Search PubMed⌕ Search

Biomedical subjects

Nicolaas P Pronk

Publications and source records attributed to Nicolaas P Pronk.

At least 19 recordsLinked to original sources
PubMed2006

Specific food intake, fat and fiber intake, and behavioral correlates of BMI among overweight and obese members of a managed care organization.

BACKGROUND: The study examined correlates of body mass index (BMI) in overweight and obese members of a managed care organization seeking treatment for obesity. It assessed intake of specific foods, dietary fat or fiber, and behaviors attempted to control weight. METHODS: Participants were 508 men and 1293 women who were > 18 years and had a self-reported BMI > 27.0. This paper reports analyses of baseline and 24-month follow-up data from a randomized weight-loss trial. Cross-sectional and prospective relationships between BMI and behaviors were examined with regression analyses controlling for age and education. RESULTS: At baseline, hamburger and beef consumption were associated with higher BMI for men; for women, hamburger, fried chicken, hot dog, bacon or sausage, egg, French fry, and overall fat consumption were associated with higher BMI, while eating high fiber cereal, fruit, and overall fiber intake were associated with lower BMI. Virtually all forms of weight control behavior were reported more often in heavier people. Subscribing to exercise magazines, however, was associated with lower BMI. Decreased fat intake and increased fruit/vegetable/fiber intake over the course of the study were associated with reductions in BMI at 24 months. CONCLUSION: The same behaviors that differentiate individuals with different body weight in the general population also differentiate between individuals of different body weights at the high end of the weight distribution. Educational efforts aimed at preventing weight gain and reducing obesity might benefit from focusing on specific foods known to be associated empirically with body weight and weight change over time.

Journal Article↗
PubMed2006

Tobacco cessation interventions in dental networks: a practice-based evaluation of the impact of education on provider knowledge, referrals, and pharmacotherapy use.

Tobacco is a significant risk factor for oral diseases. Dental care providers have the opportunity to inform patients about the risks associated with tobacco use and refer them to tobacco cessation resources. Although dental teams usually ask their patients about their tobacco use, most do not provide tobacco cessation counseling. This project involved four staff-model dental clinics and four contracted network dental clinics. Project goals were to 1) describe current practice patterns of tobacco cessation intervention, 2) increase the use of steps for treatment, known as the 5 As, recommended by the U.S. Public Health Service, 3) increase referrals to a tobacco helpline, and 4) increase use of pharmacotherapy for tobacco dependence treatment. The project included training and program support (e.g., sharing of project data, weekly newsletters, discussion at clinic meetings). Results indicate that this approach to addressing tobacco dependence in a dental clinic setting can effectively change dental provider knowledge and action.

Bupropion↗
PubMed2006

The relationship between prevalence and duration of weight loss strategies and weight loss among overweight managed care organization members enrolled in a weight loss trial.

BACKGROUND: Many adults in the United States report engaging in weight loss behaviors. The current study examined weight loss strategies among managed care organization members, to determine the prevalence and impact of weight loss behaviors in this population. We hypothesized that greater engagement in weight loss strategies would be associated with greater weight loss success. METHODS: Data were taken from Weigh-to-Be (WTB), a two-year weight loss trial (N = 1801, 72% female, mean age = 50.7 years, mean weight = 95.9 kg, mean BMI = 34.2 kg/m2). Every six months, participants completed a questionnaire assessing frequency and duration of weight loss strategies (calorie reduction, fat reduction, increased fruit/vegetable intake, increased exercise, elimination of sweets, consumption of less food). General linear models and structural equation methods were used to examine associations between weight loss strategy use and weight change over time. RESULTS: Weight loss strategy prevalence rates ranged from 68% to 76% over two years. For all dietary strategies, any use of the strategy between baseline and 24 months was associated with weight loss at 24 months; those who did not engage in the strategy showed weight gains during that period. Results of general linear models and structural equation models indicated that increased use of weight loss strategies was significantly associated with greater 24-month weight loss. CONCLUSION: The prevalence of weight loss strategies in this obese adult managed care population was quite high, and use of these strategies was associated in dose-response fashion with better weight loss. Future interventions may benefit from emphasis on persistence of similar strategies to achieve more successful outcomes.

Journal Article↗
PubMed2006

Telephone-based counseling improves dietary fat, fruit, and vegetable consumption: a best-evidence synthesis.

Eating more fruits/vegetables and less dietary fat rank among the most important nutrition recommendations for health improvement. Telephone counseling is an increasingly popular means of delivering support for diet modification. Using a best-evidence synthesis, the purpose of this review was to assess the effectiveness of telephone-based counseling on improving dietary fat, fruit, and vegetable consumption for adults. Online databases and article bibliographies were searched to produce relevant randomized-controlled trials published during the past 5 years. Nine studies were ultimately included and the weight of the evidence indicated that telephone-based counseling promotes significantly greater improvements in fruit/vegetable consumption (median effect size=0.41) and dietary fat intake (median effect size=0.22) relative to usual care. Improvements were especially pronounced among women with (or at high risk for developing) cancer. In some studies, telephone-based counseling was also associated with greater improvement in blood lipid levels and weight. Based on these findings, several design considerations (eg, population focus, counseling intensity) for program managers are proposed. Telephone-based counseling was found to be a moderately effective intervention, but there are not enough studies yet to draw conclusions on other research questions, such as how advantageous telephone-based counseling is over traditional forms of dietary counseling. At present, telephone-based counseling may best be used as a complement to clinical care and a means to broaden the outreach of nutrition services.

Counseling↗
PubMed2005

Health care charges associated with physical inactivity, overweight, and obesity.

INTRODUCTION: Physical inactivity, overweight, and obesity are associated with increased morbidity and mortality. The objective of this study was to estimate the proportion of total health care charges associated with physical inactivity, overweight, and obesity among U.S. populations aged 40 years and older. METHODS: A predictive model of health care charges was developed using data from a cohort of 8000 health plan members aged 40 and older. Model cells were defined by physical activity status, body mass index, age, sex, smoking status, and selected chronic diseases. Total health care charges were estimated by multiplying the percentage of the population in each cell by the predicted charges per cell. Counterfactual estimates were computed by reclassifying all individuals as physically active and of normal weight while leaving other characteristics unchanged. Charges associated with physical inactivity, overweight, and obesity were computed as the difference between current risk profile total charges and counterfactual total charges. National population percentage estimates were derived from the National Health Interview Survey; those estimates were multiplied by the predicted charges per cell from the health plan analysis. RESULTS: Physical inactivity, overweight, and obesity were associated with 23% (95% confidence interval [CI], 10%-34%) of health plan health care charges and 27% (95% CI, 10%-37%) of national health care charges. Although charges associated with these risk factors were highest for the oldest group (aged 65 years and older) and for individuals with chronic conditions, nearly half of aggregate charges were generated from the group aged 40 to 64 years without chronic disease. CONCLUSION: Charges associated with physical inactivity, overweight, and obesity constitute a significant portion of total medical expenditures. The results underscore the importance of addressing these risk factors in all segments of the population.

Adult↗
PubMed2005

Frequency of physician-directed assistance for smoking cessation in patients receiving cessation medications.

BACKGROUND: Little is known about current physician-patient interactions regarding smoking cessation when a prescription is given for cessation medications. METHODS: We identified 1360 health plan members who were smokers and had filled prescriptions for bupropion hydrochloride or nicotine replacement products from March 26, 2002, through April 8, 2003. These members were surveyed 3 months after the order was filled to learn about the physician encounter that produced these prescriptions and the role of the physician in selecting the medication, supporting cessation, and achieving desirable outcomes. RESULTS: Among the 1035 eligible complete responses (adjusted response rate, 78%), only 36.4% reported being asked to set a specific quit date; 25.3%, to use cessation counseling; and 23.3%, to have any type of follow-up. The only physician action associated with the use of the medication was asking to set a quit date (90.7% vs 83.5%; P = .001) and no action was significantly associated with cessation. Smokers with tobacco-related chronic conditions were more likely to report physician influence but less likely to report receiving information on using the quit aid (60.6% vs 66.5%; P = .048) or being asked to set a quit date (31.7% vs 41.4%; P = .001). CONCLUSIONS: Despite the evidence-based guideline recommendations for more support for cessation, physician support actions for those receiving prescriptions appear to be relatively infrequent and to have little influence on the use of medication by smokers or on their smoking cessation. Other environmental changes may be needed to facilitate more thorough support.

Adult↗
PubMed2005

Offering telephone counseling to smokers using pharmacotherapy.

Whereas telephone-based counseling has been found to be effective in supporting smokers interested in quitting smoking, it is not known whether proactive efforts to reach smokers receiving cessation medications will enhance their likelihood of successful quitting. We had an opportunity to test, in a health plan setting, an offer of telephone-based counseling with smokers identified from health plan records as recently filling a prescription for nicotine replacement therapy or bupropion. After we removed 31 members determined to be ineligible, 1,329 were randomly allocated to receive an invitation either to telephone-based counseling (n = 663) or to a control group (n = 666). On average, 7 days (range = 3-15 days) elapsed from the day of the prescription fill until the Center for Health Promotion began calling to invite members to participate in telephone counseling. The Center for Health Promotion was able to reach 49% of those in the intervention group (323/663). Of these members, 118 (37%) declined any participation. Therefore, in response to the proactive contact, 63% (205/323) of those reached and 31% (205/663) of those eligible participated in some smoking cessation counseling. At the 3-month follow-up, we observed an increased quit rate (33.1% vs. 27.4%) among health plan members randomized to telephone-based smoking cessation counseling. The results varied by gender and amount smoked. In addition, the variables associated with quitting in a multivariate logistic regression model included older age and using more than 30 days of medication.

Adult↗
PubMed2005

Self-weighing in weight gain prevention and weight loss trials.

BACKGROUND: Although self-monitoring is a central tenet of behavioral approaches to changing health behavior, clinical and public health recommendations for better controlling body weight do not emphasize weight self-monitoring. PURPOSE: The objective was to determine whether more frequent self-weighing exerts a positive influence on weight loss or weight gain prevention. METHODS: This study examined cross-sectional and longitudinal associations between self-weighing frequency and weight in two distinct groups: 1,226 adults who were enrolled in a weight gain prevention trial, and 1,800 adults who were enrolled in a weight loss trial. RESULTS: Although the samples differed significantly in weight and baseline demographic characteristics, the distribution of baseline weighing frequencies did not differ by study. In both groups, more frequent self-weighing at baseline was associated with greater age, lower fat intake, White ethnicity, current nonsmoking status, a greater history of dieting to lose weight, and lower current body mass index. Despite similar weighing instructions, differential patterns of weighing frequency over time were observed: Weight loss dieters increased weighing over time regardless of treatment group (control or intervention), whereas weight gain preventers decreased weighing over time in the control group and increased weighing over time in intervention groups. Most important, higher weighing frequency was associated with greater 24-month weight loss or less weight gain. CONCLUSIONS: Results support the idea that daily weighing is valuable to individuals trying to lose weight or prevent weight gain. Daily self-weighing should be emphasized in clinical and public health messages about weight control. Experimental studies on the effects of weighing frequency in these contexts are recommended.

Adult↗
PubMed2004

Assessing multiple risk behaviors in primary care. Screening issues and related concepts.

The concept of behavioral risk refers to health behaviors that increase the likelihood of a variety of illness conditions. With increased scientific research, it has become clear that this concept is useful in understanding the linkage between behavior and health. This paper reviews scientific, conceptual, and practical issues related to the identification of health risk behaviors in primary care. It includes both a literature review and an analysis of the feasibility of screening and health risk appraisal from a public health perspective, giving special attention to four behavioral risk factors: cigarette smoking, alcohol misuse, physical inactivity, and unhealthy diet. The review indicates that there are a wide variety of acceptable screening tests that can be used for population screening programs, and a large number of health risk appraisal instruments to employ in medical and work settings where preventive health services are available. Given the variety of available assessment procedures, the choice of a given instrument will depend on the target population, the purpose of the program, the time available for assessment, and a number of other practical considerations, such as cost. Multiple risk factor screening is feasible, but there is no single instrument or procedure that is optimal for all risk factors or populations. Based on the results of this review, the specific test or combination of tests is less important than the use of screening to make both patients and healthcare providers more aware of the critical importance of monitoring behavioral risk factors on a routine basis. We conclude that while further research and development work needs to be done, sufficient progress has been made to warrant a more ambitious effort that would bring behavioral risk factor screening into the mainstream of preventive medicine and public health.

Alcohol Drinking↗
PubMed2004

Translating what we have learned into practice. Principles and hypotheses for interventions addressing multiple behaviors in primary care.

BACKGROUND: The evidence base regarding what works in practice for helping patients change multiple risk behaviors is less developed than is the more basic literature on behavior change. Still, there is enough consistency of findings to present testable hypotheses for clinicians and administrators to evaluate and guide practice until more definitive evidence is available. METHODS: The behavior change principles known as the 5A's outline a sequence of support activities (assess, advise, agree, assist, arrange) that are effective for helping patients to change various health behaviors. These same principles also apply at the clinic level for designing activities to support behavior change. RESULTS: Successful practices promoting sustainable changes in multiple behaviors are patient centered, tailored, proactive, population based, culturally proficient, multilevel, and ongoing. Often a stepped-care model can be used to provide increasingly intensive (and costly) interventions for patients who are not successful at earlier intervention levels. CONCLUSIONS: Contextual factors are influential in determining success at both the patient and the office practice level. Therefore, greater attention should be paid to creating supportive family, healthcare system, and community resources and policies. We enumerate 15 hypotheses to be tested for improving patient-clinician interactions and for medical office change.

Behavior Therapy↗
PubMed2004

Meeting recommendations for multiple healthy lifestyle factors. Prevalence, clustering, and predictors among adolescent, adult, and senior health plan members.

BACKGROUND: Whereas much is known about single lifestyle-related health risk factor prevalence and covariates, more research is needed to elucidate the interactions among multiple healthy lifestyle factors and variables that may predict adherence to these factors. Such data may guide both clinical and health policy decision making and person-centered approaches to population health improvement. METHODS: We document the prevalence and cluster patterns of multiple healthy lifestyle factors among a random sample of adolescents (n =616), adults (n =585), and seniors (n =685) from a large Midwestern health plan. Modifiable, lifestyle-related health factors assessed included physical activity, nonsmoking, high-quality diet, and healthy weight for all subjects; adults and seniors were also asked about their alcohol consumption. Second, we sought to identify characteristics associated with the likelihood of meeting recommendations for healthy lifestyle factors. The healthy lifestyle factors sum score was categorized into three levels, that is, 0 to 2, 3, or 4 to 5 healthy lifestyle factors (4 for adolescents), and we used ordinal logistic regression to estimate the odds of meeting each of these criteria from several demographic characteristics and disease states. RESULTS: Overall, only 14.5% of adolescent, adult, and senior health plan members meet recommended guidelines for four common healthy lifestyle factors. Only 10.8% of adults and 12.8% of seniors met all five behavior-related factors. For adolescents, only being nondepressed was associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors (odds ratio [OR]=2.15; p <0.05). For adults, being in the 50- to 64-year-old cohort (OR=1.46, p<0.05), having a college degree (OR=1.65; p <0.05), and having no chronic disease (OR=1.92; p <0.05) were all associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors. For seniors, having a college degree (OR=1.61; p <0.05), was the only variable associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors. CONCLUSIONS: A small proportion of health plan members meet multiple recommended healthy lifestyle guidelines at once. This analysis identifies population subgroups of specific interest and importance based on adherence to multiple healthy lifestyle factors, and predictors for increased likelihood to be in adherence to multiple healthy lifestyle factors. It presents a potentially useful summary measure based on person-centered measures of healthy lifestyle factors. Clinicians may derive meaningful information from analyses that address adherence to multiple healthy lifestyle factors. Health systems administrators may use this information to influence health policy and resource allocation decisions. Further studies are needed to assess the usefulness of this comprehensive lifestyle-related health measure as a metric of progress toward public health goals, or as a clinical metric that conveys information on future health status and directs interventions at the individual level.

Adolescent↗
PubMed2004

Addressing multiple behavioral risk factors in primary care. A synthesis of current knowledge and stakeholder dialogue sessions.

BACKGROUND: Addressing behavioral risk factors in primary care has become a pressing concern due to the increasing burden of behavioral risk factors on disease, healthcare costs, and public health. Risk factors considered include smoking, risky drinking, sedentary lifestyle, and unhealthy diet-singly or in combination. The already burdened primary care system needs a practical approach to efficiently and effectively address any combination of multiple risk factors. Multiple perspectives and broad insight are urgently needed to gain a deeper understanding of the interacting scientific, systems, and policy issues associated with multiple risk factor interventions (MRFIs). PURPOSE: This paper synthesizes findings from literature reviews, epidemiologic analyses, and structured interactive dialogue sessions, and includes a set of recommendations designed to stimulate further action. METHODS: Several papers were produced to document current knowledge, research evidence, and salient issues related to multiple risk factor assessment and intervention. Structured interactive dialogue sessions were then conducted with clinician, health system, and health policy leaders regarding what advantage or energy would be liberated by a multiple risk factor approach (rather than separate single risk factor approaches), and how to build a policy framework or constituency for MRFIs. This information is synthesized in this paper. RESULTS: There is a clear need to address MRFIs among multiple stakeholders, including patients, purchasers, payers, clinicians, health system leaders, and policy-level stakeholders. MRFIs need to bring with them a compelling value proposition for all stakeholders, and a vision of practical and systematic ways to make it a reality in already-pressed primary care practices. Involving stakeholders in dialogue aimed at helping them see the world through each other's eyes helps overcome discouragement and generates energy for jointly designing new approaches. Recommendations for further action include the creation of multistakeholder dialogue, creation of a policy agenda, development of a translation or integration agenda that connects researchers and practitioners in a two-way exchange, initiation of a series of demonstration projects around MRFIs, and support for research on multiple (rather than only single) risk factor interventions. CONCLUSIONS: The need to address multiple behavioral risk factors in primary care is increasingly urgent. Whereas stakeholders by themselves may be willing to address multiple risk factors, they agree that it can only be done successfully with a collaborative approach. Findings based on evidence reviews, hypotheses generation, and stakeholder dialogue provide guidance for appropriate further action that, based on what is known already, can be initiated right away.

Adult↗
PubMed2004

The association between work performance and physical activity, cardiorespiratory fitness, and obesity.

The purpose of this study was to test the association between lifestyle-related modifiable health risks (physical activity, cardiorespiratory fitness, and obesity) and work performance. Data were obtained from 683 workers. Dependent variables included number of work loss days, quantity and quality of work performed, overall job performance, extra effort exerted, and interpersonal relationships. Results indicated that higher levels of physical activity related to reduced decrements in quality of work performed and overall job performance; higher cardiorespiratory fitness related to reduced decrements in quantity of work performed, and a reduction in extra effort exerted to perform the work; obesity related to more difficulty in getting along with coworkers; severe obesity related to a higher number of work loss days. It is concluded that lifestyle-related modifiable health risk factors significantly impact employee work performance.

Adult↗
PubMed2004

Effects of major depression on moment-in-time work performance.

OBJECTIVE: Although major depression is thought to have substantial negative effects on work performance, the possibility of recall bias limits self-report studies of these effects. The authors used the experience sampling method to address this problem by collecting comparative data on moment-in-time work performance among service workers who were depressed and those who were not depressed. METHOD: The group studied included 105 airline reservation agents and 181 telephone customer service representatives selected from a larger baseline sample; depressed workers were deliberately oversampled. Respondents were given pagers and experience sampling method diaries for each day of the study. A computerized autodialer paged respondents at random time points. When paged, respondents reported on their work performance in the diary. Moment-in-time work performance was assessed at five random times each day over a 7-day data collection period (35 data points for each respondent). RESULTS: Seven conditions (allergies, arthritis, back pain, headaches, high blood pressure, asthma, and major depression) occurred often enough in this group of respondents to be studied. Major depression was the only condition significantly related to decrements in both of the dimensions of work performance assessed in the diaries: task focus and productivity. These effects were equivalent to approximately 2.3 days absent because of sickness per depressed worker per month of being depressed. CONCLUSIONS: Previous studies based on days missed from work significantly underestimate the adverse economic effects associated with depression. Productivity losses related to depression appear to exceed the costs of effective treatment.

Absenteeism↗
PubMed2004

Recruitment to mail and telephone interventions for obesity in a managed care environment: the Weigh-To-Be project.

OBJECTIVE: To evaluate the success of mail- and telephone-based weight loss programs in recruiting a representative sample of overweight members of a managed care organization (MCO). STUDY DESIGN: Cross-sectional. PATIENTS AND METHODS: A total of 1801 members of an MCO were recruited by direct mail, clinic flier, and physician referral for a research study evaluating mail- and telephone-based weight loss programs; 412 additional overweight members of the same MCO were identified in a general member survey for comparison purposes. Body mass index, demographics, diet, and exercise habits were measured. RESULTS: Study volunteers were heavier, more likely to be women, more likely to be minorities, more educated, and younger than the general sample of overweight members. They also had a more extensive history of dieting, ate a diet higher in fat and lower in fruit and vegetables, and were more likely to report binge eating than the general sample. However, study volunteers reported a higher level of physical activity. CONCLUSIONS: Invitations to participate in weight loss programs can attract large numbers of people in a managed care setting. However, the participation bias in recruitment to such programs is similar to that seen in traditional face-to-face interventions. Women of higher socioeconomic status who are severely obese and who have an extensive history of weight control efforts are more likely to participate. Additional research is needed to find ways to reach more men and older adults.

Adult↗
PubMed2003

Changes in physical activity and short-term changes in health care charges: a prospective cohort study of older adults.

BACKGROUND: Better understanding the impact of changes in physical activity behavior on short-term health care charges may inform resource allocation decisions to increase population levels of physical activity. This study examines the prospective relationship of changes in physical activity status on short-term changes in health care charges for older adults. METHODS: A prospective cohort study was done on a stratified random sample of 2,393 adults aged 50 and older enrolled in a Minnesota health plan, predicting changes in resource use between two periods (September 1994 to August 1995 and September 1996 to August 1997) based on billed health care charges. RESULTS: After adjustment for age, gender, comorbidity, smoking status, and body mass index, all physical activity states had declining health care charges, relative to those who were consistently inactive. Subjects who increased their physical activity from 0-1 to 3+ days/week had significant declines in their mean annualized total charges (-2,202 dollars, P < 0.01) relative to those who remained inactive. CONCLUSIONS: Increased physical activity among older adults is associated with lower health care charges within 2 years, relative to charges for those who were persistently inactive. These cost savings may justify investments in effective interventions to increase physical activity in older adults.

Adult↗
PubMed2003

Identifying individuals at risk for the development of type 2 diabetes mellitus.

OBJECTIVE: To describe a population-based approach to the identification of individuals at high risk for the development of type 2 diabetes mellitus (DM). STUDY DESIGN: A prospective analysis of the incidence of DM in low- and high-risk groups. PATIENTS AND METHODS: Questions associated with the risk of developing DM were incorporated into a health risk assessment (HRA), and health plan members were invited to complete the HRA as part of worksite health promotion efforts or medical clinic visits. Points were applied to the risk factors for DM, and individual HRA responders were assigned to low- or high-risk groups. A total of 16 427 members completed the HRA. To assess the incidence of new cases of DM, follow-up time was up to 4.8 years (mean, 2.55 years). New-onset DM cases were identified using International Classification of Diseases, Ninth Revision, coding for DM during the timeframe subsequent to HRA completion. RESULTS: The incidence of new DM at the end of the study was 3.5% in the high-risk group and 0.7% in the low-risk group (P < .001). CONCLUSIONS: Identification of individuals at risk for DM using this HRA approach increases by 5-fold the likelihood that the targeted risk reduction efforts will reach the right individuals. This approach allows for resource-efficient targeted intervention efforts designed to reduce the incidence of new DM cases.

Adult↗