Health behaviors in major chronic diseases patients: trends and regional variations analysis, 2008-2017, Korea

Effects of nurse-led intervention programs based on King's theory of goal attainment on health-promoting behaviors and life satisfaction in patients with type 2 diabetes: a randomized controlled clinical trial

BACKGROUND

Type 2 diabetes being a chronic condition that requires long-term care. This study examined the impact of an educational program using King's goal attainment model on health behaviors and life satisfaction in type 2 diabetes patients.

METHODS

This is a randomized controlled clinical trial with no blinding in which we tested two groups of intervention control. 70 patients with type 2 diabetes were allocated to an intervention (N = 35) and a control group randomly (N = 35). The nursing process stages included examination, diagnosis, goal determination, transaction based on patient preferences, and evaluation based on King's theory. Data was gathered using the Walker Health-Promoting Lifestyle Profile (HPLP) and Satisfaction with Life Scale (SWLS, before, after, and 3 months, post-intervention. Data were analyzed in SPSS25 through descriptive statistics, Chi-square Test, Independent and paired sample T-test, two-way ANOVA, and multivariate repeated measures ANCOVA. P-values < 0.05 were considered as the level of significance.

RESULTS

In the intervention group, there was a significant difference in the mean score of health-promoting behaviors and life satisfaction between the three time points (before, immediately after, and 3 months after). However, in the control group, there was no significant difference in the mean score of health-promoting behaviors and life satisfaction.

CONCLUSION

The results of this study suggest that an educational program based on King's goal attainment model can be effective in improving health-promoting behaviors and life satisfaction in patients with type 2 diabetes. Further studies are recommended to be conducted in different settings and with a longer follow-up period.

IRANIAN REGISTRY OF CLINICAL TRIALS

IRCT registration number: IRCT20190917044802N8.

REGISTRATION DATE

16/12/2022.

Health-risk behaviours co-occur among children with untreated caries

OBJECTIVES

The aim of this study was to examine whether an aggregate of health risk behaviours is associated with the number of untreated dental caries among 12- and 15-year-old children in England, Wales and Northern Ireland.

MATERIALS AND METHODS

Data were from the Children's Dental Health Survey (CDHS) 2013, a nationally representative sample of England, Wales and Northern Ireland. The survey included assessment of oral health and data on socioeconomic, demographic and behavioural factors pertaining to children aged 12-15 years. Tooth condition (decayed, missing and filled) was assessed by NHS dentists. The survey included questions on age, sex, country, index of multiple deprivation, smoking, alcohol consumption, frequent sugar consumption and sweetened sodas, infrequent dental visit, infrequent toothbrushing and infrequent consumption of fresh fruits. Health risk behaviours were summed up to create an aggregate variable of health risk behaviour. The association between number of untreated caries and the aggregate of health risk behaviours was assessed using negative binomial regression and adjusting for age, sex, country and deprivation.

RESULTS

The total number of children included in the analysis was 4414. The mean number of untreated caries was generally higher among children with health risk behaviours. The aggregate of risk behaviour was associated with greater prevalence of untreated dental caries with rate ratio (RR) 1.26 (95% confidence interval: 1.18, 1.36).

CONCLUSION

This study demonstrated an association between an aggregate of health risk behaviours and untreated caries. The findings highlight the importance of addressing multiple risk factors not only those directly related to dental caries.

Cardiovascular disease and preventive care service utilization among midlife adults: The roles of diagnosis and depression

Objectives

Secondary preventive care is important for monitoring the progression of cardiovascular disease (CVD). However, the factors that promote secondary prevention were not well understood. This study addressed this gap by investigating the impact of CVD diagnosis on preventive care utilization among midlife adults. Given the high prevalence of depression among this population, it further examined whether depression interacted with CVD diagnosis to affect preventive care utilization.

Methods

The study sample included 6,222 midlife adults from six waves of the National Longitudinal Survey of Youth 1979 (NLSY79) collected between 2006 and 2016. Multiple logistic regressions were conducted to examine the relationship between a CVD diagnosis and each of the five types of preventive care utilization: influenza vaccinations, electrocardiography (EKG) and screening for high blood pressure, cholesterol, and blood sugar. Depression was then added to examine its possible moderation effect.

Results

The results showed that midlife adults with a CVD diagnosis were more likely to utilize all five types of preventive care services. EKG, the most relevant preventive care type with CVD diagnosis, had the largest strength of likelihood. Depression strengthened the relationship between a CVD diagnosis and the utilization of blood pressure tests, but it showed no associations with other four types of preventive care utilization.

Conclusions

The study findings indicate that a CVD diagnosis could serve as an opportunity for promoting secondary preventive care utilization. Future research needs to explore how a CVD diagnosis affects different population groups, and further explore the roles of depression.

Determinants of unhealthy living by gender, age group, and chronic health conditions across districts in Korea using the 2010-2017 Community Health Surveys

OBJECTIVES

We investigated the prevalence and determinants of unhealthy living by gender, age, and comorbidities across Korean districts.

METHODS

For 806,246 men and 923,260 women from 245 districts who participated in the 2010-2017 Korean Community Health Surveys, risk scores were calculated based on obesity, physical inactivity, smoking, and high-risk alcohol consumption, each scored from 0 (lowest risk) to 2 (highest risk). A risk score ≥4 was defined as indicating unhealthy living, and weighted proportions were calculated for each district. Using multivariate regression, an ecological model including community socioeconomic, interpersonal, and neighborhood factors was examined by gender, age, and comorbidities.

RESULTS

The mean age-standardized rate of unhealthy living was 24.05% for men and 4.91% for women (coefficients of variation, 13.94% and 29.51%, respectively). Individuals with chronic diseases more frequently exhibited unhealthy lifestyles. Unhealthy lifestyles were associated with educational attainment (β-coefficients: men, -0.21; women, -0.15), high household income (β=0.08 and 0.03, respectively), pub density (β=0.52 and 0.22, respectively), and fast-food outlet density (β=2.81 and 1.63, respectively). Negative associations were observed with manual labor, social activity participation, and hospital bed density. Unhealthy living was positively associated with living alone among women and with being unemployed among middle-aged men. Access to parks was negatively associated with unhealthy living among young men and women. The ecological model explained 32% of regional variation in men and 41% in women.

CONCLUSIONS

Improving the neighborhood built and socioeconomic environment may reduce regional disparities in lifestyle behaviors; however, the impacts may vary according to socio-demographic traits and comorbidities.

Self-effectiveness and healthy lifestyle behaviors in adolescents with asthma

OBJECTIVES

The aim of this study was to examine the self-efficacy and healthy lifestyle behavior levels in adolescents with asthma.

MATERIALS AND METHODS

Socio-demographic questionnaire form, questions about adherence to asthma medication, asthma control test, healthy lifestyle behaviors scale, and self-efficacy scale for children and adolescents with asthma were administered to 150 patients whom age range between 12-18, in follow up with asthma in the pediatric allergy outpatient clinic.

RESULTS

There was no statistically significant relationship between healthy lifestyle behaviors scale and self-efficacy scale scores between adolescents with controlled and uncontrolled asthma. When patients were grouped regarding the treatment compliance, both healthy lifestyle behaviors scale and asthma self-efficacy scale scores were found to be higher in patients with treatment compliance. When the patients were grouped on the basis of gender, regular follow-up visits, and smoking, there was no significant difference between healthy lifestyle behaviors and self-efficacy scale scores.

CONCLUSIONS

The findings showed us the importance of the relationship between healthy living and adolescent self-efficacy in adherence to treatment, while there are many more components in asthma control.

The effect of telenursing education of self-care on health-promoting behaviors in patients with multiple sclerosis during the COVID-19 pandemic: A clinical trial study

INTRODUCTION

Multiple sclerosis is associated with decrease in health-promoting behaviors (HPBs) and require appropriate nursing interventions. Telenursing can play an important role in education of patients during the COVID-19 pandemic in which face-to-face education is limited. This study aimed to investigate the effect of self-care education with telenursing approach on HPBs in patients with MS.

MATERIALS AND METHODS

In this clinical trial, 68 patients with MS were selected using simple random sampling from Jahrom MS Society and randomly assigned to the intervention (n = 34) and control (n = 34) groups. In the intervention group, educational sessions were held three days a week for six weeks. Data were collected using demographic information and Walker's Health-Promoting Lifestyle questionnaires before and immediately after the intervention. Data were analyzed by Mann-Whitney and Wilcoxon tests using SPSS software (Ver. 21).

RESULTS

Based on the findings, immediately after the intervention, the mean score of HPBs was significantly higher (p = 0.005) in the intervention group (145.38 ± 26.66) than the control group (129.18 ± 22.35). The means of nutrition, exercise, health responsibility, and stress management were significantly different between the intervention and control groups immediately after the intervention (p < 0.05).

CONCLUSION

results this study indicated that self-care education with telenursing approach was effective on HPBs in patients with MS. It can be beneficial to employ as an educative-supportive approach in MS patients.

Association of lifestyle behaviors with health-related quality of life among patients with hematologic diseases

PURPOSE

Health-related quality of life (HRQoL) is a multi-dimensional construct used to assess the impact of health status on quality of life, and it is known to be affected by lifestyle behaviors. This study focused on multiple lifestyle behaviors among patients with hematologic diseases, including physical activity, dietary intake, sleep quality, occupational exposure, alcohol consumption and smoking. The main objective was to investigate the association of both individual and clustering of health behaviors with HRQoL among the population with hematologic diseases based on a comprehensive lifestyle survey.

METHODS

A total of 539 patients with hematologic diseases aged over 18 years were enrolled in this cross-sectional study. Latent class analysis was used to identify homogeneous, mutually exclusive lifestyle classes, and multinomial logistic regression was then performed to explore the association of lifestyle classes membership with HRQoL. Meanwhile, multiple linear regression and quantile regression were used to identify the relationship between individual lifestyle behaviors and HRQoL.

RESULTS

A three-class model was selected based on conceptual interpretation and model fit. We found no association between multiple lifestyle behaviors and HRQoL in the 3-class model, either in the whole patients or in subgroups stratified by hematological malignancies. Further research on each lifestyle found that physical activity, dietary intake, occupational exposure, alcohol consumption or smoking were independent of HRQoL. Sleep quality was positively associated with HRQoL.

CONCLUSION

Our findings suggested that clustering of lifestyle behaviors may not be an indicator to reflect the health quality of patients with hematologic diseases. Sleep represents a viable intervention target that can confer health benefits on the hematologic patients.

Patterns of smoked and smokeless tobacco use among multimorbid and non-multimorbid middle-aged and older-aged adults in Karachi, Pakistan: a cross-sectional survey

OBJECTIVES

The objective of this study was to compare the patterns of smoked and smokeless tobacco use among multimorbid and non-multimorbid middle-aged and older-aged individuals in Karachi, Pakistan.

STUDY DESIGN

This was an observational cross-sectional study conducted during 2015-2016.

STUDY SETTING AND PARTICIPANTS

A total of 3250 participants aged 30 years and above, residing in the Gulshan-e-Iqbal town, Karachi, Pakistan were enrolled in the study through systematic random sampling. The selected area of residence represents diverse socioeconomic and ethnic groups of the city. People who could speak and write English or Urdu, and those who provided written informed consent were included in the study.

OUTCOME MEASURES

The primary outcome measure of the study was to determine the differences in patterns of tobacco consumption among multimorbid and non-multimorbid adult individuals.

RESULTS

We found no difference in patterns of smoked (adjusted OR (aOR) 1.15, 95% CI 0.88 to 1.50, p=0.289) or smokeless tobacco (aOR 1.13, 95% CI 0.86 to 1.48, p= 0.379) use among multimorbid and non-multimorbid individuals. Individuals who perceived tobacco as a risk were less likely to consume smokeless tobacco products.

CONCLUSION

There was no difference in tobacco consumption among individuals with and without multimorbidity. Evidenced-based guidelines are required to implement mental and behavioural interventions in patients with multiple chronic diseases to help them modify their behaviours.

Comparison of low-salt preference trends and regional variations between patients with major non-communicable diseases and the general population

Background

We compared low-salt preference between patients with major chronic diseases, also known as non-communicable diseases (hereinafter referred to as ‘“major NCD patients’”), and the general population.

Methods

We used data extracted from the Korea Community Health Survey Community during the period of 2008–2019. We evaluated the low-salt preference of 13 major NCD patients by year and region to analyse recent changes in low-salt preference trends, using joinpoint regression.

Results

A greater majority of major NCD patients had a higher low-salt preference than general population; however, the overall trend was not significantly significant. The low-salt preference rate (Type III) was highest among patients with diabetes (15.6%), followed by hypertension (14.1%) and dyslipidaemia (13.4%), with the general population displaying the lowest rate (11.3%). The rates of adherence to a low-salt diet and fried food without soy sauce gradually increased until 2013 and then declined. The rate of adherence to not adding salt and soy sauce at the table gradually increased and maintained a high rate of adherence until 2019, except for patients with some diseases. Regional variations in low-salt preference tended to be greater in patients with major NCDs than general population.

Conclusion

There is a need to improve the low-salt diet behaviour of not only major NCD patients, but also the general population. Various low-salt diet programs need to be promoted, such as education on a low-salt diet, certification for low-salt restaurants, and sodium tax. Moreover, it is necessary to continuously monitor the low-salt preferences of major NCD patients.

A participatory practice study for the improvement of sub-regional health vulnerabilities: a qualitative study

Background

This study aimed to explore the experiences of the residents of Samho-dong with the health environment in the local community, and their in-depth opinions on health promotion using a photovoice methodology. Alternatives to improve health among the residents of Samho-dong were also discussed with the local residents, with the aim of translating suggestions from the discussion into practice.

Methods

A total of 195 photographs taken by the 15 participants over the course of 7 weeks were collected, along with 96 photovoice activity logs and transcription data from 5 rounds of focus group discussions. The photovoice activity logs consisted of the photographer’s name, the dates photos were taken, and a series of responses to the following SHOWeD questions: “What do you SEE here?”, “What is really HAPPENING?”, “How does this situation or scenario affect OUR lives/health?”, “WHY does this problem or strength Exist?”, “What can we DO about it?”. Direct content analysis was used for analysis.

Results

The analysis yielded a total of 247 semantic units, which were categorized into the themes, “the good, but insufficiency, living environment in Samho-dong,” “the health environment in Samho-dong needs improvement,” “small efforts to improve Samho-dong,” and “points of improvement for a better Samho-dong”. Samho-dong was found to have a poorer walking and transportation infrastructure than other regions, even though it was a town with a large elderly population. The dark streets in the residential complex made participants hesitate to engage in afternoon activities, and the insufficient traffic environment made it difficult to live a natural daily life by solving food, clothing, and shelter. Participants have made various attempts to solve areas that need improvement in the Samho-dong, which has led to actual improvement. It was analyzed that in order to make Samho-dong better, it was necessary to improve the perception of residents in Samho-dong and cooperate with the local community.

Conclusions

This study was significant in that it enabled the in-depth exploration and identification of areas of improvement from the participants’ perception of their health environment, considering that as residents, they are the direct stakeholders of the community health environment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14111-x.

Diagnóstico clínico integral de adultos mayores atendidos en Perú

Introducción: Los adultos mayores constituyen el grupo poblacional más vulnerable y el menos favorecido por los sistemas de salud, transitan por un proceso de involución progresiva que puede repercutir en su salud; por tanto, se torna relevante el diagnóstico clínico oportuno y adecuado para identificar eventuales alteraciones. Objetivo: Establecer el diagnóstico clínico integral según sexo y edad de adultos mayores atendidos a nivel nacional en el Perú. Materiales y métodos: Se realizó un estudio descriptivo, transversal y retrospectivo, durante marzo y abril del 2021, en 60698 adultos mayores atendidos en todos los departamentos del Perú. La valoración física, funcional, mental y social de los adultos mayores se realizó mediante la Historia Clínica de Atención Integral de Salud del Adulto Mayor y se interpretó con su guía técnica. Se describieron frecuencias absolutas, relativas, intervalos de confianza para proporciones al 95% y el chi cuadrado de homogeneidad. Resultados: El 49,4% de adultos mayores estaban enfermos, de los cuales el 50,8% fueron mujeres y el 47,4% varones, el 50,0% tenían de 60 a 69 años, el 50,6% de 70 a 79 años y el 46,1% de 80 a más años. Se encontraron diferencias estadísticamente significativas entre el diagnóstico clínico integral por sexo y edad (p = 0,000). Discusión: Independientemente del número de participantes en todos los contextos estudiados, al menos una enfermedad crónica coexiste medianamente en los adultos mayores, sin ser determinante el lugar donde viven, pues el proceso de envejecimiento solo puede ser distinto en su velocidad de progresión y en las condiciones en que se presenta. Conclusión: Los adultos mayores en su mayoría estaban enfermos, fueron mujeres y tenían de 70 a 79 años, las diferencias por sexo y edad en el diagnóstico clínico integral fueron significativas. Las intervenciones en etapas previas contribuirían de manera importante en un envejecimiento saludable. Como citar este artículo: Asenjo-Alarcón José Ander. Diagnóstico clínico integral de adultos mayores atendidos en Perú. Revista Cuidarte. 2022;13(2): e2485. http://dx.doi.org/10.15649/cuidarte.2485

The impact of free vaccination policies under the Korean Influenza National Immunization Program: Trends in influenza vaccination rates in South Korea from 2010 to 2019

Background

Annual vaccination for influenza is recommended for high-risk populations for its high morbidity and mortality. South Korea provides free influenza vaccination to some target groups under the National Immunization Program (NIP), and discrepantly high vaccination rates are observed in such populations. In this study, we analyzed the trends in influenza vaccination rates and evaluated the impact of the recent expansion of financial coverage to children ≤12 years and pregnant women.

Methods

We conducted a cross-sectional study with nationwide survey data from Korea National Health and Nutrition Examination Survey (KNHANES). From 2010 to 2019, we evaluated the trends in influenza vaccination rates of the following four target groups: children ≤12 years, adults ≥65 years, pregnant women, and people with chronic diseases.

Results

In total, 80,861 individuals were analyzed. From 2017 to 2019, the vaccination coverage of children ≤12 years increased from 66.2% to 83.1%; pregnant women from 44.1% to 68.5% (comparing the mean of 2010–2017 and 2018–2019, P <0.001 for both). The elderly ≥65 years showed the highest rates (85.8% in 2019), while people with chronic diseases marked the lowest (41.9% in 2019). People with liver diseases showed the lowest vaccination rate of 27.8%, while that of other common diseases ranged between 31.7–44.1%.

Conclusion

The discrepancy between target groups corresponds to their financial coverage under NIP. The recent expansion of financial aids to children ≤12 years and pregnant women was followed by significant increases in vaccination rates in both groups. We suggest that free vaccination policy is one of the most effective strategies to enhance vaccination coverage, and we call for its expansion to other under-vaccinated target groups, especially people with chronic diseases.

Lifestyle Modification in the Management of Metabolic Syndrome: Statement From Korean Society of CardioMetabolic Syndrome (KSCMS)

Metabolic syndrome (MetS) is highly prevalent and is associated with worse cardiovascular outcome. Lifestyle modification is the most effective way to reduce the incidence of cardiovascular complications caused by MetS. Here, we would like to review the effects and specific methods of the 6 lifestyle modifications (weight control, smoking cessation, alcohol drinking in moderation, diet control, exercise and physical activity, and cognitive behavioral therapy) and control of blood pressure, dyslipidemia, and blood sugar based on evidence in the management of MetS.

With the recent rapid increase in obesity worldwide, metabolic syndrome (MetS) has gained significant importance. MetS is a cluster of obesity-related cardiovascular risk factors including abdominal obesity, atherogenic dyslipidemia, high blood pressure and impaired glucose tolerance. MetS is highly prevalent and strongly associated with an increased risk of developing diabetes and cardiovascular disease, putting a great burden on human society. Therefore, it is very important to reduce MetS risk, which can improve patients’ cardiovascular prognosis. The primary and most effective strategy to control each component of MetS is lifestyle change such as losing body weight, keeping regular exercise, adopting a healthy diet, quitting smoking and alcohol drinking in moderation. Many studies have shown that lifestyle modification has improved all components of MetS, and reduces the incidence of diabetes and cardiovascular disease. Here, the Korean Society of CardioMetabolic Syndrome has summarized specific and practical methods of lifestyle modification in the management of MetS in the healthcare field.

Perception and preventive behavior during COVID-19 pandemic among urban residents in Banda Aceh, Indonesia: a cross-sectional study

BACKGROUND It is critical to evaluate the perception and preventive behavior of COVID-19 to formulate the optimal public health strategies for tackling the ongoing pandemic. This study aimed to enhance knowledge on the perception and preventive behavior toward COVID-19 among urban residents in Banda Aceh, Indonesia. METHODS A cross-sectional population-based survey was conducted from September to October 2020 using a structured questionnaire for the attendants of the six public health centers in Banda Aceh. Information about sociodemographic, perception, and preventive behavior toward COVID-19 were collected. The data were analyzed to find the association between the level of preventive behavior and covariates. RESULTS Among 1,067 respondents, 71.1% were female, 52.5% were aged between 40 and 60 years, 31.2% were university graduates, and >60% were unemployed with underlying diseases such as diabetes, hypertension, and cardiopulmonary diseases. The responses of each statement toward COVID-19 were varied. The multivariable model of covariates showed that females had good preventive behavior toward COVID-19 (adjusted OR: 1.849, 95% CI: 1.359–2.515). Urban residents in Banda Aceh with the underlying diseases had poor preventive behavior, while those with higher educational level and perception scores were more inclined to engage in good preventive behavior. CONCLUSIONS Most urban residents in Banda Aceh showed positive perception and propensity for adopting preventive measures. Health education is necessary for susceptible residents, such as males, less educated people, and people with underlying diseases. It should be stressed on specific practices and knowledge.