Background/purpose: For prevention of sarcopenia and functionaldecline in community-dwelling older adults, a higher daily proteinintake is needed. A new e-health strategy for dietary counselling wasused with the aim to increase total daily protein intake to optimallevels (minimal 1.2 g/kg/day, optimal 1.5 g/kg/day) through use ofregular food products.Methods: The VITAMIN (VITal Amsterdam older adults IN the city)RCT included 245 community-dwelling older adults (age ≥ 55y):control, exercise, and exercise plus dietary counselling (protein)group. The dietary counselling intervention was based on behaviourchange and personalization. Dietary intake was measured by a 3ddietary record at baseline, after 6-month intervention and 12-monthfollow-up. The primary outcome was average daily protein intake(g/kg/day). Sub-group analysis and secondary outcomes includeddaily protein distribution, sources, product groups. A Linear MixedModels (LMM) of repeated measures was performed with STATAv13.Results: Mean age of the 224 subjects was 72.0(6.5) years, a BMI of26.0(4.2). The LMM showed a significant effect of time and time*group(p<0.001). The dietary counselling group showed higher protein intakethan either control (1.41 vs 1.13 g/kg/day; β +0.32; p<0.001) or exercisegroup (1.41 vs 1.11 g/kg/day; β +0.33; p<0.001) after 6-month interventionand 12-month follow-up.Conclusions and implications: This study shows digitally supporteddietary counselling improves protein intake sufficiently in communitydwellingolder adults with use of regular food products. Protein intakeincrease by personalised counselling with e-health is a promising strategyfor dieticians.
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Each of us has a story that comes alive as we wake up in the morning, develops throughout the day, and holds layers of meaning as we lay our heads down at night – it might be called a narrative of our identity. When loss occurs, our story fragments into unfamiliar pieces, and who we identify as becomes scattered – sometimes even shattered. We must work to reconstruct meaning in our lives and to rebuild our identity. As leading author on this editorial, with an article of my own in this issue, I confronted this when my father died. I felt his story slipping away, becoming blurred, forgotten, and for some, erased – and the same held true for me. The chaos of my shattered identity exacerbated the deep pain of losing him and I experienced complicated grief. I had to reshape my narrative to remember the authentic parts of me and rebuild a new self in a fatherless world. This journey is in part what motivated me to become a symposium co-editor for the journal. All four of us editors of this special issue have experienced “living with loss” following the premature loss of either our father or spouse, and I wanted to see what lived experience and knowledge we could bring to the readers about loss in the fields of both guidance and counselling.
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We set out to bring into being a Creative Methods issue to inform and support researchers, practitioners, educators, and those they serve. We did so with what William Blake called “a firm persuasion” (Whyte, 2001, p. 3), and in the process of expanding the vidence-base for creative methods in guidance and counselling we are affirmed that this is both essential and rewarding. In our call for papers, we identified a number of reasons that creative methods are essential to guidance and counselling; for instance, they reintroduce playfulness, which is an often-undervalued capacity of humans that can help create space to respond to serious questions. Creative methods also allow us to be less resistant to so-called “negative” feelings and they let us break rank with the rational linear thinking, planning, efficiency and goal-orientation that has dominated policy and some practice discourses. In essence, this has supressed the creative, sensory and feeling side of human needs and behaviours. Indeed a common theme that appeared in all the articles is the importance of making room for the affective, before connecting that with more cognitive articulations. “This is an Accepted Manuscript of an article published by Taylor & Francis in "British Journal of Guidance and Counselling" on 05/14/16, available online: https://doi.org/10.1080/03069885.2018.1442917. LinkedIn: https://www.linkedin.com/in/reinekke-lengelle-phd-767a4322/
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Digitally supported dietary counselling may be helpful in increasing the protein intake in combined exercise and nutritional interventions in community-dwelling older adults. To study the effect of this approach, 212 older adults (72.2 ± 6.3 years) were randomised in three groups: control, exercise, or exercise plus dietary counselling. The dietary counselling during the 6-month intervention was a blended approach of face-to-face contacts and videoconferencing, and it was discontinued for a 6-month follow-up. Dietary protein intake, sources, product groups, resulting amino acid intake, and intake per eating occasion were assessed by a 3-day dietary record. The dietary counselling group was able to increase the protein intake by 32% at 6 months, and the intake remained 16% increased at 12 months. Protein intake mainly consisted of animal protein sources: dairy products, followed by fish and meat. This resulted in significantly more intake of essential amino acids, including leucine. The protein intake was distributed evenly over the day, resulting in more meals that reached the protein and leucine targets. Digitally supported dietary counselling was effective in increasing protein intake both per meal and per day in a lifestyle intervention in community-dwelling older adults. This was predominantly achieved by consuming more animal protein sources, particularly dairy products, and especially during breakfast and lunch.
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Background: There is still limited evidence on the effectiveness and implementation of smoking cessation interventions for people with severe mental illness (SMI) in Dutch outpatient psychiatric settings. The present study aimed to establish expert consensus on the core components and strategies to optimise practical implementation of a smoking cessation intervention for people treated by Flexible Assertive Community Treatment (FACT) teams in the Netherlands. Design: A modified Delphi method was applied to reach consensus on three core components (behavioural counselling, pharmacological treatment and peer support) of the intervention. The Delphi panel comprised five experts with different professional backgrounds. We proposed a first intervention concept. The panel critically examined the evolving concept in three iterative rounds of 90 min each. Responses were recorded, transcribed verbatim and thematically analysed. Results: Overall, results yielded that behavioural counselling should focus on preparation for smoking cessation, guidance, relapse prevention and normalisation. Pharmacological treatment consisting of nicotine replacement therapy (NRT), Varenicline or Bupropion, under supervision of a psychiatrist, was recommended. The panel agreed on integrating peer support as a regular part of the intervention, thus fostering emotional and practical support among patients. Treatment of a co-morbid cannabis use disorder needs to be integrated into the intervention if indicated. Regarding implementation, staff’s motivation to support smoking cessation was considered essential. For each ambulatory team, two mental health care professionals will have a central role in delivering the intervention. Conclusions: This study provides insight into expert consensus on the core components of a smoking cessation intervention for people with SMI. The results of this study were used for the development of a comprehensive smoking cessation program.
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Stimulating physical activity behaviour in persons with a physical disability is important, especially after discharge from rehabilitation. A tailored counselling programme covering both the period of the rehabilitation treatment and the first months at home seems on the average effective. However, a considerable variation in response is observed in the sense that some patients show a relevant beneficial response while others show no or only a small response on physical activity behaviour. The Rehabilitation, Sports and Active lifestyle (ReSpAct) study aims to estimate the associations of patient and programme characteristics with patients' physical activity behaviour after their participation in a tailored counselling programme. METHODS AND ANALYSIS: A questionnaire-based nationwide longitudinal prospective cohort study is conducted. Participants are recruited from 18 rehabilitation centres and hospitals in The Netherlands. 2000 participants with a physical disability or chronic disease will be followed during and after their participation in a tailored counselling programme. Programme outcomes on physical activity behaviour and patient as well as programme characteristics that may be associated with differences in physical activity behaviour after programme completion are being assessed. Data collection takes place at baseline and 14, 33 and 52 weeks after discharge from rehabilitation. ETHICS AND DISSEMINATION: The study protocol has been approved by the Medical Ethics Committee of the University Medical Centre Groningen and at individual participating institutions. All participants give written informed consent. The study results will provide new insights into factors that may help explain the differences in physical activity behaviour of patients with a physical disability after they have participated in the same physical activity and sports stimulation programme. Thereby, it will support healthcare professionals to tailor their guidance and care to individual patients in order to stimulate physical activity after discharge in a more efficient and effective way.
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Purpose: With the ageing population, there is an increasing demand for strategies to optimise muscle mass, strength and physical performance in community dwelling older adults. We designed a new innovative e-health intervention "VITAMIN" to improve physical performance in older adults. The blended home-based exercise intervention contains digital support to improve personalised coaching as well as dietary protein counselling. This study evaluates the 6 months effectiveness of the intervention. Methods: The cluster RCT included 245 community dwelling older adults (age = 55y) randomised to control, exercise, and exercise+dietary protein counselling group. Data was collected at baseline and after 6 months of intervention. The primary outcome was the modified Physical Performance test (mPPT) with an emphasis on daily functioning. Secondary measures were gait speed (GS; m/s), physical activity level (PAL), protein intake (g/kg/d), appendicular skeletal muscle mass by DXA (ASMM; kg), hand grip strength (HGS; kg). For statistical analysis SPSSv24.0 was used. A mixed models analysis was performed, with group, time and group*time interaction as fixed factors, subject and cluster as random factors, and additional posthoc Bonferroni test. Results: Mean age of the 224 evaluated participants was 72.0±smn;6.5y, 71% were females and 44% low educated. No significant intervention effect was found for mPPT (p=.889). Secondary outcomes showed a significant intervention effect: GS (p=.002), PAL (p=.014), protein intake (p<.001), ASSM (p=.029),HGS (p<.001). Posthoc Bonferroni showed that exercise+protein group had statistical improved outcome compared to control for these secondary outcomes (p<.001; p=.003; p<.001; p=.009; p<.001). Control group showed declined values at 6 months compared to baseline for GS (D-.23 m/s), PAL (D -.03), ASSM (D -.32 kg) and HGS (D -.96 kg).Conclusions: Older adults had already very high scores for physical performance (mPPT), however the blended home-based exercise intervention with protein counselling was still effective for gait speed, physical activity level, dietary protein intake, muscle mass and strength. This personalised innovative e-health intervention showed to be a promising strategy for community dwelling older adults for maintenance instead of declining physical function.
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Abstract Background Smoking among people with severe mental illness (SMI) is highly prevalent and strongly associated with poor physical health. Currently, evidence-based smoking cessation interventions are scarce and need to be integrated into current mental health care treatment guidelines and clinical practice. Therefore, the present study aims to evaluate the implementation and effectiveness of a smoking cessation intervention in comparison with usual care in people with SMI treated by Flexible Assertive Community Treatment (FACT) teams in the Netherlands. Methods A pragmatic, cluster-randomised controlled trial with embedded process evaluation will be conducted. Randomisation will be performed at the level of FACT teams, which will be assigned to the KISMET intervention or a control group (care as usual). The intervention will include pharmacological treatment combined with behavioural counselling and peer support provided by trained mental health care professionals. The intervention was developed using a Delphi study, through which a consensus was reached on the core elements of the intervention. We aim to include a total of 318 people with SMI (aged 18–65 years) who smoke and desire to quit smoking. The primary outcome is smoking status, as verified by carbon monoxide measurements and self-report. The secondary outcomes are depression and anxiety, psychotic symptoms, physical fitness, cardiovascular risks, substance use, quality of life, and health-related self-efficacy at 12 months. Alongside the trial, a qualitative process evaluation will be conducted to evaluate the barriers to and facilitators of its implementation as well as the satisfaction and experiences of both patients and mental health care professionals. Discussion The results of the KISMET trial will contribute to the evidence gap of effective smoking cessation interventions for people treated by FACT teams. Moreover, insights will be obtained regarding the implementation process of the intervention in current mental health care. The outcomes should advance the understanding of the interdependence of physical and mental health and the gradual integration of both within the mental health care system. Trial registration Netherlands Trial Register, NTR9783. Registered on 18 October 2021.
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Abstract Background Smoking among people with severe mental illness (SMI) is highly prevalent and strongly associated with poor physical health. Currently, evidence-based smoking cessation interventions are scarce and need to be integrated into current mental health care treatment guidelines and clinical practice. Therefore, the present study aims to evaluate the implementation and efectiveness of a smoking cessation intervention in comparison with usual care in people with SMI treated by Flexible Assertive Community Treatment (FACT) teams in the Netherlands. Methods A pragmatic, cluster-randomised controlled trial with embedded process evaluation will be conducted. Randomisation will be performed at the level of FACT teams, which will be assigned to the KISMET intervention or a control group (care as usual). The intervention will include pharmacological treatment combined with behavioural counselling and peer support provided by trained mental health care professionals. The intervention was developed using a Delphi study, through which a consensus was reached on the core elements of the intervention. We aim to include a total of 318 people with SMI (aged 18–65 years) who smoke and desire to quit smoking. The primary outcome is smoking status, as verifed by carbon monoxide measurements and self-report. The secondary outcomes are depression and anxiety, psychotic symptoms, physical ftness, cardiovascular risks, substance use, quality of life, and health-related self-efcacy at 12months. Alongside the trial, a qualitative process evaluation will be conducted to evaluate the barriers to and facilitators of its implementation as well as the satisfaction and experiences of both patients and mental health care professionals. Discussion The results of the KISMET trial will contribute to the evidence gap of efective smoking cessation interventions for people treated by FACT teams. Moreover, insights will be obtained regarding the implementation process of the intervention in current mental health care. The outcomes should advance the understanding of the interdependence of physical and mental health and the gradual integration of both within the mental health care system. Trial registration Netherlands Trial Register, NTR9783. Registered on 18 October 2021.
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This study aimed to evaluate outcomes and support use in 12- to 25-year-old visitors of the @ease mental health walk-in centres, a Dutch initiative offering free counselling by trained and supervised peers.
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