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Wang D, He Q, Xia B, Zheng J, Cao W, Su S, Hu F, Li J, Zhang Y, Ren Z, Li X, Wu X, Huang Y, Tang Y, Wei F, Zou H, Jiang H, Huang J, Meng W, Bai M, Yang K, Yuan J. A protocol of Chinese expert consensuses for the management of health risk in the general public. Front Public Health 2023; 11:1225053. [PMID: 37841744 PMCID: PMC10569298 DOI: 10.3389/fpubh.2023.1225053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Non-communicable diseases (NCDs) represent the leading cause of mortality and disability worldwide. Robust evidence has demonstrated that modifiable lifestyle factors such as unhealthy diet, smoking, alcohol consumption and physical inactivity are the primary causes of NCDs. Although a series of guidelines for the management of NCDs have been published in China, these guidelines mainly focus on clinical practice targeting clinicians rather than the general population, and the evidence for NCD prevention based on modifiable lifestyle factors has been disorganized. Therefore, comprehensive and evidence-based guidance for the risk management of major NCDs for the general Chinese population is urgently needed. To achieve this overarching aim, we plan to develop a series of expert consensuses covering 15 major NCDs on health risk management for the general Chinese population. The objectives of these consensuses are (1) to identify and recommend suitable risk assessment methods for the Chinese population; and (2) to make recommendations for the prevention of major NCDs by integrating the current best evidence and experts' opinions. Methods and analysis For each expert consensus, we will establish a consensus working group comprising 40-50 members. Consensus questions will be formulated by integrating literature reviews, expert opinions, and an online survey. Systematic reviews will be considered as the primary evidence sources. We will conduct new systematic reviews if there are no eligible systematic reviews, the methodological quality is low, or the existing systematic reviews have been published for more than 3 years. We will evaluate the quality of evidence and make recommendations according to the GRADE approach. The consensuses will be reported according to the Reporting Items for Practice Guidelines in Healthcare (RIGHT).
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Affiliation(s)
- Danni Wang
- Department of Epidemiology and Biostatistics, Clinical Big Data Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Qiangsheng He
- Department of Epidemiology and Biostatistics, Clinical Big Data Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Bin Xia
- Department of Epidemiology and Biostatistics, Clinical Big Data Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Jie Zheng
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, United Kingdom
| | - Wangnan Cao
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Shaochen Su
- Healthy Examination & Management Center, The First Hospital of Lanzhou University, Lanzhou, China
| | - Fulan Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Shenzhen University Health Science Center, Shenzhen, China
| | - Jiang Li
- Office for Cancer Screening, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Chinese Academy of Medical Sciences Key Laboratory for National Cancer Big Data Analysis and Implement, Beijing, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengjia Ren
- Department of Clinical Psychology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xue Li
- Center for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, China
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Xinyin Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yafang Huang
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Yongjiang Tang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Fuxin Wei
- Department of Orthopaedic Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Huachun Zou
- Department of Epidemiology, School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Huaili Jiang
- Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junjie Huang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wenbo Meng
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Ming Bai
- The Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Kehu Yang
- Health Technology Assessment Center, Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Jinqiu Yuan
- Department of Epidemiology and Biostatistics, Clinical Big Data Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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Mauch CE, Edney SM, Viana JNM, Gondalia S, Sellak H, Boud SJ, Nixon DD, Ryan JC. Precision health in behaviour change interventions: A scoping review. Prev Med 2022; 163:107192. [PMID: 35963310 DOI: 10.1016/j.ypmed.2022.107192] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/24/2022] [Accepted: 08/07/2022] [Indexed: 11/09/2022]
Abstract
Precision health seeks to optimise behavioural interventions by delivering personalised support to those in need, when and where they need it. Conceptualised a decade ago, progress toward this vision of personally relevant and effective population-wide interventions continues to evolve. This scoping review aimed to map the state of precision health behaviour change intervention research. This review included studies from a broader precision health review. Six databases were searched for studies published between January 2010 and June 2020, using the terms 'precision health' or its synonyms, and including an intervention targeting modifiable health behaviour(s) that was evaluated experimentally. Thirty-one studies were included, 12 being RCTs (39%), and 17 with weak study design (55%). Most interventions targeted physical activity (27/31, 87%) and/or diet (24/31, 77%), with 74% (23/31) targeting two to four health behaviours. Interventions were personalised via human interaction in 55% (17/31) and digitally in 35% (11/31). Data used for personalising interventions was largely self-reported, by survey or diary (14/31, 45%), or digitally (14/31, 45%). Data was mostly behavioural or lifestyle (20/31, 65%), and physiologic, biochemical or clinical (15/31, 48%), with no studies utilising genetic/genomic data. This review demonstrated that precision health behaviour change interventions remain dependent on human-led, low-tech personalisation, and have not fully considered the interaction between behaviour and the social and environmental contexts of individuals. Further research is needed to understand the relationship between personalisation and intervention effectiveness, working toward the development of sophisticated and scalable behaviour change interventions that have tangible public health impact.
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Affiliation(s)
- Chelsea E Mauch
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, SA, Australia.
| | - Sarah M Edney
- Physical Activity and Nutrition Determinants in Asia (PANDA) Programme, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
| | - John Noel M Viana
- Responsible Innovation Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD, Australia; Australian National Centre for the Public Awareness of Science, Australian National University, Canberra, ACT, Australia.
| | - Shakuntla Gondalia
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, SA, Australia; Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Adelaide, SA, Australia; Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, VC, Australia..
| | - Hamza Sellak
- Data61, Commonwealth Scientific and Industrial Research Organisation, Melbourne, VC, Australia.
| | - Sarah J Boud
- Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Dakota D Nixon
- Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Jillian C Ryan
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, SA, Australia; Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Adelaide, SA, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia.
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3
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Lee J, Keil M, Lee JS, Baird A, Choi HY. Gender Effects on the Impact of Colorectal Cancer Risk Calculators on Screening Intentions: An Experimental Study (Preprint). JMIR Form Res 2022. [DOI: 10.2196/37553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Viana JN, Edney S, Gondalia S, Mauch C, Sellak H, O'Callaghan N, Ryan JC. Trends and gaps in precision health research: a scoping review. BMJ Open 2021; 11:e056938. [PMID: 34697128 PMCID: PMC8547511 DOI: 10.1136/bmjopen-2021-056938] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/08/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To determine progress and gaps in global precision health research, examining whether precision health studies integrate multiple types of information for health promotion or restoration. DESIGN Scoping review. DATA SOURCES Searches in Medline (OVID), PsycINFO (OVID), Embase, Scopus, Web of Science and grey literature (Google Scholar) were carried out in June 2020. ELIGIBILITY CRITERIA Studies should describe original precision health research; involve human participants, datasets or samples; and collect health-related information. Reviews, editorial articles, conference abstracts or posters, dissertations and articles not published in English were excluded. DATA EXTRACTION AND SYNTHESIS The following data were extracted in independent duplicate: author details, study objectives, technology developed, study design, health conditions addressed, precision health focus, data collected for personalisation, participant characteristics and sentence defining 'precision health'. Quantitative and qualitative data were summarised narratively in text and presented in tables and graphs. RESULTS After screening 8053 articles, 225 studies were reviewed. Almost half (105/225, 46.7%) of the studies focused on developing an intervention, primarily digital health promotion tools (80/225, 35.6%). Only 28.9% (65/225) of the studies used at least four types of participant data for tailoring, with personalisation usually based on behavioural (108/225, 48%), sociodemographic (100/225, 44.4%) and/or clinical (98/225, 43.6%) information. Participant median age was 48 years old (IQR 28-61), and the top three health conditions addressed were metabolic disorders (35/225, 15.6%), cardiovascular disease (29/225, 12.9%) and cancer (26/225, 11.6%). Only 68% of the studies (153/225) reported participants' gender, 38.7% (87/225) provided participants' race/ethnicity, and 20.4% (46/225) included people from socioeconomically disadvantaged backgrounds. More than 57% of the articles (130/225) have authors from only one discipline. CONCLUSIONS Although there is a growing number of precision health studies that test or develop interventions, there is a significant gap in the integration of multiple data types, systematic intervention assessment using randomised controlled trials and reporting of participant gender and ethnicity. Greater interdisciplinary collaboration is needed to gather multiple data types; collectively analyse big and complex data; and provide interventions that restore, maintain and/or promote good health for all, from birth to old age.
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Affiliation(s)
- John Noel Viana
- Responsible Innovation Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Queensland, Australia
- Australian National Centre for the Public Awareness of Science, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sarah Edney
- Physical Activity and Nutrition Determinants in Asia (PANDA) programme, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Shakuntla Gondalia
- Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
| | - Chelsea Mauch
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
| | - Hamza Sellak
- Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
- Data61, Commonwealth Scientific and Industrial Research Organisation, Melbourne, Victoria, Australia
| | - Nathan O'Callaghan
- Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
| | - Jillian C Ryan
- Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Adelaide, South Australia, Australia
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Karatzi K, Moschonis G, Botsi E, Liatis S, Tsochev K, De Miguel-Etayo P, Kivelä J, Wikström K, Dimova R, Antal E, Lamiquiz-Moneo I, Rurik I, Cardon G, Iotova V, Makrilakis K, Manios Y. Lipidemic Profile Changes over a Two-Year Intervention Period: Who Benefited Most from the Feel4Diabetes Program? Nutrients 2020; 12:E3736. [PMID: 33291645 PMCID: PMC7761911 DOI: 10.3390/nu12123736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/30/2020] [Indexed: 12/02/2022] Open
Abstract
Identification of participants' characteristics who benefited most from large community-based intervention studies may guide future prevention initiatives in order to maximize their effectiveness. The current study aimed to examine the socio-demographic, anthropometric, and behavioral characteristics, as well as the health and eating perceptions of those who improved their lipidemic profile, in the Feel4Diabetes early screening and prevention program. In the present analyses, 1773 adults from families at high risk for developing type 2 diabetes mellitus (T2DM) were enrolled, receiving either the standard care or the more intensive intervention, and 33.3-55.2% of them improved one or more of their lipidemic indices by >5%. Women, people living in Southeastern Europe, coming from two-parent families, having higher financial security, educational level and better diet quality were associated with a 27-64% higher likelihood for benefiting from the program regarding one or more of their lipidemic profile indices. Participants who were overweight or obese (especially with central obesity), employed, with prolonged sedentary behavior, prone to emotional eating and perceiving their weight status as lower than their actual weight were 24-43% less likely to have benefited. These findings should guide future interventions, prioritizing regions in greater need, and being tailor-made to specific population characteristics in order to further improve their effectiveness.
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Affiliation(s)
- Kalliopi Karatzi
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (K.K.); (E.B.)
| | - George Moschonis
- Department of Dietetics, Nutrition and Sport, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia;
| | - Eirini Botsi
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (K.K.); (E.B.)
| | - Stavros Liatis
- National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece; (S.L.); (K.M.)
| | - Kaloyan Tsochev
- Department of Paediatrics, Medical University Varna, 9002 Varna, Bulgaria; (K.T.); (V.I.)
| | - Pilar De Miguel-Etayo
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Universidad de Zaragoza, 50009 Zaragoza, Spain;
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Jemina Kivelä
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (J.K.); (K.W.)
| | - Katja Wikström
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (J.K.); (K.W.)
| | - Roumyana Dimova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, 1431 Sofia, Bulgaria;
| | - Emese Antal
- Hungarian Society of Nutrition, 1088 Budapest, Hungary; (E.A.); (I.R.)
| | - Itziar Lamiquiz-Moneo
- Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria Aragón (IIS Aragón), CIBERCV, Universidad de Zaragoza, 50009 Zaragoza, Spain;
| | - Imre Rurik
- Hungarian Society of Nutrition, 1088 Budapest, Hungary; (E.A.); (I.R.)
| | - Greet Cardon
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000 Gent, Belgium;
| | - Violeta Iotova
- Department of Paediatrics, Medical University Varna, 9002 Varna, Bulgaria; (K.T.); (V.I.)
| | - Konstantinos Makrilakis
- National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece; (S.L.); (K.M.)
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; (K.K.); (E.B.)
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Socio-Demographic Characteristics and Body Weight Perceptions of Study Participants Benefitting Most from the Feel4Diabetes Program Based on Their Anthropometric and Glycaemic Profile Changes. Nutrients 2020; 12:nu12103117. [PMID: 33065990 PMCID: PMC7601567 DOI: 10.3390/nu12103117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/19/2022] Open
Abstract
The Feel4Diabetes program was comprised of a community-based screening and a two-year intervention phase aiming to prevent type 2 diabetes (T2D) in families at risk for diabetes across Europe. The current work aimed to identify the socio-demographic characteristics and body weight perceptions of participants who benefitted the most, achieving at least a 5% reduction in body weight, waist circumference and glycaemic indices (fasting plasma glucose, insulin, glycosylated haemoglobin levels), over two-year period. Following a two-stage screening procedure, 2294 high-risk parents were randomly allocated to standard care or more intensive intervention. The participants who benefitted most were living in Southern (OR 2.39–3.67, p < 0.001) and Eastern Europe (OR 1.55–2.47, p < 0.05), received more intensive intervention (OR 1.53–1.90, p = 0.002) and were younger (<40 years old) adults (OR 1.48–1.51, p < 0.05). Furthermore, individuals with tertiary education (OR 2.06, p < 0.001), who were unemployed (OR 1.62–1.68, p < 0.05) and perceived their body weight to be higher than normal (OR 1.58–3.00, p < 0.05) were more likely to benefit from the program. Lastly, males were more likely to show improvements in their glycaemic profiles compared to females (OR 1.40, p = 0.024). These findings point out the regions in Europe and the sociodemographic profile of individuals that benefitted the most in the current study, highlighting the need to prioritise regions in greater need for such interventions and also tailor future interventions to the characteristics and perceptions of the target populations.
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Zhang E, Tipirneni R, Beathard ER, Lee S, Kirch MA, Salman C, Solway E, Clark SJ, Haggins AN, Kieffer EC, Ayanian JZ, Goold SD. Health Risk Assessments in Michigan's Medicaid Expansion: Early Experiences in Primary Care. Am J Prev Med 2020; 58:e79-e86. [PMID: 31952944 PMCID: PMC7085853 DOI: 10.1016/j.amepre.2019.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Michigan is one of 3 states that have implemented health risk assessments for enrollees as a feature of its Medicaid expansion, the Healthy Michigan Plan. This study describes primary care providers' early experiences with completing health risk assessments with enrollees and examines provider- and practice-level factors that affect health risk assessment completion. METHODS All primary care providers caring for ≥12 Healthy Michigan Plan enrollees (n=4,322) were surveyed from June to November 2015, with 2,104 respondents (55.5%). Analyses in 2016-2017 described provider knowledge, attitudes, and experiences with the health risk assessment early in Healthy Michigan Plan implementation; multivariable analyses examined relationships of provider- and practice-level characteristics with health risk assessment completion, as recorded in state data. RESULTS Of the primary care provider respondents, 73% found health risk assessments very or somewhat useful for identifying and discussing health risks, although less than half (47.2%) found them very or somewhat useful for getting patients to change health behaviors. Most primary care provider respondents (65.3%) were unaware of financial incentives for their practices to complete health risk assessments. Nearly all primary care providers had completed at least 1 health risk assessment. The mean health risk assessment completion rate (completed health risk assessments/number of Healthy Michigan Plan enrollees assigned to that primary care provider) was 19.6%; those who lacked familiarity with the health risk assessment had lower completion rates. CONCLUSIONS Early in program implementation, health risk assessment completion rates by primary care providers were low and awareness of financial incentives limited. Most primary care provider respondents perceived health risk assessments to be very or somewhat useful in identifying health risks, and about half of primary care providers viewed health risk assessments as very or somewhat useful in helping patients to change health behaviors.
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Affiliation(s)
- Eunice Zhang
- Department of Preventive Medicine, University of Michigan, Ann Arbor, Michigan
| | - Renuka Tipirneni
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Erin R Beathard
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Sunghee Lee
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Matthias A Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Cengiz Salman
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Sarah J Clark
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Pediatric and Communicable Diseases, University of Michigan, Ann Arbor, Michigan
| | - Adrianne N Haggins
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Edith C Kieffer
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; School of Social Work, University of Michigan, Ann Arbor, Michigan
| | - John Z Ayanian
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Susan D Goold
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
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Yousuf H, Reintjens R, Slipszenko E, Blok S, Somsen GA, Tulevski II, Hofstra L. Effectiveness of web-based personalised e‑Coaching lifestyle interventions. Neth Heart J 2018; 27:24-29. [PMID: 30488381 PMCID: PMC6311162 DOI: 10.1007/s12471-018-1200-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction Interventions to reduce the impact of modifiable risk factors, such as hypercholesterolaemia, smoking, and overweight, have the potential to significantly decrease the cardiovascular disease burden. The majority of the global population is unaware of their own risk of developing cardiovascular disease. Parallel to the lack of awareness, a rise in obesity and diabetes is observed. e‑Health tools for lifestyle improvement have shown to be effective in changing unhealthy behaviour. In this study we report on the results of three different trials assessing the effectiveness of MyCLIC, an e‑Coaching lifestyle intervention tool. Methods From 2008 to 2016 we conducted three trials: 1) HAPPY NL: a prospective cohort study in the Netherlands, 2) HAPPY AZM: a prospective cohort study with employees of Maastricht UMC+ and 3) HAPPY LONDON: a single-centre, randomised controlled trial with asymptomatic individuals who have a high 10-year CVD risk. Results HAPPY NL and HAPPY AZM showed that e‑Coaching reduced cardiovascular risk. Both prospective trials showed a 20–25% relative reduction in 10-year cardiovascular disease risk. A lesser effect was seen in the HAPPY LONDON trial. A low frequency of logins suggests a low degree of content engagement in the e‑Coaching group, which could be age related as the mean age of the participants in the HAPPY LONDON study was high. Conclusion e-Coaching using MyCLIC is a low cost and effective method to perform lifestyle interventions and has the potential to reduce the 10-year cardiovascular disease risk.
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Affiliation(s)
- H Yousuf
- Amsterdam UMC (Location: VU University Medical Center), Amsterdam, The Netherlands.
| | | | | | - S Blok
- Cardiologie Centra Nederland, Amsterdam, The Netherlands
| | - G A Somsen
- Cardiologie Centra Nederland, Amsterdam, The Netherlands
| | - I I Tulevski
- Cardiologie Centra Nederland, Amsterdam, The Netherlands
| | - L Hofstra
- Amsterdam UMC (Location: VU University Medical Center), Amsterdam, The Netherlands
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Lee JW, Lim HS, Kim DW, Shin SA, Kim J, Yoo B, Cho KH. The development and implementation of stroke risk prediction model in National Health Insurance Service's personal health record. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 153:253-257. [PMID: 29157457 DOI: 10.1016/j.cmpb.2017.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 08/18/2017] [Accepted: 10/02/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE The purpose of this study was to build a 10-year stroke prediction model and categorize a probability of stroke using the Korean national health examination data. Then it intended to develop the algorithm to provide a personalized warning on the basis of each user's level of stroke risk and a lifestyle correction message about the stroke risk factors. METHODS Subject to national health examinees in 2002-2003, the stroke prediction model identified when stroke was first diagnosed by following-up the cohort until 2013 and estimated a 10-year probability of stroke. It sorted the user's individual probability of stroke into five categories - normal, slightly high, high, risky, very risky, according to the five ranges of average probability of stroke in comparison to total population - less than 50 percentile, 50-70, 70-90, 90-99.9, more than 99.9 percentile, and constructed the personalized warning and lifestyle correction messages by each category. RESULTS Risk factors in stroke risk model include the age, BMI, cholesterol, hypertension, diabetes, smoking status and intensity, physical activity, alcohol drinking, past history (hypertension, coronary heart disease) and family history (stroke, coronary heart disease). The AUC values of stroke risk prediction model from the external validation data set were 0.83 in men and 0.82 in women, which showed a high predictive power. The probability of stroke within 10 years for men in normal group (less than 50 percentile) was less than 3.92% and those in very risky group (top 0.01 percentile) was 66.2% and over. The women's probability of stroke within 10 years was less than 3.77% in normal group (less than 50 percentile) and 55.24% and over in very risky group. CONCLUSIONS This study developed the stroke risk prediction model and the personalized warning and the lifestyle correction message based on the national health examination data and uploaded them to the personal health record service called My Health Bank in the health information website - Health iN. By doing so, it urged medical users to strengthen the motivation of health management and induced changes in their health behaviors.
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Affiliation(s)
- Jae-Woo Lee
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hyun-Sun Lim
- Department of Policy Research Affair, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Dong-Wook Kim
- Department of Policy Research Affair, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Soon-Ae Shin
- Department of Big Data Steering, National Health Insurance Service, Wonju, Gangwon, Republic of Korea
| | - Jinkwon Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Bora Yoo
- Department of Family Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Kyung-Hee Cho
- Department of Family Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea.
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10
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Siren R, Eriksson JG, Vanhanen H. Observed changes in cardiovascular risk factors among high-risk middle-aged men who received lifestyle counselling: a 5-year follow-up. Scand J Prim Health Care 2016; 34:336-342. [PMID: 27822969 PMCID: PMC5217283 DOI: 10.1080/02813432.2016.1248649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the long-term impact of health counselling among middle-aged men at high risk of CVD. DESIGN An observational study with a 5-year follow-up. SETTING AND INTERVENTION All men aged 40 years in Helsinki have been invited to a visit to evaluate CVD risk from 2006 onwards. A modified version of the North Karelia project risk tool (CVD risk score) served to assess the risk. High-risk men received lifestyle counselling based on their individual risk profile in 2006 and were invited to a follow-up visit in 2011. SUBJECTS Of the 389 originally high-risk men, 159 participated in the follow-up visits in 2011. Based on their follow-up in relation the further risk communication, we divided the participants into three groups: primary health care, occupational health care and no control visits. MAIN OUTCOME MEASURES Lifestyle and CVD risk score change. RESULTS All groups showed improvements in lifestyles. The CVD risk score decreased the most in the group that continued the risk communication visits in their primary health care centre (6.1 to 4.8 [95% CI -1.6 to -0.6]) compared to those who continued risk communication visits in their occupational health care (6.0 to 5.4 [95% CI -1.3 to 0.3]), and to those with no risk communication visits (6.0 to 5.9 [95% CI -0.5 to 0.4]). CONCLUSIONS These findings indicate that individualized lifestyle counselling improves health behaviour and reduces total CVD risk among middle-aged men at high risk of CVD. Sustained improvement in risk factor status requires ongoing risk communication with health care providers. KEY POINTS Studies of short duration have shown that lifestyle changes reduce the risk of cardiovascular disease among high-risk individuals. Sustaining these lifestyle changes and maintaining the lower disease risk attained can prove challenging. Cardiovascular disease (CVD) risk assessment and individualized health counselling for high-risk men, when implemented in primary health care, have the potential to initiate lifestyle changes that support risk reduction. Attaining a sustainable reduction in CVD risk requires a willingness to engage in risk-related communication from both health care providers and the individual at high risk.
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Affiliation(s)
- Reijo Siren
- Health Centre of the City of Helsinki, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- CONTACT Reijo Siren Department of General Practice and Primary Health Care, University of Helsinki, P.O. BOX 20, 00014 Helsinki, Finland
| | - Johan G. Eriksson
- National Institute for Health and Welfare, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhalsan Research Centre, Helsinki, Finland
| | - Hannu Vanhanen
- The Social Insurance Institution of Finland (KELA), Helsinki, Finland
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11
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Simpson V, Pedigo L. Nurse and Physician Involvement in Health Risk Appraisals: An Integrative Review. West J Nurs Res 2016; 39:803-824. [PMID: 27445043 DOI: 10.1177/0193945916660341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Unhealthy lifestyle behaviors continue to be a strong contributor to chronic illness and death in the United States. Despite the health care system's efforts to refocus on prevention, primary care visits remain acute care focused. Health risk appraisals are tools that can be used by primary care providers to enhance lifestyle behavior change and prevention efforts. The purpose of this integrative review is to examine nurse and physician use of health risk appraisals in primary care. A total of 26 national and international papers, selected through an electronic database and ancestry search, were reviewed. Identified nurse and physician interventions in addition to other programming included helping participants understand and interpret feedback, behavioral counseling, and development of plans to address unhealthy lifestyle behaviors. The most common intervention was provision of telephonic nurse advice lines. Overall outcomes were positive. The use of these tools could be key to enhancing primary care prevention.
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12
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Kallenberg FGJ, Vleugels JLA, de Wijkerslooth TR, Stegeman I, Stoop EM, van Leerdam ME, Kuipers EJ, Bossuyt PMM, Dekker E. Adding family history to faecal immunochemical testing increases the detection of advanced neoplasia in a colorectal cancer screening programme. Aliment Pharmacol Ther 2016; 44:88-96. [PMID: 27170502 DOI: 10.1111/apt.13660] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/15/2016] [Accepted: 04/21/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Faecal immunochemical testing (FIT) for colorectal cancer (CRC) screening has suboptimal sensitivity for detecting advanced neoplasia. To increase its performance, FIT could be combined with other risk factors. AIM To evaluate the incremental yield of a screening programme using a positive FIT or a CRC family history, to offer a diagnostic colonoscopy. METHODS For this post hoc analysis, data were collected in the colonoscopy arm of a colonoscopy or colonography for screening study. In this study, 6600 randomly selected, asymptomatic men and women (50-75 years) were invited for screening colonoscopy. 1112 Participants completed a FIT and a questionnaire prior to colonoscopy. We compared the yield of FIT-only and FIT combined with CRC family history, defined as having one or more first-degree relatives with CRC. RESULTS At a 10 μg Hb/g faeces FIT-positivity threshold the combined strategy would increase the yield from 36 (3.2%; CI: 2.4-4.5%) to 53 (4.8%; CI: 3.7-6.2%) cases of advanced neoplasia, at the expense of 148 additional negative colonoscopies. Sensitivity in detecting advanced neoplasia would increase from 36% (CI: 26-46%) to 52% (CI: 42-63%), whereas specificity would decrease from 93% (CI: 92-95%) to 79% (CI: 76-81%). The strategy will be preferred if one accepts 8.8 false positives for every additional participant in whom advanced neoplasia can be detected. CONCLUSIONS Offering colonoscopy to those with a positive FIT or CRC family history increases the yield of a FIT-based screening programme. Depending on the number of negative colonoscopies one accepts, this combined approach can be considered for improving CRC screening.
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Affiliation(s)
- F G J Kallenberg
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J L A Vleugels
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - T R de Wijkerslooth
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - I Stegeman
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E M Stoop
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M E van Leerdam
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - E J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - P M M Bossuyt
- Department of Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - E Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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13
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Wright DR, Lozano P, Dawson-Hahn E, Christakis DA, Haaland WL, Basu A. Parental Predictions and Perceptions Regarding Long-Term Childhood Obesity-Related Health Risks. Acad Pediatr 2016; 16:475-481. [PMID: 26875508 PMCID: PMC4931970 DOI: 10.1016/j.acap.2016.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/02/2016] [Accepted: 02/06/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess how parents perceive long-term risks for developing obesity-related chronic health conditions. METHODS A Web-based nationally representative survey was administered to 502 US parents with a 5- to 12-year-old child. Parents reported whether their child was most likely to be at a healthy weight or overweight, and the probability that their child would develop hypertension, heart disease, depression, or type 2 diabetes in adulthood. Responses of parents of children with overweight and obesity were compared to those of healthy-weight children using multivariate models. RESULTS The survey had an overall response rate of 39.2%. The mean (SD) unadjusted parent predicted health risks were 15.4% (17.7%), 11.2% (14.7%), 12.5% (16.2%), and 12.1% (16.1%) for hypertension, heart disease, depression, and diabetes, respectively. Despite underperceiving their child's current body mass index class, parents of children with obesity estimate their children to be at greater risk for obesity-related health conditions than parents of healthy-weight children by 5 to 6 percentage points. Having a family history of a chronic disease, higher quality of care, and older parent age were also significant predictors of estimating higher risk probabilities. CONCLUSIONS Despite evidence that parents of children who are overweight may not perceive these children as being overweight, parents unexpectedly estimate greater future risk of weight-related health conditions for these children. Focusing communication about weight on screening for and reducing the risk of weight-related diseases may prove useful in engaging parents and children in weight management.
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Affiliation(s)
- Davene R Wright
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash; Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Wash.
| | | | - Elizabeth Dawson-Hahn
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash; Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Wash
| | - Dimitri A Christakis
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash; Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Wash
| | - Wren L Haaland
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Wash
| | - Anirban Basu
- Department of Pharmacy, University of Washington School of Pharmacy, Seattle, Wash
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14
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IJspeert JEG, Bossuyt PM, Kuipers EJ, Stegeman I, de Wijkerslooth TR, Stoop EM, van Leerdam ME, Dekker E. Smoking status informs about the risk of advanced serrated polyps in a screening population. Endosc Int Open 2016; 4:E73-8. [PMID: 26793788 PMCID: PMC4713182 DOI: 10.1055/s-0034-1393361] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Evidence has accumulated that approximately 15 % to 30 % of colorectal cancers (CRC) arise from serrated polyps (SP). Population screening, therefore, should be designated to detect advanced SP, in addition to advanced adenomas and CRC. We aimed to evaluate whether CRC risk factors also act as risk factors for advanced SP. PATIENTS AND METHODS Data were collected in the colonoscopy arm of a multicenter randomized trial comparing colonoscopy with CT-colonography for primary population screening. Information on risk factors was obtained by screening participants before colonoscopy with a validated risk questionnaire. Advanced SP were defined as SP ≥ 10 mm and/or with dysplasia. Endoscopists were instructed to resect all detected lesions. Odds ratios (OR) for the detection of advanced SP as most advanced lesion were calculated using multiple logistic regression analysis. RESULTS Of 6 600 invited participants, 1 426 underwent a colonoscopy and 1 236 also completed the questionnaire. In 40 participants an advanced SP was the most advanced lesion detected. Multivariate analysis demonstrated a strong association between current smoking and the presence of at least one advanced SP (OR 4.50; 95 % CI 2.23 - 8.89; P < 0.001). A significant association was also demonstrated for higher fiber intake (OR 1.36 per 20 gram intake; CI 1.07 - 1.73; P = 0.01). Other clinical CRC risk factors did not show a significant association with the presence of at least one advanced SP in the univariate analyses. Fecal haemoglobin levels were also not significantly associated with the presence of advanced SPs (OR 1.00 per 10 ng/mL CI 0.97 - 1.03, P = 0.99). CONCLUSIONS Current smoking is a strong clinical risk factor for the presence of advanced SPs. As such, smoking status could contribute to risk stratification in targeted CRC population screening. Dutch Trial Register: NTR1829 (www.trialregister.nl).
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Affiliation(s)
- J. E. G. IJspeert
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - P. M. Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, Netherlands
| | - E. J. Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - I. Stegeman
- Department of Otolaryngology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - T. R. de Wijkerslooth
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - E. M. Stoop
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - M. E. van Leerdam
- Department of Gastroenterology and Hepatology, National Cancer Institute, Amsterdam, The Netherlands
| | - E. Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands,Corresponding author Evelien Dekker, MD PhD Department of Gastroenterology and HepatologyAcademic Medical CentreMeibergdreef 9 1105 AZAmsterdamThe Netherlands+31 20 566 4702+31 20 691 7033
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15
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Damman OC, Bogaerts NMM, van Dongen D, Timmermans DRM. Barriers in using cardiometabolic risk information among consumers with low health literacy. Br J Health Psychol 2015. [PMID: 26213137 DOI: 10.1111/bjhp.12149] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify the barriers from the perspective of consumers with low health literacy in using risk information as provided in cardiometabolic risk assessments. DESIGN A qualitative thematic approach using cognitive interviews was employed. METHODS We performed interviews with 23 people with low health literacy/health numeracy, who were recruited through (1) several organisations and snowball sampling and (2) an online access panel. Participants completed the risk test of the Dutch national cardiometabolic risk assessment and viewed the personalized information about their risk. They were asked to answer probing questions about different parts of the information. The qualitative data were analysed by identifying main themes related to barriers in using the information, using a descriptive thematic approach. RESULTS The four main themes identified were as follows: (1) People did not fully accept the risk message, partly because numerical information had ambiguous meaning; (2) people lacked an adequate framework for understanding their risk; (3) the purpose and setting of the risk assessment was unclear; and (4) current information tells nothing new: A need for more specific risk information. CONCLUSIONS The main barriers were that the current presentation seemed to provoke undervaluation of the risk number and that texts throughout the test, for example about cardiometabolic diseases, did not match people's existing knowledge, failing to provide an adequate framework for understanding cardiometabolic risk. Our findings have implications for the design of disease risk information, for example that alternative forms of communication should be explored that provide more intuitive meaning of the risk in terms of good versus bad. STATEMENT OF CONTRIBUTION What is already known on this subject? Online disease risk assessments have become widely available internationally. People with low SES and health literacy tend to participate less in health screening. Risk information is difficult to understand, yet little research has been carried out among people with low health literacy. What does this study add? People with low health literacy do not optimally use risk information in an online cardiometabolic risk assessment. The texts provided in the cardiometabolic risk assessment do not suit to their existing knowledge. The typical risk communication (numbers, bar graph, verbal label) seems to provoke undervaluation of risk.
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Affiliation(s)
- Olga C Damman
- Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Nina M M Bogaerts
- Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Diana van Dongen
- Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Danielle R M Timmermans
- Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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16
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van den Brekel-Dijkstra K, Rengers AH, Niessen MAJ, de Wit NJ, Kraaijenhagen RA. Personalized prevention approach with use of a web-based cardiovascular risk assessment with tailored lifestyle follow-up in primary care practice – a pilot study. Eur J Prev Cardiol 2015; 23:544-51. [DOI: 10.1177/2047487315591441] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 05/26/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Karolien van den Brekel-Dijkstra
- Leidsche Rijn Julius Gezondheidscentra, Utrecht, The Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
| | | | - Maurice AJ Niessen
- NDDO Institute for Prevention and Early Diagnostics (NIPED), Amsterdam, The Netherlands
| | - Niek J de Wit
- Leidsche Rijn Julius Gezondheidscentra, Utrecht, The Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
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17
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Widmer RJ, Collins NM, Collins CS, West CP, Lerman LO, Lerman A. Digital health interventions for the prevention of cardiovascular disease: a systematic review and meta-analysis. Mayo Clin Proc 2015; 90:469-80. [PMID: 25841251 PMCID: PMC4551455 DOI: 10.1016/j.mayocp.2014.12.026] [Citation(s) in RCA: 218] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/19/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the potential benefit of digital health interventions (DHIs) on cardiovascular disease (CVD) outcomes (CVD events, all-cause mortality, hospitalizations) and risk factors compared with non-DHIs. PATIENTS AND METHODS We conducted a systematic search of PubMed, MEDLINE, EMBASE, Web of Science, Ovid, CINHAL, ERIC, PsychINFO, Cochrane, and Cochrane Central Register of Controlled Trials for articles published from January 1, 1990, through January 21, 2014. Included studies examined any element of DHI (telemedicine, Web-based strategies, e-mail, mobile phones, mobile applications, text messaging, and monitoring sensors) and CVD outcomes or risk factors. Two reviewers independently evaluated study quality utilizing a modified version of the Cochrane Collaboration risk assessment tool. Authors extracted CVD outcomes and risk factors for CVD such as weight, body mass index, blood pressure, and lipid levels from 51 full-text articles that met validity and inclusion criteria. RESULTS Digital health interventions significantly reduced CVD outcomes (relative risk, 0.61; 95% CI, 0.46-0.80; P<.001; I(2)=22%). Concomitant reductions in weight (-2.77 lb [95% CI, -4.49 to -1.05 lb]; P<.002; I(2)=97%) and body mass index (-0.17 kg/m(2) [95% CI, -0.32 kg/m(2) to -0.01 kg/m(2)]; P=.03; I(2)=97%) but not blood pressure (-1.18 mm Hg [95% CI, -2.93 mm Hg to 0.57 mm Hg]; P=.19; I(2)=100%) were found in these DHI trials compared with usual care. In the 6 studies reporting Framingham risk score, 10-year risk percentages were also significantly improved (-1.24%; 95% CI, -1.73% to -0.76%; P<.001; I(2)=94%). Results were limited by heterogeneity not fully explained by study population (primary or secondary prevention) or DHI modality. CONCLUSION Overall, these aggregations of data provide evidence that DHIs can reduce CVD outcomes and have a positive impact on risk factors for CVD.
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Affiliation(s)
- R Jay Widmer
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - C Scott Collins
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Colin P West
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN; Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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18
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Memish ZA, Saeedi MY, Al Madani AJ, Junod B, Jamo A, Abid O, Alanazi FM, Alrewally FG, Mandil AMA. Factors associated with public awareness of the Crown Health Program in the Al-Jouf Region. J Family Community Med 2015; 22:31-8. [PMID: 25657609 PMCID: PMC4317992 DOI: 10.4103/2230-8229.149586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives: A community-based intervention, the Crown Health Project (CHP), was developed by the Ministry of Health. It was implemented on a small-scale in Al-Jouf Region in Northern Kingdom of Saudi Arabia to assess its feasibility and effectiveness so that it can be scaled up. This study primarily aimed at investigating factors associated with the awareness of CHP in order to improve subsequent campaigns for the program in Al-Jouf and other regions. A secondary aim was to assess possible changes of public awareness during intensification of the awareness campaign between October 2011 and May 2012. Methods: A pre- and post-questionnaire cross-sectional approach was undertaken, and the intervention was an awareness campaign. Variables collected included demographic characteristics (e.g., age, gender, education, occupation, urban/rural residence) and CHP awareness (its existence, sources of knowledge about CHP, its goals and objectives, its target diseases, location of activities, participation in such activities). Logistic regression was used to analyze the awareness of the program according to participant characteristics, with a time of the survey as a variable. Results: Awareness of the program was found to be 11 times higher among postsurvey respondents than presurvey respondents. Respondents of the second survey were better at correctly identifying “health education” as the main goal of the CHP (odds ratio [OR], 4.1; 95% confidence interval [CI], 3.1–5.5), “noncommunicable diseases” as the main diseases targeted (OR, 4.8; 95% CI, 3.6–6.4) and “attention to health” as the purpose (OR, 6.0; 95% CI, 4.0–8.9). Conclusion: The different activities of the CHP were successful in dramatically increasing awareness of the CHP program in Al-Jouf.
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Affiliation(s)
- Ziad A Memish
- Public Health Directorate, Ministry of Health, Kingdom of Saudi Arabia
| | - Mohammad Y Saeedi
- Public Health Directorate, Ministry of Health, Kingdom of Saudi Arabia
| | - Ahmed J Al Madani
- Public Health Directorate, Ministry of Health, Kingdom of Saudi Arabia
| | - Bernard Junod
- Public Health Directorate, Ministry of Health, Kingdom of Saudi Arabia
| | - Abdelgadier Jamo
- Public Health Directorate, Ministry of Health, Kingdom of Saudi Arabia
| | - Omer Abid
- Public Health Directorate, Ministry of Health, Kingdom of Saudi Arabia
| | - Faisal M Alanazi
- Public Health Directorate, Ministry of Health, Kingdom of Saudi Arabia
| | | | - Ahmed M A Mandil
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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19
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Kim CJ, Schlenk EA, Kang SW, Park JB. Effects of an internet-based lifestyle intervention on cardio-metabolic risks and stress in Korean workers with metabolic syndrome: a controlled trial. PATIENT EDUCATION AND COUNSELING 2015; 98:111-119. [PMID: 25468401 DOI: 10.1016/j.pec.2014.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 09/21/2014] [Accepted: 10/19/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This study examined the effects of an Internet-based Best Exerciser Super Trainer (BEST) program on cardio-metabolic risks and stress among workers with metabolic syndrome. METHODS This study utilized a non-randomized, pretest, and posttest, controlled design with a convenience sample of 48 Korean male workers. The workers in the BEST group participated in a 16-week Internet-based program: 150 min of regular physical activity per week, 200- to 300-kcal reduced daily diet for weight control, one-on-one counseling, and mobile phone text messages. Workers in the Education group received text messages and an educational booklet. RESULTS There were significant group by time interactions in cardio-metabolic risks: body weight (p = .022), visceral fat mass (p = .033), and waist circumference (p = .037). There was no group by time interaction in stress (p > .05); however, the BEST group showed a significantly greater reduction in health-related stress than those in the Education group (p = .025). CONCLUSION This study yielded evidence of the beneficial impact of the Internet-based BEST program for workers with metabolic syndrome on selected cardio-metabolic risks and health-related stress. PRACTICE IMPLICATIONS Internet-based one-on-one counseling and mobile phone text messages can assist individuals with targeted lifestyle modifications for metabolic syndrome.
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Affiliation(s)
- Chun-Ja Kim
- Department of Adult Health Nursing, Ajou University College of Nursing, Suwon, South Korea.
| | | | - Se-Won Kang
- College of Nursing and Healthcare Science, Dong-Eui University, Busan, South Korea
| | - Jae-Bum Park
- Department of Occupational and Environmental Medicine, Ajou University School of Medicine, Suwon, South Korea
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20
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Witt S, Leidl R, Becker C, Holle R, Block M, Brachmann J, Silber S, Stollenwerk B. The effectiveness of the cardiovascular disease prevention programme 'KardioPro' initiated by a German sickness fund: a time-to-event analysis of routine data. PLoS One 2014; 9:e114720. [PMID: 25486421 PMCID: PMC4259463 DOI: 10.1371/journal.pone.0114720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 11/13/2014] [Indexed: 11/29/2022] Open
Abstract
Background Cardiovascular disease is the leading cause of morbidity and mortality in the developed world. To reduce this burden of disease, a German sickness fund (‘Siemens-Betriebskrankenkasse’, SBK) initiated the prevention programme ‘KardioPro’ including primary (risk factor reduction) and secondary (screening) prevention and guideline-based treatment. The aim of this study was to assess the effectiveness of ‘KardioPro’ as it is implemented in the real world. Methods The study is based on sickness fund routine data. The control group was selected from non-participants via propensity score matching. Study analysis was based on time-to-event analysis via Cox proportional hazards regression with the endpoint ‘all-cause mortality, acute myocardial infarction (MI) and ischemic stroke (1)’, ‘all-cause mortality (2)’ and ‘non-fatal acute MI and ischemic stroke (3)’. Results A total of 26,202 insurants were included, 13,101 participants and 13,101 control subjects. ‘KardioPro’ enrolment was associated with risk reductions of 23.5% (95% confidence interval (CI) 13.0–32.7%) (1), 41.7% (95% CI 30.2–51.2%) (2) and 3.5% (hazard ratio 0.965, 95% CI 0.811–1.148) (3). This corresponds to an absolute risk reduction of 0.29% (1), 0.31% (2) and 0.03% (3) per year. Conclusion The prevention programme initiated by a German statutory sickness fund appears to be effective with regard to all-cause mortality. The non-significant reduction in non-fatal events might result from a shift from fatal to non-fatal events.
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Affiliation(s)
- Sabine Witt
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
- Ludwig-Maximilians-Universität, Munich Center of Health Sciences, Munich, Germany
| | - Christian Becker
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | - Rolf Holle
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | | | | | | | - Björn Stollenwerk
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
- * E-mail:
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Pietrzak E, Cotea C, Pullman S. Primary and Secondary Prevention of Cardiovascular Disease. J Cardiopulm Rehabil Prev 2014; 34:303-17. [DOI: 10.1097/hcr.0000000000000063] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Arena R, Arnett DK, Terry PE, Li S, Isaac F, Mosca L, Braun L, Roach WH, Pate RR, Sanchez E, Carnethon M, Whitsel LP. The role of worksite health screening: a policy statement from the American Heart Association. Circulation 2014; 130:719-34. [PMID: 25013030 DOI: 10.1161/cir.0000000000000079] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Badenbroek IF, Stol DM, Nielen MMJ, Hollander M, Kraaijenhagen RA, de Wit GA, Schellevis FG, de Wit NJ. Design of the INTEGRATE study: effectiveness and cost-effectiveness of a cardiometabolic risk assessment and treatment program integrated in primary care. BMC FAMILY PRACTICE 2014; 15:90. [PMID: 24884779 PMCID: PMC4022539 DOI: 10.1186/1471-2296-15-90] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 04/30/2014] [Indexed: 11/20/2022]
Abstract
Background The increasing prevalence of cardiometabolic disease (CMD) in combination with an ageing population is a major public health problem. Early detection and management of individuals at risk for CMD is required to prevent future health problems with associated costs. General practice is the optimal health care setting to accomplish this goal. Prevention programs for identification and treatment of patients with an increased risk for CMD in primary care have been proven feasible. However, the effectiveness and cost-effectiveness have yet to be demonstrated. The ‘Personalized Prevention Approach for CardioMetabolic Risk’ (PPA CMR) is such a prevention program. The objective of the INTEGRATE study is to investigate the effectiveness and cost-effectiveness of PPA CMR, as well as to establish determinants for participation and compliance. Methods The INTEGRATE study is designed as a stepped-wedge randomized controlled trial with a waiting list control group. In approximately 40 general practices, all enlisted patients without CMD aged 45–70 years, are invited to participate in PPA CMR. After an online risk estimation, patients with a score above risk threshold are invited to the GP for additional measurements, detailed risk profiling and tailored treatment of risk factors through medication and/or lifestyle counseling. At baseline and after twelve months of follow-up lifestyle, health and work status of all participants are established with online questionnaires. Additionally after twelve months, we will determine health care utilization, costs of PPA CMR and compliance. Primary endpoints are the number of newly detected patients with CMD and changes in individual risk factors between the intervention and waiting list control group. Medical data will be extracted from the GPs’ electronic medical records. In order to assess factors related to participation, we will send questionnaires to non-participants and assess characteristics of participating practices. For all participants, additional demographic characteristics will be available through Statistics Netherlands. Discussion The INTEGRATE study will provide insight into the effectiveness and cost-effectiveness of PPA CMR as well as determinants for participation and compliance, which represents essential information to guide further large-scale implementation of primary prevention programs for CMD. Trial registration number NTR4277, The Netherlands National Trial Register, 26-11-2013.
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Affiliation(s)
- Ilse F Badenbroek
- Netherlands Institute for Health Services Research (NIVEL), P,O, Box 1568, 3500 BN Utrecht, The Netherlands.
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Aneni EC, Roberson LL, Maziak W, Agatston AS, Feldman T, Rouseff M, Tran TH, Blumenthal RS, Blaha MJ, Blankstein R, Al-Mallah MH, Budoff MJ, Nasir K. A systematic review of internet-based worksite wellness approaches for cardiovascular disease risk management: outcomes, challenges & opportunities. PLoS One 2014; 9:e83594. [PMID: 24421894 PMCID: PMC3885454 DOI: 10.1371/journal.pone.0083594] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 11/14/2013] [Indexed: 11/18/2022] Open
Abstract
Context The internet is gaining popularity as a means of delivering employee-based cardiovascular (CV) wellness interventions though little is known about the cardiovascular health outcomes of these programs. In this review, we examined the effectiveness of internet-based employee cardiovascular wellness and prevention programs. Evidence Acquisition We conducted a systematic review by searching PubMed, Web of Science and Cochrane library for all published studies on internet-based programs aimed at improving CV health among employees up to November 2012. We grouped the outcomes according to the American Heart Association (AHA) indicators of cardiovascular wellbeing – weight, BP, lipids, smoking, physical activity, diet, and blood glucose. Evidence Synthesis A total of 18 randomized trials and 11 follow-up studies met our inclusion/exclusion criteria. Follow-up duration ranged from 6 – 24 months. There were significant differences in intervention types and number of components in each intervention. Modest improvements were observed in more than half of the studies with weight related outcomes while no improvement was seen in virtually all the studies with physical activity outcome. In general, internet-based programs were more successful if the interventions also included some physical contact and environmental modification, and if they were targeted at specific disease entities such as hypertension. Only a few of the studies were conducted in persons at-risk for CVD, none in blue-collar workers or low-income earners. Conclusion Internet based programs hold promise for improving the cardiovascular wellness among employees however much work is required to fully understand its utility and long term impact especially in special/at-risk populations.
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Affiliation(s)
- Ehimen C. Aneni
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida, United States of America
| | - Lara L. Roberson
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida, United States of America
| | - Wasim Maziak
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida, United States of America
| | - Arthur S. Agatston
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida, United States of America
| | - Theodore Feldman
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida, United States of America
| | - Maribeth Rouseff
- Baptist Health South Florida, Miami, Florida, United States of America
| | - Thinh H. Tran
- Baptist Health South Florida, Miami, Florida, United States of America
| | - Roger S. Blumenthal
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, United States of America
| | - Michael J. Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, United States of America
| | - Ron Blankstein
- Brigham and Women's Hospital, Harvard School of Medicine, Boston, Massachusetts, United States of America
| | | | - Matthew J. Budoff
- Los Angeles Biomedical Research Institute, Torrance, California, United States of America
| | - Khurram Nasir
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida, United States of America
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida, United States of America
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, United States of America
- Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
- * E-mail:
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Huntink E, Heijmans N, Wensing M, van Lieshout J. Effectiveness of a tailored intervention to improve cardiovascular risk management in primary care: study protocol for a randomised controlled trial. Trials 2013; 14:433. [PMID: 24341368 PMCID: PMC3895794 DOI: 10.1186/1745-6215-14-433] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 12/02/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is an important worldwide cause of mortality. In The Netherlands, CVD is the leading cause of death for women and the second cause of death for men. Recommendations for diagnosis and treatment of CVD are not well implemented in primary care. In this study, we aim to examine the effectiveness of a tailored implementation program targeted at practice nurses to improve healthcare for patients with (high risk for) CVD. METHODS/DESIGN A two-arm cluster randomized trial is planned. We offer practice nurses a tailored program to improve adherence to six specific recommendations related to blood pressure and cholesterol target values, risk profiling and lifestyle advice. Practice nurses are offered training and feedback on their motivational interviewing technique and an e-learning program on cardiovascular risk management (CVRM). They are also advised to screen for the presence and severity of depressive symptoms in patients. We also advise practice nurses to use selected E-health options (selected websites and Twitter-consult) in patients without symptoms of depression. Patients with mild depressive symptoms are referred to a physical exercise group. We recommend referring patients with major depressive symptoms for assessment and treatment of depressive symptoms if appropriate before starting CVRM. Data from 900 patients at high risk of CVD or with established CVD will be collected in 30 general practices in several geographical areas in The Netherlands. The primary outcome measure is performance of practice nurses in CVRM and reflects application of recommendations for personalized counselling and education of CVRM patients. Patients' health-related lifestyles (physical exercise, diet and smoking status) will be measured with validated questionnaires and medical record audit will be performed to document estimated CVD risk. Additionally, we will survey and interview participating healthcare professionals for exploration of processes of change. The control practices will provide usual care. DISCUSSION Tailored interventions can improve healthcare. An understanding of the methods to reach the improved healthcare can be improved. This research contributes a share of it. Identification of the determinants of practice and developing implementation interventions were two steps which were completed. The subsequent step was implementation of the tailored intervention program. TRIAL REGISTRATION Name trial register: Nederlands trial register. Web address of trial register: http://www.trialregister.nl. Data of registration: 11 July 2013. Number of registration: NTR4069.
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Affiliation(s)
- Elke Huntink
- Radboud University Nijmegen Medical Center, Scientific Institute for Quality of Healthcare, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Naomi Heijmans
- Radboud University Nijmegen Medical Center, Scientific Institute for Quality of Healthcare, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Michel Wensing
- Radboud University Nijmegen Medical Center, Scientific Institute for Quality of Healthcare, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Jan van Lieshout
- Radboud University Nijmegen Medical Center, Scientific Institute for Quality of Healthcare, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
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del Pozo-Cruz B, del Pozo-Cruz J, Adsuar JC, Parraca J, Gusi N. Reanalysis of a tailored web-based exercise programme for office workers with sub-acute low back pain: Assessing the stage of change in behaviour. PSYCHOL HEALTH MED 2013; 18:687-97. [DOI: 10.1080/13548506.2013.765019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Stegeman I, de Wijkerslooth TR, Stoop EM, van Leerdam M, van Ballegooijen M, Kraaijenhagen RA, Fockens P, Kuipers EJ, Dekker E, Bossuyt PM. Risk factors for false positive and for false negative test results in screening with fecal occult blood testing. Int J Cancer 2013; 133:2408-14. [PMID: 23649826 DOI: 10.1002/ijc.28242] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 04/09/2013] [Indexed: 12/27/2022]
Abstract
Differences in the risk of a false negative or a false positive fecal immunochemical test (FIT) across subgroups may affect optimal screening strategies. We evaluate whether subgroups are at increased risk of a false positive or a false negative FIT result, whether such variability in risk is related to differences in FIT sensitivity and specificity or to differences in prior CRC risk. Randomly selected, asymptomatic individuals were invited to undergo colonoscopy. Participants were asked to undergo one sample FIT and to complete a risk questionnaire. We identified patient characteristics associated with a false negative and false positive FIT results using logistic regression. We focused on statistically significant differences as well as on variables influencing the false positive or negative risk for which the odds ratio exceeded 1.25. Of the 1,426 screening participants, 1,112 (78%) completed FIT and the questionnaire; 101 (9.1%) had advanced neoplasia. 102 Individuals were FIT positive, 65 (64%) had a false negative FIT result and 66 (65%) a false positive FIT result. Participants at higher age and smokers had a significantly higher risk of a false negative FIT result. Males were at increased risk of a false positive result, so were smokers and regular NSAID users. FIT sensitivity was lower in females. Specificity was lower for males, smokers and regular NSAID users. FIT sensitivity was lower in women. FIT specificity was lower in males, smokers and regular NSAID users. Our results can be used for further evidence based individualization of screening strategies.
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Affiliation(s)
- Inge Stegeman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academical Medical Center, Amsterdam, The Netherlands; Department of research and development, NDDO Institute for Prevention and Early Diagnostic, Amsterdam, The Netherlands
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Chen YC, Tsao LI, Huang CH, Yu YY, Liu IL, Jou HJ. An Internet-based health management platform may effectively reduce the risk factors of metabolic syndrome among career women. Taiwan J Obstet Gynecol 2013; 52:215-21. [DOI: 10.1016/j.tjog.2013.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2012] [Indexed: 10/26/2022] Open
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Stegeman I, de Wijkerslooth TR, Stoop EM, van Leerdam ME, Dekker E, van Ballegooijen M, Kuipers EJ, Fockens P, Kraaijenhagen RA, Bossuyt PM. Colorectal cancer risk factors in the detection of advanced adenoma and colorectal cancer. Cancer Epidemiol 2013; 37:278-83. [PMID: 23491770 DOI: 10.1016/j.canep.2013.02.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 02/06/2013] [Accepted: 02/13/2013] [Indexed: 12/18/2022]
Abstract
Several risk factors for colorectal cancer (CRC) have been identified. If individuals with risk factors are more likely to harbor cancer or it precursors screening programs should be targeted toward this population. We evaluated the predictive value of colorectal cancer risk factors for the detection of advanced colorectal adenoma in a population based CRC colonoscopy screening program. Data were collected in a multicenter trial conducted in the Netherlands, in which 6600 asymptomatic men and women between 50 and 75 years were randomly selected from a population registry. They were invited to undergo a screening colonoscopy. Based on a review of the literature CRC risk factors were selected. Information on risk factors was obtained from screening attendees through a questionnaire. For each CRC risk factor, we estimated its odds ratio (OR) relative to the presence of advanced neoplasia as detected at colonoscopy. Of the 1426 screening participants who underwent a colonoscopy, 1236 (86%) completed the risk questionnaire. 110 participants (8.9%) had advanced neoplasia. The following risk factors were significantly associated with advanced neoplasia detected by colonoscopy: age (OR: 1.06 per year; 95% CI: 1.03-1.10), calcium intake (OR: 0.99 per mg; 95% CI: 0.99-1.00), positive CRC family history (OR: 1.55 per first degree family member; 95%CI: 1.11-2.16) and smoking (OR: 1.75; 95%CI: 1.09-2.82). Elderly screening participants, participants with lower calcium intake, a CRC family history, and smokers are at increased risk of harboring detectable advanced colorectal neoplasia at screening colonoscopy.
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Affiliation(s)
- Inge Stegeman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands.
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Senesael E, Borgermans L, Van De Vijver E, Devroey D. Effectiveness of a quality improvement intervention targeting cardiovascular risk factors: are patients responsive to information and encouragement by mail or post? Vasc Health Risk Manag 2013; 9:13-20. [PMID: 23426275 PMCID: PMC3576014 DOI: 10.2147/vhrm.s39919] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction There is important evidence on the beneficial effects of treatment of cardiovascular risk factors in terms of morbidity and mortality, but important challenges remain in motivating patients to adhere to their treatment regimen. This study aimed to describe the effectiveness of a quality improvement intervention that included information and regular encouragement by email or letter on cardiovascular risk factors for patients at high risk for cardiovascular disease. Methods This randomized single-blind study included patients of both sexes aged between 45 and 80 years old who had increased cardiovascular risk. Patients were randomly allocated to either a usual care group (UCG) or advanced care group (ACG). Patients in the UCG received regular care while patients in the ACG received usual care plus regular information and encouragement on cardiovascular risk factors by email or letter. Visits for both groups were planned at 0, 3, and 6 months. The outcome measures were blood pressure, weight, body mass index (BMI), waist circumference (WC), and smoking status. Results Out of 178 eligible patients from one single primary care practice, 55 participated in the study, three of whom dropped out. After 6 months, there was a significant decrease in mean systolic and diastolic blood pressure in the UCG and ACG (P < 0.05). The decreases were already significant after 3 months, except for systolic blood pressure in the UCG. There was also a significant increase in the proportion of patients who met the target values for blood pressure in the UCG and ACG. There was a nonsignificant decrease of the average weight in the ACG, but significantly more patients lost weight in the UCG (P = 0.02). BMI, WC, and smoking status did not change in either group. Conclusion This study found that there was a significant decrease of systolic and diastolic blood pressure in both study groups. Weight, BMI, WC, and smoking did not improve in either group. Information on cardiovascular risk factors and encouragement by means of letters or email did not provide additional benefits. Thus, effective patient empowerment probably requires more behaviorally sophisticated support to increase self-management, self-efficacy, and self-esteem in patients.
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Affiliation(s)
- Ellie Senesael
- Department of Family Medicine, Vrije Universiteit Brussel, Brussels, Belgium
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Tokgozoglu L, Bruckert E. Implementation, target population, compliance and barriers to risk guided therapy. Eur J Prev Cardiol 2012; 19:37-41. [DOI: 10.1177/2047487312448989] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Eric Bruckert
- Service of Endocrinology, Hôpital Pitié-Salpétrière, France
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