Quality of life among colorectal cancer survivors participating in a pilot randomized controlled trial of a web-based dietary intervention with text messages.

PURPOSE: We aimed to estimate the effect of a 12-week web-based dietary intervention with text messages on quality of life (QoL) among colorectal cancer (CRC) survivors. METHODS: Between 2017 and 2018, 50 CRC survivors were randomized (1:1) to receive a 12-week web-based dietary intervention with daily text messages or wait-list control. Health-related QoL was assessed using the European Organization for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) and colorectal quality of life module (QLQ-CR29) at baseline, 12, and 24 weeks. Within- and between-group mean changes in health-related QoL with 95% confidence intervals (CI) were calculated for both arms. RESULTS: Compared to the controls, participants receiving the intervention had an improvement in emotional functioning (mean change: 14.3; 95% CI: 3.0, 25.6) at 12 weeks and social functioning (mean change: 13.8; 95% CI: 2.1, 25.5) at 24 weeks. A decrease of fatigue from baseline was also observed in the intervention arm (mean change: - 9.1; 95% CI: - 17.1, - 1.1) at 24 weeks. No other changes in QoL scores were associated with the intervention. CONCLUSION: CRC survivors randomized to receive a web-based dietary intervention with text messages experienced higher emotional and social functioning. Further study with a larger population may be warranted. TRIAL REGISTRATION: clinicaltrials.gov, NCT02965521. Registered 16 November 2016, https://clinicaltrials.gov/ct2/keydates/NCT02965521.

Quality of life of colorectal cancer survivors participating in a pilot randomized controlled trial of physical activity trackers and daily text messages.

PURPOSE: There are over 1.3 million colorectal cancer (CRC) survivors in the USA, many of whom report lower health-related quality of life (HRQoL) years after treatment. This study aimed to explore the effect of digital health tools on HRQoL in CRC survivors. METHODS: We conducted a two-arm, randomized controlled trial of 42 subjects who had completed treatment for CRC. Participants in the intervention arm received a Fitbit Flex™ and daily text messages for 12 weeks. HRQoL was assessed as a secondary endpoint in both arms at enrollment and 12 weeks using the Medical Outcomes Study Short Form Survey (SF-36) and the Functional Assessment of Cancer Therapy-Colorectal (FACT-C). Survey score changes from enrollment to 12 weeks were compared between the two arms using independent t tests, and scores at enrollment and 12 weeks were compared using paired t tests. RESULTS: An increase in the FACT-C functional well-being subscale was observed in individuals in the intervention arm pre- to post-intervention (median difference, 2; interquartile range (IQR), 1, 4; P = .02). Although the between-group comparison was not statistically significant, no change in the functional well-being subscale was observed in the control arm (median difference, 0; IQR, 1, 1; P = .71). No other measures of HRQoL appeared to differ within arm across time points or between arms. CONCLUSION: A 12-week digital physical activity intervention may improve functional well-being among CRC survivors. Larger randomized studies are needed to determine if digital health tools improve functional well-being among CRC survivors and if this improvement can be sustained over time. TRIAL REGISTRATION: NCT02966054; registration date, November 17, 2016.

Feasibility and Acceptability of a Physical Activity Tracker and Text Messages to Promote Physical Activity During Chemotherapy for Colorectal Cancer: Pilot Randomized Controlled Trial (Smart Pace II).

BACKGROUND: We conducted a pilot 2-arm randomized controlled trial to assess the feasibility of a digital health intervention to increase moderate-to-vigorous physical activity in patients with colorectal cancer (CRC) during chemotherapy. OBJECTIVE: This study aimed to determine whether a digital health physical activity intervention is feasible and acceptable during chemotherapy for CRC. METHODS: Potentially eligible patients with CRC expected to receive at least 12 weeks of chemotherapy were identified in person at the University of California, San Francisco, and on the web through advertising. Eligible patients were randomized 1:1 to a 12-week intervention (Fitbit Flex, automated SMS text messages) versus usual care. At 0 and 12 weeks, patients wore an Actigraph GT3X+ accelerometer for 7 days and completed surveys, body size measurements, and an optional 6-minute walk test. Participants could not be masked to their intervention arm, but people assessing the body size and 6-minute walk test outcomes were masked. The primary outcomes were adherence (eg, Fitbit wear and text response rate) and self-assessed acceptability of the intervention. The intervention would be considered feasible if we observed at least 80% complete follow-up and 70% adherence and satisfaction, a priori. RESULTS: From 2018 to 2020, we screened 240 patients; 53.3% (128/240) of patients were ineligible and 26.7% (64/240) declined to participate. A total of 44 patients (44/240, 18%) were randomized to the intervention (n=22) or control (n=22) groups. Of these, 57% (25/44) were women; 68% (30/44) identified as White and 25% (11/44) identified as Asian American or Pacific Islander; and 77% (34/44) had a 4-year college degree. The median age at enrollment was 54 years (IQR 45-62 years). Follow-up at 12 weeks was 91% (40/44) complete. In the intervention arm, patients wore Fitbit devices on a median of 67 out of 84 (80%) study days and responded to a median of 17 out of 27 (63%) questions sent via SMS text message. Among 19 out of 22 (86%) intervention patients who completed the feedback survey, 89% (17/19) were satisfied with the Fitbit device; 63% (12/19) were satisfied with the SMS text messages; 68% (13/19) said the SMS text messages motivated them to exercise; 74% (14/19) said the frequency of SMS text messages (1-3 days) was ideal; and 79% (15/19) said that receiving SMS text messages in the morning and evening was ideal. CONCLUSIONS: This pilot study demonstrated that many people receiving chemotherapy for CRC are interested in participating in digital health physical activity interventions. Fitbit adherence was high; however, participants indicated a desire for more tailored SMS text message content. Studies with more socioeconomically diverse patients with CRC are required. TRIAL REGISTRATION: ClinicalTrials.gov NCT03524716; https://clinicaltrials.gov/ct2/show/NCT03524716.

A systematic review of artificial intelligence chatbots for promoting physical activity, healthy diet, and weight loss.

BACKGROUND: This systematic review aimed to evaluate AI chatbot characteristics, functions, and core conversational capacities and investigate whether AI chatbot interventions were effective in changing physical activity, healthy eating, weight management behaviors, and other related health outcomes. METHODS: In collaboration with a medical librarian, six electronic bibliographic databases (PubMed, EMBASE, ACM Digital Library, Web of Science, PsycINFO, and IEEE) were searched to identify relevant studies. Only randomized controlled trials or quasi-experimental studies were included. Studies were screened by two independent reviewers, and any discrepancy was resolved by a third reviewer. The National Institutes of Health quality assessment tools were used to assess risk of bias in individual studies. We applied the AI Chatbot Behavior Change Model to characterize components of chatbot interventions, including chatbot characteristics, persuasive and relational capacity, and evaluation of outcomes. RESULTS: The database search retrieved 1692 citations, and 9 studies met the inclusion criteria. Of the 9 studies, 4 were randomized controlled trials and 5 were quasi-experimental studies. Five out of the seven studies suggest chatbot interventions are promising strategies in increasing physical activity. In contrast, the number of studies focusing on changing diet and weight status was limited. Outcome assessments, however, were reported inconsistently across the studies. Eighty-nine and thirty-three percent of the studies specified a name and gender (i.e., woman) of the chatbot, respectively. Over half (56%) of the studies used a constrained chatbot (i.e., rule-based), while the remaining studies used unconstrained chatbots that resemble human-to-human communication. CONCLUSION: Chatbots may improve physical activity, but we were not able to make definitive conclusions regarding the efficacy of chatbot interventions on physical activity, diet, and weight management/loss. Application of AI chatbots is an emerging field of research in lifestyle modification programs and is expected to grow exponentially. Thus, standardization of designing and reporting chatbot interventions is warranted in the near future. SYSTEMATIC REVIEW REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO): CRD42020216761 .

Artificial Intelligence Chatbot Behavior Change Model for Designing Artificial Intelligence Chatbots to Promote Physical Activity and a Healthy Diet: Viewpoint.

BACKGROUND: Chatbots empowered by artificial intelligence (AI) can increasingly engage in natural conversations and build relationships with users. Applying AI chatbots to lifestyle modification programs is one of the promising areas to develop cost-effective and feasible behavior interventions to promote physical activity and a healthy diet. OBJECTIVE: The purposes of this perspective paper are to present a brief literature review of chatbot use in promoting physical activity and a healthy diet, describe the AI chatbot behavior change model our research team developed based on extensive interdisciplinary research, and discuss ethical principles and considerations. METHODS: We conducted a preliminary search of studies reporting chatbots for improving physical activity and/or diet in four databases in July 2020. We summarized the characteristics of the chatbot studies and reviewed recent developments in human-AI communication research and innovations in natural language processing. Based on the identified gaps and opportunities, as well as our own clinical and research experience and findings, we propose an AI chatbot behavior change model. RESULTS: Our review found a lack of understanding around theoretical guidance and practical recommendations on designing AI chatbots for lifestyle modification programs. The proposed AI chatbot behavior change model consists of the following four components to provide such guidance: (1) designing chatbot characteristics and understanding user background; (2) building relational capacity; (3) building persuasive conversational capacity; and (4) evaluating mechanisms and outcomes. The rationale and evidence supporting the design and evaluation choices for this model are presented in this paper. CONCLUSIONS: As AI chatbots become increasingly integrated into various digital communications, our proposed theoretical framework is the first step to conceptualize the scope of utilization in health behavior change domains and to synthesize all possible dimensions of chatbot features to inform intervention design and evaluation. There is a need for more interdisciplinary work to continue developing AI techniques to improve a chatbot's relational and persuasive capacities to change physical activity and diet behaviors with strong ethical principles.

Feasibility and Acceptability of a Web-Based Dietary Intervention with Text Messages for Colorectal Cancer: A Randomized Pilot Trial.

BACKGROUND: Diet is associated with colorectal cancer survival. Yet, adherence to nutrition guidelines is low among colorectal cancer survivors. METHODS: We conducted a pilot trial among colorectal cancer survivors to evaluate a 12-week remote dietary intervention. Participants received print materials and were randomized (1:1) to intervention (website, text messages) or wait-list control. Primary outcomes included feasibility and acceptability. We also explored change in diet from 0 to 12 and 24 weeks and change from 0 to 12 weeks in anthropometry and circulating biomarkers (Trial Registration: NCT02965521). RESULTS: We randomized 50 colorectal cancer survivors (25 intervention, 25 control). Retention was 90% at 12 weeks and 84% at 24 weeks. Participants had a median age of 55 years and were 66% female, 70% non-Hispanic white, and 96% had a college degree. The intervention arm responded to a median 15 (71%) of 21 text messages that asked for a reply [interquartile range (IQR) = 8, 19] and visited the website a median of 13 (15%) days (IQR = 1, 33) of the 84 study days. CONCLUSIONS: We developed a Web-based dietary intervention for colorectal cancer survivors. Our pilot results suggest that colorectal cancer survivors may engage more with text messages than a study website. Research to improve tailoring of text messages, while maintaining scalability, is needed. IMPACT: Remote dietary interventions using text messages may be feasible for colorectal cancer survivors.See all articles in this CEBP Focus section, "Modernizing Population Science."

Predictors for Blood Pressure Reduction in American Latinos: Secondary Analysis of the Adelgaza Program Data.

Little is known about factors that predict blood pressure (BP) reduction in overweight American Latinos. The aim of this secondary analysis was to explore predictors of changes in mean systolic and diastolic BPs over an 8-week weight loss intervention period in a sample of 54 overweight American Latinos using data collected during the Adelgaza trial. Baseline BP, exercise energy use (in units of metabolic equivalent of task), weight change, average daily intake of calories from beverages, average daily intake of calories from fat, age, and gender were considered as potential predictors of reductions in BP, as measured at baseline, 3, and 8 weeks. Baseline characteristics were as follows: mean age 45.3 (SD = 10.8) years, 31.5% male, 61.1% born in the United States. Mean baseline systolic and diastolic BPs were 122.1 (SD = 14.4) mmHg and 76.6 (SD = 9.8) mmHg, respectively. Both baseline systolic and diastolic BPs predicted reductions in systolic BP after adjusting for other factors (p < .001). None of the nine variables predicted reductions in diastolic BP (p > .05). This finding suggests that overweight American Latinos with higher baseline systolic or diastolic BP should be identified and provided with early intervention education to achieve better hypertension management or prevention.

Self-monitoring and reminder text messages to increase physical activity in colorectal cancer survivors (Smart Pace): a pilot randomized controlled trial.

BACKGROUND: Over 1.3 million people live with colorectal cancer in the United States. Physical activity is associated with lower risk of colorectal cancer recurrence and mortality. Interventions are needed to increase physical activity in colorectal cancer survivors. METHODS: We conducted a 2-arm non-blinded pilot randomized controlled trial at the University of California, San Francisco among 42 individuals who had completed curative-intent treatment for colorectal cancer to determine the feasibility and acceptability of a 12-week (84 days) physical activity intervention using a Fitbit Flex™ and daily text messages. Participants were randomized 1:1 to receive the intervention with print educational materials or print educational materials alone. We explored the impact of the intervention versus usual care on physical activity using ActiGraph GT3X+ accelerometers pre-/post-intervention. RESULTS: We screened 406 individuals and randomized 42 to intervention (n = 21) or control (n = 21) groups. During the 12-week study, the intervention arm wore their Fitbits a median of 74 days [88% of days in study period, interquartile range: 23-83 days] and responded to a median of 34 (out of 46) text messages that asked for a reply (interquartile range: 13-38 text messages). Among the 16 intervention participants who completed the feedback survey, the majority (88%) reported that the intervention motivated them to exercise and that they were satisfied with their experience. No statistically significant difference in change in moderate-to-vigorous physical activity was found from baseline to 12 weeks between arms. CONCLUSION: A 12-week physical activity intervention with a Fitbit and text messages was feasible and acceptable among colorectal cancer patients after curative treatment. Larger studies are needed to determine whether the intervention increases physical activity. TRIAL REGISTRATION: Clinicaltrials.gov Identifier NCT02966054 . Registered 17 November 2016, retrospectively registered.

Feasibility of Reidentifying Individuals in Large National Physical Activity Data Sets From Which Protected Health Information Has Been Removed With Use of Machine Learning.

Importance: Despite data aggregation and removal of protected health information, there is concern that deidentified physical activity (PA) data collected from wearable devices can be reidentified. Organizations collecting or distributing such data suggest that the aforementioned measures are sufficient to ensure privacy. However, no studies, to our knowledge, have been published that demonstrate the possibility or impossibility of reidentifying such activity data. Objective: To evaluate the feasibility of reidentifying accelerometer-measured PA data, which have had geographic and protected health information removed, using support vector machines (SVMs) and random forest methods from machine learning. Design, Setting, and Participants: In this cross-sectional study, the National Health and Nutrition Examination Survey (NHANES) 2003-2004 and 2005-2006 data sets were analyzed in 2018. The accelerometer-measured PA data were collected in a free-living setting for 7 continuous days. NHANES uses a multistage probability sampling design to select a sample that is representative of the civilian noninstitutionalized household (both adult and children) population of the United States. Exposures: The NHANES data sets contain objectively measured movement intensity as recorded by accelerometers worn during all walking for 1 week. Main Outcomes and Measures: The primary outcome was the ability of the random forest and linear SVM algorithms to match demographic and 20-minute aggregated PA data to individual-specific record numbers, and the percentage of correct matches by each machine learning algorithm was the measure. Results: A total of 4720 adults (mean [SD] age, 40.0 [20.6] years) and 2427 children (mean [SD] age, 12.3 [3.4] years) in NHANES 2003-2004 and 4765 adults (mean [SD] age, 45.2 [19.9] years) and 2539 children (mean [SD] age, 12.1 [3.4] years) in NHANES 2005-2006 were included in the study. The random forest algorithm successfully reidentified the demographic and 20-minute aggregated PA data of 4478 adults (94.9%) and 2120 children (87.4%) in NHANES 2003-2004 and 4470 adults (93.8%) and 2172 children (85.5%) in NHANES 2005-2006 (P < .001 for all). The linear SVM algorithm successfully reidentified the demographic and 20-minute aggregated PA data of 4043 adults (85.6%) and 1695 children (69.8%) in NHANES 2003-2004 and 4041 adults (84.8%) and 1705 children (67.2%) in NHANES 2005-2006 (P < .001 for all). Conclusions and Relevance: This study suggests that current practices for deidentification of accelerometer-measured PA data might be insufficient to ensure privacy. This finding has important policy implications because it appears to show the need for deidentification that aggregates the PA data of multiple individuals to ensure privacy for single individuals.

Comparing Asian American Women's Knowledge, Self-Efficacy, and Perceived Risk of Heart Attack to Other Racial and Ethnic Groups: The mPED Trial.

OBJECTIVE: The aim of the study was to compare knowledge and awareness of heart attacks/heart disease and perceived risk for future heart attack in Asian/Pacific Islander women, compared to other racial and ethnic groups. MATERIALS AND METHODS: In this cross-sectional study, 318 women enrolled in a mobile phone-based physical activity education trial were analyzed. Heart attack knowledge, self-efficacy for recognizing and responding to heart attack symptoms, and perceived risk for a future heart attack were measured. Analyses were conducted using logistic, proportional odds, and linear regression models, depending on the outcome and adjusting for age. Pairwise differences between Asian/Pacific Islanders and the other four groups were assessed using a Bonferroni correction (p < 0.0125). RESULTS: Asian/Pacific Islander women had significantly lower total scores for knowledge of heart attack and self-efficacy for heart attack recognition and care seeking behavior compared to the Caucasian women (p = 0.001 and p = 0.002, respectively). However, perceived risk did not differ among the groups. Forty-six percent of the Asian American women, compared to 25% of Caucasian women, falsely believed "breast cancer is the number one cause of death for women (p = 0.002)." In addition, Asian/Pacific Islander women were less likely to report "arm pain, numbness, tingling, or radiating" as one of the heart attack symptoms compared to the Caucasian and the multiracial group (34%, 63% [p < 0.001], and 66% [p = 0.004], respectively). CONCLUSIONS: These findings highlight the urgent need to develop effective, tailored campaigns to close the knowledge gap between Asian/Pacific Islander women and Caucasian women.

Family history and body mass index predict perceived risks of diabetes and heart attack among community-dwelling Caucasian, Filipino, Korean, and Latino Americans--DiLH Survey.

AIM: The purpose of the study was to explore the perceived risk for diabetes and heart attack and associated health status of Caucasian, Filipino, Korean, and Latino Americans without diabetes. METHODS: A cross-sectional survey was conducted with 904 urban adults (mean age 44.3±16.1 years; 64.3% female) in English, Spanish or Korean between August and December 2013. RESULTS: Perceived risk for developing diabetes was indicated by 46.5% (n=421), and 14.3% (n=129) perceived themselves to be at risk for having a heart attack in their lifetime. Significant predictors of pessimistic diabetes risk perceptions: Filipino (adjusted odds ratio [AOR]=1.7; 95% CI: 1.04-2.86) and Korean (AOR=2.4; 1.33-4.48) ethnicity, family history of diabetes (AOR=1.4; 1.00-1.84), female gender (AOR=1.4; 1.04-1.96), high cholesterol (AOR= 1.6; 1.09-2.37) and higher body mass index (BMI) (AOR=1.1; 1.08-1.15). Predictors of pessimistic heart attack risk perceptions were family history of an early heart attack (AOR=2.9; 1.69-5.02), high blood pressure (AOR=2.4; 1.45-3.84), and higher BMI (AOR=1.1; 1.04-1.12) after controlling for socio-demographic factors. Older age, physical inactivity, smoking, and low HDL levels were not associated with risk perceptions. CONCLUSION: Multiple risk factors were predictive of greater perceived diabetes risk, whereas, only family history of heart attack, high blood pressure and increases in BMI significantly contributed to perceived risk of heart attack among ethnically diverse at risk middle-aged adults. It is important that healthcare providers address the discordance between an individual's risk perceptions and the presence of actual risk factors.

Randomized controlled trial lifestyle interventions for Asian Americans: a systematic review.

OBJECTIVE: Asian Americans are the fastest-growing race in the United States. However, they are largely underrepresented in health research, particularly in lifestyle interventions. A systematic review was conducted to analyze the characteristics and quality of lifestyle intervention literature promoting changes in physical activity (PA), diet, and/or weight management targeting Asian Americans. METHOD: A systematic electronic database search identified randomized controlled clinical trials (RCTs), involving lifestyle interventions for Asian Americans, published from 1995 to 2013 conducted in the US. Data extraction was conducted from August through December 2013. RESULTS: Seven RCTs met the review criteria. Cross-study comparisons were difficult due to diversity in: RCT intervention designs, cultural appropriateness, outcome measures, sample size, and race/ethnic groups. Overall, risk of bias and cultural appropriateness scores were moderate to low. Five out of seven RCTs showed significant between group differences for PA, diet, and weight. In general, sample sizes were small or lacked sufficient power to fully analyze intervention efficacy. CONCLUSION: Evidence of the efficacy for lifestyle interventions among Asian Americans was mixed. Recommendations include: more rigorous RCT designs, more objective measures, larger Asian American sample sizes, culturally appropriate interventions, individual tailoring, maintenance phase with support, and providing education and modeling of lifestyle behaviors.

The effects of physical activity and physical activity plus diet interventions on body weight in overweight or obese women who are pregnant or in postpartum: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To review the effectiveness of physical activity (PA) and PA plus diet interventions in managing weight among overweight or obese (OW/OB) pregnant or postpartum women. METHODS: Four databases were searched for randomized controlled studies published between January 2000 and December 2011 that reported weight change outcomes of PA interventions in OW/OB pregnant or postpartum women. PA alone as well as PA plus diet interventions were included. RESULTS: Of 681 abstracts identified, 11 were included (7 trials with pregnant women and 4 trials with postpartum women). Overall, we found that PA interventions were effective for OW/OB pregnant as well as postpartum women. On average, pregnant women in the intervention groups gained 0.91kg less (95% CI: -1.76, -0.06) compared with those in the usual care groups. Postpartum women in the intervention groups significantly lost more body weight (-1.22kg; 95% CI: -1.89, -0.56) than those in the control groups. In the subgroup analyses by PA intervention types, supervised PA plus diet interventions were the most effective. CONCLUSIONS: PA plus diet interventions may require more than advice; supervised PA programs or personalized prescription/goals are needed to prevent excessive weight gain for OW/OB pregnant women and excessive weight retention for OW/OB postpartum women.

Cluster analysis of elderly cardiac patients' prehospital symptomatology.

BACKGROUND: Chest pain routinely brings patients into the healthcare system, and elderly patients may present with more complex symptoms presaging ischemic heart changes than do younger patients. OBJECTIVE: To examine, using cluster analysis, how elderly patients experiencing an ischemic coronary heart disease cluster based on presenting symptoms in the week before hospitalization and how they vary in terms of their general physical and mental health, mood states, and quality of life. METHODS: Elderly (age >or=65 years), unpartnered patients (N = 247) admitted with ischemic coronary heart disease to one of five university medical centers were inducted into a clinical trial; only baseline data are reported. Interviews assessed cardiac symptoms, medical history, general physical and mental health, mood states, and quality of life. Patients were clustered (grouped) using squared Euclidean distances and weighted average linkage. Characteristics of patients were examined using analysis of variance and chi-squared analyses. RESULTS: Three clusters (groups) were identified: (a) Classic Acute Coronary Syndrome (severe ischemic pain; 22%), (b) Weary (severe fatigue, sleep disturbance, and shortness of breath; 29%), and (c) Diffuse Symptoms (mild symptomatology; 49%). Post hoc tests revealed that the Weary group was more likely to have a history of heart failure; they also exhibited significantly more psychological distress and lower quality of life than the other subgroups. CONCLUSION: Cluster analysis proved useful in grouping patients based on their symptom experience, but further research is needed to clarify the relationships among identified symptoms, psychological distress, and health outcomes; develop interventions for Weary patients; and extend the findings of this study.

Cluster analysis: a useful technique to identify elderly cardiac patients at risk for poor quality of life.

OBJECTIVE: The purposes of this study are (1) to examine the frequency of cardiac symptoms in elderly people one year after acute myocardial infarction (AMI) and/or coronary artery bypass surgery (CABG); (2) to identify patient subgroups (cluster solutions) based on cardiac symptoms after cardiac events and (3) to determine if these subgroups vary based on health related quality of life and psychological distress. METHODS: A sample of 206 elderly, unpartnered, patients (age > or = 65) were interviewed one year after AMI and/or CABG by telephone. Cardiac symptoms, SF-36, POMS, and QOL-I were measured. A hierarchical cluster analysis was used to identify patient subgroups based on cardiac symptoms, using a combination of dendrograms and stopping rules. RESULTS: Three subgroups were identified: (1) the Weary (19.4%), (2) the Diffuse symptom (68.4%), and (3) the Breathless groups (12.2%). The Weary group had significantly lower scores on all of SF-36 subscales (except for social functioning) and higher scores on all of POMS subscales (except for Anger/hostility and Confusion/Bewilderment) compared to the Diffuse symptom group. CONCLUSIONS: The cluster analysis was useful to identify the subgroup with poorer recovery. Patients in the Weary group need more attention and intervention strategies to improve their health.

Illness attribution among Japanese patients with acute myocardial infarction.

OBJECTIVE: The purpose of this study was to describe causal attribution of acute myocardial infarction (AMI) in Japanese patients. DESIGN: A cross-sectional study design was used. SETTING: The setting for this study was 5 hospitals in urban areas in Japan. SAMPLE: A convenience sample of 155 patients admitted with AMI was used. MEASURES: Causal attribution was assessed by a semi-structured interview. Known risk factors were assessed by medical record review and patient interview. RESULTS: Twenty-two different primary causes for AMI were identified. Patients most commonly cited smoking, stress, and diet as risk factors. Except for smoking, Japanese patients did not identify their cardiac risk factors as a cause of their AMI. Controlling for sociodemographic characteristics, patients with a recorded history of coronary heart disease were significantly less likely to attribute their cardiac risk factors to their AMI (P <.05). CONCLUSIONS: Effective education and counseling of patients after an AMI must be coupled with their view of what factors put them at risk for future AMIs.