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...

BackgroundOlder persons often have interacting physical and social problems and complex care needs. An integrated care approach in the local context with collaborations between community-, social-, and health-focused organisations can contribute to the promotion of independent living and quality of life. In the Urban Health Centres Europe (UHCE) project, five European cities (Greater Manchester, United Kingdom; Pallini (in Greater Athens Area), Greece; Rijeka, Croatia; Rotterdam, the Netherlands; and Valencia, Spain) develop and implement a care template that integrates health and social care and includes a preventive approach. The UHCE project includes an effect and process evaluation.MethodsIn a one-year pre-post controlled trial, in each city 250 participants aged 75+ years are recruited to receive the UHCE approach and are compared with 250 participants who receive ‘care as usual’. Benefits of UHCE approach in terms of healthy life styles, fall risk, appropriate medication use, loneliness level and frailty, and in terms of level of independence and health-related quality of life and health care use are assessed. A multilevel modeling approach is used for the analyses. The process evaluation is used to provide insight into the reach of the target population, the extent to which elements of the UHCE approach are executed as planned and the satisfaction of the participants.DiscussionThe UHCE project will provide new insight into the feasibility and effectiveness of an integrated care approach for older persons in different European settings.Trial registrationISRCTN registry number is ISRCTN52788952. Date of registration is 13/03/2017.

Modifiable determinants as attitude and barriers can be addressed to enhance preconception care attendance.

OBJECTIVES To examine the longitudinal association between frequency of moderate physical activity (PA) and overall, physical, psychological, and social frailty among community‐dwelling older adults older than 70 years. Second, we assessed the association between a 12‐month change in frequency of moderate PA and frailty. DESIGN Longitudinal cohort study. SETTING Community settings in Spain, Greece, Croatia, the Netherlands, and the United Kingdom. PARTICIPANTS A total of 1735 participants (61.1% female; mean age = 79.6 years; SD = 5.5 years). MEASUREMENTS The frequency of self‐reported moderate PA was measured and classified into two categories: “regular frequency” and “low frequency.” The 12‐month change in frequency of moderate PA between baseline and follow‐up was classified into four categories: “continued regular frequency,” “decreased frequency,” “continued low frequency,” and “increased frequency.” The 15‐item Tilburg Frailty Indicator assessed overall, physical, psychological, and social frailty. RESULTS Participants who undertook moderate PA with a regular frequency at baseline were less frail at 12‐month follow‐up than participants with a low frequency. Participants who undertook moderate PA with a continued regular frequency were least frail at baseline and at 12‐month follow‐up. After controlling for baseline frailty and covariates, compared with participants with a continued regular frequency, participants with a decreased frequency were significantly more overall (B = 1.31; 95% confidence interval [CI] = 0.99‐1.63), physically (B = 0.80; 95% CI = 0.58‐1.03), psychologically (B = 0.43; 95% CI = 0.30‐0.56), and socially frail (B = 0.14; 95% CI = 0.04‐0.23) at 12‐month follow‐up; participants with a continued low frequency were significantly more overall (B = 1.16; 95% CI = 0.84‐1.49), physically (B = 0.73; 95% CI = 0.51‐0.96), psychologically (B = 0.42; 95% CI = 0.29‐0.55), and socially frail (B = 0.13; 95% CI = 0.04‐0.23) at 12‐month follow‐up; the 12‐month follow‐up frailty level of participants who undertook moderate PA with an increased frequency was similar to those with a continued regular frequency. CONCLUSION Maintaining a regular frequency of PA as well as increasing to a regular frequency of PA are associated with maintaining or improving overall, physical, psychological, and social frailty among European community‐dwelling older adults older than 70 years. J Am Geriatr Soc 68:1484‐1493, 2020.

Promotion of a healthy pregnancy is a top priority of the health care policy in many European countries. Perinatal mortality is an important indicator of the success of this policy. Recently, it was shown that the Netherlands has relatively high perinatal death rates when compared to other European countries. This is in particular true for large cities where perinatal mortality rates are 20–50% higher than elsewhere. Consequently in the Netherlands, there is heated debate on how to tackle these problems. Without the introduction of measures throughout the entire perinatal health care chain, pregnancy outcomes are difficult to improve. With the support of health care professionals, the City of Rotterdam and the Erasmus University Medical Centre have taken the initiative to develop an urban perinatal health programme called ‘Ready for a Baby’. The main objective of this municipal 10-year programme is to improve perinatal health and to reduce perinatal mortality in all districts to at least the current national average of l0 per 1000. Key elements are the understanding of the mechanisms of the large health differences between women living in deprived and non-deprived urban areas. Risk guided care, orientation towards shared-care and improvement of collaborations between health care professionals shapes the interventions that are being developed. Major attention is given to the development of methods to improve risk-selection before and during pregnancy and methods to reach low-educated and immigrant groups.