Smoking-behavior during pregnancy and the reliability of an interview were prospectively investigated. The tobacco-exposure was assessed a) by an intake interview b) by a smoking diary and c) by maternal thiocyanate and carboxy-hemoglobin concentrations. Of the 115 nulliparous women, 66 smoked (57.4%). Seventeen women (25.8%) quit and 39 women (59.1%) reduced smoking. Directly after intake, in the first week of the diary, significantly more cigarettes were smoked than stated during the intake interview. According to the diaries, the number of cigarettes increased during the first half of pregnancy. In the 24th week significantly more cigarettes were smoked than in the first week after intake. Also a significant increase of thiocyanate between the measurements at intake and in the 24th of amenorrhea was found. The maternal carboxy-hemoglobin levels did not significantly change during pregnancy. Investigators should be aware of changes in smoking behavior during pregnancy and the potential bias of self reported smoking behavior at the beginning of pregnancy. The tobacco-exposure should be assessed (anamnestic or biochemical) several times during pregnancy, anyway it should include the second half of pregnancy.
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In dit artikel wordt gekeken naar de relatie tussen het gebruik van mobiele applicaties en fysieke activiteit en gezonde leefstijl. Dit is gedaan op basis van een vragenlijst onder deelnemers aan een hardloopevenement, de Dam tot Damloop. Er werden aparte analyses gedaan voor 8km lopers en 16 km lopers. Een positieve relatie werd gevonden tussen app gebruik en meer bewegen en zich gezonder voelen. App gebruik was ook positief gerelateerd aan beter voelen over zichzelf, je voelen als een atleet, anderen motiveren om te gaan hardlopen en afvallen. Voor de 16 km lopers was app gebruik gerelateerd aan gezonder eten, zich meer energieker voelen en een hogere kans om het sportgedrag vol te houden. De resultaten van dit onderzoek laten zien dat app gebruik mogelijk een ondersteunende rol kunnen hebben in de voorbereiding op een hardloopevenemen, aangezien het gezondheid en fysieke activiteit stimuleert.
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CONCEPT 15-01-2012: gebaseerd op het Rapport ‘Gedragsverandering via campagnes’ van het Ministerie van Algemene Zaken; Zie Renes, et al., 2011 De publiekscampagnes van de Nederlandse rijksoverheid zijn effectiever in het realiseren van kennisoverdracht dan in het (op korte termijn) veranderen van houding en gedrag (zie o.a. Jaarevaluatie Postbus 51-campagnes 2009, 2010). Nederlandse ministeries hechten steeds meer belang aan gedragseffecten en gebruiken dit ook als criterium om de effectiviteit van campagnes te beoordelen. Momenteel zijn veel campagnes nog gebaseerd op klassieke modellen die sterk uitgaan van systematische informatieverwerking en rationeel keuzegedrag (Wevers, Renes, Van Woerkum, 2010). Door groeiend inzicht dat deze modellen niet meer voldoen, heeft de vraag hoe communicatie effectiever kan bijdragen aan gedragsverandering het afgelopen jaar veel aandacht gekregen binnen de Dienst Publiek en Communicatie (DPC), onderdeel van het Ministerie van Algemene Zaken, en verantwoordelijk voor het uitvoeren en evalueren van Postbus 51 campagnes.
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Vaker sporten. Minder alcohol drinken. Stoppen met roken. Nu echt op tijd naar bed. Dat leefstijlverandering lastig kan zijn, weten we allemaal. Maar voor sommigen lijkt het welhaast onmogelijk. Leefstijlverandering kost energie en aandacht. Wat als je daar helemaal geen ruimte voor hebt, omdat je wordt afgeleid door belangrijkere zaken, zoals de zorg voor een ziek familielid of doordat je de huur weer niet kunt betalen? Waar moet je het in zo’n situatie vandaan halen om gezonder te gaan leven? Vooral onder mensen met een lage sociaaleconomische status (SES) komt zo’n situatie regelmatig voor. Welke bijdrage zou de eerstelijnsgeneeskunde hieraan kunnen leveren? De oplossing is gecompliceerd en de weg ernaartoe is vaak frustrerend, vooral omdat gezondheidscommunicatie alleen kan werken als het in nevenschikking met andere instrumenten wordt gecombineerd. Het antirookbeleid is een mooi voorbeeld waar veel is bereikt door een combinatie van instrumenten.
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Chronic diseases represent a significant burden for the society and health systems; addressing this burden is a key goal of the European Union policy. Health and other professionals are expected to deliver behaviour change support to persons with chronic disease. A skill gap in behaviour change support has been identified, and there is room for improvement. Train4Health is a strategic partnership involving seven European Institutions in five countries, which seeks to improve behaviour change support competencies for the self-management of chronic disease. The project envisages a continuum in behaviour change support education, in which an interprofessional competency framework, relevant for those currently practising, guides the development of a learning outcomes-based curriculum and an educational package for future professionals (today’s undergraduate students).
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Gedragsveranderende gezondheidscommunicatie is voor veel communicatieprofessionals een uitdaging. Ontwikkelingen op het gebied van interactieve media kunnen hierbij een doorslaggevende rol spelen. De gezondheidsprofessional krijgt hierdoor nieuw gereedschap in handen. In dit artikel wordt uiteengezet hoe interactieve media strategisch kunnen worden ingezet ten einde de effectiviteit te vergroten van een drietal belangrijke ommunicatiestrategieën: inhaken op het kritieke moment, voelbaar maken van sociale druk en afstemming op het individu.
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Background: There is still limited evidence on the effectiveness and implementation of smoking cessation interventions for people with severe mental illness (SMI) in Dutch outpatient psychiatric settings. The present study aimed to establish expert consensus on the core components and strategies to optimise practical implementation of a smoking cessation intervention for people treated by Flexible Assertive Community Treatment (FACT) teams in the Netherlands. Design: A modified Delphi method was applied to reach consensus on three core components (behavioural counselling, pharmacological treatment and peer support) of the intervention. The Delphi panel comprised five experts with different professional backgrounds. We proposed a first intervention concept. The panel critically examined the evolving concept in three iterative rounds of 90 min each. Responses were recorded, transcribed verbatim and thematically analysed. Results: Overall, results yielded that behavioural counselling should focus on preparation for smoking cessation, guidance, relapse prevention and normalisation. Pharmacological treatment consisting of nicotine replacement therapy (NRT), Varenicline or Bupropion, under supervision of a psychiatrist, was recommended. The panel agreed on integrating peer support as a regular part of the intervention, thus fostering emotional and practical support among patients. Treatment of a co-morbid cannabis use disorder needs to be integrated into the intervention if indicated. Regarding implementation, staff’s motivation to support smoking cessation was considered essential. For each ambulatory team, two mental health care professionals will have a central role in delivering the intervention. Conclusions: This study provides insight into expert consensus on the core components of a smoking cessation intervention for people with SMI. The results of this study were used for the development of a comprehensive smoking cessation program.
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Abstract Background Smoking among people with severe mental illness (SMI) is highly prevalent and strongly associated with poor physical health. Currently, evidence-based smoking cessation interventions are scarce and need to be integrated into current mental health care treatment guidelines and clinical practice. Therefore, the present study aims to evaluate the implementation and effectiveness of a smoking cessation intervention in comparison with usual care in people with SMI treated by Flexible Assertive Community Treatment (FACT) teams in the Netherlands. Methods A pragmatic, cluster-randomised controlled trial with embedded process evaluation will be conducted. Randomisation will be performed at the level of FACT teams, which will be assigned to the KISMET intervention or a control group (care as usual). The intervention will include pharmacological treatment combined with behavioural counselling and peer support provided by trained mental health care professionals. The intervention was developed using a Delphi study, through which a consensus was reached on the core elements of the intervention. We aim to include a total of 318 people with SMI (aged 18–65 years) who smoke and desire to quit smoking. The primary outcome is smoking status, as verified by carbon monoxide measurements and self-report. The secondary outcomes are depression and anxiety, psychotic symptoms, physical fitness, cardiovascular risks, substance use, quality of life, and health-related self-efficacy at 12 months. Alongside the trial, a qualitative process evaluation will be conducted to evaluate the barriers to and facilitators of its implementation as well as the satisfaction and experiences of both patients and mental health care professionals. Discussion The results of the KISMET trial will contribute to the evidence gap of effective smoking cessation interventions for people treated by FACT teams. Moreover, insights will be obtained regarding the implementation process of the intervention in current mental health care. The outcomes should advance the understanding of the interdependence of physical and mental health and the gradual integration of both within the mental health care system. Trial registration Netherlands Trial Register, NTR9783. Registered on 18 October 2021.
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Abstract Background Smoking among people with severe mental illness (SMI) is highly prevalent and strongly associated with poor physical health. Currently, evidence-based smoking cessation interventions are scarce and need to be integrated into current mental health care treatment guidelines and clinical practice. Therefore, the present study aims to evaluate the implementation and efectiveness of a smoking cessation intervention in comparison with usual care in people with SMI treated by Flexible Assertive Community Treatment (FACT) teams in the Netherlands. Methods A pragmatic, cluster-randomised controlled trial with embedded process evaluation will be conducted. Randomisation will be performed at the level of FACT teams, which will be assigned to the KISMET intervention or a control group (care as usual). The intervention will include pharmacological treatment combined with behavioural counselling and peer support provided by trained mental health care professionals. The intervention was developed using a Delphi study, through which a consensus was reached on the core elements of the intervention. We aim to include a total of 318 people with SMI (aged 18–65 years) who smoke and desire to quit smoking. The primary outcome is smoking status, as verifed by carbon monoxide measurements and self-report. The secondary outcomes are depression and anxiety, psychotic symptoms, physical ftness, cardiovascular risks, substance use, quality of life, and health-related self-efcacy at 12months. Alongside the trial, a qualitative process evaluation will be conducted to evaluate the barriers to and facilitators of its implementation as well as the satisfaction and experiences of both patients and mental health care professionals. Discussion The results of the KISMET trial will contribute to the evidence gap of efective smoking cessation interventions for people treated by FACT teams. Moreover, insights will be obtained regarding the implementation process of the intervention in current mental health care. The outcomes should advance the understanding of the interdependence of physical and mental health and the gradual integration of both within the mental health care system. Trial registration Netherlands Trial Register, NTR9783. Registered on 18 October 2021.
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BackgroundA healthy lifestyle is indispensable for the prevention of noncommunicable diseases. However, lifestyle medicine is hampered by time constraints and competing priorities of treating physicians. A dedicated lifestyle front office (LFO) in secondary/tertiary care may provide an important contribution to optimize patient-centred lifestyle care and connect to lifestyle initiatives from the community. The LOFIT study aims to gain insight into the (cost-)effectiveness of the LFO.MethodsTwo parallel pragmatic randomized controlled trials will be conducted for (cardio)vascular disorders (i.e. (at risk of) (cardio)vascular disease, diabetes) and musculoskeletal disorders (i.e. osteoarthritis, hip or knee prosthesis). Patients from three outpatient clinics in the Netherlands will be invited to participate in the study. Inclusion criteria are body mass index (BMI) ≥25 (kg/m2) and/or smoking. Participants will be randomly allocated to either the intervention group or a usual care control group. In total, we aim to include 552 patients, 276 in each trial divided over both treatment arms. Patients allocated to the intervention group will participate in a face-to-face motivational interviewing (MI) coaching session with a so-called lifestyle broker. The patient will be supported and guided towards suitable community-based lifestyle initiatives. A network communication platform will be used to communicate between the lifestyle broker, patient, referred community-based lifestyle initiative and/or other relevant stakeholders (e.g. general practitioner). The primary outcome measure is the adapted Fuster-BEWAT, a composite health risk and lifestyle score consisting of resting systolic and diastolic blood pressure, objectively measured physical activity and sitting time, BMI, fruit and vegetable consumption and smoking behaviour. Secondary outcomes include cardiometabolic markers, anthropometrics, health behaviours, psychological factors, patient-reported outcome measures (PROMs), cost-effectiveness measures and a mixed-method process evaluation. Data collection will be conducted at baseline, 3, 6, 9 and 12 months follow-up.DiscussionThis study will gain insight into the (cost-)effectiveness of a novel care model in which patients under treatment in secondary or tertiary care are referred to community-based lifestyle initiatives to change their lifestyle.Trial registrationISRCTN ISRCTN13046877. Registered 21 April 2022.
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