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Smink FRE, van Hoeken D, Donker GA, Susser ES, Oldehinkel AJ, Hoek HW. Three decades of eating disorders in Dutch primary care: decreasing incidence of bulimia nervosa but not of anorexia nervosa. Psychol Med 2016; 46:1189-1196. [PMID: 26671456 DOI: 10.1017/s003329171500272x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Whether the incidence of eating disorders in Western, industrialized countries has changed over time has been the subject of much debate. The purpose of this primary-care study was to examine changes in the incidence of eating disorders in The Netherlands during the 1980s, 1990s and 2000s. METHOD A nationwide network of general practitioners (GPs), serving a representative sample (~1%) of the total Dutch population, recorded newly diagnosed patients with anorexia nervosa (AN) and bulimia nervosa (BN) in their practice during 1985-1989, 1995-1999, and 2005-2009. GPs are key players in the Dutch healthcare system, as their written referral is mandatory in order to get access to specialized (mental) healthcare, covered by health insurance. Health insurance is virtually universal in The Netherlands (99% of the population). A substantial number of GPs participated in all three study periods, during which the same case identification criteria were used and the same psychiatrist was responsible for making the final diagnoses. Incidence rates were calculated and for comparison between periods, incidence rate ratios. RESULTS The overall incidence rate of BN decreased significantly in the past three decades (from 8.6 per 100,000 person-years in 1985-1989 to 6.1 in 1995-1999, and 3.2 in 2005-2009). The overall incidence of AN remained fairly stable during three decades, i.e. 7.4 per 100,000 person-years in 1985-1989, 7.8 in 1995-1999, and 6.0 in 2005-2009. CONCLUSIONS The incidence rate of BN decreased significantly over the past three decades, while the overall incidence rate of AN remained stable.
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Affiliation(s)
- F R E Smink
- Parnassia Psychiatric Institute,The Hague,The Netherlands
| | - D van Hoeken
- Parnassia Psychiatric Institute,The Hague,The Netherlands
| | - G A Donker
- NIVEL Primary Care Database, Sentinel Practices,Utrecht,The Netherlands
| | - E S Susser
- Department of Epidemiology,Columbia University,Mailman School of Public Health,New York,USA
| | - A J Oldehinkel
- Department of Psychiatry,University Medical Center Groningen,University of Groningen,Groningen,The Netherlands
| | - H W Hoek
- Parnassia Psychiatric Institute,The Hague,The Netherlands
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Dijkshoorn H, Nicolaou M, Ujcic-Voortman JK, Schouten GM, Bouwman-Notenboom AJ, Berns MPH, Verhoeff AP. Overweight and obesity in young Turkish, Moroccan and Surinamese migrants of the second generation in the Netherlands. Public Health Nutr 2014; 17:2037-44. [PMID: 24053886 PMCID: PMC11108712 DOI: 10.1017/s1368980013002322] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 06/24/2013] [Accepted: 07/11/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine differences in overweight and obesity of second-generation Turkish, Moroccan and Surinamese migrants v. first-generation migrants and the ethnic Dutch. We also studied the influence of sociodemographic factors on this association. DESIGN Data were collected in 2008 in a cross-sectional postal and online health survey. SETTING Four major Dutch cities. SUBJECTS In the survey 42 686 residents aged 16 years and over participated. Data from Dutch (n 3615) and second/first-generation Surinamese (n 230/139), Turkish (n 203/241) and Moroccan (n 172/187) participants aged 16-34 years were analysed using logistic regression with overweight (BMI ≥ 25·0 kg/m²) and obesity (BMI ≥ 30·0 kg/m²) as dependent variables. BMI was calculated from self-reported body height and weight. Sociodemographic variables included sex, age, marital status, educational level, employment status and financial situation. RESULTS After controlling for age, overweight (including obesity) was more prevalent in most second-generation migrant subgroups compared with the Dutch population, except for Moroccan men. Obesity rates among second-generation migrant men were similar to those among the Dutch. Second-generation migrant women were more often obese than Dutch women. Ethnic differences were partly explained by the lower educational level of second-generation migrants. Differences in overweight between second- and first-generation migrants were only found among Moroccan and Surinamese men. CONCLUSIONS We did not find a converging trend for the overweight and obesity prevalence from second-generation migrants towards the Dutch host population. Therefore, preventive interventions should also focus on second-generation migrants to stop the obesity epidemic.
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Affiliation(s)
- Henriëtte Dijkshoorn
- Department of Epidemiology, Documentation and Health Promotion, Public Health Service of Amsterdam, PO Box 2200, 1000 CE Amsterdam, The Netherlands
| | - Mary Nicolaou
- Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Joanne K Ujcic-Voortman
- Department of Epidemiology, Documentation and Health Promotion, Public Health Service of Amsterdam, PO Box 2200, 1000 CE Amsterdam, The Netherlands
| | - Gea M Schouten
- Public Health Service of Rotterdam-Rijnmond, Rotterdam, The Netherlands
| | | | - Mary PH Berns
- Department of Epidemiology and Health Promotion, Public Health Service of The Hague, The Hague, The Netherlands
| | - Arnoud P Verhoeff
- Department of Epidemiology, Documentation and Health Promotion, Public Health Service of Amsterdam, PO Box 2200, 1000 CE Amsterdam, The Netherlands
- Department of Sociology and Anthropology, University of Amsterdam, Amsterdam, The Netherlands
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Del Duca GF, Nahas MV, Silva DAS, Hallal PC, Malta DC, Peres MA. Physical activity indicators in adults from a state capital in the South of Brazil: a comparison between telephone and face-to-face surveys. CAD SAUDE PUBLICA 2014; 29:2119-29. [PMID: 24127105 DOI: 10.1590/0102-311x00130412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 04/21/2013] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to compare estimates of prevalence of physical activity indicators and associated sociodemographic factors obtained from telephone and face-to-face interviews with adults. Data from a cross-sectional populationbased survey of adults living in Florianópolis, Santa Catarina State, Brazil was compared to data collected through the telephonic system VIGITEL. There was no significant difference between the results from telephone interviews (n = 1,475) and face-to-face interviews (n = 1,720) with respect to prevalence of sufficient leisure time physical activity (19.3% versus 15.5%, respectively), sufficient leisure time and/or commuting physical activity (35.1% versus 29.1%, respectively) and physical inactivity (16.2% versus 12.6%, respectively). Some differences were observed with respect to the sociodemographic factors associated with leisure time and/or commuting physical activity and physical inactivity. The two techniques yielded generally similar results with respect to prevalence and sociodemographic factors associated to physical activity indicators.
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de Glas NA, Fontein DBY, Bastiaannet E, Pijpe A, De Craen AJM, Liefers GJ, Nortier HJWR, de Haes HJCJM, van de Velde CJH, van Leeuwen FE. Physical activity and survival of postmenopausal, hormone receptor-positive breast cancer patients: results of the Tamoxifen Exemestane Adjuvant Multicenter Lifestyle study. Cancer 2014; 120:2847-54. [PMID: 24840230 DOI: 10.1002/cncr.28783] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 04/16/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Physical activity has been related to improved breast cancer outcomes. Especially in the older breast cancer population, physical activity may be important because old age is associated with comorbidities and decreased physical function. The purpose of this study was to investigate the relation between physical activity and overall survival, breast cancer-specific survival, and recurrence in several age groups of postmenopausal breast cancer patients. METHODS The Tamoxifen Exemestane Adjuvant Multinational Lifestyle study was a side study of the Tamoxifen Exemestane Adjuvant Multinational trial and prospectively investigated lifestyle habits of postmenopausal, hormone receptor-positive breast cancer patients. The relations between prediagnosis and postdiagnosis physical activity and overall survival, breast cancer-specific survival, and recurrence-free survival were assessed with Cox regression and competing risk regression models. RESULTS Among 521 patients, high levels of physical activity before and after the diagnosis were associated with better overall survival (the multivariate hazard ratios were 0.50 [95% confidence interval = 0.26-0.98] and 0.57 (95% confidence interval = 0.26-1.40] for patients who were very active before and after the diagnosis, respectively, in comparison with inactive patients). This was most evident in patients who were 65 years old or older. Physical activity was not significantly associated with breast cancer-specific survival or the relapse-free period. CONCLUSIONS Overall survival was better for patients who were active before and after the diagnosis. In contrast with previous studies, breast cancer survival and the risk of recurrence were not significantly associated with physical activity. These findings confirmed the need for more studies investigating the use of physical activity to supplement breast cancer treatment in older patients.
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Affiliation(s)
- Nienke A de Glas
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Hirsch JA, Diez Roux AV, Moore KA, Evenson KR, Rodriguez DA. Change in walking and body mass index following residential relocation: the multi-ethnic study of atherosclerosis. Am J Public Health 2014; 104:e49-56. [PMID: 24432935 DOI: 10.2105/ajph.2013.301773] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated whether moving to neighborhoods with closer proximity of destinations and greater street connectivity was associated with more walking, a greater probability of meeting the "Every Body Walk!" campaign goals (≥ 150 minutes/week of walking), and reductions in body mass index (BMI). METHODS We linked longitudinal data from 701 participants, who moved between 2 waves of the Multi-Ethnic Study of Atherosclerosis (2004-2012), to a neighborhood walkability measure (Street Smart Walk Score) for each residential location. We used fixed-effects models to estimate if changes in walkability resulting from relocation were associated with simultaneous changes in walking behaviors and BMI. RESULTS Moving to a location with a 10-point higher Walk Score was associated with a 16.04 minutes per week (95% confidence interval [CI] = 5.13, 29.96) increase in transport walking, 11% higher odds of meeting Every Body Walk! goals through transport walking (adjusted odds ratio = 1.11; 95% CI = 1.02, 1.21), and a 0.06 kilogram per meters squared (95% CI = -0.12, -0.01) reduction in BMI. Change in walkability was not associated with change in leisure walking. CONCLUSIONS Our findings illustrated the potential for neighborhood infrastructure to support health-enhancing behaviors and overall health of people in the United States.
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Affiliation(s)
- Jana A Hirsch
- Jana A. Hirsch, Ana V. Diez Roux, and Kari A. Moore are with the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor. Kelly R. Evenson is with the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Daniel A. Rodriguez is with the Department of City & Regional Planning, University of North Carolina at Chapel Hill
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The Netherlands Epidemiology of Obesity (NEO) study: study design and data collection. Eur J Epidemiol 2013; 28:513-23. [DOI: 10.1007/s10654-013-9801-3] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 03/27/2013] [Indexed: 10/27/2022]
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Mast ME, Struikmans H, Schreur JHM, Struikmans H. In reply to Gyenes and Butler. Int J Radiat Oncol Biol Phys 2013; 85:579-80. [PMID: 23374991 DOI: 10.1016/j.ijrobp.2012.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 06/20/2012] [Indexed: 12/01/2022]
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Van Holle V, Deforche B, Van Cauwenberg J, Goubert L, Maes L, Van de Weghe N, De Bourdeaudhuij I. Relationship between the physical environment and different domains of physical activity in European adults: a systematic review. BMC Public Health 2012; 12:807. [PMID: 22992438 PMCID: PMC3507898 DOI: 10.1186/1471-2458-12-807] [Citation(s) in RCA: 189] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 09/13/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the past decade, various reviews described the relationship between the physical environment and different physical activity (PA) domains. Yet, the majority of the current review evidence relies on North American/Australian studies, while only a small proportion of findings refer to European studies. Given some clear environmental differences across continents, this raises questions about the applicability of those results in European settings. This systematic review aimed at summarizing Europe-specific evidence on the relationship between the physical environment and different PA domains in adults. METHODS Seventy eligible papers were identified through systematic searches across six electronic databases. Included papers were observational studies assessing the relationship between several aspects of the physical environment and PA in European adults (18-65y). Summary scores were calculated to express the strength of the relationship between each environmental factor and different PA domains. RESULTS Convincing evidence on positive relationships with several PA domains was found for following environmental factors: walkability, access to shops/services/work and the composite factor environmental quality. Convincing evidence considering urbanization degree showed contradictory results, dependent on the observed PA domain. Transportation PA was more frequently related to the physical environment than recreational PA. Possible evidence for a positive relationship with transportation PA emerged for walking/cycling facilities, while a negative relationship was found for hilliness. Some environmental factors, such as access to recreational facilities, aesthetics, traffic- and crime-related safety were unrelated to different PA domains in Europe. CONCLUSIONS Generally, findings from this review of European studies are in accordance with results from North American/Australian reviews and may contribute to a generalization of the relationship between the physical environment and PA. Nevertheless, the lack of associations found regarding access to recreational facilities, aesthetics and different forms of safety are likely to be Europe-specific findings and need to be considered when appropriate interventions are developed. More research assessing domain-specific relationships with several understudied environmental attributes (e.g., residential density) is needed.
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Affiliation(s)
- Veerle Van Holle
- Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, B-9000, Ghent, Belgium.
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Djelantik AAAMJ, Kunst AE, van der Wal MF, Smit HA, Vrijkotte TGM. Contribution of overweight and obesity to the occurrence of adverse pregnancy outcomes in a multi-ethnic cohort: population attributive fractions for Amsterdam. BJOG 2011; 119:283-90. [PMID: 22168897 DOI: 10.1111/j.1471-0528.2011.03205.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To estimate the contribution of pre-pregnancy excessive weight to the occurrence of adverse pregnancy outcomes and to detect the differences in these contributions between different ethnic groups. DESIGN Prospective multi-ethnic community-based cohort study. SETTING The prevalence of excessive weight is increasing and in general higher in immigrant groups in many industrialised countries. Maternal excessive weight, like smoking during pregnancy, is an important risk factor for adverse pregnancy outcomes. POPULATION A total of 8266 pregnant women, living in the Netherlands, were included in the ABCD study between January 2003 and March 2004. METHODS After applying the exclusion criteria, the analysis included 7871 pregnancies. Binomial log-linear regression analyses were performed to estimate relative risks (RRs) expressing the association between overweight/obesity and small-for-gestational-age (SGA), large-for-gestational-age (LGA), preterm birth (PTB; <37 weeks of gestation) and extreme PTB (<32 weeks of gestation), controlling for parity, maternal age, education level and smoking. Next, the RRs were used to estimate population attributive fractions (PAF) for Amsterdam and separately for several ethnic groups. MAIN OUTCOME MEASURES The RRs and PAFs. RESULTS The PAFs for overweight/obesity were: SGA -4.9%, LGA 15.3%, PTB 6.6% and extreme PTB 22.0%. In absolute terms, this corresponds to -47 SGA infants, 126 LGA infants, 35 PTB and 20 extreme PTB per year in Amsterdam. Except for SGA, these PAFs were higher than those for smoking (6.2%, -3.9%, 5.5% and 10.6%, respectively). The contribution of overweight/obesity to LGA and PTB was higher in non-Western immigrant groups. CONCLUSIONS Overweight/obesity has become an important contributor to the occurrence of adverse pregnancy outcomes in Amsterdam. For most outcomes, these contributions are larger than those for smoking. Development of special obesity prevention programmes for young women is required, especially focused on immigrant groups.
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Affiliation(s)
- A A A M J Djelantik
- Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands
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Barte JCM, ter Bogt NCW, Beltman FW, van der Meer K, Bemelmans WJE. Process Evaluation of a Lifestyle Intervention in Primary Care. HEALTH EDUCATION & BEHAVIOR 2011; 39:564-73. [DOI: 10.1177/1090198111422936] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The Groningen Overweight and Lifestyle (GOAL) intervention effectively prevents weight gain. The present study describes a process evaluation in which 214 participants in the intervention group received a structured questionnaire within 7 months (a median of 5 months) after the end of the intervention. The authors investigated the content of the intervention (on basis of the participants’ recall), the participants’ satisfaction of the intervention, the participants’ satisfaction with the nurse practitioners (NPs), and the determinants of the participants’ satisfaction. In general, the results show that the content corresponded well with the protocol for the intervention, except for the number of telephone calls and the percentage of participants with individualized goals for a healthy lifestyle. The overall satisfaction of the participants was high, and success and perceived success and a low educational level were important determinants for a higher overall satisfaction grade. Furthermore, the NP was considered to be an expert and motivational to learning and keeping up a healthy lifestyle. The authors therefore conclude that the GOAL study is feasible and indicates that the NP is well equipped to treat these patients. However, it is recommended to reinforce the advice given and the lifestyle goals after the first contact sessions.
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Affiliation(s)
- Jeroen C. M. Barte
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
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Majer IM, Nusselder WJ, Mackenbach JP, Klijs B, van Baal PHM. Mortality risk associated with disability: a population-based record linkage study. Am J Public Health 2011; 101:e9-15. [PMID: 22021307 DOI: 10.2105/ajph.2011.300361] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed the association between mortality and disability and quantified the effect of disability-associated risk factors. METHODS We linked data from cross-sectional health surveys in the Netherlands to the population registry to create a large data set comprising baseline covariates and an indicator of death. We used Cox regression models to estimate the hazard ratio of disability on mortality. RESULTS Among men, the unadjusted hazard ratio for activities of daily living, mobility, or mild disability defined by the Organization for Economic Co-operation and Development at age 55 years was 7.85 (95% confidence interval [CI] = 4.36, 14.13), 5.21 (95% CI = 3.19, 8.51), and 1.87 (95% CI = 1.58, 2.22), respectively. People with disability in activities of daily living and mobility had a 10-year shorter life expectancy than nondisabled people had, of which 6 years could be explained by differences in lifestyle, sociodemographics, and major chronic diseases. CONCLUSIONS Disabled people face a higher mortality risk than nondisabled people do. Although the difference can be explained by diseases and other risk factors for those with mild disability, we cannot rule out that more severe disabilities have an independent effect on mortality.
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Affiliation(s)
- Istvan M Majer
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
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GEOGRAPHICAL VARIATION AND MIGRATION ANALYSIS OF HEIGHT, WEIGHT AND BODY MASS INDEX IN A BRITISH COHORT STUDY. J Biosoc Sci 2011; 43:733-49. [PMID: 21794200 DOI: 10.1017/s0021932011000381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SummaryUsing a sample of 2090 father and son pairs, the regional variation in height, weight and body mass index (BMI) with intra- and inter-generational migration within Britain was examined. Highly significant regional differences in means were found only for fathers. The overall mean height difference between regions ranged from about 2.7 cm to 3.1 cm, with the tallest fathers being found in the East & South-East region and the shortest in Wales. The variation in mean weight between regions was less significant, with the difference between the heaviest region (West Midlands) and lightest (South-West) being about 3.5 kg. For BMI the highest mean was in the North and Wales and the lowest in the South-West (difference of about 1 kg m−2). Intra-generational migrants were, on average, significantly taller than non-migrants for both fathers (+1.4 cm) and sons (+2 cm), but BMI was only significant in fathers, with migrant fathers, on average, having a lower BMI. There were no significant differences in weight between geographically mobile groups for either fathers or sons. Differentiating between regional in- and out-migration revealed that in the fathers' generation in-migrants were taller, on average, in six of the nine regions. The tallest in-migrants among fathers came into the North region; the tallest out-migrants were from Yorkshire & Humberside and the shortest were from Scotland. The largest positive gain on fathers' height was in the West Midlands region and Scotland, while negative effects were found in the Yorkshire & Humberside, East Midlands and East & South-East regions. For sons in-migrants were taller in all regions except Wales, with the largest differences between in-migrants and non-migrants being in the South-East and South-West. For out-migrants, the tallest sons came from Wales, while the shortest came from the East Midlands region. The North, East Midlands, East & South-East and West Midlands regions were net gainers, while Wales and Scotland were net losers. For BMI among fathers, in-migrants were of lower BMI than non-migrants. For out-migrant fathers, the North-West and South-West regions were the only two regions showing positive values, with the largest negative values being found in the East Midlands and Yorkshire & Humberside. The net effect of migration indicated that the largest gains were in the East Midlands and Yorkshire & Humberside regions and the largest losses were in Scotland and Wales. The inter-generational migration for BMI showed that in-migrating sons into the North-West and Wales had higher BMI than sedentes, while in-migrants into Yorkshire & Humberside were lower in BMI. In all regions out-migrants had lower BMI than non-migrants. The net effect of migration revealed that six of the nine regions were net gainers, while the Yorkshire & Humberside region was a net loser.
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van Gool CH, Picavet HSJ, Deeg DJH, de Klerk MMY, Nusselder WJ, van Boxtel MPJ, Wong A, Hoeymans N. Trends in activity limitations: the Dutch older population between 1990 and 2007. Int J Epidemiol 2011; 40:1056-67. [PMID: 21324941 DOI: 10.1093/ije/dyr009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is not clear whether recent increases in life expectancy are accompanied by a concurrent postponement of activity limitations. The objective of this study was to give best estimates of the trend in the prevalence of activity limitations among the non-institutionalized population aged 55-84 years over the period 1990-2007 in The Netherlands. METHODS We examined self-reports on 12 measures of moderate or severe activity limitations in stair climbing, walking and getting dressed as assessed by OECD long-term disability questionnaire or Short Form-36 (SF-36) items, using original data from five population-based cross-sectional and longitudinal surveys (n = 54,847 respondents). To account for heterogeneity between surveys, we used meta-analyses to study time trends. RESULTS Time trends of 10 out of the 12 activity limitation variables studied were stable. The prevalence of at least moderate activity limitations in stair climbing [odds ratio (OR) = 1.03)] and getting dressed (OR = 1.04) based on OECD items increased over the study period. Age- and gender-stratified time trend analyses showed consistent patterns. CONCLUSIONS No declines were observed in the prevalence of activity limitations in the Dutch older population over the period 1990-2007. The increase in life expectancy in this period is accompanied by a stable prevalence of most activity limitations.
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Affiliation(s)
- Coen H van Gool
- Center for Public Health Forecasting, National Institute for Public Health and Environment, Bilthoven, The Netherlands
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Peeters A, Nusselder WJ, Stevenson C, Boyko EJ, Moon L, Tonkin A. Age-specific trends in cardiovascular mortality rates in the Netherlands between 1980 and 2009. Eur J Epidemiol 2011; 26:369-73. [PMID: 21298468 PMCID: PMC3109255 DOI: 10.1007/s10654-011-9546-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 01/20/2011] [Indexed: 12/01/2022]
Abstract
Recent analyses suggest the decline in coronary heart disease mortality rates is slowing in younger age groups in countries such as the US and the UK. This work aimed to analyse recent trends in cardiovascular mortality rates in the Netherlands. Analysis was of annual all circulatory, ischaemic heart disease (IHD), and cerebrovascular disease mortality rates between 1980 and 2009 for the Netherlands. Data were stratified by sex and 10-year age group (age 35–85+). The annual rate of change and significant changes in the trend were identified using joinpoint Poisson regression. For almost all age and sex groups examined the rate of IHD and cerebrovascular disease mortality in the Netherlands has more than halved between 1980 and 2009. The decline in mortality from both IHD and cerebrovascular disease is continuing for all ages and sex groups, with anacceleration in the decline apparent from the late 1990s/early 2000s. The decline in age-specific all circulatory, coronary heart disease and cerebrovascular disease mortality rates continues for all age and sex groups in the Netherlands.
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Affiliation(s)
- Anna Peeters
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
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PICAVET HSUSANJ, WENDEL-VOS GCWANDA, VREEKEN HILDAL, SCHUIT AJANTINE, VERSCHUREN WMONIQUEM. How Stable Are Physical Activity Habits among Adults? The Doetinchem Cohort Study. Med Sci Sports Exerc 2011; 43:74-9. [DOI: 10.1249/mss.0b013e3181e57a6a] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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van Roermund JGH, Hinnen KA, Tolman CJ, Bol GH, Witjes JA, Bosch JLHR, Kiemeney LA, van Vulpen M. Periprostatic fat correlates with tumour aggressiveness in prostate cancer patients. BJU Int 2010; 107:1775-9. [PMID: 21050356 DOI: 10.1111/j.1464-410x.2010.09811.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
STUDY TYPE Prognostic (case series). LEVEL OF EVIDENCE 4. What's known on the subject? and What does the study add? Nowadays more and more publications have been published about the topic prostate cancer aggressiveness and obesity with mixed results. However, most of the publications used the BMI as a marker for obesity, while the most metabolic active fat is the visceral fat. To learn more about these relations we measured and used the visceral fat in our paper. OBJECTIVE To examine if the periprostatic fat measured on computed tomography (CT) correlates with advanced disease we examined patients who received radiotherapy for localized prostate cancer. Several USA reports found a positive association between obesity and prostate cancer aggressiveness. However, in recent European studies these conclusions were not confirmed. Studies concerning this issue have basically relied on body mass index (BMI), as a marker of general obesity. Visceral fat, however, is the most metabolically active and best measured on CT. PATIENTS AND METHODS In 932 patients, who were treated with external radiotherapy (N=311) or brachytherapy (N=621) for their T1-3N0M0 prostate cancer, different fat measurements (periprostatic fat, subcutaneous fat thickness) were performed on a CT. Associations between the different fat measurements and risk of having high-risk (according to Ash et al., PSA>20 or Gleason score≥8 or T3) disease was measured. RESULTS The median age (IQR) was 67.0 years (62.0-71.0) and median BMI (IQR) was 25.8 (24.2-28.3). Logistic regression analyses, adjusted for age, revealed a significant association between periprostatic fat density (PFD) and risk of having a high risk disease. (Odds ratio [95% CI] 1.06 [1.04-1.08], P<0.001) CONCLUSION Patients with a higher PFD had more often aggressive prostate cancer.
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Vandelanotte C, Duncan MJ, Caperchione C, Hanley C, Mummery WK. Physical activity trends in Queensland (2002 to 2008): are women becoming more active than men? Aust N Z J Public Health 2010; 34:248-54. [PMID: 20618264 DOI: 10.1111/j.1753-6405.2010.00521.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Regular monitoring of population levels of physical activity is an effective way to assess change over time towards meeting public health recommendations. The objective of this study was to determine physical activity trends in Central Queensland over the period 2002 to 2008. METHODS Data was obtained from the Central Queensland Social Survey (CQSS) conducted annually from 2002 to 2008. A total sample of 8,936 adults aged 18 and over participated in seven cross-sectional surveys. Physical activity was measured using the Active Australia Questionnaire. Binary logistic regression was used to examine trends in sufficient physical activity. RESULTS Averaged over all survey years 46.5% of study participants met national physical activity guidelines. A small significant upward trend was found for meeting physical activity recommendations across all years (OR=1.03; 95%CI=1.01-1.05), indicating that the odds of meeting the guidelines increased by an average of 3% per year from 2002 to 2008. Slightly more men than women met the activity guidelines (ns); however a significant positive trend in achieving sufficient activity levels was present in women only (4%). CONCLUSIONS AND IMPLICATIONS Although an increasing trend for sufficient physical activity was observed, overall physical activity levels in Central Queensland remain suboptimal and more efforts to increase physical activity are needed. The gender differences in physical activity trends indicate that men and women might need to be targeted differently in health promotion messages. The continuous monitoring of population levels of physical activity in Australia, which allow both state specific and international comparisons, is needed.
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Affiliation(s)
- Corneel Vandelanotte
- CQ University Australia, Institute for Health and Social Sciences Research, Building 18, Bruce Highway, Rockhampton QLD 4702.
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Lee ACK, Maheswaran R. The health benefits of urban green spaces: a review of the evidence. J Public Health (Oxf) 2010; 33:212-22. [PMID: 20833671 DOI: 10.1093/pubmed/fdq068] [Citation(s) in RCA: 525] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Urban development projects can be costly and have health impacts. An evidence-based approach to urban planning is therefore essential. However, the evidence for physical and non-physical health benefits of urban green space is unclear. METHODS A literature search of academic and grey literature was conducted for studies and reviews of the health effects of green space. Articles found were appraised for their relevance, critically reviewed and graded accordingly. Their findings were then thematically categorized. RESULTS There is weak evidence for the links between physical, mental health and well-being, and urban green space. Environmental factors such as the quality and accessibility of green space affects its use for physical activity. User determinants, such as age, gender, ethnicity and the perception of safety, are also important. However, many studies were limited by poor study design, failure to exclude confounding, bias or reverse causality and weak statistical associations. CONCLUSION Most studies reported findings that generally supported the view that green space have a beneficial health effect. Establishing a causal relationship is difficult, as the relationship is complex. Simplistic urban interventions may therefore fail to address the underlying determinants of urban health that are not remediable by landscape redesign.
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Affiliation(s)
- A C K Lee
- Section of Public Health, School of Health and Related Research, The University of Sheffield, Sheffield S1 4DA, UK.
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Voskuil DW, van Nes JGH, Junggeburt JMC, van de Velde CJH, van Leeuwen FE, de Haes JCJM. Maintenance of physical activity and body weight in relation to subsequent quality of life in postmenopausal breast cancer patients. Ann Oncol 2010; 21:2094-2101. [PMID: 20357033 DOI: 10.1093/annonc/mdq151] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND We prospectively examined the association between physical activity, body weight and quality of life in Dutch postmenopausal early breast cancer patients treated with adjuvant endocrine therapy. PATIENTS AND METHODS In this side study of a large clinical trial, lifestyle and quality-of-life questionnaires were filled out 1 and 2 years after the start of endocrine therapy (T1 and T2, respectively) and included a pre-diagnosis lifestyle assessment (T0). A total of 435 breast cancer patients returned both questionnaires. RESULTS Individuals with a physical activity level above the median who maintained this level from T0 to T1 reported the best global quality of life and physical functioning and the least fatigue at T2, as compared with individuals with low levels of physical activity which further decreased after diagnosis (difference of +16, +14, and -22 points on a 0-100 quality-of-life scale, respectively; P < 0.01). Overweight or obese women who gained body weight after diagnosis reported worst quality of life and most fatigue as compared with women who maintained a stable body weight (difference of -8, -10 and +2 points, respectively; P < 0.01). CONCLUSION Maintaining high pre-diagnosis physical activity levels and a healthy body weight is associated with better quality of life after breast cancer.
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Affiliation(s)
- D W Voskuil
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam.
| | - J G H van Nes
- Department of Surgery, Leiden University Medical Centre, Leiden
| | | | | | - F E van Leeuwen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam
| | - J C J M de Haes
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Socio-economic differences in the use of dairy fat in Russian and Finnish Karelia, 1994–2004. Int J Public Health 2010; 55:325-37. [DOI: 10.1007/s00038-010-0136-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 01/09/2010] [Accepted: 03/01/2010] [Indexed: 10/19/2022] Open
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van Roermund JGH, Bol GH, Witjes JA, Ruud Bosch JLH, Kiemeney LA, van Vulpen M. Periprostatic fat measured on computed tomography as a marker for prostate cancer aggressiveness. World J Urol 2009; 28:699-704. [PMID: 20033185 PMCID: PMC2966948 DOI: 10.1007/s00345-009-0497-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Accepted: 12/07/2009] [Indexed: 01/31/2023] Open
Abstract
Objective Several reports found that obesity was associated with prostate cancer (PC) aggressiveness among men treated with radical prostatectomy or radiotherapy. Studies concerning this issue have basically relied on body mass index (BMI), as a marker for general obesity. Because visceral fat is the most metabolic active fat, we sought to evaluate if periprostatic fat measured on a computed tomography (CT) is a better marker than BMI to predict PC aggressiveness in a Dutch population who underwent brachytherapy for localized PC. Patients and methods Of the 902 patients who underwent brachytherapy, 725 CT scans were available. Subcutaneous fat thickness (CFT), periprostatic fat area (cm2) and fat-density (%) were determined on the CT scan. Patients were stratified into three groups: <25, 25–75 and >75 percentile of the fat-density. Associations between the three fat-density subgroups and BMI and PC aggressiveness were examined. Results 237 patients were classified as having normal weight (37.2%), 320 as overweight (50.2%) and 80 as obese (12.6%). There was a strong significant association between BMI and fat-density and CFT. The strongest correlation was seen between BMI and CFT (Pearson r coefficient = 0.71). Logistic regression analysis revealed no statistically significant association between the different fat measurements and the risk of having a high-risk disease. Conclusions Periprostatic fat and fat-density as measured with CT were not correlated with PC aggressiveness in patients receiving brachytherapy. However, 31% of the patients with a normal BMI had a fat-density of >75 percentile of the periprostatic fat-density.
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Affiliation(s)
- Joep G H van Roermund
- Department of Urology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
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ter Bogt NCW, Bemelmans WJE, Beltman FW, Broer J, Smit AJ, van der Meer K. Preventing weight gain: one-year results of a randomized lifestyle intervention. Am J Prev Med 2009; 37:270-7. [PMID: 19765497 DOI: 10.1016/j.amepre.2009.06.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 04/21/2009] [Accepted: 06/19/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lifestyle interventions targeting prevention of weight gain may have better long-term success than when aimed at weight loss. Limited evidence exists about such an approach in the primary care setting. DESIGN An RTC was conducted. SETTING/PARTICIPANTS Participants were 457 overweight or obese patients (BMI=25-40 kg/m(2), mean age 56 years, 52% women) with either hypertension or dyslipidemia, or both, from 11 general practice locations in The Netherlands. INTERVENTION In the intervention group, four individual visits to a nurse practitioner (NP) and one feedback session by telephone were scheduled for lifestyle counseling with guidance of the NP using a standardized computerized software program. The control group received usual care from their general practitioner (GP). MAIN OUTCOME MEASURES Changes in body weight, waist circumference, blood pressure, and blood lipids after 1 year (dropout <10%). Data were collected in 2006 and 2007. Statistical analyses were conducted in 2007 and 2008. RESULTS There were more weight losers and stabilizers in the NP group than in the general practitioner usual care (GP-UC) group (77% vs 65%; p<0.05). In men, mean weight losses were 2.3% for the NP group and 0.1% for the GP-UC group (p<0.05). Significant reductions occurred also in waist circumference but not in blood pressure, blood lipids, and fasting glucose. In women, mean weight losses were in both groups 1.6%. In the NP group, obese people lost more weight (-3.0%) than the non-obese (-1.3%; p<0.05). CONCLUSIONS Standardized computer-guided counseling by NPs may be an effective strategy to support weight-gain prevention and weight loss in primary care, in the current trial, particularly among men. TRIAL REGISTRATION The study was registered with the Netherlands Trial Register (NTR), www.trialregister.nl, study no. TC 1365.
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Affiliation(s)
- Nancy C W ter Bogt
- Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands.
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van Roermund JGH, Hinnen KA, Battermann JJ, Witjes JA, Bosch JLHR, Kiemeney LA, van Vulpen M. Body mass index is not a prognostic marker for prostate-specific antigen failure and survival in Dutch men treated with brachytherapy. BJU Int 2009; 105:42-8. [PMID: 19519759 DOI: 10.1111/j.1464-410x.2009.08687.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the relationship between body mass index (BMI) and biochemical recurrence (BCR), cancer-specific (CSS) and overall survival (OS) in men treated with permanent prostate brachytherapy (PPB), as there is limited information on the affect of obesity on treatment outcomes for prostate cancer. PATIENTS AND METHODS In all, 1530 patients with clinically localized prostate cancer who underwent PPB were studied. Clinical and pathological data were retrospectively obtained from medical records. The BMI was classified as normal (< 25 kg/m(2)), overweight (25-30 kg/m(2)) and obese (> or = 30 kg/m(2)). BCR was defined as a rise in PSA levels of > or = 2 ng/mL after the nadir had been reached. The cause of death was determined for each deceased patient. Patients with metastatic prostate cancer who died of any cause were classified as prostate cancer deaths. RESULTS In all, 617 (40%) patients were classified as having a normal weight, 754 (49%) overweight and 159 (10%) were obese. The Kaplan-Meier 8-year risk of BCR (95% confidence interval) was 33.3% (27.2-39.4), 29.2% (23.5-34.9) and 29.3% (12.4-46.2) for patients with a BMI of < 25 kg/m(2), 25-30 kg/m(2) and > or = 30 kg/m(2), respectively. The 8-year CSS was 88.2% (83.1-93.3), 88.6% (83.7-93.5) and 90.6% (79.9-101.4) and the 8-year OS was 70.1% (63.6-76.6), 72.9% (66.6-79.2) and 81.8% (69.3-94.3) for these three groups, respectively. Multivariate proportional hazard regression analyses of BMI and established prognostic factors for BCR confirmed the absence of any prognostic value of BMI on BCR, CSS and OS. CONCLUSIONS BMI did not appear to have any prognostic value for BCR, CCS or OS in patients with clinically localized prostate cancer treated with PPB.
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Affiliation(s)
- Joep G H van Roermund
- Department of Urology, University Medical Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands.
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van Roermund JGH, Kok DEG, Wildhagen MF, Kiemeney LA, Struik F, Sloot S, van Oort IM, Hulsbergen-van de Kaa CA, van Leenders GJLH, Bangma CH, Witjes JA. Body mass index as a prognostic marker for biochemical recurrence in Dutch men treated with radical prostatectomy. BJU Int 2009; 104:321-5. [PMID: 19220264 DOI: 10.1111/j.1464-410x.2009.08404.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate whether body mass index (BMI) is a prognostic factor for biochemical recurrence (BCR) in Dutch men after radical prostatectomy (RP), as although epidemiological studies of obesity in relation to prostate cancer have provided conflicting results, recent studies from the USA suggest that a higher BMI is a risk factor for progression of prostate cancer. PATIENTS AND METHODS Of the 1417 patients with prostate cancer who had RP at two University hospitals, 1302 were included in the present study. BMI (kg/m(2)) classes were defined as normal (<25), overweight (25-30) and obese (> or =30). The median follow-up was 59 months and clinical data were obtained retrospectively from charts. BCR was defined as two consecutive prostate-specific antigen (PSA) levels of >0.1 ng/mL. RESULTS In all, 600 patients were classified as having normal weight (43.9%), 665 as overweight (48.6%) and 103 as obese (7.5%). Overall, 297 patients developed BCR after RP; the 10-year risk (95% confidence interval) of BCR was 31.9 (26.6-37.2)%, 30.5 (25.8-35.2)% and 23.9 (14.9-32.9)% for patients in the three categories, respectively (P = 0.836). Multivariable proportional hazard regression analyses of BMI and established prognostic factors for BCR did not change these results. CONCLUSION BMI appeared to have no prognostic value for BCR in Dutch patients with clinically localized prostate cancer and treated with RP.
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Visser F, Hiddink G, Koelen M, van Binsbergen J, Tobi H, van Woerkum C. Longitudinal changes in GPs' task perceptions, self-efficacy, barriers and practices of nutrition education and treatment of overweight. Fam Pract 2008; 25 Suppl 1:i105-11. [PMID: 19112085 DOI: 10.1093/fampra/cmn078] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND GPs play a role in prevention by giving nutrition education and advice on overweight. Over the years, GP's tasks and working environment changed. OBJECTIVE To know how task perceptions, perceptions of own ability and perceived barriers regarding nutrition education and treatment of overweight of Dutch GPs have developed from 1992 to 2007. METHODS In all, 488 GPs, first included in study in 1992, were asked in 2007 to return the Wageningen PCPs Nutritional Practices Questionnaire. Crohnbach's alphas and sum scores were calculated and differences between 1992 and 2007 were investigated using a paired t-test. RESULTS In all, 247 GPs responded (51%). 'Noticing patients overweight and guidance of treatment' did not change in GPs from 1992 to 2007. The task perception about health education and prevention did not change and the perception of daily activities shifted from the curative to the preventive side. Interest in the influence of nutrition on health increased in 2007. GPs less often managed to counsel on nutrition in daily practice. Their perceived capacity to counsel and their self-efficacy regarding overweight management declined over the years. In 2007, more GPs perceived the barriers 'lack of time' to treat overweight and to give nutrition education. The most important barrier in 2007 was lack of patient motivation. CONCLUSIONS The GPs perceived overweight and nutrition education as important and were still favourable towards prevention. However, their potential to give nutrition education or guide in treatment of overweight was not fully utilized because of decreased self-efficacy factors and perceived barriers.
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Affiliation(s)
- Femke Visser
- Netherlands Institute for Sport and Physical Activity, Bennekom.
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Overweight and health problems of the lower extremities: osteoarthritis, pain and disability. Public Health Nutr 2008; 12:359-68. [PMID: 18426630 DOI: 10.1017/s1368980008002103] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIM To examine the association between overweight and health problems of the lower extremities, i.e. osteoarthritis (OA), pain and disability. METHODS Cross-sectional data from the Dutch population-based Musculoskeletal Conditions & Consequences Cohort (DMC3), comprising a random sample from the Dutch population aged >25 years (n 3664), were analysed using multivariate logistic regression. Overweight was defined as BMI > or = 25.0 kg/m2, moderate overweight as 25.0 kg/m2 < or = BMI < 30.0 kg/m2 and obesity as BMI > or = 30.0 kg/m2. Health problems of the lower extremities were: (i) self-reported OA of the hip or knee as told by a doctor; (ii) presence of self-reported chronic pain (>3 months) of the lower extremities; and (iii) disabilities in mobility as measured by the Euroqol questionnaire (EQ-5D). RESULTS Moderate overweight was associated with self-reported OA of the hip or knee (OR = 1.7; 95 % CI 1.4, 2.1), chronic pain of the lower extremities at one or more location(s) (OR = 1.6; 95 % CI 1.3, 1.9) and disability in mobility (OR = 1.7; 95 % CI 1.4, 2.0). For obesity these odds were higher: 2.8 (95 % CI 2.1, 3.7), 2.5 (95 % CI 1.9, 3.2) and 3.0 (95 % CI 2.3, 3.9), respectively. Also, among those with OA, moderate overweight and obesity were associated with disability in mobility. CONCLUSION There is a strong association between overweight/obesity and health problems of the lower extremities, i.e. OA, pain and disability. The increasing prevalence of overweight and obesity worldwide urges for public health action not only for diabetes and heart disease, but also OA.
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Louwman WJ, van de Poll-Franse LV, Fracheboud J, Roukema JA, Coebergh JWW. Impact of a programme of mass mammography screening for breast cancer on socio-economic variation in survival: a population-based study. Breast Cancer Res Treat 2007; 105:369-75. [PMID: 17211536 PMCID: PMC2190785 DOI: 10.1007/s10549-006-9464-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Accepted: 11/25/2006] [Indexed: 11/30/2022]
Abstract
Background After a systematic mass mammography breast cancer screening programme was implemented between 1991 and 1996 (attendance 80%), we evaluated its impact on survival according to socioeconomic status (SES). Methods We studied survival rates up to 1-1-2005 for all consecutive breast cancer patients aged 50–69 and diagnosed in the period 1983–2002 in the area of the Eindhoven Cancer Registry (n = 4939). Multivariate analyses were performed using Cox regression analysis. Results The proportion of breast cancer patients with a low SES decreased from 22% in 1983–1990 to 14% in 1997–2002 when attendance was 85%. The proportion of newly diagnosed patients with stage III or IV disease in 1997–2002 was only 10% compared to 14% in 1991–1996 and 26% in 1983–1989 (P < 0.0001). Stage distribution improved for all socio-economic groups (P = 0.01). Survival was similar for all socio-economic groups in 1983–1990, but after the introduction of the screening programme women with low SES had lower age- and stage-adjusted survival rates (HR 2.0, 95%CI: 1.3–3.0). Survival was better for patients diagnosed in 1997–2002 compared to 1983–1990 for all socioeconomic strata; it was substantially better for the high SES group (HR 0.36, 0.2–0.5) compared to the lowest SES (HR 0.77, 0.6–1.1). Conclusion Although survival improved for women from each of the socio-economic strata, related to the high participation rate of the screening programme, women from lower socio-economic strata clearly benefited less from the breast cancer screening programme. That is also related to the higher prevalence of comorbidity and possibly suboptimal treatment.
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Affiliation(s)
- W J Louwman
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), Eindhoven, P.O. Box 231, 5600 AE, Eindhoven, The Netherlands.
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