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Managing Adult Overweight and Obesity in Primary Care
Published in Ruth Chambers, Paula Stather, Tackling Obesity and Overweight Matters in Health and Social Care, 2022
The population strategy aims to shift the whole distribution of a risk factor in a favourable direction. But the ‘prevention paradox’ means that preventive actions that greatly benefit the population at large may bring only small benefits for individuals. A population-based approach must target the whole population, from young people to older adults, through educational programmes that promote and encourage the local population to increase the extent of their physical activity and adopt a healthy diet. Health goals should include individuals: Gaining a good quality of lifeAvoiding comorbidities and premature death Good information will help people with coronary heart disease make choices about their diet, smoking, physical activity and other health-related behaviour. Lifelong exercise and the avoidance of overweight and obesity seem to protect someone against the risk of stroke.
Public health, behavioural medicine and eHealth technology
Published in Lisette van Gemert-Pijnen, Saskia M. Kelders, Hanneke Kip, Robbert Sanderman, eHealth Research, Theory and Development, 2018
Rik Crutzen, Rosalie van der Vaart, Andrea Evers, Christina Bode
These results are consistent with all types of interventions (not only eHealth interventions) in the field of public health in general, where small-to-moderate effect sizes are commonly reported. This can be partly explained by the prevention paradox: the seemingly contradictory situation where the majority of cases of a disease come from a population at low or moderate risk of that disease, and only a minority of cases come from the high-risk population (Rose, 1985). In other words, most interventions in the field of public health target the general population that is healthy and at low or moderate risk of disease. The changes needed are small in nature but can still have a large impact at population level because of the high number of people that are at low or moderate risk. So small-to-moderate effect sizes can have a large impact if large audiences are reached. This is also relevant in terms of behaviour maintenance. Prevention of obesity, for example, is thought to be most successful when focusing on small changes in dietary intake and physical activity, since small changes are easier to maintain in the long run (Hill, 2009).
Non-communicable diseases
Published in Liam J. Donaldson, Paul D. Rutter, Donaldsons' Essential Public Health, 2017
Liam J. Donaldson, Paul D. Rutter
The high-risk strategy is a good and effective one, but it has a problem – it is not only those with high blood pressure or extreme obesity who are at high risk of strokes and heart attacks. Many people who are mildly overweight or have even normal blood pressure also have heart attacks and strokes. In fact, people with normal blood pressure have more strokes than people with hypertension do. This phenomenon may sound counterintuitive, but occurs because there are many more people with normal blood pressure in the population than there are people with hypertension. For each individual with normal blood pressure, the risk of having a stroke is lower, but it is not zero. This is known as the prevention paradox – that a large number of people at low risk may give rise to more cases of disease than a small number at high risk.
Delivering Take Root to Military Families with a Child 0-to 3-Years-Old: Examining Feasibility and Proof-of-Concept
Published in Military Behavioral Health, 2022
Ryan P. Chesnut, Terri L. Rudy, Janet A. Welsh, Daniel F. Perkins
Despite the strength of the evidence base, only a small percentage of parents have access to and participate in, in-person PFIs (Prinz & Sanders, 2007; Sanders, 2019). Several factors have been identified as contributors to the low uptake, including high cost, logistical burdens (e.g., space considerations, child care, transportation, family schedules, relocations), stigma, and service disruption during major health crises (e.g., COVID-19; MacDonell & Prinz, 2017; Prinz & Sanders, 2007; Yoshikawa et al., 2020). Consequently, increased attention has been paid to making PFIs available through technology-based delivery platforms (e.g., websites, mobile apps, videoconferencing software). Further, there is growing interest in applying a public health approach to parenting support (Prinz, 2019; Salari & Enebrink, 2018; Sanders & Burke, 2018), and technology-based PFIs are considered an integral part of such an approach (Baker et al., 2017). A public health approach to parenting support employs a stepped care model operating under the principle of minimal-sufficiency (i.e., providing parents with just enough assistance to meet their needs; Sanders & Burke, 2018). This approach also embraces a philosophy made popular by Rose (1981) known as the prevention paradox. In essence, this states that wide-scale, community-level change cannot be achieved by solely treating problems; rather, efforts also need to target low and moderate risk populations to maximize impact. Perhaps the most well-known PFI that embraces the public health approach to parenting support is the Triple P system, which offers a series of low- and high-intensity programming, that can be either self-directed (i.e., no professional support) or therapist-assisted, across a variety of delivery platforms (Sanders, 2019).
Is self-regulation key in reducing running-related injuries and chronic fatigue? A randomized controlled trial among long-distance runners
Published in Journal of Applied Sport Psychology, 2022
Luuk P. van Iperen, Jan de Jonge, Josette M. P. Gevers, Steven B. Vos, Luiz Hespanhol
Although more explicit measures of self-regulatory behavior were absent, we did account for self-regulatory patterns in the latent profile subgroup analysis. This analysis involved employed running-related coping strategies and passion for running as indicators of latent (risk) profiles, which, in their interaction together, highlight patterns of self-regulation among runners through their coping with running-related demands (see van Iperen et al., 2022). The resulting analysis was used to determine whether any effects of the REMBO app differed per risk profile of long-distance runners. This approach was included in a post-hoc fashion due to promising findings of such profiles in recent studies (e.g., Martin et al., 2021; van Iperen et al., 2022). Tests of boundary conditions reaffirmed the value of these latent profiles, which, assessed at baseline, largely predicted RRI status and chronic fatigue at the follow-up measurement. In contrast, the test of Hypothesis 3 revealed that the app effects did, at face value, align with these profiles, but not in a strict statistically significant manner. Therefore, we can only conclude that risk profiles did not attenuate app effects in the current study, noting limited power. However, other studies have highlighted the potential value of subgrouping approaches (e.g., Li et al., 2020; Yosmaoğlu et al., 2020). Similarly, passion for running combined with running-related coping strategies has shown to be predictive of RRIs (e.g., de Jonge et al., 2020). An interesting counterstatement on these subgrouping approaches concerns the prevention paradox (Raza et al., 2018). This paradox, translated to the current study, suggests that a small reduction of injuries at the population level (i.e., despite its lower risk level) may realize more benefits than aiming for a high reduction of injuries in a high-risk population (e.g., high-risk profile runners), in part because the number of injuries in the latter will be significantly lower. This would imply aiming for a broadly adopted intervention, which could deliver more effects than an intervention that works for a niche of high-risk runners. However, there are arguments to be found for both strategies (see also Hunt & Emslie, 2001).