Behavioral Health Risk Factors and Motivation to Change among Cardiovascular General Hospital Patients Aged 50 to 79 Years

Little is known about the (co-)occurrence of smoking, alcohol at-risk drinking, physical inactivity and overweight, and the motivation to change these behavioral health risk factors (HRFs) in older general hospital patients with cardiovascular disease. Between October and December 2016, all consecutively admitted patients aged 50 to 79 years were proactively recruited on 3 cardiology wards and asked to participate in a survey on HRFs and behavior change motivation. Of the eligible patients, 80.4% participated in the survey (n = 328). The mean age was 66.5 years (standard deviation 9.0), and 65.5% were male. At least 1 HRF was present in 91.8% (n = 280), at least 2 HRFs in 54.4% (n = 166), and 3 or 4 HRFs in 12.1% (n = 37) of participants. The proportion of older adults who contemplated or were changing or planning to change their behavior to meet health behavior recommendations ranged between 66.0% (smoking) and 93.2% (alcohol consumption). The results indicate a notable co-occurrence of behavioral HRFs in older patients with cardiovascular disease. The majority of older adults were at least considering changing the respective behavior. To prevent and treat diseases efficiently, hospitalization may be a suitable moment for systematic multiple HRF screening and intervention.Peer Reviewe

Querschnitterhebung zu Determinanten der Inanspruchnahme und der Erreichbarkeit niedergelassener Ärzte für über 60-Jährige in ländlichen und städtischen Regionen Vorpommerns

Für die vorliegende Arbeit wurde eine Querschnitterhebung zu möglichen Einflussfaktoren auf die ambulante Inanspruchnahme medizinischer Leistungen durchgeführt. Die Erhebung erfolgte von August 2009 bis Februar 2010. Es nahmen 800 Männer und Frauen (Response von 68,4%) im Alter von 60 Jahren oder älter mit Wohnsitz in Vorpommern teil. Als theoretischer Hintergrund diente das “Health Behavior Model“ von Andersen (1995). Zusätzlich zu den im Verhaltensmodell benannten Faktoren wurden weitere mögliche Einflussfaktoren auf die Inanspruchnahme berücksichtigt, wie die Mobilität der Bevölkerung, die subjektiv eingeschätzte Erreichbarkeit von niedergelassenen Ärzten und der wahrgenommene Zeitaufwand der Inanspruchnahme (Wartezeiten). Zwischen ländlichen und städtischen Regionen in Vorpommern wurden Unterschiede in den Einschätzungen der Erreichbarkeit, v.a. der Wegzeiten zu Haus- und Fachärzten, aufgezeigt. Die Assoziationen der von den Probanden eingeschätzten Erreichbarkeitsaspekte mit den Indikatoren der ambulanten Inanspruchnahme in multivariaten Modellen verdeutlichen die Wichtigkeit der Sicherstellung einer flächendeckenden, wohnortnahen medizinischen Versorgung.For the present study a cross-sectional survey on possible factors influencing the use of outpatient health care services was conducted. The survey was realized between August 2009 and February 2010, with 800 men and women (response rate of 68.4%) at the age of 60 years old or older living in the region of Western Pomerania. The "health behavior model" by Andersen (1995) was used as theoretical background. In addition to the factors stated in the health behavior model further factors that could influence health care utilization were considered, like the mobility of the population, the subjectively perceived accessibility of outpatient care and the perceived expenditure of time of health care utilization (waiting times). Differences in the estimates of accessibility, especially the travel time to general practitioners and specialists, were revealed between rural and urban areas in Western Pomerania. The associations of the accessibility as assessed by the subjects with the indicators of outpatient health care utilization in multivariate models illustrate the importance of ensuring a comprehensive, community-based medical care

Die Adhärenz Erwachsener an der Bewegungsaufzeichnung über 7 Tage mittels Akzelerometer

Hintergrund: Über den Einsatz direkter Messmethoden zur Erfassung körperlicher Aktivität bei Erwachsenen in Deutschland ist bislang wenig bekannt. Ziel der Studie ist die Beschreibung der Adhärenz und die Analyse individueller Determinanten, ein Akzelerometer über 7 Tage zu tragen. Material und Methoden: In einem Einkaufszentrum wurden 365 Personen (40 bis 75 Jahre) für eine 7-tägige Aufzeichnung ihrer körperlichen Aktivität gewonnen. Von diesen hatten 231 (63,3 %) das Gerät täglich mindestens 10 h getragen. Ergebnisse: Teilnehmende in Partnerschaft trugen das Akzelerometer mit höherer Wahrscheinlichkeit entsprechend der Anweisung verglichen mit jenen ohne Partnerschaft. Schlechtere subjektive Gesundheit war mit einer geringeren Einhaltung der Anweisungen, das Akzelerometer zu tragen, assoziiert. Diskussion: Um möglichst valide Daten über Umfang und Intensität körperlicher Aktivität zu erhalten, sollten Menschen ohne Partner und solche mit schlechterer subjektiver Gesundheit über den Tragezeitraum des Gerätes hinweg motiviert werden, es regelmäßig zu tragen

Behavioral health risk factor profiles in general hospital patients: identifying the need for screening and brief intervention

Background Little is known about the clustering of behavioral health risk factors (HRFs), namely the occurrence of 16 specific combinations of tobacco smoking, at-risk alcohol use, overweight and physical inactivity in general hospital patients. Furthermore, social inequalities in HRFs, health and life expectancy are a major concern in public health. In order to establish the need for screening and intervention in general hospital care, the study aimed to determine the co-occurrence of HRFs in patients in four medical departments, and to investigate differences by gender, age and socio-economic characteristics. Methods Over 17 months, a systematic multiple HRF screening was conducted at one general hospital in northeastern Germany. In total, 6251 18–64 year old patients (92% of eligibles) participated. Proportions and confidence intervals were calculated for all 16 HRF profiles stratified by department, gender, age group, school education, and employment status. Results In total, 92.2% of the participants (58.6% male) reported ≥1 HRF, and 65.7% ≥2 HRFs. Men (71.2%), patients aged 35–49 (67.9%) and 50–64 years (69.5%), lower educated (79.0%), and unemployed (77.8%) patients had larger proportions of ≥2 HRFs than their counterparts. In all departments, the most common HRF profiles included overweight. HRF profiles that included alcohol and/ or smoking were more common in ear-nose-throat and trauma surgery than in internal medicine and general surgery patients. Men had higher rates concerning almost all HRF profiles including ≥2 HRFs and alcohol; women concerning profiles that included ≤2 HRFs and inactivity. In older patients, profiles with ≥2 HRFs including overweight; and in younger patients, profiles with smoking and/or alcohol were more common. In lower educated patients, profiles with ≥2 HRFs including inactivity; and in higher educated patients profiles with ≤2 HRFs including alcohol were more common. Compared to others, unemployed patients had higher rates of profiles with ≥3 HRFs including smoking. Conclusions Two in three patients require interventions targeting two or more HRFs. The findings help to develop screening and brief intervention for patients with specific health risk profiles, that can reach most patients, including those most in need and those most hard to reach, with socio-economically disadvantaged people in particular.Peer Reviewe

Changes in Body Weight and Composition Are Associated With Changes in Left Ventricular Geometry and Function in the General Population

Background-The different effects of total body weight (TBW), fat-free mass (FFM), and fat mass (FM) on left ventricular (LV) geometry and function are complex. We investigated the associations of changes over time in TBW, FM, and FFM with changes in LV geometry and function. Methods and Results-We analyzed data from 1189 subjects (694 women), aged 44 to 86 years, from the baseline and the 5-year follow-up examination of the population-based SHIP (Study of Health in Pomerania). TBW was measured, and FFM and FM were calculated based on height-weight models derived from bioelectrical impedance studies. Echocardiographic measurements of LV geometry and function were performed according to the guidelines of the American Society of Echocardiography. Changes in body composition measures were associated with changes in LV geometry and function by multivariable-adjusted linear regression models. A 1-kg increase/decrease in TBW or FM was associated, respectively, with an increase/decrease of 0.89 g or 1.84 g in LV mass, whereas there was no such association on changes in FFM. Moreover, an increase in FM was associated with LV concentric remodeling and impairment of systolic and diastolic function parameters, whereas an increase in FFM was associated with LV eccentric remodeling and improved systolic and diastolic functional variables. Conclusions-Our findings indicate that changes in LV morphology and function depend on the type of body mass composition. Prospective data need to address whether specific changes in body composition over time may affect the risk for heart dysfunction more precisely than the change in TBW

Maternal socioeconomic and lifestyle factors and life dissatisfaction associated with a small for gestational age infant. The Survey of Neonates in Pomerania (SNiP)

Purpose The aim is to investigate the associations of the mother’s socioeconomic and lifestyle factors and life satisfaction with the delivery of a small for gestational age (SGA) infant. Methods Data from 4598 participants of the population-based birth cohort study Survey of Neonates in Pomerania (SniP) including comprehensive information on pregnancies, mothers, and their offspring in Western Pomerania, Germany were used in this study. The associations were analyzed using linear and logistic regression models. Results After logistic regression analysis adjusted for height of the mother, women who delivered SGA infants, had lower education (p < 0.01) and smoked more frequently during pregnancy (p < 0.01) compared with mothers of adequate for gestational age (AGA) neonates. A mother with less than 10 years of education and one who continued smoking during pregnancy had an odds ratio (OR) of 2.23 [95% confidence interval (CI) = 1.44 to 3.46] and 2.68 (95% CI = 2.06–3.49) of having an SGA infant, respectively. There was no association between the employment of the mother (p = 0.28), the monthly income (p = 0.09), the family status (p = 0.80), the number of friendships outside the household that the mother would not wish to relinquish (p = 0.47), the number of people that she could rely on in case of an emergency (p = 0.75), or alcohol consumption prior to (p = 0.14) or during the pregnancy (p = 0.99) with SGA. Finally, women who delivered SGA infants were more frequently dissatisfied with their employment (p = 0.03) and financial status (p < 0.01). Conclusions Women who delivered SGA infants had more associated socioeconomic and lifestyle risk factors and were more frequently dissatisfied with their life conditions than mothers of AGA neonates

Glucose and insulin levels are associated with arterial stiffness and concentric remodeling of the heart

Background Mortality attributable to heart failure remains high. The prevalence of heart failure in patients with diabetes mellitus ranges from 19 to 26%. It is estimated that up to 21.1 million adults in the United States have diagnosed diabetes mellitus and around 80.8 million have impaired fasting glucose. We investigated the associations of fasting glucose (FG) and fasting insulin (FI), the homeostasis model assessment-insulin resistance index (HOMA-IR) and 2-h postload glucose (2HG) and insulin (2HI) with parameters of left ventricular geometry and function and arterial stiffness determined by magnetic resonance imaging in individuals without diagnosed type 2 diabetes. Methods Cross-sectional analyses of 1001 individuals (453 women, 45.3%), aged 21 to 80 years, from two independent population-based studies, the Study of Health in Pomerania (SHIP-TREND-0) and KORA FF4 Study. FG, FI, HOMA-IR, 2HG and 2HI, as well as glucose tolerance categories, were analyzed for associations with heart and arterial parameters using multivariable-adjusted linear regression models. Results In total, 390 individuals (39%) had prediabetes (isolated impaired fasting glucose, isolated glucose tolerance or both), and 49 (4.9%) were found to have unknown type 2 diabetes. In the multivariable-adjusted analysis, positive linear associations of FG, FI, HOMA-IR, 2HG and 2HI with arterial stiffness index and left ventricular wall-thickness and concentricity and inverse linear associations with left ventricular end-diastolic volume were observed. A 1 mmol/l higher FG was associated with a 1.18 ml/m(2.7) (1.80 to 0.57; p &lt; 0.001) lower left ventricular end-diastolic volume index, a 0.042 mm/m(2.7) (0.014 to 0.070) higher left ventricular wall-thickness index, a 0.12 mmHg m(2.7)/ml (0.06 to 0.17; p &lt; 0.001) greater arterial stiffness index and a 0.037 g/ml (0.018 to 0.056; p &lt; 0.001) higher left ventricular concentricity. Conclusions Our findings suggest that higher glucose levels in the prediabetic range and insulin resistance might lead to higher arterial stiffness and concentric remodeling of the heart

Insufficient physical activity and multimorbidity was associated with low physical functional performance in older adults: a cross-sectional study

OBJECTIVE: Aging, physical inactivity, and chronic disease can decrease strength and muscle mass and affect mobility and autonomy in older adults. This study aimed to analyze the prevalence and associated factors of low physical functional performance among older adults in the city of Pomerode, in southern Brazil. METHODS: This is a cross-sectional population-based study with data on 733 older adults from the Study of Health in Pomerode — SHIP-Brazil. Low functional physical performance was defined as handgrip strength &le; 32 kg for men or &le; 20 kg for women and/or a Timed Up and Go test &ge; 11 seconds for men or &ge; 13 seconds for women. Associations were analyzed by multiple logistic regression. RESULTS: The prevalence of low physical functional performance was 43.7% (42.2% among women and 45.5% among men). Low physical functional performance was associated with the 70–79 years age group (odds ratio [OR] = 2.07) and insufficient physical activity (OR = 2.73) in men, and with the 70–79 years age group (OR = 2.09) and multimorbidity (OR = 1.87) in women. In general, older age, insufficient physical activity, and multimorbidity were associated with low physical functional performance in older adults. CONCLUSION: Our findings suggest that while insufficient physical activity is crucial for physical functional performance in older men, multimorbidity appears to be crucial for older women.</p

Central obesity and fat-free mass are associated with a larger spleen volume in the general population

Background and aim: As the spleen plays a significant role in immunity, the aim was to investigate the associations of different body composition markers derived from various sources with spleen volume in a general population sample. Materials and methods: Cross-sectional data of 1095 individuals (570 women; 52%) aged between 30 and 90 years were collected in the Study of Health in Pomerania (SHIP-START-2). We measured spleen volume by magnetic resonance imaging (MRI).Body composition markers were derived from classic anthropometry, bioelectrical impedance analysis, including absolute fat mass (FM) and fat-free mass (FFM), as well as from MRI, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and liver fat content. Sex-stratified-adjusted linear regression models were used to analyze the associations of body composition markers with spleen volumes. Results: We observed positive associations of body mass index, body weight, waist circumference, hip circumference, waist-to-height ratio, absolute FM, absolute FFM, and VAT and SAT with spleen volume in men and women. An 8.12 kg higher absolute FFM was associated with a 38.4 mL (95% confidence interval [CI]: 26.7–50.1) higher spleen volume in men and a 5.21 kg higher absolute FFM with a 42.6 mL (95% CI: 26.2–59.0) higher spleen volume in women. Conclusion: Our findings indicate that obesity-related body composition markers and FFM are associated with a higher spleen volume. Particularly, higher absolute FFM showed a strong association with a larger spleen volume in both men and women. Further studies are warranted to understand the clinical significance of body composition markers on large spleen volume