Running title: Effect of coordinated preventive care for healthy ageing 34 Impact statement: We certify that this work is novel. This study showed that a general 35 template for preventive integrated care aimed at healthy ageing can successfully be 36 implemented in various European settings. 37 Word count text: 4594 Word count abstract: 400 Number Tables: 4 38 Number Figures: 1 Supplements: 7 Number references: 53 39 40 2 effect paper UHCE_IJNS_revised2ABSTRACT 41 Background: Older persons often have multiple health and social problems and need a variety 42 of health services. A coordinated preventive approach that integrates the provision of health 43 and social care services could promote healthy ageing. Such an approach can be organised 44 differently, depending on the availability and organizational structures in the local context. 45 Therefore, it is important to evaluate the effectiveness of a coordinated preventive care 46 approach in various European settings. 47 Objectives: This study explored the effects of a coordinated preventive health and social care 48 approach on the lifestyle, health and quality of life of community-dwelling older persons in five 49 European cities. 50 Design: International multi-center pre-post controlled trial. 51 Setting: Community settings in cities in the United Kingdom, Greece, Croatia, the Netherlands 52 and Spain. 53 Participants: 1844 community-dwelling older persons (mean age=79.5; SD=5.6). 54 Methods: The Urban Health Centres Europe (UHCE) approach consisted of a preventive 55 multidimensional health assessment and, if a person was at-risk, coordinated care-pathways 56 targeted at fall risk, appropriate medication use, loneliness and frailty. Intervention and control 57 sites were chosen based on their location in distinct neighbourhoods in the participating cities. 58 Persons in the catchment area of the intervention sites 'the intervention group' received the 59 UHCE approach and persons in catchment areas of the control sites 'the control group' received 60 care as usual. A questionnaire and two measurements were taken at baseline and at one-year 61 3 effect paper UHCE_IJNS_revised2 follow-up to assess healthy lifestyle, fall risk, appropriate medication use, loneliness level, 62 frailty, level of independence, health-related quality of life and care use. To evaluate 63 differences in outcomes between intervention group and control group for the total study 64 population, for those who received follow-up care-pathways and for each city separately 65 (multilevel) logistic and linear regression analyses were used. 66 Results: Persons in the intervention group had less recurrent falls (OR= 0.65, 95% CI = 0.48; 67 0.88) and lower frailty (B=-0.43, 95% CI= -0.65--0.22) at follow-up compared with persons in 68 the control group. Physical health-related quality of life and mental well-being was better 69 (B=0.95; 95% CI= 0.14-1.76; and B=1.50; 95% CI=0.15-2.84 respectively). The effects of the 70 UHCE approach were stronger in the subgroup of persons (53.6%) enrolled in c...

Reduced physical activity is a known risk factor for many illnesses. Research in adolescent populations found increased physical activity levels improves objective health outcomes, but there is conflicting evidence regarding the relationship between physical activity levels and self-reported health status. To synthesise current evidence on the association between physical activity and self-reported health status in adolescents. Secondary objectives are to assess whether the relationship is dose dependant, and the appropriateness of WHO recommendations on adolescents' physical activity. The main databases were searched using keywords for the main outcome of interest (health status, health behaviour and self-perception) and exposure of interest (motor activity, physical activity and exercise), supplemented with manual searches, secondary citation and reference searches. Quality appraisal was carried out using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Eleven studies entered this review. Nine studies reported a significant relationship between increased levels of physical activity and improved self-reported health status, however two did not. Two studies followed up participants and found that the relationship persisted over time. Two papers described a dose-response relationship. Improvements in self-perceived health can be observed even below the current recommended levels of physical activity. The review supports initiatives to encourage adolescents to engage in physical activity as it improves self-reported health status. Sub-optimal levels of physical activity can also be beneficial. Further research should use standardised measurement scales and objectively measured physical activity levels. The roles of gender, income and culture should be further investigated.

BackgroundThe UK has one of the lowest breastfeeding rates worldwide and in recent years the Government has made breastfeeding promotion one of its priorities. The UNICEF UK Baby Friendly Initiative is likely to increase breastfeeding initiation but not duration. Other strategies which involve provision of support for breastfeeding mothers in the early weeks after birth are therefore required to encourage UK mothers to breastfeed for the recommended duration. This paper examines the effects of maternal socio-demographic factors, maternal obstetric factors, and in-hospital infant feeding practices on breastfeeding cessation in a peer support setting.MethodsData on mothers from Blackburn with Darwen (BwD) and Hyndburn in Eastern Lancashire who gave birth at the Royal Blackburn Hospital and initiated breastfeeding while in hospital were linked to the Index of Multiple Deprivation (IMD). The data were analysed to describe infant feeding methods up to 6 months and the association between breastfeeding cessation, and maternal factors and in-hospital infant feeding practices.ResultsThe mean breastfeeding duration was 21.6 weeks (95% CI 20.86 to 22.37 weeks) and the median duration was 27 weeks (95% CI 25.6 to 28.30 weeks). White mothers were 69% more likely to stop breastfeeding compared with non-White mothers (HR: 0.59; 95% CI, 0.52 to 0.67 [White mothers were the reference group]). Breastfeeding cessation was also independently associated with parity and infant feeding practices in hospital. There were no significant associations between breastfeeding cessation and marital status, mode of delivery, timing of breastfeeding initiation and socio-economic deprivation.ConclusionIn this study ethnicity, parity and in-hospital infant feeding practices remained independent predictors of breastfeeding cessation in this peer support setting. However other recognised predictors such as marital status, mode of delivery, timing of breastfeeding initiation and socio-economic deprivation were not found to be associated with breastfeeding cessation.