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Objectives: Poor Food security (FS) is associated with risk of diet-related diseases and rising healthcare costs. Produce Prescription Interventions (PRx) are emerging clinical tools to improve FS and diet quality, but their impact in families with children is not well established. This study evaluates the impact of a pediatric PRx on FS and nutrition-related behaviors. Methods: Adult caregivers of children (0-18) were enrolled within a 6-month produce delivery and nutrition education intervention. A validated food security survey was administered pre/post intervention to determine FS scores and "Food Secure" status. Statistical analyses tested pre-post differences in FS scores and proportion of scores within the "Food Secure" range. Semi-structured interviews were performed post-intervention to explore families' experiences with low FS and healthy behaviors and were thematically analyzed. Results: Between October 2021 and December 2022, 82 families were enrolled, 65 completed FS survey at baseline and 54 completed it at post-intervention. FS scores improved post-intervention (P <.05) and a greater proportion of household- and child-level scores fell within the "Food Secure" range post-intervention (P <.05). Twenty-eight interviews were analyzed. Three salient themes were identified: (1) value of healthcare-based screening and intervention, (2) food and education motivate behavior change, and (3) perceptions of post-intervention lifestyle sustainability. Conclusions: Participation in the PRx was associated with improvements in FS and nutrition-related attitudes and behaviors. PRx can be implemented by health systems to improve FS and health behaviors associated with risk for diet-related diseases. Longer-term support may be needed to maintain healthy behavior changes associated with PRx participation. [ABSTRACT FROM AUTHOR]

Background: Thai older adults are valuable resources in their society. The Thai health service system is challenged when it comes to ensuring that older Thai adults can continue to live healthy and independent lives in society. It is of great value to support independence and improve older people's active ageing. Promoting lifestyle changes by applying the Plan-Do-Study-Act cycle (PDSA cycle), at group meetings in a municipality context, is a way of focusing on active ageing. This study aims to describe older adults´ experiences of lifestyle change six months after finishing group meetings applying the PDSA cycle. Methods: A qualitative approach with individual interviews and a qualitative content analysis were used with 12 Thai older adults who participated in the meetings applying the PDSA cycle. Results: Six months after finishing applying the PDSA cycle, some older adults kept their individual goals and were influenced by their family surroundings. They also formulated additional goals. Three categories and six sub-categories emerged: Keeping individual goals, influenced by the surroundings, and formulation of additional goals were the overall categories. Conclusions: These Thai older adults showed that they had the ability to make lifestyle changes with the support of the PDSA cycle, but not all maintained their planned activities after six months. The question is how healthcare professionals and the surroundings, may further support and motivate these people to maintain these changes based on their own preferences in a sustainable way. [ABSTRACT FROM AUTHOR]

Objective: Despite the availability of pharmacological treatment for seizures, people with epilepsy (PwE) commonly experience impairments in quality of life (QoL). Given the limited access to psychosocial treatments for PwE, digital interventions could bridge treatment gaps and help improve QoL. The objective of this study was to examine the effectiveness of emyna, a fully automated digital intervention based on cognitive behavioral therapy (CBT) techniques, in improving health‐related QoL among PwE who reported impairments in QoL. A previous trial showed that emyna was effective in improving depressive symptoms among PwE with a comorbid depressive disorder, but its effects on QoL among PwE without comorbid depression remain unknown. Methods: A pragmatic randomized controlled trial was conducted with N = 438 PwE (mean age = 37.5, 70.3% women, physician‐verified diagnoses) who were assigned to the intervention group (n = 216), which used emyna alongside treatment as usual (TAU), or the control group (n = 222), which received TAU only. QoL and secondary outcomes such as general self‐efficacy, medication adherence, general distress, and epilepsy‐related work and social adjustment were assessed at baseline, 3 months, and 6 months. The primary outcome was QoL assessed with the Quality of Life in Epilepsy [QOLIE‐31] total score at 3 months post‐randomization. Results: Findings from the intent‐to‐treat analyses showed that after 3 months, participants in the intervention group experienced significant and clinically relevant improvements in health‐related QoL compared to the control group (baseline‐adjusted group difference = 4.5; 95% CI = [2.0, 6.9], p < 0.001; Cohen's d = 0.32). Effects on secondary outcomes did not reach statistical significance. Significance: This study extends previous research by demonstrating that emyna facilitates improvements in QoL in a diverse group of PwE treated in routine care settings. This CBT‐based digital intervention therefore presents a convenient and cost‐effective addition to healthcare providers' treatment repertoire. Plain Language Summary: In our study, we tested a digital program called emyna, which conveys cognitive behavioral therapy (CBT) techniques to help improve the quality of life for people living with epilepsy. We found that those who used emyna alongside their usual treatments felt better about their quality of life compared to those who did not use the program. Emyna offers a new, convenient way for people with epilepsy to manage their condition, which can be used alongside currently available treatments. [ABSTRACT FROM AUTHOR]

Abstract Background Thai older adults are valuable resources in their society. The Thai health service system is challenged when it comes to ensuring that older Thai adults can continue to live healthy and independent lives in society. It is of great value to support independence and improve older people’s active ageing. Promoting lifestyle changes by applying the Plan-Do-Study-Act cycle (PDSA cycle), at group meetings in a municipality context, is a way of focusing on active ageing. This study aims to describe older adults´ experiences of lifestyle change six months after finishing group meetings applying the PDSA cycle. Methods A qualitative approach with individual interviews and a qualitative content analysis were used with 12 Thai older adults who participated in the meetings applying the PDSA cycle. Results Six months after finishing applying the PDSA cycle, some older adults kept their individual goals and were influenced by their family surroundings. They also formulated additional goals. Three categories and six sub-categories emerged: Keeping individual goals, influenced by the surroundings, and formulation of additional goals were the overall categories. Conclusions These Thai older adults showed that they had the ability to make lifestyle changes with the support of the PDSA cycle, but not all maintained their planned activities after six months. The question is how healthcare professionals and the surroundings, may further support and motivate these people to maintain these changes based on their own preferences in a sustainable way.

Abstract Objective Despite the availability of pharmacological treatment for seizures, people with epilepsy (PwE) commonly experience impairments in quality of life (QoL). Given the limited access to psychosocial treatments for PwE, digital interventions could bridge treatment gaps and help improve QoL. The objective of this study was to examine the effectiveness of emyna, a fully automated digital intervention based on cognitive behavioral therapy (CBT) techniques, in improving health‐related QoL among PwE who reported impairments in QoL. A previous trial showed that emyna was effective in improving depressive symptoms among PwE with a comorbid depressive disorder, but its effects on QoL among PwE without comorbid depression remain unknown. Methods A pragmatic randomized controlled trial was conducted with N = 438 PwE (mean age = 37.5, 70.3% women, physician‐verified diagnoses) who were assigned to the intervention group (n = 216), which used emyna alongside treatment as usual (TAU), or the control group (n = 222), which received TAU only. QoL and secondary outcomes such as general self‐efficacy, medication adherence, general distress, and epilepsy‐related work and social adjustment were assessed at baseline, 3 months, and 6 months. The primary outcome was QoL assessed with the Quality of Life in Epilepsy [QOLIE‐31] total score at 3 months post‐randomization. Results Findings from the intent‐to‐treat analyses showed that after 3 months, participants in the intervention group experienced significant and clinically relevant improvements in health‐related QoL compared to the control group (baseline‐adjusted group difference = 4.5; 95% CI = [2.0, 6.9], p

Abstract Background Over half of adults from rural South Africa are hypertensive. Apart from pharmaceutical treatment, lifestyle changes such as increasing physical activity and reducing dietary salt have been strongly advocated for the control of hypertension. However, the control rates of hypertension for adults in rural South Africa are low. In this paper we explore whether this is due to the recommended lifestyle intervention not aligning with the individual’s socio-cultural determinants of behaviour change. Aim To explore the social and cultural beliefs, perceptions and practices regarding physical activity and diet as a hypertension control intervention on hypertensive adults living in a rural sub-district in South Africa. Methods Nine focus group discussions were conducted with hypertensive adults aged 40 years and above from Bushbuckridge sub-district in Mpumalanga Province of South Africa using a semi-structured interview guide. Each session began with introductions of the discussion theme followed by a short discussion on what the participants know about hypertension and the normal blood pressure readings. Physical activity and dietary habits were then introduced as the main subject of discussion. Probing questions were used to get more insight on a specific topic. A thematic analysis approach was used to generate codes, categories, and themes. A manual approach to data analysis was chosen and data obtained through transcripts were analysed inductively. Findings Participants had a lack of knowledge about blood pressure normal values. Perceived causes of hypertension were alluded to psychosocial factors such as family and emotional-related issues. Physical activity practices were influenced by family and community members’ attitudes and gender roles. Factors which influenced dietary practices mainly involved affordability and availability of food. To control their hypertension, participants recommend eating certain foods, emotional control, taking medication, exercising, praying, correct food preparation, and performing house chores. Conclusion Lifestyle interventions to control hypertension for adults in a rural South African setting using physical activity promotion and dietary control must consider the beliefs related to hypertension control of this population.

Metabolic-associated fatty liver disease (MAFLD) is the most common chronic liver disease observed in clinical practice worldwide. This disorder has been independently associated with an increased risk of developing chronic kidney disease (CKD). The aim of this study was to evaluate whether a 2-year intervention based on a Mediterranean diet (MedDiet) and physical activity focussed on reducing intrahepatic fat contents (IFC) was associated with a decreased risk of CKD. Forty adults (50% women) residing in Mallorca, aged 48 to 60 years, diagnosed with MAFLD were recruited. Participants were divided into two groups based on whether they improved IFC measured by nuclear magnetic resonance. Anthropometric and clinical parameters improved in responders, including reduced weight, body mass index (BMI), and waist circumference. Only responders showed improvements in lipid profile and liver enzymes. Haematological parameters showed favourable changes in both groups. Oxidative stress and inflammatory biomarkers differed between groups. Responders had lower plasma interleukine-18 (IL-18) levels, but higher erythrocyte malonaldehyde (MDA) levels. Non-responders showed increased erythrocyte catalase and superoxide dismutase activity. After 2 years, non-responders had higher serum creatinine, Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) levels, while responders showed reductions in these parameters together with uric acid and urine albumin-to-creatinine ratio (UACR). Positive correlations were found between changes in IFC and kidney injury biomarkers, including MDRD and serum creatinine levels. In conclusion, a healthy diet based on the Mediterranean dietary pattern and lifestyle promotes significant improvements in parameters related to cardiovascular, hepatic, and renal health. [ABSTRACT FROM AUTHOR]

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IntroductionAmong all Asian American subgroups, Filipino-Americans have consistently been shown to have the highest rates of hypertension, raising risks of heart attack and stroke. Despite this alarming fact, little has been done to investigate culturally-sensitive interventions to control hypertension rates in this vulnerable population. To address the lack of culturally-relevant lifestyle options for blood pressure management currently available to the Filipino community, this exploratory pilot study used a design thinking approach informed by culinary medicine to develop a culturally-tailored, heart-healthy, and low sodium recipe cookbook for Filipino Americans with hypertension and evaluate its feasibility as a hypertension intervention.MethodsOur team developed a cookbook using participatory methods and design thinking, utilizing input from five Filipino culinary experts and a Registered Dietitian. The cookbook incorporates traditional Filipino recipes, excerpts from community members' interviews, and nutrient analyses. Twenty Filipinx-identifying individuals* who self-reported physician-diagnosed hypertension were recruited from Filipino community-based organizations, enrolled into this study, provided with the cookbook, and asked to cook at least one recipe. Pre- and post-intervention surveys were conducted and centered around behavior change and features of the cookbook.ResultsThis study provided evidence for the cookbook's acceptability and feasibility, with participants' open-ended responses revealing that the recipes, nutrition labels, illustrations, and cultural aspects of the cookbook increased motivation to achieve dietary change, including reducing sodium in their diet to improve their blood pressure. Participant responses also indicated positive behavior change as a result of using the cookbook, with participants reporting increased likelihood of adopting recommended actions to lower their BP after utilizing the cookbook ( x¯ = 80.83%), compared to before ( x¯ = 63.75%, p < 0.008), according to Hypertension Self-Care Management scaled scores.DiscussionIn conclusion, the results of this pilot study demonstrated acceptability of this unique cookbook and provide preliminary findings consistent with increased motivation in participants to make dietary changes and improve personal health, drawing attention to the importance of considering future culturally-tailored health interventions. Next steps should include a robust, randomized controlled trial design comparing measured blood pressure outcomes of an intervention vs. control group. *Filipinx is an inclusive term representing the gender identities of all participants in our study.

This study investigated lifestyle changes in physical activity, sleep, and diet among healthcare workers and their impact on their mental health during the COVID-19 pandemic in China. Healthcare workers (N = 589) completed an online survey about demographic and personal characteristics, working experiences, COVID-19-related stressors, lifestyle changes, and mental health (anxiety and depression) about three months after the lift of the lockdown policy in China. Lifestyle Changes (including changes in physical activity, sleep, and diet), Generalized Anxiety Disorder (GAD-7), and Depression (PHQ-9) were used to measure main outcomes. Of the participants, 39.7% (N = 234) had less physical activity, 36.0% (N = 212) slept less, and 41.8% (N = 246) ate healthier than before pandemic. Lower educational level, working within original hospitals, less physical activity and less sleep time was associated with increased anxiety. Working within original hospitals, less physical activity and an unhealthier diet was associated with increased depression. In summary, healthcare workers who became less healthy in lifestyles experienced a higher level of anxiety and depression symptoms during the COVID-19 pandemic. Strategies to promote healthy living and improve mental health among healthcare workers should be developed and implemented both during the ongoing COVID-19 pandemic and beyond. [ABSTRACT FROM AUTHOR]

Purpose of Review: The population of older adults 60–79 years globally is projected to double from 800 million to 1.6 billion between 2015 and 2050, while adults ≥ 80 years were forecast to more than triple from 125 to 430 million. The risk for cardiovascular events doubles with each decade of aging and each 20 mmHg increase of systolic blood pressure. Thus, successful management of hypertension in older adults is critical in mitigating the projected global health and economic burden of cardiovascular disease. Recent Findings: Women live longer than men, yet with aging systolic blood pressure and prevalent hypertension increase more, and hypertension control decreases more than in men, i.e., hypertension in older adults is disproportionately a women's health issue. Among older adults who are healthy to mildly frail, the absolute benefit of hypertension control, including more intensive control, on cardiovascular events is greater in adults ≥ 80 than 60–79 years old. The absolute rate of serious adverse events during antihypertensive therapy is greater in adults ≥ 80 years older than 60–79 years, yet the excess adverse event rate with intensive versus standard care is only moderately increased. Among adults ≥ 80 years, benefits of more intensive therapy appear non-existent to reversed with moderate to marked frailty and when cognitive function is less than roughly the twenty-fifth percentile. Accordingly, assessment of functional and cognitive status is important in setting blood pressure targets in older adults. Summary: Given substantial absolute cardiovascular benefits of more intensive antihypertensive therapy in independent-living older adults, this group merits shared-decision making for hypertension targets. [ABSTRACT FROM AUTHOR]

Ibtissam Talha, Noureddine Elkhoudri, Abderraouf Hilali Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, MoroccoCorrespondence: Ibtissam Talha, Email ib.talha@uhp.ac.maIntroduction: Morocco, a north African country undergoing a significant nutritional transition, with a clear shift from traditional dietary patterns towards those of the Western model. This transition has a profound impact on the health of its population, most notably in the rise of chronic illnesses and mainly cardiovascular diseases. The following cross-sectional study examines risk factors associated with these nutritional and lifestyle changes and their effects on cardiovascular risk among adults residing in Settat, central Morocco.Subjects and Methods: The study was conducted between January 20th and April 25th, 2023, involving 981 participants aged 20 and above who attended health centers in Settat. Risk factors were assessed using a questionnaire encompassing sociodemographic, health, clinical, dietary, and lifestyle data. To estimate cardiovascular risk, the National Health and Nutrition Examination Survey “NHANES” risk score was employed.Results: Abdominal obesity, a sedentary lifestyle, hypertension, hyperglycemia, and hypercholesterolemia stood out as the most prevalent risk factors, with percentages of 44.3%, 69.7%, 17.6%, 15%, and 26.5%, respectively. As per the “NHANES” risk score, 22.8% were projected to face a cardiovascular risk exceeding 20% within the following five years. This risk was notably linked to the population’s sedentary lifestyle and the dietary habits oscillating between the traditional Moroccan pattern and the Western one, marking the nutritional transition.Conclusion: The high prevalence of cardiovascular risk factors underlines the substantial impact of lifestyle changes and nutritional transitions on cardiovascular risk. Consequently, this situation calls for immediate action to devise and deploy strategies aimed at promoting healthy lifestyle choices. Raising awareness about the critical importance of maintaining such a lifestyle is imperative to mitigate the risks and prevent the onset of cardiovascular diseases.Keywords: Nutritional transition, lifestyle change, cardiovascular incidence, cardiovascular risk, settat, Morocco

Abstract Background Globally, an estimated 14% of adults live with migraine disease which impacts their physical, emotional and social wellbeing. To target the disease comprehensively, research recommends a multidisciplinary approach to migraine management. Yet, at present, migraine management primarily centers around pharmaceutical treatments. The aim of this study was to investigate the extent to which emotional awareness could influence the uptake of self-care behaviours of community-dwelling adults with migraine. Methods A cross-sectional online survey explored personal experiences with migraine disease and strategies or behaviours to manage migraine attacks. Chi-squared tests were used to investigate differences in ratings of migraine prevention and management strategies between users and non-users of the strategies. Univariable logistic regressions were used to assess the effectiveness of self-care behaviours to manage or prevent migraine attacks. Results We surveyed 170 community-dwelling adults with migraine in the United Kingdom, Austria, Germany and the United States. Most (85%) respondents had experienced migraine for over five years, where 42% of attacks usually lasted several days. Whereas we did not differentiate between diagnosis by a neurologist or self-diagnosis, the most common diagnoses in the cohort were migraine without aura (38.9%) and migraine with aura (29%). Staying hydrated was the most popular preventative strategy (87%), 70.2% used prescription medication and 64.9% changed their diet and/or supplements. Almost all ( 92.4%) respondents stated that their mood or emotions could trigger their migraine attacks. Keeping a headache or mood diary was the lowest-rated prevention strategy and was rated as "probably ineffective" or causing "no change" in preventing migraine attacks. Over a third (39.7%) kept track of their physical wellbeing and symptoms. Reasons stated for tracking symptoms included to identify triggers (65.8%), show reports to a healthcare professional (59.6%), understand when they must take medication (48.1%), track improvements (67.3%) or deteriorations (67.3%). Conclusions Migraine management is dominated by pharmaceutical management for acute pain attacks and lifestyle changes for managing migraine long-term. Perception of the effectiveness of those techniques is high, whereas perception of interventions that target the emotional or psychological components of chronic pain management (keeping a mood diary, and mental health support) is mixed. There exists a gap between the recommended biopsychosocial approach and the current state of migraine management. Graphical Abstract

Aim: The aim of this study was to explore how employees and participants experienced digital courses at a healthy life center. Material and methods: Two focus group interviews with a total of nine employees and seven in-depth interviews with participants were conducted. Interviews were analyzed using systematic text condensation. Findings: The digital room was experienced as a “new and unknown terrain” for both employees and participants. In addition, the employees experienced legal restrictions in terms of privacy protection and confidentiality. Employees and participants experienced that they “lost a lot” with digital courses, including exchange of experience, questions, the social fellowship and body language. Furthermore, both groups experienced that the digital courses provided opportunities as it was efficient and flexible. Both groups were positive to more use of digital courses and expressed that it might be a useful supplement to ordinary courses. Conclusion: Employees and participants were positive to more use of digital courses and digital tools as a supplement to physical courses, but expressed skepticism to all-digital courses. Both groups described “loosing” a lot during digital courses, specially the social aspect and the exchange of experiences. Many opportunities were described with digitalization such as being effective and time saving. The employees experienced that the technology was a barrier for digitalization.

Amaç: Çalışmanın amacı hipertansiyon hastalarında tedaviye uyum ve yaşam tarzı değişikliği başarı durumunu ölçmek ve bu durumun kan basıncı kontrolü üzerindeki etkilerini incelemektir. Yöntem: Çalışma, 300 hipertansiyon hastası ile yapıldı. Hastaların boy, kilo, kan basıncı ve bel çevresi ölçümleri, biyokimya ve hemogram sonuçları kaydedildi. Hastalara; tıbbi bilgileri, sosyodemografik özellikleri, yaşam tarzı alışkanlıklarını içeren anket soruları soruldu. Hipertansif Bireylerin Tedaviye Uyum ve Yaşam Değişikliği Başarısını Değerlendirme Ölçeği uygulandı. Bulgular: Hastaların yaş ortalaması 62,41±10,49 yıl idi. Ortanca hipertansiyon süresi 10 yıl saptandı. Katılımcıların %36,7’si üç veya daha fazla antihipertansif ilaç kullanmaktaydı. Katılımcıların %44,7’sinde sistolik kan basıncı ≥140 mmHg, %33’ünde diyastolik kan basıncı ≥90 mmHg olarak ölçüldü. Hastaların %52’si tedaviye rağmen hipertansif olarak bulundu. Vücut kitle indeksine göre hastaların %59,7’si obezdi. Vücut kitle indeksi, kadınlarda 34,14±6,84 kg/m² iken, erkeklerde 30,20±4,76kg/m² idi (p=0,001). Sistolik ve diyastolik kan basıncı yüksek olanlarda vücut kitle indeksi ve bel çevreleri, kan basıncı normal olanlara göre daha yüksekti (p=0,001 ve p=0,001). Hipertansif Bireylerin Tedaviye Uyum ve Yaşam Değişikliği Başarısını Değerlendirme Ölçeğine göre hastaların %81’i uyumluydu. Uyumsuz hastaların %66,7’si, uyumlu hastaların %48,6’sı hipertansifti (p=0,014). Haftada en az 3 gün egzersiz yapan hastalar daha uyumlu bulundu (p=0,007). Uyumlu hasta grubunun obezite oranları daha düşüktü (p=0,047). Sonuç: Çalışmamızda uyum oranı yüksek olarak değerlendirilen hasta grubunun obezite oranı daha düşük saptandı. Aynı grubun kan basıncı kontrollerinin daha iyi olduğu değerlendirildi. Hipertansiyon tedavisinde başarıya ulaşılabilmesi için, hastaların tedaviye uyum ve yaşam tarzı değişikliği konularında eğitilmesi gerekir.

Abstract Objective Evaluations of lifestyle modification interventions (LMIs), modeled after the Diabetes Prevention Program, have repeatedly shown a dose‐response relationship between session attendance and weight loss. Despite this, not all participants had “average” weight loss experiences. Nearly one‐third of LMI participants experienced unexpected, paradoxical outcomes (i.e., high attendance with little weight loss, and low attendance with clinically significant weight loss). Paradoxical weight‐loss outcomes were characterized based on session attendance among participants in a group‐based LMI in a real‐world healthcare setting. This group‐based LMI was delivered over 1 year to participants with the possibility of attending up to 25 sessions total. Methods LMI participants identified in 2010–2017 from electronic health records were characterized as having low (

Abstract Background Pregnancy causes physiological changes to the maternal organ systems that can be regarded as a cardiometabolic stress test for women. Preeclampsia, a pregnancy complication characterized by new onset of hypertension in combination with proteinuria or end-organ dysfunction, affects approximately 2–8% of pregnancies. Adverse pregnancy outcomes, including preeclampsia, have been described as a failed stress test and have been consistently linked with increased risk of cardiovascular disease later in life. The postpartum period is therefore often regarded as a window of opportunity for cardiovascular disease prevention. However, we lack knowledge about how women with preeclampsia experience current postpartum care in the Norwegian health system. The aim of this qualitative study is to uncover women’s perspectives and preferences regarding postpartum follow-up. Methods Semi-structured telephone interviews were conducted with 17 women following a six-month lifestyle intervention study. Participants were 9–20 months postpartum, following a pregnancy complicated by preeclampsia. Data were analyzed using Malterud’s systematic text condensation. Results We identified five themes, each with 2–3 subthemes, that demonstrate how women with recent preeclampsia experience postpartum follow-up: (1) fear and uncertainty (a body out of balance and facing an uncertain future), (2) a conversation on lifestyle – not really that difficult (preeclampsia as a gateway, a respectful approach, and a desire for more constructive feedback), (3) when your own health is not a priority (a new everyday life, out of focus, and lack of support), (4) motivation for lifestyle changes (an eye opener, lack of intrinsic motivation, and a helping hand), and (5) lack of structured and organized follow-up (there should be a proper system, a one-sided follow-up care, and individual variation in follow-up care). Conclusions Findings from this study highlight the need for more systematic postpartum follow-up for women after a pregnancy complicated by preeclampsia. Further research is required to explore the potential use of standardized guidelines and routine invitations to postpartum care. Furthermore, exploring health care professionals’ experiences is crucial to ensure their engagement in postpartum care after complicated pregnancies.

Objective: Adherence to lifestyle changes after bariatric surgery is associated with better health outcomes; however, research suggests that patients struggle to follow post‐operative recommendations. This systematic review aimed to examine psychological factors associated with adherence after bariatric surgery. Methods: PubMed, PsycInfo, and Embase were searched (from earliest searchable to August 2022) to identify studies that reported on clinically modifiable psychological factors related to adherence after bariatric surgery. Retrieved abstracts (n = 891) were screened and coded by two raters. Results: A total of 32 studies met the inclusion criteria and were included in the narrative synthesis. Appointment attendance and dietary recommendations were the most frequently studied post‐operative instructions. Higher self‐efficacy was consistently predictive of better post‐operative adherence to diet and physical activity, while pre‐operative depressive symptoms were commonly associated with poorer adherence to appointments, diet, and physical activity. Findings were less inconsistent for anxiety and other psychiatric conditions. Conclusions: This systematic review identified that psychological factors such as mood disorders and patients' beliefs/attitudes are associated with adherence to lifestyle changes after bariatric surgery. These factors can be addressed with psychological interventions; therefore, they are important to consider in patient care after bariatric surgery. Future research should further examine psychological predictors of adherence with the aim of informing interventions to support recommended lifestyle changes. [ABSTRACT FROM AUTHOR]

Background: The delivery channels and approaches related to cardiac rehabilitation (CR), such as eHealth, mHealth, and telehealth, are evolving. Several studies have identified their effects on patients with coronary heart disease, although no studies have focused on all the approaches collectively. Methods: Randomized controlled trials have investigated lipid profiles, through systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index (BMI). Stata software was used for analysis, while Egger's linear regression test and Begg's funnel plot were also applied. Results: Technology-based home CR revealed significantly lower total cholesterol (TC) levels (standardized mean difference (SMD) = -0.19; 95% confidence interval [CI]: [-0.27, -0.11]); triglyceride (TG) levels (SMD = -0.26; 95% CI: [-0.35, 0.17]); low-density lipoprotein (LDL) levels (SMD = -0.18; 95% CI: [ -0.25, -0.11]); SBP (SMD = -0.26; 95% CI: [-0.33, -0.19]); DBP (SMD = -0.24; 95% CI: [-0.32, -0.16]); BMI (SMD = -0.12; 95% CI: [-0.18, -0.05]), and improved high-density lipoprotein (HDL) levels (SMD = 0.22; 95% CI: [0.14, 0.31]). Conclusions: Technology-based home CR can be used to lower TC, TG, and LDL levels, alongside the BMI, SBP, and DBP indexes, while also raising HDL levels; thus, its use should be widely promoted. [ABSTRACT FROM AUTHOR]

Background: Globally, an estimated 14% of adults live with migraine disease which impacts their physical, emotional and social wellbeing. To target the disease comprehensively, research recommends a multidisciplinary approach to migraine management. Yet, at present, migraine management primarily centers around pharmaceutical treatments. The aim of this study was to investigate the extent to which emotional awareness could influence the uptake of self-care behaviours of community-dwelling adults with migraine. Methods: A cross-sectional online survey explored personal experiences with migraine disease and strategies or behaviours to manage migraine attacks. Chi-squared tests were used to investigate differences in ratings of migraine prevention and management strategies between users and non-users of the strategies. Univariable logistic regressions were used to assess the effectiveness of self-care behaviours to manage or prevent migraine attacks. Results: We surveyed 170 community-dwelling adults with migraine in the United Kingdom, Austria, Germany and the United States. Most (85%) respondents had experienced migraine for over five years, where 42% of attacks usually lasted several days. Whereas we did not differentiate between diagnosis by a neurologist or self-diagnosis, the most common diagnoses in the cohort were migraine without aura (38.9%) and migraine with aura (29%). Staying hydrated was the most popular preventative strategy (87%), 70.2% used prescription medication and 64.9% changed their diet and/or supplements. Almost all (92.4%) respondents stated that their mood or emotions could trigger their migraine attacks. Keeping a headache or mood diary was the lowest-rated prevention strategy and was rated as "probably ineffective" or causing "no change" in preventing migraine attacks. Over a third (39.7%) kept track of their physical wellbeing and symptoms. Reasons stated for tracking symptoms included to identify triggers (65.8%), show reports to a healthcare professional (59.6%), understand when they must take medication (48.1%), track improvements (67.3%) or deteriorations (67.3%). Conclusions: Migraine management is dominated by pharmaceutical management for acute pain attacks and lifestyle changes for managing migraine long-term. Perception of the effectiveness of those techniques is high, whereas perception of interventions that target the emotional or psychological components of chronic pain management (keeping a mood diary, and mental health support) is mixed. There exists a gap between the recommended biopsychosocial approach and the current state of migraine management. [ABSTRACT FROM AUTHOR]

Purpose: To explore perspectives of participants in the WISEWOMAN program in Pennsylvania (PA-WISE) on challenges and facilitators of reducing cardiovascular disease risk as low-income and un-/under-insured middle-aged women. Approach: Researchers conducted this 2 year qualitative data collection as one component of a broader, 5 year PA-WISE process and outcome evaluation. Setting: Women from across Pennsylvania, primarily from rural communities. Participants: Interviewees were low-income, un-/under-insured women aged 40-64 years who had recently participated in PA-WISE-facilitated health coaching and lifestyle programs (HC/LSPs). Methods – data collection and analysis: Researchers conducted individual telephone interviews with 38 women from four discrete samples of PA-WISE participants at 4 time points. Three researchers used grounded theory, and an iterative process of line-by-line coding, data display, and reanalysis to identify emerging themes, sub-themes, and their relationships. Results: Participants shared the important benefits of specific PA-WISE program traits. However, participants described significant financial constraints, difficult schedules, caregiving responsibilities, and insufficient social support as persistent challenges in their lives, making lifestyle changes in general, and program participation specifically, difficult. Conclusion: The challenges that low-income and un-/under-insured women identified amplify the importance of having interventions that offer flexibility, options, and tailoring of supports and resources. The timeless challenges articulated by participants in this study completed just before the COVID-19 pandemic, remain relevant to be addressed through the pandemic and beyond. [ABSTRACT FROM AUTHOR]

Background: Pregnancy causes physiological changes to the maternal organ systems that can be regarded as a cardiometabolic stress test for women. Preeclampsia, a pregnancy complication characterized by new onset of hypertension in combination with proteinuria or end-organ dysfunction, affects approximately 2–8% of pregnancies. Adverse pregnancy outcomes, including preeclampsia, have been described as a failed stress test and have been consistently linked with increased risk of cardiovascular disease later in life. The postpartum period is therefore often regarded as a window of opportunity for cardiovascular disease prevention. However, we lack knowledge about how women with preeclampsia experience current postpartum care in the Norwegian health system. The aim of this qualitative study is to uncover women's perspectives and preferences regarding postpartum follow-up. Methods: Semi-structured telephone interviews were conducted with 17 women following a six-month lifestyle intervention study. Participants were 9–20 months postpartum, following a pregnancy complicated by preeclampsia. Data were analyzed using Malterud's systematic text condensation. Results: We identified five themes, each with 2–3 subthemes, that demonstrate how women with recent preeclampsia experience postpartum follow-up: (1) fear and uncertainty (a body out of balance and facing an uncertain future), (2) a conversation on lifestyle – not really that difficult (preeclampsia as a gateway, a respectful approach, and a desire for more constructive feedback), (3) when your own health is not a priority (a new everyday life, out of focus, and lack of support), (4) motivation for lifestyle changes (an eye opener, lack of intrinsic motivation, and a helping hand), and (5) lack of structured and organized follow-up (there should be a proper system, a one-sided follow-up care, and individual variation in follow-up care). Conclusions: Findings from this study highlight the need for more systematic postpartum follow-up for women after a pregnancy complicated by preeclampsia. Further research is required to explore the potential use of standardized guidelines and routine invitations to postpartum care. Furthermore, exploring health care professionals' experiences is crucial to ensure their engagement in postpartum care after complicated pregnancies. [ABSTRACT FROM AUTHOR]

Healthy lifestyle change improves outcomes in coronary heart disease (CHD), but is rarely sustained. To better understand barriers to lifestyle change, we examined couples' talk of engaging with lifestyle advice after one partner receives a diagnosis of CHD. A longitudinal qualitative design, in which a poststructuralist discourse analysis was performed on 35 interviews, conducted with 22 heterosexual British people in a long term relationship. The interviews occurred over three months after one partner was referred to a cardiac rehabilitation programme designed to support lifestyle change. Couples understood their health as a shared practice underpinned by an ideological framework of healthism, creating a form of 'relational healthism'. Practicing relational healthism was not straightforward because the practices of surveillance, control, and discipline related to healthism often contravened relationship norms of support, acceptance and respect for the other's autonomy. Couples struggled to resolve this tension, dynamically adopting, resisting, and occasionally transforming discourses of health and love in ways that worked for and against engagement in lifestyle change. In foregrounding the discursive and relational contexts of behavioural change engagement, we show the considerable complexity for couples, including costs related to engagement with lifestyle advice. [ABSTRACT FROM AUTHOR]

Objective: Evaluations of lifestyle modification interventions (LMIs), modeled after the Diabetes Prevention Program, have repeatedly shown a dose‐response relationship between session attendance and weight loss. Despite this, not all participants had "average" weight loss experiences. Nearly one‐third of LMI participants experienced unexpected, paradoxical outcomes (i.e., high attendance with little weight loss, and low attendance with clinically significant weight loss). Paradoxical weight‐loss outcomes were characterized based on session attendance among participants in a group‐based LMI in a real‐world healthcare setting. This group‐based LMI was delivered over 1 year to participants with the possibility of attending up to 25 sessions total. Methods: LMI participants identified in 2010–2017 from electronic health records were characterized as having low (<75%) or high (≥75%) session attendance. Weight‐loss outcomes were defined as expected (≥5%, high‐attendance; <5%, low‐attendance) or paradoxical (≥5%, low‐attendance; <5%, high‐attendance). Paradoxical‐outcome‐associated characteristics were identified using logistic regression. Results: Among 1813 LMI participants, 1498 (82.6%) had low and 315 (17.4%) high session attendance; 555 (30.6%) had paradoxical outcomes, comprising 415 (74.8%) responders (≥5% weight‐loss) and 140 (25.2%) non‐responders (<5% weight‐loss). Among participants with high session attendance, paradoxical non‐responders were more likely to be female (odds ratio [OR]: 2.76; 95% confidence interval [CI]: 1.32, 5.77) and have type 2 diabetes (OR: 3.32; 95% CI: 1.01, 10.95). Among low‐attendance participants, paradoxical responders were more likely to be non‐Hispanic White and less likely to be non‐Hispanic Black (OR: 0.35; 95% CI: 0.18, 0.69), non‐Hispanic Asian (OR: 0.40; 95% CI: 0.22, 0.73), or Hispanic (OR: 0.53; 95% CI: 0.35, 0.80). Conclusions: In a healthcare setting, nearly one‐third of LMI participants experienced paradoxical outcomes. More research is needed to understand the facilitators and barriers to weight loss above and beyond session attendance. [ABSTRACT FROM AUTHOR]

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eHealth lifestyle interventions without human support (self-help interventions) are generally less effective, as they suffer from lower adherence levels. To solve this, we investigated whether (1) using a text-based conversational agent (TCA) and applying human cues contribute to a working alliance with the TCA, and whether (2) adding human cues and establishing a positive working alliance increase intervention adherence. Participants (N = 121) followed a TCA-supported app-based physical activity intervention. We manipulated two types of human cues: visual (ie, message appearance) and relational (ie, message content). We employed a 2 (visual cues: yes, no) x 2 (relational cues: yes, no) between-subjects design, resulting in four experimental groups: (1) visual and relational cues, (2) visual cues only, (3) relational cues only, or (4) no human cues. We measured the working alliance with the Working Alliance Inventory Short Revised form and intervention adherence as the number of days participants responded to the TCA's messages. Contrary to expectations, the working alliance was unaffected by using human cues. Working alliance was positively related to adherence (t(78) = 3.606, p = .001). Furthermore, groups who received visual cues showed lower adherence levels compared to those who received relational cues only or no cues (U = 1140.5, z = −3.520, p

The prevalence of obesity, which is defined by the World Health Organization as abnormal or excessive fat accumulation in the body that impairs health, is increasing day by day. In addition to behavioral therapy aimed at changing the individual’s lifestyle based on the strategies developed against the disease, diet therapy, exercise, medical nutrition therapy, pharmacological and, as a last resort, surgical treatment are recommended. The effect of methods other than surgical treatment on weight loss is slow. For this reason, many obese patients prefer obesity surgery to lose weight quickly, but these methods have many complications such as weight regain, tachycardia, fistula, bleeding, herniation, anastomotic stenosis, gastric erosion, small bowel obstructions, deep vein thrombosis and pulmonary embolism. Post-surgical weight regain and complications have recently led to new searches, and the use of medical nutrition and phytotherapy products has again come to the fore as hope. Phytotherapy products can also be used alone or in combination with other methods. Natural anti-obesity products have functional ingredients such as phytochemicals, polyphenols, flavonoids and phytosterols. There are many natural products used in this field and therefore there are different classifications. Phytotherapeutics are classified according to their effectiveness as those that increase fat burning and stimulate metabolism, suppress appetite, create a feeling of satiety, control blood sugar and insulin, inhibit the absorption of carbohydrates and fats, and inhibit inflammation. However, more clinical research is needed to elucidate the antiobesity effectiveness and mechanism of action of natural products. The risks and side effects of the method to be chosen in obesity treatment should be discussed with the patient. Recommendations to the patient should be given after a multidisciplinary evaluation. Treatment should be started with the most appropriate and least risky method for the patient's current condition. It should be explained to the patient that it is most likely that he/she will lose weight with one of these methods, but that the important thing is to maintain his/her weight through behavioral changes.

Metabolic-associated fatty liver disease (MAFLD) is the most common chronic liver disease observed in clinical practice worldwide. This disorder has been independently associated with an increased risk of developing chronic kidney disease (CKD). The aim of this study was to evaluate whether a 2-year intervention based on a Mediterranean diet (MedDiet) and physical activity focussed on reducing intrahepatic fat contents (IFC) was associated with a decreased risk of CKD. Forty adults (50% women) residing in Mallorca, aged 48 to 60 years, diagnosed with MAFLD were recruited. Participants were divided into two groups based on whether they improved IFC measured by nuclear magnetic resonance. Anthropometric and clinical parameters improved in responders, including reduced weight, body mass index (BMI), and waist circumference. Only responders showed improvements in lipid profile and liver enzymes. Haematological parameters showed favourable changes in both groups. Oxidative stress and inflammatory biomarkers differed between groups. Responders had lower plasma interleukine-18 (IL-18) levels, but higher erythrocyte malonaldehyde (MDA) levels. Non-responders showed increased erythrocyte catalase and superoxide dismutase activity. After 2 years, non-responders had higher serum creatinine, Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) levels, while responders showed reductions in these parameters together with uric acid and urine albumin-to-creatinine ratio (UACR). Positive correlations were found between changes in IFC and kidney injury biomarkers, including MDRD and serum creatinine levels. In conclusion, a healthy diet based on the Mediterranean dietary pattern and lifestyle promotes significant improvements in parameters related to cardiovascular, hepatic, and renal health.

The paper is devoted to assessing the level of physical activity of some population groups. Researching the level of physical activity of the population in the conditions of the physical, social and economic environment surrounding it, without taking into account direct sports, provides an important tool that serves to integrate the efforts of interdepartmental interaction in the implementation of federal and regional programs aimed at improving the health of citizens. The research was conducted using the International Physical Activity Questionnaire (IPAQ). The purpose of the research was to assess the level of physical activity and the degree of motivation to change it among the region’s adult population in the conditions of changing hiking to driving a car. Surveys on the level of physical activity were conducted on an anonymous, voluntary basis. The research results showed that about a third of respondents experienced a constant lack of movement and confirmed that the adult population pays insufficient attention to the simplest preventive measures to improve their health, one of which is physical activity.

Abstract Objective Adherence to lifestyle changes after bariatric surgery is associated with better health outcomes; however, research suggests that patients struggle to follow post‐operative recommendations. This systematic review aimed to examine psychological factors associated with adherence after bariatric surgery. Methods PubMed, PsycInfo, and Embase were searched (from earliest searchable to August 2022) to identify studies that reported on clinically modifiable psychological factors related to adherence after bariatric surgery. Retrieved abstracts (n = 891) were screened and coded by two raters. Results A total of 32 studies met the inclusion criteria and were included in the narrative synthesis. Appointment attendance and dietary recommendations were the most frequently studied post‐operative instructions. Higher self‐efficacy was consistently predictive of better post‐operative adherence to diet and physical activity, while pre‐operative depressive symptoms were commonly associated with poorer adherence to appointments, diet, and physical activity. Findings were less inconsistent for anxiety and other psychiatric conditions. Conclusions This systematic review identified that psychological factors such as mood disorders and patients' beliefs/attitudes are associated with adherence to lifestyle changes after bariatric surgery. These factors can be addressed with psychological interventions; therefore, they are important to consider in patient care after bariatric surgery. Future research should further examine psychological predictors of adherence with the aim of informing interventions to support recommended lifestyle changes.

IntroductionThe link between lifestyles and Greenhouse Gas (GHG) emissions has prioritized climate mitigation strategies of cities worldwide. As cities have increasingly generated GHG emissions by their industrial and transportation activities, their role in climate mitigation has gained prominence. Cities' climate mitigation policies to reduce the GHG intensity of their residents' daily lives are one of their significant efforts to tackle climate change. Lighthouse Cities (LCs), in particular, have emerged as remarkable actors in promoting lifestyle changes for their residents.MethodsThis study examines climate mitigation strategies of LCs of Climate CAMPAIGNers project, including Baku, Vilnius, Lahti, Izmir, Trujillo, Athens, Linz, Milan, Cape Town, Dublin, and Skopelos, addressing lifestyle changes by conducting an expert survey in 11 LCs involving 89 respondents. The findings of the expert survey are comparatively analyzed across 11 LCs.ResultsThe results show that experts form Lighthouse Cities identify increasing awareness and information provision as a significant component of climate mitigation policies. Concerning lifestyle changes, strategies toward energy efficiency and sustainable mobility are highlighted as the primary areas to be prioritized.DiscussionThis study enhances the understanding of cities' capacity to reduce their residents' GHG emissions. The findings can be utilized to identify and tailor policies for supporting the Lighthouse Cities in their climate change mitigation efforts and provide pointers for selecting the lifestyle changes that can be promoted and prioritized in Lighthouse Cities.

This paper examines the emission mitigation potential of Chinese households’ low-carbon behavior by 2030 through a global carbon footprint scenario analysis. The emission reduction effect is estimated by comparing the projected global emissions in 2030 in a lifestyle emulation scenario and a low-carbon scenario, in which Chinese households adopt low-carbon consumption behaviors. Lifestyle emulation is modeled based on what we call “world Engel curves”, which describe how the expenditure share of a certain consumption good depends on the total per capita expenditures for household consumption (which depends on income). By including a dynamic link between household lifestyle changes and GDP, we then obtain the emission projections under different scenarios in 2030, based on the historical data for 49 countries from 1995 to 2011 from EXIOBASE. Our results show that adopting a mild low-carbon lifestyle by households helps only little in terms of reducing GHG emissions. Reducing avoidable waste and expanding the lifetime of products are not enough to help meeting the 2 °C goal. More drastic changes are required.

• Chinese population, representing the largest aging demographic worldwide, confronts an urgent need for preventive measures against dementia. Despite this, persistent research indicates a notable absence of motivation that impedes dementia prevention initiatives within this demographic. • The Motivation to Change Lifestyle and Health Behaviors for Dementia Risk Reduction scale (MCLHB-DRR) offers a valuable tool for nurses to assess attitudes towards dementia risks and their impact on motivation for lifestyle changes. This instrument allows nurses to identify influencing factors and evaluate interventions for promoting behavioral changes towards dementia prevention. • The Chinese version of MCLHB-DRR showed satisfactory psychometric properties in assessing motivation for lifestyle changes concerning dementia risk reduction. This study also offers valuable insights into promoting dementia risk reduction, taking into account the cultural nuances that influence motivations and knowledge of dementia-related lifestyle changes among the Chinese. To assess the psychometric properties of Chinese version of Motivation to Change Lifestyle and Health Behaviors for Dementia Risk Reduction (MCLHB-DRR) scale in Chinese community-dwelling older adults. A convenience sample of 150 Chinese adults aged ≥50 was recruited from local community facilities. Reliability of MCLHB-DRR was evaluated using internal consistency and test-retest reliability over two weeks. Content validity and construct validity were assessed. Translation process followed Brislin's translation model. After excluding two items with poor loadings, the confirmatory factor analysis revealed a good model fit (χ2/df=2.14; CFI=0.91; IFI=0.91; RMSEA=0.087). The scale exhibited good internal consistency (Cronbach's alpha = 0.865), as well as acceptable test-retest reliability (ICC=0.730). The Chinese MCLHB-DRR showed satisfactory psychometric properties, providing valuable insights for promoting dementia risk reduction in Chinese population, considering cultural nuances that shape motivations and knowledge of lifestyle changes. [ABSTRACT FROM AUTHOR]

Lifestyle change is a fundamental component of transformative pathways to net‐zero emissions. Despite the pervasive use of 'lifestyle' as a concept, there is lack of convergence on what constitutes lifestyle due to contrasting perspectives and approaches within and across disciplines. While there is a long tradition of lifestyle research in public health and in marketing, this does not currently inform low‐carbon lifestyle research. We review a wide range of empirical and theoretical lifestyle studies using a directed thematic approach. Focusing on current knowledge within low‐carbon lifestyles research, we draw insights from two contrasting research perspectives (health, marketing) to support and advance low‐carbon research. We argue that 'lifestyle' is a unifying meta‐concept comprised of three common integrating elements: behaviours, cognitions, and context. We find variation across research fields reflecting differing emphasis and differentiate integrative from domain‐specific frameworks. Fragmented approaches in low‐carbon research compartmentalise concepts within domains such that 'lifestyle' is aligned more closely in meaning to 'behaviour', accentuating inconsistencies. Lifestyle heterogeneity is characterised by clusters of cognitive and behavioural factors linked to broad social and material contexts. We identify drivers of lifestyle change, and argue lifestyle is not purely a matter of choice but shaped by contextual factors which lock‐in unsustainable behaviours or facilitate sustainable behaviours. There are important implications for research and intervention. Lifestyle complexities demand a wider analytical lens incorporating cross‐disciplinary datasets and integrative frameworks. Broadening cognitive and contextual dimensions would deepen understanding of lifestyle change. Comprehensive low‐carbon lifestyle interventions should combine multiple strategies, at‐risk groups, and opportunistic circumstance. This article is categorized under:Climate and Environment > Net Zero Planning and DecarbonizationHuman and Social Dimensions > Behavioral Science [ABSTRACT FROM AUTHOR]

Objective: Acid reflux disease is a common condition with recurrent symptoms affecting the quality of life of many Americans. Lifestyle/dietary modification is critical for management of acid reflux disease. Adherence to these recommendations is variable. The purpose of this study was to better understand the experience of patients with reflux disease (GERD/LPR) and explore factors that impact the integration of lifestyle modifications into their daily lives. Methods: Patient with diagnoses of GERD and/or LPR were recruited from an outpatient laryngology clinic and completed the Reflux Symptom Index (RSI) and a semi-structured interview. Interviews were transcribed and underwent thematic analysis. Results: Twenty-three patients—mean age and RSI of 61 and 16.1 respectively—were recruited. Four main themes emerged: (1) Care team interaction—focus and quality of physician counseling, useful educational handouts, dietician/nutritionist counseling; (2) Motivation to change—impact on symptom severity, avoiding undesired interventions, and poor health outcomes; (3) Implementing lifestyle changes; and (4) Impact of disease on patient. No patient had seen a dietician. Patients who experienced dietary counseling for other conditions felt reflux-specific counseling with a dietician would be beneficial. While patients found educational material on diet to be helpful, lists of foods to avoid were discouraging; providing a positive list of preferred foods may be more helpful. Conclusion: Lifestyle modification counseling should incorporate multiple aspects of the patient experience. Patients desire information regarding medication side effects. Educational handouts should include prioritized list of recommended dietary restrictions and acceptable/alternative food options. Referral for dedicated dietician counseling can also be considered to increase understanding of the importance of, and adherence to, lifestyle modification. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore experiences of applying the Plan-Do-Study-Act (PDSA) cycle among older Thai adults. A qualitative research approach was used based on focus group interviews with eight male and five female participants aged 62–78 years old. Data was analyzed using qualitative thematic analysis. The findings presented how older adults set, carried out, and adjusted their own lifestyle change plans to enhance active aging. Although participants experienced difficulties at first, learning during the group process following the PDSA steps became easier. Support from the moderator during meetings, as well as family during the execution of their plans at home ensured successful application of the PDSA cycle. The PDSA cycle encouraged participants to be concerned about their health, something they themselves found beneficial. This tool will be useful to apply in health practice and policy when performing group activities to enhance active aging. [ABSTRACT FROM AUTHOR]

Background: Loneliness is described as a public health problem and can be both a consequence of aging and a cause of ill health. Lonely older adults tend to have difficulties making new social connections, essential in reducing loneliness. Loneliness often varies over time, but established loneliness tends to persist. Maintaining good health is fundamental throughout the life course. Social connections change with aging, which can contribute to loneliness. Aim: This study aimed to investigate loneliness in relation to social factors and self-reported health among older adults. Method: A cross-sectional research design was used based on data from the Swedish National Study on Aging and Care, Blekinge (SNAC-B), from February 2019 to April 2021. Statistical analysis consisted of descriptive and inferential analysis. Results: Of n = 394 participants, 31.7% (n = 125) stated loneliness. Close emotional connections were necessary for less loneliness. Loneliness was more common among those who did not live with their spouse or partner and met more rarely. Furthermore, seeing grandchildren and neighbors less often increased loneliness, and a more extensive social network decreased loneliness. Conclusion: This study underlined the importance of social connections and having someone to share a close, emotional connection with to reduce loneliness. [ABSTRACT FROM AUTHOR]

The family doctor has an extremely important role in the management of prediabetes and diabetes, having at hand all the intervention mechanisms, but nevertheless many patients have an uncontrolled evolution of diabetes, with the onset of complications sooner or later. Our goal was to see if an intervention from the family doctor’s office on the lifestyle of these patients, on changing their diet, has a positive impact on the evolution of their health. Starting from the Predimed study, showing the beneficial effect of the Mediterranean diet, we chose a group of patients diagnosed with diabetes who followed this diet for two months. The results of our study were more than encouraging. After only two months of intervention, there was a normalization of basal blood glucose from 16.7% to 52.9% of patients, a decrease in fat mass and an increase in muscle mass, along with an improvement of lipid profile. In conclusion, in addition to appropriate drug treatment for each patient, changing diet is essential for controlling metabolic disorders associated with diabetes. The close cooperation between the family doctor and the nutritionist is imperative for the correct management of the patient with diabetes. [ABSTRACT FROM AUTHOR]

Purpose: To elicit feedback from participants who completed the eMOMSTM study, a feasibility randomized controlled trial (NCT04021602), on their perceptions of program strengths and weaknesses. Study Design: Qualitative - Semi-structured, telephone interview guide using open-ended questions. Setting: Rural Great Plains state, United States. Participants: Of 26 individuals who completed the eMOMSTM study, 24 consented to an interview. Method: Interviews were completed between October 2020 and May 2021. Audio-recordings were transcribed verbatim and organized in Microsoft 365. Data were analyzed using an exploratory, inductive thematic analysis. Results: Participants' mean age was 27.5 (± 5.4) years and mean pre-pregnancy BMI was 29.5 kg/m2 (± 2.7). The majority (71%) were non-Hispanic White and 54% had a high school education/some college. Based on specific areas of inquiry, the following themes emerged: convenience of online program access using Facebook, importance of health coach's support and online interaction, positivity toward improving one's health, increased consciousness of health behaviors, diverse lactation educational needs, importance of educational materials on depression, and grief over the loss of birth expectations during COVID-19. Conclusion: Findings suggest participants' perceived value of a lifestyle change program coupled with lactation education and support delivered using social media. Findings inform future studies to further adapt lifestyle change programs. [ABSTRACT FROM AUTHOR]

Apply it!: By reading this article, you will learn: • By "coming alongside" the athlete, you will begin to build greater engagement and have the athlete demonstrate greater autonomy toward their change. • To avoid "traps" in the conversation such as the expert trap, question–answer trap, and prematurely fixing without fully understanding the athlete's perception of the challenge. • To use the athlete as the best resource for change strategies—work together to identify action plans that are flexible and based on their readiness to change. • Relapse is a normal part of change; be patient and flexible as the athlete experiences how this feels and build in maintenance strategies to the change plan. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: The Centers for Disease Control and Prevention recognizes routine vaccination, sufficient sleep, and adequate physical activity as behavioral approaches to reduce the incidence of influenza. We aimed to determine the joint national prevalence of these health behaviors among U.S. adults, which has not been reported. Methods: We used the 2020 National Health Interview Survey to assess prevalence of receiving influenza vaccination in the past 12 months, obtaining sufficient sleep, and achieving adequate physical activity among U.S. adults (n = 30,312). We calculated the joint prevalence overall and by sociodemographic and health-related variables. Results and Conclusions: The overall joint prevalence was 8.5% (95% CI, 8.0-9.0). Prevalence was lower among older persons (vs younger); Hispanic and non-Hispanic Black persons (vs non-Hispanic White); current and former smokers (vs never smokers); postpartum women (vs neither pregnant nor postpartum); and those with a history of coronary heart disease, hypertension, stroke, diabetes, and chronic obstructive pulmonary disease (vs not having those respective condition). In addition to recommending annual vaccination, primary care providers might encourage sufficient sleep and adequate physical activity—especially among patients who have increased risk for influenza complications and are less likely to achieve these behaviors. [ABSTRACT FROM AUTHOR]

The prevalence of obesity, which is defined by the World Health Organization as abnormal or excessive fat accumulation in the body that impairs health, is increasing day by day. In addition to behavioral therapy aimed at changing the individual's lifestyle based on the strategies developed against the disease, diet therapy, exercise, medical nutrition therapy, pharmacological and, as a last resort, surgical treatment are recommended. The effect of methods other than surgical treatment on weight loss is slow. For this reason, many obese patients prefer obesity surgery to lose weight quickly, but these methods have many complications such as weight regain, tachycardia, fistula, bleeding, herniation, anastomotic stenosis, gastric erosion, small bowel obstructions, deep vein thrombosis and pulmonary embolism. Post-surgical weight regain and complications have recently led to new searches, and the use of medical nutrition and phytotherapy products has again come to the fore as hope. Phytotherapy products can also be used alone or in combination with other methods. Natural anti-obesity products have functional ingredients such as phytochemicals, polyphenols, flavonoids and phytosterols. There are many natural products used in this field and therefore there are different classifications. Phytotherapeutics are classified according to their effectiveness as those that increase fat burning and stimulate metabolism, suppress appetite, create a feeling of satiety, control blood sugar and insulin, inhibit the absorption of carbohydrates and fats, and inhibit inflammation. However, more clinical research is needed to elucidate the antiobesity effectiveness and mechanism of action of natural products. The risks and side effects of the method to be chosen in obesity treatment should be discussed with the patient. Recommendations to the patient should be given after a multidisciplinary evaluation. Treatment should be started with the most appropriate and least risky method for the patient's current condition. It should be explained to the patient that it is most likely that he/she will lose weight with one of these methods, but that the important thing is to maintain his/her weight through behavioral changes. [ABSTRACT FROM AUTHOR]

Objective: To appraise and synthesize evidence on the effects of health coaching as the primary intervention on cardiometabolic health among middle-aged adults. Data Source: Six electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, PubMed, and the Cochrane library) were searched from inception until July 2021. Study Inclusion and Exclusion Criteria: Randomized controlled trials and controlled clinical trials published in English, reporting health coaching aimed to promote behavioral changes for improving cardiometabolic health among middle-aged adults were included. Studies on health coaching as secondary intervention were excluded. Data Extraction: Two reviewers selected the articles, appraised the study quality, and extracted data independently. All kinds of outcomes related to cardiometabolic health, including health behaviors, psychological and physiological outcomes, were included. Data Synthesis: Meta-analysis was performed if three or more studies reported the same outcomes. Narrative synthesis was performed if pooling of data for meta-analysis was not feasible. Results: Eight studies were reviewed. Most studies involved substantial risk of bias. The majority of the participants were women (99.1%). Meta-analysis showed a small but significant effect of health coaching on increasing physical activity (SMD =.34, 95% CI =.08–.60, p =.01, I 2 = 0%); however, its effect on perceived barriers to physical activity and depressive symptoms was nonsignificant. Narrative synthesis yielded inconsistent results on diet, smoking, anxiety, goal achievement and self-efficacy for behavioral change, physiological outcomes, and metabolic syndrome severity, and nonsignificant effects on alcohol consumption, sleep quality, perceived benefits of physical activities, and cardiovascular symptoms. Conclusions: Health coaching has significant effects on increasing physical activity among middle-aged adults; however, its effects on health behaviors and risk factors related to cardiometabolic health are inconclusive. Further efforts are warranted to examine how health coaching can improve cardiometabolic health among middle-aged adults. [ABSTRACT FROM AUTHOR]

Background: Healthy lifestyle habits are recommended in prevention of cardiovascular disease (CVD). However, there is limited knowledge concerning the change in lifestyle-related factors from before to after a CVD event. Thus, this study aimed to explore if and how lifestyle habits and other lifestyle-related factors changed between two health assessments in individuals experiencing a CVD event between the assessments, and if changes varied between subgroups of sex, age, educational level, duration from CVD event to second assessment and type of CVD event. Methods: Among 115,504 Swedish employees with data from two assessments of occupational health screenings between 1992 and 2020, a total of 637 individuals (74% men, mean age 47 ± SD 9 years) were identified having had a CVD event (ischemic heart disease, cardiac arrythmia or stroke) between the assessments. Cases were matched with controls without an event between assessments from the same database (ratio 1:3, matching with replacement) by sex, age, and time between assessment (n = 1911 controls). Lifestyle habits included smoking, active commuting, exercise, diet, alcohol intake, and were self-rated. Lifestyle-related factors included overall stress, overall health (both self-rated), physical capacity (estimated by submaximal cycling), body mass index and resting blood pressure. Differences in lifestyle habits and lifestyle-related factors between cases and controls, and changes over time, were analysed with parametric and non-parametric tests. Multiple logistic regression, OR (95% CI) was used to analyse differences in change between subgroups. Results: Cases had, in general, a higher prevalence of unhealthy lifestyle habits as well as negative life-style related factors prior to the event compared to controls. Nevertheless, cases improved their lifestyle habits and lifestyle factors to a higher degree than controls, especially their amount of active commuting (p = 0.025), exercise (p = 0.009) and non-smoking (p < 0.001). However, BMI and overall health deteriorated to a greater extent (p < 0.001) among cases, while physical capacity (p < 0.001) decreased in both groups. Conclusion: The results indicate that a CVD event may increase motivation to improve lifestyle habits. Nonetheless, the prevalence of unhealthy lifestyle habits was still high, emphasizing the need to improve implementation of primary and secondary CVD prevention. [ABSTRACT FROM AUTHOR]

Background: Type 1 diabetes (T1D) has a significant impact on the well-being and behavioral pattern of affected adolescents, and can lead to affective disorders including depression and anxiety. An emphasis on cognitive and behavioral patterns is necessary to aid the stress and emotions associated with the diagnosis of T1D and is an essential part of optimum care. Aim: This study aims to assess the perceptions and behavioral patterns of Asian Indian adolescents diagnosed with T1D. Materials and Methods: Twenty-one adolescents with T1D (between the ages of 10 and 19 years) with a duration of diabetes up to 24 months were identified from the electronic medical records of a large chain of diabetes centers in India. Telephonic interviews were conducted to fill out questionnaires regarding dietary habits, insulin treatment, and physical activity of participants. Results: The majority (81%) of the adolescents interviewed were adapted to their condition. Most received support from their peers and teachers at school (57%), but 85% continued to have cravings for foods that were restricted from their diet. Almost half (42.9%) of participants and their parents experienced high levels of stress during the initial stages of diagnosis. Most (80%) of them were engaged in physical activities such as jogging, walking, dancing, yoga, and cycling. Conclusion: This pilot study suggests that by providing psychological support to adolescents with T1D, it is possible to overcome the stress that accompanies the diagnosis and adaptation to lifestyle changes. [ABSTRACT FROM AUTHOR]

Purpose: Complications after metabolic and bariatric surgery are common due to the patient's poor commitment to postoperative lifestyle changes. Therefore, intensive follow-up from a multidisciplinary team might improve outcomes. The present study aimed to translate and validate the Eating Behavior after Bariatric Surgery (EBBS) questionnaire into Arabic for use in clinical and research settings. Materials and Methods: The study followed World Health Organization guidelines for translation and questionnaire adaptation, including forward translation, back translation, pilot testing, and the creation of the final version of the tool. A total of 390 patients who had undergone metabolic and bariatric surgery 3 years ago or more were involved in testing the questionnaire's validity and reliability. Results: The mean age of participants was 36 years (range: 20 to 70 years), 56% were females, 94.1% were Saudis, and 56% had bachelor's degrees. The internal consistency of the questionnaire was tested using Cronbach's alpha. One item (alcohol consumption) was excluded during the reliability analysis due to low variance. The reliability analysis results showed that the 10 items were internally consistent, with a Cronbach's α of 0.851. Conclusion: The validation and reliability of the Arabic-language version of the EBBS questionnaire were found to be satisfactory. The presence of a validated Arabic version of this instrument may help practitioners estimate patients' adherence to dietary and lifestyle recommendations after metabolic and bariatric surgery. Furthermore, the questionnaire may aid in identifying factors that influence the efficacy of these procedures. [ABSTRACT FROM AUTHOR]