Personal Health Behaviors Research Articles

Burnout as a multidimensional phenomenon: How can workplaces be healthy environments?

Abstract Purpose Burnout was already a significant problem before the pandemics, but in the aftermath became a serious concern and a public health and occupational health priority. This study had two aims. First, it investigated how different healthy workplace dimensions and other health individual-level variables are related to burnout. Second, it examined differences in terms of presentism, absenteeism, quality of life between employees who report burnout symptoms and those who do not. Methods Participants were 1702 Portuguese employees from various organizations. 69.68% were female, age ranged from 18 to 72 years (M = 43.25 years, SD = 10.40). Almost half of the participants (49.9%; 851 participants) reported having at least one burnout symptom. Results Participants reported that they have felt exhausted (43.7%), irritated (34.5%) and sad (30.5%) always or very often in the last 4 weeks. Regression analysis revealed that the global score on burnout symptoms was negatively related to leadership engagement, psychosocial work environment, personal health resources, health behaviours, and satisfaction with salary. In addition, the global score on burnout symptoms was positively related to worker involvement, enterprise community involvement, perceived stress, and screen time at work. Furthermore, females tend to report a higher level of burnout symptoms compared to males. In addition, burnout has an impact on sickness absenteeism, presentism, and quality of life. Conclusions Our findings have an important contribution to understanding and promoting a healthier work environment and reinforce the need for measures and policies to promote mental health, manage stress, and prevent burnout in the workplace. Key messages • What best explains the burnout symptoms is the workers’ perceived stress, followed by psychosocial risk factors at work. • There is a positive relationship between perceived stress and burnout: effective work stress management is one of the protective factors that prevents burnout.

Association between cannabis use and physical activity in the United States based on legalization and health status

BackgroundStudies investigating the association between cannabis use and physical activity have had mixed results. This study provided a population-based assessment while determining how the relationship is affected by variables such as cannabis legalization status and chronic medical conditions.MethodsBehavior Risk Factor Surveillance System (BRFSS) data were used to evaluate the association between cannabis use and physical activity among adults ages 18 years and older in several states and territories of the U.S. during 2016–2022. Adjusted odds ratios (ORs) measuring the relationship between physical activity in the past 30 days (yes vs. no) and cannabis use in the past 30 days (yes vs. no) based on legalization and health status were estimated using logistic regression.ResultsPhysical activity increased from 73.16% in 2016 to 75.72% in 2022 (3.5% increase) and current cannabis use increased from 7.48% in 2016 to 14.71% in 2022 (96.7% increase). Current cannabis use was 6.5% higher in areas of legalized recreational cannabis (vs. not legal) and 0.7% higher in areas of legalized medical cannabis (vs. not legal). For the combined years, the OR measuring the association between cannabis use and physical activity was 1.24 (95% CI 1.10–1.41), after adjusting for age, sex, race/ethnicity, marital status, employment status, education, smoking status, weight classification, legal status, and chronic medical condition. The adjusted OR was 1.47 (95% CI 1.34–1.62) in areas with legalized recreational and medical cannabis (vs. illegal) and 1.05 (95% CI 0.98–1.12) in areas with legalized medical cannabis only (vs. illegal). Having a medical condition was significantly associated with lower prevalence of physical activity in the adjusted models (overall adjusted OR = 0.79, 95% CI 0.73–0.85). However, this significantly lower odds ratio was insignificant for current cannabis users.ConclusionsPublic policy and personal health behaviors may improve with the findings that legal medical cannabis promotes greater physical activity in those experiencing chronic medical conditions and legal recreational cannabis promotes (even more so) greater physical activity in those not experiencing chronic medical conditions.

Comparative Evaluation of Severity of Periodontitis in Patients with and without Dyssomnias

Introduction: Sleep disorders can affect on different organs and increase the risk of cardiovascular disease, diabetes, depression, immunity disorders and decrease the bone density. Periodontitis includes inflammation of periodontium because of increased or decreased response of the host immunity to predisposing factors (it can be in presence of systemic diseases). The aim of this study was to evaluate the relationship between sleep disorders and periodontal diseases. Methods: In this analytic-cross sectional study, 60 individuals clinically healthy that referring to Department of Periodontology of Isfahan Dental School at year 2018-19 categorized into 2 groups: with or without dyssomnias (with PSQI questionnaire). In this study, Sillness and Loe plaque index, Loe and Sillness gingival index and calculus index were investigated. Similarly assessed demographic factors, personal health behaviors and relation between the severity of periodontitis and dyssomnia and were assessed. Data analyzed by SPSS statistics 16 software using independent T-test, Mann-Whitney, Pearson and multinominal regression. Results: Severity of periodontitis had a significant relationship with age, BMI (Body Mass Index), calculus index, frequency of flossing and brushing as well as score of PSQI questionnaire (p<0.5). By controlling age, gender, mass and plaque index, there was a significant relationship between dyssomnias and severity of periodontal disease in the patients with moderate periodontitis (P>0.001) and severe periodontitis (P=0.006), but in the case of mild periodontitis, the relationship was close to the significant level (p=0.087). Conclusion: It seems that dyssomnias is in relation to severity of periodontitis; therefore sleep hygiene may help controlling periodontal diseases. However more studies are needed in this field.

“It’s what we perceive as different”: an interpretative phenomenological analysis of Nigerian women’s characterization of their health during the COVID-19 pandemic

BackgroundHealth has historically been adversely affected by social, economic, and political pandemics. In parallel with the spread of diseases, so do the risks of comorbidity and death associated with their consequences. As a result of the current pandemic, shifting resources and services in resource-poor settings without adequate preparation has intensified negative consequences, which global service interruptions have exacerbated. Pregnant women are especially vulnerable during infectious disease outbreaks, and the current pandemic has significantly impacted them.MethodsThis study used an interpretive phenomenological analysis study with a feminist lens to investigate how women obtained healthcare in Ebonyi, Ogun, and Sokoto states Nigeria during the COVID-19 pandemic. We specifically investigated whether the epidemic influenced women’s decisions to seek or avoid healthcare and whether their experiences differed from those outside of it.ResultsWe identified three superordinate themes: (1) the adoption of new personal health behaviour in response to the pandemic; (2) the pandemic as a temporal equalizer for marginalized individuals; (3) the impacts of the COVID-19 pandemic on maternal health care. In Nigeria, pregnant women were affected in a variety of ways by the COVID-19 epidemic. Women, particularly those socially identified as disabled, had to cross norms of disadvantage and discrimination to seek healthcare because of the pandemic’s impact on prescribed healthcare practices, the healthcare system, and the everyday landscapes defined by norms of disadvantage and discrimination.ConclusionIt is clear from the current pandemic that stakeholders must begin to strategize and develop plans to limit the effects of future pandemics on maternal healthcare, particularly for low-income women.

Heart health champions: how to develop student nurses as role models for cardiovascular health

Abstract Background Nurses as health promotors are optimally placed to identify cardiovascular disease risk factors and discuss behaviour change strategies for modifiable risk factors, but most undergraduate curriculums lack detailed content regarding these topics. Unfortunately evidence indicates that student nurses often demonstrate risky behaviours such as smoking, physical inactivity, excessive alcohol consumption and poor nutritional choices. As nursing is a pressurised career with long shifts and often challenging emotional encounters, it can be easy to overlook personal health behaviours. Purpose Given that nursing students are our potential health promotors of the future, we aimed to enhance cardiovascular knowledge and behaviour change awareness in their undergraduate education by implementing a co-designed digital educational resource - ASMOSUS. It sought to embed knowledge and risk assessment of cardiovascular disease risk factors, while motivating and sustaining behaviour change within undergraduates, facilitating them to make healthier lifestyle choices themselves and act as role models for patients. We developed roles of ‘Heart Health Champions’ within university and clinical placements, which is novel for both clinical practice and Higher Education Institutes. Methods Any nursing student who had received the ASMOSUS digital educational resource in the first semester of their undergraduate program and had an interest in further knowledge acquisition and health promotion amongst their peers were invited to become a Heart Health Champion. Alongside the recruitment of Heart Health Champions the cohort received cardiovascular risk factor specific educational sessions on physical exercise, smoking and vaping cessation, nutrition and alcohol consumption. Results We recruited 9 Heart Health Champions from the cohort representing all fields of undergraduate nursing. These students have undertaken 30 hours of required participation, leading to a university recognised qualification- FutureReady on graduation. This included attending cardiac risk and prevention training with cardiac rehabilitation nurses. They have taken the initiative to plan activities such as a sponsored walk, a ‘dancercise' class and support for their peers in harnessing healthy lifestyle behaviours through role modelling and motivational interviewing techniques. Results demonstrate that these sessions and student led activities are well attended and positively evaluated, which shows that including cardiovascular prevention techniques in undergraduates is feasible and acceptable. Conclusion Heart Health Champions are a valuable asset and can promote modifiable risk factor change amongst their peers and may help to maintain a healthy lifestyle. Further Heart Health Champions will be recruited over the next undergraduate nursing cohorts with a planned study to explore their effectiveness.

Evaluating Oral Hygiene and Caries Prevalence among Deaf and Hard of Hearing Orphans at Karya Murni Orphanage in Medan

Access to equal oral health attention is the right of all human beings, including orphan children with hearing loss or deaf and hard of hearing (DHH) conditions. Therefore, this study aimed to determine the correlation between the level of oral hygiene and caries indexing among the sub-population of DHH orphans receiving special care at Karya Murni orphanage in Medan City. A cross-sectional design was used with non-probability sampling to select 58 orphans willing to engage in the Oral Hygiene Index-Simplified (OHI-S) and mean of Decayed, Missing, and Filled Permanent Teeth (DMFT) assessment during dental and oral cavity screening after participating in counseling activities. Furthermore, the results showed a positive correlation (p=0.007) between oral hygiene and caries, suggesting that OHI-S impacted DMFT by approximately 34.9%, with both index scores presenting proportional equivalence. There is a need to conduct regular dental health monitoring along with education on visual methods and sign language among DHH orphans. Additionally, DHH orphan caregivers should actively engage in enhancing personal health behaviors, particularly to maintain oral and dental health.

Poor Health Behaviour in Medical Students at a South African University: A Cross-Sectional Survey Study.

Personal health behaviours and lifestyle habits of health professionals influence their counselling practices related to non-communicable diseases (NCDs). There are limited data on the prevalence of unhealthy lifestyle habits among medical students and the impact of acquired health knowledge throughout the curriculum. The aim of this study was to determine and compare the prevalence of modifiable behavioural NCD risk factors of medical students in different academic years at a South African tertiary institution. A cross-sectional observational study of 532 consenting medical students was conducted. Participants completed five online questionnaires regarding lifestyle behaviours (physical activity, dietary habits, smoking, alcohol consumption and sleep). Lifestyle-related risk factors with the highest prevalence were poor sleep quality (66.0%), low levels of habitual physical activity (55.8%) and low-to-moderate diet quality (54.5%). There were no differences between academic years for all risk factors measured. Over 60% of the cohort had two or more NCD risk factors and this prevalence did not differ across the degree program with the acquisition of more health knowledge. Medical students have a high prevalence of poor sleep quality, low levels of physical activity and low-to-moderate diet quality, which does not appear to change over the course of their academic career. Sleep hygiene, regular physical activity and healthy nutrition should be targeted in intervention programmes and be more prevalent in the medical curriculum.

Effectiveness of BNT162b2 Vaccine Against Symptomatic SARS-CoV-2 Infection in Children Aged 5-11 Years in Japan During Omicron Variant Predominate Periods.

Although the effectiveness of BNT162b2 messenger RNA vaccines against the Omicron variant has been reported in several countries, data are limited in children living in Asian countries. Therefore, this study aimed to estimate the effectiveness of the pediatric primary two-dose monovalent mRNA vaccine series in preventing symptomatic novel coronavirus disease 2019 (COVID-19) in Japan. We conducted a test-negative case-control study (262 test-positive cases and 259 test-negative controls) in patients aged 5-11 years who presented with COVID-19-like symptoms during the Omicron BA.2- and BA.5-predominant periods. Vaccination status, demographic data, underlying medical conditions, lifestyle, personal protective health behaviors, living environment, and PCR test results were obtained using parent-administered questionnaires and clinical records. Vaccine effectiveness (VE) against symptomatic COVID-19 was calculated using a multivariate logistic regression analysis. Of the test-positive cases and test-negative controls, 9.2% (n = 24) and 12.7% (n = 33) received two vaccine doses, respectively. Having siblings and a BA.5-dominant period were significantly associated with symptomatic COVID-19. After adjusting for age, siblings, study period, and duration after the last vaccination, the overall VE of two-dose vaccination was 50.0% (95% confidence interval [CI], 5-74%). VE was 72% (95% CI, 24-89%) within 3 months after the two-dose vaccination, while it decreased to 24% (95% CI, -80% to 68%) after 3 months. Two BNT162b messenger RNA vaccine doses provided moderate protection against symptomatic COVID-19 during the Omicron variant period. A time-dependent decrease in VE was noted after the second dose; thus, a booster dose 3 months after the second dose is warranted.

Association between US Residents’ Health Behavior and Good Health Status at the City Level

ABSTRACT Introduction Poor health behaviors, such as physical inactivity, exacerbate the overall health status of residents. Evidence regarding the impact of personal health behaviors on health status at the city level is lacking. Thus, we aimed to examine the association between health behaviors and good health status of residents of large US cities. Methods Our panel study used 2018 to 2022 American Fitness Index® data measured annually for the 100 most populous US cities. The study outcome was good health status of city residents, and exposures were their health behaviors—exercising, meeting aerobic activity guidelines, meeting both aerobic and strength activity guidelines, bicycling or walking to work, using public transportation to work, consuming two or more fruits or three or more vegetables per day, sleeping 7+ h·d−1, and current smoking habits. We adopted crude and multivariable-adjusted linear mixed and general linear models for our analyses. Results Mean values of the majority of health behavior factors were under 50% between 2018 and 2022. Higher percentages of city residents exercising, meeting aerobic activity guidelines, meeting both aerobic and strength activity guidelines, bicycling/walking to work, and consuming three or more vegetables or two or more fruits per day and lower percentage of residents who currently smoke were associated with higher percentages of good health status. Baseline percentages meeting aerobic activity guidelines, meeting both aerobic and strength activity guidelines, using public transportation, consuming two or more fruits per day, and sleeping 7+ h·d−1 and lower percentage of residents who currently smoke were also significantly associated with change in percentage of residents with good health status over time. Conclusion Our study shows room for improvement in health behaviors in all cities. The findings of our study also suggest that all health behaviors measured were associated with the general health status of residents of the most populous US cities.

The Javanese Cultural Beliefs and Practices Among Patients With End-Stage Renal Disease Undergoing Hemodialysis.

Introduction: Poor prognosis and higher mortality of chronic kidney disease are linked with cultural beliefs and practices. This study explored cultural beliefs and practices of Javanese people with end-stage renal disease undergoing hemodialysis for ≥5 years. Methods: A qualitative narrative inquiry was applied in this study. Data were collected through in-depth narrative interviews, followed by text messages, calls, and audio-visual calls for 6 weeks. Results: There were 14 participants; their mean age was 51.15 years and hemodialysis duration was 5 years and 2 months up to 10 years and 9 months. Four themes emerged: life-and-death acceptance, expectation of end-of-life care, contemplation of withdrawal from hemodialysis, and wishing for a good death. Discussion: Life values guided the ability to survive for the individual. Adherence to renal disease management regimen clashed with cultural values on occasions, such as social gatherings. Therefore, the unmet needs of patients should be addressed with a transcultural approach to modify personal health behaviors.

Burnout as a multidimensional phenomenon: how can workplaces be healthy environments?

Abstract Purpose Burnout was already a significant problem before the pandemic, but in the aftermath became a serious concern and a public health and occupational health priority. This study had two aims. First, we investigated how different healthy workplace dimensions and other health individual-level variables are related to burnout. Second, we examined differences in terms of presenteeism, absenteeism, and quality of life between employees who report burnout symptoms and those who do not. Methods Participants were 1702 Portuguese employees from various organizations; 69.68% were female, age ranged from 18 to 72 years (mean = 43.25 years, SD = 10.40). Almost half of the participants (49.9%; 851 participants) reported having at least one burnout symptom. Results Participants reported that they have felt exhausted (43.7%), irritated (34.5%) and sad (30.5%) always or very often in the last 4 weeks. Regression analysis revealed that the global score on burnout symptoms was negatively related to leadership engagement, psychosocial work environment, personal health resources, health behaviours, and satisfaction with salary. In addition, the global score on burnout symptoms was positively related to worker involvement, enterprise community involvement, perceived stress, and screen time at work. Furthermore, females tend to report a higher level of burnout symptoms compared to males. In addition, burnout has an impact on sickness absenteeism, presenteeism, and quality of life. Conclusions Our findings have an important contribution to understanding and promoting a healthier work environment, and reinforce the need for measures and policies to promote mental health, manage stress, and prevent burnout in the workplace.

Positive emotions co-experienced with strangers and acquaintances predict COVID-19 vaccination intentions through prosocial tendencies

BackgroundThe efficacy of vaccination depends on its widespread adoption, making vaccine uptake not just a personal health behavior but also a prosocial one. Previous research has shown that everyday moments of co-experienced positive emotions (positivity resonance) are associated with higher prosocial tendencies, and these moments, in turn, prospectively predict people's pandemic hygiene behaviors. Yet, limited research has explored how moments of positivity resonance may have predicted greater COVID-19 vaccine intentions during the early months of the pandemic. MethodsWe longitudinally surveyed a national U.S. sample across four weeks during the fall of 2020. We tested the hypothesis that positivity resonance with strangers and acquaintances indirectly predicts COVID-19 vaccine intentions, as statistically mediated by prosocial tendencies. We also aimed to replicate the indirect effects of positivity resonance on hygiene behaviors (such as mask wearing and hand washing), effects that have been demonstrated in previous research. ResultsIn a pre-registered structural equation model, we found that perceived positivity resonance experienced with strangers and acquaintances prospectively predicted prosocial tendencies, which in turn amplified people's COVID-19 vaccine intentions (β = 0.053) and hygiene behaviors – i.e., social distancing (β = 0.032), mask wearing (β = 0.027), hand washing (β = 0.049). ConclusionsUnderstanding the effects of high-quality social interactions with strangers and acquaintances on vaccine intentions and hygiene behaviors is critical, particularly given the likelihood of emerging pandemics and novel vaccines. We discuss theoretical and practical implications related to perceived positivity resonance, prosocial tendencies, and vaccination uptake for novel vaccines.

Integrating the HBM and the PEN-3 model to explain the health behavior of persons with DLD

Background: Investigating factors that dictate the health-seeking process in persons with developmental language disorders (DLDs) is critical for enhancing early intervention and effective utilization of treatment services among persons with DLDs. This study sought to understand factors that determine health seeking in persons with DLDs using the Health Belief Model (HBM) and the PEN-3 model. Methods: A qualitative study of 36 semi-structured interviews explored health-seeking behavior among stakeholders involved in the management of children with DLDs. Interviews were conducted with parents, teachers, and speech-language therapists on health behaviors and factors that dictate health behavior during intervention seeking. Data coding was done inductively, and analysis was carried out using qualitative content analysis. Results: Findings revealed that both the HBM and the PEN-3 model were well represented in the dataset, and that integration of both models contributes to a systematic understanding of health behavior in persons with DLDs. Conclusion: The study details how demographic, psychological, and sociocultural variables interact to shape the health-seeking process among persons with DLDs and the resulting impact of these interactions on the effective management of DLDs.

Anxiety over the Spread of COVID-19 and its related Factors among Older Adults in Bangkok

Background: Older adults are the population most at risk of death from the outbreak of COVID-19. Promotion of health literacy and COVID-19 prevention behavior among older adults is needed to lessen their anxiety. Objective: To analyze the relationships among age, health literacy, health behavior, and anxiety over the spread of COVID-19 among older adults in Bangkok. Methods: The participants were 480 male and female Thai older adults aged 60 and over who lived in Bangkok as listed in the household registration. A multi-stage sampling was used to select the participants. The research tools were interview forms covering data about personal information, health literacy, and health behavior. The research period was from September to November 2022. The data were analyzed using descriptive statistics, Pearson’s correlation coefficient, and multiple regression analysis through an SPSS (version 24) Results: Older adults in Bangkok had a high level of anxiety over the spread of COVID-19 ( = 16.02, SD = 5.22). Health literacy (r =−0.220) and health behavior (r =−0.390) were associated with the anxiety of older adults at a statistical significance level of 0.05 and could significantly predict 16.5% of older adults’ anxiety. Conclusion: A holistic system or approach should be established to promote older adults’ access to health services and enhance their health literacy in preventing COVID-19. This will make them have appropriate health behavior, be able to prevent the disease continuously, and have less anxiety during the COVID-19 outbreak.

Mental health differences in medical students based on curriculum and gender

BackgroundThe prevalence of mental health struggles among students in medical school is widely reported; however, little is known about how it is impacted by the medical school curriculum. This study aimed to evaluate differences in anxiety, depression, and emotional exhaustion in medical students based on gender, class year, and curriculum.MethodsAn anonymous online survey consisting of questions from established, validated questionnaires about demographics, anxiety, depression, emotional exhaustion, and personal health behaviors was sent to 817 medical students who attended Rowan-Virtua School of Osteopathic Medicine during the Spring of 2021. When applying to this school, each of these students had the option to choose either the problem-based learning (PBL) or lecture-based learning (LBL) curriculum track.ResultsThe survey was completed by 222 students. Females experienced higher levels of anxiety, depression, and emotional exhaustion than males. Students in the PBL had lower levels of emotional exhaustion than their peers in the LBL. Increase in emotional exhaustion was most pronounced between 1st and 2nd year students. Emotional exhaustion was inversely correlated with sleep and exercise.ConclusionsOn average, students who were either male or in the PBL curriculum experienced less mental distress in the form of anxiety, depression, and emotional exhaustion than their peers. While gender continues to be an established factor in how mental distress is experienced, the reduced levels of emotional exhaustion in PBL students is a novel finding that can potentially shed light on how to better optimize medical education. Despite the inherent selection bias and lower number of PBL students, to our knowledge, this is the first study comparing two different curricula within a single institution. This finding along with a focus on good sleep and exercise habits may provide a path for improving mental health in medical students.

Personal health behaviors and physical activity and nutrition counseling by nurse practitioners: An online survey.

Personal health behaviors and physical activity and nutrition counseling by nurse practitioners: An online survey.

Poor cardiorespiratory fitness in first year medical students at a South African University

ABSTRACT The personal health behaviours, including physical activity, of healthcare professionals influence their counselling practices as they relate to non-communicable diseases (NCDs). However, despite the importance of producing healthy, physically active graduates, there are limited data on the physical fitness of future healthcare professionals. This cross-sectional observational study determined the prevalence of below-average fitness in the four components of fitness in first-year university medical students. 152 participants (46 male, 106 female, 20.16 ± 2.69 years) completed cardiorespiratory fitness tests (submaximal step test), flexibility (sit-and-reach test), muscle strength (handgrip), and muscle endurance tests (sit-ups, push-ups). Sex differences were reported using one-way ANOVA or Chi square test and significance was set at p < 0.05. The prevalence (%) of below-average fitness was 69.54% for cardiorespiratory, 25.66% for handgrip strength, 65.79% for sit-ups, 23.03% for push-ups and 7.24% for flexibility. Physical fitness parameters (mean±standard deviation (SD)) were compared between sexes, where it was found that females were more flexible than males (40.61 ± 8.40 cm vs 36.70 ± 9.31 cm, p = 0.012). Males had better handgrip strength (88.96 ± 12.04 kg vs 59.34 ± 10.36 kg, p < 0.001), muscle endurance sit-ups (33.46 ± 9.04 vs 24.48 ± 12.18, p < 0.001) and push-ups (30.28 ± 13.95 vs 24.27 ± 12.35, p = 0.009). First-year medical students have poor physical fitness, notably cardiorespiratory fitness and muscle strength, which are important markers for NCD risk assessment. Tertiary institutions training healthcare professionals should consider developing interventions to improve students’ physical fitness thereby influencing their health, wellbeing, academic performance and future counselling practices.

Health behaviors of people with multiple sclerosis and its associations with MS related outcomes: a German clinical cohort.

Health behaviors in persons with multiple sclerosis (pwMS) have been associated with MS-related disease outcomes. The aim of the study was to gain knowledge about current patient health behaviors in a convenience sample representative for pwMS presenting to a large university-based outpatient clinic and to investigate associations between modifiable risk factors with physical impairment, quality of life (QoL) and cardiovascular comorbidities. A questionnaire was administered at the MS Outpatient Clinic of the University Medical Center Hamburg Eppendorf asking for health behaviors regarding dietary habits assessed with the German adaptation of the validated Spanish short Diet Quality Screener (sDQS), level of physical activity assessed with the Godin Leisure Time Questionnaire (GLTEQ) and tobacco smoking. Participants were asked to report cardiovascular comorbidities using items from the Self-Report Comorbidity Questionnaire for Multiple Sclerosis. Additionally, cardiovascular risk factors like blood pressure, height and weight (to calculate BMI) and waist circumference were measured. MS specific clinical data, e.g., disease course, duration, disability and MS-specific QoL were collected from the clinical database. Descriptive analyses were performed and multivariate regression analyses for complete cases were carried out for each of the three outcome variables including all mentioned modifiable risk factors (dietary behavior, smoking, physical activity and BMI) as independent variables. In this sample of 399 pwMS the mean age was 42 years (SD 12.8) with a mean disease duration since diagnosis of 7.4 years (SD 8.4) and a mean EDSS of 2.8 (SD 1.9). 24% were current smokers, 44% were insufficiently physically active and 54% did not follow a healthy dietary pattern. 49% of this relatively young clinical population was overweight and 27% reported one or more cardiovascular comorbidities. Most modifiable risk factors showed no convincing associations with MS-related disease outcomes in the multiple regression analyses. This clinical cohort of pwMS shows a high prevalence of critical health behaviors and comorbidities and emphasizes the need for monitoring, education and assistance for behavior change in this population.

Personal health behaviors and physical activity and nutrition counseling by nurse practitioners: An online survey.

Healthy lifestyle counseling improves nutritional intake and participation in exercise, yet the rate of patient counseling varies and clinicians' personal behaviors can influence counseling practices. This cross-sectional study evaluated lifestyle counseling by nurse practitioners (NPs) and the relationship between their personal behaviors and patient counseling. Practicing NPs ( N = 1,220) completed an online survey regarding personal behaviors and counseling for healthy body weight, moderate-vigorous physical activity, muscle strengthening, fruit and vegetable consumption, and dietary protein. The majority reported counseling "usually" or "often" for healthy weight (54%), moderate-vigorous physical activity (53%), and fruits/vegetables (57%), whereas only 44% and 17% reported "usually" or "often" counseling for dietary protein and muscle strengthening. When NPs did not personally engage in the behavior, the odds for counseling were significantly reduced: NPs were 21% less likely to counsel for moderate-vigorous physical activity (odds ratio [OR] = 0.79 [0.65-0.97], p = .026), 27% less likely to counsel for muscle strengthening (OR = 0.73 [0.60-0.90], p = .004), 57% less likely to counsel for fruit/vegetable consumption (OR = 0.43 [0.35-0.54], p < .001), and 72% less likely to counsel for dietary protein (OR = 0.28 [0.18-0.45], p < .001). Personal body mass index did not predict counseling for a healthy weight. Although NPs report regular patient counseling regarding healthy lifestyle behaviors, the odds for counseling are increased approximately 20-75% when they engage in the behaviors themselves. Promotion of healthy behaviors during professional education may have long-term implications for preventive health counseling.

Role of personal aptitudes as determinants of incident morbidity, lifestyles, quality of life, use of the health services and mortality (DESVELA cohort): qualitative study protocol for a prospective cohort study in a hybrid analysis.

Maintaining or acquiring healthier health-oriented behaviours and promoting physical and mental health amongst the Spanish population is a significant challenge for Primary Health Care. Although the role of personal aptitudes (characteristics of each individual) in influencing health behaviours is not yet clear, these factors, in conjunction with social determinants such as gender and social class, can create axes of social inequity that affect individuals' opportunities to engage in health-oriented behaviours. Additionally, lack of access to health-related resources and opportunities can further exacerbate the issue for individuals with healthy personal aptitudes. Therefore, it is crucial to investigate the relationship between personal aptitudes and health behaviours, as well as their impact on health equity. This paper outlines the development, design and rationale of a descriptive qualitative study that explores in a novel way the views and experiences on the relationship between personal aptitudes (activation, health literacy and personality traits) and their perception of health, health-oriented behaviours, quality of life and current health status. This qualitative research is carried out from a phenomenological perspective. Participants will be between 35 and 74 years of age, will be recruited in Primary Health Care Centres throughout Spain from a more extensive study called DESVELA Cohort. Theoretical sampling will be carried out. Data will be collected through video and audio recording of 16 focus groups in total, which are planned to be held in 8 different Autonomous Communities, and finally transcribed for a triangulated thematic analysis supported by the Atlas-ti program. We consider it essential to understand the interaction between health-related behaviours as predictors of lifestyles in the population, so this study will delve into a subset of issues related to personality traits, activation and health literacy.Clinical trial registration: ClinicalTrials.gov, identifier NCT04386135.