Abstract
Background
The primary aim of this review was to establish whether health literacy interventions, in adults, are effective for improving health literacy. Two secondary aims assessed the ...impact of health literacy interventions on health behaviours and whether health literacy interventions have been conducted in cardiovascular patients.
Methods
A systematic review (Prospero registration: CRD42018110772) with no start date running through until April 2020. Eligible studies were conducted in adults and included a pre/post measure of health literacy. Medline, Embase, Eric, PsychINFO, CINAHL, Psychology and Behavioural Science, HMIC, Web of Science, Scopus, Social Care Online, NHS Scotland Journals, Social Policy and Practice, and Global Health were searched. Two thousand one hundred twenty-seven papers were assessed, and 57 full text papers screened to give 22 unique datasets from 23 papers. Risk of bias was assessed regarding randomisation, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting and other biases. Intervention reporting quality was assessed using the TIDieR checklist.
Results
Twenty-two studies were included reporting on 10,997 participants in nine countries. The majority of studies (14/22) were published in 2018 or later. Eight studies (n = 1268 participants) also reported on behavioural outcomes. Health literacy interventions resulted in improvements in at least some aspect of health literacy in 15/22 studies (n = 10,180 participants) and improved behavioural outcomes in 7/8 studies (n = 1209 participants). Only two studies were conducted with cardiovascular patients. All studies were at risk of bias with 18 judged as high risk. In addition, there was poor reporting of intervention content with little explication of the theoretical basis for the interventions.
Conclusions
Health literacy interventions can improve health literacy and can also lead to changes in health behaviours. Health literacy interventions offer a way to improve outcomes for populations most at risk of health inequalities. Health literacy is a developing field with very few interventions using clear theoretical frameworks. Closer links between health literacy and behaviour change theories and frameworks could result in higher quality and more effective interventions.
Prospero registration
Prospero registration: CRD42018110772
Researchers have begun to investigate the issue of epoch length on children's physical activity using small sample sizes, and to date, no studies have been conducted in adolescents.
The purpose of ...this study was to investigate the effect of different epoch lengths (5, 15, 30, and 60 s) on derived levels of physical activity in both a child and an adolescent sample.
Three hundred and eleven children age 7-11 yr and 234 adolescents age 12-16 yr were asked to wear an accelerometer during waking hours for 7 d. The epoch was set at 5 s, and when data were downloaded, the activity counts were then reintegrated into 15-, 30-, and 60-s epochs.
A significant epoch effect was seen for time spent in vigorous physical activity, light physical activity, and rest in the child and adolescent samples and moderate-to-vigorous and moderate physical activities in the child sample only. The Bland-Altman analysis showed reasonable agreement on moderate-to-vigorous, moderate, vigorous, and light physical activities and rest between 5- and 15-, 5- and 30-, and 30- and 60-s epochs in the child sample and between 5- and 15-, 5- and 30-, and 15- and 30-s epochs in the adolescent sample.
A short epoch is strongly recommended for child and adolescent samples to obtain a "real" picture of young people's physical activity behavior and to prevent accumulation of counts reflecting the average activity level when longer epochs are used. Activity prevalence studies using epoch lengths of 5 and 60 s in a child or an adolescent sample should not be compared nor should 15- and 60- and 30- and 60-s epochs in an adolescent sample.
Globally, 2.2 billion people live with some form of vision impairment and/or eye disease. To date, most systematic reviews examining associations have focused on a single eye disease and there is no ...systematic evaluation of the relationships between eye diseases and diverse physical and mental health outcomes. Moreover, the strength and reliability of the literature is unclear. We performed an umbrella review of observational studies with meta analyses for any physical and/or mental comorbidities associated with eye disease. For each association, random-effects summary effect size, heterogeneity, small-study effect, excess significance bias and 95% prediction intervals were calculated, and used to grade significant evidence from convincing to weak. 34 studies were included covering 58 outcomes. No outcomes yielded convincing evidence, six outcomes yielded highly suggestive results (cataract positively associated with type 2 diabetes, open-angled glaucoma positively associated with myopia and diabetes, diabetic retinopathy positively associated with cardiovascular disease and cardiovascular mortality, and retinopathy of prematurity positively associated with chorioamnionitis), eight outcomes yielded suggestive results (diabetic retinopathy positively associated with all-cause mortality and depression, diabetic macular oedema positively associated with dyslipidaemia, cataract positively associated with gout, nuclear sclerosis positively associated with all-cause mortality, open angled glaucoma positively associated with migraine and hypertension, and age-related macular degeneration positively associated with diabetes), and 18 outcomes yielded weak evidence. Results show highly suggestive or suggestive evidence for associations between several types of eye diseases with several comorbid outcomes. Practitioners and public health policies should note these findings when developing healthcare policies.
To review associations between the family environment and young people's fruit and vegetable consumption.
A systematic review. Published English-language (n 60) papers were identified using ...electronic databases and manual searches of personal files and reference lists. Observational research reporting a measure of fruit/vegetable intake for children (aged 6-11 years) and/or adolescents (aged 12-18 years) and at least one potential family correlate of dietary intake was included.
Parental modelling and parental intake were consistently and positively associated with children's fruit and fruit, juice and vegetable (FJV) consumption. There were also positive associations between home availability, family rules and parental encouragement and children's fruit and vegetable consumption. Parental intake was positively associated with adolescents' fruit and vegetable consumption. There were also positive associations between parental occupational status and adolescent fruit consumption and between parental education and adolescents' FJV consumption.
Our findings highlight the importance of targeting the family environment for the promotion of healthy eating behaviours among children and adolescents. Future interventions should encourage parents to be positive role models by targeting parental intake and to create a supportive home environment through increased encouragement and availability of fruits and vegetables and employing rules to govern eating behaviours. For adolescents, indicators of family circumstances (e.g. parental education) should be used to identify target groups for interventions aimed at promoting healthy eating.
In recent years there has been a growing interest in the relationship between sedentary behaviour (sitting) and health outcomes. Only recently have there been studies assessing the association ...between time spent in sedentary behaviour and the metabolic syndrome. The aim of this study is to quantify the association between sedentary behaviour and the metabolic syndrome in adults using meta-analysis.
Medline, Embase and the Cochrane Library were searched using medical subject headings and key words related to sedentary behaviours and the metabolic syndrome. Reference lists of relevant articles and personal databases were hand searched. Inclusion criteria were: (1) cross sectional or prospective design; (2) include adults ≥ 18 years of age; (3) self-reported or objectively measured sedentary time; and (4) an outcome measure of metabolic syndrome. Odds Ratio (OR) and 95% confidence intervals for metabolic syndrome comparing the highest level of sedentary behaviour to the lowest were extracted for each study. Data were pooled using random effects models to take into account heterogeneity between studies. Ten cross-sectional studies (n = 21393 participants), one high, four moderate and five poor quality, were identified. Greater time spent sedentary increased the odds of metabolic syndrome by 73% (OR 1.73, 95% CI 1.55-1.94, p<0.0001). There were no differences for subgroups of sex, sedentary behaviour measure, metabolic syndrome definition, study quality or country income. There was no evidence of statistical heterogeneity (I(2) = 0.0%, p = 0.61) or publication bias (Eggers test t = 1.05, p = 0.32).
People who spend higher amounts of time in sedentary behaviours have greater odds of having metabolic syndrome. Reducing sedentary behaviours is potentially important for the prevention of metabolic syndrome.
The assessment of physical activity is an essential part of understanding patterns and influences of behaviour, designing interventions, and undertaking population surveillance and monitoring, but it ...is particularly problematic when using self-report instruments with young people. This study reviewed available self-report physical activity instruments developed for use with children and adolescents to assess their suitability and feasibility for use in population surveillance systems, particularly in Europe.
Systematic searches and review, supplemented by expert panel assessment.
Papers (n=437) were assessed as potentially relevant; 89 physical activity measures were identified with 20 activity-based measures receiving detailed assessment. Three received support from the majority of the expert group: Physical Activity Questionnaire for Children/Adolescents (PAQ-C/PAQ-A), Youth Risk Behaviour Surveillance Survey (YRBS), and the Teen Health Survey.
Population surveillance of youth physical activity is strongly recommended and those involved in developing and undertaking this task should consider the three identified shortlisted instruments and evaluate their appropriateness for application within their national context. Further development and testing of measures suitable for population surveillance with young people is required.
The Daily Mile is a physical activity programme made popular by a school in Stirling, Scotland. It is promoted by the Scottish Government and is growing in popularity nationally and internationally. ...The aim is that each day, during class time, pupils run or walk outside for 15 min (~1 mile) at a self-selected pace. It is anecdotally reported to have a number of physiological benefits including increased physical activity, reduced sedentary behaviour, increased fitness and improved body composition. This study aimed to investigate these reports.
We conducted a quasi-experimental repeated measures pilot study in two primary schools in the Stirling Council area: one school with, and one without, intention to introduce the Daily Mile. Pupils at the control school followed their usual curriculum. Of the 504 children attending the schools, 391 children in primary classes 1-7 (age 4-12 years) at the baseline assessment took part. The follow-up assessment was in the same academic year. Outcomes were accelerometer-assessed average daily moderate to vigorous intensity physical activity (MVPA) and average daily sedentary behaviour, 20-m shuttle run fitness test performance and adiposity assessed by the sum of skinfolds at four sites. Valid data at both time points were collected for 118, 118, 357 and 327 children, respectively, for each outcome.
After correction for age and gender, significant improvements were observed in the intervention school relative to the control school for MVPA, sedentary time, fitness and body composition. For MVPA, a relative increase of 9.1 min per day (95% confidence interval or 95%CI 5.1-13.2 min, standardised mean difference SMD = 0.407, p = 0.027) was observed. For sedentary time, there was a relative decrease of 18.2 min per day (10.7-25.7 min, SMD = 0.437, p = 0.017). For the shuttle run, there was a relative increase of 39.1 m (21.9-56.3, SMD = 0.236, p = 0.037). For the skinfolds, there was a relative decrease of 1.4 mm (0.8-2.0 mm, SMD = 0.246, p = 0.036). Similar results were obtained when a correction for socioeconomic groupings was included.
The findings show that in primary school children, the Daily Mile intervention is effective at increasing levels of MVPA, reducing sedentary time, increasing physical fitness and improving body composition. These findings have relevance for teachers, policymakers, public health practitioners, and health researchers.
Abstract
Background
Psychological stress is a prevalent factor in inflammatory bowel disease (IBD) with detrimental effects on patients’ quality of life and possibly disease course. Although the ...aetiology of symptom exacerbation in IBD has been explored, determining any causation between psychological stress and symptom worsening remains challenging and requires a methodologically rigorous approach.
Aim
The aim of this systematic review with meta-analysis was to determine a causal relationship between psychological stress and symptom exacerbation in IBD, subsequently utilising Bradford Hill’s criteria (approach never used in this topic area before) to evaluate the likelihood of causal associations.
Methods
Medline, EMBASE, CINAHL and PsycInfo were searched for relevant studies up to July 20, 2019. Data extraction and quality appraisal were performed by two independent reviewers. Results of all retained papers were presented as a narrative synthesis. A random-effect meta-analysis was conducted on studies meeting the criteria for meta-analysis. Bradford Hill criteria were applied to assess the causality of the relationship between all psychological factors and symptom exacerbation.
Results
The searches yielded 2472 potential articles. Nineteen clinical prospective cohort studies were eligible for the narrative review with five suitable for the meta-analysis. Meta-analysis showed depression, anxiety and perceived stress did not have a statistically significant association with an increased risk of symptom exacerbation. Four of the Bradford Hill criteria were met which indicates that there is weak to moderate evidence of a causal association between all the psychological factors and disease activity. Inconsistent results and a dearth of studies using the same tools for measuring psychological factors suggest the need for more research to be done to facilitate more conclusive findings.
Conclusions
This original review utilising Bradford Hill criteria in addition to meta-analysis to evaluate the causality of relationship between psychological factors and symptom exacerbation in IBD provides evidence that psychological factors have a weak to moderate causal involvement in IBD symptom exacerbation. However, when combining this finding with the outcomes of the meta-analysis, we can say that the results were inconclusive
.
Interventions to reduce the associated psychological impact should be part of the treatment plan for patients with IBD.
Systematic review registration
PROSPERO
CRD42012003143
Data on the association between visual difficulty and physical activity (PA) from low- and middle-income countries (LMICs) are scarce. Thus, the aim of the study was to investigate the association ...between visual difficulty and PA among adults from 36 LMICs, and to assess the mediators in this association.
Cross-sectional, community-based, predominantly nationally representative data from the World Health Survey were analysed. The final sample included 199,110 individuals aged ≥18 years mean (SD) age 38.6 (16.1) years; 49.4% males. Visual difficulty referred to having severe/extreme difficulties in seeing and recognizing a person that the participant knows across the road. Low PA was defined as not complying with PA recommendations of 150 min of moderate-vigorous PA per week. Multivariable logistic regression, meta-analysis, and mediation analysis were conducted to assess associations.
Meta-analysis based on country-wise multivariable logistic regression analysis showed that overall, visual difficulty is associated with a 1.53 (95% CI = 1.38-1.71) times higher odds for low PA. Particularly strong associations were observed in males (OR = 1.72; 95% CI = 1.45-2.05) and adults aged ≥65 years (OR = 1.95; 95% CI = 1.67-2.29). Interpersonal activities, cognition, and sleep/energy explained >10% of the association between visual difficulty and low PA.
In conclusion, we found evidence that especially in the case of males and older adults with visual difficulties in LMICs, there were low levels of engagement with PA. Addressing issues such as interpersonal activities, cognition, and sleep/energy in people with visual difficulties may increase levels of PA.
Little is known about the association between cataract and multimorbidity. Therefore, the aim of the present study was to examine the relationship between cataract and chronic conditions and ...multimorbidity in a large representative sample of Spanish adults.
This study used data from the Spanish National Health Survey 2017, a cross-sectional sample of 23,089 adults aged ≥15 years from Spain 54.1% female; mean (standard deviation) age 53.4 (18.9) years. Cataract and 30 other physical and mental chronic conditions were self-reported. Multimorbidity was defined as the presence of at least two physical and/or mental chronic conditions (excluding cataract). Control variables included sex, age, marital status, education, smoking, and alcohol consumption. Multivariable logistic and negative binomial regression analyzes were conducted to assess associations.
The prevalence of cataract and multimorbidity was 12.5% and 56.5%, respectively. All chronic conditions were significantly more frequent in individuals with than in those without cataract. Overall, there was a positive relationship between cataract and multimorbidity odds ratio (OR) = 2.77; 95% confidence interval (CI): 2.39-3.21. In addition, cataract was significantly associated with the number of chronic conditions in the whole population incidence rate ratio (IRR) = 1.34; 95% CI: 1.29-1.38.
Cataract is positively associated with chronic conditions and multimorbidity in adults. Interventions specifically designed for those with cataract to reduce or manage co-occurring chronic conditions and multimorbidity are urgently required.
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