Atrial fibrillation

This issue of eMedRef provides information to clinicians on the pathophysiology, diagnosis, and therapeutics of atrial fibrillation

Associations of physical inactivity and COVID-19 outcomes among subgroups

Introduction Physical activity before COVID-19 infection is associated with less severe outcomes. The study determined whether a dose‒response association was observed and whether the associations were consistent across demographic subgroups and chronic conditions. Methods A retrospective cohort study of Kaiser Permanente Southern California adult patients who had a positive COVID-19 diagnosis between January 1, 2020 and May 31, 2021 was created. The exposure was the median of at least 3 physical activity self-reports before diagnosis. Patients were categorized as follows: always inactive, all assessments at 10 minutes/week or less; mostly inactive, median of 0–60 minutes per week; some activity, median of 60–150 minutes per week; consistently active, median>150 minutes per week; and always active, all assessments>150 minutes per week. Outcomes were hospitalization, deterioration event, or death 90 days after a COVID-19 diagnosis. Data were analyzed in 2022. Results Of 194,191 adults with COVID-19 infection, 6.3% were hospitalized, 3.1% experienced a deterioration event, and 2.8% died within 90 days. Dose‒response effects were strong; for example, patients in the some activity category had higher odds of hospitalization (OR=1.43; 95% CI=1.26, 1.63), deterioration (OR=1.83; 95% CI=1.49, 2.25), and death (OR=1.92; 95% CI=1.48, 2.49) than those in the always active category. Results were generally consistent across sex, race and ethnicity, age, and BMI categories and for patients with cardiovascular disease or hypertension. Conclusions There were protective associations of physical activity for adverse COVID-19 outcomes across demographic and clinical characteristics. Public health leaders should add physical activity to pandemic control strategies

The possibilities and potential of social ecological frameworks to understand health behaviours and outcomes

The health status of individuals and groups is influenced by a wide array of factors. In 2000 a landmark publication, Promoting Human Wellness’ edited by Jamner-Schneider and Stokols, provided compelling evidence of the “complex web of interrelated influences that operate dynamically to determine health and wellness” (p. 1). Thirteen years later, it is timely to revisit this work in light of subsequent changes to our world, and ebb and flow of research trends. Scholarly and societal interest in the multifaceted influences on physical and emotional well-being has stimulated growing interest in social ecological (SE) analyses of health among community and environmental health specialists and other professionals. These professional groups have found SE to be a valuable framework for understanding the multiple levels of influence on human behavior. There is increasing recognition of the value of utilising broader conceptual models for purposes of understanding and managing various intrapersonal, interpersonal, physical environmental and sociocultural influences on health outcomes and health behaviors. This symposium will examine SE models of health and will feature a number of pioneers who have drawn upon SE principles to better understand health behavior, and to develop multi-faceted health promotion interventions ranging from macro-societal to micro-environmental level research. Speakers will discuss their reasons for utilizing a SE framework to effectively understand and influence bi-directional, multi-level processes that either support or hinder an individual’s engagement in health protective behaviours. The symposium presentations also will suggest guidelines for health promotion interventions focusing on multiple environmental levels

A systematic review of nudge interventions to optimize medication prescribing

Background: The benefits of medication optimization are largely uncontroversial but difficult to achieve. Behavior change interventions aiming to optimize prescriber medication-related decisions, which do not forbid any option and that do not significantly change financial incentives, offer a promising way forward. These interventions are often referred to as nudges. Objective: The current systematic literature review characterizes published studies describing nudge interventions to optimize medication prescribing by the behavioral determinants they intend to influence and the techniques they apply. Methods: Four databases were searched (MEDLINE, Embase, PsychINFO, and CINAHL) to identify studies with nudge-type interventions aiming to optimize prescribing decisions. To describe the behavioral determinants that interventionists aimed to influence, data were extracted according to the Theoretical Domains Framework (TDF). To describe intervention techniques applied, data were extracted according to the Behavior Change Techniques (BCT) Taxonomy version 1 and MINDSPACE. Next, the recommended TDF-BCT mappings were used to appraise whether each intervention applied a sufficient array of techniques to influence all identified behavioral determinants. Results: The current review located 15 studies comprised of 20 interventions. Of the 20 interventions, 16 interventions (80%) were effective. The behavior change techniques most often applied involved prompts (n = 13). The MINDSPACE contextual influencer most often applied involved defaults (n = 10). According to the recommended TDF-BCT mappings, only two interventions applied a sufficient array of behavior change techniques to address the behavioral determinants the interventionists aimed to influence. Conclusion: The fact that so many interventions successfully changed prescriber behavior encourages the development of future behavior change interventions to optimize prescribing without mandates or financial incentives. The current review encourages interventionists to understand the behavioral determinants they are trying to affect, before the selection and application of techniques to change prescribing behaviors. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42020168006]

Extra-curricular physical activity and socioeconomic status in Italian adolescents

BACKGROUND: The relationship between physical activity and health status has been thoroughly investigated in several studies, while the relation between physical activity and socio-economic status (SES) is less investigated. The aim of this study was to measure the extra-curricular physical activity of adolescents related to the socio-economic status (SES) of their families. METHODS: The survey was carried out by submitting an anonymous questionnaire to junior high school students in the following Regions: Lazio, Abruzzo, Molise, Campania, Puglia, during the school year 2002–2003. Extra-curriculum physical activity was evaluated considering whether or not present and hours of activity weekly conducted. 2411 students agreed to participate in the study. RESULTS: Participants were 1121 males (46.5%) and 1290 females (53.5%), aged between 11 and 17 years (median age: 12 years). 71.1% of the students reported to practice extra-curricular physical activity. Parents' educational levels and work activities play an important role in predicting students' physical activity, with the more remunerative activities and higher educational levels being more predictive. CONCLUSION: The results confirm the relationship between adolescents' physical activity and their families' SES. In particular, a positive relationship between participation in extra-curricular physical activity and their families high SES was found. These data will be useful for school administrators and for politicians in order to reduce the gap between adolescents from the least and most disadvantaged families

Scale Development for Perceived School Climate for Girls’ Physical Activity

Objectives: To test an original scale assessing perceived school climate for girls\u27 physical activity in middle school girls. Methods: Confirmatory factor analysis (CFA) and structural equation modeling (SEM). Results: CFA retained 5 of 14 original items. A model with 2 correlated factors, perceptions about teachers\u27 and boys\u27 behaviors, respectively, fit the data well in both sixth and eighth-graders. SEM detected a positive, significant direct association of the teacher factor, but not the boy factor, with girls\u27 self-reported physical activity. Conclusions:School climate for girls\u27 physical activity is a measurable construct, and preliminary evidence suggests a relationship with physical activity

Scale Development for Perceived School Climate for Girls’ Physical Activity

Objectives: To test an original scale assessing perceived school climate for girls\u27 physical activity in middle school girls. Methods: Confirmatory factor analysis (CFA) and structural equation modeling (SEM). Results: CFA retained 5 of 14 original items. A model with 2 correlated factors, perceptions about teachers\u27 and boys\u27 behaviors, respectively, fit the data well in both sixth and eighth-graders. SEM detected a positive, significant direct association of the teacher factor, but not the boy factor, with girls\u27 self-reported physical activity. Conclusions: School climate for girls\u27 physical activity is a measurable construct, and preliminary evidence suggests a relationship with physical activity

Neighborhood health‐promoting resources and obesity risk (the multi‐ethnic study of atherosclerosis)

Objective: While behavioral change is necessary to reverse the obesity epidemic, it can be difficult to achieve and sustain in unsupportive residential environments. This study hypothesized that environmental resources supporting walking and a healthy diet are associated with reduced obesity incidence. Design and Methods: Data came from 4,008 adults aged 45‐84 at baseline who participated in a neighborhood ancillary study of the Multi‐Ethnic Study of Atherosclerosis. Participants were enrolled at six study sites at baseline (2000‐2002) and neighborhood scales were derived from a supplementary survey that asked community residents to rate availability of healthy foods and walking environments for a 1‐mile buffer area. Obesity was defined as BMI ≥ 30 kg/m 2 . Associations between incident obesity and neighborhood exposure were examined using proportional hazards and generalized linear regression. Results: Among 4,008 nonobese participants, 406 new obesity cases occurred during 5 years of follow‐up. Neighborhood healthy food environment was associated with 10% lower obesity incidence per s.d. increase in neighborhood score. The association persisted after adjustment for baseline BMI and individual‐level covariates (hazard ratio (HR) 0.88, 95% confidence interval (CI): 0.79, 0.97), and for correlated features of the walking environment but CIs widened to include the null (HR 0.89, 95% CI: 0.77, 1.03). Associations between neighborhood walking environment and lower obesity were weaker and did not persist after adjustment for correlated neighborhood healthy eating amenities (HR 0.98, 95% CI: 0.84, 1.15). Conclusions: Altering the residential environment so that healthier behaviors and lifestyles can be easily chosen may be a precondition for sustaining existing healthy behaviors and for adopting new healthy behaviors.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97459/1/20255_ftp.pd

Self-Management Strategies Mediate Self-Efficacy and Physical Activity

Self-efficacy theory proposes that girls who have confidence in their capability to be physically active will perceive fewer barriers to physical activity or be less influenced by them, be more likely to pursue perceived benefits of being physically active, and be more likely to enjoy physical activity. Self-efficacy is theorized also to influence physical activity through self-management strategies (e.g., thoughts, goals, plans, and acts) that support physical activity, but this idea has not been empirically tested

Efficacy of exercise counselling as an aid for smoking cessation: a randomized controlled trial.

To examine whether exercise counselling increases smoking abstinence and reduces tobacco withdrawal and gains in weight and body fat