International Journal of Environmental Research and Public Health

Research

23 pages, 661 KiB

Open AccessArticle

Diabetes and Cardiovascular Diseases Risk Assessment in Community Pharmacies: An Implementation Study

by Sarah Rondeaux, Tessa Braeckman, Mieke Beckwé, Natacha Biset, Joris Maesschalck, Nathalie Duquet, Isabelle De Wulf, Dirk Devroey and Carine De Vriese

Int. J. Environ. Res. Public Health 2022, 19(14), 8699; https://doi.org/10.3390/ijerph19148699 - 17 Jul 2022

Cited by 6 | Viewed by 2510

Abstract

The implementation of a new service is often challenging when translating research findings into routine clinical practices. This paper presents the results of the implementation study of a pilot project for a diabetes and cardiovascular diseases risk-assessment service in Belgian community pharmacies. To [...] Read more.

The implementation of a new service is often challenging when translating research findings into routine clinical practices. This paper presents the results of the implementation study of a pilot project for a diabetes and cardiovascular diseases risk-assessment service in Belgian community pharmacies. To evaluate the implementation of the service, a mixed method was used that follows the RE-AIM framework. During the testing stage, 37 pharmacies participated, including five that dropped out due to a lack of time or COVID-19-related temporary obligations. Overall, 502 patients participated, of which 376 (74.9%) were eligible for according-to-protocol analysis. Of these, 80 patients (21.3%) were identified as being at high risk for the targeted diseases, and 100 (26.6%) were referred to general practice for further investigation. We presented the limited effectiveness and the key elements influencing optimal implementation. Additional strategies, such as interprofessional workshops, a data-sharing platform, and communication campaigns, should be considered to spread awareness of the new role of pharmacists. Such strategies could also promote collaboration with general practitioners to ensure the follow-up of patients at high risk. Overall, this service was considered easy to perform and feasible in practice but would require financial and external support to ensure its effectiveness, sustainability, and larger-scale implementation. Full article

(This article belongs to the Special Issue Assessment and Management of Lifestyle-Related Risk Factors for the Prevention and Management of Non-communicable Disease in Primary and Community Care)

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26 pages, 705 KiB

Open AccessArticle

Prevention of Cardiovascular Diseases in Community Settings and Primary Health Care: A Pre-Implementation Contextual Analysis Using the Consolidated Framework for Implementation Research

by Naomi Aerts, Sibyl Anthierens, Peter Van Bogaert, Lieve Peremans and Hilde Bastiaens

Int. J. Environ. Res. Public Health 2022, 19(14), 8467; https://doi.org/10.3390/ijerph19148467 - 11 Jul 2022

Cited by 14 | Viewed by 4256

Abstract

Cardiovascular diseases are the world’s leading cause of mortality, with a high burden especially among vulnerable populations. Interventions for primary prevention need to be further implemented in community and primary health care settings. Context is critically important to understand potential implementation determinants. Therefore, [...] Read more.

Cardiovascular diseases are the world’s leading cause of mortality, with a high burden especially among vulnerable populations. Interventions for primary prevention need to be further implemented in community and primary health care settings. Context is critically important to understand potential implementation determinants. Therefore, we explored stakeholders’ views on the evidence-based SPICES program (EBSP); a multicomponent intervention for the primary prevention of cardiovascular disease, to inform its implementation. In this qualitative study, we conducted interviews and focus groups with 24 key stakeholders, 10 general practitioners, 9 practice nurses, and 13 lay community partners. We used adaptive framework analysis. The Consolidated Framework for Implementation Research guided our data collection, analysis, and reporting. The EBSP was valued as an opportunity to improve risk awareness and health behavior, especially in vulnerable populations. Its relative advantage, evidence-based design, adaptability to the needs and resources of target communities, and the alignment with policy evolutions and local mission and vision, were seen as important facilitators for its implementation. Concerns remain around legal and structural characteristics and intervention complexity. Our results highlight context dimensions that need to be considered and tailored to primary care and community needs and capacities when planning EBSP implementation in real life settings. Full article

(This article belongs to the Special Issue Assessment and Management of Lifestyle-Related Risk Factors for the Prevention and Management of Non-communicable Disease in Primary and Community Care)

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13 pages, 935 KiB

Open AccessArticle

Medication Knowledge and Adherence in Type 2 Diabetes Mellitus Patients in Brunei Darussalam: A Pioneer Study in Brunei Darussalam

by Najwa Hazwani Muhammad Haskani, Hui Poh Goh, Daniel Vui Teck Wee, Andi Hermansyah, Khang Wen Goh and Long Chiau Ming

Int. J. Environ. Res. Public Health 2022, 19(12), 7470; https://doi.org/10.3390/ijerph19127470 - 18 Jun 2022

Cited by 11 | Viewed by 4047

Abstract

Aim: The present study measured the medication knowledge and medication adherence in patients with type 2 diabetes in Brunei Darussalam. Demographic details and diabetes knowledge were also evaluated. Methods: A cross-sectional study conducted via the administration of a structured questionnaire consisting of 4 [...] Read more.

Aim: The present study measured the medication knowledge and medication adherence in patients with type 2 diabetes in Brunei Darussalam. Demographic details and diabetes knowledge were also evaluated. Methods: A cross-sectional study conducted via the administration of a structured questionnaire consisting of 4 sections via a face-to-face interview. Results: A total of 118 participants were interviewed. A majority of the participants were aged 40 years or above (106, 89.8%). The mean number of total medications that the participants were taking was 7.36 ± 2.87 and the mean number of antidiabetic medications was 2.39 ± 1.06. As for the antidiabetic therapy, the largest proportion of the participants were taking oral antidiabetic medications only (87, 73.73%). In the diabetes knowledge section of the questionnaire, more than half of the participants (63, 53.34%) scored higher than the acquired mean score. Family history, education level, and total medications taken were significantly correlated with diabetes knowledge. However, in the medication knowledge section of the questionnaire, the mean score (3.37 ± 1.38) was below the intended score for good knowledge. Medication knowledge has been significantly associated with gender, family history and total medications taken. A majority of the participants reported non-adherence (74, 62.71%) due to various reasons. In this study, those of the Malay race were significantly correlated with adherence to their medication regimen. This study also revealed that there is no significant relationship between diabetes knowledge, medication knowledge and medication adherence. Conclusions: The present study provides insights in regard to patients with type 2 diabetes in Brunei Darussalam and their knowledge towards the disease as well as their medications. Despite the lack of significance between the variables, the rate of non-adherence is still alarming. Further studies are required to better understand the barriers to non-adherence in these patients. Full article

(This article belongs to the Special Issue Assessment and Management of Lifestyle-Related Risk Factors for the Prevention and Management of Non-communicable Disease in Primary and Community Care)

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9 pages, 989 KiB

Open AccessArticle

How Many Hours of Device Wear Time Are Required to Accurately Measure Physical Activity Post Stroke?

by Natalie A. Fini, Anne E. Holland, Julie Bernhardt and Angela T. Burge

Int. J. Environ. Res. Public Health 2022, 19(3), 1191; https://doi.org/10.3390/ijerph19031191 - 21 Jan 2022

Cited by 6 | Viewed by 2710

Abstract

Background. Inadequate physical activity participation is a risk factor for secondary stroke. Before implementing appropriate management strategies, we need to accurately measure the physical activity of stroke survivors. We aimed to determine the duration of physical activity monitoring post-stroke that constitutes a valid [...] Read more.

Background. Inadequate physical activity participation is a risk factor for secondary stroke. Before implementing appropriate management strategies, we need to accurately measure the physical activity of stroke survivors. We aimed to determine the duration of physical activity monitoring post-stroke that constitutes a valid day. Methods. We sampled stroke survivors’ physical activity for one week following discharge from inpatient rehabilitation using the Sensewear Armband (Bodymedia, Pittsburgh, PA, USA). To determine the impact of total daily wear time on activity estimate (sedentary, light, and moderate to vigorous physical activity) accuracy, we performed simulations, removing one, two, three, or four hours from a 14-h reference day, and analysed them with linear mixed models. Results. Sixty-nine participants (46 male, 65 ± 15 years) with 271 days of physical activity data were included. All physical activity variables were significantly underestimated for all data sets (10, 11, 12, or 13 h) compared to the 14-h reference data set. The number of days classified as not meeting physical activity recommendations increased as daily monitoring duration decreased: 13% misclassification with 10-h compared to 14-h dataset (p = 0.011). Conclusions. The accuracy of physical activity estimates increases with longer daily monitoring periods following stroke, and researchers should aim to monitor post-stroke physical activity for 14 daytime hours. Full article

(This article belongs to the Special Issue Assessment and Management of Lifestyle-Related Risk Factors for the Prevention and Management of Non-communicable Disease in Primary and Community Care)

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13 pages, 1155 KiB

Open AccessArticle

Adding Estimated Cardiorespiratory Fitness to the Framingham Risk Score and Mortality Risk in a Korean Population-Based Cohort Study

by Inhwan Lee, Jeonghyeon Kim and Hyunsik Kang

Int. J. Environ. Res. Public Health 2022, 19(1), 510; https://doi.org/10.3390/ijerph19010510 - 3 Jan 2022

Cited by 9 | Viewed by 2891

Abstract

Background: The added value of non-exercise-based estimation of cardiorespiratory fitness (eCRF) to cardiovascular disease (CVD) risk factors for mortality risk has not been examined in Korean populations. Methods: This population-based prospective cohort study examined the relationship of the 10-year Framingham risk score (FRS) [...] Read more.

Background: The added value of non-exercise-based estimation of cardiorespiratory fitness (eCRF) to cardiovascular disease (CVD) risk factors for mortality risk has not been examined in Korean populations. Methods: This population-based prospective cohort study examined the relationship of the 10-year Framingham risk score (FRS) for CVD risk and eCRF with all-cause and CVD mortality in a representative sample of Korean adults aged 30 years and older. Data regarding a total of 38,350 participants (16,505 men/21,845 women) were obtained from the 2007–2015 Korea National Health and Nutrition Examination Survey (KNHANES). All-cause and CVD mortality were the main outcomes. The 10-year FRS point sum and eCRF level were the main exposures. Results: All-cause and CVD mortality was positively correlated with the 10-year FRS point summation and inversely correlated with eCRF level in this study population. The protective of high eCRF against all-cause and CVD mortality was more prominent in the middle and high FRS category than in the low FRS category. Notably, the FRS plus eCRF model has better predictor power for estimating mortality risk compared to the FRS only model. Conclusions: The current findings indicate that eCRF can be used as an alternative to objectively measured CRF for mortality risk prediction. Full article

(This article belongs to the Special Issue Assessment and Management of Lifestyle-Related Risk Factors for the Prevention and Management of Non-communicable Disease in Primary and Community Care)

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12 pages, 840 KiB

Open AccessArticle

Prediction of Cardiorespiratory Fitness in Czech Adults: Normative Values and Association with Cardiometabolic Health

by Geraldo A. Maranhao Neto, Iuliia Pavlovska, Anna Polcrova, Jeffrey I. Mechanick, Maria M. Infante-Garcia, Jose Pantaleón Hernandez, Miguel A. Araujo, Ramfis Nieto-Martinez and Juan P. Gonzalez-Rivas

Int. J. Environ. Res. Public Health 2021, 18(19), 10251; https://doi.org/10.3390/ijerph181910251 - 29 Sep 2021

Cited by 3 | Viewed by 2738

Abstract

Cardiorespiratory fitness (CRF) is a strong independent predictor of morbidity and mortality. However, there is no recent information about the impact of CRF on cardiometabolic risk specifically in Central and Eastern Europe, which are characterized by different biological and social determinants of health. [...] Read more.

Cardiorespiratory fitness (CRF) is a strong independent predictor of morbidity and mortality. However, there is no recent information about the impact of CRF on cardiometabolic risk specifically in Central and Eastern Europe, which are characterized by different biological and social determinants of health. In this cross-sectional study normative CRF values were proposed and the association between CRF and cardiometabolic outcomes was evaluated in an adult Czechian population. In 2054 participants (54.6% females), median age 48 (IQR 19 years), the CRF was predicted from a non-exercise equation. Multivariable-adjusted logistic regressions were carried out to determine the associations. Higher CRF quartiles were associated with lower prevalence of hypertension, type 2 diabetes (T2D) and dyslipidemia. Comparing subjects within the lowest CRF, we see that those within the highest CRF had decreased chances of hypertension (odds ratio (OR) = 0.36; 95% CI: 0.22–0.60); T2D (OR = 0.16; 0.05–0.47), low HDL-c (OR = 0.32; 0.17–0.60), high low-density lipoprotein (OR = 0.33; 0.21–0.53), high triglycerides (OR = 0.13; 0.07–0.81), and high cholesterol (OR = 0.44; 0.29–0.69). There was an inverse association between CRF and cardiometabolic outcomes, supporting the adoption of a non-exercise method to estimate CRF of the Czech population. Therefore, more accurate cardiometabolic studies can be performed incorporating the valuable CRF metric. Full article

(This article belongs to the Special Issue Assessment and Management of Lifestyle-Related Risk Factors for the Prevention and Management of Non-communicable Disease in Primary and Community Care)

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14 pages, 927 KiB

Open AccessArticle

Classroom Movement Breaks Reduce Sedentary Behavior and Increase Concentration, Alertness and Enjoyment during University Classes: A Mixed-Methods Feasibility Study

by Casey L. Peiris, Gráinne O’Donoghue, Lewis Rippon, Dominic Meyers, Andrew Hahne, Marcos De Noronha, Julia Lynch and Lisa C. Hanson

Int. J. Environ. Res. Public Health 2021, 18(11), 5589; https://doi.org/10.3390/ijerph18115589 - 24 May 2021

Cited by 16 | Viewed by 12899

Abstract

This mixed-methods study aimed to determine the feasibility of incorporating movement breaks into university classes in terms of acceptability (disruption, engagement, satisfaction), practicality (ease of scheduling and conducting breaks) and efficacy (sedentary time, concentration, alertness, enjoyment). Movement breaks of five to 10 min [...] Read more.

This mixed-methods study aimed to determine the feasibility of incorporating movement breaks into university classes in terms of acceptability (disruption, engagement, satisfaction), practicality (ease of scheduling and conducting breaks) and efficacy (sedentary time, concentration, alertness, enjoyment). Movement breaks of five to 10 min duration were scheduled after 20 min of sedentary time during 2-h classes. Classes without movement breaks were used as a comparison. Data were collected using surveys, objective physical activity monitoring and focus group interviews of students (n = 85) and tutors (n = 6). Descriptive statistics (quantitative data) and independent coding and thematic analysis (qualitative data) were completed. Students (mean age 23 ± 2 years, 69% female) actively engaged in movement breaks with no adverse events. Movement breaks were perceived to be beneficial for concentration, engagement and productivity. Timing of the break was perceived to be important to enhance the benefit and reduce disruption. Students preferred outdoor or competitive movement breaks. Students spent 13 min less time sitting (95%CI 10 to 17), took 834 more steps (95%CI 675 to 994) and had higher levels of concentration, alertness and enjoyment (p < 0.001) in classes with movement breaks compared to classes without. Classroom movement breaks are feasible and may be considered for incorporation into university classes to reduce sedentary behaviour and increase physical activity, alertness, concentration and enjoyment. Full article

(This article belongs to the Special Issue Assessment and Management of Lifestyle-Related Risk Factors for the Prevention and Management of Non-communicable Disease in Primary and Community Care)

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10 pages, 1187 KiB

Open AccessArticle

The Effect of a Physical Activity Coaching Intervention on Accelerometer-Measured Sedentary Behaviours in Insufficiently Physically Active Ambulatory Hospital Patients

by Stephen Barrett, Stephen Begg, Paul O′Halloran and Michael Kingsley

Int. J. Environ. Res. Public Health 2021, 18(11), 5543; https://doi.org/10.3390/ijerph18115543 - 22 May 2021

Cited by 2 | Viewed by 2740

Abstract

Little is known about the impact that physical activity (PA) coaching interventions have on sedentary behaviours. The aim of this study was to investigate if a coaching intervention that increases PA coincidentally influences objectively measured sedentary time in insufficiently physically active adults. We [...] Read more.

Little is known about the impact that physical activity (PA) coaching interventions have on sedentary behaviours. The aim of this study was to investigate if a coaching intervention that increases PA coincidentally influences objectively measured sedentary time in insufficiently physically active adults. We recruited 120 insufficiently physically active ambulatory hospital patients and randomized them to either receive a PA coaching intervention designed to increase objectively measured moderate-to-vigorous-intensity PA (MVPA) or be part of a control group. Participants wore an accelerometer for seven days at baseline, post-intervention (three months) and follow-up (nine months). Changes in the average length of sedentary bouts, proportion of time in sedentary behaviours and number of sedentary bouts were evaluated using mixed-model ANOVAs. At baseline, both groups undertook 67 ± 13 sedentary bouts and spent 69% ± 6% of their time in sedentary behaviours. Compared with control, the intervention group decreased the number of sedentary bouts by 24% and the proportion of time in sedentary behaviours by 7% (p < 0.001). Significant changes were not observed between the groups for average length of sedentary bouts. The PA intervention led to a decrease in the number of sedentary bouts and proportion of time in sedentary behaviours. Future research should investigate PA coaching interventions designed to target simultaneous changes in MVPA and sedentary behaviours. Full article

(This article belongs to the Special Issue Assessment and Management of Lifestyle-Related Risk Factors for the Prevention and Management of Non-communicable Disease in Primary and Community Care)

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11 pages, 3434 KiB

Open AccessArticle

Predictors of Adherence to Lifestyle Recommendations in Stroke Secondary Prevention

by Olive Lennon, Patricia Hall and Catherine Blake

Int. J. Environ. Res. Public Health 2021, 18(9), 4666; https://doi.org/10.3390/ijerph18094666 - 27 Apr 2021

Cited by 12 | Viewed by 4165

Abstract

The risk of recurrent vascular events is high following ischaemic stroke or transient ischaemic attack (TIA). Unmanaged modifiable risk factors present opportunities for enhanced secondary prevention. This cross-sectional study (n = 142 individuals post-ischaemic stroke/TIA; mean age 63 years, 70% male) describes [...] Read more.

The risk of recurrent vascular events is high following ischaemic stroke or transient ischaemic attack (TIA). Unmanaged modifiable risk factors present opportunities for enhanced secondary prevention. This cross-sectional study (n = 142 individuals post-ischaemic stroke/TIA; mean age 63 years, 70% male) describes adherence rates with risk-reducing behaviours and logistical regression models of behaviour adherence. Predictor variables used in the models com-prised age, sex, stroke/TIA status, aetiology (TOAST), modified Rankin Scale, cardiovascular fit-ness (VO_2peak) measured as peak oxygen uptake during incremental exercise (L/min) and Hospital Anxiety and Depression Score (HADS). Of the study participants, 84% abstained from smoking; 54% consumed ≥ 5 portions of fruit and vegetables/day; 31% engaged in 30 min moderate-to-vigorous physical activity (MVPA) at least 3 times/week and 18% were adherent to all three behaviours. VO_2peak was the only variable predictive of adherence to all three health behaviours (aOR 12.1; p = 0.01) and to MVPA participation (aOR 7.5; p = 0.01). Increased age (aOR 1.1; p = 0.03) and lower HADS scores (aOR 0.9; p = 0.02) were predictive of smoking abstinence. Men were less likely to consume fruit and vegetables (aOR 0.36; p = 0.04). Targeted secondary prevention interventions after stroke should address cardiovascular fitness training for MVPA and combined health behaviours; management of psychological distress in persistent smokers and consider environmental and social factors in dietary interventions, notably in men. Full article

(This article belongs to the Special Issue Assessment and Management of Lifestyle-Related Risk Factors for the Prevention and Management of Non-communicable Disease in Primary and Community Care)

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21 pages, 993 KiB

Open AccessArticle

Patients’ Perspectives about Lifestyle Behaviors and Health in the Context of Family Medicine: A Cross-Sectional Study in Portugal

by Rosália Páscoa, Andreia Teixeira, Micaela Gregório, Rosa Carvalho and Carlos Martins

Int. J. Environ. Res. Public Health 2021, 18(6), 2981; https://doi.org/10.3390/ijerph18062981 - 14 Mar 2021

Cited by 5 | Viewed by 3810

Abstract

Lifestyle interventions are recognized as essential in the prevention and treatment of non-communicable diseases. Previous studies have shown that Portuguese patients tend to give more importance to diagnostic and laboratory tests than to lifestyle measures, and seem unaware that behavioral risks are the [...] Read more.

Lifestyle interventions are recognized as essential in the prevention and treatment of non-communicable diseases. Previous studies have shown that Portuguese patients tend to give more importance to diagnostic and laboratory tests than to lifestyle measures, and seem unaware that behavioral risks are the main modifiable risk factors. The study aimed to analyze patients’ perspectives about lifestyle behaviors and health in the context of family medicine in Portugal. A population-based cross-sectional study was carried out in Portugal (the mainland). A total of 900 Portuguese patients aged ≥20 years, representative of the population, were surveyed using face-to-face questionnaires. Participants were selected by the random route method. Descriptive statistics and non-parametric tests were performed to evaluate differences between the personal beliefs and the personal behavior self-assessment, as well as between the level of importance given to the family doctor to address health behaviors and the reported approach implemented by the family doctor, and its association with bio-demographic variables. The results indicate that the vast majority of this Portuguese cohort has informed beliefs regarding lifestyle behaviors, tends to overestimate their own behavior self-assessment, and strongly agrees that it is important that their family doctor asks/advises on these lifestyle behaviors, although the proportion of those who totally agree that their family doctor usually does this is significantly lower. Differences concerning bio-demographic variables were found. Future research directions should focus on the politics, economics, and policy aspects that may have an impact in this area. It will also be important to understand more broadly the relationships between lifestyle behaviors and clinical, physical, and sociodemographic variables. Full article

(This article belongs to the Special Issue Assessment and Management of Lifestyle-Related Risk Factors for the Prevention and Management of Non-communicable Disease in Primary and Community Care)

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11 pages, 328 KiB

Open AccessArticle

The Influence of Social Isolation on the Preventive Behaviors for Non-Communicable Diseases in Community-Dwelling Older Adults in Japan

by Yuko Yamaguchi, Masako Yamada, Elsi Dwi Hapsari and Hiroya Matsuo

Int. J. Environ. Res. Public Health 2020, 17(23), 8985; https://doi.org/10.3390/ijerph17238985 - 2 Dec 2020

Cited by 7 | Viewed by 3208

Abstract

This study aimed to examine the relationship between one’s physical status related to non-communicable diseases (NCDs) and social isolation, and to identify lifestyle behaviors for the prevention of NCDs associated with social isolation among community-dwelling older adults in Japan. A cross-sectional study was [...] Read more.

This study aimed to examine the relationship between one’s physical status related to non-communicable diseases (NCDs) and social isolation, and to identify lifestyle behaviors for the prevention of NCDs associated with social isolation among community-dwelling older adults in Japan. A cross-sectional study was conducted to investigate lifestyle behaviors for NCD prevention associated with social isolation in Japanese adults aged 60 years and above in a community setting. Out of 57 participants, 17.5% were not socially participative, 66.7% hardly ever, 29.8% sometimes, and 3.5% often felt loneliness. Non-social participation and loneliness were negatively related to the frequency of vegetable and fruit intake. Additionally, loneliness was positively associated with one’s duration of smoking and current smoking habits, and negatively associated with the frequency of moderate-intensity activities, with marginal significance. Those with non-social participation or loneliness were less likely to eat a healthy diet and live a smoke-free lifestyle. The findings of this study suggest that a mutual health support system in the community and the development of community-based approaches for the prevention of NCDs among Japanese older adults are needed. Full article

(This article belongs to the Special Issue Assessment and Management of Lifestyle-Related Risk Factors for the Prevention and Management of Non-communicable Disease in Primary and Community Care)

11 pages, 577 KiB

Open AccessArticle

Dietary Diversity Score: Implications for Obesity Prevention and Nutrient Adequacy in Renal Transplant Recipients

by I-Hsin Lin, Tuyen Van Duong, Shih-Wei Nien, I-Hsin Tseng, Hsu-Han Wang, Yang-Jen Chiang, Chia-Yen Chen and Te-Chih Wong

Int. J. Environ. Res. Public Health 2020, 17(14), 5083; https://doi.org/10.3390/ijerph17145083 - 14 Jul 2020

Cited by 13 | Viewed by 4127

Abstract

Obesity affects both medical and surgical outcomes in renal transplant recipients (RTRs). Dietary diversity, an important component of a healthy diet, might be a useful nutritional strategy for monitoring patients with obesity. In this cross-sectional study, the data of 85 eligible RTRs were [...] Read more.

Obesity affects both medical and surgical outcomes in renal transplant recipients (RTRs). Dietary diversity, an important component of a healthy diet, might be a useful nutritional strategy for monitoring patients with obesity. In this cross-sectional study, the data of 85 eligible RTRs were analyzed. Demographic data, routine laboratory data, and 3-day dietary data were collected. Participants were grouped into nonobesity and obesity groups based on body mass index (BMI) (for Asian adults, the cutoff point is 27 kg/m²). Dietary diversity score (DDS) was computed by estimating scores for the six food groups emphasized in the Food Guide. The mean age and BMI of participants were 49.7 ± 12.6 years and 24.0 ± 3.8 kg/m², respectively. In the study population, 20.0% (n = 17) were obese. DDS was significantly lower in obese participants than in those who were not obese (1.53 ± 0.87 vs. 2.13 ± 0.98; p = 0.029). In addition, DDS was correlated with nutrition adequacy of the diet. Multivariate analysis showed that the odds of obesity decreased with each unit increase in DDS (odds ratio, 0.278; 95% confidence interval, 0.101–0.766; p = 0.013). We conclude that patients with higher dietary diversity have a lower prevalence of obesity. Full article

(This article belongs to the Special Issue Assessment and Management of Lifestyle-Related Risk Factors for the Prevention and Management of Non-communicable Disease in Primary and Community Care)

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Review

Jump to: Research, Other

16 pages, 752 KiB

Open AccessReview

Lifestyle Interventions to Improve Glycemic Control in Adults with Type 2 Diabetes Living in Low-and-Middle Income Countries: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (RCTs)

by Grainne O’Donoghue, Cliona O’Sullivan, Isabelle Corridan, Jennifer Daly, Ronan Finn, Kathryn Melvin and Casey Peiris

Int. J. Environ. Res. Public Health 2021, 18(12), 6273; https://doi.org/10.3390/ijerph18126273 - 10 Jun 2021

Cited by 18 | Viewed by 7067

Abstract

Alongside glucose lowering therapy, clinical guidelines recommend lifestyle interventions as cornerstone in the care of people living with type 2 diabetes (T2DM). There is a specific need for an up-to-date review assessing the effectiveness of lifestyle interventions for people with T2DM living in [...] Read more.

Alongside glucose lowering therapy, clinical guidelines recommend lifestyle interventions as cornerstone in the care of people living with type 2 diabetes (T2DM). There is a specific need for an up-to-date review assessing the effectiveness of lifestyle interventions for people with T2DM living in low-and-middle income countries (MICs). Four electronic databases were searched for RCTs published between 1990 and 2020. T2DM, lifestyle interventions, LMICs and their synonyms were used as search terms. Data codebooks were developed and data were extracted. Narrative synthesis and meta-analysis were conducted using random effects models to calculate mean differences (MD) and standardized mean differences (SMD) and 95% confidence intervals (CI). Of 1284 articles identified, 30 RCTs (n = 16,670 participants) met the inclusion criteria. Pooled analysis revealed significant improvement in HBA1c (MD −0.63; CI: −0.86, −0.40), FBG (SMD −0.35; CI: −0.54, −0.16) and BMI (MD −0.5; CI: −0.8, −0.2). In terms of intervention characteristics, those that included promoted self-management using multiple education components (e.g., diet, physical activity, medication adherence, smoking cessation) and were delivered by healthcare professionals in a hospital/clinic setting were deemed most effective. However, when interpreting these results, it is important to consider that most included studies were evaluated as being of low quality and there was a significant amount of intervention characteristics heterogeneity. There is a need for further well-designed studies to inform the evidence base on which lifestyle interventions are most effective for glycemic control in adults with T2DM living in LMICs. Full article

(This article belongs to the Special Issue Assessment and Management of Lifestyle-Related Risk Factors for the Prevention and Management of Non-communicable Disease in Primary and Community Care)

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25 pages, 2276 KiB

Open AccessReview

Impact of Lifestyle Intervention Programs for Children and Adolescents with Overweight or Obesity on Body Weight and Selected Cardiometabolic Factors—A Systematic Review

by Beata Bondyra-Wiśniewska, Joanna Myszkowska-Ryciak and Anna Harton

Int. J. Environ. Res. Public Health 2021, 18(4), 2061; https://doi.org/10.3390/ijerph18042061 - 20 Feb 2021

Cited by 33 | Viewed by 6587

Abstract

Excessive body mass is a health problem among children and adolescents that contributes to the occurrence of lipid disorders and abnormal blood pressure. Effective treatment of excessive body mass in children is essential for the health of population in the future. The aim [...] Read more.

Excessive body mass is a health problem among children and adolescents that contributes to the occurrence of lipid disorders and abnormal blood pressure. Effective treatment of excessive body mass in children is essential for the health of population in the future. The aim of the study was to identify universal components of lifestyle interventions in children and adolescents with overweight or obesity leading to weight loss and improvement of selected cardiometabolic parameters. The review included studies from the PubMed and Google Scholar databases published in 2010–2019, which were analyzed for eligibility criteria including age of the participants, BMI defined as overweight or obese, nutritional intervention and the assessment of BMI and/or BMI z-score and at least one lipid profile parameter. Eighteen studies were included in the review, presenting the results of 23 intervention programs in which a total of 1587 children and adolescents participated. All interventions, except one, were multi-component. Data analysis suggests a relationship between a decrease in BMI and/or BMI z-score with diet and physical activity, the involvement of a dietician/nutrition specialist and physician in the treatment team and a longer duration of intervention. Moreover, it seems that a decrease in BMI is mostly associated with decreases in total cholesterol, triglycerides, low density lipoprotein cholesterol and blood pressure. No change in BMI and/or BMI z-score is associated with no change in blood pressure. Our data can be used by public health authorities to design effective weight loss programs for children and adolescents. Full article

(This article belongs to the Special Issue Assessment and Management of Lifestyle-Related Risk Factors for the Prevention and Management of Non-communicable Disease in Primary and Community Care)

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Other

Jump to: Research, Review

15 pages, 1921 KiB

Open AccessSystematic Review

Classroom Movement Breaks and Physically Active Learning Are Feasible, Reduce Sedentary Behaviour and Fatigue, and May Increase Focus in University Students: A Systematic Review and Meta-Analysis

by Julia Lynch, Gráinne O’Donoghue and Casey L. Peiris

Int. J. Environ. Res. Public Health 2022, 19(13), 7775; https://doi.org/10.3390/ijerph19137775 - 24 Jun 2022

Cited by 14 | Viewed by 8554

Abstract

Background: University students are mostly sedentary in tertiary education settings which may be detrimental to their health and learning. This review aimed to examine the feasibility and efficacy of classroom movement breaks (CMB) and physically active learning (PAL) on physical and cognitive outcomes [...] Read more.

Background: University students are mostly sedentary in tertiary education settings which may be detrimental to their health and learning. This review aimed to examine the feasibility and efficacy of classroom movement breaks (CMB) and physically active learning (PAL) on physical and cognitive outcomes in university students in the tertiary setting. Methods: Five electronic databases (MEDLINE, CINAHL, Embase, PsychINFO, and PubMed) were searched for articles published up until November 2021. Manual searching of reference lists and citation tracking were also completed. Two reviewers independently applied inclusion and exclusion criteria and completed quality assessment. Articles were included if they evaluated CMB or PAL interventions delivered to university students in a tertiary setting. Results: Of the 1691 articles identified, 14 studies with 5997 participants met the inclusion criteria. Average study quality scores were poor for both CMB and PAL studies. CMBs and PAL are feasible in the tertiary setting and increase physical activity, reduce sedentary behaviour, increase wellbeing, and reduce fatigue in university students. In addition, CMBs increased student focus and attention in class and PAL had no detrimental effect on academic performance. Conclusions: University educators should feel confident in introducing CMB and/or PAL interventions into their classes to improve student health and wellbeing. Full article

(This article belongs to the Special Issue Assessment and Management of Lifestyle-Related Risk Factors for the Prevention and Management of Non-communicable Disease in Primary and Community Care)

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Open AccessProtocol

A Global Perspective of Racial–Ethnic Inequities in Dental Caries: Protocol of Systematic Review

by Sonia Nath, Sneha Sethi, João L. Bastos, Helena M. Constante, Kostas Kapellas, Dandara Haag and Lisa M. Jamieson

Int. J. Environ. Res. Public Health 2022, 19(3), 1390; https://doi.org/10.3390/ijerph19031390 - 26 Jan 2022

Cited by 6 | Viewed by 3692

Abstract

Though current evidence suggests that racial–ethnic inequities in dental caries persist over time and across space, their magnitude is currently unknown from a global perspective. This systematic review aims to quantify the magnitude of racial/ethnic inequities in dental caries and to deconstruct the [...] Read more.

Though current evidence suggests that racial–ethnic inequities in dental caries persist over time and across space, their magnitude is currently unknown from a global perspective. This systematic review aims to quantify the magnitude of racial/ethnic inequities in dental caries and to deconstruct the different taxonomies/concepts/methods used for racial/ethnic categorization across different populations/nations. This review has been registered in PROSPERO; CRD42021282771. An electronic search of all relevant databases will be conducted until December 2021 for both published and unpublished literature. Studies will be eligible if they include data on the prevalence or severity of dental caries assessed by the decayed, missing, filled teeth index (DMFT), according to indicators of race-ethnicity. A narrative synthesis of included studies and a random-effects meta-analysis will be conducted. Forest plots will be constructed to assess the difference in effect size for the occurrence of dental caries. Study quality will be determined via the Newcastle–Ottawa Scale and the GRADE approach will be used for assessing the quality of evidence. This systematic review will enhance knowledge of the magnitude of racial/ethnic inequities in dental caries globally by providing important benchmark data on which to base interventions to mitigate the problem and to visualize the effects of racism on oral health. Full article

(This article belongs to the Special Issue Assessment and Management of Lifestyle-Related Risk Factors for the Prevention and Management of Non-communicable Disease in Primary and Community Care)

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