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1.
Crit Rev Food Sci Nutr ; : 1-17, 2023 Apr 10.
Artículo en Inglés | MEDLINE | ID: mdl-37035931

RESUMEN

Cruciferous vegetables and oilseeds are rich in glucosinolates that can transform into isothiocyanates upon enzymic hydrolysis during post-harvest handling, food preparation and/or digestion. Vegetables contain glucosinolates that have beneficial bioactivities, while glucosinolates in oilseeds might have anti-nutritional properties. It is therefore important to monitor and assess glucosinolates and isothiocyanates content through the food value chain as well as for optimized crop production. Vibrational spectroscopy methods, such as infrared (IR) spectroscopy, are used as a nondestructive, rapid and low-cost alternative to the current and common costly, destructive, and time-consuming techniques. This systematic review discusses and evaluates the recent literature available on the use of IR spectroscopy to determine glucosinolates and isothiocyanates in vegetables and oilseeds. NIR spectroscopy was used to predict glucosinolates in broccoli, kale, rocket, cabbage, Brussels sprouts, brown mustard, rapeseed, pennycress, and a combination of Brassicaceae family seeds. Only one study reported the use of NIR spectroscopy to predict broccoli isothiocyanates. The major limitations of these studies were the absence of the critical evaluation of errors associated with the reference method used to develop the calibration models and the lack of interpretation of loadings or regression coefficients used to predict glucosinolates.

2.
J Nutr ; 152(3): 680-689, 2022 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-34910161

RESUMEN

BACKGROUND: The gut microbiome has been associated with cardiorespiratory fitness. OBJECTIVES: To assess the effects of oligofructose (FOS)-enriched inulin supplementation on the gut microbiome and the peak oxygen uptake (V̇O2peak) response to high-intensity interval training (HIIT). METHODS: The study was a randomized controlled trial. Forty sedentary and apparently healthy adults [n = 31 women; aged 31.8 ± 9.8 y, BMI (in kg⋅m-2) 25.9 ± 4.3] were randomly allocated to 1) 6 wk of supervised HIIT (4 × 4-min bouts at 85-95% peak heart rate, interspersed with 3 min of active recovery, 3·wk-1) + 12 g·d-1 of FOS-enriched inulin (HIIT-I) or 2) 6 wk of supervised HIIT (3·wk-1, 4 × 4-min bouts) + 12 g·d-1 of maltodextrin/placebo (HIIT-P). Each participant completed an incremental treadmill test to assess V̇O2peak and ventilatory thresholds (VTs), provided a stool and blood sample, and completed a 24-h diet recall questionnaire and FFQ before and after the intervention. Gut microbiome analyses were performed using metagenomic sequencing. Fecal short-chain fatty acids were measured by mass spectrometry. RESULTS: There were no differences in the mean change in V̇O2peak response between groups (P = 0.58). HIIT-I had a greater improvement in VTs than HIIT-P [VT1 (lactate accumulation): mean difference + 4.3% and VT2 (lactate threshold): +4.2%, P < 0.05]. HIIT-I had a greater increase in the abundance of Bifidobacterium taxa [false discovery rate (FDR) < 0.05] and several metabolic processes related to exercise capacity (FDR < 0.05). Exploratory analysis of merged data found participants with a greater response to HIIT (V̇O2peak ≥3.5 mL⋅kg-1⋅min-1) had a 2.2-fold greater mean abundance of gellan degradation pathways (FDR < 0.05) and a greater, but not significant, abundance of Bifidobacterium uniformis species (P < 0.00023, FDR = 0.08). CONCLUSIONS: FOS-enriched inulin supplementation did not potentiate HIIT-induced improvements in V̇O2peak but led to gut microbiome changes possibly associated with greater ventilatory threshold improvements in healthy inactive adults. Gellan degradation pathways and B. uniformis spp. were associated with greater V̇O2peak responses to HIIT.


Asunto(s)
Microbioma Gastrointestinal , Entrenamiento de Intervalos de Alta Intensidad , Adulto , Femenino , Entrenamiento de Intervalos de Alta Intensidad/métodos , Humanos , Inulina/farmacología , Ácido Láctico , Masculino , Oligosacáridos , Consumo de Oxígeno/fisiología
3.
J Biomed Sci ; 28(1): 37, 2021 May 13.
Artículo en Inglés | MEDLINE | ID: mdl-33985508

RESUMEN

BACKGROUND: Low cardiorespiratory fitness (V̇O2peak) is highly associated with chronic disease and mortality from all causes. Whilst exercise training is recommended in health guidelines to improve V̇O2peak, there is considerable inter-individual variability in the V̇O2peak response to the same dose of exercise. Understanding how genetic factors contribute to V̇O2peak training response may improve personalisation of exercise programs. The aim of this study was to identify genetic variants that are associated with the magnitude of V̇O2peak response following exercise training. METHODS: Participant change in objectively measured V̇O2peak from 18 different interventions was obtained from a multi-centre study (Predict-HIIT). A genome-wide association study was completed (n = 507), and a polygenic predictor score (PPS) was developed using alleles from single nucleotide polymorphisms (SNPs) significantly associated (P < 1 × 10-5) with the magnitude of V̇O2peak response. Findings were tested in an independent validation study (n = 39) and compared to previous research. RESULTS: No variants at the genome-wide significance level were found after adjusting for key covariates (baseline V̇O2peak, individual study, principal components which were significantly associated with the trait). A Quantile-Quantile plot indicates there was minor inflation in the study. Twelve novel loci showed a trend of association with V̇O2peak response that reached suggestive significance (P < 1 × 10-5). The strongest association was found near the membrane associated guanylate kinase, WW and PDZ domain containing 2 (MAGI2) gene (rs6959961, P = 2.61 × 10-7). A PPS created from the 12 lead SNPs was unable to predict V̇O2peak response in a tenfold cross validation, or in an independent (n = 39) validation study (P > 0.1). Significant correlations were found for beta coefficients of variants in the Predict-HIIT (P < 1 × 10-4) and the validation study (P < × 10-6), indicating that general effects of the loci exist, and that with a higher statistical power, more significant genetic associations may become apparent. CONCLUSIONS: Ongoing research and validation of current and previous findings is needed to determine if genetics does play a large role in V̇O2peak response variance, and whether genomic predictors for V̇O2peak response trainability can inform evidence-based clinical practice. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR), Trial Id: ACTRN12618000501246, Date Registered: 06/04/2018, http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374601&isReview=true .


Asunto(s)
Capacidad Cardiovascular/fisiología , Ejercicio Físico/fisiología , Variación Genética , Estudio de Asociación del Genoma Completo , Adulto , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad
4.
Prev Med ; 147: 106507, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33667468

RESUMEN

The aim of this study was to compare the associations between indicators of energy intake and expenditure with excess weight and obesity in women who work full-time in sedentary and less sedentary jobs. Data were from 3444 participants the Australian Longitudinal Study on Women's Health, who reported their weight, dietary intake, physical activity and occupation in 2009 (baseline), and weight in 2012 (follow-up). Participants were categorised as being in a 'less sedentary' or 'sedentary' job, based on occupational activity patterns. Odds of excess weight (BMI ≥ 25) at baseline and of being obese (BMI ≥ 30) at follow-up, by indicators of energy intake and expenditure, were compared in the two occupational groups. In multivariate analyses, high non-work sitting time and saturated fat intake were associated with increased odds of obesity at 3-year follow-up in both occupational groups. In the sedentary job group, high physical activity (in leisure and transport) was associated with a 51% reduction in odds of obesity (OR 0.49, 95%CI 0.25-0.97). In the less-sedentary job group, energy intake and high soft drink consumption were associated with markedly increased odds of obesity (OR 1.67 95%CI 1.07-2.61; OR 2.08 95%CI1.42-3.05, respectively). In this cohort of young Australian women, sedentariness at work did not markedly affect the prevalence of excess weight or obesity. Indicators of high energy intake and low energy expenditure were associated with increased odds of both excess weight and obesity, regardless of sedentariness of occupational group.


Asunto(s)
Gastos en Salud , Obesidad , Australia/epidemiología , Índice de Masa Corporal , Ingestión de Energía , Femenino , Humanos , Estudios Longitudinales , Obesidad/epidemiología
5.
Am J Public Health ; 109(11): e13-e20, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31536404

RESUMEN

Background. Shift work is characterized by employees working outside the standard hours of 7:00 am to 6:00 pm. Because shift work includes night work, the normal sleep-wake cycle (circadian rhythm) is disrupted, with potential consequences for shift workers' physical and mental health.Objectives. To assess the pooled effects of shift work on mental health and to evaluate whether these differ in men and women.Search Methods. We searched PubMed, Scopus, and Web of Science databases for peer-reviewed or government reports published up to August 2018Selection Criteria. To be included, studies had to be longitudinal or case-control studies of shift work exposure associated with adverse mental health outcomes. For subanalyses, we grouped these outcomes as anxiety symptoms, depressive symptoms, or general poor mental health symptoms.Data Collection and Analysis. We followed the Meta-Analysis of Observational Studies in Epidemiology Group guidelines. We extracted adjusted risk estimates for each study to calculate pooled effect sizes (ESs) using random effect models and metaregression analysis to explore sources of heterogeneity.Main Results. We included 7 longitudinal studies, with 28 431 unique participants. Shift work was associated with increased overall risk of adverse mental health outcomes combined (ES = 1.28; 95% confidence interval [CI] = 1.02, 1.62; I2 = 70.6%) and specifically for depressive symptoms (ES = 1.33; 95% CI = 1.02, 1.74; I2 = 31.5%). Gender differences explained more than 90% of heterogeneity, with female shift workers more likely to experience depressive symptoms than female non-shift workers (odds ratio = 1.73; 95% CI = 1.39, 2.14).Authors' Conclusions. To our knowledge, this is the first meta-analysis to investigate the pooled effects of shift work on the risk of poor mental health, including subanalyses by type of poor mental health and gender. Shift workers, particularly women, are at increased risk for poor mental health, particularly depressive symptoms.Public Health Implications. Depression accounts for 4.3% of the global burden of disease and incidence, with mental disorders worldwide predicted to cost US $16.3 million by 2030. With 1 in 5 people in the United States and Europe doing shift work, and the increased risk of poor mental health among shift workers, shift work industries are a priority context for reducing this burden. Workplace health promotion programs and policies are needed to minimize shift workers' risk of poor mental health.


Asunto(s)
Salud Mental/estadística & datos numéricos , Horario de Trabajo por Turnos/estadística & datos numéricos , Lugar de Trabajo/estadística & datos numéricos , Estudios de Casos y Controles , Depresión/epidemiología , Humanos , Estudios Longitudinales , Factores Sexuales
6.
BMC Public Health ; 19(Suppl 2): 452, 2019 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-31159755

RESUMEN

BACKGROUND: Differences in how shift workers accumulate physical activity (PA) while at work and in leisure time, on days when they are working at night, during the day, or on non-work days, are largely unexplored. The aim of this study was to improve understanding of physical activity patterns in two groups of shift workers, and to measure variations according to their shift schedules. METHODS: This pragmatic pilot study was conducted in two workplaces. Employees in Workplace 1 (n = 10) were required to drive for most of their shift. Workplace 2 was a manufacturing company where most of the employees' (n = 30) occupational tasks were completed while standing. Use of time was assessed using the adult version of the Multimedia Activity Recall for Children and Adults (MARCA) administered by telephone interview. Three MARCA interviews were conducted with each participant, in order to capture a typical profile of a day-shift day, a night-shift day and a non-work day, using a two-day recall for each interview. Participants were asked to wear the activPAL3™ activity monitor, for 7 consecutive days. Paired and independent t-tests were used to compute significant differences between day-shift, night-shift and non-work days within and between workplaces. RESULTS: The total number of days quantified for the MARCA data was 192 days (64 day-shift, 60 night-shift and 68 non-work days). Workplace 2 participants reported more physical activity and less sedentary behaviour on day-shift and night shift days than on non-work days. Time spent in sedentary behaviour was similar on day-shift, night-shift and non-work days in Workplace 1. Workplace 1 participants were more sedentary (p = 0.003) and engaged in more light intensity PA (p = 0.031) on day-shift and night-shift workdays, than those from Workplace 2. Sleep times were lowest on day-shift days. CONCLUSION: As the occupational tasks for participants in Workplace 2 involved physical activities, the findings do not support the conventional view that shift workers are more sedentary than those who only work during the day. Rather occupational tasks appear to be a more important determinant of physical activity patterns both on work and non-work days than varying shift patterns.


Asunto(s)
Conducción de Automóvil/estadística & datos numéricos , Industria Manufacturera/estadística & datos numéricos , Horario de Trabajo por Turnos/estadística & datos numéricos , Factores de Tiempo , Lugar de Trabajo/estadística & datos numéricos , Adulto , Ejercicio Físico , Femenino , Humanos , Actividades Recreativas , Masculino , Persona de Mediana Edad , Proyectos Piloto , Conducta Sedentaria , Sueño , Tolerancia al Trabajo Programado
7.
Nutrients ; 11(4)2019 Apr 11.
Artículo en Inglés | MEDLINE | ID: mdl-30978932

RESUMEN

The positive effects of dietary fibre on gut barrier function and inflammation have not been completely elucidated. Mice studies show gut barrier disruption and diet-induced insulin resistance can be alleviated by cytokine interleukin-22 (IL-22). However, little is known about IL-22 in humans and its association with gut-beneficial nutrients like fibre. We investigated whether fibre intake was associated with circulating levels of IL-22 in 48 participants with metabolic syndrome (MetS). Bivariate analysis was used to explore associations between circulating IL-22, fibre intake, MetS factors, body composition, and cardiorespiratory fitness (peak oxygen uptake, V ˙ O2peak). Hierarchical multiple regression (HMR) was used to test the independent association of fibre intake with circulating IL-22, adjusting for variables correlated with IL-22. Circulating IL-22 was positively associated with fibre intake (rs = 0.393, p < 0.006). The HMR-adjusted model explained 40% of circulating IL-22 variability, and fibre intake significantly improved the prediction model by 8.4% (p < 0.022). Participants with fibre intake above median intake of 21.5 g/day had a significantly higher circulating IL-22 than the lower intake group (308.3 ± 454.4 vs. 69.0 ± 106.4 pg/mL, p < 0.019). Fibre intake is independently associated with increased circulating IL-22 in individuals with MetS. Findings warrant further investigations to evaluate whether changes in dietary fibre intake alter circulating IL-22, and its effects on health outcomes.


Asunto(s)
Fibras de la Dieta/administración & dosificación , Interleucinas/sangre , Síndrome Metabólico/sangre , Adulto , Anciano , Animales , Composición Corporal , Dieta , Ejercicio Físico , Femenino , Humanos , Resistencia a la Insulina/fisiología , Masculino , Síndrome Metabólico/inmunología , Síndrome Metabólico/prevención & control , Ratones , Persona de Mediana Edad , Consumo de Oxígeno , Interleucina-22
8.
J Nutr Educ Behav ; 50(10): 1015-1025, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29650395

RESUMEN

OBJECTIVE: To use the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to evaluate and understand key implementation and context factors of a diet and physical activity (PA) workplace intervention for nurses. METHODS: A 3-month pilot intervention was developed to promote diet and PA behavior through self-monitoring, goal setting, and social support using pedometers, a smartphone app, and a dedicated Facebook group. Measures included diet quality, daily PA, adoption, and implementation (including qualitative data). Maintenance was assessed at 6-month follow-up. RESULTS: Forty-seven nurses participated in the study. At 3 months, fruit and vegetable intake significantly increased (P = .04) whereas PA significantly decreased (P = .01). The intervention was partially adopted as planned, with low reach and efficacy. Participants reported that changing 2 behaviors at the same time was difficult, with the majority feeling it was easier to change diet than to become more physically active. CONCLUSIONS AND IMPLICATIONS: The ability to change diet and PA behaviors at the same time was challenging in nurses. Future studies examining whether similar occupational groups with high stress, fatigue, and lack of time face the same challenges would contribute to understanding these results.


Asunto(s)
Dieta/estadística & datos numéricos , Conductas Relacionadas con la Salud/fisiología , Promoción de la Salud/métodos , Enfermeras y Enfermeros , Lugar de Trabajo , Adulto , Ejercicio Físico/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto
9.
Artículo en Inglés | MEDLINE | ID: mdl-30135386

RESUMEN

Physical activity (PA) is an independent predictor of mortality and frailty in middle-aged women, but fatigue remains a major barrier in this group. While caffeine intake has been associated with reduced exertion and perceived fatigue, it is not well understood whether consumption of naturally caffeinated drinks is associated with physical activity. The aim of this study was to determine whether habitual consumption of coffee and tea is associated with participation in physical activity. Women (n = 7580) from the Australian Longitudinal Study on Women's Health were included in this investigation. Participants reported average tea and coffee intake over the last 12 months and usual PA. Logistic regression models were adjusted for relevant health and lifestyle confounders, and Sobel test was used for mediation analysis. Participants who consumed 1⁻2 cups of coffee/day were 17% more likely to meet the recommended 500 metabolic equivalent (MET).min/week than women who had <1 cup/day (odds ratio (OR) 1.17, 95% confidence interval (CI) 1.04⁻1.32). Participants who reported drinking either 1⁻2 cups or >3 cups/day of tea were 13⁻26% more likely to meet 500 MET.min/week than those who had <1 cup/day (OR 1.26, 95% CI 1.08⁻1.46 and OR 1.13, 95% CI 1.01⁻1.26, respectively). Tiredness and energy mediated associations between intake of coffee (fully) and tea (partially) and PA. Middle-aged women who drink 1⁻2 cups of coffee or >1 cup of tea/day are more likely to meet the moderate-to-vigorous PA guidelines than those who drink <1 cup/day. Future research is warranted to investigate causality and effects of specific coffee and tea amounts.


Asunto(s)
Cafeína/farmacología , Café , Conducta de Ingestión de Líquido , Ejercicio Físico/fisiología , , Salud de la Mujer , Anciano , Antioxidantes/farmacología , Estimulantes del Sistema Nervioso Central/farmacología , Fatiga/fisiopatología , Fatiga/prevención & control , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Prospectivos
10.
Scand J Work Environ Health ; 44(3): 229-238, 2018 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-29247501

RESUMEN

Objectives The aim of this review was to assess the risk of cardiovascular disease (CVD) events associated with shift work and determine if there is a dose-response relationship in this association. Method Electronic databases (PubMed, Scopus, and Web of Science) were searched for cohort or case-control control study designs in any population, reporting exposure to shift work as the main contributing factor to estimate CVD risk. For each study, adjusted relative risk (RR) ratios and 95% confidence intervals (CI) were extracted, and used to calculate the pooled RR using random-effect models. Meta-regression analysis was conducted to explore potential heterogeneity sources. Potential non-linear dose-response relationships were examined using fractional polynomial models. Results We included 21 studies with a total of 173 010 unique participants. The majority of the studies were ranked low-to-moderate risk of bias. The risk of any CVD event was 17% higher among shift workers than day workers. The risk of coronary heart disease (CHD) morbidity was 26% higher (1.26, 95% CI 1.10-1.43, I 2= 48.0%). Sub-group analysis showed an almost 20% higher risk of CVD and CHD mortality among shift workers than those who did not work shifts (1.22, 95% CI 1.09-1.37, I 2= 0% and 1.18, 95% CI 1.06-1.32 I 2=0%; respectively). After the first five years of shift work, there was a 7.1% increase in risk of CVD events for every additional five years of exposure (95% CI 1.05-1.10). Heterogeneity of the pooled effect size (ES) estimates was high (I 2=67%), and meta-regression analysis showed that sample size explained 7.7% of this. Conclusions The association between shift work and CVD risk is non-linear and seems to appear only after the first five years of exposure. As shift work remains crucial for meeting production and service demands across many industries, policies and initiatives are needed to reduce shift workers' CVD risk.


Asunto(s)
Enfermedades Cardiovasculares/etiología , Enfermedades Profesionales/etiología , Horario de Trabajo por Turnos/efectos adversos , Sesgo , Enfermedades Cardiovasculares/mortalidad , Femenino , Humanos , Masculino , Enfermedades Profesionales/mortalidad , Factores de Riesgo , Factores de Tiempo
11.
Curr Protein Pept Sci ; 19(11): 1107-1113, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29879883

RESUMEN

BACKGROUND: The co-stimulatory B7 family members are cell-surface protein ligands, binding to receptors on lymphocytes to regulate immune responses. One of them is the inducible co-stimulatory molecule ligand (ICOS-L). This protein is expressed on professional antigen-presenting cells (APCs), including B cells, macrophages, and dendritic cells (DCs), but it can also be expressed by endothelial cells, lung epithelium and in tumour microenvironment cells. ICOS-L is important for memory and effector T cells during the specific humoral immune responses, but its role in cancer is not yet understood. OBJECTIVE: To discuss the role of ICOS/ICOS-L in cancer, given importance of identifying selective targets for cancer treatment, and knowing the mechanism of immune evasion by tumour. MAIN FINDINGS: ICOS/ICOS-L signal has opposite effects on the T-cell response. ICOS-L is activated in several types of cancers to maintain immunosuppressive CD4+ T cell subsets, such as regulatory T cells (Tregs). ICOS-L over-expression is associated with tumour progression and poor overall survival. In colon cancer, activation of this co-stimulatory signal is associated with improved survival suggesting a dualistic effect of the ICOS/ICOs-L signal pathway. Interestingly, following anti-cancer vaccine or anti- CTLA-4 treatment, ICOS+ T cells increased significantly in both the CD4+ and CD8+ population and the ratio Teff/Treg increased in tumour microenvironment. This suggests a potential role of ICOS/ICOS-L in improving effectiveness of cancer therapy. CONCLUSION: ICOS/ICOS-L signal pathway has the potential to improve cancer treatment. However, studies in other models are needed to understand whether inhibition of ICOS expression or the blockage of its co-stimulation could be a potential therapeutic target or adjuvant treatment for immunotherapy.


Asunto(s)
Ligando Coestimulador de Linfocitos T Inducibles/metabolismo , Neoplasias/metabolismo , Neoplasias/terapia , Antineoplásicos/uso terapéutico , Biomarcadores de Tumor/metabolismo , Humanos , Inmunosupresores/uso terapéutico , Inmunoterapia , Terapia Molecular Dirigida , Neoplasias/inmunología , Microambiente Tumoral
12.
Am J Health Promot ; 31(1): 19-27, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26389980

RESUMEN

OBJECTIVE: To systematically review the effectiveness of intervention studies promoting diet and physical activity (PA) in nurses. DATA SOURCE: English language manuscripts published between 1970 and 2014 in PubMed, Scopus, CINAHL, and EMBASE, as well as those accessed with the PICO tool, were reviewed. STUDY INCLUSION AND EXCLUSION CRITERIA: Inclusion criteria comprised (1) nurses/student nurses working in a health care setting and (2) interventions where PA and/or diet behaviors were the primary outcome. Exclusion criteria were (1) non-peer-reviewed articles or conference abstracts and (2) interventions focused on treatment of chronic conditions or lifestyle factors other than PA or diet in nurses. DATA EXTRACTION: Seventy-one full texts were retrieved and assessed for inclusion by two reviewers. Data were extracted by one reviewer and checked for accuracy by a second reviewer. DATA SYNTHESIS: Extracted data were synthesized in a tabular format and narrative summary. RESULTS: Nine (n = 737 nurses) studies met the inclusion criteria. Quality of the studies was low to moderate. Four studies reported an increase in self-reported PA through structured exercise and goal setting. Dietary outcomes were generally positive, but were only measured in three studies with some limitations in the assessment methods. Two studies reported improved body composition without significant changes in diet or PA. CONCLUSIONS: Outcomes of interventions to change nurses' PA and diet behavior are promising, but inconsistent. Additional and higher quality interventions that include objective and validated outcome measures and appropriate process evaluation are required.


Asunto(s)
Dieta , Ejercicio Físico , Promoción de la Salud , Enfermeras y Enfermeros , Dieta/métodos , Promoción de la Salud/métodos , Humanos
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