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1.
Phys Chem Chem Phys ; 22(19): 10911-10916, 2020 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-32373834

RESUMO

The properties of pairs of doubly charged solute ions are studied as a function of their separation in the ionic liquid, dimethylimidazolium chloride ([dmim][Cl]). Free energy (potential of mean force) profiles show that, as for singly charged ions, there is a barrier to oppositely charged ion pairs forming a contact ion pair. However for doubly charged ions this barrier is about twice as large (45 ± 10 kJ mol-1 rather than 20 ± 5 kJ mol-1). Contact ion pairs form when the short range repulsive force balances the direct interaction plus the screening force, and hence depend on the sizes of the solute ions. In order to understand the existence of the barrier and the extent of screening, local charge density distributions and various contributions to the energetics were examined. The barrier arises when the decrease in stabilisation of individual ions by their own solvation shells is balanced by the increase in other screening effects and the direct solute-solute interaction.

2.
Artigo em Inglês | MEDLINE | ID: mdl-32354133

RESUMO

The STOEMP network is, to our knowledge, one of the first initiatives to bring different sectors together in a municipality so as to increase accessibility to healthy and sustainable foods for all, with particular attention for the disadvantaged population. This qualitative study aimed to gain an in-depth insight into how the STOEMP network aims to reach its goal of making healthy, sustainable food available to everyone, through an intersectoral, collaborative process, exploring the facilitators and challenges of taking a systems-oriented approach to achieving this. Interviews were conducted among 15 stakeholders of the STOEMP network between March-July 2019 in Ghent (Belgium). Factors that facilitated the development and work of the network are reported, including having an external, neutral process manager, shared values, multisector engagement, enthusiasm, resources, and sense of ownership, as well as the barriers that were faced, such as time issues, uncertainty regarding continuation and funding, and discrepancy in visions. These issues reflect the strengths and challenges of taking a systems approach that aims to formulate solutions to widening access to healthy and sustainable foods. STOEMP would like to influence policy and thereby strengthen its impact, but needs further discussions to collectively formulate exact needs.

3.
BMC Health Serv Res ; 20(1): 307, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32293424

RESUMO

BACKGROUND: The National Health Service diabetes prevention programme in England, (NHS DPP) aims to identify people at high risk of type 2 diabetes (T2D) and offer them a face-to-face, group-based, behaviour change intervention for at least 9 months. The NHS DPP was rolled out in phases. We aimed to elicit stakeholders' perceptions and experiences of the factors influencing implementation of, and participation in, the programme during the development phase. METHODS: Individual, semi-structured telephone interviews were conducted with 50 purposively sampled stakeholders: service users (n = 20); programme commissioners (n = 7); referrers (n = 8); and intervention deliverers (n = 15). Topic guides were structured using a pragmatic, theory-informed approach. Analysis employed the framework method. RESULTS: We identified factors that influenced participation: Risk communication at referral - stakeholders identified point of referral as a window of opportunity to offer brief advice, to provide an understanding of T2D risk and information about the programme; Perceived impact of the NHS DPP - service users highlighted the positive perceived impact on their behaviour change, the peer support provided by participating in the programme, the option to involve a relative, and the 'knock on' effect on others. Service users also voiced disappointment when blood test results still identified them at high risk after the programme; and Behavioural maintenance - participants highlighted the challenges linked to behavioural maintenance (e.g. discontinuation of active support). Factors influencing implementations were also identified: Case finding - stakeholders suggested that using community involvement to identify service users could increase reach and ensure that the workload was not solely on GP practices; Adaptability: intervention deliverers acknowledged the need to tailor advice to service users' preferences and needs; Accountability - the need to acknowledge who was responsible for what at different stages of the NHS DPP pathway; and Fidelity - stakeholders described procedures involved in monitoring service users' satisfaction, outcome data collection and quality assurance assessments. CONCLUSIONS: The NHS DPP offers an evidence-informed behavioural intervention for T2D prevention. Better risk communication specification could ensure consistency at the referral stage and improve participation in the NHS DPP intervention. Cultural adaptations and outreach strategies could ensure the NHS DPP contributes to reducing health inequalities.

4.
Artigo em Inglês | MEDLINE | ID: mdl-32325854

RESUMO

The opening up of green spaces could provide significant benefits to society. This study develops a framework to assess the economic benefits and costs of public interventions providing citizen access to urban green spaces. The Thinking Fadura project in Getxo (Spain) was used as a case study. A method for participatory benefit-cost analysis is developed, where a stakeholder-participatory evaluation is combined with a standard cost-benefit analysis. The participatory evaluation followed a bottom-up approach in a sequential evaluation including three main focal points: key stakeholders and experts, visitors and the general public. The assessment demonstrates that the Thinking Fadura project's benefits outweigh the costs. The results suggest that projects designed with the purpose of improving green space accessibility to the general public can be beneficial from a societal perspective. The highest economic benefits were an increase in the amenity and recreational value and an increase in people's physical activity. The participatory evaluation indicates that giving access to people of lower socio-economic status and vulnerable groups and improving recreational use were perceived as the most beneficial. An increase in noise, dirt, and risk of criminal activities as well as potential conflicts between green space users were perceived as the most negative impacts of opening a previously restricted area to the general public. The economic assessment of Thinking Fadura project could serve as a model in the decision-making process in locations where the use of greenspaces is restricted.

5.
Artigo em Inglês | MEDLINE | ID: mdl-31835473

RESUMO

Green space areas offer several benefits that support our physical, psychological, and social health. However, the level of engagement with green space areas may not be the same across population groups. Using a mixed-method research design, we investigated the use of a green space area and whether and how the area was beneficial for health, social inclusion, and physical activity for all socioeconomic groups in a suburban area in Norway. The study showed significantly increased use of the area from 2015-2018 and that users belonged to different socioeconomic groups. The motivation for using the area was the opportunity to experience nature and to interact socially. While no significant changes in self-rated health, life satisfaction, or levels of physical activity were found, the study indicates that factors such as location, availability, and designated places for social interaction are important motivating factors for use. Users from the lower socioeconomic groups were among the frequent users but were also the least satisfied with the quality and availability of the path. Our findings call for closer consideration of the location and availability of green spaces and that including places for social interaction and relaxation can contribute to increased use of green spaces.


Assuntos
Planejamento Ambiental , Características de Residência , Fatores Socioeconômicos , Adulto , Exercício Físico , Feminino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Noruega , Satisfação Pessoal , Relaxamento , Inquéritos e Questionários
6.
BMJ Open ; 9(12): e029930, 2019 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-31874867

RESUMO

OBJECTIVES: To synthesise the findings of qualitative research exploring parents' experiences, views and decisions about becoming pregnant following a perinatal death or fetal loss. DESIGN: Systematic review and meta-synthesis of qualitative research. DATA SOURCES: Medline, Web of Science, CINAHL, PsycINFO, ASSIA, Embase, PUBMED, Scopus and Google Scholar. ELIGIBILITY CRITERIA: Nine electronic databases were searched using predefined search terms. Articles published in English, in peer-reviewed journals, using qualitative methods to explore the experiences and attitudes of bereaved parents following perinatal or fetal loss, were included. DATA EXTRACTION AND SYNTHESIS: Qualitative data relating to first-order and second-order constructs were extracted and synthesised across studies using a thematic analysis. RESULTS: 15 studies were included. Four descriptive themes and 10 subthemes were identified. The descriptive themes were: deciding about subsequent pregnancy, diversity of reactions to the event, social network influences, and planning or timing of subsequent pregnancy. The decision to become pregnant after death is complex and varies between individuals and sometimes within couples. Decisions are often made quickly, in the immediate aftermath of a pregnancy loss, but may evolve over time. Bereaved parents may feel isolated from social networks. CONCLUSIONS: There is an opportunity to support parents to prepare for a pregnancy after a fetal or perinatal loss, and conversations may be welcomed at an early stage. Health professionals may play an important role providing support lacking from usual social networks. PROSPERO REGISTRATION NUMBER: CRD42018112839.

7.
Artigo em Inglês | MEDLINE | ID: mdl-31842456

RESUMO

PROVE is a Portuguese program that empowers small-scale farmers organized into local networks to directly commercialize baskets of locally produced fruits and vegetables to consumers. This study applied a post-test-only non-equivalent group design to evaluate the resulting influence on the social empowerment of farmers and on consumer diets. The method included conducting a survey of PROVE farmers (n = 36) and a survey of PROVE consumers (n = 294) that were compared against matched samples of Portuguese respondents of international surveys (European Social Survey, n = 36 and the INHERIT Five-Country Survey, n = 571, respectively). PROVE farmers reported higher scores for perceived influence on the work environment than the national sample. PROVE consumers were more likely to eat five or more portions of fruits and vegetables a day in comparison to the matched sample of Portuguese citizens (average odds ratio: 3.05, p < 0.05). Being a PROVE consumer also generated an impact on the likelihood of consuming no more than two portions of red meat a week (average odds ratio: 1.56, p < 0.05). The evaluation study suggests that the promotion of short supply chains of fruits and vegetables can make a positive contribution to a healthier, more sustainable, and fairer future in food consumption.


Assuntos
Abastecimento de Alimentos , Frutas , Equidade em Saúde , Promoção da Saúde/métodos , Verduras , Adolescente , Adulto , Dieta , Fazendeiros , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Portugal , Inquéritos e Questionários , Adulto Jovem
8.
Artigo em Inglês | MEDLINE | ID: mdl-31717956

RESUMO

Urbanization, costs of green space maintenance, and diminishing connection between people and nature all exert pressures on urban green space. This is regrettable as green space has the potential to create wins for environmental sustainability, health, and health equity. This paper explores this potential triple win and investigates how to increase the use of urban green space through behavior change. A narrative literature review was conducted and was supplemented with literature suggested by experts. Results show that creating well-designed green spaces and stimulating people to use them can indeed deliver this triple win. Providing accessible, attractive, well-maintained green space with room for socialization, and where people feel safe, may increase the opportunity and motivation of people to use it more often. Informing and educating people and organizing activities may increase capability (and motivation) to use green space. Since the use of green space depends on life stage, lifestyle factors and individual values, it is important to involve potential users in its design. We recommend a specific focus on those groups who may benefit most from the use of green space. More evaluation is needed to inform effective green space interventions and to assess related economic, social, and environmental benefits.


Assuntos
Terapia Comportamental , Conservação dos Recursos Naturais , Equidade em Saúde , Urbanização , Humanos , Saúde da População Urbana
9.
Artigo em Inglês | MEDLINE | ID: mdl-31698796

RESUMO

Combined diet and physical activity school-based interventions (rather than only diet or physical activity interventions) are more likely to help prevent children from becoming overweight in the long term. However, such interventions are less prevalent, and therefore, this pilot study aimed to assess the feasibility of a gardening intervention coupled with awareness about plant-based meals among 9-10 year old children in a London primary school. We recruited 60 children from two Year 5 classes, one class participated as an intervention group, and results were compared against another class who acted as the control group. Children's physical activity (PA) was measured using GENEActiv wrist-worn accelerometers. Their fruit and vegetable intake and attitudes to and preferences in eating fruits and vegetables were measured using a self-report questionnaire. Furthermore, three focus groups were held with children in the intervention group to understand the reasons behind any change as a result of the intervention. Results are inconclusive; however, they indicate some impact on reduction of sedentary behaviour, increase of moderate to vigorous PA, knowledge of nutrition and some level of acceptance in trying new vegetables. School-based interventions involving gardening show some promise to increase children's PA and improve their attitudes to eating fruits and vegetables.


Assuntos
Atitude Frente a Saúde , Dieta Saudável/psicologia , Exercício Físico/psicologia , Estilo de Vida Saudável , Serviços de Saúde Escolar/organização & administração , Estudantes/psicologia , Criança , Feminino , Humanos , Londres , Masculino , Projetos Piloto , Inquéritos e Questionários
10.
Artigo em Inglês | MEDLINE | ID: mdl-31744247

RESUMO

The world's challenges of climate change, damage to ecosystems, and social and health inequalities require changes in human behaviours at every level of organisation, among governments, business, communities, and individuals. An important question is how behaviour change can be enabled and supported at the scale and speed required. The research reported in this paper describes important lessons for good practice in changing contexts to modify behaviours for a triple win for health, equity and environmental sustainability. Authors synthesised learning from qualitative, quantitative and cost benefit evaluations of 15 case studies conducted in 12 countries in Europe. The case studies address ways of living (green spaces and energy efficient housing), moving (active transport) and consuming (healthy and sustainable diets) that support the triple win. Ten lessons for good practice were identified. These include bringing a triple win mindset to policy and practice in planning interventions, with potential to improve environmental sustainability, health and equity at the same time. The lessons for good practice are intended to support governmental and non-governmental actors, practitioners and researchers planning to work across sectors to achieve mutual benefits for health and environmental sustainability and in particular to benefit poorer and more socio-economically disadvantaged groups.


Assuntos
Mudança Climática , Ecossistema , Equidade em Saúde/economia , Nível de Saúde , Habitação/economia , Fatores Socioeconômicos , Europa (Continente) , Humanos
11.
BMC Health Serv Res ; 19(1): 297, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31072363

RESUMO

BACKGROUND: Smoking in pregnancy causes harm to mother and baby. Despite evidence from trials of what helps women quit, implementation in the real world has been hard to achieve. An evidence-based intervention, babyClear©, involving staff training, universal carbon monoxide monitoring, opt-out referral to smoking cessation services, enhanced follow-up protocols and a risk perception tool was introduced across North East England. This paper presents the results of the qualitative analyses, reporting acceptability of the system changes to staff, as well as aids and hindrances to implementation and normalization of this complex intervention. METHODS: Process evaluation was used to complement an effectiveness study. Interviews with maternity and smoking cessation services staff and observations of training were undertaken. Normalization Process Theory (NPT) was used to frame the interview guides and analysis. NPT is an empirically-derived theory, developed by sociologists, that uses four concepts to understand the process of routinising new practices. RESULTS: Staff interviews took place across eight National Health Service trusts at a time of widespread restructuring in smoking cessation services. Principally interviewees worked in maternity (n = 63) and smoking cessation services (n = 35). Five main themes, identified inductively, influenced the implementation: 1) initial preparedness of the organisations; 2) staff training; 3) managing partnership working; 4) resources; 5) review and planning for sustainability. CONCLUSIONS: NPT was used to show that the babyClear© package was acceptable to staff in a range of organisations. Illustrated in Themes 1, 2 & 3, staff welcomed ways to approach pregnant women about their smoking, without damaging their professional relationship with them. Predicated on producing individual behaviour change in women, the intervention does this largely through reorganising and standardising healthcare systems that are required to implement best practice guidelines. Changing organisational systems requires belief and commitment from staff, so that they set up and maintain practical adjustments to their practice and are reflective about adapting themselves and the work context as new challenges are encountered. The ongoing challenge is to identify and maintain the elements of the intervention package which are essential for its effectiveness and how to tailor them to local circumstances and resources without compromising its core ingredients.


Assuntos
Complicações na Gravidez/prevenção & controle , Abandono do Hábito de Fumar/métodos , Inglaterra , Feminino , Recursos em Saúde/estatística & dados numéricos , Humanos , Gravidez , Gestantes , Cuidado Pré-Natal/métodos , Avaliação de Processos em Cuidados de Saúde , Encaminhamento e Consulta , Prevenção do Hábito de Fumar/métodos , Fumar Tabaco/efeitos adversos , Fumar Tabaco/prevenção & controle
13.
Int J Soc Psychiatry ; 65(2): 107-113, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30654680

RESUMO

BACKGROUND: Mental health can help explain how social inequalities impact on health. Many current public health challenges are shaped by social, economic and environmental conditions that take a mental toll on society. PURPOSE: This article describes a conceptual framework illustrating the psychosocial pathways that link the wider conditions to health behaviours and outcomes. It draws out implications of this framework for mental health practice that aim to support policy and decision-making on future action to reduce health inequalities and presents practical examples of what can be done. METHODS: This article expands on a report commissioned by Public Health England. A narrative review and synthesis of relevant evidence built on existing research by the Institute of Health Equity. A conceptual framework was developed and a consultation exercise with stakeholders helped to revise and illustrate it with practice examples. CONCLUSIONS: The field of mental health has much to contribute to prevention, not just of mental illness but also of physical health conditions and reduction of inequalities in life expectancy and healthy life expectancy, especially through collaborative public health action.


Assuntos
Disparidades nos Níveis de Saúde , Transtornos Mentais/prevenção & controle , Saúde Mental , Administração em Saúde Pública/tendências , Medicina Estatal/organização & administração , Comportamento Cooperativo , Inglaterra , Humanos , Modelos Psicológicos , Pesquisa Qualitativa , Determinantes Sociais da Saúde , Medicina Estatal/tendências
14.
PLoS One ; 13(12): e0208441, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30586426

RESUMO

BACKGROUND: Disability rates increase with age. In 2012, Peruvian older adults (≥ 65 years) represented 9% of the population. Additionally, older population reported disabilities at about 5 times the rate of Peruvians between 36 and 64 years old, and 30% of older population lived in poverty. Peruvian seniors living in extreme poverty experience disabilities and the extent of their access to healthcare is unknown. OBJECTIVE: This study assesses associations between disability and access to healthcare among Peruvians older individuals living in extreme poverty. METHODS: Secondary analysis of a national representative population based survey that utilizes information from Peru's 2012 survey Health and Wellbeing in Older Adults (ESBAM), which includes older adults living in extreme poverty. We define disability in terms of the Activities of Daily Living (ADL disability) framework. Healthcare access was assessed as having any of Peru's available health insurance schemes combined with preventive health services (vision assessment, influenza vaccination, blood pressure assessment, diabetes screening, and cholesterol assessment). Poisson robust regression models were used to evaluate the associations among relevant variables. Prevalence Ratios and 95% confidence intervals (95%CI) were reported. RESULTS: Data from 3869 individuals (65 to 80 years old), of whom 1760 (45.5%) were females, were analyzed. The prevalence of ADL disability was 17.3% (95%CI: 16.0%-18.4%). In addition, more than 60% had never received any of the preventive measures evaluated, except for the blood pressure assessment. In the adjusted model, people with ADL disability had 63% less probability of having extensive insurance, compared to those without disability (p<0.05). CONCLUSIONS: This study shows that this Peruvian older population living in extreme poverty has limited access to healthcare services. Although there was no consistent association between ADL disability and the healthcare access, there is an urgent need to reduce the inequitable access to healthcare of this poor Peruvian older population.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Idoso Fragilizado/estatística & dados numéricos , Acesso aos Serviços de Saúde , Pobreza , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Peru/epidemiologia , Pobreza/estatística & dados numéricos , Prevalência
15.
Phys Chem Chem Phys ; 20(41): 26558-26569, 2018 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-30306995

RESUMO

A comparative study of the intermolecular dynamics of CS2 in monocationic and dicationic ionic liquids (ILs) was performed using optical heterodyne-detected Raman-induced Kerr effect spectroscopy (OHD-RIKES). The reduced spectral densities (RSDs) of mixtures of CS2 in 1-alkyl-3-methylimidazolium bis[(trifluoromethane)sulfonyl]amide ([CnC1im][NTf2] for n = 3-5) and 1,2n-bis(3-methylimidazolium-1-yl) alkane bis[(trifluoromethane)sulfonyl]amide ([(C1im)2C2n][NTf2]2 for n = 3-5) were investigated as a function of concentration at 295 K. An additivity model was used to obtain the CS2 contribution to the RSD of a mixture in the 0-200 cm-1 region. One of the aims of this study is to show how CS2 can be used as a probe of intermolecular/interionic interactions in ILs. The concentrations were chosen such that the CS2-to-imidazolium ring mole fraction of a mixture with [(C1im)2C2n][NTf2]2 (DIL(2n)) is the same as that of a mixture with [CnC1im][NTf2] (MIL(n)). As found previously for CS2 in monocationic ILs, the intermolecular spectrum of CS2 in dicationic ILs is lower in frequency and narrower than that of neat CS2. The new result is that the intermolecular spectrum of CS2 is higher in frequency in DIL(2n) than in the corresponding MIL(n), indicating that CS2 molecules experience a stiffer potential in dicationic ILs than in monocationic ILs. The intermolecular dynamics of CS2 being higher in frequency in DIL(2n) than in MIL(n) is consistent with recent molecular dynamics simulations (Lynden-Bell and Quitevis, J. Chem. Phys., 2018, 148, 193844) that show the stiffer potential is the result of greater confinement of CS2 in DIL(2n) than in MIL(n). We also show in this study how effects due to dilution and the intermolecular potential seen by a solute molecule in solution are unraveled.

16.
Diabetes Res Clin Pract ; 146: 58-66, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30287228

RESUMO

AIMS: To describe national implementation of gestational diabetes (GDM) risk-factor based screening guidelines, and barriers to implementation relating to maternal body mass index (BMI). METHODS: National online survey of NHS Trusts offering maternity services in England. A questionnaire was emailed to clinical staff involved in care of pregnant women assessing compliance with NICE guidelines for risk-factor based screening, BMI thresholds for offering OGTT and barriers to offering OGTT to women with BMI ≥ 30 kg/m2. RESULTS: Health professionals from 113 (84%) of NHS Trusts in England responded to the survey. Most Trusts (81%) offered OGTT at 26-28 weeks gestation to women with selected risk factors for GDM. However, almost 40% of Trusts were not fully compliant with NICE screening criteria for all risk factors, mainly due to not offering OGTT to women with previous GDM (25% of Trusts), BMI ≥ 30 kg/m2 or ethnic minority groups (22% of Trusts). The main barriers to compliance with the BMI threshold were lack of capacity, resource and funding given the high prevalence of maternal obesity. Forty one percent of Trusts used diagnostic thresholds for GDM which differed from NICE recommendations. CONCLUSIONS: Additional resources are required for NHS Trusts to fully implement and sustain risk-factor screening, especially for women with previous GDM, BMI ≥ 30 kg/m2 and ethnic minority groups.


Assuntos
Diabetes Gestacional/epidemiologia , Teste de Tolerância a Glucose/métodos , Programas de Rastreamento/métodos , Adulto , Inglaterra , Feminino , Maternidades , Humanos , Gravidez , Fatores de Risco , Inquéritos e Questionários
17.
Nutrients ; 10(8)2018 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-30061547

RESUMO

: Obesity in pregnancy may negatively influence maternal and infant iron status. The aim of this study was to examine the association of obesity with inflammatory and iron status in both mother and infant in two prospective studies in pregnancy: UPBEAT and SCOPE. Maternal blood samples from obese (n = 245, BMI ≥ 30 kg/m²) and normal weight (n = 245, BMI < 25 kg/m²) age matched pregnant women collected at approximately 15 weeks' gestation, and umbilical cord blood samples collected at delivery, were analysed for a range of inflammatory and iron status biomarkers. Concentrations of C- reactive protein and Interleukin-6 in obese women compared to normal weight women were indicative of an inflammatory response. Soluble transferrin receptor (sTfR) concentration [18.37 nmol/L (SD 5.65) vs 13.15 nmol/L (SD 2.33)] and the ratio of sTfR and serum ferritin [1.03 (SD 0.56) vs 0.69 (SD 0.23)] were significantly higher in obese women compared to normal weight women (P < 0.001). Women from ethnic minority groups (n = 64) had higher sTfR concentration compared with white women. There was no difference in maternal hepcidin between obese and normal weight women. Iron status determined by cord ferritin was not statistically different in neonates born to obese women compared with neonates born to normal weight women when adjusted for potential confounding variables. Obesity is negatively associated with markers of maternal iron status, with ethnic minority women having poorer iron statuses than white women.


Assuntos
Anemia Ferropriva/etiologia , Sangue Fetal/metabolismo , Inflamação/etiologia , Ferro/sangue , Troca Materno-Fetal , Obesidade/complicações , Complicações na Gravidez/metabolismo , Adulto , Anemia Ferropriva/sangue , Anemia Ferropriva/etnologia , Biomarcadores/sangue , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Grupos Étnicos , Feminino , Ferritinas/sangue , Hepcidinas/sangue , Humanos , Recém-Nascido , Inflamação/sangue , Interleucina-6/sangue , Ferro/deficiência , Masculino , Mães , Estado Nutricional , Obesidade/sangue , Gravidez , Estudos Prospectivos , Receptores da Transferrina/sangue
18.
Artigo em Inglês | MEDLINE | ID: mdl-29986493

RESUMO

The need for analysis and action across the interrelated domains of human behaviors and lifestyles, environmental sustainability, health and inequality is increasingly apparent. Currently, these areas are often not considered in conjunction when developing policies or interventions, introducing the potential for suboptimal or conflicting outcomes. The INHERIT model has been developed within the EU-funded project INHERIT as a tool to guide thinking and intersectoral action towards changing the behaviors and lifestyles that play such an important role in today’s multidisciplinary challenges. The model integrates ecological public health and behavioral change models, emphasizing inequalities and those parts of the causal process that are influenced by human behaviors and lifestyles. The model was developed through web-based and live discussions with experts and policy stakeholders. To test the model’s usability, the model was applied to aspects of food consumption. This paper shows that the INHERIT model can serve as a tool to identify opportunities for change in important −food-related behaviors and lifestyles and to examine how they impact on health, health inequalities, and the environment in Europe and beyond. The INHERIT model helps clarify these interrelated domains, creating new opportunities to improve environmental health and health inequality, while taking our planetary boundaries into consideration.


Assuntos
Conservação dos Recursos Naturais , Comportamentos Relacionados com a Saúde/fisiologia , Equidade em Saúde , Promoção da Saúde/métodos , Estilo de Vida , Assistência à Saúde , Europa (Continente) , Disparidades nos Níveis de Saúde , Humanos , Saúde Pública
19.
BMC Res Notes ; 11(1): 510, 2018 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-30053828

RESUMO

OBJECTIVE: The National Health Service (NHS) in England planned a national diabetes prevention programme (NHS DPP) with phased implementation. Evidence-based guidelines and service specifications support efficient and effective translation of research into practice. We aimed to evaluate the use of a structured mapping exercise to appraise how evidence, service specification and early phase practice could inform recommendations to guide subsequent implementation of the NHS DPP. RESULTS: The mapping exercise facilitated comparison and appraisal of key components from different documentary sources (evidence-based NICE guidelines, service specification, and provider documents). Key components were categorised into (A) pathways into programmes, (B) intervention content (C) inequalities and (D) quality assurance and staff training. We identified where key components were the same (accordance), where they varied (discrepancies) and where they were lacking (discontinuities), across the documentary sources. For example there was discrepancy in intervention duration and discontinuity in intervention enrolment procedures. This mapping exercise was useful to compare the fidelity in translation of evidence-based guidance into service specification and programme documents, thus identifying where future service implementation might be improved. This method may be applicable for use with other health conditions where research evidence requires translation into real world population programmes.


Assuntos
Diabetes Mellitus/prevenção & controle , Exercício Físico , Programas Nacionais de Saúde , Inglaterra , Humanos
20.
BMC Res Notes ; 11(1): 203, 2018 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-29587868

RESUMO

OBJECTIVE: This paper highlights recruitment and retention problems identified during a pilot randomised controlled trial and process evaluation. The pilot trial aimed to evaluate the feasibility and acceptability of a web-delivered weight loss intervention for postnatal women and associated trial protocol. RESULTS: General practice database searches revealed low rates of eligible postnatal women per practice. 16 (10%) of the 168 identified women were recruited and randomised, seven to the intervention and nine to the control. 57% (4/7) of the intervention women completed 3 month follow-up measurements in comparison to 56% (5/9) in the control group. By 12 months, retention in the intervention group was 43% (3/7), with 2/7 women active on the website, in comparison to 44% (4/9) of the control group. Interview findings revealed the web as an acceptable method for delivery of the intervention, with the suggestion of an addition of a mobile application. Alternative recruitment strategies, using health visitor appointments, midwifery departments or mother and baby/toddler groups, should be explored. Greater involvement of potential users should enable better recruitment methods to be developed. Trial registration ISRCTN: ISRCTN48086713, Registered 26 October 2012.


Assuntos
Internet , Seleção de Pacientes , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Programas de Redução de Peso/métodos , Adulto , Estudos de Viabilidade , Feminino , Humanos , Sobrepeso/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Projetos Piloto , Período Pós-Parto
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