, College of Nursing, 5721 USA Drive North, Mobile, AL 36688, United States of America.
| | - Leigh A Minchew
- University of South Alabama, College of Nursing, 5721 USA Drive North, Mobile, AL 36688, United States of America.
| | - Susan Williams
- University of South Alabama, College of Nursing, 5721 USA Drive North, Mobile, AL 36688, United States of America.
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Eisenberg D, Noria S, Grover B, Goodpaster K, Rogers AM. ASMBS position statement on weight bias and stigma. Surg Obes Relat Dis 2019; 15:814-821. [DOI: 10.1016/j.soard.2019.04.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 04/27/2019] [Indexed: 12/14/2022]
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Gottschlich EA, Larson K, Sisk B, Pat Frintner M. Sleep, Physical Activity, and General Health Status: US Pediatricians and the General US Adult Population. Acad Pediatr 2019; 19:269-277. [PMID: 30103049 DOI: 10.1016/j.acap.2018.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/24/2018] [Accepted: 08/05/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine US pediatricians and US adults on 3 self-reported health measures (sleep, physical activity, and general health status) and to assess factors related to these measures for each group. METHODS Pediatrician data were collected through a 2012 American Academy of Pediatrics Periodic Survey (response rate = 64.0%). US population data originated from the 2012 National Health Interview Survey (response rate = 61.2%). Analytic samples included those currently working and ≥30 years old and were restricted to post-trainees (pediatricians; n = 854) and US adults with at least a bachelor's degree (n = 5447). Accounting for sample demographic differences, predicted probabilities compared the proportions reporting ≥7 hours of sleep, meeting physical activity recommendations, and reporting very good or excellent health. Multivariable logistic regression examined characteristics associated with health measures for pediatricians and US adults separately. RESULTS When the US population demographic profile was adjusted to resemble the pediatrician sample, 7 in 10 pediatricians (71.2%; confidence interval [CI], 68.0-74.5) and US adults (69.9%; CI, 67.8-72.0) reported ≥7 hours of sleep. Pediatricians were more likely than US adults to meet physical activity recommendations (71.4%; CI, 68.0-74.8 vs. 62.9%; CI, 60.6-65.2) and less likely to report very good or excellent health (74.3%; CI, 71.2-77.3 vs. 80.2%; CI, 78.3-82.1). In pediatrician and US population multivariable models, self-identified Asians and those working ≥50 hours were less likely to get ≥7 hours of sleep (P < .05). CONCLUSIONS Most US pediatricians and US adults reported getting the recommended amounts of sleep and physical activity and rated their health as very good or excellent. Those working fewer hours reported more sleep. Organization-directed approaches may be needed to help physicians maintain and improve their health.
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Affiliation(s)
| | - Kandyce Larson
- Department of Research, American Academy of Pediatrics, Itasca, Ill
| | - Blake Sisk
- Department of Research, American Academy of Pediatrics, Itasca, Ill
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Butt F, Farooq Butt A, Alam F, Aslam N, Abdul Moeed H, Butt FA. Perception and Management of Obesity Among Pakistani Doctors. Cureus 2019; 11:e4156. [PMID: 31058039 PMCID: PMC6488467 DOI: 10.7759/cureus.4156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The incidence of obesity has been on the rise worldwide. In Pakistan alone, one in four adults is overweight/obese and thus at risk of developing a number of comorbidities such as cardiovascular disease and diabetes. This research aimed to examine how doctors perceived and managed their obese patients. Methods A standardized questionnaire was filled by 100 doctors working in Pakistan, either by hand or online. The study was conducted from November 2017 to January 2018. Results It was found that only 8% of doctors had completed a training course on obesity. Doctors discussed the links between obesity and diabetes (88%) most often whilst neglecting cancer (30%) and dementia (17%). Only 60% of doctors calculated body mass index (BMI) for adult obese patients, with general practitioners (GPs) being the most confident in discussing their weight issues (p=0.001). In terms of childhood obesity, 54% of doctors were confident in putting in place a weight management program. Doctors who checked their weight more than four times a year were found to calculate the BMI of children and adult patients more often (p=0.000 and p=0.044). Comparably, doctors of normal weight were more confident in managing the complications of adult obesity (p=0.015). Conclusion Training courses regarding obesity should be provided to doctors not only to increase their knowledge but also to increase their confidence levels in managing such patients. Further research needs to be carried out in order to understand the patients' perception of obesity management.
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Affiliation(s)
- Farooq Butt
- Surgery, University of Health Sciences, Gujranwala, PAK
| | - Ayesha Farooq Butt
- Internal Medicine, Combined Military Hospital Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Fatima Alam
- Internal Medicine, Combined Military Hospital Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Nabiha Aslam
- Internal Medicine, Combined Military Hospital Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Hussain Abdul Moeed
- Internal Medicine, Combined Military Hospital Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Furqan A Butt
- Genetics, University of Eastern Finland, Kuopio, FIN
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Clinical Staff's Motivators and Barriers to Engagement in Health-Promoting Behaviors. J Nurses Prof Dev 2019; 35:85-92. [PMID: 30762842 DOI: 10.1097/nnd.0000000000000541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Clinical staff can promote patients' engagement in health-promoting behaviors to prevent/treat obesity. However, some clinical staff are overweight/obese and may not model health behaviors for their patients. This cross-sectional survey study tested the hypotheses that clinical staff's level of (1) motivators and (2) barriers to engaging in health-promoting behaviors would be significantly associated with their body mass index (BMI). Barriers were significantly correlated and motivators were not correlated with caregivers' BMI. Implications for nurses in professional development are discussed.
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Tumiel E, Wichniak A, Jarema M, Lew-Starowicz M. Nonpharmacological Interventions for the Treatment of Cardiometabolic Risk Factors in People With Schizophrenia-A Systematic Review. Front Psychiatry 2019; 10:566. [PMID: 31481903 PMCID: PMC6709656 DOI: 10.3389/fpsyt.2019.00566] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/19/2019] [Indexed: 01/05/2023] Open
Abstract
Background: People suffering from schizophrenia are notably vulnerable to cardiometabolic risk factors (CMRF), such as obesity, high blood pressure, hyperglycemia and insulin resistance, high serum triglycerides, and low serum high-density lipoprotein (HDL), which are related to increased mortality and decreased quality of life. The increased risk of "metabolic syndrome" (MS) is related to low physical activity, an unhealthy diet, and side effects of antipsychotic drugs. Nonpharmacological interventions seem to be important in the prevention and therapy of MS. Aim: This paper provides an overview of published studies and a critical analysis of pilot programs involving nonpharmacological measures aimed at prevention and treatment of CMRF in patients with schizophrenia. Material and Method: We searched the PubMed, PsycARTICLES, and Cochrane Library databases to identify clinical trials. We included full-text studies that met the following criteria: age > 18 years, a diagnosis of schizophrenia or schizoaffective disorder, and monitored parameters associated with MS. Results: All 1,555 references were evaluated for inclusion in the review, and 20 met the inclusion criteria. Nonpharmacological interventions led to improvement in physical health and showed a promising potential for implementation in treatment programs dedicated to this particular group of patients. However, a critical analysis revealed limitations, which have implications for the direction of future research. Conclusions: Patients suffering from schizophrenia can benefit from nonpharmacological interventions aimed at counteracting CMRF, improving either metabolic parameters, cardiovascular fitness, or their health perception. Notwithstanding, to achieve long-term effects, future studies should comprise appropriate follow-up procedures.
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Affiliation(s)
- Ewa Tumiel
- III Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Adam Wichniak
- III Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Marek Jarema
- III Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Michał Lew-Starowicz
- III Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland.,Department of Psychiatry, Centre of Postgraduate Medical Education, Warsaw, Poland
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Ambakederemo TE, Chikezie EU. Assessment of some traditional cardiovascular risk factors in medical doctors in Southern Nigeria. Vasc Health Risk Manag 2018; 14:299-309. [PMID: 30498356 PMCID: PMC6207391 DOI: 10.2147/vhrm.s176361] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Almost one third of deaths globally are caused by cardiovascular diseases (CVDs). Certain occupations may promote the development and worsening of risk factor for CVDs. We assessed some traditional cardiovascular risk factors and lifestyle choices that may predispose to CVDs in medical doctors in a tertiary health facility in Southern Nigeria. STUDY DESIGN Cross-sectional study. PARTICIPANTS AND METHODS One hundred sixty-nine apparently healthy medical doctors were recruited. A structured self-administered questionnaire was used to gather data on CVD risk factors. Anthropometric and blood pressure (BP) measurements were taken. RESULTS Majority were males (68.0%), aged 20-39 years (43.8%), single (62.7%), and house officers (58.0%) with<1 year (48.5%) work experience. Over half were either overweight or obese. While 77.2% of those not centrally obese were males, only about 22.8% of females did not meet the criteria for central obesity (P-value < 0.05). While respondents had BP in prehypertensive (48.2%), stage 1 (18.5%), or stage 2 hypertension (3.6%) ranges, only 7.7% had a previous diagnosis of hypertension. Only 25.4% took fruits on a daily basis and engaged in aerobic exercises up to 30 minutes daily or at least 3-5 times a week. Other poor lifestyle choices included non-lean meat intake (76.8%), low water intake (88.2%), and junk food and soda drinks intake (daily 28%, weekly 51.2%). CONCLUSION Findings of a high prevalence of overweight/obesity, physical inactivity, and junk food intake and low fruits intake among doctors is worrisome. There is a need to educate doctors on adopting healthier lifestyles to reduce risk of CVDs.
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Affiliation(s)
| | - Eze Uzoechi Chikezie
- Department of Mental Health, Niger Delta University Teaching Hospital, Okolobiri, Bayelsa, Nigeria
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Baute V, Sampath-Kumar R, Nelson S, Basil B. Nutrition Education for the Health-care Provider Improves Patient Outcomes. Glob Adv Health Med 2018; 7:2164956118795995. [PMID: 30159213 PMCID: PMC6109840 DOI: 10.1177/2164956118795995] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/06/2018] [Accepted: 07/10/2018] [Indexed: 11/15/2022] Open
Abstract
Nutrition education is globally lacking in medical training, despite the fact that dietary habits are a crucial component of physician self-care, disease prevention, and treatment. Research has shown that a physician’s health status directly affects the quality of their preventative health counseling and patient outcomes, yet on average less than 20 hours over 4 years of medical education is spent teaching nutrition. This leaves providers with a gap in knowledge regarding this critical component of health. In a recent study, only 14% of resident physicians reported being adequately trained to provide nutritional counseling. Educating health-care professionals on how to eat well provides an opportunity to improve physician and patient well-being.
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Affiliation(s)
- Vanessa Baute
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Sarah Nelson
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Barbara Basil
- Wake Forest School of Medicine, Winston-Salem, North Carolina
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Hite A, Victorson D, Elue R, Plunkett BA. An Exploration of Barriers Facing Physicians in Diagnosing and Treating Obesity. Am J Health Promot 2018; 33:217-224. [PMID: 29986601 DOI: 10.1177/0890117118784227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine whether primary care physicians can accurately assess body mass index (BMI) by visual inspection and to assess barriers related to the diagnosis and management of obesity. DESIGN Prospective Survey Study. SETTING Hospitals and Clinics. SUBJECTS Primary care providers in the fields of Internal Medicine, Family Medicine and Obstetrics/Gynecology. MEASURES Measures investigated included providers visual assessment of BMI, BMI knowledge, diagnosis and management of obese patients, and perceived barriers to treatment. ANALYSIS Top and bottom quartiles and total scores were determined for responses regarding the reported management of obesity, reported comfort with care, and reported barriers to care and used as the cut point. Statistical analyses were utilized to examine relations and compare groups. RESULTS 206 (74%) of the 280 eligible providers completed the survey. The accuracy of visual assessment of BMI was 52%. Physicians were more likely to underestimate BMI than overestimate (36% ± 4% vs 12% ± 6%, respectively, P < .001). Although 91% of providers report routinely calculating BMI, only 61% routinely discuss BMI. Providers feel comfortable providing exercise (72%) and dietary counseling (61%). However, fewer are comfortable prescribing medical (16.4%) and surgical options (36%). CONCLUSION Visual assessment of BMI is not reliable. Primary care physicians in our study population do not consistently discuss obesity with their patients and many report insufficient knowledge with regard to treatment options. Further studies are needed to determine whether these results are valid for other physicians in various practice settings and to mid-level providers. In addition, research is needed that investigate how collaboration with providers outside the medical field could reduce the burden on physicians in treating patients with overweight or obesity.
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Affiliation(s)
- Ashley Hite
- 1 Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Pritzker School of Medicine, University of Chicago, Evanston, IL, USA
| | - David Victorson
- 2 Department of Medical Social Science, Northwestern University, Chicago, IL, USA
| | - Rita Elue
- 1 Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Pritzker School of Medicine, University of Chicago, Evanston, IL, USA
| | - Beth A Plunkett
- 1 Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Pritzker School of Medicine, University of Chicago, Evanston, IL, USA
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VanFrank BK, Park S, Foltz JL, McGuire LC, Harris DM. Physician Characteristics Associated With Sugar-Sweetened Beverage Counseling Practices. Am J Health Promot 2018; 32:1365-1374. [PMID: 27956472 PMCID: PMC5612916 DOI: 10.1177/0890117116680472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE Frequent sugar-sweetened beverage (SSB) consumption is associated with chronic disease. Although physician counseling can positively affect patient behavior, physicians' personal characteristics may influence counseling practices. We explored SSB-related topics physicians discuss when counseling overweight/obese patients and examined associations between physicians' SSB-related counseling practices and their personal and medical practice characteristics. DESIGN Cross-sectional survey. SETTING DocStyles survey, 2014. PARTICIPANTS A total of 1510 practicing US physicians. MEASURES Physician's SSB counseling on calories, added sugars, obesity/weight gain, health effects, consumption frequency, water substitution, and referral. ANALYSIS Adjusted odds ratios (aORs) were calculated with multivariable logistic regression, adjusting for physician's personal and medical practice characteristics. RESULTS Most physicians (98.5%) reported SSB-related counseling. The most reported topic was obesity/weight gain (81.4%); the least reported were added sugars (53.1%) and referral (35.0%). Physicians in adult-focused specialties had lower odds than pediatricians of counseling on several topics (aOR range: 0.26-0.64). Outpatient physicians had higher odds than inpatient physicians of counseling on consumption frequency and water substitution (aOR range: 1.60-2.01). Physicians consuming SSBs ≥1 time/day (15.7%) had lower odds than nonconsumers of counseling on most topics (aOR range: 0.58-0.68). CONCLUSION Most physicians reported SSB-related counseling; obesity/weight gain was discussed most frequently. Counseling opportunities remain in other topic areas. Opportunities also exist to strengthen SSB counseling practices in adult-focused specialties, inpatient settings, and among physicians who consume SSBs daily.
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Affiliation(s)
- Brenna K. VanFrank
- Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sohyun Park
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer L. Foltz
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- US Public Health Service Commissioned Corps, USA
| | - Lisa C. McGuire
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Diane M. Harris
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Praz C, Ducki J, Connaissa ML, Terrier P, Vuistiner P, Léger B, Luthi F. Working Together and Being Physically Active Are Not Enough to Advise Uniformly and Adequately Low Back Pain Patients: A Cross-Sectional Study. Pain Res Manag 2018; 2018:4128913. [PMID: 30046363 PMCID: PMC6038593 DOI: 10.1155/2018/4128913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/22/2018] [Indexed: 01/02/2023]
Abstract
The profession of the health-care providers (HCPs) influences their recommendations to the patients. Conversely, interdisciplinarity seeks to challenge such differences, so that the patient receives one single and consistent therapeutic message. Some studies also suggest associations between HCPs life habits and recommendations. Our hypotheses were (1) that despite interdisciplinary work, the profession remains a predictor of recommendations and (2) that HCPs who are more physically active recommend more activity. Three clinical vignettes were presented to a group of experts of low back pain (LBP) (guidelines), and 20 physicians, 22 physiotherapists, and 23 nurses to assess how they evaluate the symptoms and pathologies of LBP patients and how much work and physical activity they recommend. Physical activity was assessed with accelerometers and questionnaires. Some interprofessional differences remained present within an interdisciplinary team. The nurses were more restrictive and further away from the guidelines. The physicians were the most in line with them. The physiotherapists recommend as much physical activity, but less work activity than the physicians. The level of physical activity of the HCPs is not associated with their recommendations. To ensure a clear and unique message, educational actions may be undertaken to promote the biopsychosocial model and clarify the guidelines.
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Affiliation(s)
- C. Praz
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suvacare, Avenue Grand-Champsec 90, 1950 Sion, Switzerland
| | - J. Ducki
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suvacare, Avenue Grand-Champsec 90, 1950 Sion, Switzerland
- Institute of Sports Sciences, University of Lausanne, Géopolis, Campus Dorigny, 1015 Lausanne, Switzerland
| | - M. L. Connaissa
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suvacare, Avenue Grand-Champsec 90, 1950 Sion, Switzerland
- Institute of Sports Sciences, University of Lausanne, Géopolis, Campus Dorigny, 1015 Lausanne, Switzerland
| | - P. Terrier
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suvacare, Avenue Grand-Champsec 90, 1950 Sion, Switzerland
| | - P. Vuistiner
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suvacare, Avenue Grand-Champsec 90, 1950 Sion, Switzerland
| | - B. Léger
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suvacare, Avenue Grand-Champsec 90, 1950 Sion, Switzerland
| | - F. Luthi
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suvacare, Avenue Grand-Champsec 90, 1950 Sion, Switzerland
- Department for Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation Suvacare, Avenue Grand-Champsec 90, 1950 Sion, Switzerland
- Department of Physical Medicine and Rehabilitation, Orthopaedic Hospital, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
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