The Role of Prevention in Healthy Aging

Futures of gastric cancer: The fundamental level of prevention in health promotion using casual layered analysis

Gastric cancer is the leading cause of cancer mortality among men and the second leading cause among women in Iran. Given the high incidence and mortality rates of this disease in the country, a deeper investigation into its effective causes is essential. One effective approach to uncovering the unknowns related to gastric cancer is the application of critical-deconstructive future-thinking tools, particularly Causal Layer Analysis (CLA). This qualitative study involved a review of theoretical foundations and meta-documents, along with interviews with a group of experts. By employing triangulation, the findings from the literature review were integrated with thematic analysis of the interviews through the CLA framework. At the litany layer, gastric cancer is identified as the second most prevalent and deadly cancer in Iran. The systemic layer explores the "social, technological, economic, environmental, and political" origins of gastric cancer, highlighting factors such as globalization, governance weaknesses, and cultural shifts. The third layer challenges the conceptualization of cancer as a metaphysical sin, advocating for a new narrative centered on Fundamental Prevention. Effective cancer control should focus on preventing the emergence and institutionalization of factors at the worldview and metaphorical levels that contribute to economic, political, social, and cultural attitudes, ultimately manifesting in high-risk behaviors and pathogenic processes. Designing complex social nudges is crucial for establishing this new narrative based on fundamental prevention. This study effectively combines a systematic literature review and semi-structured interviews to investigate the factors influencing gastric cancer in Iran through Causal Layer Analysis (CLA) and proposes a new layer to the conventional three-pronged prevention model called "fundamental level prevention." The findings suggest that interventions targeting worldviews and cultural beliefs can promote behavior change and enhance health outcomes, particularly among marginalized groups. Furthermore, prioritizing fundamental changes at these layers can lead to positive reductions in disease incidence. This research holds significant implications for international audiences, highlighting the complexities of gastric cancer and the necessity for cultural interventions and global collaboration to address this pressing health issue.

Barriers and facilitators for implementation of a combined lifestyle intervention in community-dwelling older adults: a scoping review

Background

Lifestyle interventions, combining nutrition and exercise, are effective in improving the physical functioning of community-dwelling older adults and preventing healthcare risks due to loss in muscle mass. However, the potential of these types of interventions is not being fully exploited due to insufficient implementation. Having insight into the determinants that could hinder or facilitate the implementation of a combined lifestyle intervention could improve the development of matching implementation strategies and enhance the implementation of such lifestyle interventions. The aim of this study was to identify barriers and facilitators for the successful implementation of a combined lifestyle intervention for community-dwelling older adults.

Method

A scoping review was conducted. A literature search was conducted in four electronic databases, and references were checked for additional inclusion. Studies were screened if they met the inclusion criteria. Barriers and facilitators were extracted from the included studies. To validate the results of the literature search, healthcare professionals and community-dwelling older adults were interviewed. Barriers and facilitators were categorized by two researchers according to the constructs of the Consolidated Framework for Implementation Research (CFIR).

Results

The search identified 12,364 studies, and 23 were found eligible for inclusion in the review. Barriers and facilitators for 26 of the 39 constructs of the CFIR were extracted. The interviews with healthcare professionals and older adults yielded six extra barriers and facilitators for implementation, resulting in determinants for 32 of the 39 CFIR constructs. According to literature and healthcare professionals, cosmopolitanism (network with external organizations), patient needs and resources, readiness for implementation, costs, knowledge and beliefs about the intervention, network and communication, and engaging were found to be the most important determinants for implementation of a combined lifestyle intervention.

Conclusion

A broad range of barriers and facilitators across all domains of the CFIR framework emerged in this study. The results of this review reflect on determinants that should be taken into account when planning for the implementation of a combined lifestyle intervention. A further step in the implementation process is the development of implementation strategies aiming at the identified determinants to enhance the implementation of a combined lifestyle intervention in community care.

The ups and downs of caloric restriction and fasting: from molecular effects to clinical application

Age-associated diseases are rising to pandemic proportions, exposing the need for efficient and low-cost methods to tackle these maladies at symptomatic, behavioral, metabolic, and physiological levels. While nutrition and health are closely intertwined, our limited understanding of how diet precisely influences disease often precludes the medical use of specific dietary interventions. Caloric restriction (CR) has approached clinical application as a powerful, yet simple, dietary modulation that extends both life- and healthspan in model organisms and ameliorates various diseases. However, due to psychological and social-behavioral limitations, CR may be challenging to implement into real life. Thus, CR-mimicking interventions have been developed, including intermittent fasting, time-restricted eating, and macronutrient modulation. Nonetheless, possible side effects of CR and alternatives thereof must be carefully considered. We summarize key concepts and differences in these dietary interventions in humans, discuss their molecular effects, and shed light on advantages and disadvantages.