Siglang Buhay

BackgroundThe disease burden due to poor nutrition, physical inactivity and obesity is high and increasing. An adequately sized and skilled workforce is required to respond to this issue. This study describes the public health nutrition and physical activity (NAPA) practice priorities and explores health managers and practitioner’s beliefs regarding workforce capacity to deliver on these priorities.MethodsA workforce audit was conducted including a telephone survey of all managers and a postal survey of practitioners working in the area of NAPA promotion in Western Australia in 2004. Managers gave their perspective on workforce priorities, current competencies and future needs, with a 70 % response rate. Practitioners reported on public health workforce priorities, qualifications and needs, with a 56 % response rate.ResultsThe top practice priorities for managers were diabetes (35 %), alcohol and other drugs (33 %), and cardiovascular disease (27 %). Obesity (19 %), poor nutrition (15 %) and inadequate physical activity (10 %) were of lower priority. For nutrition, managers identified lack of staff (60.4 %), organisational and management factors (39.5 %) and insufficient financial resources (30.2 %) as the major barriers to adequate service delivery. For physical activity services, insufficient financial resources (41.7 %) and staffing (35.4 %) and a lack of specific physical activity service specifications (25.0 %) were the main barriers. Practitioners identified inadequate staffing as the main barrier to service delivery for nutrition (42.3 %) and physical activity (23.3 %). Ideally, managers said they required 152 % more specialist nutritionists in the workforce and 131 % specialists for physical activity services to meet health outcomes in addition to other generalist staff.ConclusionHuman and financial resources and organisational factors were the main barriers to meeting obesity, and public health nutrition and physical activity outcomes. Services were being delivered by generalists rather than specialists, which may reduce service effectiveness. Although conclusions from this research need to take into account the fact that the audit was conducted in 2004, the findings suggest that there was a need to equip health services with an adequately skilled workforce of sufficient capacity to deliver an effective public health response to the obesity epidemic, particularly addressing poor nutrition and physical inactivity.

Background and Aim: Functional constipation is one of the most common health problems in older adults. Its development greatly depends on nutritional status in that a high fiber diet including fruits and vegetables can prevent or manage it. The present study aimed at assessing vegetable and fruit consumption among the elderly with functional constipation, based on the health belief model. Methods: This was a cross-sectional study conducted on 163 elderly people aged 60 and older, who referred to retirement houses located in Isfahan, Iran, in 2013. The Rome III diagnostic criteria were used for functional constipation screening. Moreover, a demographic questionnaire, a researcher-made questionnaire developed based on the constructs of the health belief model, and a researcher-made 24-hour fruit and vegetable consumption checklist were used for data collection. Data analysis was done using SPSS Software (V, 20.0) and by running independent sample t test, Pearson correlation analysis, one-way analysis of variance, and multiple linear regression analysis at a significance level of less than 0.05. Results: The mean of participants’ age was 70.04 ± 6.41, while the means of their fruit consumption and vegetable consumption were 1.61 ± 0.73 and 1.31 ± 0.87 servings daily, respectively. Almost 44.2% of the participants consumed less than 2 servings of fruits and 55.8% consumed less than 2 servings of vegetables daily. Fruit and vegetable consumption was directly correlated with perceived susceptibility, perceived severity, perceived self-efficacy, perceived benefits, and knowledge and was inversely correlated with perceived barriers (P < 0.001). Moreover, perceived severity, perceived self-efficacy, perceived benefits, and knowledge explained 58% of the total variance of fruit consumption, while perceived self-efficacy, and perceived benefits, and knowledge explained 65.7% of the total variance of vegetable consumption. The most important cues to fruit and vegetable consumption were television (57.7%) and family and relatives (46%). Conclusions: This study revealed that the elderly with functional constipation consume inadequate amount of fruits and vegetables and the health belief model is a significant predictor of fruit and vegetable consumption among the elderly. Educational interventions based on the health belief model can be helpful in promoting the consumption of fruit and vegetable consumption in the elderly.

Medicare and Fruit and Vegetable Consumption in Hypertensive Adults Aged 55–75: A Regression Discontinuity Study

Fruits and vegetables may induce greater satiety, reduce hunger, decrease energy intake, and modulate energy metabolism, thereby playing a role in weight loss. To determine the associations between changes in fruit and vegetable consumption and weight change over a 5-year interval in Japanese adults. This cohort study included 54,015 subjects (54.6% female, mean age 56.5 years) of the Japan Public Health Center-based Prospective Cohort Study who had no known history of major chronic diseases at baseline. Data on fruit and vegetable consumption were collected using a validated food frequency questionnaire. Body weight was self-reported. We used multivariable linear mixed-effects regression models to examine the associations between changes in fruit and vegetable consumption and change in body weight. On average, body weight decreased by 25g [95% confidence interval (CI), 3, 47] for every 100g/d increase in total vegetable consumption. Change in fruit consumption was nonlinearly associated with weight change. Fruit consumption was directly associated with weight change among subjects who increased consumption (70g; 95% CI, 39, 101) but was not associated with weight change among subjects who reduced or did not change fruit consumption. These associations did not vary by sex, age, and body mass index (BMI) at baseline. The association with vegetables was restricted to yellow/red vegetables (- 74g; 95% CI, - 129, - 18) and allium vegetables (- 129g; 95% CI, - 231, - 28). Lower-fiber vegetables were inversely associated with weight change, whereas lower-fiber fruits or higher-energy fruits were directly associated with weight change beyond 0g/d change in consumption. Change in vegetable consumption was inversely associated with weight change while fruit consumption was positively associated with weight change among subjects who increased consumption. The influence of fruits and vegetables on weight change may depend on the characteristics of the fruits and vegetables.

Women face particular challenges when quitting smoking, especially those with weight concerns. A multi-behavioral smoking cessation intervention addressing these concerns and incorporating guided imagery may assist women to engage in healthy lifestyle behaviors. An mHealth app can easily disseminate such an intervention. The goals of this pilot study were to develop and test the feasibility and potential of the See Me Smoke-Free™ mHealth app to address smoking, diet, and physical activity among women smokers. We used pragmatic, direct-to-consumer methods to develop and test program content, functionality, and the user interface and conduct a pre-/post-test, 90-day pilot study. We enrolled 151 participants. Attrition was 52%, leaving 73 participants. At 90days, 47% of participants reported 7-day abstinence and significant increases in physical activity and fruit consumption. Recruitment methods worked well, but similar to other mHealth studies, we experienced high attrition. This study suggests that a guided imagery mHealth app has the potential to address multiple behaviors. Future research should consider different methods to improve retention and assess efficacy.

New mothers frequently report a lack of adequate physical activity (PA) due to a variety of constraints. PA is an important factor in developing and maintaining a healthy lifestyle and may assist new mothers in returning to pre-pregnancy weight. Despite the potential positive impact of PA on new mothers, PA level during the postpartum period is unknown. PURPOSE: To evaluate the impact of a PA intervention in increasing postpartum PA level and weight loss. METHODS: Thirty-two postpartum women (mean age=33±3, mean BMI=27.8±5.6 kg/m2) were randomized into control (n=16) and intervention (n=16) groups. The intervention group was instructed to engage in 150 minutes of MVPA each week and take 10,000 steps per day, the control group was given no physical activity prescription. Measures of body weight and PA (by wrist-worn ActiGraph Link accelerometers worn continuously over 7 days) were made at 3, 6, 9, and 12 months postpartum. PA data was expressed as the vector magnitude of counts (VMC) across the three axes. Differences in PA and body weight between groups over time were examined using two-way ANOVA with repeated measures and Tukey post hoc analysis. RESULTS: The intervention protocol was successful at increasing women’s overall PA during the postpartum period (main effect: 2.9x106±0.4x106 vs. 2.6x106±0.4x106 counts, p<0.05) but the only significant differences in PA by time between groups was at the initial 3 month postpartum visit (2.7x106±0.3x106 vs. 2.4x106±0.4x106 counts, p<0.05) as the intervention did not lead to a further significant increases in PA throughout the remainder of the postpartum period. The control group showed a significant increase in PA from the 3 month to the 12 month visit (2.4x106±0.4x106 vs. 2.8x106±0.4x106 counts, p<0.05), ultimately reaching similar PA to that of the intervention group. Body weight was similar at the initial 3 month visit and decreased significantly in both groups during the postpartum period, however the intervention group had a significantly lower body mass by the end of the postpartum period compared to the control group (70.2±14.8 vs.72.6±16.8 kg, p<0.05). CONCLUSION: Increased PA habits during the postpartum period may help women more successfully return to pre-pregnancy body weight and reduce the risk for overweight or obesity following childbirth.

Recommendations for physical activity to lower risk of cardiovascular disease (CVD) are widely known but not often followed. The purpose of this study was to determine the demographic, lifestyle, and psychosocial variables that predict improved physical activity among participants in a CVD prevention lifestyle intervention trial. Adult family members (N = 501; 66% female; 36% nonwhite; mean age, 48 years) of cardiac patients were randomized to a 1-year special intervention that received education on physical activity or to a control intervention. Demographics, physical activity, stage of change, and CVD risk factors were measured systematically at baseline and 1 year (94% follow-up). Lipids were analyzed in a core laboratory. Linear regression models were adjusted for confounders. At baseline, 21% of participants reported exercising more than 3 d/wk, which did not differ by group assignment. The special intervention and control intervention experienced significant increases in physical activity at 1 year with mean physical activity days per week in the special intervention significantly greater than the control intervention (2.5 vs 2.0 d/wk, P = .03). Significant predictors of increased physical activity at 1 year were group assignment (P = .03), female sex (P = .04), nonminority status (P <.01), greater readiness to change (P <.01), and baseline measurements of lower body mass index (P <.01) and waist size (P <.01), greater diet adherence (P <.01), higher high-density lipoprotein cholesterol (P <.01), lower high-sensitivity C-reactive protein (P = .02), less depression (P <.01), and higher social support (P = .03). In multiple regression models, group assignment, female, and nonminority status remained independent predictors of higher physical activity levels at 1 year. Several predictors of improved physical activity levels at 1 year were documented among clinical trial participants. Racial/ethnic minorities and men were significantly less likely to make positive changes and may need more targeted efforts to improve physical activity levels.

Epidemic increases in childhood obesity and associated health risks are resulting in efforts to implement school policies related to nutrition and physical activity (NPA). With multicomponent policy efforts, challenges exist in characterizing the extent of policy change across the breadth of NPA policies. Aggregated policy indices were created to characterize NPA policy implementation in Arkansas public schools from 2004 through 2009. Index scores are presented by year, domain, and school level. Both mean and median index scores increased over time, with greater changes seen in nutrition than in physical activity policy scores. The composite index score was heavily dependent on the nutrition index score and, thus, is relatively less useful for the purposes of our evaluation. Policy index scores varied by school level, rurality, enrollment size, and percentage of students eligible for federal meal programs. The policy index approach facilitates the consideration of the effect of school policy change in a holistic, aggregated way. School characteristics influence policy adoption, and thus, should be taken into consideration in the promotion of policy change.

BackgroundLittle information exists on the content of inpatient rehabilitation stay when individuals with spinal cord injury (SCI) are not engaged in structured rehabilitation therapy sessions. Investigation of inpatient therapy content is incomplete without the context of activities outside of this time. We sought to quantify physical activity occurring outside of physical therapy (PT) and occupational therapy (OT) sessions during inpatient SCI rehabilitation and examine how this activity changes over time from admission to discharge.MethodsIn this longitudinal observational study at two inpatient SCI rehabilitation centres, 95 participants were recruited through consecutive admissions. Physical activity at admission and discharge was recorded by 1) self-report (PARA-SCI questionnaire) and 2) real-time accelerometers worn on the dominant wrist, and hip if ambulatory. For analyses, we separated participants into those with paraplegia or tetraplegia, and a subgroup of those ambulatory at discharge. Wilcoxon signed rank tests (admission vs. discharge) were used for PARA-SCI minutes and accelerometry activity kilocounts.ResultsThere was no change in self-report physical activity, where the majority of time was spent in leisure time sedentary activity (~4 h) and leisure time physical activity at a higher intensity had a median value of 0 min. In contrast, significant increases in physical activity outside PT and OT sessions from admission to discharge were found for wrist accelerometers for individuals with tetraplegia (i.e., upper limb activity) and hip accelerometers for ambulatory individuals (i.e., walking activity).ConclusionPhysical activity is low in the inpatient SCI rehabilitation setting outside of structured therapy with a substantial amount of time spent in leisure time sedentary activity. Individuals appear to have the capacity to increase their levels of physical activity over the inpatient stay.

Association of fruit and vegetable intake with dietary fat intake

Social class and coronary artery disease in India

The 15 Minute Challenge is an mHealth workplace wellness initiative, employing gamification to promote physical activity, aiming to enhance health outcomes and overall well-being. This retrospective cohort study evaluated the effectiveness of the program among employees at various Australian, New Zealand, and UK workplaces. Real-world data from 11,575 participants across 73 companies were analyzed. The program encouraged daily 15 min physical activity sessions over six weeks. Participants self-reported their physical activity and fitness, energy, overall health, sleep quality, and mood at baseline and 6 weeks. Program satisfaction, engagement rates, and adherence to the program were also assessed. Effectiveness was evaluated using multi-level mixed-effects linear regression analyses. The intervention showed significant increases in physical activity, with 95% of participants meeting or exceeding international physical activity guidelines, up from 57% at baseline (p < 0.05). Self-reported fitness, energy, overall health, sleep quality, and mood significantly improved (between 7.1 and 14.0% improvement; all p < 0.05). High satisfaction was reported, with 92% of participants recommending the program. The 15 Minute Challenge effectively increased physical activity levels and improved self-reported health outcomes among participating employees. The high satisfaction rates and significant health improvements highlight the potential of workplace wellness programs to combat sedentary behavior and promote a healthier, more active lifestyle.

BackgroundThe increasing prevalence of smartphone apps to help people find different services raises the question of whether apps to help people find physical activity (PA) locations would help better prevent and control having overweight or obesity.ObjectiveThe aim of this paper is to determine and quantify the potential impact of a digital health intervention for African American women prior to allocating financial resources toward implementation.MethodsWe developed our Virtual Population Obesity Prevention, agent-based model of Washington, DC, to simulate the impact of a place-tailored digital health app that provides information about free recreation center classes on PA, BMI, and overweight and obesity prevalence among African American women.ResultsWhen the app is introduced at the beginning of the simulation, with app engagement at 25% (eg, 25% [41,839/167,356] of women aware of the app; 25% [10,460/41,839] of those aware downloading the app; and 25% [2615/10,460] of those who download it receiving regular push notifications), and a 25% (25/100) baseline probability to exercise (eg, without the app), there are no statistically significant increases in PA levels or decreases in BMI or obesity prevalence over 5 years across the population. When 50% (83,678/167,356) of women are aware of the app; 58.23% (48,725/83,678) of those who are aware download it; and 55% (26,799/48,725) of those who download it receive regular push notifications, in line with existing studies on app usage, introducing the app on average increases PA and decreases weight or obesity prevalence, though the changes are not statistically significant. When app engagement increased to 75% (125,517/167,356) of women who were aware, 75% (94,138/125,517) of those who were aware downloading it, and 75% (70,603/94,138) of those who downloaded it opting into the app’s push notifications, there were statistically significant changes in PA participation, minutes of PA and obesity prevalence.ConclusionsOur study shows that a digital health app that helps identify recreation center classes does not result in substantive population-wide health effects at lower levels of app engagement. For the app to result in statistically significant increases in PA and reductions in obesity prevalence over 5 years, there needs to be at least 75% (125,517/167,356) of women aware of the app, 75% (94,138/125,517) of those aware of the app download it, and 75% (70,603/94,138) of those who download it opt into push notifications. Nevertheless, the app cannot fully overcome lack of access to recreation centers; therefore, public health administrators as well as parks and recreation agencies might consider incorporating this type of technology into multilevel interventions that also target the built environment and other social determinants of health.

High fruit and vegetable consumption is associated with a lower risk of breast cancer. The incidence of breast cancer is continuously increasing in Korea, but only a few studies on nutrition intervention in breast cancer patients has been reported. The aim of this study was to investigate whether an 8-week nutrition intervention based on dietary counseling can promote fruit and vegetable consumption, increase serum antioxidant nutrient levels, and improve quality of life in Korean breast cancer patients. Sixty-one breast cancer patients received either standard care (n = 31) or nutrition counseling (n = 30). The standard care group was given brochures recommending phytochemical rich diet. The intervention group was provided with two nutrition counseling sessions and one cooking class session, thereby encouraged subjects to eat at least 10 or more servings of fruits and vegetables per day. After 8-week intervention, waist circumference in the intervention group was significantly decreased (p < 0.001) even though no difference was reported for body mass index. Energy intake (p = 0.007), fiber (p < 0.001), and antioxidant nutrient (vitamin A, C, E, and β-carotene, p < 0.001, respectively) intakes were significantly increased. Serum antioxidant level was also increased significantly, i.e., vitamin A (p = 0.048); vitamin E (p = 0.004). Total vegetable intake (excluding kimchi intake) in the intervention group was increased from 425 g to 761 g (p < 0.001), fruit consumption was also increased from 232 g to 334 g (p < 0.001), while standard care group did not show any significant change. Our study showed that nutrition counseling and providing cooking tips helped to encourage the patient to consume and maintain more fruit and vegetable intakes.

Background/Objectives: Low physical activity (PA) is becoming an increasingly serious health problem among overweight school-age children. This study aimed to evaluate the influence of elevated PA during school hours on the nutritional behavior and fat mass of overweight and obese children. Methods: The study involved 11-year-old children (n = 148) who were overweight and obese. In the control group, children received physical education lessons in the standard dimension (4 h a week) while the intervention group received 10 h. Body mass index (BMI), fat mass (FM), and nutritional behavior were analyzed. Results: Compared to baseline, at the end of the intervention, the proportion of obese children increased in the control group and decreased in the intervention group. Regarding nutritional behavior, low consumption of vegetables, fruits, whole grains, poultry, and fish was observed. After a 12-month period, the intervention group showed a slight decrease in the consumption of fruits, vegetables, cold cuts, fried dishes, sweets, and fast food, and an increase in the consumption of white bread, whole-grain bread, poultry, red meat, and dairy products (milk, yogurt). In the control group, children exhibited an average increase in the consumption of fruits, vegetables, poultry, red meat, sweets, and fast food Conclusions: Although extended physical activity during school hours was correlated with a decrease in the number of obese children, the observational nature of the study precludes the drawing of definitive conclusions. The intervention may have contributed to an increase in energy expenditure, which could account for the improvements in BMI and FM. Nevertheless, the impact on nutritional behavior was limited.