Lifestyle Domains Research Articles

Past or Present; Which Exposures Predict Metabolomic Aging Better? The Doetinchem Cohort Study.

People age differently. Differences in aging might be reflected by metabolites, also known as metabolomic aging. Predicting metabolomic aging is of interest in public health research. However, the added value of longitudinal over cross-sectional predictors of metabolomic aging is unknown. We studied exposome-related exposures as potential predictors of metabolomic aging, both cross-sectionally and longitudinally in men and women. We used data from 4 459 participants, aged 36-75 of Round 4 (2003-2008) of the long-running Doetinchem Cohort Study (DCS). Metabolomic age was calculated with the MetaboHealth algorithm. Cross-sectional exposures were demographic, biological, lifestyle, and environmental at Round 4. Longitudinal exposures were based on the average exposure over 15 years (Round 1 [1987-1991] to 4), and trend in these exposure over time. Random Forest was performed to identify model performance and important predictors. Prediction performances were similar for cross-sectional and longitudinal exposures in both men (R2 6.8 and 5.8, respectively) and women (R2 14.8 and 14.4, respectively). Biological and diet exposures were most predictive for metabolomic aging in both men and women. Other important predictors were smoking behavior for men and contraceptive use and menopausal status for women. Taking into account history of exposure levels (longitudinal) had no added value over cross-sectionally measured exposures in predicting metabolomic aging in the current study. However, the prediction performances of both models were rather low. The most important predictors for metabolomic aging were from the biological and lifestyle domain and differed slightly between men and women.

Acquired hypothalamic dysfunction in childhood: 'what do patients need?' - an Endo-ERN survey.

Hypothalamic dysfunction is a rare condition and can be encountered in patients who have been diagnosed or treated for a suprasellar brain tumor. Due to its rarity, the signs and symptoms of hypothalamic dysfunction may be difficult to recognize, leading to delayed diagnosis of the suprasellar brain tumor or to difficulties in finding the health-care expertise for hypothalamic dysfunction after tumor treatment. To improve the care and outcome of patients with acquired hypothalamic dysfunction, professionals are required to understand the patient's needs. A worldwide online survey was distributed from April 2022 to October 2022 to patients with childhood-onset hypothalamic dysfunction (as reported by the patient) following a brain tumor. Patients were notified about the survey through patient advocacy groups, the SIOPe craniopharyngioma working group and the Endo-ERN platform. In total, 353 patients with hypothalamic dysfunction following craniopharyngioma (82.2%), low-grade glioma (3.1%) or a pituitary tumor (8.2%) or caregivers responded to the survey. Sixty-two percent had panhypopituitarism. Obesity (50.7%) and fatigue (48.2%) were considered the most important health problems. Unmet needs were reported for help with diet, exercise and psychosocial issues. Patients' suggestions for future research include new treatments for hypothalamic obesity and alternative ways for hormone administration. According to the patient's perspective, care for acquired hypothalamic dysfunction can be improved if delivered by experts with a holistic view of the patient in a multidisciplinary setting with a focus on quality of life. Future care and research on hypothalamic dysfunction must integrate the patients' unmet needs. Patients with hypothalamic dysfunction may experience a variety of symptoms, which are not always adequately recognized or addressed. In previous papers, the perspective of caregivers of children with craniopharyngioma has been reported (Klages et al. 2022, Craven et al. 2022). Now we address the patients' perspective on acquired hypothalamic dysfunction using an Endo-ERN global survey. According to the patients' perspective, care can be improved, with needs for improvement in the domains of obesity, fatigue and lifestyle. Research may focus on ways to improve hypothalamic obesity and alternative ways for hormone administration. Ideally, care should be delivered by doctors who have a holistic view of the patient in a multidisciplinary expert team. The results of this study can be used to formulate best practices for clinical care and to design future research proposals.

Lifestyle factors related to prevalent chronic disease multimorbidity: A population-based cross-sectional study.

Multimorbidity is associated with poor quality of life, polypharmacy, health care costs and mortality, with those affected potentially benefitting from a healthy lifestyle. We assessed a comprehensive set of lifestyle factors in relation to multimorbidity with major chronic diseases. This cross-sectional study utilised baseline data for adults from the prospective Lifelines Cohort in the north of the Netherlands (N = 79,345). We defined multimorbidity as the co-existence of two or more chronic diseases (i.e. cardiovascular disease, cancer, respiratory disease, type 2 diabetes) and evaluated factors in six lifestyle domains (nutrition, physical (in)activity, substance abuse, sleep, stress, relationships) among groups by the number of chronic diseases (≥2, 1, 0). Multinomial logistic regression models were created, adjusted for appropriate confounders, and odds ratios (OR) with 95% confidence intervals (95%CI) were reported. 3,712 participants had multimorbidity (4.7%, age 53.5 ± 12.5 years), and this group tended to have less healthy lifestyles. Compared to those without chronic diseases, those with multimorbidity reported physical inactivity more often (OR, 1.15; 95%CI, 1.06-1.25; not significant for one condition), chronic stress (OR, 2.14; 95%CI, 1.92-2.38) and inadequate sleep (OR, 1.70; 95%CI, 1.41-2.06); as expected, they more often watched television (OR, 1.70; 95%CI, 1.42-2.04) and currently smoked (OR, 1.91; 95%CI, 1.73-2.11), but they also had lower alcohol intakes (OR, 0.66; 95%CI, 0.59-0.74). Chronic stress and poor sleep, in addition to physical inactivity and smoking, are lifestyle factors of great concern in patients with multimorbidity.

Self-rated health and its related influencing factors among emergency department physicians: a national cross-sectional study.

Protecting and improving the personal health of healthcare workers is critical to improving the efficiency and quality of care. To effectively meet the needs of the emergency service system, emergency physicians need to be in a good state of health. However, due to the special characteristics of work in the emergency department, emergency physicians have to face various psychosocial pressures, which may bring them physical and mental distress. Therefore, this study aims to explore the emergency physicians' self-rated health status and its related factors, to provide an empirical study for the improvement of emergency physicians' self-rated health status. A cross-sectional survey of emergency physicians was conducted in China between July and August 2018. The questionnaires contained items on demographic characteristics, behavioral lifestyle and job-related factors, as well as self-rated health. The generalized ordinal logistic model was used to identify related factors of emergency physicians' self-rated health status. Only 14.4% of Chinese emergency physicians considered themselves in good health status. Results showed that emergency physicians who never exercised (β = 0.76, p < 0.001) and exercised <2 times per week (β = 0.34, p < 0.001) were more likely to report poor health status. In addition, emergency physicians with good sleep quality (β = -3.84, p < 0.001), fewer night work shifts (β = -0.47, p < 0.001), less frequency of visiting patients (β = -0.33, p < 0.001), never suffered the workplace violence (β = -0.47, p < 0.001) and never perceived effort-reward imbalance (β = -0.68, p < 0.001) were more likely to report good self-rated health. Chinese emergency physicians' self-rated health status was not optimistic. Self-rated health is associated with multiple domains of work-related factors and personal lifestyle. Feasible measures should be taken to improve the working environment of emergency physicians, develop acceptable shift schedules for employees, monitor and maintain the health status of emergency department physicians.

Cognitive and physical age gaps in relation to mild cognitive impairment and behavioral phenotypes.

We can study how fast our biological aging clocks tick by calculating the difference (i.e., age gaps) between machine learning estimations of biological age and chronological age. While this approach has been increasingly used to study various aspects of aging, few had applied this approach to study cognitive and physical age gaps; not much is known about the behavioral and neurocognitive factors associated with these age gaps. In the present study, we examined these age gaps in relation to behavioral phenotypes and mild cognitive impairment (MCI) among community-dwelling older adults. Participants (N = 822, Agemean = 67.6) were partitioned into equally-sized training and testing samples. Cognitive and physical age-prediction models were fitted using nine cognitive and eight physical fitness test scores, respectively, within the training samples, and subsequently used to estimate cognitive and physical age gaps for each subject in the testing sample. These age gaps were then compared among those with and without MCI and correlated with 17 behavioral phenotypes in the domains of lifestyle, well-being, and attitudes. Across 5000 random train-test split iterations, we showed that older cognitive age gaps were significantly associated with MCI (versus cognitively normal) and worse outcomes across several well-being and attitude-related measures. Both age gaps were also significantly correlated with each other. These results suggest accelerated cognitive and physical aging were linked to worse well-being and more negative attitudes about the self and others and reinforce the link between cognitive and physical aging. Importantly, we have also validated the use of cognitive age gaps in the diagnosis of MCI.

Фреймовое моделирование предметной области ЗДОРОВЫЙ ОБРАЗ ЖИЗНИ в арабском медиадискурсе

The work studies the content of the HEALTHY LIFESTYLE domain in the Arabic linguistic consciousness through the use of methods of frame, conceptual and contextual analysis of the vocabulary belonging to the domain under consideration. The collective, culturally and nationally conditioned understanding of this domain is examined. The aim of the paper is to build a frame model of the HEALTHY LIFESTYLE domain in the Arabic-language media discourse. Frames, subframes and slots revealing the content and structure of the vocabulary of the HEALTHY LIFESTYLE domain (نمط الحياة الصحية) in the studied worldview, as well as the features of its verbalization in the Arabic-language media discourse are identified and analyzed. The paper is novel in that it is the first to categorize and parameterize the HEALTHY LIFESTYLE domain in media texts in Arabic linguoculture based on frame analysis. As a result, the research revealed the objective essential features of the HEALTHY LIFESTYLE domain at the semantic level, classified its nuclear and peripheral features and provided a description of the experience of modeling the HEALTHY LIFESTYLE domain using frame structure.

Identifying key multi-modal predictors of incipient dementia in Parkinson's disease: a machine learning analysis and Tree SHAP interpretation.

Persons with Parkinson's disease (PD) differentially progress to cognitive impairment and dementia. With a 3-year longitudinal sample of initially non-demented PD patients measured on multiple dementia risk factors, we demonstrate that machine learning classifier algorithms can be combined with explainable artificial intelligence methods to identify and interpret leading predictors that discriminate those who later converted to dementia from those who did not. Participants were 48 well-characterized PD patients (Mbaseline age = 71.6; SD = 4.8; 44% female). We tested 38 multi-modal predictors from 10 domains (e.g., motor, cognitive) in a computationally competitive context to identify those that best discriminated two unobserved baseline groups, PD No Dementia (PDND), and PD Incipient Dementia (PDID). We used Random Forest (RF) classifier models for the discrimination goal and Tree SHapley Additive exPlanation (Tree SHAP) values for deep interpretation. An excellent RF model discriminated baseline PDID from PDND (AUC = 0.84; normalized Matthews Correlation Coefficient = 0.76). Tree SHAP showed that ten leading predictors of PDID accounted for 62.5% of the model, as well as their relative importance, direction, and magnitude (risk threshold). These predictors represented the motor (e.g., poorer gait), cognitive (e.g., slower Trail A), molecular (up-regulated metabolite panel), demographic (age), imaging (ventricular volume), and lifestyle (activities of daily living) domains. Our data-driven protocol integrated RF classifier models and Tree SHAP applications to selectively identify and interpret early dementia risk factors in a well-characterized sample of initially non-demented persons with PD. Results indicate that leading dementia predictors derive from multiple complementary risk domains.

Cardiovascular disease (CVD) outcomes and associated risk factors in a medicare population without prior CVD history: an analysis using statistical and machine learning algorithms.

There is limited information on predicting incident cardiovascular outcomes among high- to very high-risk populations such as the elderly (≥ 65years) in the absence of prior cardiovascular disease and the presence of non-cardiovascular multi-morbidity. We hypothesized that statistical/machine learning modeling can improve risk prediction, thus helping inform care management strategies. We defined a population from the Medicare health plan, a US government-funded program mostly for the elderly and varied levels of non-cardiovascular multi-morbidity. Participants were screened for cardiovascular disease (CVD), coronary or peripheral artery disease (CAD or PAD), heart failure (HF), atrial fibrillation (AF), ischemic stroke (IS), transient ischemic attack (TIA), and myocardial infarction (MI) for a 3-yr period in the comorbid history. They were followed up for up to 45.2months. Analyses included descriptive approaches in terms of incidence rates and density ratios, and inferential in terms of main effect statistical/complex machine learning modeling. The contemporary risk factors of interest spanned across the domains of comorbidity, lifestyle, and healthcare utilization history. The cohort consisted of 154,551 individuals (mean age 68.8years; 62.2% female). The overall crude incidence rate of CVD events was 9.9 new cases per 100 person-years. The highest rates among its component outcomes were obtained for CAD or PAD (3.6 for each), followed by HF (2.2) and AF (1.8), then IS (1.3), and finally TIA (1.0) and MI (0.9).Model performance was modest in terms of discriminatory power (C index: 0.67, 95%CI 0.667-0.674 for training; and 0.668, 95%CI 0.663-0.673 for validation data), equal agreement between predicted and observed events for calibration purposes, and good clinical utility in terms of a net benefit of 15 true positives per 100 patients relative to the All-patient treatment strategy. Complex models based on machine learning algorithms yielded incrementally better discriminatory power and much improved goodness-of-fitness tests from those based on main effect statistical modeling. This Medicare population represents a highly vulnerable group for incident CVD events. This population would benefit from an integrated approach to their care and management, including attention to their comorbidities and lifestyle factors, as well as medication adherence.

Changes in supportive care needs over time from diagnosis up to two years after treatment in head and neck cancer patients: A prospective cohort study

To investigate changes in supportive care needs (SCNs) over time from diagnosis up to 2 years after treatment among head and neck cancer (HNC) patients, in relation to demographic, personal, clinical, psychological, physical, social, lifestyle, and cancer-related quality of life factors. Data of the longitudinal NETherlands QUality of Life and Biomedical Cohort study (NET-QUBIC) was used. SCNs were measured using the Supportive Care Needs Survey (SCNS-SF34) and HNC-specific module (SCNS–HNC) before treatment, three, six, 12 and 24 months after treatment. Linear mixed model analyses were used to study SCNs on the physical & daily living (PDL), psychological (PSY), sexuality (SEX), health system, information and patient support (HSIPS), HNC-functioning (HNC-Function), and lifestyle (HNC-Lifestyle) domain, in relation to demographic, personal, clinical, psychological, physical, social, lifestyle, and cancer-related symptoms as measured at baseline. In total, 563 patients were included. SCNs changed significantly over time. At baseline, 65% had ≥1 moderate/high SCN, versus 42.8% at 24 months. Changes in PDL needs were associated with gender, tumor location, smoking, fear of cancer recurrence, oral pain, and appetite loss, changes in PSY with tumor location, fear of recurrence, social support, emotional functioning, physical functioning, coughing, and use of painkillers, changes in SEX with treatment, changes in HSIPS with muscle strength, changes in HNC-Function with tumor stage, location, social support, physical functioning, fatigue, nausea and vomiting, and speech problems, and changes in HNC-Lifestyle with smoking and alcohol use. SCNs diminish over time, but remain prevalent in HNC patients.

The Effect of Lifestyle on Pain Intensity in Knee Osteoarthritis Patients

Background &amp; Objectives: Knee osteoarthritis (OA) is a degenerative condition that damages the cartilage in the knee joint. The cartilage is a soft, rubbery tissue that acts as a joint cushion and friction reducer. As the joint’s cartilage diminishes, the bones rub against one another, resulting in pain, stiffness, and less mobility. Knee OA is a painful disorder that progresses with time and affects the whole knee joint, leading to varying pain intensity, stiffness, and swelling in the knee. It can also lead to disability, and Lifestyle factors were found to be related to knee OA. This study’s aim was to evaluate how lifestyle choices affected knee OA in patients visiting hospitals in Mosul, Iraq. The specific objectives of the study were to:1. Evaluate the socio-demographic characteristics for knee OA patients. To identify the lifestyle factors for patients with knee OA. To assess the effect of lifestyle on the pain intensity of knee OA. Methods: A cross-sectional study design was adopted for the period extended from the 1st of December 2022, to the 20th of July 2023. It included 500 knee osteoarthritis patients collected from consulting clinics in four teaching hospitals in Mosul, Iraq, by using a developed interviewing and self-admission questionnaire that assessed sociodemographic characteristics, health history, lifestyle factors, and the pain intensity on knee OA patients. Results: The mean age of patients (59.4) The majority of the participants were female (83.4%). (74.6%) of the sample were housewives, (75.4%) lived in urban. The most common risk factors for knee OA were obesity (27.2%), and family history (47.4%). (90.8%) of the patients had low education level. 37.2% of them at severe levels of constant pain intense. 28.6% of them at moderate levels of intermittent pain. Most of patients have a sedentary lifestyle. There are significant association between lifestyle domains with joint pain intensity. Lifestyle domains, except health self-responsibility and nutrition, significantly impact constant pain in knee and Health self-responsibility is associated with intermittent pain. Conclusion: Certain demographic and socio-demographic factors, such as age, gender, education, residency, occupation, BMI, previous knee injuries, and family history, had a significant association with knee osteoarthritis patients. This study has shown that lifestyle factors play a role in the pain intensity of knee OA. Lifestyle factors, such as physical activity, stress management, and enough sleep, have been shown to be effective in managing joint pain.. The findings can suggest that modification of lifestyle may be a protective against knee OA. Participants who reported being more physically active, eating a healthier diet, and maintaining a healthy weight were less likely to have knee pain. Keyword: Knee Osteoarthritis, Life-Style, Factor

Impact of Lifestyle on Knee Osteoarthritis in Mosul Hospitals

Background &amp; Objectives: Osteoarthritis (OA) is the most prevalent form of arthritis. It is a chronic, degenerative disease of the musculoskeletal system that causes significant disability in patients all over the world. The knee is the most commonly affected joint by OA, especially in older people. Knee OA is a painful disorder that progresses with time and affects the whole knee joint, leading to varying degrees of severe joint failure. It can cause pain, stiffness, and swelling in the knee. It can also lead to disability ,and Lifestyle factors were found to be related to knee OA. This study’s aim was to evaluate how lifestyle choices affected knee OA in patients visiting hospitals in Mosul, Iraq. The specific objectives of the study were to 1 Evaluate demographic characteristics of individuals with knee OA. 2 Discover the lifestyle factors for patients with knee OA. 3 Determine the relationship between lifestyle and the severity of knee OA. Methods: A cross-sectional study design was adopted for the period extended from the 1st of December 2022, to the 20th of July 2023. It included 500 knee osteoarthritis patients collected from consulting clinics in four teaching hospitals in Mosul, Iraq, by using a developed interviewing questionnaire that assessed sociodemographic characteristics, health history, lifestyle factors, and the severity of knee OA. Results: The mean age of patients (59.4) The majority of the participants were female (83.4%). (74.6%) of the sample were housewives, (75.4%) lived in urban. The most common risk factors for knee OA were obesity (27.2%), and family history (47.4%). (90.8%)of the patients had low education level. Patients had bilateral joint OA(right and left) were 64.6%. Most of patients have a sedentary lifestyle. There are significant association between lifestyle domains like health self-responsibility, nutrition, physical activity, stress management, and spiritual growth with joint OA severity. The highest association between lifestyle domains and severity is seen in the areas of health self-responsibility, diet, and physical exercise. Conclusion: Certain demographic and socio-demographic factors, such as age, gender, education, residency, occupation, BMI, previous knee injuries, and family history, had a significant association with knee osteoarthritis patients. This study has shown that lifestyle factors play a role in the development and severity of knee OA. Physical inactivity, poor diet, and obesity are all major risk factors for knee OA. The findings can suggest that modification of lifestyle may be a protective against knee OA. Participants who reported being more physically active, eating a healthier diet, and maintaining a healthy weight were less likely to have severe knee OA. Interventions that target lifestyle factors may be beneficial in preventing and managing knee OA. Keyword: Knee Osteoarthritis, Life-Style, Factor

A lifestyle monitoring system for cardiovascular care: protocol of a prospective observational trial

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation. Background In cardiac rehabilitation, technological innovations can improve patient-relevant outcomes and are associated with reductions in health care costs by enabling personalized care. Lifestyle factors such as physical fitness, dietary habits, mental stress, and sleep quality, are strong predictors of the occurrence, clinical course, and overall treatment outcomes of common cardiovascular diseases such as coronary artery disease and atrial fibrillation. However, these lifestyle factors are rarely monitored, nor used in daily clinical practice and personalized cardiac care. Moreover, non-adherence to long-term self-reporting is common. Purpose The main purpose of this study is to evaluate adherence to a continuous unobtrusive and patient-friendly lifestyle monitoring system. Methods In a prospective observational trial we investigate usability and adherence of a monitoring system for lifestyle factors, i.e., daily physical activity levels, dietary habits, mental stress, smoking habit, and sleep quality. Patients (n = 100) scheduled for or who recently underwent coronary artery bypass surgery, an electrophysiology study and/or radiofrequency catheter ablation, a transcatheter aortic valve implantation, a fractional flow reserve test and/or a percutaneous coronary intervention, and/or valve surgery are asked to participate. The monitoring system consists of a care platform with a custom-built conversational interface—a chatbot—and a wrist-worn wearable medical device. The wrist-worn device collects continuous objective data on physical activity and the chatbot collects subjective data (e.g., sleep quality, nutrition intake and mental stress levels), both for 7 separate days per month repeatedly during the study period. Data collection starts one week before treatment and continues until 1-year after discharge. Via a dashboard, patients can observe their lifestyle measures and adherence to self-reporting, track personal goals, and share their lifestyle data with practitioners and relatives. The primary outcome of the trail is adherence to using the integrated platform for self-tracking data. The secondary outcomes include system usability, determinants of adherence and the relation between baseline lifestyle behaviour and long-term patient-relevant outcomes. Discussion Systematic monitoring during daily life is key to gain insights into patients’ lifestyle behaviours. In this context, adherence to monitoring systems is critical for cardiologists and other care providers to obtain crucial information to personalize care. In this project, we present insights into the evaluation of adherence to monitoring technology including a conversational agent and continuous monitoring, focusing on multiple lifestyle domains for one year. This work contributes to our understanding of adherence, patient-centred data collection and interpretation, to enable personalized cardiac interventions, improve patient-relevant outcomes, and reduce health care costs.

Evaluation of an application for self-assessment of cardiovascular risk behaviour: a pilot study

Abstract Funding Acknowledgements Type of funding sources: None. Background An important aim of cardiac rehabilitation (CR) programs is to reduce the risk of further cardiac events and improve the ability of people living with cardiovascular disease to manage their symptoms. Current CR strategies focus on (lifestyle) behaviour change, however, often patients are not activated enough to generate and self-sustain this lifestyle behaviour change. To stimulate adherence to lifestyle change recommendations, health behaviour should be (self-)assessed and then optimized in a personalized treatment plan. Although lifestyle monitoring apps are emerging rapidly, these applications are mostly targeted at a single lifestyle domain and often lack clinical validation. Purpose The purpose of the study was to evaluate the usability of a self-developed mobile application (Lifestylescore), that enables (self-)assessment of all cardiovascular risk behaviour domains (e.g. body composition, physical activity and sedentary behaviour, smoking, alcohol consumption, nutrition behaviour and psychological stress), using a combination of validated instruments. Secondly, it was investigated whether the use of the app was associated with an increase in patient activation and health behaviour improvement. Methods In this single-centre, non-randomized observational pilot study patients referred for CR due to coronary artery disease (stable angina pectoris or acute coronary syndrome, or after coronary revascularization) were recruited. Patients were asked to complete the Lifestylescore application, and, in addition, the Patient Activation Measure (PAM-13), and System Usability Scale (SUS). All measurements were performed during the intake procedure (baseline) and after completion of the rehabilitation program (after three months (follow-up)). After completion of the application, patients discussed the results with their CR case manager and set individual goals. Results All participants (n = 20) completed the study. The participants scored the Lifestylescore application with a SUS-score of above average (&amp;gt;68). Patient activation did not increase after the CR program as compared to baseline. Although the majority of the patients acknowledged that activation for lifestyle improvement is important, only a small minority reported that they took action (Figure 1). Also, there was no improvement in lifestyle behaviour after completion of CR (Figure 2). Conclusions The Lifestylescore application showed acceptable usability among CR patients. However, its use was not associated with an increase in patient activation, nor with an improvement in lifestyle behaviour after CR. Therefore, further research is needed to evaluate how the application should be incorporated in the CR program to further increase patient’s awareness, empowerment and, ultimately, effectuate more sustained behavioral change.

Adherence to the Mediterranean lifestyle pattern is associated with favorable weight loss outcomes: the MedWeight study

Individual lifestyle targets have been associated with weight loss outcomes, yet few studies have examined associations of one's total lifestyle with weight loss maintenance. We aimed to examine the relationship between lifestyle patterns and weight loss outcomes in weight loss maintainers and regainers. We hypothesized that higher adherence to a broader healthy lifestyle favors maintenance (over regain). This is a cross-sectional analysis of 470 adults (62% women) with a history of overweight/obesity and significant weight loss 12 months before study entry. Participants were classified as maintainers (current weight ≤90% maximum weight) or regainers. They were asked to fill in a series of questionnaires on demographics and lifestyle habits (dietary intake and eating behaviors through two 24-hour recalls, physical activity, and sleep). A total Mediterranean Lifestyle Index (total-MLI, range 0-13) was generated by summing up ratings in the lifestyle domain quartiles (diet quality, physical activity, and sleep habits) and dietary behaviors (seasonal food and vegetable intake, intake of traditional foods, responsibility for food preparation, conviviality). Maintainers scored higher in the total-MLI than regainers (6.93 ± 2.31 vs 5.78 ± 2.49, P < .001). Adherence to the total-MLI was associated with 28% higher odds for weight loss maintenance (per unit increment) in linear analyses. Being in the highest total-MLI quartile was associated with 5.27 (95% CI, 2.77-10.02) odds for maintenance. Higher adherence to a comprehensive Mediterranean lifestyle pattern was associated with higher odds for weight loss maintenance. Our findings suggest that even modest shifts toward a healthier living may contribute to favorable weight loss outcomes.

Clinical guidelines for the use of lifestyle-based mental health care in major depressive disorder: World Federation of Societies for Biological Psychiatry (WFSBP) and Australasian Society of Lifestyle Medicine (ASLM) taskforce

Objectives The primary objectives of these international guidelines were to provide a global audience of clinicians with (a) a series of evidence-based recommendations for the provision of lifestyle-based mental health care in clinical practice for adults with Major Depressive Disorder (MDD) and (b) a series of implementation considerations that may be applicable across a range of settings. Methods Recommendations and associated evidence-based gradings were based on a series of systematic literature searches of published research as well as the clinical expertise of taskforce members. The focus of the guidelines was eight lifestyle domains: physical activity and exercise, smoking cessation, work-directed interventions, mindfulness-based and stress management therapies, diet, sleep, loneliness and social support, and green space interaction. The following electronic bibliographic databases were searched for articles published prior to June 2020: PubMed, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), CINAHL, PsycINFO. Evidence grading was based on the level of evidence specific to MDD and risk of bias, in accordance with the World Federation of Societies for Biological Psychiatry criteria. Results Nine recommendations were formed. The recommendations with the highest ratings to improve MDD were the use of physical activity and exercise, relaxation techniques, work-directed interventions, sleep, and mindfulness-based therapies (Grade 2). Interventions related to diet and green space were recommended, but with a lower strength of evidence (Grade 3). Recommendations regarding smoking cessation and loneliness and social support were based on expert opinion. Key implementation considerations included the need for input from allied health professionals and support networks to implement this type of approach, the importance of partnering such recommendations with behaviour change support, and the need to deliver interventions using a biopsychosocial-cultural framework. Conclusions Lifestyle-based interventions are recommended as a foundational component of mental health care in clinical practice for adults with Major Depressive Disorder, where other evidence-based therapies can be added or used in combination. The findings and recommendations of these guidelines support the need for further research to address existing gaps in efficacy and implementation research, especially for emerging lifestyle-based approaches (e.g. green space, loneliness and social support interventions) where data are limited. Further work is also needed to develop innovative approaches for delivery and models of care, and to support the training of health professionals regarding lifestyle-based mental health care.

Rescripting Riyadh: how the capital of Saudi Arabia employs urban megaprojects as catalysts to enhance the quality of life within the city’s neighborhoods

PurposeThis study aims to investigate whether the correlation between Saudi Arabia’s social and economic reforms, urban megaprojects and sustainable urbanism can lead to an increased quality of life (QoL) in the capital, create a comprehensive lifestyle setup for Riyadh’s residents while also aiming to attract foreign investment.Design/methodology/approachThis research examines five government-sponsored mega-destinations and their master plans against the objectives of Saudi Arabia’s Vision 2030’s Quality of Life Program. Furthermore, the author analyzed to what extent the proposed projects fulfill global mandates of sustainable urban development and how they might help raise the QoL for Riyadh’s residents. The author’s methodology rests primarily on detailed policy evaluation proposed by Vision 2030, literature research and data collected from proposed urban development plans. In parallel, the author conducted informal conversations with people living in affected areas and architectural offices who are involved in the design of the five megaprojects. After collecting the data for each project, the author compared the QoL Program criteria to the data of the proposed megaprojects to examine to what extent the proposed designs implement the QoL criteria of Vision 2030. In the last step, the author evaluated whether and how the proposed plans adhere to globally established guidelines of sustainable urban revitalization by studying possible overlaps and contingencies on an urban level.FindingsThe analysis reveals that although each case study project targets one or more specific lifestyle domains, the projects combined fulfill all lifestyle categories specified in Saudi Arabia’s QoL program. In addition, each project contributes measures to improve livability in the categories of urban design and environment, infrastructure and transport, social engagement and safety while also providing a range of economic and educational opportunities for different demographics. In terms of sustainable development criteria, the analysis demonstrates that all case studies provide ample measures to enhance Riyadh’s mobility by providing greenways for pedestrians and cyclists, which connect to public transport. Furthermore, when strategically combined as a series of urban layers, the projects demonstrate potential to form urban synergies among different lifestyle domains that could positively affect existing and proposed neighborhoods, particularly when extended through an inclusive, participatory planning framework, which, in turn, could significantly raise the QoL for a broad socioeconomic demographic.Research limitations/implicationsThis research reveals the complex role of megaprojects as change agents for socioeconomic reforms, as signifiers of livability and as planning frameworks to implement sustainable urbanism in Saudi Arabia’s capital, while also creating a lifestyle infrastructure for Riyadh’s residents.Practical implicationsWith their sensitive approach to climate, ecologically driven landscape projects and regionalist architecture inspired by the traditional Arab city, these case study projects may serve as an example to other countries in hot arid zones on sustainably revitalizing their urban environments.Social implicationsThis study demonstrates how social and economic reforms intertwine with sustainable urban planning and placemaking to create a comprehensive lifestyle setup for Riyadh’s residents that has not previously existed. On the planning side, this includes creating a massive public infrastructure that encourages walkability and residents’ active participation in recreational, cultural, entertainment and sports activities. However, as the analysis has also revealed, while offering a large number of public facilities, the projects do not embrace a mixed-income project model, which would allow low-income families to live within a market-rate environment. In addition, one of the projects entails the displacement of benefit low-income and migrant communities. Although the government has a separate program that specifically aims at providing affordable housing in other areas of the city, these model destinations primarily target luxury tourists and affluent Saudis, potentially cementing existing socio-spatial divides in the city. Consequently, the megaprojects demonstrate Saudi Arabia’s conflicted response to the logic of entrepreneurial neoliberalism: on the one side, progressive attempts to promote an egalitarian approach to urban livability; on the other, strategic efforts to use megaprojects as spectacular showcases in the global marketplace.Originality/valueThe correlation between Saudi Arabia’s socioeconomic reforms, megaprojects and sustainable urbanism in Riyadh has not been previously explored. Compared to Western countries’ cities, few attempts have been made to investigate the role of livability in the context of emerging countries’ fast-growing urban areas. This paper presents a considerable case study in Saudi Arabia that ties into a more extensive debate on cultural globalization where cities, particularly in the developing world, use megaprojects as change agents to reconstruct their urban territories according to standardized livability indices to elevate their image in the global marketplace.

The Whole PERSON Health Score: A Patient-Focused Tool to Measure Nonmedical Determinants of Health

Summary The development of a plan to deliver health care in America often ignores the nonmedical deficits in patients’ socioeconomic resources, well-being, and quality of life, all of which contribute to patient dissatisfaction, poor clinical outcomes, and higher health care costs and utilization. Social determinants of health have been recognized as significant contributors to health, well-being, and, ultimately, longevity, but have been largely unaddressed in primary care because clinicians lack the tools and training to incorporate them while delivering routine care. Riverside University Health System developed a novel and holistic patient-centered assessment tool named the Whole PERSON Health Score (WPHS) to address these critical needs. This article discusses the framework involved in developing, implementing, and evaluating the WPHS in a multidisciplinary, primary care, safety-net setting. The assessment tool consists of 28 questions (or elements) across six domains of health (one for each letter in the PERSON score [Physical Health, Emotional Health, Resource Utilization, Socioeconomics, Ownership, and Nutrition and Lifestyle]) that were chosen on the basis of a literature review of factors that affect lifespan, mortality, and longevity. The patient receives a letter grade ranging from A (the best) to Z (the worst) in each domain. The A–Z letter assignment is not based on a normalized calculation. Rather, letter assignment is based on anticipated impact on life expectancy. The grades are classified into three colors — red, yellow, and green — on the basis of the severity of the intervention needed. This color-coding system highlights the areas of critical need and prompts the provider to engage with the patient to act. Riverside administered 10,166 WPHS assessments from August 2020 to October 2021, out of which 9,809 were completed, representing 8,829 unique patients. In this article, analysis focuses on the 7,926 unique patients who completed a single assessment, to avoid any confusions pertaining to longitudinal analysis. Overall, the greatest need was in the Nutrition and Lifestyle domain (15.22% of the patients assessed, but 49.79% of all red-zone triggers). That domain was followed by Emotional Health (10.59% of patients, 34.64% of red-zone triggers), and Socioeconomics (9.35% of patients, 30.59% of red-zone triggers). In contrast, the least-triggered need for intervention was the Physical Health domain (1.35% of patients, 4.42% of red-zone triggers). On the basis of a provider survey, the value of the WPHS in providing care differed by discipline. The value was greatest for the Probationer Care Management team, which focuses on the needs of recently released probationers (84.61%), followed by the Behavioral Health integration team (66.67%), the Complex Care Management team (50%), and the Primary Care team (44.82%). The WPHS nudges health care teams to prioritize nontraditional upstream patient needs, including emotional health, ownership, and social determinants of health. Completing the WPHS assessment did lead to a recognition of the nonmedical needs of the patient.

The Role of Personality Traits and Lifestyle in Predicting Anxiety and Depression During the Covid-19 Pandemic: A Web-Based Cross-Sectional Study

Background: Social gathering restrictions and quarantine for reducing the spread of coronavirus can reduce social interactions and cause mental health problems such as depression and anxiety. Objective This study aims to investigate the role of personality traits and health-promoting lifestyles in predicting anxiety and depression during the COVID-19 pandemic in Najafabad, Iran Methods: This is a cross-sectional study conducted in April 2021 during the fourth wave of the COVID-19 outbreak. The study population consisted of people aged &gt;18 years old living in Najafabad. Using a convenience sampling method, 225 people were selected and completed questionaries online. Of these, the data of 217 questionnaires were analyzed. Beck Depression Inventory, Corona Disease Anxiety Scale, short form of Big-Five-Factor Inventory, and Walker’s Health Promoting Lifestyle Profile were used to collect data. Data analysis was performed using Multiple Linear Regression and SPSS v. 24 statistical software. Results: The personality traits of neuroticism (r=0.343, r=0.176) and extraversion (r=-0.503, r=-0.375) were positively and negatively correlated with depression and anxiety, respectively, and were the predictive of depression and anxiety (P&lt;0.05). The agreeableness trait (r=0.233) was also negatively correlated with anxiety, and was its significant predictor (P&lt;0.05). Among the health-promoting lifestyle domains, self-fulfillment (r=-0.489) and physical activity (r=-0.348) had a negative correlation with depression, while health responsibility (r=-0.285) had a negative correlation with anxiety; they were the significant predictors of depression and anxiety (P&lt;0.05) during the COVID-19 pandemic. Conclusion: Given the effect of personality traits and health-promoting lifestyles on depression and anxiety during the COVID-19 outbreak, the interventions focused on these components can be effective in improving the mental health of people.

A study protocol of the adaptation and evaluation by means of a cluster-RCT of an integrated workplace health promotion program based on a European good practice

BackgroundAn integrated workplace health promotion program (WHPP) which targets multiple lifestyle factors at different levels (individual and organizational) is potentially more effective than a single component WHPP. The aim of this study is to describe the protocol of a study to tailor a European good practice of such an integral approach to the Dutch context and to evaluate its effectiveness and implementation.MethodsThis study consists of two components. First, the five steps of the Map of Adaptation Process (MAP) will be followed to tailor the Lombardy WHP to the Dutch context. Both the employers and employees will be actively involved in this process. Second, the effectiveness of the integrated Dutch WHPP will be evaluated in a clustered randomized controlled trial (C-RCT) with measurements at baseline, 6 months and 12 months. Clusters will be composed based on working locations or units - dependent on the organization’s structure and randomization within each organization takes place after baseline measurements. Primary outcome will be a combined lifestyle score. Secondary outcomes will be the separate lifestyle behaviors targeted, stress, work-life balance, need for recovery, general health, and well-being. Simultaneously, a process evaluation will be conducted. The study population will consist of employees from multiple organizations in different industry sectors. Organizations in the intervention condition will receive the integrated Dutch WHPP during 12 months, consisting of an implementation plan and a catalogue with activities for multiple lifestyle themes on various domains: 1) screening and support; 2) information and education; 3) adjustments in the social, digital or physical environment; and 4) policy.DiscussionThe MAP approach provides an appropriate framework to systematically adapt an existing WHPP to the Dutch context, involving both employers and employees and retaining the core elements, i.e. the catalogue with evidence-based activities on multiple lifestyle themes and domains enabling an integrated approach. The following process and effect evaluation will contribute to further insight in the actual implementation and effectiveness of the integrated WHP approach.Trial registrationNTR (trialregister.nl), NL9526. Registered on 3 June 2021.

Validity, reliability, and responsiveness of the Swedish version of Western Ontario Osteoarthritis of the Shoulder index

BackgroundThe Western Ontario of the Shoulder index (WOOS) is a patient-reported, disease-specific instrument, designed to measure quality of life in patients with osteoarthritis of the shoulder. The Swedish Shoulder Arthroplasty Registry (SSAR) uses WOOS and EuroQoL 5-dimensions 3 levels (EQ-5D-3L) as patient reported outcome measures. The purpose of this study was to test the validity, responsiveness, and reliability of the Swedish translation of WOOS for patients with osteoarthritis of the shoulder.MethodsData was collected from three shoulder arthroplasty studies performed during 2005–2013, with 23, 21, and 19 patients respectively. Forms were collected preoperatively, and postoperatively between 12 and 24 months. WOOS and EQ-5D-3L were used in all three studies. Additionally, the Oxford Shoulder Score (OSS) (n = 23) was used in one study, and the Constant-Murley score (CMS) (n = 40) in two of the studies. Validity was analysed by calculating Pearson’s correlation coefficient (PCC). Cronbach’s alpha (CA) was used to estimate internal consistency and reliability. The responsiveness of WOOS was measured by calculating effect size and standardized response mean. To assess the performance of WOOS over time, we present repeated measures of WOOS in the registry over a 10-year period.ResultsThe validity analysis showed excellent correlations of WOOS to CMS, OSS and EQ-5D 3L, with Pearson’s correlation coefficient of 0.72, 0.83, and 0.62 respectively (P < 0.001). There were adequate floor effects in the sport and lifestyle domains preoperatively, and adequate ceiling effects in all domains postoperatively. There were no floor effects and adequate ceiling effects for total WOOS. Analyzing reliability, Cronbach’s alpha was 0.95 for the pre- and postoperative WOOS scores combined. The analysis of responsiveness for WOOS showed an effect size of 2.52 and a standardized response mean of 1.43.The individual results measured by WOOS within the registry shows stable levels from 1 to 10 years.ConclusionThe Swedish translation of WOOS is valid, reliable, and responsive for use in a clinical setting for patients with glenohumeral osteoarthritis treated with shoulder arthroplasty, and we regard it as an appropriate instrument for use in the Swedish Shoulder Arthroplasty Registry.