Salt restriction in hypertension--the effect of dietary advice and self monitoring of chloride concentration in urine. More dietetic time, better outcome? A randomized prospective study investigating the effect of more dietetic time on phosphate control in end-stage kidney failure haemodialysis patients. Effects of a videotape information intervention at discharge on diet and exercise compliance after coronary bypass surgery. Evaluation of a PDA-based dietary assessment and intervention program: a randomized controlled trial. Dietary and fluid compliance: an educational intervention for patients having haemodialysis. Regimen compliance two years after myocardial infarction. Development and evaluation of DASH diet tailored messages for hypertension treatment. Adoption and maintenance of a Mediterranean diet in patients with coronary heart disease from a Northern European population: a pilot randomised trial of different methods of delivering Mediterranean diet advice. Education by a dietitian in patients with heart failure results in improved adherence with a sodium-restricted diet: a randomized trial. Cognitive rehearsal in the treatment of obesity: a comparison against cue avoidance and social pressure. Impact of intensified dietary therapy on energy and nutrient intakes and fatty acid composition of serum lipids in patients with recently diagnosed non-insulin-dependent diabetes mellitus. Impact of telephone reinforcement of risk reduction education on patient compliance. Self-monitoring of blood glucose changed non-insulin-treated Type 2 diabetes patients' beliefs about diabetes and self-monitoring in a randomized trial. A comparison of nutrient-based and exchange-group methods of diet instruction for patients with noninsulin-dependent diabetes. A nurse-led cardiac rehabilitation programme improves health behaviours and cardiac physiological risk parameters: evidence from Chengdu, China. Nurse-mediated cholesterol management compared with enhanced primary care in siblings of individuals with premature coronary disease. An online lifestyle diary with a persuasive computer assistant providing feedback on self-management. Influence of imaginative teaching of diet on compliance and metabolic control in insulin dependent diabetes. Adherence to a Very Low Fat Diet for Cardiac Rehabilitation Patients. Effects of intervention on compliance to referral and lifestyle recommendations given at cholesterol screening programs. Minimal in-person support as an adjunct to internet obesity treatment. Assessment of two culturally competent diabetes education methods: individual versus individual plus group education in Canadian Portuguese adults with type 2 diabetes. Self-efficacy training for patients with end-stage renal disease. Menu suggestion: an effective way to improve dietary compliance in peritoneal dialysis patients. Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-randomised controlled trial. Adherence to cardiovascular risk factor modification in patients with hypertension. Randomized, controlled trial promotes physical activity and reduces consumption of sweets and sodium among overweight and obese adults. Simultaneous vs sequential counseling for multiple behavior change. Intervention strategies to improve compliance with medical regimens by ambulatory hemodialysis patients. Effects of 8 weeks sustained follow-up after a nurse consultation on hypertension: a randomised trial.
The aims of this present study were firstly to examine whether diet compliance and blood pressure effect could be enhanced by self monitoring with a titrator strip (Quantab 1176) measuring the urine chloride concentration. This was achieved by an open, randomized parallel group design. The study also sought to evaluate the blood pressure effect of a moderately salt restricted diet by using a pre-test-post-test design with a run-in period and controlling for relevant confounding factors (weight, training and alcohol consumption). Furthermore, the study aims were to validate the measurement of chloride concentration in the morning urine by the Quantab titrator strip. We compared Quantab 1176 measurement of chloride concentration in the morning urine with 24 h sodium excretion, determined by the clinical chemical laboratory, was performed. Twenty men and 14 women (mean age 53 years) with essential hypertension (mean: 165/96 mmHg) were observed during a run-in period of 4 weeks before randomization to either dietary advice combined with self monitoring of morning urine chloride concentration for 12 weeks, or dietary advice alone. The reduction in diastolic blood pressure of 6 mmHg was not different in the two groups (between groups p = 0.44). Within group changes of systolic blood pressure were 10 mmHg and 6 mmHg (p = 0.006 and p = 0.04) in the diet plus Quantab group, and the diet only group respectively (between groups p = 0.30). No significant difference in 24 h sodium excretion could be detected between the groups. The morning urine chloride concentration correlated moderately to the 24 h urine sodium excretion (r = 0.66, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS) A randomized controlled trial was conducted involving 67 stable adult haemodialysis patients with hyperphosphataemia. The objective was to determine the effect of monthly dietetic consultations on patients' serum phosphate concentrations and calcium x phosphate product.
                The intervention group received monthly dietetic consultations for 6 months using advanced counselling skills aimed at limiting phosphate intake in the diet and improving compliance with phosphate binders, whereas standard care with dietetic consultations every 6 months was provided to the control group.
                Serum phosphate concentrations decreased in the intervention group from 2.05 +/- 0.48 to 1.80 +/- 0.48 mmol/l by month 3 (p < 0.05). However, this subsequently increased and by month 6 there was no significant difference from baseline. After controlling for confounding variables, the difference between the groups was approaching significance at month 3, but there was no difference by month 6, or following conclusion of the study. The calcium x phosphate product similarly decreased in both groups, achieving K/DOQI standards, but was not sustained either during the remainder of the study but decreased further by the 12-month follow-up and, although it was not significantly different, it did improve significantly from baseline in both the intervention and control groups.
                Increased frequency of dietetic consultations can result in improved phosphate control in the short term, and therefore more innovative strategies appear necessary to sustain longer-term control.
                Copyright 2008 S. Karger AG, Basel. This study evaluated the relative effects on compliance with recommended lifestyle changes of two experimental videotapes that involved different approaches for preparing coronary artery bypass graft (CABG) patients for the posthospital recovery period. The tapes differed in the extent to which they portrayed the recovery period as a steady, forward progression versus a series of "ups and downs."
                Two hundred sixteen male and female CABG patients were assigned randomly either to view one of the two videotapes before discharge from the hospital or to receive only the standard discharge preparation provided by the hospital. All patients completed measures of anxiety and self-efficacy at discharge, 1 month and 3 months after discharge from the hospital. Patients also completed measures of dietary fat consumption and activity level 1 and 3 months after discharge.
                Relative to controls, patients who viewed either of the videotapes before hospital release reported higher self-efficacy for adhering to the recommended low-fat diet both at discharge and 1 month after surgery. Viewing either of the videotapes also resulted in significantly less dietary fat intake 1 month after hospital release compared with controls. Patients who viewed the tape that portrayed the recovery period as consisting of ups and downs also reported significantly more frequent moderate exercise at 1 month and more frequent strenuous exercise 3 months after discharge.
                The experimental videotapes proved to be an effective method for increasing dietary and exercise compliance during the first 3 months after CABG. To evaluate the capability of DietMatePro, a PDA-based dietary assessment program, to monitor dietary intake and to improve adherence to a dietary regimen.
                Randomized controlled trial.
                Overweight and obese (Body Mass Index (BMI) 25-40) participants without dietary restrictions.
                Participants (n = 174) were randomized to record usual dietary intake using either DietMatePro or a paper food diary for one week to compare concordance with 24-hr recall. At the week 1 visit, participants were individually counseled to follow the diet recommendations of the Ornish Prevention Diet for three weeks and continue monitoring food intake using the assigned method to estimate adherence to the intervention by monitoring condition.
                Spearman correlations between week 1 24-hr recall and the assigned recording method were compared to assess validity. Mean pre-post changes in intake measured by 24-hr recall were compared according to monitoring condition to measure adherence to the Ornish diet.
                Correlations of energy and nutrient values reported on the food label ranged from 0.41 to 0.71 for the DietMatePro condition versus 0.63 to 0.83 for the paper-based diary. Diet adherence was higher among DietMatePro (43%) compared to the paper diary (28%) group (p = 0.039).
                DietMatePro does not appear to produce more valid data than paper-based approaches. DietMatePro may improve adherence to dietary regimens compared to paper-based methods. This paper is a report of a study conducted to determine the effect of an educational intervention on dietary and fluid compliance in patients having haemodialysis.
                Many of the clinical problems experienced by patients having haemodialysis are related to their failure to eat appropriate foods and restrict their fluid intake. Educational intervention in patients having haemodialysis to improve their compliance with dietary and fluid restrictions appears to be effective.
                Sixty-three patients having haemodialysis in three general hospitals in Tehran, Iran, were allocated into two groups at random for oral and/or video education. They were asked to give demographic and medical data. Bimonthly average values of serum potassium, sodium, calcium, phosphate, albumin, creatinine, uric acid, and blood urea nitrogen and interdialytic weight gain were measured before and after the teaching programmes. The data were collected in 2007.
                Compliance in terms of biochemical parameters and interdialytic weight gain was observed in 63.5% and 76.2% of patients in the oral and video teaching groups respectively. Statistically significant correlations were observed between demographic variables (age, educational level and occupation) and dietary and fluid compliances (P < 0.001). There was no difference between the effectiveness of two educational interventions.
                Nurses should emphasize sodium compliance in patients having haemodialysis and explain its adverse effects, such as excessive weight gain, hypertension, and peripheral oedema. Two-years postinfarction, the effect of a nursing intervention at 30 days postinfarction, and intentions, attitudes, and perceived beliefs of others on regimen compliance of myocardial infarction patients was investigated. The sample was comprised of 51 patients (E = 29, C = 22) who participated in a five-phase study over 2 years. No differences were found between experimental and control groups for regimen compliance to activity, stress, and medication prescriptions. The experimental group was significantly more compliant to the diet prescription than the control group. The control group was significantly more compliant than the experimental group with cessation from smoking. Perceived beliefs of others were predictive of compliance for all regimen prescriptions at 2 years. Attitude was also predictive of compliance with the diet, smoking, and stress regimens. For this study, the Manage Associated Perceptions (MAP) of Dietary Behavior Study, researchers developed, evaluated, and tested messages tailored to improve compliance with the Dietary Approaches to Stop Hypertension (DASH) diet by gradually instilling healthy Cognitive Representations of the DASH Diet (CRDDs). The sample consisted of women from diverse backgrounds (N = 53), randomly assigned to two experimental groups (n = 13 and n = 14) and to two control groups (n = 12 and n = 14). The experimental groups performed a version of the intervention for 30 days. Data about dietary compliance and CRDDs were collected at 30, 60, and 90 days. Compared to control group members, experimental group members demonstrated greater improvements in CRDD scores and were significantly more compliant with the diet. Another significant finding was that older women were more compliant. A Mediterranean diet has been shown to protect against coronary heart disease (CHD). Adherence to a Mediterranean diet can be assessed using a Mediterranean diet score. The primary aim of this pilot study was to examine whether CHD patients in a Northern European population would adopt and maintain a Mediterranean diet, with a secondary aim of comparing the effectiveness of different methodologies aimed at improving compliance.
                Sixty-one patients with a diagnosis of CHD were randomised to one of three groups: either to receive conventional dietetic advice for CHD or advice to implement a Mediterranean-style diet using either behavioural counselling or nutritional counselling. Patients received a follow-up assessment at 6 months (adoption) and a subset of patients was followed up at 12 months (maintenance). The primary outcome measure was the between-group difference in the mean change in Mediterranean diet score (MDS).
                The change in MDS was not significantly different between groups. However, all three groups reported a significant within-group increase in MDS (P < 0.01) at 6 and 12 months follow-up.
                All three groups made dietary changes towards a Mediterranean diet, but behavioural counselling did not have significant additional benefit over nutritional counselling in initiating and maintaining dietary change, and neither method offering specific Mediterranean diet advice had any significant benefit in terms of improvement in MDS over conventional dietetic practice. Multidisciplinary heart failure (HF) programs reduce hospital readmission and improve clinical outcomes. Although dietitians are often members of such teams, no randomized studies have demonstrated the independent benefit of dietitian-administered dietary counseling for patients with HF. The purpose of this study was to evaluate the effect of dietitian education on adherence to a sodium-restricted diet in ambulatory patients with stable HF.
                Patients with HF (left ventricular ejection fraction < 35%) were randomized into a dietitian education group (n = 23) or a usual care group (n = 24), then observed for 3 months. Both groups received a 2 g/d dietary sodium prescription. The usual care group received nutrition advice by way of self-help literature, whereas the dietitian education group returned for 2 counseling sessions with a dietitian.
                Dietitian education resulted in a significant decrease in sodium intake at 3 months (2.80 +/- 0.30 to 2.14 +/- 0.23 g/d, P < .05). In contrast, there was no change in sodium intake in the usual care group (3.00 +/- 0.31 to 2.74 +/- 0.35 g/d, P = ns).
                Dietitian-administered counseling was more effective than providing literature in reducing dietary sodium intake in patients with stable HF. The effects of a cognitive (cognitive rehearsal) in the treatment of obesity were evaluated in a 16-week weight reduction programme by comparison against two other treatments, cue avoidance, and social pressure. Fifty-three obese females, categorised (on the basis of their weight loss after 3 weeks of dieting) as either high losers or low losers, were randomly assigned to one of these three treatments. Posttreatment weight losses were significantly greater for high losers than low losers, and for subjects in cue avoidance than those in social pressure. Those in cue avoidance went over their diet less often than others, and reported greater changes in eating habits, and in the cognitive domain. Neither subject type nor treatment type has a significant effect on weight change during the follow-up year. High losers adhered to the diet more initially, but also, throughout treatment, lost more weight for the same degree of dietary adherence. Behavioural and physiological characteristics underlying this important dimension of individual differences were discussed. Compliance with dietary recommendations and the effect of intensified dietary therapy on energy and nutrient intakes and fatty acid composition of serum lipids were studied in 86 obese subjects (aged 40 to 64 years) with recently diagnosed non-insulin-dependent diabetes mellitus (NIDDM). After three months of basic education, the subjects were randomly separated into an intervention group (n = 40) and a conventional treatment group (n = 46). Members of the intervention group participated in 12 months of intensified education; those in the conventional group visited local health centers. Compliance with dietary instructions was monitored through food records. Intensified dietary therapy resulted in greater weight loss, better metabolic control, and a less atherogenic lipid profile than conventional treatment. Intake of energy and saturated fatty acids tended to decline in the intervention group. A higher percentage of patients in the intervention group had a total fat intake of 30% of energy or less after 15 months (32.5% [12 of 38] vs 17.4% [8 of 46]). Similarly, more patients in the intervention group had a saturated fatty acid intake of 10% or less of total energy intake at the end of the study (35.0% [13 of 38] vs 8.7% [4 of 46]). The mean dietary cholesterol intake was within recommendations in both groups at the end of the study. The relative percentage of linoleic acid of serum lipids increased significantly and the relative percentage of palmitic acid of serum triglycerides, phospholipids, and cholesterol esters decreased in the intervention group. These changes indicate that intensified dietary therapy improved the quality of fat in the diet of patients with NIDDM. Smoking and hyperlipidemia are key risk factors resulting in peripheral arterial disease. These risk factors can be reduced when appropriate lifestyle changes are made, especially for patients less than 60 years of age. Therefore patient education regarding smoking cessation and healthy diet changes may positively impact the course of disease. The ability to make a lifestyle change is affected by (1) an individual's belief that his or her behavior affects the condition and (2) the social support received from family, especially a primary caregiver. This pilot study compared two randomized groups of patients with peripheral arterial disease for a 1-year period. The control group received the standardized teaching plan regarding smoking cessation and diet at the postoperative clinic visit. The experimental group received the standardized teaching plan in addition to quarterly telephone calls to reinforce smoking cessation and diet information. At the end of 1 year, both groups received follow-up telephone calls at the conclusion of the study for endpoint data collection. Specifically, this project investigated the following research statements: (1) Patients who receive periodic telephone follow-up will have greater compliance with the recommendations regarding smoking and diet than those who do not receive follow-up. (2) Patients whose caregivers are compliant with the recommendations regarding smoking cessation and diet will have significantly higher compliance themselves. The data were analyzed by using cross tabulation, sign test, and McNemar's test for nonparametric data to measure mobility, overall perception of health, knowledge of risk reduction information, and compliance with the smoking cessation and low fat/cholesterol diet plan. The results of this pilot study revealed no significant differences between the control and experimental groups. Telephone reinforcement was not sufficient in this study to influence lifestyle change. However, standardized teaching improved diet scores in both groups. Differences were found between smokers and nonsmokers. To determine whether differences in beliefs about diabetes and its treatment resulted from different intensities of self-monitoring of blood glucose (SMBG) in non-insulin treated patients with Type 2 diabetes in the Diabetes Glycaemic Education and Monitoring (DiGEM) trial.
                Patients (n = 453) were randomized to usual care, less-intensive SMBG and more intensive SMBG. Beliefs about diabetes were measured with a standard questionnaire (the revised Illness Perceptions Questionnaire; IPQ-R). Changes in beliefs were analysed using analysis of covariance (ancova) with adjustment for baseline values. Mediation analyses assessed whether differences in behavioural outcomes between groups could be attributed to differences in beliefs.
                Completed questionnaires were returned by 339 patients (74.8%). Respondents were mean (+/- sd) age 65.9 +/- 10 years and with diabetes duration of 4.8 +/- 4.7 years (median 36, range 1-384 months). Concerns about the consequences of diabetes increased in both self-monitoring groups, relative to control subjects [P = 0.004; Cohen's d standardized effect size = 0.19 less intensive and d = 0.36 more intensive monitoring]. No other beliefs about diabetes differed between groups. Beliefs about the importance of self-testing increased in both self-monitoring groups relative to the usual-care group (P < 0.001; d = 0.57 less intensive and d = 0.63 more intensive monitoring). Changes in psychological well-being did not differ between groups, but control patients reported greater increases in general (P = 0.014) and specific (P < 0.001) dietary adherence than did patients in the self-monitoring groups. These outcomes were not mediated by intervention-related changes in beliefs.
                Despite changes in some beliefs about diabetes differing between groups there were no corresponding changes in self-reported health behaviours. This suggests that changes in illness beliefs resulting from SMBG do not cause changes in diabetes-related health behaviours. This study compared effectiveness of nutrient-based (Diet Guide) vs food-group (Exchange Lists) methods of diabetic diet evaluation in improving dietary compliance, glycemic control, and biochemical indicators of heart disease risk. Eighty-three persons with noninsulin-dependent diabetes were taught one of two diet-planning methods in a 3-session workshop. Both methods led to reductions in energy intake and percent of calories from fat and saturated fatty acids in 6 mo postworkshop. Reductions in fat intake were greater and more long lasting for persons using Diet Guide than using Exchange Lists method of diet planning. Despite dietary changes, neither diet-planning method led to significant decreases in weight or skinfold thickness. Few differences were seen in clinical measurements pre- and 6 mo postworkshop. Total and LDL cholesterol values were lower than preworkshop values for men in both groups. Suggestions are given for improving effectiveness of both diet-planning methods. The aim of this study was to examine the effect of a cardiac rehabilitation programme on health behaviours and physiological risk parameters in patients with coronary heart disease in Chengdu, China.
                Epidemiological studies indicate a dose-, level- and duration-dependent relationship exists between cardiac behavioural and physiological risks and coronary heart disease incidence as well as subsequent cardiac morbidity and mortality. Cardiac risk factor modification has become the very primary goal of modern cardiac rehabilitation programmes.
                A randomized controlled trial was conducted. Coronary heart disease patients (n = 167) who met the sampling criteria in two tertiary medical centres in Chengdu, south-west China, were randomly assigned to either an intervention group (the cardiac rehabilitation programme) or control group (the routine care). The change of health behaviours (walking performance, step II diet adherence, medication adherence, smoking cessation) and physiological risk parameters (serum lipids, blood pressure, body weight) were assessed to evaluate the programme effect.
                Patients in the intervention group demonstrated a significantly better performance in walking, step II diet adherence, medication adherence; a significantly greater reduction in serum lipids including triglyceride, total cholesterol, low-density lipoprotein; and significantly better control of systolic and diastolic blood pressure at three months. The majority of these positive impacts were maintained at six months. The effect of the programme on smoking cessation, body weight, serum high-density lipoprotein, was not confirmed.
                A cardiac rehabilitation programme led by a nurse can significantly improve the health behaviours and cardiac physiological risk parameters in coronary heart disease patients. Nurses can fill significant treatment gaps in the risk factor management of patients with coronary heart disease.
                This study raises attention regarding the important roles nurses can play in cardiac rehabilitation and the unique way for nurses to meet the rehabilitative care needs of coronary heart disease patients. Furthermore, the hospital-home bridging nature of the programme also created a model for interfacing the acute care and community rehabilitative care. Siblings of individuals with premature coronary heart disease have a high prevalence of low-density lipoprotein cholesterol (LDL-C) levels requiring treatment.
                To evaluate management strategies for high LDL-C levels in apparently healthy 30- to 59-year-old siblings of individuals with documented coronary heart disease prior to age 60 years.
                In a 2-year trial of care provided by either a nurse trained in lipid management (NURS) or enhanced primary care (EPC), in which physicians received recommendations based on national guidelines, 156 siblings with LDL-C levels of 4.14 mmol/L (160 mg/dL) were randomized by family. The LDL-C goal levels below 3.36 mmol/L (130 mg/dL) were compared between and within intervention groups. Multiple logistic regression analyses were applied to predict 2-year achievement of the goal.
                The NURS group achieved a significantly greater percentage of goal LDL-C levels than the EPC group (26% vs 10%; P=.008). The NURS LDL-C levels decreased an average of 0.91 mmol/L (35 mg/dL) while EPC levels decreased by 0.52 mmol/L (24 mg/dL) (P=.09). In the final multivariate model, siblings taking lipid-lowering drug treatment were 6.02 times more likely (95% confidence interval, 2.24-16.18) than those not receiving pharmacotherapy to achieve LDL-C goals; nurse management (P=.09) was marginally significant. Pharmacotherapy was instituted in 45.2% of NURS and 16.7% of EPC siblings (P=.001).
                High LDL-C levels in siblings were more effectively treated by a trained nurse, probably related to greater adherence to the application of national guidelines. Nonetheless, the majority of siblings with high LDL-C levels did not meet goal levels 2 years after an index case coronary heart disease event. In accordance with the global trend, in The Netherlands approximately 45% of the population is overweight. Existing studies show that patient self-management can reduce these figures, but medical non-adherence is a persistent problem. eHealth can potentially increase adherence to self-management. Consequently, we designed a persuasive computer assistant and evaluated its influence on self-management, i.e., the use of an online lifestyle diary called DieetInzicht.nl. The assistant is represented by an animated iCat, which shows different facial expressions and provides cooperative feedback following principles from the motivational interviewing method. We conducted a randomized controlled trial with 118 overweight people over a period of four weeks and studied the difference between diary use with and without computer assistant feedback. Results show that the computer assistant contributed to filling in the diary more frequently, reduced the decline in motivation to perform self-management, lowered the (reported) BMI, and improved the ease of use. Furthermore, diary use increased knowledge of maintaining a healthy lifestyle. Finally, personal characteristics, i.e., locus of control, vocabulary, computer experience, age, gender, education level and initial BMI, explained the variance in the diary use and its outcome. Of the 118 participants 35 filled in the closing survey, covering motivation, BMI, lifestyle knowledge and ease of use, which implies that the findings based on these results are mainly representative for motivated participants. In general, this study shows that the Dieetinzicht eHealth service, including a personal computer assistant, is likely to support motivated overweight people and lifestyle related diseases to get a better insight in and adhere to their self-management. Dietary non-compliance is an important cause of poor metabolic control in insulin dependent diabetes. Patients are often blamed, but teaching methods may be at fault, so a prospective study was set up to compare the effect of three different teaching methods. After a three month run in, 40 adults with longstanding poorly controlled insulin dependent diabetes (mean haemoglobin A1 13.0%) were allocated at random to three teaching methods: conventional diet sheet instruction (group 1); practical lunchtime demonstrations (group 2); videotape education (group 3). Knowledge was assessed by questionnaires, compliance by seven day food records, and glycaemic control by serial glycosylated haemoglobin measurements. During six months of follow up there was no improvement in knowledge, compliance, or HbA1 in group 1, but in groups 2 and 3 both knowledge and compliance improved. In group 2 HbA1 fell to 10.6 (SD 2.1)% and in group 3 to 9.6 (2.3)%. The change in HbA1 showed an appreciable correlation with dietary compliance as judged by day to day consistency in carbohydrate intake. These findings show that new and interesting educational methods can have a major influence on knowledge, compliance, and metabolic control in insulin dependent diabetes. Diets encouraging 10% or less fat energy intake have been advocated to prevent progression of coronary artery disease. In this study, a randomized, controlled, repeated measures experimental design was used to determine if reducing fat intake incrementally to an eventual goal of 10% of total energy intake would result in better dietary adherence than would an immediate reduction to 10%. After completing a lifestyle education program and receiving personal dietary counselling, volunteers recruited from a cardiac rehabilitation program (treatment group, n = 4; control group, n = 3) completed a 24-hour recall at two, four, and seven months post-intervention. At these intervals, subjects also spoke with the dietitian to set dietary targets for the incremental reduction group or reinforce them for the immediate reduction group. Neither group achieved the goal of reducing fat intake to 10% of total energy intake, a finding that suggests this may be an unrealistic target. Because both groups consumed about the same percentage of fat energy, there appeared to be no benefit from incremental reduction of fat intake as a strategy to improve dietary adherence. To enhance compliance to physician referral as well as dietary and other lifestyle recommendations given at blood cholesterol (BC) screening programs, we randomized Pawtucket Heart Health Program SCORE (screening, counseling, referral event) participants with elevated BC levels into one of four groups: usual care group; a participant intervention group (mailed reminder letter and refrigerator magnet); a physician intervention group (mailed packet to participant's physician including letter, National Cholesterol Education Program [NCEP] guidelines, and preaddressed postcard to mail to patient); and a group that received both interventions. Beginning four months after the screening, we surveyed study subjects by phone. The participant intervention increased recall of physician referral and dietary recommendations; however, neither intervention successfully improved compliance to referral or dietary and lifestyle recommendations. Overall, 58%, 67% and 34% of subjects reported complying to physician referral, dietary recommendations, and lifestyle recommendations, respectively. Referral compliance was associated with a longer time interval between screening and survey (relative risk [RR] = 1.3, 95% confidence interval [CI[ = 1.0, 1.7), possession of medical insurance that covered physician visits (RR = 2.1, 95% CI = 0.98, 4.4), and history of hypertension (RR = 2.6, 95% CI = 1.1, 5.8). Dietary compliance was positively associated with baseline BC levels > or = 240 mg/dL (RR = 3.3, 95% CI = 1.4, 7.3) and negatively associated with increasing age; each one year increase in age corresponded to a 3% decrease in compliance (RR = 0.97, 95% CI = 0.9. 1.0).(ABSTRACT TRUNCATED AT 250 WORDS) Internet-based weight-loss programs appear promising in the short-term but, to date, have not been able to produce the level of weight loss seen in traditional in-person treatment; thus, novel approaches are necessary. Using a combination of interactive technology and in-person support has been beneficial in other areas of medicine.
                The aim of this study is to compare 12-month weight-loss outcomes of an Internet-only behavioral weight-loss treatment with the same program supplemented with monthly in-person meetings.
                One hundred and twenty-three participants were randomized to an Internet-only (n = 62) or an Internet + in-person treatment (I+IPS; n = 61). All participants then participated in a 12-month behavioral weight-loss program conducted over the Internet. The groups met online weekly for the first 6 months and biweekly for the second half of the intervention. The I+IPS group had access to the same Web site as the Internet-only group but, once a month, attended an in-person meeting in place of an online chat. Assessments included body weight, program adherence, and social support measures.
                An intent-to-treat analysis (n = 123) revealed there were no significant Group x Time differences (p = .15) in weight loss at either 6 (-6.8 +/- 7.8 vs. -5.1 +/- 4.8, p = .15) or 12 months (-5.1 +/- 7.1 kg vs. -3.5 +/- 5.1 kg, p = .17, for Internet-only and I+IPS, respectively). Differences between groups for those completing all measures (n = 77) also revealed no significant differences at 6 months (-9.2 +/- 7.0 kg vs. -6.9 +/- 4.2 kg, p = .08) or 12 months (-8.0 +/- 7.5 kg vs. -5.6 +/- 5.5 kg, p = .10 for the Internet-only and I+IPS conditions, respectively).
                Supplementation of an Internet weight-loss treatment with monthly in-person meetings did not result in greater weight losses over 12 months. Dynamic, socially supportive, and interactive elements of the Web site may have obviated the need for further interpersonal behavioral counseling. To examine the impact of two culturally competent diabetes education methods, individual counselling and individual counselling in conjunction with group education, on nutrition adherence and glycemic control in Portuguese Canadian adults with type 2 diabetes over a three-month period.
                The Diabetes Education Centre is located in the urban multicultural city of Toronto, Ontario, Canada. We used a three-month randomized controlled trial design. Eligible Portuguese-speaking adults with type 2 diabetes were randomly assigned to receive either diabetes education counselling only (control group) or counselling in conjunction with group education (intervention group). Of the 61 patients who completed the study, 36 were in the counselling only and 25 in the counselling with group education intervention. We used a per-protocol analysis to examine the efficacy of the two educational approaches on nutrition adherence and glycemic control; paired t-tests to compare results within groups and analysis of covariance (ACOVA) to compare outcomes between groups adjusting for baseline measures. The Theory of Planned Behaviour was used to describe the behavioural mechanisms that influenced nutrition adherence.
                Attitudes, subjective norms, perceived behaviour control, and intentions towards nutrition adherence, self-reported nutrition adherence and glycemic control significantly improved in both groups, over the three-month study period. Yet, those receiving individual counselling with group education showed greater improvement in all measures with the exception of glycemic control, where no significant difference was found between the two groups at three months.
                Our study findings provide preliminary evidence that culturally competent group education in conjunction with individual counselling may be more efficacious in shaping eating behaviours than individual counselling alone for Canadian Portuguese adults with type 2 diabetes. However, larger longitudinal studies are needed to determine the most efficacious education method to sustain long-term nutrition adherence and glycemic control. Patients with end-stage renal disease often fail to follow a prescribed diet and fluid regimen, which undermines the effectiveness of care and leads to unpredictable progression of the disease and greater likelihood of complications.
                The purpose of this randomized controlled study was to examine the effectiveness of self-efficacy training on fluid intake compliance.
                This study took place in northern Taiwan. Eligible patients were receiving routine haemodialysis; 20-65 years of age; living in a community setting; able to read and write; and willing to participate. Sixty-two end-stage renal disease patients participated in the study. Those in the experimental group (n = 31) received 12 sessions of structured self-efficacy training; the control group patients (n = 31) received only routine care. The intervention was based on Bandura's theory and included an educational component, performance mastery, experience sharing, and stress management. The outcome measure was the mean body weight gain between dialysis sessions. Data were collected at baseline, 1, 3 and 6 months following the intervention and analysed by a descriptive and repeated-measures anova.
                Experimental group mean weight gains decreased gradually following self-efficacy training. However, control group mean weight gains decreased only slightly over time. These results were statistically significant when baseline differences controlled for (P < 0.05).
                The study supports the effectiveness of the self-efficacy training in controlling mean body weight gains of end-stage renal disease patients receiving haemodialysis. Poor compliance with the dietary prescriptions is quite common in dialysis patients. We believe that most of the noncompliance is caused by the patient's poor understanding of the dietary prescription. Therefore, in the present study, we tried to investigate the role of menu suggestion in improving the patient's compliance with the dietary prescription.
                A longitudinal cohort study conducted at an outpatient dialysis clinic.
                Seventy clinically stable patients on peritoneal dialysis were included in this prospective study during April 1, 2004, to November 31, 2004, in a single center. Patients who had significant cognitive impairment and thus did not understand the food contents during the training course were not eligible for enrollment.
                All the patients were randomly assigned to 1 of 2 groups. Group 1 patients received the traditional patient education method. Group 2 patients additionally received individualized menu suggestions based on their food preferences and education on how to exchange the foods at equivalent amounts according to the exchange list.
                At present, there are no clear optimal dietary protein intake levels for peritoneal dialysis patients. Our experience is that a dietary protein intake level of 0.8 to 1.2 g/kg/d can maintain our patients in a good nutritional status. Thereafter, in this study we prescribed the dietary protein intake level at 0.8 to 1.2 g/kg/d and defined compliance as meeting this target protein intake level.
                There were 35 patients in each group. The compliance was 22.9% in group 1 and 57.1% in group 2 (P < .05).
                Our study suggests that menu suggestion may be an effective way of improving the compliance with the diet in peritoneal dialysis patients. It improves the patient's understanding of the dietary prescription. Our aim was to investigate whether a nurse-coordinated multidisciplinary, family-based preventive cardiology programme could improve standards of preventive care in routine clinical practice.
                In a matched, cluster-randomised, controlled trial in eight European countries, six pairs of hospitals and six pairs of general practices were assigned to an intervention programme (INT) or usual care (UC) for patients with coronary heart disease or those at high risk of developing cardiovascular disease. The primary endpoints-measured at 1 year-were family-based lifestyle change; management of blood pressure, lipids, and blood glucose to target concentrations; and prescription of cardioprotective drugs. Analysis was by intention to treat. The trial is registered as ISRCTN 71715857.
                1589 and 1499 patients with coronary heart disease in hospitals and 1189 and 1128 at high risk were assigned to INT and UC, respectively. In patients with coronary heart disease who smoked in the month before the event, 136 (58%) in the INT and 154 (47%) in the UC groups did not smoke 1 year afterwards (difference in change 10.4%, 95% CI -0.3 to 21.2, p=0.06). Reduced consumption of saturated fat (196 [55%] vs 168 [40%]; 17.3%, 6.4 to 28.2, p=0.009), and increased consumption of fruit and vegetables (680 [72%] vs 349 [35%]; 37.3%, 18.1 to 56.5, p=0.004), and oily fish (156 [17%] vs 81 [8%]; 8.9%, 0.3 to 17.5, p=0.04) at 1 year were greatest in the INT group. High-risk individuals and partners showed changes only for fruit and vegetables (p=0.005). Blood-pressure target of less than 140/90 mm Hg was attained by both coronary (615 [65%] vs 547 [55%]; 10.4%, 0.6 to 20.2, p=0.04) and high-risk (586 [58%] vs 407 [41%]; 16.9%, 2.0 to 31.8, p=0.03) patients in the INT groups. Achievement of total cholesterol of less than 5 mmol/L did not differ between groups, but in high-risk patients the difference in change from baseline to 1 year was 12.7% (2.4 to 23.0, p=0.02) in favour of INT. In the hospital group, prescriptions for statins were higher in the INT group (810 [86%] vs 794 [80%]; 6.0%, -0.5 to 11.5, p=0.04). In general practices in the intervention groups, angiotensin-converting enzyme inhibitors (297 [29%] INT vs 196 [20%] UC; 8.5%, 1.8 to 15.2, p=0.02) and statins (381 [37%] INT vs 232 [22%] UC; 14.6%, 2.5 to 26.7, p=0.03) were more frequently prescribed.
                To achieve the potential for cardiovascular prevention, we need local preventive cardiology programmes adapted to individual countries, which are accessible by all hospitals and general practices caring for coronary and high-risk patients. The effectiveness of the support of a healthcare practitioner and a family member in producing changes in cardiovascular risk factor modification was tested in a randomised, controlled trial in patients with hypertension.
                The primary outcome measured after the 24-week intervention was blood pressure change. Secondary outcomes included patients' adherence to the programme, their knowledge about hypertension, exercise capacity, body weight, self-reported ability to control stress, adherence to medication and salt restriction, as well as symptoms.
                There were no marked improvements in blood pressure regulation in either group. The differences between the experimental and control groups were 3 mmHg (CI -6.18-12.18) for systolic blood pressure and 4 mmHg (CI -1.48-9.48) for diastolic blood pressure. The estimated blood pressure effects were small increases in both diastolic and systolic blood pressure, due to larger changes in the control group. These small changes were of no clinical significance. This intervention was not successful in reducing blood pressure of hypertensive patients who participated in a lifestyle programme. Secondary outcomes did show positive changes as a result of the given intervention. The absolute difference in improvement between the two groups was significantly greater for the experimental group than for the control group for the following variables: 24% better adherence to the programme (p = 0.007); 10% higher mean percentage score of hypertension knowledge and its management (p = 0.04); 20% more patients could control their stress levels (p = 0.05); 26% more patients could control their salt ingestion (p = 0.02); and 20% had better adherence to their given medication regimen (p = 0.05). The experimental group had a statistically significant weight reduction of 1 (+/- 4) kg relative to the control group (p = 0.03). Both groups increased their exercise capacity during the trial (p = 0.03). On the completion of the intervention, significantly fewer patients in the experimental group than in the control complained of tiredness (p = 0.05). Patients who had a 75% adherence or more to the programme were found to have maintained their knowledge and their exercise capacity, but not their weight loss after a maintenance phase of 12 weeks, during which time there was no intervention.
                Patients in a supported environment such as the one in this study were able to modify their cardiovascular risk factors, even though there were non-significant changes in blood pressure reported in this study. The present study sought to assess the impact of an intervention to reduce weight and control risk factors of noncommunicable chronic diseases in overweight or obese adults who are users of primary and secondary healthcare units of the public health system of Pelotas, Brazil. We hypothesized that individuals who received an educational intervention regarding how to lose weight and prevent other noncommunicable chronic disease risk factors through nutrition would lose weight and acquire active habits during leisure time more frequently than individuals under regular care. Two hundred forty-one participants from the Nutrition Outpatient Clinic of the Medical Teaching Hospital of the Federal University of Pelotas, Brazil, aged 20 years or older and classified as overweight or obese were randomly allocated to either the intervention group (IG; n = 120) or control group (CG; n = 121). The IG received individualized nutritional care for 6 months, and the CG received individualized usual care of the health services. Intention-to-treat analyses showed that at 6 months, mean fasting glycemia and daily consumption of sweet foods and sodium were reduced, and the time spent on physical leisure activity was increased in IG. Analysis of adherence to the protocol of the study revealed that individuals from IG had lost more in body weight, waist circumference, and fasting glucose compared to the CG. Leisure time physical activity increased in IG. Individuals adhered equally to the dietetic recommendations, irrespective of the nutrition approach that was used.
                Copyright © 2010 Elsevier Inc. All rights reserved. Many patients in primary care settings present with multiple behavioral risk factors for cardiovascular disease. Research has provided little information on the most effective ways to approach multiple behavior change counseling in clinical settings.
                We implemented a randomized trial in a publicly funded primary care setting to test whether a sequential presentation of stage of change-based counseling to stop smoking, reduce dietary sodium level to less than 100 mEq/L per day, and increase physical activity by at least 10,000 pedometer steps per week would be more effective than simultaneous counseling. African Americans with hypertension, aged 45 to 64 years, initially nonadherent to the 3 behavioral goals, were randomized to the following conditions: (1) 1 in-clinic counseling session on all 3 behaviors every 6 months, supplemented by motivational interviewing by telephone for 18 months; (2) a similar protocol that addressed a new behavior every 6 months; or (3) 1-time referral to existing group classes ("usual care"). The primary end point was the proportion in each arm that met at least 2 behavioral criteria after 18 months.
                A total of 289 individuals (67.3% female) were randomized, and 230 (79.6%) completed the study. At 18 months, only 6.5% in the simultaneous arm, 5.2% in the sequential arm, and 6.5% in the usual-care arm met the primary end point. However, results for single behavioral goals consistently favored the simultaneous group. At 6 months, 29.6% in the simultaneous, 16.5% in the sequential, and 13.4% in the usual-care arms had reached the urine sodium goal (P = .01). At 18 months, 20.3% in the simultaneous, 16.9% in the sequential, and 10.1% in the usual-care arms were urine cotinine negative (P = .08).
                Long-term multiple behavior change is difficult in primary care. This study provides strong evidence that addressing multiple behaviors sequentially is not superior to, and may be inferior to, a simultaneous approach. This research examined the relative efficacies of three intervention strategies designed to increase compliance to medical regimens in a group of ambulatory hemodialysis patients. The interventions examined included behavioral contracting (with or without the involvement of a family member or friend) and weekly telephone contacts with patients. Compliance was assessed with regard to following dietary restrictions and limiting fluid intake. Data were collected from 116 patients drawn from two outpatient clinics. Within clinics, patients were randomly assigned either to an intervention program or to a control group. The study employed a pretest-posttest control group design. Patients were interviewed before the intervention programs began (T1), after a 6-week intervention period (T2), and 3 months after completion of the intervention period (T3). Results showed that the interventions achieved substantial reductions in patients' serum potassium levels and in weight gains between dialysis treatments between T1 and T2. In general, however, these program effects tapered off to preintervention levels between T2 and T3. The findings thus indicate a need for long-term intervention programs. The prevalence of hypertension is high, but the overall control rate is low. Poor control of, hypertension is associated with a number of diseases, such as stroke, heart and renal failure, and high, mortality rates. Studies have shown the separate effects of nurse clinics and telephone follow-up on, blood pressure control, but the incremental effect of combining the two interventions is unknown.
                This study examines whether there is an incremental effect on blood pressure control when using a nurse clinic combined with telephone follow-up.
                This was a randomised controlled trial. The primary outcome measure was blood pressure reading. The secondary outcome measures included adherence to home blood pressure monitoring, exercise, diet, medication, and satisfaction with care.
                There were no significant differences in the baseline measures between the control and study groups. Significant differences were found at 8 weeks after intervention was initiated between groups in, systolic blood pressure (control -7.97 vs study -19.03, t=2.35, p=0.022, CI 1.66-20.47) and diastolic, blood pressure (control -3.72 vs study -11.68, t=3.02, p=0.004, CI 2.68-13.24). Other variables with a significant between-group differences (p<0.05) were blood pressure control rate, adherence, to home blood pressure monitoring, exercise and satisfaction with care. Further analysis using, regression showed that home blood pressure monitoring is the most significant predictor for improved, systolic blood pressure.
                This study showed that nurse clinics have positive effects on blood pressure control and adherence to healthy lifestyle, but telephone follow-up after such clinics augments the effects of the clinic consultation. This combined mode of services is worth considering for other chronic disease, management programmes.
                Copyright 2010 Elsevier Ltd. All rights reserved.
There is a need for further, long-term, good-quality studies using more standardized and validated measures of adherence to identify the interventions that should be used in practice to enhance adherence to dietary advice in the context of a variety of chronic diseases.