Cost Analysis of Developing, Implementing, and Evaluating a Multi-Disciplinary Teaching Kitchen

INTRODUCTION

Teaching kitchens have emerged as strategies to deliver lifestyle medicine principles and practices. However, a better understanding of their implementation, delivery cost, and potential benefits are needed. This article provides a comprehensive analysis of the costs associated with the development, deployment, and evaluation of the Emory Healthy Kitchen Collaborative (EHKC) teaching kitchen clinical trial.

METHODS

The actual number of hours spent and costs incurred to develop and deploy the EHKC teaching kitchen were recorded and broadly categorized into 1 of 4 areas: program development, course delivery, research, and optional enhancements. Costs of each item were assigned as fixed or variable, enabling calculation of the marginal per participant program cost.

RESULTS

Total costs were US$123,898, with 3/4 incurred for program development, research, and optional enhancements. Delivery of the course alone (not including program development costs, research, or any optional enhancements) cost US$30,194. The total cost per participant for the course was US$755, with a marginal participant cost of US$141.

CONCLUSION

Teaching kitchens represent viable options to deliver lifestyle medicine interventions. However, more research and cost analyses are needed to better understand the value teaching kitchens provide to determine if they are an effective and economical way to deliver lifestyle medicine.

Psychological and pharmacological interventions for depression in patients with coronary artery disease

BACKGROUND

Depression occurs frequently in individuals with coronary artery disease (CAD) and is associated with a poor prognosis.

OBJECTIVES

To determine the effects of psychological and pharmacological interventions for depression in CAD patients with comorbid depression.

SEARCH METHODS

We searched the CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL databases up to August 2020. We also searched three clinical trials registers in September 2021. We examined reference lists of included randomised controlled trials (RCTs) and contacted primary authors. We applied no language restrictions.

SELECTION CRITERIA

We included RCTs investigating psychological and pharmacological interventions for depression in adults with CAD and comorbid depression. Our primary outcomes included depression, mortality, and cardiac events. Secondary outcomes were healthcare costs and utilisation, health-related quality of life, cardiovascular vital signs, biomarkers of platelet activation, electrocardiogram wave parameters, non-cardiac adverse events, and pharmacological side effects.

DATA COLLECTION AND ANALYSIS

Two review authors independently examined the identified papers for inclusion and extracted data from the included studies. We performed random-effects model meta-analyses to compute overall estimates of treatment outcomes.

MAIN RESULTS

Thirty-seven trials fulfilled our inclusion criteria. Psychological interventions may result in a reduction in end-of-treatment depression symptoms compared to controls (standardised mean difference (SMD) -0.55, 95% confidence interval (CI) -0.92 to -0.19, I² = 88%; low certainty evidence; 10 trials; n = 1226). No effect was evident on medium-term depression symptoms one to six months after the end of treatment (SMD -0.20, 95% CI -0.42 to 0.01, I² = 69%; 7 trials; n = 2654). The evidence for long-term depression symptoms and depression response was sparse for this comparison. There is low certainty evidence that psychological interventions may result in little to no difference in end-of-treatment depression remission (odds ratio (OR) 2.02, 95% CI 0.78 to 5.19, I² = 87%; low certainty evidence; 3 trials; n = 862). Based on one to two trials per outcome, no beneficial effects on mortality and cardiac events of psychological interventions versus control were consistently found. The evidence was very uncertain for end-of-treatment effects on all-cause mortality, and data were not reported for end-of-treatment cardiovascular mortality and occurrence of myocardial infarction for this comparison. In the trials examining a head-to-head comparison of varying psychological interventions or clinical management, the evidence regarding the effect on end-of-treatment depression symptoms is very uncertain for: cognitive behavioural therapy compared to supportive stress management; behaviour therapy compared to person-centred therapy; cognitive behavioural therapy and well-being therapy compared to clinical management. There is low certainty evidence from one trial that cognitive behavioural therapy may result in little to no difference in end-of-treatment depression remission compared to supportive stress management (OR 1.81, 95% CI 0.73 to 4.50; low certainty evidence; n = 83). Based on one to two trials per outcome, no beneficial effects on depression remission, depression response, mortality rates, and cardiac events were consistently found in head-to-head comparisons between psychological interventions or clinical management. The review suggests that pharmacological intervention may have a large effect on end-of-treatment depression symptoms (SMD -0.83, 95% CI -1.33 to -0.32, I² = 90%; low certainty evidence; 8 trials; n = 750). Pharmacological interventions probably result in a moderate to large increase in depression remission (OR 2.06, 95% CI 1.47 to 2.89, I² = 0%; moderate certainty evidence; 4 trials; n = 646). We found an effect favouring pharmacological intervention versus placebo on depression response at the end of treatment, though strength of evidence was not rated (OR 2.73, 95% CI 1.65 to 4.54, I² = 62%; 5 trials; n = 891). Based on one to four trials per outcome, no beneficial effects regarding mortality and cardiac events were consistently found for pharmacological versus placebo trials, and the evidence was very uncertain for end-of-treatment effects on all-cause mortality and myocardial infarction. In the trials examining a head-to-head comparison of varying pharmacological agents, the evidence was very uncertain for end-of-treatment effects on depression symptoms. The evidence regarding the effects of different pharmacological agents on depression symptoms at end of treatment is very uncertain for: simvastatin versus atorvastatin; paroxetine versus fluoxetine; and escitalopram versus Bu Xin Qi. No trials were eligible for the comparison of a psychological intervention with a pharmacological intervention.

AUTHORS' CONCLUSIONS

In individuals with CAD and depression, there is low certainty evidence that psychological intervention may result in a reduction in depression symptoms at the end of treatment. There was also low certainty evidence that pharmacological interventions may result in a large reduction of depression symptoms at the end of treatment. Moderate certainty evidence suggests that pharmacological intervention probably results in a moderate to large increase in depression remission at the end of treatment. Evidence on maintenance effects and the durability of these short-term findings is still missing. The evidence for our primary and secondary outcomes, apart from depression symptoms at end of treatment, is still sparse due to the low number of trials per outcome and the heterogeneity of examined populations and interventions. As psychological and pharmacological interventions can seemingly have a large to only a small or no effect on depression, there is a need for research focusing on extracting those approaches able to substantially improve depression in individuals with CAD and depression.

[The role of excess weight in the quality of life of patients with ischemic heart disease]

[No disponible]

The Complete Health Improvement Program (CHIP) and reduction of chronic disease risk factors in Canada

PURPOSE

The short-term effectiveness of the nutrition-centred Complete Health Improvement Program (CHIP) lifestyle intervention for improving selected chronic disease risk factors was examined in the Canadian setting.

METHODS

A total of 1003 people (aged 56.3 ± 12.1 years, 68% female) were self-selected to participate in one of 27 CHIP interventions hosted in community settings by Seventh-day Adventist churches throughout Canada, between 2005 and 2011. The program centred on the promotion of a whole-food, plant-based eating pattern, and daily physical activity was also encouraged. Biometric measures, including body mass index (BMI), blood pressure (BP), blood lipid profile, and fasting blood sugar (FBS), were determined at program entry and 30 days into the intervention.

RESULTS

Over 30 days, significant overall reductions (P<0.001) were recorded in the participants' BMI (-3.1%), systolic BP (-7.3%), diastolic BP (-4.3%), total cholesterol ([TC] -11.3%), low-density lipoprotein cholesterol ([LDL-C] -12.9%), triglycerides ([TG] -8.2%), and FBS (-7.0%). Participants with the highest classifications of TC, LDL-C, TG, and FBS at program entry experienced approximately 20% reductions in these measures in 30 days.

CONCLUSIONS

The CHIP intervention, which centres on a whole-food, plant-based eating pattern, can lead to rapid and meaningful reductions in chronic disease risk factors in the Canadian context.

'Live more': Study protocol for a community-based lifestyle education program addressing non-communicable diseases in low-literacy areas of the South Pacific

Background

Non-communicable diseases (NCDs) have reached epidemic proportions in Pacific Island countries. Unhealthy lifestyle is one of the major risk factors and lifestyle interventions have been shown to be efficacious for primary, secondary and early tertiary prevention. However, there is a paucity of evidence regarding effective community-based lifestyle interventions in the Pacific Islands. The Complete Health Improvement Program for high-income countries was contextualised for rural communities with relatively low-literacy rates in low-income countries using the REFLECT delivery approach. This study will assess the effect of this ‘Live More’ program to reduce participant’s NCD risk factors and improve lifestyle behaviours associated with health and wellbeing, in low-literacy communities in countries of the South Pacific.

Methods/Design

This study is a 6-month cluster-randomised controlled trial of 288 adults (equal proportions of men and women aged 18 years and over) with waist circumference of ≥92 cm for men and ≥80 cm for women in four rural villages in each of Fiji, Vanuatu and Solomon Islands. Participants will permanently reside in their village and be able to prepare their own meals. Two villages will be randomised to the ‘Live More’ intervention (n = 24) or to control receiving only country specific Ministry of Health literature (n = 24). Intervention participants will meet three times a week in the first month, then once a week for the next two months and once a month for the last three months. Themes covered include: NCDs and their causes; and the benefits of positive lifestyle choices, positive psychology, stress management, forgiveness and self-worth, and how these influence long-term health habits. Outcome assessments at baseline, 30-days, 3-months and 6-months include body mass index, waist circumference, blood lipids, blood pressure and blood glucose. Secondary outcomes include changes in medication and substance use, diet, physical activity, emotional health and supportive relationships, collected by lifestyle questionnaire at the same time points.

Discussion

This is the first lifestyle intervention using the Reflect approach to target NCDs. The findings from the study will be used to guide broader delivery of a lifestyle intervention to improve health and wellbeing across the South Pacific.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12614001206617.

The impact of whole-of-diet interventions on depression and anxiety: a systematic review of randomised controlled trials

Objective

Non-pharmacological approaches to the treatment of depression and anxiety are of increasing importance, with emerging evidence supporting a role for lifestyle factors in the development of these disorders. Observational evidence supports a relationship between habitual diet quality and depression. Less is known about the causative effects of diet on mental health outcomes. Therefore a systematic review was undertaken of randomised controlled trials of dietary interventions that used depression and/or anxiety outcomes and sought to identify characteristics of programme success.

Design

A systematic search of the Cochrane, MEDLINE, EMBASE, CINAHL, PubMed and PyscInfo databases was conducted for articles published between April 1971 and May 2014.

Results

Of the 1274 articles identified, seventeen met eligibility criteria and were included. All reported depression outcomes and ten reported anxiety or total mood disturbance. Compared with a control condition, almost half (47 %) of the studies observed significant effects on depression scores in favour of the treatment group. The remaining studies reported a null effect. Effective dietary interventions were based on a single delivery mode, employed a dietitian and were less likely to recommend reducing red meat intake, select leaner meat products or follow a low-cholesterol diet.

Conclusions

Although there was a high level of heterogeneity, we found some evidence for dietary interventions improving depression outcomes. However, as only one trial specifically investigated the impact of a dietary intervention in individuals with clinical depression, appropriately powered trials that examine the effects of dietary improvement on mental health outcomes in those with clinical disorders are required.

The Complete Health Improvement Program (CHIP): History, Evaluation, and Outcomes

The Complete Health Improvement Program (CHIP) is a premier lifestyle intervention targeting chronic disease that has been offered for more than 25 years. The intervention has been used in clinical, corporate, and community settings, and the short-term and long-term clinical benefits of the intervention, as well as its cost-effectiveness, have been documented in more than 25 peer-reviewed publications. Being an easily administered intervention, CHIP has been presented not only by health professionals but also by non-health-trained volunteers. The benefits of the program have been extensively studied under these 2 delivery channels, consistently demonstrating positive outcomes. This article provides a brief history of CHIP and describes the content and structure of the intervention. The published evaluations and outcomes of the intervention are presented and discussed and future directions are highlighted.

A small business worksite wellness model for improving health behaviors

OBJECTIVES

To evaluate the effectiveness of a wellness program delivered by WellSteps, LLC, aimed at improving employee health behaviors in small companies that lack the resources to independently develop and manage a wellness program.

METHODS

Analyses are based on 618 employees from five diverse companies that completed an initial personal health assessment.

RESULTS

Exercise and dietary behaviors significantly improved across the five companies. Significant improvements in health perception and life satisfaction also resulted and were associated with improvements in health behaviors. Three of the five companies, each with fewer than 50 employees, were most effective in influencing positive health behaviors, health perceptions, and life satisfaction.

CONCLUSIONS

The worksite wellness program effectively improved health behaviors, health perceptions, and life satisfaction.

Short-term effectiveness of a lifestyle intervention program for reducing selected chronic disease risk factors in individuals living in rural appalachia: a pilot cohort study

Most Western chronic diseases are closely tied to lifestyle behaviors, and many are preventable. Despite the well-distributed knowledge of these detrimental behaviors, effective efforts in disease prevention have been lacking. Many of these chronic diseases are related to obesity and type 2 diabetes, which have doubled in incidence during the last 35 years. The Complete Health Improvement Program (CHIP) is a community-based, comprehensive lifestyle modification approach to health that has shown success in addressing this problem. This pilot study demonstrates the effectiveness of CHIP in an underserved, rural, and vulnerable Appalachian population. Two hundred fourteen participants in CHIP collectively demonstrated significant reductions in body mass index, systolic and diastolic blood pressure, and fasting blood levels of total cholesterol, low-density lipoprotein, and glucose. If these results can be repeated in other at-risk populations, CHIP has the potential to help reduce the burden of preventable and treatable chronic diseases efficiently and cost-effectively.

Long-term effectiveness of the community-based Complete Health Improvement Program (CHIP) lifestyle intervention: a cohort study

OBJECTIVE

To examine the long-term (three or more years) effectiveness of the volunteer-delivered Complete Health Improvement Program (CHIP) intervention.

DESIGN

Cohort study.

SETTING

Hawera, New Zealand.

PARTICIPANTS

Of the total cohort of 284 individuals who self-selected to complete the CHIP lifestyle intervention between 2007 and 2009, 106 (37% of the original cohort, mean age=64.9±7.4 years, range 42-87 years; 35% males, 65% female) returned in 2012 for a complimentary follow-up health assessment (mean follow-up duration=49.2+10.4 months).

INTERVENTION

30-day lifestyle modification programme (diet, physical activity, substance use and stress management) delivered by volunteers in a community setting.

MAIN OUTCOME MEASURES

Changes in body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP), fasting plasma glucose (FPG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglycerides (TG).

RESULTS

After approximately 4 years, participants with elevated biometrics at programme entry maintained significantly lowered BMI (-3.2%; 34.8±5.4 vs 33.7±5.3 kg/m(2), p=0.02), DBP (-9.4%; 89.1±4.1 vs 80.8±12.6 mm Hg, p=0.005), TC (-5.5%; 6.1±0.7 vs 5.8±1.0 mmol/L, p=0.04) and TG (-27.5%; 2.4±0.8 vs 1.7±0.7 mmol/L, p=0.002). SBP, HDL, LDL and FPG were not significantly different from baseline. Participants with elevated baseline biometrics who reported being compliant to the lifestyle principles promoted in the intervention (N=71, 67% of follow-up participants) recorded further reductions in BMI (-4.2%; 34.8±4.5 vs 33.4±4.8 kg/m(2), p=0.02), DBP (-13.3%; 88.3±3.2 vs 77.1±12.1 mm Hg, p=0.005) and FPG (-10.4%; 7.0±1.5 vs 6.3±1.3 mmol/L, p=0.02).

CONCLUSIONS

Individuals who returned for follow-up assessment and entered the CHIP lifestyle intervention with elevated risk factors were able to maintain improvements in most biometrics for more than 3 years. The results suggest that the community-based CHIP lifestyle intervention can be effective in the longer term, even when delivered by volunteers.