Objectively measured physical activity and obesity prevention in children, adolescents and adults: a systematic review of prospective studies.

This study aimed at synthesizing the prospective associations between measured physical activity (PA) and change in adiposity in children, adolescents and adults following from two previous reviews. Search terms were adapted and a systematic literature search was conducted (January 2000-September 2008) and later updated (up to October 2009), considering observational and intervention studies of weight gain that measured both PA and body composition. Sixteen observational studies (six comprising adults) and five trials (one comprising adults) were eligible. For consistency, whenever possible either baseline PA energy expenditure or accelerometer output (counts min(-1) ) and change in per cent body fat were the extracted exposure and outcome measures. Results of observational studies suggest that PA is not strongly prospectively related with adiposity: five studies on children and three on adults reported no association between baseline PA and change in adiposity, one study found a weak positive association and the other studies observed a weak negative association. Negative associations were more frequently observed in studies that analysed the association between change in the exposure and outcome. Intervention studies show generally no effect on either PA or adiposity. In conclusion, despite the well-established health benefits of PA, it may not be a key determinant of excessive gain in adiposity.

The effects of aerobic exercise on metabolic risk, insulin sensitivity and intrahepatic lipid in healthy older people from the Hertfordshire Cohort Study: a randomised controlled trial.

AIMS/HYPOTHESIS: We sought to determine the effect of an aerobic exercise intervention on clustered metabolic risk and related outcomes in healthy older adults in a single-centre, explanatory randomised controlled trial. METHODS: Participants from the Hertfordshire Cohort Study (born 1931-1939) were randomly assigned to 36 supervised 1 h sessions on a cycle ergometer over 12 weeks or to a non-intervention control group. Randomisation and group allocation were conducted by the study co-ordinator, using a software programme. Those with prevalent diabetes, unstable ischaemic heart disease or poor mobility were excluded. All data were collected at our clinical research facility in Cambridge. Components of the metabolic syndrome were used to derive a standardised composite metabolic risk score (zMS) as the primary outcome. Trial status: closed to follow-up. RESULTS: We randomised 100 participants (50 to the intervention, 50 to the control group). Mean age was 71.4 (range 67.4-76.3) years. Overall, 96% of participants attended for follow-up measures. There were no serious adverse events. Using an intention-to-treat analysis, we saw a non-significant reduction in zMS in the exercise group compared with controls (0.07 [95% CI -0.03, 0.17], p = 0.19). However, the exercise group had significantly decreased weight, waist circumference and intrahepatic lipid, with increased aerobic fitness and a 68% reduction in prevalence of abnormal glucose metabolism (OR 0.32 [95% CI 0.11-0.92], p = 0.035) compared with controls. Results were similar in per-protocol analyses. CONCLUSIONS/INTERPRETATION: Enrolment in a supervised aerobic exercise intervention led to weight loss, increased fitness and improvements in some but not all metabolic outcomes. In appropriately screened older individuals, such interventions appear to be safe. TRIAL REGISTRATION: Controlled-trials.com ISRCTN60986572 FUNDING: Medical Research Council.

A cross-sectional analysis of physical activity and obesity indicators in European participants of the EPIC-PANACEA study.

OBJECTIVES: Cross-sectional data suggest a strong association between low levels of physical activity and obesity. The EPIC-PANACEA (European Prospective Investigation into Cancer-Physical Activity, Nutrition, Alcohol, Cessation of Smoking, Eating out of home And obesity) project was designed to investigate the associations between physical activity and body mass index (BMI) and waist circumference based on individual data collected across nine European countries. METHODS: In the European Prospective Investigation into Cancer and Nutrition (EPIC), 519 931 volunteers were recruited between 1992 and 2000, of whom 405 819 had data on main variables of interest. Height, body weight and waist circumference were measured using standardized procedures. Physical activity was assessed using a validated four-category index reflecting a self-reported usual activity during work and leisure time. The associations between physical activity and BMI and waist circumference were estimated using multilevel mixed effects linear regression models, adjusted for age, total energy intake, smoking status, alcohol consumption and educational level. RESULTS: A total of 125 629 men and 280 190 women with a mean age of 52.9 (s.d. 9.7) and 51.5 (s.d. 10.0) years, respectively were included. The mean BMI was 26.6 kg/m(2) (s.d. 3.6) in men and 25.0 kg/m(2) (s.d. 4.5) in women. Fifty percent of men and 30% of women were categorized as being active or moderately active. A one-category difference in the physical activity index was inversely associated with a difference of 0.18 kg/m(2) in the mean BMI (95% confidence interval, CI, 0.11, 0.24) and 1.04-cm (95% CI 0.82, 1.26) difference in waist circumference in men. The equivalent figures for women were 0.31 kg/m(2) (95% CI 0.23, 0.38) and 0.90 cm (95% CI 0.71, 1.08), respectively. CONCLUSIONS: Physical activity is inversely associated with both BMI and waist circumference across nine European countries. Although we cannot interpret the association causally, our results were observed in a large and diverse cohort independently from many potential confounders.

Tobacco smoking, alcohol drinking and Hodgkin's lymphoma: a European multi-centre case-control study (EPILYMPH).

We analysed the effects of tobacco and alcohol in the aetiology of Hodgkin's lymphoma (HL), based on 340 cases and 2465 controls enrolled in Spain, France, Italy, Germany, Ireland and Czech Republic, between 1998 and 2004. Current smokers showed a significantly increased odds ratio (OR) of HL of 1.39 (95% confidence interval (CI) = 1.04-1.87). Analyses were also conducted separately for subjects younger than 35 years (179 cases) and for older subjects (161 cases). For subjects below age 35, no association was observed between tobacco and HL, whereas for older subjects, ever-smokers experienced a doubled risk of HL as compared to never smokers and the OR of HL for current smoking was 2.35 (95% CI = 1.52-3.61), with suggestion of a dose-response relationship. A protective effect of alcohol was observed in both age groups. The OR for ever-regular drinking was 0.58 (95% CI = 0.38-0.89) for younger subjects and 0.50 (95% CI = 0.34-0.74) for older subjects. There was no evidence of interaction between tobacco and alcohol. Our results are consistent with previous studies, suggesting a protective effect of alcohol on HL. An effect of tobacco was suggested for HL occurring in middle and late age, although this finding might have occurred by chance.

Factores psico-sociales implicados en la alimentación del anciano / Psychological and social factors implied in the alimentation of the elder

El presente estudio, tiene por objetivo revisarlos factores psicológicos y sociales implicadosen la alimentación del anciano.Se incluyen los factores psicológicos másimportantes tales como: los hábitos y costumbresalimenticias, las preferencias y deseos, lasmodificaciones actitudinales resultantes delperíodo de ajuste continuo a nuevas situaciones,la soledad (que puede inducir al incremento dela ingestión de alimentos como forma indirectade satisfacción del yo o, por el contrario, a unadisminución de la ingesta por carencia de motivosexistenciales), la baja autoestima, el cambiode roles en el hogar, producido por la edad,la jubilación o alguna otra patología y las relacionesafectivas, entre las cuales encontramosa la familia como fuente inagotable para el apoyoemocional del anciano.Por otro lado, existe una red de factores socialesque incluyen factores socio-económicos yeducativos, ligados a la dieta alimenticia, yaque ésta resulta de los ingresos de las clasessociales, de la disponibilidad y distribución denutrientes en el mercado y del grado de informacióny de educación de los diferentes grupos.Entre los factores educativos citaremos: el patróncultural, el nivel educativo y las preferenciasalimenticias y entre los socio-económicoscitaremos: el estatus socio-económico, elingreso, los cambios en la estructura familiary la jubilación, entre otros.Por último, llegamos a la conclusión de que lacarencia de recursos para satisfacer las necesidadesdel anciano: alimentación, salud, educación,seguridad social, entre otras, van en detrimentode sus condiciones de vida

The present study has the objective of studyingthe psychological and social factors impliedin the alimentation of the elder.This, including the most important psychologicalfactors such as: The habits and costumesof alimentation, the preferences or desirers, theattitudinal modifications resulting from the periodof adjustment to constant and new situations,the solitude (which might indulge to the increaseof alimentation as an indirect way of satisfactionof the self, or by the contrary, a diminutionof the ingest for lack of existential motives,)the low self-esteem, the change of roles in thehouse- that might be produced by the age, theretirement, or some other pathological factorandthe affective relationships in which we findthe family as the never ending source for emotionalsupport of the elder.On the other hand, the existence of a conglomerateof social factors that include: socio-economical and educative factors, intertwined with adiet that results from the: income of social classes,the availability and distribution of the nutrientsin the market and the degree of informationand education of the different groups. In theeducational factors we can find: The cultural patron,the level of education and the alimentationpreferences. In the socio-economical factorsquote: The social economical status, theincome, the changes in the structure of the familyand the retirement among others.At last we have reached the conclusion thatthe lack of resources to satisfy the necessities ofthe elder, including: alimentation, health, education,social security among others; go in detrimentof their life conditions

Educación holística en Geriatría / Holistic Education in Geriatrics

El objetivo del presente trabajo es promover laeducación holística en geriatría como una necesidadimpostergable para el estudio del ser humanoentrado en años.Basamos nuestro estudio, en los conocimientosresultantes de la exploración del entorno paradetectar las condiciones psico-sociales de 20ancianos atendidos, por diversas patologías, enconsulta ambulatoria durante tres años, los cualespresentaban situaciones multifactoriales ydonde una atención integral mejoró su estado desalud y por ende su calidad de vida. Esta experiencia,nos llevó a considerar a la persona comoun holo, una realidad entera con un conjunto demanifestaciones, de valores y de expresionesque revelan la integralidad de su constitución.Por ésta condición es integral, única, universal eindivisible, es expresión de múltiples eventos, interaccionesy situaciones, una realidad vista yatendida en su complejidad a partir de todos ycada uno de los aspectos que componen suidentidad, percepción que nos invita a asumirlaen su totalidad con criterios holísticos y no puedeser comprendida desde perspectivas dualistaso dicotómicas, en efecto, es una manera decomprender la realidad con criterios de universalidady entenderla desde el punto de vista de lasmúltiples interacciones que la caracterizan, correspondea una actitud integradora y a una teoríaexplicativa que orienta hacia la comprensióncontextual de los procesos, de los protagonistasy de los eventos. Por esto, propicia la figura delsintagma, integrando así a los anteriores paradigmas.Para el estudio de la geriatría y gerontología,es condición indispensable una visión holísticadel anciano, basamos nuestra propuesta en susprincipios: del holo, la universalidad, la integración,la identidad, la continuidad, la integralidad,la relatividad y el sintagma., donde un aspectofundamental lo constituye la exploración del entorno,que haremos a través de múltiples acciones.En holística, la gerencia debe estar caracterizadapor la formación profesional especializada,es éste caso, geriatría y gerontología, peroabierta a comprensiones multidisciplinarias, enbase a liderazgos compartidos, los cuales propicianla participación de los involucrados en elproceso, una gerencia de criterios que conduzcaa visualizar el holo.Conclusión. El mejoramiento de la calidad dela educación latinoamericana en geriatría y gerontologíaresulta una tarea urgente, dada la importanciaen ésta área de la atención y de laeducación como instrumento de transformaciónpara una sociedad, donde el grupo de edadavanzada se incrementa y en algunos países comienzaa perfilarse con características de masificación.El geriatra, debe asumir una actitud reflexivade internalización de su acción, bajo unaperspectiva holistica que le permita crear sintagmasentre los integrantes del equipo multidisciplinarioen geriatría, para ordenar su ejecución comoun todo. La docencia en geriatría, debe serentendida como un todo bajo consideracionesholisticas

The objective of the present study is to promotethe education of holism in gerontology for thestudy of the ageing human being.We base our studies in the knowledge resultingfrom the exploration of our surrounding todetect psychological and social conditions of 20old people. Who, with diverse pathologies andmultifactor situations where attended in 3 yearsof investigation during which we noticed that theirconditions improved.Taking us consider the human being as an“holo”, a total, a complete reality and a consolidateof manifestations, values and expressionsthat reveals the integrity of their conditions. Themakings of this condition are complete, unique,universal and undividable. They are expressionsof multiples events, intervelated situations of areality viewed and attended in it’s complexityfrom each one of the aspects that make the patientsidentity.For the study of geriatrics and gerontology thenumber one condition resides in the holistic visionof the patient. With this perspective, we baseour proposal in eight basic principals, whichare: holos, universality, integration, identity, continuity,relativity, and a syntactic approach. In theholistic studies, is necessary the formation ofspecialized geriatric and gerontologists openedto a comprehension of a multidisciplined leadership.Conclusion. The improvement in the qualityof the Latin American education concerning geriatricsresults in an urgent assignment. This isimportant since the education serves as an instrumentof promoting a transformation for a societyin witch everyday the number of old peopleincreases making it undeniable to attend theirnecessities. The theory of holistics in gerontologyabides in the importance of a total view concerningthe patient and his or hers standard of living

[Factors associated with the late management of HIV-infected patients: literature review]. / Facteurs associés à une prise en charge tardive des patients infectés par le VIH: revue de la littérature.

In the United States, Australia and Europe, many HIV infected individuals are still diagnosed and/or treated late in the course of the disease. This literature review of studies published over a ten year period between 1993 and 2003 has identified the following principle factors associated with the late diagnosis of HIV: male gender, aged older than 45 years, heterosexual intercourse, the lack of previous screening. It also identified the factors linked to the delay in beginning anti-retroviral treatment as being male gender, the lack of awareness or denial of the possibility of HIV infection, intravenous drug use, lack of post-screening follow-up or counseling, lack of social protection, and the lack of regular medical visits and care. Early detection and suitable early treatment of the HIV virus are the main determining factors which will effectively contribute to the control and maintenance of the virus in as much as they are focused upon these particular at-risk populations.

[The role of pediatric assistants in health education]. / La place des auxiliaires de puériculture en éducation pour la santé.

France has a category of health workers called auxiliary paediatric nurse (APN) who takes care of children from zero to six years of age. APNs play a very important role in the child's development since they feed him, wash him, play with him and look after him while he sleeps. Most of the time, however, they are not aware of the important psychological role they play and consider themselves only responsible for good hygiene. The author suggests that APNs should be taught during their training to make a number of psychological observations relating to the child's development and emotional life. It is important that APNs be also trained as health educators, a task they have to perform every day.