Lifestyle Behavior Change Research Articles

Analisis Uji Beda Gaya Hidup Mahasiswa Urban dan Rural Terhadap Perubahan Perilaku di Fakultas Kedokteran Universitas Prima Indonesia

This research aims to examine the influence of urban and rural backgrounds on the lifestyle choices and behavioral changes among medical students. The study addresses the question of how different backgrounds shape the students' lifestyles and behavioral patterns. A quantitative approach was employed, involving a sample of 100 medical students (50 from urban areas and 50 from rural areas). Data were collected through a questionnaire and analyzed using a t-test to compare the differences between the two groups. The findings indicate significant variations in lifestyle choices and behavioral changes between urban and rural medical students, with rural students exhibiting higher levels of consumerism and more pronounced behavioral shifts. The study concludes that the students' urban or rural backgrounds play a crucial role in shaping their lifestyles and behaviors, emphasizing the need for contextual considerations in educational interventions and support systems.

Longitudinal patterns of lifestyle risk behaviours among UK adults with established cardiovascular disease: a latent transition analysis.

People with cardiovascular disease (CVD) need to engage in healthy lifestyle behaviours. However, there is a gap in identifying longitudinal patterns of change in lifestyle behaviours among people with CVD. This study aimed to identify clustering of lifestyle risk behaviours and their 4 ± year changes among UK adults with CVD, and to determine the associated factors. We used the UK Biobank data collected at two time points (2006-2010/baseline data = T0 and 2014+/third visit data = T4). Six key lifestyle risk behaviours were assessed: smoking, high alcohol intake, poor fruit and vegetable consumption, physical inactivity, poor sleep balance (<7 or >8 h/night) and prolonged sitting. A random intercept latent transition analysis was performed to identify patterns of lifestyle risk behaviours at T0 and their changes from T0 to T4. We included 5,304 participants with CVD whose data on lifestyle risk behaviours were collected at two-time points. Alcohol intake and current smoking were 75.7% and 5.4% at baseline, respectively, and 67.4% and 3.0% at follow-up. Three latent classes emerged: Latent class (LC) 1-"high alcohol intake, poor sleep balance and poor fruit and vegetable intake", LC2-"high alcohol intake and poor fruit and vegetable intake", and LC3-"high alcohol intake". Most adults remained in the same LC over the 4 + years (range: 83.9%-100.0%). After 4 + years, 3.5% from LC3 and 10.4% from LC2 at baseline moved into LC1. The odds of transitioning to LC2 relative to staying in LC1 and LC3 were 2.22 and 4.13 times higher for males than for females, respectively. A single-year increase in participants' age was associated with a 1.16 times increase in the odds of moving to LC1 relative to staying in LC2. People with CVD did not show improvement in lifestyle risk behaviours, and interventions targeting multiple lifestyle risk behaviours are needed to improve CVD.

Improvements in cardiovascular disease risk factors associated with modest weight loss following treatment in patients with binge-eating disorder and obesity.

Modest weight losses may be associated with improvements in cardiovascular disease risk factors (CVDRF) in patients with obesity. The effects of weight losses on CVDRF in persons with binge-eating disorder (BED) are unknown. This study prospectively examined changes in CVDRF among patients receiving behaviorally-based weight-loss treatment (BBWLT) who attained modest weight losses (≥5 to <10% and ≥10%). Of 191 participants, CVDRF variables were re-assessed in 168 participants at posttreatment and in 151 at 12-month follow-up. Participants who attained ≥5 to <10% weight loss were compared to those who did not on CVDRFs (total cholesterol, HDL, LDL, triglycerides, HbA1C, mean plasma glucose, heart rate, and systolic/diastolic blood pressure); similar comparisons were completed for those who attained ≥10% weight loss. At posttreatment, ≥5 to <10% weight loss (N = 42; 25.0%) was associated with significant improvements in HbA1c and mean plasma glucose, whereas ≥10% weight loss (N = 40, 23.8%) was associated with significant improvements in total cholesterol, triglycerides, HbA1c, mean plasma glucose, and heart rate. At 12-month follow-up, ≥5 to <10% weight loss (N = 17; 11.1%) was related to significant improvements on HDL, triglycerides, HbA1c, and mean plasma glucose, whereas ≥10% weight loss (N = 40, 26.0%) was associated with significant improvements on all the CVDRF variables (except blood pressure). Modest weight loss is associated with significant improvements in CVDRFs in patients with BED and obesity following treatment and at 12-month follow-up. Future work should examine whether improvements in CVDRF are attributable to weight loss per se and/or to other related lifestyle changes. Individuals with binge-eating disorder and obesity who attain modest weight loss following treatment exhibit improvements in various measures of cardiovascular disease risk compared to those who do not. While weight loss has been challenging for individuals with binge-eating disorder, clinicians should inform patients of the potential health benefits of modest weight loss. Future research should investigate whether weight loss itself and/or related behavioral lifestyle changes drive improved cardiovascular disease risk factors.

Changes in dietary and lifestyle behaviors and mental stress among medical students upon Ramadan diurnal intermittent fasting: a prospective cohort study from Taif/Saudi Arabia

BackgroundIntermittent fasting (IF) is a popular dietary plan for weight loss. In fact, fasting is a common practice in different religions such as Buddhism, Hinduism, Judaism, Christianity, and Islam. During the month of Ramadan, more than 1.5 billion Muslims worldwide fast from dawn to sunset. Ramadan diurnal intermittent fasting (RDIF) has health benefits, including a reduction in cardiovascular disease (CVD) risk and an improvement in mood. However, little is known about the effects of RDIF on lifestyle behaviors, such as regular exercise, consuming healthy diet, and avoiding harmful substances, as well as mental stress, and academic performance in high school and university students.MethodsIn this prospective cohort study, two self-reported questionnaires were sent one week before and during the last week of Ramadan (April 2022; Ramadan 1443 in Hijri Islamic Calendar) to assess changes in lifestyle, perceived stress, and academic achievement of medical students at Taif University in Taif city, Saudi Arabia. Healthy lifestyle components data were collected to calculate healthy lifestyle scores, including body mass index, physical activity, adherence to a Mediterranean diet, smoking status, and sleep duration.ResultsRDIF was associated with a healthier lifestyle in both female and male participants (pre-RDIF mean score: 2.42 vs post-RDIF mean score: 2.74; statistical power = 0.99; P-value < 0.05). They were more active and adherent to the Mediterranean diet during RDIF. Additionally, the post-RDIF smoking rate declined by 53.4%. Male participants showed higher perceived stress scores during RDIF (pre-RDIF mean score: 19.52 vs post-RDIF mean score: 22.05; P-value < 0.01). No changes in academic performance were observed upon RDIF.ConclusionMedical students show healthier dietary and lifestyle behaviors and their academic performance is not affected during RDIF. However, perceived stress is higher among male students.

A cluster randomized trial of a comprehensive intervention nesting family and clinic into school centered implementation to reduce myopia and obesity among children and adolescents in Beijing, China: study protocol

BackgroundMyopia and obesity in children and adolescents have become serious public health problems that endanger public health, especially in China. Unhealthy lifestyle behaviors are environmental drivers of both myopia and obesity. This protocol describes a study to evaluate the effectiveness of “22510SS”, that is 2 h of daytime outdoor activities (‘2’); Limit screen time to no more than 2 h per day (‘2’); Consume at least 5 servings of fruits and vegetables daily (‘5’); Attain 1 h of physical activity daily (‘1’); Consume 0 sugar-sweetened beverages (‘0’); Reasonable sleep duration (‘S’); Regular supervision (‘S’). A school-based, multifaceted intervention strategy for myopia and obesity prevention, and to assess and explore the implementation of “22510SS” with regards to acceptability, feasibility, adoption, usage and maintenance.Methods and analysisThis study aims to develop a comprehensive intervention strategy "22510SS" based on the socio-ecological model, and A two-arm cluster randomized trial with a parallel-group of a 1:1 allocation ratio in 36 primary and secondary schools to test its evidence-based intervention programs on the effects and implementation of myopia and obesity epidemics in children and adolescents in grades 4 and 7. The primary outcomes will include differences in visual acuity, body mass index, outdoor activity indicators, screen time, fruit and vegetable intake, high-quality protein intake, sugar-sweetened beverage intake, sleep duration, and level of monitoring among children and adolescents. Secondary outcomes will assess the acceptability, feasibility, uptake, use, and maintenance of the intervention. Effects on the primary and secondary outcomes will be analyzed using linear and logistic regression analyses, as well as difference-in-difference analysis, taking into account cluster effects and possible confounding factors. Process assessments will also be conducted through quantitative and qualitative analyses, including acceptability, feasibility, gender, adoption, implementation, and sustainability.DiscussionThis study will evaluate the effectiveness of “22510SS” and examine its implementation in the school-based network nesting family and clinic. Following this intervention study, the integrated intervention program focused on myopia and obesity among children and adolescents have great potential to be implemented in China to promote and support healthy lifestyle behavior change and reduce the risk of myopia and obesity in children and adolescents.Trial registrationNCT05275959. Registered 23 Mach 2022.

Assessment of the COVID-19 virus outbreak on dietary patterns, physical activity, and lifestyle behaviours: a survey among adult European citizens

PurposeThis study examined the relationship between adult respondents' COVID-19 risk perception and its impact on changes in eating habits, physical activity, alcohol consumption, and smoking.Design/methodology/approachA cross-sectional online questionnaire was used to collect data during the first wave of the pandemic, in the European spring and summer of 2020. Kruskal–Wallis and Pearson chi-squared tests were used to determine the associations between the consumers' COVID-19 risk perception and the respondents' country of origin. The respondents were primarily university employees and students from four European countries (the Czech Republic, France, the United Kingdom, and Italy).FindingsThe study showed significant changes in lifestyle behaviours of the respondents during the COVID-19 pandemic compared with the pre-outbreak period. Approximately half of all respondents reported a decrease in alcohol consumption, smoking, and physical activity, while eating habits among European consumers showed trends towards both healthier and less healthy dietary patterns. The most significant changes were recorded in reducing alcohol consumption, smoking, and physical activity among almost half of the respondents. Positive COVID-19 test experience, age, and country of the respondents had a negative influence, whereas healthy food consumption and alcohol consumption had a positive influence on the COVID-19 related risk perception.Originality/valueThe fear of the COVID-19 outbreak together with the restrictions imposed by national governments in response to the pandemic fundamentally affected the respondents' lifestyles. Understanding these changes can help establish interventions to alleviate the adoption of negative lifestyles and attitudes in subsequent waves of the COVID-19 pandemic or other similar situations.

PS10 Can an aerobic exercise intervention for patients with psoriasis improve health outcomes and support lifestyle behaviour change?

Abstract Patients with psoriasis do not exercise to the extent recommended for cardiovascular health, due to significant disease-specific barriers, which may augment their increased risk of CVD and metabolic syndrome. Therefore, we developed a bespoke, evidenced-based exercise programme for patients with psoriasis, hypothesizing that it may have utility in the management of psoriasis. Eight patients with psoriasis (32.5 ± 12.02 years old, BMI 26.7 ± 3.3 kg m-2) completed a 20-week physical activity intervention. The first 10 weeks of the intervention comprised two walking sessions per week. Each session was of 1h duration and led by a sports-scientist for small-groups of patients with psoriasis. The volume of exercise per session was calculated so that participants would incrementally progress to heart-healthy levels of exercise over the programme. During weeks 10–20 of the programme, participants engaged in independent activities. Warm-ups, pre-exercise stretching, and cool-downs were incorporated into each of the sports-scientist led sessions. Step counts were recorded using a Newfeel Onwalk 900 pedometer throughout the study. Measurements at pre-, mid-, and post-intervention endpoints (week 0, 10 and 20) included assessment of (i) psoriasis: Psoriasis Area and Severity (PASI); Physicians Global Assessment (PGA); (ii) quality of life: Dermatology Life Quality Index (DLQI), Short Form 36 (SF-36); and (iii) cardiometabolic disease/risk – pulse wave velocity (PWV); blood pressure (BP); body weight and BMI. In addition, cardiorespiratory fitness (CRF) was assessed by: 30-s sit-to-stand (30STS); timed up and go (TUG); single leg balance (SLB); static body-weight wall-squat (SBWS); and step count. Recruitment to the study is ongoing. We observed a significant reduction in both Psoriasis Area and Severity Index and systolic BP at the weeks 10 and 20 timepoints (P &amp;lt; 0.05). We also observed a statistically significant improvement in the SF-36 mental health domain between the weeks 10 and 20 timepoints (P = 0.035). The CRF statistically significantly improved across the duration of the study, with a statistically significant improvement in exercise performance, as evidenced by 30STS, TUG and pedometer step counts at week 10 (P &amp;lt; 0.05), SLB between baseline and week 20 (P = 0.043) and SBWS performance across all timepoints. Exercise induces health benefits, including reduced skin inflammation and systolic BP, and increased CRF, and may improve some aspects of quality of life in those with psoriasis. The impact of lifestyle on psoriasis warrants further investigation. Our data suggest that exercise could represent an adjuvant therapy in the future management of psoriasis.

Smartphone Applications (Apps) for Nutrition Education: A Qualitative Analysis of Outpatient Dietitian Perspectives

ObjectiveTo explore how outpatient dietitians select and use applications (apps) to support nutrition education. MethodsQualitative analysis of 20 dietitians who participated in semistructured interviews investigating their app use and recommendation processes. Transcripts were analyzed using thematic analysis. ResultsFour themes described how dietitians perceive apps for nutrition education: (1) nutrition education goals focus on long-term lifestyle behavior change while protecting patients’ relationship with food, (2) attitudes toward tracking apps influence app selection, (3) dietitians differentiate among patients who will benefit from tracking vs information apps, and (4) barriers to optimal app use result in adaptations by dietitians. Conclusions and ImplicationsBarriers exist to optimal app use for nutrition education. However, accessible app design, app selection guides, and research expounding the effects of apps and their use by dietitians may improve how practitioners incorporate apps into nutrition education.

1061-P: Food Recording and HbA1c Improvement —GluCare.Health Remote Monitoring Program Compared with Traditional Care in Patients with Obesity

Introduction: Technology is intended to assist with diagnosing, treating, and monitoring patients remotely. All studies reported positive findings between technology and weight loss. Food record has been used to monitor patients with obesity, but its impact on outcomes is still little known (1). The GluCare Health care model is centered on the use of Continuous Metabolic Monitoring (CMM) and behavioral change to address metabolic diseases in a continuous manner. The app also allows for nutrition intervention through meal logging and feedback from dietitians to improve understanding of macronutrient quality and quantity. Overall, the GluCare CMM program aims to provide continuous patient supervision and support through personalized lifestyle coaching and behavioral change. Material and Methods: Thirty participants were enrolled during 2022 at GluCare Health, Dubai (UAE). Participants were male and female aged 18 years or older with a starting body mass index (BMI) of &amp;gt;25kg/m². All the participants were on treatment using the GLP-1 analogue. Fifteen participants opted for the GluCare Health program and fifteen opted for traditional care. Outcomes: BMI and HbA1c reduction in each group after 3 months follow-up and description of number of food logs per opt-in patient. Results : On opt-in GluCare program, BMI average reduction was 2.89 kg/m² and mean HbA1c reduction was statistically significant (p= 0.002) with mean difference of 17% of reduction meanwhile on the opt-out group, BMI average reduction was 1.21 kg/m² and the HbA1c reduction was not statistically significant (p= 0.117) with 3.4% of reduction. The average of food records per opt-in patient/monthly was 71.29. Conclusion: Food monitoring and personalized dietary remote orientation by specialist healthcare providers are relevant tools to reduce HbA1c and manage obesity effectively. Disclosure B.Demircan: None. M.Caccelli: None. Y.Said: None. V.Munirathinam: None. C.Palsky: None. I.Almarzooqi: None. A.Hashemi: None.

Obesity Management in Children and Adolescents

Obesity in the pediatric population is increasing in the United States and globally. Childhood obesity is associated with cardiometabolic and psychosocial comorbidities and decreased overall life span. The cause of pediatric obesity is multifactorial and includes genetic predisposition, lifestyle, behavioral patterns, and consequences of social determinants of health. Routine screening of BMI and comorbid conditions is essential to identifying patients who require treatment. The AAP recommends immediate Intensive Health Behavior and Lifestyle Treatment for children with obesity, encompassing lifestyle changes, behavioral changes, and mental health treatments. Pharmacologic interventions and metabolic and bariatric surgery are also available when indicated.

Association between social media use and health promotion among individuals with depression and anxiety: Insights from the 2017–2020 Health Information National Trends Survey

IntroductionIndividuals with mental disorders have elevated risk factors for cardiovascular disease, and as a result, experience earlier mortality than the general population. Yet, evidence-based strategies and interventions to promote physical and cardiometabolic health in mental health contexts remains limited. Social media has emerged as a promising and readily affordable tool to expand the reach of mental health services, including the delivery of behavioral and physical health interventions. Despite its widespread availability, the potential for social media use to support positive lifestyle behaviors in mental health contexts remains relatively unexplored. We examined the potential for using social media tools for health promotion by people with anxiety or depression. MethodsUsing cross-sectional data from the 2017–2020 edition of the Health Information National Trends Survey (HINTS), we evaluated differences between individuals with self-reported history of diagnosed depression/anxiety and the general population concerning health-related usage of social media platforms. Multivariable logistic regression was performed to evaluate the association between social media usage and positive health behaviors. ResultsOverall, individuals with mental disorders were more likely than the general population to engage in health-related social media usage. Those with anxiety or depression who engaged in health-related social media usage were significantly more likely to; report intentions to quit smoking (OR 3.13, 95% CI 1.12 – 8.70; p = 0.029) endorse past 12-month attempts at smoking cessation (OR 3.41, 95% CI 1.32 –8.82; p = 0.012) and were more likely to meet national recommendation for weekly strength training (OR 1.49, 95% CI 1.11 – 2.00; p = 0.008). ConclusionsPeople with anxiety or depression use social media for health purposes at rates higher than the general population. Our findings suggest that these tools can reach many people with mental disorders and offer a novel window of opportunity to promote physical health and positive lifestyle behavior change in this highly vulnerable population.

“We are competing with culture” the chasm between healthcare professionals and Australian Samoan women in the prevention and management of gestational diabetes mellitus

Objective: The Samoan community has a disproportionately higher incidence of gestational diabetes mellitus (GDM). We explored consumer and healthcare providers’ insight into perceptions of risk, attitudes to lifestyle behaviour change and experiences of GDM among Australian Samoan women in South Western Sydney. Methods: Semi-structured interviews and a focus group with Samoan women recruited through three churches, a diabetes and pregnancy clinic in South Western Sydney and via social media were conducted. Semi-structured interviews with healthcare providers’ were also conducted. Main themes were thematically analysed to identify recurring patterns using Quirkos software. Identified themes were framed against the constructs of the Health Belief Model. Results: One focus group (n=4) and 12 one-to one interviews were conducted among Samoan women. Eighteen semi-structured interviews with healthcare providers’ were also conducted. There was a high concordance between Samoan women and healthcare providers’ regarding perception of risk and barriers to maintaining a healthy lifestyle. However, Samoan women reported negative interactions with healthcare providers’ that hindered their behaviour change, while healthcare providers’ reported that normalisation of diabetes, confusion of GDM with type 2 diabetes and spiritual health beliefs were deterrents to behaviour change among Samoan women. Conclusion: Cross-cultural factors can influence the uptake of a healthy lifestyle. Future research should consider use of culturally tailored strategies when developing educational resources targeting Samoan women. Implications for research, policy and practice: The participants’ viewpoints expressed in this study suggest a critical need for the development of culturally-tailored health promotion strategies for Samoan women and cultural training for healthcare providers’, to improve GDM care and subsequent pregnancy outcomes.

Association of modifiable lifestyle with colorectal cancer incidence and mortality according to metabolic status: prospective cohort study.

Metabolic syndrome has been linked to an increased risk of colorectal cancer (CRC) incidence and mortality, but whether adopting a healthy lifestyle could attenuate the risk of CRC conferred by metabolic syndrome remains unclear. The aim of the study is to investigate the individual and joint effects of modifiable healthy lifestyle and metabolic health status on CRC incidence and mortality in the UK population. This prospective study included 328,236 individuals from the UK Biobank. An overall metabolic health status was assessed at baseline and categorized based on the presence or absence of metabolic syndrome. We estimated the association of the healthy lifestyle score (derived from 4 modifiable behaviors: smoking, alcohol consumption, diet, physical activity and categorized into "favorable," "intermediate", and "unfavorable") with CRC incidence and mortality, stratified by metabolic health status. During a median follow-up of 12.5 years, 3,852 CRC incidences and 1,076 deaths from CRC were newly identified. The risk of incident CRC and its mortality increased with the number of abnormal metabolic factors and decreased with healthy lifestyle score (P trend = 0.000). MetS was associated with greater CRC incidence (HR = 1.24, 95% CI: 1.16 - 1.33) and mortality (HR = 1.24, 95% CI: 1.08 - 1.41) when compared with those without MetS. An unfavorable lifestyle was associated with an increased risk (HR = 1.25, 95% CI: 1.15 - 1.36) and mortality (HR = 1.36, 95% CI: 1.16 - 1.59) of CRC across all metabolic health status. Participants adopting an unfavorable lifestyle with MetS had a higher risk (HR = 1.56, 95% CI: 1.38 - 1.76) and mortality (HR = 1.75, 95% CI: 1.40 - 2.20) than those adopting a favorable healthy lifestyle without MetS. This study indicated that adherence to a healthy lifestyle could substantially reduce the burden of CRC regardless of the metabolic status. Behavioral lifestyle changes should be encouraged for CRC prevention even in participants with MetS.

Prevalence of Diabetes in Nepali-Speaking Bhutanese Americans Living in the Greater Harrisburg Area.

Members of the Nepali-speaking Bhutanese refugee community had resettled in the United States beginning in 2008 after previously being settled in United Nations (UN) refugee camps in Nepal. Due to the recency of their resettlement, there has been little research regarding diabetes in the Nepali-speaking Bhutanese American community. This study sought to identify the prevalence of diabetes in Nepali-speaking Bhutanese Americans living in the Greater Harrisburg Area and whether this community was at a higher risk of developing diabetes due to changes in diet and physical activity lifestyle behaviors. This study was conducted using an anonymous online survey. Anyone over the age of 18 and a self-identified member of the Nepali-speaking Bhutanese American community living in the Greater Harrisburg Area was included, regardless of their diabetes status. This study excluded individuals under the age of 18, those found outside the limits of the targeted region, and those who do not self-identify as members of the Nepali-speaking Bhutanese American community. Through this survey, data regarding demographics (age and gender), length of stay in the US, diabetes status (present or absent), consumption of rice (increased or decreased post-resettlement), and physical activity status (increased or decreased post-resettlement) were collected. The current prevalence of diabetes in this population was compared against the one reported by the CDC before migration and against the prevalence of diabetes in the general population of the United States of America (USA). The association between rice consumption, physical activity, and diabetes was analyzed using the odds ratio. The survey yielded responses from 81 participants. Results showed a 2.29 times higher prevalence of diabetes in the Bhutanese-speaking Nepali population of the Greater Harrisburg Area, Pennsylvania, compared to the general population of the USA. Results indicated a 37 times higher prevalence of diabetes after resettlement in the USA compared to the population's self-reported prevalence before the resettlement. The data showed that increased rice consumption or decreased physical activity alone did not significantly increase the risk of developing diabetes. However, the combination of decreased physical activity and increased rice consumption significantly increased the risk of diabetes, with an odds ratio of 5.94 (CI: 1.27 to 27.56, p-value: 0.01). The higher prevalence of diabetes in this community justifies diabetes education around causes, symptoms, treatments, and preventative healthcare methods. Greater awareness of the issue among the members of this community, as well as their healthcare providers, paves the way for future studies to identify all possible risk factors for diabetes in this community. Once risk factors are identified, early interventions and screening tools can be implemented to mitigate the onset of disease in this population in the future.

A review of caregiver distress and coronary artery disease: prevalence, risk, outcomes, and management

Abstract Funding Acknowledgements Type of funding sources: None. Background Witnessing a loved one experience an acute, life-threatening event may prompt distress among those caring for patients with coronary artery disease. Furthermore, medical management and lifestyle behaviour change is often required of the patient with assistance from the caregiver, which may prompt feelings of caregiver burden. Reviews have highlighted the risks and rewards of caregiving in the heart failure context but there has been no synthesis of the literature on caregiver distress in other cardiac patient populations. A summary of accumulated knowledge is required to estimate caregivers’ potential risk, identify potentially efficacious practices and programming to respond to this risk, and highlight gaps in the research. Purpose This narrative review synthesizes existing research on distress in caregivers of patients who experienced an acute coronary syndrome (ACS) and/or coronary revascularization (PCI/CABG). Methods Eligibility criteria included English, primary studies (published between 2002-2022) using quantitative research methods that investigated caregiver distress (defined as anxiety, depression, quality of life, perceived burden and strain) as a descriptive, predictive, or outcome variable. Patients must have experienced an ACS or PCI/CABG. Results Overall, 31 articles met the eligibility criteria (20 observational; 11 intervention). The sample sizes ranged from 33-460 caregivers, with a total of 4943 caregivers (71.3% female; 80% spouses). Caregiver distress varied widely (6-67% of the samples had distress scores &amp;gt; cut offs). Sociodemographic correlates of worse caregiver distress were younger age and less education. Sex-and-gender specific analyses were seldom conducted. Caregiver distress was higher in those with poorer preventative health behaviours, lower quality of life, passive coping strategies, and reduced caregiver competence. Predictors of caregiver distress were patients’ depression symptoms, poor relationship quality/marital satisfaction, less optimism, and fear of the patient’s illness progression. A patient’s increased access to informational and emotional support reduced caregiver distress; patients’ elevated levels of anxiety and depression were associated with greater caregiver distress. Interventions were broadly categorized as educational, psychosocial, and cardiac rehabilitation. Most interventions were brief (&amp;lt;6 sessions) with follow-ups ranging from three days to two-years. In general, 70% of interventions yielded positive changes in caregiver distress. Conclusions This review synthesized contemporary data on distress in caregivers of patients with CAD. These results are far from definitive, however, as there is heterogeneity in study samples, measurements used, and timing of assessments and programming. Further advancement in caregiving science and clinical care is required to adequately understand and respond to the needs of caregivers throughout the patient’s illness trajectory.

Evaluation of an application for self-assessment of cardiovascular risk behaviour: a pilot study

Abstract Funding Acknowledgements Type of funding sources: None. Background An important aim of cardiac rehabilitation (CR) programs is to reduce the risk of further cardiac events and improve the ability of people living with cardiovascular disease to manage their symptoms. Current CR strategies focus on (lifestyle) behaviour change, however, often patients are not activated enough to generate and self-sustain this lifestyle behaviour change. To stimulate adherence to lifestyle change recommendations, health behaviour should be (self-)assessed and then optimized in a personalized treatment plan. Although lifestyle monitoring apps are emerging rapidly, these applications are mostly targeted at a single lifestyle domain and often lack clinical validation. Purpose The purpose of the study was to evaluate the usability of a self-developed mobile application (Lifestylescore), that enables (self-)assessment of all cardiovascular risk behaviour domains (e.g. body composition, physical activity and sedentary behaviour, smoking, alcohol consumption, nutrition behaviour and psychological stress), using a combination of validated instruments. Secondly, it was investigated whether the use of the app was associated with an increase in patient activation and health behaviour improvement. Methods In this single-centre, non-randomized observational pilot study patients referred for CR due to coronary artery disease (stable angina pectoris or acute coronary syndrome, or after coronary revascularization) were recruited. Patients were asked to complete the Lifestylescore application, and, in addition, the Patient Activation Measure (PAM-13), and System Usability Scale (SUS). All measurements were performed during the intake procedure (baseline) and after completion of the rehabilitation program (after three months (follow-up)). After completion of the application, patients discussed the results with their CR case manager and set individual goals. Results All participants (n = 20) completed the study. The participants scored the Lifestylescore application with a SUS-score of above average (&amp;gt;68). Patient activation did not increase after the CR program as compared to baseline. Although the majority of the patients acknowledged that activation for lifestyle improvement is important, only a small minority reported that they took action (Figure 1). Also, there was no improvement in lifestyle behaviour after completion of CR (Figure 2). Conclusions The Lifestylescore application showed acceptable usability among CR patients. However, its use was not associated with an increase in patient activation, nor with an improvement in lifestyle behaviour after CR. Therefore, further research is needed to evaluate how the application should be incorporated in the CR program to further increase patient’s awareness, empowerment and, ultimately, effectuate more sustained behavioral change.

Lower risk of depression after smoking cessation and alcohol abstinence in patients with gastric cancer who underwent gastrectomy: A population-based, nationwide cohort study.

Although depression is associated with poor treatment outcomes in patients with cancer, little is known about whether lifestyle modifications could help prevent depression. The authors aimed to identify the effect of lifestyle modifications, including smoking cessation, alcohol abstinence, and starting regular physical activity, on new-onset depression in patients with gastric cancer who underwent surgery. By using the Korean National Health Insurance Service database, patients with gastric cancer who underwent surgery between 2010 and 2017 were identified. Self-reported lifestyle behaviors within 2 years before and after surgery were analyzed using the health examination database. Patients were classified according to changes in lifestyle behaviors, and their risk of new-onset depression was compared. Among 18,902 patients, 2302 (12.19%) developed depression (26.00 per 1000 person-years). Smoking cessation (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.66-0.91) and alcohol abstinence (HR, 0.79; 95% CI, 0.69-0.90) were associated with reduced risk of depression development compared with persistent smoking and persistent drinking, respectively. Starting regular physical activity was not associated with risk of depression. When lifestyle behaviors after gastrectomy were scored from 0 to 3 points (1 point each for not smoking, not drinking, and being physically active), the risk of depression tended to decrease as lifestyle scores increased from 0 points (reference) to 1 point (HR, 0.69; 95% CI, 0.55-0.83), 2 points (HR, 0.60; 95% CI, 0.50-0.76), and 3 points (HR, 0.55; 95% CI, 0.45-0.68). Smoking cessation and alcohol abstinence are associated with reduced risk of developing depression in patients with gastric cancer who undergo surgery.

Design and methods of a translational, community-based, lifestyle weight management pilot intervention trial in breast cancer survivors with overweight or obesity

BackgroundBreast cancer survivors (BCS) with overweight or obesity are at heightened risk of cancer recurrence, cardiometabolic disease, and compromised quality of life. Given the prevalence of significant weight gain during and following breast cancer treatment, there is growing recognition of the need to develop efficacious, widely-accessible, weight management programs for BCS. Unfortunately, access to evidence-based weight management resources for BCS remains limited and little is known of the optimal theoretical basis, program components, and mode of delivery for community-based interventions. The primary aim of the Healthy New Albany Breast Cancer (HNABC) pilot trial was to determine the safety, feasibility, and preliminary efficacy of delivering a translational, evidence-based, and theory-driven lifestyle weight management intervention to BCS with overweight or obesity in the community setting. MethodsHNABC was a single-arm, pilot trial evaluating a 24-week, multi-component intervention leveraging exercise, dietary modification, and group-mediated cognitive behavioral (GMCB) counseling components designed to facilitate lifestyle behavior change and promote sustained independent adherence. Assessments of various objectively-determined and patient-reported outcomes and theory-derived determinants of behavioral adoption and maintenance were obtained at baseline, 3- and 6-month follow-up. Measures of trial feasibility were calculated prospectively throughout the study. ConclusionFindings from the HNABC pilot trial will provide evidence demonstrating the feasibility and preliminary efficacy of a multi-component, community-based, GMCB lifestyle weight management intervention for BCS. Results will inform the design of a future, large-scale, randomized controlled efficacy trial. If successful, this approach could offer a widely accessible, community-based intervention model for weight management programs in BCS.

The Effect of Periodic Email Prompts on Participant Engagement With a Behavior Change mHealth App: Longitudinal Study

Following the need for the prevention of noncommunicable diseases, mobile health (mHealth) apps are increasingly used for promoting lifestyle behavior changes. Although mHealth apps have the potential to reach all population segments, providing accessible and personalized services, their effectiveness is often limited by low participant engagement and high attrition rates. This study concerns a large-scale, open-access mHealth app, based in the Netherlands, focused on improving the lifestyle behaviors of its participants. The study examines whether periodic email prompts increased participant engagement with the mHealth app and how this effect evolved over time. Points gained from the activities in the app were used as an objective measure of participant engagement with the program. The activities considered were physical workouts tracked through the mHealth app and interactions with the web-based coach. The data analyzed covered 22,797 unique participants over a period of 78 weeks. A hidden Markov model (HMM) was used for disentangling the overtime effects of periodic email prompts on participant engagement with the mHealth app. The HMM accounted for transitions between latent activity states, which generated the observed measure of points received in a week. The HMM indicated that, on average, 70% (15,958/22,797) of the participants were in the inactivity state, gaining 0 points in total per week; 18% (4103/22,797) of the participants were in the average activity state, gaining 27 points per week; and 12% (2736/22,797) of the participants were in the high activity state, gaining 182 points per week. Receiving and opening a generic email was associated with a 3 percentage point increase in the likelihood of becoming active in that week, compared with the weeks when no email was received. Examining detailed email categories revealed that the participants were more likely to increase their activity level following emails that were in line with the program's goal, such as emails regarding health campaigns, while being resistant to emails that deviated from the program's goal, such as emails regarding special deals. Participant engagement with a behavior change mHealth app can be positively influenced by email prompts, albeit to a limited extent. Given the relatively low costs associated with emails and the high population reach that mHealth apps can achieve, such instruments can be a cost-effective means of increasing participant engagement in the stride toward improving program effectiveness.

Pelatihan Kewirausahaan Makanan Khas Budaya Karo di UD Silangit Kabanjahe Kabupaten Karo

In this Millennial era, there are a lot of rapid changes resulting in every time our footsteps must also change quickly for a better direction. It cannot be denied that in the end changes are able to follow it and have a negative impact on those who are slow to respond. Of the many changes that have occurred, the most important changes to pay attention to are changes in human thinking patterns, changes in lifestyle, tastes and personal behavior, from children to adults, both in cities and villages which ultimately affect one's view of something. including changes in the mindset of our students today.&#x0D; The background of why entrepreneurship is necessary is to be able to look at a better future. With entrepreneurship, it is hoped that someone will be able to be independent, create jobs for others, and be the boss of their business. In other words, it is better to pay a salary than to be a salary person.&#x0D; It is necessary to create a climate that can change the mindset, both mental and motivation of parents, lecturers and students so that later their children are accustomed to creating jobs rather than looking for work. One way is to change the mentality and motivation that has been so embedded in every human being, especially in the Karo Culture Food Entrepreneurship Training UD Silangit Karo Regency.