Lifestyle Changes Research Articles

Lifestyle changes and psychological anxiety during the Coronavirus Disease 2019 pandemic: Using the Korean Community Health Survey

This study investigated changes in lifestyles and psychological anxiety among Koreans during the Coronavirus Disease 2019 (COVID-19) pandemic using the 2020 data from the nationwide Korean Community Health Survey. The study outcomes were psychological anxiety about the infection and death, due to COVID-19. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to evaluate the relationship between psychological anxiety and lifestyle changes. During the COVID-19 pandemic, people who practiced healthy behaviors and followed social distancing and quarantine regulations experienced increased psychological anxiety for infection and death. Daily life changes during the COVID-19 pandemic were not associated with psychological anxiety. The result of this study can provide baseline measures for further study on psychological anxiety during re-infection of COVID-19 and future pandemics in Korea.

Olanzapine-Induced Weight Gain in A 13-Year-Old Patient with Trichotillomania: A Case Report

Objective: To emphasize a case of olanzapine-induced weight gain in a 13-year-old girl with trichotillomania and discuss the management strategies implemented. Case Summary: A 13-year-old female diagnosed with trichotillomania experienced significant weight gain after being prescribed olanzapine. The patient also developed increased appetite. Consequently, olanzapine was discontinued and replaced with other antipsychotic agent, alongside lifestyle modifications including diet modifications and regular physical activity. Conclusion: The case highlights the potential for olanzapine to induce significant weight gain and emphasizes the need for careful monitoring and timely intervention. A shift to safer option and lifestyle changes are essential in managing the patient’s condition. Keywords: Trichotillomania, Olanzapine, Weight Gain, Paediatrics, Atypical Antipsychotics, Metabolic Effects

Review of alternative medicine (AM) treatments for diabetes

In the US, diabetes is a signification public health issue. It is one of the leading causes of death and number one cause of kidney failure. Even with increased awareness and medical advances, the diabetic trends with the US adult population are not very encouraging. The number of diabetes cases in the US the last twenty years has more than doubled and out of the 37.3 million adults in the US with diabetes, 20% of them don’t even know that they have it.1 Diabetes is a chronic disease with no available cure, medical practitioners and researchers have focused on controlling it with through medicine and lifestyle changes. Diet, exercise and healthy lifestyle are the most important factors on managing diabetes. There are several Alternative Medicine (AM) treatments that are available to manage diabetes today. Diet, exercise, herbs and supplements, yoga and meditation are some of the available AM treatments for diabetes. Herbs and supplements do not come under the purview of the U.S. Food and Drug Administration (FDA) because they are not classified as medicines. Moreover, there are not enough definitive research that proves the efficiency and efficacy of AM treatments. In this paper, I have described AM treatments available today and their impact on diabetes management.

The Evolving Landscape of Small Fiber Neuropathy.

Small fiber neuropathy (SFN) belongs to a heterogeneous group of disorders in which thinly myelinated Aδ and unmyelinated C-fibers are primarily affected, leading to neuropathic pain and autonomic symptoms. SFN can be associated with systemic conditions such as diabetes, autoimmune diseases, exposure to drugs and toxins, and infection, with the list of associated diseases continuing to expand. Variants in the SCN9A, SCN10A, and SCN11A genes encoding Nav 1.7, Nav 1.8, and Nav 1.9 sodium channel subunits, as well as in the TRPA1 gene, have been found in SFN patients, expanding the spectrum of underlying conditions and enhancing our understanding of pathophysiological mechanisms. There is also growing interest in immune-mediated forms that could help identify potentially treatable subgroups. According to international criteria, diagnosis is established through clinical examination, the assessment of intraepidermal nerve fiber density, and/or quantitative sensory testing. Autonomic functional tests allow for a better characterization of dysautonomia in SFN, which can be subclinical. Other tests can support the diagnosis. Currently, the management of SFN prioritizes treating the underlying condition, if identified, within a multidisciplinary approach that combines symptomatic pain therapy, lifestyle changes, and biopsychological interventions. Emerging insights from the molecular characterization of SFN channelopathies hold promise for improving diagnosis, potentially leading to the discovery of new drugs and refining trial designs in the future. This article reviews the clinical presentation, diagnostic workup, and advancing knowledge of associated conditions and interventional management of SFN.

Lifestyle changes and patient-reported outcomes over five years in a sample of people with multiple sclerosis after a single multimodal intensive lifestyle education workshop.

Modifiable lifestyle risk factors for progression of multiple sclerosis (MS) have been increasingly studied. This study employed a single-group design involving a one-off intensive live-in educational workshop on lifestyle modification for people with MS. We aimed to examine changes in a range of clinical and lifestyle variables and quality of life, self-efficacy, physical impact of MS and disability from baseline to 3- and 5-years post-intervention. 95 participants completed the baseline survey. Data included lifestyle risk factors of diet quality, meat and dairy consumption, omega 3 and vitamin D supplementation, physical activity, stress reducing activities, and smoking status, and use of disease-modifying therapies (DMTs). Patient-reported outcomes included health-related quality of life, self-efficacy, physical impact of MS and disability. Generalised estimating equation models were used to account for within-participant correlation over time. Sixty participants (63.2%) provided data at 3- and 5-years. Significant improvements in diet quality, omega 3 supplementation, and non-smoking were seen at both timepoints. Use of DMTs and disability remained unchanged. Mental (8.8- and 6.9-point) and physical (10.5- and 7.3-point) quality of life, and self-efficacy (2.4- and 1.9-point) improved significantly at 3- and 5-years, respectively. Physical impact of MS reduced from baseline to 3-years (-3.7 points) with a trend towards reduction at 5-years (-2.9 points; p = 0.079). Education on lifestyle modification can lead to lifestyle modification and short and long-term improvements in mental and physical wellbeing outcomes. Results suggest potential value in lifestyle modification as an adjunctive component to standard therapy for MS.

Comparison of the Effect of Structured Lifestyle Changes Versus Verbal Advice Only on Blood Pressure Control Among Hypertensive Adults in a Tertiary Hospital in North Central Nigeria

Background: Results from several clinical trials show that comprehensive behavioral intervention programs improve lifestyle behaviors and lower blood pressure. The study compared the effect of structured lifestyle modification versus verbal advice only on blood pressure control among hypertensive adults presenting in the GOPD of JUTH. Study Design/Setting: The study was a randomized study involving hypertensive adults aged 20 years and above presenting in GOPD of JUTH. Methods: Participants were consecutively selected and randomized into two groups, a structured lifestyle modification group (Group A) and a verbal advice only group (Group B). Group A was offered a structured lifestyle modification counseling while routine advice only was offered to group B. Data was collected about patients’ socio-demographic, medical and lifestyle habits that included dietary and exercise history. Physical examination included blood pressure measurement. Participants were followed up monthly for twelve weeks during which blood pressure measurement was routinely carried out and changes in their lifestyle habits reported. The primary outcome was reduction in BP. The means at 95% confidence intervals of the blood pressure values of the two groups were determined using paired t-test analysis. Data was analyzed on an intention to treat basis. A p-value of <0.05 was considered significant in all analyses. Results: The mean systolic blood pressure reduction in group A was 17 mmHg (8.7, 25.3; 95% CI) after 12 weeks versus 6.67 mmHg (0.47, 12.87, 95% CI) in group B. The mean diastolic pressure reduction after the same period was 8 mmHg (3.5, 12.5; 95% CI) in group A and 5.33 mmHg (1.5, 9.1; 95% CI) in group B. Paired t-test analyses revealed that these reductions were statistically significant in both groups. Conclusion: Findings from the study show that individuals with hypertension can make and sustain, during a period of 12 weeks, multiple lifestyle modifications which can control or reduce blood pressure. There is therefore a need for improved lifestyle intervention programs, including those appropriate for delivery in the clinical setting, that enable individuals with or at risk for hypertension to adopt long-term healthier lifestyles Keywords: Lifestyle modification, Hypertension, Blood pressure

A critical review on diabetes mellitus type 1 and type 2 management approaches: from lifestyle modification to current and novel targets and therapeutic agents.

Diabetes mellitus (DM) has emerged as an international health epidemic due to its rapid rise in prevalence. Consequently, scientists and or researchers will continue to find novel, safe, effective, and affordable anti-diabetic medications. The goal of this review is to provide a thorough overview of the role that lifestyle changes play in managing diabetes, as well as the standard medications that are currently being used to treat the condition and the most recent advancements in the development of novel medical treatments that may be used as future interventions for the disease. A literature search was conducted using research databases such as PubMed, Web of Science, Scopus, ScienceDirect, Wiley Online Library, Google Scholar, etc. Data were then abstracted from these publications using words or Phrases like "pathophysiology of diabetes", "Signe and symptoms of diabetes", "types of diabetes", "major risk factors and complication of diabetes", "diagnosis of diabetes", "lifestyle modification for diabetes", "current antidiabetic agents", and "novel drugs and targets for diabetes management" that were published in English and had a strong scientific foundation. Special emphasis was given to the importance of lifestyle modification, as well as current, novel, and emerging/promising drugs and targets helpful for the management of both T1DM and T2DM.

Effects of frying and food items on the physicochemical properties of palm oil obtained from Nigeria

The consumption of palm oil has particularly increased in Nigeria due to increased population, lifestyle changes, and its health benefits. The conversion and recycling of the ever-growing food waste from household and commercial is one of the known cost-effective and sustainable management strategies. This study investigates the effect of processing on the physicochemical properties of palm oil. Neat palm oil (NPO) and waste palm oil (WPO) samples, derived from frying four different Nigerian food items, were analyzed to determine changes in their physicochemical properties. The outcome of the investigation reveals that higher temperature during frying and contamination from different food items weakens the molecular structure of the palm oil thereby reducing the quality and stability of the samples which is expressed by the differences in their physicochemical properties. The density, peroxide value, and carbon, hydrogen, and oxygen (CHO) values of NPO were 886 kg/m3, 9.473 meqO2/kg, and 39.233% while that of the WPO samples vary between 3.989–4.692 kg/m3, 10.858–15.362 meqO2/kg, and 52.346–58.468%, for density, peroxide value, and CHO, respectively. The result of the descriptive statistics shows that in the 1 series, the mean ± standard deviation (SD) [coefficient of variation (CV%)] is 119.76 ± 263.87 (220.33%). Both the SD and CV% are greater than the mean; this is due to the heterogeneous nature of the parameter values in the samples. When subjected to inferential statistical analysis, the results show that the error of prediction of relationship in NPO sample versus WPO samples is just 5.290% whereas the reduction in the error is 94.71%. More collaborative investigations are needed to determine the ease of conversion to biodiesel and the properties of biodiesel produced from WPO used to fry different Nigerian food items.

Infective endocarditis: Awareness, knowledge gaps and behaviours amongst adults with congenital heart disease

BackgroundAdults with congenital heart disease (ACHD) have an increased risk of infective endocarditis (IE), associated with significant morbidity and mortality. This risk is compounded by patient-related factors, including lack of awareness of IE and the presence of a learning disability (LD). Our study sought to evaluate patients' understanding of the risks and symptoms of IE and to identify patients who could benefit from targeted education. MethodsPatients attending the outpatient department of a tertiary ACHD referral centre completed a questionnaire that assessed their knowledge, attitudes and behaviours towards IE. Baseline demographics and clinical data were collected from electronic patient records. ResultsA total of 132 ACHD patients completed the questionnaires (age 41.7 ± 16.4 years, 50 % male, 11 % with an LD). Only 37.1 % of patients accurately defined IE, none of whom had an LD. Most patients chose pyrexia (47 %) and tiredness (39.4 %) as potential symptoms of IE, however, none correctly identified all symptoms. Only 19.7 % were aware of the requirement for prolonged antibiotic treatment for IE. A third of all patients reported that they would have made lifestyle changes had they been aware of the complications of IE. There was a statistically significant association between learning disability and poor level of awareness in the questionnaire. ConclusionsOur study demonstrates awareness issues regarding IE among ACHD patients, highlighting the need to invest further on patient education. This should start at the time of transition from paediatric to adult services and continue lifelong, with emphasis on patients with a learning disability.

SICOB Italian clinical practice guidelines for the surgical treatment of obesity and associated diseases using GRADE methodology on bariatric and metabolic surgery.

Obesity is a chronic disease associated with increased morbidity and mortality and reduced quality of life. Pharmacotherapy can be associated with life style changes in increasing and maintaining weight loss and ameliorating obesity-related complications and comorbidities. In patients affected by obesity and uncontrolled obesity-associated complications or high degrees of BMI (> 40 Kg/m2), metabolic bariatric surgery can be a valid therapeutic option. Many different types of surgical procedures have been developed in last decades, mainly performed via laparoscopic approaches. However, clinical indications for metabolic and bariatric surgery (MBS) and the choice of the most appropriate type of procedure have not been clarified so far.The Italian Society of Bariatric and Metabolic Surgery for Obesity (Società Italiana di Chirurgia dell'Obesità e delle Malattie Metaboliche-SICOB) decided to design and develop the updated version of the Italian guidelines aimed at assisting healthcare professionals in the choice of the surgical option for the treatment of obesity and related conditions. Between June and October 2022, a panel of 24 experts and an evidence review team (ERT, 10 members), participated in the definition of clinical questions, outcomes, and recommendations and collected and analyzed all the available evidence on the basis of pre-specified search strategies. GRADE methodology and PICO (Patient, Intervention, Comparison, Outcome) conceptual framework have been adopted for the development of the present guidelines. Aim of the present guideline is to verify indications to surgery with respect to the presence of comorbid conditions, evaluate the different types of surgical approaches and endoscopic bariatric procedure and revise indication to revision surgery and postoperative procedures.

An expert consensus on the most effective components of integrated motivational interviewing and cognitive behavioural therapy for lifestyle behaviour change: protocol for an online modified Delphi study

IntroductionBehaviour change interventions are advocated as a key approach to manage behavioural risk factors such as insufficient physical activity, poor diet and smoking. Integrated motivational interviewing and cognitive behavioural therapy...

A Saudi Heart Association Position Statement on Obesity and Cardiovascular Disease.

The obesity pandemic is a major public health concern in Saudi Arabia, with significant impact on cardiovascular disease (CVD). This position statement aims to provide an overview of available evidence as well as the recommendations of the Saudi Heart Association on the management of obesity associated with CVD. Under the auspices of the Saudi Heart Association, a multidisciplinary expert panel comprised of cardiologists and endocrinologists discussed available evidence and provided recommendations on the management of obesity in CVD. The expert panel discussions occurred between September of 2023 and May of 2024 and also took into consideration local expertise in addition to published data in the management of obesity and CVD in the Kingdom of Saudi Arabia. The expert panel explored studies on obesity and its implication on CVD assessment modalities, while also examining the efficacy and cardiovascular safety of available interventions for weight reduction. The association between obesity and CVD is undeniable. The treatment of obesity, be it through lifestyle changes, pharmacological therapy or surgery, is an effective strategy for both weight loss as well as the primary and secondary prevention of CVD. The Saudi Heart Association position statement thus provides guidance and recommendations for the management of obesity/overweight and CVD in Saudi Arabia. This position statement is expected to contribute towards obesity and CVD prevention efforts in Saudi Arabia by promoting adequate and time-appropriate treatment of these conditions.

24-hour Movement Behaviour study—Lithuanian protocol: a comprehensive overview of behaviours and health outcomes in adolescents

The 24-hour Movement Behaviour (24-h MovBeh) paradigm, encompassing physical activity (PA), sedentary behaviour (SB) and sleep patterns, is recognised as a holistic approach to adolescent health. It emphasises promoting PA,...

The problem of constipation in the practice of an outpatient doctor

Constipation is a disorder that affects a large number of people and has a negative impact on quality of life. Constipation is one of the common reasons for seeking medical help from an outpatient doctor. The problem of constipation can often be multifactorial, with important causes being low fiber in the diet, decreased fluid intake and physical inactivity. For some patients, constipation is not a chronic problem, but may occur at some point in their lives, usually lasts a limited period of time and is not a serious problem, the solution to which may be changes in diet and lifestyle, or a short course of laxatives. In everyday outpatient practice, so-called simple or functional constipation is more common. At the same time, long-term or chronic constipation is often a complex problem for both the doctor and the patient; it is often secondary in nature, affecting not only personal well-being and quality of life, but also causes considerable financial costs, since most patients do not immediately seeks medical help, trying to self-medicate, for a long time and not always successfully, transforming the problem into a chronic one, further complicating the diagnostic search and choice of treatment tactics. Chronic constipation is more often a problem for women and older people. Knowledge and understanding of the causes and possibilities for diagnosing constipation, approaches to therapy, as well as measures for its prevention will allow the outpatient doctor to choose the necessary tactics for managing the patient. The article provides a review of the literature on the etiopathogenetic, diagnostic aspects of constipation, as well as the possibility of an integrated approach in the treatment of patients. Algorithms for diagnostic search and choice of therapy for a patient with constipation are convenient for practical use, which is also presented in the article.

The potential benefits of extra screening for glycated haemoglobin, total cholesterol and low-density lipoprotein cholesterol on donor health management and retention.

An extra health screening, including glycated haemoglobin (HbA1c), total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), was initiated for regular donors aged over 40 in Taiwan in November 2015. This study aimed to determine its benefits on donor health management and retention. A stratified random mail survey was conducted among donors who received HbA1c, TC and LDL-C screening between November 2015 and June 2017 to investigate their awareness of the screening, medical histories and post-screening behaviours. Their subsequent screening results and donation records from 3 years before and after the initial screening were obtained up to December 2021. In total, 2070 donors participated in the mail survey, with participation rates ranging 15.7%-23.2% across study groups. The screening newly detected hyperglycaemia in 1.6% (95% confidence interval [CI]: 1.2%-2.0%) and hyperlipidaemia in 1.0% (95% CI: 0.7%-1.4%) of participants, with 42.7% (95% CI: 40.3%-45.2%) of participants unaware of the screening. Participants with initially abnormal or borderline TC or LDL-C results showed significant decreases in the subsequent screening (all p values<0.05). No difference was found in participants' awareness of the screening. However, those who sought medical consultation or made specific lifestyle changes tended to show greater improvements. Awareness of the screening was associated with increased whole blood donations and donated units. The extra health screening has limited benefits for donor health management without additional interventions, but it may motivate donors to donate more frequently. Raising donors' awareness of the screening is also crucial to maximize its benefits.

Perbedaan Perubahan Tekanan Darah Antara yang Diberikan Jus Mentimun (Cucumis Sativus Linn) dengan Jus Pepaya (Carica Papaya) Terhadap Penderita Hipertensi Primer di Wilayah Kerja Puskesmas Ampenan

Hypertension is the leading cause of death in Indonesia and has a high risk of heart failure, stroke, kidney failure and myocardial infarction. Management of hypertension includes lifestyle changes, diet, stress management and others. In addition, giving cucumber juice and papaya juice is also recommended as a nursing management to lower blood pressure because the content of potassium, magnesium, phosphorus can treat hypertension. The purpose of this study was to determine the difference in blood pressure changes between those given cucumber juice (cucumis sativus linn) and papaya juice (carica papaya) for patients with primary hypertension in the Ampenan Health Center work area. The research method used was a Quasy Experimental study with a pretest-posttest control group design with a quantitative approach in the cucumber juice group and the papaya juice group with a control group without treatment. Random sampling technique was used to obtain 30 respondents divided into 3 groups. The results of the study showed that the results of the dependent t test showed a p value = &lt;0.05 so that there was a difference in blood pressure reduction between those given cucumber juice and those given papaya juice in patients with hypertension.

Product aesthetics and consumer buying decision in the cosmetic sub-sector in Nigeria

In the recent modern marketing age, there is huge competition of product atheistic due to changing life style of the consumers and the improvement in cosmetic products. Every organization focuses on the packaging positioning of products because that is the main tool of stimulating consumer buying decision. The objective of this paper was to examine the effect of product aesthetics on the consumer buying decision. This research identified the relationship between the dependent and independent variables. This survey research consists on the primary data which were collected through the distribution of the questionnaire and SPSS software was b used for the purpose of the analysis. This study consists on the response of the 100 respondents and tested the reliability of the model. Findings shows that the dimensions of product atheistic such as product information and product packaging have positive effect on consumer buying decision. Results also shows that the dimensions of product packaging explain the variability of consumer buying decision of cosmetic brands in selected super supermarkets. The study recommended that management of supermarkets should engage the services of professionals who are knowledgeable about customer reactions towards product information and texts in order to continuously develop and improve on their packaging so as to boost their consumer purchase decision. Keywords: Product Aesthetics, Product Information, Product Packaging, Consumer and Buying Decision.

Association of lifestyle trajectory and total lifestyle change score with risk of metabolic syndrome: The prospective community-based Ansung-Ansan cohort study

Background&AimsWe aimed to examine the association of lifestyle trajectory and total lifestyle change score with the risk of metabolic syndrome (MetS). MethodsWe analyzed 2,048 participants aged 40 to 69 years without MetS at baseline in the Ansung-Ansan cohort study. Lifestyle trajectories were identified using group based trajectory analysis, and total lifestyle change score were identified using index analysis. Healthy lifestyle trajectory and total lifestyle change score as exposure, and MetS as outcome. Cox proportional-hazards regression was used to examine the hazard ratios (HRs) for the exposure-outcome association. ResultsDuring the median 9.8-year follow-up, 756 cases were recorded. Compared with those in the the stable low healthy lifestyle trajectory, the stable high healthy lifestyle trajectory showed a protective effect on reducing the risk of MetS (men: HR, 0.47; 95% confidence interval [95% CI], 0.34-0.66; women: HR, 0.62; 95% CI, 0.43-0.91). Similar results were observed in the index based analysis, compared with those with lower total lifestyle change scores, men and women with higher scores had 46% and 47% lower risks of developing MetS, respectively (men: HR, 0.54; 95%CI, 0.41-0.71; women: HR, 0.53; 95% CI, 0.41-0.68). ConclusionsStable healthy lifestyle trajectory was associated with a reduced risk of MetS among Korean adults. Furthermore, a higher total lifestyle change score was inversely associated with the risk of MetS.

Experiences of Postpartum Follow-Up and Participation in a Lifestyle Intervention after Gestational Diabetes: A Qualitative Study

Background/Objectives: Gestational diabetes is associated with an increased risk of future type 2 diabetes and cardiovascular disease, but healthy lifestyle changes can prevent the development of these diseases. This study aimed to identify factors that can improve intervention programmes and postpartum support after gestational diabetes. Methods: Twenty-two women who had experienced gestational diabetes in Norway participated in in-depth interviews following a six-month intervention programme focusing on healthy lifestyle changes. Participants were included 3–12 months after giving birth. The data were analysed using reflexive thematic analysis. Results: Four themes were developed: (1) A status report on my health and lifestyle—crucial for recognising the need for change; (2) encouragement and cheering on: getting started and maintaining changes; (3) life’s challenging moments: looking after the baby and prioritising one’s own health; and (4) the first period with the newborn baby—a good time to make changes. Participants described maternity leave as a suitable time for lifestyle change. Adequate information about and insight into their health were important for success. The focus on small changes motivated them to improve their lifestyle. Participants emphasised individualised help, support from others, noticing an improvement and seeing a positive effect on their family members as motivational factors for maintaining the changes. However, they found it difficult to prioritise themselves and to maintain lifestyle changes in challenging life situations and transitional phases. Conclusions: The study findings can help support the development of future intervention programmes for women who have experienced gestational diabetes.

Limited health literacy increases the likelihood of cognitive frailty among older adults

BackgroundCognitive frailty is a dual geriatric syndrome that is preventable with lifestyle changes. Lifestyle changes are influenced by literacy level. However, the association between limited health literacy (HL) and cognitive frailty (CF) is yet to be discovered.ObjectivesThis study aims to determine the association between HL and CF among older adults.MethodsData was collected between April 2021 to March 2022 in this cross-sectional study. Citizens aged 60 years and older who can understand Malay and English were selected through purposive sampling from the AGELESS Trial screening sample frame. HLS-M-Q18 was administered to determine HL and CDR, and Fried’s Criteria were used to assess the CF status.ResultsA total of 757 participants were included in the analysis. 68.2% of the total participants had a limited HL level. The prevalence of CF among older adults with limited HL was 48.2% as compared to those with adequate HL (28.2%) (p < 0.001). Based on the HLS-M-Q18 index scores, the robust group had a higher HL index score than those in the CF group: 36.1 (SD = 10.5) and 33.4 (SD = 8.6), respectively, p < 0.05. In binary logistic regression, limited HL, increasing age, lower income, lower education level and rural locality were associated with the increase of CF occurrence. Older adults with limited HL have 2.6 times higher odds of having CF.ConclusionApproximately two-thirds of multiethnic older adults in the study had limited HL, with those with limited HL has 2.6 times higher odds of having CF. These findings emphasize the importance of addressing HL to improve their health outcomes and well-being.