Strategies to Promote Healthy Eating Among University Students: A Qualitative Study Using the Nominal Group Technique.

INTRODUCTION: The years spent at university are critical in terms of altering people's dietary patterns. This study aimed to: (1) understand the main dietary changes that students experience after starting university; (2) determine the personal and objective factors that hinder healthy eating, and (3) define possible strategies to facilitate healthier diets among university students. METHODS: The nominal group technique (NGT) was used to elicit ideas from 39 students from the University of Parma, Italy. The sample comprised 16 freshmen and 23 non-freshmen. Participants prioritized and weighed their top five ideas regarding dietary changes, barriers to healthy eating, and possible strategies to maintain a healthy diet. A thematic analysis was conducted to compare the priorities across groups. RESULTS: Forty-three themes were elected as the most significant changes related to diet, 39 themes related to personal barriers, 43 themes related to objective barriers, and 55 themes related to strategies. A lack of time for cooking, low financial availability, consumption of unvaried food or junk food, and gaining knowledge about food were identified as the main changes. Personal barriers to eating healthy were intrinsic (i.e., lack of willpower, personal gluttony, and little effort in cooking preparation), poor dietary information, and a busy lifestyle. Market and financial factors (i.e., the high price of healthy products and low financial availability), as well as social factors (i.e., the negative influence of social networks, childhood food education, and origin/tradition), emerged as objective barriers. Possible strategies that could encourage students to adopt a healthy diet include varying the food products offered in university canteens, including organizing spaces where students who prepare meals from home can warm up and eat their food. Student discounts at supermarkets and information on nutrition and a healthy diet were also identified as important ways of supporting students. CONCLUSION AND IMPLICATION FOR PRACTICE: In order to make students part of the solution, the NGT provided them with the opportunity to equally contribute their ideas and opinions about having a healthy diet in a university context. This could potentially lead to tailor-made solutions for policymakers, educators, and foodservice providers in promoting healthy eating habits.

Prospective cohort study of early biosignatures of response to lithium in bipolar-I-disorders: overview of the H2020-funded R-LiNK initiative.

BACKGROUND: Lithium is recommended as a first line treatment for bipolar disorders. However, only 30% of patients show an optimal outcome and variability in lithium response and tolerability is poorly understood. It remains difficult for clinicians to reliably predict which patients will benefit without recourse to a lengthy treatment trial. Greater precision in the early identification of individuals who are likely to respond to lithium is a significant unmet clinical need. STRUCTURE: The H2020-funded Response to Lithium Network (R-LiNK; http://www.r-link.eu.com/ ) will undertake a prospective cohort study of over 300 individuals with bipolar-I-disorder who have agreed to commence a trial of lithium treatment following a recommendation by their treating clinician. The study aims to examine the early prediction of lithium response, non-response and tolerability by combining systematic clinical syndrome subtyping with examination of multi-modal biomarkers (or biosignatures), including omics, neuroimaging, and actigraphy, etc. Individuals will be followed up for 24 months and an independent panel will assess and classify each participants' response to lithium according to predefined criteria that consider evidence of relapse, recurrence, remission, changes in illness activity or treatment failure (e.g. stopping lithium; new prescriptions of other mood stabilizers) and exposure to lithium. Novel elements of this study include the recruitment of a large, multinational, clinically representative sample specifically for the purpose of studying candidate biomarkers and biosignatures; the application of lithium-7 magnetic resonance imaging to explore the distribution of lithium in the brain; development of a digital phenotype (using actigraphy and ecological momentary assessment) to monitor daily variability in symptoms; and economic modelling of the cost-effectiveness of introducing biomarker tests for the customisation of lithium treatment into clinical practice. Also, study participants with sub-optimal medication adherence will be offered brief interventions (which can be delivered via a clinician or smartphone app) to enhance treatment engagement and to minimize confounding of lithium non-response with non-adherence. CONCLUSIONS: The paper outlines the rationale, design and methodology of the first study being undertaken by the newly established R-LiNK collaboration and describes how the project may help to refine the clinical response phenotype and could translate into the personalization of lithium treatment.

The Ecuadorian Spanish version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR).

The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the Ecuadorian Spanish language. The reading comprehension of the questionnaire was tested in 10 JIA parents and patients. Each participating centre was asked to collect demographic, clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the 3 Likert assumptions, floor/ceiling effects, internal consistency, Cronbach's alpha, interscale correlations, test-retest reliability, and construct validity (convergent and discriminant validity). A total of 23 JIA patients (17.4% systemic, 17.4% RF negative poly-arthritis, 17.4% RF positive poly-arthritis, and 47.8% other categories) and 23 healthy children were enrolled in the paediatric centre of Guayaquil. The JAMAR components discriminated well healthy subjects from JIA patients. Notably, there is no significant difference between the healthy subjects and their affected peers in the school-related problems variable. All JAMAR components revealed good psychometric performances. In conclusion, the Ecuadorian Spanish version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and clinical research.

Urinary incontinence in adults: nurses' beliefs, education and role in continence promotion. A narrative review.

INTRODUCTION: Urinary incontinence (UI) has a high prevalence worldwide, in both genders; the available data suggest that the number of incontinent people will dramatically increase in the next few years. The costs generated by UI are similar to those induced by HIV and breast cancer. We aimed to investigate nurses' beliefs, knowledge and educational situation in the field of urinary continence. METHODS: We performed a narrative review of literature, by searching qualitative and qualitative studies (2006-11) in PubMed, CINAHL and the Cochrane Library. Papers investigating pharmacological and/or surgical intervention were excluded. Only studies referred to adults have been taken into consideration. RESULTS: Prevalence ranges from 25 to 45% in women; in men, post-prostatectomy UI occurs in a median of 10-15% of the total cases. Benign prostatic hyperplasia, which affects 50% of men aged 50 to 60, is often associated with urge incontinence. The yearly individual expense for pads in Italy has been estimated to be as high as 913 euros in 2004. People often do not know about the possible solutions to UI; nurses seem to lack education in continence promotion, notwithstanding the proven effectiveness of the conservative interventions they could perform in autonomy. In Italy, few academic programs offer nursing education in this field. CONCLUSIONS: Urinary incontinence seems to be an underestimated problem; nurses often lack proper education in continence promotion. Academic, structured courses would be a solution; however, since education itself is not sufficient to really improve clinical practice, organizational support would be required to effectively promote continence in the broadest possible population. This would be a long-term investment for both quality of care and costs. Further studies are needed, regarding conservative management of UI; research could lead to a strong integration between clinical and academic branches of nursing, resulting in good quality evidence for clinical practice.