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Background: Triglyceride-glucose (TyG) index was regarded as a cost-efficient and reliable clinical surrogate marker for insulin resistance (IR), which was significantly correlated with cardiovascular disease (CVD). However, the TyG index and incident CVD in non-diabetic hypertension patients remains uncertain. The aim of study was to explore the impact of TyG index level and variability on risk of CVD among non-diabetic hypertension patients. Methods: A total of 9313 hypertensive patients without diabetes aged 30–70 years in Jiangsu Province who participated in the baseline survey from January 2010 to December 2010 and were followed up to May 2020 were included in this study. The TyG index was calculated as ln [fasting triglyceride (TG) (mg/dl) × fasting plasma glucose (FPG) (mg/dl)/2] and variation degree was calculated as the TyG index at first year follow-up (2011) minus that at baseline (2010). Cox proportional analysis regression and restricted cubic spline were used to investigate the association between TyG index level as well as variability and CVD risk. Results: Of 9313 included participants, 5423(58.23%) were female. During a mean follow-up of 8.32 ± 1.43 years, 890(9.56%) CVD events was identified. Cox regression analysis showed that with the highest TyG index in Q4 group at baseline, the incidence of CVD risk increased by 33.6% after adjustment for multiple confounders compared to Q1 group. Compared with TyG index variation degree 0 ~ < 1, the hazard ratios (HR) and 95% confidence interval (CI) respectively in < 0, 1 ~ < 2 and 2 ~ were 0.326(0.276, 0.384), 3.216(2.697,3.835) and 4.225(3.359,5.314). The restricted cubic spline indicated that there was a non-linear dose-response relationship between the change degree of TyG and risk of CVD. Similar results were obtained by subgroup analysis and sensitivity analysis. Conclusion: Elevated TyG index may be used as a surrogate for IR and help optimize risk stratification of CVD as well as prevention and management. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome (MetS) increases the risk of cardiovascular disease morbidity and mortality. Physical activity (PA) reduces the likelihood of MetS, but it is a complex behavior and is accumulated in multiple domains. Purpose: To cross-sectionally investigate the total and domain-specific relationships between PA and MetS in U.S. adults. Methods: Data from 3,408 adults participating in the National Health and Nutrition Examination Survey (2013–2018) were analyzed. Blood pressure (BP), waist circumference (WC), fasting blood glucose (GLU), triglycerides (TRIG), and high-density lipoprotein (HDL) were measured. MetS and its risk factors were the primary and secondary outcomes, respectively. Weekly minutes of total PA and domain-specific PA (i.e., leisure-time (LTPA), transportation (TPA), occupational & household (OHPA)), were self-reported. For each exposure, participants were grouped into weekly PA: (1) 0 min, (2) 1–149 min, (3) 150–299 min, (4) 300–599 min, and (5) 600 + minutes. Logistic regression estimated the odds of having MetS, and its risk factors from PA. Results: Total PA was associated with lower odds of most MetS risk factors. Compared to no LTPA, and independent of TPA and OHPA, engaging in 150–299 and 300–599 min/week of LTPA was associated with 30% (OR = 0.70 [95%CI: 0.50, 0.98]) and 43% (OR = 0.57 [95%CI: 0.35, 0.92]) lower odds of MetS, respectively. LTPA was also associated with lower odds of having high WC, GLU, TRIG, and low HDL (ORs = 0.52–0.68). Compared to no TPA, and independent of LTPA and OHPA, engaging in 300–599 min/week of TPA was associated with 54% lower odds of MetS (OR = 0.46 [95%CI: 0.25, 0.84]) and 40% lower odds of having a high WC (OR = 0.40 [95%CI: 0.21, 0.76]). Engaging in OHPA was not associated with MetS but was associated with greater odds of having a high WC (OR = 1.44 [95%CI: 1.03, 2.01]), and GLU (ORs = 1.52–1.83), independent of LTPA and TPA. Conclusion: Total PA, seemingly driven by LTPA, was inversely associated with cardiometabolic health. TPA also showcases some protective associations, while OHPA appears to not confer cardiometabolic health benefits. Longitudinal data should confirm these associations using more robust PA measurement tools. [ABSTRACT FROM AUTHOR]

Abstract Background The centrality of community engagement in disease prevention and health promotion interventions highlights the need to understand the contextual factors that shape participation. Sense of Community (SoC), characterized by feelings of belonging, connection, and interdependence among members of a community, has emerged as a key component of community capacity and is therefore expected to influence engagement outcomes. However, empirical evidence is needed to assess its actual impact on community engagement. Additionally, the literature lacks a broader synthesis of the role and implications of SoC in this context. This study aims to review the empirical literature on SoC in disease prevention and health promotion, with a special focus on its association with community engagement. Methods A scoping review was conducted following the PRISMA guidelines, searching for empirical studies published between 1974 and 2023 via Scopus, Web of Science, and PubMed. Results Nineteen studies were included in the review, revealing three key themes: (1) the community to which SoC refers – among intervention participants, within community coalitions, and defined by the place of residence; (2) the interpretation of SoC, either as a generic, intuitive concept or as a theoretically defined construct; (3) the ways in which SoC is studied – as a predictor of engagement but also as an outcome of the interventions. Generic SoC among intervention participants emerged as a positive outcome and a factor contributing to engagement. However, as the scope expanded to encompass broader communities and SoC became more theoretically grounded, these dynamics shifted. SoC related to the place of residence did not exhibit significant improvement after interventions. Broader community-level SoC showed positive associations with engagement among members of community coalitions, but evidence was less consistent among the individuals targeted by interventions. Conclusions The review highlighted a scarcity of empirical research on SoC despite its recognition as a key component of community capacity. Contextualizing SoC is crucial, as its interpretation significantly influences its role in disease prevention and health promotion interventions. Further research is needed to clarify whether SoC can foster engagement at all community levels, especially among the general population. This is particularly relevant amid the current context of escalating health needs and strained traditional resources, where community engagement is increasingly essential to ensuring the sustainable delivery of disease prevention and health promotion efforts. If SoC can drive widespread engagement, it could play a pivotal role in building more proactive and autonomous health-promoting communities.

Background: The centrality of community engagement in disease prevention and health promotion interventions highlights the need to understand the contextual factors that shape participation. Sense of Community (SoC), characterized by feelings of belonging, connection, and interdependence among members of a community, has emerged as a key component of community capacity and is therefore expected to influence engagement outcomes. However, empirical evidence is needed to assess its actual impact on community engagement. Additionally, the literature lacks a broader synthesis of the role and implications of SoC in this context. This study aims to review the empirical literature on SoC in disease prevention and health promotion, with a special focus on its association with community engagement. Methods: A scoping review was conducted following the PRISMA guidelines, searching for empirical studies published between 1974 and 2023 via Scopus, Web of Science, and PubMed. Results: Nineteen studies were included in the review, revealing three key themes: (1) the community to which SoC refers – among intervention participants, within community coalitions, and defined by the place of residence; (2) the interpretation of SoC, either as a generic, intuitive concept or as a theoretically defined construct; (3) the ways in which SoC is studied – as a predictor of engagement but also as an outcome of the interventions. Generic SoC among intervention participants emerged as a positive outcome and a factor contributing to engagement. However, as the scope expanded to encompass broader communities and SoC became more theoretically grounded, these dynamics shifted. SoC related to the place of residence did not exhibit significant improvement after interventions. Broader community-level SoC showed positive associations with engagement among members of community coalitions, but evidence was less consistent among the individuals targeted by interventions. Conclusions: The review highlighted a scarcity of empirical research on SoC despite its recognition as a key component of community capacity. Contextualizing SoC is crucial, as its interpretation significantly influences its role in disease prevention and health promotion interventions. Further research is needed to clarify whether SoC can foster engagement at all community levels, especially among the general population. This is particularly relevant amid the current context of escalating health needs and strained traditional resources, where community engagement is increasingly essential to ensuring the sustainable delivery of disease prevention and health promotion efforts. If SoC can drive widespread engagement, it could play a pivotal role in building more proactive and autonomous health-promoting communities. [ABSTRACT FROM AUTHOR]

Abstract Background Advertising is one of the most important solutions that health centers and medical services around the world use to try to encourage public opinion to create a positive attitude towards preventive measures and vaccination. This study has been done with the aim of text analysis of billboards and infographics related to promoting preventive behaviors and vaccination against the coronavirus pandemic and providing solutions and models for preventive information and advertising in the field of health. Methods The study method in this research is a combination of qualitative and content analysis. Data collection was done in a targeted manner. The sample size includes 33 advertising billboards and infographics. Data collection has been done through searching the sites and websites of health networks and medical education centers in Iran, taking pictures of infographics and billboards in public places, and also receiving archive files of pictures from the public relations of health networks and medical services. The data was collected from February 19, 2020 to December 30, 2022 (the time frame of the pandemic and public vaccination program in Iran). The data was analyzed based on the three-dimensional discourse analysis theory of Fairclough. Then, an online survey about promoting preventive behaviors and vaccination against the coronavirus pandemic in the format of billboards and infographics was designed in SurveyMonkey and its link was provided to the audience through virtual networks and other platforms. The age group of people was selected from 18 to 70 years. Considering that the number of participants should be representative of the entire community under investigation, therefore, based on Cochran’s formula, the sample size was equal to 350 people. Finally, users’ opinions were analyzed using descriptive statistics. The assessment of validity involved experts in infection control and linguistics. The reliability of the measurement, determined through the Cronbach’s alpha internal consistency coefficient, yielded a coefficient of 0.968. Results The results show that among the four linguistic components of words, syntax, coherence and text structure; “live metaphors”, “pronoun “we”, “collocation and reference”, and “attitude markers” have the most impact on the audience. The frequency percentage of the data shows that these language elements have tremendous power in attracting the audience to perform preventive behaviors. The results show that the language reflects the culture, opinions and needs of people in the society. Also, the results show that encouraging people to perform preventive behaviors should be through the integration of medical information with motivational linguistic factors in order to attract the audience more. Conclusions It can be concluded that the use of the appropriate pattern of medical advertising discourse and correct communication strategies, will help public participation in the field of epidemic control. The language of effective health education and health communication during an epidemic must be related to the ways of thinking and speaking of ordinary people. Also, words with metaphorical and ironic meanings have a high potential to influence the health performance of people in society and increase public awareness of health communication. Therefore, using them to create a new value system with the aim of controlling and overcoming the consequences of the epidemic is very effective.

Background: Advertising is one of the most important solutions that health centers and medical services around the world use to try to encourage public opinion to create a positive attitude towards preventive measures and vaccination. This study has been done with the aim of text analysis of billboards and infographics related to promoting preventive behaviors and vaccination against the coronavirus pandemic and providing solutions and models for preventive information and advertising in the field of health. Methods: The study method in this research is a combination of qualitative and content analysis. Data collection was done in a targeted manner. The sample size includes 33 advertising billboards and infographics. Data collection has been done through searching the sites and websites of health networks and medical education centers in Iran, taking pictures of infographics and billboards in public places, and also receiving archive files of pictures from the public relations of health networks and medical services. The data was collected from February 19, 2020 to December 30, 2022 (the time frame of the pandemic and public vaccination program in Iran). The data was analyzed based on the three-dimensional discourse analysis theory of Fairclough. Then, an online survey about promoting preventive behaviors and vaccination against the coronavirus pandemic in the format of billboards and infographics was designed in SurveyMonkey and its link was provided to the audience through virtual networks and other platforms. The age group of people was selected from 18 to 70 years. Considering that the number of participants should be representative of the entire community under investigation, therefore, based on Cochran's formula, the sample size was equal to 350 people. Finally, users' opinions were analyzed using descriptive statistics. The assessment of validity involved experts in infection control and linguistics. The reliability of the measurement, determined through the Cronbach's alpha internal consistency coefficient, yielded a coefficient of 0.968. Results: The results show that among the four linguistic components of words, syntax, coherence and text structure; "live metaphors", "pronoun "we", "collocation and reference", and "attitude markers" have the most impact on the audience. The frequency percentage of the data shows that these language elements have tremendous power in attracting the audience to perform preventive behaviors. The results show that the language reflects the culture, opinions and needs of people in the society. Also, the results show that encouraging people to perform preventive behaviors should be through the integration of medical information with motivational linguistic factors in order to attract the audience more. Conclusions: It can be concluded that the use of the appropriate pattern of medical advertising discourse and correct communication strategies, will help public participation in the field of epidemic control. The language of effective health education and health communication during an epidemic must be related to the ways of thinking and speaking of ordinary people. Also, words with metaphorical and ironic meanings have a high potential to influence the health performance of people in society and increase public awareness of health communication. Therefore, using them to create a new value system with the aim of controlling and overcoming the consequences of the epidemic is very effective. [ABSTRACT FROM AUTHOR]

Abstract Background Governments have attempted to combat the COVID-19 pandemic by issuing guidelines for disease prevention behavior (e.g., wearing masks, social distancing, etc.) and by enforcing these guidelines. However, while some citizens have complied with these guidelines, others have ignored them or have even participated in large-scale protests. This research aims both to understand the causes of such variation in citizens’ adherence to government guidelines on disease prevention behavior and to extend the scientific literature on disease prevention to account for the collective resilience of a society to diseases. Thus, this research draws on the health belief model and collective resilience theory to develop hypotheses about the determinants of a citizen’s disease prevention behavior. These hypotheses deal with how citizens’ vulnerability, attitudes toward disease prevention, and social orientation are associated with COVID-19 prevention behaviors. Methods From March 24 to April 4, 2020, a cross-sectional online survey was conducted in Bolivia. It included questions on demographic characteristics, chronic health problems, emotional burden, attitudes towards preventive behaviors, trust in public institutions, and culture. Among 5265 participants who clicked on the survey, 1857 at least partially filled it out. After removing data with missing responses to any variable, the final sample consists of 1231 respondents. The collected data were analyzed using hierarchical linear modeling. Results Regarding a citizen’s vulnerability, chronic health problems have a U-shaped association with disease prevention behavior. Moreover, age, female gender, and worries have positive associations with disease prevention behavior, whereas depression showed a negative association. Regarding attitudes toward disease prevention, trust in public institutions, and attitudes toward social distancing, a government-imposed lockdown and the enforcement of this lockdown showed positive associations with disease prevention behavior. Regarding social orientation, individualism and collectivism both have positive relationships with disease prevention behavior. Conclusions In the COVID-19 pandemic, a citizen’s low vulnerability, weak social orientation, and beliefs about low benefits of disease prevention behavior are associated with poor compliance with guidelines on disease prevention behavior. More research on these associations would help generalize these findings to other populations and other public health crises.

Abstract Background We aimed to provide a comprehensive overview of methodological challenges in economic evaluations of disease prevention and health promotion (DPHP)-measures. Methods We conducted an overview of reviews searching MEDLINE, EMBASE, NHS Economic Evaluation Database, Database of Promoting Health Effectiveness Reviews, Cochrane Database of Systematic Reviews (CDSR) and Database of Promoting Health Effectiveness Reviews (DOPHER) (from their inception to October 2021). We included both systematic and scoping reviews of economic evaluations in DPHP addressing following methodological aspects: (i) attribution of effects, (ii) outcomes, (iii) inter-sectoral (accruing to non-health sectors of society) costs and consequences and (iv) equity. Data were extracted according to the associated sub-criteria of the four methodological aspects including study design economic evaluation (e.g. model-based), type/scope of the outcomes (e.g. outcomes beyond health), perspective, cost categories related to non-health sectors of society, and consideration of equity (method of inclusion). Two reviewers independently screened all citations, full-text articles, and extracted data. A narrative synthesis without a meta-analysis or other statistical synthesis methods was conducted. Results The reviewing process resulted in ten systematic and one scoping review summarizing 494 health economic evaluations. A lifelong time horizon was adopted in about 23% of DPHP evaluations, while 64% of trial-based evaluations had a time horizon up to 2 years. Preference-based outcomes (36%) and non-health outcomes (8%) were only applied in a minority of studies. Although the inclusion of inter-sectoral costs (i.e. costs accruing to non-health sectors of society) has increased in recent years, these were often neglected (between 6 and 23% depending on the cost category). Consideration to equity was barely given in economic evaluations, and only addressed in six of the eleven reviews. Conclusions Economic evaluations of DPHP measures give only little attention to the specific methodological challenges related to this area. For future economic DPHP evaluations a tool with structured guidance should be developed. This overview of reviews was not registered and a published protocol does not exist.

Background: Governments have attempted to combat the COVID-19 pandemic by issuing guidelines for disease prevention behavior (e.g., wearing masks, social distancing, etc.) and by enforcing these guidelines. However, while some citizens have complied with these guidelines, others have ignored them or have even participated in large-scale protests. This research aims both to understand the causes of such variation in citizens' adherence to government guidelines on disease prevention behavior and to extend the scientific literature on disease prevention to account for the collective resilience of a society to diseases. Thus, this research draws on the health belief model and collective resilience theory to develop hypotheses about the determinants of a citizen's disease prevention behavior. These hypotheses deal with how citizens' vulnerability, attitudes toward disease prevention, and social orientation are associated with COVID-19 prevention behaviors. Methods: From March 24 to April 4, 2020, a cross-sectional online survey was conducted in Bolivia. It included questions on demographic characteristics, chronic health problems, emotional burden, attitudes towards preventive behaviors, trust in public institutions, and culture. Among 5265 participants who clicked on the survey, 1857 at least partially filled it out. After removing data with missing responses to any variable, the final sample consists of 1231 respondents. The collected data were analyzed using hierarchical linear modeling. Results: Regarding a citizen's vulnerability, chronic health problems have a U-shaped association with disease prevention behavior. Moreover, age, female gender, and worries have positive associations with disease prevention behavior, whereas depression showed a negative association. Regarding attitudes toward disease prevention, trust in public institutions, and attitudes toward social distancing, a government-imposed lockdown and the enforcement of this lockdown showed positive associations with disease prevention behavior. Regarding social orientation, individualism and collectivism both have positive relationships with disease prevention behavior. Conclusions: In the COVID-19 pandemic, a citizen's low vulnerability, weak social orientation, and beliefs about low benefits of disease prevention behavior are associated with poor compliance with guidelines on disease prevention behavior. More research on these associations would help generalize these findings to other populations and other public health crises. [ABSTRACT FROM AUTHOR]

Background: Having an unhealthy lifestyle is associated with a higher risk of developing lifestyle-related diseases. Current evidence suggests that interventions targeting health-risk behaviors can help people improve their lifestyles and prevent lifestyle-related diseases. However, preventive programs are often challenged by low participation rates. Reasons for non-participation include lack of time and/or interest, and/or no perceived need for lifestyle intervention. This study explores causes for non-participation in a sample of people who chose not to take up a targeted preventive program (TOF pilot2 study). Patient-reported reasons as well as sociodemographic characteristics and lifestyle factors are in focus. Methods: A total of 4633 patients from four Danish GP clinics received an invitation to take part in the TOF pilot2 study. Patients who chose not to participate in the TOF pilot2 study were asked to fill in a questionnaire concerning reasons for non-participation, lifestyle, BMI and self-rated health. Descriptive analyses were used to summarize the results. Results: A total of 2462 patients (53.1%) chose not to participate in the TOF pilot2 study. Among these, 84 (3.4%) answered the full questionnaire on reasons for not participating, lifestyle, BMI and self-rated health. The most common reasons for non-participation were lack of time, having an already healthy lifestyle, and feeling healthy. Based on their self-reported lifestyle 45 (53.6%) of the non-participants had one or more health-risk behaviors including smoking, unhealthy diet, BMI ≥ 35 and/or sedentary lifestyle and were therefore eligible to receive the targeted intervention at the GP or the MHC in the original TOF pilot2 study. Conclusion: When planning future preventive programs it is important to know the main reasons for patients to not participate. This study provides rare insight into why people opt out of health interventions and advances the evidence base in this area. Our results may inform efforts to better involve these patients in preventive health programs. Trial registration: Trial registration number: NCT02797392. [ABSTRACT FROM AUTHOR]

Abstract Background Recent improvements in life expectancy in many countries stem from reduced mortality from cardiovascular disease and cancer above the age of 60. This is the combined result of decreased incidence and improved survival among those with disease. The latter has led to a higher proportion in the population of people with a past history of disease. This is a group with higher mortality than the general population. How growing shares of persons with past history of disease and improved survival with disease have affected changes in life expectancy of the total population is the objective of this paper. Methods Using register data for the total Swedish population, we stratified the population based on whether individuals have been diagnosed with myocardial infarction, stroke, hip fracture, colon cancer, or breast cancer. Using a novel decomposition approach, we decomposed the changes in life expectancy at age 60 between 1994 and 2016 into contributions from improved survival with disease and from changes in proportion of people with past history of disease. Results Improvements in survival from disease resulted in gains of life expectancy for the total population. However, while the contributions to life expectancy improvements from myocardial infarction, stroke and breast cancer were substantial, the contributions from the other diseases were minor. These gains were counteracted, to various degrees, by the increasing proportion of people with raised mortality due to a past history of disease. For instance, the impact on life expectancy by improved survival from breast cancer was almost halved by the increasing share of females with a past history of breast cancer. Conclusion Rising numbers of survivors of different diseases can slow the increase in life expectancy. This dynamic may represent the costs associated with successful treatment of diseases, and thus, a potential “failure of success.” This dynamic should be considered when assessing mortality and life expectancy trends. As populations are aging and disease survival continues to improve, this issue is likely to become even more important in the future.

Background: We aimed to provide a comprehensive overview of methodological challenges in economic evaluations of disease prevention and health promotion (DPHP)-measures.Methods: We conducted an overview of reviews searching MEDLINE, EMBASE, NHS Economic Evaluation Database, Database of Promoting Health Effectiveness Reviews, Cochrane Database of Systematic Reviews (CDSR) and Database of Promoting Health Effectiveness Reviews (DOPHER) (from their inception to October 2021). We included both systematic and scoping reviews of economic evaluations in DPHP addressing following methodological aspects: (i) attribution of effects, (ii) outcomes, (iii) inter-sectoral (accruing to non-health sectors of society) costs and consequences and (iv) equity. Data were extracted according to the associated sub-criteria of the four methodological aspects including study design economic evaluation (e.g. model-based), type/scope of the outcomes (e.g. outcomes beyond health), perspective, cost categories related to non-health sectors of society, and consideration of equity (method of inclusion). Two reviewers independently screened all citations, full-text articles, and extracted data. A narrative synthesis without a meta-analysis or other statistical synthesis methods was conducted.Results: The reviewing process resulted in ten systematic and one scoping review summarizing 494 health economic evaluations. A lifelong time horizon was adopted in about 23% of DPHP evaluations, while 64% of trial-based evaluations had a time horizon up to 2 years. Preference-based outcomes (36%) and non-health outcomes (8%) were only applied in a minority of studies. Although the inclusion of inter-sectoral costs (i.e. costs accruing to non-health sectors of society) has increased in recent years, these were often neglected (between 6 and 23% depending on the cost category). Consideration to equity was barely given in economic evaluations, and only addressed in six of the eleven reviews.Conclusions: Economic evaluations of DPHP measures give only little attention to the specific methodological challenges related to this area. For future economic DPHP evaluations a tool with structured guidance should be developed. This overview of reviews was not registered and a published protocol does not exist. [ABSTRACT FROM AUTHOR]

Abstract Background The prevalence of diabetes in China has rapidly increased in recent years. Family history and physical inactivity are known risk factors for developing diabetes. As automated telephone-based communication is recognized as a cost-effective health promoting device, the present study aims at evaluating the efficacy of an automated telephone counselor (TLC-PA-China) for promoting physical activity to the WHO-recommended level among physically inactive family members of diabetes patients. Methods This study employed a parallel, two-group, non-blinded, randomized controlled trial design with equal allocation to the intervention group (TLC-PA-China), and a control group. Voluntary participants with at least one first-degree relative diagnosed with diabetes mellitus were recruited through eight Community Health Centers in Shenzhen, China. The intervention group was requested to use the system once per week during a six-month period. The control group received an information pamphlet about the benefits of regular physical activity. Results Two hundred ten eligible participants were randomized to TLC-PA-China (n = 109) or Control (n = 101) groups. Using intention-to-treat analysis, the TLC-PA-China group was significantly more likely to meet the WHO physical activity recommendation than the control (GEE: OR = 6.37, p

Background: Recent improvements in life expectancy in many countries stem from reduced mortality from cardiovascular disease and cancer above the age of 60. This is the combined result of decreased incidence and improved survival among those with disease. The latter has led to a higher proportion in the population of people with a past history of disease. This is a group with higher mortality than the general population. How growing shares of persons with past history of disease and improved survival with disease have affected changes in life expectancy of the total population is the objective of this paper. Methods: Using register data for the total Swedish population, we stratified the population based on whether individuals have been diagnosed with myocardial infarction, stroke, hip fracture, colon cancer, or breast cancer. Using a novel decomposition approach, we decomposed the changes in life expectancy at age 60 between 1994 and 2016 into contributions from improved survival with disease and from changes in proportion of people with past history of disease. Results: Improvements in survival from disease resulted in gains of life expectancy for the total population. However, while the contributions to life expectancy improvements from myocardial infarction, stroke and breast cancer were substantial, the contributions from the other diseases were minor. These gains were counteracted, to various degrees, by the increasing proportion of people with raised mortality due to a past history of disease. For instance, the impact on life expectancy by improved survival from breast cancer was almost halved by the increasing share of females with a past history of breast cancer. Conclusion: Rising numbers of survivors of different diseases can slow the increase in life expectancy. This dynamic may represent the costs associated with successful treatment of diseases, and thus, a potential "failure of success." This dynamic should be considered when assessing mortality and life expectancy trends. As populations are aging and disease survival continues to improve, this issue is likely to become even more important in the future. [ABSTRACT FROM AUTHOR]

Abstract Background A dearth of knowledge exists regarding how multiple health behavior changes made within an exercise prescription programme can improve health parameters. This study aimed to analyse the impact of changing diet and increasing exercise on health improvements among exercise prescription patients. Methods In 2016, a representative sample of all enroled New Zealand exercise prescription programme (Green Prescription) patients were surveyed (N = 1488, 29% male, 46% ≥ 60 yr). Seven subsamples were created according to their associated health problems; metabolic (n = 1192), physiological (n = 627), psychological (n = 447), sleep problems (n = 253), breathing difficulties (n = 243), fall prevention (n = 104), and smoking (n = 67). After controlling for sex and age, multinomial regression analyses were executed. Results Overall, weight problems were most prevalent (n = 886, 60%), followed by high blood pressure/risk of stroke (n = 424, 29%), arthritis (n = 397, 27%), and back pain/problems (n = 382, 26%). Among patients who reported metabolic health problems, those who changed their diet were 7.2, 2.4 and 3.5 times more likely to lose weight, lower their blood pressure, and lower their cholesterol, respectively compared to the control group. Moreover, those who increased their physical activity levels were 5.2 times more likely to lose weight in comparison to controls. Patients who both increased physical activity and improved diet revealed higher odds of experiencing health improvements than those who only made one change. Most notably, the odds of losing weight were much higher for patients changing both behaviours (17.5) versus changing only physical activity (5.2) or only diet (7.2). Conclusions Although it is not currently a programme objective, policy-makers could include nutrition education within the Green Prescription initiative, particularly for the 55% of patients who changed their diet while in the programme. Physical activity prescription with a complimentary nutrition education component could benefit the largest group of patients who report metabolic health problems.

Background: To achieve a sustainable working life it is important to know more about what could encourage employers to increase the use of preventive and health promotive interventions. The objective of the study is to explore and describe the employer perspective regarding what incentives influence their use of preventive and health promotive workplace interventions.Method: Semi-structured focus group interviews were carried out with 20 representatives from 19 employers across Sweden. The economic sectors represented were municipalities, government agencies, defence, educational, research, and development institutions, health care, manufacturing, agriculture and commercial services. The interviews were transcribed verbatim and the data were analysed using latent content analysis.Results: Various incentives were identified in the analysis, namely: "law and provisions", "consequences for the workplace", "knowledge of worker health and workplace health interventions", "characteristics of the intervention", "communication and collaboration with the provider". The incentives seemed to influence the decision-making in parallel with each other and were not only related to positive incentives for engaging in workplace health interventions, but also to disincentives.Conclusions: This study suggests that the decision to engage in workplace health interventions was influenced by several incentives. There are those incentives that lead to a desire to engage in a workplace health intervention, others pertain to aspects more related to the intervention use, such as the characteristics of the employer, the provider and the intervention. It is important to take all incentives into consideration when trying to understand the decision-making process for workplace health interventions and to bridge the gap between what is produced through research and what is used in practice. [ABSTRACT FROM AUTHOR]

Background: Health literacy, or the ability to access, understand, appraise and apply health information, is central to individuals' health and well-being. A comprehensive, concept-based measure of most dimensions of health literacy has been developed for the general population in Europe, which enables comparisons within and between countries. This study seeks to validate this tool for use in Japan, and to use a Japanese translation to compare health literacy levels in Japan and Europe. Methods: A total of 1054 Japanese adults recruited through an Internet research service company, completed a Japanese-language version of the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47). The survey was administered via an online questionnaire, and participant demographics were closely matched to those of the most recent Japanese national census. Survey results were compared with those previously reported in an eight-country European study of health literacy. Results: Internal consistency for the translated questionnaire was valid across multiple metrics. Construct validity was checked using confirmatory factor analyses. The questionnaire correlated well with existing scales measuring health literacy and mental health status. In general, health literacy in the Japanese population was lower than in Europe, with Japanese respondents rating all test items as more difficult than European respondents. The largest difference (51.5 %) was in the number of respondents finding it difficult to know where to get professional help when they are ill. Conclusions: This study translated a comprehensive health literacy questionnaire into Japanese and confirmed its reliability and validity. Comparative results suggest that Japanese health literacy is lower than that of Europeans. This discrepancy may be partly caused by inefficiency in the Japanese primary health care system. It is also difficult to access reliable and understandable health information in Japan, as there is no comprehensive national online platform. Japanese respondents found it more difficult to judge and apply health information, which suggests that there are difficulties in health decision-making in Japan. Numerous issues may be linked to lower levels health literacy in Japan, and further studies are needed to improve this by developing individual competencies and building supportive environments. [ABSTRACT FROM AUTHOR]

Background Non-pharmaceutical interventions (NPIs) constituted the principal public health response to the previous influenza A (H1N1) 2009 pandemic and are one key area of ongoing preparation for future pandemics. Thailand is an important point of focus in terms of global pandemic preparedness and response due to its role as the major transportation hub for Southeast Asia, the endemic presence of multiple types of influenza, and its role as a major receiving country for migrants. Our aim was to collect information about vulnerable migrants' perceptions of and ability to implement NPIs proposed by the WHO. We hope that this information will help us to gauge the capacity of this population to engage in pandemic preparedness and response efforts, and to identify potential barriers to NPI effectiveness. Methods A cross-sectional survey was performed. The study was conducted during the influenza H1N1 2009 pandemic and included 801 migrant participants living in border areas thought to be high risk by the Thailand Ministry of Public Health. Data were collected by Migrant Community Health Workers using a 201-item interviewer-assisted questionnaire. Univariate descriptive analyses were conducted. Results With the exception of border measures, to which nearly all participants reported they would be adherent, attitudes towards recommended NPIs were generally negative or uncertain. Other potential barriers to NPI implementation include limited experience applying these interventions (e.g., using a thermometer, wearing a face mask) and inadequate hand washing and household disinfection practices. Conclusions Negative or ambivalent attitudes towards NPIs combined with other barriers identified suggest that vulnerable migrants in Thailand have a limited capacity to participate in pandemic preparedness efforts. This limited capacity likely puts migrants at risk of propagating the spread of a pandemic virus. Coordinated risk communication and public education are potential strategies that may reduce barriers to individual NPI implementation. [ABSTRACT FROM AUTHOR]

Background Metabolic syndrome is a cluster of cardiovascular risk factors that greatly increase the risk of developing cardiovascular disease and type 2 diabetes. Regular exercise improves the risk profile, but most people do not successfully change their exercise habits to beneficially reduce risk. Tailored exercise prescribed by a family physician has shown promise as a means to increase fitness and reduce cardiometabolic risk, but optimal implementation practices remain unknown. Mobile health technologies have proved to be a beneficial tool to achieve blood pressure and blood glucose control in patients with diabetes. These technologies may address the limited access to health interventions in rural and remote regions. However, the potential as a tool to support exercise-based prevention activities is not well understood. This study was undertaken to investigate the effects of a tailored exercise prescription alone or supported by mobile health technologies to improve metabolic syndrome and related cardiometabolic risk factors in rural community-dwelling adults at risk for cardiovascular disease and type 2 diabetes. Methods/Design Adults (n = 149) with at least two metabolic syndrome risk factors were recruited from rural communities and randomized to either: 1) an intervention group receiving an exercise prescription and devices for monitoring of risk factors with a smartphone data portal equipped with a mobile health application; or 2) an active control group receiving only an exercise prescription. All participants reported to the research centre at baseline, and at 12-, 24- and 52-week follow-up visits for measurement of anthropometrics and blood pressure and for a blood draw to test blood-borne markers of cardiometabolic health. Vascular and autonomic function were examined. Fitness was assessed and exercise prescribed according to the Step Test and Exercise Prescription protocol. Discussion This study tested the effects of a prescriptive exercise intervention alone, versus one supported by mobile health technology on cardiometabolic risk factors. The intervention was designed to be translated into clinical or community-based programming. Results will contribute to the current literature by investigating the utility of mobile health technology support for exercise prescription interventions to improve cardiometabolic risk status and maintain improvements over time; particularly in rural communities. [ABSTRACT FROM AUTHOR]

Background: As more people reach older age, there is a growing interest in improving old person's health, activity, independence and social participation, thereby adding quality to the extended years. Preventive home visits (PHV) programs for old people have received much attention in recent decades. A large body of research shows mixed effects, and argues that a home visit is a complex social process influenced by numerous factors. To evaluate the impact of PHV, as well as making decisions on whether, how, and to whom the service should be provided, requires a deeper understanding of PHV than we have now. Consequently, the aim of the study was to describe the variations in older people's (80+) experiences of a single preventive home visit and its consequences for health. Methods: Seventeen participants between 80 and 92 years of age who had all received a structured PHV were interviewed in their own homes. The interviews were analyzed using the phenomenographic method, looking at the variations in the participants' experiences. Results: The interviews revealed four categories: "The PHV made me visible and proved my human value"; "The PHV brought a feeling of security"; "The PHV gave an incentive to action"; and "The PHV was not for me". Conclusions: The experiences of a PHV were twofold. On one hand, the positive experiences indicate that one structured PHV was able to empower the participants and strengthen their self-esteem, making them feel in control over their situation and more aware of the importance of keeping several steps ahead. Together this could motivate them to take measures and engage in health-promoting activities. On the other hand, the PHV was experienced as being of no value by a few. These findings may partly explain the positive results from PHV interventions and emphasize that one challenge for health care professionals is to motivate older people who are healthy and independent to engage in health-promoting and disease-preventive activities. [ABSTRACT FROM AUTHOR]

Background: The prevalence of diabetes in China has rapidly increased in recent years. Family history and physical inactivity are known risk factors for developing diabetes. As automated telephone-based communication is recognized as a cost-effective health promoting device, the present study aims at evaluating the efficacy of an automated telephone counselor (TLC-PA-China) for promoting physical activity to the WHO-recommended level among physically inactive family members of diabetes patients.Methods: This study employed a parallel, two-group, non-blinded, randomized controlled trial design with equal allocation to the intervention group (TLC-PA-China), and a control group. Voluntary participants with at least one first-degree relative diagnosed with diabetes mellitus were recruited through eight Community Health Centers in Shenzhen, China. The intervention group was requested to use the system once per week during a six-month period. The control group received an information pamphlet about the benefits of regular physical activity.Results: Two hundred ten eligible participants were randomized to TLC-PA-China (n = 109) or Control (n = 101) groups. Using intention-to-treat analysis, the TLC-PA-China group was significantly more likely to meet the WHO physical activity recommendation than the control (GEE: OR = 6.37, p < 0.001). The number of physically inactive people to intervene upon for one to become active was 2.84 at 3 months and 3.31 at 6 months.Conclusions: TLC-PA-China increased physical activity levels among physically inactive adults in China who were at high risk of developing diabetes. This study lays the groundwork for application of behavioral informatics intervention in China.Trial Registration: Chinese Clinical Trial Registry ChiCTR-PRC-13003361 . Registered 15 May 2013 (Retrospectively registered). [ABSTRACT FROM AUTHOR]