Individual Health Goals Research Articles

CONSUMER PERCEPTIONS TOWARDS INTAKE AND PRESCRIPTION OF ORGANIC FOOD PRODUCTS FOR HEALTH SUSTAINABILITY

The impact of our eating habits on health and the environment, as well as the consequences, is becoming more widely recognized. Individuals should learn to assess their daily consumption and actively participate in the process. The study’s main goal is to determine consumer perception of organic food products. This study aims to fill knowledge vacuum by studying consumer perspectives on organic food products. The current study using both quantitative and qualitative research approaches. The sample of 200 respondents provides an overview of consumer perceptions towards intake organic food products among youth girls. This research is expected to contribute to the existing body of knowledge on consumer behavior towards organic food products. Furthermore, the insights gained from this study can inform policymakers, healthcare professionals, and industry stakeholders about effective ways to promote the adoption of organic food products for both individual health and broader sustainability goals. Key Words: Consumer perception, Organic food, Sustainability, Intake prescription, Food consumption.

McDonald's food target recognition and calorie display based on YOLOv5 algorithm

This research paper delves into the development and assessment of a novel food recognition and evaluation system tailored for McDonald's menu items, leveraging the capabilities of the YOLOv5 algorithm. The study demonstrates that the system can successfully identify McDonald's food items from images and seamlessly query calorie and nutritional information from a backend database. The data is then presented to the user, aiding in more informed dietary choices and promoting public health awareness. The system has particular utility for McDonald's customers, facilitating real-time decisions that align with individual health goals and nutritional requirements. Our experimental findings show a high degree of accuracy and efficiency, although the system's scope is currently limited to five key menu items. Future directions for this work include expanding the range of recognizable food categories and implementing user feedback mechanisms to refine recognition accuracy. Moreover, the paper discusses potential optimizations for reducing system response time and further enhancing the practical utility of the technology. This research serves as a significant step towards utilizing computer vision technologies for public health interventions, aiming to combat the rise of obesity and related diseases.

Using artificial intelligence for exercise prescription in personalised health promotion: A critical evaluation of OpenAI's GPT-4 model.

The rise of artificial intelligence (AI) applications in healthcare provides new possibilities for personalized health management. AI-based fitness applications are becoming more common, facilitating the opportunity for individualised exercise prescription. However, the use of AI carries the risk of inadequate expert supervision, and the efficacy and validity of such applications have not been thoroughly investigated, particularly in the context of diverse health conditions. The aim of the study was to critically assess the efficacy of exercise prescriptions generated by OpenAI's Generative Pre-Trained Transformer 4 (GPT-4) model for five example patient profiles with diverse health conditions and fitness goals. Our focus was to assess the model's ability to generate exercise prescriptions based on a singular, initial interaction, akin to a typical user experience. The evaluation was conducted by leading experts in the field of exercise prescription. Five distinct scenarios were formulated, each representing a hypothetical individual with a specific health condition and fitness objective. Upon receiving details of each individual, the GPT-4 model was tasked with generating a 30-day exercise program. These AI-derived exercise programs were subsequently subjected to a thorough evaluation by experts in exercise prescription. The evaluation encompassed adherence to established principles of frequency, intensity, time, and exercise type; integration of perceived exertion levels; consideration for medication intake and the respective medical condition; and the extent of program individualization tailored to each hypothetical profile. The AI model could create general safety-conscious exercise programs for various scenarios. However, the AI-generated exercise prescriptions lacked precision in addressing individual health conditions and goals, often prioritizing excessive safety over the effectiveness of training. The AI-based approach aimed to ensure patient improvement through gradual increases in training load and intensity, but the model's potential to fine-tune its recommendations through ongoing interaction was not fully satisfying. AI technologies, in their current state, can serve as supplemental tools in exercise prescription, particularly in enhancing accessibility for individuals unable to access, often costly, professional advice. However, AI technologies are not yet recommended as a substitute for personalized, progressive, and health condition-specific prescriptions provided by healthcare and fitness professionals. Further research is needed to explore more interactive use of AI models and integration of real-time physiological feedback.

Progress in the study of the effects of medical nutrition therapy on adverse pregnancy outcomes in patients with gestational diabetes mellitus and their offspring

Gestational diabetes mellitus (GDM) belongs to a particular type of diabetes mellitus. Not only are patients with GDM at a more significant risk of converting to diabetes mellitus later in life, but GDM can also have both short-term and long-term effects on the health of the mother and child, such as congenital anomalies, spontaneous abortions, macrosomia, preterm labor, excessive amniotic fluid, and many other adverse outcomes. Medical nutrition therapy (MNT) interventions for patients with GDM can be extremely beneficial to the pregnancy outcomes of GDM patients and their offspring by helping them to act on their individual and clear health goals and adopt healthy behaviors. The article starts from the effect of MNT on the pregnancy outcome of GDM patients and their offspring, reviews the latest research progress on the adverse pregnancy outcome of GDM patients and their offspring, and analyzes the problems and importance of medical nutrition therapy for GDM patients with the aim of better promoting the outcome of GDM patients mothers and infants, and reaching the long-term effect of MNT.

Review of the Prospective Significance and Recommendations of Pearl Millet (Pennisetum glaucum) for Diabetes Mellitus

Pearl millet (Pennisetum glaucum) is a nutritious and drought-resistant cereal grain that has been traditionally grown in many parts of the world, particularly in arid and semiarid regions. In recent years, there has been growing interest in the potential significance of pearl millet in the management and prevention of diabetes mellitus. This review will discuss some of the prospective benefits and significance of pearl millet for individuals with diabetes mellitus. Pearl millet has a low glycemic index, which means it has a relatively slow and steady impact on blood sugar levels when compared to high-GI foods. This is particularly beneficial for individuals with diabetes as it can help control post-meal blood sugar spikes. It's important to note that while pearl millet can be a valuable addition to the diet of individuals with diabetes, it should be part of a well-balanced diet that is tailored to their specific needs. The overall dietary approach should be coordinated with a healthcare professional or dietitian to ensure that it aligns with the individual's health goals and needs. Additionally, individuals with diabetes should monitor their blood sugar levels and make adjustments to their diet in consultation with a healthcare provider, as the impact of specific foods can vary from person to person. Pearl millet, like any other food, should be consumed in moderation as part of a diversified diet. In conclusion, pearl millet has the potential to be a significant component of a diabetes-friendly diet due to its low glycemic index, high fiber content, nutrient profile, and antioxidant properties. However, it should be part of an overall strategy that includes other healthy eating habits and lifestyle choices to effectively manage and prevent diabetes mellitus.

1043-P: Uncovering Root Causes Contributing to Persistent Gaps in Glycemic Control and Effective Weight Management in Patients with Type 2 Diabetes and Obesity

This QI initiative in 2 large US-based community health systems assessed root causes hindering A1C control and weight management in people with T2D and obesity through health care provider (HCP) surveys (n = 29), baseline EMR audits (n = 100), team-based audit-feedback (AF) sessions, and patient-provider collaborative education sessions. Lack of treatment access and delayed treatment intensification were identified as factors contributing to inadequate A1C control. In the survey, 48% of HCPs reported providing treatment access support as a top barrier. Missed opportunities to escalate care were revealed through gaps in key care measures for patients not on target to achieve their A1C goal, including reevaluating current diabetes medication (77% HCPs reported routinely performing) and referring patients to a diabetes care and education specialist (49%). Following the AF intervention, the percentage of HCPs who plan to consider therapy escalation within 3 months increased from 38% to 80%. Following collaborative education, the percentage of patients who reported understanding the importance of achieving their A1C goal increased from 47% to 71% and 81% committed to taking a more active role in their diabetes management and self-care. Gaps were uncovered in weight management counseling, support, and shared decision-making (SDM). Asking patients about treatment goals was documented in 57% of charts. Reporting weight loss goal discussion every 3 months were 60% of HCPs and 33% of patients. Following AF sessions, the percentage of HCPs who plan to prioritize SDM as a top 2 goal increased from 21% to 53% and HCPs committed to updating patient materials to support more productive conversations about individual health goals. Key factors hindering attainment of A1C and weight management goals revealed through this study include gaps in treatment access, treatment intensification, SDM, and weight management counseling, support. Disclosure E.Zyborowicz: None. C.Heggen: None. M.A.Rodriguez: None. J.D.Carter: None. J.P.Frias: Advisory Panel; Becton, Dickinson and Company, Pfizer Inc., Sanofi, Consultant; Akero Therapeutics, Inc., 89bio, Inc., Aimmune, Boehringer Ingelheim Inc., Eli Lilly and Company, Carmot Therapeutics, Inc., Echosens, Merck & Co., Inc., Metacrine, Inc., Novo Nordisk, Pfizer Inc., Sanofi, Employee; Ionis Pharmaceuticals, Research Support; Akero Therapeutics, Inc., 89bio, Inc., Altimmune, Axcella Health Inc., Boehringer Ingelheim Inc., Eli Lilly and Company, Intercept Pharmaceuticals, Inc., Carmot Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Metacrine, Inc., Novo Nordisk, Oramed Pharmaceuticals, Novartis, Pfizer Inc., Sanofi, Speaker's Bureau; Eli Lilly and Company, Sanofi. Funding Eli Lilly and Company (A-31209)

Investigation of the effects of bovine collagen peptides and mixed berries on rheological properties and biological activity of egg white-based beverage via central composite design.

Modern consumer expectations have become highly diversified: they want more opportunities to meet diverse family needs (diversity of family members in age, gender, physical activity, etc. ,) and individual health goals with a huge variety of sensorial preferences. Our research is aimed to develop a protein-dense, highly bioactive, lactose- and whey protein-free beverage applying a central composite rotational design (CCRD) with 2 factors. For this purpose, an egg white-based beverage was flavored with mixed berries (factor A) and enriched with bovine collagen peptides (factor B). After suitable sample preparation, the rheological properties were investigated by an Anton Paar MCR 92 rheometer (with CC 27 system, and flow behavior was analyzed with a Herschel-Bulkley (H-B) model). The antioxidant capacity of samples was investigated by Ferric Reducing Antioxidant Power (FRAP) method, the total anthocyanin content was estimated based on a spectrophotometric method, and the total phenolic content was determined by the Folin Ciocalteu method. Our results are figured on response surfaces demonstrating that both factors and their interactions show a positive correlation with the examined parameters. Based on the CCRD, all investigated parameters are significantly influenced by at least one aspect and can be adequately estimated for further product development.

COVID-19 Vaccine-Related Beliefs and Behaviors Among Patients With and Survivors of Hematologic Malignancies.

Patients with and survivors of hematologic malignancies are particularly vulnerable to COVID-19 disease and complications. This study examined patients' vaccination attitudes and behaviors and their correlates. A two-wave survey was fielded in December 2020 and June 2021 among hematologic malignancy patients and survivors (N = 2,272). Demographic characteristics, intent to get vaccinated, vaccination status, attitudes toward vaccination, and level of trust in specific sources of information about COVID-19 vaccines were assessed. Descriptive statistics were calculated, and linear probability models were estimated to examine binary outcomes and their correlates. In December 2020, before COVID-19 vaccines were available, 73% stated they were likely or very likely to get vaccinated if an FDA-approved vaccine became available; however, in June 2021 over 90% reported being vaccinated. Being younger, unmarried, trusting local faith leaders, and not having a bachelor's degree or more were negatively associated with getting vaccinated. Among those hesitant in December 2020, those who expressed a distrust of vaccines in general were least likely to get vaccinated. Being vaccinated in June 2021 was positively associated with the degree to which respondents trust their oncologist, federal agencies, and pharmaceutical companies. Oncologists and primary care physicians were reported as the most trusted sources for information about vaccines. COVID-19 vaccine hesitancy remains a public policy concern even now, as additional boosters are recommended among vulnerable populations. Our findings suggest that patient trust in their treating physicians can play a critical role in promoting individual patient and public health goals.

COVID-19 triggered a physically active lifestyle of people with cardiovascular diseases: Results of a small Austrian qualitative study.

ObjectiveThis paper explores physical activity patterns and compensation strategies of people with cardiovascular diseases. The aim is to provide insights into the factors and their relationships that may affect physical activity levels positively or negatively during the pandemic.MethodsWe adopted a qualitative approach with 35 participants who were purposively sampled from different provinces in Austria, including rural and urban areas. Semi-structured interviews were conducted during the second COVID-19 wave in autumn/winter 2020 and the fourth wave in autumn/winter 2021. Content analysis was applied to explore physical activity patterns, the perceived impact of the pandemic on physical activity as well as strategies adopted by participants to maintain physically active during the pandemic waves.ResultsResults show encouraging signs of a recovery or even increase in physical activity during the pandemic waves. The main drivers for maintaining or even increasing physical activity were intrinsic motivation and self-determined motivation relating to the pursue of individual health goals. Furthermore, analysis suggests a reinforcing effect of exercising in green natural areas by decreasing perception of effort and increasing motivation. There was also one group who experienced difficulties in adapting physical activity behaviors. Study participants who were used to exercise indoors struggled to replace accustomed activity patterns with alternatives that were not impacted by lockdown restrictions.ConclusionsThis study provides novel qualitative evidence on the effect of COVID-19 lockdowns on physical activity patterns of people with cardiovascular diseases. Public health interventions to enhance a physically active lifestyle during and beyond the COVID-19 pandemic are recommended to target moderate outdoor exercising and enhance adaptive capacities of people with cardiovascular diseases.

Weight stigma and prenatal physical activity: Exploring the perspectives of pregnant women living with obesity

ObjectiveTo identify sources of weight stigma in physical activity (PA)-related milieus reported by pregnant women living with obesity. We also report person-informed strategies to improve the delivery of PA promotions and prescriptions to prevent weight stigma and improve maternal PA. DesignThis is a qualitative descriptive study and semi-structured interviews were conducted. Setting and ParticipantsPurposive sampling including pregnant women living with obesity, with a body mass index ≥35.0 kg/m2, ≥18 years of age, and receiving specialized prenatal care were recruited from an obstetrics clinic in Kingston, Canada. Measurement and FindingsData were assessed by a content analysis, whereby coded themes represented sources of weight stigma related to prenatal PA. Demographic characteristics (pre-pregnancy body mass index, age, gestational age) were summarized and presented as means and standard deviations. In-depth interview data were collected from eight women. Average pre-pregnancy BMI, age, and gestational age were 44.6±4.8 kg/m2, 32.0±4.1 years, 31.1±5.8 weeks, respectively. Two sources of weight stigma related to prenatal PA were identified: 1. Lack of visual representation – online images and images found in exercise promotional material do not include women who have obesity; 2. Lack of individualized recommendations – currently available prenatal PA guidelines and/or recommendations from healthcare providers do not always consider individual physical barriers or health goals women may have. Key Conclusion and Implications for PracticeBy increasing body positive representation of pregnant women exercising and offering person-centered prenatal PA recommendations, maternal PA may improve including women living with obesity. Findings from this work can inform future PA interventions, health promotion programming, and prescriptions from prenatal care providers to implement person-oriented strategies to prevent weight stigma and improve the delivery of care for pregnant women living with obesity.

Evaluating a Whole Health Approach to Enhance Veteran Care: Exploring the Staff Experience

The Whole Health Initiative is a redesign of health care delivery that focuses on administering personalized veteran health plans rather than focusing on treating disease. In 2018, Whole Health launched at 36 Veteran Affairs (VA) facilities throughout the country. Flagship sites (<em>N</em> = 18) implemented the full Whole health system and design sites (<em>N</em> = 18) implemented elements of Whole Health. The project purpose was to identify efforts to improve implementation for this national initiative to improve veterans’ lives. This evaluation project used a cross-sectional design to obtain qualitative semi-structured interview data. Rapid analysis using Consolidated Framework for Implementation Research Constructs (CFIR) was used to identify themes. A snowball sample of 45 staff participants from five design sites and one flagship site participated. Participants represented management and providers among other Whole Health staff. Facilities varied in the degree to which Whole Health was implemented. The provision of leadership support and resources, the need to address national policies and procedures and the need for standardized measures used to measure Whole Health outcomes were common experiences. Implementation of Whole Health to improve veterans’ lives is a complex endeavor. Providers, clinicians, and leadership are engaged and motivated to implement this new delivery model at their facilities, understanding it changes the focus of their relationships with veterans from one of focusing on problems to one of collaboratively working with veterans to achieve individual health goals. Identified barriers limit implementation and expose issues such as lack of facility resources, hiring and training mechanisms, and leadership endorsement. Whole Health is a priority within the VA and the motivation and readiness of VA staff to move into a more collaborative relationship with the veterans they serve are foundational to success and longevity of the program. Our findings created an opportunity to promote sustainable outcomes for future Whole Health implementation efforts.

Influence of Shared Decision Making on Decisional Conflict and Regret in Postpartum Mother–Infant Care: A Randomized Controlled Trial

ObjectivesAlthough postpartum rooming-in is encouraged by the World Health Organization, independent separated nursery care is still widely adopted in Eastern countries. Our aim is to evaluate the effect of shared decision making (SDM) assisted by patient decision aids on subjective decisional conflict and regret among women who are required to make choices regarding postpartum infant care. MethodsA total of 196 pregnant women who came for routine checkups 1 month before delivery were randomly assigned to the SDM group or the classic group. Before the mothers were discharged after delivery, their decision-making difficulties were evaluated. The primary outcome was the decisional conflict, which was assessed using the SURE (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) scale. The secondary outcome was the decisional regret, which was measured using the Decision Regret scale. ResultsCompared with the classic group, SDM group had surer feelings about the choice (P＜.001), felt more confident about knowing the benefits and risks of each option (P＜.001), had a clearer understanding of the benefits and risks (P＜.001), and felt sufficiently supported with enough advice to make a suitable choice (P＜.001). No significant difference was noted in the Decision Regret scores between groups. The choice of 24-hour rooming-in, 12-hour rooming-in, and separated nursery care was not significantly different between groups. ConclusionsSDM reduced the decisional conflict and uncertainty of the mothers. Available choices of postpartum mother–infant care should be provided to mothers through SDM that includes individual values, health goals, and clear knowledge and transparency.

Development of a Multicomponent Intervention to Initiate Health Behavior Change in Primary Care: The Kickstart Health Program.

There is a growing movement to integrate behavioral health specialists into primary care settings in order to better manage patients' health behaviors. Group interventions in healthcare settings can provide services to multiple individuals simultaneously; however, the participants' experiences taking part in these activities and the logistics of integrating them into clinical settings are largely under-studied. This article describes the development and implementation of a novel group intervention for health behavior change, The Kickstart Health Program, which integrates components of cognitive, behavioral, acceptance, and experiential therapies. Participant feasibility, acceptability, experiences, and treatment course were assessed. Acceptability among a small sample of attendees was high, and initial data on behavior change suggest there were benefits to patients who attended the program. Increases in mindfulness practice and decreases in exercise barriers from baseline to 10-week follow-up were detected as were improvements in overall perceived health and well-being. Participants expressed that the program was acceptable and successful at helping them reach their individual health goals; however, enrollment barriers negatively impacted the feasibility of the program in regard to attendance. Modification to the enrollment process such as embedding referrals into the electronic medical record, encouraging spouse or family co-enrollment, and peer coaching may address these barriers. The Kickstart Health Program has the potential to improve health behaviors and paves the way for unique studies of dissemination and implementation of efficacious behavioral health interventions into real-world healthcare settings.

E-LEARNING: APPROPRIATE E-MATERIALS FORMATTING FOR USERS HEALTH

E-learning has a direct relationship with public health as e-materials are making a huge amount of near workload for e-learners' eyes. As it is known, the huge near workload is one of the main reasons for the myopia development of nowadays population. The visual system can quickly become overloaded, especially by inappropriate e-material formatting. Based on theoretical research, incorrect formatting is used in most e-materials based on wrong recommendations. Recommendations and methodologies are not up-to-date for screen use. According to publications in the period of more than 20 years, near work and accommodation are the key factors for myopia development and progression. Appropriate formatting parameters of e-materials play an important role in reducing possible risk factors for myopia development. It could be achieved by using appropriate formatting parameters for e-learners. E-material font type must be perceptible and comprehensible from the screen, font size and line spacing must be appropriate for the reader based at least on its age and intellectual level, colour of background and text must help perception and reading process and could be different for each individual. All variables are important for individual and public health goals. New recommendations and automatization of the formatting process are developed to reach improvement.

Socio-environmental influences on Nordic walking participation and their implications for well-being

This article presents a mixed method approach to merge the results from quantitative and qualitative studies into Nordic walking. By doing so, this study provides the multiple perspectives of the social and environmental influences on participation in Nordic walking together with exploration of the relationships between Nordic walking and well-being. Two hundred twenty British Nordic walking practitioners completed the online questionnaire about socio-environmental influences on their walking and measured their mental wellbeing using the Warwick Edinburgh Mental Well-being Scale (WEMWBS). Ten women and two men with various levels of Nordic walking experience were interviewed during walking events in the United Kingdom. By employing a thematic analysis, socio-environmental influences and their implications for well-being were explored.This study adds a further dimension to the theoretical knowledge of the role of the social and environmental factors that influence the engagement in Nordic walking and contribute to well–being.The findings suggest that Nordic walking can benefit well-being through promoting positive feelings related to the companionship in a group, offering social support of instructors in reaching individual health and fitness goals, providing the options for exploring personal capacities and developing skills, which contribute to a sense of achievement and self-worth, and leading to feelings of satisfaction with the activity. Management implicationsThe management implication of this study is in acknowledging that the growing popularity of Nordic walking as a leisure activity provides the opportunity for reinventing leisure walking as an innovative means to maintain and improve physical health of the sedentary and older populations.Public health strategies for adopting Nordic walking as a health intervention should also acknowledge its well-being benefits, positive social interactions and skills development that rise from the participation.Urban planning policies should focus on developing aesthetic walkable neighbourhoods characterised by well-maintained paths and lighting that promote physical activity.The successful implementation of strategies to promote Nordic walking clearly has the potential to make a substantial contribution towards increasing the activity levels of the sedentary and older populations.

Project Management Strategies and Sustainability of Community Based Health Projects in Mandera County, Kenya

Mandera County,Kenya has shown a lot of commitment in the health sector. However, in spite of the efforts by the County to undertake health projects; there is a number of projects whose sustainability have been in jeopardy. There is myriad of challenges undermining the sustainability of the projects developed. The purpose of the study was to determine the effect of project management strategies on sustainability of community based health projects in Mandera County, Kenya. The specific objectives were: to establish the effect of resource mobilization and utilization, community participation, capacity building, and leadership styles on sustainability of community based health projects in Mandera County, Kenya. The study adopted a descriptive design. The target population was 27 health projects within Mandera County,Kenya. The respondents were 81 respondents who included the community leaders, donors, the County health officials such as the executive committee and the chief officer for health. The study collected primary data through use of questionnaires. The collected data was analyzed through descriptive and inferential statistics. The study findings were that there was a strong correlation coefficient between sustainabilityqof community based health projects and resource mobilization and utilization, there exists a significant positive relationship between community participation and sustainability of community based health projects in Mandera County, Kenya there was a positive correlation coefficient between sustainability of community based healthq projects in Mandera County and capacity building and there was a positive correlation between leadership styles and sustainability of community based health projects in Mandera County,Kenya. The study concludes that community members have individual and collective resources such as time, money, materials and energy to contribute toward their individual and collective health goals, if a project does not have the resources it requires to implement a project plan it cannot be prosperous hence projects obtain these resources from both internal and external sources such as stakeholders or community contribution and project leaders need to have clarity of purpose and tasks; good organizational skills; ability to communicate tasks and expected results effectively. The study recommends that organizations need to seek for resources from like minded institutions and proper use of resources enhances sustainability of community based health projects and determining goals should be carried out together with the community since this enhances sustainability of community based health projects in the area and community responsibilities in the health projects determine their sustainability.

Nephrologists' perspectives on ambulatory care of patients with non-dialysis chronic kidney disease - A qualitative study.

Little is known on the perspectives of nephrologists on managing non-dialysis patients with chronic kidney disease (CKD). The purpose of this qualitative study was to explore the experiences and perspectives of nephrologists regarding the interface with general practitioners (GP) and GPs' management of patients with non-dialysis CKD, so that barriers to cooperation and need for improved management can be identified. Twenty semi-structured interviews were conducted for this qualitative study. The interviews were audio-recorded and coded to be analysed. The concept of knowledge systems served as a sensitising concept. Optimising underlying diseases, medication adaptation and patient awareness of CKD were regarded as the most important treatment measures in CKD management. Differing views exist on who should be responsible for lifestyle interventions, patient education and timing of referral. Nephrologists generally preferred the referral of patients with high progression risk and co-treatment models in which daily care was performed by GP, but some preferred referral of all patients with early CKD and some nephrologists stated that patient care should be in the hands of nephrologists entirely in case of CKD. Doctor-patient communication predominantly remained within the medical-scientific knowledge system whereas patients' everyday knowledge systems were rarely considered. While stressing optimisation of laboratory values, diabetes and hypertension, patients' perspectives and shared decision-making to identify and prioritise patients' individual health goals were rarely considered by nephrologists. Instead, most nephrologists regarded educating patients and GPs as an important part of their professional role. Defining the interface between GPs and nephrologists, with specific recommendations on when to refer and which tasks each professional group should perform can lead to standardisation and improved interdisciplinary management of CKD patients. Addressing patients' everyday knowledge systems can be valuable in formulating and prioritising health goals with patients.

Abstract 011: Comprehensive Cardiovascular Risk Reduction Trial in Persons With Serious Mental Illness (IDEAL Trial)

Introduction: Persons with serious mental illness (SMI) are at high risk for cardiovascular disease (CVD), with CVD mortality with rates at least twice those of the overall US. Potentially modifiable CV risk behaviors (tobacco smoking, obesity, physical inactivity, unhealthy diet) and risk factors (hypertension, diabetes, dyslipidemia) are all markedly elevated in persons with SMI. This vulnerable population often has substantial challenges related to cognitive impairment and psychiatric symptoms in addition to high prevalence of substance use, low income and social isolation. Accomplishing meaningful reductions in CVD risk for persons with SMI will require special efforts to develop interventions to promote CV health in this high-risk group. Our objective was to determine the effectiveness of an 18-month comprehensive CVD risk reduction intervention in adults with SMI. Hypothesis: The active intervention is more effective than the control condition in reducing CVD risk as assessed by the global Framingham Risk Score (FRS). Methods: We conducted a NHLBI-sponsored RCT in 269 adults with SMI who had at least one of the following CV risk behaviors/ factors: BMI≥25 kg/m 2 , tobacco smoking, hypertension, diabetes, or dyslipidemia. Participants were recruited from four locations of an outpatient community mental health organization. Those in the active intervention received an 18-month individual-level intervention delivered by a health coach and a nurse providing 1) tailored CVD risk reduction counseling; 2) collaboration with physicians to implement appropriate management of CVD health risks; and 3) coordination with mental health staff and social supports to encourage and motivate attainment of individual CV health goals. We also provided training and resources to promote group physical activity classes, and a dietician to consult with kitchen staff to provide healthier meals (accessible to all mental health program attendees). Results: At baseline, mean(SD) age was 48.8(11.9) years, range 21-71. Of 269, 48% (N=128) were male, 46% (125) were African-American, 84%(226) received disability, 59%(159) had schizophrenia/schizoaffective disorder, 25%(67) had bipolar disorder, and 14%(38) had depression. BMI was 33.7(7.2) kg/m 2 ; 51% (138) smoked tobacco, 52% (141) had hypertension, 35% (93) had diabetes, 65%(175) had dyslipidemia. Mean(SD) baseline global FRS was 12.1(12.1)% overall, 16.9(14.6)% for men, 7.9(6.8)% for women. By October 15, 2018, 94%(253 of 269) participants completed the trial and had 18-month data collected. Eighteen-month data collection for the trial will conclude in November, 2018. Conclusion: Unless effective interventions that effect CV health outcomes are implemented, populations with SMI will continue to lag far behind the nation’s CVD goals. The IDEAL intervention is well positioned to address all CV risks in persons with SMI.

Competency Based Approach to Community Health (COACH): The methods of a family-centered, community-based, individually adaptive obesity randomized trial for pre-school child-parent pairs

Competency-Based Approaches to Community Health (COACH) is a randomized controlled trial of a family-centered, community-based, and individually-tailored behavioral intervention for childhood obesity among Latino pre-school children. COACH focuses on improving personal agency for health behavior change by tailoring content to overcome contextual barriers. The intervention focuses on diet, physical activity, sleep, media use, and engaged parenting. The content is individually adapted based on routine assessments of competency in specific health behaviors using a mobile health platform and novel measurement tools developed by our team. In response to these regular assessments, health coaches provide tailored health behavior change strategies to help families focus on the areas where they decide to improve the most. The intervention consists of a 15-week group-based intensive phase, with weekly sessions delivered by health coaches in community centers. Following weekly sessions, a 3-month maintenance phase of the intervention consists of twice monthly coaching calls for participants to focus on individual health goals for their families.The primary outcome of the trial is child body mass index trajectory over 1 year. Secondary outcomes include parent body mass index change, child waist circumference, child diet, child physical activity, and other psychosocial mediators of child health behavior change. The control arm consists of a school readiness intervention, delivered by the Nashville Public Library.By applying a personalized approach to child behavior change, in the setting of both family and community, COACH aims to develop sustainable solutions for childhood obesity by supporting healthy childhood growth in low-income, minority preschool children.

Diabetes Prevention Using a Simulation Model That Explains Individual Variability in Response to Diet Change

Objectives: Limited understanding of the causes of variability in individual response to similar lifestyle changes makes it challenging to design individualized diet plans for diabetes prevention. We previously reported a simulation model of lifestyle disease and tested it using data from DPP and a low carb-low fat diet crossover study. Here we used the model to analyze data from J-DOIT1 to understand the causes of variability and to optimize diet therapy. Methods: J-DOIT1 is a large-scale intervention study of 2,607 subjects with a 5.5 year follow-up. We selected 60 baseline-matched individuals from placebo and intervention arms. Model was calibrated to each subject’s body weight, FPG, HbA1c time courses to estimate physiology and lifestyle parameters (e.g., RMR, diet intake). Simulation analysis was used to optimize individual diet. Results: Individuals with the most and least improved biomarkers showed no significant difference in model-estimated energy balance or in self-reported lifestyle at baseline. Neither caloric deficit nor linear combinations of model-estimated parameters were predictive of outcomes, showing the value of our complex physiological model for prediction. The model suggests that unique sets of optimal diets exist for achieving individual health goals (Fig. 1). Fig. 1. Optimized changes in fat and carbohydrate intake for two individuals to reduce body weight by 5-7%. Fig. 1. Optimized changes in fat and carbohydrate intake for two individuals to reduce body weight by 5-7%. Disclosure J.H. Chen: None. M. Fukasawa: None. Q. Chen: None. S.P. Burns: None. K. Kumar: None. S. Nirengi: None. K. Takahashi: None. A. Suganuma: None. H. Kuzuya: None. N. Sakane: Research Support; Spouse/Partner; Pwc. G. Dwivedi: None.