LITERATURE Health Promotion Disease

LITERATURE Health Promotion & Disease Prevention Lecture 2 – Upstream Determinants of Lifestyle Behaviors and Chronic Disease Risk The Upstream Determinants of Adult Obesity Jeroen Lakerveld, Joreintje Mackenbach; The Upstream Determinants of Adult Obesity. Obes Facts 13 July 2017; 10 (3): 216–222. https://doi.org/10.1159/000471489 Fundamental cause of obesity is an imbalance between calories consumed and calories expended.Overconsumption of high-energy foods, lack of physical activity, lack of sleep, high stress levels and sedentary behavior play a role; these are obesogenic behaviors. These are in turn influenced by a range of individual factors, including biological, genetic and psychological factors, which are nested within contexts that contain influencing characteristics further upstream.Attention for upstream determinants of obesity is important for population-level action to prevent obesity and reduce its prevalence and burden.In history, we have adapted the context we live in. High availability of calorie-dense foods, and avoidance of physical activity at any time.Upstream determinants of health: overarching factors that are largely beyond the control of the individual and which have significant spill-over effects on other more proximal/downstream determinants of health. An upstream determinant of obesity is defined as any contextual characteristic that influences obesogenic behaviors.Upstream determinants are multiple, none operates in isolation, and they interact at different levels.Research is challenging due to the complexity of causal pathways and the long time periods during which effects manifest themselves. Mostly studied in cross-sectional observational studies.Types of environments in which upstream determinants of obesity appear can be divided into physical, socio-cultural, economic and political.-Physical: little evidence of single physical environmental factors being strongly related to obesity.However, urban sprawl and land-use mix are consistently correlated with weigh status.oUrban sprawl: residents may be less inclined to opt for active modes of travel, have decreased access to facilities and engage less in social interaction.oLand-use mix: better mix is associated with less obesity, likely due to levels of active modes of travel and more amenities available.

-Socio-cultural: socio-economic status and inequality

oLower SEP, and more inequality in general, is associated with higher obesity in adults. May be due to lack of psycho-social and material resources.oSocial networks also have an important impact, via social contagion (network influences behavior via modelling), social capital (sense of belonging and social support influences behaviors), and social selection (individual’s network is function of their weight).oHowever, in general, few social environmental factors are consistently related to adult obesity. 1 / 3

-Economic: sparse research.

oEffect of cost of a healthy diet influences behavior.-Political: many determinants of obesity require political action. However, there is general lack of insight into the political upstream determinants of obesity.oQuality of governance is associated with obesity as increased stability and greater effectiveness of government provide more opportunities for policy makers to focus on key public health problems.oNo government has implemented a comprehensive or effective set of policy approaches.Obesity is caused by a complex system of both downstream and upstream factors that interact with one another  recognition of the need to consider the multifaceted and complex nature of upstream influences on obesogenic behaviors.In contrast, efforts to prevent obesity and/or reduce prevalence do not necessarily have to be complex. By refraining from making political decisions about prevention, responsibility of the problem is shifted downstream to medical doctors. Individual-level approaches remain important, but priority should be given to political actions that address the obesogenic environment. 2 / 3

Lecture 3 – Hearing Problems Effectiveness of an online SUpport PRogramme (SUPR) for older hearing aid users: study protocol for a cluster randomized controlled trial Meijerink, J. F., Pronk, M., Paulissen, B., Witte, B. I., Van Der Wouden, B., Jansen, V., & Kramer, S. E. (2017). Effectiveness of an online SUpport PRogramme (SUPR) for older hearing aid users: study protocol for a cluster randomised controlled trial. BMJ open, 7(5), e015012.Hearing impairments is one of the most prevalent chronic health conditions affecting older adults. It leads to inability to communicate effectively, in turn may lead to poor psychosocial outcomes. It is also associated with accelerated cognitive decline and falls. Also partners/spouses can be negatively affected.The usual care is often restricted to assessment of hearing loss and fitting of hearing aids. Hearing aid use has positive effects on quality of life, wellbeing and may reduce depressive complaints and cognitive decline. However, the uptake and use of hearing aids is low. Reasons include low perceived need, limited acceptance of hearing loss, low expectations, limited gain in noisy situations and low overall sound quality. Other barriers include stigma, high costs and need for regular hearing aid care and maintenance. Also lack of social support or social pressure to get hearing aid.Therefore, it is argued that hearing healthcare should not be restricted to provision of hearing aids only. Because experienced hearing disability is the outcome of a complex interaction between an individual and his/her contextual factors.Various interventions, including aimed to improve speech perception and/or communication management. These have shown improvement in communication. However, these are rarely offered in hearing healthcare. Also there are barriers, such as lack of time or no easy access. But these can be overcome with e-health and technology. Some studies have evaluated online communication programs and these show benefits. However, there is no study evaluating the effectiveness of an online communication training program on a large scale  this article.Aim: determine effectiveness of SUPR as part of standard hearing aid dispensing care among older hearing aid users and their communication partners.Clustered randomized controlled trial – 18-month follow-up

-Intervention: hearing aid fitting + SUPR

-Control: hearing aid fitting only

Outcomes:

-Primary outcome: use of communication strategies, measured with questionnaire.

-Secondary outcomes include: personal adjustment to hearing impairment, self-efficacy, hearing aid use, self-reported intervention outcomes, satisfaction with service, self-reported activity limitations and participation restrictions, readiness to do something about hearing problems, emotional response.Process evaluation includes seven parameters: recruitment, reach, fidelity, dose delivered, dose received and implemented, satisfaction and perceived benefit.SUPR’s primary aims: to improve older hearing aid owners’ communication strategies and personal adjustment and decrease disability of communication partners.

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