Evaluation of weight loss counsel for Osteoarthritis patients: A cross-sectional analysis of NHANES 2011-2018.

OBJECTIVE: Though health care providers (HCPs) know the importance of weight loss counsel for Osteoarthritis (OA), little is known about how frequently it is practiced and even less of its effectiveness. Thus, we analyzed the prevalence and effectiveness of weight counsel receipt in overweight/obese OA patients. DESIGN: Using 2011-2018 National Health and Nutrition Examination Survey data, we cross-sectionally analyzed overweight/obese patients in the United States to determine the prevalence of receipt of HCP weight counsel in those with OA and among other variables. We used multivariate logistic regression models to calculate odds ratios of being counseled and of achieving ten percent weight loss in groups with and without counsel. Mean weight losses were also compared among groups. RESULTS: 39,156 patients were identified, of whom 1948 met inclusion criteria. Overall, 51.89% of overweight/obese OA patients received weight counseling. The odds of receiving counsel varied with several demographic variables. The odds of achieving 10% weight loss in those counseled was 1.84 times (95% confidence interval: 1.028, 3.299) that of those not counseled (p = 0.04). In contrast, patients counseled lost a mean of 0.49 pounds while those not counseled gained a mean of 0.03 pounds, a difference which was not statistically significant (p = 0.59). CONCLUSION: Prevalence of weight counsel receipt for OA has not changed significantly between 2011 and 2018. Though counsel for weight more frequently leads to adequate weight loss in those with OA, the average weight loss is minimal regardless of counsel. Thus, refinement of this intervention may be needed to bolster weight loss.

Physical activity modification following a Transient Ischemic Attack in individuals with diabetes.

BACKGROUND: Individuals with diabetes exhibit a higher risk of cardiovascular disease and mortality compared to healthy individuals. Following a transient ischemic attack (TIA) the risk of stroke and death increase further. Physical activity engagement after a TIA is an effective way of secondary prevention. However, there's a lack of research on how individuals with diabetes modify physical activity levels and how these adjustments impact survival post-TIA. This study aimed to determine the extent to which individuals with diabetes alter their physical activity levels following a TIA and to assess the impact of these changes on mortality. METHODS: This was a nationwide longitudinal study, employing data from national registers in Sweden spanning from 01/01/2003 to 31/12/2019. Data were collected 2 years retro- and prospectively of TIA occurrence, in individuals with diabetes. Individuals were grouped based on decreasing, remaining, or increasing physical activity levels after the TIA. Cox proportional hazards models were fitted to evaluate the adjusted relationship between change in physical activity and all-cause, cardiovascular, and non-cardiovascular mortality. RESULTS: The final study sample consisted of 4.219 individuals (mean age 72.9 years, 59.4% males). Among them, 35.8% decreased, 37.5% kept steady, and 26.8% increased their physical activity after the TIA. A subsequent stroke occurred in 6.7%, 6.4%, and 6.1% of individuals, while death occurred in 6.3%, 7.3%, and 3.7% of individuals, respectively. In adjusted analyses, participants who increased their physical activity had a 45% lower risk for all-cause mortality and a 68% lower risk for cardiovascular mortality, compared to those who decreased their physical activity. CONCLUSIONS: Positive change in physical activity following a ΤΙΑ was associated with a reduced risk of mortality. Increased engagement in physical activity should be promoted after TIA, thereby actively supporting individuals with diabetes in achieving improved health outcomes.

Evaluation of a Multimodal Stress Management and Comprehensive Lifestyle Modification Program on Quality of Life and Gastrointestinal Symptoms in Patients with Crohn's Disease: A Randomized Controlled Pilot Trial with 9-Month Follow-Up.

INTRODUCTION: Stress and lifestyle factors impact the course of Crohn's disease (CD). Our primary objective was to assess whether patients with CD benefit from a mind-body-medicine stress management and lifestyle modification (MBM) program. METHODS: This 9-month two-arm pilot trial was conducted in Bamberg, Germany (2020-2021). Patients (18-75 years) with mild to moderate activity of CD and stable medication were enrolled and randomly assigned to either a 10-week MBM program (intervention group, IG) or a single 90-min education session (waiting list control group, CG). Primary endpoints were quality of life (IBDQ) and disease activity (HBI). Secondary endpoints were emotional distress, core self-evaluation, and inflammatory biomarkers 3 and 9 months after baseline assessment. RESULTS: We analyzed data from 37 patients (IG: n = 19, mean ± SD age 49.6 ± 13.1 years, 68% female; CG: 18, 46.8 ± 11.4, 67% female). Immediately after the intervention, 79% (IG) and 44% (CG) experienced a clinically relevant improvement (IBDQ score ≥16 points). This was similar after 9 months (63% vs. 44%). There was no difference in disease activity (3 months: p = 0.082, 95% CI -1.3 to 2.6; 9 months: p = 0.251, 95% CI -1.2 to 2.5). Secondary outcomes indicated improvements in emotional distress, core self-evaluation, erythrocyte sedimentation rate after three and in emotional distress, T-cell profiling in the blood, and fecal lactoferrin and calprotectin group after 9 months in the IG. CONCLUSION: Our study suggested benefits of a multimodal stress management and lifestyle modification program for patients with CD. Larger trials are needed to determine if the program can supplement or at least partially replace pharmacological treatment approaches.

Low Health Literacy, Lack of Knowledge, and Self-Control Hinder Healthy Lifestyles in Diverse Patients with Steatotic Liver Disease.

INTRODUCTION: In parallel with the obesity and diabetes epidemics, steatotic liver disease (SLD) has emerged as a major global public health concern. The mainstay of therapy is counseling on weight loss and increased exercise. However, such lifestyle modifications infrequently lead to success. We aimed to identify barriers to diet and lifestyle modification in patients with SLD. METHODS: Patients with SLD completed a 14-item questionnaire that assigned barriers to healthy eating to three categories: lack of knowledge, lack of self-control, and lack of time, with a higher summary score indicating more perceived barriers. We administered assessments of health literacy and physical activity. We analyzed the data using descriptive statistics and ordinal regression analysis. RESULTS: We included 151 participants with a median age of 64; 54% were female and 68.2% were Hispanic. Median BMI was 31.9 kg/m2. Most respondents, 68.2%, had low health literacy and were either underactive, 29.1% or sedentary, 23.2%. Lack of self-control was the strongest barrier to achieving a healthy lifestyle, followed by lack of knowledge. Lack of time was not significant barrier. Patients with the most significant barriers were more likely to have obesity, low health literacy, and be sedentary. DISCUSSION: Lack of self-control and knowledge are the greatest barriers to adopting a healthy lifestyle in patients with SLD. Future clinical interventions should integrate education that targets various health literacy levels with behavioral approaches to improve a sense of agency.

Attitudes of cardiac rehabilitation and stroke teams towards integration of stroke survivors into adapted cardiac rehabilitation: A focus group study.

OBJECTIVE: To explore the attitudes and beliefs of cardiac rehabilitation and stroke teams towards adapted cardiac rehabilitation, and the broader topics of exercise, healthy lifestyles and health behaviour change, for people with mild-to-moderate severity stroke in the sub-acute phase of recovery. DESIGN: Qualitative focus group-based study. SETTING: Acute and community national health service trusts. PARTICIPANTS: Stroke and cardiac rehabilitation team members. INTERVENTION: Adapted cardiac rehabilitation. MAIN MEASURES: Focus groups. Thematic analysis was applied to the transcribed data. RESULTS: Overall, 57 health professionals participated in 12 focus groups. Positive impacts for teams and stroke survivors were identified particularly confidence. However, there were negatives, barriers and adaptations identified. In addition, there was a lack of knowledge for cardiac rehabilitation teams in relation to stroke survivors and stroke teams in relation to cardiac rehabilitation, exercise and healthy lifestyles. CONCLUSIONS: Cardiac rehabilitation and stroke staff attitudes to cardiac rehabilitation for stroke survivors showed a range of benefits, negatives, barriers and adaptations needed. Confidence and knowledge of the cardiac rehabilitation and stroke teams needs to be addressed. REGISTRATION: ISRCTN65957980.

Stronger together than apart: The role of social support in adopting a healthy plant-based eating pattern.

The influence of the social environment on health behaviors is well documented. In recent years, there is mounting evidence of the health benefits of a plant-based eating pattern, yet little is known about how the social environment impacts the adoption of a plant-based eating pattern, specifically. In this convergent parallel mixed-methods study, we analyzed quantitative survey data and qualitative focus group data to assess how social support impacted participants of a lifestyle medicine intervention focused on the adoption of a plant-predominant eating pattern. Regression analysis of survey data showed a positive association between positive social support and healthy plant-based eating, while no association was found between negative social support and healthy plant-based eating. Focus groups yielded further insights into how positive aspects of social relationships with family and friends facilitated the adoption of plant-predominant eating among participants. Qualitative findings also showed the ways in which negative social support hindered progress to adopt a plant-predominant eating pattern including not eating the same foods as participants, being judgmental about new dietary behaviors, and encouraging participants to eat non-plant-based foods. Taken together, social support appears to be an important factor for individuals adopting a plant-predominant eating pattern. Future research is needed to explore mechanisms to enhance positive social support while mitigating negative aspects of social relationships for individuals participating in similar lifestyle medicine interventions that emphasize on plant-predominant eating.

"Mindset Matters": Perseverance, a balanced approach and structured support as facilitators of whole foods plant-based adoption.

Whole foods plant-based diets (WFPBD) show potential for preventing and addressing chronic diseases. However, concerns exist about their acceptability and feasibility. Research on firsthand WFPBD adoption experiences is limited but crucial for promoting dietary change. In a 12-week remotely delivered lifestyle modification program using an ad libitum WFPBD, twenty weight-loss seeking adults (ages 18-75) with overweight or obesity completed self-report surveys and semi-structured interviews via Zoom. The study aimed to explore: (1) experiences with WFPBD adoption; (2) factors that helped or hindered adherence; and (3) perceived salient benefits. Interviews were analyzed inductively through a conventional content analysis, and associations between variables examined with correlational analyses. Participants overall reported WFPBD adoption being a positive, new experience, with an equal number (30%) finding it easy/easier than expected as challenging. Key cited challenges included overwhelm, different eating habits in the household, and meal preparation. Key cited facilitators included adopting an incremental approach to dietary change, persisting after setbacks, and having simple go-to meals. Greater self-compassion and family support, and less sabotage from friends and family corresponded to greater dietary change (rs > 0.45, ps < .05). Participants valued accountability, structure, human support, nutrition psychoeducation and recipes in the program. Three categories emerged regarding perceived benefits of following the WFPBD: physical health benefits, improvements to eating habits, and greater perceived control/agency over health. Results indicate that future interventions should include psychological strategies alongside nutrition education to enhance self-efficacy, address household barriers, and combat feelings of overwhelm through sufficient structure, support, and meal preparation guidance. Messaging around WFPBD may benefit from discussing prevailing positive experiences with adoption, common benefits experienced, and options for an incremental approach given that feasibility and acceptability concerns may deter efforts.

Mobile App-Based Lifestyle Coaching Intervention for Patients With Nonalcoholic Fatty Liver Disease: Randomized Controlled Trial.

BACKGROUND: Lifestyle modification in patients with nonalcoholic fatty liver disease (NAFLD) is key to improving health outcomes. Mobile health technologies may offer potential effective and efficient health care support to facilitate self-management. OBJECTIVE: This study aims to develop a lifestyle coaching intervention using a mobile app for patients with NAFLD and evaluate physiological and psychological health outcomes for 6 months. METHODS: This study was a randomized controlled trial. The personalized lifestyle coaching intervention using a mobile app was developed through established guidelines and literature reviews. This intervention consisted of information on NAFLD management, diet and physical activity self-monitoring, and coaching sessions based on patient records and SMS text messages. A total of 102 individuals were enrolled in the study and randomly assigned to the intervention group (n=48) or the control group (n=54). The outcomes were improvements in physiological (weight, liver fat score, aspartate aminotransferase, alanine transferase, and gamma-glutamyl transferase) and clinical outcomes (self-management, NAFLD self-management knowledge, self-efficacy, fatigue, depression, and quality of life). Data were analyzed using descriptive analysis and a linear mixed model to test the effects of the intervention. RESULTS: All participants completed the study. The mean age of the participants was 48.9 (SD 13.74) years, 38.2% (39/102) were female participants, and 65.7% (67/102) were married. There were no differences in baseline demographic and clinical data between the intervention and control groups. Changes from baseline to 6 months were significant only within the intervention group for weight (P<.001), liver fat score (P=.01), aspartate aminotransferase (P=.03), alanine transferase (P=.002), gamma-glutamyl transferase (P=.04), self-management (P<.001), fatigue (P=.005), depression (P=.003), and quality of life (P<.001). The differences between the 2 groups for the changes over the 6 months were significant in self-management (P=.004), self-management knowledge (P=.04), fatigue (P=.004), depression (P=.04), and quality of life (P=.01). However, the intervention-by-time interaction was significantly effective only for self-management (P=.006) and fatigue (P=.02). CONCLUSIONS: Nonpharmacological interventions using a mobile app may be effective in improving the physiological and psychological health outcomes of patients with NAFLD. TRIAL REGISTRATION: Clinical Research Information Service KCT0005549; http://tinyurl.com/y2zb6usy.

Wait Times for Scheduling Appointments for Prevention of Macrovascular and Microvascular Complications of Diabetes: Cross-Sectional Descriptive Study.

BACKGROUND: Diabetes is a chronic disease that requires lifelong management and care, affecting around 422 million people worldwide and roughly 37 million in the United States. Patients newly diagnosed with diabetes must work with health care providers to formulate a management plan, including lifestyle modifications and regular office visits, to improve metabolic control, prevent or delay complications, optimize quality of life, and promote well-being. OBJECTIVE: Our aim is to investigate one component of system-wide access to timely health care for people with diabetes in New York City (NYC), namely the length of time for someone with newly diagnosed diabetes to obtain an appointment with 3 diabetes care specialists: a cardiologist, an endocrinologist, and an ophthalmologist, respectively. METHODS: We contacted the offices of 3 different kinds of specialists: cardiologists, endocrinologists, and ophthalmologists, by telephone, for this descriptive cross-sectional study, to determine the number of days required to schedule an appointment for a new patient with diabetes. The sampling frame included all specialists affiliated with any private or public hospital in NYC. The number of days to obtain an appointment with each specialist was documented, along with "time on hold" when attempting to schedule an appointment and the presence of online booking capabilities. RESULTS: Of the 1639 unique physicians affiliated with (private and public) hospitals in the 3 subspecialties, 1032 (cardiologists, endocrinologists, and ophthalmologists) were in active practice and did not require a referral. The mean wait time for scheduling an appointment was 36 (SD 36.4; IQR 12-51.5) days for cardiologists; 82 (SD 47; IQR 56-101) days for endocrinologists; and 50.4 (SD 56; IQR 10-72) days for ophthalmologists. The median wait time was 27 days for cardiologists, 72 days for endocrinologists, and 30 days for ophthalmologists. The mean time on hold while attempting to schedule an appointment with these specialists was 2.6 (SD 5.5) minutes for cardiologists, 5.4 (SD 4.3) minutes for endocrinologists, and 3.2 (SD 4.8) minutes for ophthalmologists, respectively. Over 46% (158/341) of cardiologists enabled patients to schedule an appointment on the web, and over 55% (128/228) of endocrinologists enabled patients to schedule an appointment on the web. In contrast, only approximately 25% (117/463) of ophthalmologists offered web-based appointment scheduling options. CONCLUSIONS: The results indicate considerable variation in wait times between and within the 3 specialties examined for a new patient in NYC. Given the paucity of research on wait times for newly diagnosed people with diabetes to obtain an appointment with different specialists, this study provides preliminary estimates that can serve as an initial reference. Additional research is needed to document the extent to which wait times are associated with complications and the demographic and socio-economic characteristics of people served by different providers.

Comprehensive lifestyle modification interventions for metabolic syndrome: A systematic review and meta-analysis.

INTRODUCTION: Previous systematic reviews and meta-analyses have mainly focused on improvements in the number of metabolic syndrome risk factors and individual changes in each risk factor, making it challenging to examine the impact of comprehensive lifestyle modification interventions on adherence to recommended health behaviors. To address this gap, we conducted a systematic and meta-analysis aimed at identifying clinical parameter levels associated with lifestyle modification outcomes and adherence to recommended health behaviors for individuals with metabolic syndrome. METHODS: A total of seven studies retrieved from four databases (CINAHL, Medline via PubMed, American Psychological Association PsycINFO, and Embase) were included in the review. The selected studies, which demonstrated improvements in health behaviors, all included diet and exercise as main factors of comprehensive lifestyle modification in home settings. RESULTS: Our findings suggest that a 6-month comprehensive intervention including diet and exercise can be effective in decreasing glucose levels and systolic blood pressure. However, given the limited available data, further studies investigating the efficacy of interventions of varying durations are needed. DISCUSSION: Although our review included a small number of studies, comprehensive lifestyle modifications consisting of at least two components (primarily diet and exercise) can improve health behaviors and some clinical parameters among individuals with metabolic syndrome. Future studies are needed to investigate the long-term effects of lifestyle modifications on health behavior adherence and explore effective interventions to address certain clinical parameters, such as high-density lipoprotein levels. Also, we recommend using objective and quantifiable measure to compare adherence to recommended lifestyle modifications across studies. CLINICAL RELEVANCE: This research provides empirical evidence of the effectiveness of comprehensive lifestyle modification and emphasizes the need to develop long-term nursing strategies in public health that can be used to effectively manage metabolic syndrome.

New-onset atrial fibrillation prediction: the HARMS2-AF risk score.

AIMS: Lifestyle risk factors are a modifiable target in atrial fibrillation (AF) management. The relative contribution of individual lifestyle risk factors to AF development has not been described. Development and validation of an AF lifestyle risk score to identify individuals at risk of AF in the general population are the aims of the study. METHODS AND RESULTS: The UK Biobank (UKB) and Framingham Heart Study (FHS) are large prospective cohorts with outcomes measured >10 years. Incident AF was based on International Classification of Diseases version 10 coding. Prior AF was excluded. Cox proportional hazards regression identified independent AF predictors, which were evaluated in a multivariable model. A weighted score was developed in the UKB and externally validated in the FHS. Kaplan-Meier estimates ascertained the risk of AF development. Among 314 280 UKB participants, AF incidence was 5.7%, with median time to AF 7.6 years (interquartile range 4.5-10.2). Hypertension, age, body mass index, male sex, sleep apnoea, smoking, and alcohol were predictive variables (all P < 0.001); physical inactivity [hazard ratio (HR) 1.01, 95% confidence interval (CI) 0.96-1.05, P = 0.80] and diabetes (HR 1.03, 95% CI 0.97-1.09, P = 0·38) were not significant. The HARMS2-AF score had similar predictive performance [area under the curve (AUC) 0.782] to the unweighted model (AUC 0.802) in the UKB. External validation in the FHS (AF incidence 6.0% of 7171 participants) demonstrated an AUC of 0.757 (95% CI 0.735-0.779). A higher HARMS2-AF score (≥5 points) was associated with a heightened AF risk (score 5-9: HR 12.79; score 10-14: HR 38.70). The HARMS2-AF risk model outperformed the Framingham-AF (AUC 0.568) and ARIC (AUC 0.713) risk models (both P < 0.001) and was comparable to the CHARGE-AF risk score (AUC 0.754, P = 0.73). CONCLUSION: The HARMS2-AF score is a novel lifestyle risk score which may help identify individuals at risk of AF in the general community and assist population screening.

Effect of Motivational Interviewing on Lifestyle Modification among Patients with Hypertension Attending the Family Medicine Clinics of ISTH, Irrua, Nigeria (Milmaph Study) - A Randomised Control Trial Study Protocol.

BACKGROUND: Hypertension is a leading cause of morbidity and mortality globally. Over a quarter of patients with hypertension have uncontrolled hypertension. Lifestyle modification has been shown to improve blood pressure control, thus measures that would help patients with hypertension achieve positive lifestyle modification would improve BP control. The study aims to determine the effect of motivational interviews on lifestyle modification and blood pressure control among patients with hypertension attending the Family Medicine Clinics of Irrua Specialist Teaching Hospital (ISTH), Irrua, Nigeria. METHODS: The proposed study will be a randomised control trial (PACTR202301917477205). About 212 adults between 18 and 65 years with hypertension presenting to the Family Medicine Clinics of ISTH will be randomised into intervention and control groups. The intervention group will be given a motivational interview (MI) on lifestyle modification at the start of the study and monthly for 6 months in addition to standard care for the management of hypertension. The control group will be given standard care for the management of hypertension only without MI and seen monthly for 6 months. Both groups will be assessed at baseline and 6 months. At baseline, a qualitative technique will be used to determine the reason for not adopting lifestyle modification. STUDY OUTCOME: The primary outcome shall be lifestyle modification at 6 months while the secondary outcome shall be blood pressure control at 6 months. CONCLUSION: Findings from the study will provide cost-effective ways of blood pressure control and reduction in the disease burden of hypertension in Nigeria.

CONTEXTE: L'hypertension est l'une des principales causes de morbidité et de mortalité à l'échelle mondiale. Plus d'un quart des patients hypertendus ont une hypertension non contrôlée. La modification du mode de vie a été démontrée pour améliorer le contrôle de la pression artérielle, ainsi les mesures qui aideraient les patients hypertendus à réaliser une modification positive de leur mode de vie amélioreraient le contrôle de la PA. L'étude vise à déterminer l'effet des entretiens motivationnels sur la modification du mode de vie et le contrôle de la pression artérielle chez les patients hypertendus fréquentant les cliniques de médecine familiale de l'hôpital spécialisé d'enseignement d'Irrua (ISTH), Irrua, Nigeria. MÉTHODES: L'étude proposée sera un essai contrôlé randomisé (PACTR202301917477205). Environ 212 adultes âgés de 18 à 65 ans atteints d'hypertension se présentant aux cliniques de médecine familiale de l'ISTH seront randomisés en groupes d'intervention et de contrôle. Le groupe d'intervention recevra un entretien motivationnel (EM) sur la modification du mode de vie au début de l'étude et mensuellement pendant 6 mois en plus des soins standard pour la prise en charge de l'hypertension. Le groupe témoin recevra uniquement les soins standard pour la prise en charge de l'hypertension sans EM et sera vu mensuellement pendant 6 mois. Les deux groupes seront évalués au départ et à 6 mois. Au début, une technique qualitative sera utilisée pour déterminer la raison de la non-adoption de la modification du mode de vie. RÉSULTAT DE L'ÉTUDE: Le critère de jugement principal sera la modification du mode de vie à 6 mois, tandis que le critère de jugement secondaire sera le contrôle de la pression artérielle à 6 mois. CONCLUSION: Les résultats de l'étude fourniront des moyens rentables de contrôle de la pression artérielle et de réduction de la charge de morbidité de l'hypertension au Nigeria. MOTS-CLÉS: hypertension, entretien motivationnel, modification du mode de vie, contrôle de la pression artérielle, médecine familiale.

Updated Perspectives on Lifestyle Interventions as Secondary Stroke Prevention Measures: A Narrative Review.

Despite being highly preventable, stroke is the second-most common cause of death and disability in the world. Secondary prevention is critical as the stroke recurrence risk is 6- to 15-fold higher than the risk of stroke in the general population. Stroke recurrence is associated with higher mortality rates and increased disability levels. Lifestyle modifications should address not single but multiple cardiovascular risk factors to effectively reduce the risk of stroke. Lifestyle modifications on a personal level should include adequate physical activity, a healthy diet, the cessation of smoking and alcohol consumption, and stress reduction. Physical activities should be performed in a healthy environment without air pollution. According to recent studies, up to 90% of strokes might be prevented by addressing and treating ten modifiable stroke risk factors, half of which are related to lifestyle modifications. These lifestyle modifications, which are behavioral interventions, could impact other modifiable risk factors such as arterial hypertension, hyperlipidemia, obesity, diabetes, and atrial fibrillation. The most common obstacles to effective secondary stroke prevention are motor impairment, post-stroke cognitive impairment, post-stroke depression, and stroke subtype. Long-term lifestyle modifications are difficult to sustain and require comprehensive, individualized interventions. This review underlines the benefits of adhering to lifestyle modifications as the most effective secondary stroke prevention measure.

Combined Utility of 25 Disease and Risk Factor Polygenic Risk Scores for Stratifying Risk of All-Cause Mortality.

While genome-wide association studies have identified susceptibility variants for numerous traits, their combined utility for predicting broad measures of health, such as mortality, remains poorly understood. We used data from the UK Biobank to combine polygenic risk scores (PRS) for 13 diseases and 12 mortality risk factors into sex-specific composite PRS (cPRS). These cPRS were moderately associated with all-cause mortality in independent data within the UK Biobank: the estimated hazard ratios per standard deviation were 1.10 (95% confidence interval: 1.05, 1.16) and 1.15 (1.10, 1.19) for women and men, respectively. Differences in life expectancy between the top and bottom 5% of the cPRS were estimated to be 4.79 (1.76, 7.81) years and 6.75 (4.16, 9.35) years for women and men, respectively. These associations were substantially attenuated after adjusting for non-genetic mortality risk factors measured at study entry (i.e., middle age for most participants). The cPRS may be useful in counseling younger individuals at higher genetic risk of mortality on modification of non-genetic factors.

Improved prognosis with integrated care management including early rhythm control and healthy lifestyle modification in patients with concurrent atrial fibrillation and diabetes mellitus: a nationwide cohort study.

BACKGROUND: Patients with concurrent atrial fibrillation (AF) and diabetes mellitus (DM) [AF-DM] have a high risk of cardiovascular and diabetes-related complications, but are less engaged in a comprehensive treatment approach. We evaluated the association of early rhythm control (ERC), lifestyle modification (LSM), and a combination of ERC and LSM with cardiovascular or diabetes-related complication risk in patients with AF-DM (type 2). METHODS: From the National Health Information Database, 47,940 patients diagnosed with AF-DM in 2009-2016 were included. We defined ERC as rhythm control therapy within two years of AF diagnosis and LSM as adherence to ≥ 2 of the healthy behaviors among non-current smoking, non-drinking, and regular exercise. We compared the primary (ischemic stroke) and secondary (macro- and microvascular complications, glycemic emergency, and all-cause death) outcomes in four groups: non-ERC and non-LSM (group 1), LSM only (group 2), ERC only (group 3), and both ERC and LSM (group 4). RESULTS: Of total, 10,617 (22%), 26,730 (55.8%), 2,903 (6.1%), and 7,690 (16.0%) were classified into groups 1 to 4, in sequence. The mean duration from AF diagnosis to ERC was 25.6 ± 75.5 days. During 4.0 (interquartile range: 2.5-6.2) years' follow-up, groups 2 and 3 were associated with 23% and 33% lower risks of stroke than group 1, respectively. Group 4 was associated with the lowest risk of stroke: hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.51-0.67, p < 0.001. Regarding secondary outcomes, the lowest risks were also observed in group 4; macro- and microvascular complications, glycemic emergency, and all-cause death had HRs (95% CIs) of 0.63 (0.56-0.70), 0.88 (0.82-0.94), 0.72 (0.62-0.84), and 0.80 (0.73-0.87), respectively, all p < 0.001. CONCLUSIONS: For AF-DM patients, ERC and LSM exert a synergistic effect in preventing cardiovascular and diabetes-related complications with the greatest lowered risk of stroke. A comprehensive treatment approach should be pursued in AF-DM patients.

Motivational Interviewing in Pediatric Obesity: A Meta-analysis of the Effects on Behavioral Outcomes.

BACKGROUND: Currently, the effects of motivational interviewing (MI) on children's behavioral changes remain obscure. PURPOSE: This systematic review and meta-analysis examined the effects of MI on children's lifestyle behavioral changes (fruits and vegetables [F/V], dairy, sugary beverages, calories, snacks, fat intake, moderate vigorous physical activity [MVPA], and screen time). METHODS: Six databases (CINAHL, Cochrane, Embase, PsycINFO, PubMed, and Web of Sciences) from 2005 to 2022 were searched. Thirty-one intervention studies with a comparison group met the criteria. Random-effects models were performed to estimate the pooled effects; exploratory moderation analyses with mixed-effects models were used to explore potential intervention moderators. RESULTS: The pooled effect size was 0.10 (p = .334) on ↑F/V, 0.02 (p = .724) on ↑dairy, -0.29 (p < .001) on ↓calories, -0.16 (p = .054) on ↓sugary beverages, -0.22 (p = .002) on ↓snacks, -0.20 (p = .044) on ↓fat, 0.22 (p = .001) on ↑MVPA, and -0.06 (p = .176) on ↓screen time. The effects of MIs were moderated by ↑MI sessions regarding ↓snacks (B = -0.04, p = .010). Multicomponent and clinical programs had greater effects on dairy intake than their counterparts (0.09 vs. -0.21, p = .034; 0.12 vs. -0.14, p = .027, respectively). Similarly, interventions with a fidelity check resulted in greater dairy intake than those without a check (0.29 vs. -0.15, p = .014). A few long-term follow-up assessments revealed effects on ↓F/V (-0.18; p = .143, k = 2), ↓dairy (-0.13, p = .399, k = 4), ↓MVPA (-0.04; p = .611, k = 6), and ↑screen time (0.12; p = .242, k = 4). CONCLUSIONS: Our findings support the short-term effects of MI on improving children's lifestyle behaviors. Additional investigations are needed to better sustain children's long-term behavioral changes.

Although motivational interviewing (MI) techniques are often recommended and used by clinicians to promote healthy behaviors, their effects on children's behavioral changes are not clear. This systematic review and meta-analysis examined the effects of MI on children's lifestyle behavioral changes particularly in children's intakes in fruits and vegetables, dairy, sugary drinks, calories, snacks, and high-fat diet, as well as children's physical activity and screen time. A total of 957 articles from six databases were screened for eligibility. Among them, 31 eligible articles were retrieved for knowledge synthesis. This review found that MI techniques were effective in lowering children's intakes in calories, sugary drinks, snacks, high-fat diets. In addition, MI techniques were also effective in promoting children's moderate to vigorous physical activities. It seemed that more MI sessions were more likely to decrease children's snacks intakes. Taken together, our findings support the short-term effects of MI on improving children's lifestyle behaviors. Additional investigations are needed to better sustain children's long-term behavioral changes.

Comparing the effectiveness of metformin with lifestyle modification for the primary prevention of type II diabetes: a systematic review and meta-analysis.

BACKGROUND: Concerning ascending trend in the prevalence of chronic type II diabetes, prevention and the development of an effective approach after the recognition of at-risk individuals is crucial. This study aims to investigate comparing the influence of lifestyle modification and metformin interventions in the prevention of type II diabetes developments. METHOD: The search was conducted using PubMed, Google Scholar, Scopus and Web of Science databases. The inclusion criteria include randomized controlled trials (RCT) which studied both lifestyle modification and metformin interventions in the population above 18 years old without a history of any type of diabetes. After excluding studies with intervention time of fewer than 6 months, a systematic review and meta-analysis were performed to evaluate relative risk (RR) with a confidence interval (CI) of 95% of type II diabetes development. RESULTS: Data from 5 studies were included in the meta-analysis. The population also consists of individuals with a mean age of 50 years old with BMI and FBS of 35.5 and 104.7 mg/dl respectively. Participants range of prevention years was between 2-3 years with a mean of 2.8 years. Lifestyle modification decreases the probability of the incidence of type II diabetes by 25.3% (RR: 0.747, 95% CI, 0.6-0.92) compared to the metformin intervention (p-value = 0.007). Our results indicate that long-term lifestyle modifications can prevent diabetes type II and decrease diabetes mellitus incidence down to one-quarter in comparison to metformin. CONCLUSION: Lifestyle modification can be more efficacious than metformin in diminishing the incidence of type II diabetes. Therefore, lifestyle modification can be a therapeutic strategy for controlling type II diabetes incidence, especially in high-risk individuals.

Bite by byte: can fitness wearables help bariatric patients lose more weight after surgery?

BACKGROUND: Multidisciplinary approaches to weight loss have been shown to improve outcomes in bariatric patients. Few studies have been performed assessing the utility and compliance of fitness tracking devices after bariatric surgery. We aim to determine whether use of an activity tracking device assists bariatric patients in improving postoperative weight loss behaviors. METHODS: A fitness wearable was offered to patients undergoing bariatric surgery from 2019 to 2022. A telephone survey was conducted to elucidate the impact of the device on the patient's postoperative weight loss efforts 6 to 12 months after surgery. Weight loss outcomes of sleeve gastrectomy (SG) patients receiving the fitness wearable (FW) were compared to those of a group of SG patients who did not receive one (non-FW). RESULTS: Thirty-seven patients were given a fitness wearable, 20 of whom responded to our telephone survey. Five patients reported not using the device and were excluded. 88.2% reported that using the device had a positive impact on their overall lifestyle. Patients felt that using the fitness wearable to keeping track of their progress helped them both to achieve short-term fitness goals and sustain them in the long run. From the patients that utilized the device, 44.4% of those that discontinued felt like it helped them build a routine that they maintained even after they were no longer using it. Demographic data between FW and non-FW groups (age, sex, CCI, initial BMI, and surgery BMI) did not differ significantly. The FW group trended towards greater %EWL at 1 year post-operation (65.2% versus 52.4%, p = 0.066) and had significantly greater %TWL at 1 year post-operation (30.3% versus 22.3%, p = 0.02). CONCLUSION: The use of an activity tracking device enhances a patient's post-bariatric surgery experience, serving to keep patients informed and motivated, and leading to improved activity that may translate to better weight loss outcomes.

Building a personalized patient education model for general practice by Delphi method.

BACKGROUND: As one of the 3 strategic measures for disease prevention and control in the 21st century identified by WHO, patient education is the most effective measure to change people's behaviour and lifestyle. However, there are many problems with patient education in general practice in China. Because there is no suitable and uniform mode of patient education for the busy and crowded Chinese general practice. Therefore, it is necessary to establish an appropriate personalized patient education model. METHODS: There were 3 rounds of consultation of the Delphi method. Each round of consultation is adjusted, modified, or deleted based on the previous round according to the degree of concentration and coordination of expert opinions. Thus form the index system of personalized patient education model. Using Cronbach α to conduct an internal consistency test for the index system. RESULTS: Twenty-three participants participated in the study. The effective recovery rate of consultation was 100%. In the third round of consultation, the variation importance coefficient was 0-0.25, the variation operability coefficient was 0.07-0.26. Kendall's W of importance and operability score was significant (Kendall's W = 0.186; P < 0.01). The chi-square test result of importance is (X2 = 232.744) and operability is (X2 = 246.156). The Cronbach α was 0.974. EFA (exploratory factor analysis) indicates the model has good construct validity. CONCLUSIONS: The CAPDCA personalized patient education model was preliminarily constructed in this study. Specifically, 6 first-level indicators including collection (C), assessment (A), plan (P), do (D), check (C), aggrandizement (A), 24 second-level indicators, and 34 third-level indicators. That forms the cyclic personalized patient education paradigm which has reasonable structure and high feasibility.

Evaluation of a pharmacist's impact on the use of glucagon-like peptide-1 receptor agonists for weight management in a family medicine setting.

BACKGROUND: Glucagon-like peptide-1 receptor (GLP-1) agonists carry benefits and risks that must be evaluated prior to use and monitored throughout weight management therapy. Pharmacists possess the accessibility and extensive medication knowledge to evaluate and monitor the use of GLP-1 therapy in weight management patients. OBJECTIVE: Evaluate the clinical and financial impact of a pharmacist-directed weight management service utilizing GLP-1 receptor agonists in a family practice setting. METHODS: A retrospective cohort study including patients at 2 family practices, aged 18 and older, prescribed a weight management GLP-1 between October 1, 2021 and March 1, 2022 was performed. Patients who met inclusion and were prescribed a weight loss GLP-1 but were not managed by the clinical pharmacist were compared with the pharmacist cohort. Descriptive statistics and inferential statistics including an independent t-test were used in the data analysis. RESULTS: There were 46 and 39 patients identified in the clinical pharmacist and primary care physician cohorts respectively. Patients in the clinical pharmacist cohort achieved a mean body weight reduction of 9.32% compared to 5.11% body weight reduction for patients in the primary care physician cohort (P = 0.01). There were 63 months identified of inappropriate GLP-1 therapy deprescribed in the clinical pharmacist cohort resulting in an estimated cost savings of $101,985.66. CONCLUSIONS: The implementation of a pharmacist-led weight management clinic in 2 family medicine offices resulted in a significant reduction in body weight and reduction in total costs to the healthcare system compared to patients receiving weight management services from their primary care physician alone.