-
1.
Improving Cardiovascular Health in a Pediatric Preventive Cardiology Practice.
Gooding, HC, Gauvreau, K, Bachman, J, Baker, A, Griggs, SS, Hartz, J, Huang, Y, Mendelson, MM, Palfrey, H, de Ferranti, SD
The Journal of pediatrics. 2021;:282-286.e1
Abstract
Poor childhood cardiovascular health translates into poor adult cardiovascular health. We hypothesized care in a preventive cardiology clinic would improve cardiovascular health after lifestyle counseling. Over a median of 3.9 months, mean cardiovascular health score (range 0-11) improved from 5.8 ± 2.2 to 6.3 ± 2.1 (P < .001) in 767 children.
-
2.
Providing routine chronic disease preventive care in community substance use services: a pilot study of a multistrategic clinical practice change intervention.
Tremain, D, Freund, M, Wye, P, Bowman, J, Wolfenden, L, Dunlop, A, Bartlem, K, Lecathelinais, C, Wiggers, J
BMJ open. 2018;(8):e020042
Abstract
OBJECTIVES To evaluate the potential effectiveness of a practice change intervention in increasing preventive care provision in community-based substance use treatment services. In addition, client and clinician acceptability of care were examined. DESIGN A pre-post trial conducted from May 2012 to May 2014. SETTING Public community-based substance use treatment services (n=15) in one health district in New South Wales (NSW), Australia. PARTICIPANTS Surveys were completed by 226 clients and 54 clinicians at baseline and 189 clients and 46 clinicians at follow-up. INTERVENTIONS A 12-month multistrategic clinician practice change intervention that aimed to increase the provision of preventive care for smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity. PRIMARY AND SECONDARY OUTCOME MEASURES Client and clinician reported provision of assessment, brief advice and referral for three modifiable health risk behaviours: smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity. Clinician-reported optimal care was defined as providing care to 80% of clients or more. Client acceptability and clinician attitudes towards preventive care were assessed at follow-up. RESULTS Increases in client reported care were observed for insufficient fruit and/or vegetable consumption including: assessment (24% vs 54%, p<0.001), brief advice (26% vs 46%, p<0.001), and clinicians speaking about (10% vs 31%, p<0.001) and arranging a referral (1% vs 8%, p=0.006) to telephone helplines. Clinician reported optimal care delivery increased for: assessment of insufficient fruit and/or vegetable consumption (22% vs 63%, p<0.001) and speaking about telephone helplines for each of the three health risk behaviours. Overall, clients and clinicians held favourable views regarding preventive care. CONCLUSION This study reported increases in preventive care for insufficient fruit and/or vegetable consumption; however, minimal increases were observed for smoking or insufficient physical activity. Further investigation of the barriers to preventive care delivery in community substance use settings is needed. TRIALREGISTRATION NUMBER ACTRN12614000469617.
-
3.
[Assessment of an intervention on cardiovascular risk factors in patients with rheumatoid arthritis].
Zacarías, A, Narváez, J, Rodríguez Moreno, J, Jordana, M, Nolla, JM, Gómez Vaquero, C
Medicina clinica. 2016;(3):109-12
Abstract
OBJECTIVES To evaluate the effectiveness of an intervention on cardiovascular risk factors (CVRF) in patients with rheumatoid arthritis. METHODS After determining their CVRF and cardiovascular risk (CVR) by modified SCORE, we gave the patients a letter for their general practitioners in which they were requested for their cooperation in controlling CVRF and where the therapeutic goal for LDL cholesterol was specified. Three months later, any therapeutic intervention was recorded as well as the results. RESULTS We included 211 patients, 29% with a high CVR. There were new diagnoses of CVRF in 100 patients (47%). The general practitioner changed the treatment in 2/12 diabetes, 30/84 HBP, 74/167 with elevation of LDL cholesterol and 21/51 with hypertriglyceridemia. The percentage of patients with good control over CVRF was: a) in HBP, 25 to 73%; b) elevation of LDL cholesterol from 10 to 17%; and c) in hypertriglyceridemia, 25 to 38%. CONCLUSIONS Through this intervention, a new CVRF was diagnosed in nearly half of the patients. The effectiveness of the intervention on CVRF was low.
-
4.
Prevention of diabetes and cardiovascular diseases in occupational health care: feasibility and effectiveness.
Viitasalo, K, Hemiö, K, Puttonen, S, Hyvärinen, HK, Leiviskä, J, Härmä, M, Peltonen, M, Lindström, J
Primary care diabetes. 2015;(2):96-104
Abstract
AIMS: To evaluate feasibility and effectiveness of lifestyle counseling in occupational setting on decreasing risk for diabetes and cardiovascular disease. METHODS A health check-up including physical examination, blood tests, questionnaires and health advice was completed on 2312 employees of an airline company. Participants with elevated risk for type 2 diabetes based on FINDRISC score and/or blood glucose measurement (n=657) were offered 1-3 additional lifestyle counseling sessions and 53% of them agreed to participate. After 2.5 years, 1347 employees of 2199 invited participated in a follow-up study. RESULTS Among women and men with low baseline diabetes risk, cardiovascular risk factors increased slightly during follow-up. Larger proportion of the men who attended interventions lost weight at least 5% compared with the non-attendees (18.4% vs. 8.4%, p=0.031) and their FINDRISC score increased less (0.6 vs. 1.5, p=0.037). Older age associated with participation in follow-up and higher baseline FINDRISC score and presence of clinical and lifestyle risk factors and problems in sleep and mood increased attendance in interventions. CONCLUSIONS Identification of employees with cardiovascular and diabetes risk, and the low intensity lifestyle intervention were feasible in occupational health-care setting. However, the health benefits were modest and observed only for men with increased risk.
-
5.
The effects of an exercise and lifestyle intervention program on cardiovascular, metabolic factors and cognitive performance in middle-aged adults with type II diabetes: a pilot study.
Fiocco, AJ, Scarcello, S, Marzolini, S, Chan, A, Oh, P, Proulx, G, Greenwood, C
Canadian journal of diabetes. 2013;(4):214-219
Abstract
BACKGROUND Canada is experiencing a rise in type II diabetes mellitus (T2DM), a known risk factor for accelerated cognitive decline and dementia. Within the context of an aging population, this will impose significant individual and societal burden, making the development of prevention programs imperative. OBJECTIVE This pilot study examines the effects of the Diabetes Exercise and Healthy Lifestyle Service, a 24-week intervention program, on cardiovascular, metabolic regulation and cognitive function in adults with T2DM. METHODS Seventeen middle-aged participants provided blood samples for biological markers, underwent cognitive testing and a physical stress test pre- and post-intervention. Cognitive performance was evaluated using the California Verbal Learning Test (CVLT), Digit Symbol Substitution Tasl (DSST) and fluency test. RESULTS Adjusted models reveal participants displayed increased cardiovascular fitness (VO2 peak: Mchange=4.09 mL∙kg∙min(-1) SE=1.4), peak heart rate (Mchange= 9.28 beats⋅min(-1) SE=2.68) and change in heart rate (Mchange=10.71 SE=1.76) in response to the stress test (ps<0.05) following the 24-week intervention. A decrease in body mass index (BMI) (Mchange= -1.03 SE=0.40) and depressive symptomatology (CES-D: Mchange = -3.62 SE=1.44) was also found (ps<0.05). No change was found for lipid and glucose levels. Surprisingly, analyses showed that cognitive performance on the CVLT immediate recall (M= -4.37 SE=2.21), CVTL short-delay recall (M= -1.06 SE=0.55), DSST (Mchange= -3 SE=0.53) and category fluency (Mchange= -1.69 SE=0.78) declined following the intervention (ps<0.05); however, decline on the CVLT was limited to adults with co-morbid T2DM and hypertension. CONCLUSION Additional research is needed to evaluate the benefit of an exercise and lifestyle program that targets cognitive health in those with T2DM.
-
6.
Comparing care for breast cancer survivors to non-cancer controls: a five-year longitudinal study.
Snyder, CF, Frick, KD, Peairs, KS, Kantsiper, ME, Herbert, RJ, Blackford, AL, Wolff, AC, Earle, CC
Journal of general internal medicine. 2009;(4):469-74
-
-
Free full text
-
Abstract
BACKGROUND Deficiencies in care for cancer survivors may result from unclear roles for primary care providers (PCPs) and oncology specialists in follow-up. OBJECTIVES To compare cancer survivors' care to non-cancer controls. DESIGN Retrospective, longitudinal, controlled study starting 366 days post-diagnosis. SUBJECTS Stage 1-3 breast cancer survivors age 65+ diagnosed in 1998 (n = 1961) and matched non-cancer controls (n = 1961). MEASUREMENTS Using the SEER-Medicare database, we examined the number of visits to PCPs, oncology specialists, and other physicians; receipt of influenza vaccination, cholesterol screening, colorectal cancer screening, bone densitometry, and mammography; and whether care receipt was associated with physician mix visited. RESULTS Survivors were consistently less likely to receive influenza vaccination, cholesterol screening, colorectal cancer screening, and bone densitometry but more likely to receive mammograms than controls (all p < 0.05). Over time, colorectal cancer screening and mammography decreased and influenza vaccination increased for both groups (all p < 0.0001). Trends over time in care receipt were similar for survivors and controls. In Year 1, survivors had more visits to PCPs but fewer visits to other physicians than controls (both p < 0.05). Over time, survivors' visits to PCPs and other physicians increased and to oncology specialists decreased (all p < 0.0001). Controls' visits to PCPs increased (p < 0.0001) faster than survivors' (p = 0.003). Controls' visits to other physicians increased (p < 0.0001) at a rate similar to survivors. Survivors who visited both a PCP and oncology specialist were most likely to receive each service. CONCLUSIONS Better coordination between PCPs and oncology specialists may improve care for older breast cancer survivors.
-
7.
A successful diabetes prevention study in Eskimos: the Alaska Siberia project.
Ebbesson, SO, Ebbesson, LO, Swenson, M, Kennish, JM, Robbins, DC
International journal of circumpolar health. 2005;(4):409-24
Abstract
OBJECTIVES To test the efficacy of a simple intervention method to reduce risk factors for type 2 diabetes (DM) and cardiovascular disease (CVD) in Alaskan Eskimos. STUDY DESIGN The study consisted of 1) a comprehensive screening for risk factors of 454 individuals in 4 villages, 2) a 4-year intervention and 3) a repetition of the screening in year 5 to test the efficacy of the intervention. METHODS Personal counseling (1hr/year) stressed the consumption of more traditional foods high in omega-3 fatty acids and less of certain specific store-bought foods high in palmitic acid, which was identified as being associated with glucose intolerance. RESULTS The intervention resulted in significant reductions in plasma concentrations of total cholesterol (p = 0.0001), LDL cholesterol (p = 0.0001), fasting glucose (p = 0.0001), diastolic blood pressure (p = 0.0007) and improved glucose tolerance (p = 0.0006). This occurred without loss of body weight. Sixty percent of the participants had improved glucose tolerance; only one of the 44 originally identified with impaired glucose tolerance (IGT) developed DM during the study. CONCLUSIONS Dramatic improvements of risk factors for DM and CVD were achieved in the intervention by primarily stressing the need for changes in the consumption of specific fats. The results suggest that fat consumption is an important risk factor for DM.
-
8.
Healthy weight control and dissonance-based eating disorder prevention programs: results from a controlled trial.
Stice, E, Trost, A, Chase, A
The International journal of eating disorders. 2003;(1):10-21
Abstract
OBJECTIVE Because universal psychoeducational eating disorder prevention programs have had little success, we developed and evaluated two interventions for high-risk populations: a healthy weight control intervention and a dissonance-based intervention. METHOD Adolescent girls (N = 148) with body image concerns were randomized to one of these interventions or to a waitlist control group. Participants completed baseline, termination, and 1, 3, and 6-month follow-up surveys. RESULTS Participants in both interventions reported decreased thin-ideal internalization, negative affect, and bulimic symptoms at termination and follow-up relative to controls. However, no effects were observed for body dissatisfaction or dieting and effects diminished over time. DISCUSSION Results provide evidence that both interventions effectively reduce bulimic pathology and risk factors for eating disturbances.
-
9.
Sustainability of a practice-individualized preventive service delivery intervention.
Stange, KC, Goodwin, MA, Zyzanski, SJ, Dietrich, AJ
American journal of preventive medicine. 2003;(4):296-300
Abstract
BACKGROUND The long-term effect of most interventions has not been studied. Changes due to interventions to improve patient care may revert to baseline after the intervention stimulus ends. This analysis reports the 24-month follow-up of a practice-tailored intervention to increase preventive service delivery rates. DESIGN Group randomized clinical trial with 24-month follow-up of intervention sites. SETTING/PARTICIPANTS Seventy-seven community family practices in northeast Ohio. INTERVENTION Practice-individualized facilitation of implementation of tools and approaches. MAIN OUTCOME MEASURES Summary scores of health habit counseling, screening, and immunization services recommended by the U.S. Preventive Services Task Force that were up to date for consecutive patients during randomly selected chart review days. RESULTS Previously reported increases in global preventive service delivery rates, health habit counseling, and screening rates at 12 months were sustained after 24 months. CONCLUSIONS A practice-individualized approach can result in sustainable increases in rates of preventive service delivery, even 1 year after the outside intervention stimulus ends. Tailoring of approaches to the unique characteristics of each practice may result in institutionalization of changes.
-
10.
Nonresponse bias: does it affect measurement of clinician behavior?
Solberg, LI, Beth Plane, M, Brown, RL, Underbakke, G, McBride, PE
Medical care. 2002;(4):347-52
Abstract
BACKGROUND Previous studies of nonresponders have not assessed the effects of nonresponse on the accuracy of clinician behavior measurements. Knowledge of these effects is critical to both research and quality improvement. OBJECTIVE To evaluate the hypothesis that nonresponders to a survey would not adversely affect the ability to measure rates of preventive services. RESEARCH DESIGN Four primary-care medical practices participating in a randomized clinical trial provided an unusual opportunity to compare the medical record-documented care of both responders and nonresponders to a survey of their patients. SUBJECTS Three hundred forty-five nonresponders and 321 responders to a questionnaire requesting participation in the study. MEASURES Differences in patient characteristics and diseases and documentation of screening and management of tobacco use, hypertension, and hypercholesterolemia. RESULTS Although the survey process resulted in a response rate of only 52.5% and some statistically significant differences in responder and nonresponder characteristics, there were no differences in management behavior regarding cardiovascular risk factors. Responders were more likely to have adjusted documentation of tobacco use (OR = 1.4), blood pressure measurement (OR = 9.8), and cholesterol testing (OR = 2.0), but not family history of cardiovascular disease. The most striking difference in subject characteristics was that 22.0% of nonresponders and only 12.1% of responders were tobacco users (P = 0.002). CONCLUSIONS This study confirms that survey nonresponders may have some different characteristics and risk factor screening rates than responders. However, if confirmed by others, nonresponders who have risk factors identified may not be managed differently than responders.