Dietary quality, lifestile factors and healthy ageing in Europe

Keywords: dietary quality, dietary patterns, lifestyle factors, smoking, physical activity, elderly, mortality, Mediterranean Diet Score, Healthy Diet Indicator, healthy ageing, self-rated health, functional statusThe contribution of diet and lifestyle factors to healthy ageing was investigated in European elderly, born between 1913 and 1918, of the SENECA study. First, the Mediterranean Diet Score (MDS), Healthy Diet Indicator (HDI), and cluster analysis were validated as measures of quality of dietary patterns in the SENECA study as well as the Framingham study. Cluster analysis, MDS, and HDI showed strong similarities in the classification of persons into dietary quality groups. High-quality diets were associated with nutritional status and health-related indicators. It is concluded that dietary quality can be assessed using diet scores as well as cluster analysis, the approaches being complementary. The relationships of the three lifestyle factors diet, physical activity, and smoking habits to survival and maintenance of health at old age were investigated, using Cox's proportional hazards analysis and logistic regression. Single unhealthy lifestyle behaviours were related to an increased mortality risk. For men, the mortality risk for a low-quality diet was 1.2 (95 percent confidence interval (CI): 0.9, 1.7), for inactivity 1.4 (95% CI: 1.1, 1.7), and for smoking 2.1 (95% CI: 1.6, 2.6). For women, the mortality risk for smoking was 1.8 (95% CI: 1.1, 2.7), for inactivity 1.8 (95% CI: 1.3, 2.4), and for a low-quality diet 1.3 (95% CI: 0.9, 1.8). The risk of death was increased for all combinations of two unhealthy lifestyle behaviours. Men and women with three unhealthy lifestyle behaviours had a three to four-fold increase in mortality risk. Self-rated health and functional status both declined in men and women with healthy and unhealthy lifestyle habits over a 10-year follow-up period, but the deterioration in health was delayed by the healthy lifestyle behaviours, non-smoking and physical activity. Inactive men had a 2.8 (90% CI: 1.3, 6.2) times increased risk for a decline in self-rated health and a 1.9 (90% CI: 0.9, 3.9) times increased risk to become dependent. Smoking men had a two-fold increased risk (90% CI: 1.0, 4.1) for a decline in self-rated health and a 2.2 (90% CI: 1.1, 4.5) times increased risk to become dependent. In women, inactivity was related to a 2.6 (90%CI: 1.4, 4.9) times increased risk to become dependent.In conclusion, a lifestyle characterised by non-smoking, physical activity and a high-quality diet contributes to healthy ageing. A healthy lifestyle at older ages is positively related to a reduced mortality risk and to a delay in the deterioration in health status. This postponement of the onset of major morbidity is likely to go together with a compressed cumulative morbidity. It is concluded that health promotion at older ages can contribute to healthy ageing.</p

Evaluatie en borging van Smaaklessen met aanvullende activiteiten : het Smaaklessen groentemenu onderzoek

Onderzocht is wat het toegevoegde effect is van de Smaaklessen arrangementen ten opzichte van reguliere Smaaklessen en tevens zijn de mogelijkheden verkend voor borging van Smaaklessen arrangementen

The association between indoor temperature and body mass index in children:the PIAMA birth cohort study

Background: Several experimental studies showed consistent evidence for decreased energy expenditure at higher ambient temperatures. Based on this, an association between thermal exposure and body weight may be expected. However, the effect of thermal exposure on body weight has hardly been studied. Therefore, this study investigated the association between indoor temperature and body mass index (BMI) in children in real life. Methods: This longitudinal observational study included 3 963 children from the Dutch Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort that started in 1996. These children were followed from birth until the age of 11 years. Winter indoor temperature (living room and bedroom) was reported at baseline and BMI z-scores were available at 10 consecutive ages. Missing data were multiply imputed. Associations between indoor temperature and BMI were analyzed using generalized estimating equations (GEE), adjusted for confounders and stratified by gender. In a subgroup of 104 children, bedroom temperature was also measured with data loggers. Results: Mean reported living room and bedroom temperature were 20.3 degrees C and 17.4 degrees C, respectively. Reported and measured bedroom temperatures were positively correlated (r = 0.42, p = 0.001). Neither reported living room temperature (-0.03 = 0.04) and bedroom temperature (-0.01 = 0.02) nor measured bedroom temperature (-0.04 = 0.05) were associated with BMI z-score between the age of 3 months and 11 years. Conclusions: This study in children did not support the hypothesized association between indoor temperature and BMI in a real life setting

Adapting the SLIM diabetes prevention intervention to a Dutch real-life setting: joint decision making by science and practice

Background - Although many evidence-based diabetes prevention interventions exist, they are not easily applicable in real-life settings. Moreover, there is a lack of examples which describe the adaptation process of these interventions to practice. In this paper we present an example of such an adaptation. We adapted the SLIM (Study on Lifestyle intervention and Impaired glucose tolerance Maastricht) diabetes prevention intervention to a Dutch real-life setting, in a joint decision making process of intervention developers and local health care professionals. Methods - We used 3 adaptation steps in accordance with current adaptation frameworks. In the first step, the elements of the SLIM intervention were identified. In the second step, these elements were judged for their applicability in a real-life setting. In the third step, adaptations were proposed and discussed for those elements which were deemed not applicable. Participants invited for this process included intervention developers and local health care professionals (n=19). Results - In the first adaptation step, a total of 22 intervention elements were identified. In the second step, 12 of these 22 intervention elements were judged as inapplicable. In the third step, a consensus was achieved for the adaptations of all 12 elements. The adapted elements were in the following categories: target population, techniques, intensity, delivery mode, materials, organisational structure, and political and financial conditions. The adaptations either lay in changing the SLIM protocol (6 elements) or the real-life working procedures (1 element), or a combination of both (4 elements). Conclusions -he positive result of this study is that a consensus was achieved within a relatively short time period (nine months) between the developers of the SLIM intervention and local health care professionals on the adaptations needed to make SLIM applicable in a Dutch real-life setting. Our example shows that it is possible to combine the perspectives of scientists and practitioners, and to find a balance between evidence-base and applicability concerns

Co-design of a digital dietary intervention for adults at risk of type 2 diabetes

Background Co-design has the potential to create interventions that lead to sustainable health behaviour change. Evidence suggests application of co-design in various health domains has been growing; however, few public-facing digital interventions have been co-designed to specifically address the needs of adults at risk of Type 2 diabetes (T2D). This study aims to: (1) co-design, with key stakeholders, a digital dietary intervention to promote health behaviour change among adults at risk of T2D, and (2) evaluate the co-design process involved in developing the intervention prototype. Methods The co-design study was based on a partnership between nutrition researchers and designers experienced in co-design for health. Potential end-users (patients and health professionals) were recruited from an earlier stage of the study. Three online workshops were conducted to develop and review prototypes of an app for people at risk of T2D. Themes were inductively defined and aligned with persuasive design (PD) principles used to inform ideal app features and characteristics. Results Participants were predominantly female (range 58–100%), aged 38 to 63 years (median age = 59 years), consisting of a total of 20 end-users and four experts. Participants expressed the need for information from credible sources and to provide effective strategies to overcome social and environmental influences on eating behaviours. Preferred app features included tailoring to the individual’s unique characteristics, ability to track and monitor dietary behaviour, and tools to facilitate controlled social connectivity. Relevant persuasive design principles included social support, reduction (reducing effort needed to reach target behaviour), tunnelling (guiding users through a process that leads to target behaviour), praise, rewards, and self-monitoring. The most preferred prototype was the Choices concept, which focusses on the users’ journey of health behaviour change and recognises progress, successes, and failures in a supportive and encouraging manner. The workshops were rated successful, and feedback was positive. Conclusions The study’s co-design methods were successful in developing a functionally appealing and relevant digital health promotion intervention. Continuous engagement with stakeholders such as designers and end-users is needed to further develop a working prototype for testing

Loneliness Literacy Scale: Development and Evaluation of an Early Indicator for Loneliness Prevention

To develop and evaluate the Loneliness Literacy Scale for the assessment of short-term outcomes of a loneliness prevention programme among Dutch elderly persons. Scale development was based on evidence from literature and experiences from local stakeholders and representatives of the target group. The scale was pre-tested among 303 elderly persons aged 65 years and over. Principal component analysis and internal consistency analysis were used to affirm the scale structure, reduce the number of items and assess the reliability of the constructs. Linear regression analysis was conducted to evaluate the association between the literacy constructs and loneliness. The four constructs “motivation”, “self-efficacy”, “perceived social support” and “subjective norm” derived from principal component analysis captured 56 % of the original variance. Cronbach’s coefficient α was above 0.7 for each construct. The constructs “self-efficacy” and “perceived social support” were positively and “subjective norm” was negatively associated with loneliness. To our knowledge this is the first study developing a short-term indicator for loneliness prevention. The indicator contributes to the need of evaluating public health interventions more close to the intervention activities. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11205-013-0322-y) contains supplementary material, which is available to authorized users

Identifying critical features of type two diabetes prevention interventions: A Delphi study with key stakeholders

Aims This study aims to identify critically important features of digital type two diabetes mellitus (T2DM) prevention interventions. Methods A stakeholder mapping exercise was undertaken to identify key end-user and professional stakeholders, followed by a three-round Delphi procedure to generate and evaluate evidence statements related to the critical elements of digital T2DM prevention interventions in terms of product (intervention), price (funding models/financial cost), place (distribution/delivery channels), and promotion (target audiences). Results End-user (n = 38) and professional (n = 38) stakeholders including patients, dietitians, credentialed diabetes educators, nurses, medical doctors, research scientists, and exercise physiologists participated in the Delphi study. Fifty-two critical intervention characteristics were identified. Future interventions should address diet, physical activity, mental health (e.g. stress, diabetes-related distress), and functional health literacy, while advancing behaviour change support. Programs should be delivered digitally or used multiple delivery modes, target a range of population subgroups including children, and be based on collaborative efforts between national and local and government and non-government funded organisations. Conclusions Our findings highlight strong support for digital health to address T2DM in Australia and identify future directions for T2DM prevention interventions. The study also demonstrates the feasibility and value of stakeholder-led intervention development processes

Effect evaluation of a two-year complex intervention to reduce loneliness in non-institutionalised elderly Dutch people

Background: Public health policy calls for intervention programmes to reduce loneliness in the ageing population. So far, numerous loneliness interventions have been developed, with effectiveness demonstrated for few of these interventions. The loneliness intervention described in this manuscript distinguishes itself from others by including multiple intervention components and targeting individuals and their environment. Intervention components included a mass media campaign, information meetings, psychosocial group courses, social activities organised by neighbours, and training of intermediaries. The aim of this manuscript is to study the effects of this integrated approach on initial and long-term outcomes. Methods: A quasi-experimental pre-test post-test intervention study was conducted among non-institutionalised elderly people aged 65 years and over to evaluate the effectiveness of the intervention by comparing the intervention community and the control community. Data on outputs, initial and long-term outcomes, and the overall goal were collected by self-administered questionnaires. Data of 858 elderly people were available for the analyses. To assess the effect linear regression analyses with adjustments for age, gender, church attendance, and mental health were used. In addition, the process evaluation provided information about the reach of the intervention components. Results: After two years, 39% of the elderly people were familiar with the intervention programme. The intervention group scored more favourably than the control group on three subscales of the initial outcome, motivation (-4.4%, 95% CI-8.3-0.7), perceived social support (-8.2%, 95% CI-13.6-2.4), and subjective norm (-11.5%, 95% CI-17.4-5.4). However, no overall effects were observed for the long-term outcome, social support, and overall goal, loneliness. Conclusions: Two years after its initiation the reach of the intervention programme was modest. Though no effect of the complex intervention was found on social support and loneliness, more favourable scores on loneliness literacy subscales were induced

The impact of emerging sustainable technologies on existing electrical infrastructure in Ontario

Sustainable energy sources are urgently required, as traditional non-renewable energy sources are increasing in scarcity and subsequently in cost. Significant innovation and investment is required to incorporate newly developed sustainable energy technologies into the existing energy infrastructure network. This presentation will review how emerging sustainable technologies are interacting with existing energy infrastructure. Specifically it will review the existing electrical grid in Ontario, Canada, and the impact of sustainable technologies such as electric cars and distributed generation. When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/3107