Disease Prevention Interventions Research Articles

Gender Specificity of Spousal Concordance in the Development of Chronic Disease among Middle-Aged and Older Chinese Couples: A Prospective Dyadic Analysis.

This study aimed to explore the gender specificity of spousal concordance in the development of chronic diseases among middle-aged and older Chinese couples. Data of 3420 couples were obtained from the China Health and Retirement Longitudinal Study (CHARLS). Multivariate logistic regression was used to analyze the incidence of chronic disease development over 4 years, conditional on the spousal baseline chronic disease status; and stepwise adjusting for the couples’ sociodemographic characteristics (i.e., age, education, retirement status and household income), and their individual lifestyle (i.e., smoking, drinking, exercise, social participation and BMI) all measured at baseline. The incidence of chronic diseases after 4 years of follow-up was 22.95% in the husbands (605/2636) and 24.71% in the wives (623/2521). Taking the couples’ baseline sociodemographic and lifestyle covariates into account, husbands whose wife had chronic diseases at baseline showed an increased risk of developing chronic diseases over 4 years (ORadjusted = 1.24, 95%CI: 1.02, 1.51), but this risk was not statistically-significant for wives (ORadjusted = 0.88, 95%CI: 0.71, 1.08). Our study identified gender specificity of spousal concordance in the development of chronic diseases among middle-aged and older Chinese couples. This finding may contribute to the design of couple-based intervention for disease prevention and management for community-dwelling older adults.

A Single Microbiome Gene Alters Murine Susceptibility to Acute Arsenic Exposure.

Environmental toxicant exposure contributes to morbidity and mortality of many human diseases. With respect to arsenic, microbially driven chemical transformations dictate its toxicity and mobility in virtually every environment yet studied, so a general hypothesis is that the human gut microbiome determines disease outcome following exposure. However, the complex nature of the gut microbiome and the myriad of potential interactions with human cells/tissues make it challenging to quantify the influence of specific arsenic-active functions-a requisite step in developing effective disease prevention and/or clinical intervention strategies. To control both mammalian and microbial function during toxicant exposure, we genetically defined the gut microbiome of mice using only Escherichia coli strain, AW3110 (▵arsRBC), or the same strain carrying a single genome copy of the Fucus vesiculosus metallothionein gene (AW3110::fmt); a cysteine-rich peptide that complexes with arsenite, facilitating bioaccumulation and reducing its toxic effects. AW3110::fmt bioaccumulated significantly more arsenic and gnotobiotic mice colonized by this strain excreted significantly more arsenic in stool and accumulated significantly less arsenic in organs. Moreover, AW3110::fmt gnotobiotic mice were protected from acute toxicity exposure (20 ppm AsIII) relative to controls. This study demonstrates-in a highly controlled fashion-that a single microbiome function (arsenic bioaccumulation) encoded by a single gene in a single human gut microbiome bacterium significantly alters mammalian host arsenic exposure. The experimental model described herein allows for a highly controlled and directed assessment of microbiome functions, and is useful to quantify the influence of specific microbiome-arsenic interactions that help mitigate human disease.

Population-Level Reach of Cardiovascular Disease Prevention Interventions in a Rural Community: Findings from the Heart of New Ulm Project.

This study examines participation by residents of a rural community in programs implemented as part of The Heart of New Ulm (HONU) Project, a population-based cardiovascular disease (CVD) prevention initiative. The study compares participation rates for the various interventions to assess which were the most engaging in the priority community and identifies factors that differentiate participants vs. nonparticipants. Participation data were merged with electronic health record (EHR) data representing the larger community population to enable an analysis of participation in the context of the entire community. HONU individual-level interventions engaged 44% of adult residents in the community. Participation ranked as follows: (1) heart health screenings (37% of adult residents), (2) a year-long community weight loss intervention (12% of adult residents), (3) community health challenges (10% of adult residents), and (4) a phone coaching program for invited high CVD-risk residents (enrolled 6% of adult residents). Interventions that yielded the highest engagement were those that had significant staffing and recruited participants over several months, often with many opportunities to participate or register. Compared to nonparticipants, HONU participants were significantly older and a higher proportion were female, married, overweight or obese, and had high cholesterol. Participants also had a lower prevalence of smoking and diabetes than nonparticipants. Findings indicate community-based CVD prevention initiatives can be successful in engaging a high proportion of adult community members. Partnering with local health care systems can allow for use of EHR data to identify eligible participants and evaluate reach and engagement of the priority population.

Maßnahmen zur Krankheitsprävention bei Schülerinnen und Schülern der Gesundheits- und Krankenpflege: eine kontrollierte sechswöchige Pilotstudie

Interventions for disease prevention among nursing students: A controlled six-week pilot study Objectives: This study was designed to evaluate whether training on disease prevention results in measurable behavioural change among nursing students in terms of number of steps, sport units and portions of fruit/vegetables. Methods: Two classes of nursing students were allocated into an interventional and a control group. Only the interventional group received training on health promotion and disease prevention, but both groups were monitored for 42 days. The main end points were number of steps per day, number of sport units per week and portions of fruit/vegetables per day. Mean values and standard deviations (SD) were calculated and statistically compared between both groups. Results: A total of 46 students were included in the study. The mean age of the participants was 21.3 (SD 5.2) years in the interventional group (n=22) and 19.0 (SD 1.4) years in the control group (n=24). Participants in the interventional group walked more steps per day and completed more sport units per week over the whole study period, with significant differences compared to the control group only during the period from day 29 to day 42 (Steps: 6258 vs. 3654; Δ: 2604.4 [95% CI: 556.8; 4652.1]; p=0.015/Sport units: 3.1 [SD 2.1] vs. 1.6 [SD 1.4]; Δ1.5 [95% CI: 0.2; 2.3]; p=0.03) respectively. There was no significant difference between both groups for portions of fruit/vegetables per day. Conclusion: This pilot study indicates that the cost-effective training of nursing students could result in a change in exercise behaviour. Nevertheless, these are only initial findings and further long-term studies are needed before definitive conclusions can be drawn. Keywords: disease prevention – nursing students – nursing

The Cardiometabolic Health Benefits of Sauna Exposure in Individuals with High-Stress Occupations. A Mechanistic Review.

Components of the metabolic syndrome (i.e., hypertension, insulin resistance, obesity, atherosclerosis) are a leading cause of death in the United States and result in low-grade chronic inflammation, excessive oxidative stress, and the eventual development of cardiometabolic diseases (CMD). High-stress occupations (HSO: firefighters, police, military personnel, first responders, etc.) increase the risk of developing CMD because they expose individuals to chronic and multiple stressors (i.e., sleep deprivation, poor nutrition habits, lack of physical activity, psychological stress). Interestingly, heat exposure and, more specifically, sauna bathing have been shown to improve multiple markers of CMD, potentially acting as hormetic stressors, at the cellular level and in the whole organism. Therefore, sauna bathing might be a practical and alternative intervention for disease prevention for individuals with HSO. The purpose of this review is to detail the mechanisms and pathways involved in the response to both acute and chronic sauna bathing and collectively present sauna bathing as a potential treatment, in addition to current standard of care, for mitigating CMD to both clinicians and individuals serving in HSO.

Prevalence and Predictors of Health-Related Internet and Digital Device Use in a Sample of South Asian Adults in Edmonton, Alberta, Canada: Results From a 2014 Community-Based Survey.

BackgroundSouth Asian Canadians are at high risk of developing cardiovascular disease and diabetes. Consumer-oriented health information technology may help mitigate lifestyle risk factors and improve chronic disease self-management.ObjectiveThis study aims to explore the prevalence, patterns, and predictors of the use of the internet, digital devices, and apps for health purposes as well as preferences for future use of eHealth support in South Asian Canadians.MethodsWe conducted a cross-sectional, mixed-mode survey in a convenience sample of 831 South Asian adults recruited at faith-based gathering places, health care settings, and community events in Edmonton, Alberta, in 2014. The 706 responders (mean age 47.1, SD 17.6 years; n=356, 50.4% female; n=509, 72.1% Sikh) who provided complete sociodemographic information were included in the analysis, and the denominators varied based on the completeness of responses to each question. Multivariate logistic regression was used to determine sociodemographic and health status predictors of internet use, being a web-based health information seeker, smartphone or tablet ownership, health app use, and willingness to use various modes of eHealth support.ResultsOf all respondents, 74.6% (527/706) were internet users and 47.8% (336/703) were web-based health information seekers. In addition, 74.9% (527/704) of respondents owned a smartphone or tablet and 30.7% (159/518) of these had a health and fitness app. Most internet users (441/527, 83.7%) expressed interest in using ≥1 mode of eHealth support. Older age, being female, having less than high school education, preferring written health information in languages other than English, and lacking confidence in completing medical forms predicted lack of internet use. Among internet users, factors that predicted web-based health information seeking were being female, use of the internet several times per day, being confident in completing medical forms, and preferring health information in English. Predictors of not owning a smartphone or tablet were being older, preferring health information in languages other than English, having less than high school education, living in Canada for <5 years, having a chronic health condition, and having diabetes. Increasing age was associated with lower odds of having a health app. Preferring health information in languages other than English consistently predicted lower interest in all modes of eHealth support.ConclusionseHealth-based chronic disease prevention and management interventions are feasible for South Asian adults, but digital divides exist according to language preference, education, age, sex, confidence in completing medical forms, and number of years lived in Canada. Community-based, culturally tailored strategies targeting these factors are required to address existing divides and increase the uptake of credible web-based and app-based resources for health purposes.

Progress in research of allergen detection methods

Allergic diseases have continued to increase year by year causing serious physical and mental injury to patients, families and individuals. This increase has been driven by conventional environmental and nutritional changes but is also created by the continual introduction of food additives into the diet and novel interior decoration materials into the living space. The causes of allergic diseases are complex and diverse, and the medical laboratory often is not be able to identify the allergic trigger; this creates a difficult environment to identify the appropriate clinical treatment for disease prevention and control. Physicians must be able to identify these triggers to help patients avoid the underlying allergenic cause of their disease. This can only be done by actively knowing a patient's medical history, identifying the clinical manifestations of hypersensitivity and utilizing confirmatory testing as an important clinical tool in identifying the allergic source.

Communication of Public Health Policy and Guidelines to Physicians and Clinic Staff During a Pandemic

Background Communication overload is a substantial trial during a pandemic. One major obstacle is the overwhelming amount of changing public health guidelines and clinic policies. Strategies for effective communication are vital for disease prevention treatment and control during a pandemic. Objective The purpose of this quality improvement initiative was to evaluate different communication methods regarding frequently changing guidelines and recommendations between organizational leadership and multidisciplinary clinical teams. Methods During the 2020 COVID-19 pandemic, we performed a longitudinal exploratory analysis focusing on different processes for communication. This quality improvement initiative was conducted from March 2020 to April 2020. A total of 52 primary care physicians and 24 staff members (nurses, medical assistants, case managers) in two separate family medicine residency clinics located in Utah were included. A daily, standardized COVID update Short Message Service (SMS) system was implemented in addition to the regular email updates. Data collection included a pre and post-intervention survey distributed to clinicians and staff. Results In post-intervention analysis, clinicians and staff respondents reported an increase in communication effectiveness and satisfaction of 66.5% and 71.3%, respectively (P&lt;.001). Additionally, clinicians and staff respondents reported an increase in feeling safe in the workplace of 49.3% (P&lt;.001). During the intervention period, clinicians and staff members reported a 71.4% and 70.0% decrease, respectively, in experiencing an error or adverse event within the 4-week period compared to the pre-intervention period. This study was conducted at the Regional Medical Center, a community hospital in Anniston, AL. We examined the outcomes of healthcare workers that were in contact with two patients that were asymptomatic during their stay, but were subsequently found to be positive upon discharge. The results of this study provide a better understanding of the risks of SARS-CoV-2 spread in asymptomatic patients with a focus on transmission to healthcare workers. Conclusions Implementing a regular SMS messaging communication system during a pandemic may improve communication efficacy, satisfaction, and safety while decreasing unintended errors.

A culturally and gender responsive stress and chronic disease prevention intervention for low/no-income African American men: The MOCHA moving forward randomized control trial protocol

Low/no-income, African American men are disproportionally burdened by chronic disease resulting from a complex interplay of systemic, sociocultural, and individual factors. These disparities are related to poverty, racism, gender role strain, high levels of stress, low levels of physical activity, and malnutritious diet. Men of Color Health Awareness (MOCHA) is a community-driven movement to address the physical, mental, social, and spiritual needs of men of color. As part of ongoing programming, the MOCHA Standard intervention consists of a 10-week program including: (1) small group discussions of issues particularly relevant to men of color, (2) classes on health topics focusing on chronic disease control, such as nutrition, obesity, high blood pressure, fitness, and the social determinants of health; and (3) 60-min of moderately intensive aerobic exercise twice a week. While the MOCHA Standard intervention has yielded positive results, feedback from previous participants warranted an in-depth sociocultural tailoring of the curriculum to improve community receptiveness, in particular, revising the sessions to “narrativize” the materials to strengthen their potential effectiveness. This manuscript describes the novel recruitment strategies; the development of an enhanced MOCHA+ Stories Matter program that uses narrative communication strategies; and the methodology used to assess the comparative effectiveness of the MOCHA Standard relative to MOCHA+ Stories Matter program in lowering stress and risk of chronic diseases in a randomized controlled trial. The results of this research will contribute to the identification of effective interventions to address health disparities in low-income African-American men and the dissemination of effective chronic disease prevention programming.

High prevalence of undiagnosed hypertension among men in North Central Nigeria: Results from the Healthy Beginning Initiative.

BackgroundThe prevalence of hypertension in Nigeria is high and growing. The burden and risk factor distribution also vary by geographical zone. Information about prevalence, risk factors and disease status awareness are needed to guide evidence based public health response at the national and sub- national levels.PurposeThis paper describes the prevalence of hypertension and its correlates, as well as hypertension status awareness among men in North Central, Nigeria.MethodsA cross sectional survey was administered to male partners of pregnant women participating in the Healthy Beginning Initiative program from 2016–2018. Information on socio-demographic characteristics, risk factors, physical measurement and blood pressure readings were collected using a standardized protocol. Data was analyzed with simple and multiple logistic regression.ResultsThe 6,538 men had a median age of 31 years [IQR: 26–37]. The prevalence of hypertension was 23.3% (95% CI: 22.3%-24.4%), while 46.7% had prehypertension. The odds of hypertension was associated with increasing age (OR:1.02, CI:1.01–1.03), being overweight (aOR:1.5,CI:1.3–1.8), being obese (aOR:2.6,CI:2.0–3.3), living in an urban area (aOR:1.6,CI:1.2–2.1), and alcohol use in the 30 days prior (aOR:1.2,CI:1.1–1.4). Overall, 4.5% (297/6,528) of participants had ever been told they have hypertension. Among the 23.3% (1,527/6,528) with hypertension, 7.1% (109/1,527) were aware of their disease status. Men aged 41–50 years (aOR: 1.8, CI: 1.0–3.3), and > 50 years (aOR: 2.2, CI: 1.1–4.3), had higher odds disease status awareness. Living in an urban area was associated with lower odds (aOR: 0.2, CI: 0.03–0.7) of hypertension status awareness.ConclusionThis study showed that hypertension is already a significant public health burden in this population and that disease awareness level is very low. Alcohol use and obesity were associated with hypertension, highlighting some modifiable cardiovascular disease risk factors that are prevalent in the study population. Taken together, these findings can inform the design of interventions for primary and secondary cardiovascular disease prevention in Nigeria and similar settings.

Synbiotic and antioxidant activity of fruit by-products and their effect on human health

Food supplements are extensively used as a natural remedy to improve human health condition. Considerable progress has been reported recently by several studies to analyse the bioactive substances and their functional activities of fruit by-product. The food industry generates a vast amount of wastes during manufacturing or processing, which are mainly skins, kernels, and seeds. These by-products contain valuable bioactive compounds such as antioxidants, vitamins, minerals, and indigestible food ingredients called prebiotics. Peels from fruits like yellow rambutan, green kiwi, mango, and papaya exhibit a strong anti-proliferative, anti-cardiovascular, anti-oxidant, and hepatoprotective effects due to the presence of bioactive compounds namely flavonoid, B-type catechin dimer, and penta-O-galloyl-glucoside. This review will illustrate a new concept of functional foods by providing information on alternative sources of bioactive compounds from food by-product and their efficacy in human nutrition. This study will also recapitulate the presence of bioactive components in fruit by-product, their way of action, constitution, health benefits, and probable therapeutic action in the treatment of disease prevention.

9.G. Workshop: Evaluation of scale-up of health systems interventions: what and how? Lessons for scale-up projects

Abstract Objectives Non-communicable diseases (NCD) are a major challenge for health systems across the globe. Although effective interventions for prevention, detection and control exist, these do not reach all people in need, especially the poor and most vulnerable. Scale-up strategies are developed to increase universal access to those interventions, addressing demand-side and supply-side barriers and to facilitate integration in the health system. While there are useful frameworks to conceptualise and operationalise scale-up of NCD interventions, there is a knowledge gap on what and how to evaluate. This session addresses that knowledge gap, presenting evaluation methods for scale-up from four large multi-country research projects. The objectives are: To increase knowledge on four dimensions of scale-up evaluation: 1) contextualisation of methods; 2) implementation evaluation; 3) cost-evaluation and 4) use of health information systemsTo present methods and results of implementation research on NCDs as an example for other chronic diseasesTo illustrate how contextualisation, implementation and evaluation varies across different stages of scale-upTo stimulate learning by experience through small-group discussion with session participants This workshop provides added value through the four coherent presentations combined with small group interactions on the same topics. It allows the audience to link the case study lessons to their own research and wider application. Format Four different elements of scale-up evaluation are addressed: 1) Contextualisation of evaluation methods from a common framework; 2) Implementation evaluation at operational level; 3) Cost-evaluation of NCD interventions; and 4) Large-scale evaluation through routine health information systems (HIS). Case studies from four large-scale Horizon2020 funded research projects in 14 countries in Europe, Africa and Asia will be presented, each case focusing on one dimension. Cross-cutting themes of adaptation and transferability of methods will also be addressed. After the presentations, there will be an interactive session to promote experience-based learning in small-group discussions. Presentations Self-Management Approach and Reciprocal Learning for Type 2 Diabetes (SMART2D)Scaling-up Packages of Interventions for cardiovascular disease prevention in Europe and Sub-Saharan Africa (SPICES)Scaling-Up NCD Interventions in South-East Asia (SUNI-SEA)The Scale-Up of Diabetes and Hypertension Care (SCUBY) The presentations will provide the introduction to subsequent small-table discussions, around the following questions: How to measure and monitor implementation and outcome of intervention scale-up?How to generate transferrable lessons from cross-country studies?How to conduct cross-setting evaluation of the effect and cost of NCD interventions? Key messages The global scale-up of NCD interventions calls for robust evaluation methods of effect, implementation and cost. Evaluation methods need to be fit to the country context and health information systems.

Scaling-up Packages of Interventions for cardiovascular disease prevention in Europe and Sub-Saharan Africa (SPICES) - implementation evaluation at operational level

Abstract SPICES focuses on the primary prevention of CVDs in vulnerable populations in Europe and Sub-Saharan Africa by raising awareness regarding CVD and its risk factors and by supporting lifestyle behaviour change in primary care and community settings. It is an implementation project employing a mixed methods evaluation approach. The RE-AIM QuEST and CFIR frameworks are used to guide the evaluation of impact on lifestyle and actual CVD risk and describe implementation barriers and explain how implementation context may influence translation to different settings. The presentation will focus on how these frameworks were used in practice and across settings.

Primary Care Prognostic (PCP) Index of 11-Year Mortality Risk: Development and Validation of a Brief Prognostic Tool.

Healthcare providers use a life expectancy of at least 5 to 10 years in shared clinical decision-making with older adults about cancer screening, major surgeries, and disease prevention interventions. At present, few prognostic indexes predict long-term mortality beyond 10 years or are suited for use in primary care settings. We developed and validated an 8-item multidimensional index predicting 11-year mortality for use in primary care. Using data from the Singapore Longitudinal Ageing Studies (SLAS), we developed a Primary Care Prognostic (PCP) Index for predicting 11-year mortality risk in a development cohort (n = 1550) and validated it in a geographically different cohort (n = 928). The PCP Index was derived from eight indicators (body mass loss, weakness, slow gait, comorbidity, polypharmacy, IADL/BADL dependency, low albumin, low total cholesterol, out of 25 candidate indicators) using stepwise Cox proportional hazard models. In the developmental cohort, the mortality hazard ratio increased by 53% per PCP point score increase, independent of age and sex. Across risk categories, absolute risks of mortality increased from 5% (score 0) to 67.9% (scores 7-9), with area under curve (AUC = 0.77 (95% CI 0.73-0.80)). The PCP Index also predicted mortality in the validation cohort, with AUC = 0.70 (95% CI 0.64-0.75). The PCP Index using simple clinical assessments and point scoring is a potentially useful prognostic tool for predicting long-term mortality and is well suited for risk stratification and shared clinical decision-making with older adults in primary care.

Developing co-funded multi-sectoral partnerships for chronic disease prevention: a qualitative inquiry into federal governmental public health staff experience

BackgroundMulti-sectoral partnerships (MSPs) are frequently cited as a means by which governments can improve population health while leveraging the resources and expertise of the private and non-profit sectors. As part of their efforts in this area, the Public Health Agency of Canada (the Agency) introduced a novel funding programme requiring applicants to procure matched resources from private sources to support large-scale interventions for chronic disease prevention. The current literature on MSPs is limited in its applicability to this model of multi-sectoral engagement. The purpose of this study was to explore the experiences of Agency staff working with potential partners to develop programme applications, such that we might identify lessons from adopting this type of partnership approach.MethodsSemi-structured interviews were conducted with the 12 staff working in the MSP programme. Interviews were recorded, transcribed and analysed using thematic analysis. Preliminary themes were used to inform follow up focus-groups sessions. A second round of analysis was conducted guided by a coding paradigm focused on understanding process.ResultsWe identified “experiencing uncertainty” to be a central concept in participants’ accounts of the MSP process, related specifically to the MSP programme’s novel conditions, shifts that occurred in sectoral roles and demands for new capacities. In response, Agency staff employed strategies to clarify partner interests, build trust in inter-sectoral relationships, and support internal and partner capacity. Outcomes associated with this process include impacts on trust between the Agency and potential partners, a deeper understanding of other sectors, and programme adaptations and refinements to address challenges related to the programme model.ConclusionsThe co-funding model employed by the Agency is a potentially popular one for government bodies wanting to leverage funding from private sector sources. Our study identifies the potential challenges that can occur under this model. Some challenges are related to addressing material conditions related to partner capacity, whereas other challenges speak to deeper and more difficult to address concerns regarding trust and alignment of motivations and interests between partners. Future research exploring the challenges associated with specific models of MSP engagement is necessary to inform approaches to addressing complex problems through collaborative efforts.

Spatial association between sporotrichosis in cats and in human during a Brazilian epidemics

Sporotrichosis is a subcutaneous granulomatous disease caused by the fungus Sporothrix spp. In Brazil, S. brasiliensis is reported in regions of outbreaks and epidemics in the zoonotic form of the disease where cats play an important role in the transmission of the disease to humans. Therefore, it is important to assess how the presence of infected cats impacts the risk for sporotrichosis in humans. The objective of this study was to analyze the spatial association of sporotrichosis in cats and in humans from Belo Horizonte, a Brazilian city where an epidemics of sporotrichosis occurs since the first human case register in 2015, through an inhomogeneous Poisson process model. Feline and human cases of sporotrichosis recorded between January 2016 and June 2019 were georeferenced by address and spatial point patterns were generated. Feline case intensity and human demographic density were calculated using a kernel smoothed estimate. The distance to the nearest feline case was also compute. Model parameters were estimated by Maximum Likelihood Estimate. The model validation was performed by the evaluation of partial residual, leverage and influence measure. There were 343 cases of cats and 135 human cases of sporotrichosis. The average incidence of human sporotrichosis in the period was 1.343 per 100 thousand inhabitants, which is relatively low in relation to the population, but higher than that observed in other regions in zoonotic outbreak of the disease. The southern region of the municipality has a higher intensity of feline cases. According to the fitted model, the risk for human sporotrichosis is greater when at distances very close to a feline case, with a virtually stable effect for distances greater than 1 km. Regarding the intensity of feline cases there is a gradual increase in risk as the intensity of cases increases. From the leverage analysis it was observed that the model was particularly sensitive to the occurrence of human cases in the south and east regions, places with extreme values ​​of covariates. Poisson point process model seems to be a reasonable approach in spatial epidemiology when multiple sources of infection are involved, and there is a low incidence of the disease as long as it is reasonable to assume independence between cases. Interventions for disease prevention and control in humans are suggested to encompass disease control in cats and the search for feline cases, focused on diagnosis and control, close to reported human cases.

Be Healthe for Your Heart: A Pilot Randomized Controlled Trial Evaluating a Web-Based Behavioral Intervention to Improve the Cardiovascular Health of Women with a History of Preeclampsia.

This pilot randomized controlled trial (RCT) aimed to determine the acceptability and preliminary efficacy of a web-based cardiovascular disease (CVD) prevention intervention for women following preeclampsia. Australian women with a recent history (≤4 years post diagnosis) of preeclampsia were randomized into two study arms: (1) Be Healthe for your Heart, a web-based behavioral intervention or; (2) Control, access to the National Heart Foundation website. Assessments were conducted at baseline, and after three months. Intervention acceptability and impact on absolute CVD 30-year risk score, CVD risk markers and health behaviors were assessed. Twenty-four of 31 (77.4%) women completed the three-month assessment. Eleven out of 13 intervention participants (84.6%) agreed/strongly agreed they were satisfied with the program, with a mean score of 4.2 ± 0.9 (maximum of five). There were no significant between or within group differences in absolute CVD risk, CVD risk markers or health behaviors from baseline to three months. Women with a history of preeclampsia were successfully recruited and retained and they reported high levels of acceptability with the Be Healthe for your Heart program. Further research is therefore needed from powered trials to determine the impact of web-based lifestyle interventions on CVD risk in this at-risk group.

Health Promotion and Disease Prevention Interventions for the Elderly: A Scoping Review from 2015–2019

In this study, a scoping review method is used to review the distribution and trends in health promotion research and explore the use and contribution of eHealth technologies in health promotion in the elderly. The study includes six search databases: PubMed, CINAHL, the CochraneLibrary, EMBASE, PubPsych, and ERIC (EBSCOhost), and studies published from January 2015 to October 2019, written in English, were included and analyzed. The findings of the study reveal that the amount of literature on promoting health for the elderly has increased, and some specific types of interventions are still favored in current health promotion efforts for older adults. The most commonly used methods were found to be health promotion (n = 322), followed by screening (n = 264), primary prevention (n = 114), and finally social support (n = 72). Beyond the above interventions, eHealth technology is also used in health promotion activities to prevent the elderly from falling and to improve home safety, etc. However, although the application of eHealth technology has been applied in areas such as fall prevention, mental health promotion, and home security monitoring, it is still immature, and thus more rigorous research is needed in different areas, especially in older populations, various professions, women, and people with dementia.

General practitioners\u2019 perceptions of their practice of evidence-based chronic disease prevention interventions: a quantitative study in Shanghai, China

BackgroundEpidemic chronic diseases pose significant challenges to the improvement of healthcare in China and worldwide. Despite increasing international calls for the inclusion of evidence-based decision-making (EBDM) processes in chronic disease prevention and control programming as well as policymaking, there is relatively little research that assesses the current capacity of physicians and the factors that influence that capacity in China.MethodThis cross-sectional study was conducted in community health centres (CHCs) in Shanghai, China, using multistage cluster sampling. An evidence-based chronic disease prevention (EBCDP) evaluation tool was employed to assess physician EBCDP awareness, adoption, implementation and maintenance based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and using a 7-point Likert scale. Linear regression analysis was used to assess associations between each EBCDP aspect and overall EBCDP status with participant characteristics or organizational factors.ResultA total of 892 physicians from CHCs in Shanghai, China, were assessed. The physicians perceived their awareness (mean = 4.90, SD = 1.02) and maintenance (mean = 4.71, SD = 1.07) of EBCDP to be relatively low. Physicians with relatively lower job titles and monthly incomes (> 9000 RMB) tended to have relatively higher scores for the awareness, adoption, and implementation of EBCDP (P < 0.05). Those who had participated in one program for chronic disease prevention and control were less likely to adopt (b = − 0.284, P = 0.007), implement (b = − 0.292, P = 0.004), and maintain (b = − 0.225, P = 0.025) EBCDP than those who had participated in more programs. Physicians in general practice (Western medicine) had a lower level of awareness of EBCDP than those in other departments (P < 0.0001). Physician from CHCs located in suburban areas had lower scores for awareness (b = − 0.150, P = 0.047), implementation (b = − 0.171, P = 0.029), and maintenance (b = − 0.237, P = 0.002) that those from urban CHCs. Physicians in CHCs affiliated with universities had higher scores on all four EBCDP aspects that those in CHCs not affiliated with a university.ConclusionsThis study provides quantitative evidence illustrating EBCDP practices among physicians in CHCs with various personal and organizational characteristics, respectively. More methods should be provided to increase the awareness of such physicians regarding EBCDP to stimulate the use of EBCDP for their patients and in connection with other public health priorities.

A case study of using the He Pikinga Waiora Implementation Framework: challenges and successes in implementing a twelve-week lifestyle intervention to reduce weight in M\u0101ori men at risk of diabetes, cardiovascular disease and obesity

BackgroundMāori men have stark health inequities around non-communicable diseases. This study describes the case of a partnership attempting to develop and implement a culturally centred intervention through a collaborative partnership to potentially address the inequities. In particular, the partnership followed a participatory, co-design approach using the He Pikinga Waiora (HPW) Implementation Framework; the study presents lessons learnt in addressing health inequities following this framework.MethodsThe partnership involved a university research team and a Māori community health provider. They engaged with other stakeholders and several cohorts of Māori men through a co-design process to adapt a 12-week lifestyle intervention. The co-design process was documented through meeting notes and interviews with partners. Two cohorts participated in separate single group pre-intervention/post-intervention designs with multi-method data collection. Key outcome measures included weight loss, self-reported health, physical activity, and nutrition. Post-intervention data collection included qualitative data.ResultsThe co-design process resulted in a strong and engaged partnership between the university team and the provider. There were significant challenges in implementing the intervention including having two additional partner organisations dropping out of the partnership just after the initial implementation phase. However, a flexible and adaptable partnership resulted in developing two distinct lifestyle interventions run with 32 Māori men (in two different cohorts of 8 and 24). All but one in the first cohort completed the programme. The first cohort had a modest although statistically insignificant improvement in weight loss (d = 1.04) and body mass index (BMI; d = 1.08). The second cohort had a significant reduction in weight loss (d = 1.16) and BMI (d = 1.15). They also had a significant increase in health-related quality of life (d = 1.7) and self-rated health (d = 2.0).ConclusionThe HPW Framework appears to be well suited to advance implementation science for Indigenous communities in general and Māori in particular. The framework has promise as a policy and planning tool to evaluate and design interventions for chronic disease prevention in Indigenous communities. Despite this promise, there are structural challenges in developing and implementing interventions to address health inequities.Trial registrationRetrospectively registered, Australia New Zealand Clinical Trials Registry, ACTRN12619001783112.