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Modifiable health risk behaviors such as smoking, overweight and obesity, risky alcohol consumption, physical inactivity, and poor nutrition contribute to a substantial proportion of the world’s morbidity and mortality burden. General practitioners (GPs) play a key role in identifying and managing modifiable health risk behaviors. However, these are often underdetected and undermanaged in the primary care setting. We describe the potential of eHealth to help patients and GPs to overcome some of the barriers to managing health risk behaviors. In particular, we discuss (1) the role of eHealth in facilitating routine collection of patient-reported data on lifestyle risk factors, and (2) the role of eHealth in improving clinical management of identified risk factors through provision of tailored feedback, point-of-care reminders, tailored educational materials, and referral to online self-management programs. Strategies to harness the capacity of the eHealth medium, including the use of dynamic features and tailoring to help end users engage with, understand, and apply information need to be considered and maximized. Finally, the potential challenges in implementing eHealth solutions in the primary care setting are discussed. In conclusion, there is significant potential for innovative eHealth solutions to make a contribution to improving preventive care in the primary care setting. However, attention to issues such as data security and designing eHealth interfaces that maximize engagement from end users will be important to moving this field forward.

Background: Future medical and financial planning is important for persons with dementia given the impact of the disease on capacity for decision making. Aims: To explore from the perspective of carers of persons with dementia: (1) Participation in future medical and financial planning by the person they care for, including when planning was undertaken and the characteristics associated with having an advance care directive completed; (2) The type of healthcare providers who discussed advance care planning following diagnosis; and (3) Preferences for timing of discussions about advance care planning following diagnosis. Methods: Recruitment and data collection took place between July 2018 and June 2020. Carers of persons with dementia aged 18 years and older were mailed a survey. Participants completed questions regarding completion of various future planning documents by the person they support, including time of completion and who discussed advance care planning following diagnosis. Participants were presented with information about the benefits and consequences of early and late discussions of advance care planning and asked when discussions about advance care planning were best initiated. Results: 198 carers participated. Most participants were female (74%) and had been a carer for more than 2 years (82%). Most participants reported that the person with dementia they support had made a Will (97%) and appointed an Enduring Guardian (93%) and Enduring Power of Attorney (89%). Only 47% had completed an advance care directive. No significant associations were found between characteristics of persons with dementia and completion of an advance care directive. Geriatricians (53%) and GPs (51%) most often discussed advance care planning following diagnosis. Most carers thought that discussions about advance care planning should occur in the first few weeks or months following diagnosis (32%), at the healthcare provider's discretion (31%), or at the time of diagnosis (25%). Conclusions: More than half of persons with dementia do not have an advance care directive. There is variability in preferences for timing of discussions following dementia diagnosis. [ABSTRACT FROM AUTHOR]

Adjustment of response threshold for speed compared with accuracy instructions in two-choice decision-making tasks is associated with activation in the fronto-striatal network, including the pre-supplementary motor area (pre-SMA) and striatum (Forstmann et al., 2008). In contrast, increased response conservativeness is associated with activation of the subthalamic nucleus (STN) (Frank et al., 2007). We investigated the involvement of these regions in trial-by-trial adjustments of response threshold in humans, using a cued-trials taskswitching paradigm. Fully and partially informative switch cues produced more conservative thresholds than repeat cues. Repeat cues were associated with higher activation in pre-SMA and striatum than switch cues. For all cue types, individual variability in response threshold was associated with activation level in pre-SMA, with higher activation linked to lower threshold setting. In the striatum, this relationship was found for repeat cues only. These findings support the notion that pre-SMA biases the striatum to lower response threshold under more liberal response regimens. In contrast, a high threshold for switch cues was associated with greater activation in right STN, consistent with increasing response caution under conservative response regimens. We conclude that neural models of response threshold adjustment can help explain executive control processes in task switching. [ABSTRACT FROM AUTHOR]

Background and Aims: While cancer patients' preferences for their level of involvement in treatment decision making (TDM) vary, previous research indicates a large proportion of patients are not experiencing TDM that meets their preferences. Evidence is needed to identify the characteristics of cancer patients who are less likely to report experiencing their preferred level of involvement in TDM, so that appropriate decision‐making support can be provided to them. We examined in a sample of medical oncology outpatients (1) the level of agreement between preferred and perceived involvement in TDM and (2) demographic, psychological, disease, and treatment characteristics associated with having unmet preferences for involvement in TDM. Methods and Results: Cancer patients from three medical oncology treatment centers in Australia completed surveys assessing demographic, disease and treatment variables, psychological distress, and preferred and perceived involvement in TDM. Data were collected between February 2013 and December 2014. Factors associated with having unmet TDM preferences were examined using logistic regression. There were 355 patients included in the analysis (75% response rate). The mean age (±SD) of the participants was 61 (±12), and 45% were male. Overall, 60% of participants reported that their preferences for involvement in TDM were met. No demographic, psychological, disease, or treatment characteristics were significantly associated with an increased probability of not having TDM preferences met. Conclusions: In line with previous research, a large proportion (40%) of patients reported TDM experiences that were not in alignment with their preferences. Future research should explore additional characteristics that are associated with a lower likelihood of having TDM preferences met. [ABSTRACT FROM AUTHOR]