Actividades realizadas, experiencias exitosas y resultados

El texto aborda la elaboración e implementación de modelos como la Guía de Servicios de Salud y el modelo de Fortalecimiento de la Salud, la capacitación en Qi Gong realizada en diferentes estados, y el desarrollo del Modelo de la Dieta de la Milpa en colaboración con diversas comunidades y especialistas. Destaca la capacitación para formar replicadores en varios estados y la promoción de una metodología educativa intercultural basada en teorías pedagógicas reconocidas. Durante la pandemia, se realizaron talleres online para continuar con la formación, y se promovió activamente la Dieta de la Milpa a través de diversos materiales educativos. Además, se implementaron estos modelos en unidades de salud con la colaboración de autoridades tradicionales y se reconocieron experiencias exitosas en centros de salud que incluyeron actividades físicas y promoción de alimentos saludables.

Management of non-alcoholic fatty liver disease: Lifestyle changes.

In this editorial, we commented on a recently released manuscript by Zeng et al in the World Journal of Gastroenterology. We focused specifically on lifestyle changes in patients with non-alcoholic fatty liver disease (NAFLD). NAFLD is a hepatic manifestation of the metabolic syndrome, which ultimately leads to advanced hepatic fibrosis, cirrhosis, and hepatocellular carcinoma and affects more than 25% of the population globally. Existing therapeutic strategies against NAFLD such as pharmacologic therapies focus on liver protection, anti-inflammation, and regulating disease-related metabolic disorder symptoms. Although several drugs are in late-stage development, potent drugs against the diseases are lacking. Additionally, existing surgical approaches such as bariatric surgery are not routinely used to treat NAFLD. Intervening in patients' unhealthy lifestyles, such as weight loss through dietary changes and exercises to ameliorate patient-associated metabolic disorders and metabolic syndrome, is the first-line treatment for patients with NAFLD. With sufficient intrinsic motivation and adherence, the management of unhealthy lifestyles can reduce the severity of the disease, improve the quality of life, and increase the survival expectancy of patients with NAFLD.

A holistic lifestyle mobile health intervention for the prevention of type 2 diabetes and common mental disorders in Asian women with a history of gestational diabetes: a randomised control trial with 3-year follow-up protocol.

BACKGROUND: Women with a history of gestational diabetes mellitus (GDM) are 12-fold more likely to develop type 2 diabetes (T2D) 4-6 years after delivery than women without GDM. Similarly, GDM is associated with the development of common mental disorders (CMDs) (e.g. anxiety and depression). Evidence shows that holistic lifestyle interventions focusing on physical activity (PA), dietary intake, sleep, and mental well-being strategies can prevent T2D and CMDs. This study aims to assess the effectiveness of a holistic lifestyle mobile health intervention (mHealth) with post-GDM women in preventing T2D and CMDs in a community setting in Singapore. METHODS: The study consists of a 1-year randomised controlled trial (RCT) with a 3-year follow-up period. Post-GDM women with no current diabetes diagnosis and not planning to become pregnant will be eligible for the study. In addition, participants will complete mental well-being questionnaires (e.g. depression, anxiety, sleep) and their child's socio-emotional and cognitive development. The participants will be randomised to either Group 1 (Intervention) or Group 2 (comparison). The intervention group will receive the "LVL UP App", a smartphone-based, conversational agent-delivered holistic lifestyle intervention focused on three pillars: Move More (PA), Eat Well (Diet), and Stress Less (mental wellbeing). The intervention consists of health literacy and psychoeducational coaching sessions, daily "Life Hacks" (healthy activity suggestions), slow-paced breathing exercises, a step tracker (including brisk steps), a low-burden food diary, and a journaling tool. Women from both groups will be provided with an Oura ring for tracking physical activity, sleep, and heart rate variability (a proxy for stress), and the "HAPPY App", a mHealth app which provides health promotion information about PA, diet, sleep, and mental wellbeing, as well as display body mass index, blood pressure, and results from the oral glucose tolerance tests. Short-term aggregate effects will be assessed at 26/27 weeks (midpoint) and a 1-year visit, followed by a 2, 3, and 4-year follow-up period. DISCUSSION: High rates of progression of T2D and CMDs in women with post-GDM suggest an urgent need to promote a healthy lifestyle, including diet, PA, sleep, and mental well-being. Preventive interventions through a holistic, healthy lifestyle may be the solution, considering the inextricable relationship between physical and psychological health. We expect that holistic lifestyle mHealth may effectively support behavioural changes among women with a history of GDM to prevent T2D and CMDs. TRIAL STATUS: The protocol study was approved by the National Healthcare Group in Singapore, Domain Specific Review Board (DSRB) [2023/00178]; June 2023. Recruitment began on October 18, 2023. TRIAL REGISTRATION: ClinicalTrials.gov NCT05949957. The first submission date is June 08, 2023.

The measured healthy lifestyle habits among Saudi university females in Medina, Saudi Arabia: A cross-sectional study.

Lifestyle plays a crucial role in shaping an individual's health outcomes, we aim to calculate the prevalence of lifestyle habits among female populations in the College of Medicine, Taibah University including poor dietary habits, lack of physical activity (PA), poor coping with stress, and impaired sleep patterns and to find factors that are correlated to them. A cross-sectional study was conducted among Saudi females at the College of Medicine, Taibah University, from January 1 to June 1, 2023. Data were collected through interviewing them using validated questionnaires assessing 5 different lifestyle domains. Statistical analysis was performed using Statistical Package for the Social Sciences version 21.0. A total of 263 cases were interviewed. The mean age was 22 ±â€…8.4 years old. The average sleep quality measured by the Pittsburgh Sleep Quality Index of 2.6 ±â€…1.1, suggesting relative difficulty in sleep quality. A total of 68.6% participated in moderate PA. Dietary habits indicated a high prevalence of consumption of sweets, and fast meals, alongside low intake of fruits and vegetables. Emotional well-being, as assessed by the World Health Organization-5 questionnaire, yielded an average score of 7.8 ±â€…5.7, 58.9% moderate stress, and 8% high perceived stress. Adequate sleep quality is crucial for well-being, necessitating lifestyle modifications, particularly weight management, to address sleep disorders. Varied PA levels (46% meeting recommendations) highlight the need for standardized guidelines and tailored interventions. The high prevalence of unhealthy dietary habits underscores the importance of targeted nutritional interventions. Stress prevalence (40%) emphasizes the need for individualized stress management strategies.

Impact of the ActTeens Program on physical activity and fitness in adolescents: a cluster randomized controlled trial.

BACKGROUND: The aim of our study was to evaluate the impact of the ActTeens Program on physical activity and health-related physical fitness among adolescents in Brazil. METHODS: The "ActTeens Program" was conducted using a cluster-randomized controlled trial during 24-week school term. The sample consisted of 317 adolescents (52.7% girls; 13.61 ± 0.70 years) from four secondary schools that were randomly assigned to intervention group (N = 169) or control group (N = 148). This school-based physical activity (PA) intervention involved two components: (i) structured physical activity sessions delivered within physical education (PE) and (ii) healthy lifestyle guidance (mHealth). The primary outcome was PA assessed using Physical Activity Questionnaire for Adolescents (PAQ-A); secondary outcomes included muscular (MF) and cardiorespiratory fitness (CRF) assessed using 90-push-up, handgrip dynamometer, standing long jump, and 20 m PACER shuttle run test. Assessments were conducted at baseline, 12- and 24-week. Intervention effects were assessed using linear mixed models (LMM). RESULTS: For the primary outcome (PA), no significant group-by-time effects were observed for physical education based-PA (0.3 score; 95%CI: -0.1; 0.6; and - 0.01 score; 95%CI: -0.03; 0.03, at 12-wk and 24-wk respectively) and total PA (-0.02 score; 95%CI: -0.2; 0.2; and - 0.01score; 95%CI: -0.2; 0.2, at 12 and 24 weeks respectively). After 24 weeks, we observed a significant group by time effects for lower body muscular fitness (12.9 cm; 95%CI, 3.2 to 22.2). CONCLUSION: The implementation of aerobic and muscle-strengthening exercises used in the ActTeens intervention did not lead to improvements in physical activity. The intervention resulted in improved lower body muscular fitness, however, we found no significant differences for upper body muscular and cardiorespiratory fitness.

Determinants of health-promoting behaviors in pregnant women.

OBJECTIVE: The aim of the study was to examine the relationship between social support, marital dissatisfaction, psychological factors, and health-promoting behaviors in pregnant women. METHODS: This cross-sectional study was conducted on 1,265 pregnant women who visited the outpatient clinic of a maternity hospital between May and August 2023. The Health Promotion Lifestyle-II Questionnaire was used to measure the healthy lifestyle behaviors of pregnant women. The mental health status of pregnant women was measured using the Depression Anxiety and Stress Scale-21. The Marital Disaffection Scale was used to assess the level of disaffection toward a spouse. Perceived social support was measured by the Multidimensional Perceived Social Support Scale. RESULTS: Pregnant women had a mean age of 26.46±5.09 years. Multivariate linear regression analysis revealed that there was a positive association between perceived social support and health-promoting behaviors. It was also found that marital disaffection was negatively associated with health-promoting behaviors (p<0.001). CONCLUSION: The present study suggests that stress, anxiety, depression, and marital disaffection are negatively associated with health-promoting lifestyle behaviors, while social support is positively associated with the adoption of health practices in pregnant women. Understanding the complex interplay between psychosocial factors and healthy behaviors is crucial to improving healthy behaviors in pregnant women.

Association between Lifestyle Modification and All-Cause, Cardiovascular, and Premature Mortality in Individuals with Non-Alcoholic Fatty Liver Disease.

BACKGROUND: This study is designed to explore the correlation between multiple healthy lifestyles within the framework of "lifestyle medicine", and the mortality risk of nonalcoholic fatty liver disease (NAFLD). METHODS: The National Health and Nutrition Examination Survey (NHANES) database was employed. The analysis consisted of 5542 participants with baseline NAFLD and 5542 matched non-NAFLD participants from the database. Lifestyle information, including five low risk factors advocated by lifestyle medicine (healthy diet, vigorous physical activity, healthy sleep duration, avoiding smoking, and maintaining a non-depressed psychological status), was collected through a baseline questionnaire. Cox proportional hazards regression models and Kaplan-Meier survival curve were used to evaluate risk of mortality. In addition, subgroups were analyzed according to gender, age, body mass index and waist circumference. RESULTS: In total, 502 deaths (n = 181 deaths from cardiovascular disease (CVD)) were recorded among NAFLD participants after the median follow up duration of 6.5 years. In the multivariate-adjusted model, compared to participants with an unfavorable lifestyle (scoring 0-1), NAFLD participants with a favorable lifestyle (scoring 4-5) experienced a 56% reduction in all-cause mortality and a 66% reduction in CVD mortality. Maintaining an undepressed psychological state and adhering to vigorous exercise significantly reduced CVD mortality risk in NAFLD participants (HR, 0.64 [95% CI, 0.43-0.95]; HR, 0.54 [95% CI, 0.33-0.88]) while maintaining healthy sleep reduced premature mortality due to CVD by 31%. CONCLUSIONS: Healthy lifestyle, characterized by maintaining an undepressed mental state and healthy sleep, significantly mitigates the risk of all-cause, CVD, and premature mortality risk among NAFLD patients, with a particularly pronounced effect observed in female and obese subpopulations.

Does Serum Uric Acid Mediate Relation between Healthy Lifestyle and Components of Metabolic Syndrome?

A healthy lifestyle is related to metabolic syndrome (MetS), but the mechanism is not fully understood. This study aimed to examine the association of components of MetS with lifestyle in a Chinese population and potential mediation role of serum uric acid (SUA) in the association between lifestyle behaviors and risk of components of MetS. Data were derived from a baseline survey of the Shaanxi urban cohort in the Regional Ethnic Cohort Study in northwest China. The relationship between components of MetS, healthy lifestyle score (HLS), and SUA was investigated by logistic or linear regression. A counterfactual-based mediation analysis was performed to ascertain whether and to what extent SUA mediated the total effect of HLS on components of MetS. Compared to those with 1 or less low-risk lifestyle factors, participants with 4-5 factors had 43.6% lower risk of impaired glucose tolerance (OR = 0.564; 95%CI: 0.408~0.778), 60.8% reduction in risk of high blood pressure (OR = 0.392; 95%CI: 0.321~0.478), 69.4% reduction in risk of hypertriglyceridemia (OR = 0.306; 95%CI: 0.252~0.372), and 47.3% lower risk of low levels of HDL cholesterol (OR = 0.527; 95%CI: 0.434~0.641). SUA mediated 2.95% (95%CI: 1.81~6.16%) of the total effect of HLS on impaired glucose tolerance, 14.68% (95%CI: 12.04~18.85%) on high blood pressure, 17.29% (95%CI: 15.01~20.5%) on hypertriglyceridemia, and 12.83% (95%CI: 10.22~17.48%) on low levels of HDL cholesterol. Increased HLS tends to reduce risk of components of MetS partly by decreasing the SUA level, which could be an important mechanism by which lifestyle influences MetS.

The 6E approach to a healthy life.

The increasing pandemic of metabolic disease has spurred us to focus on promotion of health and prevention of disease. Simple public health messaging is required to inform and motivate the public to follow evidence-based interventions which can help prevent metabolic illnesses and their complications. We present a catchy 6E framework which enjoins individuals to Eat well, Exercise well, Eliminate unhealthy behaviours/habits, Ensure adequate Entertainment, relaxation and sleep, practice Emotional control, and Eschew/avoid extremes. This message can be used at individual, family as well as public health levels, to spread awareness about healthy behaviours and lifestyle.

On the use of the healthy lifestyle index to investigate specific disease outcomes.

The healthy lifestyle index (HLI), defined as the unweighted sum of individual lifestyle components, was used to investigate the combined role of lifestyle factors on health-related outcomes. We introduced weighted outcome-specific versions of the HLI, where individual lifestyle components were weighted according to their associations with disease outcomes. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), we examined the association between the standard and the outcome-specific HLIs and the risk of T2D, CVD, cancer, and all-cause premature mortality. Estimates of the hazard ratios (HRs), the Harrell's C-index and the population attributable fractions (PAFs) were compared. For T2D, the HR for 1-SD increase of the standard and T2D-specific HLI were 0.66 (95% CI: 0.64, 0.67) and 0.43 (0.42, 0.44), respectively, and the C-index were 0.63 (0.62, 0.64) and 0.72 (0.72, 0.73). Similar, yet less pronounced differences in HR and C-index were observed for standard and outcome-specific estimates for cancer, CVD and all-cause mortality. PAF estimates for mortality before age 80 were 57% (55%, 58%) and 33% (32%, 34%) for standard and mortality-specific HLI, respectively. The use of outcome-specific HLI could improve the assessment of the role of lifestyle factors on disease outcomes, thus enhancing the definition of public health recommendations.

Quantitative assessment of self-management in patients with non-alcoholic fatty liver disease: An unmet clinical need.

In this editorial we comment on the article titled "Establishment and validation of an adherence prediction system for lifestyle interventions in non-alcoholic fatty liver disease" by Zeng et al published in a recent issue of the World Journal of Gastroenterology. Non-alcoholic fatty liver disease (NAFLD) represents one of the current challenges in hepatology and public health, due to its continuous growing prevalence and the rising incidence of NAFLD-related fibrosis, non-alcoholic steatohepatitis and cirrhosis. The only effective therapeutic strategy for this disease is represented by encouraging patients to improve their lifestyle through the modification of dietary intake and increased physical exercise, but the effective application of such modifications is often limited by various factors such as lack of information, psychological barriers or poor social support. While poor adherence to a healthy lifestyle can be decisive in determining the clinical outcome, in daily practice there is a lack of quantitative instruments aimed at identifying patients with the lowest adherence to lifestyle changes and higher risk of disease progression in the course of follow-up. In this article, Zeng et al propose a quantitative scale to assess the grade of adherence of patients with NAFLD to healthy lifestyle intervention, called the Exercise and Diet Adherence Scale (EDAS). This scale, consisting of 33 items divided into 6 dimensions which relates to six subjective aspects in the self-management of NAFLD, has shown a good correlation with the identification of the sub-cohort of patients with the highest reduction in caloric intake, increase in physical exercise, probability of a reduction in liver stiffness measurement and alanine aminotransferase levels. The correlation among clinical outcomes and specific dimensions of this scale also highlights the pivotal role of a good and confidential doctor-patient relationship and of an effective communication. There is an urgent need for practical and effective instruments to assess the grade of self-management of NAFLD patients, together with the development of multidisciplinary teams with the aim of applying structured behavioral interventions.

Impact of Healthy Lifestyle Factors on Life Expectancy and Lifetime Health Care Expenditure: Nationwide Cohort Study.

BACKGROUND: The association between lifestyle risk factors and the risk of mortality and chronic diseases has been established, while limited research has explored the impact of healthy lifestyle factors on lifetime health care expenditure using longitudinal individual data. OBJECTIVE: We aimed to determine the individual and combined effects of 5 healthy lifestyle factors on life expectancy and lifetime health care expenditure in Taiwan. METHODS: Using data from the National Health Interview Survey cohort, 5 healthy lifestyle behaviors were defined and analyzed: nonsmoking, avoiding excessive alcohol consumption, engaging in sufficient physical activity, ensuring sufficient fruit and vegetable intake, and maintaining a normal weight. We used a rolling extrapolation algorithm that incorporated inverse probability of treatment weighting to estimate the life expectancy and lifetime health care expenditure of the study populations with and without healthy lifestyle factors. RESULTS: A total of 19,893 participants aged ≥30 (mean age 48.8, SD 13.4) years were included, with 3815 deaths recorded during a median follow-up period of 15.6 years. The life expectancy and per capita estimated lifetime health care expenditures for the overall study population were 35.32 years and US $58,560, respectively. Multivariable-adjusted hazard ratios for all-cause mortality in participants adhering to all 5 healthy lifestyle factors, compared with those adhering to none, were 0.37 (95% CI 0.27-0.49). We found significant increases in life expectancy for nonsmokers (2.31 years; 95% CI 0.04-5.13; P=.03), those with sufficient physical activity (1.85 years; 95% CI 0.25-4.34; P=.02), and those with adequate fruit and vegetable intake (3.25 years; 95% CI 1.29-6.81; P=.01). In addition, nonsmokers experienced a significant reduction in annual health care expenditure (-9.78%; 95% CI -46.53% to -1.45%; P=.03), as did individuals maintaining optimal body weight (-18.36%; 95% CI -29.66% to -8.57%; P=.01). Overall, participants adhering to all 5 healthy lifestyle behaviors exhibited a life gain of 7.13 years (95% CI 1.33-11.11; P=.02) compared with those adhering to one or none, with a life expectancy of 29.19 years (95% CI 25.45-33.62). Furthermore, individuals adopting all 5 healthy lifestyle factors experienced an average annual health care expenditure reduction of 28.12% (95% CI 4.43%-57.61%; P=.02) compared with those adopting one or none. CONCLUSIONS: Adopting a healthy lifestyle is associated with a longer life expectancy and a reduction of health care expenditure in Taiwanese adults. This contributes to a more comprehensive understanding of the impact of healthy lifestyle factors on the overall health and economic burden.

Psychological distress, health-promoting lifestyle and sociodemographic factors in Honduran university students: a structural equation model.

This study sought to analyze an explanatory model on the relationship among sociodemographic factors, health-promoting lifestyle behaviors and psychological distress (depression, anxiety and stress) in college students. This is an observational, analytical and cross-sectional study conducted on a national sample of 4203 students who entered a macro university in Honduras in 2021, 2022 and 2023. We used a sociodemographic survey, the Health-Promoting Lifestyle Profile (HPLP-II) and the Depression, Anxiety and Stress Scales (DASS-21). Univariate analysis and a multivariate structural equation model were conducted. The average HPLP-II score was 117.45 (±â€…23.41), and the average DASS-21 score was 20.06 (±â€…14.16). The multivariate model showed a good data fit (comparative fit index = 0.951; Tucker-Lewis index = 0.957; root mean square error of approximation = 0.067 [90% CI = 0.067-0.068]). Results indicate that being a woman (ß = 0.11; p < 0.001) and being enrolled in biological and health sciences (ß = 0.09; p < 0.001) significantly predict HPLP-II scores. Furthermore, being a woman (ß = 0.17; p < 0.001), age (ß = 0.10; p < 0.001) and having pre-existing medical conditions (ß = 0.16; p < 0.001) significantly explain part of the variance of DASS-21. A significant reverse relationship between health-promoting behavior and psychological distress was shown (r = -0.36; p < 0.001). This study identifies protective and risky sociodemographic factors linked to health-promoting lifestyle behaviors and psychological distress. Our findings have implications for developing comprehensive intervention policies and strategies to promote health in higher education settings.

[The physical activity paradox.] / Il paradosso dell'attività fisica.

Recent discoveries have shown that the effects of physical activity on health are not the same in all its domains. In particular, the health effects of physical activity differ not only in terms of modality and intensity, but also based on the context in which it is carried out. Several studies have observed that those who do a lot of physical activity at work tend to have worse health outcomes than those who do less physical activity at work but more exercise in their free time. This phenomenon has been defined as the "physical activity paradox". However, it is worth reporting that differences in health outcomes have been observed for different socioeconomic positions and that more favorable socioeconomic positions tend to have healthier lifestyles.

[The attitude of foreign students to healthy life-style and confidence to modern medicine as exemplified by students of Kursk].

The article investigates attitude of foreign students to health and a healthy lifestyle. The main practices of maintenance of health and healthy lifestyle are analyzed. The opinions of foreign students related to their health and their modes of dealing with stress in new social cultural conditions are considered. The results of sociological survey carried out in January 2024 covering students of the Kursk State Medical University - foreign students who arrived to receive higher education were chosen as the analysis base. The study established that foreign students more often associate healthy lifestyle with maintenance of mental health, healthy diet and domestic hygiene. At that, considering medicine and physician visits, percentage of respondents attributing these aspects to healthy lifestyle and themselves applying to medical workers is far lower than those giving up bad habits and maintain hygiene. The conclusion is made that it is necessary to increase awareness of foreign students about their rights to receive qualified medical care that will serve as factor increasing confidence in medical institutions and physicians.

[A healthy lifestyle of students is a resource for preserving the health of the working-age population in the near future].

The issues of acceptance and support of a healthy lifestyle by various social and age groups of the population, especially among the younger generation and youth, through the pursuit of physical, mental and social well-being remain relevant. Educational organizations, including universities, are important actors in this direction, since their students will soon become leaders in society, decision makers, as well as parents of tomorrow. According to scientists, a weak attitude towards sports, lack of time for physical education lead to a vicious circle of focusing on intellectual education, high knowledge scores, low physical abilities and physical fitness. It is emphasized that universities should have organizational systems for managing educational materials, teaching staff, as well as technologies to improve learning processes through a technology platform. Universities are strategic places to launch a wellness campaign and «have conversations¼ about healthy lifestyles and sustainable development.

A life span perspective on competencies for a healthy, physically active lifestyle: Findings of a data pooling initiative with over 7000 individuals.

Individuals are recommended to lead active lifestyles throughout the life course. The model of physical activity-related health competence (PAHCO) adopts a competence approach by integrating physical, cognitive, and motivational determinants for health-enhancing PA (movement competence, control competence, self-regulation competence). Drawing on a comprehensive dataset pooling, the goal of the present study was to model the idiosyncratic courses of 10 PAHCO indicators over the life span. We identified studies that empirically operationalized PAHCO, combining data of 7134 individuals (age range: 15-97 years; 61% female) from 18 different populations (prevention and rehabilitation sectors). We applied a stepwise multilevel analysis approach with disjunct sub-samples (n = 48) to examine linear and quadratic associations between age and PAHCO. Indicators of movement competence (i.e., manageability of endurance, strength, and balance demands; task-specific self-efficacy) congruently showed negative associations with age (0.054 ≤  R marg 2 ${R}_{\text{marg}}^{2}$  ≤ 0.211). However, parameters of control competence remained stable across the life span (-0.066 ≤ ß ≤ 0.028). The three indicators of self-regulation competence revealed an inconsistent relationship with age, though uncovering positive associations for self-control (ß = 0.106) and emotional attitude toward PA (ß = 0.088). The associations of some indicators varied significantly across sub-samples. The results suggest differential analyses for associations between PAHCO and age. While the physically determined PAHCO indicators (movement competence) probably decline across the life span, the ability to ensure regularity of PA (self-regulation competence) or align PAs with an individual's health (control competence) appear to remain constant or improve with increasing age. The findings reinforce a de-stigmatizing approach for PA promotion practices with considerable space for aligning activities with health also in the elderly.

Mediterranean Diet Adherence, Physical Activity, and Advanced Glycation End Products in Complex PTSD: A Comprehensive Examination of Lifestyle and Cardiovascular Risk in War Veterans.

As accumulated evidence suggests that individuals with post-traumatic stress disorder (PTSD) encounter earlier and more frequent occurrences of cardiovascular diseases, the aim of this study was to ascertain the differences in lifestyle and cardiovascular risk between PTSD and complex PTSD patients. We enrolled 137 male war veterans with PTSD (89 had complex PTSD). The diagnosis was established based on 11th revision of International Classification of Diseases (ICD-11), and cardiovascular risk was estimated by the measurement of advanced glycation end products. Adherence to Mediterranean diet (MD) was lower in the complex PTSD group (2.2% vs. 12.5%, p = 0.015). Accordingly, patients with complex PTSD had lower healthy lifestyle scores in comparison to PTSD counterparts (50.6 ± 9.7 vs. 59.6 ± 10.1, p < 0.001), and a positive association was noted between MD adherence and a healthy lifestyle (r = 0.183, p = 0.022). On the other hand, differences were not noted in terms of physical activity (p = 0.424), fat % (p = 0.571) or cardiovascular risk (p = 0.573). Although complex PTSD patients exhibit worse adherence to MD and lower healthy lifestyle scores, these differences do not seem to impact physical activity, body composition, or estimated cardiovascular risk. More research is needed to clarify if this lack of association accurately reflects the state of the PTSD population or results from insufficient statistical power.

Scalable Telehealth Cancer Care: integrated healthy lifestyle program to live well after cancer treatment.

Northwestern University's Center for Scalable Telehealth Cancer Care (STELLAR) is 1 of 4 Cancer Moonshot Telehealth Research Centers of Excellence programs funded by the National Cancer Institute to establish an evidence base for telehealth in cancer care. STELLAR is grounded in the Institute of Medicine's vision that quality cancer care includes not only disease treatment but also promotion of long-term health and quality of life (QOL). Cigarette smoking, insufficient physical activity, and overweight and obesity often co-occur and are associated with poorer treatment response, heightened recurrence risk, decreased longevity, diminished QOL, and increased treatment cost for many cancers. These risk behaviors are prevalent in cancer survivors, but their treatment is not routinely integrated into oncology care. STELLAR aims to foster patients' long-term health and QOL by designing, implementing, and sustaining a novel telehealth treatment program for multiple risk behaviors to be integrated into standard cancer care. Telehealth delivery is evidence-based for health behavior change treatment and is well suited to overcome access and workflow barriers that can otherwise impede treatment receipt. This paper describes STELLAR's 2-arm randomized parallel group pragmatic clinical trial comparing telehealth-delivered, coach-facilitated multiple risk behavior treatment vs self-guided usual care for the outcomes of reach, effectiveness, and cost among 3000 cancer survivors who have completed curative intent treatment. This paper also discusses several challenges encountered by the STELLAR investigative team and the adaptations developed to move the research forward.