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Background: Protein intake greater than the currently recommended amount is suggested to improve physical functioning and well-being in older adults, yet it is likely to increase diet-associated greenhouse gas emissions (GHGEs) if environmental sustainability is not considered.Objectives: We aimed to identify dietary changes needed to increase protein intake while improving diet environmental sustainability in older adults.Methods: Starting from the habitual diet of 1,354 Dutch older adults (aged 56-101 y) from the Longitudinal Aging Study Amsterdam cohort, mathematical diet optimization was used to model high-protein diets with minimized departure from habitual intake in cumulative steps. First, a high-protein diet defined as that providing ≥1.2 g protein · kg body weight-1 · d-1 was developed isocalorically while maintaining or improving nutritional adequacy of the diet. Second, adherence to the Dutch food-based dietary guidelines (FBDG) was imposed. Third, a stepwise 10% GHGE reduction was applied.Results: Achieving a high-protein diet aligned with the FBDG without considering GHGEs required an increase in vegetables, legumes, nuts, whole grains, meat/dairy alternatives, dairy, and eggs and a reduction in total meat (for men only) and discretionary products, but it resulted in a 5% increase in GHGEs in men and 9% increase in women. When a stepwise GHGE reduction was additionally applied, increases in poultry and pork (mainly for women) and decreases in beef/lamb and processed meat were accrued, with total meat staying constant until a 50-60% GHGE reduction. Increases in whole grains, nuts, and meat/dairy alternatives and decreases in discretionary products were needed to lower GHGEs.Conclusions: A high-protein diet aligned with FBDG can be achieved in concert with reductions in GHGEs in Dutch older adults by consuming no more than the recommended 500 g meat per week while replacing beef and lamb and processed meat with poultry and pork and increasing intake of diverse plant-protein sources. [ABSTRACT FROM AUTHOR]

The use of patient-reported outcomes to improve burn care increases. Little is known on burn patients' views on what outcomes are most important, and about preferences regarding online Patient Reported Outcome Measures (PROMs). Therefore, this study assessed what outcomes matter most to patients, and gained insights into patient preferences towards the use of online PROMs. Adult patients (≥18 years old), 3–36 months after injury completed a survey measuring importance of outcomes, separately for three time periods: during admission, short-term (<6 months) and long-term (6–24 months) after burn injury. Both open and closed-ended questions were used. Furthermore, preferences regarding the use of patient-reported outcome measures in burn care were queried. A total of 140 patients were included (response rate: 27%). 'Not having pain' and 'good wound healing' were identified as very important outcomes. Also, 'physical functioning at pre-injury level', 'being independent' and 'taking care of yourself' were considered very important outcomes. The top-ten of most important outcomes largely overlapped in all three time periods. Most patients (84%) had no problems with online questionnaires, and many (67%) indicated that it should take up to 15 minutes. Patients' opinions differed widely on the preferred frequency of follow-up. Not having pain and good wound healing were considered very important during the whole recovery of burns; in addition, physical functioning at pre-injury level, being independent, and taking care of yourself were deemed very important in the short and long-term. These outcomes are recommended to be used in burn care and research, although careful selection of outcomes remains crucial as patients prefer online questionnaires up to 15 minutes. • This study investigated what outcomes are most important to adult burn patients. • 'Not having pain' is a very important outcome during admission. • And 'good wound healing' and 'taking care of yourself' during the whole recovery. • Identified outcomes are recommended to be used to evaluate burn care. • Online questionnaires of maximum 15 minutes are a good method for most patients. [ABSTRACT FROM AUTHOR]

To evaluate the effectiveness of psychosomatic therapy versus care as usual in primary care for patients with persistent somatic symptoms (PSS). We conducted a pragmatic, two-armed, randomised controlled trial among primary care patients with PSS in the Netherlands that included 39 general practices and 34 psychosomatic therapists. The intervention, psychosomatic therapy, consisted of 6–12 sessions delivered by specialised exercise- and physiotherapists. Primary outcome measure: patient's level of functioning. Secondary outcomes: severity of physical and psychosocial symptoms, health-related quality of life, health-related anxiety, illness behaviour and number of GP contacts. Compared to usual care (n = 85), the intervention group (n = 84) showed no improvement in patient's level of functioning (mean difference − 0.50 [95% CI -1.10 to 0.10]; p =.10), and improvement in health-related anxiety (mean difference − 1.93 [95% CI -3.81 to −0.04]; p =.045), over 12 months. At 5-month follow-up, we found improvement in physical functioning, somatisation, and health-related anxiety. The 12-month follow-up revealed no therapy effects. Subgroup analyses showed an overall effect in patient's level of functioning for the group with moderate PSS (mean difference − 0.91 [95% CI -1.78 to −0.03]; p =.042). In the year after the end of therapy, the number of GP contacts did not differ significantly between the two groups. We only found effects on some secondary outcome measures, and on our primary outcome measure especially in patients with moderate PSS, the psychosomatic therapy appears promising for further study. Trial registration: the trial is registered in the Netherlands Trial Registry, https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7356 under ID NTR7356. • We investigated the effectiveness of psychosomatic therapy for PSS. • No improvement was established in patient's level of functioning. • We only found effects on some secondary outcome measures. • Especially patients with moderate PSS benefited from the psychosomatic therapy. • Psychosomatic therapy could be an important treatment to improve PSS management. [ABSTRACT FROM AUTHOR]

• Care independency for hygiene is a predictor for using absorbing material. • Urinary incontinence prior to admission is associated with using absorbing material. • Diagnosis dementia is not a predictor for using absorbing material. The purpose of this study is to explore the characteristics and capabilities of nursing home residents with urinary incontinence in relation to urinary incontinence interventions. A secondary data-analysis on the data from 1417 residents (65 years and above), suffering from urinary incontinence and living in nursing homes and collected by a cross-sectional multi-center point prevalence measurement, the Dutch annual independent (Inter)national Prevalence Measurement of Quality of Care of Maastricht University, was performed. In order to explore the relationship between an urinary incontinence intervention and the predictors diagnosis dementia, body posture, mobility, (un)dressing, hygiene and communication; onset urinary incontinence; frequency, time of loss and quantity urinary incontinence and fecal incontinence, a Chi-squared Automatic Interaction Detector (CHAID) analysis was performed. The level of care dependency for hygiene is the key variable in predicting the use of an urinary incontinence intervention. The ability to adopt an appropriate body posture, being urinary incontinence prior to admission into a nursing home and being diagnosed with dementia are identified as significant predictors. Residents care independent for hygiene and for adopting an appropriate body posture and urinary incontinence before admission into a nursing home are more likely to use absorbing material. In residents being care dependent for hygiene and for adopting an appropriate body posture and diagnosed with dementia, a combination of absorbing material with toileting or other interventions are mostly applied. Results reveal that residents' characteristics and capabilities determine the implementation of an urinary incontinence intervention. [ABSTRACT FROM AUTHOR]

To individualize nutritional interventions for the prevention and treatment of malnutrition and sarcopenia, it is required to understand the nutritional needs of older adults. This study explores the nutritional needs of geriatric outpatients. We hypothesized that inadequate energy and protein intake is common in geriatric outpatients. Data were retrieved from 2 cohort studies encompassing community-dwelling older adults referred to geriatric outpatient mobility clinics in Amsterdam, The Netherlands and Melbourne, Australia. Indirect calorimetry and a food diary, respectively, were used to assess resting metabolic rate (RMR) and energy and protein intake. Total energy expenditure (TEE) was calculated by the RMR multiplied by an activity factor of 1.4. An energy deficit was defined as a relative difference >10% between TEE and energy intake. A protein deficit was defined as protein intake <1.2 g/kg body weight per day. Bland-Altman analysis assessed the agreement between energy and protein requirements versus intake at an individual level. Seventy-four outpatients were included (25 males, median age 78.9 [IQR: 72.8-86.1] years). The mean difference between TEE and energy intake was 292 (SD 481) kcal/d. An energy deficit was present in 46 outpatients. The median protein intake was 1.00 (IQR: 0.87-1.19) g/kg body weight per day and a protein deficit was present in 57 outpatients. There was a low agreement between energy and protein requirements versus intake at an individual level. In conclusion, over half of the outpatients had energy and/or protein deficits. Integrating dietetic services at geriatric outpatient mobility clinics could potentially improve nutrition- and muscle-related outcomes in a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Survey data on adherence to COVID-19 prevention measures have often been used to inform policy makers and public health professionals. Although behavioural survey data are often considered to suffer from biases, there is a lack of studies critically examining the validity, reliability and responsiveness of population-survey data on behaviour throughout the COVID-19 pandemic. We studied the measurement properties of the COVID-19 Adherence to Prevention Advice Survey (CAPAS), a novel questionnaire implemented in a repeated cross-sectional (i.e., 'Trend') Study and a Cohort Study in the Netherlands during the COVID-19 pandemic. The CAPAS is a novel questionnaire developed in March 2020, with the aim to assess social activity and adherence to COVID-19 prevention measures. Items were formulated to minimise social desirability and aid memory retrieval. Based on the COSMIN framework, we selected the most suitable test for each behavioural question. We investigated criterion validity of vaccination, testing behaviour and mobility by comparing (aggregate) trends of self-reported behaviour to trends in objective data. Responsiveness of mobility and ventilation behaviour was assessed by studying whether self-reported behaviour changed following contextual (e.g., policy) changes. Test-retest reliability of hygienic behaviour, wearing face masks, ventilation behaviour and social distancing was examined during a period in which the context was stable. Overall, aggregate trends in self-reported behaviour closely corresponded to trends in external objective data. Self-reported behaviours were responsive to contextual changes and test-retest reliabilities were adequate. For infrequent behaviours reliability improved when measures were dichotomised. We were able to examine national representativeness for vaccination, which suggested a modest overestimation of on average 3.7%. This study supports the suitability of using carefully designed, self-reported surveys (and the CAPAS specifically) to study changes in protective behaviours in a dynamic context. • CAPAS was used to measure (changes in) preventive behavior of the Dutch population. • We studied its criterion validity, responsiveness and test-retest reliability. • Results support the validity, responsiveness and reliability of the survey. • Carefully designed surveys can be used to study (changes in) protective behavior. [ABSTRACT FROM AUTHOR]

Physical activity in people with dementia (PwD) may enhance physical and mental functioning. Exergaming, which combines physical exercise with cognitive stimulation in a gaming environment, was developed to overcome barriers in performing physical activities. We evaluated the effects of exergaming in day care centers (DCCs) for PwD and informal caregivers (ICs). A randomized controlled trial among 23 DCCs across the Netherlands randomized to exergaming (interactive cycling during 6 months) or a care-as-usual control group. A total of 112 (73 exergaming, 39 control) community-dwelling dyads (PwD, IC), with the PwD visiting a DCC at least twice per week. All outcomes were assessed using structured questionnaires during interviews with PwD and ICs at baseline (T0), 3 months (T1), and 6 months (T2). Primary outcomes: physical activity and mobility of the PwD. Secondary outcomes: physical, cognitive, emotional and social functioning, and quality of life for PwD. For ICs: experienced burden, quality of life, and positive care experiences. Mixed-model analyses showed no statistically significant effects on primary outcomes. There were statistically significant positive effects on PwD's secondary outcomes at T2 on cognition [Mini-Mental State Examination (MMSE): r = 2.30, 95% confidence interval (CI): 0.65, 3.96, P =.007; and Trail Making Test part A (TMT-A): r = −28.98, 95% CI: −54.89, −3.08, P =.029], social functioning (Behavior Observation Scale for Intramural Psychogeriatrics subscale 1 (GIP): r = −1.86, 95% CI: −3.56, −0.17, P =.031), and positive post-test effects in ICs on distress caused by the PwD's neuropsychiatric symptoms (NPI-Q total distress: r = −3.30, 95% CI: −6.57, −0.03, P =.048) and on sense of competence (SSCQ: r = 2.78, 95% CI: 0.85, 4.71, P =.005). Exergaming appeared not effective on the primary outcomes. Despite the study being underpowered, we found positive effects on secondary outcomes for PwD and ICs, and no negative effects. We therefore recommend further study, dissemination, and implementation. [ABSTRACT FROM AUTHOR]