Dementia incidence trend over 1992-2014 in the Netherlands: analysis of primary care data

$\textbf{Background:}$ Recent reports have suggested declining age-specific incidence rates of dementia in high-income countries over time. Improved education and cardiovascular health in early age have been suggested to bring about this effect. The aim of this study was to estimate the age- specific dementia-incidence trend in primary care records from a large population in the Netherlands. $\textbf{Methods and findings:}$ A dynamic cohort representative of the Dutch population was composed using primary care records from general practice registration networks (GPRN) across the country. Data regarding dementia incidence were obtained using general practitioner-recorded diagnosis of dementia within the electronic health records. Age-specific dementia incidence rates were calculated for all persons aged 60 years and over; negative binomial regression analysis was used to estimate the time trend. Nine out of eleven GPRNs provided data on more than 800,000 older people between 1992 and 2014, corresponding to over 4 million person- years and 23,186 incident dementia cases. The annual growth in dementia incidence rate was estimated to be 2.1% (95%CI 0.5 to 3.8%), and incidence rates were 1.08 (95%CI 1.04 to 1.13) times higher for women compared to men. There was no significant overall change since the start of a national dementia program in 2003. Despite their relatively low numbers of person years, the highest age groups contributed most to the increasing trend. Increased awareness of dementia by patients and doctors in more recent years may have influenced dementia diagnosis in GPs’ electronic health records, and needs to be taken into account when interpreting the data. $\textbf{Conclusions:}$ Within the clinical records of a large, representative sample of the Dutch population, we found no evidence for a declining incidence trend of dementia in the Netherlands. This could indicate true stability in incidence rates, or a balance between increased detection and a true reduction. Irrespective of the exact rates and mechanisms underlying these findings, they illustrate that the burden of work for physicians and nurses in general practice associated with newly diagnosed dementia has not been subject to substantial change in the past two decades. Hence, with the ageing of Western societies, we still need to anticipate on a dramatic absolute increase of dementia occurrence over the years to come

Weight change over five-year periods and number of components of the metabolic syndrome in a Dutch cohort

Overweight and obesity are associated with the metabolic syndrome (MetS). We studied the association of weight change over three consecutive 5-year periods with the number of MetS components in people aged 20–59 years. 5735 participants from the Doetinchem Cohort Study were included. Weight was measured in round 1 and at each 5-year interval follow-up (round 2, 3 and 4). Weight change was defined as the absolute weight change between two consecutive measurements. The number of MetS components (assessed in round 2, 3 and 4) was based on the presence of the following components of the MetS: central obesity, raised blood pressure, reduced high density lipoprotein cholesterol and elevated glucose. Associations of weight change and the number of components of the MetS were analyzed with Generalized Estimating Equations for Poisson regression, stratified for 10-year age groups. For each age group, 1 kg weight gain was positively associated with the number of components of the MetS, independent of sex and measurement round. The association was stronger in 30–39 years (adjusted rate ratio: 1.044; 95%CI: 1.040–1.049) and smaller in older age groups. Compared to stable weight (>−2.5 kg and < 2.5 kg), weight loss (≤−2.5 kg) and weight gain (≥2.5 kg) was associated with a lower and higher rate ratio respectively, for the number of components of the MetS. Our results support the independent association of weight change with the number of MetS components with a more pronounced association in younger people

Study protocol of a cluster randomised controlled trial investigating the effectiveness of a tailored energy balance programme for recent retirees

BACKGROUND: People in transitional life stages, such as occupational retirement, are likely to gain weight and accumulate abdominal fat mass caused by changes in physical activity and diet. Hence, retirees are an important target group for weight gain prevention programmes, as described in the present paper. METHODS/DESIGN: A systematic and stepwise approach (Intervention Mapping) is used to develop a low-intensity energy balance intervention programme for recent retirees. This one-year, low-intensity multifaceted programme aims to prevent accumulation of abdominal fat mass and general weight gain by increasing awareness of energy balance and influencing related behaviours of participants' preference. These behaviours are physical activity, fibre intake, portion size and fat consumption. The effectiveness of the intervention programme is tested in a cluster randomised controlled trial. Measurements of anthropometry, physical activity, energy intake, and related psychosocial determinants are performed at baseline and repeated at 6 months for intermediate effect, at 12 months to evaluate short-term intervention effects and at 24 months to test the sustainability of the effects. DISCUSSION: This intervention programme is unique in its focus on retirees and energy balance. It aims at increasing awareness and takes into account personal preferences of the users by offering several options for behaviour change. Moreover, the intervention programme is evaluated at short-term and long-term and includes consecutive outcome measures (determinants, behaviour and body composition)

The contribution of lifestyle to weight gain among young adults

In dit rapport gaan we na welke specifieke aspecten van leefstijl verantwoordelijk zijn voor gewichtstijging bij jongvolwassenen. De aard van de leefstijlfactoren die bijdragen aan gewichtstijging verschilt tussen mannen en vrouwen. Het lijkt bijvoorbeeld zo te zijn dat bij mannen het eten van zoute snacks samenhangt met gewichtstijging, terwijl bij vrouwen juist het eten van zoete snacks lijkt samen te hangen met gewichtstijging. Echter, de resultaten van de verschillende studies over de invloed van voeding op gewichtstijging spreken elkaar vaak tegen. Voor lichamelijke activiteit is er iets meer duidelijkheid. Weinig bewegen hangt, met name bij mannen, samen met gewichtstijging. Het is echter niet duidelijk om welke specifieke activiteiten het gaat. Zowel uit literatuurstudie als uit eigen analyses bleek dat jongvolwassenen die gestopt zijn met roken een grotere gewichtstijging hebben. Wij concluderen dat er redelijke tot goede onderbouwing is voor de samenhang tussen leefstijlfactoren en gewichtstijging. Er zijn echter onvoldoende gegevens beschikbaar om dit toe te schrijven aan specifieke aspecten van leefstijl.In this report, the contribution of lifestyle to weight gain in young adults is addressed. Aspects of lifestyle factors associated with weight gain differ between men and women. For example, among men consumption of savoury snacks seemed to be associated with weight gain, whereas among women consumption of sweet snacks seemed to be associated with weight gain. However, results of the various studies on the influence of diet on weight gain are often contradictory. For physical activity, the results are more equivocal. Mainly among men, sedentary lifestyle was associated with weight gain. However, it is not clear how specific activities are associated with weight gain. Both review of literature and data analyses showed that giving up smoking was associated with weight gain. There is reasonable evidence for the association between lifestyle and weight gain. However, there is insufficient data to attribute weight gain to specific aspects of lifestyle.VWS-PO

The contribution of lifestyle to weight gain among young adults

In this report, the contribution of lifestyle to weight gain in young adults is addressed. Aspects of lifestyle factors associated with weight gain differ between men and women. For example, among men consumption of savoury snacks seemed to be associated with weight gain, whereas among women consumption of sweet snacks seemed to be associated with weight gain. However, results of the various studies on the influence of diet on weight gain are often contradictory. For physical activity, the results are more equivocal. Mainly among men, sedentary lifestyle was associated with weight gain. However, it is not clear how specific activities are associated with weight gain. Both review of literature and data analyses showed that giving up smoking was associated with weight gain. There is reasonable evidence for the association between lifestyle and weight gain. However, there is insufficient data to attribute weight gain to specific aspects of lifestyle.In dit rapport gaan we na welke specifieke aspecten van leefstijl verantwoordelijk zijn voor gewichtstijging bij jongvolwassenen. De aard van de leefstijlfactoren die bijdragen aan gewichtstijging verschilt tussen mannen en vrouwen. Het lijkt bijvoorbeeld zo te zijn dat bij mannen het eten van zoute snacks samenhangt met gewichtstijging, terwijl bij vrouwen juist het eten van zoete snacks lijkt samen te hangen met gewichtstijging. Echter, de resultaten van de verschillende studies over de invloed van voeding op gewichtstijging spreken elkaar vaak tegen. Voor lichamelijke activiteit is er iets meer duidelijkheid. Weinig bewegen hangt, met name bij mannen, samen met gewichtstijging. Het is echter niet duidelijk om welke specifieke activiteiten het gaat. Zowel uit literatuurstudie als uit eigen analyses bleek dat jongvolwassenen die gestopt zijn met roken een grotere gewichtstijging hebben. Wij concluderen dat er redelijke tot goede onderbouwing is voor de samenhang tussen leefstijlfactoren en gewichtstijging. Er zijn echter onvoldoende gegevens beschikbaar om dit toe te schrijven aan specifieke aspecten van leefstijl

Integrating Evidence From Systematic Reviews, Qualitative Research, and Expert Knowledge Using Co-Design Techniques to Develop a Web-Based Intervention for People in the Retirement Transition

Background: Integrating stakeholder involvement in complex health intervention design maximizes acceptability and potential effectiveness. However, there is little methodological guidance about how to integrate evidence systematically from various sources in this process. Scientific evidence derived from different approaches can be difficult to integrate and the problem is compounded when attempting to include diverse, subjective input from stakeholders. Objective: The intent of the study was to describe and appraise a systematic, sequential approach to integrate scientific evidence, expert knowledge and experience, and stakeholder involvement in the co-design and development of a complex health intervention. The development of a Web-based lifestyle intervention for people in retirement is used as an example. Methods: Evidence from three systematic reviews, qualitative research findings, and expert knowledge was compiled to produce evidence statements (stage 1). Face validity of these statements was assessed by key stakeholders in a co-design workshop resulting in a set of intervention principles (stage 2). These principles were assessed for face validity in a second workshop, resulting in core intervention concepts and hand-drawn prototypes (stage 3). The outputs from stages 1-3 were translated into a design brief and specification (stage 4), which guided the building of a functioning prototype, Web-based intervention (stage 5). This prototype was de-risked resulting in an optimized functioning prototype (stage 6), which was subject to iterative testing and optimization (stage 7), prior to formal pilot evaluation. Results: The evidence statements (stage 1) highlighted the effectiveness of physical activity, dietary and social role interventions in retirement; the idiosyncratic nature of retirement and well-being; the value of using specific behavior change techniques including those derived from the Health Action Process Approach; and the need for signposting to local resources. The intervention principles (stage 2) included the need to facilitate self-reflection on available resources, personalization, and promotion of links between key lifestyle behaviors. The core concepts and hand-drawn prototypes (stage 3) had embedded in them the importance of time use and work exit planning, personalized goal setting, and acceptance of a Web-based intervention. The design brief detailed the features and modules required (stage 4), guiding the development of wireframes, module content and functionality, virtual mentors, and intervention branding (stage 5). Following an iterative process of intervention testing and optimization (stage 6), the final Web-based intervention prototype of LEAP (Living, Eating, Activity, and Planning in retirement) was produced (stage 7). The approach was resource intensive and required a multidisciplinary team. The design expert made an invaluable contribution throughout the process. Conclusions: Our sequential approach fills an important methodological gap in the literature, describing the stages and techniques useful in developing an evidence-based complex health intervention. The systematic and rigorous integration of scientific evidence, expert knowledge and experience, and stakeholder input has resulted in an intervention likely to be acceptable and feasible