Does participation in a population-based dietary intervention scheme have a lasting impact on fruit intake in young children?

BACKGROUND: The National Schools Fruit Scheme (NSFS) is intended to improve fruit intake in young children by providing free daily fruit at school. METHODS: We used a parentally completed questionnaire for three consecutive years to study fruit intake in young children before, during and after participation in the NSFS compared with a control region. RESULTS: In 2003, 2004 and 2005, a total of 224, 220 and 179 schools, respectively, were studied with responses from 5,606, 5,111 and 3,382 children for each survey. Between 2003 and 2004, individual fruit consumption in the intervention region increased by more (from a median of 7.5 to 14.0 pieces/week) than in the control region (from a median of 9.2-11.0 pieces/week), resulting in a difference (P < 0.001) between the two regions in 2004. However, after ceasing to be eligible for the NSFS, fruit intake in children in the intervention region fell to a median of 12 pieces per week, lower than that in the control region (median value of 14 pieces per week, P = 0.02). CONCLUSIONS: School-based fruit distribution schemes providing free fruit at school appear to be an effective means of increasing dietary fruit intake in young children, including those who live in relatively socio-economically deprived areas. However, this approach does not influence fruit intake after the provision of free fruit ends, so schemes may need to be sustained to provide the maximum benefit to young children.     

Preventing cancer: dietary lifestyle or clinical intervention?

In Australia, colorectal, prostate and breast cancers are the most frequently occurring cancers in our society, a pattern that is quite different from that of underdeveloped countries. While diet is largely responsible for these differences, technological advances mean that the solutions can be viewed as systematic, financial, lifestyle or technological. They range from those that require self-discipline and care for personal well-being through to those that are seemingly a quick technological fix that will work in spite of an unhealthy lifestyle. There are three main approaches available for prevention of these cancers: dietary lifestyle, chemoprevention and screening. It has been estimated that the potential for prevention by a healthy dietary lifestyle is excellent and might reduce the burden of breast, prostate and colorectal cancer by 33-55%, 10-20% and 66-75%, respectively. This should be safe and inexpensive and have collateral benefit such as reduced cardiovascular disease and osteoporosis. But, population compliance with more plant-based, less calorie dense foods is uncertain, the most healthy are likely to be the most compliant and evidence for effectiveness when interventional programs are undertaken is disappointing. It is not clear how dependable the dietary approach would be where inherited genetic factors determine risk for one of these cancers. Chemoprevention, the administration of natural or synthetic agents that delay, slow down or inhibit the process of tumorigenesis, are still under development and study. Hormone receptor modulators for breast and derivatives of non-steroidal anti-inflammatory drugs for colorectal cancers seem to have most promise and may reduce tumour incidence or death by as much as 50%. These agents are simpler to comply with than changing dietary lifestyle and they are more potent, hence they may be of particular value in high-risk settings. But they are likely to be more costly and run the risk of adverse effects with few collateral benefits. Screening, or the testing of an individual for a disease when that individual does not have any symptoms or signs suggesting that the disease is present, aims to prevent or delay the development of the cancer. Screening impacts on mortality more so than on incidence, reducing colorectal cancer mortality in the range 15-60% and breast cancer mortality by 23-37%. Screening has the advantage of being effective in high-risk as well as average-risk groups and is an 'easy' solution for the person who elects not to follow a healthy dietary lifestyle. Nonetheless, it is expensive, demanding on resources, provides no collateral benefits and does not have the same potential to reduce incidence of disease as does the dietary approach. With these Western cancers, we are fortunate that there are options for prevention. At least choices are available and some will suite certain circumstances and personalities more than others.     

Does the population approach increase health inequality?

The population approach is well recognized as an effective strategy to improve population health, as well as the population-at-risk approach. It aims to decrease risk exposure of the total population through a change of contextual conditions. However, the population approach has the possibility of increasing health inequality because of variation in the effectiveness of the strategy in accordance with the risk exposure. This paper proposes the "vulnerable population approach" as an alternative and supplemental strategy. It aims to decrease health inequalities between socially defined groups, by shifting the distribution of a lower level of risk exposure of the groups through changes in social and environmental conditions that make groups at higher risk. No interventional approach can be singly applied to all health problems. To improve population health, it is important to select the most effective strategy among the three approaches, considering their advantages and limitations, and to adopt a suitable combination of different approaches.     

Does social participation improve self-rated health in the older population? A quasi-experimental intervention study

Social participation has been linked to healthy aging and the maintenance of functional independence in older individuals. However, causality remains tenuous because of the strong possibility of reverse causation (healthy individuals selectively participate in social activities). We describe a quasi-experimental intervention in one municipality of Japan designed to boost social participation as a way of preventing long-term disability in senior citizens through the creation of ‘salons’ (or community centers). In this quasi-experimental intervention study, we compared 158 participants with 1391 non-participants in salon programs, and examined the effect of participation in the salon programs on self-rated health. We conducted surveys of community residents both before (in 2006) and after (in 2008) the opening of the salons. Even with a pre/post survey design, our study could be subject to reverse causation and confounding bias. We therefore utilized an instrumental variable estimation strategy, using the inverse of the distance between each resident's dwelling and the nearest salon as the instrument. After controlling for self-rated health, age, sex, equivalized income in 2006, and reverse causation, we observed significant correlations between participation in the salon programs and self-rated health in 2008. Our analyses suggest that participation in the newly-opened community salon was associated with a significant improvement in self-rated health over time. The odds ratio of participation in the salon programs for reporting excellent or good self-rated health in 2008 was 2.52 (95% CI 2.27–2.79). Our study provides novel empirical support for the notion that investing in community infrastructure to boost the social participation of communities may help promote healthy aging.     

Ethnic differences in social participation and social capital in Malmö, Sweden: a population-based study

The aim of this study was to investigate ethnic differences in different aspects of social participation in Malm?, Sweden. The public health survey in Malm? 1994 is a cross-sectional study. A total of 5600 randomly chosen individuals aged 20-80 years were asked to complete a postal questionnaire. The participation rate was 71%. The population was divided into categories born in Sweden, Denmark/Norway, other Western countries, former Yugoslavia, Poland, Arabic speaking countries and all other countries. The age-adjusted and multivariate analyses were performed using a logistic regression model in order to investigate the importance of possible confounders (age, education, economic stress and unemployment) on the differences by country of origin in different aspects of social participation. Men and women born in Arabic speaking countries and other countries (Iran, Turkey, Vietnam, Chile and subsaharan Africa) participate to a significantly lower extent in a variety of civic and social activities when compared to the reference population born in Sweden. The differences in participation in these groups compared to the group born in Sweden are observed both for social participation items at the core of the definition of social capital and cultural and other activities unrelated to social capital. This pattern is particularly pronounced for women born in Arabic speaking countries. These women even sharply differ from the participation rates of men born in Arabic speaking countries. The ethnic differences in most cases do not seem to be explained satisfactorily by education, economic stress or possibly unemployment.     

Association between dietary glycemic index, glycemic load, and body mass index in the Inter99 study: is underreporting a problem?

BACKGROUND: The few studies examining the potential associations between glycemic index (GI), glycemic load (GL), and body mass index (BMI) have provided no clear pictures. Underreporting of energy intake may be one explanation for this. OBJECTIVE: We examined the associations between GI, GL, and BMI by focusing on the confounding factor of total energy intake and the effect of exclusion of low energy reporters (LERs). DESIGN: This was a cross-sectional study of 6334 subjects aged 30-60 y. Dietary intake was estimated from a food-frequency questionnaire. GI and GL were estimated by using white bread as the reference food. Underreporting of energy intake was assessed as reported energy intake divided by basal metabolic rate (EI/BMR); LERs were defined as those having an EI/BMR < 1.14. Univariate and multiple linear regression models were used to test for associations between GI, GL, and BMI. The confounders were sex, age, smoking, physical activity, alcohol intake, and energy intake. All analyses were conducted on 1) the entire population and 2) a subsample excluding LERs. RESULTS: In the univariate analyses of the entire population, GL was inversely associated with BMI. No association was observed for GI. After full adjustment (including energy intake), both GI and GL were positively associated with BMI. When LERs were excluded, GL was positively associated with BMI in all analyses, and GI was positively associated with BMI in the multiple analyses. CONCLUSIONS: We showed a positive association between GI, GL, and BMI. Energy adjustment and the exclusion of LERs significantly affected the results of the analysis; thus, we stress the importance of energy adjustment.     

Mental health symptoms in relation to socio-economic conditions and lifestyle factors – a population-based study in Sweden

Background  

Poor mental health has large social and economic consequences both for the individual and society. In Sweden, the prevalence of mental health symptoms has increased since the beginning of the 1990s. There is a need for a better understanding of the area for planning preventive activities and health care.     

Does regulatory focus play a role in dietary restraint?

Regulatory-Focus Theory [Higgins, E. T. (1997). Beyond pleasure and pain. American Psychologist, 52, 1280-1300.] distinguishes between self-regulation with a promotion focus (focusing on the presence and absence of positive outcomes) and a prevention focus (focusing on the presence and absence of negative outcomes). We examined whether regulatory-focus theory can help us to better understand the weight-related beliefs and dieting behaviors of restrained eaters. In two studies, participants completed measures of dietary restraint, regulatory focus, beliefs about the outcomes associated with weight loss and weight gain, and dieting behaviors. Overall, restrained eaters were more self-regulatory than were unrestrained eaters. Across both studies, dietary restraint was the best predictor of weight-related beliefs and dieting behaviors; in contrast, regulatory focus was largely unrelated to beliefs and behaviors. In addition, restrained eaters were highly motivated to control their weight irrespective of how close or how far they were from their ideal weight, whereas unrestrained eaters were more motivated to control their weight when they were further from their ideal. Our results suggest that future research should focus on the obstacles to successful weight regulation, rather than on individuals' regulatory focus.     

Results from a dietary intervention study in preschools “Beastly Healthy at School”

Objective:  Applying the Intervention Mapping Protocol, an intervention was developed to assist Belgian preschools in the implementation of a healthy school food policy. In the present study the impact of the intervention on children’s food consumption is investigated. Methods:  Teachers and parents from 16 schools (8 intervention; 8 control) were asked to participate in the study. Teachers registered the children’s available food and beverages during the morning and afternoon breaks (data of baseline and follow-up was matched for 618 intervention and 445 control children). Parents were asked to complete a food frequency questionnaire on their children’s general consumption (308 intervention and 168 control matches). Linear mixed model analyses were used to investigate the intervention effect. Results:  Both assessment methods indicate an increased fruit consumption for intervention children in comparison with control children, although the effect was only significant for the parental reported fruit consumption. Additionally the results suggest that the change is mainly due to increased availability at school. No significant associations were found for the other food items (snacks, vegetables and different types of beverages). Conclusion:  The results indicate that a healthy food policy at school can improve young children’s diet. Submitted: 28 February 2008; revised: 21 September 2008; accepted: 31 January 2009     

Does access to care affect outcomes of appendicitis in children? - a population-based cohort study

Background  

The annual number of pediatric appendectomies in Ontario was stable throughout the study period, but with a significant level of regional variations across regions. The objective of this study is to use population-based data to measure the associations and to explain the variations of appendectomy rates with population socio-demographic indicators.     

Does the abolition of copayment increase ambulatory care utilization?: a quasi-experimental study in Germany

The European Journal of Health Economics - Due to a problematic situation with public finances, Germany introduced a copayment scheme for ambulatory care visits in 2004. In 2012, Germany achieved a...     

Does intergenerational social mobility among men affect cardiovascular mortality? A population-based register study from Sweden

BACKGROUND: Socioeconomic inequalities in cardiovascular mortality are well documented. The aim here is to examine the relation between childhood and adulthood class as well as the role of unique intergenerational social mobility trajectories in such mortality. METHODS: Data were obtained from Swedish registries. Childhood and adulthood information were from the 1960 and 1990 censuses. Men born 1945-59 (809,199) were followed-up for four cardiovascular mortality outcomes 1990- 2002 (5533 deaths) by means of Cox regressions. Three different approaches were applied to study mobility between four main classes. RESULTS: In mutually adjusted models, the effect of a manual adulthood class (compared with non-manuals) was clearly larger (hazard ratios (HR) were 1.56 for MI, 1.70 for stroke, 1.64 for other cardiovascular disease (CVD), 1.62 for all CVD) as for a manual childhood class (1.38, 1.17, 1.24 and 1.28, respectively). This also applied to unclassifiable, while there were few systematic findings for self-employed. When adjusting for education level, childhood class was still significant for MI, other and all CVD, but adulthood class was significant for all outcomes. Trajectory-specific analyses revealed that mobile men from non-manual to manual had significantly higher mortality than mobile from manual to non-manual and stable non-manuals, but not significantly lower than stable manuals. CONCLUSIONS: Cardiovascular mortality was clearly structured by adulthood class, but not as consistently structured by childhood class. The mediating role of education suggests that a major part of life-course disadvantages or advantages in relation to CVD was due to achieved education.     

Does stage of change predict outcome in a primary-care intervention to encourage an increase in fruit and vegetable consumption?

Our aim was to investigate the response of participants in different Stage of Change (SOC) groups to an intervention to increase fruit and vegetable consumption. Participants recruited from a primary-care health centre were entered into a trial investigating an intervention to increase fruit and vegetable consumption. A total of 729 men and women were randomized into intervention and control groups. Participants attended two appointments 6 months apart and completed postal questionnaires before each appointment. The questionnaire included SOC questions which were used to classify participants into 'pre-contemplation', 'contemplation' and 'action' groups at baseline and at follow-up. All intervention participants received a standard intervention to increase consumption of fruit and vegetables to at least five portions per day. After 6 months at the end of the trial control participants received the same intervention. The main outcome measures were the changes in plasma concentrations of antioxidant vitamins. Changes in self-reported fruit and vegetable intake were a secondary outcome measure. At baseline, 38% (113/297) of the intervention participants were described as being in the 'pre-contemplation' stage, 35% in 'contemplation' and 27% in 'action' groups. For control participants, 36% (112/310) were in 'pre-contemplation', 34% in 'contemplation' and 30% in 'action' groups. In the intervention groups, 50% (57/113) of 'pre-contemplators' moved to the 'action' stage and 37% (42/113) moved to 'contemplation'. There was little movement in the control 'SOC' groups between baseline and follow-up, other than a small drift to 'contemplation'. Overall, the intervention group reported a greater increase in fruit and vegetable consumption than the controls (mean difference in change of 1.4 daily portions; 95% confidence interval 1.2, 1.6; after adjustment for baseline intake and gender) and significantly greater changes were reported in all three intervention 'SOC' groups compared to the corresponding 'control' groups (P < 0.001 in each case). These results suggest that peoples' SOC may have little bearing on their success in increasing fruit and vegetable consumption.     

Does heavy physical exertion trigger myocardial infarction? A case-crossover analysis nested in a population-based case-referent study

To study possible triggering of first events of acute myocardial infarction by heavy physical exertion, the authors conducted a case-crossover analysis (1993-1994) within a population-based case-referent study in Stockholm County, Sweden (the Stockholm Heart Epidemiology Program). Interviews were carried out with 699 myocardial infarction patients after onset of the disease. These cases represented 47 percent of all cases in the study base, and 70 percent of all nonfatal cases. The relative risk from vigorous exertion was 6.1 (95% confidence interval: 4.2, 9.0). The rate difference was 1.5 per million person-hours, and the attributable proportion was 5.7 percent. The risk was modified by physical fitness, with an increased risk being seen among sedentary subjects as in earlier studies, but the data also suggested a U-shaped association. In addition, the trigger effect was modified by socioeconomic status. Premonitory symptoms were common, and this implies risks of reverse causation bias and misclassification of case exposure information that require methodological consideration. Different techniques (the use of the usual-frequency type of control information, a pair-matched analysis, and a standard case-referent analysis) were applied to overcome the threat of misclassification of control exposure information. A case-crossover analysis in a random sample of healthy subjects resulted in a relative risk close to unity, as expected.     

Are social inequalities in mortality in Britain narrowing? Time trends from 1978 to 2005 in a population-based study of older men

OBJECTIVE: To examine whether social inequalities in all-cause and coronary heart disease (CHD) mortality in Britain have reduced between 1978 and 2005. DESIGN: A prospective study of a socioeconomically representative population. SETTING: 24 British towns. PARTICIPANTS: 7735 Men, aged 40-59 years at recruitment in 1978-1980 and followed up until 2005 through the National Health Service Central Register (164 120 person-years). MAIN OUTCOME MEASURES: Relative hazards and absolute risk differences for all-cause and CHD death comparing manual with non-manual social classes, calculated for different calendar periods. RESULTS: 3009 Deaths from all causes (1003 from CHD) occurred during follow-up. The overall hazard ratio (manual versus non-manual) was 1.56 (95% CI 1.45 to 1.69, p<0.001) for all-cause mortality and 1.54 (95% CI 1.35 to 1.76, p<0.001) for CHD mortality. The relative difference between these social groups tended to increase over time. The overall relative increase in hazard ratio comparing manual with non-manual groups over a 20-year calendar period was 1.22 (95% CI 0.83 to 1.80, p = 0.31) for all-cause mortality and 1.75 (95% CI 0.89 to 3.45, p = 0.11) for CHD mortality. The absolute difference in probability of survival to age 65 years between non-manual and manual groups fell from 29% in 1981 to 19% in 2001 for all-cause mortality and from 17% to 7% for CHD mortality. CONCLUSION: Relative differences in all-cause and CHD mortality between manual and non-manual social class groups persisted and may have increased during this period. Absolute differences in mortality between these social groups decreased as a result of falling overall mortality rates. Greater effort is needed to reduce social inequalities in all-cause and CHD mortality in the new millennium.     

Does work heal? The role of work in social rehabilitation in prisons

Less than 18% of current convicts in Italy participate in job rotation (about one month a year) employed by the Prison Administration. Only 1% are employed by cooperative societies or external companies with a regular paid job (with national collective sector contracts). In this 1% relapse into crime is much lower. What features must work possess to reduce recidivism? Work must have a meaning. From the story of several cases key-words emerge that are not referred to strictly occupational categories, but to "affective" categories, such as esteem - good - human context - care of oneself- meaning - value. The expression "high and low" is also used as if the acceptance of a cyclic yield and a never final result could be principles to live with and which work organization must constantly address. Therefore the solution does not consist only in giving work to fragile individuals such as a prison inmates or the disabled, but the real problem is: what kind of work do we want to give them?. Or better, what do we want to give them through work? For the human being, because of human nature itself work has an intrinsic value, via which self-fulfilment and meaning are sought. Self-fulfilment via work, the discovery of one's own capabilities, inclinations and attitudes, allows the human being to know his own possibilities and limits. Work becomes one with the person who, through what he/she person does, can take care of his/herself and of his/her true nature. And it is not the kind of work that makes the difference: in the "noblest" work as in the most humble t is possible to work with diligence, ingenuity and competence. It is possible to achieve a sense of oneself dedicate oneself to the job and discover the positive effects of this attitude to work.