Coenraad K van Kalken

Bio: Coenraad K van Kalken is an academic researcher. The author has contributed to research in topics: Behavior change & Health care. The author has an hindex of 3, co-authored 5 publications receiving 91 citations.

Effects on cardiovascular disease risk of a web-based health risk assessment with tailored health advice: a follow-up study.

Abstract: textIntroduction: A large proportion of the cardiovascular disease (CVD) burden can potentially be prevented by primary prevention programs addressing major causal risk factors. A Web- based health risk assessment (HRA) with tailored feedback for individual health promotion is a promising strategy. We evaluated the effect on CVD risk of such a program among employees of a Dutch worksite. Methods: We conducted a prospective follow-up study among 368 employees who voluntarily participated in a Web-based HRA program at a single Dutch worksite in 2008. The program included a multicomponent HRA through a Web-based electronic questionnaire, biometrics, and laboratory evaluation. The results were combined with health behavior change theory to generate tailored motivational and educational health advice. On request, a health counseling session with the program physician was available. Follow-up data on CVD risk were collected 1 year after initial participation. The primary outcome was a change in Framingham CVD risk at 6 months relative to baseline. We checked for a possible background effect of an increased health consciousness as a consequence of program introduction at the worksite by comparing baseline measurements of early program participants with baseline measurements of participants who completed the program 6 months later. Results: A total of 176 employees completed follow-up measurements after a mean of 7 months. There was a graded relation between CVD risk changes and baseline risk, with a relative reduction of 17.9% (P = 0.001) in the high-risk category (baseline CVD risk ≥20%). Changes were not explained by additional health counseling, medication, or an increase in health consciousness within the company. Conclusions: Voluntary participation in a Web-based HRA with tailored feedback at the worksite reduced CVD risk by nearly 18% among participants at high CVD risk and by nearly 5% among all participants. Web-based HRA could improve CVD risk in similar populations. Future research should focus on the persistence of the effects underlying the CVD risk reduction.

Initiation of health-behaviour change among employees participating in a web-based health risk assessment with tailored feedback

Abstract: Background: Primary prevention programs at the worksite can improve employee health and reduce the burden of cardiovascular disease. Programs that include a web-based health risk assessment (HRA) with tailored feedback hold the advantage of simultaneously increasing awareness of risk and enhancing initiation of health-behaviour change. In this study we evaluated initial health-behaviour change among employees who voluntarily participated in such a HRA program. Methods: We conducted a questionnaire survey among 2289 employees who voluntarily participated in a HRA program at seven Dutch worksites between 2007 and 2009. The HRA included a web-based questionnaire, biometric measurements, laboratory evaluation, and tailored feedback. The survey questionnaire assessed initial selfreported health-behaviour change and satisfaction with the web-based HRA, and was e-mailed four weeks after employees completed the HRA. Results: Response was received from 638 (28%) employees. Of all, 86% rated the program as positive, 74% recommended it to others, and 58% reported to have initiated overall health-behaviour change. Compared with employees at low CVD risk, those at high risk more often reported to have increased physical activity (OR 3.36, 95% CI 1.52-7.45). Obese employees more frequently reported to have increased physical activity (OR 3.35, 95% CI 1.726.54) and improved diet (OR 3.38, 95% CI 1.50-7.60). Being satisfied with the HRA program in general was associated with more frequent self-reported initiation of overall health-behaviour change (OR 2.77, 95% CI 1.734.44), increased physical activity (OR 1.89, 95% CI 1.06-3.39), and improved diet (OR 2.89, 95% CI 1.61-5.17). Conclusions: More than half of the employees who voluntarily participated in a web-based HRA with tailored feedback, reported to have initiated health-behaviour change. Self-reported initiation of health-behaviour change was more frequent among those at high CVD risk and BMI levels. In general employees reported to be satisfied with the HRA, which was also positively associated with initiation of health-behaviour change. These findings indicate that among voluntary participating employees a web-based HRA with tailored feedback may motivate those in greatest need of health-behaviour change and may be a valuable component of workplace health promotion programs.

Effect of a Web-based Health Risk Assessment with Tailored Feedback on Lifestyle among Voluntary Participating Employees: A Long-term Followup Study

Abstract: Background: Primary prevention of cardiovascular disease (CVD) by means of web-based Health Risk Assessment (HRA) with tailored feedback for individual health promotion is promising. We evaluated the effects on lifestyle of such a HRA program among employees of a Dutch worksite. Methods: We conducted a prospective follow-up study among employees who voluntarily participated in a webbased HRA including tailored feedback, offered to them by their employer. The program includes a multi-component HRA through a web-based electronic questionnaire, biometrics and laboratory evaluation. Results are combined with health behavior change theory to generate tailored motivating and educating health recommendations. Upon request, a health counseling session with the program physician is available. Follow-up data on lifestyle were collected one year after initial participation. Primary outcomes were the changes relative to baseline in proportions meeting recommendations for physical activity, fruit and vegetable intake, smoking and alcohol consumption. We checked for a possible background effect of an increased health consciousness as a consequence of program introduction at the worksite by comparing baseline measurements of early program participants with baseline measurements of participants who completed the program a year later. Results: A total of 142 employees completed follow-up measurements after mean 15 months. The proportion with a total physical activity amount of ≥ 150 minutes/week increased from 46% to 71% (p<0.001). The proportion with a physical activity pattern according to local recommendation (at least 30 minutes of moderate intensity physical activity on at least five days a week) was not increased. No differences were found in the proportions meeting recommendations for daily intake of fruit and vegetables, of moderate alcohol consumption, and smoking cessation. Changes were not explained by additional health counseling or increased health consciousness within the company. Conclusions: Among employees who voluntarily participated in a web-based HRA with tailored feedback the proportion with a total physical activity of ≥ 150 minutes/week increased by 25%. Web-based HRA programs with tailored feedback could help employers to enhance employee physical activity.

A Holistic Approach for Prevention and Early Diagnostics :Personal Health Management with Web-based Personal Health Records

Abstract: Prevention and early diagnostics are actual topics in today's healthcare. A structured and integrated approach is desired to optimize and benefit from preventive healthcare. We envision personal health records (PHRs) to be a platform for personal health services. The current PHRs, however, mainly provide services that are focussed on cost reduction and management of specific diseases. Integrated prevention and early diagnostics approach is currently not a part of PHRs, whereas an expansion with such a service is desired to create a direct value proposition for health consumers. PHR-based services thus need to focus on prevention, early diagnostics and subsequent early intervention, next to disease management. In this paper we propose a holistic approach for preventive health services via PHRs and identify the issues related to this approach.

Ensemble electronique permettant d'etablir un diagnostic

Abstract: L'invention concerne un procede et un ensemble electronique (55) permettant de communiquer avec un ou plusieurs ensembles electroniques (51(i), 52(j), 53(k)) equipes d'un processeur et d'une memoire contenant des donnees et des instructions stockees de facon que le processeur puisse executer un programme predetermine. Sur la base de donnees d'anamnese (62), de donnees physiques/diagnostiques (63) et de donnees d'essai en laboratoire, le processeur calcule une probabilite de la maladie predeterminee. Si la probabilite de la maladie, se situe en-dessous d'un premier seuil, le processeur indique qu'un essai supplementaire n'est pas requis et qu'un traitement medical n'est pas necessaire. Si la probabilite de la maladie se situe entre le premier et le second seuils, le processeur indique qu'un essai supplementaire relatif a la ou aux maladies est requis et que le traitement medical depend de cet essai supplementaire. Si la probabilite de la maladie depasse le second seuil, le processeur indique qu'une intervention medicale est necessaire. Les seuils dependent notamment de l'âge et du sexe du sujet.

Digital health interventions for the prevention of cardiovascular disease: a systematic review and meta-analysis.

Abstract: Objective To assess the potential benefit of digital health interventions (DHIs) on cardiovascular disease (CVD) outcomes (CVD events, all-cause mortality, hospitalizations) and risk factors compared with non-DHIs. Patients and Methods We conducted a systematic search of PubMed, MEDLINE, EMBASE, Web of Science, Ovid, CINHAL, ERIC, PsychINFO, Cochrane, and Cochrane Central Register of Controlled Trials for articles published from January 1, 1990, through January 21, 2014. Included studies examined any element of DHI (telemedicine, Web-based strategies, e-mail, mobile phones, mobile applications, text messaging, and monitoring sensors) and CVD outcomes or risk factors. Two reviewers independently evaluated study quality utilizing a modified version of the Cochrane Collaboration risk assessment tool. Authors extracted CVD outcomes and risk factors for CVD such as weight, body mass index, blood pressure, and lipid levels from 51 full-text articles that met validity and inclusion criteria. Results Digital health interventions significantly reduced CVD outcomes (relative risk, 0.61; 95% CI, 0.46-0.80; P I 2 =22%). Concomitant reductions in weight (−2.77 lb [95% CI, −4.49 to −1.05 lb]; P I 2 =97%) and body mass index (−0.17 kg/m 2 [95% CI, −0.32 kg/m 2 to −0.01 kg/m 2 ]; P =.03; I 2 =97%) but not blood pressure (−1.18 mm Hg [95% CI, −2.93 mm Hg to 0.57 mm Hg]; P =.19; I 2 =100%) were found in these DHI trials compared with usual care. In the 6 studies reporting Framingham risk score, 10-year risk percentages were also significantly improved (−1.24%; 95% CI, −1.73% to −0.76%; P I 2 =94%). Results were limited by heterogeneity not fully explained by study population (primary or secondary prevention) or DHI modality. Conclusion Overall, these aggregations of data provide evidence that DHIs can reduce CVD outcomes and have a positive impact on risk factors for CVD.

A Systematic Review of Internet-Based Worksite Wellness Approaches for Cardiovascular Disease Risk Management: Outcomes, Challenges & Opportunities

Abstract: Author(s): Aneni, Ehimen C; Roberson, Lara L; Maziak, Wasim; Agatston, Arthur S; Feldman, Theodore; Rouseff, Maribeth; Tran, Thinh H; Blumenthal, Roger S; Blaha, Michael J; Blankstein, Ron; Al-Mallah, Mouaz H; Budoff, Matthew J; Nasir, Khurram | Abstract: ContextThe internet is gaining popularity as a means of delivering employee-based cardiovascular (CV) wellness interventions though little is known about the cardiovascular health outcomes of these programs. In this review, we examined the effectiveness of internet-based employee cardiovascular wellness and prevention programs.Evidence acquisitionWe conducted a systematic review by searching PubMed, Web of Science and Cochrane library for all published studies on internet-based programs aimed at improving CV health among employees up to November 2012. We grouped the outcomes according to the American Heart Association (AHA) indicators of cardiovascular wellbeing--weight, BP, lipids, smoking, physical activity, diet, and blood glucose.Evidence synthesisA total of 18 randomized trials and 11 follow-up studies met our inclusion/exclusion criteria. Follow-up duration ranged from 6-24 months. There were significant differences in intervention types and number of components in each intervention. Modest improvements were observed in more than half of the studies with weight related outcomes while no improvement was seen in virtually all the studies with physical activity outcome. In general, internet-based programs were more successful if the interventions also included some physical contact and environmental modification, and if they were targeted at specific disease entities such as hypertension. Only a few of the studies were conducted in persons at-risk for CVD, none in blue-collar workers or low-income earners.ConclusionInternet based programs hold promise for improving the cardiovascular wellness among employees however much work is required to fully understand its utility and long term impact especially in special/at-risk populations.

The use of personalized behavioral feedback for online gamblers: an empirical study

Abstract: Over the last few years, online gambling has become a more common leisure time activity. However, for a small minority, the activity can become problematic. Consequently, the gambling industry has started to acknowledge their role in player protection and harm minimization and some gambling companies have introduced responsible gambling tools as a way of helping players stay in control. The present study evaluated the effectiveness of mentor (a responsible gambling tool that provides personalized feedback to players) among 1,015 online gamblers at a European online gambling site, and compared their behavior with matched controls (n = 15,216) on the basis of age, gender, playing duration, and theoretical loss (i.e., the amount of money wagered multiplied by the payout percentage of a specific game played). The results showed that online gamblers receiving personalized feedback spent significantly less time and money gambling compared to controls that did not receive personalized feedback. The results suggest that responsible gambling tools providing personalized feedback may help the clientele of gambling companies gamble more responsibly, and may be of help those who gamble excessively to stay within their personal time and money spending limits.

The role of knowledge and perceived susceptibility in intentions to optimize fertility: findings from the International Fertility Decision-Making Study (IFDMS)

Abstract: STUDY QUESTION What is the role of knowledge, perceived vulnerability and level of risk of infertility in women's intentions to take action to improve their chance of becoming pregnant (i.e. by seeking medical and/or non-medical help and making lifestyle changes)? SUMMARY ANSWER Women younger than age 35 were more likely to intend to take measures to improve their chance of conceiving when they were knowledgeable about fertility and felt susceptible to infertility; however, there was no such association in older women. WHAT IS KNOWN ALREADY The majority of young adults wish to become parents but many are jeopardizing their chances by engaging in behaviours that decrease fertility (e.g. smoking, not seeking timely medical advice when faced with problems conceiving). Research is needed to establish what motivates people to take steps to optimize their chances of pregnancy. The Health Belief Model (HBM) postulates that knowledge and beliefs about susceptibility to infertility are critical in whether people will engage in fertility-optimizing behaviours. STUDY DESIGN, SIZE AND DURATION This cross-sectional survey included 1345 childless women (trying to conceive and having never engaged in fertility medical treatment) from the International Fertility Decision-Making Study (IFDMS). PARTICIPANTS/MATERIALS, SETTING, METHODS Infertility risk factors were determined using the FertiSTAT. The Cardiff Fertility Knowledge Scale (CFKS) assessed fertility knowledge. Perceived susceptibility was defined as whether a fertility problem was suspected. The outcome measure was intentions to optimize one's fertility by making lifestyle changes and/or seeking help. MAIN RESULTS AND THE ROLE OF CHANCE In this study, 75.5% of women had an infertility risk factor and 60.3% suspected a fertility problem. The average correct score on the CFKS was 51.9%. Intentions to optimize fertility were lower among women who were heavy smokers (P < 0.05) and who had been trying to conceive for a year or over (P < 0.01), while intentions to optimize fertility were greater among those with a higher body mass index or greater knowledge and those who suspected a fertility problem (all P < 0.001). These overall effects were qualified in some subgroups. Heavy smokers were more likely to intend to seek medical help when they had greater knowledge (P < 0.001) and women having difficulty conceiving were more likely to intend to seek medical help if they felt susceptible to infertility (P < 0.001). Heavy smokers who were knowledgeable intended to change their lifestyle only when they felt they had a fertility problem (P < 0.01). Intentions to change were not dependent on knowledge and perceived susceptibility in older women. LIMITATIONS, REASONS FOR CAUTION The data were cross-sectional and thus we cannot infer causality. The results may have been affected by the sample profile, which was biased towards high levels of perceived susceptibility and low levels of knowledge. WIDER IMPLICATIONS OF THE FINDINGS To maximize impact, educational campaigns should take into account the presence and type of infertility risk factors in the target audience.