Food access and dietary variety among older people

Decentralisation of many food retailers to edge-of-town and out-of-town locations has resulted in some older people experiencing difficulty in accessing food shops and those experiencing the greatest difficulties in food shopping are considered to be at the greatest nutritional risk. The present study examines how and to what extent usage of, and physical access to food shops might influence dietary variety. Shopping behaviour and dietary variety are investigated using focus groups, a consumer questionnaire and a food frequency questionnaire (FFQ). A dietary variety score system, developed from the FFQ, is employed in this study. Neither usage of (particular) food shops nor basic accessibility variables are found to have a direct effect on dietary variety. Yet, coping strategies employed by older consumers to obtain food are revealed to be important. This suggests that more complex access factors remain an important issue for study in relation to the shopping experience of a proportion of the older population

Patients Emotions during Meal Experience: Understanding through Critical Incident Technique

Background and Objectives: It was established that eating experience may affect patients emotionally. Acknowledging the role and understanding the basis of patients’ emotions in their food consumption may assist in identifying their nutritional status as well as their satisfaction with foodservice. To date, there are limited studies focusing on patients’ food-related emotional experiences. Hence the present study sought to explore the issue using a qualitative approach. Methods: The study was conducted in three Malaysian public hospitals, two of which from rural and one from urban areas. Information about aspects of the hospital food experience was gathered using semi-structured interview method. A total of 29 patients who felt well enough to provide information about the hospital food were identified with the help of the head nurses. Patients were recruited based on the concept of data saturation. The interview was implemented based on Critical Incident Technique (CIT), which enables systematic extraction of information from the wealth of data in the stories told by the interviewees about things which have happened to them. Data were analysed using content analysis method. Findings: Patients were found toexperience emotions including frustration, interest, enjoyment, hostility, shame, boredom, sadness, anger, surprise and satisfaction in relation to food provision. The frequency of incidents eliciting negative emotions (56.7%) was higher than that of positive incidents (43.3%). Frustration, interest, and enjoyment were the most frequently reported emotions. Conclusions: Our study highlights emotion as an important aspect of patients’ food consumption, and lays a ground for incorporation of food-related emotion into hospital services and patient management research. Our study also indicated the CIT to be effective and credible in elucidating hidden patients’ emotions, which encourages its application in future relevant studies

Escolha alimentar e fatores determinantes em idosos europeus

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From childhood to old age: a qualitative approach to the study of Portuguese ederly's perception of meals across the life cycle

A alimentação dos mais velhos tem sido alvo de investigação nas últimas décadas, especialmente no que se refere ao estado nutricional e ao consumo de alimentos. Embora os determinantes biológicos, psicológicos, pessoais e económicos da escolha de alimentos sejam bem conhecidos, a relação com o ambiente cultural tem sido menos explorada. As regras culturais determinam a sequência diária e semanal das refeições, o tempo e tipo de refeição, o que constitui uma refeição, o que é considerado uma verdadeira refeição, e distingue ainda uma refeição de uma merenda.O objetivo deste estudo foi compreender as refeições em idade sénior numa população de idosos Portugueses, focando as diferenças ao longo do ciclo de vida, usando uma abordagem qualitativa. A nossa investigação incluiu 80 idosos portugueses a viver na comunidade. Verificou-se que a abundância ou as dificuldades económicas na infância apresentam um impacto positivo ou negativo na visão que os idosos têm sobre as suas refeições no passado e no presente. As experiências na vida adulta (migração, casamento, ter filhos, trabalho, doença) influenciaram as rotinas diárias, incluindo a alimentação, para homens e mulheres. As refeições ao longo da vida são definidas por papéis relacionados com o sexo e a descontinuidade nos relacionamentos. Assim, a presença de novas relações e circunstâncias de vida irá refletir-se em novos desafios nas atividades domésticas. Na velhice, estar sozinho e isolado era um importante determinante dos hábitos alimentares. A perda do parceiro foi a situação mais reportada, estando associada a comer sozinho e a menos satisfação com as refeições. Ter o apoio da família ou de uma instituição especializada era essencial para as rotinas diárias com as refeições.Compreender o significado de refeições na velhice pode ser muito útil para o desenvolvimento de melhores estratégias para esta população.Food in later life has been the focus of research in the past decades, especially in what refers to nutritional status and food consumption. Although biological, psychological, personal and economic determinants in food choice are well known, the relationship with the cultural environment has been less explored. Cultural rules determine daily and weekly sequence of meals, time and type of meal, what constitutes a meal, what is considered a proper meal, and distinguish a meal event from a snack.The purpose of this study was to understand meals in the later life of Portuguese older people, focusing on the differences in the life cycle through a qualitative approach. Our research involved 80 Portuguese older people, free living in the community. We found that an easy childhood or the economic constraints in early childhood had a positive or negative impact in older people view of meals in past and present. The experiences in adult life (migration, marriage, having children, labour, disease) influenced daily routines, including eating, for both men and women. Meals across life were defined by gendered roles and discontinuity in relationships. Therefore, the presence of new relationships or life conditions will reflect in new challenges in domestic activities. In older age, being alone or isolated was an important determinant for eating habits. The loss of partner was the most reported situation, which was linked to eating alone and less satisfaction with meals. Having support from family or a specialized institution is central to the daily routines with meals.Understanding the meaning of meals in later life can be very useful in order to develop appropriate strategies for this population

Life-Time Covariation of Major Cardiovascular Diseases: A 40-Year Longitudinal Study and Genetic Studies

BACKGROUND: It is known that certain cardiovascular diseases (CVD) are associated, like atrial fibrillation and stroke. However, for other CVDs, the links and temporal trends are less studied. In this longitudinal study, we have investigated temporal epidemiological and genetic associations between different CVDs. METHODS: The ULSAM (Uppsala Longitudinal Study of Adult Men; 2322 men aged 50 years) has been followed for 40 years regarding 4 major CVDs (incident myocardial infarction, ischemic stroke, heart failure, and atrial fibrillation). For the genetic analyses, publicly available data were used. RESULTS: Using multistate modeling, significant relationships were seen between pairs of all of the 4 investigated CVDs. However, the risk of obtaining one additional CVD differed substantially both between different CVDs and between their temporal order. The relationship between heart failure and atrial fibrillation showed a high risk ratio (risk ratios, 24-26) regardless of the temporal order. A consistent association was seen also for myocardial infarction and atrial fibrillation but with a lower relative risk (risk ratios, 4-5). In contrast, the risk of receiving a diagnosis of heart failure following a myocardial infarction was almost twice as high as for the reverse temporal order (risk ratios, 16 versus 9). Genetic loci linked to traditional risk factors could partly explain the observed associations between the CVDs, but pathway analyses disclosed also other pathophysiological links. CONCLUSIONS: During 40 years, all of the 4 investigated CVDs were pairwise associated with each other regardless of the temporal order of occurrence, but the risk magnitude differed between different CVDs and their temporal order. Genetic analyses disclosed new pathophysiological links between CVDs

Transforming and evaluating electronic health record disease phenotyping algorithms using the OMOP common data model: a case study in heart failure

Objective: The aim of the study was to transform a resource of linked electronic health records (EHR) to the OMOP common data model (CDM) and evaluate the process in terms of syntactic and semantic consistency and quality when implementing disease and risk factor phenotyping algorithms. Materials and Methods: Using heart failure (HF) as an exemplar, we represented three national EHR sources (Clinical Practice Research Datalink, Hospital Episode Statistics Admitted Patient Care, Office for National Statistics) into the OMOP CDM 5.2. We compared the original and CDM HF patient population by calculating and presenting descriptive statistics of demographics, related comorbidities, and relevant clinical biomarkers. Results: We identified a cohort of 502 536 patients with the incident and prevalent HF and converted 1 099 195 384 rows of data from 216 581 914 encounters across three EHR sources to the OMOP CDM. The largest percentage (65%) of unmapped events was related to medication prescriptions in primary care. The average coverage of source vocabularies was >98% with the exception of laboratory tests recorded in primary care. The raw and transformed data were similar in terms of demographics and comorbidities with the largest difference observed being 3.78% in the prevalence of chronic obstructive pulmonary disease (COPD). Conclusion: Our study demonstrated that the OMOP CDM can successfully be applied to convert EHR linked across multiple healthcare settings and represent phenotyping algorithms spanning multiple sources. Similar to previous research, challenges mapping primary care prescriptions and laboratory measurements still persist and require further work. The use of OMOP CDM in national UK EHR is a valuable research tool that can enable large-scale reproducible observational research

Endogenous angiotensins and catecholamines do not reduce skin blood flow or prevent hypotension in preterm piglets

Endocrine control of cardiovascular function is probably immature in the preterm infant; thus, it may contribute to the relative ineffectiveness of current adrenergic treatments for preterm cardiovascular compromise. This study aimed to determine the cardiovascular and hormonal responses to stress in the preterm piglet. Piglets were delivered by cesarean section either preterm (97 of 115 days) or at term (113 days). An additional group of preterm piglets received maternal glucocorticoids as used clinically. Piglets were sedated and underwent hypoxia (4% FiO2 for 20 min) to stimulate a cardiovascular response. Arterial blood pressure, skin blood flow, heart rate and plasma levels of epinephrine, norepinephrine, angiotensin II (Ang II), angiotensin-(1-7) (Ang-(1-7)), and cortisol were measured. Term piglets responded to hypoxia with vasoconstriction; preterm piglets had a lesser response. Preterm piglets had lower blood pressures throughout, with a delayed blood pressure response to the hypoxic stress compared with term piglets. This immature response occurred despite similar high levels of circulating catecholamines, and higher levels of Ang II compared with term animals. Prenatal exposure to glucocorticoids increased the ratio of Ang-(1-7):Ang II. Preterm piglets, in contrast to term piglets, had no increase in cortisol levels in response to hypoxia. Preterm piglets have immature physiological responses to a hypoxic stress but no deficit of circulating catecholamines. Reduced vasoconstriction in preterm piglets could result from vasodilator actions of Ang II. In glucocorticoid exposed preterm piglets, further inhibition of vasoconstriction may occur because of an increased conversion of Ang II to Ang-(1-7)

How to estimate the association between change in a risk factor and a health outcome?

Estimating the effect of a change in a particular risk factor and a chronic disease requires information on the risk factor from two time points; the enrolment and the first follow-up. When using observational data to study the effect of such an exposure (change in risk factor) extra complications arise, namely (i) when is time zero? and (ii) which information on confounders should we account for in this type of analysis? From enrolment or the 1st follow-up? Or from both?. The combination of these questions has proven to be very challenging. Researchers have applied different methodologies with mixed success, because the different choices made when answering these questions induce systematic bias. Here we review these methodologies and highlight the sources of bias in each type of analysis. We discuss the advantages and the limitations of each method ending by making our recommendations on the analysis plan

Hábitos alimentares de idosos portugueses: Uma perspetiva da evolução ao longo da vida

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