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To explore determinants of dietary and physical activity behaviours among women of reproductive age.
Data were collected through focus group discussions (FGD). The FGD guide was based on a modified theoretical framework; theory of planned behaviour was incorporated with constructs of health belief model, precaution adoption process model, social cognitive and social support theory. Discussions were audio recorded, transcribed verbatim and analysed thematically.
Women were categorised into young adults; 18–34 years and adults; 35–45 years
Separate FGD with independent participants were conducted for dietary and physical activity behaviours until data saturation was achieved. Six FGD were conducted per behaviour. Determinants of dietary behaviours at intra-individual level included gaps in food skills, knowledge and self-efficacy, food safety concerns, convenience, finances and physiological satisfaction. The social-cultural norms were relationship between vegetable consumption and low social status, consideration of fruits as a snack for children and not food and habitual orientation towards carbohydrate foods. At environment level, social networks and increased availability of energy-dense, nutrient poor, street and processed foods influence dietary behaviour. For physical activity, intra-individual determinants were knowledge gaps and self-efficacy, while socio-cultural norms included gender stereotypes. Home (limited space and sedentary entertainment like social media and TV) and physical environment (cheap motorised transportation) influence physical activity.
The existing cultural beliefs promote dietary and physical activity behaviours which are divergent from healthy recommendations. Therefore, a comprehensive intervention is needed to address socio-cultural misconceptions, financial and time limitations in urban Uganda.
As a preconception healthy diet is not only beneficial for couples’ general health but also for their reproductive health, effective interventions are necessary and lacking. In the field of nutrition, the concept of food literacy is emerging. Food literacy is the interrelated combination of knowledge, skills and self-efficacy on food planning, selecting foods, food preparation, eating and evaluating information about food with the ultimate goal of developing a lifelong healthy, sustainable and gastronomic relationship with food. The present study describes the systematic development of a food literacy intervention for couples trying to conceive.
Materials and methods
The development of the food literacy intervention was guided by Intervention Mapping, a protocol for developing theory- and evidence-based health promotion interventions in combination with consulting stakeholders. Decisions during intervention development were based on literature, an observational study evaluating the diet of couples trying to conceive using a food frequency questionnaire (FFQ) and semi-structured interviews and user tests with experts in the field and couples trying to conceive.
An innovative intervention to influence preconception diet and food literacy based on stakeholders opinion, effective behavior change strategies and attractive intervention channels was developed. Regarding needs assessment, the observational study showed that the diet of couples trying to conceive (n = 57) was inadequate (i.e. lack of vegetable intake) and highly correlated between partners. Objectives regarding food literacy were determined by participating experts (n = 12) rating ‘making healthy food choices’ as most important objective. A blended format (i.e. a mobile application in combination with telephone interaction with a health care professional) was selected as intervention channel based on semi-structured interviews with people trying to conceive (n = 17) as they highlighted the importance of support by experts and a time efficient intervention. Knowledge and self-efficacy regarding food literacy were selected as determinants to address. The main behavioral change strategies included in the intervention were tailoring, goal setting and motivational interviewing resulting in tailored goals, tips about food literacy and recipes. Experts (n = 15) and couples trying to conceive (n = 8) evaluated the intervention as easy to use.
This intervention will be evaluated on reproductive and dietary outcomes via a randomized controlled trial in Belgian Fertility clinics among 460 couples trying to conceive. If this theory- and evidence based food literacy intervention proves to be effective on reproductive and dietary outcomes in couples trying to conceive, it will offer vision and practical tools for implementing food literacy interventions in preconception care.
Urban sub-Saharan Africa is in a nutrition transition shifting towards consumption of energy-dense nutrient-poor diets and decreasing physical activity. Determinants of nutrition transition in sub-Saharan Africa are presently not well understood. The objective of this review was to synthesise available data on determinants of dietary and physical activity behaviours among women of reproductive age in urban sub-Saharan Africa according to the socio-ecological framework. We searched MEDLINE, Embase, Scopus, Web of Science and bibliographies of included articles for qualitative, observational and randomised controlled studies published in English from January 2000 to September 2018. Studies conducted within general populations of women aged 18–49 years were included. Searches were according to a predefined protocol published on PROSPERO (ID = CRD42018108532). Two reviewers independently screened identified studies. From a total of 9853 unique references, twenty-three studies were retained and were mainly from South and West Africa. No rigorous designed quantitative study was identified. Hence, data synthesis was narrative. Notable determinants of dietary behaviour included: convenience, finances, social network, food skills and knowledge gaps, food deserts and culture. Cultural beliefs include strong relationship between high social status and weight gain, energy-dense confectionery, salt or fat-rich foods. Physical activity is influenced by the fast-changing transport environment and cultural beliefs which instigate unfavourable gender stereotypes. Studies with rigorous qualitative and quantitative designs are required to validate and develop the proposed frameworks further, especially within East Africa. Nevertheless, available insights suggest a need for comprehensive skill-based interventions focusing on socio-cultural misconceptions and financial limitations.
Attention Deficit Hyperactivity Disorder (ADHD) is a serious risk factor for co-occurring psychiatric disorders and negative psychosocial consequences in adulthood. Given this background, there is great need for an effective treatment of adult ADHD patients.
Therefore, our research group has conducted a first controlled randomized multicenter study on the evaluation of disorder-tailored DBT-based group program in adult ADHD compared to a psychophar-macological treatment.
Between 2007 and 2010, in a four-arm-design 433 patients were randomized to a manualized dialectical behavioural therapy (DBT) based group program plus methylphenidate or placebo or clinical management plus methylphenidate or placebo with weekly sessions in the first twelve weeks and monthly sessions thereafter. Therapists are graduated psychologists or physicians. Treatment integrity is established by independent supervision. Primary endpoint (ADHD symptoms measured by the Conners Adult ADHD Rating Scale) is rated by interviewers blind to the treatment allocation (Current Controlled Trials ISRCTN54096201). The trial is funded by the German Federal Ministry of Research and Education (01GV0606) and is part of the German network for the treatment of ADHD in children and adults (ADHD-NET). In the lecture the first data of our interim analysis are presented (baseline data, results of treatment compliance and adherence).
The German version of the Conners Adult ADHD Rating Scales (CAARS) has proven to show very high model fit in confirmative factor analyses with the established factors inattention/memory problems, hyperactivity/restlessness, impulsivity/emotional lability, and problems with self-concept in both large healthy control and ADHD patient samples. This study now presents data on the psychometric properties of the German CAARS-self-report (CAARS-S) and observer-report (CAARS-O) questionnaires.
CAARS-S/O and questions on sociodemographic variables were filled out by 466 patients with ADHD, 847 healthy control subjects that already participated in two prior studies, and a total of 896 observer data sets were available. Cronbach's-alpha was calculated to obtain internal reliability coefficients. Pearson correlations were performed to assess test-retest reliability, and concurrent, criterion, and discriminant validity. Receiver Operating Characteristics (ROC-analyses) were used to establish sensitivity and specificity for all subscales.
Coefficient alphas ranged from .74 to .95, and test-retest reliability from .85 to .92 for the CAARS-S, and from .65 to .85 for the CAARS-O. All CAARS subscales, except problems with self-concept correlated significantly with the Barrett Impulsiveness Scale (BIS), but not with the Wender Utah Rating Scale (WURS). Criterion validity was established with ADHD subtype and diagnosis based on DSM-IV criteria. Sensitivity and specificity were high for all four subscales.
The reported results confirm our previous study and show that the German CAARS-S/O do indeed represent a reliable and cross-culturally valid measure of current ADHD symptoms in adults.
Family practice aims to recognize the health problems and needs expressed by the person rather than only focusing on the disease. Documenting person-related information will facilitate both the understanding and delivery of person-focused care.
To explore if the patients’ ideas, concerns and expectations (ICE) behind the reason for encounter (RFE) can be coded with the International Classification of Primary Care, version 2 (ICPC-2) and what kinds of codes are missing to be able to do so.
In total, 613 consultations were observed, and patients’ expressions of ICE were narratively recorded. These descriptions were consequently translated to ICPC codes by two researchers. Descriptions that could not be translated were qualitatively analysed in order to identify gaps in ICPC-2.
In all, 613 consultations yielded 672 ICE expressions. Within the 123 that could not be coded with ICPC-2, eight categories could be defined: concern about the duration/time frame; concern about the evolution/severity; concern of being contagious or a danger to others; patient has no concern, but others do; expects a confirmation of something; expects a solution for the symptoms without specification of what it should be; expects a specific procedure; and expects that something is not done.
Although many ICE can be registered with ICPC-2, adding eight new categories would capture almost all ICE.
Patterns of lower autonomic nervous system (ANS) and
hypothalamic–pituitary–adrenal (HPA) axis activity have
been found in children with oppositional defiant disorder (ODD). The
aim of the present study was to investigate whether children with
attention-deficit/hyperactivity disorder (ADHD) differ from ODD
children with (OD/AD) or without comorbid ADHD in ANS and HPA axis
activity under baseline and stressful conditions. The effects of stress
on cortisol, heart rate (HR), and skin conductance level (SCL) were
studied in 95 children (26 normal control [NC] children and
69 child psychiatric patients referred for externalizing behavior
problems [15 ODD, 31 OD/AD, and 23 ADHD]). No baseline
differences were found in cortisol between the four groups. However,
the ODD and OD/AD groups showed a significantly weaker cortisol
response to stress compared to the ADHD and NC groups; the ADHD group
had a similar cortisol response as the NC group. Within the ODD group
this pattern of low cortisol responsivity was most clearly present in
the more severely affected inpatients. With respect to HR, the ODD
group had a significantly lower HR during baseline and stressful
conditions. The higher HR levels in the OD/AD and ADHD groups were
likely to be caused by methylphenidate. The externalizing groups had
significantly lower SCL levels, and no differences were found between
these groups. It was concluded that differences in cortisol
responsivity during stress exposure are important in distinguishing
within a group of children with externalizing behavior between those
with ODD and ADHD.
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