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The COVID-19 pandemic created an unprecedented need for population-level clinical trials focused on the discovery of life-saving therapies and treatments. However, there is limited information on perception of research participation among perinatal populations, a population of particular interest during the pandemic.
Eligible respondents were 18 years or older, were currently pregnant or had an infant (≤12 months old), and lived in Florida within 50 miles of sites participating in the OneFlorida Clinical Research Consortium. Respondents were recruited via Qualtrics panels between April and September 2020. Respondents completed survey items about barriers and facilitators to participation and answered sociodemographic questions.
Of 533 respondents, most were between 25 and 34 years of age (n = 259, 49%) and identified as White (n = 303, 47%) and non-Hispanic (n = 344, 65%). Facebook was the most popular social media platform among our respondents. The most common barriers to research participation included poor explanation of study goals, discomforts to the infant, and time commitment. Recruitment through healthcare providers was perceived as the best way to learn about clinical research studies. When considering research participation, "myself" had the greatest influence, followed by familial ties. Noninvasive biological samples were highly acceptable. Hispanics had higher positive perspectives on willingness to participate in a randomized study (p = 0.009). Education (p = 0.007) had significant effects on willingness to release personal health information.
When recruiting women during the pregnancy and postpartum periods for perinatal studies, investigators should consider protocols that account for common barriers and preferred study information sources. Social media-based recruitment is worthy of adoption.
The Bangladeshi population is one of the fastest growing ethnic groups within the UK. In 2011 the Bangladeshi population resident in England and Wales was 447,201, or 0.8 per cent of the total UK population; this is an increase of just over 50 per cent from the previous census in 2001 (ONS, 2012). Additionally, this group is reported to be one of the most deprived populations in the UK, having high rates of unemployment, social deprivation and low rates of education (Brice, 2008; Alexander et al, 2010). This group also has poorer self-reported and measured health status indicated by higher rates of disability, centralised obesity and chronic diseases such as type 2 diabetes and cardiovascular disease (Sproston and Mindell, 2006). Older Bangladeshi women are particularly affected as they play a lead role in caretaking for multiple generations within relatively large extended families, and many struggle to cope with the complex challenges of ageing, poverty, racism and social exclusion.
The migration of Bangladeshis to the UK has a long history, with the majority of those migrating originating from the Sylhet region in northeast Bangladesh (Gardner, 2002). Research has been dedicated to understanding how to improve the health of Bangladeshi residents in the UK; however, the majority of this research has concentrated on the Tower Hamlets region of London, limiting the amount of knowledge about those communities living outside of the London area (Brice, 2008). Findings from these studies may not be generalisable to other UK communities, so more research is needed to expand our understanding of this minority ethnic group and how to improve their health and wellbeing and reduce existing health inequalities.
MINA was a three-year project that examined ageing, migration and nutrition across two generations of Bangladeshi women living in Cardiff, UK and Sylhet, Bangladesh. The 2011 Census indicates that the Bangladeshi population living in Cardiff is 4,838, or approximately 45 per cent of the Bangladeshis living in Wales (ONS, 2012). This research builds on the existing literature focusing on migration and ageing among UK Bangladeshis (Gardner, 2002; Phillipson et al, 2003), providing new insights into specifically food, nutrition and their interactions with ageing and migration among UK Bangladeshi families who are living in communities outside of Tower Hamlets, London.
Dietary advice is fundamental in the prevention and management of type 2 diabetes (T2DM). Advice is improved by individual assessment but existing methods are time-consuming and require expertise. We developed a twenty-five-item questionnaire, the UK Diabetes and Diet Questionnaire (UKDDQ), for quick assessment of an individual’s diet. The present study examined the UKDDQ’s repeatability and relative validity compared with 4 d food diaries.
The UKDDQ was completed twice with a median 3 d gap (interquartile range=1–7 d) between tests. A 4 d food diary was completed after the second UKDDQ. Diaries were analysed and food groups were mapped on to the UKDDQ. Absolute agreement between total scores was examined using intra-class correlation (ICC). Agreement for individual items was tested with Cohen’s weighted kappa (κw).
South West of England.
Adults (n 177, 50·3 % women) with, or at high risk for, T2DM; mean age 55·8 (sd 8·6) years, mean BMI 34·4 (sd 7·3) kg/m2; participants were 91 % White British.
The UKDDQ showed excellent repeatability (ICC=0·90 (0·82, 0·94)). For individual items, κw ranged from 0·43 (‘savoury pastries’) to 0·87 (‘vegetables’). Total scores from the UKDDQ and food diaries compared well (ICC=0·54 (0·27, 0·70)). Agreement for individual items varied and was good for ‘alcohol’ (κw=0·71) and ‘breakfast cereals’ (κw=0·70), with no agreement for ‘vegetables’ (κw=0·08) or ‘savoury pastries’ (κw=0·09).
The UKDDQ is a new British dietary questionnaire with excellent repeatability. Comparisons with food diaries found agreements similar to those for international dietary questionnaires currently in use. It targets foods and habits important in diabetes prevention and management.
Weight loss is crucial for treating type 2 diabetes mellitus (T2DM). It remains unclear which dietary intervention is best for optimising glycaemic control, or whether weight loss itself is the main reason behind observed improvements. The objective of this study was to assess the effects of various dietary interventions on glycaemic control in overweight and obese adults with T2DM when controlling for weight loss between dietary interventions. A systematic review of randomised controlled trials (RCT) was conducted. Electronic searches of Medline, Embase, Cinahl and Web of Science databases were conducted. Inclusion criteria included RCT with minimum 6 months duration, with participants having BMI≥25·0 kg/m2, a diagnosis of T2DM using HbA1c, and no statistically significant difference in mean weight loss at the end point of intervention between dietary arms. Results showed that eleven studies met the inclusion criteria. Only four RCT indicated the benefit of a particular dietary intervention over another in improving HbA1c levels, including the Mediterranean, vegan and low glycaemic index (GI) diets. However the findings from one of the four studies showing a significant benefit are questionable because of failure to control for diabetes medications and poor adherence to the prescribed diets. In conclusion there is currently insufficient evidence to suggest that any particular diet is superior in treating overweight and obese patients with T2DM. Although the Mediterranean, vegan and low-GI diets appear to be promising, further research that controls for weight loss and the effects of diabetes medications in larger samples is needed.
Extending participation and social connectivity is now widely accepted as central to adding life to years as well as healthy years to life, while participation in the life of the community is seen as critical to well-being (Sen, 1992, p 39), and capable of addressing older people's rights, extending inclusion, reducing exclusion, easing demand on national budgets and building social cohesion. The central conundrums of increasing participation and social connectivity are, first, the intermeshing of personal, local, meso and macro level factors in shaping participation and social connectivity, and second, how the drive towards increased participation can be included in framing policy in such a way that participation is individually meaningful, social connectivity is enhanced and benefits flow to participants and to society in general. Underlying the application of the concepts of participation and social connectivity to older people is the idea that old age places people outside the mainstream: that older people's participation and social connectivity is wanting in scale or scope, that they do want or should want to participate more and that it is chiefly the impediment of old age that constrains their participation. Categorised as outside the mainstream, older people become defined by their age rather than those other salient aspects of their social identity, class, sexuality, ethnicity, education, histories and personal outlook that policy makers and implementers find difficult to respond to in relation to older people. This chapter examines older people's experiences of participation and social connectivity across a range of geographical and social locations within the UK and within low and middle-income countries, in order to test conceptualisations of older people's participation and social connectivity against experience, and to begin to trace the individual, local, meso and macro factors and linkages that need to be addressed to extend meaningful participation and engagement for people who happen to be older.
As explained in Chapter One, a major focus of the New Dynamics of Ageing (NDA) Programme was nutrition, and the two connected critical issues concerning older people: malnutrition and obesity. Malnutrition is defined as a state in which there is a deficiency, excess or imbalance of energy and nutrients which leads to adverse effects on body tissues, function and/or clinical outcomes (MAG, 2011). In the UK, it is estimated that at any one time under-nutrition affects over three million older people (The Advisory Group on Malnutrition, 2009). Approximately 10–14 per cent of people living in sheltered housing have been found to be at risk of under-nutrition, as well as 30–42 per cent of residents recently admitted to care homes (BAPEN Quality Group, 2010, p 4). Even older adults living at home are at risk – data from the 2012 Health Survey for England (HSCIC, 2013) indicate that 0.5 per cent of those aged 65–74 and 1.3 per cent of those aged 75 or older are underweight (defined as a body mass index <18.5kg/m2). Concurrently, overweight and obesity are a growing concern in older adults as they increase the risks for, and complications of, chronic diseases such as cardiovascular disease, type 2 diabetes, hypertension and some cancers. The prevalence of obesity in the UK is 34.1 per cent in men and 35.9 per cent in women aged 65–74, and 29.8 per cent in men and 28.7 per cent of women 75 years or older, respectively (HSCIC, 2013).
Various important contributors to under-nutrition, overweight and obesity in older adults have been identified. These include medication use, age-related physiological and psychological changes such as reduced mobility or problems with chewing and swallowing, depression or social isolation, cognitive factors such as dementia or other neurological illnesses, financial limitations, low levels of physical activity and function, limited access to affordable and appetising healthier foods, and difficulties in acquiring, preparing and consuming healthier meals (Brownie, 2006). These factors can result in an inadequate nutritional intake or an imbalance between energy intake and expenditure, both of which increase the risks for malnutrition and related acute and chronic illnesses.
Maintaining independence and autonomy are critical features of healthy and successful ageing. This includes being able to look after oneself, including shopping and preparing meals (McKie, 1999; Rioux, 2005).
Identifying risk factors for insulin resistance in adolescence could provide valuable information for early prevention. The study sought to identify risk factors for changes in insulin resistance and fasting blood glucose levels.
Prospective cohort of girls participating in the National Heart, Lung, and Blood Institute Growth and Health Study.
Adolescent girls (n 774) assessed at the ages of 16–17 and 18–19 years. Over a 3-year period, measurements of fasting blood glucose and insulin and serum cotinine were taken, and dietary intake (3 d food diary), smoking status and physical activity levels were self-reported.
Improvements in homeostasis model assessment of insulin resistance (HOMA-IR) were associated with increases in the percentage of energy intake from polyunsaturated fats (β = −3·33, 95 % CI −6·28, −0·39, P = 0·03) and grams of soluble fibre (β = −5·20, 95 % CI −9·81, −0·59, P = 0·03) between the ages of 16–17 and 18–19 years; with similar findings for insulin. Transitioning into obesity was associated with an increase in insulin (β = 6·34, 95 % CI 2·78, 9·91, P < 0·001) and HOMA-IR (β = 28·77, 95 % CI 8·13, 49·40, P = 0·006). Serum cotinine concentrations at 16–17 years, indicating exposure to tobacco, were associated with large increases (β = 15·43, 95 % CI 6·09, 24·77, P < 0·001) in fasting blood glucose concentrations.
Increases in the percentage of energy from polyunsaturated fat and fibre, and avoidance of excess weight gain and tobacco exposure, could substantially reduce the risk of insulin resistance in late adolescence.
To investigate the food shopping habits of older adults in the UK and explore their potential associations with selected health-related indicators.
A cross-sectional study including objectively measured physical activity levels, BMI, physical function and self-reported health status and dietary intake.
A total of 240 older adults aged ≥70 years living independently.
Mean age was 78·1 (sd 5·7) years; 66·7 % were overweight or obese and 4 % were underweight. Most (80·0 %) carried out their own food shopping; 53·3 % shopped at least once weekly. Women were more likely to shop alone (P < 0·001) and men more likely to shop with their spouse (P < 0·001). Men were more likely than women to drive to food shopping (P < 0·001), with women more likely to take the bus or be driven (P < 0·001). Most reported ease in purchasing fruit and vegetables (72·9 %) and low-fat products (67·5 %); 19·2 % reported low fibre intakes and 16·2 % reported high fat intakes. Higher levels of physical function and physical activity and better general health were significantly correlated with the ease of purchasing fresh fruit, vegetables and low-fat products. Shopping more often was associated with higher fat intake (P = 0·03); higher levels of deprivation were associated with lower fibre intake (P = 0·019).
These findings suggest a pattern of food shopping carried out primarily by car at least once weekly at large supermarket chains, with most finding high-quality fruit, vegetables and low-fat products easily accessible. Higher levels of physical function and physical activity and better self-reported health are important in supporting food shopping and maintaining independence.
To examine knowledge of and adherence to the Mediterranean dietary pattern (MDP) among Greek adolescents, assess associations between MDP knowledge and adherence with BMI, and determine socio-cultural factors predicting MDP compliance.
Greek adolescents aged 15–17 years.
Two hundred adolescents (103 females, ninety-seven males) from six schools on the Greek island of Chios. The sampling procedure was similar for all schools; schools were randomly selected from different geographic areas and all municipalities. BMI was calculated from measured height and weight; participants completed four questionnaires assessing parents’ socio-economic status and education, adolescents’ perceived and actual MDP knowledge, past-week dietary habits, and MDP adherence.
Participants’ BMI indicated 64·5 % were normal weight and 35·5 % were overweight/obese (mean BMI 23·7 (sd 3·8) kg/m2). Over half had very poor MDP knowledge (58·5 %) and adherence (59·5 %); both perceived (F = 3·35, P = 0·037) and actual MDP knowledge (F = 3·45, P = 0·034) were significantly different across MDP adherence. Perceived MDP knowledge was positively correlated with vegetable consumption (r = 0·185, P = 0·009); actual knowledge was negatively correlated with meat consumption (r = −0·191, P = 0·007). BMI was negatively correlated with family income (r = −0·202, P = 0·004), indicating higher BMI in less affluent households. Actual MDP knowledge was the only significant predictor of MDP adherence (standardized β = 0·162, P = 0·030) in a model accounting for 7·3 % of overall variance.
Greek adolescents reported consuming a more Westernized diet detached from the traditional MDP. Actual MDP knowledge and family income were important factors affecting MDP adherence and BMI, respectively. Promoting the traditional MDP among Greek adolescents and their families appears warranted.
Regular and goal-appropriate exercise is critical to improving and maintaining both health and performance. However, the frequency, intensity, duration and type of activities needed to optimise health or achieve successful sports performance will differ considerably depending on an individual's goals and capabilities. Although sport is one of many forms of exercise that can be counted towards daily physical activity, participation in sport is not necessary to meet current physical activity recommendations. The current consensus is that the minimum amount of physical activity needed to improve and maintain good health is 30 min moderate-intensity activity/d on ≥5 d/week. The evidence supporting this consensus is based on predominantly observational evidence that performing regular aerobic (endurance)-type physical activity is associated with reduced morbidity and premature mortality from CVD, CHD, stroke and colo-rectal cancer. The exact dose needed to improve health and the slope of the dose–response gradient between physical activity and mortality for various diseases are not known, and one major limitation of the existing evidence is the lack of objective measurement of physical activity. Limited evidence indicates that a much higher dose of activity (45–90 min each day on ≥5 d/week) may be needed to prevent overweight and obesity and to avoid weight regain in previously overweight and obese individuals. The role of resistance training and heavy domestic work in reducing morbidity and premature mortality for various diseases is unclear. As most adults do not meet current recommendations there is a critical need for innovative approaches to increase physical activity across large-scale populations.
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