移动网络认知行为治疗对社交焦虑者的干预

目的：针对社交焦虑个体进行的网络认知行为治疗干预已经积累了相当多的有效性证据,但对基于智能手机的移动网络干预的有效性研究仍然数量很少。本研究开发了针对社交焦虑的移动网络认知行为治疗课程。方法：在全国范围内公开招募了100名社交焦虑者按照2:2:1的比例随机分配到移动组、网页组和等待组进行干预。结果：经过10周的干预,完成干预的移动组(n=31)与网页组(n=22)的被试,其社交焦虑水平与等待组(n=15)相比,均得到了明显改善(其中移动组P_SIAS<0.01, d_SIAS=0.95;移动组P_SPS=0.08, d_SPS=0.73);两个干预组的干预效果之间不存在显著差异。结论：本研究验证了移动网络认知行为治疗干预社交焦虑的有效性,为此前已经通过网页形式得到验证的本土化网络干预方案后续在移动平台的进一步推广提供了支持性证据。     

分析以"互联网+专科医生"为中心的慢病管理模式对社区原发性高血压患者的影响

目的:探讨以"互联网+专科医生"为中心的慢病管理模式对社区原发性高血压患者随访管理依从性及病情控制的影响.方法:回顾性收集分析2018年11月～2020年10月期间在本院就诊的132例社区原发性高血压患者的临床资料.根据社区门诊随访管理方式不同将其分为对照组(65例,常规随访管理);观察组(67例,以"互联网+专科医生"为中心的慢病管理模式).评估对比两组的自护能力、随访管理依从性,血压变化以及并发症发生情况.结果:干预后观察组自护能力量表各项评分均明显高于对照组(P<0.05).干预后观察组各项依从性评分均明显高于对照组(P<0.05).干预后观察组的收缩压和舒张压均明显低于对照组(P<0.05).观察组并发症发生率为16.42％,明显低于对照组的35.38％(P<0.05).结论:以"互联网+专科医生"为中心的慢病管理模式能提高社区原发性高血压患者随访管理依从性、自护能力和血压控制水平,并且降低并发症风险.     

我国青少年健康行为研究现状及展望

本文针对我国健康行为相关研究、研究工具、健康行为涉及的内容等方面进行综述,以期为形成健康干预体系,全面系统展开健康行为的干预研究及健康行为教育提供参考.     

基于居民健康大数据的肥胖与常见慢病关联规则分析

目的探讨肥胖程度与常见慢性病之间的关联关系,为常见慢病的预防和管理提供大数据支撑。方法基于社区公共卫生系统数据集,通过使用Apriori关联规则算法挖掘高血压、冠心病、糖尿病这3种常见慢病与肥胖程度(超重或肥胖)之间的关联关系,并根据关联规则的支持度、置信度和提升度评价肥胖程度对发生常见慢病的影响。结果共对196 554名居民的健康数据进行分析,高血压的患病率(48.6%)明显高于冠心病(22.9%)和糖尿病(20.3%),51.0%的人至少患有其中一种慢病,10.6%的人同时患有该3种慢病。关联规则分析结果显示,超重与高血压、冠心病之间均有强关联性,肥胖与高血压之间也有强关联性,而糖尿病与体型因素的关联性较弱。3种慢病之间均有强关联性,饮食嗜好与这3种慢病都有关联,老年人常常伴随发生高血压、糖尿病与冠心病。结论超重和肥胖会增加高血压、冠心病和糖尿病的发生风险,因此,为尽可能减少这些慢病的发生,健康人群要关注自身的肥胖情况,特别是老年人、有饮食偏好的人以及女性。     

行为治疗和心身疾病

行为医学是一门交叉学科,其研究领域涉及行为和生物医学科学的发现以及技术的发展和综合。这些发现和技术与健康和疾病的了解相关。并可用于预防、诊断、治疗以及康复。因此,与“心身疾病”关系极为密切。行为治疗是基于这种假设,即在生理、认知及指向活动方面,行为是一种从属变量,通过对独立变量施加影响可以使它改变。     

阜蒙县2006年民治社区基线调查诊断结果

目的 摸清影响我县社区居民健康主要危险因素和一些慢病现患状况.方法 2006年3--5月在阜蒙县城区的4个街道、8个社区整群随机抽取20岁以上常住居民进行调查.结果 民治社区居民的主要行为危险因素是大量饮酒、吸烟、膳食结构不合理、肥胖.非行为危险因素是:高血压、缺乏必要的健康知识、失业、低收入、心理负担过重等.慢病现患状况为冠心病2.6%,脑血栓2.6%,恶性肿瘤0.4%,糖尿病1.5%.结论 确立以降低慢病危险因数为我县健康促进的主要防病措施.     

健康意识理论的健康教育对高血压患者心理状态、健康行为及血压控制的影响

目的:探究健康意识理论教育对高血压患者心理状态、健康行为和血压控制的影响.方法:选取某院2018年8月至2019年6月收治的高血压患者124例,根据健康教育方式不同分为对照组(n = 56)和研究组(n=68),其中对照组患者进行常规健康教育,研究组在对照组的基础上进行基于健康意识理论的健康教育.分析比较两组患者干预前...     

成长型思维对健康的影响：效果、机制和干预

成长型思维是指个体认为个人属性可以改变的一种信念。成长型思维通过激发积极认知和有效策略,既可促使个体养成健康的生活方式和改善不良的生活习惯,也可预测个体的社交心理问题、心理健康问题和幸福感等。成长型思维干预大多采用随机对照试验设计,通过面对面、互联网和虚拟现实等方式,实施单次或多阶段干预。未来研究还应继续拓展健康领域成长型思维的理论研究,探究其作用机制,并推动干预的应用和效果评估。     

一例唐氏综合征儿童课堂退缩行为的个案研究

目的:探讨行为改变技术对克服课堂退缩行为问题的可行性。方法:采用促进、代币治疗、差别强化等行为改变技术对一例唐氏综合征患儿的课堂退缩行为进行干预。结果:干预期、追踪期个案的问题行为日平均发生次数显著低于基线期(χ2=5.556,P<0.025,χ2=11.267,P<0.005),干预期和追踪期差异不显著。结论:行为改变技术可明显降低个案的问题行为次数且追踪效果理想,干预方法值得特教工作者及家长借鉴。     

基于行为改变理论的运动干预方案设计方法与系统实现

目的针对大众对运动干预依从性低、运动习惯难以育成的现状,研究一种基于行为改变理论的运动干预方案设计方法并通过系统实现,以提升大众运动参与度。方法采用跨理论模型,根据不同阶段下个体的行为特征及自我效能特点,将运动干预过程划分为运动意识培养、运动习惯育成和科学健身指导三个阶段,针对性地提出对应的运动干预方案设计方法。基于该方法构建一套运动干预服务系统,实现干预方案的自动推理以及干预过程跟踪管理。结果在某社区医疗卫生机构的实际应用初步证明了该系统在基层运动指导中的适用性。结论基于跨理论模型的运动干预方案设计方法及其系统实现,为基层运动指导提供了必要的技术支撑,对于推动全民健身运动计划具有参考价值。     

Spanish-Language Consumer Health Information Technology Interventions: A Systematic Review

BackgroundAs consumer health information technology (IT) becomes more thoroughly integrated into patient care, it is critical that these tools are appropriate for the diverse patient populations whom they are intended to serve. Cultural differences associated with ethnicity are one aspect of diversity that may play a role in user-technology interactions.ObjectiveOur aim was to evaluate the current scope of consumer health IT interventions targeted to the US Spanish-speaking Latino population and to characterize these interventions in terms of technological attributes, health domains, cultural tailoring, and evaluation metrics.MethodsA narrative synthesis was conducted of existing Spanish-language consumer health IT interventions indexed within health and computer science databases. Database searches were limited to English-language articles published between January 1990 and September 2015. Studies were included if they detailed an assessment of a patient-centered electronic technology intervention targeting health within the US Spanish-speaking Latino population. Included studies were required to have a majority Latino population sample. The following were extracted from articles: first author’s last name, publication year, population characteristics, journal domain, health domain, technology platform and functionality, available languages of intervention, US region, cultural tailoring, intervention delivery location, study design, and evaluation metrics.ResultsWe included 42 studies in the review. Most of the studies were published between 2009 and 2015 and had a majority percentage of female study participants. The mean age of participants ranged from 15 to 68. Interventions most commonly focused on urban population centers and within the western region of the United States. Of articles specifying a technology domain, computer was found to be most common; however, a fairly even distribution across all technologies was noted. Cancer, diabetes, and child, infant, or maternal health were the most common health domains targeted by consumer health IT interventions. More than half of the interventions were culturally tailored. The most frequently used evaluation metric was behavior/attitude change, followed by usability and knowledge retention.ConclusionsThis study characterizes the existing body of research exploring consumer health IT interventions for the US Spanish-speaking Latino population. In doing so, it reveals three primary needs within the field. First, while the increase in studies targeting the Latino population in the last decade is a promising advancement, future research is needed that focuses on Latino subpopulations previously overlooked. Second, preliminary steps have been taken to culturally tailor consumer health IT interventions for the US Spanish-speaking Latino population; however, focus must expand beyond intervention content. Finally, the field should work to promote long-term evaluation of technology efficacy, moving beyond intermediary measures toward measures of health outcomes.     

健康画像在慢阻肺个性化健康管理系统中的应用研究

目的:旨在探讨个性化健康画像在慢性病健康管理中的应用,以慢性阻塞性肺疾病（COPD）为例,为COPD患者构建健康画像模型,并基于模型开发设计个性化的健康管理系统。方法:以基于知识的标签提取技术结合电子病历数据挖掘构建患者健康画像模型,并在模型基础上,根据COPD全球倡议设计针对COPD的评估方法、药物推荐算法及个性化健康推荐方法,设计开发了基于.NET平台和SQL技术C/S架构的COPD个性化健康管理系统。结果:从患者及疾病两个维度,构建出包含患者个人信息、诊断信息、并发症、用药数据及住院情况的患者群体画像模型,包含患者基本信息、主要临床表现、检查检验结果、诊断记录、治疗记录、疾病相关因素的个性化健康画像模型,并设计开发由患者主导、医生参与、能够全面展示患者群体画像及个性化健康画像并能进行个性化健康评估及推荐的COPD管理系统。结论:患者健康画像模型能为COPD的诊断、评估、治疗、病情监测、疾病预后、管理提供数据支撑。本研究基于COPD患者健康画像开发的健康管理系统从患者个性化需求的角度出发,为COPD稳定期患者提供了一个契合自身特点的实用的健康管理平台。     

Opportunities and challenges in the prevention and control of cancer and other chronic diseases: children's diet and nutrition and weight and physical activity

OBJECTIVE: The purpose of this article is to review the role of behavioral research in disease prevention and control, with a particular emphasis on lifestyle- and behavior-related cancer and chronic disease risk factors--specifically, relationships among diet and nutrition and weight and physical activity with adult cancer, and tracking developmental origins of these health-promoting and health-compromising behaviors from childhood into adulthood. METHOD: After reviewing the background of the field of cancer prevention and control and establishing plausibility for the role of child health behavior in adult cancer risk, studies selected from the pediatric published literature are reviewed. Articles were retrieved, selected, and summarized to illustrate that results from separate but related fields of study are combinable to yield insights into the prevention and control of cancer and other chronic diseases in adulthood through the conduct of nonintervention and intervention research with children in clinical, public health, and other contexts. RESULTS: As illustrated by the evidence presented in this review, there are numerous reasons (biological, psychological, and social), opportunities (school and community, health care, and family settings), and approaches (nonintervention and intervention) to understand and impact behavior change in children's diet and nutrition and weight and physical activity. CONCLUSIONS: Further development and evaluation of behavioral science intervention protocols conducted with children are necessary to understand the efficacy of these approaches and their public health impact on proximal and distal cancer, cancer-related, and chronic disease outcomes before diffusion. It is clear that more attention should be paid to early life and early developmental phases in cancer prevention.     

Comparing the efficacy of staff versus housestaff instruction in an intervention to improve hypertension management.

PURPOSE: To determine whether a resident physician can be as effective as a faculty opinion leader in changing physicians' compliance with a hypertension practice guideline. METHOD: At a general internal medicine clinic associated with an internal medicine residency program, sequential charts were reviewed for patients with uncontrolled or new-onset hypertension who were seen routinely during a two-week period. Subsequently, 23 providers were randomly assigned to an academic intervention to implement a hypertension practice guideline led by a single second-year resident instructor (RI), and 21 providers were assigned to the same intervention led by a single staff internist (SI) with an interest in hypertension. The intervention involved academic detailing, chart audit with feedback, and behavior reinforcement. Six weeks later, the chart audit was repeated to assess the change in practice patterns among providers taught by the RI compared with those taught by the SI. RESULTS: Overall, management consistent with the practice guideline improved from 32% (51/157) to 45% (56/123) (p < .01) after the intervention. This change was due to improvement in the care provided by providers from the SI-led intervention: 28% (17/60) to 57% (26/46) (p < .003). Providers from the RI-led intervention showed no improvement: 35% (34/97) to 39% (30/77) (p = NS). CONCLUSIONS: This intervention was effective in improving providers' compliance with a hypertension practice guideline, but only when led by a faculty opinion leader. A resident instructor using the same format was unable to change the providers' behaviors.     

A Web-Based Peer-Modeling Intervention Aimed at Lifestyle Changes in Patients With Coronary Heart Disease and Chronic Back Pain: Sequential Controlled Trial

Background

Traditional secondary prevention programs often fail to produce sustainable behavioral changes in everyday life. Peer-modeling interventions and integration of peer experiences in health education are a promising way to improve long-term effects in behavior modification. However, effects of peer support modeling on behavioral change have not been evaluated yet. Therefore, we implemented and evaluated a website featuring patient narratives about successful lifestyle changes.

Objective

Our aim is to examine the effects of using Web-based patient narratives about successful lifestyle change on improvements in physical activity and eating behavior for patients with coronary heart disease and chronic back pain 3 months after participation in a rehabilitation program.

Methods

The lebensstil-aendern (“lifestyle-change”) website is a nonrestricted, no-cost, German language website that provides more than 1000 video, audio, and text clips from interviews with people with coronary heart disease and chronic back pain. To test efficacy, we conducted a sequential controlled trial and recruited patients with coronary heart disease and chronic back pain from 7 inpatient rehabilitation centers in Germany. The intervention group attended a presentation on the website; the control group did not. Physical activity and eating behavior were assessed by questionnaire during the rehabilitation program and 12 weeks later. Analyses were conducted based on an intention-to-treat and an as-treated protocol.

Results

A total of 699 patients were enrolled and 571 cases were included in the analyses (control: n=313, intervention: n=258; female: 51.1%, 292/571; age: mean 53.2, SD 8.6 years; chronic back pain: 62.5%, 357/571). Website usage in the intervention group was 46.1% (119/258). In total, 141 trial participants used the website. Independent t tests based on the intention-to-treat protocol only demonstrated nonsignificant trends in behavioral change related to physical activity and eating behavior. Multivariate regression analyses confirmed belonging to the intervention group was an independent predictor of self-reported improvements in physical activity regularity (β=.09, P=.03) and using less fat for cooking (β=.09, P=.04). In independent t tests based on the as-treated protocol, website use was associated with higher self-reported improvements in integrating physical activity into daily routine (d=0.22, P=.02), in physical activity regularity (d=0.23, P=.02), and in using less fat for cooking (d=0.21, P=.03). Multivariate regression analyses revealed that using the website at least 3 times was the only factor associated with improved lifestyle behaviors.

Conclusions

Usage of the lebensstil-aendern website corresponds to more positive lifestyle changes. However, as-treated analyses do not allow for differentiating between causal effects and selection bias. Despite these limitations, the trial indicates that more than occasional website usage is necessary to reach dose-response efficacy. Therefore, future studies should concentrate on strategies to improve adherence to Web-based interventions and to encourage more frequent usage of these programs.     

Preventing the Obesity Epidemic by Second Generation Tailored Health Communication: An Interdisciplinary Review

Background

The prevention of obesity and health concerns related to obesity are major challenges worldwide. The use of eHealth communication and the tailoring of information delivered via the Internet at the individual level may increase the effectiveness of interventions. Mastering behaviors related to nutrition, physical activity, and weight management are the main issues in preventing obesity, and the need for interdisciplinary knowledge within this area is obvious.

Objective

The objectives were to review the literature on tailored health communication and to present an interdisciplinary analysis of studies on “second” generation tailored interventions aimed at behavior change in nutrition, physical activity, or weight management.

Methods

A literature search was conducted of the main electronic information sources on health communication. Selection criteria were defined, and 23 intervention studies were selected. The content analysis focused on the following: study designs, objectives of behavior change, target groups, sample sizes, study lengths, attrition rates, theories applied, intervention designs, computer-based channels used, statistically significant outcomes from the perspective of tailoring, and possible biases of the studies. However, this was not a structured meta-analysis and cannot be replicated as such.

Results

Of the 23 studies, 21 were randomized controlled trials, and all focused on behavior change: 10 studies focused on behavior change in nutrition, 7 on physical activity, 2 on nutrition and physical activity, and 4 on weight management. The target groups and the number of participants varied: 8 studies included more than 500 participants, and 6 studies included less than 100. Most studies were short; the duration of 20 studies was 6 months or less. The Transtheoretical Model was applied in 14 of the 23 studies, and feedback as a tailoring mechanism was used in addition to an Internet site (or program) in 15 studies and in addition to email in 11 studies. Self-reporting was used in 15 studies, and 14 studies did not have a no-information control group. Tailoring was more effective in nutrition interventions than in physical activity and weight management interventions. The outcomes were mixed or negative in 4 studies of physical activity interventions and in 3 studies of weight management. The use of a no-information control group seemed to have been linked to statistically significant between-group effects in measuring physical activity. This bias effect related to intervention design may explain the differences in the outcomes of the physical activity studies.

Conclusions

Tailoring was shown to have been an effective method in nutrition interventions, but the results for physical activity were mixed, which is in line with previous studies. Nevertheless, the effect of possible biases, such as relying solely on self-reports and on intervention design without a no-information control group, should not be underestimated. Thus, the issue of bias merits more attention in planning interventions and in future meta-analyses.     

Improving remote lifestyle intervention studies in children: Participant and caregiver feedback of the smart heart study

ObjectivesWe sought to describe and analyze the quantitative and qualitative feedback obtained from participants and their caregivers of the Smart Heart study, a successful 12-month lifestyle intervention for children with overweight or obesity and congenital heart disease that provided remote lifestyle counseling, to improve future lifestyle interventions in children.MethodsThirty-six participants and caregivers were polled using a standard program evaluation questionnaire at the end of the intervention. Feedback was compiled into themes, and facilitators and barriers to program success were identified.ResultsThere was a high level of satisfaction with the intervention and staff interactions as well as a low perceived burden of participation. There were also specific concerns, including mixed impressions regarding technology usage and a less impressive indication of actual impactful behavior change.ConclusionsThe study identified five themes, and corresponding facilitators and barriers to participant compliance, from the Smart Heart intervention feedback and offered suggestions for improving future lifestyle behavioral intervention study designs in children.Practice implicationsRemote smartphone counseling is effective and efficient. It is recommended that the counseling messages are specific, the counseling schedule is patient-centric, patient burden is limited, methods with immediate patient feedback are used and family is included when feasible.     

Evaluating national AIDS programmes: new core indicators

National AIDS Programs (NAPs) need assistance in evaluating the implementation, relevance, and adequacy of programs. This article distills important features of reviews of NAPs which can form the basis of reprogramming. These features included management information, prevention indicators, condom availability, sexually transmitted disease (STD) case management, evaluation outcomes, HIV/syphilis prevalence, and recommended program indicators and evaluation protocols. It is expected that in January 1994 a WHO evaluation package will be available for WHO regional offices and NAPs, and regional training workshops for NAP staff will follow. WHO's Global Programme on AIDS (GPA) is developing a microcomputer spreadsheet with database functions for extracting, sorting, and searching for data and insertion of textual information. Reports may then be generated for planning, monitoring, coordinating, and reporting to program staff and donors. The prevention indicators (PIs) developed by GPA include knowledge of prevention practices, condom availability, sexual behavior change, quality of STD case management, and HIV/STD seroprevalence. Age and sex statistics will be extracted from community surveys, health facility surveys, serosurveys in prenatal clinics, and reviews of condom distribution records. The PIs were developed only for intra-country comparisons and were field-tested in 1992-93 in 8 countries. The condom measures included the average number of condoms available per person aged 15-49 years annually and estimates of the stock of condoms on hand at the beginning of the previous 12-month period. Methods of data collection for condom indicators was provided. STD data collection involves enumeration of health care facilities and case management with STD care and individual health care provider practices. Protocols provide for appropriate STD assessment and treatment and advice to be given on condoms and partner notification. Repeated interview population surveys are designed to measure condom usage and reported number of sexual partners, symptoms of urethritis in adult men, and knowledge of prevention practices in urban and rural areas.     

Positive effects of a psycho-educational group intervention for children with a chronic disease: first results

OBJECTIVE: To determine the effectiveness of a psycho-educational group intervention for chronically ill children. METHODS: Based on principles from cognitive behavior therapy and information from previous research about children's experiences with coping with a chronic disease we developed an intervention to be used for children with different chronic diseases. The program, called Op Koers (OK), with six sessions for different age groups, was evaluated by standardised and researcher-developed psychological measures. RESULTS: A total of 109 patients participated in the study on the effects of the psycho-educational intervention. Improvements in behavioral-emotional outcomes, social competence, information seeking, relaxation and positive thinking were found both in short and medium term. Additionally, the sessions received positive appraisals. CONCLUSIONS: The program appears to have a significant and positive impact on chronically children. Further research is needed to establish the effects of the intervention. PRACTICE IMPLICATIONS: Beneficial effects can be expected from the implementation of a psycho-educational group intervention for children with heterogeneous chronic health conditions.     

A framework for modeling health behavior protocols and their linkage to behavioral theory

With the rise in chronic, behavior-related disease, computerized behavioral protocols (CBPs) that help individuals improve behaviors have the potential to play an increasing role in the future health of society. To be effective and widely used CBPs should be based on accepted behavioral theory. However, designing CBPs while at the same time specifying their linkages to behavioral theory and developing reusable CBP components (interventions) are challenges to developers of CBPs. Having an ontology with which to describe CBPs could help with these issues. As a first step towards creating such an ontology, we modeled PACE-Adolescent, a theory-based behavioral protocol that uses the Stages of Change Model and Social Cognitive Theory, using PROTEGE-2000, an ontology editor and knowledge acquisition system. We created a three-part knowledge model. Two sub-ontologies described behavioral interventions and psychological theories. The third component, implemented using Guideline Interchange Format (GLIF3), provided a way to describe the structure of a protocol and to link intervention resources and groups of actions to elements of psychological theory. Using this framework, we formally described the PACE-Adolescent protocol. Creating knowledge models such as this may lead to improvements in the design and evaluation of computerized health behavior protocols.