Wednesday, October 14, 2015

Socio-demographic inequalities across a range of health status indicators and health behaviours among pregnant women

Suboptimal health behaviours and maternal health conditions (e.g. smoking, alcohol consumption, obesity, underweight, depression and stress) a during pregnancy have been associated with negative pregnancy outcomes. The first aim of our study just published in BMC Pregnancy & Child Birth was to provide an overview of the self-reported health status and health behaviours of pregnant women under midwife-led primary care in the Netherlands. Our second aim was to identify potential differences in these health status indicators and behaviours according to educational level and ethnicity of the mothers.
We used data from the DELIVER study, a multicentre prospective cohort study conducted from September 2009 to March 2011 among 6711 pregnant women.
Lower educated women were 11 times more likely to smoke and 10 times more likely to experience low health control. They were also less likely to attend antenatal classes and not take folic acid supplementation, as well as somewhat more likely to skip breakfast daily, be obese, underweight and depressed or anxious. Non-western women were especially more likely not to take folic acid supplementation; have low health control beliefs and not to attend antenatal classes.
We concluded that substantial socio-demographic inequalities persist with respect to many health-related issues in medically low risk pregnancies in the Ne
therlands. Improved strategies are needed to address the specific needs of socio-demographic groups at higher risk and the structures underlying social inequalities in pregnant women.

Sunday, October 11, 2015

Determinants of engaging in sedentary behavior across the lifespan; lessons learned from two reviews conducted within DEDIPAC

As part of the Determinants of Diet and Physical Activity (DEDIPAC) joint action of the European Healthy Diet for a Health Life initiative, we conduct a series of reviews on determinants of dietary behaviours, physical activity and sedentary behaviour. In the International Journal of Behavioral Nutrition and Physical Activity recently two reviews were published on potential determinants of sedentary behaviour; one on older adults and one on youth.
Older adults are the most sedentary of all age groups and high sedentary time is associated with poor health and wellbeing. Identifying determinants of sedentary behaviour is a necessary step to develop interventions to reduce sedentary time. In the paper just published in the International Journal of Behavioural Nutrition and Physical Activity, we report on a systematic literature review to identify factors associated with sedentary behaviour in older adults. Twenty-two original studies were identified. Personal factors were the most frequently investigated. Higher age, obesity, retirement, and lower health status were consistently associated with more sedentary time.

In the same journal a second systematic review was published on potential determinants of sedentary behaviour in youth. Together with Prof. Mai Chin A Paw I wrote a short commentary paper on both reviews that was also published in the journal.  we concluded that in both reviews, the included studies were predominantly conducted in Europe, the US, and Australia. Most studies were limited to TV or ‘screen’ time rather than sedentary behavior and relied on self-report. In both age groups there is a lack of qualitative studies as well as studies looking into the more motivational and contextual potential determinants of sedentary behavior. Both reviews indicate that to date there is limited evidence on the determinants of sedentary behaviour in youth and older adults. In youth, age and weight status were identified as determinants of sedentary behavior, with more sedentary time among older and heavier kids. In adults, age and retirement were determinants, with older and retired elderly sitting more.

Additional Findings from the B-PROOF Study; no effects of Vit B12 and Folic Acid on Physical Performance, Strength, and Falling

Elevated homocysteine is associated with a decline in physical function in elderly persons. Homocysteine-lowering therapy may slow down this decline. In the B-proof study we aimed to examine the effect of a 2-year intervention of vitamin B12 and folic acid supplementation on -among other issues- physical performance, handgrip strength, and risk of falling in elderly subjects in a double-blind, randomized placebo-controlled trial. The results on these outcomes were just published in the journal Calcified Tissue International. Participants aged ≥65 years with elevated plasma homocysteine concentrations were randomly assigned to daily supplementation of vitamin B12, folic acid, and vitamin D3, or to placebo with vitamin D3. Physical performance and handgrip strength were measured at baseline and after 2 years. Falls were reported prospectively on a research calendar.  No differences in physical performance level and handgrip strength or time to first fall were found between the B12 and folic acid supplemented group and the placebo group. Despite the overall null-effect, the results provided indications for a positive effect of the intervention on gait, as well as on physical performance among compliant persons >80 years. These effects should be further tested in future studies. In earlier analyses of the B-proof data of the effects of the supplementation on fracture incidence, also no main effects were found.