Healthy lifestyle behaviors play a significant role in promoting cardiovascular health. Primary care clinicians (PCCs) are tasked with promoting cardiovascular health through the assessment of lifestyle behaviors and the use of behavior change counseling. However, PCCs face several barriers including a lack of training in counseling techniques. We propose a framework to guide the development of a patient-centered digital communication bundle that can aid PCCs in helping their patients create and sustain feasible lifestyle changes. Our framework proposes that this digital communication bundle contains the following features: assess and analyze an individual's cardiovascular health status; communicate personalized information in a health-literacy-friendly, visual format; assess behavioral components of change (e.g., motivation) that can inform the PCC's approach in guiding behavior change; provide PCCs with brief, behavior change counseling prompts that are grounded in motivational interviewing; and assess and address potential structural, socioeconomic, and environmental barriers, thereby fostering resilience in patients' lifestyle change efforts. We highlight the available research to support the need for such a tool and its potential ability to guide PCCs while also promoting behavior change in a patient-centered manner.

Self-management support is widely considered a critical aspect of nursing. Still, many studies indicate that nurses frequently experience difficulties in daily practice.

To gain a deeper understanding of the factors perceived by nurses to impede or promote their support of patients' self-management within the dynamic environment of the in-patient hospital setting.

Mixed methods design.

Nurses (n = 269) working in a teaching hospital in the Netherlands completed a questionnaire. Subsequently, 38 nurses participated in interviews.

The SEPSS-36 questionnaire assessed nurses' self-efficacy and performance in self-management support. Semi-structured interviews were conducted to address salient results from the questionnaire, focusing on factors influencing self-management support, goal setting, follow-up care, and the nurse's role in a hospital setting.

the response rate for the questionnaire study was 62 %. A paired t-test revealed a significant mean difference of 6.30 95 % CI [5.91-6.69] p ≤ 0.001 between nurses' perceived self-efficacy (mean = 18.34/24) and their actual performance (mean = 12.03/24) in self-management support. The interviews revealed that nurses typically focus on medical procedures and maintaining patients' functional status. Spending time with patients to offer emotional support was viewed as 'something extra' rather than a core part of their job. High patient turnover hindered nurses from having meaningful conversations with patients.

Short-term priorities such as 'getting the work done' dominate nurses' daily tasks in hospital wards, leading them to overlook often the benefits of supporting patient self-management. This narrow view of their responsibilities can hinder patient care, whereas adopting a broader perspective on the patient journey could be very beneficial.

Pulmonary rehabilitation (PR) is essential for treating interstitial lung disease (ILD). The 5A nursing model enhances patients' health-promoting behaviors by improving their self-management skills. The aim of this study is to examine and analyze the effectiveness of the PR program based on the 5A nursing model concerning lung function, dyspnea, anxiety, depression, self-efficacy, quality of life, and PR compliance in patients with ILD.

64 hospitalized ILD patients were enrolled in this quasi-experimental study. Patients were randomly assigned to an intervention group (PR program based on the 5A nursing model) and a control group (conventional PR) on a ward-by-ward basis. The allocation was not concealed from the patients. A pre- and post-test design was used. An exercise training diary was utilized to evaluate PR compliance, data was gathered using the mMRC, HADS, PRAISE, and SGRQ, and lung function was assessed by a professional PR-trained nurse. SPSS 26.0 was used to analyze the data. For within/between-groups comparisons, the Wilcoxon signed-rank test, Fisher's exact test, t-test, χ²-test, and Mann-Whitney U-test were employed.

Baseline demographics were generally similar between the two groups (P > 0.05). After 10 weeks of intervention, the PR program based on the 5A nursing model group had more significant improvements in self-efficacy (P = 0.001), anxiety (P = 0.005), and depression (P = 0.018) compared to the control group, but there were no significant differences in dyspnea, lung function, or quality of life (P > 0.05). PR compliance was significantly higher in the intervention group than in the control group (P = 0.028). Further within-group comparisons showed significant improvements in DLCO%pred (P = 0.003), dyspnea (P = 0.001), anxiety (P = 0.006), self-efficacy (P < 0.001), and quality of life (P < 0.001) at post-test in patients in the intervention group compared to pre-test.

The PR program based on the 5A nursing model is an effective way to reduce anxiety, depression, and improve self-efficacy and PR compliance in patients with ILD.

Retroactive registration is underway on the Chinese Clinical Trial Registry (ChiCTR).

Uncontrolled hypertension is the leading cause of cardiovascular and cerebrovascular diseases in Ethiopia. Early detection and referral of hypertensive patients for clinical care is critical for initiating lifestyle changes and antihypertensive medications. This study aimed to evaluate the effects of health extension workers led home-based multicomponent intervention on linkage to hypertension care in patients with hypertension in rural districts of northwest Ethiopia.

A parallel group, cluster randomized controlled trial was conducted in 20 rural communities. A total of 456 (228 in the intervention and 228 in the control clusters) participants were enrolled and followed for nine months. Participants in the intervention clusters received the interventions (home health education, behavioral and medication adherence counseling, and referral to nearby health facility) four times every other month for 40-60 min. The primary outcome was clinical linkage for hypertension care and the secondary outcome was initiation of antihypertensive treatment. Generalized estimating equation was used to evaluate the intervention's effect using an intention-to-treat approach. Effect sizes of relative benefit increases, absolute benefit increases, and attributable benefit were used. All statistical analyses were two-sided with a p-value of < 0.05.

The overall average systolic and diastolic blood pressure at baseline were 145.81 (± 13.89) mmHg and 87.11 (± 7.42) mmHg, respectively. The proportion of linkage to hypertension care increased from 11.0% at baseline to 66.2% at 9 months in the intervention group and from 12.3 to 39.7% in the control group, with an absolute benefit increase of 27.5% (95% CI: 19.6%, 35.4%; P-value < 0.001). The attributable benefit associated with the intervention was 40.1% (95% CI 20.7%, 59.5%) which means that more than a third of linkage to hypertension care was due to the HEWs led home-based multicomponent intervention. However, it is noteworthy that only 10.3% of patients initiated antihypertensive medication.

In this study, health extension workers led home-based multicomponent interventions that provided home health education, behavioral counseling, and referral to a nearby health facility to improve linkage to hypertension care. A multicomponent intervention implemented on a large scale is likely to improve linkage to hypertension care and reduce hypertension-related morbidity and mortality in the country.

PACTR202102729454417.

Lifestyle changes can effectively prevent diabetes onset in individuals with prediabetes. Although nurse-led interventions have proven to be cost-effective and feasible in the management of diabetes and hypertension in primary care, low-intensity lifestyle interventions for people with prediabetes led by nurses remain poorly evaluated.

To assess whether a low-intensity nurse-led telephone lifestyle intervention is effective in reducing fasting plasma glucose levels in individuals with prediabetes.

A two-arm, parallel, randomized controlled clinical.

Five Primary Care Centres in the Balearic Islands, Spain.

A total of 206 participants were enrolled, 103 in each group.

Consenting participants aged 25-75 years, with fasting plasma glucose levels of 100-125 mg/dL, and body mass index ≥27 and < 40 kg/m2 were randomly assigned (1:1) to either a 9-month nurse-led telephone lifestyle intervention (intervention) or short text messages with general lifestyle advice (control). Research staff and the statistician were masked to group allocation. The primary outcome was fasting plasma glucose at 9-month follow-up, analyzed per protocol and by intention-to-treat.

Among the 206 participants (103 in each group), 189 (91·8 %; n = 91 in the intervention group, n = 98 in the control group) completed the 4-month follow-up and 181 (87·9 %; n = 87 in the intervention group, n = 94 in the control group) completed the 9-month follow-up. Among the 206 randomized participants, 52.9 % were women, 73.8 % were obese, and 69.4 % were of Spanish nationality. Differences in fasting plasma glucose between groups at 9-months were not statistically significant (Intervention group n = 85 mean 103·4 mg/dL [SD 9·6] vs Control group n = 91 mean 104·8 mg/dL [SD 9·7]; adjusted mean difference 1·1 mg/dL [95 % CI -1·6 to 3·8]; p-value = 0·43). Difference in waist circumference at 9 months were statistically significant (Intervention group n = 85 mean 100.6 cm [SD 10.2] vs Control group n = 91 mean 104.0 cm [SD 10.2]; adjusted mean difference 1.9 cm [95 % CI 0.6 to 3.3]; p-value <0.01). At 9-month follow-up, diet quality improved in the intervention group (intervention group n = 86 mean 8.4 points [SD 2.0] vs control group n = 93 mean 7.5 points [SD 2.1], adjusted mean difference - 1.3 points [95 CI -1.7 to -0.7]; p-value <0.01). Likewise, sedentary behavior presented statistically significant differences at 9-month follow-up (intervention group n = 86 mean 5.4 H/d [SD 1.8] vs control group n = 93 mean 6.3 H/d [SD 1.9], adjusted mean difference 1.0 H/d [95 CI 0.5 to 1.4]; p-value <0.01).

These results do not support the effectiveness of a low-intensity nurse-led telephone lifestyle intervention in reducing fasting plasma glucose in individuals with prediabetes, although changes in diet quality and sedentary behavior were observed.

https://clinicaltrials.gov/study/NCT04735640?term=prediphone&rank=1NCT04735640. Registered 03/02/2021, first recruitment 13/04/2021.

A nurse-led phone intervention had no significant benefits on glucose levels in patients with prediabetes. @GlobalHealth_rg.

Numerous studies have explored the impact of controlled exercise interventions in type 2 diabetes, as physical activity can positively influence its progression. However, our understanding of how broader lifestyle interventions can effectively promote physical activity in practical real-world scenarios remains limited.

This systematic review and meta-analysis aimed to investigate the potential of lifestyle interventions targeting the promotion of physical activity on physical activity outcomes and glycated hemoglobin (HbA1c), providing a comprehensive understanding of both behavioral and clinical impacts.

We performed a systematic review and meta-analysis, searching three databases and examined the study design, structure, and content of the lifestyle interventions. We assessed physical activity and HbA1c as endpoints and performed a multivariate meta-regression to explore physical activity's impact on HbA1c.

This review incorporated 13 studies (n = 5301 patients), with heterogeneity in intervention designs, components, and durations. Lifestyle interventions showed a slight increase in physical activity, equivalent to an average of 9.0 min more total physical activity per day (95% confidence interval 5.8, 12.2) and 1.7 min more moderate-to-vigorous physical activity per day (95% confidence interval 1.1, 2.3), irrespective of objective (e.g., accelerometers) or subjective measurement (e.g., questionnaires) method. However, HbA1c reduction through these interventions was minimal 0.09% (95% confidence interval - 0.20, 0.03). The effect of physical activity was - 0.04 (standard error = 0.05, 95% confidence interval - 0.15, 0.06), suggesting that physical activity does not act as a moderator for changes in HbA1c.

Lifestyle interventions effectively increase physical activity but have limited impact on HbA1c compared to controls. The role of physical activity as a moderator for changes in HbA1c remains uncertain. Further research is needed to enhance the efficacy of these interventions in reducing HbA1c in individuals with type 2 diabetes.

Patients with cancer can have problems sleeping. One measure that can help patients with cancer to improve the quality of their sleep is the 5A Self Management Model method.

This study aimed to determine the effect of the 5A Self Management Model on the quality of sleep of patients with cancer.

In this clinical trial, 106 patients with cancer were recruited by convenient sampling, and randomly allocated to experimental and control groups. Data collection tools were a demographic checklist and Pittsburgh Sleep Quality Questionnaire. Patients in the experimental group received a self-management programme with the 5A method for 3 months and the control group obtained the routine intervention. Data were analysed via SPSS 25 software using Wilcoxon, Mann-Whitney U, independent t-test, paired t-test and descriptive statistics.

Before the intervention, the mean scores of sleep quality were 13.41 (1.78) in the experimental group and 9.64 (2.45) in the control group. However, after the intervention, the mean score of sleep quality decreased in the experimental group to 5.07 (1.19) and increased by 12.81 (2.26) in the control group, significantly.

The 5A Self Management Model programme improved the quality of sleep of patients with cancer in this trial. It is recommended nurses consider this method as a part of caring for patients with cancer.

Self-management is important for people coping with chronic diseases. The self-determination theory (SDT) emphasizes the role of healthcare professionals' (HCPs) (de)motivating interaction styles in either supporting or thwarting patients' self-management behavior. Since developing (de)motivating interaction styles starts during education, this study aimed to identify profiles among HCPs in training based on their (de)motivating interaction styles and to assess how these profiles differ in sample characteristics, SDT-beliefs, and self-efficacy in self-management support. Cross-sectional data were collected using self-reported questionnaires among nurses (n = 125) and physiotherapists (n = 257) in training (total participants: n = 382). Cluster analyses were performed to identify the profiles followed by chi-square tests and MANCOVA-tests to assess profile differences. Five profiles were identified, labelled as: motivating (16%), active (22%), undifferentiated (29%), demotivating (17%) and inactive (17%). The motivating profile contained fewer men (10%), while the demotivating profile had a higher proportion of men (52%) compared to the whole sample distribution (28%). Fewer nursing students were categorized to the active profile (20%) compared to the overall sample distribution (33%). Higher SDT-beliefs and self-efficacy in self-management support were noted in the motivating and active profiles as opposed to the demotivating and inactive profiles. These results contribute to a better understanding of healthcare students' interaction styles during patient self-management support. In education of HCPs, a focus on improving SDT-beliefs and self-efficacy in self-management support, may help HCPs to improve their interaction profile towards people with chronic diseases.

The growing prevalence of E-cigarette use among adolescents is alarming because it increases the probability of persistent tobacco use and addiction to nicotine. Healthcare providers are in a unique position to influence their patients' use of E-cigarettes. The purpose of the study is to determine the frequency at which providers screen adolescents for E-cigarette use and advise against use during healthcare visits. The study also examines associations between provider intervention and adolescent harm perception.

Using data from the 2021 National Youth Tobacco Survey, the authors examined provider E-cigarette screening and advice to not use from 16,910 participants who self-reported receiving medical care within the preceding year. Multivariable logistic regression models were used to assess whether the odds of provider intervention varied by age, sex, and race/ethnicity and whether receiving provider intervention was associated with a likelihood for harm perception.

Provider intervention was more likely among those aged 13-18 years, who are male, and who are White and/or non-Hispanic (p<0.001). The authors found no association between provider intervention and increased harm perception of E-cigarettes; however, provider intervention was associated with the belief that E-cigarettes are equally or more addictive than cigarettes (p<0.0001).

Study findings emphasize the significance of addressing disparities in E-cigarette use and healthcare provider intervention among minority adolescents, underscoring the need for healthcare providers to be thorough in screening for E-cigarette use and providing appropriate cessation support.

Obesity is a significant global public health concern, and health care providers play a crucial role in addressing it by offering healthy lifestyle counseling and weight management support. Evidence demonstrates that even brief counseling on healthy behaviors can lead to meaningful changes and sustained weight management. However, weight consultations are often underutilized in primary care due to various barriers, including biases against patients with obesity, misconception of physicians with obesity, or concerns about stigmatizing them by initiating discussions about weight. This paper explores the impact of biases, misconceptions, and stigma on the communication and treatment of patients with obesity and proposes strategies to overcome these challenges. Practical solutions include fostering inclusive health care environments for individuals of all body sizes and utilizing the 5A model (Ask, Assess, Advise, Agree, Assist) to guide respectful and effective weight management conversations.

Disparities in access to tobacco cessation support and resources remain significant issues among community members with low socioeconomic status (SES). Community health workers (CHWs) can connect with community members and have flexibility in delivering treatments to underserved populations. The Community Health Allies Nicotine Guidance Education (C.H.A.N.G.E.) project, designed for CHWs, aimed to address the disparities by implementing a tailored tobacco cessation training program. The current study examined the C.H.A.N.G.E. program's preliminary effectiveness on CHW knowledge gain.

Data were collected from CHWs in Chicago, IL who participated in the training program between October 2022 and December 2023, and CHWs completed a tobacco cessation knowledge questionnaire pre-training, post-training, and at 1- and 6-month follow-up. A paired samples t-test was conducted to assess changes in CHWs' pre-post knowledge change. Descriptive analyses were also explored to examine the type of knowledge that was retained and whether that differed by the client population that CHWs served.

CHWs (N = 72) were mostly women (68%) who worked in their current role for an average of 2.34 years (SD = 1.54). The mean age of participants in the study was 38.06 years (SD = 13.09). Baseline knowledge was low (M = 3.75 [1.18] out of 10) but significantly increased post-training (M = 6.64 [1.13]; P < .001). There was no difference in change of tobacco cessation knowledge scores for groups based on client population served.

The C.H.A.N.G.E. training effectively improved CHWs' tobacco cessation knowledge. However, knowledge changes had no differences based on client types of CHWs. This study highlighted the importance of continuous adaptation and evaluation of training programs to fit the needs of CHWs and their clients in underserved, community-based settings.

This study aimed to investigate the effect of empowerment-based interventions on self-efficacy and self-care capacity among adults with sickle cell disease (SCD).

A randomized control trial was conducted [NCT06296654]. A total of 76 patients were recruited by using a cluster sampling technique in the two health centers in Bahrain from February to May 2022 and randomly allocated to the intervention group (n = 38) or control group (n = 38). The intervention group received the empowerment-based intervention implemented through structured small-group discussion sessions, individualized consultations (5A model: assess, advise, agree, assist, and arrange), and follow-up sessions, while the control group received routine health education. The Sickle Cell Self-Efficacy Scale (SCSES) and the Appraisal of the Self-Care Agency Scale-Revised (ASA-R) were measured at baseline and one month after the intervention among two groups of patients.

A total of 68 patients completed the study (36 patients in the intervention group and 32 patients in the control group). After the intervention, the score of SCSES in the intervention group was 37.0 (35.0, 39.8) higher than the control group 28.0 (25.2, 32.0) (U = - 6.121, P < 0.001); the score of ASA-R in the intervention group was 61.0 (58.3, 65.0) higher than the control group 49.0 (43.3, 53.0) (U = 0.653, P < 0.001).

Adopting the empowerment-based intervention using the 5As model effectively improves self-efficacy and self-care capacity among patients with SCD.

HAPpEN aims to implement and evaluate a holistic general practitioner-centered, interdisciplinary obesity management strategy in rural Germany, focusing on feasibility, health outcomes, and economic benefits.

HAPpEN is a 12-month, pragmatic single-arm, multicenter trial, informed by a formative survey, and initiated in April 2023 with 98 obese participants (body mass index, BMI ≥ 30 kg/m2) in Kulmbach, Germany. The program integrates nutritional counseling, physical activity, and behavior change techniques, including smartphone-based self-monitoring. Monthly consultations help set personalized goals using a multi-stage grading scale. Primary outcomes include BMI, body weight, waist circumference, heart rate, blood pressure and parameters, while secondary outcomes assess quality of life, wellbeing, health literacy, social interaction, and digital therapy support.

The baseline cohort (mean age: 46.9 ± 11.8 years, 74.1 % female) exhibited high obesity rates (mean BMI: 40.1 ± 6.1 kg/m2), with 48.5 % classified as grade III obese. Common comorbidities were hypertension (51.8 %), dyslipidemia (30.5 %) and diabetes (21.8 %). Chronic joint paint, mainly in the knees and hips, affected up to 82.4 %. A familial aggregation of obesity, diabetes, and cardiovascular diseases was noted, alongside behavioral challenges such as lack of physical activity (81.8 %) and unhealthy eating habits (56.8 %).

HAPpEN addresses obesity's multifactorial nature through general practitioner-led, community-based, and digital strategies to promote sustainable lifestyle changes in rural areas. The trial aims to inform primary care obesity management guidelines, focusing on improving health literacy, patient engagement, and long-term clinical benefits. German Clinical Trials Register: DRKS00033916.

Guidelines recommend cardiovascular (CV) risk assessment and counseling for cancer survivors. This study evaluated the automated heart-health assessment (AH-HA) clinical decision support tool to promote provider-patient CV health (CVH) discussions in outpatient oncology.

The AH-HA trial (WF-1804CD), coordinated by the Wake Forest National Cancer Institute Community Oncology Research Program Research Base, randomized practices to the AH-HA tool or usual care (UC) and enrolled survivors receiving routine care ≥6 months after curative cancer treatment. The tool displayed American Heart Association Life's Simple 7 CVH factors (BMI, physical activity, diet, smoking status, blood pressure, cholesterol, and glucose), populated from the electronic health record (EHR), alongside cancer treatments received with cardiotoxic potential. The primary end point was survivor-reported discussion of nonideal or missing CVH factors. A mixed-effects logistic regression model assessed the effect of AH-HA on CVH discussions, adjusting for practice.

Five UC and four AH-HA practices enrolled 645 survivors (82% breast, 8% endometrial, 5% colorectal, and 5% lymphoma, prostate, or multiple types) from October 1, 2020, to February 28, 2023. Most survivors were female (96%; 84% White/non-Hispanic, 8% Black; 3% Hispanic). Nearly all survivors (98%) in AH-HA practices reported a discussion for ≥1 nonideal or missing CVH factor compared with 55% in UC (P < .001). The average number of survivor-reported factors discussed was higher in AH-HA compared with UC (mean, 4.06 v 1.27; P < .001), as were EHR-documented discussions (3.83 v 0.77; P = .03). Survivors in AH-HA practices were also significantly more likely to report a recommendation to see a primary care provider (39%) compared with UC practices (25%, P = .02). Reported recommendations to see a cardiologist were low (approximately 6%) and did not differ between groups.

The AH-HA tool was effective at promoting CVH discussions during routine follow-up care for survivors and recommendations to consult primary care.

The 5A's Framework (Assess, Advise, Assist, Agree, and Arrange) has been recommended as a practice guide for obesity counseling. Its integration in research, however, is not well known. This systematic review was to find how the 5A's Framework was integrated in research on obesity and weight counseling. Methods: A systematic search of four databases was conducted combining two concepts: "5 A's Framework" and "obesity, body size, dieting/eating, exercise, weight loss." Inclusion criteria were quantitative studies with the 5A's Framework as a singular intervention or combined with others to influence patients' healthy eating, physical activity, and weight outcomes or care providers' counseling behaviors. Twenty-two studies were included in the final analysis. Results: Most studies were conducted in the primary care setting. The 5A's Framework was (1) integrated in training interventions as formal medical curricular and on-the-job education workshops to influence obesity/weight counseling skills, (2) utilized to develop assessment tools to evaluate counseling behaviors, and (3) combined with behavior change strategies to impact the patient's weight management behaviors and outcomes. Conclusion: The integration of the 5A's Framework in obesity and weight counseling research is wide-ranging. The findings have implications for clinicians to use the framework to better obesity/weight counseling.

Lifestyle-related problems are common in people with mental illness, contributing to a decreased life expectancy and high societal and personal burden. This study aimed to investigate the feasibility, acceptability, and preliminary effectiveness on recovery of a multidomain lifestyle intervention in patients with severe or chronic mental illnesses. Twenty transdiagnostic outpatients were 1:1 randomised in intervention or control. The lifestyle intervention consisted of 11 three-hour group sessions about physical activity, nutrition, relaxation, sleep, substance use, and purpose and meaning. Self-report questionnaires, physical measurements, diary questions, and accelerometers were administered at baseline, halfway and post intervention. Outcomes included attrition, retention rates, protocol deviations, quantitative evaluations and effectiveness. Both the intervention and research protocol appeared feasible and acceptable, with relaxation, purpose and meaning and nutrition as highest appreciated themes. Intervention simplification and deepening was necessary to suit the heterogeneous participants. Preliminary effects were found in all recovery domains, with biggest effects in societal recovery and smallest effects in clinical recovery. To prevent dropout and match the outpatient population, small intervention adaptations are recommended. Effects can be expected in all domains of recovery and should be measured accordingly. Research with greater sample sizes is necessary.

This study compared the effects of 12 weeks of intensive nutrition education (IE) using the 5A's behavioral change model and basic nutrition education (BE) on nutritional knowledge and nutrient intake among Korean adolescent athletes. This study included elite adolescent athletes (IE group: n = 65, BE group: n = 65) at a physical education high school in Seoul. In this prospective, randomized, controlled trial, the athletes' body composition, nutritional knowledge, nutrient intake, and self-management practices were evaluated at the beginning and end of the intervention. Both groups had increased levels of nutrition knowledge between pre- and post-test, but the change in total score for nutrition knowledge was significantly higher in the IE group than in the BE group (p < 0.001). Energy intake post-test increased significantly in the IE group (from 2,185 to 2,651 kcal/day, p < 0.001) but not in the BE group. The intake of carbohydrates, protein, and fat also increased significantly in the IE group (carbohydrates: from 298 to 352 g/day, protein: from 86 to 106 g/day, fat: from 71 to 88 g/day, all p < 0.001), but the change in the BE group was not significant. Additionally, the IE group showed a significant overall increase in vitamins and minerals compared to the BE group at post-test. Adolescent athletes in the IE group showed improved nutritional knowledge and intake compared to those in the BE group 12 weeks after the intervention.

It is the position of the Academy of Nutrition and Dietetics and the American Council on Exercise that nutrition and physical activity interventions delivered by qualified nutrition and exercise practitioners, within their scopes of practice, can improve lifestyle behaviors and cardiometabolic risk factors for adults in the general population. Effective interventions require client-centered, evidence-based care provided by skilled practitioners using inclusive, dynamic methods, and collaboration with an interprofessional team, as appropriate. Increased access to evidence-based nutrition and physical activity interventions is necessary to improve public health and should be a target for policymakers, health care systems, and practitioners. Adults who attain a nutritious diet and adequate physical activity have improved overall health compared with their counterparts. However, most adults do not meet population recommendations. Qualified nutrition and exercise practitioners can collaborate with clients and interprofessional teams to provide nutrition and physical activity interventions and improve outcomes. However, recent guidelines have identified a need for guidance on best practices for delivering behavioral lifestyle counseling, referring to other practitioners, and improving access to disease prevention services. This Academy of Nutrition and Dietetics Position Paper aims to address common barriers for nutrition and exercise practitioners providing nutrition and physical activity interventions for adults in the general population, and best practices for overcoming these barriers. Collective action from interprofessional practitioners and implementation partners can increase access to high-quality, individualized services to prevent disease and improve health and well-being on a population level. This position was approved in July 2024 and will remain in effect until December 31, 2031.

There are minimal evidence-based outcomes from clinical trials for medical-dental integration. This formative work and pilot study is a precursor to a larger cluster-randomized clinical trial in adult primary care practices to test an electronic health record (EHR) structured workflow for primary care providers (physicians/nurse practitioners [NPs]) and medical staff (medical assistants [MAs] and nurses) with oral health (OH) screening and referral for Medicaid-enrolled adults ≥55 years.

This study was conducted in 2 practices with providers, medical staff, and older adults. Focus groups preceded the pilot study to gain stakeholder insights prior to the multilevel interventions of systems changes and provider education. The system-level EHR changes for medical staff included ask (OH screening), advise (visit dentist soon/annually), assess (need for referral: eReferral to co-located dentists or structured referral to community dentists), and connect (referral; resources). Provider education (didactic and skills) was based on the Common-Sense Model of Self-Regulation (CSM) to deliver OH facts to older adults at primary care visits. Descriptive analysis was used to report on process outcomes of reach, adoption, and implementation/fidelity.

After stakeholder input, the CSM-based didactic and skills curriculum was developed, and 4 physicians were trained. Changes in the Epic EHR were implemented, and 19 medical staff were trained in this new structured workflow together with physicians. In terms of reach, 83% (N = 80) of older adults were enrolled out of 96 approached (female: 66%; non-Hispanic: 83%; Caucasian: 43%). Workflow adoption was 100% of MAs completing the EHR questions and 89% of providers documenting giving OH facts. About 94% of older adults reported their physician giving them OH facts indicating implementation/fidelity of the intervention. About 60% of older adults reported no dental visits in the past year, and 66% requested eReferrals.

This study presents an innovative systems-based multilevel intervention for medical-dental integration.

The results of this study can be used by practice leadership and clinicians when incorporating oral health into primary care for older adults. Considering adoption and implementation costs, this information could lead to a more complete approach to address oral health with patients.

Developing a Precision Periodontal Health Care Chart (PPHCC) in the electronic dental record (EDR) system and evaluating its clinical usability and effects on clinical outcomes.

A survey with ten questions based on the System Usability Scale (SUS) and six questions about assessing clinical impact was used to evaluate the satisfaction of periodontitis patients and care providers with PPHCC before and after non-surgical periodontal therapy (NSPT). The clinical outcomes, including probing depth (PD), interdental clinical attachment loss (CAL), and bleeding on probing (BOP), in patients who used PPHCC (PC) were compared to those in patients without using PPHCC (control). The associations between risk assessments included in PPHCC and clinical outcomes of NSPT were also analyzed.

The mean scores of SUS questions at the initial periodontal examination were 74.26 ± 18.89 (n = 37) for patients and 88.31 ± 14.14 (n = 37) for care providers. The mean scores of SUS questions at re-evaluation were 74.84 ± 17.78 (n = 16) for patients and 89.63 ± 13.48 (n = 20) for care providers. The changes in the percentages of teeth with interdental CAL 1-2 mm (p = 0.019) and CAL 3-4 mm (p = 0.026) at the re-evaluation visit were significantly different between the PC and control groups, but the other parameters were not.

Both patients and care providers were satisfied with using PPHCC in the clinic. However, the short-term clinical outcomes in the PC group were similar to those in the control group.

PPHCC, as a tool for delivering clinical and educational information, can motivate patients to control periodontitis and assist clinicians in making a personalized treatment plan.

The Patient Assessment of Chronic Illness Care (PACIC-5As) questionnaire has been designed to evaluate the healthcare experiences of individuals with chronic diseases such as diabetes. Older adults are at higher risk for diabetes and its associated complications. The aim of this study was transcultural adaptation and evaluation of the validity and reliability of the PACIC-5As questionnaire in older patients with diabetes residing in Qazvin City, Iran.

In this validation study, we recruited 306 older patients with diabetes from Comprehensive Health Centers in Qazvin, Iran. The multi-stage cluster sampling technique was used to choose a representative sample. The PACIC-5As questionnaire was translated into Persian using the World Health Organization (WHO) standardized method. The validity (face, content, and construct) and reliability (Cronbach's alpha) of the PACIC-5As were assessed. Data analysis was conducted using R software and the Lavaan package.

The mean age of the older patients was 69.99 ± 6.94 years old. Most older participants were female (n = 180, 58.82%) and married (n = 216, 70.59%). Regarding face validity, all items of PACIC-5As had impact scores greater than 1.5. In terms of content validity, all items had a content validity ratio > 0.49 and a content validity index > 0.79. The results of confirmatory factor analysis demonstrated that the model exhibited satisfactory fit across the expected five factors, including assess, advise, agree, assist, and arrange, for the 25 items of the PACIC-5As questionnaire. The Cronbach's alpha coefficient for the PACIC-5As questionnaire was 0.805.

This study indicates that the Persian version of the PACIC-5As questionnaire is valid and reliable for assessing healthcare experiences in older patients with diabetes. This means that the questionnaire can be effectively used in this population.

To evaluate effects of health extension workers-led home-based multicomponent intervention on blood pressure change in hypertensive patients in rural districts of northwest Ethiopia.

Two-arm cluster randomised controlled trial was conducted.

Hypertensive patients' age ≥25 years were included. 20 clusters or kebeles with 456 participants were randomly assigned to the intervention group (10 clusters with 228 participants) and the control group (10 clusters with 228 participants).

Participants in the intervention kebeles received health extension workers-led home-based multicomponent interventions every other month for 40-60 min for 9 months.

The primary outcomes were the differences in mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) changes from baseline between patients in the intervention and control groups. Intention-to-treat analysis was used for the primary analyses. Linear mixed effect model was used to evaluate the intervention's effect on change in mean SBP and DBP. Effect sizes of mean difference and relative benefit increase were used.

At 9 months, the mean SBP decreased by 15.8 mm Hg (95% CI: 13.5, 18.1) in the intervention and 10.8 mm Hg (95% CI: 8.7, 12.9) in the control groups; with a 5.0 mm Hg (95% CI: 1.9, 8.1) greater reduction in the intervention group. The mean DBP decreased by 12.1 mm Hg (95% CI: 10.6, 13.5) in the intervention and 8.4 mm Hg (95% CI: 7.0, 9.8) in the control group. The proportion of optimal blood pressure control was higher in the intervention group (45.8%) than the control group (28.2%) with percentage difference of 17.6% (95% CI: 8.5, 26.7).

Health extension workers-led home-based multicomponent intervention has resulted significant reduction of blood pressure and achieved a higher proportion of optimal blood pressure control. This strategy is effective, but further research is needed to determine its cost effectiveness for scaling up and integrating in primary care settings.

The trial is registered with Pan African clinical trial registry (PACTR202102729454417).

Childhood cancer survivors are at increased risk for underinsurance and health insurance-related financial burden. Interventions targeting health insurance literacy (HIL) to improve the ability to understand and use health insurance are needed.

We codeveloped a four-session health insurance navigation tools (HINT) intervention, delivered synchronously by a patient navigator, and a corresponding booklet. We conducted a randomized pilot trial with survivors from the Childhood Cancer Survivor Study comparing HINT with enhanced usual care (EUC; booklet). We assessed feasibility, acceptability, and preliminary efficacy (HIL, primary outcome; knowledge and confidence with health insurance terms and activity) on a 5-month survey and exit interviews.

Among 231 invited, 82 (32.5%) survivors enrolled (53.7% female; median age 39 years, 75.6% had employer-sponsored insurance). Baseline HIL scores were low (mean = 28.5; 16-64; lower scores better); many lacked knowledge of Affordable Care Act (ACA) provisions. 80.5% completed four HINT sessions, and 93.9% completed the follow-up survey. Participants rated HINT's helpfulness a mean of 8.9 (0-10). Exit interviews confirmed HINT's acceptability, specifically its virtual and personalized delivery and helpfulness in building confidence in understanding one's coverage. Compared with EUC, HINT significantly improved HIL (effect size = 0.94. P < .001), ACA provisions knowledge (effect size = 0.73, P = .003), psychological financial hardship (effect size = 0.64, P < .006), and health insurance satisfaction (effect size = 0.55, P = .03).

Results support the feasibility and acceptability of a virtual health insurance navigation program targeted for childhood survivors to improve HIL. Randomized trials to assess the efficacy and sustainability of health insurance navigation on HIL and financial burden are needed.

Lack of access to primary care contributes to health inequities. Treatment settings that utilize the full experience and training of nurses, both registered nurses (RNs) and advanced practice registered nurses (APRNs), can expand in primary care and successfully address health inequities. This small study describes the implementation of a model of primary care called intensive primary care (IPC), which has eight elements that support the full utilization of a nurse's experience and training. This is a mixed method qualitative study, which reports the observations of the implementation and pre- and post-intervention measures. The IPC model was implemented at a free clinic, which targeted underserved population between 2020 and 2023. Participants were selected as a convenience sample. Participants were to have two or more chronic health problems The participants received primary care using the IPC model, which included setting self-management goals, and meeting with RN or APRN on a monthly basis (face to face, via phone or zoom) to monitor progress toward goals. Twenty-two people were approached, and 19 completed the intervention. Pre- and Post-intervention measures (Patient Assessment of Chronic Illness Care [PACIC]-20); Functional, Communicative, Critical Thinking Health Literacy; Perceived Stress; Patient Activation; Perceived Self Efficacy for Chronic Disease; EuroQo- 5 Dimension (EQ-5D); Trust in Provider; Emotional Support-Patient Reported Outcome Measure Information System (PROMIS); and Patient Health Questionnaire-9) were obtained and analyzed with paired T test (α < .05). Nurses involved meet weekly to share observations recorded in free form notes. These observations were summarized by two of the authors (MD and KF) at the end of the study. All patients had improved physical health outcomes, but more importantly, there were significant improvements in measures known to impact health and health outcomes, specifically, patient activation, self-efficacy for chronic illness, PACIC, and trust in provider. Time spent with patients, both duration and frequency of contact, was observed to have significant impacts.

Brief motivational coaching, integrated into health care; seems promising to address physical inactivity of people with serious mental illness (SMI).

To test the impact of a self-determined health coaching approach (the "SAMI" intervention) during outpatient mental health treatment on moderate-to-vigorous physical activity (MVPA) of people with SMI.

Adults (mean age = 41.9, SD = 10.9) with an ICD-10 diagnosis of mental illness were semi-randomized to the SAMI-intervention group (IG) or control group (CG). The IG received 30 minutes of health coaching based on the self-determination theory (SDT). MVPA and sedentary time (ST) were measured with the International Physical Activity Questionnaire - short form (IPAQ-SF) and symptoms of mental illness with the Brief Symptom Inventory (BSI-18), each at baseline and follow-up (3-4 months). Differences in primary (MVPA) and secondary (ST, BSI-18) outcomes were evaluated using negative binomial regressions and general linear models.

In the IG (n = 30), MVPA increased from 278 (interquartile range [IQR] = 175-551) to 435 (IQR = 161-675) min/week compared to a decrease from 250 (IQR = 180-518) to 155 (IQR = 0-383) min/week in the CG (n = 26; adjusted relative difference at follow-up: Incidence Rate Ratio [IRR] = 2.14, 95% CI: 1.17-3.93, p = 0.014). There were no statistically significant differences in ST and BSI-18.

Brief self-determined health coaching during outpatient treatment could increase post-treatment MVPA in people with SMI, potentially up to a clinically relevant level. However, great uncertainty (for all outcomes) weakens the assessment of clinical relevance.

Integrated primary care programs for patients living with chronic pain which are accessible, interdisciplinary, and patient-centered are needed for preventing chronicity and improving outcomes. Evaluation of the implementation and impact of such programs supports further development of primary care chronic pain management. This study examined patient-reported outcomes among individuals with low back pain (LBP) receiving care in a novel interdisciplinary primary care program.

Patients were referred by primary care physicians in four regions of Quebec, Canada, and eligible patients received an evidence-based interdisciplinary pain management program over a six-month period. Patients were screened for risk of chronicity. Patient-reported outcome measures of pain interference and intensity, physical function, depression, and anxiety were evaluated at regular intervals over the six-month follow-up. A multilevel regression analysis was performed to evaluate the association between patient characteristics at baseline, including risk of chronicity, and change in pain outcomes.

Four hundred and sixty-four individuals (mean age 55.4y, 63% female) completed the program. The majority (≥ 60%) experienced a clinically meaningful improvement in pain intensity and interference at six months. Patients with moderate (71%) or high risk (81%) of chronicity showed greater improvement in pain interference than those with low risk (51%). Significant predictors of improvement in pain interference included a higher risk of chronicity, younger age, female sex, and lower baseline disability.

The outcomes of this novel LBP program will inform wider implementation considerations by identifying key components for further effectiveness, sustainability, and scale-up of the program.

In Saudi Arabia, approximately 70,000 deaths yearly occur from diseases caused by smoking. Assessing patients' smoking behavior in primary care has apparent benefits. Assisting patients with smoking cessation is one of the essential roles of primary care. This study evaluated the quality of smoking cessation clinic counseling in Riyadh, Saudi Arabia, based on customer opinions of such services.

This research employed a cross-sectional approach involving individuals attending smoking cessation clinics located within primary health care centers in Riyadh city. The participants were chosen through random selection. They were informed about the study's objectives, and those who consented to take part were contacted and provided with an online questionnaire to complete.

A total of 340 subjects participated (95.6%) of them were males, and 41.2% were in the age group of 25 to 35 years old. The common modality of tobacco use was cigarettes (82.6%), and 87.9% reported consuming tobacco daily. The mean (±SD) total score of the Fagerstrom Test of Nicotine Dependence was 5.03 (±2.36), and the highest percentage (44.4%) of the participants had a moderate level of nicotine dependence. The vast majority (93.8%) of the participants had former quitting experiences. Half (50.9%) of the participants showed complete satisfaction with the cessation clinics, while 13.2% and 9.1% of them were not satisfied or slightly satisfied, respectively.

The majority of smoking cessation clinic visitors were satisfied with the services provided, exceeding three-quarters of them, with half totally satisfied.

Neoadjuvant therapy has become a standard treatment for patients with stage II/III HER2 positive and triple negative breast cancer, and in well-selected patients with locally advanced and borderline resectable high risk, luminal B breast cancer. Side effects of neoadjuvant therapy, such as fatigue, cardiotoxicity, neurotoxicity, anxiety, insomnia, vasomotor symptoms, gastrointestinal disturbance as well as a raft of immune-related adverse events, may impact treatment tolerance, long-term outcomes, and quality of life. Providing early supportive care prior to surgery (typically termed 'prehabilitation') may mitigate these side effects and improve quality of life.During our codesign of the intervention, consumers and healthcare professionals expressed desire for a programme that 'packaged' care, was easy to access, and was embedded in their care pathway. We hypothesise that a multimodal supportive care programme including exercise and complementary therapies, underpinned by behavioural change theory will improve self-efficacy, quality of life, readiness for surgery and any additional treatment for women with breast cancer. We seek to explore cardiometabolic, residual cancer burden and surgical outcomes, along with chemotherapy completion (relative dose intensity). This article describes the protocol for a feasibility study of a multimodal prehabilitation programme.

This is a prospective, mixed-method, feasibility study of a multi-modal programme in a hospital setting for 20-30 women with breast cancer receiving neoadjuvant therapy. Primary outcomes are recruitment rate, retention rate, adherence and acceptability. Secondary outcomes include patient reported outcome measures (PROMs), surgical outcomes, length of stay, satisfaction with surgery, chemotherapy completion rates, changes in metabolic markers and adverse events. Interviews and focus groups to understand the experience with prehabilitation and different factors that may affect feasibility of the intervention . The output of this study will be a codesigned, evidence-informed intervention assessed for feasibility and acceptability by women with breast cancer and the healthcare professionals that care for them.

The study received ethics approval from the St Vincents Hospital HREC (HREC/2021/ETH12198). Trial results will be communicated to participants, healthcare professionals, and the public via publication and conferences.

ACTRN12622000584730.

Since multidimensional barriers challenge nursing homes, a socio-ecological approach is needed for physical activity promotion in this setting. So far, little is known about how such an approach can be transferred into the successful development and implementation of PA-promoting actions together with stakeholders on-site. We aimed to investigate the actions and dimensions of PA-promoting actions and their sustainable implementation. To contribute to closing this gap, we present a 10-step program for co-developing and co-evaluating PA-promoting actions in nursing homes through an integrated counselling approach.

We used a multiple case study approach that built upon manifold data sources, collected in 7 nursing homes over 3 years between 2021 and 2023. We collected fieldnotes and photologs from 14 future workshops (2 per home); 7 evaluation workshops (1 per home); 36 individual counsellings (2 sessions per resident), as well as 87 implementation protocols (action type and frequency), 11 evaluation questionnaires (changes among resources, cooperations, and collaborations); 7 goal attainment scales and 18 individual activity schedules. In addition, we retrieved and documented progress information at regular intervals by phone or email.

With staff, residents, relatives, and volunteers, we co-developed 112 ideas for PA promotion; from which 54 ideas were implemented and integrated into everyday life, differentiated into "activities of daily living," "structured activities," and "activity-friendly environments."; 18 residents in 4 homes participated in individual counselling to develop individual activity schedules. Eighteen actions were rated as "(much) more successful than expected"; 10 "(much) worse than expected," and 23 "as successful as expected." Three actions were not evaluated.

The participatory integrated counselling approach led to home-specific actions and promoted implementation into everyday life. The number and dimensions of actions implemented largely depended on the mission and vision of the respective home. The lack of staff could partially be compensated for by involving neighbourhoods, volunteers, and community organisations, such as local clubs.

To effectively promote PA in nursing homes, a tailored approach considering structural conditions, locations, volunteer engagement, and organisational visions is essential. Long-lasting partnerships and low-threshold opportunities prove promising. Future research should delve into structural-level change processes and outcomes in this context.

The public health policy "Making Every Contact Count" (MECC) compels healthcare professionals to deliver health behaviour change interventions during routine consultations. As healthcare systems continue their recovery from the impacts of the COVID-19 public health emergency, supporting people to modify health behaviours is more important now than when the policy was introduced. The present study aims to: (a) examine changes in healthcare professionals' awareness of, and engagement with the policy over a five-year period, (b) examine the psychosocial drivers associated with delivering behaviour change interventions, and (c) identify targets to increase healthcare professionals' delivery of interventions.

Comparison of data from two independent representative surveys of NHS healthcare professionals working in the UK. In both surveys (July-September 2017; N = 1387, and February-March 2022; N = 1008), participants were asked to report: (1) awareness of the MECC policy, (2) the prevalence of MECC-related practice (perceived patient benefit, how often interventions were delivered, and time spent delivering interventions), and (3) perceptions of capabilities, opportunities and motivations to deliver behaviour change interventions. T- tests (independent-samples), MANOVA, multiple linear regression, and chi-square analyses were used to generate comparisons between the surveys.

Awareness of the policy increased from 2017 (31.4%) to 2022 (52.0%). However, in 2022 compared with 2017, healthcare professionals reported (a) fewer patients would benefit from behaviour change interventions (49.1% versus 55.9%), (b) they delivered behaviour change interventions to a lower proportion of patients (38.0% versus 50.0%), and (c) they spent a lower proportion of the consultation time delivering interventions (26.5% versus 35.3%). Further, in 2022, compared with 2017, healthcare professionals reported fewer physical opportunities, fewer social opportunities, and fewer psychological capabilities to deliver behaviour change interventions. In the 2022 survey, perceptions of patient benefit and delivery of interventions was associated with greater perceptions of opportunities and motivations.

Health behaviour change interventions remain an important part of routine healthcare in the continued recovery from COVID-19 public health emergency, however reported engagement with MECC-related practices appears to have reduced over time. Future research should consider how healthcare professionals identify patients who might benefit from opportunistic behaviour change interventions, and to increase capabilities, opportunities, and motivations to deliver interventions during routine consultations.

To develop and psychometrically test the Self-Efficacy and Performance in Self-Management Support instrument for physiotherapists (SEPSS-PT), based on the SEPSS-36, the corresponding instrument for nurses.

Instrument development including content validation and psychometric evaluation (construct validity, factor structure, and reliability).

Data were collected from literature, expertmeetings, and online questionnaire PARTICIPANTS: Next to a comprehensive literature study, experts (self-management experts (n=2); physiotherapists (n=10); patients (n=6)) and physiotherapists and physiotherapy students (n=334), participated in different stages of the study.

Not applicable.

Not applicable. A literature study (n=42 reviews) and consultations with physiotherapists and patients identified the specific content for physiotherapy. The Five-A's model and overarching competencies of "supportive partnership attitude", were used to structure the items. Psychometric evaluation of the draft questionnaire (40 items) was tested in a sample of 334 physiotherapists and physiotherapy students from the Netherlands, of whom 33 filled out the questionnaire twice to establish the test-retest reliability.

Confirmatory factor analyses revealed satisfactory fit indices for both the 6-factor model and hierarchical model, with best fit for the 6-factor model. The questionnaire discriminated between physiotherapists and physiotherapy students, and between physiotherapists who did or did not consider self-management support important. The overall internal consistency (Cronbach's alpha) was high, both for the self-efficacy and the performance items. In most of the subscales, test-retest intra-class correlation coefficients for both overall self-efficacy and performance were good, but in 3 subscales insufficient for performance.

The SEPSS-PT questionnaire is a 40-item, Likert-scaled instrument with good content and construct validity, good internal consistency and reliability, and sufficient test-retest reliability. Future research in a larger and more diverse sample could confirm stability and discriminating power.

Providing effective healthy behavior change interventions within primary care presents numerous challenges. Obesity, tobacco use, and sedentary lifestyle negatively impact the health quality of numerous medical patients, particularly in underserved patient populations with limited resources. Primary Care Behavioral Health (PCBH) models, which incorporate a Behavioral Health Consultant (BHC), can offer point-of-contact psychological consultation, treatment, and also provide opportunities for interdisciplinary psychologist-physician clinical partnerships to pair a BHC's health behavior change expertise with the physician's medical care. Such models can also enhance medical training programs by providing resident physicians with live, case-based learning opportunities when partnered with a BHC to address patient health behaviors. We will describe the development, implementation, and preliminary outcomes of a PCBH psychologist-physician interdisciplinary health behavior change clinic within a Family Medicine residency program. Patient outcomes revealed significant reductions (p < .01) in weight, BMI, and tobacco use. Implications and future directions are discussed.

Clinic-based or community-based interventions can improve adherence to guideline-directed medication therapies (GDMTs) among patients with heart failure (HF). However, opportunities for such interventions are frequently missed, as providers may be unable to recognise risk patterns for medication non-adherence. Machine learning algorithms can help in identifying patients with high likelihood of non-adherence. While a number of multilevel factors influence adherence, prior models predicting non-adherence have been limited by data availability. We have established an electronic health record (EHR)-based cohort with comprehensive data elements from multiple sources to improve on existing models. We linked EHR data with pharmacy refill data for real-time incorporation of prescription fills and with social determinants data to incorporate neighbourhood factors.

Patients seen at a large health system in New York City (NYC), who were >18 years old with diagnosis of HF or reduced ejection fraction (<40%) since 2017, had at least one clinical encounter between 1 April 2021 and 31 October 2022 and active prescriptions for any of the four GDMTs (beta-blocker, ACEi/angiotensin receptor blocker (ARB)/angiotensin receptor neprilysin inhibitor (ARNI), mineralocorticoid receptor antagonist (MRA) and sodium-glucose cotransporter 2 inhibitor (SGLT2i)) during the study period. Patients with non-geocodable address or outside the continental USA were excluded.

Among 39 963 patients in the cohort, the average age was 73±14 years old, 44% were female and 48% were current/former smokers. The common comorbid conditions were hypertension (77%), cardiac arrhythmias (56%), obesity (33%) and valvular disease (33%). During the study period, 33 606 (84%) patients had an active prescription of beta blocker, 32 626 (82%) had ACEi/ARB/ARNI, 11 611 (29%) MRA and 7472 (19%) SGLT2i. Ninety-nine per cent were from urban metropolitan areas.

We will use the established cohort to develop a machine learning model to predict medication adherence, and to support ancillary studies assessing associates of adherence. For external validation, we will include data from an additional hospital system in NYC.

Preventing progression to moderate or severe opioid use disorder (OUD) among people who exhibit risky opioid use behavior that does not meet criteria for treatment with opioid agonists or antagonists (subthreshold OUD) is poorly understood. The Subthreshold Opioid Use Disorder Prevention (STOP) Trial is designed to study the efficacy of a collaborative care intervention to reduce risky opioid use and to prevent progression to moderate or severe OUD in adult primary care patients with subthreshold OUD.

The STOP trial is a cluster randomized controlled trial, randomized at the PCP level, conducted in 5 distinct geographic sites. STOP tests the efficacy of the STOP intervention in comparison to enhanced usual care (EUC) in adult primary care patients with risky opioid use that does not meet criteria for moderate-severe OUD. The STOP intervention consists of (1) a practice-embedded nurse care manager (NCM) who provides patient participant education and supports primary care providers (PCPs) in engaging and monitoring patient-participants; (2) brief advice, delivered to patient participants by their PCP and/or prerecorded video message, about health risks of opioid misuse; and (3) up to 6 sessions of telephone health coaching to motivate and support behavior change. EUC consists of primary care treatment as usual, plus printed overdose prevention educational materials and an educational video on cancer screening. The primary outcome measure is self-reported number of days of risky (illicit or nonmedical) opioid use over 180 days, assessed monthly via text message using items from the Addiction Severity Index and the Current Opioid Misuse Measure. Secondary outcomes assess other substance use, mental health, quality of life, and healthcare utilization as well as PCP prescribing and monitoring behaviors. A mixed effects negative binomial model with a log link will be fit to estimate the difference in means between treatment and control groups using an intent-to-treat population.

Given a growing interest in interventions for the management of patients with risky opioid use, and the need for primary care-based interventions, this study potentially offers a blueprint for a feasible and effective approach to improving outcomes in this population.

Clinicaltrials.gov, identifier NCT04218201, January 6, 2020.

Counselling and management of overweight and obesity are tasks for which general practitioners possess favourable qualifications. Based on a long-term doctor-patient relationship, GPs have various options for actions to deal with overweight problems. To date, however, there is only little evidence on the experiences which people with obesity have made with the primary physician model and the care needs and wishes they actually address to their GPs. This study investigated what experiences people with obesity have had with GP care and what care needs and wishes they communicated to their GPs. The results will be used to derive starting points for optimising the primary healthcare setting.

A total of 32 individuals affected by obesity were recruited over 24 online health forums. With them, we conducted qualitative interviews in the time between April and October 2022.

The respondents considered the primary care physician to be the central contact person when they sought advice and support with weight problems. The advice of the GP was associated with an increased willingness to deal with reducing one's own weight. Despite this positive perception, widespread drawbacks existed from the perspective of the respondents: (1) incidental or late discovery of obesity, (2) absence of continuous weight counselling, (3) no agreement on specific weight reduction goals, (4) no referrals to help and support services, (5) insensitive discussion. Only some of the respondents who have recently been able to reduce their weight sustainably attributed their success primarily to the support they received from their GP.

GPs should be encouraged to address obesity consistently and promptly. In addition, concrete recommendations and realistic goals for weight loss should be formulated. Continuous and motivating discussions are crucial in this regard. A focus on nutrition and exercise counselling in the GP's office should also be encouraged. GPs should be strengthened in their role as mediators by integrating their patients into a network of further assistance as needed. The development of care structures for obesity management should be promoted.

The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes).

A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate.

Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.

Lifestyle behavior modification is an essential component to prevention and treatment of non-communicable diseases worldwide. For the last 40 years, studies have recognized that there is suboptimal training of physicians in lifestyle medicine and its implementation in clinical settings. The lack of nutrition and exercise counseling occurring in the medical office does not reflect the high level of evidence supporting its use. Lifestyle behavior counseling is complex; as are the individualized needs of patients. Therefore, we suspect that the lack of knowledge in nutrition and exercise prescriptions are not the only barriers to providing optimal care. Reframing lifestyle medicine interventions like nutrition and exercise from adjunctive to central to treatment and reframing the role of the physician therein may be necessary to address important barriers to overall lifestyle behavioral counseling.

Dental caries remains one of the most prevalent but preventable diseases among children worldwide and especially affects children with a lower socioeconomic status or ethnic minority background. It is important that all groups of children are reached by preventive interventions to reduce oral health inequalities. So far, it is unknown whether children from different social and ethnic groups benefit equally from potentially effective oral health interventions.

This scoping review aimed to identify European public health interventions that report their effect on dental caries across different social groups.

Four databases were searched for studies evaluating the effect of oral health interventions on dental caries among children from 0 to 12 y, and studies were included when results were presented by children of different social groups separately.

A total of 14 studies were included, representing 4 different countries: 3 randomized and 11 nonrandomized studies. Most studies were performed at schools. Six studies showed results indicative of a reduction in oral health inequalities, 4 studies showed results that potentially widen oral health inequalities, and 5 studies showed results that were indicative of no impact on oral health inequalities. Interventions that contain early approaches, with a high frequency, approaching multiple levels of influence, and including at least the broader organizational or public policy level, may have the potential to reduce oral health inequalities among children from birth to young adolescence.

We recommend researchers to perform high-quality intervention studies and to evaluate the effectiveness of oral health intervention always in different socioeconomic or ethnic groups separately, to better understand their contribution toward oral health (in)equalities.

This review offers insight in the differential effects that oral health interventions might have across different social groups. Its results can be used to develop interventions that might reduce oral health inequalities among children. Also, we recommend future researchers to always evaluate the effects of any preventive oral health measure in different social groups separately.

The public health impact of the Irish Making Every Contact Count (MECC) brief intervention programme is dependent on delivery by health care professionals. We aimed to identify enablers and modifiable barriers to MECC intervention delivery to optimize MECC implementation.

Online cross-sectional survey design.

Health care professionals (n = 4050) who completed MECC eLearning were invited to complete an online survey based on the Theoretical Domains Framework (TDF). Multiple regression analysis identified predictors of MECC delivery (logistic regression to predict delivery or not; linear regression to predict frequency of delivery). Data were visualized using Confidence Interval-Based Estimates of Relevance (CIBER).

Seventy-nine per cent of participants (n = 283/357) had delivered a MECC intervention. In the multiple logistic regression (Nagelkerke's R2  = .34), the significant enablers of intervention delivery were 'professional role' (OR = 1.86 [1.10, 3.15]) and 'intentions/goals' (OR = 4.75 [1.97, 11.45]); significant barriers included 'optimistic beliefs about consequences' (OR = .41 [.18, .94]) and 'negative emotions' (OR = .50 [.32, .77]). In the multiple linear regression (R2  = .29), the significant enablers of frequency of MECC delivery were 'intentions/goals' (b = 10.16, p = .02) and professional role (b = 6.72, p = .03); the significant barriers were 'negative emotions' (b = -4.74, p = .04) and 'barriers to prioritisation' (b = -5.00, p = .01). CIBER analyses suggested six predictive domains with substantial room for improvement: 'intentions and goals', 'barriers to prioritisation', 'environmental resources', 'beliefs about capabilities', 'negative emotions' and 'skills'.

Implementation interventions to enhance MECC delivery should target intentions and goals, beliefs about capabilities, negative emotions, environmental resources, skills and barriers to prioritization.

Background: In low-to-middle income countries (LMICs), there is a growing burden of non-communicable diseases (NCDs) placing strain on the facilities and human resources of healthcare systems. Prevention strategies that include lifestyle behavior counseling have become increasingly important. We propose a potential solution to the growing burden of NCDs through an expansion of the role for community health workers (CHWs) in prescribing and promoting physical activity in public health settings. This discussion paper provides a theoretical model for task-shifting of assessment, screening, counseling, and prescription of physical activity to CHWs. Five proposed tasks are presented within a larger model of service delivery and provide a platform for a structured, standardized, physical activity prevention strategy aimed at NCDs using CHWs as an integral part of reducing the burden of NCDs in LMICs. However, for effective implementation as part of national NCD plans, it is essential that CHWs received standardized, ongoing training and supervision on physical activity and other lifestyle behaviors to optimally impact community health in low resource settings.