15 research outputs found
Barriers and facilitators for the implementation and evaluation of community-based interventions to promote physical activity and healthy diet: A mixed methods study in Argentina
Background: Obesogenic environments promote sedentary behavior and high dietary energy intake. The objective of the study was to identify barriers and facilitators to the implementation and impact evaluation of projects oriented to promote physical activity and healthy diet at community level. We analyzed experiences of the projects implemented within the Healthy Municipalities and Communities Program (HMCP) in Argentina. Methods: A mixed methods approach included (1) in-depth semi-structured interviews, with 44 stakeholders; and (2) electronic survey completed by 206 individuals from 96 municipalities across the country. Results: The most important barriers included the lack of: adequate funding (43%); skilled personnel (42%); equipment and material resources (31%); technical support for data management and analysis (20%); training on project designs (12%); political support from local authorities (17%) and acceptance of the proposed intervention by the local community (9%). Facilitators included motivated local leaders, inter-sectorial participation and seizing local resources. Project evaluation was mostly based on process rather than outcome indicators. Conclusions: This study contributes to a better understanding of the difficulties in the implementation of community-based intervention projects. Findings may guide stakeholders on how to facilitate local initiatives. There is a need to improve project evaluation strategies by incorporating process, outcome and context specific indicators.Fil: Belizan, Maria. Instituto de Efectividad ClĂnica y Sanitaria; ArgentinaFil: Chaparro, Raul Martin. Instituto de Efectividad ClĂnica y Sanitaria; ArgentinaFil: Santero, Marilina. Instituto de Efectividad ClĂnica y Sanitaria; ArgentinaFil: Elorriaga, Natalia. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Oficina de CoordinaciĂłn Administrativa Parque Centenario. Centro de Investigaciones en EpidemiologĂa y Salud PĂșblica. Instituto de Efectividad ClĂnica y Sanitaria. Centro de Investigaciones en EpidemiologĂa y Salud PĂșblica; Argentina. Instituto de Efectividad ClĂnica y Sanitaria; ArgentinaFil: Kartschmit, Nadja. No especifĂca;Fil: Rubinstein, Adolfo Luis. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Oficina de CoordinaciĂłn Administrativa Parque Centenario. Centro de Investigaciones en EpidemiologĂa y Salud PĂșblica. Instituto de Efectividad ClĂnica y Sanitaria. Centro de Investigaciones en EpidemiologĂa y Salud PĂșblica; Argentina. Instituto de Efectividad ClĂnica y Sanitaria; ArgentinaFil: Irazola, Vilma. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Oficina de CoordinaciĂłn Administrativa Parque Centenario. Centro de Investigaciones en EpidemiologĂa y Salud PĂșblica. Instituto de Efectividad ClĂnica y Sanitaria. Centro de Investigaciones en EpidemiologĂa y Salud PĂșblica; Argentina. Instituto de Efectividad ClĂnica y Sanitaria; Argentin
Walkability and its association with prevalent and incident diabetes among adults in different regions of Germany:results of pooled data from five German cohorts
Walkability and its association with walking/cycling and body mass index among adults in different regions of Germany:a cross-sectional analysis of pooled data from five German cohorts
Framework and baseline examination of the German National Cohort (NAKO)
The German National Cohort (NAKO) is a multidisciplinary, population-based prospective cohort study that aims to investigate the causes of widespread diseases, identify risk factors and improve early detection and prevention of disease. Specifically, NAKO is designed to identify novel and better characterize established risk and protection factors for the development of cardiovascular diseases, cancer, diabetes, neurodegenerative and psychiatric diseases, musculoskeletal diseases, respiratory and infectious diseases in a random sample of the general population. Between 2014 and 2019, a total of 205,415 men and women aged 19â74Â years were recruited and examined in 18 study centres in Germany. The baseline assessment included a face-to-face interview, self-administered questionnaires and a wide range of biomedical examinations. Biomaterials were collected from all participants including serum, EDTA plasma, buffy coats, RNA and erythrocytes, urine, saliva, nasal swabs and stool. In 56,971 participants, an intensified examination programme was implemented. Whole-body 3T magnetic resonance imaging was performed in 30,861 participants on dedicated scanners. NAKO collects follow-up information on incident diseases through a combination of active follow-up using self-report via written questionnaires at 2â3Â year intervals and passive follow-up via record linkages. All study participants are invited for re-examinations at the study centres in 4â5Â year intervals. Thereby, longitudinal information on changes in risk factor profiles and in vascular, cardiac, metabolic, neurocognitive, pulmonary and sensory function is collected. NAKO is a major resource for population-based epidemiology to identify new and tailored strategies for early detection, prediction, prevention and treatment of major diseases for the next 30Â years. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10654-022-00890-5
Messung der körperlichen Fitness in der NAKO Gesundheitsstudie: Methoden, QualitÀtssicherung und erste deskriptive Ergebnisse
Die körperliche Fitness ist das MaĂ fĂŒr die individuelle FĂ€higkeit, körperlich aktiv zu sein. Ihre wesentlichen Komponenten sind die kardiorespiratorische Fitness (Cardiorespiratory Fitness, CRF), die Muskelkraft und die Beweglichkeit. Neben der körperlichen AktivitĂ€t ist die körperliche Fitness ein wesentlicher PrĂ€diktor fĂŒr MorbiditĂ€t und MortalitĂ€t. Ziel der Arbeit sind die Beschreibung der Erhebungsmethoden körperlicher Fitness in der NAKO Gesundheitsstudie und die Darstellung erster deskriptiver Ergebnisse. In der NAKO-Basiserhebung wurden die maximale Handgreifkraft (Grip Strength, GS) und die CRF als Komponenten der körperlichen Fitness ĂŒber ein Handdynamometer bzw. ĂŒber einen Fahrradergometertest mit submaximaler Belastung erhoben. Daraus wurde die maximale Sauerstoffaufnahme (VO2max) zur Beurteilung der CRF abgeleitet. Die Ergebnisse von insgesamt 99.068 GS-Messungen und 3094 Messungen der CRF beruhen auf einem Datensatz zur Halbzeit der Basiserhebung der NAKO (Alter 20â73 Jahre, 47âŻ% MĂ€nner). MĂ€nner zeigten im Vergleich zu Frauen höhere Werte der körperlichen Fitness (MĂ€nner: GSâŻ=â47,8âŻkg, VO2maxâŻ=â36,4âŻml·minâ1âŻÂ·âkgâ1; Frauen: GSâŻ=â29,9âŻkg, VO2maxâŻ=â32,3âŻml·minâ1âŻÂ·âkgâ1). UngefĂ€hr ab dem 50. Lebensjahr konnte ein RĂŒckgang der GS verzeichnet werden, wohingegen die CRF ab der Altersgruppe 20â29 Jahre bis zu den â„60-JĂ€hrigen kontinuierlich abfiel. Die GS und die VO2max zeigten nach Korrektur fĂŒr das Körpergewicht einen linear positiven Zusammenhang (MĂ€nner ÎČâŻ=â0,21; Frauen ÎČâŻ=â0,35). Die Analysen zeigten eine gute Ăbereinstimmung der Verteilung der körperlichen Fitness in der NAKO im Vergleich zu anderen bevölkerungsbasierten Studien. ZukĂŒnftige Auswertungen werden insbesondere die unabhĂ€ngige Bedeutung der GS und CRF bei der PrĂ€diktion von MorbiditĂ€t und MortalitĂ€t beleuchten.Physical fitness is defined as an individualâs ability to be physically active. The main components are cardiorespiratory fitness (CRF), muscle strength, and flexibility. Regardless of physical activity level, physical fitness is an important determinant of morbidity and mortality. The aim of the current study was to describe the physical fitness assessment methodology in the German National Cohort (NAKO) and to present initial descriptive results in a subsample of the cohort. In the NAKO, hand grip strength (GS) and CRF as physical fitness components were assessed at baseline using a hand dynamometer and a submaximal bicycle ergometer test, respectively. Maximum oxygen uptake (VO2max) was estimated as a result of the bicycle ergometer test. The results of a total of 99,068 GS measurements and 3094 CRF measurements are based on a data set at halftime of the NAKO baseline survey (age 20â73 years, 47% men). Males showed higher values of physical fitness compared to women (males: GSâŻ=â47.8âŻkg, VO2maxâŻ=â36.4âŻml·minâ1âŻÂ·âkgâ1; females: GSâŻ=â29.9âŻkg, VO2maxâŻ=â32.3âŻmlâŻÂ·âminâ1âŻÂ·âkgâ1). GS declined from the age of 50 onwards, whereas VO2max levels decreased continuously between the age groups of 20â29 and â„60 years. GS and VO2max showed a linear positive association after adjustment for body weight (males ÎČâŻ=â0.21; females ÎČâŻ=â0.35). These results indicate that the physical fitness measured in the NAKO are comparable to other population-based studies. Future analyses in this study will focus on examining the independent relations of GS and CRF with risk of morbidity and mortality
Effect of Health Care Access on General Health Related Quality of Life (HRQoL) among Diabetics in the Southern Cone of Latin America
Background: Health related quality of life (HRQoL) is an important health outcome
measure in diabetics and is influenced by socioeconomic, demographic and disease related
factors. Additionally, health care access could affect HRQoL in diabetics. The effect of access
to care on HRQoL could be more prominent in people with diabetes than in people
without diabetes. However, these associations have been rarely investigated. Especially in
the Southern Cone of Latin America, were diabetes is increasing and access to care may be
impeded, there is a lack of research regarding this topic. Hence, the aim of this thesis was
to enhance knowledge on the effect of health care access in diabetics HRQoL in the Southern
Cone of Latin America.
Methods: Data of 1025 diabetics and 6064 non-diabetics of the CESCAS I study were
analyzed. The physical component summary (PCS-12) and the mental component summary
(MCS-12) of the SF-12, a generic instrument to measure HRQoL, were used to determine
HRQoL. 4 groups were compared 1) Insured people without barriers to realized
access (no problems in accessing health care), 2) Uninsured people without barriers to realized
access (no potential, but realized access), 3) Insured people with barriers to realized
access (no realized, but potential access) 4) Uninsured people with barriers to realized access
(no potential and no realized access).
Group differences among diabeticsâ characteristics and HRQoL as well as between diabetics
and non-diabetics were analyzed using Chi Square test, One Way ANOVA, unadjusted
and adjusted two-factorial univariate ANOVA, Welch test, Tukey, Bonfferoni and Games
Howell as post hoc tests, when appropriate. The association between HRQoL in the diabetic
sample and health care access was adjusted for important covariates using multivariate
linear regression. Reasons for barriers to realized access were analyzed descriptively.
Results: In diabetics, HRQoL was lowest in the fourth group for both component summary
scales and highest in the first group followed by the second and the third group. (p-value <
0.001). In adjusted analyses, HRQoL was associated with a decrease of 2 points for the
PCS-12 in the second (p-value 0.014), 4.75 points in the third (p-value 0.007) and 6.13
points in the fourth group (p-value < 0.001) compared to the first group. For the MCS-12,
the decrease was 4.82 points for the second (p-value 0.032) and 5.6 points in the fourth
group (p-value 0.001) compared to the first group. The decrease of 0.62 points in the second
group was not significant (p-value 0.553). Reasons for barriers to realized care included long appointment waiting times and compulsory copayments. Diabetes and access to
care significantly predicted lower HRQoL regarding the PCS-12 (p-value < 0.001). The
MCS-12 was significantly predicted by access to care (p-value < 0.001), but not by diabetes
(p-value 0.349). Diabetes and access to care were not interacting in predicting HRQoL
in neither the PCS-12 (p-value 0.853), nor the MCS-12 (p-value 0.425).
Discussion and Conclusion: In the Southern Cone of Latin America, impeded health care
access is common among diabetics and non-diabetics. Realized health care access seems to
play a more important role than health insurance status in determining the physical and
mental component of HRQoL in both, diabetic and non-diabetic patients. Diabetes seems
to negatively affect the physical, but not the mental component of HRQoL. Interventions
should be implemented to overcome especially the barriers to realized health care access in
order to enhance HRQoL among diabetics
Measuring Cognitive Reserve (CR) - A systematic review of measurement properties of CR questionnaires for the adult population.
AimThe aim of this systematic review was to summarize and critically appraise the quality of published literature on measurement properties of questionnaires assessing Cognitive Reserve (CR) in adults (>18 years).MethodsWe systematically searched for published studies on MEDLINE, PsycINFO, and Web of Science through August 2018. We evaluated the methodological quality of the included studies and the results on measurement properties based on a consensus-based standard checklist.ResultsThe search strategy identified 991 publications, of which 37 were selected evaluating the measurement properties of six different questionnaires. Construct validity of the Cognitive Reserve Index questionnaire was most extensively evaluated, while evaluation of the remaining measurement properties of this questionnaire was scarce. Measurement properties of the Cognitive Reserve Questionnaire and the Cognitive Reserve Scale were assessed more completely. While the Lifetime of Experience Questionnaire seems to be the most thorough instrument, a finale recommendation for one specific questionnaire cannot be drawn, since about half of the measurement properties for each questionnaire were poorly or not assessed at all.ConclusionsThere is a need of high quality methodological studies assessing measurement properties of CR questionnaires, especially regarding content validity, structural validity, and responsiveness.Trial registrationPROSPERO Registration number CRD42018107766
Association between Parenthood and Health Behaviour in Later Life—Results from the Population-Based CARLA Study
Previous research has focused on comparing health behaviour between parents and non-parents at younger ages, while little is known about the impact of being a parent on health behaviours in later life. We studied whether parenthood is associated with later physical activity (PA), dietary pattern, smoking status and alcohol consumption in German adults of middle and old age. We used data from the baseline examination of the population-based CARLA-study in Halle (Saale), comprising 1779 adults aged 45–83. Linear and logistic regression analyses assessed the relationship between parenthood and health behaviours while controlling for age, partner status, education, income, occupational position, socioeconomic status in childhood, and number of chronic diseases. Of the participants, 89.1% had biological children. Being a father was associated with higher PA in sports (sport index ß = 0.29, 95% confidence interval [0.14; 0.44]), but not with PA in leisure time (excluding sports), dietary pattern, consumption of alcohol and smoking status. No associations were found between being a mother with all outcome variables. Provided that PA of fathers is typically reduced when the children are young, the development towards higher PA at later age needs to be studied in more detail