Healthy Ageing in Europe:Prioritizing Interventions to improve Health Literacy

Background: Health literacy (HL) is low for 40-50% of the population in developed nations, and is strongly linked to many undesirable health outcomes. Older adults are particularly at risk. The Irohla project systematically created a large inventory of HL interventions targeting adults age 50+, to support practical production of policy and practice guidelines for promoting health literacy in European populations. Methods: We comprehensively surveyed international scientific literature, grey literature and other sources (published 2003+) for implemented HL interventions that involved older adults. Studies were screened for eligibility criteria and further selected for aspects important in European public health policy, including priority diseases, risk factors and vulnerable target groups. Interventions were prioritised using a multiple criteria tool to select final interventions that also featured strong evidence of efficacy and a broad range of strategies. Results: From nearly 7000 written summaries, 1097 met inclusion criteria, of which 233 were chosen for scoring and ranking. Of these, 7 had the highest multi-criteria scores. Eight more articles were selected based on rounded criteria including a high multi-criteria score as well as elements of innovation. Final selections were 18 articles describing 15 programmes. Conclusions: 15 promising intervention projects that feature strong evidence of efficacy among important diseases or risk factors and vulnerable groups, or that had success with elements of innovation were identified. These programmes have multiple positive attributes which could be used as guidance for developing innovative intervention programmes to trial on European older adults. They provide evidence of efficacy in addressing high priority diseases and risk factors

Methodological review: quality of randomized controlled trials in health literacy

Background: The growing move towards patient-centred care has led to substantial research into improving the health literacy skills of patients and members of the public. Hence, there is a pressing need to assess the methodology used in contemporary randomized controlled trials (RCTs) of interventions directed at health literacy, in particular the quality (risk of bias), and the types of outcomes reported. Methods: We conducted a systematic database search for RCTs involving interventions directed at health literacy in adults, published from 2009 to 2014. The Cochrane Risk of Bias tool was used to assess quality of RCT implementation. We also checked the sample size calculation for primary outcomes. Reported evidence of efficacy (statistical significance) was extracted for intervention outcomes in any of three domains of effect: knowledge, behaviour, health status. Demographics of intervention participants were also extracted, including socioeconomic status. Results: We found areas of methodological strength (good randomization and allocation concealment), but areas of weakness regarding blinding of participants, people delivering the intervention and outcomes assessors. Substantial attrition (losses by monitoring time point) was seen in a third of RCTs, potentially leading to insufficient power to obtain precise estimates of intervention effect on primary outcomes. Most RCTs showed that the health literacy interventions had some beneficial effect on knowledge outcomes, but this was typically for less than 3 months after intervention end. There were far fewer reports of significant improvements in substantive patient-oriented outcomes, such as beneficial effects on behavioural change or health (clinical) status. Most RCTs featured participants from vulnerable populations. Conclusions: Our evaluation shows that health literacy trial design, conduct and reporting could be considerably improved, particularly by reducing attrition and obtaining longer follow-up. More meaningful RCTs would also result if health literacy trials were designed with public and patient involvement to focus on clinically important patient-oriented outcomes, rather than just knowledge, behaviour or skills in isolation

The relationship between unhealthy food sales, socio-economic deprivation and childhood weight status: results of a cross-sectional study in England.

BACKGROUND: Recent increases in obesity prevalence have led to research into the neighbourhood food environment. Research suggests that proximity and density of food outlets around the home is associated with childhood obesity prevalence, however, the evidence is inconclusive, and associations between food outlet locations and diet are less clear. The purpose of this study is to assess area level associations between sales of unhealthy foods in supermarkets and weight status of children. METHODS: This study examined the association between weight status in children (4-5 year olds and 10-11 year olds) measured in the National Child Measurement Programme over three time points (2008/9, 2009/10, 2010/11) and annual sales of unhealthy foods (2012/3), as identified from a large supermarket chain. Geographical analysis was conducted to link store-based food sales for 537 stores with 6517 UK Census Areas. Unadjusted associations were examined with error-bar plots and linear regression was used to examine the relationship between the prevalence of overweight and obesity and sales of unhealthy food, while controlling for covariates known to predict weight status in children. RESULTS: A statistically significant relationship was identified between the sales of unhealthy foods and the prevalence of overweight and obese children in both age groups (p < 0.01). Of the covariates, area deprivation was positively associated with weight status (p < 0.001). Non-white population (%) was negatively associated (p < 0.001) with overweight and obesity among Reception children, but positively associated with the other weight statuses (p < 0.001). A higher proportion of children in the same age group were associated with statistically significantly lower overweight and obesity prevalence in Reception (p <0.01) but not Year 6 children. CONCLUSIONS: The study provides novel findings linking supermarket food sales with the weight status of children. Food sales in geographically referenced supermarkets are a valuable source of data for research into the factors that influence the weight of the surrounding population. Future research could identify factors that might modify food shopping in supermarkets and use of purchasing data could be an effective way to measure the impact of healthy eating campaigns on the weight status of children over time.The Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence, supported the work of FH and AJ. Funding for CEDAR from the British Heart Foundation, Economic and Social Research Council, Medical Research Council, National Institute for Health Research and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged (grant code RES-590-28-002). Sincere thanks to Jacqueline Collier for her professional support to the SHW and critical review of the manuscript.This is the final version of the article. It first appeared from BioMed Central via http://dx.doi.org/10.1186/s12966-016-0345-

Systematic overview of economic evaluations of health-related rehabilitation

Background: Health related rehabilitation is instrumental in improving functioning and promoting participation by people with disabilities. To make clinical and policy decisions about health-related rehabilitation, resource allocation and cost issues need to be considered. Objectives: To conduct an overview of systematic reviews (SRs) on economic evaluations of health-related rehabilitation. Methods: We searched multiple databases to identify relevant SRs of economic evaluations of health-related rehabilitation. Review quality was assessed by AMSTAR checklist. Results: We included 64 SRs, most of which included economic evaluations alongside randomised controlled trials (RCTs). The review quality was low to moderate (AMSTAR score 5-8) in 35, and high (score 9-11) in 29 of the included SRs. The included SRs addressed various health conditions, including spinal or other pain conditions (n=14), age-related problems (11), stroke (7), musculoskeletal disorders (6), heart diseases (4), pulmonary (3), mental health problems (3), and injury (3). Physiotherapy was the most commonly evaluated rehabilitation intervention in the included SRs (n=24). Other commonly evaluated interventions included multidisciplinary programmes (14); behavioural, educational or psychological interventions (11); home-based interventions (11); complementary therapy (6); self-management (6); and occupational therapy (4). Conclusions: Although the available evidence is often described as limited, inconsistent or inconclusive, some rehabilitation interventions were cost-effective or showed cost-saving in a variety of disability conditions. Available evidence comes predominantly from high income countries, therefore economic evaluations of health-related rehabilitation are urgently required in less resourced settings

Food sales and adult weight status: results of a cross-sectional study in England

Ecological studies often use supermarket location as a proxy measure of the food environment. In this study, we used data on sales at a leading mainstream supermarket chain to explore how area-level supermarket use is associated with overweight and obesity in English adults. Sales data were aggregated to local authority level and joined to a national dataset describing self-reported height and weight and fruit and vegetable consumption. Regression models showed a modest association between higher levels of unhealthy food sales relative to health food sales and increased odds of being overweight and obese. Although effect sizes were small, they persisted after adjustment for area-level deprivation. Supermarket sales data provide additional understanding in the study of food environments and their impact on increasing weight status. Future health policies should consider using ‘big data’ combined with other research methods to address the increasing consumption of unhealthy and highly processed foods

Societal costs of chemotherapy in the UK: an incidence-based cost-of-illness model for early breast cancer

Aim To estimate annual societal costs associated with chemotherapy for early breast cancer in the UK. Design Mixed methods: (a) an incidence-based cost-of-illness model was developed of indirect costs in patients with breast cancer and carers, and estimated from diagnosis through active treatment until death; (b) interviews with stakeholders were also undertaken to understand actual experiences and impacts of these costs. Data sources Model data were collated from relevant national data sources covering general population statistics, UK cancer registries, clinical guidelines and published literature, and patient survey data. Patient and staff views were collected through semistructured interviews. Participants Model: patients with early breast cancer receiving systemic anticancer therapy in the UK. Interviews were undertaken with women who had chemotherapy and medical practitioners involved in breast cancer care. Results Total costs of chemotherapy in the UK economy are over £248 million. Societal productivity losses amount to £141.4 million, which includes £3.2 million associated with premature mortality, short-term and long-term work absence (£28.6 million and £105 million, respectively). £3.4 million is associated with mortality losses from secondary malignancies due to adjuvant chemotherapy. A further £1.1 million in lost productivity arises from informal care provision. Out-of-pocket costs per round of chemotherapy account for £4.2 million, or an annual average of almost £1100 per patient. Interview findings support the cost burden modelled and also highlight the impact on cognitive function of patients and how this could increase the cost burden to patients, their families and wider society. In addition, estimated costs for carer emotional well-being are £82 million in lost quality of life. Conclusion Chemotherapy use carries significant indirect costs for society, as well as patients and their carers. These wider costs and societal perspective should be considered by commissioners to ensure chemotherapy is better targeted at those who most need it and to avoid placing unnecessary costs on patients, their caregivers and wider society

PPI and Scoping Review for GP at Door of Accident and Emergency services

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“That is an Awful Lot of Fruit and Veg to Be Eating”. Focus Group Study on Motivations for the Consumption of 5 a Day in British Young Men

Young men do not consume enough fruit and vegetables, increasing their risk for future ill health. To understand what motivates their food choice, a novel conceptual framework that included key concepts from the theory of planned behavior and risk theory was developed. Thirty-four British men (18–24 years) took part in focus groups, where innovative visual qualitative methods provided insight into participants’ motivations for fruit and vegetable consumption. Based on information from food diaries, participants were described as high (4+ portions) or low (up to 3 portions) consumers. Interviews were coded thematically into concepts and characteristics of the conceptual framework. Young men were generally unaware of the UK government’s recommendation to consume 5 portions of fruit and vegetable a day and chronic health risks associated with low consumption. High consumers were motivated by perceived risk, perceived behavioral control, and health-conscious self-identity. They held internalized, holistic beliefs about diet and health, whereas low consumers’ beliefs were externalized, based on physical appearances. Low consumers were driven by social influences to consume cheap, easily available convenience foods. The conceptual framework differentiated levels of fruit and vegetable consumption between the two groups and provided new information about young men’s motivations for fruit and vegetable consumption

Low-intake dehydration prevalence in non-hospitalised older adults: Systematic review and meta-analysis

Background and Aims: Low-intake dehydration amongst older people, caused by insufficient fluid intake, is associated with mortality, multiple long-term health conditions and hospitalisation. The prevalence of low-intake dehydration in older adults, and which groups are most at-risk, is unclear. We conducted a high-quality systematic review and meta-analysis, implementing an innovative methodology, to establish the prevalence of low-intake dehydration in older people (PROSPERO registration: CRD42021241252).   Method: We systematically searched Medline (Ovid), Cochrane CENTRAL, Embase (Ovid), CINAHL and Proquest from inception until April 2023 and Nutrition and Food Sciences until March 2021. We included studies that assessed hydration status for non-hospitalised participants aged ≥65 years, by directly-measured serum/plasma osmolality, calculated serum/plasma osmolarity and/or 24-hour oral fluid intake. Inclusion, data extraction and risk of bias assessment was carried out independently in duplicate.   Results: From 11,077 titles and abstracts, we included 61 (22,398 participants), including 44 in quality-effects meta-analysis.   Meta-analysis suggested that 24% (95% CI: 0.07, 0.46) of older people were dehydrated (assessed using directly-measured osmolality >300mOsm/kg, the most reliable measure). Subgroup analyses indicated that both long-term care residents (34%, 95% CI: 0.09, 0.61) and community-dwelling older adults (19%, 95% CI: 0.00, 0.48) were highly likely to be dehydrated. Those with more pre-existing illnesses (37%, 95% CI: 0.14, 0.62) had higher low-intake dehydration prevalence than others (15%, 95% CI: 0.00, 0.43), and there was a non-significant suggestion that those with renal impairment (42%, 95% CI: 0.23, 0.61) were more likely to be dehydrated than others (23%, 95% CI: 0.03, 0.47), but there were no clear differences in prevalence by age, sex, functional, cognitive or diabetic status. GRADE quality of evidence was low as to the exact prevalence due to high levels of heterogeneity between studies.   Conclusion: Quality-effects meta-analysis estimated that a quarter of non-hospitalised older people were dehydrated. Widely varying prevalence rates in individual studies, from both long-term care and community groups, highlight that dehydration is preventable amongst older people.   Implications: One in every 4 older adults has low-intake dehydration. As dehydration is serious and prevalent, research is needed to better understand drinking behaviour and assess effectiveness of drinking interventions for older people