Related Behavioral Changes Research Articles

(227) HIV Sensory Neuropathy Related Behaviors in Doxycycline Inducible HIV-1 Tat Transgenic Mice

Peripheral neuropathies are the most frequent neurological complications associated with HIV, within which HIV sensory neuropathy (SN) is the most common form, which affects 30-50% of HIV/acquired immunodeficiency syndrome (AIDS) patients. HIV SN is frequently manifested with hard-to-manage pain and is often under-diagnosed and/or under-treated. Tat, trans-activator of transcription, is a key activator of HIV transcription. Despite that recent studies have highlighted the role of HIV Tat in the pathophysiology of HIV-associated neurocognitive disorders (HANDs), the involvement of HIV Tat in neuropathic pain associated with HIV SN has not been extensively investigated. Our preliminary data showed that both single and repeated intrathecal injection(s) of HIV Tat induced mechanical hypersensitivity. In the current study, we further examined pain and functional related behavioral changes in doxycycline inducible HIV-1 Tat transgenic (iTat Tg) mice following the induction of Tat expression. Two induction regimen were compared: 7-day daily injection vs. 21-day daily injection of doxycycline (i.p. at 100mg/kg). Sensory sensitivities (mechanical, heat and cold) were assessed to evaluate pain-like behaviors. Sensory (pin prick assay) and motor (hind limb grip strength, toe spread reflex and toe spacing score) functional tests were used to evaluate hind paw functions associated with Tat expression. Both regimens induced significant mechanical hypersensitivity and significant reduction of grip strength from day 3 post the initiation of Tat induction to the end of the experiment (day 35) in iTat Tg mice. Tat induction for 21 days also significantly induced cold hypersensitivity in iTat Tg mice up to day 14 post-the first doxycycline injection. Neither regimen induced significant heat hypersensitivity or affected other functional measurements. Together, our results suggest the utility of iTat Tg mice in studying the role of Tat in HIV SN. Sex-depended differences and Tat-induced molecular pathways will be further investigated in future studies. (Grant support: R21 DA044886 [PI Cao])

Fluoride related changes in behavioral outcomes may relate to increased serotonin

Fluoride ingestion has been linked to changes in behavior in mice and rats, related to dose, sex of the animal, and the timing of exposure. Previous studies have shown the behavior of female rats to be most affected by postnatal fluoride exposure, and in this study we determined the effects of postnatal fluoride exposure on anxiety related behavior and serotonin. Mice given 50 ppm fluoride in drinking water had increased entries in the open arms of the elevated plus maze, suggesting reduced anxiety. Both peripheral and central serotonin was increased in the fluoride treated mice. In a cohort of children drinking water containing 2.5 ppm fluoride, serum serotonin was also increased as compared to controls. The mechanisms by which fluoride results in an increase peripheral and central serotonin are not well understood, but warrant further study, as these effects may also be relevant to prenatal fluoride related changes in behavior in both mice and humans.

Degradation of mechanical properties of CA mortar caused by calcium leaching

Abstract Calcium leaching is an important durability problem for cement asphalt (CA) mortar used in ballastless slab track. In this paper, calcium leaching in CA mortar was accelerated by immersing in 6 mol/L ammonium nitrate solution. The leaching kinetics and related changes in mechanical behavior and microstructure of CA mortar were studied. Results showed that calcium leaching followed the Fick’s law. The calcium leaching led to the formation of three distinct zones in term of local calcium content in the direction of radius of the specimen. Due to the leaching of calcium hydroxide and the progressive decalcification of C S H, the three zones had different chemical compositions. The compressive mechanical behavior was modeled by a compression damage model derived from Weibull distribution. The degradation damage model was established on the distribution of local elastic modulus. The combination of these two models can well predict the compressive behavior of partially leached CA mortar.

Interannual Variation in the Population Dynamics of Juveniles of the Deep-Sea Crab Chionoecetes tanneri

Understanding the population dynamics of commercially fished deep-sea species, on seasonal to inter-annual scales, is of great importance in areas where fishing pressure is high. The remoteness of the deep-sea environment constitutes a challenge for monitoring these populations. The few studies that have investigated population structure of deep-sea species, have used trawls, a destructive approach for benthic ecosystems. The development of deep-sea observatories offers a continuous long-term presence on the seafloor. Using imagery from the Ocean Network Canada deep-sea observatory, video footage was acquired on a daily basis and analyzed to describe the population dynamics of the deep-sea crab Chionoecetes tanneri located in depths of 900-1000 m in Barkley Canyon, off Vancouver Island (BC, Canada). The objectives here were to describe the dynamics of the local population in relation to changes in environment and/or life-cycle related behaviors. Sampling sites were located along the canyon axis and on the canyon wall. Only juveniles (1-10 cm) were found at the axis site (1000 m depth) with densities varying from 0 to 144 individuals/m(2). On the canyon wall (900 m depth), adults (> 10 cm) were sporadically observed and densities were lower (max. 13 individuals/m(2)). Variation in density between the two sites reflected the observed arrival of small individuals (<2.4 cm) at the axis site in summer and autumn. Apart from a distinct migration event in January 2015, intra-annual variability in density was higher than inter-annual variability as illustrated by significant annual and sub-annual cycles of 7.5 and 3.5 months. Our results confirmed the hypothesis of ontogenic migration and provide further insight into inter-molt periodicity; we demonstrated a duration of 16 months for one crab to grow from 1.8 cm to more than 5 cm. Our findings also show a correlation between population dynamics, chlorophyll concentration, surface wave height and wind speed, suggesting that surface blooms have a potential influence on the migration patterns of C. tanneri. Although our study was spatially limited (maximum surface 9 m), this innovative long-term study of a deep-sea crab demonstrates the potential of deep-sea observatories to enable research into the population dynamics of some deep-sea species.

A scoping review of behaviour change theories in adults without dementia to adapt and develop the ‘PHYT in dementia’, a model promoting physical activity in people with dementia

IntroductionResearch has established that exercise and physical activity can improve executive functioning, independence and quality of life in people with dementia. A dedicated theory explaining behaviour change in relation to physical activity in people with dementia does not exist. We aimed to develop a theoretical model which can be used to inform effective interventions to promote physical activity in people with dementia. MethodsThere were five phases: 1. A search of the literature to identify theories which have been used to explain behaviour change in relation to physical activity in adult populations without a diagnosis of dementia; 2. Description of the theories (and sub-theories) and their main constructs; 3. Synthesis of the constructs; 4. Adaptation of the constructs to dementia; 5. Development and explanation of a model for physical activity in people with dementia (the ‘PHYT in dementia’). ResultsWe identified nine theories used to explain behaviour change in relation to physical activity in adult populations without a diagnosis of dementia. Through our synthesis, we identified nine umbrella constructs. We integrated three more dementia-relevant constructs and developed the ‘PHYT in dementia’. The model was explained by providing a practical example of its application. DiscussionBased on a scoping review of behaviour change theories in adults without dementia and following adaptation of the constructs from these theories to dementia, we derived a new theoretical model, the ‘PHYT in dementia’, which includes both individual-level and environment-level constructs. The model needs to be tested empirically, which our research team will do in the process evaluation of the Promoting Activity, Independence and Stability in Early Dementia and Mild Cognitive Impairment (PrAISED 2) study. Results from field-testing will inform refinement of the model.

An ecological model of climate marketing: A conceptual framework for understanding climate science related attitude and behavior change

Climate change is a problem that will require cooperation across different levels of government, society, community and individual action. For this reason, communicating about climate change repres...

Predicting fire spread and behaviour on the fireline. Wildfire analyst pocket: A mobile app for wildland fire prediction

Accurately predicting fire spread and behaviour on the fireline, in the field, is highly important in order to prevent the loss of human life, improve the success of initial attack and better understand the potential fire behaviour, minimizing many risks for firefighters. We present the Wildfire Analyst™ Pocket Edition application (WFA Pocket), a mobile tool aimed to be used by the fire fighter community. It shows punctual fire characteristics and estimated progression based on user introduced input data in an intuitive 3D map interface in real-time, allowing the user to interactively change parameters and analyze how the fire behaviour changes in relation to the inputs. The mathematical models implemented are all well-known by the scientific community and reported in this article. The application has integrated GIS capabilities, can work online and offline, and can retrieve fuel, weather and canopy data from online servers for the georeferenced ignition point. We describe the background and model foundation of WFA Pocket as well as its system design and main features. We also evaluate its robustness of results and present a case study to show the potential use of this tool in the field. Limitations and assumptions in the use of the application as well as potential improvements for the future are discussed.

온라인 쇼핑 확대 시대의 대형마트 의무휴업일로 인한 소비자 행동 변화 : 온라인과 주변점포를 중심으로

2013년부터 시행된 대형마트 의무휴업일은 올해로 5년이 되었다. 본 연구는 온라인과 오프라인의 경쟁이 더 심해지고 있는 현재의 상황에서 대형마트 의무휴업일이 대형마트 상권 內있는 소비자들의 행동 변화를 통해 대형마트 의무휴업일의 효과에 대해서 분석하였다. 분석결과 대형마트 의무휴업일로 인한 주변 점포의 매출액 상승은 크지 않았지만, 의무휴업이 아닌 날보다 의무휴업일에 온라인 이용 금액이 더 증가하는 것으로 나타났다. 특히, 일요일에 의무휴업을 하게 되면 온라인 쇼핑이 더 가속화되는 것으로 나타났다. 또한 대형마트와 경쟁관계인 슈퍼마켓을 규모별로 세분화해서 분석한 결과 대형 슈퍼마켓(매출액 50억 이상)은 의무휴업일로 인해서 상권 內고객의 이용이 증가하지만, 소형 슈퍼마켓의 경우, 오히려 의무휴업일에 이용 금액이 감소하여 대형마트의 의무휴업은 소형 슈퍼마켓이 아닌 의무휴업일 규제를 안 받는 대형 슈퍼마켓에 긍정적인 효과가 있는 것으로 나타났다. 따라서 대형마트 의무휴업일은 온라인 쇼핑을 가속화하고 대형 슈퍼마켓만 매출액이 증가하기 때문에 대형마트 의무휴업일의 실효성에 대한 검토가 필요하다고 할 수 있다.

How we eat determines what we become: opportunities and challenges brought by food delivery industry in a changing world in China.

Rapid economic growth and urbanization have brought notable changes in China. This trend had dramatic impacts to food industry and diet-related behaviors, which leads to increasing prevalence of overweight and obesity as well as diet-related non-communicable diseases (NCDs). With a rapid development of internet and e-commerce market, another emerging trend that should not be overlooked is the change in food shopping habits induced by the popularity of online-to-offline (O2O) food delivery service in China. The O2O food market is a booming industry in China, the market scale of O2O food industry is increasing with remarkable speed. More than 1/5 of total population in China has already became the users of O2O food delivery market. Development of this new trend in food environment is inevitable. This game-changing trend brings great opportunities to improve food accessibility and availability but meanwhile poses inevitable challenges to the whole public health system and social environment in China. This paper offers a unique perspective of the opportunities and challenges that the new industry brings to food environment, health outcomes caused by related behavior change, and its broader influence on social environment.

Design of a randomized controlled trial comparing a mobile phone-based hypertension health coaching application to home blood pressure monitoring alone: The Smart Hypertension Control Study

BackgroundHypertension is a major cause of morbidity and mortality but frequently remains uncontrolled. A smartphone application that provides coaching regarding home blood pressure monitoring and other aspects of hypertension self-care and related behavior change may be a scalable way to help manage hypertension. Methods/designThe Smart Hypertension Control Study is a prospective, randomized controlled trial to assess the effects of a hypertension personal control program (HPCP), which consists of an automated artificial intelligence smartphone application that provides individualized support and coaching to promote home monitoring and healthy behavior changes related to hypertension self-management. Enrolled adults with uncontrolled hypertension will be randomized in a 1:1 fashion to the HPCP with home blood pressure monitoring or to home monitoring alone. We plan to enroll 350 participants, with a target of 300 participants with complete six-month follow-up data. The primary study outcome will be systolic blood pressure at six months. Additional outcomes include measures of antihypertensive medication adherence, home blood pressure monitoring practices, self-management practices, weight, and self-reported health behaviors. ConclusionThe Smart Hypertension Control Study will evaluate blood pressure and hypertension self-management behavior outcomes in participants with uncontrolled hypertension exposed to a smartphone-based hypertension health coaching application in addition to home blood pressure monitoring compared to those exposed to home blood pressure monitoring alone.

Two-Year Changes in Child Weight Status, Diet, and Activity by Neighborhood Nutrition and Physical Activity Environment.

The aim of this study was to examine 2-year changes in weight status and behaviors among children living in neighborhoods differing on nutrition and activity environments. A prospective observational study, the Neighborhood Impact on Kids study, was conducted in King County, Washington, and San Diego County, California. Children 6 to 12 years old and a parent or caregiver completed Time 1 (n = 681) and Time 2 (n = 618) assessments. Children lived in neighborhoods characterized as "high/favorable" or "low/unfavorable" in nutrition and activity environments, respectively (four neighborhood types). Child BMI z score and overweight or obesity status were primary outcomes, with diet and activity behaviors as behavioral outcomes. After adjusting for sociodemographics and Time 1 values, children living in two of the three less environmentally supportive neighborhoods had significantly less favorable BMI z score changes (+0.11, 95% CI: 0.01-0.21; + 0.12, 95% CI: 0.03-0.21), and all three less supportive neighborhoods had higher overweight or obesity (relative risks, 1.41-1.49; 95% CI: 1.13-1.80) compared with children in the most environmentally supportive neighborhoods. Changes in daily energy intake and sedentary behavior by neighborhood type were consistent with observed weight status changes, with unexpected findings for physical activity. More walkable and recreation-supportive environments with better nutrition access were associated with better child weight outcomes and related behavior changes.

Detecting change in comparison to peers in NHS prescribing data: a novel application of cumulative sum methodology

BackgroundThe widely used OpenPrescribing.net service provides standard measures which compare prescribing of Clinical Commissioning Groups (CCGs) and English General Practices against that of their peers. Detecting changes in prescribing behaviour compared with peers can help identify missed opportunities for medicines optimisation. Automating the process of detecting these changes is necessary due to the volume of data, but challenging due to variation in prescribing volume for different measures and locations. We set out to develop and implement a method of detecting change on all individual prescribing measures, in order to notify CCGs and practices of such changes in a timely manner.MethodsWe used the statistical process control method CUSUM to detect prescribing behaviour changes in relation to population trends for the individual standard measures on OpenPrescribing. Increases and decreases in percentile were detected separately, using a multiple of standard deviation as the threshold for detecting change. The algorithm was modified to continue re-triggering when trajectory persists. It was deployed, user-tested, and summary statistics generated on the number of alerts by CCG and practice.ResultsThe algorithm detected changes in prescribing for 32 prespecified measures, across a wide range of CCG and practice sizes. Across the 209 English CCGs, a mean of 2.5 increase and 2.4 decrease alerts were triggered per CCG, per month. For the 7578 practices, a mean of 1.3 increase and 1.4 decrease alerts were triggered per practice, per month.ConclusionsThe CUSUM method appears to effectively discriminate between random noise and sustained change in prescribing behaviour. This method aims to allow practices and CCGs to be informed of important changes quickly, with a view to improve their prescribing behaviour. The number of alerts triggered for CCGs and practices appears to be appropriate. Prescribing behaviour after users are alerted to changes will be monitored in order to assess the impact of these alerts.

Goal-setting and volitional behavioural change: Results from a school meals intervention with vitamin-A biofortified sweetpotato in Nigeria

Malnutrition, particularly vitamin A deficiency, is a major public health problem in many developing countries. This study investigated whether priming or self-generation of goals, or whether attention to instrumental or experiential goals together with use of a reminder condition or not, promotes dietary behaviour intentions and change. A set of 556 randomly selected children aged 7–12 in Osun state, Nigeria, participated in an four-week intervention and field experiment in which a meal based on orange-fleshed sweetpotato, rich in pro-vitamin A, was introduced on five occasions as a complement to the existing school meal. Baseline intentions, anticipated feelings and repeated measures of post-consumption and experience were assessed. The analyses included a generalised linear mixed model for consumption and a linear mixed model for feelings and experience. The results confirmed that attention to instrumental goals undermines goal pursuit, while a focus on experiential goals increases the persistence of pursuit. Priming of experiential goals should be recommended, especially because this approach evokes positive feelings after eating. There was no evidence of an effect from repeated pairing of goals with the school meal, but use of planning by stating intentions increased the amount eaten. These results have implications for how school meals programmes should be designed to better align personal motivation with behavioural change in relation to dietary health.

P150 - Dietary and Health Related Behaviors of WIC-Enrolled Pregnant Women

Background (Background, Rationale, Prior Research, and/or Theory): Pregnancy is a critical period in a woman's lifecycle, during which good maternal nutrition can positively impact the health of both the mother and the fetus. Objective: The objective of this study was to evaluate the effect of pregnancy on dietary and health related behaviors of WIC-enrolled women, the quantity of food consumed, and the perceived quality of the diet. Study Design, Setting, Participants, Intervention: A cross-sectional study using a self-reported questionnaire was conducted. Sixty pregnant women between 12 and 24 weeks of gestation and carrying a single fetus were recruited from the WIC program at a community health center. Outcome Measures and Analysis: The self- reported questionnaire consisted of open-ended questions that evaluated changes in participants' dietary and other health related behaviors, and frequency of consumption of foods from the different food groups before and after pregnancy. Demographic data were also collected. Descriptive statistics were used to compare changes in the frequency of consumption of specific foods (WIC allowable and others), and smoking habits before and after pregnancy. Responses to open-ended questions addressing changes in quantity and quality of the diet before and after pregnancy were analyzed qualitatively using content analysis. Results: Sixty-seven percent of women reported experiencing morning sickness, and 60% stated that it affected their food intake. Despite this, 60% reported healthier eating behaviors, and higher average intakes of fruits, milk, and breakfast cereals. Twenty-two percent of participants stopped smoking. Conclusions and Implications: Participants improved their food choices after becoming pregnant and majority reported adopting healthier behaviors. This indicates that these women were committed to improving their health habits to ensure positive pregnancy outcomes. This shows pregnant women are a particularly receptive group for nutrition education interventions. Funding: None.

Key actors in driving behavioural change in relation to on-farm biosecurity; a Northern Ireland perspective

BackgroundAgriculture and farming are valued contributors to local economy in Northern Ireland (NI). There is limited knowledge about farmers’ behaviours and attitudes towards disease biosecurity measures. As part of a larger project, a scenario-based workshop with key stakeholders was organised by the Agri-Food and Biosciences Institute (AFBI)-NI in December 2015.ResultsA total of 22 participants belonging to 12 different institutions took part in the workshop. Participants were presented with an overview of previously conducted biosecurity research in NI and England. In small groups, participants were subsequently asked to discuss and give their opinions about a series of questions across four key areas in a semi-structured approach with an external facilitator. The key areas were 1- disease risk perception at the farm level; 2-perceived barriers to implementing on farm biosecurity measures; 3- avenues to successful behaviour change and 4-key industry responsibilities and roles. The discussion showed that training in biosecurity for farmers is important and necessary. Training was recommended to be provided by veterinary surgeons, preferably via a face-to-face format. The discussion addressing disease disclosure proved particularly challenging between those who were prospective buyers of cattle, and those who sold cattle.ConclusionsThis workshop provided a unique and invaluable insight into key issues regarding farm level biosecurity activities. From a policy perspective, delivering improved on-farm biosecurity must be addressed via a multidisciplinary approach. This can only be achieved with active involvement, commitment and support of a number of key industry and government stakeholders.

Promoting low carbon behaviours through personalised information? Long-term evaluation of a carbon calculator interview

The UK needs to accelerate action to achieve its 80 per cent carbon reduction target by 2050 as it is otherwise in danger of lagging behind. A much discussed question in this context is whether voluntary behaviour change initiatives can make a significant contribution to reaching this target.While providing individuals with general information on climate change or low carbon action is increasingly seen as ineffective, some studies argue that personalised information has greater potential to encourage behaviour change. This mixed methods study examines this claim through a longitudinal field experiment which tested the effectiveness of a carbon calculator interview. It finds that the intervention significantly raised awareness of ways in which participants could reduce their carbon footprint. However, this increased awareness did not translate into measurable behaviour changes in relation to home energy and travel. Qualitative analysis shows that participants refer to infrastructural, social and psychological barriers to change. This indicates that more ambitious government and corporate action is required to speed up carbon reduction.

Evaluating the effects of general anesthesia on sleep in children undergoing elective surgery: an observational case-control study.

Previous research has suggested that general anesthetics can disturb postoperative sleep patterns by affecting the sleep-wake cycle. The objective was to identify the effects of general anesthetics on sleep quality and related behavioral changes in children. This was a prospective, observational case-control study with children, aged 18 months to 8 years, undergoing general anesthesia for elective surgery. Participants wore an actigraph for 7 days on three occasions: prior to surgery, the immediate postoperative period, and 3 months after surgery. Data regarding behavior patterns were collected using behavioral assessments at baseline, the first postoperative week, and 3 months following surgery. Thirty-one participants (mean age 4.8 ± 2.0 years, 81% male) underwent urologic or otolaryngologic surgery. The median (interquartile range) anesthetic duration was 132.0 (80.0-184.0) min. No significant differences were found in sleep efficiency, total sleep time, wake time after sleep onset, or sleep onset latency between baseline, 7 day postoperative period, and the 3 month follow-up. No significant differences were found in sleep-related behavioral metrics including internalizing and externalizing behaviors, and executive functioning. Data were compared with a control group of 18 participants (mean age 5.3 ± 1.8 years, 61% male). No significant differences were found in sleep patterns and related behavioral metrics between both groups. In this study, general anesthesia did not result in disturbed sleep or associated negative behavioral changes in otherwise healthy children undergoing elective surgeries of low complexity. Physicians can advise parents that a child's surgery and associated general anesthetic exposure may not result in significant changes in postoperative sleep patterns.

Oxidation and corrosion behavior of commercial 5 wt% Al-Zn coated steel during austenitization heat treatment

A commercial 5 wt% Al-Zn coated steel was employed to detail the microstructural evolution, oxidation, and the related corrosion behavior changes during the austenitization heat treatment. During the early stages of austenitization, Fe2Al5Znx phase forms between the coating and the steel substrate. With continued austenitization, the inner part of the coating transforms to the Γ-Fe3Zn10 phase and the outer part of the coating to the FeAl phase, accompanying with the formation of a thin surface oxide layer mainly composed of Al2O3 with minor ZnO. Subsequently, the coating transforms to the Γ-Fe3Zn10 phase and α-Fe(Zn), and finally to the single α-Fe(Zn) phase. The Al in the coating is distributed mainly on the surface of the alloy layer and suppresses the oxidation of the alloy layer. The austenitization treatment enriches the coating with Fe, which, in turn, ennobles the corrosion potential and reduces the corrosion current density of the coating. Conversely, the potential difference between the coating and the steel substrate is reduced after austenitization.

Mechanisms of Behavior Change Within Peer-Implemented Alcohol Interventions

Colleges continue to experience a high number of referred students because of campus alcohol violations. Subsequently, there has been a trend to use peer-implemented minimal interventions (PMIs), often using motivational interviewing (MI). However, little is known about how PMIs facilitate behavior change. This study aims to examine the mechanisms of behavior change within PMIs and their influence on alcohol reduction among mandated students. Participants (N = 146; mean age = 18.7 years; 67% male; 94% White) were college students who violated campus alcohol policy at a Northeastern liberal arts college who received a 15-minute PMI addressing their alcohol use. The Motivational Interviewing Skill Code (Miller et al., 2003) was used to identify peer counselor behaviors that were MI consistent (MICO), client change talk (CT), and client self-exploration. MICO behaviors were positively associated with CT and self-exploration. Client CT and self-exploration were negatively associated with alcohol-related outcomes. Furthermore, mediational models examining MICO behaviors revealed effects for two paths: (a) from MICO to client CT to reduced alcohol use; and (b) from MICO to client self-exploration to reduced alcohol-related consequences and use. These data support the primary causal chain examining the influence of MICO on in-session client behaviors and related post-session behavior change in PMIs among at-risk students.

The Spa Resort, an ideal place for patient education. Examples in Venous and Lymphatic disorders”

The health of patients with chronic diseases cannot be improved substantially on the long run by the treatment of their lesions or even of their disease alone. They need in addition a patient-based approach, involving their ability to participate in the management of their disease. Therapeutic education falls within the scope of patient-based treatment approach. Its purpose is to help the patient with chronic disease to achieve the changes in lifestyle and health related behaviors required by his health condition and to cope with the everyday limitations he encounters. This is carried out through structured programs involving both group workshops and faceto-face interviews conducted by specially trained health professionals, aiming at improving his knowledge, skills and motivation. Although at first restricted to diabetes mellitus and asthma, the field of therapeutic education of the patient now widened to almost any chronic disease, and spa resorts have proven to provide a suitable setting for the development of such therapeutic education programs, because of the large number of patients present at the same site with the same disease, the motivation and availability of the patient during his stay in the Spa resort, but also to a positive interaction between the physical experience of the balneotherapeutic sessions and the education process. In France, balneology is a popular treatment for patients with chronic venous and lymphatic insufficiencies with close to 100 000 patients treated each year. With the logistic help of the Francaise pour la Recherche Thermale, we were able to develop the Veinothermes program dedicated to patients with advanced venous insufficiency (with skin trophic changes) and the 'Thermœdeme program for patients with lymphedema. Both programs were accredited by the French public health system, and we were able to show their ability to improve the patients' health related behaviors and compliance to their treatment at 3 and 9 months, with parallel improvement of their quality of life. In the case of venous insufficiency, a randomized controlled trial evaluation the combination of balneology and therapeutic education showed a long-lasting (12 months), large and significant improvement of patients symptoms, quality of life and health status. Another RCT is presently starting regarding lymphedema. The presentation will summarize the data of these four studies. Works supported by grants from the Association Francaise pour la Recherche Thermale.