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Martin FC, Quinn TJ, Straus SE, Anand S, van der Velde N, Harwood RH. New horizons in clinical practice guidelines for use with older people. Age Ageing 2024; 53:afae158. [PMID: 39046117 PMCID: PMC11267466 DOI: 10.1093/ageing/afae158] [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: 08/25/2023] [Revised: 03/12/2024] [Accepted: 07/12/2024] [Indexed: 07/25/2024] Open
Abstract
Globally, more people are living into advanced old age, with age-associated frailty, disability and multimorbidity. Achieving equity for all ages necessitates adapting healthcare systems. Clinical practice guidelines (CPGs) have an important place in adapting evidence-based medicine and clinical care to reflect these changing needs. CPGs can facilitate better and more systematic care for older people. But they can also present a challenge to patient-centred care and shared decision-making when clinical and/or socioeconomic heterogeneity or personal priorities are not reflected in recommendations or in their application. Indeed, evidence is often lacking to enable this variability to be reflected in guidance. Evidence is more likely to be lacking about some sections of the population. Many older adults are at the intersection of many factors associated with exclusion from traditional clinical evidence sources with higher incidence of multimorbidity and disability compounded by poorer healthcare access and ultimately worse outcomes. We describe these challenges and illustrate how they can adversely affect CPG scope, the evidence available and its summation, the content of CPG recommendations and their patient-centred implementation. In all of this, we take older adults as our focus, but much of what we say will be applicable to other marginalised groups. Then, using the established process of formulating a CPG as a framework, we consider how these challenges can be mitigated, with particular attention to applicability and implementation. We consider why CPG recommendations on the same clinical areas may be inconsistent and describe approaches to ensuring that CPGs remain up to date.
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Affiliation(s)
- Finbarr C Martin
- Population Health Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Terence J Quinn
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Sharon E Straus
- Department of Medicine, University of Toronto and Li Ka Shing Knowledge Institute of St. Michael’s, Toronto, Ontario, Canada
| | - Sonia Anand
- Departments of Medicine and Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nathalie van der Velde
- Department of Internal Medicine, Section of Geriatric Medicine, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute (Aging and Later Life), Amsterdam, The Netherlands
| | - Rowan H Harwood
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Yang L, Courneya KS, Friedenreich CM. The Physical Activity and Cancer Control (PACC) framework: update on the evidence, guidelines, and future research priorities. Br J Cancer 2024:10.1038/s41416-024-02748-x. [PMID: 38926526 DOI: 10.1038/s41416-024-02748-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/22/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND We proposed the Physical Activity and Cancer Control (PACC) framework in 2007 to help organise, focus, and stimulate research on physical activity in eight cancer control categories: prevention, detection, treatment preparation/coping, treatment coping/effectiveness, recovery/rehabilitation, disease prevention/health promotion, palliation, and survival. METHODS This perspective paper provides a high-level overview of the scientific advances in physical activity research across cancer control categories, summarises current guidelines, updates the PACC framework, identifies remaining and emerging knowledge gaps, and provides future research directions. RESULTS Many scientific advances have been made that are reflected in updated physical activity guidelines for six of the cancer control categories apart from detection and palliation. Nevertheless, the minimal and optimal type, dose, and timing of physical activity across cancer control categories remain unknown, especially for the understudied population subgroups defined by cancer type, age, race/ethnicity, and resource level of regions/countries. CONCLUSION To achieve the full benefit of physical activity in cancer control, future research should use innovative study designs that include diverse at-risk populations and understudied cancer sites. Additionally, effective behaviour change strategies are needed to increase physical activity levels across populations that use implementation science to accelerate the translation from evidence generation into practical, real-world interventions.
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Affiliation(s)
- Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport and Recreation, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada.
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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van den Bekerom L, van Gestel LC, Schoones JW, Bussemaker J, Adriaanse MA. Health behavior interventions among people with lower socio-economic position: a scoping review of behavior change techniques and effectiveness. Health Psychol Behav Med 2024; 12:2365931. [PMID: 38903803 PMCID: PMC11188964 DOI: 10.1080/21642850.2024.2365931] [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: 11/06/2023] [Accepted: 06/04/2024] [Indexed: 06/22/2024] Open
Abstract
Background Behavior change interventions can unintendedly widen existing socio-economic health inequalities. Understanding why interventions are (in)effective among people with lower socio-economic position (SEP) is essential. Therefore, this scoping review aims to describe what is reported about the behavior change techniques (BCTs) applied within interventions and their effectiveness in encouraging physical activity and healthy eating, and reducing smoking and alcohol consumption according to SEP. Methods A systematic search was conducted in 12 electronic databases, and 151 studies meeting the eligibility criteria were included and coded for health behavioral outcomes, SEP-operationalization, BCTs (type and number) and effectiveness. Results Findings suggest that approaches for measuring, defining and substantiating lower SEP vary. Current studies of behavior change interventions for people of different SEP do not systematically identify BCTs, making systematic evaluation of BCT effectiveness impossible. The effectiveness of interventions is mainly evaluated by overall intervention outcomes and SEP-moderation effects are mostly not assessed. Conclusion Using different SEP-operationalizations and not specifying BCTs hampers systematic evidence accumulation regarding effective (combinations of) BCTs for the low SEP population. To learn which BCTs effectively improve health behaviors among people with lower SEP, future intervention developers should justify how SEP is operationalized and must systematically describe and examine BCTs.
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Affiliation(s)
- Loes van den Bekerom
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague/Leiden, the Netherlands
| | - Laurens C. van Gestel
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - Jan W. Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, the Netherlands
| | - Jet Bussemaker
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague/Leiden, the Netherlands
- The Institute of Public Administration, Leiden University, Leiden, the Netherlands
| | - Marieke A. Adriaanse
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague/Leiden, the Netherlands
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
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Brand T, Herrera-Espejel P, Muellmann S, Wiersing R, Busse H. [Social inequality in the context of digital health applications: digital divides in access, use, effectiveness, and privacy]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:268-276. [PMID: 38289381 DOI: 10.1007/s00103-024-03832-6] [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: 09/15/2023] [Accepted: 12/21/2023] [Indexed: 03/12/2024]
Abstract
Given the massive increase in digital health tools, the question about the impact of these tools on health equity has gained importance. The aim of this narrative review is to discuss the extent and central aspects of the digital divide. To illustrate the extent of the digital divide, we draw on data from the Liter@te study, which interviewed low-literacy individuals regarding their use of digital health tools and their digital health literacy. The results of the Liter@te study are compared with population surveys conducted in parallel. Four areas can be distinguished in relation to digital divides: access, use, effectiveness, and privacy. Inequalities can be observed in all four areas. While differences in access or material infrastructure, as well as in usage patterns and the required literacies, have already been investigated in some studies, the data basis for a comprehensive assessment of the unequal effects of digital health tools in different population groups is still lacking. Digital divides in the area of privacy protection is an emerging field. However, transparent and understandable privacy measures will undoubtedly be an important prerequisite for the widespread use of digital health tools. Overall, in addition to a better data base, involvement of disadvantaged population groups in the development of digital health interventions is necessary.
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Affiliation(s)
- Tilman Brand
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Achterstr. 30, 28359, Bremen, Deutschland.
- Leibniz-WissenschaftsCampus Digital Public Health Bremen, Bremen, Deutschland.
| | - Paula Herrera-Espejel
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Achterstr. 30, 28359, Bremen, Deutschland
- Leibniz-WissenschaftsCampus Digital Public Health Bremen, Bremen, Deutschland
| | - Saskia Muellmann
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Achterstr. 30, 28359, Bremen, Deutschland
- Leibniz-WissenschaftsCampus Digital Public Health Bremen, Bremen, Deutschland
| | - Rebekka Wiersing
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Achterstr. 30, 28359, Bremen, Deutschland
| | - Heide Busse
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Achterstr. 30, 28359, Bremen, Deutschland
- Leibniz-WissenschaftsCampus Digital Public Health Bremen, Bremen, Deutschland
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Harkko J, Pietiläinen O, Jousilahti P, Rahkonen O, Kouvonen A, Lallukka T. Trajectories of CVD medication after statutory retirement: contributions of pre-retirement sociodemographic, work and health-related factors: a register study in Finland. BMC Geriatr 2023; 23:570. [PMID: 37723432 PMCID: PMC10506324 DOI: 10.1186/s12877-023-04272-8] [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: 07/03/2022] [Accepted: 09/01/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are prevalent in older people, but few studies focus on developmental patterns in CVD medication directly after transition to statutory retirement. We thus aimed to identify trajectories of CVD medication after retirement, and their sociodemographic, work and health-related determinants. METHODS We used complete register data of former employees of the City of Helsinki, Finland. All who reached their statutory retirement in 2000-2013, with five-year follow-up data (n = 6,505, 73% women), were included. Trajectories of CVD medication were identified with group-based trajectory modelling using data from Finnish Social Insurance Institution's reimbursement register. Sociodemographic, work and health-related determinants of trajectory group membership were analysed using multinomial logistic regression. RESULTS Six trajectories of CVD medication were distinguished: "constant low" (35%), "late increase" (6%), "early increase" (5%), "constant high" (39%), "high and decreasing " (8%), and "low and decreasing" (7%). The majority (74%) of the retirees fell into the "constant low" and "constant high" categories. Lower occupational class and increased pre-retirement sickness absence were associated with the "constant high" trajectory. Further, those with lower educational attainment were more prone to be in the "early increase" trajectory. CONCLUSIONS Individuals in lower socioeconomic positions or with a higher number of pre-retirement sickness absence may be considered at higher risk and might benefit from early interventions, e.g. lifestyle interventions and interventions targeting working conditions, or more frequent monitoring.
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Affiliation(s)
- Jaakko Harkko
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
- University of Helsinki, P.O. Box 20 (Tukholmankatu 8 B), N00014, Helsinki, Finland.
| | - Olli Pietiläinen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Pekka Jousilahti
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Tea Lallukka
- University of Helsinki, P.O. Box 20 (Tukholmankatu 8 B), N00014, Helsinki, Finland.
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
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Patterson R, Ogilvie D, Laverty AA, Panter J. Equity impacts of cycling investment in England: A natural experimental study using longitudinally linked individual-level Census data. SSM Popul Health 2023; 23:101438. [PMID: 37304734 PMCID: PMC10251149 DOI: 10.1016/j.ssmph.2023.101438] [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: 03/09/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/13/2023] Open
Abstract
Background Cycling is beneficial for health and the environment but the evidence on the overall and differential impacts of interventions to promote cycling is limited. Here we assess the equity impacts of funding awarded to support cycling in 18 urban areas between 2005 and 2011. Methods We used longitudinally linked 2001 and 2011 census data from 25,747 individuals in the Office for National Statistics Longitudinal Study of England and Wales. Logistic regression was used to assess the impacts of funding on commute mode as the interaction between time and area (intervention/comparison) in individual-level difference-in-difference analyses, adjusting for a range of potential confounding factors. Differential impacts were examined by age, gender, education and area-level deprivation, and uptake and maintenance of cycling were examined separately. Results Difference-in-difference analyses showed no intervention impact on cycle commuting prevalence in the whole sample (AOR = 1.08; 95% CI 0.92, 1.26) or among men (AOR = 0.91; 95% CI 0.76, 1.10) but found an intervention effect among women (AOR = 1.56; 95% CI 1.16, 2.10). The intervention promoted uptake of cycling commuting in women (AOR = 2.13; 95% CI 1.56, 2.91) but not men (AOR = 1.19; 95% CI 0.93, 1.51). Differences in intervention effects by age, education and area-level deprivation were less consistent and more modest in magnitude. Conclusions Living in an intervention area was associated with greater uptake of cycle commuting among women but not men. Potential gender differences in the determinants of transport mode choice should be considered in the design and evaluation of future interventions to promote cycling.
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Affiliation(s)
- Richard Patterson
- MRC Epidemiology Unit, University of Cambridge, Box 285 Institute of Metabolic Science, Cambridge, CB2 0QQ, UK
| | - David Ogilvie
- MRC Epidemiology Unit, University of Cambridge, Box 285 Institute of Metabolic Science, Cambridge, CB2 0QQ, UK
| | - Anthony A. Laverty
- Public Health Policy Evaluation Unit, Imperial College London, Reynold Building, St Dunstan's Road, London, W6 8RP, UK
| | - Jenna Panter
- MRC Epidemiology Unit, University of Cambridge, Box 285 Institute of Metabolic Science, Cambridge, CB2 0QQ, UK
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Jabardo-Camprubí G, Puig-Ribera A, Donat-Roca R, Farrés-Godayol P, Nazar-Gonzalez S, Sitjà-Rabert M, Espelt A, Bort-Roig J. Assessing the Feasibility and Acceptability of a Primary Care Socio-Ecological Approach to Improve Physical Activity Adherence among People with Type 2 Diabetes: The SENWI Project. Healthcare (Basel) 2023; 11:1815. [PMID: 37444649 DOI: 10.3390/healthcare11131815] [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] [Received: 05/24/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
Maintaining an active lifestyle is a key health behavior in people with type 2 diabetes (T2D). This study assessed the feasibility and acceptability of a socio-ecological Nordic walking intervention (SENWI) to enhance healthy behaviors in primary healthcare settings. Participants included individuals with T2D (n = 33; age 70 (95% CI 69-74)) and healthcare professionals (HCPs, n = 3). T2D participants were randomly assigned to a SENWI, active comparator, or control group for twelve weeks. Feasibility and acceptability were evaluated based on a mixed methodology. Quantitative data reported adherence information, differences between follow-up and dropout participants and pre- and post-intervention on physical activity, sedentary behavior, and health outcomes. Qualitative data acquisition was performed using focus groups and semi-structured interviews and analyzed using thematic analysis. Thirty-three T2D invited participants were recruited, and twenty-two (66.7%) provided post-intervention data. The SENWI was deemed acceptable and feasible, but participants highlighted the need to improve options, group schedules, gender inequities, and the intervention's expiration date. Healthcare professionals expressed a lack of institutional support and resources. Nevertheless, no significant difference between the SENWI follow-up and dropout participants or pre- and post- intervention was found (only between the active comparator and control group in the physical quality of life domain). Implementing the SENWI in primary healthcare settings is feasible and acceptable in real-world conditions. However, a larger sample is needed to assess the program's effectiveness in improving healthy behaviors and its impact on health-related outcomes in the long term.
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Affiliation(s)
- Guillem Jabardo-Camprubí
- Faculty of Health Science at Manresa, University of Vic-Central University of Catalonia, Av. Universitaria 4-6, 08242 Manresa, Spain
- Sports and Physical Activity Research Group, Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (Iris-CC), Ctra. De Roda Núm. 70, 08500 Vic, Spain
| | - Anna Puig-Ribera
- Sports and Physical Activity Research Group, Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (Iris-CC), Ctra. De Roda Núm. 70, 08500 Vic, Spain
| | - Rafel Donat-Roca
- Sport Exercise and Human Movement (SEaMH), Faculty of Health Science at Manresa, University of Vic-Central University of Catalonia, Av. Universitaria 4-6, 08242 Manresa, Spain
| | - Pau Farrés-Godayol
- Research Group on Methodology, Methods, Models and Outcome of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, University of Vic-Central University of Catalonia, Sagrada Familia 7, 08500 Vic, Spain
| | - Sebastian Nazar-Gonzalez
- Department of Physical Therapy, Faculty of Health Science Blanquerna, Ramon Llul University, Padilla, 326-332, 08022 Barcelona, Spain
| | - Mercè Sitjà-Rabert
- Faculty of Health Science Blanquerna, Global Research on Wellbeing (GRoW) Research Group, Ramon Llull University, Padilla, 326-332, 08022 Barcelona, Spain
| | - Albert Espelt
- Faculty of Health Science at Manresa, University of Vic-Central University of Catalonia, Av. Universitaria 4-6, 08242 Manresa, Spain
- Departament de Psicologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, CIBER de Epidemiologia i Salud Pública, 08193 Barcelona, Spain
| | - Judit Bort-Roig
- Sports and Physical Activity Research Group, Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (Iris-CC), Ctra. De Roda Núm. 70, 08500 Vic, Spain
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