RESUMEN
Objectives: The Open Source Wellness (OSW) model was designed to function as a behavioral pharmacy; an affordable, accessible delivery system for a universal experiential prescription: MOVE (physical activity), NOURISH (healthy meals), CONNECT (social support), and BE (stress reduction). This study evaluates the OSW model in a billable group medical visit (GMV) format in a federally qualified health center (FQHC). Intervention: Patients with behaviorally mediated conditions, including cardiovascular disease, diabetes, and depression, as well as poor social determinants of health, such as food insecurity, were prescribed participation in the OSW program by their medical team. Groups met for 2 h each week for 16 weeks to complete 30 min of socially engaging physical activity, 5 min of mindfulness meditation, a 10-min interactive, didactic health lesson, a 5-min nutrition lesson, and 60 min of small-group coaching over a plant-based meal. Paraprofessional health coaches worked with participants in small groups to provide support and create accountability to goals. In addition, participants received a $10 voucher to Food Farmacy, which provided free produce. Subjects: The sample consisted of 49 patients from the Hayward Wellness Center, an FQHC in Hayward, California. They were mostly women, 59.6%, and racially and ethnically diverse: 23.1% African American, 5.8% Asian, 26.9% Hispanic/Latino, 11.5% Pacific Islander, and 32.7% Caucasian. Participants averaged 59.1 years of age (SD = 10.6). Outcome measures: Blood pressure and weight were recorded weekly. Demographic and acute care utilization data were drawn from the electronic medical record. Self-report questionnaires assessed diet, exercise, and mood on a monthly basis. Methods and results: Longitudinal data were analyzed with linear mixed models. Participants (n = 49) demonstrated significant increases in daily servings of fruits and vegetables, b = 0.31, p < 0.01, and exercise, b = 11.50, p < 0.01, as well as significant reductions in body mass index, b = -0.10, p = 0.05. Acute care utilization decrease was not statistically significant, b = -0.07, p = 0.14. Depressed patients (n = 11) saw reductions in depression, b = -1.72, p < 0.01, and hypertensive patients (n = 24) saw reductions in systolic blood pressure, b = -4.04, p < 0.01, but not diastolic blood pressure, b = 0.04, p = 0.95. Conclusions: This study demonstrates the effectiveness of the OSW behavioral pharmacy model within a GMV context; pathways for adaptation, spread/scale, and incorporation of this work as a component of the broader health ecosystem and national commitment to health equity are discussed.
Asunto(s)
Medicina de la Conducta/métodos , Enfermedad Crónica/terapia , Citas Médicas Compartidas , Anciano , Presión Sanguínea/fisiología , Peso Corporal/fisiología , Atención a la Salud , Dieta , Ejercicio Físico , Femenino , Humanos , Estudios Longitudinales , Persona de Mediana Edad , Apoyo SocialRESUMEN
BACKGROUND: Epidemiologic evidence shows an increase in obesity concurrent with a reduction in average sleep duration among Americans. Although clinical studies propose that restricted sleep affects hormones related to appetite, neuronal activity in response to food stimuli after restricted and habitual sleep has not been investigated. OBJECTIVE: The objective of this study was to determine the effects of partial sleep restriction on neuronal activation in response to food stimuli. DESIGN: Thirty healthy, normal-weight [BMI (in kg/m²): 22-26] men and women were recruited (26 completed) to participate in a 2-phase inpatient crossover study in which they spent either 4 h/night (restricted sleep) or 9 h/night (habitual sleep) in bed. Each phase lasted 6 d, and functional magnetic resonance imaging was performed in the fasted state on day 6. RESULTS: Overall neuronal activity in response to food stimuli was greater after restricted sleep than after habitual sleep. In addition, a relative increase in brain activity in areas associated with reward, including the putamen, nucleus accumbens, thalamus, insula, and prefrontal cortex in response to food stimuli, was observed. CONCLUSION: The findings of this study link restricted sleep and susceptibility to food stimuli and are consistent with the notion that reduced sleep may lead to greater propensity to overeat.