Development and implementation of a lifestyle intervention to promote physical activity and healthy diet in the Dutch general practice setting: the BeweegKuur programme

<p>Abstract</p> <p>Background</p> <p>The number of patients with diabetes is increasing. BeweegKuur (Dutch for 'Exercise Therapy') is a Dutch lifestyle intervention which aims to effectively and feasibly promote physical activity and better dietary behaviour in primary health care to prevent diabetes.</p> <p>Methods</p> <p>The goal of this paper is to present the development process and the contents of the intervention, using a model of systematic health promotion planning. The intervention consists of a 1-year programme for diabetic and prediabetic patients. Patients are referred by their general practitioner (GP) to a lifestyle advisor (LSA), usually the practice nurse or a physiotherapist. Based on specific inclusion criteria and in close collaboration with the patient, an individual exercise programme is designed and supervised by the LSA. This programme can be attended at existing local exercise facilities or (temporarily) under the supervision of a specialized exercise coach or physiotherapist. All participants are also referred to a dietician and receive diet-related group education. In the first pilot year (2008), the BeweegKuur programme was implemented in 7 regions in the Netherlands (19 GP practices and health centres), while 14 regions (41 GP practices and health centres) participated during the second year. The aim is to implement BeweegKuur in all regions of the Netherlands by 2012.</p> <p>Discussion</p> <p>The BeweegKuur programme was systematically developed in an evidence- and practice-based process. Formative monitoring studies and (controlled) effectiveness studies are needed to examine the diffusion process and the effectiveness and cost-effectiveness of the intervention.</p

DISTILLER: a data integration framework to reveal condition dependency of complex regulons in Escherichia coli

DISTILLER, a data integration framework for the inference of transcriptional module networks, is presented and used to investigate the condition dependency and modularity in Escherichia coli networks

Implementatie van het diabetes-jaargesprek

Inleiding Steeds breder wordt erkend dat een persoonsgerichte aanpak en gedeelde besluitvorming onontbeerlijk zijn in de diabeteszorg. De Nederlandse Diabetes Federatie ontwikkelde een model voor een diabetes-jaargesprek ter vervanging van de jaarcontrole, wij onderzochten de toepassing, bruikbaarheid en toegevoegde waarde. Methode In Nederlandse huisartsenpraktijken en ziekenhuizen rekruteerden we zorgverleners en patiënten met diabetes type 1 en type 2. De zorgverleners kregen twee gesprekstrainingen van elk twee uur. Patiënten en zorgverleners vulden bij ieder gesprek vragenlijsten in, biomedische gegevens haalden we uit de dossiers. We vergeleken de antwoorden van patiënten in de eerste en de tweede lijn, en analyseerden verschillen tussen gesprekken die gevoerd werden door een arts dan wel een praktijkondersteuner of diabetesverpleegkundige. Resultaten Onder de deelnemers waren 57 huisartsen, 23 praktijkondersteuners, 17 internisten, 8 diabetesverpleegkundigen en 1366 patiënten met diabetes type 2. De meeste gesprekken (72%) duurden korter dan 25 minuten. Zorgverleners vonden het diabetes-jaargesprek goed toepasbaar (artsen iets minder vaak dan praktijkondersteuners en diabetesverpleegkundigen). Acht op de tien gesprekken mondden uit in een gezamenlijke beslissing, in negen op de tien gesprekken kwamen persoonsgebonden factoren aan de orde, vier op de tien patiënten voelden zich meer dan voorheen betrokken bij behandelbeslissingen en de helft van de patiënten vond het gesprek prettiger dan voorheen. Conclusie Het gespreksmodel is goed toepasbaar. Uit de gesprekken blijkt dat persoonsgebonden factoren grote invloed hebben op persoonlijke doelen en daarmee op de behandeling van diabetes. Een korte training volstaat en het is dus goed mogelijk het model snel op nationale schaal te implementeren

Efficacy and use of an internet-delivered computer-tailored lifestyle intervention, targeting saturated fat intake, physical activity and smoking cessation: A randomized controlled trial

Background Although experts claim that computer-tailored interventions provided over the Internet have great potential to promote health behavior change, few studies have tested the efficacy of computer-tailored lifestyle interventions online-delivered over the Internet. Purpose To evaluate the short-term (1 month) efficacy of an Internet-delivered, computer-tailored lifestyle intervention targeting saturated fat intake, physical activity (PA), and smoking cessation, and to evaluate exposure to the intervention. Methods A pretest-posttest randomized controlled trial with an intervention group and a no intervention waiting list control group was conducted. Self-reported behavior and determinants were assessed at baseline and 1 month follow-up. Exposure to the intervention was monitored through server registrations. The data were analyzed using multiple linear and logistic regression analysis. Results The intervention resulted in a significantly lower self-reported saturated fat intake (b=-0.76, p <0.01) and a higher likelihood of meeting the PA guidelines among respondents who were insufficiently active at baseline (OR=1.34, 95%CI=1.001-1.80). No significant intervention effects were found for self-reported smoking status. Of the participants, 81% actually visited the website. Conclusions The Internet-delivered, computer-tailored lifestyle intervention was effective in reducing self-reported saturated fat intake and in increasing self-reported PA among participants who completed the study

Re: An Easy Prediction of Urinary Incontinence Duration After Retropubic Radical Prostatectomy Based on Urine Loss the First Day After Catheter Withdrawal Reply

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Implementation of a Structured Diabetes Consultation Model to Facilitate a Person-Centered Approach: Results From a Nationwide Dutch Study

OBJECTIVE: We assessed both from a patient and provider perspective the usefulness and added value of a consultation model that facilitates person-centered diabetes care. RESEARCH DESIGN AND METHODS: The model consists of 1) inventory of disease and patient-related factors; 2) setting personal goals; 3) choosing treatment; and 4) determination of required care. It was implemented in 47 general practices and 6 hospital outpatient clinics. Providers were trained, and patients were recommended to prepare their visit. All filled out a questionnaire after every consultation. Differences between primary and secondary care practices and between physician-led and nurse-led consultations were analyzed. RESULTS: Seventy-four physicians and thirty-one nurses participated, reporting on 1,366 consultations with type 2 diabetes patients. According to providers, the model was applicable in 72.4% (nurses 79.3% vs. physicians 68.5%, P < 0.001). Physicians more often had a consultation time <25 min (80.4% vs. 56.9%, P < 0.001). According to providers, two of three patients spoke more than half of the consultation time (outpatient clinics 75.2% vs. general practices 66.6%, P = 0.002; nurses 73.2% vs. physicians 64.4%, P = 0.001). Providers stated that person-related factors often determined treatment goals. Almost all patients (94.4%) reported that they made shared decisions; they felt more involved than before (with physicians 45.1% vs. with nurses 33.6%, P < 0.001) and rated the consultation 8.6 of 10. After physician-led consultations, 52.5% reported that the consultation was better than before (nurse visit 33.7%, P < 0.001). CONCLUSIONS: A consultation model to facilitate person-centered care seems well applicable and results in more patient involvement, including shared decision making, and is appreciated by a substantial number of patients

Determinants of active self-care behaviour of insulin treated patients with diabetes: Implications for diabetes education

The most important aim of diabetes education is to alter the self-care behaviour of patients with diabetes. In order to change their behaviour its determinants must be known. The pretest of a multicentre evaluation study with 558 participating insulin treated patients with diabetes was analysed to test the usefulness of the attitude-behaviour theory of Fishbein & Ajzen in explaining and possibly changing diabetes related active self-care behaviour. The theory of Fishbein & Ajzen is based on the assumption that human behaviour is reasoned behaviour. The theory views a person's intention as the immediate determinant of action. Determinants of intention are attitude and social norm. The results showed that the attitude was the most important determinant of active self-care, while a sufficient level of knowledge and a low orientation on the powerful others health locus of control scale were prerequisites for a positive attitude. The influence of the social environment was detrimental; although people tried to motivate patients to active self-care, they could not provide any real help in performing this desired behaviour. According to the results of this study, diabetes education should first aim at improving the level of knowledge and the health locus of control of the patients and second, at a positive attitude to active self-care. It is necessary to educate the social environment to create a more supportive atmosphere for the patient with diabetes.diabetes education attitude-behaviour theories self-care behaviour Fishbein & Ajzen

Patient activation in individuals with type 2 diabetes mellitus: associated factors and the role of insulin

Aim: This study explored the relationship between insulin use and patient activation (a person's internal readiness and capabilities to undertake health-promoting actions) in individuals with type 2 diabetes mellitus and aimed to identify demographic, clinical and psychosocial factors involved in patient activation. Methods: In this cross-sectional study, baseline data from a Dutch nationwide study were analyzed. Patient activation was assessed with the Patient Activation Measure 13. A linear mixed model was used to take clustering into account. Results: In total, 1,189 persons were included (310 of whom were on insulin), enrolled via 47 general practices and six hospitals. Their mean Patient Activation Measure 13 score was 59±12. We found no association between insulin therapy and patient activation. In the multivariable analysis, individuals with a better health status, very good or very poor social support (vs good social support), individuals who felt they had greater control over their illness and those with a better subjective understanding of their illness showed higher patient activation. Individuals with a lower educational level and those who expected their illness to continue showed a lower activation level. Conclusion: Patient activation does not differ between individuals with type 2 diabetes mellitus on insulin therapy and those on other therapies

Patient activation in individuals with type 2 diabetes mellitus : Associated factors and the role of insulin

Aim: This study explored the relationship between insulin use and patient activation (a person’s internal readiness and capabilities to undertake health-promoting actions) in individuals with type 2 diabetes mellitus and aimed to identify demographic, clinical and psychosocial factors involved in patient activation. Methods: In this cross-sectional study, baseline data from a Dutch nationwide study were analyzed. Patient activation was assessed with the Patient Activation Measure 13. A linear mixed model was used to take clustering into account. Results: In total, 1,189 persons were included (310 of whom were on insulin), enrolled via 47 general practices and six hospitals. Their mean Patient Activation Measure 13 score was 59±12. We found no association between insulin therapy and patient activation. In the multivariable analysis, individuals with a better health status, very good or very poor social support (vs good social support), individuals who felt they had greater control over their illness and those with a better subjective understanding of their illness showed higher patient activation. Individuals with a lower educational level and those who expected their illness to continue showed a lower activation level. Conclusion: Patient activation does not differ between individuals with type 2 diabetes mellitus on insulin therapy and those on other therapies