Do heart failure status and psychosocial variables moderate the relationship between leisure time physical activity and mortality risk among patients with a history of myocardial infarction?

Background: Leisure time physical activity (LTPA) is inversely related to mortality risk among patients with a history of myocardial infarction (MI). The aims were to explore if heart failure (HF) status and psychosocial variables moderate the association.Methods: Participants (n = 1169) were from a multi-center prospective cohort study. Information on LTPA (none, irregular,1–150, 151–300 and >300 weekly minutes), depression, social support and other prognostic indicators were collected 10–13 years after index MI. Cox regressions were conducted, adjusting for potential confounders. In case of significant moderation by HF-status or psychosocial variables, stratified analyses were performed.Results: During follow-up (M = 8.4 years), 25.6 % of the sample had died. LTPA was inversely associated with mortality (p for trend < 0.01 in all models). HF did not, but psychosocial variables did, moderate the association. In the LTPA category 1–150 weekly minutes, patients with a high level of depression had a lower mortality risk in comparison to those with a low level (hazard ratios (95 % confidence intervals) were 0.43 (0.25, 0.75) versus 0.69 (0.36, 1.32)), and patients with a low level of social support had a lower mortality risk in comparison to those with a high level (0.40 (0.21, 0.77) versus 0.71 (0.39, 1.27)). In the category >300 min, patients with a high level of social support had a lower mortality risk than those with a low level (0.38 (0.19, 0.79) versus 0.51 (0.30, 0.87)).Conclusions: LTPA was inversely related to mortality risk of post-MI patients. HF did not moderate the relationship; depression and social support partially did

Promoting Self-care Behavior among Heart Failure Patients

Brug, J. [Promotor]Stut, W.J.J. [Copromotor]Velde, S.J. te [Copromotor

Assistive Technology to Promote Communication and Social Interaction for People With Deafblindness:A Systematic Review

Background: People with deafblindness experience stigmatization, exclusion, and isolation. Due to complex communication challenges, feelings of isolation and exclusion can increase. However, assistive technology can change these negative outcomes. The aim of this systematic review is to synthesize and analyze the research published in journal articles focused on the use of assistive technology to improve communication and social interaction for people with deafblindness. Methods: A qualitative review study, examining journal articles focusing on the use of assistive technology to support social interaction of people with deafblindness as found in the following databases: IEEE Xplore, ProQuest, Cochrane, Embase, CINANHL, PsychINFO, Web of Science, PubMed, and ProQuest, was conducted. An in-depth analysis of the selected articles was performed. Results: Nine articles were included in this systematic review. The Technology Readiness Levels indicated that the communication assistive technologies reported in the included journal articles span across readiness levels, but mostly remained in the prototype phase. The identified themes are: (1) the objective of the assistive technology, with as sub-themes two-way communication, and access to information; (2) design and development, with as sub-themes new communication assistive technology design, and development, usability and co-creators; (3) acquisition and implementation; and (4) the impact of the assistive technology, with as sub-themes social integration and expansion, autonomy and confidence, and well-being. Conclusions: This systematic review provides a roadmap for the way forward in the use of assistive technology in communication and social interaction for people with deafblindness. Co-creation should start during the design and development stages and continue into testing, evaluating and implementation. A greater understanding of the unique communication needs and challenges may contribute to the development of more advanced technologies which can be used in daily situations and contribute to support two-way communication and social inclusion of people with deafblindness. Furthermore, a challenge remains to focus on the development of assistive technology supporting declarative communication, which includes giving comments, declarations, predictions, and reflections during a conversation. More research conducted over the long-term is needed to bring the communication assistive technologies into more advanced stages of readiness

The LEDs move pilot study: the Light Curtain and physical activity and well-being among people with visual and intellectual disabilities

Background: Moving around and being physically active can often be challenging for people with a visual impairment. The combination of a visual and intellectual disability can make being physically active even more difficult. The aim of the current study was to examine whether a technological device for physical activity promotion would be associated with more movement and whether using it would be experienced as enjoyable for people with visual and intellectual disabilities. Methods: A randomised multiple baseline design was used for this study. The participants were nine adults with a visual impairment and an IQ between 20 and 50. As participants interacted with the Light Curtain, movement was measured with triaxial accelerometers embedded in the Empatica E4 wristband. Independent observers scored activity, alertness and well-being from video-recordings using the following observation lists: the Happiness Feature Score (HFS) and the Arousal and Valence Scale (AVS). Results: Physical activity measured with the accelerometer and positive excitement measured with the AVS significantly increased among participants when they were engaged with the Light Curtain compared with care-as-usual activities. Well-being measured with the HFS did not show a significant difference between the baseline and intervention phases. Conclusions: Engagement with the Light Curtain increased physical activity and positive excitement in persons with visual and intellectual disabilities, but more research is necessary to understand how the Light Curtain might affect happiness and well-being

An interactive-technology health behavior promotion program for heart failure patients: A pilot study of experiences and needs of patients and nurses in the hospital setting

Background: Heart failure (HF) is a chronic condition, prevalent especially among older people, characterized by acute episodes leading to hospitalization. To promote HF patients' engagement in physical activity (PA) and adherence to medication, we developed Motivate4Change: A new interactive, information and communication technology (ICT)-based health promotion program for delivery in the hospital. The development of this program was guided by the Intervention Mapping protocol for the planning of health promotion programs. The users of Motivate4Change were defined as hospitalized HF patients and hospital nurses involved in HF patient education. Objective: Two aims were addressed. First, to explore the use of interactive technology in the hospital setting and second, to evaluate user needs in order to incorporate them in Motivate4Change. Methods: Participant observations at a hospital in the United Kingdom and semistructured interviews were conducted with hospitalized HF patients and HF nurses following their completion of Motivate4Change. Interviews were recorded, transcribed, and analyzed according to a thematic coding approach. Results: Seven patients and 3 nurses completed Motivate4Change and were interviewed. Results demonstrated that patient needs included empathic and contextual content, interactive learning, and support from others, including nurses and family members. The nurse needs included integration in current educational practices and finding opportunities for provision of the program. Conclusions: The current work provides insight into user needs regarding an interactive-technology health promotion program for implementation in the hospital setting, such as Motivate4Change

Determinants of adherence to heart failure medication : a systematic literature review

A systematic literature review was conducted to summarize the existing evidence on presumed determinants of heart failure (HF) medication adherence. The aim was to assess the evidence and provide directions for future medication adherence interventions for HF patients. Based on a search in relevant databases and a quality assessment, eleven articles were included in the review. A best evidence synthesis was used to combine the results of presumed determinants that were found more than once in the literature. Results were classified according the World Health Organization’s (WHO) multidimensional adherence model. Results demonstrated a relationship between having been institutionalized in the past (including hospitalizations and nursing home visits) and higher adherence levels. This finding is related to the healthcare system dimension of the WHO model. The presumed determinants related to the other dimensions, such as social and economic factors, condition-related, therapy-related, and patient-related factors of the multidimensional adherence model all had inconsistent evidence. However, there was also an indication that patients’ educational level and the number of healthcare professionals they have visited are not related to higher adherence levels. Based on the current review, HF patients who have been institutionalized in the past are more adherent to HF medication. Many other presumed determinants were investigated, but displayed inconsistent evidence. Due to the lack of evidence, it was not possible to make recommendations for future interventions

Pedagogically psychological help for the future mothers

A systematic literature review was conducted to summarize the existing evidence on presumed determinants of heart failure (HF) medication adherence. The aim was to assess the evidence and provide directions for future medication adherence interventions for HF patients. Based on a search in relevant databases and a quality assessment, eleven articles were included in the review. A best evidence synthesis was used to combine the results of presumed determinants that were found more than once in the literature. Results were classified according the World Health Organization’s (WHO) multidimensional adherence model. Results demonstrated a relationship between having been institutionalized in the past (including hospitalizations and nursing home visits) and higher adherence levels. This finding is related to the healthcare system dimension of the WHO model. The presumed determinants related to the other dimensions, such as social and economic factors, condition-related, therapy-related, and patient-related factors of the multidimensional adherence model all had inconsistent evidence. However, there was also an indication that patients’ educational level and the number of healthcare professionals they have visited are not related to higher adherence levels. Based on the current review, HF patients who have been institutionalized in the past are more adherent to HF medication. Many other presumed determinants were investigated, but displayed inconsistent evidence. Due to the lack of evidence, it was not possible to make recommendations for future interventions