To Plan or Not to Plan? Experiences and Challenges of Older Swiss Adults Facing End-of-Life Decisions.

End-of-life (EoL) planning and the drafting of advance care directives (ACD) are challenging for older adults. As part of a mixed study, the content of 18 semi-structured interviews with Swiss community-dwelling older adults was analyzed to investigate contextual and interactional aspects that might influence their choice to complete ACD. Results show that EoL planning vary greatly. Three types of planners were highlighted: the solo planners, the collaborative planners, and the delegators. Each represents a specific way of conceiving autonomy, the usefulness of ACD and of involving third parties in the decision-making process. Whereas for solo planners, ACD is a personal, rational affair, for collaborative planners and delegators, reflection and decisions on EoL issues are interactional and iterative processes. The results suggest that health and social care professionals would benefit from taking into consideration the various types of planning, in order to provide the best support to older adults for ACD completion.

A Battle of Words: "Dignity" and "Peace" in the Writings of Elisabeth Kübler-Ross.

This article analyzes the writings of Elisabeth Kübler-Ross through the discursive lens of the phrase "dying with dignity." For her, the phrase meant allowing someone to die comfortably his/her own death. This phrase has to be understood in relationship with the final "stage of acceptance" of her model. Describing this key part of her well-known scientific output, she often used, in the early 1970s, the phrase "dying in peace and dignity." An evaluation of the evidence suggests that because the concept of dignity was co-opted by the pro-euthanasia movement during this decade, the language of dignity was little by little abandoned by her. In later years, only "peace" survived from her favorite expression. Although this concept of peace remains present to the end in all Kübler-Ross writings, the pro-euthanasia movement has also started to speak the language of peace.

Higher intakes of energy and grain products at 4 years of age are associated with being overweight at 6 years of age.

This study examined dietary factors associated with overweight in a population-based sample of 6-y-old children. Analyses of data from the Québec Longitudinal Study of Child Development (QLSCD) included a representative sample (n = 1014) of children born in 1998 in the province of Québec, Canada. Dietary intake was measured by using a 24-h dietary recall administered at 4 y of age. Weight and height were measured using a standard protocol at 6 y. Using logistic regression, higher daily energy intake at 4 y was significantly related to overweight at 6 y. After adjustment for confounding and overweight at 4 y, the relationship remained significant among girls (P = 0.04) but became marginally significant among boys (P = 0.07). Additionally, boys who consumed ≥5 servings of grain products/d at 4 y were more likely to be overweight at 6 y compared to those who did not [adjusted OR = 3.20 (95% CI): 1.72-5.97]. The association attenuated somewhat after adjustment for overweight at 4 y [OR = 1.82 (95% CI): 0.894-3.71; P = 0.09]. The findings provide support for the revisions made in the Canadian dietary guidelines for young children, which now recommend 4-7 servings of grain products daily for children aged 4-8 y rather than the excessive 5-12 servings of previous recommendations.

Demographic and socio-economic factors related to food intake and adherence to nutritional recommendations in a cohort of pre-school children.

OBJECTIVE: To examine: (i) children's food intake and adherence to both Canada's Food Guide for Healthy Eating and Dietary Reference Intakes; and (ii) the social and demographic factors related to children's food intake. DESIGN: A cross-sectional study. SETTING: Data were obtained through the Quebec Longitudinal Study of Child Development 1998-2010, a representative sample (n 2103) of children born in 1998 in the province of Quebec, Canada. Information on energy, macronutrient and food consumption was derived from responses to a 24 h dietary recall interview addressed to children's mothers and day-care staff when the children were 4 years old. SUBJECTS: A total of 1549 children aged 4 years who participated in a nutritional sub-study. RESULTS: The mean daily total energy intake was 6360 kJ (1520 kcal) for girls and 6916 kJ (1653 kcal) for boys. For boys and girls alike, energy intake was comprised of approximately 54 % carbohydrates, 31 % fats and 15 % proteins. The mean number of servings consumed from each of the four essential food groups closely approached the dietary recommendations made by Canada's Food Guide for Healthy Eating; however, <2 % of the children in the present study actually met the full dietary guidelines. The dietary intake of pre-school children was associated with socio-economic and demographic factors, most notably mother's level of education, mother's immigrant status and sex of the child. CONCLUSIONS: Diet-related disparities associated with socio-economic and demographic factors exist from as early as 4 years of age.

Household food insecurity and childhood overweight in Jamaica and Québec: a gender-based analysis.

BACKGROUND: Childhood overweight is not restricted to developed countries: a number of lower- and middle-income countries are struggling with the double burden of underweight and overweight. Another public health problem that concerns both developing and, to a lesser extent, developed countries is food insecurity. This study presents a comparative gender-based analysis of the association between household food insecurity and overweight among 10-to-11-year-old children living in the Canadian province of Québec and in the country of Jamaica. METHODS: Analyses were performed using data from the 2008 round of the Québec Longitudinal Study of Child Development and the Jamaica Youth Risk and Resiliency Behaviour Survey of 2007. Cross-sectional data were obtained from 1190 10-year old children in Québec and 1674 10-11-year-old children in Jamaica. Body mass index was derived using anthropometric measurements and overweight was defined using Cole's age- and sex-specific criteria. Questionnaires were used to collect data on food insecurity. The associations were examined using chi-square tests and multivariate regression models were used to estimate odds ratios (OR) and 95% confidence intervals. RESULTS: The prevalence of overweight was 26% and 11% (p < 0.001) in the Québec and Jamaican samples, respectively. In Québec, the adjusted odds ratio for being overweight was 3.03 (95% CI: 1.8-5.0) among children living in food-insecure households, in comparison to children living in food-secure households. Furthermore, girls who lived in food-insecure households had odds of 4.99 (95% CI: 2.4-10.5) for being overweight in comparison to girls who lived in food-secure households; no such differences were observed among boys. In Jamaica, children who lived in food-insecure households had significantly lower odds (OR 0.65, 95% CI: 0.4-0.9) for being overweight in comparison to children living in food-secure households. No gender differences were observed in the relationship between food-insecurity and overweight/obesity among Jamaican children. CONCLUSIONS: Public health interventions which aim to stem the epidemic of overweight/obesity should consider gender differences and other family factors associated with overweight/obesity in both developed and developing countries.

Parental overweight/obesity, social factors, and child overweight/obesity at 7 years of age.

BACKGROUND: This study used gender-based analyses to examine whether child overweight/obesity is related to parental overweight/obesity and sociodemographic factors, in a representative population-based cohort of 7-year-old children. METHODS: Data from the Québec Longitudinal Study of Child Development 1998-2010 was used. Children (n= 1336) were randomly selected from each public health region of Québec. The study was based on face-to-face interviews and a set of questionnaires addressed to mothers and fathers. RESULTS: Compared to children with no overweight/obese parent, the adjusted odds ratio (OR) of being overweight/obese with two overweight/obese parents was 5 for boys (95% confidence interval [CI]: 2.31-10.85) and 5.87 for girls (95%CI: 2.63-13.12). Gender differences appeared when one parent was overweight/obese. For girls, having either an overweight/obese mother (OR, 3.10; 95%CI: 1.14-8.38) or father (OR, 3.64; 95%CI: 1.68-7.91) significantly increased the odds of being overweight/obese at 7 years. For boys, however, having only an overweight/obese father (OR, 2.05; 95%CI: 1.01-4.16) was related to overweight/obesity, but having only an overweight/obese mother was not related to overweight/obesity at 7 years for boys. In girls, but not in boys, having an immigrant mother also significantly related to overweight/obesity (OR, 2.71; 95%CI: 1.28-5.75) at 7 years, after controlling for other social factors. CONCLUSIONS: Gender differences in socialization may explain why at 7 years of age, girls' bodyweight is influenced by having even one overweight/obese parent (mother or father), while boys' bodyweight appears to be influenced only by father's overweight/obesity when only one parent is overweight/obese.

Arguments at mealtime and child energy intake.

OBJECTIVE: To examine how arguments at mealtimes relate to children's daily energy intake. DESIGN: A cross-sectional study using data obtained through the Québec Longitudinal Study of Child Development 1998-2010 (QLSCD), a representative sample of children born in 1998, in the province of Québec, Canada. SETTING: Face-to-face interviews, questionnaires, and 24-hour dietary recall interviews addressed to children's parents. PARTICIPANTS: One thousand five hundred forty-nine 4-year-old children who participated in a nutrition substudy. MAIN OUTCOME MEASURE: Children's energy intakes were measured through a 24-hour dietary recall interview administered to parents by trained nutritionists, in the children's homes. ANALYSIS: The main associations were examined through chi-square tests of independence and through multivariate logistic regression analyses. RESULTS: The adjusted odds for consuming a high daily energy intake was 2.5 (95% confidence interval: 1.3-4.9) in children who were never exposed to arguments (between parents and children) at mealtimes, in comparison to children who were often or always exposed to arguments. CONCLUSIONS AND IMPLICATIONS: Mealtimes that are free of arguments, specifically between parents and children, appear to associate with high daily energy intakes in children, even after controlling for other factors, including a child's level of physical activity, eating in front of the television, mother's educational level, and number of overweight parents, among others.