Ileostomy formation requires major dietary adjustments to prevent complications and maintain nutritional status, yet dietary advice is often inconsistent, and evidence guiding best practice remains limited. This study explored how people living with an ileostomy (ileostomates) and healthcare professionals (HCPs) experience and support dietary management, uniquely comparing UK and Australian perspectives. Fifty semi-structured interviews were conducted with ileostomates (n = 26) and HCPs (n = 12 stoma care nurses, n = 12 dietitians) across the UK and Australia. Interviews were recorded, transcribed and analysed using thematic content analysis guided by the Social Ecological Model (SEM). Seven main categories emerged, spanning intrapersonal, interpersonal, community, institutional and public policy factors. Ileostomates reported persistent dietary restriction, fear of food bolus blockages, and reliance on online forums when HCP follow up was limited. HCP transcripts highlighted variations in practice, constrained caseloads, and gaps in evidence underpinning dietary guidance. Country-specific differences were observed, with Australian ileostomates emphasising hydration and geographical barriers. HCPs in the UK highlighted reinforcement of advice from a stoma nurse or dietitian as being central to dietary reintroduction, whereas their Australian counterparts prioritised a patient-led approach. Findings reveal systemic gaps in dietary support across both countries and highlight the need for individualised support, improved professional training, and integration of digital or telehealth solutions to enhance accessibility and continuity of care.

The Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets have been shown to slow cognitive decline. However, these diets were not originally developed with dementia prevention as their primary focus. In contrast, the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet was specifically designed based on evidence linking individual dietary components to brain health and the prevention of cognitive decline. The aim of this research was to test the effectiveness of the MIND diet on cognitive function, mood, and quality of life using the Behaviour Change Wheel, and to design an intervention using the COM-B model to promote the MIND diet at midlife. An online pilot randomised control trial (RCT) was conducted. Forty-one participants (aged 40–55 years, male and female) were randomised into a MIND diet with support group (n = 15), MIND diet group with no support (n = 14) or control group (n = 12) for 12 weeks. Baseline and follow-up measures of cognitive function, mood, quality of life (QOL) and adherence to MIND diet was assessed in each group. Capability, opportunity, and motivation (COM-B) towards MIND diet behaviour were also assessed pre and post intervention. A repeated measures ANOVA showed that in comparison to the control group, both intervention groups significantly improved mood, quality of life, MIND diet score and all COM-B components at follow-up (p < 0.05). No significant differences or interactions in cognitive function were found between groups. There are only two RCT’s that test the effectiveness of the MIND diet on cognitive function, and this is the first RCT to assess the usefulness of the COM-B in increasing adherence to the MIND diet. Future interventions with longer duration are needed to establish an association with MIND diet and cognitive function in adults at midlife. This study recommends using less Behaviour Change Techniques (BCTs) with a focus on self-monitoring, goal setting and education on diet as an effective strategy for promoting adherence to the MIND diet. Trial registered at ClinicalTrials.gov Protocol Record NCT04654936, May 2019.

Stoma surgery can be critical in helping to restore the well-being of patients suffering from gastrointestinal disease or injury but it inevitably comes with numerous psychological and physiological complications. Disposable pouch systems which enable the collection of bowel waste have revolutionized stoma care but providing robust, discreet devices that can efficiently meet the requirements of the patient can be challenging. Pouches must securely store a microbially active waste whilst preventing leakage, protecting the underlying skin from inflammation and minimizing odor. All of this needs to be achieved within the design constraints of a pouch that is easy to manage and yet still maintains a discreet body contour. Stoma collection has moved from the waste being collected in butyl rubber pouches to much more elaborate systems incorporating assemblies of polyvinylidene chloride, ethylene vinyl acetate, ethyl vinyl alcohol and polyvinyl alcohol with new, skin-friendly adhesive such as hydrocolloid and silicones impregnated with ceramides and aloe. Moreover, 3D printing has emerged as a means of providing personalized stoma pouches that can potentially address the age-old issue of leakage. Despite such advances, stoma pouches have evolved slowly over the past 70 or so years. A survey of the literature reveals an abundance of quality-of-life studies but a dearth of reports addressing the key technological challenges. Consequently, this narrative review considers current stoma pouch technology and highlights the issues that continue to afflict stoma patients. Research and patent literature is critically appraised in terms of current pouch technology and the potential opportunities for new composite materials are identified.

Substantial health benefits can be derived from walking at a moderate intensity cadence. To help regulate this cadence, three distinct aids exist 1) self-perception; 2) cadence prescription; 3) auditory cues. This study aimed to compare the effectiveness and explore perceptions of these aids to promote moderate intensity walking and effects on affective states, thereby addressing an important research gap. Individualised moderate relative intensity waking cadence was determined for participants (n = 23, Mage = 26.35, SD = 10.11). A convergent mixed-methods design was employed. A within-persons repeated measures design was used to explore the effectiveness of three aids (general guidelines, cadence prescription, and music) on promoting moderate intensity physical activity and positive affective states. Perceptions of these aids were elicited through qualitative interviews and thematic content analysis. Main effects for condition on relative physical activity intensity (η2 = .72) and positive affect (η2 = .25) were observed. Music evoked significantly higher relative physical activity intensity than other conditions (p values < .01), and higher positive affect compared to the general guidelines condition (p = .038). A significantly greater proportion of participants achieved moderate relative intensity physical activity during the music compared to general guidelines condition (p = .03). Congruently, qualitative findings suggested that participants predominantly perceived music as most effective for promoting a moderate intensity cadence and positive affect. However, individual variability existed in ability to utilise this aid. Implications of the findings for practitioners seeking to promote a moderate intensity cadence and positive affect during walking are discussed.

Menopause is a natural developmental phase that all women go through from their early forties to mid-fifties, marking the transition from the reproductive to the non-reproductive years. This is characterised as the permanent cessation of menses due to progressive ovarian failure. Each woman's experience of the menopause is unique. Biopsychosocial changes occur during this time with some symptoms affecting up to 80 % of women and lasting for 4-5 years from the peri- to post-menopause. Reduced oestrogen may predispose some women to health issues following menopause, such as heart disease, diabetes, stroke and cognitive decline. It is vital to understand how to promote health and well-being to reduce the risk of developing chronic conditions in later life. Increased symptoms and concerns about health during the menopausal transition can be cues to action for some women to actively maintain their health. Menopause represents a window of opportunity to promote health, and to support women to make healthier lifestyle choices, part of the National Institute for Clinical Excellence guidelines for menopause management. Identifying appropriate strategies to change behaviour is less clear. Theories of behaviour change can provide frameworks to gain more insight into the facilitators and barriers to behaviour and can inform the researcher on what needs to change. This information can be used to inform the design, content, implementation and evaluation of a lifestyle intervention. This review paper will explore the impact of menopause on health and well-being generally, and the benefits of designing more effective theory-driven behaviour change interventions for menopause.

Abstract Aims This study compared those living with and without an intestinal stoma in relation to physical and psychological health, stress and coping, quality of life and resilience. Also, identifying factors that could be used to promote better self‐care in stoma patients in the future. Design A cross‐sectional and comparative study design was employed. Methods Participants were recruited via email and social media (Facebook and Twitter) between August 2018 and March 2019, to complete an online survey. The data were analysed using analysis of variance to examine group difference and a series of hierarchical linear regression analyses determining predictors of psychological well‐being. Results Of 278 participants aged 18–68 years who completed the survey, 129 (46%) had a stoma and reported significantly poorer physical health. Approximately one‐fifth experienced problems with stoma management. Psychological well‐being was mediated by the duration of living with a stoma (under 3 years) and frequency of leaks (weekly and monthly).

Background An extended version of the theory of planned behaviour (TPB) was used to inform the design of a framework for an educational resource around e-cigarette use in young people. Methods A sequential exploratory design was employed. In Phase 1, elicited behavioural, normative and control beliefs, via 7 focus groups with 51 participants, aged 11–16 years, identified salient beliefs around e-cigarette use. These were used to construct a questionnaire administered to 1511 young people aged 11–16 years, which determined predictors of e-cigarette use and ever use. In Phase 2, sociodemographic variables, e-cigarette knowledge, access, use, marketing and purchasing of e-cigarettes and smoking behaviour were also gathered. The composite findings from Phase 1 and 2 informed the design of a post primary educational resource in Phase 3 around e-cigarette use. Results Current e-cigarette use was 4%, with almost 23% reporting ever use, suggesting current use is stable but experimentation may be increasing in this cohort. Sociodemographic variables, knowledge of e-cigarettes, smoking behaviour and TPB variables (direct and indirect measures of attitudes, subjective norm, and perceived behavioural control) accounted for 17% of the variance in current e-cigarette use, with higher intentions to use e-cigarettes within the next month, having the strongest impact on use ( p < 0.001), followed by self-efficacy ( p = 0.016). Sociodemographic and TPB variables accounted for 65% of the variance in intentions to use e-cigarettes in the next month; current e-cigarette use ( p < 0.001), more positive attitudes ( p < 0.001), stronger social influence ( p < 0.001), higher self-efficacy ( p < 0.001), higher control beliefs ( p < 0.001) and greater motivation to use e-cigarettes ( p < 0.001) were the main predictors of intentions. Phases 1 and 2 informed the mapping of key predictors of intentions and use of e-cigarettes onto the Theoretical Domains Framework, which identified appropriate intervention functions and behaviour change techniques. Conclusions This paper is the first to bridge the theoretical-practice gap in an area of significant public health importance through the development of a framework for a novel theory driven school-based educational resource aimed at reducing experimentation and uptake of e-cigarette use in young people.

Objectives: Identify prevalence rates and attitudes towards e-cigarette use among parents to inform prevention strategies designed to reduce uptake in young people.Study design: A mixed methods sequential study guided by the Theory of Planned Behaviour.Methods: This research involved two phases. Phase one was an elicitation study using focus groups, interviews and open-ended questionnaires (N = 17) to elicit parental behavioural, normative, and control beliefs around e-cigarette use. Findings from phase 1 were used to inform a questionnaire administered to a sample of 612 parents in phase 2. The aim of phase 2 was to identify and explain factors that influence parental attitudes and motivations towards e-cigarette use. Parents were recruited through post-primary schools and were sent a link to an online survey.Results: Approximately 19% of parents had tried an e-cigarette, with 9% reporting current use. Sociodemographic variables, TPB constructs and knowledge of e-cigarettes, accounted for 43% and 60% of ever use and intention to use an e-cigarette, respectively. Intention, gender, age and free school meal entitlement were associated with ever use. Intention to use an e-cigarette was related to lower educational level, current smoking of traditional cigarettes, more positive attitudes, greater social pressure, having greater control over use and knowledge.Conclusions: Prevention strategies designed to reduce uptake in young people should raise awareness of the health risks of e-cigarette use, legislation and regulations and highlight the role parents play in encouraging young people to abstain from using an e-cigarette.

Abstract Background The aim of the study was to identify and compare components of the COM-B (capability, opportunity, motivation and behaviour) model, that influences behaviour to modify dietary patterns in 40–55-year olds living in Northern Ireland (NI) and Italy, in order to reduce the risk of cognitive decline in later life. Methods This was a qualitative study examining factors influencing Mediterranean-DASH (Dietary Approaches to Stop Hypertension) Intervention for Neurodegenerative Delay (MIND) diet behaviour. This study further elaborated the COM-B components into the 14 domains of the Theoretical Domains Framework to further understand behaviour. Twenty-five Northern Irish and Italian participants were recruited onto the study, to take part in either a focus group or an interview. Participants were both male and female aged between 40 and 55 years. Results Thematic analysis revealed that the main barriers to the uptake of the MIND diet were; time, work environment (opportunity), taste preference and convenience (motivation). Culture (motivation), seasonal foods and lack of family support (opportunity) to be a barrier to the Italian sample only. The main facilitators reported were; improved health, memory, planning and organisation (motivation) and access to good quality food (opportunity). Cooking skills, knowledge (capability) and heathy work lunch (opportunity) reported as a facilitator to the Italian sample only. Conclusions Cross-cultural differences in relation to psychosocial barriers and facilitators were found in both samples. More barriers than facilitators towards uptake of the MIND diet were found. There is a need for interventions that increase capability, opportunity, and motivation to aid behaviour change. The findings from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel.

Evidence suggests that being physically active may improve quality of life through the menopausal transition. This study is one of the first to investigate how meeting the UK Physical Activity Guidelines (PAG) impacted quality of life, stress, coping and menopausal symptoms in UK midlife women, aged 45-55 years, during the unfolding Covid pandemic (Phase 1 quantitative, n=164). The study also explored their motivation to undertake regular physical activity during Covid lockdown (Phase 2 qualitative, n=4). An explanatory sequential mixedmethods design was used to collate quantitative (survey) and qualitative (focus group) data. Participants who met PAG experienced fewer depressive symptoms and less perceived stress, and had better physical and mental health and quality of life than women who did not. This was supported by focus group discussions reporting lack of facilities, time constraints, reduced social support and existing health complaints as barriers to physical activity. Factors motivating women to exercise during Covid lockdown were benefits for physical and mental health, and support from friends (Qualitative). Women are postmenopausal for one-third of their lives, and health interventions need to promote positive healthy ageing around menopause. Menopausal changes could be used by clinicians as cues to action to promote female health and well-being. Clinicians should be promoting the health benefits of exercise and making women aware of the importance of aiming to meet the PAG for optimal health benefits. Women should be encouraged to increase their levels of physical activity by making plans and setting goals and gaining support by exercising with friends or family, as a way to better control menopausal symptoms.

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BACKGROUND:The term 'whole dietary pattern' can be defined as the quantity, frequency, variety and combination of different foods and drinks typically consumed and a growing body of research supports the role of whole dietary patterns in influencing the risk of non-communicable diseases. For example, the 'Mediterranean diet', which compared to the typical Western diet is rich in fruits and vegetables, whole grains, and oily fish, is associated with reduced risk of cardiovascular disease and cancer. Social Cognition Models provide a basis for understanding the determinants of behaviour and are made up of behavioural constructs that interventions target to change dietary behaviour. The aim of this systematic review was to provide a comprehensive assessment of the effectiveness and use of psychological theory in dietary interventions that promote a whole dietary pattern.METHODS:We undertook a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis to synthesize quantitative research studies found in Embase, Medline, PsycInfo, CINAHL and Web of Science. The studies included were randomised and non-randomised trials published in English, involving the implementation of a whole dietary pattern using a Social Cognition Model to facilitate this. Two independent reviewers searched the articles and extracted data from the articles. The quality of the articles was evaluated using Black and Down quality checklist and Theory Coding Scheme.RESULTS:Nine intervention studies met the criteria for inclusion. Data from studies reporting on individual food group scores indicated that dietary scores improved for at least one food group. Overall, studies reported a moderate application of the theory coding scheme, with poor reporting on fidelity.CONCLUSION:To our knowledge, this is the first review to investigate psychological theory driven interventions to promote whole dietary patterns. This review found mixed results for the effectiveness of using psychological theory to promote whole dietary pattern consumption. However, the studies in this review scored mostly moderate on the theory coding scheme suggesting studies are not rigorously applying theory to intervention design. Few studies reported high on treatment fidelity, therefore, translation of research interventions into practice may further impact on effectiveness of intervention. Further research is needed to identify which behaviour change theory and techniques are most salient in dietary interventions.

Background: The aim of this study was to develop a “behavioural diagnosis” of factors influencing the uptake of the MIND diet in 40-55-year olds according to the COM-B model, in order to reduce the risk of cognitive decline in later life. Comparing a Mediterranean (Italy) and non-Mediterranean (Northern Ireland) country to inform an intervention. This study also sought to identify intervention functions and behaviour change techniques (BCTs) that are likely to be effective in changing MIND diet behaviour. Methods: This was a qualitative study that was used to elicit beliefs surrounding Capability, Opportunity, Motivation and Behaviour (COM-B) with adhering to a diet associated with a reduced risk of cognitive decline, the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND diet). This study further elaborated the COM-B components into the 14 domains of the Theoretical Domains Framework (TDF) to further understand behaviour. Twenty-five Northern Irish (NI) and Italian participants were recruited onto the study, to take part in either a focus group or an interview. Participants were both male and female aged between 40-55 years. Results: Thematic analysis revealed that the main barriers to the uptake of the MIND diet were; time, work environment (opportunity), taste preference and convenience (motivation). Culture (motivation), seasonal foods and lack of family support (opportunity) to be a barrier to the Italian sample only. The main facilitators reported were; improved health, memory, planning and organisation (motivation) and access to good quality food (opportunity). Cooking skills, knowledge (capability) and heathy work lunch (opportunity) being a facilitator to the Italian sample only. Five intervention functions and fifteen BCTs were identified for possible inclusion in intervention development. Conclusions: The “behavioural diagnosis” provides comparisons and valuable insight into the personal, social and environmental factors that participants report as barriers and facilitators to the uptake of the MIND diet in the two samples. More barriers to healthy dietary change were found than facilitators. There is a need for interventions that increase capability, opportunity and motivation to aid behaviour change. The “behavioural diagnosis” from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel (BCW).

Objective: The aim of the study was to identify components of the COM-B (capability, opportunity, motivation and behaviour) model that influences behaviour to modify dietary patterns in 40-55-year-olds living in the UK, in order to influence the risk of cognitive decline in later life. Design: This is a qualitative study using the COM-B model and theoretical domains framework (TDF) to explore beliefs to adopting the Mediterranean-DASH Intervention for Neurodegenerative delay (MIND) diet. Setting: Northern Ireland. Participants: Twenty-five participants were recruited onto the study to take part in either a focus group or an interview. Participants were men and women aged between 40 and 55 years. Participants were recruited via email, Facebook and face to face. Results: Content analysis revealed that the main perceived barriers to the adoption of the MIND diet were time, work environment, taste preference and convenience. The main perceived facilitators reported were improved health, memory, planning and organisation, and access to good quality food. Conclusions: This study provides insight into the personal, social and environmental factors that participants report as barriers and facilitators to the adoption of the MIND diet among middle-aged adults living in the UK. More barriers to healthy dietary change were found than facilitators. Future interventions that increase capability, opportunity and motivation may be beneficial. The results from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel.

Objective: Dietary soy may improve menopausal symptoms, and subsequently mediate mood. This novel study examines various doses of dietary soy drink on everyday mood stability and variability in postmenopausal women. Methods: Community-dwelling women (n = 101), within 7 years postmenopause, consumed daily either a low (10 mg, n = 35), medium (35 mg, n = 37), or high (60 mg, n = 29) dose of isoflavones, for 12 weeks. Menopausal symptoms and repeated measures of everyday mood (positive [PA] and negative [NA] affect) (assessed at four time points per day for 4 consecutive days, using The Positive and Negative Affect Schedule) were completed at baseline and follow-up. Results: The dietary soy intervention had no effect on everyday mood stability (for PA [F{2,70} = 0.95, P = 0.390] and NA [F{2,70} = 0.72, P = 0.489]) or variability (for PA [F{2,70} = 0.21, P = 0.807] and for NA [F{2,70} = 0.15, P = 0.864]), or on menopausal symptoms (for vasomotor [F{2,89} = 2.83, P = 0.064], psychological [F{2,88} = 0.63, P = 0.535], somatic [F{2,89} = 0.32, P = 0.729], and total menopausal symptoms [F{2,86} = 0.79, P = 0.458]). There were between-group differences with the medium dose reporting higher PA (low, mean 24.2, SD 6; and medium, mean 29.7, SD 6) and the low dose reporting higher NA (P = 0. 048) (low, mean 11.6, SD 2; and high, mean 10.6, SD 1) in mood scores. Psychological (baseline M = 18 and follow-up M = 16.5) and vasomotor (baseline M = 4.2 and follow-up M = 3.6) scores declined from baseline to follow-up for the overall sample. Conclusions: Soy isoflavones had no effect on mood at any of the doses tested. Future research should focus on the menopause transition from peri to postmenopause as there may be a window of vulnerability, with fluctuating hormones and increased symptoms which may affect mood.

Cognitive decline is commonly reported during the menopausal transition, with memory and attention being particularly affected. The aim of this study was to investigate the effects of a commercially available soy drink on cognitive function and menopausal symptoms in post-menopausal women. 101 post-menopausal women, aged 44–63 years, were randomly assigned to consume a volume of soy drink providing a low (10 mg/day; control group), medium (35 mg/day), or high (60 mg/day) dose of isoflavones for 12 weeks. Cognitive function (spatial working memory, spatial span, pattern recognition memory, 5-choice reaction time, and match to sample visual search) was assessed using CANTAB pre- and post-the 12 week intervention. Menopausal symptoms were assessed using Greene’s Climacteric Scale. No significant differences were observed between the groups for any of the cognitive function outcomes measured. Soy drink consumption had no effect on menopausal symptoms overall; however, when women were stratified according to the severity of vasomotor symptoms (VMS) at baseline, women with more severe symptoms at baseline in the medium group had a significant reduction (P = 0.001) in VMS post-intervention (mean change from baseline score: − 2.15 ± 1.73) in comparison to those with less severe VMS (mean change from baseline score: 0.06 ± 1.21). Soy drink consumption had no effect on cognitive function in post-menopausal women. Consumption of ~ 350 ml/day (35 mg IFs) for 12 weeks significantly reduced VMS in those with more severe symptoms at baseline. This finding is clinically relevant as soy drinks may provide an alternative, natural, treatment for alleviating VMS, highly prevalent among western women.

Background Levels of physical activity decline with age. Some of the most disadvantaged individuals in society, such as those with a lower rather than a higher socioeconomic position, are also the most inactive. Peer-led physical activity interventions may offer a model to increase physical activity in these older adults and thus help reduce associated health inequalities. This study aims to develop and test the feasibility of a peer-led, multicomponent physical activity intervention in socioeconomically disadvantaged community-dwelling older adults. Objectives The study aimed to develop a peer-led intervention through a rapid review of previous peer-led interventions and interviews with members of the target population. A proposed protocol to evaluate its effectiveness was tested in a pilot randomised controlled trial (RCT). Design A rapid review of the literature and the pilot study informed the intervention design; a pilot RCT included a process evaluation of intervention delivery. Setting Socioeconomically disadvantaged communities in the South Eastern Health and Social Care Trust and the Northern Health and Social Care Trust in Northern Ireland. Participants Fifty adults aged 60–70 years, with low levels of physical activity, living in socioeconomically disadvantaged communities, recruited though community organisations and general practices. Interventions ‘Walk with Me’ is a 12-week peer-led walking intervention based on social cognitive theory. Participants met weekly with peer mentors. During the initial period (weeks 1–4), each intervention group participant wore a pedometer and set weekly step goals with their mentor’s support. During weeks 5–8 participants and mentors met regularly to walk and discuss step goals and barriers to increasing physical activity. In the final phase (weeks 9–12), participants and mentors continued to set step goals and planned activities to maintain their activity levels beyond the intervention period. The control group received only an information booklet on active ageing. Main outcome measures Rates of recruitment, retention of participants and completeness of the primary outcome [moderate- and vigorous-intensity physical activity measured using an ActiGraph GT3X+ accelerometer (ActiGraph, LLC, Pensacola, FL, USA) at baseline, 12 weeks (post intervention) and 6 months]; acceptability assessed through interviews with participants and mentors. Results The study planned to recruit 60 participants. In fact, 50 eligible individuals participated, of whom 66% (33/50) were female and 80% (40/50) were recruited from general practices. At 6 months, 86% (43/50) attended for review, 93% (40/43) of whom returned valid accelerometer data. Intervention fidelity was assessed by using weekly step diaries, which were completed by both mentors and participants for all 12 weeks, and checklists for the level of delivery of intervention components, which was high for the first 3 weeks (range 49–83%). However, the rate of return of checklists by both mentors and participants diminished thereafter. Outcome data indicate that a sample size of 214 is required for a definitive trial. Limitations The sample was predominantly female and somewhat active. Conclusions The ‘Walk with Me’ intervention is acceptable to a socioeconomically disadvantaged community of older adults and a definitive RCT to evaluate its effectiveness is feasible. Some modifications are required to ensure fidelity of intervention delivery is optimised. Future research needs to identify methods to recruit males and less active older adults into physical activity interventions. Trial registration Current Controlled Trials ISRCTN23051918. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 10. See the NIHR Journals Library website for further project information. Funding for the intervention was gratefully received from the Health Improvement Division of the Public Health Agency.

Background: Zinc is an essential component for all living organisms, representing the second most abundant trace element, after iron. This element is widely distributed in the tissues of a human body where it is involved in normal growth, reproduction and several biological functions including immunity, energy metabolism and antioxidant processes. Because of its essential role, zinc levels in the human body must remain constant, independently of dietary intake fluctuations. The homeostasis of zinc is a well-regulated cellular process and has been reported to be chiefly mediated by the expression and activity of zinc-binding proteins such as metallothioneins and zinc transporters. Genes encoding for these proteins are subjected to genetic variants. Methods: We performed a multi-database electronic search to provide an overview on the relationship between specific polymorphisms (SNP) of genes encoding for metallothioneins and zinc transporters and their relationship with zinc status, immune function and some non-communicable diseases. Results: A number of SNP are implicated in a range of metabolic disease. Some SNP may affect the impact of zinc supplementation on immune function, diabetes, and obesity. Conclusion: New studies are needed to clarify the interaction between individual genetic profile and zinc status. Moreover, there is a need for a better interaction between the scientific bodies and health professionals to allow better dietary and behavioural recommendations to promote human health, with particular concern to elderly people.

This study sought to identify which of the many facilitators and barriers to physical activity (PA) and walking are most significant to changing midlife women's exercise behaviour, with a view to informing future interventions. A cross-sectional survey explored associations of PA and sedentary time with self-reported health value, health locus of control (HLOC) and physical and mental health. Open-ended questions were included to elicit barriers and facilitators to walking. A sample of 295 women, aged 35-55, was recruited via women's groups, social media, online forums, and posters in doctors' surgeries, and completed the survey online. Quantitative data were analysed using descriptive statistics, t-test, analysis of variance and regression analyses. The low activity levels reported underline the urgency of developing interventions for this population. Results suggest that the key factors associated with higher activity levels are having a more internal HLOC, better mental health and placing greater value on health. While health cognitions may therefore be one important factor to target, these must be tackled in the context of women's other barriers to and facilitators of exercise. Thematic analysis of the open-ended questions revealed that the key barrier to walking was women's busy lives and their many competing priorities and that the most important facilitators were mental health and social connection. Overall, results suggest that, rather than emphasizing physical health and activity targets, practitioners should seek to make walking more relevant to women by emphasizing mental wellbeing and self-care, and more enjoyable by focusing on social and family-based walking interventions.

Objective: A daily intake of dietary soy may improve vasomotor symptoms (hot flushes, night sweats), which has the potential to impact on mood and quality of life during menopause. This study investigated various doses of a dietary soy drink on vasomotor symptoms and everyday mood in postmenopausal women.