Disease Prevention Counseling Research Articles

PS-C11-2: FACTORS AFFECTING HOME BLOOD PRESSURE AND HEART RATE VARIABILITY POST-COVID INFECTION

Objective: There is a scarcity of data on the factors that influence home blood pressure (BP) and heart rate (HR) variability. This study was undertaken to determine the factors that influence home BP and HR fluctuation post COVID infection in the urban Indian population. Designs and Methods: We conducted a cross-sectional study among 1000 patients between the ages of 30 and 80 who were previously infected with COVID-19 infection, but not hospitalized. These patients were guided and trained to measure BP at home. BP and HR readings were taken at home twice a day, in the morning and evening, for seven days (28 measurements). The SD of morning minus evening, and first minus second readings was used to calculate BP and HR variability. Results: Old age, cardiovascular illness, diabetes, and high home blood pressure were all found to be independent predictors of an increased morning than evening home blood pressure variability. Old age, and high home blood pressure were all independent determinants of greater day-to-day home blood pressure variability, while old age, female sex, cardiovascular disease, and high home blood pressure were all independent determinants of greater first versus second home blood pressure variability. Young age, and high home HR, on the other hand, were all independent drivers of increased morning vs evening variability. Young age, female sex, and a high home HR were also independent predictors of first versus second home HR variability. Conclusion: Considering home BP and HR fluctuation have prognostic value, it is critical for clinicians to understand the underlying reasons for these variables. Doctors should focus on alcohol, diabetes, and cardiovascular disease prevention counseling for their high-risk patients.

Adults Eligible for Cardiovascular Disease Prevention Counseling and Participation in Aerobic Physical Activity - United States, 2013.

Cardiovascular disease (CVD) is the leading cause of death in the United States, and physical inactivity is a major risk factor (1). Health care professionals have a role in counseling patients about physical activity for CVD prevention. In August 2014, the U.S. Preventive Services Task Force (USPSTF) recommended that adults who are overweight or obese and have additional CVD risk factors be offered or referred to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention. Although the USPSTF recommendation does not specify an amount of physical activity, the 2008 Physical Activity Guidelines for Americans state that for substantial health benefits adults should achieve ≥150 minutes per week of moderate-intensity aerobic physical activity or ≥75 minutes per week of vigorous-intensity aerobic activity, or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity. To assess the proportion of adults eligible for intensive behavioral counseling and not meeting the aerobic physical activity guideline, CDC analyzed data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS). This analysis indicated that 36.8% of adults were eligible for intensive behavioral counseling for CVD prevention. Among U.S. states and the District of Columbia (DC), the prevalence of eligible adults ranged from 29.0% to 44.6%. Nationwide, 19.9% of all adults were eligible and did not meet the aerobic physical activity guideline. These data can inform the planning and implementation of health care interventions for CVD prevention that are based on physical activity.

A Muslim Family with Several Members with Celiac Disease and Other Autoimmune Disorders

The Bedouin community of Israel is a traditional Muslim society. It is characterized by one of the highest rates of population growth in the world. The custom of intermarriage, especially among cousins or within the extended family, is very common because of the community's tribal structure. The rate of genetic disease in this population is high. We present a Bedouin family in which the father suffers from celiac disease and Hashimoto's disease, his daughter has celiac and Crohn's disease, three other children have IgA deficiency, and a half uncle has Crohn's disease. In describing this family we present the familial nature of these diseases, the age at diagnosis, the marital relationships of the family members and co-morbid diseases and medical conditions. Family doctors can develop and use genograms that can facilitate their understanding of the situation and enable them to develop plans for health promotion and disease prevention counseling in the community.

Factors affecting the difference between morning and evening home blood pressure: The Finn-Home study

Objective. The aim of this study was to assess the determinants of home morning and evening blood pressure (BP) differences in general population. Methods. We studied a representative sample of the general Finnish adult population with 1919 study subjects, aged 41–74 years. Study subjects underwent a clinical interview, clinical examination and home BP measurement (28 measurements performed twice in the morning and in the evening during 7 consecutive days). Results. In untreated hypertensive subjects, systolic home BP was lower in the morning than in the evening while no difference was detected for diastolic home BP (137.7/85.1 vs 141.5/85.2 mmHg, p < 0.001/0.64). In treated hypertensive subjects, the difference between systolic morning and evening BP was smaller (136.2 vs 137.1 mmHg, p = 0.023) and diastolic morning BP was even higher than evening BP (83.3 vs 82.1 mmHg, p < 0.001). In the univariate analysis, higher home BP and higher body mass index were associated with relatively higher morning BP compared with evening BP. In addition, men, excessive alcohol users, subjects with cardiovascular disease, sleep apnea and subjects using antihypertensive medication had relatively higher morning BP compared with evening BP. In the multivariate analysis, male gender, excessive alcohol consumption, cardiovascular disease, sleep apnea and use of antihypertensive medication were independent determinants of elevated morning BP compared with evening BP. Conclusion. Knowledge of the underlying causes affecting morning and evening home BP difference in patients facilitates physicians to make rational antihypertensive medication and lifestyle adjustments, such as examining probable sleep disorder, and give alcohol and cardiovascular disease prevention counseling.

Factors affecting the variability of home-measured blood pressure and heart rate: the Finn-home study

Information of the determinants affecting home blood pressure (BP) and heart rate (HR) variability is very limited. The objective of the study was to assess the determinants of home BP and HR variability in an unselected European population. We studied a sample of 1908 patients aged 41-74 years. Study participants underwent a clinical examination and determination of serum lipids and glucose. Home BP and HR measurements were performed twice in the morning and in the evening during 7 consecutive days (28 measurements). BP and HR variability was defined as the SD of morning minus evening, day-by-day and first minus second measurements. Old age, cardiovascular disease, diabetes and high home BP were independent determinants of greater morning minus evening home BP variability. Old age, excessive use of alcohol and high home BP were independent determinants of greater day-by-day home BP variability, and old age, female sex, cardiovascular disease and high home BP were independent determinants of greater first minus second home BP variability. On the contrary, young age, moderate use of alcohol and high home HR were independent determinants of both greater morning minus evening and day-by-day home HR variability. In addition, young age, female sex and high home HR were independent determinants of first minus second home HR variability. As home BP variability and HR variability have prognostic significance, it is important for the physicians to understand underlying causes of home BP and HR variation. Physicians should focus alcohol, diabetes and cardiovascular disease prevention counseling on their high-risk patients.

Opportunities and barriers to disease prevention counseling in the primary care setting: a multisite qualitative study with US health consumers

The purpose of this study is to understand people's receptivity to seeking out disease prevention counseling from their primary care provider. Since patients' openness to health messages may vary depending on how they seek out their health information, participants were segmented into one of four unique information-seeking groups. This study explores the differences among these groups, what approaches would be most effective in motivating different health consumers to seek out behavioral counseling in the primary care setting and the opportunities during the medical visit most appropriate for this counseling. To this end, a total of 32 focus groups were conducted with American adults. Participants were segmented by information-seeking orientation (independent actives, doctor-dependent actives, independent passives and doctor-dependent passives), age and gender. Findings showed that participants of the four information-seeking groups possessed distinct differences in their desire for and perceived barriers to requesting counseling from their provider. Overall, participants wanted prevention counseling to include tailored information, encouragement and follow-up. Participants among the various segments identified two key windows of opportunity-during a routine checkup and when discussing their family history-where patients and providers can incorporate more in-depth prevention discussions into the medical visit. Findings from this study suggest that targeting health messages according to health consumers' information-seeking orientations may provide an effective tool for practitioners. Additionally, many health consumers are open to behavioral counseling in the primary care setting and would be satisfied if this counseling were integrated into traditional procedures, such as during a routine checkup or when discussing their family medical history.

Facilitating Behavior Change: Strategies for Education and Practice

ABSTRACT- This paper develops an argument for the inclusion of brief disease prevention counseling into the training curricula of physical therapists. Cited literature suggests that practicing therapists are likelv not taking full advantage of concepts from behavior theory that can guide prevention counseling. Those concepts, along with the Brief prevention Counseling Model, are described and applied to a case scenario. In addition, the knowledge, skills, and attitude components of a counseling curriculum, including their assessment, are discussed. Key Words: Behavior theory, Brief counseling, Exercise, Physical therapy. Mr Jones, a 55-year-old, sedentary, obese, mate smoker, comes to you with a referral from a family physician for knee pain associated with osteoarthritis. As a skilled therapist, you assess the man's knee range of motion (ROM) and strength and decide that function may he prolonged if regular strengthening exercises are done. After telling the patient that and instructing him on how to do his exercises, you watch him do them until you are satisfied that he does them correctly. He misses his 2-week return visit. After a call to his home., he returns to your clinic 4 weeks from the initial visit, His ROM and strength are not appreciably improved, and you correctly infer that he has not adhered to his exercise regimen. When asked directly, your patient mumbles something about being too busy and that the exercises are boring. You reiterate the importance of the exercises for maintaining function, watch him do them, and make a return visit appointment. It is likely that most therapists have had patients like Mr Jones. With a bit of reflection, most therapists would admit to the disappointment and frustration of patients like him who do not follow their advice. Although the patient has to assume responsibility for choosing to improve his condition, it may also be that the therapist did not use all the tools available to influence the patient's choices. In response to patients like Mr Jones, many therapists would try to influence the patient's adherence by giving more information. However, any therapist who reflects on his or her practice is likely to conclude that giving patients more information on the condition, its causes, or the treatment often does not increase treatment adherence. And what about the missed opportunities for prevention? The patient was obese, sedentary, and a smokerthree important cardiovascular risk factors that are modifiable but about which the therapist said nothing to the patient. Because over 875,000 deaths in the United States in 1990 were considered attributable to lifestylerelated behavior,1 the US Preventive Services Task Force recommended universal risk assessment of patients' tobacco and alcohol consumption, seat belt use, diet, stress, safe sex practices, and physical activity and discussion of these health risks with patients when indicated.2 Current recommendations by numerous health-related governmental and medical organizations make increasing patients' activity level nearly a universal prescription.3-10 This paper asserts that physical therapists have advantages over many health care practitioners for providing effective treatment and prevention counseling, especially for voluntary exercise, but that they may not be taking the fullest advantage of those opportunities. There are cognitive behavior theories that offer constructs useful for guiding therapists' efforts to influence patients' behavioral choices. There is a process that therapists can use with any patient that is brief, incorporates those behavioral theory constructs, and can be tailored to the patient. Educating student therapists about these cognitive behavior theories and providing practice and feedback in treatment adherence and prevention education could be included as part of their course work and clinical experiences. THE PATIENT EDUCATION OPPORTUNITY The presentation of a patient with a musculoskeletal problem to a physical therapist offers an opportunity to assess and intervene with the presenting problems and to influence prevention behavior, especially in a voluntary exercise program. …

Breaking the Silence on Emergency Contraception

In the US about 10 million couples risk unplanned pregnancy every night and more than half of the 6.3 million annual pregnancies are unintended. While emergency postcoital contraception is available to reduce this risk most women do not know about it because pharmaceutical companies have failed to apply to the US Food and Drug Administration (FDA) for permission to advertise the oral contraceptive (OC) regimen that can be used in emergencies. If adolescents seek emergency contraception they can be given contraceptive and disease prevention counseling at the same time. Recently significant steps are being taken to inform women about the availability of emergency contraception. The Reproductive Health Technologies Project has launched a year-long nationwide media campaign to educate women about emergency contraception and has created an emergency contraceptive hotline (888-NOT-2-LATE) as well as a web site containing a list of local providers of emergency contraception (http://opt.princeton.edu/ed/). The campaign seeks to educate primary care providers as well as women. Also the FDA has declared several brands of OCs to be safe and effective for use as emergency contraception and has explicitly invited companies to file for the opportunity to market OCs for this purpose. Making emergency contraception widely available is the most important step in preventing unwanted pregnancies.

THE ROLE OF MIDLEVEL PROVIDERS IN CANCER SCREENING

Data indicate that midlevel providers are more likely to provide health promotion and disease prevention counseling, health education, and preventive health and screening services as well as use more community resources. Although the literature is sparse regarding cancer screening activities by midlevel providers, such activities are routinely taught in midlevel educational programs, and midlevel providers see these activities as consistent with their roles. Therefore, it is only logical to assume that use of midlevel providers, who have already been shown to focus on health promotion and disease prevention, would be an effective way to provide quality, cost-effective cancer screening. In fact, models of this sort exist around the United States at the present time, such as the one at Moffitt Cancer Center's Lifetime Cancer Screening Program in Tampa, Florida. In such programs, midlevel providers are successfully conducting comprehensive cancer screening activities. Outcome data from these programs have yet to be published, however. In a collaborative practice environment, the delivery of preventive care, including cancer screening activities, is best accomplished when both the physician and the midlevel provider agree on the importance of these screening activities and work together as a team to integrate these preventive health activities into their office practice. Office systems that are sensitive to patient preferences and that promote preventive care, such as protocols and checklists or health maintenance flowsheets, along with appropriate education tailored to patients' ages and to their social, cultural, and educational backgrounds also help to improve compliance with cancer screening guidelines. More than ever before, health care reform has been the focus of national debate. Most of the health care reform proposals that have been advanced recognize the importance of primary and preventive health care and the role that midlevel providers could and should be playing in such a system. As competent providers, NPs, CNMs, and PAs have the ability to enhance medicine's effectiveness in preventive care, through improved outreach and more thorough screening.

Prevention: Where Do We Draw the Line?

To the editors: The articles by Schwartz and colleagues (1) and Lewis and coworkers (2) reporting survey results regarding internists' practice of disease prevention counseling were interesting and...