The effect of a cluster-randomized controlled trial on lifestyle behaviors among families at risk for developing type 2 diabetes across Europe: the Feel4Diabetes-study

Background: This study investigated the effect of the Feel4Diabetes-intervention, a 2-year multilevel intervention, on energy balance-related behaviors among European families at risk for developing type 2 diabetes. Intervention effects on self-reported physical activity, sedentary behavior and eating behaviors were investigated across and within the participating countries: Belgium, Finland, Greece, Spain, Hungary and Bulgaria. Methods: Families were recruited through schools, located in low socio-economic status areas. In total, 4484 families at risk for developing type 2 diabetes were selected using the FINDRISC-questionnaire. Parents’ and children’s energy balance-related behaviors data were collected by questionnaires at three time points (baseline, mid- and post intervention). Families assigned to the intervention group were invited to participate in a 2-year school-, community-, and family-based intervention to promote a healthier lifestyle, including counseling sessions (first intervention year) and text messages (second intervention year). Families assigned to the control group received standard care, including medical check-up results and recommendations and tips regarding a healthy lifestyle. To assess the intervention-effects, Mixed Models were conducted using the R-Package “lmer “with R v3.2. Results: Significant intervention effects were found on a certain number of families’ lifestyle behaviors. Significant favorable intervention effects were detected on parents’ water consumption and consumption of fruit and vegetables, and on children’s consumption of sweets and moderate-to-vigorous physical activity. Analyses by country revealed significant favorable intervention effects on water consumption and on moderate-to-vigorous physical activity in Belgian parents and on fruit and vegetable consumption among Belgian children, on sweets consumption among Spanish parents and children, and on moderate-to-vigorous physical activity among Finnish children. Unfavorable intervention effects were found on the consumption of soft drinks and sugar-containing juices among Hungarian children and parents, while when examining the intervention effects for the overall population and per country, 10 from the 112 investigated outcome variables were improved in the intervention group compared to the control group (9%). Conclusions: The Feel4Diabetes-intervention managed to improve a certain number of targeted lifestyle behaviors while the intervention was not effective on a large number of targeted lifestyle behaviors. The findings of the current study are encouraging, but further research is needed on how we can further improve effectiveness of lifestyle interventions to prevent type 2 diabetes in families at risk. Trial registration: The Feel4Diabetes-study is registered with the clinical trials registry http://clinicaltrials.gov, ID: 643708. © 2021, The Author(s)

Area minimizing discs in metric spaces

We solve the classical problem of Plateau in the setting of proper metric spaces. Precisely, we prove that among all disc-type surfaces with prescribed Jordan boundary in a proper metric space there exists an area minimizing disc which moreover has a quasi-conformal parametrization. If the space supports a local quadratic isoperimetric inequality for curves we prove that such a solution is locally Hölder continuous in the interior and continuous up to the boundary. Our results generalize corresponding results of Douglas Radò and Morrey from the setting of Euclidean space and Riemannian manifolds to that of proper metric spaces

Feel4Diabetes healthy diet score: Development and evaluation of clinical validity

Background: The aim of this paper is to present the development of the Feel4Diabetes Healthy Diet Score and to evaluate its clinical validity. Methods: Study population consisted of 3268 adults (63% women) from high diabetes risk families living in 6 European countries. Participants filled in questionnaires at baseline and after 1 year, reflecting the dietary goals of the Feel4Diabetes intervention. Based on these questions the Healthy Diet Score was constructed, consisting of the following components: breakfast, vegetables, fruit and berries, sugary drinks, whole-grain cereals, nuts and seeds, low-fat dairy products, oils and fats, red meat, sweet snacks, salty snacks, and family meals. Maximum score for each component was set based on its estimated relative importance regarding T2DM risk, higher score indicating better quality of diet. Clinical measurements included height, weight, waist circumference, heart rate, blood pressure, and fasting blood sampling, with analyses of glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides. Analysis of (co) variance was used to compare the Healthy Diet Score and its components between countries and sexes using baseline data, and to test differences in clinical characteristics between score categories, adjusted for age, sex and country. Pearson''s correlations were used to study the association between changes from baseline to year 1 in the Healthy Diet Score and clinical markers. To estimate reproducibility, Pearson''s correlations were studied between baseline and 1 year score, within the control group only. Results: The mean total score was 52.8 ± 12.8 among women and 46.6 ± 12.8 among men (p < 0.001). The total score and its components differed between countries. The change in the Healthy Diet Score was significantly correlated with changes in BMI, waist circumference, and total and LDL cholesterol. The Healthy Diet Score as well as its components at baseline were significantly correlated with the values at year 1, in the control group participants. Conclusion: The Feel4Diabetes Healthy Diet Score is a reproducible method to capture the dietary information collected with the Feel4Diabetes questionnaire and measure the level of and changes in the adherence to the dietary goals of the intervention. It gives a simple parameter that associates with clinical risk factors in a meaningful manner

THE ROLE OF VENOUS CONSTRICTION IN CIRCULATORY DISORDERS

The role of active venous function in the regulation of normal and pathological circulation has been dealt with in an increasing number of reports. As a matter of fact, this conception is not new, its outlines having been laid down decades ago (Goltz, 1864; Bayliss and Starling, 1895; Hooker, 1920; Donegan, 1922; Fleisch, 1930, and others). In a monograph written 25 years ago Gollwitzer-Meyer summed up all the aspects of the problem known up to those days, and emphasized that the asphyxia, hypoxia, and hypercapnia increase not only the arterial but, as a consequence of the constriction of the veins, also the venous pressure. These data have of late been confirmed both in man and animal by the use of more refined techniques (Alexander, 1954; Duggan et al., 1953; and Page et al., 1955). Roy and Sherrington proved as early as 1890 that as a consequence of nervous stimulation venous pressure increased, that is, the veins constricted. Fleisch (1930), assumed the existence of a venomotor centre regulating venous function. Several investigations (Doupe et al., 1938; Duggan et al., 1953; Page et al., 1955; and Alexander, 1954 and 1955) left no doubt that active venous function depended on venomotor regulation (venomotor tone) the increase of the latter causing the constriction of the veins. According to Gollwitzer-Meyer (1932), Green et al. (1943), and Guyton (1951), the activity of the vasomoto

Participatory design of impact indicators for nursing research

As the Catalan research assessment agency, we designed and implemented an ongoing, ex-post and impact assessment system in the area of health system (SARIS), which includes a crucial pillar: engagement. We developed an approach that combines the co-creation with the stakeholders in order to define topics of interests, with the formulation of preliminary indicators to assess the impact of nursing research. Therefore, a 2-phase approach was developed. First, discussion groups with the main purpose of identifying topics of interest in relations to the impact of nursing research were developed. Nurses from different settings, territories and disciplines made emerge four topics of interest: ‘advancement of knowledge’, ‘results dissemination’, ‘nurse training and networks’ and ‘results application’. Second, the suggested ideas from the focus groups were analysed and discussed in order to elaborate 30 preliminary indicators. Next steps will include a consensus in order to assess the relevance of these indicators. In the current context, where research in nursery care has not been measured before, co-creation with stakeholders might be a win-win strategy to reach three objectives: 1) obtaining a meaningful and measurable set of indicators, 2) raising awareness on the transformative potential of nursery care research, and 3) in motivating researchers in nursery care to maximize the impact