Ongezond leefstijlgedrag is een van de belangrijkste te voorkomen oorzaken van lichamelijke en psychische klachten en ziekten, ongevallen, vroegtijdige sterfgevallen en sociaal-maatschappelijke problemen, zoals delicten, huiselijk geweld, kindermishandeling en schulden. Zorgprofessionals moeten in het contact met hun patiënten het belang van gezond leefstijlgedrag benoemen, screenen op ongezond leefstijlgedrag en indien nodig de patiënt zo motiveren, ondersteunen en behandelen dat hij of zij het ongezonde gedrag wil en kan reduceren of ermee kan stoppen. Daarmee kunnen ongewenste consequenties voorkomen of reeds bestaande negatieve gevolgen verminderd worden. In dit hoofdstuk ligt de nadruk op wat een zorgprofessional zou kunnen doen om het leefstijlgedrag van patiënten te beïnvloeden. Ook zullen we in dit hoofdstuk bespreken of en wat men eventueel buiten de behandelsetting kan doen om de omvang van de leefstijlgerelateerde problematiek in de maatschappij en de ggz-populatie terug te dringen. Dit hoofdstuk is geschreven voor alle zorgprofessionals. Het is bedoeld om een goede basis te leggen waarmee een zorgprofessional doelbewuster en –gerichter kan bepalen of een leefstijlinterventie moet worden uitgevoerd, welke doelpersoon of doelgroep wordt beïnvloed, welke interventie wordt gedaan en waar dit waarschijnlijk effect op zal hebben. Hiervoor wordt een praktisch denkmodel geïntroduceerd waarmee alle zorgprofessionals hun invloed kunnen uitoefenen om anderen in beweging te brengen als het gaat om leefstijlgedrag.
In 2012, the World Health Organization raised the alarm by announcing a pandemic called physical inactivity.1 This pandemic is associated with numerous chronic diseases, about 5.3 million premature deaths worldwide every year, and an enormous economic burden.2 So far, attempts to reduce sedentary lifestyle have been largely unsuccessful.3 How do we get people out of their chairs? As an addiction medicine specialist, I (RvdG) treat patients who are addicted to the use of rewarding consumer products, such as alcohol, tobacco, ultra-processed food, or different types of drugs. Comfortable chairs are also a rewarding consumer product. Consequently, I hypothesized that individuals with excessive sedentary behavior should be regarded as being addicted to chairs. To test this hypothesis, I started treating patients with symptoms of a “chair use disorder” (based on the DSM-5 criteria of substance use disorders). The treatment consisted of cognitive behavioral therapy and was aimed to reduce total daily chair use time. Although all patients (and colleagues) initially reacted with surprise to this new “diagnosis,” preliminary findings were promising. The total daily chair use time reduced substantially. Patients experienced withdrawal symptoms, such as increased tiredness, irritability, and an uncomfortable feeling or pain in the lower limbs, buttocks, lower back, shoulders, and neck in the first 2 to 4 weeks. Patients started to view chairs as a potentially harmful and addictive consumer product, and motivation to use chairs decreased. Interestingly, they also reported a chair time reducing effect in their social networks, indicating an effect beyond the treated patient, which is similar with other addictions. The next step is to generate more robust scientific evidence of the effectiveness of framing excessive chair use as an addiction and treating it accordingly. In addition to individual (or group) therapy, preventive public health strategies to reduce sedentary behavior should also be based on the potential addictiveness of chairs, which are attractive consumer products developed and sold by an industry that we (like “Big Tobacco,” “Big Alcohol,” and “Big Food”) should call “Big Chair.”
Het veranderen van verslavingsgedrag of andere, veelal diep ingesleten, gedragspatronen is een proces dat vaak veel van patiënten en de directe omgeving vraagt. Het is belangrijk om als zorgprofessional, zeker binnen de huisartsenpraktijk, aandacht hiervoor te hebben en hulp aan te bieden. Het is van belang om dit binnen de praktijk goed te organiseren. De hulp bestaat voor een belangrijk deel uit gedragsmatige begeleiding van de patiënt tijdens het veranderproces, en zo nodig kan medicatie daarbij helpen, vooral tijdens de eerste detoxificatieperiode. Er moet voor gewaakt worden om alleen te focussen op het gedrag dat de patiënt wil veranderen, omdat er geregeld sprake is van een complex van ongezonde leefstijlpatronen die met elkaar in verband staan. Dit hoofdstuk laat zien hoe om te gaan met roken en alcohol in de praktijk en geeft praktische adviezen voor in de spreekkamer. Het bouwt een brug tussen verslavingsgeneeskunde (‘addiction medicine’) en leefstijlgeneeskunde (‘lifestyle medicine’), twee vakgebieden die elkaar naadloos aanvullen. De beide vakgebieden zijn ontstaan vanuit verschillende achtergronden, maar patiënten vragen in de dagelijkse praktijk om een geïntegreerde verslavings- en leefstijlgeneeskundige aanpak.
Background: Annexin A5 is thought to have a role in the pathophysiology of the antiphospholipid syndrome (APS)—a syndrome characterised by recurrent thrombosis and pregnancy morbidity. Objective: To investigate whether anti-annexin A5 immunoglobulin (Ig)M or IgG antibodies, or the −1C→T polymorphism of annexin A5, is a risk factor for thrombosis or miscarriage, and whether the −1C→T polymorphism is correlated with APS. Methods: A cohort study was carried out with a population of 198 patients with primary APS, systemic lupus erythematosus or lupus-like disease. For the detection of anti-annexin A5 antibodies and the measurement of annexin A5 plasma levels, ELISA-type methods were used. The annexin A5 −1C→T mutation was detected by restriction fragment length polymorphism. Results: 71 patients were positive for annexin A5 IgM or IgG antibodies, of whom 53 patients were positive for anti-annexin A5 IgG antibodies and 27 of 198 patients were positive for anti-annexin A5 IgM antibodies. The prevalence of IgM or IgG anti-annexin A5 antibodies was not significantly associated with thrombosis or miscarriage on multivariate analysis. The prevalence of the −1C→T mutation in the annexin A5 gene (46/198 patients) was significantly associated with miscarriage (odds ratio 2.7, 95% confidence interval 1.1 to 6.7, independent risk factor). Conclusion: The detection of anti-annexin A5 antibodies does not seem relevant for estimating the risk for thrombosis or miscarriage in APS. The −1C→T mutation was an independent risk factor for miscarriage, which is independent of APS.
In their review of organizational changes required to achieve smoke-free environments in drug and alcohol treatment programmes, Skelton et al. 1 argue for the integration of as many strategies as possible. From our experience, we would argue that a radical change in treatment culture has to occur based on a paradigm shift in thinking about smoking tobacco. Our opinion is based on the experience of the implementation of a completely smoke-free policy in our own organization 2 (approximately 1000 staff, more than 10 000 patients treated yearly), which started in 2013 and is still ongoing. At the start of this cultural change, smoking was integrated into our treatment culture; we had structured ‘smoking breaks’ as part of the treatment programme, staff and patients smoked together, and tobacco was provided to our patients when considered ‘necessary’. Also, smoking rates among staff and patients were high: approximately 41% of our staff 3 and 79% of the patients smoked 4. We began by discussing the issue of becoming smoke-free with our staff and patients. It seemed to us that the main reason behaviour changed was not the fact that smoking is a harmful habit, but the realization that tobacco addiction is a ‘real’ addiction, as is addiction to alcohol and drugs. As we consider ourselves to be experts in addiction treatment, our staff became motivated to help the patients with not only the classic addictions, but also tobacco addiction. In one of our in-patient clinics, the staff decided at the end of 2016 to become completely smoke-free. This meant that tobacco addiction would be treated in exactly the same way as other addictions. For example, the clinic is alcohol-, drugs- and tobacco-free; and we do not use the term ‘smoking cessation support’, but instead refer to ‘tobacco addiction treatment’. Because the staff's own behaviour during work hours is essential to induce a behavioural change at our patients, the staff decided to stop smoking themselves during work. For implementation of the strategy we used the systematic approach of the Global Network For Tobacco Free Health Care Services (www.tobaccofreehealthcare.org). This approach is based on eight evidence-based standards, namely: (1) governance and commitment, (2) communication, (3) education and training, (4) identification, diagnosis and tobacco cessation support, (5) tobacco-free environment, (6) healthy work-place, (7) community engagement and (8) monitoring and evaluation. Use of these standards ensured that we did not overlook potentially important options during the implementation process. Within 1 year this clinic became completely smoke-free. The staff do not smoke during working hours and all patients with a tobacco addiction are treated for this [audit Global Network, March 19th, 2018]. The long-term effect on smoking cessation is not yet known; this also depends upon the follow-up out-patient care and regional and national tobacco control 5. None.
Achtergrond: het percentage rokers onder medewerkers van de verslavingszorg is hoger dan onder de Nederlandse bevolking. Voor een succesvolle behandeling van een tabaksverslaving is het van groot belang dat de behandelaar niet rookt. Verslavingszorg Noord Nederland (VNN) streeft ernaar rookvrij te zijn, en daarom richt dit onderzoek zich op het in kaart brengen van barrières die rokende medewerkers ervaren bij het stoppen met roken.
