Healthy Lifestyle Changes Research Articles

Semmelweis University’s innovative Center of Preventive Services in support of healthy ageing

Abstract Issue/problem Europe’s aging population presents substantial hurdles for healthcare sustainability. To alleviate the social and economic impacts of age-related diseases, promoting healthy aging is imperative. However, motivating individuals to adopt a healthier lifestyle proves challenging. Description of the problem Semmelweis University, a leading institution in medicine, health sciences, and health care in Hungary and Central Eastern Europe, has addressed this challenge by establishing the Center of Preventive Services (CPS), serving 12,500 Semmelweis University employees. The CPS conducts comprehensive health risk assessments and offers consultations with specialists in preventive medicine, public health, dietetics, physiotherapy, and health psychology. Motivational interviewing is used to enhance patient engagement and commitment to healthy lifestyle changes. Results The CPS has effectively integrated preventive services into the university’s healthcare system, reaching a significant number of employees. Early results show improvements in participants’ lifestyle and health behaviors due to the effective use of motivational interviewing. According to the first preliminary result, a study on step count conducted within the CPS found that those taking part in motivational interviewing session were able to increase their average daily step count by 1074 (95% Confidence Interval: 116-2033) steps more than controls. Lessons The Semmelweis University’s CPS provides valuable lessons for integrating healthy aging-focused preventive care into healthcare systems: 1. Effective preventive care requires targeted interventions based on detailed risk assessment and motivational interviewing; 2. Embedding preventive services within existing health infrastructure improves accessibility and utilization; 3. Collaborative and multidisciplinary approaches are essential to comprehensively address the needs of ageing populations. Key messages • Motivational interviewing boosts the effectiveness and engagement of preventive health services, which is essential to meet the challenges of ageing populations. • The Semmelweis University’s model program shows that embedding preventive services into the infrastructure of existing institutions like universities is scalable for better public health.

Gap between estimated cardiovascular risk and individual risk perception: a survey from a cardiovascular prevention center.

Abstract Background Cardiovascular risk scores represent a great achievement of preventive cardiology, since they allow to stratify individual risk. The recently updated European Society of Cardiology Scores offer an accurate cardiovascular risk estimation. However, a gap between perceived and calculated risk may strongly interfere in healthy lifestyle changes as well as in cardioprotective drugs adherence. Purpose: The aim of the present study was to evaluate and quantify the above-mentioned gap. Methods A cohort of subjects referred to our Cardiovascular Prevention Center were included in the present study. Cardiologists assessed each tradional and emerging risk factor in terms of presence or absence, severity, distance from target, and the cardiovascular risk was calculated using appropriate ESC scores. Each subject filled out a questionnaire in which they were asked to declare their perceived cardiovascular risk and to report, among all the traditional and emerging cardiovascular risk factors, which ones they believed to have greater impact on their individual risk. Results 366 consecutive subject were included, 70% in primary prevention and 30% with atherosclerotic cardiovascular disease, mean age was 65 years, male gender was prevalent (57%), arterial hypertension (AHT) was found in 78,7% (43,4% uncontrolled), dyslipidaemia in 91,5% (87,5% not at target), diabetes in 18,6%, smokers were 12,9% and 24,4% had obesity. Among emerging risk factors, sedentary lifestyle was found in 63%, while 18% reported regular aerobic physical activity, mediterranean diet adherence was found in 26% and moderate-to-severe perceived anxiety in 23%, depression in 17% and stress in 66%. 6,6% had low risk cardiovascular risk, 16,1% intermediate, 38,0% high and 39,3% very high. A concordance between estimated and perceived risk was found in 18,9% while a discordance in 81,1%; 93,3% underestimate their risk, while 6,7% only overestimate it (figure 1A). A significant higher rate of discordance was found with the progressive increase of the risk (p<0.0001). Different perceived cardiovascular risk among each estimated classes of risk was shown in figure 1B and figure 2; of note only 11% of high risk and 8% of very high risk were concordant in their risk perception. In particular, elderly (p<0.001), male (p<0.001), subjects with AHT (p=0.001) and dyslipidaemia (p=0.02) showed higher rate of underestimation while younger (p<0.001), female (p<0.001) as well as anxiety (p=0.047) and depressed (p=0.010) had higher rate of overestimation. Conclusions A high rate of subject underestimate its cardiovascular risk; the higher the risk, the higher the gap between perceived and estimated risk. This risk gap represents a "risk within the risk". for these reasons it is necessary to increase all efforts towards a more effective health education in the field of cardiovascular prevention in order to reinforce patients awareness and physician-patient alliance.Figure 1Figure 2

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

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

A Behavioral Change-Based Mobile Intervention for Promoting Regular Physical Activity in Medical Rehabilitation Maintenance of Patients With Coronary Artery Disease: Controlled Trial.

Cardiac rehabilitation is known to reduce coronary artery disease (CAD) severity and symptoms, but adoption of a healthy postrehabilitation lifestyle remains challenging. Innovative eHealth solutions could help, but behavioral change-based eHealth maintenance programs for patients with CAD are scarce. RehaPlus+ aims to improve postrehabilitation outcomes with a personalized eHealth intervention built on behavioral change concepts emphasizing healthy lifestyle changes, especially regular physical activity (PA). This study aims to evaluate the effectiveness of the personalized eHealth program RehaPlus+ for promoting regular PA against usual care. A total of 169 patients with CAD who had undergone stent implantation or bypass surgery were recruited after completing center-based phase II rehabilitation. They were then divided, without blinding, into 2 groups using a quasi-experimental approach: a case manager-assisted 24-week eHealth program (RehaPlus+; n=84) and a conventional physician-assisted outpatient program (usual care; n=85). The study was designed as a noninferiority trial. RehaPlus+ participants received motivational messages twice weekly for 6 months, and the usual care group engaged in a 6-month outpatient program (twenty-four 90-minute strength and endurance training sessions). The primary outcomes, evaluated using the self-assessed Bewegungs- und Sportaktivität questionnaire, were regular PA (≥150 min/wk) and weekly activities of daily living (ADLs) 6 months after rehabilitation. Secondary outcomes involved PA during work and floors climbed weekly (measured by Bewegungs- und Sportaktivität questionnaire), psychological well-being (assessed by the 5-item World Health Organization Well-Being Index), cardiac self-efficacy, health-related quality of life (measured by the 36-Item Short Form Survey), and work ability (using the Work Ability Index). Data of 105 patients (RehaPlus+: n=44, 41.9%; usual care: n=61, 58.1%; male patients: n=80, 76.2%; female patients: n=25, 23.8%; mean age 56.0, SD 7.3 years) were available at the 6-month follow-up. At 6 months after discharge from phase II cardiac rehabilitation, the RehaPlus+ group exhibited 182 (SD 208) minutes per week of PA and the usual care group exhibited 119 (SD 175) minutes per week of PA (P=.15), with no interaction effect (P=.12). The RehaPlus+ group showed an ADL level of 443 (SD 538) minutes per week compared to the usual care group with 308 (SD 412) minutes per week at the 6-month follow-up, with no interaction effect (P=.84). The differences observed in PA and ADL levels between the RehaPlus+ and usual care groups were within the predefined 1-sided noninferiority margin, indicating that the RehaPlus+ intervention is not inferior to usual care based on these outcomes. There were no differences between the groups for all secondary outcomes (P>.05). RehaPlus+ is not inferior to the usual care program, as both groups improved PA and ADLs to a similar extent. These findings emphasize the potential of eHealth interventions to assist in maintaining healthy lifestyles after rehabilitation. ClinicalTrials.gov NCT06162793; https://clinicaltrials.gov/study/NCT06162793.

Patient Perspectives on Lifestyle Medicine Virtual Group Visits

Lifestyle Medicine Virtual Group Visits (LMVGVs) have potential for providing effective lifestyle education and counseling to patients who have or are at risk for chronic disease. The purpose of this study was to assess primary care patients’ motivations for participation in and preferences for future engagement with LMVGVs. This was a cross-sectional survey conducted in an academic community-based clinic. A total of 111 patients who signed up for LMVGVs between September 2020 and August 2021 completed the survey between February and April 2022. Patient demographics and LMVGV attendance data were collected from the medical record. The most common reported reasons for signing up for LMVGVs were to focus on lifestyle changes and to lower chronic disease risk. The most common reasons for attending subsequent LMVGVs were the focus on healthy lifestyle changes and the positive focus of the groups. Almost all (98%) respondents who attended ≥5 LMVGVs indicated they would recommend LMVGVs to family or friends. Most respondents preferred monthly LMVGVs, including 71% of those who attended ≥5 LMVGVs. These findings inform efforts to develop LMVGVs that are feasible and acceptable to patients, contributing to the promotion of lifestyle behaviors that aid in the prevention and treatment of chronic disease.

Healthy Eating and Active Lifestyle after Bowel Cancer (HEAL ABC)-feasibility randomised controlled trial.

Evidence from cohort studies indicates that a healthy lifestyle can improve cancer survival but evidence from randomised controlled trials (RCT) is lacking. Thus, this study tested the feasibility of conducting a lifestyle intervention in patients after colorectal cancer (CRC) treatment. An intervention was developed based on World Cancer Research Fund and American Institute for Cancer Research (WCRF/AICR) recommendations, the Health Action Process Approach, Motivational Interviewing and tested a feasibility, mixed-methods RCT. Participants were allocated to a three-month telephone-based intervention versus standard care control group. The follow up period was six months. Data on feasibility and secondary outcomes were collected and analysed using Stata (V15, StataCorp LLC) and NVivo 12 (QSR International Pty Ltd., Doncaster, VIC). Recruitment was challenging (31 ineligible, 37 declined; recruitment rate = 48.6%.). In total, 34/35 participants completed the intervention, and 31 (89%) completed follow up; all 31 completers participated in six telephone calls during intervention and six months follow up. Study retention was 97% (34/35) and 89% (31/35) at three and six months, respectively. Data completion rates were high (>90%). Intervention was acceptable to participants, met their needs and kept them accountable towards their goals. Participants in the intervention group showed significant improvement in WCRF/AICR, Diet Quality Index-International score and a 10% reduction in ultra-processed food consumption. The HEAL ABC intervention was feasible for 87% of intervention participants, supporting them in healthy lifestyle changes. However, alternative recruitment strategies are needed for a fully powered RCT to determine the effectiveness of the intervention.

The role of family in improving the management of diabetes mellitus patients

Introduction: diabetes mellitus is a chronic disease that requires long-term management involving patients and their families. The role of the family in improving the management of diabetes mellitus patients is very important to achieve good blood sugar control and prevent long-term complications. This study aims at the role of family in improving the management of diabetes mellitus patients. Methods: this research is a quantitative method with a quasi-experimental research design with a non-equivalent control group research design with a sample size of 20 respondents Results: shows that in the intervention group, most family roles have a good category where respondents have family roles are as many as 7 people (70%) and respondents who have poor family roles are as many as 3 people (30%). While in the control group, respondents who had poor family roles were as many as 8 people (80%) and respondents who had good family roles were as many as 2 people (20%). In the final measurement (Post-test) in the intervention group and the control group, p = 0, 028 or p < 0.05 means that there are differences in family roles in both groups in the final measurement (Post-test) Conclusions: the role of the family is very important in improving the management of diabetes mellitus patients. Family support and involvement in assisting patients in living a healthy diet, following the right medication regimen, and maintaining an active lifestyle can help achieve good blood sugar control and prevent long-term complications. Factors such as knowledge of diabetes, emotional support, and ability to manage diabetes-related situations also influence the family's role in the management of this condition. Therefore, education to families about diabetes, the psychological and practical support they provide to patients, as well as their involvement in healthy lifestyle changes are important things to note.

Application of artificial intelligence technology in monitoring students' health: Preliminary results of Syiah Kuala Integrated Medical Monitoring (SKIMM).

Health promoting university is a holistic approach to health that uses higher education settings to create a learning environment that improves the health and well-being of the campus community in a sustainable manner. The utilization of technology such as artificial intelligence (AI) could be one of the main success factors in the implementation of health-promoting universities to increase the effectiveness and efficiency of all stages of activities carried out in health promotion and prevention efforts. Integrated monitoring with the utilization of AI in this program is conducted to evaluate the health status of the students. The Syiah Kuala Integrated Medical Monitoring (SKIMM) has three components of continuous health status evaluation: vital signs, nutritional status, and burnout status. Health status monitoring was conducted continuously for three months among medical students at the Faculty of Medicine Universitas Syiah Kuala, Banda Aceh, Indonesia. This system uses the WhatsApp application as a platform to monitor health status. Student health monitoring in this program consists of two main activities: the health measurement phase and the health monitoring phase. The use of the SKIMM system to monitor students' vital signs, nutritional status and burnout status through the use of AI significantly raises students' awareness to conduct timely self-examination and enables sustainable healthy lifestyle behavior change. The adoption of AI technology allows for continuous health promotion to the entire academic community, including students in implementing the health promoting university.

Stakeholder perspectives on the barriers and facilitators of engagement in healthy lifestyle behaviours in underrepresented adolescents: a focus group study from the European SEEDS project

BackgroundObesity in adolescence has increased in the last decades. Adolescents fail to meet the recommended guidelines for physical activity (PA) and healthy diet. Adolescents with a low socioeconomic status (SES) particularly seem to have fewer healthy lifestyle behaviours. The European Science Engagement to Empower aDolescentS (SEEDS) project used an extreme citizen science approach to develop and implement healthy lifestyle behaviour interventions in high schools. As part of this project, key stakeholders were invited to reflect on the intentions of adolescents to engage in healthy lifestyle behaviours. The aim of this study was to gain stakeholder insights into the barriers and facilitators to healthy lifestyle behaviours of adolescents from low SES areas and on the possible role of these stakeholders in facilitating healthy lifestyle behaviours.MethodsSix semi-structured focus groups were conducted in four European countries with 28 stakeholders from different settings (schools, community, and government), like teachers, policy advisors and youth workers. The theoretical framework of focus groups was based on the Theory of Planned Behaviour. The main questions of the focus groups were centred on PA and healthy diet. The focus groups were qualitatively analysed in NVivo using thematic analysis to identify topics and themes.ResultsAccording to stakeholders, adolescents have sufficient understanding of the importance of PA and a healthy diet, but nevertheless engage in unhealthy behaviour. Parents were mentioned as important facilitators for engaging adolescents in healthy lifestyle behaviours. Stakeholders listed lack of knowledge, time, and financial resources as barriers for adolescents from low SES families to engage in healthy lifestyle behaviours. The school environment was listed as an important facilitator of adolescents’ healthy lifestyle changes, but stakeholders acknowledged that current school days, curriculum and buildings are not designed to promote healthy lifestyle behaviours. External support and collaboration with community and governmental stakeholders was seen as potentially beneficial to improve healthy lifestyle behaviours.ConclusionsThis study shows the variety of barriers adolescents from low SES areas face, and the need for a broader collaboration between key stakeholders to facilitate healthy lifestyle behaviours. Schools are regarded specifically as important facilitators. Currently, the school environment entails various barriers. However, when addressing those, schools can increase opportunities for healthy lifestyle behaviours of adolescents from low SES areas.Trial registrationThis study is registered in ClinicalTrials.gov on 12/08/2021: NCT05002049.

Initial Perspectives From Rural-Residing Adults on a Digital Cognitive Health Coaching Intervention: Exploratory Qualitative Analysis.

A growing body of research has examined lifestyle-based interventions for dementia prevention. Specifically, health coaching interventions have been linked to decreased risk of Alzheimer disease (AD) comorbidities, such as diabetes. Despite the association, there is a lack of research examining the efficacy and perception of digital health coaching on reducing AD risk. Understanding the perceived benefits of participating in a digital health coach program is critical to ensure long-term use, including participant adherence and engagement. The purpose of this study is to examine the initial attitudes toward a digital health coaching intervention aimed at preventing cognitive decline among at-risk, rural participants. This exploratory qualitative study is part of the ongoing Digital Cognitive Multidomain Alzheimer Risk Velocity Study (DC-MARVel; ClinicalTrials.gov NCT04559789), a 2-year randomized control trial examining the effects of a digital health coaching intervention on dementia risk, cognitive decline, and general health outcomes. Participants were recruited from the northwest region of Arkansas via word of mouth, email, local radio, and social media. At the time of the analysis, 103 participants randomly assigned to the health coaching group completed an average of 4 coaching sessions over a 4-month period. The intervention included asynchronous messages 1-2 times per week from their health coach that contained health education articles based on the participant's goals (eg, increase physical activity), unlimited access to their coach for questions and recommendations, and monthly meetings with their coach via videoconference or phone to discuss their goals. Participants were asked 2 open-ended questions, "What were your top 1 or 2 takeaways from your recent Health Coaching session?" and "Is there anything you would change about our Health Coaching sessions?" A thematic analysis was conducted using feedback responses from 80 participants (mean age, SD 7.6 years). The following four themes emerged from participants' feedback: (1) healthy lifestyle and behavioral changes, (2) a sense of self-awareness through introspection, (3) value in coach support, and (4) a desire for a change in program format (eg, frequency). In total, 93% (n=74) of participants expressed that the intervention needed no changes. Initial participation in the digital cognitive health coaching intervention was well received, as evidenced by participants reporting value in goal setting and strategies for healthy lifestyle and behavioral changes as well as self-reflection on their personal lifestyle choices. Feedback about their assigned coach also offers insight into the importance of the coach-participant relationship and may serve as a significant factor in overall participant success. Given the exploratory nature of this study, more robust research is needed to elicit more information from participants about their experiences to fully understand the acceptability of the digital health coaching intervention. ClinicalTrials.gov NCT04559789; https://clinicaltrials.gov/show/NCT04559789. RR2-10.2196/31841.

Household chaos and childhood obesity-related health outcomes.

Household chaos, defined as a lack of organization, structure, and predictability, has been linked to deleterious childhood health outcomes and may hinder attempts to initiate and maintain healthy lifestyle changes. This study examined the associations of household chaos and obesity-related health conditions in a sample of youth being treated for obesity. Participants were 715 patients (61.8% girls; Mage = 12.3 years; 68.7% non-Hispanic Black; M% of 95th BMI %-ile = 146.9%) enrolled in a pediatric weight management clinic. Caregiver report of household chaos was measured using the Confusion, Hubbub and Order Scale (CHAOS). Physiological obesity-related comorbidities (e.g., insulin resistance, hypertension, dyslipidemia) were assessed by a medical clinician and abstracted from electronic medical records; health conditions were dichotomized as present or not present. Psychological functioning was measured with the Pediatric Symptom Checklist, a caregiver-completed mental health screen that assesses internalizing, externalizing, and attention concerns. The Wilcoxon rank-sum test was used to test differences in household chaos scores for each obesity-related health condition. Caregivers of youth diagnosed with hypertension and obstructive sleep apnea reported significantly lower levels of household chaos, while caregivers who reported clinical levels of psychological dysfunction reported higher levels of chaos. Traditional management of childhood obesity requires changes across multiple health domains (e.g., dietary, exercise, sleep), and such change may be facilitated by structure and consistency. Present findings suggest that psychological resources within pediatric weight management settings should address individual patient-level factors associated with physiological and mental health as well as household functioning.

Program Pengabdian Masyarakat Dengan Skrining Urin Dan Edukasi Kesehatan Untuk Pencegahan Infeksi Saluran Kemih

Urinary tract infection (UTI) is a medical condition caused by a bacterial infection of the urinary system. In the elderly, urinary tract infections can occur without obvious symptoms, so screening for urinary tract infections is needed for early detection and appropriate management. Education is also needed regarding risk factors, such as urinary retention habits and personal hygiene, so that the risk of infection can be reduced. This activity is carried out using the PDCA (Plan-Do-Check-Act) method, so it is hoped that it can increase effectiveness in preventing UTIs. This activity is carried out with the aim of maintaining and improving the quality of life of the elderly, especially in preventing urinary tract infections through early detection and healthy lifestyle changes. Keywords: Education, Elderly, Urinary tract infections, Urin examination

A pilot study of Keto Prescribed+: A healthy thinking and eating educational program for African American women.

African American (AA) women have the highest prevalence of obesity in addition to health disparities in preventable diet-related diseases (i.e., diabetes, hypertension), which places them at increased risk for cardiovascular disease. The purpose of this pilot study was to assess the feasibility, acceptability, and preliminary effectiveness of the Keto Prescribed+ (KetoRx+) program on associated physical and psychosocial outcomes among this population. The KetoRx+ program is a healthy eating and thinking educational intervention. The program combined online and in-person community group sessions over 8 weeks. The Keto Prescribed+ was found to be feasible and acceptable with comments on ways to increase acceptability from participants completing program (n = 10). Physical outcomes changed showed an average decrease in weight of 10lbs (SD = 5), baseline average 226lbs. Waist-to-hip ratio and systolic blood pressure also trended down. Psychosocial outcomes showed improvement trends. The KetoRx+ program is feasible and acceptable for overweight or obese AA women. Preliminary efficacy was established for most physical and psychosocial outcomes. However, more research is needed to identify specific program components contributing to healthy lifestyle behavior change and to establish program efficacy and effectiveness. Culturally adapted community-based biopsychosocial interventions using ketogenic nutrition therapy may help improve cardiovascular health of adult AA women.

Kegiatan Pengukuran Tekanan Darah dan Penyakit Darah Tinggi pada Populasi Usia Produktif

Hypertension is an increasing global health problem. By 2025, it is estimated that 1.5 billion people will suffer from hypertension, with 10.44 million deaths annually caused by hypertension and its complications. Most cases are idiopathic, related to genetic factors, diet and lifestyle. Uncontrolled hypertension significantly increases the risk of cardiovascular disease, kidney failure, and stroke. This activity uses the PDCA (Plan-Do-Check-Act) method for blood pressure screening and counseling in adults at PT. Narindo, North Jakarta. The results of blood pressure examination showed that 4 people (3.08%) had grade 3 hypertension, 7 people (5.38%) had grade 2 hypertension, 20 people (15.38%) had grade 1 hypertension. Monitor blood pressure regularly and increasing public health knowledge can increase awareness and encourage healthy lifestyle changes, reducing the prevalence and complications of hypertension.

A critical review of health and financial implications of obesity during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) was reported in Wuhan, China, in December 2019. There is a link between increased mortality and obese individuals with the disease. The disease has been claimed to have disproportionately affected non-Hispanic blacks and Hispanics. The rise in food accessibility and the drop in the relative cost of junk food items are the two most significant changes in dietary patterns. Around the world, 2.8 million people die from being overweight or obese, and those with more body fat also have a higher risk of diabetes (44%) and heart disease (23%). Obesity weakens the immune system because adipose cells infiltrate the bone marrow, spleen, and thymus. Obesity was substantially more common among COVID-19 patients who were hospitalized than those who were not hospitalized. Over 900,000 adults in the United States are hospitalized due to a COVID-19 infection. Hospitalizations in 271,700 (30.2%) cases have been attributed to obesity. Obese patients may be experiencing reduced thoracic expansion following bariatric surgery. Less tracheal collapse and air-trapping at end-expiration chest CT were observed post-surgery, and patients reported reduced dyspnea. COVID-19 is estimated to cost the European Union €13.9 billion in secondary care, with 76% of that cost attributed to treatment for overweight and obese individuals. The average price per hospitalized patient also increased with increasing body mass index (BMI). Screening for obesity, preventive measures, and recommendations for healthy lifestyle changes should be of the utmost importance to decrease both the health and financial implications of COVID-19.

Self-Help Movement and the Change Process of Recovery

The path of recovery from both addiction and trauma to resilience and transformation is rooted in the concept that all life is a balance between spirit and matter. Caring for the spiritual and physical selves requires self-reflection regarding life experiences and personal constructs. The central issue to positive mental health and the resolution of life problems, such as alcohol or drug addiction, gambling, abuse, etc., is partly vested in a robust management system that impacts an individual’s cultural and social support system. The demise of supportive communities is one of the significant losses of modern life. The self-help movement of Alcoholics Anonymous and other 12-step programs have always provided social support and encouragement to reflect on behaviors, motivations, and patterns that support healthy lifestyle changes. While it is not necessary for a recovering person to be religious, the movement may draw parallels to various spiritual and religious doctrines that recovering persons subscribe to; therefore, drawing these parallels only strengthens a person’s chances for long-term recovery

Noncommunicable disease risk behaviors and protective factors among children in Samoa: Retrospective trend analysis of global school-based health surveys in 2011 and 2017.

Pacific Island countries experience a high prevalence of noncommunicable diseases (NCDs), which may be prevented by reducing risk behaviors and strengthening protective factors in childhood and adolescence. To better inform preventative interventions, our objective was to use publicly available data from the Global School-based Student Health Survey (GSHS), to provide cross-sectional and trend estimates for the prevalence of NCD risk and protective factors among school-aged children in 2011 and 2017 in Samoa. Two waves of cross-sectional data included 4,373 children (51.98% female), with a median age of 15 years, who were mainly in school years 9-10 in Samoa. Retrospective analyses were adjusted for the GSHS multistage stratified cluster sample design. Weighted prevalences of overweight/obesity, dietary behaviors, physical activity, and sedentary behavior, oral and hand hygiene, emotional and mental health, and community protective factors were reported by study year. Logistic regressions were fitted to assess differences in the prevalence of risk and protective factors, adjusted for age group, sex, and school year. In 2011 and 2017, the prevalence of overweight/obesity remained consistently high in females (59.12% and 64.29%, p = 0.428) and increased from 44.21% to 53.65% in males (p = 0.039). Time spent sitting for long periods, smoking cigarettes, using other tobacco products, and drinking alcohol were lower in 2017 compared to 2011 (all p<0.05). Many children reported experiencing bullying (33.27% for females and 59.30% for males in 2017), while physical fighting was common among males (73.72% in 2011 and 57.28% in 2017). The high prevalence of obesity and related NCD risk factors require urgent public health action in Samoa. Alongside the continued reduction of tobacco and alcohol use, emotional and mental wellness should be prioritized in interventions and programs to promote healthy behaviors and lifestyle changes starting in childhood.

Testicular cancer survivorship program at National Cancer Institute in Slovakia.

e13792 Background: Testicular germ cell tumors (GCTs) are highly curable malignancies. Survivors of GCTs represent a growing population with a long life expectancy after curative cancer treatment. GCT survivors may experience a variety of late adverse effects of treatment and reduced quality of life. Therefore, National Cancer Institute in Slovakia has developed a testicular cancer survivorship program with a long-term follow-up of GCT survivors aiming to evaluate late toxicities and their underlying molecular mechanisms. Methods: The long-term annual follow-up of GCT survivors is established per our institutional guidelines for testicular cancer survivorship program. GCT survivors are referred to our testicular survivorship outpatient clinic at least 5 years after completion of curative treatment, and are followed annually throughout their lives. During each visit, patient’s history is updated, physical examination is performed, blood and urine samples are collected, and survivors complete validated questionnaires for evaluation of late toxicities (peripheral neuropathy, sexual dysfunction, cognitive impairment) and quality of life. Complete blood count, metabolic panel, lipid panel, levels of serum tumor markers, testosterone, luteinizing hormone and follicle stimulating hormone are measured at each visit. Plasma aliquots and urine samples from every visit are prospectively collected and stored in the biobank of our Translational Research Unit. Data including age, medical history, histological type, stage, prognostic group, type of treatment, laboratory values, and questionnaire scores are collected and recorded in our electronic survivorship database. In addition, information on important survivorship topics is provided and healthy lifestyle changes are suggested to all survivors. Results: From August 2015 to January 2024 our testicular survivorship outpatient clinic performed 1733 follow-up visits in 407 GCT survivors treated at our institution from 1984 to 2019. Median age at the first follow-up visit at the survivorship clinic was 41 years (range 21 - 77). Median time from the curative treatment to the first follow-up visit at the survivorship clinic was 7 years (range 4 - 32). To date, 104 patients have had at least 7 follow-ups. Eighty-six (21.13 %) patients were treated with surgery only, 278 (68.3 %) with chemotherapy, 28 (6.88 %) with radiotherapy, and 15 (3.69 %) patients with both chemotherapy and radiotherapy. To date, 18 publications (including papers and abstracts) have been published using the data from our testicular survivorship database. Conclusions: Testicular cancer survivorship program with the long-term annual follow-up of GCT survivors has been established at National Cancer Institute in Slovakia. The ongoing prospective study for evaluation of late toxicities and their underlying mechanisms is part of the program. Our large database offers valuable data for the future research.

Integrating a multimodal lifestyle intervention with medical food in prodromal Alzheimer’s disease: the MIND-ADmini randomized controlled trial

BackgroundThe Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) showed cognitive benefits from a multidomain lifestyle intervention in at-risk older people. The LipiDiDiet trial highlighted benefits of medical food in prodromal Alzheimer’s disease (AD). However, the feasibility and impact of multimodal interventions combining lifestyle with medical food in prodromal AD is unclear.MethodsMIND-ADmini was a 6-month multinational (Sweden, Finland, Germany, France) proof-of-concept randomized controlled trial (RCT). Participants were 60–85 years old, had prodromal AD (International Working Group-1 criteria), and vascular/lifestyle risk factors. The parallel-group RCT had three arms: multimodal lifestyle intervention (nutritional guidance, exercise, cognitive training, vascular/metabolic risk management and social stimulation); multimodal lifestyle intervention + medical food (Fortasyn Connect); and regular health advice/care (control). Participants were randomized 1:1:1 (computer-generated allocation at each site). Outcome evaluators were blinded to randomization. Primary outcome was feasibility of the multimodal intervention, evaluated by recruitment rate during a 6-month recruitment phase, overall adherence in each intervention arm, and 6-month retention rate. Successful adherence was pre-specified as attending ≥ 40% of sessions/domain in ≥ 2/4 domains (lifestyle intervention), and consuming ≥ 60% of the medical food (lifestyle intervention + medical food). The secondary outcomes included adherence/participation to each intervention component and overall adherence to healthy lifestyle changes, measured using a composite score for healthy lifestyle. Cognitive assessments were included as exploratory outcomes, e.g. Clinical Dementia Rating scale.ResultsDuring September 2017-May 2019, 93 individuals were randomized (32 lifestyle intervention, 31 lifestyle + medical food, and 30 control group). Overall recruitment rate was 76.2% (64.8% during the first 6 months). Overall 6-month retention rate was 91.4% (lifestyle intervention 87.5%; lifestyle + medical food 90.3%; control 96.7%). Domain-specific adherence in the lifestyle intervention group was 71.9% to cognitive training, 78.1% exercise, 68.8% nutritional guidance, and 81.3% vascular risk management; and in the lifestyle + medical food group, 90.3% to cognitive training, 87.1% exercise, 80.7% nutritional guidance, 87.1% vascular risk management, and 87.1% medical food. Compared with control, both intervention arms showed healthy diet improvements (βLifestyle×Time = 1.11, P = 0.038; βLifestyle+medical food×Time = 1.43, P = 0.007); the lifestyle + medical food group also showed vascular risk reduction (P = 0.043) and less cognitive-functional decline (P < 0.05, exploratory analysis). There were 5 serious adverse events (control group: 1; lifestyle intervention: 3; lifestyle + medical food: 1) unrelated to interventions.ConclusionsThe multidomain lifestyle intervention, alone or combined with medical food, had good feasibility and adherence in prodromal AD. Longer-term cognitive and other health benefits should be further investigated in a larger-scale trial.Trial registrationClinicalTrials.gov NCT03249688.

Healthy lifestyle change and all-cause and cancer mortality in the European Prospective Investigation into Cancer and Nutrition cohort

BackgroundHealthy lifestyles are inversely associated with the risk of noncommunicable diseases, which are leading causes of death. However, few studies have used longitudinal data to assess the impact of changing lifestyle behaviours on all-cause and cancer mortality.MethodsWithin the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, lifestyle profiles of 308,497 cancer-free adults (71% female) aged 35–70 years at recruitment across nine countries were assessed with baseline and follow-up questionnaires administered on average of 7 years apart. A healthy lifestyle index (HLI), assessed at two time points, combined information on smoking status, alcohol intake, body mass index, and physical activity, and ranged from 0 to 16 units. A change score was calculated as the difference between HLI at baseline and follow-up. Associations between HLI change and all-cause and cancer mortality were modelled with Cox regression, and the impact of changing HLI on accelerating mortality rate was estimated by rate advancement periods (RAP, in years).ResultsAfter the follow-up questionnaire, participants were followed for an average of 9.9 years, with 21,696 deaths (8407 cancer deaths) documented. Compared to participants whose HLIs remained stable (within one unit), improving HLI by more than one unit was inversely associated with all-cause and cancer mortality (hazard ratio [HR]: 0.84; 95% confidence interval [CI]: 0.81, 0.88; and HR: 0.87; 95% CI: 0.82, 0.92; respectively), while worsening HLI by more than one unit was associated with an increase in mortality (all-cause mortality HR: 1.26; 95% CI: 1.20, 1.33; cancer mortality HR: 1.19; 95% CI: 1.09, 1.29). Participants who worsened HLI by more than one advanced their risk of death by 1.62 (1.44, 1.96) years, while participants who improved HLI by the same amount delayed their risk of death by 1.19 (0.65, 2.32) years, compared to those with stable HLI.ConclusionsMaking healthier lifestyle changes during adulthood was inversely associated with all-cause and cancer mortality and delayed risk of death. Conversely, making unhealthier lifestyle changes was positively associated with mortality and an accelerated risk of death.