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The primary goal of this project was to develop, implement, and evaluate a lifestyle modification intervention that did not require extensive, ongoing personal contact to improve lifestyle behaviors shown to lower blood pressure (BP) in adults with prehypertension (N=23, mean age=54, mean BP=126.7/75.1). Incorporating clinical practices and psychological approaches to behavior change, this intervention used primarily the DASH Eating Plan, coupled with a low-sodium diet and a walking program; it applied social cognitive theory to health behavior change, specifically self-regulation for self-monitoring and management of BP, diet, exericse, and weight. The study compared two conditions, the DASH 2 Wellness Only standard of care condition to the DASH 2 Wellness Plus treatment condition on the primary outcome measures of fruit and vegetable (servings/day), sodium consumption (milligrams/day), physical activity (steps/day), weight (kgs), and blood pressure (primarily systolic BP). Consistent with hypotheses, MANOVAs detected significant differences between the conditions with D2W Plus evidencing a larger increase in change of total daily steps (M= 2900.14, SD= 1903.83) than D2W Only, (M= 636.39, SD= 1653.26), a larger decrease in systolic BP change (MMHG) (M= 15.14, SD= 4.33) than D2W Only, (M= 4.61, SD= 8.28), and a larger decrease in weight change (kg) (M= 4.78, SD= 3.81) than D2W Only, (M= 1.47, SD= 2.57). While conditions did not significantly differ on daily sodium reduction or fruit and vegetable increase, D2W Plus evidenced a larger decrease in sodium (mg) (M= 932.22, SD= 1019.22) than D2W Only, (M= 423.64, SD= 749.15) and larger increase in fruit and vegetable increase, (M= 2.10, SD= 1.73) than D2W Only, (M= 1.02, SD= 2.24). It was also hypothesized that the D2W Plus condition would show greater improvements in nutrition-specific and PA-specific health beliefs of self-regulation, social support, self-efficacy, social support, and outcome-expectancy compared to those in the D2W Only condition. A MANOVA revealed significant group differences in PA-specific health beliefs primarily attributable to increased PA self-regulation in D2W Plus compared to D2W Only, (M= 1.78, SD= 0.75) and (M= 0.55, SD= 0.57), respectively. While no overall significant group differences were found for nutrition-specific health beliefs, analyses showed meaningful differences in nutrition-specific health beliefs attributable to increased nutrition self-regulation strategies in D2W Plus compared to D2W Only. Results provide preliminary support for the efficacy of an electronic delivery of an intervention aimed at improving lifestyle behaviors and lowering BP in middle-aged individuals with prehypertension. / Ph. D.

We did not know the patterns of using antihypertensive drugs in outpatient settings in Israel that is why we raised a research aim to analyze the pattern of use of HBP in outpoint setting. In order to meet this aim we raised several research objectives:. 1) Does lifestyle modification is important for the patient for blood pressure control? 2) Do the patients need to change their medication at set of time until BP goals reached? 3) Does the use of more than one drug would help achieving better HBP results? Does the use of single doses combination would have better affect then using fixed dose combination? 4) How often noncompliance take in HBP control? 5) How many patients suffer from side effects? Methods: a questionnaire composed of 36 questions and qualitative statistical analysis. / Mes nežinojome, kad naudojant antihipertenzinių vaistinių preparatų ir ambulatorinėmis Izraelyje, kuris yra, kodėl mes iškėlė Tyrimo tikslas išanalizuoti naudojimo HBP Išėjo taško nustatymo modelį modelius. Siekiant įgyvendinti šį tikslą, mes iškėlė kelis mokslinių tyrimų tikslams:. 1) Ar gyvenimo būdo pakeitimas yra svarbus kraujospūdžio kontrolės pacientui? 2) Ar pacientai turi pakeisti savo vaistą esant rinkinį, kol pasiekė BP tikslai? 3) Ar iš daugiau nei vieno narkotiko naudojimas padėtų pasiekti geresnių HBP rezultatus? Ar vienos dozės deriniu būtų geriau veikia tada naudojant fiksuotų dozių derinys? 4) Kaip dažnai nesilaikymo imtis HBP kontrolės? 5) Kiek pacientų kenčia nuo šalutinio poveikio? Metodai: Klausimynas sudarytas iš 36 klausimų ir kokybinio statistinę analizę.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第18467号 / 人健博第21号 / 新制||人健||2(附属図書館) / 31345 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 任 和子, 教授 横出 正之, 教授 田村 恵子 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Förmaksflimmer är den vanligaste hjärtarytmin globalt och associeras med ökad risk för utveckling av andra sjukdomar som negativt påverkar patientens hälsorelaterade livskvalitet. De flesta komorbida tillstånd som obesitas, hypertoni, alkoholöverkonsumtion, rökning, diabetes, och sömnapné kan påverkas genom livsstilsförändring. Att ändra på en levnadsvana är en utmaning och bör ses som en process. Genom att arbeta på ett personcentrerat förhållningssätt främjas patientens egen förmåga att förbättra livskvaliteten.  Syftet med denna litteraturöversikt var att undersöka hälsorelaterad livskvalitet hos personer med förmaksflimmer. Vilka är riskfaktorerna för en försämrad hälsorelaterad livskvalitet? Kan en förbättrad livsstil ge en bättre hälsorelaterad livskvalitet? Totalt granskades femton vetenskapliga artiklar med kvantitativ ansats. Databaserna som användes för att hitta artiklarna var PubMed och CINAHL. Artiklarna granskades utifrån Sophiahemmets Högskolas bedömningsunderlag. Artiklarna som inkluderades hade en god till hög kvalitet. Resultatet av artiklarnas analys sammanfattades av en integrerad dataanalys. Vid analysen framkom kategorier och underkategorier som beskrev artiklarnas resultat.  Resultatet sammanställdes från fyra huvudkategorier: Påverkan av faktorer, påverkan av livsstilmodifiering, påverkan av behandlingsstrategi och påverkan av könstillhörighet för patienter med förmaksflimmer. Resultatet visade att patienter med förmaksflimmer har försämrad hälsorelaterad livskvalitet och att kvinnor skattar sin hälsorelaterade livskvalitet generellt lägre än männen. De flesta riskfaktorer som sänker patientens hälsorelaterade livskvalitet bedöms vara modifierbara. Val av behandlingsstrategi påverkar patientens hälsorelaterade livskvalitet. Slutsats: Hälsorelaterad livskvalitet är oftast försämrad hos patienter med förmaksflimmer och underliggande riskfaktorer är modifierbara. Patientutbildning och stöd av specialistsjuksköterskan är fördelaktig och kan öka patientens hälsorelaterade livskvalitet. Nyckelord: Förmaksflimmer, livsstilsförändringar, livsstilsmodifiering, livskvalitet / Atrial fibrillation is the most common cardiac arrhythmia globally and is associated with increased risk of developing other diseases that negatively affect the patient's health-related quality of life. Most comorbid conditions like obesity, hypertension, alcohol overconsumption, smoking, diabetes, and sleep apnea can be affected by lifestyle change. Changing a lifestyle is a challenge and should be seen as a process. By working on a personcentered approach, the patient's own ability to improve quality of life is promoted. The purpose of this literature review was to investigate health-related quality of life in people with atrial fibrillation. What are the risk factors for a deterioration in health-related quality of life? Can an improved lifestyle provide a better health-related quality of life? A total of fifteen scientific articles with a quantitative approach were reviewed. The databases used to find the articles were PubMed and CINAHL. The articles were reviewed based on Sophiahemmet University's assessment data. The items included had a good to high quality. The results of the articles' analysis were summarized by an integrated data analysis. The analysis revealed categories and subcategories that described the results of the articles. The results were compiled from four main categories: Influence of factors, influence of lifestyle modification, influence of treatment strategy and influence of gender for patients with atrial fibrillation. The results showed that patients with atrial fibrillation have impaired health-related quality of life and that women rate their health-related quality of life generally lower than men. Most risk factors that lower the patient's health-related quality of life are considered modifiable. The choice of treatment strategy affects the patient's health-related quality of life. Conclusion: Health-related quality of life is most often impaired in patients with atrial fibrillation and underlying risk factors are modifiable. Patient education and the support of the specialist nurse are beneficial and can increase the patient's health-related quality of life.Keywords: Atrial fibrillation, lifestyle changes, lifestyle modification, quality of life

The purpose of this study was to increase knowledge of diabetes and promote healthy lifestyle behaviors to reduce diabetes onset in a community with a relatively high incidence of type 2 diabetes. Three hundred eighty seven students grades 7 – 12 participated in the program and taste test. Changes in knowledge before and after an educational program focusing on diabetes prevention were measured by comparison of identical pre, post, and retention tests. Students were also asked to name specific behaviors they could use to decrease the risk of diabetes. Responses were analyzed using Chi square analysis and content analysis. Overall, respondents demonstrated a statistically significant increase in knowledge. The taste test was very well accepted, with 50% of respondents preferring low fat milk instead of a higher fat option. Goals set by participants to decrease the risk of diabetes strongly emphasized physical activity and healthy eating, further indicating increased knowledge and awareness.

Cardiovascular disease (CVD) is a major public health problem and a primary cause of morbidity and mortality in the United States. Regular physical activity is recommended for prevention and management of CVD. Despite the cardiovascular health benefits of physical activity most adults are physically inactive. Therefore, the aim of this dissertation was to examine the factors associated with adherence to physical activity among individuals with or without CVD. The first paper is a report of a study conducted to examine which baseline demographic (age, gender, marital status, socioeconomic status, and place of residency), psychosocial (social support, depression, anxiety, and fatalism), and clinical (past history of exercising, comorbidity, and health literacy) variables predicted successful adoption of the active lifestyle recommendation of increasing moderate-to-vigorous physical activity by an accumulated 15 minutes or more each day following a CVD risk reduction intervention and 2) to identify which of those same factors predicted dropout from the CVD risk reduction intervention among at-risk individuals in rural America. The study sample consisted of 399 rural Americans. The results revealed that a higher anxiety level was a predictor of active lifestyle modification following a CVD risk reduction intervention. In contrast, younger age and low health literacy were predictors of dropout from a CVD risk reduction intervention. The second paper is a literature review of studies investigating the factors that affected enrollment in cardiac rehabilitation in patients with heart failure (HF). The aims of this review were to: (a) describe enrollment rates of patients with HF in cardiac rehabilitation programs, (b) review the literature on factors affecting enrollment of patients with HF, and (c) identify areas for future research. It is difficult to draw conclusion about enrollment rates because the period of time after hospital discharge that enrollment was measured varied across studies. A wide array of demographic, psychosocial, and clinical variables have been identified as potential barriers of enrollment in cardiac rehabilitation programs. Additional research including patients with HF is needed. The third paper is a report of a cross-sectional study of 279 patients with HF. The aims were to determine 1) the amount of variance in the functional status predicted by depressive symptoms, perceived control, self-rated health, HF self-care maintenance behaviors, and serum N-terminal pro-B-type natriuretic peptide ( NT-pro-BNP) biomarker of cardiac dysfunction in patients with HF and 2) whether NT-pro-BNP mediated the relationship between self-care maintenance behaviors and functional status. Depressive symptoms, poor self-rated health, non-adherence to physical activity, and greater serum NT-pro-BNP levels were independently associated with worse perceptions of functional status. Serum NT-pro-BNP levels partially mediated the association between adherence to physical activity and perception of functional status. The findings from this dissertation provided further evidence of the importance of adherence to physical activity and identify key variables that promote participation in interventions to promote heart healthy lifestyles and adherence to physical activity.

An educational module, based on evidence-based practice (EBP) guidelines by the 8th Joint National Committee (JNC 8) and the American College of Cardiology (ACC), was created and implemented to determine if its implementation would impact the knowledge of clinic staff regarding current EBP guidelines about self-management of hypertension (HTN). The module has the potential to contribute to the resolution of patient noncompliance on HTN treatment and management by increasing nursing staff proficiency in knowledge transfer to patients on effective self-management of their health condition. The creation of the module was guided by the concept of need or asset assessment and the theory of planned behavior. The module was composed of 2 short lecture presentations on HTN, current EBP guidelines on lifestyle modifications, and proper blood pressure measurement. The module also included pre- and postlecture surveys to evaluate knowledge and practices of staff, and reiterated the current guidelines and approaches presented in the lectures. Survey data were analyzed using McNemar’s test for paired and binary data. Results showed the agreement of all the staff in recognizing the utility of the module in standardizing their knowledge of current EBP guidelines on lifestyle modifications and blood pressure measurement procedures. The results also showed the enhancement of staff proficiency which might lead to efficient education of patients on effective HTN treatment and management protocol. This pathway has the potential to bring about social change by decreasing the incidence of patient noncompliance and improving patient health.

Master of Public Health / Human Nutrition / Richard R. Rosenkranz / Background: Type 2 diabetes mellitus (T2DM) is a costly and burdensome lifelong disease, and without proper glycemic control, severe life-threatening complications result. In Southeast Asia, the prevalence of T2DM is forecast to increase markedly from 2000 to 2030. Although literature reviews on lifestyle modification for glycemic control are available, these are mainly for the Western context, and there is a dearth of evidence for Southeast Asians who are at greater risk of T2DM and have differing patterns of diet, physical activity and body composition than Western populations. Objective: To systematically review literature on the effectiveness of lifestyle modification interventions for glycemic control in T2DM patients from Southeast Asia. Methods: Randomized controlled trials (RCT) with interventions ≥ 8 weeks that compared HbA1c or blood glucose for intervention (lifestyle modification) versus control groups were identified from searches in Cochrane Library, CINAHL, PubMed, ProQuest, Science Direct, SPORTDiscus, Scopus and Web of Science. Results: Seven RCTs (679 participants) meeting inclusion and exclusion criteria were identified. There was a significant reduction in HbA1c% (MD = -0.56%; 95% CI = -0.95,-0.16%; p = 0.006; n = 5 studies) and in blood glucose mg/dl (MD = -16.76 mg/dl; 95% CI = -31.36, -2.17 mg/dl; p = 0.02; n = 4 studies) over 3 months for lifestyle modification intervention groups. Lifestyle interventions included diet (n = 2), exercise (n = 2), and general lifestyle interventions (n = 3). Duration of interventions ranged from 12 weeks to 6 months. Studies included populations from Thailand (n = 5) and Malaysia (n = 2). Conclusion: Overall, lifestyle modification interventions are effective for the glycemic control of T2DM patients in countries of Southeast Asia.

Background: Diabetes is a common and costly disease that is expected to continue even to grow in prevalence and health expenditures over the coming decades. Type 2 diabetes is the most common diabetes type and is characterized by insulin resistance and relative insulin deficiency. Type 2 diabetes develops over a long period and is often undetected over years. During this time, people almost always first develop any of the pre-diabetic states, i.e. impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or a combination of both (IFG&IGT). This thesis focuses on type 2 diabetes only. In the following, the term diabetes is used to refer to type 2 diabetes only. Diabetes is associated with a sedentary lifestyle and obesity. While those are not the only factors contributing to the development and maintenance of diabetes, several studies have shown that prevention of diabetes among individuals at high risk through lifestyle change is possible, effective and cost-effective, especially targeting diet and exercise to reduce weight. No previous study had, however, estimated the cost-effectiveness of diabetes prevention strategies from a population-based perspective including healthy individuals and also considered IFG and IGT as two distinct pre-diabetic states. Objective: The overall objective of this thesis was to establish, describe and evaluate a model that can assess the cost-effectiveness of lifestyle intervention programs to prevent diabetes. Methods: First, a Markov Model was established using data from the literature. The cost of a German diabetes prevention program was estimated. Second, risk equations for change to worsened glucose states were estimated using factor analysis and logistic regression based on consecutive data from the Västerbotten Intervention Program (VIP). The risk equations described transition probabilities in the final model and were based on several risk factors such as age, sex, physical activity and smoking status. Third, information on the Short-Form 36 questionnaire from the VIP population was transformed into Short-Form 6D. Health utility weights (HUW) by glucose group and four risk factors were estimated using beta regression. Fourth, an updated Markov model was established using an updated model structure compared to the one in Paper I, program costs of Paper I, risk equations of Paper II, health utility weights of Paper III and updated cost and mortality estimates. Results: The first model in Paper I showed that lifestyle intervention programs have the potential to be cost-effective with a high degree of uncertainty. The risk equations in Paper II indicated that the impact of each risk factor depended on the starting and ending pre-diabetes state, where high levels of triglyceride, hypertension, and high body mass index were the strongest risk factors to transit to a worsened glucose state. The overall mean HUW in Paper III was 0.764 with healthy individuals having the highest HUW, those with diabetes the lowest and those in pre-diabetic states ranging in between. The intervention described in Paper IV was cost-effective for all sex and age scenarios ranging from 3,833 EUR/QALY gained (women, 30 years) to 9,215 EUR/QALY gained (men, 70 years). The probability that the intervention is cost-effective was high (85.0-91.1%). Conclusion: We established a model that can estimate the cost-effectiveness of different scenarios of initiatives to prevent diabetes. The prevention or the delay of the onset of diabetes is feasible and cost-effective. A small investment in a healthy lifestyle with the change in physical activity and diet together with weight loss can have a decent, cost-effective result. The full range of possibilities this model offers has not been evaluated so far. We have, however, shown that implementing a lifestyle intervention program like the Västerbotten Intervention Programme would be cost-effective.