The bases of targeting behavior in health promotion and disease prevention

ObjectiveHealth behaviors shape more than 30% of one’s physical and mental health, as well as overall well-being. Yet, changing behavior is difficult. This paper aims first at operationalizing the concept of health behavior by focusing on its main components and determinants. Second, it gives insights into how to influence health behavior by providing an overview of some of the most commonly used approaches to the design of behavioral interventions.MethodsThis is a position paper that presents a selection of evidence-based theories, models and approaches to understand and address behavior.ResultsA health behavior broadly refers to every individual action affecting health, disease, disability, or mortality. Behavior is shaped by factors within the skin (biological, psychological) and outside the skin (interpersonal, environmental, policy). Behavior change has therefore to be addressed from an ecological perspective. Specifically, behavior change can be influenced by changing capability, opportunity and motivation. Depending on the specific determinants of the behavior at stake, there are numerous approaches that can be taken. The main steps to design interventions are: defining the problem, selecting and analyzing the target audience, setting objectives, designing the intervention, planning and implementing an evaluation.ConclusionBehaviors should not be targeted in isolation but within a socio-ecological approach that accounts for both their individual and environmental determinants.Practice implicationsThis paper provides practitioners with the bases of behavior change. It offers a road-map of the main factors to consider and shows how to address behavior by planning an intervention in all its main steps.     

The influence of beverage composition on delivery of phenolic compounds from coffee and tea

Epidemiological data suggest that consumption of coffee and tea is associated with a reduced risk of several chronic and degenerative diseases including cardiovascular disorders, diabetes, obesity and neurodegenerative disorders. Both coffee and tea are a rich source of phenolic compounds including chlorogenic acids in coffee; and flavan-3-ols as well as complex theaflavins and thearubigens in tea. Coffee and tea are two of the most commonly consumed beverages in the world and thus represent a significant opportunity to positively affect disease risk and outcomes globally. Central to this opportunity is a need to better understand factors that may affect the bioavailability of specific phenolic components from coffee and tea based beverages. An overview of the phenolic composition of coffee and tea is discussed in the context of how processing and composition might influence phenolic profiles and bioavailability of individual phenolic components. Specifically, the impact of beverage formulation, the extent and type of processing and the influence of digestion on stability, bioavailability and metabolism of bioactive phenolics from tea and coffee are discussed. The impact of co-formulation with ascorbic acid and other phytochemicals are discussed as strategies to improve absorption of these health promoting phytochemicals. A better understanding of how the beverage composition impacts phenolic profiles and their bioavailability is critical to development of beverage products designed to deliver specific health benefits.     

The impact of post-adoption beliefs on the continued use of health apps

BackgroundRecently, there has been a rapid increase in the development and use of health apps on smartphones. In spite of research on such technologies, there exist considerable gaps between health app use and our understandings of such technology. Therefore, this study explored the process of leading people to keep using health apps, mainly based on the post-acceptance model (PAM).PurposeDespite significant previous research on health apps, few studies have focused on the post-adoption behaviors of using these technologies. To address and fill the gaps in health app research, this study has developed and tested a model to explain the micro-mechanism that determines the continuance intention to use health apps, theoretically relying on the post-acceptance model (PAM) and the technology acceptance model (TAM).MethodsA sample consisting of 343 Korean adults who were currently using health apps on smartphones participated in an online survey. A path analysis was conducted to test the proposed model composed of the main factors from PAM and TAM.ResultsThe results from the path analysis indicated that the following perceptual and emotional factors—perceived usefulness, perceived ease of use, confirmation, and satisfaction—were significantly associated with the continuance intention to use health apps on smartphones.Discussion/ConclusionMain findings from this present study contribute to developing and empirically testing a model of explaining the basic process of motivating health app users to keep using those apps. This model will be helpful for researchers to further examine health-related technologies, particularly mHealth-oriented ones.     

Predictive accuracy of a health risk appraisal program using mortality risk age in 116,927 Korean men

Health risk appraisal (HRA) is a tool for determining health risk factors and motivating individuals to maintain a healthy lifestyle. We performed this study to describe the HRA algorithm and evaluate the accuracy of an HRA program for 10-yr mortality prediction in Korean men. We used data derived from periodic health examinations of 116,927 male public officials and school personnel aged 20 or older. Risk age and the difference between risk age and calendar age were calculated. We obtained the hazard ratio (HR) of 10-yr mortality according to the calculated age difference. Of the 116,927 subjects, 1,900 (1.6%) died during the 10 yr after the 1992 medical examinations. The HR of 10-yr mortality increased significantly with age difference. Compared with the HR in the reference group (age difference below 2 yr), the HR in the group with a 2- to 6-yr age difference was 1.20 (95% confidence interval [CI]: 1.05 to 1.38) and HR in the group with more than 7-yr age difference was 1.35 (95% CI: 1.14 to 1.75). Risk age is a relatively good predictor of 10-yr mortality in Korean men and may be useful in identifying high-risk middle-aged men for health interventions.     

The impact of clinical leadership on health information technology adoption: Systematic review

PurposeTo conduct a systematic review to examine evidence of associations between clinical leadership and successful information technology (IT) adoption in healthcare organisations.MethodsWe searched Medline, Embase, Cinahl, and Business Source Premier for articles published between January 2000 to May 2013 with keywords and subject terms related to: (1) the setting – healthcare provider organisations; (2) the technology – health information technology; (3) the process – adoption; and (4) the intervention – leadership. We identified 3121 unique citations, of which 32 met our criteria and were included in the review. Data extracted from the included studies were assessed in light of two frameworks: Bassellier et al.’s IT competence framework; and Avgar et al.’s health IT adoption framework.ResultsThe results demonstrate important associations between the attributes of clinical leaders and IT adoption. Clinical leaders who have technical informatics skills and prior experience with IT project management are likely to develop a vision that comprises a long-term commitment to the use of IT. Leaders who possess such a vision believe in the value of IT, are motivated to adopt it, and can maintain confidence and stability through the adversities that IT adoptions often entail. This leads to proactive leadership behaviours and partnerships with IT professionals that are associated with successful organisational and clinical outcomes.ConclusionsThis review provides evidence that clinical leaders can positively contribute to successful IT adoption in healthcare organisations. Clinical leaders who aim for improvements in the processes and quality of care should cultivate the necessary IT competencies, establish mutual partnerships with IT professionals, and execute proactive IT behaviours to achieve successful IT adoption.     

The impact of inaccurate Internet health information in a secondary school learning environment

Background

Patients in the United States commonly use the Internet to acquire health information. While a significant amount of health-related information is available on the Internet, the accuracy of this information is highly variable.

Objectives

The objective of the study was to determine how effectively students can assess the accuracy of Internet-based material when gathering information on a controversial medical topic using simple keyword searches.

Methods

A group of 34 students from the science magnet high school in Houston, Texas searched for the terms “vaccine safety” and “vaccine danger” using Google and then answered questions regarding the accuracy of the health information on the returned sites. The students were also asked to describe the lessons they learned in the exercise and to answer questions regarding the strength of evidence for seven statements regarding vaccinations. Because of the surprising revelation that the majority of students left the exercise with inaccurate information concerning the safety and efficacy of vaccines, these same students participated in a follow-up study in which a fact-based vaccine video was shown, after which the assessment of student knowledge was repeated.

Results

Of the 34 participants, 20 (59%) thought that the Internet sites were accurate on the whole, even though over half of the links (22 out of 40, 55%) that the students viewed were, in fact, inaccurate on the whole. A high percentage of the students left the first exercise with significant misconceptions about vaccines; 18 of the 34 participants (53%) reported inaccurate statements about vaccines in the lessons they learned. Of the 41 verifiable facts about vaccines that were reported by participants in their lessons-learned statement, 24 of those facts (59%) were incorrect. Following presentation of the film, the majority of students left the exercise with correct information about vaccines, based on their lessons-learned statement. In this case, 29 of the 31 participants (94%) reported accurate information about vaccines. Of the 49 verifiable facts about vaccines that were reported by participants, only 2 (4%) were incorrect. Students had higher correct scores in the “strength of evidence” exercise following exposure to the video as well.

Conclusions

Allowing students to use the Internet to gain information about medical topics should be approached with care since students may take away predominantly incorrect information. It is important to follow up conflicting information with a solid, unambiguous message that communicates those lessons that the instructor deems most important. This final message should be fact based but may need to contain an anecdotal component to counter the strong emotional message that is often delivered by inaccurate Internet sites.     

Anxiolytic and hypnotic effects in mice of roasted coffee bean volatile compounds

To clarify the relationship between the volatile compounds present in roasted coffee beans and psychological stress, we investigated the stress-reducing potential of coffee volatiles in mice using a variety of behavioral pharmacology methods. In the elevated plus-maze test, exposure to coffee volatiles increased the time spent in and the number of entries into the open arms without increasing spontaneous locomotor activity. Pentobarbital-induced sleep time was prolonged by volatile exposure. No significant effects were detected in the open-field or forced-swim tests. These results suggest that coffee volatiles lower the arousal level and exert anti-anxiety-like, stress-reducing effects in mice.     

Understanding the impact of family caregiver cancer literacy on patient health outcomes

OBJECTIVE: Family caregivers play a significant role in the diagnosis, treatment, and recovery of individuals with cancer. This position paper reviews and links the research on family caregiving and health information with the importance of cancer literacy. METHOD: Review of literature obtained through searching in Academic Search Premier, EBSCO, Communication and Mass Media Complete, PsychArticles, PsycInfo, and Health Source: Nursing/Academic Edition library databases. RESULTS: Family members are important sources of health information, informal caregivers who learn and enact medical procedures, and influential aspects of patients' healthcare and treatment decision-making, but are not seriously considered by healthcare practitioners or researchers in terms of assessing and improving health literacy. Further, very few studies have directly examined or acknowledged the potential importance of family caregiver health literacy. CONCLUSION: The extent to which family caregivers can comprehend the health information they receive along with the patient is crucial for the patient to achieve the most successful health outcome. PRACTICE IMPLICATIONS: To acknowledge the impact that family caregiver health literacy could have on patient health outcomes, targeted practical recommendations for understanding family caregiver health literacy in the cancer context are proposed: (1) family member health literacy should be assessed; (2) close relational partners should be trained as peer health educators; (3) written cancer information should be provided directly to family caregivers; (4) health interactions between family caregivers and patients should be improved; (5) theoretical perspectives into the understanding of family caregiver health literacy should be integrated into practice; and (6) patient and family caregiver health literacy should be improved.     

Combined Effects of Depression and Chronic Disease on the Risk of Mortality: The Korean Longitudinal Study of Aging (2006-2016)

BackgroundThe prevalence of depression is much higher in people with chronic disease than in the general population. Depression exacerbates existing physical conditions, resulting in a higher-than-expected death rate from the physical condition itself. In our aging society, the prevalence of multimorbid patients is expected to increase; the resulting mental problems, especially depression, should be considered. Using a large-scale cohort from the Korean Longitudinal Study of Aging (KLoSA), we analyzed the combined effects of depression and chronic disease on all-cause mortality.MethodsWe analyzed 10-year (2006–2016) longitudinal data of 9,819 individuals who took part in the KLoSA, a nationwide survey of people aged 45–79 years. We examined the association between multimorbidity and depression using chi-square test and logistic regression. We used the Cox proportional hazard model to determine the combined effects of multimorbidity and depression on the all-cause mortality risk.ResultsDuring the 10-year follow up, 1,574 people (16.0%) died. The hazard ratio associated with mild depression increased from 1.35 (95% confidence interval [CI], 1.05–1.73) for no chronic disease to 1.25 (95% CI, 0.98–1.60) for 1 chronic disease, and to 2.00 (95% CI, 1.58–2.52) for multimorbidity. The hazard ratio associated with severe depression increased from 1.73 (95% CI, 1.33–2.24) for no chronic disease, to 2.03 (95% CI, 1.60–2.57) for 1 chronic disease, and to 2.94 (95% CI, 2.37–3.65) for multimorbidity.ConclusionPatients with coexisting multimorbidity and depression are at an increased risk of all-cause mortality than those with chronic disease or depression alone.     

The role of disease management programs in the health behavior of chronically ill patients

Objective

Investigate the effects of disease management program (DMP) implementation on physical activity, smoking, and physical quality of life among chronically ill patients.

Methods

This study used a mixed-methods approach involving qualitative (35 interviews with project managers) and quantitative (survey of patients from 18 DMPs) data collection. Questionnaire response rates were 51% (2010; 2619/5108) at T0 and 47% (2011; 2191/4693) at T1.

Results

Physical activity and the percentage of smokers improved significantly over time, whereas physical quality of life declined. After adjusting for patients’ physical quality of life at T0, age, educational level, marital status, and gender, physical activity at T0 (p < 0.01), changes in physical activity (p < 0.001), and percentage of smokers at T0 (p < 0.05) predicted physical quality of life at T1. Project managers reported that DMPs improved patient–professional interaction. The ability to set more concrete targets improved patients’ health behaviors.

Conclusions

DMPs appear to improve physical activity among chronically ill patients over time. Furthermore, (changes in) health behavior are important for the physical quality of life of chronically ill patients.

Practice implications

Redesigning care systems and implementing DMPs based on the chronic care model may improve health behavior among chronically ill patients.     

Kahweol,a natural diterpene from coffee,induces peripheral antinociception by endocannabinoid system activation

Kahweol is a compound derived from coffee with reported antinociceptive effects. Based on the few reports that exist in the literature regarding the mechanisms involved in kahweol-induced peripheral antinociceptive action, this study proposed to investigate the contribution of the endocannabinoid system to the peripheral antinociception induced in rats by kahweol. Hyperalgesia was induced by intraplantar injection of prostaglandin E₂(PGE₂) and was measured with the paw pressure test. Kahweol and the drugs to test the cannabinoid system were administered locally into the right hind paw. The endocannabinoids were purified by open-bed chromatography on silica and measured by LC-MS. Kahweol (80 µg/paw) induced peripheral antinociception against PGE₂-induced hyperalgesia. This effect was reversed by the intraplantar injection of the CB₁ cannabinoid receptor antagonist AM251 (20, 40, and 80 μg/paw), but not by the CB₂ cannabinoid receptor antagonist AM630 (100 μg/paw). Treatment with the endocannabinoid reuptake inhibitor VDM11 (2.5 μg/paw) intensified the peripheral antinociceptive effect induced by low-dose kahweol (40 μg/paw). The monoacylglycerol lipase (MAGL) inhibitor, JZL184 (4 μg/paw), and the dual MAGL/fatty acid amide hydrolase (FAAH) inhibitor, MAFP (0.5 μg/paw), potentiated the peripheral antinociceptive effect of low-dose kahweol. Furthermore, kahweol increased the levels of the endocannabinoid anandamide, but not of the other endocannabinoid 2-arachidonoylglycerol nor of anandamide-related N-acylethanolamines, in the plantar surface of the rat paw. Our results suggested that kahweol induced peripheral antinociception via anandamide release and activation of CB₁ cannabinoid receptors and this compound could be used to develop new drugs for pain relief.     

Predictors of chronic disease at midlife and beyond - the health risks of obesity

A burgeoning pandemic of obesity is well characterized. 41% of U.S. adults are projected to be obese by 2015 and obesity, a potentially modifiable risk, is emerging as a leading predictor of lifetime health. The wide spectrum of morbidities related to excess body mass includes risks for diabetes, hypertension, coronary artery disease, dyslipidemia, malignancy, venous thrombosis, degenerative joint disease, pulmonary compromise, sleep apnea, cholelithiasis, depression and overall reduced quality of life. Beyond the myriad major and minor morbidities linked to obesity, increased all-cause mortality and cardiovascular mortality is recognized in the obese. Bariatric surgery literature suggests that, in the morbidly obese, increase in the lifespan is achievable with reversal of obesity, reinforcing the realization that sequelae therein are by no means inevitable. Aggressive efforts must be targeted towards population-based strategies to educate and sensitize all generations on contributors to and sequelae of excess body mass as obesity represents one of the few modifiable factors that impact on the quantity and quality of lifespan.     

Marital status,health and mortality

Marital status and living arrangements, along with changes in these in mid-life and older ages, have implications for an individual's health and mortality. Literature on health and mortality by marital status has consistently identified that unmarried individuals generally report poorer health and have a higher mortality risk than their married counterparts, with men being particularly affected in this respect. With evidence of increasing changes in partnership and living arrangements in older ages, with rising divorce amongst younger cohorts offsetting the lower risk of widowhood, it is important to consider the implications of such changes for health in later life. Within research which has examined changes in marital status and living arrangements in later life a key distinction has been between work using cross-sectional data and that which has used longitudinal data. In this context, two key debates have been the focus of research; firstly, research pointing to a possible selection of less healthy individuals into singlehood, separation or divorce, while the second debate relates to the extent to which an individual's transitions earlier in the life course in terms of marital status and living arrangements have a differential impact on their health and mortality compared with transitions over shorter time periods. After reviewing the relevant literature, this paper argues that in order to fully account for changes in living arrangements as a determinant of health and mortality transitions, future research will increasingly need to consider a longer perspective and take into account transitions in living arrangements throughout an individual's life course rather than simply focussing at one stage of the life course.     

The impact of chocolate on cardiovascular health

Cardiovascular disease is the leading determinant of mortality and morbidity in women. Functional foods are attracting interest as potential regulators of the susceptibility to disease. Supported by epidemiological evidence, chocolate has emerged as a possible modulator of cardiovascular risk. Chocolate, or cocoa as the natural source, contains flavanols, a subclass of flavonoids. The latter years have witnessed an increasing number of experimental and clinical studies that suggest a protective effect of chocolate against atherogenesis. Oxidative stress, inflammation, and endothelial function define three biological mechanisms that have shown sensitivity to chocolate. Moreover, the consumption of chocolate has been involved in the protective modulation of blood pressure, the lipid profile, the activation of platelets, and the sensitivity to insulin. Dark chocolate seems more protective than milk or white chocolate. Despite this array of benefits, there is a lack of well designed clinical studies demonstrating cardiovascular benefit of chocolate. The high caloric content of chocolate, particularly of some less pure forms, imposes caution before recommending uncontrolled consumption.     

The impact of a peer support group for children with rheumatic heart disease in Uganda

Objective

To assess the impact of a peer-support group on knowledge, quality of life, and social support for children with rheumatic heart disease (RHD).

Utilization and impact of pre-office visit video health maintenance education

Objective

To determine what percent of patients would prepare for their periodic physical examination by viewing video education about recommended health maintenance procedures and the impact of the video on those who viewed it.

Methods

274 patients were invited via US mail and a reminder phone call to view the video. A patient survey immediately followed the visit.

Results

167 surveys were completed and 73 (44%) indicated they had viewed the video. Seventy one percent who viewed the video reported it prompted them to ask at least one health maintenance question and 25% were prompted to ask 4 or more questions. Those who viewed the video rated being more prepared to discuss and keep up to date with health maintenance procedures.

Conclusions

Nearly half of patients were willing to view an educational video from home prior to their office visits and most were prompted to ask specific health maintenance questions. Further research is needed to confirm these preliminary findings and quantify the value of this educational video in activating patients regarding receiving recommended health maintenance procedures.

Practice implications

Video education from home may active patients to improve their involvement in general health maintenance during their annual examination.     

The impact of financial circumstances on student health

Objectives To explore the impact of students' financial circumstances on their mental and physical health. Design The study employed a correlational design. Methods An opportunity sample of 89 British students and 98 Finnish students completed a questionnaire which assessed their amount of debt, financial concerns, mental and physical health, smoking and drinking behaviours, work in addition to study, and perceptions of control. Results British students reported greater levels of debt and financial concern than Finnish students. They also reported significantly worse mental and physical health on a variety of dimensions. Financial concern was a significant linear predictor of mental and physical health, with increased financial concern being consistently associated with worse health. There was no evidence that students' smoking or drinking behaviour, work in addition to study, or perceptions of control substantially mediated the relationship between financial concern and health. Conclusion The results support the position that students' financial circumstances might have serious implications for their health. It is proposed, therefore, that recent changes in government funding policies for students could have a negative impact on student health and exacerbate finance‐related health inequalities. Further research is required to identify factors that may mediate or moderate the impact of financial concern on health.     

The effects of health coaching on adult patients with chronic diseases: A systematic review

Objective

The aim of this systematic review was to describe the effects of health coaching on adult patients with chronic diseases.

Methods

The reviewers searched electronic databases and performed a manual search for studies published from 2009 to 2013. The inclusion criteria covered health coaching for adults with chronic diseases by health care professionals. The studies were original, randomized controlled trials or quasi-experimental designs.

Results

Thirteen studies were selected using the inclusion criteria. The results indicate that health coaching produces positive effects on patients’ physiological, behavioral and psychological conditions and on their social life. In particular, statistically significant results revealed better weight management, increased physical activity and improved physical and mental health status.

Conclusion

Health coaching improves the management of chronic diseases. Further research into the cost-effectiveness of health coaching and its long-term effectiveness for chronic diseases is needed.Practice implications Health care professionals play key roles in promoting healthy behavior and motivating good care for adults with chronic diseases. Health coaching is an effective patient education method that can be used to motivate and take advantage of a patient's willingness to change their life style and to support the patient's home-based self-care.     

How to classify the oldest old according to their health status: A study on 1160 subjects belonging to 552 90+ Italian sib-ships characterized by familial longevity recruited within the GEHA EU Project

The health status of the oldest old, the fastest increasing population segment worldwide, progressively becomes more heterogeneous, and this peculiarity represents a major obstacle to their classification. We compared the effectiveness of four previously proposed criteria (Franceschi et al., 2000, Evert et al., 2003, Gondo et al., 2006, Andersen-Ranberg et al., 2001) in 1160 phenotypically fully characterized Italian siblings of 90 years of age and older (90+, mean age: 93 years; age range: 90–106 years) belonging to 552 sib-ships, recruited in Northern, Central and Southern Italy within the EU-funded project GEHA, followed for a six-year-survival. Main findings were: (i) “healthy” subjects varied within a large range, i.e. 5.2% (Gondo), 8.7% (Evert), 17.7% (Franceschi), and 28.5% (Andersen-Ranberg); (ii) Central Italy subjects showed better health than those from Northern and Southern Italy; (iii) mortality risk was correlated with health status independently of geographical areas; and (iv) 90+ males, although fewer in number, were healthier than females, but with no survival advantage. In conclusion, we identified a modified version of Andersen-Ranberg criteria, based on the concomitant assessment of two basic domains (cognitive, SMMSE; physical, ADL), called “Simple Model of Functional Status” (SMFS), as the most effective proxy to distinguish healthy from not-healthy subjects. This model showed that health status was correlated within sib-ships, suggesting a familial/genetic component.