4,125 research outputs found

    Adaptations in physiological and neuronal function during diet-induced obesity

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    Obesity significantly increases the risk of developing chronic conditions including type II diabetes, cardiovascular disease, and some cancers. The rate of obesity has tripled globally since 1975, which is in part due to the sudden prevalence and overconsumption of palatable high-fat diets (HFDs). Obesity profoundly perturbs the neural control of energy balance, affecting diverse cell types within the hypothalamus. However, an incomplete understanding of how HFD impacts the regulation of energy balance hinders our ability to more effectively treat obesity. In this thesis, I describe the physiological and neuronal response to HFD feeding in rodents. We identified that HFD exposure elevates the body weight set point, which is initially driven by a transient hyperphagia. This hyperphagia coincides with increased excitatory transmission to lateral hypothalamic orexin (ORX) neurons, which regulate acute food intake. This suggests that ORX neurons may be involved in the initial hyperphagia, implicating them in the development of obesity. As HFD prolongs, body weight gain slows and reaches a new steady state regardless of age at the start, duration of feeding, or palatability of the diet. This sustained weight coincides with increased synaptic contacts to melanin-concentrating hormone (MCH) neurons, which promote weight gain and food intake, likely contributing to the maintenance of obesity. The molecular mechanism underlying the establishment of a new set point remains elusive. During HFD feeding, the presence of a chronic low-grade hypothalamic inflammation exacerbates weight gain, therefore we reasoned that inflammatory factors could modulate appetite-promoting neurons to maintain a new set point. We found that the inflammatory mediator prostaglandin E2 (PGE2) activate MCH neurons via its EP2 receptor (EP2R). Suppressing PGE2-EP2R on MCH neurons partially protects against excess weight gain and fat accumulation in the liver during HFD feeding. This mechanism could contribute to the maintenance of an elevated body weight set point in during diet-induced obesity. Without long-term treatment options in face of the increasing rates of obesity, we are in desperate need of novel interventions. In the future, we hope that targeting EP2R on MCH neurons can lower body weight set point and aid in combatting obesity

    Measuring socioeconomic position in studies of health inequalities

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    There is a consistent finding that the higher the socioeconomic position (SEP), the better the health. The choice of SEP indicator is crucial in explaining these socioeconomic inequalities. However, a poorly motivated use of SEP indicators prevails in the literature on social health inequalities, hampering the transparency and comparability across studies. Its primary aim is to explore different ways of measuring SEP to identify social inequalities in health. The thesis focuses on the most common, objective SEP indicators (education, occupation, and income); subjective SEP; and childhood circumstances. This thesis consists of three papers. Papers I and III apply data from the Tromsø Study, and Paper II is based on an online survey investigating people's views on SEP, conducted in Norway and Australia. Paper I investigates the potential to combine education and income into a composite score for SEP and how it predicts inequalities in health-related quality of life (HRQoL). Paper II assesses the relative importance of objective SEP indicators and childhood circumstances in estimating subjective SEP. Paper III explores the role of circumstances and lifestyle factors in estimating inequalities in HRQoL and self-rated health. While we found that the combination of education and income demonstrated a non-linear relationship with overall SEP, the composite SEP score was not superior as a predictor of HRQoL compared to including education and income separately. Furthermore, we found that childhood circumstances demonstrated a lasting, independent impact on subjective SEP. Paper III revealed that there were inequalities arising from circumstances, with substantial contributions from financial circumstances in childhood and education. This thesis demonstrates the need to motivate the choice of SEP indicator in studies of health inequalities. It also stresses the importance of early-life factors as determinants of adult health, advocating for policies targeting childhood circumstances in equalising early life chances.Et svært vanlig funn på tvers av land, studiepopulasjoner og helseutfall er at desto høyere sosioøkonomisk posisjon (SEP), desto bedre helse. Valg av SEP-indikator som skal reflektere de sosioøkonomiske dimensjonene i helse er avgjørende for å forklare disse helseulikhetene. Likevel er det slik at bruken av SEP-indikatorer i studier om sosial ulikhet i helse ofte preges av svak eller ingen begrunnelse med utgangspunkt i teori og hypoteser, noe som begrenser muligheten til sammenligning mellom studier. Denne avhandlingen bruker ulike tilnærminger for å måle SEP i studier av helseulikhet. Et overordnet formål er å utforske ulike måter å måle sosial posisjon for å identifisere sosiale ulikhet i helse, og hvordan livsstilsfaktorer i tillegg påvirker dette forholdet. Fokuset vil være på de tre vanligste objektive SEP-indikatorene (utdanning, yrke og inntekt); subjektiv SEP; og indikatorer for barndomsforhold. Avhandlingen består av tre artikler. Artikkel I og III er basert på data fra Tromsøundersøkelsen, mens Artikkel II benytter data fra på en nettbasert spørreundersøkelse om folks betraktninger omkring SEP, som har blitt gjennomført i Norge og Australia. Alle de tre artiklene utforsker bruken av ulike SEP-indikatorer i en helseulikhetssammenheng. Artikkel I undersøker potensialet for å kombinere utdanning og inntekt til en samleindikator for SEP, samt hvordan denne samleindikatoren predikerer helse-relatert livskvalitet (HRQoL). Artikkel II måler objektive SEP-indikatorer (utdanning, yrke og inntekt) og barndomsforholds relative betydning i å estimere subjektiv SEP. Artikkel III utforsker hvordan variabler om barndomsforhold på den ene siden og livsstilsfaktorer på den andre estimerer HRQoL og selvrapportert helse, både på et bestemt tidspunkt og over tid. Vi fant at kombinasjonen av utdanning og inntekt viste en sterk ikke-lineær sammenheng med total SEP, mens samleindikatoren for SEP viste seg å ikke være bedre i å predikere HRQoL sammenlignet med å inkludere utdanning og inntekt separat. Videre fant vi at barndomsforhold så ut til å ha en vedvarende påvirkning på subjektiv SEP, som var uavhengig av objektiv SEP. Artikkel III viste at det var ulikheter i helse med røtter i barndomsforhold, med særlig påvirkning fra økonomiske forhold i barndommen og egen utdanning. Denne avhandlingen viser behovet for å gjøre et faglig motivert valg av SEP-indikator i studier av helseulikhet. Den understreker også viktigheten av barndomsforhold som bestemmende faktorer for helseutfall senere i livet, og etterlyser dermed politikk rettet mot tidlige barndomsforhold for å utjevne ulikheter og sikre gode livssjanser

    A tailored psychological intervention for anxiety and depression management in people with chronic obstructive pulmonary disease: TANDEM RCT and process evaluation

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    Background: People with chronic obstructive pulmonary disease have high levels of anxiety and depression, which is associated with increased morbidity and poor uptake of effective treatments, such as pulmonary rehabilitation. Cognitive-behavioural therapy improves mental health of people with long-term conditions and could potentially increase uptake of pulmonary rehabilitation, enabling synergies that could enhance the mental health of people with chronic obstructive pulmonary disease. Aim: Our aim was to develop and evaluate the clinical effectiveness and cost effectiveness of a tailored cognitive-behavioural approach intervention, which links into, and optimises the benefits of, routine pulmonary rehabilitation. Design: We carried out a pragmatic multicentre randomised controlled trial using a 1.25 : 1 ratio (intervention : control) with a parallel process evaluation, including assessment of fidelity. Setting: Twelve NHS trusts and five Clinical Commissioning Groups in England were recruited into the study. The intervention was delivered in participant\u27s own home or at a local NHS facility, and by telephone. Participants: Between July 2017 and March 2020 we recruited adults with moderate/very severe chronic obstructive pulmonary disease and mild/moderate anxiety and/or depression, meeting eligibility criteria for assessment for pulmonary rehabilitation. Carers of participants were invited to participate. Intervention: The cognitive-behavioural approach intervention (i.e. six to eight 40- to 60-minute sessions plus telephone support throughout pulmonary rehabilitation) was delivered by 31 trained respiratory healthcare professionals to participants prior to commencing pulmonary rehabilitation. Usual care included routine pulmonary rehabilitation referral. Main outcome measures: Co-primary outcomes were Hospital Anxiety and Depression Scale - anxiety and Hospital Anxiety and Depression Scale - depression at 6 months post randomisation. Secondary outcomes at 6 and 12 months included health-related quality of life, smoking status, uptake of pulmonary rehabilitation and healthcare use. Results: We analysed results from 423 randomised participants (intervention, n = 242; control, n = 181). Forty-three carers participated. Follow-up at 6 and 12 months was 93% and 82%, respectively. Despite good fidelity for intervention delivery, mean between-group differences in Hospital Anxiety and Depression Scale at 6 months ruled out clinically important effects (Hospital Anxiety and Depression Scale - anxiety mean difference -0.60, 95% confidence interval -1.40 to 0.21; Hospital Anxiety and Depression Scale - depression mean difference -0.66, 95% confidence interval -1.39 to 0.07), with similar results at 12 months. There were no between-group differences in any of the secondary outcomes. Sensitivity analyses did not alter these conclusions. More adverse events were reported for intervention participants than for control participants, but none related to the trial. The intervention did not generate quality-of-life improvements to justify the additional cost (adjusted mean difference \ua3770.24, 95% confidence interval -\ua327.91 to \ua31568.39) to the NHS. The intervention was well received and many participants described positive affects on their quality of life. Facilitators highlighted the complexity of participants\u27 lives and considered the intervention to be of potential valuable; however, the intervention would be difficult to integrate within routine clinical services. Our well-powered trial delivered a theoretically designed intervention with good fidelity. The respiratory-experienced facilitators were trained to deliver a low-intensity cognitive-behavioural approach intervention, but high-intensity cognitive-behavioural therapy might have been more effective. Our broad inclusion criteria specified objectively assessed anxiety and/or depression, but participants were likely to favour talking therapies. Randomisation was concealed and blinding of outcome assessment was breached in only 15 participants. Conclusions: The tailored cognitive-behavioural approach intervention delivered with fidelity by trained respiratory healthcare professionals to people with chronic obstructive pulmonary disease was neither clinically effective nor cost-effective. Alternative approaches that are integrated with routine long-term condition care are needed to address the unmet, complex clinical and psychosocial needs of this group of patients. Trial registration: This trial is registered as ISRCTN59537391. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 13/146/02) and is published in full in Health Technology Assessment; Vol. 28, No. 1. See the NIHR Funding and Awards website for further award information.People with long-standing lung problems, such as chronic obstructive pulmonary disease, often also have anxiety and depression, which further reduces their quality of life. Two existing treatments could help. Pulmonary rehabilitation (a programme of exercise and education) improves both the physical and mental health of people with chronic obstructive pulmonary disease. Cognitive–behavioural therapy (a talking therapy) may reduce anxiety and depression. The TANDEM [Tailored intervention for Anxiety and Depression Management in chronic obstructive pulmonary disease (COPD)] intervention linked these two treatments by providing talking therapy based on cognitive–behavioural therapy during the waiting time following referral for pulmonary rehabilitation. The TANDEM treatment was delivered by respiratory healthcare professionals (e.g. nurses or physiotherapists) trained to deliver the talking therapy in six to eight weekly sessions. The sessions were conducted in the participant’s home (or another convenient location), with brief telephone support during the pulmonary rehabilitation. Of 423 participants recruited to the study, 242 participants received TANDEM talking therapy and 181 participants received usual care (including a referral to pulmonary rehabilitation). We measured mental health, quality of life, social life, attendance at pulmonary rehabilitation and healthcare use in both groups at 6 and 12 months. Forty-three carers joined the study and we assessed their mental well-being. We interviewed patients, carers and health professionals to find out their views and experience of the TANDEM treatment. We also examined whether or not the TANDEM treatment was good value for money. The TANDEM treatment did not improve the mental or the physical health of people with chronic obstructive pulmonary disease. In addition, the TANDEM treatment cost the NHS an extra \ua3770 per patient, which was not good value for money. The TANDEM treatment was well received, and many participants told us how it had helped them. Heath-care professionals noted how participants did not just have chronic obstructive pulmonary disease, but were coping with many physical, mental and social problems. The TANDEM intervention was not effective and, therefore, other strategies will be needed to help people with chronic obstructive pulmonary disease and mental health problems live with their condition

    Sociodemographic, nutritional and health status factors associated with adherence to Mediterranean diet in an agricultural Moroccan adult's population

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    Background. Numerous studies have demonstrated beneficial effects of adherence to the Mediterranean diet (MD) on many chronic diseases, including chronic kidney disease (CKD). Objective. The aim of this study was to assess the adherence of a rural population to the Mediterranean diet, to identify the sociodemographic and lifestyle determinants and to analyze the association between adherence to MD and CKD. Material and Methods. In a cross-sectional study, data on sociodemographic, lifestyle factors, clinical, biochemical parameters and diet were collected on a sample of 154 subjects. Adherence to MD was assessed according to a simplified MD score based on the daily frequency of intake of eight food groups (vegetables, legumes, fruits, cereal or potatoes, fish, red meat, dairy products and MUFA/SFA), using the sex specific sample medians as cut-offs. A value of 0 or 1 was assigned to consumption of each component according to its presumed detrimental or beneficial effect on health. Results. According to the simplified MD score, the study data show that high adherence (44.2%) to MD was characterized by intakes high in vegetables, fruits, fish, cereals, olive oil, and low in meat and moderate in dairy. Furthermore, several factors such as age, marital status, education level, and hypertension status were associated with the adherence to MD in the study population. The majority of subjects with CKD have poor adherence to the MD compared to non-CKD with a statistically insignificant difference. Conclusions. In Morocco, maintaining the traditional MD pattern play crucial role for public health. More research is needed in this area to precisely measure this association

    Living with erythropoietic protoporphyria:Bridging the gap between research and clinical practice

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    Resilience and food security in a food systems context

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    This open access book compiles a series of chapters written by internationally recognized experts known for their in-depth but critical views on questions of resilience and food security. The book assesses rigorously and critically the contribution of the concept of resilience in advancing our understanding and ability to design and implement development interventions in relation to food security and humanitarian crises. For this, the book departs from the narrow beaten tracks of agriculture and trade, which have influenced the mainstream debate on food security for nearly 60 years, and adopts instead a wider, more holistic perspective, framed around food systems. The foundation for this new approach is the recognition that in the current post-globalization era, the food and nutritional security of the world’s population no longer depends just on the performance of agriculture and policies on trade, but rather on the capacity of the entire (food) system to produce, process, transport and distribute safe, affordable and nutritious food for all, in ways that remain environmentally sustainable. In that context, adopting a food system perspective provides a more appropriate frame as it incites to broaden the conventional thinking and to acknowledge the systemic nature of the different processes and actors involved. This book is written for a large audience, from academics to policymakers, students to practitioners

    Sex, age and cyber-victimization: A meta-analysis.

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    Cyberbulling is one of the biggest challenges the school faces. However, the lack of coherence between the data of the literature review makes it necessary to consider which elements are the ones that truly lead to the appearance of cyber-victimization. Through the meta-analysis methodology, it has been tried to clarify the role of sex (k = 41 samples, n = 176,658 adolescents) and age (k = 45 samples, n = 238,977 adolescents) in cyber-victimization. The effect size for the random model is small for both sex (r = 0.058; p < 0.00, 95% CI = 0.090; 3.45) and for age (r = 0.094; p = 0.004; 95% CI = 0.015; 2.910). Indications of significant differences in sex are observed, with women being the most affected. However, the results of the meta-regression have shown how the North American culture plays a key role in age as a moderating variable in relation to the rest of continental cultures. These results support the conclusion that age and sex represent variables that influence cyber-victimization. More specifically, there is a positive relationship between age and cybervictimization, so that the older the age, the higher the cybervictimization, but this is negatively mediated by the American culture. At the same time, some socio-contextual characteristics also seem to have effects on this aspect. Considering this, some important practical implications emerge related to the need to address the study, care and prevention of cyber-victimization as well as any form of violence that occurs inside and outside the classroom

    International Academic Symposium of Social Science 2022

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    This conference proceedings gathers work and research presented at the International Academic Symposium of Social Science 2022 (IASSC2022) held on July 3, 2022, in Kota Bharu, Kelantan, Malaysia. The conference was jointly organized by the Faculty of Information Management of Universiti Teknologi MARA Kelantan Branch, Malaysia; University of Malaya, Malaysia; Universitas Pembangunan Nasional Veteran Jakarta, Indonesia; Universitas Ngudi Waluyo, Indonesia; Camarines Sur Polytechnic Colleges, Philippines; and UCSI University, Malaysia. Featuring experienced keynote speakers from Malaysia, Australia, and England, this proceeding provides an opportunity for researchers, postgraduate students, and industry practitioners to gain knowledge and understanding of advanced topics concerning digital transformations in the perspective of the social sciences and information systems, focusing on issues, challenges, impacts, and theoretical foundations. This conference proceedings will assist in shaping the future of the academy and industry by compiling state-of-the-art works and future trends in the digital transformation of the social sciences and the field of information systems. It is also considered an interactive platform that enables academicians, practitioners and students from various institutions and industries to collaborate

    Cyberbullying in educational context

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    Kustenmacher and Seiwert (2004) explain a man’s inclination to resort to technology in his interaction with the environment and society. Thus, the solution to the negative consequences of Cyberbullying in a technologically dominated society is represented by technology as part of the technological paradox (Tugui, 2009), in which man has a dual role, both slave and master, in the interaction with it. In this respect, it is noted that, notably after 2010, there have been many attempts to involve artificial intelligence (AI) to recognize, identify, limit or avoid the manifestation of aggressive behaviours of the CBB type. For an overview of the use of artificial intelligence in solving various problems related to CBB, we extracted works from the Scopus database that respond to the criterion of the existence of the words “cyberbullying” and “artificial intelligence” in the Title, Keywords and Abstract. These articles were the subject of the content analysis of the title and, subsequently, only those that are identified as a solution in the process of recognizing, identifying, limiting or avoiding the manifestation of CBB were kept in the following Table where we have these data synthesized and organized by years

    Health engagement, mood, and food choices

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    La tesi la prospettiva della psicologia dei consumi sul tema dei consumi alimentari e dell’alimentazione sana. In particolare, l’obiettivo della tesi è quindi quello di studiare e comprendere gli aspetti emotivi e motivazionali sottostanti alle scelte alimentari dei consumatori. Un costrutto, inoltre, che è stato particolarmente approfondito è quello del coinvolgimento: verso l’alimentazione (food involvement), e verso la salute (health engagement). La prospettiva di questa tesi è che il livello di coinvolgimento della persona nei confronti della propria alimentazione e della gestione della propria saluta moduli la sua relazione con il cibo, le motivazioni dietro alla sua scelta, e i comportamenti (sani o meno). La tesi include tre studi: una scoping review con l’obiettivo di identificare l’impatto delle restrizioni alimentari sulla qualità di vita di pazienti con MICI, e di capire se queste sono legate alla frequente non-aderenza ad uno stile alimentare sano; uno studio survey based, con l’obiettivo di profilare i consumatori attraverso una cluster analysis col metodo delle k-medie per identificare pattern comportamentali e motivazionali nelle scelte alimentari; uno studio basato su dati di eye-tracking per verificare come il coinvolgimento verso la salute e il cibo moduli le preferenze alimentari in una situazione in cui l’umore è stato manipolato per essere deflesso.The thesis examines the perspective of consumer psychology on the topic of food consumption and healthy eating. In particular, the goal of the thesis is to study and understand the emotional and motivational factors underlying consumers' food choices. One construct that has been particularly explored is engagement: towards food (food involvement) and towards health (health engagement). The perspective of this thesis is that the person's level of involvement in their food and health management modulates their relationship with food, the motivations behind their choices, and their behaviors (healthy or not). The thesis includes three studies: a scoping review with the aim of identifying the impact of food restrictions on the quality of life of patients with IBD, and to understand if these are related to frequent non-adherence to a healthy dietary style; a survey-based study, with the aim of profiling consumers through cluster analysis using the k-means method to identify behavioral and motivational patterns in food choices; an eye-tracking study to verify how involvement towards health and food modulates food preferences in a situation where mood was manipulated to be negative
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