Prevention of type 2 diabetes - where is the evidence? Assessment of absolute risk of death after myocardial infarction by use of multiple-risk-factor assessment equations: GISSI-Prevenzione mortality risk chart. Cardiac rehabilitation adapted to transient ischaemic attack and stroke (CRAFTS): a randomised controlled trial Do sugar-sweetened beverages cause adverse health outcomes in children? A systematic review protocol Effectiveness of community-based comprehensive healthy lifestyle promotion on cardiovascular disease risk factors in a rural Vietnamese population: a quasi-experimental study Four years of practice-based and exercise-supported behavioural medicine in one community of the German CINDI area. Countrywide Integrated Non-Communicable Diseases Intervention. Behavioural risk factors for non communicable diseases among adults in Kerala, India. The ProActive trial protocol – a randomised controlled trial of the efficacy of a family-based, domiciliary intervention programme to increase physical activity among individuals at high risk of diabetes [ISRCTN61323766] A risk table to assist health practitioners assess and prevent the onset of depression in later life. Assessing the efficacy of the healthy eating and lifestyle programme (HELP) compared with enhanced standard care of the obese adolescent in the community: study protocol for a randomized controlled trial Is level of social support associated with health behaviours modifying cardiovascular risk? Results of the WOBASZ study. A cognitive/behavioral group intervention for weight loss in patients treated with atypical antipsychotics NHS health checks through general practice: randomised trial of population cardiovascular risk reduction Etiology of overactive bladder: a diet and lifestyle model for diabetes and obesity in older women. Knowledge, Attitudes and Cardiovascular Risk Factors in Danish Adults Community pharmacy interventions for public health priorities: protocol for a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions Prevalence and associated risk factors of undiagnosed diabetes among adult Moroccan Sahraoui women. A randomized study of quality of life during multiple risk factor intervention in treated hypertensive men at high cardiovascular risk Cultural factors and patients' adherence to lifestyle measures. Behavioural interventions for type 2 diabetes: an evidence-based analysis. The effect of a multi-disciplinary obesity intervention compared to usual practice in those ready to make lifestyle changes: design and rationale of Whanau Pakari Risk factors for colonic and rectal cancer mortality: evidence from 40 years’ follow-up in the Whitehall I study The use of the mHealth program Smarter Pregnancy in preconception care: rationale, study design and data collection of a randomized controlled trial
Diabetes is an “ old disease ” . The first description of diabetes written on papyrus about 3500 years ago is found in the Ebers papyrus  , which was discovered in Egypt in 1873 by the German archeologist Georg Ebers . Humans , like most mammals , may develop diabetes , if sufficient environmental exposure to physical inactivity , unhealthy diet and obesity are present . Genetic effects are important for the individual risk of type 2 diabetes ( T2D ) but twin studies have shown that the genetic effects combined explain less than 50 % of the risk of T2D ( 1 ) . Today we know almost 100 susceptibility genes associated with T2D but the relative importance of each of these genes is low ( 2 ) , and together they explain only a small part of the disease risk . Thus , genetic screening can not be used for the prediction of T2D for individuals . On the other h and , healthy lifestyle can also prevent T2D in people who are genetically at high risk , e.g. those with positive family history ( 3 ) . Thus , the importance of lifestyle factors for the development and prevention of T2D is overwhelming . The strongest evidence in medicine is considered to come from r and omized controlled trials ( RCTs ) . They are also important in providing the link to causal inference that in most observational studies can not be derived . At the same time , observational studies are necessary for the identification of factors associated with an increased or decreased risk of a disease , and for generation of hypotheses on potential means for prevention based on modifiable risk factors . Observational studies have by now identified a large number of factors that are associated with the development of T2D or with the protection against it . Most of them are related to physical activity , diet and obesity . It has also been shown unequivocally that exposures ( poor nutrition , infections , smoking , etc . ) during fetal life and early infancy result ing in insufficient development ( often shown as low birth weight ) also predict T2D later in life ( 4 ) . Traditionally , T2D has been considered to be a disease of the elderly . However , with increasing obesity and sedentary lifestyle in children , there are increasing numbers of cases of T2D already occurring at a young age in many population s ( 5 ) . In the past two decades several innovative RCTs have repeatedly shown that interventions on modifiable risk factors can reduce the incidence of diabetes in high-risk groups . The evidence has been summarized in several systematic review s and meta-analyses ( 6,7 ) . There is compelling scientific evidence from RCTs that T2D can be prevented or its onset delayed . The key for prevention is a multimodal package of lifestyle changes that is a sum outcome of dietary and physical activity behaviours . The power of lifestyle was dramatically illustrated by the Finnish Diabetes Prevention Study ( DPS ) that explicitly showed that when the study participants with impaired glucose tolerance reached all five modest lifestyle intervention targets , none of them progressed to T2D ( 8) . Importantly , lifestyle intervention lasting for 3–6 years has been shown to have a carry-over effect on T2D incidence that lasts for several years ; up to 15 in the Finnish Diabetes Prevention Study ( 9 ) and 20 years in the China Da Qing Diabetes Prevention Study ( 10 ) . The observed sustained risk reduction seems to be a result of sustained lifestyle changes , but the legacy effect of improved glycaemia during the early intervention may also have contributed to the long-term effect . The follow-up data from the Chinese study indicate moreover that vascular risks are also reduced by lifestyle management . Several prognostic question naires exist for detecting people at risk of T2D ( 11 ) . One of the screening tools with an adequately high sensitivity and specificity is the Finnish Diabetes Risk Score ( FINDRISC ) developed in Finl and ( 12 ) . The FINDRISC has been successfully implemented in the Finnish primary health care system and used also in many other countries . The FINDRISC was also tested in the Omani population and as a result a slightly modified Omani Diabetes Risk Score was developed ( 13 ) which may be a suitable screening tool for the Arab population s in the Middle East . Lifestyle interventions aim ing at translating evidence from efficacy RCTs on T2D prevention into “ real world ” intervention programmes have also been carried out in various population s. Such data were recently combined in a meta- analysis considering the relationship between intervention effectiveness and adherence to guidelines ( 14 ) . The primary meta- analysis included 22 studies with outcome data for weight loss at 12 months . The pooled result of the direct pairwise meta- analysis shows that AIMS To present and discuss a comprehensive and ready to use prediction model of risk of death after myocardial infa rct ion based on the very recently concluded follow-up of the large GISSI-Prevenzione cohort and on the integrated evaluation of different categories of risk factors : those that are non-modifiable , and those related to lifestyles , co-morbidity , background , and other conventional clinical complications produced by the index myocardial infa rct ion . METHODS The 11 - 324 men and women recruited in the study within 3 months from their index myocardial infa rct ion have been followed-up to 4 years . The following risk factors have been used in a Cox proportional hazards model : non-modifiable risk factors : age and sex ; complications after myocardial infa rct ion : indicators of left ventricular dysfunction ( signs or symptoms of acute left ventricular failure during hospitalization , ejection fraction , NYHA class and extent of ventricular asynergy at echocardiography ) , indicators of electrical instability ( number of premature ventricular beats per hour , sustained or repetitive arrhythmias during 24-h Holter monitoring ) , indicators of residual ischaemia ( spontaneous angina pectoris after myocardial infa rct ion , Canadian Angina Classification class , and exercise testing results ) ; cardiovascular risk factors : smoking habits , history of diabetes mellitus and arterial hypertension , systolic and diastolic blood pressure , blood total and HDL cholesterol , triglycerides , fibrinogen , leukocytes count , intermittent claudication , and heart rate . Multiple regression modelling was assessed by receiver operating characteristic ( ROC ) analysis . Generalizability of the models was assessed through cross validation and bootstrapping techniques . POPULATION AND RESULTS During the 4 years of follow-up , a total of 1071 patients died . Age and left ventricular dysfunction were the most relevant predictors of death . Because of pharmacological treatments , total blood cholesterol , triglycerides , and blood pressure values were not significantly associated with prognosis . Sex-specific prediction equations were formulated to predict risk of death according to age , simple indicators of left ventricular dysfunction , electrical instability , and residual ischaemia along with the following cardiovascular risk factors : smoking habits , history of diabetes mellitus and arterial hypertension , blood HDL cholesterol , fibrinogen , leukocyte count , intermittent claudication , and heart rate . The predictive models produced on the basis of information available in the routine conditions of clinical care after myocardial infa rct ion provide ready to use and highly discriminant criteria to guide secondary prevention strategies . CONCLUSIONS AND IMPLICATION S Besides documenting what should be the preferred and practicable focus of clinical attention for today 's patients , the experience of GISSI-Prevenzione suggests that periodically and prospect ively collected data bases on naturalistic ' cohorts could be an important option for updating and verifying the impact of guidelines , which should incorporate the different components of the complex profile of cardiovascular risk . The GISSI Prevenzione risk function is a simple tool to predict risk of death and to improve clinical management of subjects with recent myocardial infa rct ion . The use of predictive risk algorithms can favour the shift from medical logic , based on the treatment of single risk factors , to one centred on the patient as a whole as well as the tailoring of medical interventions according to patients ' overall risk Background Coronary Heart Disease and Cerebrovascular Disease share many predisposing , modifiable risk factors ( hypertension , abnormal blood lipids and lipoproteins , cigarette smoking , physical inactivity , obesity and diabetes mellitus ) . Lifestyle interventions and pharmacological therapy are recognised as the cornerstones of secondary prevention . Cochrane review has proven the benefits of programmes incorporating exercise and lifestyle counselling in the cardiac disease population . A Cochrane review highlighted as priority , the need to establish feasibility and efficacy of exercise based interventions for Cerebrovascular Disease . Methods A single blind r and omised controlled trial is proposed to examine a primary care cardiac rehabilitation programme for adults post transient ischemic attack ( TIA ) and stroke in effecting a positive change in the primary outcome measures of cardiac risk scores derived from Blood Pressure , lipid profile , smoking and diabetic status and lifestyle factors of habitual smoking , exercise and healthy eating participation . Secondary outcomes of interest include health related quality of life as measured by the Hospital Anxiety and Depression Scale , the Stroke Specific Quality of Life scale and WONCA COOP Functional Health Status charts and cardiovascular fitness as measured by a sub-maximal fitness test .  A total of 144 patients , over 18 years of age with confirmed diagnosis of ischaemic stroke or TIA , will be recruited from Dublin community stroke services and two tertiary T.I.A clinics . Exclusion criteria will include oxygen dependence , unstable cardiac conditions , uncontrolled diabetes , major medical conditions , claudication , febrile illness , pregnancy or cognitive impairment . Participants will be block-statified , r and omly allocated to one of two groups using a pre-prepared computer generated r and omisation schedule . Both groups will receive a two hour education class on  risk reduction  post stroke  .  The intervention group will receive a 10 week programme of supervised aerobic exercises ( twice weekly ) and individually tailored brief intervention lifestyle counselling . Both groups will be tested on week one and week ten of the programme . Follow-up at 1 year will assess longer term benefits . Analysis will test for significant changes in the key variables indicated . Discussion Application of the Cardiac Rehabilitation paradigm to patients with ischaemic stroke or TIA has not been explored despite the obvious overlap in aetiology . It is hoped the anticipated improvement in vascular risk factors and fitness result ing from such a programme will enhance health and social gain in this population .Trial Registration Current Controlled Trials ISCTRN90272638 Background Cardiovascular disease and type 2 diabetes are examples of chronic diseases that impose significant morbidity and mortality in the general population worldwide . Most chronic diseases are associated with underlying preventable risk factors , such as elevated blood pressure , high blood glucose or glucose intolerance , high lipid levels , physical inactivity , excessive sedentary behaviours , and overweight/obesity . The occurrence of intermediate outcomes during childhood increases the risk of disease in adulthood . Sugar-sweetened beverages are known to be significant sources of additional caloric intake , and given recent attention to their contribution in the development of chronic diseases , a systematic review is warranted . We will assess whether the consumption of sugar-sweetened beverages in children is associated with adverse health outcomes and what the potential moderating factors are . Methods / Design Of interest are studies addressing sugar-sweetened beverage consumption , taking a broad perspective . Both direct consumption studies as well as those evaluating interventions that influence consumption ( e.g. school policy , educational ) will be relevant . Non-specific or multi-faceted behavioural , educational , or policy interventions may also be included subject to the level of evidence that exists for the other interventions /exposures . Comparisons of interest and endpoints of interest are pre-specified . We will include r and omized controlled trials , controlled clinical trials , interrupted time series studies , controlled before-after studies , prospect i ve and retrospective comparative cohort studies , case – control studies , and nested case – control design s. The MEDLINE ® , Embase , The Cochrane Library , CINAHL , ERIC , and PsycINFO ® data bases and grey literature sources will be search ed . The processes for selecting studies , abstract ing data , and resolving conflicts are described . We will assess risk of bias using design -specific tools . To determine sets of confounding variables that should be adjusted for , we have developed causal directed acyclic graphs and will use those to inform our risk of bias assessment s. Meta- analysis will be conducted where appropriate ; parameters for exploring statistical heterogeneity and effect modifiers are pre-specified . The Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) approach will be used to determine the quality of evidence for outcomes . Systematic review registration PROSPERO CRD42014009641 Background Health promotion is a key component for primary prevention of cardiovascular disease ( CVD ) . This study evaluated the impact of healthy lifestyle promotion campaigns on CVD risk factors ( CVDRF )  in the general population in the context of a community-based programme on hypertension management . Methods A quasi-experimental intervention study was carried out in two rural communes of Vietnam from 2006 to 2009 . In the intervention commune , a hypertensive-targeted management programme integrated with a community-targeted health promotion was initiated , while no new programme , apart from conventional healthcare services , was provided in the reference commune . Health promotion campaigns focused on smoking cessation , reducing alcohol consumption , encouraging physical activity and reducing salty diets . Repeated cross-sectional surveys in local adult population aged 25 years and over were undertaken to assess changes in blood pressure ( BP ) and behavioural CVDRFs ( smoking , alcohol consumption , physical inactivity and salty diet ) in both communes before and after the 3-year intervention . Results Overall 4,650 adults above 25 years old were surveyed , in four r and omly independent sample s covering both communes at baseline and after the 3-year intervention . Although physical inactivity and obesity increased over time in the intervention commune , there was a significant reduction in systolic and diastolic BP ( 3.3 and 4.7 mmHg in women versus 3.0 and 4.6 mmHg in men respectively ) in the general population at the intervention commune . Health promotion reduced levels of salty diets but had insignificant impact on the prevalence of daily smoking or heavy alcohol consumption . Conclusion Community-targeted healthy lifestyle promotion can significantly improve some CVDRFs in the general population in a rural area over a relatively short time span . Limited effects on a context -bound CVDRF like smoking suggested that higher intensity of intervention , a supportive environment or a gender approach are required to maximize the effectiveness and maintain the sustainability of the health intervention The main goal of the preventive intervention study in one community of the German CINDI ( Countrywide Integrated Non-Communicable Diseases Intervention programme of the WHO ) area was to improve cardiovascular health by reducing the risk factors smoking , hypertension , obesity , hypercholesterolaemia , and by changing sedentary lifestyle . The intervention was performed by using the special " Three-Level- Strategy " , which is characterised by activities of primary care physicians in the usual consulting hour ( 1st level ) , with patient groups in their practice s ( 2nd level ) , and at community level ( 3rd level ) where a special work group and a co-ordinating general practice are co-operating . To evaluate the occurrence of the risk factors in practice and the local population , four cross-sectional r and om sample s ( N(total ) = 4881 ) were carried out in seven practice s from 1992 to 1995 . On the community level , 23 special exercise-based health groups ( N(total ) = 600 ) were established and were investigated by means of a question naire , related to behaviour and health beliefs . A " Local Health Information System " facilitated the evaluation , the management of the data , and the organisation of the health programme . The results of the practice sample s showed a significant reduction of smoking ( -17.8 % ) and hypertension ( -31.5 % ) ( p < 0.01 ) . The exercise-based groups were combined with nutritional counselling or relaxation and were accepted very well by the participants ( 83.8 % ) . The participants considerably improved their health behaviour : 82 % discussed health in their family , 37.3 % stated an increase of healthy nutrition , 52 % of relaxation ; 86.2 % intended to regularly increase physical activity in leisure time and 82 % could not imagine regular health training without exercise meetings . We conclude that the practice -based " Three-Level- Strategy " provides a strong support for successful long-term prevention of cardiovascular risk , particularly , when exercise-based health training sessions are performed in order to change sedentary lifestyle . When organised on community level , they might have a positive impact on the health behaviour of the whole community . Physical activity can be used as a " prodrug " for health promotion in a holistic way BACKGROUND & OBJECTIVE Cardiovascular and other chronic diseases are becoming the major causes of morbidity and mortality in most of the third world countries including India , especially in the southern Indian States , like Kerala , where most of the health indicators match closely with those of any developed country . Various behavioural risk factors ( BRF ) namely smoking , unhealthy diet , stress at home and work place , consumption of alcohol , sedentary life style , etc . , are known to be risk factors for many such diseases . The present study was carried out to estimate the prevalence of various behavioural risk factors for chronic diseases , and to identify their biosocial correlates . METHODS A cross-sectional study was done in which the data were collected from a sample of 6579 individuals of age 30 to 74 yr , r and omly selected following a stratified multi-stage cluster sampling design covering Kerala State . The important factors investigated include various behavioural risk factors , presenting chronic diseases and family histories among close relatives . The data were analysed using both univariate and multivariate analyses . RESULTS The two major risk factors observed among males were smoking and alcohol consumption . About two fifths ( 40 % ) of them were current smokers as well as current users of alcohol ( 41 % ) . The median age at initiation was 21 yr for both smoking habits and for alcohol consumption . Nearly a quarter of the target population were inactive ( 23 % males and 22 % females ) based on work and leisure time activities . More than one-fifth of them ( 23 % ) reported stress . Obesity was found more among females ( 33 % ) than males ( 17 % ) . Low socio-economic background was found to be a high predictor ( high risk group ) for habit of smoking , alcohol consumption , stress and unhealthy diet . INTERPRETATION & CONCLUSION Substantially high levels of the various behavioural risk factors among adults in Kerala suggests an urgent need for adopting healthy life style modifications among the population in general . The increased risk observed among the younger generation for behavioural risk factors such as smoking and alcohol consumption calls for urgent corrective steps and measures for long-term monitoring of all major risk factors as well as the major chronic disease conditions Background Increasing prevalence of obesity and disorders associated with sedentary living constitute a major global public health problem . While previous evaluations of interventions to increase  physical activity  have involved communities or individuals with established disease , less attention has been given to interventions for individuals at risk of disease . Methods / design ProActive aims to evaluate the efficacy of a theoretical , evidence - and family-based intervention programme to increase physical activity  in a sedentary population , defined as being at-risk through having a parental family history of diabetes . Primary care diabetes or family history registers were used to recruit 365 individuals aged 30–50 years , screened for activity level . Participants were assigned by central r and omisation to three intervention programmes : brief written advice ( comparison group ) , or a psychologically based behavioural change programme , delivered either by telephone ( distance group ) or face-to-face in the family home over one year . The protocol -driven intervention programme is delivered by trained facilitators , and aims to support increases in physical activity through the introduction and facilitation of a range of self-regulatory skills ( e.g. goal setting ) . The primary outcome is daytime energy expenditure and its ratio to resting energy expenditure , measured at baseline and one year using individually calibrated heart rate monitoring . Secondary measures include self-report of individual and family activity , psychological mediators of behaviour change , physiological and biochemical correlates , acceptability , and costs , measured at baseline , six months and one year . The primary intention to treat analysis will compare groups at one-year post r and omisation . Estimation of the impact on diabetes incidence will be modelled using data from a parallel ten-year cohort study using similar measures . Discussion ProActiveis the first efficacy trial of an intervention programme to promote physical activity in a defined high-risk group accessible through primary care . The intervention programme is based on psychological theory and evidence ; it introduces and facilitates the use of self-regulatory skills to support behaviour change and maintenance . The trial addresses a range of method ological weaknesses in the field by careful specification and quality assurance of the intervention programme , precise characterisation of participants , year-long follow-up and objective measurement of physical activity . Due to report in 2005 , ProActivewill provide estimates of the extent to which this approach could assist at-risk groups who could benefit from changes in behaviours affecting health , and inform future pragmatic trials OBJECTIVE This study aim ed to develop a simple risk table of modifiable factors prospect ively associated with  depression in later life that could be used to guide the assessment , management and introduction of preventive strategies in clinical practice . METHODS This retrospective cohort study included 4636 men aged 65 to 83 years living in the community who denied history of past diagnosis or treatment for depression . They self-reported information about their physical activity , weight and height , smoking history , alcohol consumption and dietary habits , as well as history of hypertension , diabetes , coronary heart disease and stroke . We calculated the body mass index ( BMI ) in kg/m(2 ) . Three to 8 years later they were assessed with the Geriatric Depression Scale 15 ( GDS-15 ) and those with a total score of 7 or greater were considered to display clinical ly significant symptoms of depression . We used binomial exponentiated log-linked general linear models to estimate the risk ratio ( RR ) and 95 % confidence interval ( 95 % CI ) of incident depression after adjusting for age , education , marital status and prevalent medical illnesses . We calculated the probability of depression for each individual combination of risk factors and displayed the results in a risk table . RESULTS Two hundred and twenty-nine men ( 4.5 % ) showed evidence of incident depression 5.7±0.9 ( mean±st and ard deviation ) years later . Measured dietary factors showed no association with incident depression . The probability of depression was the highest for older men who were underweight , overweight or obese , physically inactive , risk drinkers and smokers ( 12.0 % , 95 % CI=7.0 % , 17.1 % ) , and the lowest for those who had all 4 healthy lifestyle markers : physically active , normal body mass , non-risk drinking and non-smoking ( 1.6 % , 95 % CI=0.6 % , 2.5 % ) . The probability of incident depression fell between these two extremes for different combinations of lifestyle practice s. CONCLUSION Four modifiable lifestyle factors can be used in combination to produce a risk table that predicts the probability of incident depression over a period of 3 to 8 years . The risk table is simple , informative and can be easily incorporated into clinical practice to guide assessment and risk reduction interventions Background The childhood obesity epidemic is one of the foremost UK health priorities . Childhood obesity tracks into adult life and places individuals at considerable risk for diabetes , cardiovascular disease , liver disease and other morbidities . There is widespread need for paediatric lifestyle programmes as change may be easier to accomplish in childhood than later in life . Study Design / Method The study will evaluate the management of adolescent obesity by conducting a Medical Research Council complex intervention phase III efficacy r and omised clinical trial of the Healthy Eating Lifestyle Programme within primary care . The study tests a community delivered multi-component intervention design ed for adolescents developed from best practice as identified by National Institute for Health and Clinical Excellence . The hospital based pilot reduced body mass index and improved health-related quality of life . Subjects will be individually r and omised to receiving either the Healthy Eating Lifestyle Programme ( 12 fortnightly family sessions ) or enhanced st and ard care . Baseline and follow up assessment s will be undertaken blind to allocation status . A health economic evaluation is also being conducted.200 obese young people ( 13 - 17 years , body mass index > 98th centile for age and sex ) will be recruited from primary care within the greater London area . The primary hypothesis is that a motivational and solution-focused family-based weight management programme delivered over 6 months is more efficacious in reducing body mass index in obese adolescents identified in the community than enhanced st and ard care . The primary outcome will be body mass index at the end of the intervention , adjusted for baseline body mass index , age and sex . The secondary hypothesis is that the Healthy Eating Lifestyle Programme is more efficacious in improving quality of life and psychological function and reducing waist circumference and cardiovascular risk factors in obese adolescents than enhanced st and ard care assessed at 6 and 12 months post baseline assessment .Improvement in quality of life predicts on-going lifestyle change and maximises the chances of long-term weight reduction . We will explore whether improvement in QOL may be intermediate on the pathway between the intervention and body mass index change . Trial registration IS RCT N : IS RCT BACKGROUND Psychosocial risk factors affected the human health both by autonomic , neuroendocrine and immunological mechanisms and by the influence on human lifestyle . Lack of social support can reflect the person 's lifestyle to more unhealthy . AIM To assess if low , compared to high social support level ( SSL ) , contributes to the unhealthy lifestyle in Polish general population . METHODS The r and om sample of Polish population of 6164 men and 6915 women , aged 20 - 74 , filled-in the  Berkman and Syme question naire  in 2003 - 2005 in the frame of National Multicenter Health Survey ( WOBASZ ) . RESULTS 31 % of men and 39 % of women had low SSL and they more often had high cardiovascular risk , depressive symptoms and cardiovascular disease risk factors , especially women . Men and women with low SSL more often smoked cigarettes than those with high SSL , rarely try to quit smoking , made regular physical activity , and rarely self-measured their blood pressure . Additionally men more often drank alcohol ≥ 30.0 g/day . They also more often did not take the prescribed medication , although they bought them . Out of unhealthy elements , lack of regular physical activity and blood pressure self-measuring were significantly and independently associated with SSL in both genders and additionally smoking habit and lack of quit smoking in the past in women . CONCLUSIONS Persons with low SSL had more unhealthy lifestyle than those without . In Polish population the low SSL played a greater role in creating the cardiovascular risk in women than in men Obesity and diabetes have caused problems for individuals with schizophrenia long before atypical antipsychotic agents . The prevalence of obesity , insulin resistance , impaired glucose tolerance , type 2 diabetes mellitus , dyslipidemia , and the Metabolic Syndrome has increased in people with schizophrenia as compared to the general population . Risk reduction studies for persons with obesity , diabetes , and cardiovascular disease indicate that cognitive/behavioral interventions that promote motivation and provide strategies to overcome the barriers in adherence to diet and activity modification are effective interventions for weight management and risk reduction . In the l and mark multi-center r and omized-controlled trial study , the Diabetes Prevention Project ( DPP ) , a cognitive/behavioral intervention , was more successful in producing weight loss and preventing diabetes than the drugs metformin , troglitazone or placebo . This pilot study examined the effectiveness of a cognitive/behavioral group intervention , modified after the DPP program , in individuals with schizophrenia or schizoaffective disorder taking atypical antipsychotics in a large urban public mental health system . Outcome measures included body weight , body mass index , waist-hip ratios , and fasting glucose levels . Both groups demonstrated elevated fasting glucose levels and were obese with a mean BMI of 33 . The group that received the cognitive/behavioral group intervention  lost more weight than the treatment as usual group . The CB group participants lost an average of 5.4 lb or 2.9 % of body weight , and those in the control group lost 1.3 lb or 0.6 % body weight . The range of weight loss for the treatment group was from 1 to 20 lb . This pilot study has demonstrated that weight loss is possible with cognitive/behavioral interventions in a population with a psychotic disorder Background The global burden of the major vascular diseases is projected to rise and to remain the dominant non-communicable disease cluster well into the twenty first century . The Department of Health in Engl and has developed the NHS Health Check service as a policy initiative to reduce population vascular disease risk . The aims of this study were to monitor population changes in cardiovascular disease ( CVD ) risk factors over the first year of the new service and to assess the value of tailored lifestyle support , including motivational interview with ongoing support and referral to other services . Methods R and omised trial comparing NHS Health Check service only with NHS Health Check service plus additional lifestyle support in Stoke on Trent , Engl and . Thirty eight general practice s and 601 ( 365 usual care , 236 additional lifestyle support ) patients were recruited and r and omised independently between September 2009 and February 2010 . Changes in population CVD risk between baseline and one year follow-up were compared , using intention-to-treat analysis . The primary outcome was the Framingham 10 year CVD risk score . Secondary outcomes included individual modifiable risk measures and prevalence of individual risk categories . Additional lifestyle support included referral to a lifestyle coach and free sessions as needed for : weight management , physical activity , cook and eat and positive thinking . Results Average population CVD risk decreased from 32.9 % to 29.4 % ( p < 0.001 ) in the NHS Health Check only group and from 31.9 % to 29.2 % ( p < 0.001 ) in the NHS Health Check plus additional lifestyle support group . There was no significant difference between the two groups at either measurement point . Prevalence of high blood pressure , high cholesterol and smoking were reduced significantly ( p < 0.01 ) in both groups . Prevalence of central obesity was reduced significantly ( p < 0.01 ) in the group receiving additional lifestyle support but not in the NHS Health Check only group . Conclusions The NHS Health Check service in Stoke on Trent result ed in significant reduction in estimated population CVD risk . There was no evidence of further benefit of the additional lifestyle support services in terms of absolute CVD risk reduction OBJECTIVE To evaluate a coherent , evidence -based hypothesis that specific modifiable lifestyle factors implicated in the development of diabetes and associated obesity are related to the onset of OAB . METHODS A hypothetical causative model for OAB involving modifiable lifestyle factors implicated in the development of diabetes and obesity was constructed , based on a systematic literature review . Secondary analysis of data was undertaken in a prospect i ve cohort of women aged 40 and over , living in Leicestershire , UK . Subjects included 3,411 women free from OAB at baseline and 277 incident cases of OAB . Reported diet , lifestyle , morbid , and social factors were measured at baseline and incident cases at 1-year follow-up . Graphical chain modeling was used to estimate the associations between variables and identify likely pathways involved . RESULTS All hypothesized lifestyle factors ( physical activity , high glycemic index , and high energy intake ) plus diabetes and obesity were retained within the graph as potential contributors . However , low physical activity was the only direct risk factor linked prospect ively to the onset of OAB ( RR 2.47 ; 95 % CI 1.82 , 3.36 ) , in addition to older age . CONCLUSIONS Poor lifestyle factors causally linked to diabetes and obesity may contribute to the onset of OAB ; low physical activity appears to be an important modifiable causal factor for OAB operating directly as well as indirectly via pathways involving obesity or diabetes . Further research is needed to demonstrate a causal link between lifestyle and OAB A community cardiovascular disease ( CVD ) prevention programme was undertaken in 1989 in a Danish County ( Vejle ) . A r and om sample of 5192 adults were asked to complete a mailed question naire on  knowledge , attitudes , and behaviour  in relation to CVD risk factors . The response rate was 56 % . The question naire produced baseline data for programme planning and measuring the success of on-going interventions . Smoking , overweight , and unhealthy food habits were the most prevalent CVD risk factors . A CVD risk score was calculated from the data on smoking , food habits , exercise , stress , overweight , self-reported presence of hypertension , diabetes , and gender . A high score was commoner in men , in the least educated , in groups who judged their own risk as high , and in groups with negative health beliefs . The level of knowledge about CVD risk factors was high in general . Low knowledge was commonest in the youngest age group , in the least educated , in unskilled workers , and in groups with negative health beliefs . As social position and personality factors seem to play an important role in actions people may take in prevention of CVD , they should be considered in the planning of the health promotion activities in Vejle Background Community pharmacists can deliver health care advice at an opportunistic level , related to prescription or non-prescription medicines and as part of focused services design ed to reduce specific risks to health . Obesity , smoking and excessive alcohol intake are three of the most significant modifiable risk factors for morbidity and mortality in the UK , and interventions led by community pharmacists , aim ed at these three risk factors , have been identified by the government as public health priorities . In 2008 , the Department of Health for Engl and stated that ‘ a sound evidence base that demonstrates how pharmacy delivers effective , high quality and value for money services is needed ’ ; this systematic review aims to respond to this requirement . Methods / design We will search the data bases MEDLINE , Embase , CINAHL , PsycINFO , Social Sciences Citation Index , ASSIA , IBSS , Sociological Abstract s , Scopus and NHS Economic Evaluation Data base for studies that have evaluated interventions based on community pharmacies that aim to target weight management , smoking cessation and alcohol misuse . We will include all r and omised controlled trials ( RCTs ) , non-r and omised controlled trials ( N RCTs ) , controlled before-after studies ( CBAs ) and interrupted time series ( ITS ) and repeated measures studies . Data from included studies will be extracted by two independent review ers and will include study details methods , results , intervention implementation/costs and method ological quality . Meta- analysis will be conducted if appropriate ; if not , the synthesis will be restricted to a narrative overview of individual studies looking at the same question . Discussion The review aims to summarise the evidence base on the effectiveness of community pharmacy interventions on health and health behaviours in relation to weight management , smoking cessation and alcohol misuse . It will also explore if , and how , socio-economic status , gender , ethnicity and age moderate the effect of the interventions and will describe how the interventions included in the review have been organised , implemented and delivered , since context is an important factor governing the success of public health interventions . The findings from this review will have an impact on the commissioning of public health services aim ing to promote healthy weight , smoking cessation and prevent excessive alcohol consumption . Systematic review registration The review has been registered with PROSPERO ( registration no. CRD42013005943 ) . Available at : http://www.crd.york.ac.uk/ prospero /display_record.asp?ID = CRD42013005943 OBJECTIVE The goal of the present work was to examine the prevalence and associated risk factors of undiagnosed diabetes among urban Moroccan Sahraoui women . DESIGN AND SETTING R and omised sample of adult women living in the city of Laayoune in south Morocco who visited public health centres during an immunisation campaign .  Body weight , height , waist and hip circumferences , blood pressure , fasting plasma glucose ( FPG ) , triglycerides , dietary intake and physical activity  were collected . SUBJECTS Data were obtained on 249 urban women aged 15 years and older , who were not pregnant . Only subjects identified as of Sahraoui origin were eligible for this investigation . RESULTS The prevalence of impaired fasting glucose ( IFG ) was 5.5 % and that of undiagnosed diabetes 6.4 % . Diabetes and IFG were more common among older and obese women as well as among women with hypertension or a family history of diabetes . In addition , sucrose intakes were higher in women with diabetes than in those with normal FPG . Also , physical activity estimated as the time spent in walking was negatively associated with FPG . Regression analyses showed an independent association of age , obesity , family history of diabetes and triglycerides with diabetes . CONCLUSION The high proportion of unknown diabetes suggests the need for increased diabetes awareness in this population . The data suggest also the involvement of obesity in diabetes and the potential importance of intervention strategies to reduce population adiposity for the prevention and management of cardiovascular risk factors Objective To examine the effect on quality of life in hypertensive men of a multiple risk factor intervention programme  compared with that of usual care .  Design A prospect i ve , open , r and omized , parallel-group study with allocation either to a comprehensive multiple risk factor modification programme or to usual care . Setting An outpatient clinic in a city hospital . Patients : Five hundred and eight treated hypertensive men , aged 50–72 years , with at least one of the following : serum cholesterol ≥ 6.5 mmol/l , smoking habit or diabetes mellitus . Intervention Nutritional advice , behavioural treatment principles and drug therapy . Main outcome measures : Minor symptoms evaluation profile ( MSEP ) was used to measure change in quality of life . Results The intervention programme led to sustained effects on lifestyle-related variables such as hypercholesterolaemia , body mass index and smoking habits , whereas diastolic blood pressure and HbA1c remained unchanged . The change in the MSEP during follow-up did not differ between the intervention and the usual care groups . There was a close relationship between the measurements of the three MSEP dimensions at baseline and at follow-up ( P < 0.0001 ) . None of the potential risk factors measured at entry was significantly associated with change in the three MSEP dimensions during follow-up . Conclusion The multiple risk factor intervention programme directed towards smoking habits , hypercholesterolaemia and the metabolic control of diabetes mellitus in treated hypertensive men at high cardiovascular risk was not associated with an impaired quality of life compared with that in a control group . The method used , the MSEP , has previously been found to be a reliable method with good validity , and this study 's results provide further evidence of its validity BACKGROUND Non-adherence to preventive and therapeutic lifestyle recommendations among patients at high risk of cardiovascular disease is more prevalent and varied than previously thought . The problem needs to be addressed by those who are involved in the care of these patients . AIM To measure adherence and barriers of complying with lifestyle recommendations among patients with high cardiovascular risk factors . DESIGN OF STUDY Prospect i ve study . SETTING Six family- practice health centres in Kuwait . METHOD Data are from 334 Kuwaiti adult males and females with hypertension , type 2 diabetes , or both , who completed a routine clinic visit in one of six family practice centres . Trained staff used a structured question naire to obtain a detailed medical history regarding exercise habits and barriers to compliance with diet and exercise programmes . Clinical criteria assessed were height , weight , and the control of blood pressure and blood sugar . RESULTS From the study sample , 63.5 % of patients reported that they were not adhering to any diet regimen , 64.4 % were not participating in regular exercise , and 90.4 % were overweight and obese . The main barriers to adherence to diet were unwillingness ( 48.6 % ) , difficulty adhering to a diet different from that of the rest of the family ( 30.2 % ) , and social gatherings ( 13.7 % ) . The main barriers to adherence to exercise were lack of time ( 39.0 % ) , coexisting diseases ( 35.6 % ) , and adverse weather conditions ( 27.8 % ) . Factors interfering with adherence to lifestyle measures among the total sample were traditional Kuwaiti food , which is high in fat and calories ( 79.9 % ) , stress ( 70.7 % ) , a high consumption of fast food ( 54.5 % ) , high frequency of social gatherings ( 59.6 % ) , abundance of maids ( 54.1 % ) , and excessive use of cars ( 83.8 % ) . CONCLUSION The majority of individuals in the sample were overweight , did not engage in recommended levels of physical activity , and did not follow dietary recommendations . Additional cultural and demographic variables need to be considered to improve adherence to lifestyle measures UNLABELLED In June 2008 , the Medical Advisory Secretariat began work on the Diabetes Strategy Evidence Project , an evidence -based review of the literature surrounding strategies for successful management and treatment of diabetes . This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry 's newly released Diabetes Strategy .After an initial review of the strategy and consultation with experts , the secretariat identified five key areas in which evidence was needed . Evidence -based analyses have been prepared for each of these five areas : insulin pumps , behavioural interventions , bariatric surgery , home telemonitoring , and community based care . For each area , an economic analysis was completed where appropriate and is described in a separate report . To review these titles within the Diabetes Strategy Evidence series , please visit the Medical Advisory Secretariat Web site , http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html,DIABETES STRATEGY EVIDENCE PLATFORM : Summary of Evidence -Based AnalysesContinuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics : An Evidence -Based Analysis Behavioural Interventions for Type 2 Diabetes : An Evidence -Based Analysis  BARIATRIC SURGERY FOR PEOPLE WITH DIABETES AND MORBID OBESITY : An Evidence -Based Summary Community-Based Care for the Management of Type 2 Diabetes : An Evidence -Based Analysis Home Telemonitoring for Type 2 Diabetes : An Evidence -Based Analysis Application of the Ontario Diabetes Economic Model ( ODEM ) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario OBJECTIVE The objective of this report is to determine whether behavioural interventions are effective in improving glycemic control in adults with type 2 diabetes . BACKGROUND Diabetes is a serious chronic condition affecting millions of people worldwide and is the sixth leading cause of death in Canada . In 2005 , an estimated 8.8 % of Ontario 's population had diabetes , representing more than 816,000 Ontarians . The direct health care cost of diabetes was $ 1.76 billion in the year 2000 and is projected to rise to a total cost of $ 3.14 billion by 2016 . Much of this cost arises from the serious long-term complications associated with the disease including : coronary heart disease , stroke , adult blindness , limb amputations and kidney disease . Type 2 diabetes accounts for 90 - 95 % of diabetes and while type 2 diabetes is more prevalent in people aged 40 years and older , prevalence in younger population s is increasing due to a rise in obesity and physical inactivity in children . Data from the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) has shown that tight glycemic control can significantly reduce the risk of developing serious complications in type 2 diabetics . Despite physicians ' and patients ' knowledge of the importance of glycemic control , Canadian data has shown that only 38 % of patients with diabetes have HbA1C levels in the optimal range of 7 % or less . This statistic highlights the complexities involved in the management of diabetes , which is characterized by extensive patient involvement in addition to the support provided by physicians . An enormous dem and is , therefore , placed on patients to self-manage the physical , emotional and psychological aspects of living with a chronic illness . Despite differences in individual needs to cope with diabetes , there is general agreement for the necessity of supportive programs for patient self-management . While traditional programs were didactic models with the goal of improving patients ' knowledge of their disease , current models focus on behavioural approaches aim ed at providing patients with the skills and strategies required to promote and change their behaviour . Several meta-analyses and systematic review s have demonstrated improved health outcomes with  self-management support programs in type 2 diabetics . They have all , however , either looked at a specific component of self-management support programs ( i.e. self-management education ) or have been conducted in specific population s. Most review s are also qualitative and do not clearly define the interventions of interest , making findings difficult to interpret . Moreover , heterogeneity in the interventions has led to conflicting evidence on the components of effective programs . There is thus much uncertainty regarding the optimal design and delivery of these programs by policymakers . EVIDENCE -BASED ANALYSIS OF EFFECTIVENESS : RESEARCH QUESTIONS Are behavioural interventions  effective in improving glycemic control in adults with type 2 diabetes?Is the effectiveness of the intervention impacted by intervention characteristics ( e.g. delivery of intervention , length of intervention , mode of instruction , interventionist etc . ) ? INCLUSION CRITERIA English Language Published between January 1996 to August 2008 Type 2 diabetic adult population ( > 18 years)R and omized controlled trials ( RCTs ) Systematic review s , or meta-analyses Describing a multi-faceted self-management support intervention as defined by the 2007 Self-Management Mapping Guide (1)Reporting outcomes of glycemic control ( HbA1c ) with extractable data Studies with a minimum of 6-month follow up EXCLUSION CRITERIA Studies with a control group other than usual care Studies with a sample size < 30 Studies without a clearly defined intervention OUTCOMES OF INTEREST PRIMARY OUTCOME glycemic control ( HbA1c ) SECONDARY OUTCOMES systolic blood pressure ( SBP ) control , lipid control , change in smoking status , weight change , quality of life , knowledge , self-efficacy , managing psychosocial aspects of diabetes , assessing dissatisfaction and readiness to change , and setting and achieving diabetes goals . SEARCH STRATEGY A search was performed in OVID MEDLINE , MEDLINE In-Process and Other Non-Indexed Citations , EMBASE , the Cumulative Index to Nursing & Allied Health Literature ( CINAHL ) , The Cochrane Library , and the International Agency for Health Technology Assessment ( INAHTA ) for studies published between January 1996 and August 2008 . Abstract s were review ed by a single author and studies meeting the inclusion criteria outlined above were obtained . Data on population characteristics , glycemic control outcomes , and study design were extracted . Reference lists were also checked for relevant studies . The quality of the evidence was assessed as being either high , moderate , low , or very low according to the GRADE methodology . SUMMARY OF FINDINGS The search identified 638 citations published between 1996 and August 2008 , of which 12 met the inclusion criteria and one was a meta- analysis ( Gary et al. 2003 ) . The remaining 11 studies were RCTs ( 9 were used in the meta- analysis ) and only one was defined as small ( total sample size N=47 ) . SUMMARY OF PARTICIPANT DEMOGRAPHICS ACROSS STUDIES : A total of 2,549 participants were included in the 11 identified studies . The mean age of participants reported was approximately 58 years and the mean duration of diabetes was approximately 6 years . Most studies reported gender with a mean percentage of females of approximately 67 % . Of the eleven studies , two focused only on women and four included only Hispanic individuals . All studies evaluated type 2 diabetes patients exclusively . STUDY CHARACTERISTICS : The studies were conducted between 2002 and 2008 . Approximately six of 11 studies were carried out within the USA , with the remaining studies conducted in the UK , Sweden , and Israel ( sample size ranged from 47 to 824 participants ) . The quality of the studies ranged from moderate to low with four of the studies being of moderate quality and the remaining seven of low quality ( based on the Consort Checklist ) . Differences in quality were mainly due to method ological issues such as inadequate description of r and omization , sample size calculation allocation concealment , blinding and uncertainty of the use of intention-to-treat ( ITT ) analysis . Patients were recruited from several setting s : six studies from primary or general medical practice s , three studies from the community ( e.g. via advertisements ) , and two from outpatient diabetes clinics . A usual care control group was reported in nine of 11 of the studies and two studies reported some type of minimal diabetes care in addition to usual care for the control group . INTERVENTION CHARACTERISTICS : All of the interventions examined in the studies were mapped to the 2007 Self-management Mapping Guide . The interventions most often focused on problem solving , goal setting and encouraging participants to engage in activities that protect and promote health ( e.g. modifying behaviour , change in diet , and increase physical activity ) . All of the studies examined comprehensive interventions targeted at least two self-care topics ( e.g. diet , physical activity , blood glucose monitoring , foot care , etc . ) . Despite the homogeneity in the aims of the interventions , there was substantial clinical heterogeneity in other intervention characteristics such as duration , intensity , setting , mode of delivery ( group vs. individual ) , interventionist , and outcomes of interest ( discussed below ) . DURATION , INTENSITY AND MODE OF DELIVERY : Intervention duration s ranged from 2 days to 1 year , with many falling into the range of 6 to 10 weeks . The rest of the interventions fell into categories of ≤ 2 weeks ( 2 studies ) , 6 months ( 2 studies ) , or 1 year ( 3 studies ) . Intensity of the interventions varied widely from 6 hours over 2 days , to 52 hours over 1 year ; however , the majority consisted of interventions of 6 to 15 hours . Both individual and group sessions were used to deliver interventions . Group counselling was used in five studies as a mode of instruction , three studies used both individual and group sessions , and one study used individual sessions as its sole mode of instruction . ( ABSTRACT Background Child obesity internationally has been identified as one of the major threats to future population health . Indigenous people and those from lower socio-economic background s are over-represented in obesity statistics . There is a need for evidence of effect of interventions for child obesity with long-term follow-up . Whether engaging with those that are more motivated to make lifestyle changes is a useful strategy has not been fully explored . We hypothesise that in obese/overweight children , assessed as psychologically “ ready for change ” , delivery of a 12-month multi-disciplinary intervention programme results in a significant reduction in body mass index st and ard deviation score . Methods / Design Whanau Pakari is an unblinded r and omised controlled clinical trial comparing a 12 month intervention programme with st and ard practice , with 6 monthly assessment s for 2 years , conducted in Taranaki , New Zeal and ( a region where 15.8 % of the population are indigenous ) . It specifically targets indigenous people and those in more deprived households . Obese/overweight children and adolescents aged 5–16 years are eligible . Exclusion criteria are medical/psychological conditions leading to inability to undertake physical activity/participate in group sessions ; those not “ ready ” to make lifestyle changes ; and those without a committed family member . Assessment s of health parameters , dietary history , physical activity and overall health-related quality of life/psychological functioning are completed in the participant ’s home .  Fasting blood tests are obtained at baseline , 12 and 24 months . The primary outcome is body mass index st and ard deviation score . Secondary outcomes include quality of life , dietary behaviour and physical activity , cardiovascular and metabolic profile ( blood pressure , resting heart rate , waist circumference ) , glycaemic control ( fasting glucose and glycated Haemoglobin ) , fasting insulin , and lipids . A general linear mixed model will be used to assess change from baseline using the 6 , 12 , 18 and 24 month measures , adjusting for age , gender , socioeconomic status and ethnicity , and whether at the contemplative or preparation/action stages of readiness for change . Discussion This trial will inform the development of management programmes for obese children and adolescents that are appropriate for indigenous population s. It will investigate whether those at the preparation/action stage of “ readiness ” to make lifestyle changes are more successful in making changes than those who are contemplative . Trial registration Australian New Zeal and Clinical Trials Registry (ANZCTR):12611000862943 . ( Date registered 15/08/2011 ) Background Modifiable behavioural risk factors — including exercise , obesity and smoking — have been causally associated with  colorectal cancer mortality . However , results have been inconsistent and undiagnosed cancers may affect baseline risk factors , distorting the temporal relationship that is observed between them . Objective To determine whether risk factors for colorectal cancers available in the Whitehall I study were predictive of colonic or rectal cancer mortality . Methods Prospect i ve cohort study over 40 years on Whitehall I men aged 40–69 on entry between 1967 and 1970 . Associations between baseline risk factors and cause-specific mortality were tested with Cox proportional hazards models . Events within the first 10 years of follow-up were excluded to minimise ‘ reverse causality . ’ Results 329 colon and 121 rectal cancer deaths occurred among 17 949 men followed up for a total of 472 523 person-years . Age and smoking were associated with increased mortality from colorectal cancers . Compared with never-smokers , current smoking was associated with age-adjusted HRs for colon and rectal cancers of 1.45 ( 95 % CI 1.03 to 2.03 ) and 1.97 ( 95 % CI 1.02 to 3.80 ) , respectively . A significant effect of current smoking on rectal cancer mortality was only apparent after events in the first 10 years of follow-up were excluded . No convincing evidence was found that body mass index , diabetes mellitus , blood pressure or physical activity were associated with colorectal cancer mortality . Conclusion Smoking significantly increases mortality from colorectal cancer  and its decreasing prevalence in the UK may partly explain falling mortality from the disease . Changes in health behaviours in response to early cancer symptoms may result in differential misclassification or ‘ reverse causality ’ unless early events are excluded . Although many individual cohort studies have not shown significant relationships between behavioural risk factors and colorectal cancer mortality , their contribution to meta-analyses remains important Background Unhealthy nutrition and lifestyle contribute to the worldwide rising prevalence of non-communicable diseases . This also accounts for the reproductive population , in which unhealthy behavior affects fertility and pregnancy outcome . Maternal smoking , alcohol consumption and inadequate folic acid supplement use are strongly associated with fetal complications as small for gestational age , premature birth and congenital malformations . In the Netherl and s 83 % of the perinatal mortality rate is due to these complications and is relatively high compared to other European countries . In order to reduce this prevalence rate , preconception care should be focused on the promotion of health of prospect i ve parents by identification and intervention on modifiable nutrition and lifestyle risk factors . We developed the personal mHealth program ‘ Smarter Pregnancy ’ ( Dutch version available on : https://www.slimmerzwanger.nl ) to provide individual coaching and information to improve nutrition and lifestyle during the preconception period in order to improve health of the reproductive population and subsequent generations . Methods Women between 18 and 45 years of age , and trying to conceive are eligible for inclusion in a r and omized controlled trial . Participants are allocated either to a general population cohort or a subfertile ( IVF/ICSI ) population cohort . The intervention group receives personal online coaching based on the identified nutrition and lifestyle risk factors at baseline . Coaching comprises recipes , incentives , additional questions including feedback and text and e-mail messages , with a maximum of three per week . The control group only receives one recipe per week to maintain adherence to the program and prevent drop out . Screening question naires are send in both groups at 6 , 12 , 18 , and 24 weeks of the program to monitor the change in the identified risk factors . Discussion We expect to demonstrate that the mHealth program ‘ Smarter Pregnancy ’ can effectively improve nutrition and lifestyle in couples contemplating pregnancy . By the identification and improvement of modifiable nutrition and lifestyle risk factors on a large scale , both reproductive and pregnancy outcomes can be improved and subsequent perinatal morbidity and mortality rates are expected to be reduced . The current use and rapid development of mHealth applications offers new opportunities to reach and educate large population s , which can facilitate the implementation of preconception care . Trial registration Dutch trial register : NTR4150 . ( Registered 19th August 2013
Results The results of the meta- analysis show an effect toward the experimental group .
Notably , prevention studies with individual psychoeducational programmes that include diet and /or physical activity seem to have the highest impact .
Conclusions When compared with treatment as usual in psychotic patients , preventive and individual lifestyle interventions that include diet and physical activity generally prove to be effective in reducing weight .
This percentage is below the 5 % to 10 % weight loss deemed sufficient to improve weight-related complications such as hypertension , type II diabetes , and dyslipidemia .
However , it is reported that outcomes associated with metabolic risk factors may have greater health implication s than weight changes alone .
Background Psychiatric patients have more physical health problems and much shorter life expectancies compared to the general population , due primarily to premature cardiovascular disease .
A multi-causal model which includes a higher prevalence of risk factors has provided a valid explanation .
It takes into consideration not only risks such as gender , age , and family history that are inherently non-modifiable , but also those such as obesity , smoking , diabetes , hypertension , and dyslipidemia that are modifiable through behavioural changes and improved care .
Thus , it is crucial to focus on factors that increase cardiovascular risk .
Obesity in particular has been associated with both the lifestyle habits and the side effects of antipsychotic medications .
The present systematic review and meta- analysis aims at collecting and updating available evidence on the efficacy of non-pharmacological health promotion programmes for psychotic patients in r and omised clinical trials .