Lifestyle-related Outcomes Research Articles

Chronotype and lifestyle in the transition to adulthood: Exploring the role of sleep health and circadian misalignment

ObjectivesThe present study aimed at exploring the association between eveningness and lifestyle-related variables, that is, body mass index, alcohol, and cigarette consumption, in adults (18-40years), focusing on the possible moderator effect of age and the role of sleep disturbances and circadian misalignment (social jetlag). MethodsA web-based survey was administered to 437 participants, covering demographics, lifestyle-related variables, chronotype, sleep quality, and daytime sleepiness. A subset of 206 participants wore a wrist actigraph for a week, allowing the creation of a sleep health index within the RU-SATED framework. Regression analysis was used to investigate the associations between chronotype and lifestyle-related outcomes, accounting for social jetlag and sleep health; and to explore the lifestyle trajectories over time. ResultsEvening chronotypes showed higher body mass index levels, consumed more alcohol, and smoked more cigarettes than other circadian typologies, in particular after 25 years of age. Poor sleep health and social jetlag significantly contribute to explaining evening types smoking behavior, while not affecting body mass index levels. Social jetlag plays a more important role compared to sleep disturbances and eveningness in predicting more detrimental drinking and smoking behavior. ConclusionsParticipants who maintain the evening trait past the age of 25years are more prone to adopt an unhealthy lifestyle, especially if experiencing poor sleep health and circadian misalignment. Circadian preferences and sleep health should be considered when planning interventions aimed at promoting healthy lifestyles in adults aged 18-40years. Further investigations should explore the effect of modifications in lifestyle in the prevention of noncommunicable diseases.

Abstract B060: Bridging gaps in cancer care: Evaluating community health worker presence in Alabama on rates of cancer screening and lifestyle-related outcomes

Abstract Purpose Alabama has the 7th highest cancer mortality in the US. The University of Alabama at Birmingham O’Neal Comprehensive Cancer Center—the only NCI-designated comprehensive cancer center in the state—endeavors to reduce cancer mortality and burden. For 25 years, its Office of Community Outreach and Engagement (OCOE) has applied a community health worker (CHW) outreach and engagement model for cancer awareness, navigation to screening and healthy lifestyle promotion. OCOE hired and trained CHWs to provide services in counties with highest cancer burden. CHW presence fluctuated over time due to grant-funding and other extraneous events. This study evaluates the association of CHW presence with cancer screening and lifestyle-related outcomes. Methods We utilized latest CDC PLACES data (drawn from 2018 and 2020 Behavioral Risk Factor Surveillance System) which provides model-based, population-level age-adjusted prevalence estimates of county-level cancer screening (breast, cervical, colon) and lifestyle outcomes (physical inactivity, obesity, smoking). We evaluated change in rates over time between counties with and without CHW presence using linear mixed effects models. Results Compared to counties without CHW presence, those with CHW presence in 2020 had 0.7% higher mammography rate in 2018 (95% CI: -0.8, 2.3) and 0% difference in mammography rate per year change (95% CI: -0.6, 0.7); counties with CHW presence in both years had 2.8% higher mammography rate (95% CI: 1.1, 4.6) and 0.2% faster increase in mammography rate per year (95% CI: -0.5, 1.0). Counties with CHW presence in both 2018 and 2020 had 1.8% lower rate of colon cancer screening in 2018 (95% CI: -3.6, 0.02) and 1.3% increase in colon cancer screening per year (95% CI: 0.5, 2.1). Counties with CHW presence in 2020 had 1% higher physical inactivity rate in 2018 (95% CI: -2.3, 4.3) and 0.3% faster decrease in physical inactivity rate per year (95% CI: -1.0, 0.4); counties with CHW presence in both years had 3.6% higher physical inactivity rate in 2018 and 0.2% faster decrease in physical inactivity rate per year (95% CI: -0.8, 0.5). Counties with CHW presence in 2020 only had 1.8% higher obesity rate in 2018 (95% CI: -1.7, 5.2) and 0.9% faster decline in obesity rate per year (95% CI: -2.2, 0.4); counties with CHW presence in both years had 5.1% higher obesity rate in 2018 (95% CI: 1.9, 8.3) and 0.3% faster decline in obesity rate per year (95% CI: -1.6, 0.9). There were no statistically significant differences for cervical cancer screening or smoking. Conclusion The OCOE CHW model provided access, education and empowerment for AL residents to obtain cancer screenings and participate in healthy lifestyle behaviors. CHW presence (particularly sustained presence over time) was associated with improved mammography and colon cancer screening, reduced physical inactivity and reduced obesity. Further study of CHW presence and these outcomes during and post COVID-19 is ongoing. Expansion of the CHW model across the entire state is a priority to reduce cancer mortality among Alabamians. Citation Format: Mackenzie E. Fowler, Claudia Hardy, Silvia Gisiger-Camata, Francine Walton, Rochelle Wallace, Tara Bowman, Aldenise P. Ewing, Timiya S. Nolan. Bridging gaps in cancer care: Evaluating community health worker presence in Alabama on rates of cancer screening and lifestyle-related outcomes [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B060.

Effectiveness of a blended mobile-based lifestyle intervention in women with glucose intolerance after a recent history of gestational diabetes (MELINDA): a 1-year, prospective, multicentre, randomised controlled trial

Women with glucose intolerance after gestational diabetes mellitus (GDM) are at high risk to develop type 2 diabetes. Traditional lifestyle interventions in early postpartum have limited impact. We investigated the efficacy of a blended mobile-based lifestyle intervention in women with glucose intolerance after a recent history of GDM. Prospective, double-arm, non-masked, multicentre randomised controlled trial (RCT) in which women with glucose intolerance, diagnosed 6-16 weeks after a GDM-complicated pregnancy, were assigned 1:1 to a one-year blended-care, telephone- and mobile-based lifestyle program (intervention) or usual care (control). Primary endpoint was the proportion of women able to achieve their weight goal (≥5% weight loss if prepregnancy BMI ≥ 25kg/m2 or return to prepregnancy weight if prepregnancy BMI < 25kg/m2) in the intention-to-treat sample. Key secondary outcomes were frequency of glucose intolerance, diabetes and metabolic syndrome, and lifestyle-related outcomes assessed with self-administered questionnaires. The study was registered in ClinicalTrials.gov (NCT03559621). Between April 10th 2019 and May 13th 2022, 240 participants were assigned to the intervention (n=121) or control group (n=119), of which 167 (n=82 in intervention and n=85 in control group) completed the study. Primary outcome was achieved by 46.3% (56) of intervention participants compared to 43.3% (52) in the control group [odds ratio (OR) 1.13, 95% confidence interval (CI) 0.63-2.03, p=0.680; risk ratio 1.07, 95% CI (0.78-1.48)]. Women in the intervention group developed significantly less often metabolic syndrome compared to the control group [7.3% (6) vs. 16.5% (14), OR 0.40, CI (0.22-0.72), p=0.002], reported less sedentary behaviour and higher motivation for continuing healthy behaviours. In the intervention group, 84.1% (69) attended at least eight telephone sessions and 70.7% (58) used the app at least once weekly. A blended, mobile-based lifestyle intervention was not effective in achieving weight goals, but reduced the risk to develop metabolic syndrome. Research fund of University Hospitals Leuven, Novo Nordisk, Sanofi, AstraZeneca, Boehringer-Ingelheim, Lilly.

Efficacy of a digital lifestyle intervention on health-related QUAlity of life in non-small cell LUng CAncer survivors following inpatient rehabilitation: protocol of the QUALUCA Swiss multicentre randomised controlled trial

IntroductionNon-small cell lung cancer (NSCLC) survivors suffer from impaired physical and psychological functioning and reduced health-related quality of life (HRQoL) that persist after active treatment ends. Sustaining rehabilitation benefits, promoting...

Benefits of cardiac rehabilitation following acute coronary syndrome for patients with and without diabetes: a systematic review and meta-analysis

AimThe benefits of cardiac rehabilitation (CR) after acute coronary syndrome (ACS) are well established. However, the relative benefit of CR in those with comorbidities, including diabetes, is not well understood. This systematic review and meta-analysis examined the benefit of CR on exercise capacity and secondary outcomes in ACS patients with a co-diagnosis of diabetes compared to those without.MethodsFive databases were searched in May 2021 for randomised controlled trials (RCTs) and observational studies reporting CR outcomes in ACS patients with and without diabetes. The primary outcome of this study was exercise capacity expressed as metabolic equivalents (METs) at the end of CR and ≥ 12-month follow-up. Secondary outcomes included health-related quality of life, cardiovascular- and diabetes-related outcomes, lifestyle-related outcomes, psychological wellbeing, and return to work. If relevant/possible, studies were pooled using random-effects meta-analysis.ResultsA total of 28 studies were included, of which 20 reported exercise capacity and 18 reported secondary outcomes. Overall, the studies were judged to have a high risk of bias. Meta-analysis of exercise capacity was undertaken based on 18 studies (no RCTs) including 15,288 patients, of whom 3369 had diabetes. This analysis showed a statistically significant smaller difference in the change in METs in ACS patients with diabetes (standardised mean difference (SMD) from baseline to end of CR: − 0.15 (95% CI: − 0.24 to − 0.06); SMD at the ≥ 12-month follow-up: − 0.16 (95% CI: − 0.23 to − 0.10, four studies)).ConclusionThe benefit of CR on exercise capacity in ACS patients was lower in those with diabetes than in those without diabetes. Given the small magnitude of this difference and the substantial heterogeneity in the results of the study caused by diverse study designs and methodologies, further research is needed to confirm our findings. Future work should seek to eliminate bias in observational studies and evaluate CR based on comprehensive outcomes.

The impact of eSports and online video gaming on lifestyle behaviours in youth: A systematic review

BackgroundESports has evolved into a hyper-competitive genre of video gaming. Emerging evidence has linked its intense engagement with mental health problems, with implications on youth development. We aim to summarise the impact of eSports and online video gaming on lifestyle outcomes. MethodWe conducted a systematic review and meta-analysis of studies in journals published in the English language since 2011. We searched PubMed, Web of Science (WoS) and Bielefeld Academic Search Engine (BASE) using search strings related to eSports or video-gaming and lifestyle behaviours. ResultsWe identified 3694 studies, 36 of which met the inclusion criteria. The studies reported associations between online video gaming (including eSports participation and consumption) and poor lifestyle outcomes:physical activity-related (decreased levels of physical activity, increased body mass index (BMI) and sedentary behaviour)nutrition-related (poorer diet, sweetened beverage consumption) and sleep-related outcomes (decreased quality/duration, increased sleepiness/sleep deprivation). One study investigated physical lifestyle-related outcomes (eye strain, wrist pain, neck pain) Results indicate a widening breadth of research investigating associations between lifestyle outcomes and online video gaming. ConclusionLifestyle outcomes associated with engagement in eSports and video gaming are important to consider. This emphasizes the need for longitudinal studies which examine characteristics of gaming that may increase young people's risk of practicing unhealthy lifestyle behaviours. The accessibility of eSports to a wide digital audience highlights the need for this sector to promote healthy lifestyle behaviours among consumers and gamers.

Developing Consensus-Based Outcome Domains for Trials in Children and Adolescents With CKD: An International Delphi Survey

The inconsistency in outcomes reported and lack of patient-reported outcomes across trials in children with chronic kidney disease (CKD) limits shared decision making. As part of the Standardized Outcomes in Nephrology (SONG)-Kids initiative, we aimed to generate a consensus-based prioritized list of critically important outcomes to be reported in all trials in children with CKD. An online 2-round Delphi survey in English, French, and Hindi languages. Patients (aged 8-21 years), caregivers/family, and health care professionals (HCPs) rated the importance of outcomes using a 9-point Likert scale (7-9 indicating critical importance) and completed a Best-Worst Scale. We assessed the absolute and relative importance of outcomes. Comments were analyzed thematically. 557 participants (72 [13%] patients, 132 [24%] caregivers, and 353 [63%] HCPs) from 48 countries completed round 1 and 312 (56%) participants (28 [40%] patients, 64 [46%] caregivers, and 220 [56%] HCPs) completed round 2. Five outcomes were common in the top 10 for each group: mortality, kidney function, life participation, blood pressure, and infection. Caregivers and HCPs rated cardiovascular disease higher than patients. Patients gave lower ratings to all outcomes compared with caregivers/HCPs except they rated life participation (round 2 mean difference, 0.1), academic performance (0.1), mobility (0.4), and ability to travel (0.4) higher than caregivers and rated ability to travel (0.4) higher than HCPs. We identified 3 themes: alleviating disease and treatment burden, focusing on the whole child, and resolving fluctuating and conflicting goals. Most participants completed the survey in English. Mortality, life participation, kidney function, and blood pressure were consistently highly prioritized by patients, caregivers, and HCPs. Patients gave higher priority to some lifestyle-related outcomes compared with caregivers/HCPs. Establishing critically important outcomes for all trials in children with CKD may improve consistent reporting of survival, kidney health, and clinical and life impact outcomes that are meaningful for decision making.

A Web-Based Multidomain Lifestyle Intervention for Older Adults: The eMIND Randomized Controlled Trial.

Importance/ObjectiveTo describe the feasibility and acceptability of a 6-month web-based multidomain lifestyle training intervention for community-dwelling older people and to test the effects of the intervention on both function- and lifestyle-related outcomes.Design6-month, parallel-group, randomized controlled trial (RCT).SETTINGToulouse area, South-West, France.ParticipantsCommunity-dwelling men and women, ≥ 65 years-old, presenting subjective memory complaint, without dementia.InterventionThe web-based multidomain intervention group (MIG) received a tablet to access the multidomain platform and a wrist-worn accelerometer measuring step counts; the control group (CG) received only the wrist-worn accelerometer. The multidomain platform was composed of nutritional advices, personalized exercise training, and cognitive training.Main Outcomes and MeasuresFeasibility, defined as the proportion of people connecting to ≥75% of the prescribed sessions, and acceptability, investigated through content analysis from recorded semi-structured interviews. Secondary outcomes included clinical (eg, cognitive function, mobility, health-related quality of life (HRQOL)) and lifestyle (eg, step count, food intake) measurements.ResultsAmong the 120 subjects (74.2 ± 5.6 years-old; 57.5% women), 109 completed the study (n=54, MIG; n=55, CG). 58 MIG subjects connected to the multidomain platform at least once; among them, adherers of ≥75% of sessions varied across multidomain components: 37 people (63.8% of 58 participants) for cognitive training, 35 (60.3%) for nutrition, and three (5.2%) for exercise; these three persons adhered to all multidomain components. Participants considered study procedures and multidomain content in a positive way; the most cited weaknesses were related to exercise: too easy, repetitive, and slow progression. Compared to controls, the intervention had a positive effect on HRQOL; no significant effects were observed across the other clinical and lifestyle outcomes.Conclusions and RelevanceProviding multidomain lifestyle training through a web-platform is feasible and well-accepted, but the training should be challenging enough and adequately progress according to participants’ capabilities to increase adherence. Recommendations for a larger on-line multidomain lifestyle training RCT are provided.

ImPROving TB outcomes by modifying LIFE-style behaviours through a brief motivational intervention followed by short text messages (ProLife): study protocol for a randomised controlled trial

BackgroundSouth Africa is among the seven highest tuberculosis (TB) burden countries. Harmful lifestyle behaviours, such as smoking and alcohol, and poor adherence to medication can affect clinical outcomes. Modification of these behaviours is likely to improve TB treatment outcomes and has proven possible using motivational interviewing (MI) techniques or use of short message service (SMS) text messaging. There have been no studies assessing the effect of combined MI and SMS interventions on multiple lifestyle factors and TB treatment outcomes.MethodsThis is a prospective, multicentre, two-arm individual randomised controlled trial looking at the effectiveness and cost-effectiveness of a complex behavioural intervention (the ProLife programme) on improving TB and lifestyle-related outcomes in three provinces of South Africa. The ProLife programme consists of an MI counselling strategy, delivered by lay health workers, augmented with subsequent SMS. We aim to recruit 696 adult participants (aged 18 years and over) with drug-sensitive pulmonary TB who are current smokers and/or report harmful or hazardous alcohol use. Patients will be consecutively enrolled at 27 clinics in three different health districts in South Africa. Participants randomised individually to the intervention arm will receive three MI counselling sessions one month apart. Each MI session will be followed by twice-weekly SMS messages targeting treatment adherence, alcohol use and tobacco smoking, as appropriate. We will assess the effect on TB treatment success, using standard World Health Organization (WHO) treatment outcome definitions (primary outcome), as well as on a range of secondary outcomes including smoking cessation, reduction in alcohol use, and TB medication and anti-retroviral therapy adherence. Secondary outcomes will be measured at the three-month and six-month follow-ups.DiscussionThis trial aligns with the WHO agenda of integrating TB care with the care for chronic diseases of lifestyle, such as provision of smoking cessation treatments, and with the use of digital technologies. If the ProLife programme is found to be effective and cost-effective, the programme could have significant implications for TB treatment globally and could be successfully implemented in a wide range of TB treatment settings.Trial registrationISRCTN Registry, ISRCTN62728852. Registered on 13 April 2018.

An international Delphi survey helped develop consensus-based core outcome domains for trials in peritoneal dialysis

Shared decision-making about clinical care options in end-stage kidney disease is limited by inconsistencies in thereporting of outcomes and the omission of patient-important outcomes in trials. Here we generated a consensus-based prioritized list of outcomes to be reported during trials in peritoneal dialysis (PD). In an international, online, three-round Delphi survey, patients/caregivers and health professionals rated the importance of outcomes using a 9-point Likert scale (with 7-9 indicating critical importance) and provided comments. Using a Best-Worst Scale (BWS), the relative importance of outcomes was estimated. Comments were analyzed thematically. In total, 873 participants (207 patients/caregivers and 666 health professionals) from 68 countries completed round one, 629 completed round two and 530 completed round three. The top outcomes were PD-related infection, membrane function, peritoneal dialysis failure, cardiovascular disease, death, catheter complications, and the ability to do usual activities. Compared with health professionals, patients/caregivers gave higher priority to six outcomes: blood pressure (mean difference, 0.4), fatigue (0.3), membrane function (0.3), impact on family/friends (0.1), peritoneal thickening (0.1) and usual activities (0.1). Four themes were identified that underpinned the reasons for ratings: contributing to treatment longevity, preserving quality of life, escalating morbidity, and irrelevant and futile information and treatment. Patients/caregivers and health professionals gave highest priority to clinical outcomes. In contrast to health professionals, patients/caregivers gave higher priority to lifestyle-related outcomes including the impact on family/friends and usual activities. Thus, prioritization will inform a core outcome set to improve the consistency and relevance of outcomes for trials in PD.

Workplace health promotion using a digital health programme with monthly telecoaching to improve clinical and lifestyle-related outcomes

To evaluate the effectiveness of a workplace digital health promotion programme with monthly telecoaching on various lifestyle and clinical outcome measures. We recruited 103 participants from an occupational setting in the UK. Participants were assessed at baseline, and 3 and 6 months following intervention to determine the effect of an employer sponsored digital telecoaching …

Super-cognition in aging: Cognitive profiles and associated lifestyle factors

Previous research on older adults with superior cognitive abilities (super-cognition) has typically examined cognition using a single domain approach, which may not adequately capture the multidimensional nature of successful cognitive aging. Furthermore, the lifestyle factors associated with super-cognition have not been studied adequately. The current study examined the cognitive profiles and lifestyle factors associated with super-cognition. Community-dwelling older adults (N = 693) were administered neuropsychological tests and self-reported measures of lifestyle factors at midlife (retrospectively recalled). Then, using an a priori set of criteria, we classified them as super-cognition or normal. A latent class analysis was conducted to examine the different cognitive profiles of super-cognition, and both groups were compared on their lifestyle-related outcomes. A total of 64 and 263 participants met the criteria for super-cognition and normal participants respectively. A three-class solution best described super-cognition among our participants. Approximately half of them had superior immediate memory; two other smaller groups of participants with super-cognition had superior attention, language, and visuospatial abilities. Participants with super-cognition reported less participation in social activities and, frequently, working more than 9 hours/day and feeling stressed, at midlife. Super-cognition among the elderly is associated with having a busier, more socially-isolated and stressful midlife.

Work stress and health problems of professional drivers: a hazardous formula for their safety outcomes.

BackgroundSeveral empirical studies have shown that professional drivers are a vulnerable occupational group, usually exposed to environmental stressors and adverse work conditions. Furthermore, recent studies have associated work-related stress with negative job performances and adverse health outcomes within this occupational group, including cardiovascular diseases and unsafe vehicle operation.ObjectiveThe aim of this study was to describe the working conditions and the health status of this occupational group, and to evaluate the association between the Demand–Control model of job stress and their self-reported health and safety outcomes.MethodsA pooled sample of 3,665 Colombian professional drivers was drawn from five different studies. The Job Content Questionnaire and the General Health Questionnaire were used to measure work stress and self-reported mental health, respectively. Additionally, professional drivers self-reported health problems (hypertension, dyslipidemia, diabetes and overweight) and health-related risky behaviors (smoking and sedentary behavior).ResultsRegarding the Job Demands–Control (JDC) model, it was found that approximately a third part of Colombian professional drivers suffer from high job strain (29.1%). Correlational and multivariate analyses suggest that de JDC model of stress is associated with the professional drivers’ mental health, traffic accidents and fines, but not with other physical and behavioral health-related outcomes, which are highly prevalent among this occupational group, such as hypertension, dyslipidemia, diabetes, overweight, smoking and sedentary behavior.ConclusionThe results of this study suggest that (a) stressful working conditions are associated with health and lifestyle-related outcomes among professional drivers, and (b) that evidence-based interventions are needed in order to reduce hazardous working conditions, job stress rates and their negative impact on the health of this occupational group.

Occupational Therapy for Adults with Overweight and Obesity: Mapping Interventions Involving Occupational Therapists.

Background Worldwide obesity rates are increasing. The effectiveness of occupational therapy in overweight and obese adults has not yet been clarified. Objectives The scoping review aimed at examining the evidence on interventions involving occupational therapists in the treatment of adults with overweight and obesity. Methods Data on interventions involving occupational therapists and reporting on lifestyle-related outcomes in overweight and obese adults was extracted from the databases Cochrane, PubMed, CINAHL, and Embase, including hand and reference search. The scoping review methodology of Arksey and O'Malley was used. Conclusions were based on numerical and narrative analysis. Results Thirteen articles reporting on eleven studies met the inclusion criteria. Several studies showed significant weight loss. However, the studies possessed high heterogeneity and showed insufficient explication of the role and contribution of occupational therapy to the outcomes. Conclusions The interventions with involvement of occupational therapists were suggested to help short-term weight loss. Occupational therapists contributed to the outcomes with a holistic approach, educating on the role of activity, providing technological support, and promoting enjoyment of being active. There is a need for further documentation of the effectiveness, role, and contributions of occupational therapy in the treatment of overweight and obese adults in all settings.

Developing a Set of Core Outcomes for Trials in Hemodialysis: An International Delphi Survey

Survival and quality of life for patients on hemodialysis therapy remain poor despite substantial research efforts. Existing trials often report surrogate outcomes that may not be relevant to patients and clinicians. The aim of this project was to generate a consensus-based prioritized list of core outcomes for trials in hemodialysis. In a Delphi survey, participants rated the importance of outcomes using a 9-point Likert scale in round 1 and then re-rated outcomes in rounds 2 and 3 after reviewing other respondents' scores. For each outcome, the median, mean, and proportion rating as 7 to 9 (critically important) were calculated. 1,181 participants (202 [17%] patients/caregivers, 979 health professionals) from 73 countries completed round 1, with 838 (71%) completing round3. Outcomes included in the potential core outcome set met the following criteria for both patients/caregivers and health professionals: median score≥ 8, mean score≥ 7.5, proportion rating the outcome as critically important≥ 75%, and median score in the forced ranking question<10. Patients/caregivers rated 4 outcomes higher than health professionals: ability to travel, dialysis-free time, dialysis adequacy, and washed out after dialysis (mean differences of 0.9, 0.5, 0.3, and 0.2, respectively). Health professionals gave a higher rating for mortality, hospitalization, decrease in blood pressure, vascular access complications, depression, cardiovascular disease, target weight, infection, and potassium (mean differences of 1.0, 1.0, 1.0, 0.9, 0.9, 0.8, 0.7, 0.4, and 0.4, respectively). The Delphi survey was conducted online in English and excludes participants without access to a computer and internet connection. Patients/caregivers gave higher priority to lifestyle-related outcomes than health professionals. The prioritized outcomes for both groups were vascular access problems, dialysis adequacy, fatigue, cardiovascular disease, and mortality. This process will inform a core outcome set that in turn will improve the relevance, efficiency, and comparability of trial evidence to facilitate treatment decisions.

Internet-Delivered Self-management Support for Improving Coronary Heart Disease and Self-management-Related Outcomes: A Systematic Review.

Introduction:Coronary heart disease (CHD) is associated with significant morbidity and mortality, including mental health comorbidity, which is associated with poor outcomes. Self-management is key, but there is limited access to self-management support. Internet-delivered interventions may increase access.Objective:The aim of this study was to conduct a systematic review to (1) determine the effectiveness of Internet-delivered CHD self-management support for improving CHD, mood, and self-management related outcomes and (2) identify and describe essential components for effectiveness.Method:Randomized controlled trials that met prespecified eligibility criteria were identified using a systematic search of 3 healthcare databases (Medline, PsychINFO, and Embase).Results:Seven trials, which included 1321 CHD patients, were eligible for inclusion. There was considerable heterogeneity between studies in terms of the intervention content, outcomes measured, and study quality. All 7 of the studies reported significant positive between-group effects, in particular for lifestyle-related outcomes. Personalization of interventions and provision of support to promote engagement may be associated with improved outcomes, although more data are required to confirm this. The theoretical basis of interventions was poorly developed though evidence-based behavior change interventions were used.Conclusion:More well-designed randomized controlled trials are needed. These should also explore how interventions work and how to improve participant retention and satisfaction and examine the role of personalization and support within interventions.

0117 Nonmalignant Disease Mortality among Styrene, Fibreglass, and Wood Dust Exposed Workers in the Reinforced Plastic Boatbuilding Industry

ObjectivesTo further evaluate the association of styrene, fibreglass, and wood dust exposure with non-malignant diseases, we extended follow-up through 2008 for 5203 workers exposed to styrene, fibreglass, and wood dust...

Rapid Report on Methodology: Does Loss to Follow-up in a Cohort Study Bias Associations Between Early Life Factors and Lifestyle-Related Health Outcomes?

To examine the consequences of non-response in a follow-up survey for associations between early-life factors and lifestyle-related health outcomes in adulthood. In a cohort of 11532 Danish men born in 1953 we had nearly complete follow-up in the National Patient Register, but only 66% of 9507 eligible cohort members participated in a follow-up survey, in 2004. We examined whether characteristics measured early in life and discharge from hospital for alcohol abuse or tobacco-related lung diseases, were associated with survey response. Associations between the early-life characteristics and these two health outcomes were calculated in the entire cohort and among responders, and the effect of non-response was described by a Relative Odd Ratio (ROR=OR(responders)/OR(entire cohort)). A low response rate at age 50 years was related to having a single mother at birth, low educational attainment at age 18, and low cognitive function at ages 12 and 18. The risk of alcohol overuse and tobacco-related diseases was also highest among non-responders. However, the associations between early-life characteristics and the outcomes were nearly the same in responders as in the entire cohort. Although non-responders differed from responders in terms of early-life exposures and incidence of the lifestyle-related outcomes, we found no overt effects of this on the exposure-risk associations.

Person‐centred planning: factors associated with successful outcomes for people with intellectual disabilities

Recent research in the USA and UK indicates that person-centred planning (PCP) can lead to improvements in lifestyle-related outcomes for people with intellectual disabilities (ID). It is clear, however, that the introduction of PCP does not have an equal impact for all participants. The aim of the present paper was to identify factors associated with the probability of delivering a plan and with improvements in outcomes for those who did receive a plan. Information on the life experiences of participants was collected over a period of approximately 2 years for a cohort of 93 adults with ID. There were powerful inequalities in both access to and the efficacy of PCP in relation to participant characteristics, contextual factors and elements of the PCP process. Results are discussed in relation to implications for policy and practice for increasing the effectiveness of PCP and reducing inequalities in the life experiences of people with ID.