Continuous glucose monitoring in older adults with diabetes: Data from the diabetes prospective follow-up (DPV) registry.

AIMS: To analyse predictors for continuous glucose monitoring (CGM) use in people with diabetes aged ≥60 years using insulin therapy and to assess the rates of CGM use during recent years (2019-2021). RESEARCH DESIGN AND METHODS: Prospective study including 6849 individuals with diabetes and insulin therapy (type 2 diabetes: n = 5320; type 1 diabetes: n = 1529) aged ≥60 years. Data from 129 treatment centres were retrieved from the Diabetes Prospective Follow-up Registry (DPV) in March 2023. RESULTS: Sensor use in individuals aged ≥60 years has increased in type 1 (2019: 28%, 2020: 39%, 2021: 45%) and type 2 diabetes (2019: 10%, 2020: 16%, 2021: 18%). Predictors for sensor use in older individuals with type 1 diabetes are younger age and CSII use (p < 0.001). Predictors in older individuals with type 2 diabetes are younger age, longer diabetes duration, higher BMI and CSII use (p < 0.001). CONCLUSIONS: CGM has become more common in older adults with diabetes and will presumably increase further. Age is a predictor for sensor use in older adults with diabetes. Age-related physical barriers and insufficient usability of devices, lack of interest in technologies, but possibly also effects of prejudice on the grounds of age may contribute to this finding.

Good practice recommendations on implementation evaluation for policies targeting diet, physical activity, and sedentary behaviour.

Health policies aim to achieve specific health goals through system-level changes, unlike common health interventions that focus on promoting specific health behaviors on individual level. However, reliable data on the feasibility and implementation of policy actions across Europe are lacking. Moreover, no practice-oriented guidance exists for policy makers and implementers on how to evaluate policy implementation.As part of the Policy Evaluation Network, we aimed to synthesise knowledge on how to evaluate the implementation of policies promoting healthy diets, physical activity, and reducing sedentary behaviours. The multidisciplinary working group comprised 16 researchers and conducted two scoping reviews, three systematic reviews, two meta-reviews, two qualitative case studies and one quantitative case study over three years. The target populations included the general population, those at risk for obesity, and school children. Based on these reviews and case studies, this article summarises and presents the findings and lessons learned regarding the implementation evaluation of policies in nine case reports.Drawing on these experiences, three critical requirements for policy implementation evaluation were set: 1) conduct a comprehensive policy implementation evaluation from a multi-level perspective, 2) use implementation frameworks to address processes, determinants, and outcomes, and 3) engage relevant stakeholders in policy implementation evaluation. Finally, the consensus process resulted in 10 steps for the implementation evaluation of policies to promote physical activity and a healthy diet and to reduce sedentary behaviours, which adhere to the requirements and resources of the targeted policy.The findings of an implementation evaluation can lead to a better understanding of why policies work or not and can serve as a basis for developing solutions. This practice-oriented guidance outlines factors that should be considered in policy implementation evaluation to address its complexity. In this way, involved researchers and practitioners are empowered to engage in the evaluation process to close the knowledge gap regarding policy implementation.

Frameworks for implementation of policies promoting healthy nutrition and physically active lifestyle: systematic review.

BACKGROUND: Policy frameworks focusing on policy implementation may vary in terms of their scope, included constructs, relationships between the constructs, and context factors. Although multiple policy implementation frameworks exist, the overarching synthesis characterizing differences between the frameworks is missing. This study investigated frameworks guiding implementation of policies aiming at healthy nutrition, physical activity promotion, and a reduction of sedentary behavior. In particular, we aimed at examining the scope of the frameworks and the content of included constructs (e.g., referring to implementation processes, determinants, or implementation evaluation), the level at which these constructs operate (e.g., the individual level, the organizational/community level), relationships between the constructs, and the inclusion of equity factors. METHODS: A systematic review (the PROSPERO registration no. CRD42019133251) was conducted using 9 databases and 8 stakeholder websites. The content of 38 policy implementation frameworks was coded and analyzed. RESULTS: Across the frameworks, 47.4% (18 in 38) addressed three aims: description of the process, determinants, and the evaluation of implementation. The majority of frameworks (65.8%; 25 in 38) accounted for constructs from three levels: individual, organizational/community, and the system level. System-level constructs were included less often (76.3%; 29 in 38) than individual-level or organizational/community-level constructs (86.8% [33 in 38 frameworks] and 94.7% [36 in 38 frameworks] respectively). The majority of frameworks (84.2%, 32 in 38) included at least some sections that were solely of descriptive character (a list of unassociated constructs); 50.0% (19 in 38) included sections of prescriptive character (general steps of implementation); 60.5% (23 in 38) accounted for explanatory sections (assuming bi- or uni-directorial associations). The complex system approach was accounted for only in 21.1% (8 in 38) of frameworks. More than half (55.3%; 21 in 38) of frameworks did not account for any equity constructs (e.g., socioeconomic status, culture). CONCLUSIONS: The majority of policy implementation frameworks have two or three aims (combining processes, determinants and/or the evaluation of implementation), include multi-level constructs (although the system-level determinants are less frequently included than those from the individual- or organizational/community-level), combine sections of purely descriptive character with sections accounting for prescriptive and/or explanatory associations, and are likely to include a little or no equity constructs. REGISTRATION: PROSPERO, #CRD42019133251.

Social, economic, political, and geographical context that counts: meta-review of implementation determinants for policies promoting healthy diet and physical activity.

BACKGROUND: This meta-review investigated the context-related implementation determinants from seven domains (geographical, epidemiological, sociocultural, economic, ethics-related, political, and legal) that were systematically indicated as occurring during the implementation of obesity prevention policies targeting a healthy diet and a physically active lifestyle. METHODS: Data from nine databases and documentation of nine major stakeholders were searched for the purpose of this preregistered meta-review (#CRD42019133341). Context-related determinants were considered strongly supported if they were indicated in ≥60% of the reviews/stakeholder documents. The ROBIS tool and the Methodological Quality Checklist-SP were used to assess the quality-related risk of bias. RESULTS: Published reviews (k = 25) and stakeholder documents that reviewed the evidence of policy implementation (k = 17) were included. Across documents, the following six determinants from three context domains received strong support: economic resources at the macro (66.7% of analyzed documents) and meso/micro levels (71.4%); sociocultural context determinants at the meso/micro level, references to knowledge/beliefs/abilities of target groups (69.0%) and implementers (73.8%); political context determinants (interrelated policies supported in 71.4% of analyzed reviews/documents; policies within organizations, 69.0%). CONCLUSIONS: These findings indicate that sociocultural, economic, and political contexts need to be accounted for when formulating plans for the implementation of a healthy diet and physical activity/sedentary behavior policies.

Acceptability of policies targeting dietary behaviours and physical activity: a systematic review of tools and outcomes.

BACKGROUND: Successful implementation of health policies require acceptance from the public and policy-makers. This review aimed to identify tools used to assess the acceptability of policies targeting physical activity and dietary behaviour, and examine if acceptability differs depending on characteristics of the policy and of the respondents. METHODS: A systematic review (PROSPERO: CRD42021232326) was conducted using three databases (Science Direct, PubMed and Web of Science). RESULTS: Of the initial 7780 hits, we included 48 eligible studies (n = 32 on dietary behaviour, n = 11 on physical activity and n = 5 on both), using qualitative and quantitative designs (n = 25 cross-sectional, quantitative; n = 15 qualitative; n = 5 randomized controlled trials; n = 3 mixed-methods design). Acceptability was analysed through online surveys (n = 24), interviews (n = 10), focus groups (n = 10), retrospective textual analysis (n = 3) and a taste-test experiment (n = 1). Notably, only 3 (out of 48) studies applied a theoretical foundation for their assessment. Less intrusive policies such as food labels and policies in a later stage of the implementation process received higher levels of acceptability. Women, older participants and respondents who rated policies as appropriate and effective showed the highest levels of acceptability. CONCLUSION: Highly intrusive policies such as taxations or restrictions are the least accepted when first implemented, but respondents' confidence in the relevance and effectiveness of the policy may boost acceptability over the course of implementation. Studies using validated tools and a theoretical foundation are needed to further examine opportunities to increase acceptability.

Diabetes technologies in people with type 1 diabetes mellitus and disordered eating: A systematic review on continuous subcutaneous insulin infusion, continuous glucose monitoring and automated insulin delivery.

AIMS: In this systematic review, we aimed (1) to identify and describe research investigating the use of advanced diabetes technologies (continuous subcutaneous insulin infusion, CSII; continuous glucose monitoring, CGM; automated insulin delivery, AID) in people with type 1 diabetes (T1DM) and disordered eating and (2) to discuss potential (dis)advantages of diabetes technology use in this population, derived from previous research. METHODS: We conducted a systematic literature search in two electronic databases for English articles published between 2000 and 2020 addressing eating disorders and/or dysfunctional eating behaviours and diabetes technology use in children, adolescents and adults with T1DM (PROSPERO ID CRD42020160244). RESULTS: Of 70 publications initially identified, 17 were included. Overall, evidence on the use of diabetes technologies in people with T1DM and disordered eating is scarce. The majority of the studies reports findings on CSII in people with T1DM and dysfunctional eating behaviours or eating disorders. Findings predominantly stem from observational data and are, in most cases, secondary findings of the respective studies. Providing the greatest flexibility in diabetes management, CSII may have benefits in disordered eating. CGM data may complement the diagnostic process of disordered eating with a physiological indicator of insulin restriction (i.e. time spent in hyperglycaemia). CONCLUSIONS: Results on possible (dis)advantages of diabetes technology use in people with T1DM and disordered eating are based on observational data, small pilot trials and anecdotical evidence from case reports. Prospective data from larger samples are needed to reliably determine potential effects of diabetes technology on disordered eating in T1DM.

Examining five pathways on how self-control is associated with emotion regulation and affective well-being in daily life.

OBJECTIVE: Self-control is positively connected to well-being, but less is known about what, on the mechanistic level, explains this association. We hypothesized five pathways how this connection could be explained by emotion regulation, that is, by facilitating (a) strategy effectiveness, (b), adaptive strategy selection, (c) situation selection, (d) strategy variability, or (e) social sharing. METHOD: To explore these pathways, we integrated two ambulatory assessment data sets (N = 250 participants, N = 22,796 observations) that included assessments of participants' emotions and their emotion regulation efforts. RESULTS: We found that self-control was positively associated with affective well-being. Moreover, momentary but not trait self-control was associated with favoring adaptive and interpersonal strategy selection and less emotion regulation in general as well as with increased variability across strategies. However, these emotion regulation facets could not sufficiently explain the association between self-control and affective well-being. CONCLUSIONS: Our main conclusion is that emotion regulation is not a mediator of the strong relation between self-control and affective well-being. Instead, we found evidence for the affective benefits of employing ways of emotion regulation that are less taxing mentally, which we discuss in light of current knowledge about self-control and emotion regulation.

How mindfulness shapes the situational use of emotion regulation strategies in daily life.

Mindfulness is associated with a wide range of beneficial outcomes such as well-being. However, less is known about the mechanisms underlying these benefits. Some researchers suggest that the benefits could be driven by emotion regulation, either by improving the effectiveness of emotion regulation or by lessening the need for effortful emotion regulation. By using two longitudinal Ambulatory Assessment data sets (NStudy1 = 125, NStudy2 = 175), based on a six-week randomised controlled trial and a one-week study, we tested these competing notions in daily life and found support for the latter: Mindfulness, and especially its non-judgmental acceptance facet, was significantly associated with less use of emotion regulation strategies. However, mindfulness was not significantly associated with more effective emotion regulation strategy implementation. Moreover, the mindfulness training focusing on present-moment attention and awareness did not significantly influence emotion regulation. These findings demonstrate the importance of the non-judgmental acceptance component for emotion regulation and affective well-being.

A round peg in a square hole: strategy-situation fit of intra- and interpersonal emotion regulation strategies and controllability.

Although the importance of contextual factors is often recognised, research on emotion regulation strategies (ERS) has mainly focused so far on the effectiveness of ERS across situations. In the present research, we tested the strategy-situation fit hypothesis, which does not assume general effectiveness of ERS but instead stresses the importance of the congruency between ERS and the contexts in which they are used. Using a longitudinal Ambulatory Assessment dataset (N = 138), we found that controllability of a situation positively moderated the effectiveness of interpersonal ERS, such that, e.g. providing feedback to others was significantly associated with less positive feelings but only in less controllable situations. Intrapersonal ERS were negatively moderated by controllability, such that downplaying a negative situation was associated with less negative feelings in less controllable situations. Finally, favouring interpersonal over intrapersonal ERS was also positively moderated by controllability, demonstrating the situational fit of ERS in daily life.

[Interventions To Promote Resilience In Adults - A Narrative Review]. / Interventionen zur Resilienzförderung bei Erwachsenen.

Resilience refers to the phenomenon that many people maintain mental health despite exposure to psychological or physical adversity. Recent research suggests that resilience is dynamic and can be trained. Interventions to promote resilience aim at increasing well-being. The effects of such interventions have hardly been evaluated so far. This work is a narrative review of interventions to promote resilience in adults. We evaluated the results of 4 systematic reviews and meta-analyses on the topic and summarize the evidence from 44 randomized controlled trials. Overall, interventions to promote resilience achieved small to moderate effects regarding increasing resilience and improving mental health. Despite methodological shortcomings, the available evidence suggests that intervention programs to foster resilience can be effective and indicates that they could be a promising component of current preventive effort.

Music Listening and Stress in Daily Life-a Matter of Timing.

PURPOSE: Despite increasing evidence suggesting that music listening in daily life has stress-reducing effects, studies mostly rely on subjective, retrospective data on music listening. Thus, the temporal dynamics underlying the stress-reducing effect of music listening remain unclear. Therefore, we aimed to examine the temporal dynamics of the associations between stress and music listening by assessing subjective and objective data on music in daily life. DESIGN: An exploratory Ambulatory Assessment study examining a total of 60 participants (37 women), aged 18 to 34 years (M = 22.4 years, SD = 3.5) was conducted. METHODS: For 1 week, participants answered questions on music listening and stress six times per day via an electronic diary device, which additionally objectively sampled the exact time point of music listening and its duration. RESULTS: Self-reports on mere music listening were associated with lower stress reports, whereas objectively assessed data was not. However, concerning duration of music listening, both subjective and objective data on music listening showed associations between a minimum of 20 min of music listening and lower stress reports. Concerning the latency, objective data on music listening revealed that the association between stress reports and music listening occurs in a time-delayed manner. CONCLUSIONS: Although the study design does not allow for causal inferences, substantial associations among subjectively and objectively assessed data on music listening were found to differentially affect the experience of stress after music listening. In particular, when focusing on the temporal dynamics, objectively assessed data allowed for a more fine-grained analysis. In consequence, subjectively and objectively reported data on music listening should be assessed jointly when investigating effects of music listening on health. Experimental research with rigorous methodological control is required in order to corroborate our findings in a laboratory setting.

Determinants of diet and physical activity (DEDIPAC): a summary of findings.

The establishment of the Determinants of Diet and Physical Activity (DEDIPAC) Knowledge Hub, 2013-2016, was the first action taken by the 'Healthy Diet for a Healthy Life' European Joint Programming Initiative. DEDIPAC aimed to provide better insight into the determinants of diet, physical activity and sedentary behaviour across the life course, i.e. insight into the causes of the causes of important, non-communicable diseases across Europe and beyond. DEDIPAC was launched in late 2013, and delivered its final report in late 2016. In this paper we give an overview of what was achieved in terms of furthering measurement and monitoring, providing overviews of the state-of-the-art in the field, and building toolboxes for further research and practice. Additionally, we propose some of the next steps that are now required to move forward in this field, arguing in favour of 1) sustaining the Knowledge Hub and developing it into a European virtual research institute and knowledge centre for determinants of behavioural nutrition and physical activity with close links to other parts of the world; 2) establishing a cohort study of families across all regions of Europe focusing specifically on the individual and contextual determinants of major, non-communicable disease; and 3) furthering DEDIPAC's work on nutrition, physical activity, and sedentary behaviour policy evaluation and benchmarking across Europe by aligning with other international initiatives and by supporting harmonisation of pan-European surveillance.

Adaptive modes of rumination: the role of subjective anger.

Rumination has been demonstrated to have negative consequences on affect, behaviour, and physiological markers. Recent studies, however, suggest that distinct "modes" of anger-associated rumination may lead to several positive consequences. Previous research primarily used recall procedures of anger episodes to elicit anger. By contrast, the present study focused on the effect of subjective anger on the process of rumination and tested its effects in a "staged" social interaction where a confederate provoked participants. Subsequently, participants engaged in rumination about the anger-eliciting event either in an abstract-distanced or a concrete-immersed rumination mode. Results showed an adaptive effect of abstract-distanced rumination on subjective anger primarily if anger is high prior to rumination. The findings also suggest different self-reported anger-related coping strategies in response to subjective anger intensity. These findings highlight that an abstract-distanced rumination may have differential effects on affective outcomes and anger-related coping strategies.

Restrained eating predicts effortful self-control as indicated by heart rate variability during food exposure.

When confronted with food, restrained eaters have to inhibit the pursuit of the short-term goal of enjoying their food for the sake of the long-term goal of controlling their weight. Thus, restrained eating creates a self-control situation. In the present study we investigated the initiation of effortful self-control by food cues in accordance with the level of restrained eating. We expected that a preceding act of self-control would moderate the association between restrained eating and effortful self-control initiated by food cues. Participants (N=111) were randomly assigned to a task requiring self-control or a task not requiring self-control. Subsequently, participants were exposed to palatable food, and effortful self-control was measured via heart rate variability (HRV). Restrained eating was associated with enhanced HRV during food exposure after exercising self-control but not after not exercising self-control. The results indicate that maintaining dieting goals results in food cues initiating effortful self-control after a preceding act of self-control. We suggest considering the effect of acts of self-control when modeling the initial steps on the path from food cues to unsuccessful restrained eating.

Correlation between cell free DNA levels and medical evaluation of disease progression in systemic lupus erythematosus patients.

High levels of cell free DNA (cfDNA) in human blood plasma have been described in patients with autoimmune diseases. The aim of this study was to determine the levels of cfDNA in systemic lupus erythematosus (SLE) patients and to assess fluctuations of cfDNA concentrations compared to the course of disease progression under standard treatment. Therefore, nuclear cfDNA concentrations in plasma were measured in 59 SLE patients and 59 healthy controls. Follow-up blood plasma was collected from 27 of the 59 SLE patients. Patients were characterised by clinical parameters (antinuclear antibodies (ANA), anti-dsDNA-antibodies, C3, C4, and CRP), SLE disease activity index (SLEDAI) and medical therapy. Our results showed that cfDNA concentrations were significantly higher in SLE patients compared to healthy individuals. Levels of cfDNA assessed in serial samples correlated significantly with the medical evaluation of disease activity in SLE patients. Our results could implicate cfDNA as a global marker for disease activity.

Towards the integration and development of a cross-European research network and infrastructure: the DEterminants of DIet and Physical ACtivity (DEDIPAC) Knowledge Hub.

To address major societal challenges and enhance cooperation in research across Europe, the European Commission has initiated and facilitated 'joint programming'. Joint programming is a process by which Member States engage in defining, developing and implementing a common strategic research agenda, based on a shared vision of how to address major societal challenges that no Member State is capable of resolving independently. Setting up a Joint Programming Initiative (JPI) should also contribute to avoiding unnecessary overlap and repetition of research, and enable and enhance the development and use of standardised research methods, procedures and data management. The Determinants of Diet and Physical Activity (DEDIPAC) Knowledge Hub (KH) is the first act of the European JPI 'A Healthy Diet for a Healthy Life'. The objective of DEDIPAC is to contribute to improving understanding of the determinants of dietary, physical activity and sedentary behaviours. DEDIPAC KH is a multi-disciplinary consortium of 46 consortia and organisations supported by joint programming grants from 12 countries across Europe. The work is divided into three thematic areas: (I) assessment and harmonisation of methods for future research, surveillance and monitoring, and for evaluation of interventions and policies; (II) determinants of dietary, physical activity and sedentary behaviours across the life course and in vulnerable groups; and (III) evaluation and benchmarking of public health and policy interventions aimed at improving dietary, physical activity and sedentary behaviours. In the first three years, DEDIPAC KH will organise, develop, share and harmonise expertise, methods, measures, data and other infrastructure. This should further European research and improve the broad multi-disciplinary approach needed to study the interactions between multilevel determinants in influencing dietary, physical activity and sedentary behaviours. Insights will be translated into more effective interventions and policies for the promotion of healthier behaviours and more effective monitoring and evaluation of the impacts of such interventions.

Positive affect and self-control: attention to self-control demands mediates the influence of positive affect on consecutive self-control.

Positive affect (PA) can either improve or impair self-control performance, depending on whether two tasks are dissimilar, and thus require flexible releasing and switching, or similar, which requires stable maintenance. The present study suggests that this effect is mediated by attentional shifts. The authors found that participants under PA, who performed on two dissimilar tasks and had to switch to a new response dimension, were less attentive to distracting information compared to neutral affect (NE), leading to better performance. In contrast, participants under PA who did not have to switch, were more attentive to distracting information compared to participants under NE. These findings highlight the opposite effects of PA on consecutive self-control.

Positive beliefs about rumination are associated with ruminative thinking and affect in daily life: evidence for a metacognitive view on depression.

BACKGROUND: Self-regulatory executive function theory (Wells and Matthews, 1994; Wells, 2008) stresses the role of metacognitions in the development of emotional disorders. Within this metacognitive model, positive beliefs about ruminative thinking are thought to be a risk factor for engaging in rumination and subsequently for depression. However, most of the existing research relies on retrospective self-report trait measures. AIMS: The aim of the present study was to examine the theory's predictions with an Ecological Momentary Assessment approach capturing rumination as it occurs in daily life. METHOD: Non-clinical participants (N = 93) were equipped with electronic diaries and completed four signal-contingent momentary self-reports per day for 4 weeks. A multilevel mediation model was computed to examine associations between positive beliefs about rumination and ruminative thinking and negative affect in daily life. RESULTS: Positive beliefs about rumination were significantly associated with ruminative thinking as it occurs in daily life. We further found evidence for a negative association with positive affect that was completely mediated via ruminative thinking in daily life occurring in response to negative emotions. CONCLUSIONS: Our results add ecologically valid corroborating evidence for the metacognitive model of emotional disorders within the framework of self-regulatory executive function theory.

Be Kind to Yourself: the Implications of Momentary Self-Compassion for Affective Dynamics and Well-Being in Daily Life.

Objectives: While self-compassion (SC) has mostly been understood as a stable trait-like property, growing evidence suggests that it may fluctuate over time within a given individual. However, little is known on how these fluctuations relate to affective well-being and affective dynamics, such as emotional inertia and stress reactivity in daily life. Methods: A sample of 119 non-clinical individuals (mean age: 31.3 years, 53.8% female) completed a 7-day smartphone-based ecological momentary assessment study with six semi-random signals per day. With each signal, individuals reported their momentary positive affect (PA) and negative affect (NA), recent SC, and occurrence and perceived strain of daily hassles since the last signal. Results: Whenever individuals reported higher recent SC than usual, they experienced higher momentary PA and lower momentary NA. Moreover, higher recent SC related to lower stress reactivity in terms of lower decrease of PA and lower increase of NA following the experience of daily hassles. No associations between SC and emotional inertia were found. When distinguishing between the positive components (SC-Pos) and negative components (SC-Neg) of SC, SC-Neg (compared to SC-Pos) was more strongly connected to NA, while SC-Pos and SC-Neg were similarly connected to PA. SC-Pos was associated with an attenuated NA stress reactivity, and SC-Neg with an increased NA stress reactivity. SC-Pos and SC-Neg did not significantly moderate PA stress reactivity nor emotional inertia. Conclusions: Results show that the benefits of SC for well-being and stress reactivity may unfold whenever we treat ourselves with compassion, irrespective of how self-compassionate we are in general. Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-022-02050-y.