Mapping De-Implementation Strategies To Identified Determinants of Low-Value Statin Prescription for Primary CVD Prevention in Primary Care

BackgroundDespite clear recommendations supporting healthy lifestyle promotion interventions for the primary prevention of CVD in low-risk patients, a considerable number of these people continue to receive inappropriate statin prescriptions. The present study reports on the structured process based on theory and evidence carried out for the design of de-implementation strategies to reduce the inappropriate prescription of statins and to increase the promotion of healthy lifestyles, in CVD prevention practice of primary care professionals for patients with low cardiovascular risk.MethodsA phase I formative study following a structured theory-informed process combining the Theoretical Domains Framework (TDF) and the Behavior Change Wheel (BCW) was conducted, comprising: semi-structured interviews (n=5) with primary care professionals to delimitate and define the problem in behavioral terms; focus groups (4 groups with 21 physicians; 1 group with 6 patients) to identify the determinants of potentially inappropriate prescribing [PIP] of statins and healthy lifestyle promotion actions; mapping of behavioral change interventions operationalized as de-implementation strategies for addressing identified determinants; and consensus techniques for the prioritization of strategies based on perceived effectiveness, feasibility and acceptability.ResultsNumerous multilevel determinants of both PIP of statins and healthy lifestyle promotion embracing almost all of the TDF dimensions have been identified. Guided by the BCW established procedure, 13 potential de-implementation strategies have been mapped to identified determinants. Those assessed as potentially more feasible, acceptable and potentially effective by the professionals themselves were: 1) Information/knowledge dissemination strategies: a corporate dissemination campaign on “Abandonment of Low-Value Practices”; a Clinical Pathway for the primary prevention of CVD in low-risk patients, accompanied with audiovisual and paper-based training resources; 2) Strategies for presenting relevant information for decision-making: an audit/feedback system regarding CVD prevention practice performance indicators; and 3) Strategies for helping clinical decisions: reminders, alerts, and a decision support tool incorporated into the REGICOR CVD risk calculator in the electronic clinical record.DiscussionThe methodology established by the TDF/BWC for the design of behavior change interventions has been useful for the development of de-implementation strategies targeting the decision-making process of clinicians to favor the uptake of recommended clinical practice for CVD prevention in low-risk patients.TRIAL REGISTRATIONClinicaltrials.gov identifier: NCT04022850. Registered 17 July 2019, https://www.clinicaltrials.gov/ct2/show/NCT04022850

Investigation of Health Science Students' Knowledge Regarding Healthy Lifestyle Promotion During the Spread of COVID-19 Pandemic: A Randomized Controlled Trial

Background: Health sciences students as future health care providers, can play a valuable role in protecting societies against the spread of COVID-19 through health promotion and lifestyle modification education. Therefore, proper education of these students is essential.Objective: This study sought to assess and measure the change of knowledge of health sciences students regarding healthy lifestyle promotion strategies during the spread of the Covid-19 pandemic, after participation in different types of online and social media educational programs.Methods: In order to serve the purpose of the study, a methodological research design was first used to ensure the validation of the developed scale; the COVID-19 Healthy Lifestyle Promotion Scale (COVID-19 HLPS). The study utilized a four-arm randomized control research design in which the participants were randomly assigned into one of four groups, (1) control group (placebo intervention), (2) brochure group, who received brochures relevant to healthy lifestyle promotion, (3) Instagram group, who received similar information but through Instagram posts, and (4) online interactive educational workshop group, who also received similar information through an online interactive educational workshop.Results: In total, 155 participants participated in the online and social media intervention programs. There was a significant improvement in the intervention groups in the total knowledge subscale of the healthy promotion strategies compared with the control group (p < 0.001). Overall, the workshop group was the most effective group (effect size = 1.54) followed by the Instagram group (effect size = 0.99) and then the brochure group (effect size = 0.91).Conclusions: In order to meet the challenges posed by this pandemic, the use of such online and social media interventions is essential and may be the key for health promotion during this pandemic. Health science students, as future health care professionals, can play a fundamental role during the COVID-19 pandemic in disseminating knowledge relevant to healthy lifestyle to their families and communities thus promoting healthy living and behavioral changes. We propose the development of research initiatives at both national and international levels targeting changes within health science curricula that can meet potential challenges of future pandemics, leading to advancement of health care services globally.

Penerapan Siklus Promosi Kesehatan Untuk Meningkatkan Phbs Dan Kadarzi Di Rw 40, Dusun Jaranan, Desa Banguntapan, Kecamatan Banguntapan, Kabupaten Bantul

Program promotif gaya hidup sehat telah banyak digencarkan pemerintah diantaranya Perilaku Hidup Bersih dan Sehat (PHBS) serta Keluarga Sadar Gizi (Kadarzi). Namun demikian, cakupan penerapan indikatornya seringkali tidak dapat terpenuhi, hanya beberapa atau sebagian keluarga yang menerapkan secara utuh. Dusun Jaranan menjadi salah satu yang belum menerapkan secara utuh. Data terakhir menunjukkan 53,35% untuk PHBS tahun 2018 sedangkan kadarzi sudah 95,44%. Penerapan ini selalu mengalami perubahan naik maupun turun. Oleh karena itu diperlukan penilaian kesehatan dan upaya promotif yang berkesinambungan. Studi ini bertujuan untuk melakukan seluruh tahapan siklus promosi kesehatan di RW 40 Dusun Jaranan. Metodenya penilaian kesehatan menggunakan metode kuantitatif dengan survey. Data yang dihasilkan berupa permasalahan yang prioritas yaitu masih adanya yang merokok di dalam rumah. Oleh karena itu, program yang disepakati bersama masyarakat adalah peningkatan pengetahuan tentang bahaya rook bagi perokok aktif dan pasif dengan metode ceramah dan alat bantu berupa poster, leaflet, dan video. Intervensi ini dapat berjalan sesuai rencana dan memberikan dampak berupa peningkatan pengetahuan sasaran. Upaya ini harus terus ditindaklanjuti oleh puskesmas setempat agar tidak berhenti pada peningkatan pengetahuan saja, namun juga sikap dan perilaku.---The healthy lifestyle promotion program has been intensified by the government including Clean and Healthy Behavior (PHBS) and Nutrition Conscious Families (Kadarzi). However, the scope of the application of the indicators can often not be fulfilled, only a few or some families who apply in full. Jaranan Hamlet is one that has not been implemented in full. The latest data shows 53.35% for PHBS in 2018 while the levels of have been 95.44%. This application always changes up and down. Therefore it is necessary to have an ongoing health assessment and promotive effort. This study aims to conduct all stages of the health promotion cycle in RW 40 of Jaranan Hamlet. The method of health assessment uses quantitative methods with surveys. The data generated in the form of a priority problem that is still the existence of smoking in the house. Therefore, the program agreed with the community is to increase knowledge about the dangers of rooks for active and passive smokers with lecture methods and assistive devices in the form of posters, leaflets, and videos. This intervention can go according to plan and have the effect of increasing target knowledge. This effort must continue to be followed up by local health centres so as not to stop at increasing knowledge, but also attitudes and behavior.

The ‘wellbeing’ in spite of everything: small sharing spaces with families or peer educators during the COVID-19 pandemic

During the difficult period caused by the Covid-19 pandemic, a workshop was implemented online, leading a study about the effectiveness of the 'Salotti del BenEssere©' model among students and future educators. This course is the result of the collaboration between the Suor Orsola Benincasa University in Naples and ASL Napoli 1 Centro. It’s a model of salutogenesis that specifically proposes a multicentre space for the evaluation and spread of healthy lifestyles. Due to the pandemic and the consequent social isolation, the 'keys' to access the main topics for the healthy lifestyle promotion were explored online in order to overcome social isolation; at the beginning of each lesson on the Salotti del BenEssere©, audio files were provided to guide the students through the experience of each “key”: Breathing, Nutrition and Emotions.The lessons were carried out through distance teaching on the online platform called “Google Meet”. For evaluation purposes, questionnaires that were originally created in paper format were transferred to the online opensharing platform “Google Forms”. The general aim of the evaluation is to establish whether the educational process formulated by the “Salotti del BenEssere©” has an impact on self-perception in relationships. The specific aim of this study is to verify whether there were differences between the results achieved by the students who were able to experience the face-to-face lessons and those who were forced to attend the lessons online and, if so, to record which ones are significant.We believe that these innovative and digital techniques can become a tool for future educators, especially in emergency situations, to overcome social isolation.

The Use of Information Technology for Smoking Cessation: Opinions of Romanian Patients from General Practitioners

The objectives of this study are assessing of internet use among Romanian patients from general practitioners as well as their intention to use or recommend the first computer tailored program for smoking cessation from Romania. The study involved 200 patients from general practitioners from Cluj-Napoca, Romania. A cross-sectional study was performed in 2014 through anonymous questionnaires. More than 80% of the patients declared using internet, while half were searching on internet in the last month information regarding healthy lifestyle. The prevalence of smoking was 29.5%. One out of two smokers declared intention to try the program for smoking cessation, this intention being higher among smokers with a stronger intention to quit smoking in the next 6 months, having email-address and searching healthy lifestyle information on internet in the last month. Two thirds of the participants agreed that they would inform other persons about the smoking cessation program; this intention was higher among women and among those interested in healthy lifestyle information on internet. Information technology could be use for healthy lifestyle promotion among patients from big cities of Romania, where internet access and interest for computer tailored programs for health promotion look promising.

Influence of preventive measures in a children’s polyclinic on the health status of preschool children

Prevention aims to create optimal conditions for the formation of children’s health, ensuring the protection of the child’s body from diseases. The goal is to identify priority problems in preventive work with preschool children in outpatient and polyclinic conditions. Materials and methods. Authors studied information from medical documents of 3-6 year children from the children’s polyclinics in Moscow, questionnaires of parents of children observed during 2017-2020. Preventive examinations cover 97.0% of children; a third of children have a chronic pathology. 68.1% of children passed dispensary examinations. 82.1% of children got vaccinated by age. The «Mother’s School» improves the medical literacy of parents. Conclusions. It is necessary to select a specific time for specialists during preventive examinations to intensify healthy lifestyle promotion among parents.

Content analyses of rail companies’ sites and web pages concerning healthy lifestyle promotion and prevention coronavirus infection

Introduction. The development of modern society implies that more and more information is placed in the digital space. Therefore, the attitude of the management of transport companies to the promotion of healthy lifestyle and the prevention of COVID-19 can be indirectly assessed by the content of their sites and web pages. Purpose. The purpose of this article is a content analysis of rail companies’ sites and web pages on the promotion of healthy lifestyles and the prevention of COVID-19. Materials and methods. The study was carried out once, in October 2020. We analyzed the sites and web pages of rail companies using the formation of queries, as well as using the search engines Yandex and Google. Results. The frequency of mentioning healthy lifestyle issues on the websites and web pages of the analyzed rail companies vary from 32 to 54 %. COVID-19 prevention issues are covered only in a half of cases by railway companies and in more than 90 % – on the websites and web pages of subways, high-speed trams and city trams. In general, the analyzed websites and web pages of the rail companies adequately display the information related to the prevention of COVID. Discussion. Rail companies pay attention to the formation of healthy lifestyles and prevention of COVID-19 on their web pages and sites. For this reason, it can be assumed that the management of the rail companies is concerned about these problems. At the same time, we have no reason to believe that the analyzed web documents fully reflect the ongoing preventive programs, in other words, it can be assumed that the preventive activities of rail companies are broader than shown in this study. Meanwhile, rail companies do not fully cover their social policy regarding the health of their own employees. Conclusion. The sites and web pages of rail companies, as a rule, contain scattered information on promoting healthy lifestyle. At the same time, the information on the prevention of COVID-19 is usually presented in a comprehensive manner. The issues of COVID-19 prevention in general are mentioned on more sites and web pages than the issues of healthy lifestyle formation.

The role of midwives and obstetrical nurses in the promotion of healthy lifestyle during pregnancy

Women with maternal obesity, an unhealthy lifestyle before and during pregnancy and excess gestational weight gain have an increased risk of adverse pregnancy and birth outcomes that can also increase the risk of long-term poor health for them and their children. Pregnant women have frequent medical appointments and are highly receptive to health advice. Healthcare professionals who interact with women during pregnancy are in a privileged position to support women to make lasting healthy lifestyle changes that can improve gestational weight gain and pregnancy outcomes and halt the intergenerational nature of obesity. Midwives and obstetrical nurses are key healthcare professionals responsible for providing antenatal care in most countries. Therefore, it is crucial for them to build and enhance their ability to promote healthy lifestyles in pregnant women. Undergraduate midwifery curricula usually lack sufficient lifestyle content to provide emerging midwives and obstetrical nurses with the knowledge, skills, and confidence to effectively assess and support healthy lifestyle behaviours in pregnant women. Consequently, registered midwives and obstetrical nurses may not recognise their role in healthy lifestyle promotion specific to healthy eating and physical activity in practice. In addition, practising midwives and obstetrical nurses do not consistently have access to healthy lifestyle promotion training in the workplace. Therefore, many midwives and obstetrical nurses may not have the confidence and/or skills to support pregnant women to improve their lifestyles. This narrative review summarises the role of midwives and obstetrical nurses in the promotion of healthy lifestyles relating to healthy eating and physical activity and optimising weight in pregnancy, the barriers that they face to deliver optimal care and an overview of what we know works when supporting midwives and obstetrical nurses in their role to support women in achieving a healthy lifestyle.

Effect of healthy lifestyle promotion on anthropometric variables, eating behavior and cardiometabolic risk factors in women with polycystic ovarian syndrome

Background: In women with Polycystic Ovarian Syndrome (PCOS), metabolic abnormalities are common, including insulin resistance, obesity, and dyslipidemia, suggesting an increased risk for cardiovascular disease (CVD). Objectives: To evaluate the effect of healthy lifestyle promotion on eating behavior and metabolic biomarkers in women with PCOS. Subjects and Methods: The study was carried out in 102 women (30±7 years) with PCOS. Patients received nutritional counseling based on Mediterranean diet principles and recommendations to practice a regular physical activity, and were followed up during six weeks. Dietary survey and biomarkers analysis were assessed at baseline (T0), after three weeks (T1) and 6 weeks (T2). Results: After six weeks of intervention, there was a significant decrease in total energy intake by (-30%) at T1 and (-32%) at T2 (p˂0.001), compared to baseline. Significant decrease was recorded in carbohydrates, proteins and lipids intake at T1 and T2 (p˂0.001). An increase in monounsaturated fatty acid intake was noted at T1 and T2 (p˂0.001). The body mass index (BMI) diminished at T2 (p˂0.01), and waist circumference at T1 and T2 (p˂0.001). Glucose values decreased at T1 (p˂0.05) and T2 (p˂0.001). Total cholesterol decreased at T1 (p˂0.05) and T2 (p˂0.01). HDL-C increased at T1 (p˂0.001) and T2 (p˂0.001), when CRP values remained unchanged. A decrease in Thiobarbituric acid reactive substances concentrations was observed at T1 and T2 (p˂0.05). Superoxyde Dismutase, Catalase activities and thiols amount increased at T2 (p˂0.001). Conclusion: In the long term, healthy lifestyle promotion could be beneficial to prevent or reverse the clustering of metabolic abnormalities and prevent CVD in women with PCOS. Keywords: Polycystic ovary syndrome, Metabolic abnormalities, Healthy Lifestyle, Mediterranean diet, Cardiometabolic risk.