Alzheimer's Disease is a progressive, irreversible neurodegenerative illness and the most common of the dementing disorders. Only few diseases disrupt patients and their relatives so completely or for so long a period of time as Alzheimer 's. Caring is held to be very demanding and emotionally involving. Caregiver burden has been defined as a multidimensional response to emotional, social, physical, psychological, and financial stressors associated with the caregiving experience. The objective of the 1st study was to assess the degree of burden and its possible change in family caregivers of the long-term sick family member with progressive Alzheimer's disease during eight-month monitoring. In addition to the common psychiatric examination the Mini- Mental State Examination (MMSE) was administered in patients to indicate the severity of the dementia and the Zarit Burden Interview was administered in caregivers to assessed degree of burden. The total of 60 people have been examined - 30 patients with AD and 30 their caregivers (24 females, 6 males) were recruited from the Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague. At the beginning of the study there were 18 patients with mild stage of AD (60%), 11 patients suffered...

Bakgrund: Demenssjukdom skiljer sig från naturligt åldrande och är ständigt föränderligt i sin manifestation. För varje demenssjuk individ finns det ofta åtminstone en närstående som lever en förändrad och även ibland försvårad vardag i det tysta. Närstående löper en ökad risk att drabbas av psykisk ohälsa då flera blir informella vårdgivare till den demenssjuke individen, vilket ökar den närståendes psykiska, fysiska och ekonomiska belastning. Syfte: Syftet var att belysa självupplevd hälsa bland närstående som är informella vårdgivare till individer med demenssjukdom. Metod: Denna icke-systematiska litteraturöversikt inkluderade 19 vetenskapliga originalartiklar av kvalitativ och kvantitativ design. Datainsamlingen av artiklar skedde i februari år 2021 från databaserna PubMed och CINAHL med hjälp av olika kombinationer av söktermer samt manuell sökning, vilket genererade flera artiklar. Utifrån Sophiahemmet högskolas bedömningsinstrument kvalitetsgranskades artiklarna och artiklar med låg kvalitet exkluderades. Därefter utfördes en integrerad dataanalys där resultatartiklarnas innehåll kategoriseras i två teman med tillhörande underteman. Resultat: Litteraturöversikten resulterade i att två teman och sex underteman identifierades. De två teman som urskildes var psykiska och sociala faktorer som belyste självupplevd hälsa bland närstående. Underteman som framkom var närståendes depression, stress, sorg, isolering, kommunikationsproblematik samt processen att gå från att vara närstående till att bli informell vårdgivare. Slutsats: Resultatet visade att självupplevd hälsa för närstående till individer med demenssjukdom påverkas av olika faktorer. Den självupplevda hälsan förändrades när närstående känner psykologisk och social belastning. I resultatet framkom att närstående upplevde att det var en omvälvande process att gå från att vara partner till att bli informell vårdgivare. / Background: Dementia differs from natural aging and is constantly changing in its manifestation. For every individual with dementia, there is often at least one close relative who lives an alternated and even sometimes strenuous everyday life in silence. Relatives of individuals with dementia run an increased risk of suffering from mental illness as many become informal caregivers for them, which increases the relative's mental, physical and financial burden. Aim: The aim was to portray self-perceived health among related parties to individuals with dementia. Method: A non-systematic literature review compiled with 19 original scientific articles of qualitative and quantitative design. The data collection of articles took place in February 2021 and was obtained from the databases PubMed and CINAHL using various combinations of search terms as well as manual search, which generated several articles. Based on Sophiahemmet University's assessment instruments, the articles were quality-reviewed, and then an integrated data analysis was executed, lastly the result articles were organized in two themes with associated sub-themes. Results: The literature review resulted in the identification of two themes and six sub-themes. The two distinguished themes were psychological and social factors, which described self-perceived health among related parties. Sub-themes that emerged were relatives' depression, stress, grief, isolation, communication problems and the process of going from being a partner to becoming an informal caregiver.  Conclusions: The results illustrated self-perceived health of relatives of individuals with dementia to be affected by various factors. Self-perceived health shifts when a close relative feels a psychological and social strain. The results demonstrate that close relatives felt that it was a transformative process to go from being a partner to becoming an informal caregiver.

Bakgrund: Individers delaktighet och möjlighet att påverka sin livssituation lyfts ofta fram i hälsofrämjande arbete. Forskning stödjer att skolframgång är en skyddsfaktor för att bevara en god psykisk hälsa. Elevers möjlighet att vara delaktiga och påverka sin skolsituation är faktorer som främjar både lärande och hälsa. Barns och elevers delaktighet är en viktig del av arbetet med mänskliga rättigheter och under år 2018 förväntas Förenta nationernas konvention om barnets rättigheter antas som svensk lag.  Syfte: Syftet med denna studie var att undersöka om det fanns det ett samband mellan elevers upplevda delaktighet i skolsituationen och deras hälsa samt att belysa vilka faktorer i skolsituationen som hade betydelse för upplevd delaktighet.  Metod: Studien genomfördes som en kvantitativ tvärsnittsstudie av data från elevhälsodatabasen ELSA. Sambandsanalyser gjordes med variabeln ”delaktig och får vara med och bestämma” mot elevens skolsituation, relationer, självbild, riskbeteende och upplevd hälsa. Alla sambandsanalyser gjordes med Chi2 test, signifikant var <0.05.  Resultat: Resultatet visade att elevers upplevda delaktighet hade statistiskt signifikanta samband med skolsituation, relationer, självbild, riskbeteende och upplevd hälsa. Elever med låg delaktighet uppgav en lägre grad av arbetsro på lektionerna, de var mindre nöjda med sitt skolarbete, hade färre vänner i skolan och upplevde i en lägre grad att vuxna var vänliga. Upplevelsen av låg delaktighet hade ett starkt samband med psykisk ohälsa. Det var mer än dubbelt så många elever med upplevd låg delaktighet, bland både pojkar och flickor, som kände sig ledsna och oroliga.  Konklusion: Studien belyser hur central elevers upplevda delaktighet är för deras hälsa och livssituation, även om det kausala sambandet inte kan påvisas. Att systematiskt stärka elevers delaktighet är ett hälsofrämjande arbetssätt som också kan förbättra skolans möjlighet att fullgöra sitt kompensatoriska uppdrag. Det vill säga att skolan ska möta varje elev utifrån dess individuella förutsättningar och kompensera för det som eleven kan ha behov av för att klara sina studier. / Background: Individuals' participation and ability to influence their life situation are often highlighted in health-promotion. Research supports that school success is a protective factor for maintaining good mental health. Pupils' ability to participate and influence their school situation are factors that promote both learning and health. The participation of children and pupils are an important part of the work on human rights and in 2018 the United Nations Convention on the Rights of the Child is expected to be adopted as a Swedish law. Aim: The aim of this study was to investigate whether there was a link between pupils ' perceived participation in the school situation and their health, as well as to shed light on what factors in a school situation which had significance for perceived participation.  Method: The study was conducted as a quantitative cross-sectional study of data from the health data base, ELSA. Correlation analysis was made with " included and be allowed to decide" towards the pupil's school situation, relationships, self-image, risk behavior and perceived health. All correlation analyses were done with the chi-squared test, significant were < 0.05.  Results: The results showed that pupils ' perceived participation had a statistical significant relation with school situation, relationships, self-image, risk behavior and perceived health. Pupils with low participation indicated a lower degree of calm to study, they were less satisfied with their school work, had fewer friends in school and experienced to a lesser extent that adults were friendly. The experience of low participation had a strong correlation with mental ill health. It was more than twice as many with perceived low participation, among both boys and girls, who felt sad and worried. Conclusion: This study highlights how central pupils ' perceived participation is for their health and life situation, although the causal relationship cannot be demonstrated. To systematically strengthen pupils’ participation is a health promotion approach that also can improve the school's ability to meet its compensatory mandates. That is, the school system must meet each pupil's individual needs and compensate for what the pupil may need to complete his or her studies.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / O Brasil é um dos maiores consumidores per capita de açúcar e estudos têm mostrado um papel específico do consumo excessivo de açúcar no ganho de peso. Com o aumento do ganho de peso observado em vários países, e também no Brasil, é importante testar quais mensagens, estratégias e propostas de intervenção seriam eficazes na prevenção dessa epidemia. Os dados reportados são referentes a um ensaio randomizado por conglomerado, controlado, conduzido em 20 escolas municipais na cidade metropolitana de Niterói no Estado de Rio de Janeiro, de março a dezembro de 2007, que testou a eficácia de orientações para merendeiras objetivando reduzir a disponibilidade de açúcar e de alimentos fontes de açúcar na alimentação escolar e no consumo delas. A intervenção consistiu em um programa de educação nutricional nas escolas usando mensagens, atividades e material educativo que encorajassem a redução da adição de açúcar na alimentação escolar pelas merendeiras e no consumo delas. A redução da disponibilidade per capita de açúcar pelas escolas foi analisada através de planilhas com dados da utilização dos itens do estoque. O consumo individual das merendeiras foi avaliado através de questionário de freqüência de consumo alimentar. As medidas antropométricas e bioquímicas foram realizadas de acordo com técnicas padronizadas. As escolas de intervenção apresentaram maior redução da disponibilidade per capita de açúcar quando comparadas às escolas controle (-6,0 kg vs. 3,4 kg), mas sem diferença estatisticamente significante. Houve redução no consumo de doces e bebidas açucaradas nas merendeiras dos dois grupos, mas o consumo de açúcar não apresentou diferenças estatisticamente significativas entre eles. Houve redução do consumo de energia total nos dois grupos, mas sem diferença entre eles, e sem modificação dos percentuais de adequação dos macronutrientes em relação ao consumo de energia. Ao final do estudo somente as merendeiras do grupo de intervenção conseguiram manter a perda de peso, porém sem diferença estatisticamente significante. A estratégia de redução da disponibilidade e do consumo de açúcar por merendeiras de escolas públicas não atingiu o principal objetivo de redução de adição de açúcar. Uma análise secundária dos dados avaliou a associação entre a auto-percepção da saúde e da qualidade da alimentação com o excesso de peso e concentração elevada de colesterol sérico das merendeiras na linha de base. As perguntas de auto-percepção foram coletadas por entrevista. Dentre as que consideraram a sua alimentação como saudável, 40% apresentavam colesterol elevado e 61% apresentavam excesso de peso vs. 68% e 74%, respectivamente, para as que consideraram a sua alimentação como não-saudável. Dentre as que consideraram a sua saúde como boa, 41% apresentavam colesterol elevado e 59% apresentavam excesso de peso vs. 71% e 81%, respectivamente, para as que consideraram a sua saúde como ruim. A maioria das mulheres que relatou ter alimentação saudável apresentou maior frequência de consumo de frutas, verduras e legumes, feijão, leite e derivados e menor freqüência de consumo de refrigerante. Conclui-se que perguntas únicas e simples como as utilizadas para a auto-avaliação da saúde podem também ter importância na avaliação da alimentação. / Brazil is one of the largest per capita consumers of sugar and several studies have shown a specific role of excessive consumption of sugar on weight gain. With the increased weight gain observed in several countries, including Brazil, it is important to test which messages, strategies and proposals for intervention would be effective in preventing this epidemic. The data reported are for an intervention study that tested the efficacy of guidelines for school lunch cooks aiming to reduce the added sugar in schools meals and their sugar intake. A cluster randomized controlled trial was carried out in twenty public schools in the metropolitan city of Niterói in Rio de Janeiro, Brazil, from March to December 2007, to assess the change in the availability and consumption of sugar. The intervention consisted of a nutrition educational program in schools using messages, activities and printed educational materials that encouraged the reduction of added sugar in the schools meals by the school lunch cooks and in their consumption. The reduction in per capita sugar availability by the schools was examined through spreadsheets with data from the use of inventory items. Individual food intake of the school lunch cooks was evaluated by a Food Frequency Questionnaire. Anthropometric and biochemical measurements were performed according to standard techniques and the variation in weight change was measured throughout the study. Per capita sugar availability reduced most markedly in the intervention schools compared to the control schools (-6,0 kg vs. 3,4 kg), however this difference was not statistically significant. Both groups of school lunch cooks showed a reduction in the consumption of sweets and sweetened beverages, but the difference in sugar intake was not statistically significant. A reduction in total energy consumption was observed in both groups, but there was no difference between them. Also, there was no difference in the percentage of adequacy of nutrients in relation to energy consumption. Sweetened beverages presented the most important consumption reduction. At the end of the study, only school lunch cooks in the intervention group were able to maintain weight loss, but not statistically significant. The strategy of reducing the availability and consumption of sugar by the school lunch cooks from public schools did not achieve the main goal of reducing added sugar. A secondary analysis examined the association between self-perceived health status and diet quality with overweight and high serum cholesterol concentration of the school lunch cooks at baseline. The self-perception questions were collected by interview. Among women who reported healthy diet, 40% presented high serum cholesterol and 61% were overweight. Among women who reported unhealthy diet, 68% presented high serum cholesterol and 74% presented overweight. Most women who reported healthy diet showed a higher frequency of consumption of sweets, fruits, vegetables, beans, dairy products and lower frequency of consumption of soft drink. In conclusion, single and simple questions, such as those used for self-perceived health status may also be important in assessing the diet.

Syfte och frågeställningar Syftet med studien är att undersöka och jämföra vilka faktorer i lärares arbetsmiljö i storstad och mindre tätort, som samvarierar med lärares upplevda hälsa. För att uppfylla detta syfte har tre frågeställningar utformats: (1) Vad i arbetsmiljön upplever lärarna som stressorer vilka påverkar deras upplevda hälsa? (2) Vilken roll spelar skolledningen respektive kollegorna för lärarnas upplevda hälsa? (3) Hur korrelerar lärarnas upplevda hälsa med deras fysiska aktivitetsgrad? Metod En kvantitativ metod i form av enkäter har används för att kunna besvara och analysera syftet och frågeställningarna. I huvudsak har enkäten utformats med fasta svarsalternativ. Ett så kallat bekvämlighetsurval har gjorts i val av skolor, där lärare på respektive skola som velat delta i studien har legat till grund för resultatsammanställningen. Total 98 enkäter samlades in och sammanställdes iStatistical Package for the Social Sciences - SPSS- version 19,0. Teoretiska ramverk som användes för analys av resultatet var Antonovskys KASAM-teori samt Karaseks och Theorells Krav-kontroll-stöd-modell. Resultat Studiens resultat visar att det finns en stark korrelation mellan den mentala- och kroppsliga hälsan, både för lärare i storstad (p=0,01) och i mindre tätort (p=0,08). De undersökta lärarna i storstad och mindre tätort upplever att de har en bra mental hälsa och att det är meningsfullt att gå till jobbet. Över 40 % svarar att de ofta (3-5 dagar per veckan) känner att de har egenkontroll, hanterbarhet, meningsfullhet och upplever att de är en del av ett sammanhang. Faktorer som korrelerar med den mentala hälsan är krav från elever, skolledning och sig själv. När det gäller den fysiska miljön är faktorer som påverkar lärarna, i både storstad och i mindre tätort, ljudnivå och renlighet. Skolledningen spelar en stor roll för lärarnas upplevda hälsa, såväl i storstad (p=>0,000) som i mindre tätort (p=0,009). Dock upplever över 50 % av lärarna att de inte har stöd från skolledningen. Lärarna anger att administrativa uppgifter, tid, planering och arbetsklimat är betydelsefulla faktorer som påverkar deras hälsa. Resultatet visar även att den kroppsliga hälsan korrelerar med att vakna utvilad och kunna koppla av. Lärarna i såväl storstad som i mindre tätort upplever att det har en bra kroppslig hälsa. För lärarna i storstad finns det en korrelation mellan stöd från vänner och hur fysisk aktiv du är. Slutsats Slutsatser som kan dras från denna studie är att det inte föreligger stora skillnader mellan lärares upplevda arbetsmiljö och hälsa i storstad och i mindre tätort. Lärarna upplever att de mår bra, både mentalt och kroppsligt. En bidragande faktor till detta är enligt studien att lärarna upplever högt stöd från kollegor samt från vänner och anhöriga. Detta kan tolkas som att stödet utgör en form av copingstrategi, som hjälper lärarna att hantera sin stress – något som även ett flertal tidigare studier lyfter. Studiens resultat leder även fram till slutsatsen att lärare behöver finna balans mellan upplevda krav och finna resurser för att kunna uppleva en känsla av sammanhang. Utifrån krav-kontroll-stöd-modellen gör detta att lärarna upplever en balans i anspänningsgrad. / Aim and questions The study aims to examine and compare which factors in teachers’ work environment, in both metropolitan and small urban areas, correlate with teachers' perceived health. To meet this aim, three questions were designed: (1) What do teachers experience as stress factors in their work environment affecting their health? (2) What influence do the school management and colleagues have on their perceived health? (3) How does the teachers' perceived health correlate with their physical activity level? Method A quantitative method with a questionnaire has been used for the study. In essence, the questionnaire was designed with closed answers. A so-called comfort selection has been made for the choice of schools, where teachers at each school who wanted to participate in the study formed the basis for the collection of data. Overall 98 questionnaires were collected and the statistical analysis was done with help of the Statistical Package for the Social Sciences - SPSS version 19.0. Theoretical frameworks used were Antonovsky's SOC-theory (Sense of Coherence) and Karasek´s and Theorell´s Requirements-control-support model. Results Our results show that there is a strong correlation between mental and physical health, both for teachers in the metropolitan (p = 0.01) and smaller urban area (p = 0.08). The participants from both areas feel that they have a good mental health and that it makes sense to go to work. Over 40% answer that they often (3-5 days per week) feel that they experience self-monitoring, manageability, meaningfulness as teachers and that they are a part of a context. Factors that correlate with mental health are demands from students, school management and themselves. With regard to the physical environment, factors that affect teachers in both metropolitan and small urban areas are noise level and cleanliness. School management plays a large role in teachers' perceived health, both in metropolitan (p => 0.000) and in smaller urban areas (p = 0.009). However, over 50% of the teachers feel that they do not have support from school management. Teachers indicate that administrative tasks, time, planning and working environment are important factors in relation to their experienced health. The result also shows that experienced physical health among teachers correlates with the feeling of waking up refreshed and the ability to relax. The teachers in both metropolitan and less urban areas feel that they have a good physical health. For teachers in metropolitan areas, there is a correlation between support from friends and how physically active you are. Conclusions A conclusion to be drawn from this study is that there are small differences between teachers’ experienced health and work environment in metropolitan and less urban areas. The majority of the teachers feel they have a experienced health, both mentally and physically, and are doing well. A contributing factor to this could be that teachers experience strong support from colleagues, friends and relatives. This could suggest that social networks constitute a form of coping strategy, which help teachers manage their stress. A high percentage of the teachers seem to find a balance between perceived demands and finding resources to experience the sense of coherence. Based on the demands-control-support model, this means that teachers experience a feeling of balance.

Britain's Asians are a young population and their socio-economic status is low, with racial disadvantage in housing, employment, education and health. Research on their health has usually not been conducted in its socio-economic and demographic context and there is little on their use of primary care. Three studies were conducted to investigate their relationship with primary care in Bradford. A study of general practice attenders of white/British, Pakistani and Indian origin confirmed the demographic and socio-economic differences between the groups. The former had higher rates of alcohol and cigarette consumption. For Pakistanis and Indians, fluency and literacy in English was poor. Ethnic and linguistic match between doctor and patient was more important in patients' choice of doctor than the doctor's sex. Differential employment status of Asian and white/British accounted for some of the differences in health. A study of general practice attendance showed similar rates of surgery consultations between Asians and Non-Asians; the latter made greater use of domiciliary services. Both these studies were conducted in an inner Bradford health centre with an Asian male, a white male and a white female doctor. Bradford GPs were found to perceive that Asian patients made greater use of surgery and domiciliary consultations; attended more often for trivial complaints; and had lower compliance rates than Non-Asians. These perceptions were not supported by objective data. Better qualified GPs had a smaller, and Asian doctors had a greater proportion of Asian patients on their lists. Research, and action on Asians' health, needs to take account of their poorer socio-economic status.

The aim of this thesis was to investigate if the outcome of rehabilitation efforts is depending on what view health care has in relation to what need of care people have and if the outcome for different groups of patients with low-back complaints (specific versus non-specific complaints) is various successful. The outcome is measured in length of sick leave, number of spells and granted sickness and disability pensions. This thesis combines a theoretical analysis of different theories of health with studies of two empirical materials. One material comprises a group of individuals with low-back complaints (specific versus non-specific complaints) from a nation-wide survey of Living Conditions conducted by Statistics Sweden in 1981. The other material comprises a sample of individuals on sick leave either due to low-back complaints or other kinds of complaints than low-back complaints. The outcome of these studies are measured as to what extent people with low-back complaints are granted a disability pension (Paper III) and which the characteristics are of those on sick leave due to low-back complaints compared to those with other kinds of complaints (Paper IV). The results from Paper III revealed a difference concerning socio-economic group and granted disability pension between those with specific, non-specific and frequent low-back complaints. Those with non-specific and frequent low-back complaints were to higher extent manual workers and disability pensioners. The results of Paper IV reveals also a socio-economic difference besides that those with low-back complaints had longer sick leave periods and more spells.  What does these results indicate? Are non-specific and frequent low-back complaints not successfully treated within the health care system? Is this due to how these matters have been identified? Are these individuals truly disabled due to their low-back complaints, if so how are they assessed and treated? I believe that the notions of health and disease as well as the social context in which people act influence the outcome of rehabilitation. If people judge their health as bad (here due to low-back troubles) and in need of health care and the health care system do not recognise their need when not identified as diseased a problem arises. These individuals claim that their ability to work is hampered due to the low-back complaint and the society has an obligation and needs a legitimate solution for those individuals that cannot support themselves due to ill health. This obligation makes a demand on the health care system. If non-specific complaints are assessed as non-medical problems, from a biomedical point of view, health care lacks measures to take care of these people if they ought to be taken care of within the health care system at all. But this outcome (a disability pension) may also indicate that people suffer from a “true” illness although not defined by objective findings. If that is the state one may ask if there is a lack of sufficient diagnostic procedures and measures as well. A rehabilitation approach stemming from a humanistic social perspective might lead to a more favourable outcome for people with low-back complaints, whether or not these complaints have been identified in a biomedical sense, as this perspective take into account both the goals, the resources and the social context of that individual.  This thesis has paid attention to the matter that conceptual notions, which seldom are considered within clinical praxis, are of vital importance for the outcome of rehabilitation. Health care falls short especially when it comes to non-specific and frequent low-back complaints and this may be due to the biomedical model being used too strictly within a domain where other models, here exemplified as Pörn’s Theory of Health, might result in a more favourable rehabilitation outcome for the individual. / digitalisering@umu

Conselho Nacional de Desenvolvimento Científico e Tecnológico / O Brasil é um dos maiores consumidores per capita de açúcar e estudos têm mostrado um papel específico do consumo excessivo de açúcar no ganho de peso. Com o aumento do ganho de peso observado em vários países, e também no Brasil, é importante testar quais mensagens, estratégias e propostas de intervenção seriam eficazes na prevenção dessa epidemia. Os dados reportados são referentes a um ensaio randomizado por conglomerado, controlado, conduzido em 20 escolas municipais na cidade metropolitana de Niterói no Estado de Rio de Janeiro, de março a dezembro de 2007, que testou a eficácia de orientações para merendeiras objetivando reduzir a disponibilidade de açúcar e de alimentos fontes de açúcar na alimentação escolar e no consumo delas. A intervenção consistiu em um programa de educação nutricional nas escolas usando mensagens, atividades e material educativo que encorajassem a redução da adição de açúcar na alimentação escolar pelas merendeiras e no consumo delas. A redução da disponibilidade per capita de açúcar pelas escolas foi analisada através de planilhas com dados da utilização dos itens do estoque. O consumo individual das merendeiras foi avaliado através de questionário de freqüência de consumo alimentar. As medidas antropométricas e bioquímicas foram realizadas de acordo com técnicas padronizadas. As escolas de intervenção apresentaram maior redução da disponibilidade per capita de açúcar quando comparadas às escolas controle (-6,0 kg vs. 3,4 kg), mas sem diferença estatisticamente significante. Houve redução no consumo de doces e bebidas açucaradas nas merendeiras dos dois grupos, mas o consumo de açúcar não apresentou diferenças estatisticamente significativas entre eles. Houve redução do consumo de energia total nos dois grupos, mas sem diferença entre eles, e sem modificação dos percentuais de adequação dos macronutrientes em relação ao consumo de energia. Ao final do estudo somente as merendeiras do grupo de intervenção conseguiram manter a perda de peso, porém sem diferença estatisticamente significante. A estratégia de redução da disponibilidade e do consumo de açúcar por merendeiras de escolas públicas não atingiu o principal objetivo de redução de adição de açúcar. Uma análise secundária dos dados avaliou a associação entre a auto-percepção da saúde e da qualidade da alimentação com o excesso de peso e concentração elevada de colesterol sérico das merendeiras na linha de base. As perguntas de auto-percepção foram coletadas por entrevista. Dentre as que consideraram a sua alimentação como saudável, 40% apresentavam colesterol elevado e 61% apresentavam excesso de peso vs. 68% e 74%, respectivamente, para as que consideraram a sua alimentação como não-saudável. Dentre as que consideraram a sua saúde como boa, 41% apresentavam colesterol elevado e 59% apresentavam excesso de peso vs. 71% e 81%, respectivamente, para as que consideraram a sua saúde como ruim. A maioria das mulheres que relatou ter alimentação saudável apresentou maior frequência de consumo de frutas, verduras e legumes, feijão, leite e derivados e menor freqüência de consumo de refrigerante. Conclui-se que perguntas únicas e simples como as utilizadas para a auto-avaliação da saúde podem também ter importância na avaliação da alimentação. / Brazil is one of the largest per capita consumers of sugar and several studies have shown a specific role of excessive consumption of sugar on weight gain. With the increased weight gain observed in several countries, including Brazil, it is important to test which messages, strategies and proposals for intervention would be effective in preventing this epidemic. The data reported are for an intervention study that tested the efficacy of guidelines for school lunch cooks aiming to reduce the added sugar in schools meals and their sugar intake. A cluster randomized controlled trial was carried out in twenty public schools in the metropolitan city of Niterói in Rio de Janeiro, Brazil, from March to December 2007, to assess the change in the availability and consumption of sugar. The intervention consisted of a nutrition educational program in schools using messages, activities and printed educational materials that encouraged the reduction of added sugar in the schools meals by the school lunch cooks and in their consumption. The reduction in per capita sugar availability by the schools was examined through spreadsheets with data from the use of inventory items. Individual food intake of the school lunch cooks was evaluated by a Food Frequency Questionnaire. Anthropometric and biochemical measurements were performed according to standard techniques and the variation in weight change was measured throughout the study. Per capita sugar availability reduced most markedly in the intervention schools compared to the control schools (-6,0 kg vs. 3,4 kg), however this difference was not statistically significant. Both groups of school lunch cooks showed a reduction in the consumption of sweets and sweetened beverages, but the difference in sugar intake was not statistically significant. A reduction in total energy consumption was observed in both groups, but there was no difference between them. Also, there was no difference in the percentage of adequacy of nutrients in relation to energy consumption. Sweetened beverages presented the most important consumption reduction. At the end of the study, only school lunch cooks in the intervention group were able to maintain weight loss, but not statistically significant. The strategy of reducing the availability and consumption of sugar by the school lunch cooks from public schools did not achieve the main goal of reducing added sugar. A secondary analysis examined the association between self-perceived health status and diet quality with overweight and high serum cholesterol concentration of the school lunch cooks at baseline. The self-perception questions were collected by interview. Among women who reported healthy diet, 40% presented high serum cholesterol and 61% were overweight. Among women who reported unhealthy diet, 68% presented high serum cholesterol and 74% presented overweight. Most women who reported healthy diet showed a higher frequency of consumption of sweets, fruits, vegetables, beans, dairy products and lower frequency of consumption of soft drink. In conclusion, single and simple questions, such as those used for self-perceived health status may also be important in assessing the diet.

Abstract Physical activity reduces mortality and morbidity and improves physical and psychological health. Lately, the detrimental health associations of excess sedentary time have also been acknowledged. It is still unknown how temporal patterns of physical activity and sedentary time are associated with health, as previous studies have mainly focused on summary metrics of these behaviors; for example, the weekly duration of moderate to vigorous physical activity. This study aimed to investigate the associations between the amount and temporal patterns of physical activity and sedentary time and health at mid-life. Physical activity and sedentary time were objectively measured for two weeks using an accelerometer-based activity monitor in the Northern Finland Birth Cohort 1966 46-year follow-up (n=5,621). Participants attended clinical examinations and completed health and behaviour questionnaires. A machine learning method (X-means cluster analysis) was used to identify distinct groups of participants with different patterns of physical activity and sedentary behaviour based on the activity data. A positive, dose-response association was found with perceived health and self-reported leisure time and objectively measured moderate to vigorous physical activity. Higher prolonged sedentary time was associated with better heart rate variability but not with resting heart rate or post-exercise heart rate recovery. Four distinct physical activity clusters (inactive, evening active, moderately active and very active) were recognised. The risk of developing cardiovascular disease was significantly lower in the very active cluster compared to the inactive, and in women also in the moderately active cluster compared to the inactive and evening active clusters. On average, the cardiovascular disease risk was low, indicating good cardiovascular health in the study population. Prolonged sedentary time was associated with cardiac autonomic function, which in this study was not explained by physical activity or cardiorespiratory fitness level. Higher cardiovascular disease risk was found in the activity clusters in which the amount of physical activity was lower and in women took place later in the evening. Results of the study can be used for designing feasible interventions for risk groups with unhealthy physical activity and sedentary behaviour patterns. / Tiivistelmä Fyysinen aktiivisuus vähentää sairastavuutta, kuolleisuutta sekä parantaa fyysistä ja psyykkistä terveyttä. Viime aikoina on lisäksi tunnistettu liiallisen paikallaanolon terveyshaitat. Vielä ei tiedetä, miten fyysisen aktiivisuuden ja paikallaanolon ajallinen jakautuminen päivän aikana vaikuttaa terveyteen, koska aiemmat tutkimukset ovat keskittyneet enimmäkseen tiettyihin summamuuttujiin kuten kohtuullisesti kuormittavan liikkumisen määrään viikossa. Työn tarkoituksena oli tutkia fyysisen aktiivisuuden ja paikallaanolon määrän ja ajallisen jakautumisen terveysyhteyksiä keski-iässä. Fyysinen aktiivisuus ja paikallaanolo mitattiin kiihtyvyysanturipohjaisella aktiivisuusmittarilla kahden viikon ajan Pohjois-Suomen vuoden 1966 syntymäkohortin 46-vuotistutkimuksessa (n=5621). Tutkittavat osallistuivat kliinisiin tutkimuksiin ja täyttivät kyselyitä terveydentilastaan ja käyttäytymisestään. Koneoppimismenetelmällä (X-means cluster analysis) tutkittavat luokiteltiin aktiivisuusdatan perusteella ryhmiin, joissa fyysisen aktiivisuuden määrä ja ajallinen jakautuminen päivän aikana poikkesi mahdollisimman paljon ryhmien välillä. Positiivinen annos-vasteyhteys löydettiin koetun terveyden ja itseraportoidun vapaa-ajan liikunnan sekä mitatun kohtuullisesti kuormittavan liikkumisen väliltä. Suurempi pitkittynyt paikallaanoloaika oli yhteydessä parempaan sykevälivaihteluun mutta ei leposykkeeseen tai harjoituksen jälkeiseen sykkeen palautumiseen. Neljä aktiivisuusryhmää tunnistettiin (inaktiiviset, ilta-aktiiviset, kohtuullisen aktiiviset ja erittäin aktiiviset). Sydän- ja verisuonitautien sairastumisriski oli merkitsevästi pienempi erittäin aktiivisessa ryhmässä verrattuna inaktiiviseen ryhmään ja lisäksi naisilla kohtuullisen aktiivisessa ryhmässä verrattuna inaktiiviseen ja ilta-aktiiviseen ryhmään. Sairastumisriski oli keskimäärin matala viitaten hyvään sydänterveyteen tutkimusjoukossa. Pitkillä paikallaanolojaksoilla oli yhteys sydämen autonomiseen säätelyyn, jota tässä työssä ei selittänyt fyysinen aktiivisuus tai aerobinen kunto. Korkeampi sydän- ja verisuonitautien riski löydettiin aktiivisuusryhmistä, joissa fyysisen aktiivisuuden määrä oli vähäisempää ja naisilla painottunut myöhäisempään iltaan. Tutkimuksen tuloksia voidaan hyödyntää interventioiden suunnittelussa riskiryhmille, joiden fyysisen aktiivisuuden ja paikallaanolon piirteet ovat terveydelle haitallisia.

Le confinement, notamment celui lié à la COVID-19, aurait une influence sur la qualité de vie et le bien-être des personnes âgées en raison de ses conséquences sur la santé physique, psychologique et cognitive. Cependant, les études antérieures publiées ont plusieurs limites méthodologiques, dont l’absence du statut préconfinement de même que le type de devis, souvent transversal. La présente étude propose un devis longitudinal avec des mesures préconfinement et vise à évaluer les changements en comparant la qualité de vie, la santé perçue et le bien-être entre avant le confinement (T1 = décembre 2019), trois mois après le début du premier confinement (T2 = juin 2020) et pendant le deuxième confinement (T3 = janvier 2021) dû à la COVID-19 chez un groupe de 72 personnes âgées en santé. Ces derniers ont complété un sondage électronique évaluant les facteurs personnels, les activités et la participation de même que les questionnaires EuroQol-5D et Warwick-Edinburgh Mental Well-being Scale. Une diminution de la qualité de vie, de la santé perçue et du bien-être a été observée entre T1 et T2 et entre T1 et T3, mais aucune différence n’est rapportée entre les deux périodes de confinement. Les variables associées à ces changements sont le niveau d’énergie, le sentiment de bonheur, l’activité physique, le changement de la condition médicale, des difficultés mnésiques, le sentiment d’isolement et l’âge. Cette étude permettra de cibler dans un but préventif les variables pouvant avoir un effet délétère sur les personnes âgées lors de futurs contextes de confinement. / Lockdown, particularly that related to COVID-19, is thought to influence the quality of life and well-being of the elderly because of its consequences on physical, psychological, and cognitive health. However, previous published studies have several methodological limitations, including the absence of pre-confinement status and the type of design, which is often cross-sectional. The present study proposes a longitudinal design with pre-lockdown measures and aims to assess changes by comparing quality of life, perceived health, and well-being between before lockdown (T1 = December 2019), three months after the start of the first lockdown (T2 = June 2020), and during the second lockdown (T3 = January 2021) due to COVID-19 in a group of 72 healthy elderly. They completed an electronic survey assessing personal factors, activities, and participation as well as the EuroQol-5D and Warwick-Edinburgh Mental Well-being Scale. A decrease in quality of life, perceived health and well-being was observed between T1 and T2 and between T1 and T3, but no difference was reported between the two lockdown periods. The variables associated with these changes were energy level, level of happiness, physical activity, change in medical condition, memory difficulties, level of perceived isolation and age. This study will help to target variables that may have a deleterious effect on older adults in future confinement settings for preventive purposes.