Factors associated with health-related quality of life (HRQoL): differential patterns depending on age.

PURPOSE: The aims of this study were: (1) to analyze age differences in health-related quality of life (HRQoL) between the young old (aged 65-84) and the oldest old (aged 85 and over), and (2) to investigate three types of predictors: (a) physical health [Basic Activities of Daily Living (BADL), Instrumental Activities of Daily Living, comorbidity, use of medication], (b) global cognitive ability and (c) psychosocial factors, specifically personality traits, social support and emotional functioning (positive and negative affect and life satisfaction), which may influence the HRQoL of both the young old and the oldest old. METHOD: A cross-sectional study was conducted with 257 healthy community-dwelling elderly people. HRQoL was assessed using the SF-36 Health Survey. Functional and health status, global cognitive ability and psychosocial variables were also assessed. RESULTS: Age differences were found in HRQoL, with the oldest old scoring lower for this variable. Multiple stepwise hierarchical linear regression analyses revealed that, in relation to the physical health component, use of medication, BADL and positive affect had the greatest influence among the young old (65-84), whereas among the oldest old, neuroticism and the BADL were the most influential factors. As regards the mental health component, neuroticism, use of medication and positive affect were the main predictor variables among the young old, while neuroticism and negative affect had the greatest influence among the oldest old group. CONCLUSION: The oldest old had a poorer HRQoL in both dimensions measured (physical and mental). There appear to be differences between the determinants of HRQoL for young old and oldest old adults, suggesting that these associations change with age.

Shopping for food with children: A strategy for directing their choices toward novel foods containing vegetables.

Involving children in the different steps of meal preparation has been suggested as a strategy for enhancing dietary habits in childhood. It has previously been shown that involving children in cooking can increase their willingness to taste novel foods and direct their food choices towards foods containing vegetables. The objective of the present study was to assess the effect of involving children in food purchasing on food choices, intake, liking and appetite. A between-subject experiment was conducted with 86 children (from 8 to 10 years old). Forty-three children (PURCHASE group) participated in a workshop dedicated to purchasing the necessary ingredients online for the preparation of three unfamiliar foods containing vegetables: apple and beetroot juice, zucchini tortilla sandwich and spinach cookies. Forty-three children (CONTROL group) participated instead in a creativity workshop. Afterwards, all the children were invited to choose, for an afternoon snack, between three familiar vs. unfamiliar foods: orange vs. apple and beetroot juice, potatoes vs. zucchini tortilla sandwich and chocolate vs. spinach cookie. The mean number of unfamiliar foods chosen per child was higher in the PURCHASE (0.70 ± 0.14) vs. CONTROL (0.19 ± 0.07) group (P = 0.003). The liking for 1 of the 3 unfamiliar foods was higher in the PURCHASE group (P < 0.05). We did not find any difference between the two groups in food intake estimation and in the levels of subjective appetite. This study demonstrates that involving children in purchasing food can help in directing their food choices towards unfamiliar foods containing vegetables. It highlights the importance of involving children in the different steps of meal preparation for decreasing food neophobia.

Profiles in emotional aging: does age matter?

OBJECTIVES: The aim of this research project was to define emotional profiles in elderly people and to analyze the presence of each one in different age groups (from 65 to 74, 75 to 84, 85 to 94 and 95 to 104). METHOD: The sample group comprised 257 elderly people not suffering from cognitive impairment who were independent in the Basic and Instrumental Activities of Daily Living. The following emotional variables were analyzed: positive and negative affect, life satisfaction, loneliness, and regulation strategies. RESULTS: Cluster analyses revealed three emotional profiles: 'dissatisfied' (elderly people with high levels of negative affect and loneliness who are unhappy with their lives and use problem solving to regulate their emotions), 'happy' (those with good levels of positive affect and life satisfaction, low levels of loneliness and negative affect and little use of passive strategies), and 'resilient' (those with low levels of positive and negative affect and medium levels of loneliness who are more or less satisfied with their lives and who use passive strategies to regulate their emotions). A relationship was observed between age and profile. Among the under 85s, the most common profile was 'happy', while among the over 85s, the most common profile was 'resilient.' The 'happy' profile was also observed in participants over the age of 85, although to a lesser extent. The prevalence of the 'dissatisfied' profile decreased with age. CONCLUSION: These results highlight the fact that although age seems to be a key factor in determining profile, individual differences should not be overlooked, even among the oldest old.

Involving children in cooking activities: A potential strategy for directing food choices toward novel foods containing vegetables.

Involving children in cooking has been suggested as a strategy to improve dietary habits in childhood. Interventions in schools including cooking, gardening and tasting activities have showed promising results. Several cross-sectional surveys demonstrated associations between frequency of involvement in food preparation and better diet quality. However, experimental studies confirming the beneficial effect of cooking on food choices in children are missing from the literature. The objective of the present study was to assess the effect of involving children in cooking on their willingness to taste novel foods, food intake, liking and hunger. A between-subject experiment was conducted with 137 children between 7 and 11 years old. 69 children (COOK group) participated in the preparation of three unfamiliar foods containing vegetables: apple/beetroot juice, zucchini tortilla sandwich and spinach cookies. 68 children (CONTROL group) participated, instead, in a creative workshop. Afterwards, the children were invited to choose, for an afternoon snack, between three familiar vs. unfamiliar foods: orange vs. apple/beetroot juice, potato vs. zucchini tortilla sandwich and chocolate vs. spinach cookie. The mean number of unfamiliar foods chosen per child was higher in the COOK vs. CONTROL group (P = 0.037). The overall willingness to taste the unfamiliar foods was also higher in the COOK group (P = 0.011). The liking for the whole afternoon snack (P = 0.034), for 2 of 3 unfamiliar foods and for 1 of 3 familiar foods was higher in the COOK group (P < 0.05). We did not demonstrate any difference between the two groups in overall food intake and hunger/satiety scores. This study demonstrated that involving children in cooking can increase their willingness to taste novel foods and direct food choices towards foods containing vegetables.

Age differences among older adults in the use of emotion regulation strategies. What happens among over 85s and centenarians?

OBJECTIVE: Past research on emotion regulation strategies has concluded that older adults use more passive strategies than young adults. However, we found scarce research in this field focusing on the oldest old (i.e. those aged 85 and over). The aim of this study was to analyze whether or not differences exist in the way older adults aged 85 and over (centenarians included) use emotion regulation strategies, in comparison with younger age groups (65-74 and 75-84 years old). METHOD: Participants were 257 older adults from Spain, all aged between 65 and 104. The sample was divided into four age groups: 65-74; 75-84; 85-94; and 95-104 years old. Participants completed the Strategy Questionnaire after reading each of the vignettes designed to elicit feelings of either sadness or anger. The questionnaire measures four types of regulation strategies: Passive, Express, Solve and Seek. RESULTS: The 85-94 age group and centenarians were found to use proactive (Express, Seek) and Solve strategies less in comparison with younger age groups when regulating sadness and anger. In contrast, an increased use of Passive strategies was observed in the regulation of both emotions in the 85-94 age group. Significant differences were also found between centenarians and younger age groups in the use of Passive strategies for sadness, although not for anger. CONCLUSION: Age differences were observed in the use of emotion regulation strategies, with older age groups using proactive strategies less and passive strategies more.

Diet, cognition, and Alzheimer's disease: food for thought.

INTRODUCTION: The prevention of Alzheimer's disease (AD) has become a real challenge due to its rising prevalence and the lack of an effective cure. Diet and nutrients have gained significant interest as potentially modifiable protective factors. PURPOSE: The aim of this review is to provide an updated summary of evidence related to the effect of diet and nutritional factors on the risk of AD and cognitive aging, and discuss the potential mechanisms and confounding factors involved. METHODS: A search was conducted in Medline and Web of Knowledge for epidemiological and clinical studies in the international literature from January 2000 to February 2013 using combinations of the following keywords: "Alzheimer's disease", "mild cognitive impairment", "cognitive function", "dietary factors", "omega-3", "antioxidants", "B vitamins", "dietary patterns", and "Mediterranean diet". RESULTS AND CONCLUSION: Data from observational studies point to a protective role for certain nutrients, such as omega-3 fatty acids, antioxidants or B vitamins, and dietary patterns (Mediterranean diet). However, data from randomized controlled trials do not show a consistent effect. Whether confounding factors such as age, disease stage, other dietary components, cooking processes, and other methodological issues explain the divergent results remains to be established. Moreover, if certain nutrients protect against dementia, it is as yet unknown whether they may have a general effect on brain vascular health or directly interfere with the etiopathogenesis of AD.

Integrating HIV and substance misuse services: a person-centred approach grounded in human rights.

Integrating HIV-related care with treatment for substance use disorder provides an opportunity to better meet the needs of people living with these conditions. People with substance use disorder are rendered especially vulnerable by prevailing policies, structural inequalities, and stigmatisation. In this Series paper we analyse existing literature and empirical evidence from scoping reviews on integration designs for the treatment of HIV and substance use disorder, to understand barriers to and facilitators of care integration and to map ways forward. We discuss how approaches to integration address two core gaps in current models: a failure to consider human rights when incorporating the perspectives of people living with HIV and people who use drugs, and a failure to reflect critically on structural factors that determine risk, vulnerability, health-care seeking, and health equity. We argue that successful integration requires a person-centred approach, which is grounded in human rights, treats both concerns holistically, and reconnects with underlying social, economic, and political inequalities.

Child Involvement in Choosing a Recipe, Purchasing Ingredients, and Cooking at School Increases Willingness to Try New Foods and Reduces Food Neophobia.

OBJECTIVE: To investigate the effect of involving children in their feeding process (choosing a recipe, purchasing the ingredients, and cooking) on their lunch food choice in a school environment. DESIGN: Quasi-experimental. SETTING: Two schools in Bilbao, Spain. PARTICIPANTS: A total of 202 children (aged 8-9 years) participated in the study (43% girls), with 99 in the nutrition education (NE) group and 103 in the hands-on (HO) group. INTERVENTION: Three 1-hour workshops (1 workshop/wk), different for each group: HO, cooking-related activities, and NE, healthy habits promotion through nutrition education activities. MAIN OUTCOME MEASURES: Food neophobia, diet quality, cooking self-efficacy and attitudes toward cooking, and food intake and selection of the experimental lunches. ANALYSIS: Chi-square test of independence, ANCOVA, and t tests were performed. RESULTS: Students from the HO group selected and ate more spinach/broccoli (P < 0.001 and P = 0.02, respectively) for the first lunch; and selected more spinach/broccoli (P = 0.04) for the second lunch. After the intervention, improvements were observed for spinach liking and neophobia for the HO group and cooking self-efficacy and KidMed score for both groups. CONCLUSIONS AND IMPLICATIONS: Both interventions succeeded in improving children's diet quality, but only the HO group reduced food neophobia levels. Therefore, involving children in choosing a recipe, purchasing ingredients, and cooking may promote changing eating behaviors toward healthy habits such as increasing vegetable consumption.

[The importance of involving boys and girls in food preparation]. / La importancia de involucrar a niños y niñas en la preparación de las comidas.

Child food neophobia is usually associated with a lower consumption of fruits and vegetables, and the latter, is related to a less healthy diet. Different types of programs have been conducted in order to reduce food neophobia and thus increase the intake of fruits and vegetables in childhood. Among them, sensory education programs have shown their effectiveness. On the other hand, various nutritional programs that include garden and food preparation activities are used for the same purpose. However, the heterogeneity of programs and their evaluations, make it difficult to reach firm conclusions about its effectiveness. Several experimental studies have been conducted to determine the effect of each of the stages of preparing food separately: the selection of the recipe, the purchase of food, cooking and the presentation of the plate. While the results are promising, it is necessary to realize studies in real environments to validate such experiments. An example is the EgizuSUK project, carried out at schools and that encompasses different sessions that involve children in the different stages of the preparation of new foodstuffs, and whose results, compared with a control group, seem to be in line with the experimental studies. Finally, in order to promote healthy eating in children, it is considered that programs should include elements of nutrition education, sensory education, as well as culinary skills. In addition, school setting as well as the family context should be taken into consideration as key elements in the development of such programs.

La neofobia alimentaria infantil se asocia normalmente a un menor consumo de frutas y verduras, y esto último se relaciona con una dieta menos saludable. Se han llevado a cabo diferentes tipos de programas con el objetivo de reducir la neofobia alimentaria y aumentar así la ingesta de frutas y verduras en la infancia. Entre ellos, los de educación sensorial han mostrado su eficacia. Por otro lado, los diversos programas nutricionales que incluyen actividades de huerto y preparación de alimentos se utilizan con el mismo fin. No obstante, la heterogeneidad de los programas y de sus evaluaciones dificultan llegar a conclusiones sólidas sobre su efectividad.Se han llevado a cabo diversos estudios experimentales para determinar el efecto de cada una de las etapas de la preparación de alimentos por separado: la elección de la receta, la compra de los alimentos, su cocinado y su emplatado. Si bien los resultados son prometedores, es necesario realizar estudios en entornos reales para validar dichos experimentos. Un ejemplo es el proyecto EgizuSUK, llevado a cabo en el ámbito escolar y que engloba diferentes sesiones que trabajan las etapas del proceso de alimentación y cuyos resultados, comparados con un grupo control, parecen estar en línea con los estudios experimentales.Finalmente, y con el objetivo de promover una alimentación saludable en la población infantil, se considera necesario que los programas incluyan elementos de educación nutricional y educación sensorial, así como de habilidades culinarias. Además, tener en cuenta el entorno escolar y el contexto familiar es clave para el adecuado desarrollo de dichos programas.

Defining and Estimating Healthy Aging in Spain: A Cross-sectional Study.

Purpose of the Study: Using an operational continuum of healthy aging developed by U.S. researchers, we sought to estimate the prevalence of healthy aging among older Spaniards, inform the development of a definition of healthy aging in Spain, and foster cross-national research on healthy aging. Design and Methods: The ELES pilot study is a nationwide, cross-sectional survey of community-dwelling Spaniards 50 years and older. The prevalence of healthy aging was calculated for the 65 and over population using varying definitions. To evaluate their validity, we examined the association of healthy aging with the 8 foot up & go test, quality of life scores and self-perceived health using multiple linear and logistic regression. Results: The estimated prevalence of healthy aging varied across the operational continuum, from 4.5% to 49.2%. Prevalence figures were greater for men and those aged 65 to 79 years and were higher than in the United States. Predicted mean physical performance scores were similar for 3 of the 4 definitions, suggesting that stringent definitions of healthy aging offer little advantage over a more moderate one. Implications: Similar to U.S. researchers, we recommend a definition of healthy aging that incorporates measures of functional health and limiting disease as opposed to definitions requiring the absence of all disease in studies designed to assess the effect of policy initiatives on healthy aging.

Serving the underserved: an HIV testing program for populations reluctant to attend conventional settings.

OBJECTIVES: We assess the contribution of a rapid-HIV testing program run by Médicos del Mundo and oriented to vulnerable populations reluctant to attend conventional settings. METHODS: We compare the program outcomes with a network of 20 HIV/STI clinics (EPIVIH) and the Spanish National Surveillance System (SNHSS). RESULTS: 33.3% of the new diagnoses were women (8.6% EPIVIH and 17.7% SNHSS). Transsexuals were 6.9% (1.9% EPIVIH), female sex workers 23.6% (2.0% EPIVIH) and 19.4% Sub-Saharan Africans (3.8% EPIVIH and 7.8% SNHSS). HIV prevalence in men was slightly higher than in the EPIVIH and almost twice among women. CONCLUSIONS: This program is contributing substantially to the promotion of HIV diagnosis in female sex workers, sub-Saharan Africans and transsexuals, which are less present at clinical settings.

Jejunal microvilli atrophy and reduced nutrient transport in rats with advanced liver cirrhosis: improvement by Insulin-like Growth Factor I.

BACKGROUND: Previous results have shown that in rats with non-ascitic cirrhosis there is an altered transport of sugars and amino acids associated with elongated microvilli. These alterations returned to normal with the administration of Insulin-Like Growth Factor-I (IGF-I). The aims of this study were to explore the evolution of these alterations and analyse the effect of IGF-I in rats with advanced cirrhosis and ascites. Thus, jejunal structure and nutrient transport (D-galactose, L-leucine, L-proline, L-glutamic acid and L-cystine) were studied in rats with ascitic cirrhosis. METHODS: Advanced cirrhosis was induced by CCl4 inhalation and Phenobarbital administration for 30 weeks. Cirrhotic animals were divided into two groups which received IGF-I or saline during two weeks. Control group was studied in parallel. Jejunal microvilli were studied by electron microscopy. Nutrient transport was assessed in brush border membrane vesicles using 14C or 35S-labelled subtracts in the three experimental groups. RESULTS: Intestinal active Na+-dependent transport was significantly reduced in untreated cirrhotic rats. Kinetic studies showed a decreased Vmax and a reduced affinity for sugar and four amino acids transporters (expressed as an increased Kt) in the brush border membrane vesicles from untreated cirrhotic rats as compared with controls. Both parameters were normalised in the IGF-I-treated cirrhotic group. Electron microscopy showed elongation and fusion of microvilli with degenerative membrane lesions and/or notable atrophy. CONCLUSIONS: The initial microvilli elongation reported in non ascitic cirrhosis develops into atrophy in rats with advanced cirrhosis and nutrient transports (monosaccharides and amino acids) are progressively reduced. Both morphological and functional alterations improved significantly with low doses of IGF-I.

A randomized, two-year study of the efficacy of cognitive intervention on elderly people: the Donostia Longitudinal Study.

BACKGROUND: Research on non-pharmacological therapies (cognitive rehabilitation) in old age has been very limited, and most has not considered the effect of interventions of this type over extended periods of time. OBJECTIVE: To investigate a new cognitive therapy in a randomized study with elderly people who did not suffer cognitive impairment. METHODS: The efficacy of this therapy was evaluated by means of post-hoc analysis of 238 people using biomedical, cognitive, behavioural, quality of life (QoL), subjective memory, and affective assessments. RESULTS: Scores for learning potential and different types of memory (working memory, immediate memory, logic memory) for the treatment group improved significantly relative to the untreated controls. CONCLUSIONS: The most significant finding in this study was that learning potential continued at enhanced levels in trained subjects over an intervention period lasting two years, thereby increasing rehabilitation potential and contributing to successful ageing.

Effect of insulin-like growth factor-I on nitrogen balance and intestinal galactose transport in rats with moderate liver cirrhosis.

The malnutrition caused by liver cirrhosis (LC) often worsens the course of the disease. Patients affected by LC often have a low bioavailability of the anabolic liver peptide insulin-like growth factor (IGF)-I. The present study was undertaken to investigate the effect of low doses of IGF-I on the nutritional status and in vivo jejunal transport of D-galactose in anatomically, pathologically and biochemically confirmed moderate, non-ascitic, cirrhotic rats. LC was experimentally induced in growing rats by inhalation of CCl4 and addition of phenobarbital to drinking water. Both the nutritional status, as evaluated by N balance, and in vivo intestinal transport of D-galactose, were significantly impaired in cirrhotic rats. As compared with healthy rats, administration of 20 microg human recombinant IGF-I/kg body weight for 14 d to cirrhotic rats significantly improved N balance variables and restored in vivo intestinal transport of the sugar. However, IGF-I had no effect on the steatorrhoea associated with LC. These results suggest that low doses of IGF-I may have beneficial effects on the malnutrition associated with moderate LC.

Local (gut) and systemic metabolism of rats is altered by consumption of raw bean (Phaseolus vulgaris L var athropurpurea).

The composition of the raw legume Phaseolus vulgaris L. var. athropurpurea (PhVa) and its effects on the metabolism of young growing rats have been evaluated. The levels of protein, unsaturated fatty acids, carbohydrate, fibre and bioactive factors present in PhVa were comparable with those in other Phaseolus vulgaris varieties. However, the lectins of PhVa were predominantly of the leucoagglutinating type, and concentrated in the albumin protein fraction. Rats fed a diet (110 g total protein, 16.0 MJ/kg) in which PhVa meal provided about half of the protein excreted high levels of N in faeces and urine, and grew more slowly, than rats fed a high-quality control diet (ad libitum or pair-fed). Small intestine, large intestine and pancreas weights were increased (by almost 100 %, P<0.05), whilst skeletal muscle, thymus and spleen weights were reduced. Blood insulin (16.20 v. 0.50 mU/l, P<0.05, thyroxine, glucose, protein (60.5 v. 48.3 g/l, P<0.05) and LDL-cholesterol were lowered, whilst glucagon (155.3 v. 185.4 ng/l, P<0.05), triiodothyronine and urea were elevated, as were urinary urea, creatinine and glucose. These changes in the local (gut) and systemic metabolism of rats were probably mediated primarily by lectins in PhVa, which were concentrated in the albumin protein fraction, whereas in many other Phaseolus vulgaris lines they are distributed across the globulin and albumin fractions.