N. Usheva - Academia.edu (original) (raw)

Papers by N. Usheva

Nutrition, Metabolism and Cardiovascular Diseases, 2022

Current Diabetes Reviews, 2020

European Journal of Public Health, 2013

The development of the ToyBox-intervention was based on the outcomes of the preliminary phase of ... more The development of the ToyBox-intervention was based on the outcomes of the preliminary phase of the ToyBox-study, aiming to identify young children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s key behaviours and their determinants related to early childhood obesity. The ToyBox-intervention is a multi-component, kindergarten-based, family-involved intervention with a cluster-randomized design, focusing on the promotion of water consumption, healthy snacking, physical activity and the reduction/ breaking up of sedentary time in preschool children and their families. The intervention was implemented during the academic year 2012-2013 in six European countries: Belgium, Bulgaria, Germany, Greece, Poland and Spain. Standardized protocols, methods, tools and material were used in all countries for the implementation of the intervention, as well as for the process, impact, outcome evaluation and the assessment of its cost-effectiveness. A total sample of 7,056 preschool children and their parents/caregivers, stratified by socioeconomic level, provided data during baseline measurements and participated in the intervention. The results of the ToyBox-study are expected to provide a better insight on behaviours associated with early childhood obesity and their determinants and identify effective strategies for its prevention. The aim of the current paper is to describe the design of the ToyBox-intervention and present the characteristics of the study sample as assessed at baseline, prior to the implementation of the intervention.

BMC Endocrine Disorders, 2020

Background The aim of this paper is to present the development of the Feel4Diabetes Healthy Diet ... more Background The aim of this paper is to present the development of the Feel4Diabetes Healthy Diet Score and to evaluate its clinical validity. Methods Study population consisted of 3268 adults (63% women) from high diabetes risk families living in 6 European countries. Participants filled in questionnaires at baseline and after 1 year, reflecting the dietary goals of the Feel4Diabetes intervention. Based on these questions the Healthy Diet Score was constructed, consisting of the following components: breakfast, vegetables, fruit and berries, sugary drinks, whole-grain cereals, nuts and seeds, low-fat dairy products, oils and fats, red meat, sweet snacks, salty snacks, and family meals. Maximum score for each component was set based on its estimated relative importance regarding T2DM risk, higher score indicating better quality of diet. Clinical measurements included height, weight, waist circumference, heart rate, blood pressure, and fasting blood sampling, with analyses of glucose,...

European Journal of Public Health

Introduction Vaccinations have been touted as one of the “greatest public health achievements”, b... more Introduction Vaccinations have been touted as one of the “greatest public health achievements”, but the rate of under-vaccination in child population is steadily declining, especially in low-income groups. Many studies show, that country-specific parental socio-demographic factors may influence on children's immunization coverage. Aim To assess which family socio-demographic factors influence parental vaccine hesitancy. Methods A survey was conducted among 1195 parents of children under the age of 7y., between 2015-2017, mean age of 30.9±6.4y., of Bulgarian or other ethnic groups, living in Eastern Bulgaria. Questions about family socio-demographic factors, attitude, beliefs and fears were included. Results The share of parents who state that they would not have vaccinated their children if the vaccination program was not compulsory is 20.9%. They are mainly in the age range 30-39(42,4%;Spearman's ρ = 0,13;р<0,0001), with higher education(57.6%; Pearson's r=- 0,13;р&l...

ABSTRACT Background Regional mortality differences are an important dimension of health inequalit... more ABSTRACT Background Regional mortality differences are an important dimension of health inequalities. There is a lack of both tradition and previous research on this topic in Bulgaria. Aims To assess regional differences in age-standardized mortality rates from all causes, cerebrovascular (CVD), ischaemic heart disease (IHD), cancer of lungs and breast for all 28 regions in Bulgaria for 2011. To look for an association between mortality and indicators for socio-economic deprivation. Methods Data on deaths from: all causes, CVD (ICD 10 I60-I69), IHD (I20-I25), cancer of lungs (C32-C34) and breast (C50) for 2011 and number of inhabitants in all 28 regions of Bulgaria are obtained from the National Statistical Institute. Aged-standardized mortality rates are estimated with direct standardization using the population of Bulgaria from 2011 census as a standard. In addition rate ratios (RR) with respective 95% confidence intervals (95% CI) are calculated for men and women between the region with highest and the region with lowest mortality rate. Age standardized mortality rates are tested for correlation with the following indicators for economic and social deprivation: gross domestic product (GDP) per capita, average annual income per household member, unemployment rate, relative share of population living below poverty line. Results There are marked regional differences in IHD, CVD and cancer mortality (p < 0.001) in Bulgaria. Standardized RR for IHD is 4.8 (95% CI 2.5-7.1) for men and 5.5(95% CI 3.5-7.5) for women; for CVD 3.4 (95% CI 1.3-5.6) for men and 4.5 (95%CI 2.6-6.4) for women. Rate ratio for breast cancer mortality in women is 5.4 (95%CI 4.5-6.4), for lung cancer mortality in women is 4.4 (95%CI 3.8-4.9). The observed regional variations in age standardized mortality are more marked in Bulgaria than in other European countries. There is a significant positive correlation between mortality from all causes and percent of the population living below poverty line (r = 0,541, p = 0,003). Conclusion There is a marked regional variation of mortality from IHD, CVD, cancer of the lungs and breast in Bulgaria. This fact has major implications for health policy and the health care needs of the population. This first analysis can be the basis for the establishment of a regional health profile project in Bulgaria which will support decision makers on both regional and national levels. Key messages � Regional inequalities in mortality from IHD, cerebrovascular disease, lung and breast cancer in Bulgaria. � Correlation between mortality and percent of the population living below poverty line in the regions.

Reliable assessments of health-related behaviours are necessary for accurate evaluation on the ef... more Reliable assessments of health-related behaviours are necessary for accurate evaluation on the efficiency of public health interventions. The aim of the current study was to examine the reliability of a self-administered primary caregivers questionnaire (PCQ) used in the ToyBox-intervention. The questionnaire consisted of six sections addressing sociodemographic and perinatal factors, water and beverages consumption, physical activity, snacking and sedentary behaviours. Parents/caregivers from six countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain) were asked to complete the questionnaire twice within a 2-week interval. A total of 93 questionnaires were collected. Test-retest reliability was assessed using intra-class correlation coefficient (ICC). Reliability of the six questionnaire sections was assessed. A stronger agreement was observed in the questions addressing sociodemographic and perinatal factors as opposed to questions addressing behaviours. Findings showed that 92% of the ToyBox PCQ had a moderate-to-excellent test-retest reliability (defined as ICC values from 0.41 to 1) and less than 8% poor test-retest reliability (ICC &amp;amp;amp;amp;amp;lt; 0.40). Out of the total ICC values, 67% showed good-to-excellent reliability (ICC from 0.61 to 1). We conclude that the PCQ is a reliable tool to assess sociodemographic characteristics, perinatal factors and lifestyle behaviours of pre-school children and their families participating in the ToyBox-intervention.

Obesity Reviews, 2014

The ToyBox-study aims to develop and test an innovative and evidence-based obesity prevention pro... more The ToyBox-study aims to develop and test an innovative and evidence-based obesity prevention programme for preschoolers in six European countries: Belgium, Bulgaria, Germany, Greece, Poland and Spain. In multicentre studies, anthropometric measurements using standardized procedures that minimize errors in the data collection are essential to maximize reliability of measurements. The aim of this paper is to describe the standardization process and reliability (intra- and inter-observer) of height, weight and waist circumference (WC) measurements in preschoolers. All technical procedures and devices were standardized and centralized training was given to the fieldworkers. At least seven children per country participated in the intra- and inter-observer reliability testing. Intra-observer technical error ranged from 0.00 to 0.03 kg for weight and from 0.07 to 0.20 cm for height, with the overall reliability being above 99%. A second training was organized for WC due to low reliability observed in the first training. Intra-observer technical error for WC ranged from 0.12 to 0.71 cm during the first training and from 0.05 to 1.11 cm during the second training, and reliability above 92% was achieved. Epidemiological surveys need standardized procedures and training of researchers to reduce measurement error. In the ToyBox-study, very good intra- and-inter-observer agreement was achieved for all anthropometric measurements performed.

International Journal of Behavioral Nutrition and Physical Activity, 2014

The ToyBox-study developed an evidence- and theory-based intervention to improve preschoolers&amp... more The ToyBox-study developed an evidence- and theory-based intervention to improve preschoolers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; energy balance-related behaviours - including physical activity (PA) - by targeting the kindergarten environment and involving their parents/caregivers. The present study aimed to examine the effect of the ToyBox-intervention on increasing Belgian preschoolers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; objectively measured PA levels. A sample of 472 preschoolers (4.43 ± 0.55 years; 55.1% boys) from 27 kindergartens (15 intervention, 12 control kindergartens) in Flanders, Belgium were included in the data analyses. Preschoolers wore an ActiGraph accelerometer for six consecutive days and were included in the data analyses if they had a minimum of two weekdays and one weekend day, both at baseline and follow-up (one year later). Preschoolers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; PA outcomes were estimated for an average day, weekday, weekend day, during school hours, and during after school hours. To assess intervention effects, multilevel repeated measures analyses were conducted for the total sample, and for sub-groups (according to sex, kindergarten levels of socio-economic status (SES) and risk groups (low levels of PA at baseline)) of preschoolers. Small intervention effects were found in the total sample. Most intervention effects were found in boys and in preschoolers from high SES kindergartens. Boys from the intervention group had an increase in vigorous PA (ß=1.47, p=0.03) and moderate-to-vigorous PA (ß=1.27, p=0.03) from baseline to follow-up, whereas PA levels in boys from the control group stagnated or decreased. In preschoolers from high SES kindergartens, the largest effects were found for PA outcomes during school hours and during after school hours. The results from the Belgian sample demonstrate that effects of the PA-component of the ToyBox-intervention on objectively measured PA were found in preschool boys and in preschoolers from high SES kindergartens, which means that the ToyBox-intervention was mainly effective in those sub-groups. Future interventions should search for alternative strategies to increase preschoolers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; PA levels in preschool girls and preschoolers from low SES kindergartens, as these are the most important at-risk groups regarding PA.