Els Clays

Malnutrition and associated factors in elderly hospital patients: a Belgian cross-sectional, multi-centre study.

BACKGROUND & AIMS In Belgium, general data on the prevalence of malnutrition are lacking. Prevalence rates are necessary to gain insight into the magnitude of malnutrition and to establish a nutrition policy that takes the limited health care resources into account. This study aimed to obtain insight into the prevalence of malnutrition in Belgian elderly hospital wards and to identify factors associated with the malnutrition prevalence. METHODS A cross-sectional, multi-centre study in elderly wards of Belgian hospitals. The nutritional status was assessed using the Mini Nutritional Assessment. A standardised questionnaire was used to record demographic data and data on potential factors associated with malnutrition. RESULTS Out of 2329 elderly patients, 33% suffered from malnutrition. Almost 43% of the patients were at risk of malnutrition and 24% were well-nourished. Having swallowing difficulties, taste difficulties, and being transferred from a nursing home were strongly associated with being malnourished. CONCLUSION The malnutrition prevalence in Belgian elderly hospitals wards is similar to international figures. Elderly who have swallowing difficulties, taste difficulties, or coming from a nursing home may need adequate nutritional care. Given the negative impact of malnutrition on mortality and morbidity, an emphasis should be placed on an effective nutritional policy.

The impact of psychosocial factors on low back pain : Longitudinal results from the belstress study

Study Design. An epidemiological cohort study. Objective. To describe the impact of psychosocial factors, both work and nonwork-related, on the prevalence of low back pain (LBP) after 6.6 years on average. Summary of Background Data. There is growing consensus that psychosocial factors play a role in the development of LBP, although results are not consistent across studies. Methods. Within a sample of 2556 middle-aged men and women from the Belstress study, baseline psychosocial factors were measured through self-administered questionnaires and related to prevalent cases of LBP after a mean time interval of 6.6 years through Cox regression analysis. Results. After adjustment for individual and physical risks, including occasional back pain at baseline, the prevalence rate of LBP in men is significantly related to baseline low decision latitude and low social support at work, and nonsignificantly to high job strain, low wage and job satisfaction, feeling stressed at work, and feeling depressed. High job insecurity, feeling stressed at work, and feeling depressed nonsignificantly increase the relative risks for LBP in women. Conclusions. Based on the results of this study, psychosocial factors (both work and nonwork-related) constitute nonnegligible risks for the development of LBP.

Validity and reliability of three commonly used quality of life measures in a large European population of coronary heart disease patients

OBJECTIVE To investigate the validity and reliability of the EuroQol-5D (EQ-5D), the 12-item Short-Form Health Survey (SF-12v2), and the Hospital Anxiety and Depression Scale (HADS) in a stable coronary population. STUDY DESIGN Cross-sectional study EUROASPIRE III. SETTING Quality of life data (QoL) were available on 8745 patients hospitalized for coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), acute myocardial infarction (AMI), or myocardial ischemia. They were interviewed and examined at least 6 months after their hospital admission. Reliability and validity of the 3 instruments were tested. Internal consistency, and discriminative, convergent, criterion and construct validity were assessed. RESULTS Cronbachs alpha indicated good internal consistency for all measures (0.73 to 0.87). Discriminative validity analyses confirmed significant QoL differences between known groups: age, gender, educational level. In addition, all hypothesized correlations between QoL constructs (convergent validity) and items (criterion validity) were confirmed with significant correlations. Confirmatory factor analyses indicated good construct validity for HADS and SF-12v2. On country-specific level, results were roughly similar. CONCLUSION The EQ-5D as well as the SF-12v2 and the HADS are reliable and valid instruments for use in a stable coronary population, both on aggregate European level and on country-specific level. However, our results must be generalized with caution, because EUROASPIRE III patients might not be representative for all patients with stable coronary heart disease.

Malnutrition and associated factors in nursing home residents: a cross-sectional, multi-centre study.

BACKGROUND & AIMS Malnutrition is a common problem in the elderly living in nursing homes. A clear understanding of associated factors is missing. The aim of this study was to evaluate prevalence of malnutrition and to determine factors independently associated with malnutrition in this setting. METHODS A cross-sectional, multi-centre study was conducted in 23 nursing homes in Flanders, Belgium. The nutritional status was assessed using the Mini Nutritional Assessment (MNA). Data on possible associated factors were collected using validated scales. RESULTS The study included 1188 elderly residents; 38.7% were at risk for malnutrition and 19.4% were malnourished. The presence of a wound/pressure ulcer, a recent hospitalization (<3 months ago), being involved in a tailored nutritional intervention, and suffering from a lower cognitive state were significantly associated with malnutrition. Receiving additional meals provided by family members was negatively associated with malnutrition. CONCLUSION Malnutrition is a prevalent problem in nursing homes in Flanders. Systematic screening and well-defined tailored interventions should be further developed and evaluated in this population at risk.

Health related quality of life in coronary patients and its association with their cardiovascular risk profile: Results from the EUROASPIRE III survey

BACKGROUND Cardiovascular patients are likely to have an impaired health-related quality of life (HRQoL) due to functional and psycho-social limitations. The main objective of this study was to assess the distribution of HRQoL scores in coronary heart disease (CHD) patients across 22 European countries and to identify factors associated with the variation between patients. METHODS Data from the EUROASPIRE III survey (European Action on Secondary and Primary Prevention by Intervention to Reduce Events), on 8734 patients, were used. Patients with a diagnosis of CHD (coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), acute myocardial infarction (AMI) or myocardial ischemia) were interviewed and examined at least 6 months after their acute coronary event. Quality of life of each patient was measured using 2 standardized questionnaires: the EuroQoL-5D (EQ-5D) and the 12-item short-form health survey (SF-12v2). RESULTS HRQoL values differed significantly across countries. Lower HRQoL estimates were found in women, older patients, less educated patients, patients with myocardial infarction or ischemia as recruiting diagnosis, patients with a history of stroke and patients who suffered from a recurring CHD event. In addition, HRQoL was significantly associated with current smoking, central obesity, lack of exercise and inappropriate HbA1c control in patients with diabetes. Furthermore the number of risk factors is inversely associated with HRQoL. CONCLUSION Overall, a large heterogeneity was observed in HRQoL values between countries and patient groups. There seems to be a significant association between quality of life and patient characteristics with lifestyle risk factors as important determinants of HRQoL.

Seasonality of cardiovascular risk factors: an analysis including over 230 000 participants in 15 countries

Objective To assess the seasonality of cardiovascular risk factors (CVRF) in a large set of population-based studies. Methods Cross-sectional data from 24 population-based studies from 15 countries, with a total sample size of 237 979 subjects. CVRFs included Body Mass Index (BMI) and waist circumference; systolic (SBP) and diastolic (DBP) blood pressure; total, high (HDL) and low (LDL) density lipoprotein cholesterol; triglycerides and glucose levels. Within each study, all data were adjusted for age, gender and current smoking. For blood pressure, lipids and glucose levels, further adjustments on BMI and drug treatment were performed. Results In the Northern and Southern Hemispheres, CVRFs levels tended to be higher in winter and lower in summer months. These patterns were observed for most studies. In the Northern Hemisphere, the estimated seasonal variations were 0.26 kg/m2 for BMI, 0.6 cm for waist circumference, 2.9 mm Hg for SBP, 1.4 mm Hg for DBP, 0.02 mmol/L for triglycerides, 0.10 mmol/L for total cholesterol, 0.01 mmol/L for HDL cholesterol, 0.11 mmol/L for LDL cholesterol, and 0.07 mmol/L for glycaemia. Similar results were obtained when the analysis was restricted to studies collecting fasting blood samples. Similar seasonal variations were found for most CVRFs in the Southern Hemisphere, with the exception of waist circumference, HDL, and LDL cholesterol. Conclusions CVRFs show a seasonal pattern characterised by higher levels in winter, and lower levels in summer. This pattern could contribute to the seasonality of CV mortality.

Malnutrition and nutritional care practices in hospital wards for older people

AIMS This paper is a report of a study conducted to gain a better insight into the current nutritional care practices in Belgian hospital wards for older people, and to study the association between these practices and the prevalence of malnutrition. BACKGROUND In 1999, the Council of Europe assessed nutritional care practices and support in 12 European countries and showed them to be sparse and inconsistent. At the time of research, no studies had described the association between nutritional care practices and malnutrition prevalence in Belgium. METHODS In 2007, a cross-sectional survey was carried out in a representative sample of Belgian hospital wards for older people. In total, 2094 patients from 140 wards for older people were included. RESULTS The overall prevalence rate of malnutrition in wards for older people was 31.9%. Nutritional care practices such as nutritional screening and assessment, use of a standardized screening instrument and a nutritional protocol were suboptimal. Multilevel analysis revealed that ward characteristics explained for 9.1% whether a patient was malnourished or not. None of the registered nutritional care practices could explain a patients individual risk. CONCLUSION Malnutrition is a frequently occurring problem on hospital wards for older people. Increased consciousness among healthcare professionals and hospital policy makers of the importance of nutritional care will contribute to further improvement in care quality.

Association between tobacco control policies and smoking behaviour among adolescents in 29 European countries

AIMS To investigate the associations between well-known, cost-effective tobacco control policies at country level and smoking prevalence among 15-year-old adolescents. DESIGN Multi-level modelling based on the 2005-06 Health Behaviour in School-aged Children Study, a cross-national study at individual level, and with country-level variables from the Tobacco Control Scale and published country-level databases. SETTING Twenty-nine European countries. PARTICIPANTS A total of 25 599 boys and 26 509 girls. MAIN OUTCOME MEASURES Self-reported regular smoking defined as at least weekly smoking, including daily smoking (dichotomous). FINDINGS Interaction effects between gender and smoking policies were identified, therefore boys and girls were analysed separately. Large cross-national differences in smoking prevalence were documented. Intraclass correlations (ICC) of 0.038 (boys) and 0.035 (girls) were found. In the final multi-level model for boys, besides the significance of the individual variables such as family affluence, country-level affluence and the legality of vending machines were related significantly to regular smoking [b(country affluence) = -0.010; b(partial restriction vending machines) = -0.366, P < 0.05]. Price policy was of borderline significance [b(price policy) = -0.026, P = 0.050]. All relationships were in the expected direction. The model fit is not as good for girls; only the legality of vending machines had a borderline significance in the final model [b(total ban vending machines) = -0.372, P = 0.06]. CONCLUSIONS For boys, some of the currently recommended tobacco control policies may help to reduce smoking prevalence. However, the model is less suitable for girls, indicating gender differences in the potential efficacy of smoking policies. Future research should address this issue.

Children's heart rate variability as stress indicator: association with reported stress and cortisol.

UNLABELLED Stress is a complex phenomenon coordinated by two main neural systems: the hypothalamic-pituitary-adrenal system with cortisol as classical stress biomarker and the autonomic nervous system with heart rate variability (HRV) as recently suggested stress marker. To test low HRV (5 minute measurements) as stress indicator in young children (5-10 y), associations with self-reported chronic stress aspects (events, emotions and problems) (N=334) and salivary cortisol (N=293) were performed. Peer problems, anger, anxiety and sadness were associated with lower root mean square of successive differences (RMSSD) and high frequency power (i.e. lower parasympathetic activity). Anxiety and anger were also related to a higher low frequency to high frequency ratio. Using multilevel modelling, higher cortisol levels, a larger cortisol awakening response and steeper diurnal decline were also associated with these HRV patterns of lower parasympathetic activity. CONCLUSION Low HRV (lower parasympathetic activity) might serve as stress indicator in children.

Social motives for drinking in students should not be neglected in efforts to decrease problematic drinking

High heavy drinking prevalence persists in students. Recently, drinking motivation received a lot of attention as an important determinant. Enhancement and coping motives are mostly positively related and conformity motives are mostly negatively related with heavy drinking. Relations are less clear for social motives. This study aimed at gaining more insight in the role of drinking motives in heavy drinking students. Overall, 15 897 Belgian university and college students (mean age: 20.7, SD = 2.6) anonymously participated in an online survey. Logistic regressions tested relationships between motives and problematic drinking (>weekly drinking, ≥monthly binge drinking and being at risk for problematic drinking by the Alcohol Use Disorders Identification Test [AUDIT]). Social motives had the highest prevalence, followed by enhancement, coping and conformity motives. Men engaged more in problematic drinking and reported more motives, except for coping. Enhancement, coping and social-motivated students have higher chances for problematic drinking, while the opposite is true for conformity-motivated students. Although this study found a similar ranking of motives as in other studies, a relationship between problematic drinking and all motives, including social motives, was revealed. This might indicate the different functions of social motives in heavy drinking in different cultures/sub-populations and countries. This finding is relevant for the development of interventions.