Planting a seed - child health care nurses’ perceptions of speaking to parents about overweight and obesity : a qualitative study within the STOP project

Background Nurses in child health care (CHC) centers in Sweden play a key role in the early detection and management of childhood overweight/obesity, through meeting families early, regularly and over many years. However, research focusing on CHC nurses’ perceptions of their role in childhood overweight/obesity management is scarce. As part of the EU-funded project “Science and Technology in childhood Obesity Policy” (STOP), this study examines CHC nurses’ perceptions of speaking to parents about children’s overweight/obesity and of their role in referring children to treatment for overweight/obesity. Methods All registered CHC nurses in Stockholm County (n = 442) received an email invitation letter explaining the study. Individual face-to-face visits (n = 15) in selected centers, and phone calls (n = 24) to nurses working in these centres were also conducted. In total, 17 CHC nurses (all female, average work experience 6.7 years (SD ± 4.9 years)) from 10 municipalities (including four of the top five municipalities with the highest prevalence of overweight and obesity) in Stockholm County were interviewed. The interviews were conducted by phone, transcribed and analyzed using thematic analysis. Results Two main themes were developed through the analysis: 1) The relationship between the nurse and the parent and 2) Glitch in the system. Under the first theme, nurses reported that weight-related discussions were facilitated by building and maintaining trust with parents. However, nurses also said they were reluctant to address children’s weights if this could compromise parents’ trust. Under the second theme, nurses highlighted several organizational barriers to addressing a child’s weight with parents, including insufficient cooperation with other healthcare providers and limited time for visits. Nurses also identified lack of sufficient knowledge about what to offer the family and lack of confidence in their communication skills as additional barriers. Conclusions We found that pediatric nurses perceive relational and organizational factors as barriers to address childhood obesity with parents. To improve care, it is necessary to provide nurses with continuing education about obesity and communication skills and organizational support to improve communication within the healthcare system

Food waste in Beijing - life cycle assessment approach to estimating the environmental impact and resource utilization of various alternatives for food waste treatment in Beijing

Around the world, the treatment of food waste is a major administrative and environmental problem throughout the food supply chain. Beijing, as any other mega city, is facing vast issues of sustainable food waste treatment in addition to efforts for food waste reduction. Presently the majority of Beijing's food waste is treated together with the mixed residual waste in landfills (53%) and incinerators (43%) with only 4.3 % of the food waste being organically recycled. This despite the majority of Beijing's municipal solid waste being food waste. Beijing is quickly developing its incineration capacity due to the volume reduction and energy recovery potential. Treating the food waste with anaerobic digestion could provide an alternative waste-to-energy method which includes resource recycling. Demands for the by-products of anaerobic digestion appear to increase as demand for natural gas and demand for organic produce is predicted to increase in China. The software WAMPS (Waste Management Planning System) is used to investigate six scenarios for the various possibilities of future food waste treatment in Beijing using a life cycle perspective. The scenarios are modelled after a goal scenario where 50% of the food waste is recycled and a half way scenarios between present situation and the goal. The study concludes that incineration is the most environmentally friendly alternative but foremost shows a lot of room for improvement for the present management system. The results are largely influenced by the coal based electricity production in China which causes severe environmental problems and offers great environmental advantages when reduced and replaced with cleaner electricity. The case study does not consider the sustainable use of resources, only eutrophication, acidification, greenhouse gas emissions, and photo oxidant formation

Objectively measured physical activity in two-year-old children – levels, patterns and correlates

BACKGROUND: The aim was to describe levels, patterns and correlates of physical activity and sedentary behavior in a sample of Swedish children, two years of age, with normal weight, overweight and obese parents. METHODS: Data from 123 children, 37 with normal-weight parents and 86 with overweight/obese parents, enrolled in the Early Stockholm Obesity Prevention Project study was used. Children wore an Actigraph GT3X+ accelerometer for seven days. Average activity (counts per minute), number of steps and time spent in low and high-intensity physical activity and in sedentary was assessed. Differences between weekdays and weekend days were examined as were correlations with sex, body mass index (BMI), motor skills and family-related factors. RESULTS: Children were active at high intensity 11% of the day. On average 55% of the day was spent being sedentary. Number of steps and time in low-intensity physical activity differed between weekdays and weekend days: on weekdays, 363 more steps (p = 0.01) and six more minutes in low physical activity (p = 0.04). No differences were found for any physical activity or sedentary behavior variable by sex, BMI, motor skills or any family-related variable (p = 0.07 – 0.95). CONCLUSIONS: Two-year-old children have an intermittent activity pattern, that is almost similar on weekdays and they spend about half of the daytime active. The absence of any association with sex, BMI, motor skills or parental factors indicates that the individual variation in this age group is primarily due to endogenous factors. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01198847

Insulin resistance in children and adolescents : mechanisms and clinical effects

Background: Insulin resistance is a condition in which insulin does not achieve appropriate response in different target tissues, it is associated with obesity and one of the main culprits in the development of type 2 diabetes. An early sign of disturbed glucose-insulin homeostasis is impaired fasting glucose (IFG) where glucose is elevated in the fasting state. The American Diabetes Association (ADA) and the International Society for Pediatric Diabetes (ISPAD) suggest 5.6 mmol/L as a cut-off level for IFG, the World Health Organization supports 6.1 mmol/L. Impaired glucose tolerance (IGT) is defined as elevated glucose after a 2-hour glucose tolerance test, which also is a sign of disturbed glucose-insulin homeostasis. IFG and/or IGT, collectively prediabetes, is associated with a significantly elevated risk of type 2 diabetes development in adults, but the consequences of the prediabetic condition in children is not as evident. In Sweden the prevalence of type 2 diabetes in youth has been low, in spite of an increasing overweight and obesity, which are major risk factors for type 2 diabetes. However, the exact present prevalence of type 2 diabetes in youth is currently not known. Early-onset of type 2 diabetes is associated with a high morbidity already at young age and seems to be more aggressive compared with early-onset type 1 diabetes. Aim: The aims of this thesis were to investigate the pathogenesis of prediabetes in obese children, to examine the prevalence of prediabetes and type 2 diabetes among severely obese adolescents and to estimate the occurrence of complications related to early-onset type 2 diabetes compared to type 1 diabetes of same duration. Method: Study I and II in this thesis contain data from the Swedish Childhood Obesity Register (BORIS), which is a national quality registry for obesity treatment in childhood and adolescence. Fasting glucose and glucose levels after an oral glucose tolerance test (OGTT) was made to define normal glucose tolerance or prediabetic stage. A frequently sampled intravenous glucose tolerance test was used to study acute insulin response (AIR), insulin sensitivity (Si), and disposition index (DI) in children with obesity. Study III contains data from the National Diabetes Register (NDR); both from the pediatric register (SWEDIABKIDS) and the adult register (NDR) regarding adolescents and young adults with type 1 and 2 diabetes. Study I and II are cross-sectional observational studies and Study III is a longitudinal, retrospective cohort study. Results: Among severely obese children the prevalence of isolated IFGADA was 35.8 %, isolated IGT 6% and a combined IFG and IGT in 14.2 %. Combined IFG/IGT was associated with significantly lower AIR compared with subjects who had normal glucose metabolism (p<0.05) and DI was the major determinant of 2-h OGTT glucose levels (β=−0.49, p=0.0126). Comparing IFGADA and IFGWHO in obese children, only IFGWHO was associated with a lower AIR and DI (p<0.001). In total 1413 adolescents and young adults were diagnosed and registered in NDR with type 2 diabetes between 1994-2014. Early-onset type 2 diabetes had, compared with individuals with type 1 diabetes with equivalent diabetes duration, significantly higher risk of developing microalbuminuria with a hazard ratio (HR) of 3.32 (95% CI 2.86-3.85, P < .001), and also retinopathy with a HR of 1.17 (95% CI 1.06-1.30, P 0.04). These differences occurred despite lower HbA1c levels among individuals with type 2 diabetes in comparison with type 1 diabetes. Conclusion: The prevalence of prediabetes was very high among adolescents with severe obesity. IFGWHO is significantly associated to disturbed glucose metabolism, and IFGADA could be associated with IGT. A combination of IFGADA/ IGT was significantly associated with impaired -cell function. Although both type 1 and 2 diabetes were associated with complications, the prevalence of complications and comorbidities is significantly higher among those with early-onset type 2 diabetes compared with type 1 diabetes. Our results confirm previous studies that type 2 diabetes is a severe disease when young individuals are affected, and an active treatment with a widened focus on cardiometabolic risk factors is required to reduce the risk

Exploring the genetics of irritable bowel syndrome: A GWA study in the general population and replication in multinational case-control cohorts

OBJECTIVE: IBS shows genetic predisposition, but adequately powered gene-hunting efforts have been scarce so far. We sought to identify true IBS genetic risk factors by means of genome-wide association (GWA) and independent replication studies. DESIGN: We conducted a GWA study (GWAS) of IBS in a general population sample of 11\u2005326 Swedish twins. IBS cases (N=534) and asymptomatic controls (N=4932) were identified based on questionnaire data. Suggestive association signals were followed-up in 3511 individuals from six case-control cohorts. We sought genotype-gene expression correlations through single nucleotide polymorphism (SNP)-expression quantitative trait loci interactions testing, and performed in silico prediction of gene function. We compared candidate gene expression by real-time qPCR in rectal mucosal biopsies of patients with IBS and controls. RESULTS: One locus at 7p22.1, which includes the genes KDELR2 (KDEL endoplasmic reticulum protein retention receptor 2) and GRID2IP (glutamate receptor, ionotropic, delta 2 (Grid2) interacting protein), showed consistent IBS risk effects in the index GWAS and all replication cohorts and reached p=9.31 710(-6) in a meta-analysis of all datasets. Several SNPs in this region are associated with cis effects on KDELR2 expression, and a trend for increased mucosal KDLER2 mRNA expression was observed in IBS cases compared with controls. CONCLUSIONS: Our results demonstrate that general population-based studies combined with analyses of patient cohorts provide good opportunities for gene discovery in IBS. The 7p22.1 and other risk signals detected in this study constitute a good starting platform for hypothesis testing in future functional investigations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

Gene set of nuclear-encoded mitochondrial regulators is enriched for common inherited variation in obesity

There are hints of an altered mitochondrial function in obesity. Nuclear-encoded genes are relevant for mitochondrial function (3 gene sets of known relevant pathways: (1) 16 nuclear regulators of mitochondrial genes, (2) 91 genes for oxidative phosphorylation and (3) 966 nuclear-encoded mitochondrial genes). Gene set enrichment analysis (GSEA) showed no association with type 2 diabetes mellitus in these gene sets. Here we performed a GSEA for the same gene sets for obesity. Genome wide association study (GWAS) data from a case-control approach on 453 extremely obese children and adolescents and 435 lean adult controls were used for GSEA. For independent confirmation, we analyzed 705 obesity GWAS trios (extremely obese child and both biological parents) and a population-based GWAS sample (KORA F4, n = 1,743). A meta-analysis was performed on all three samples. In each sample, the distribution of significance levels between the respective gene set and those of all genes was compared using the leading-edge-fraction-comparison test (cut-offs between the 50(th) and 95(th) percentile of the set of all gene-wise corrected p-values) as implemented in the MAGENTA software. In the case-control sample, significant enrichment of associations with obesity was observed above the 50(th) percentile for the set of the 16 nuclear regulators of mitochondrial genes (p(GSEA,50) = 0.0103). This finding was not confirmed in the trios (p(GSEA,50) = 0.5991), but in KORA (p(GSEA,50) = 0.0398). The meta-analysis again indicated a trend for enrichment (p(MAGENTA,50) = 0.1052, p(MAGENTA,75) = 0.0251). The GSEA revealed that weak association signals for obesity might be enriched in the gene set of 16 nuclear regulators of mitochondrial genes

Adopting a healthy lifestyle when pregnant and obese - an interview study three years after childbirth

Background: Obesity during pregnancy is increasing and is related to life-threatening and ill-health conditions in both mother and child. Initiating and maintaining a healthy lifestyle when pregnant with body mass index (BMI) ≥ 30 kg/m2 can improve health and decrease risks during pregnancy and of long-term illness for the mother and the child. To minimise gestational weight gain women with BMI ≥ 30 kg/m2 in early pregnancy were invited to a lifestyle intervention including advice and support on diet and physical activity in Gothenburg, Sweden. The aim of this study was to explore the experiences of women with BMI ≥ 30 kg/m2 regarding minimising their gestational weight gain, and to assess how health professionals' care approaches are reflected in the women's narratives. Methods: Semi-structured interviews were conducted with 17 women who had participated in a lifestyle intervention for women with BMI ≥ 30 kg/m2 during pregnancy 3 years earlier. The interviews were digitally recorded and transcribed in full. Thematic analysis was used. Results: The meaning of changing lifestyle for minimising weight gain and of the professional's care approaches is described in four themes: the child as the main motivation for making healthy changes; a need to be seen and supported on own terms to establish healthy routines; being able to manage healthy activities and own weight; and need for additional support to maintain a healthy lifestyle. Conclusions: To support women with BMI ≥ 30 kg/m2 to make healthy lifestyle changes and limit weight gain during pregnancy antenatal health care providers should 1) address women's weight in a non-judgmental way using BMI, and provide accurate and appropriate information about the benefits of limited gestational weight gain; 2) support the woman on her own terms in a collaborative relationship with the midwife; 3) work in partnership to give the woman the tools to self-manage healthy activities and 4) give continued personal support and monitoring to maintain healthy eating and regular physical activity habits after childbirth involving also the partner and family

O modelo sueco de home care avançado: organização e implicações da adoção desta modalidade de cuidado pelo serviço de saúde brasileiro

Este artículo tiene como objetivo describir la organización del programa de atención médica domiciliar avanzada en una región de Suecia y discutir los beneficios e implicaciones que pueden resultar de adoptar este modelo en Brasil. Como enfoque metodológico se utilizó la triangulación de datos combinando entrevista, observación y encuesta. Integraron el estudio 32 miembros del equipo profesional. Se describieron la estructura organizacional, el método de trabajo, las visitas domiciliares y los recursos de salud implicados en la atención. El modelo investigado presenta evidencias de eficiencia y efectividad y se muestra versátil para ser adaptado a Brasil para atender a las necesidades de la salud de la población. Sin duda, la mejora de la calidad de vida y de la seguridad son beneficios sociales de grande relevancia que emergen de este tipo de atención.Este artigo descreve a organização do programa de "home care" avançado em uma região da Suécia e discute os benefícios e implicações que podem resultar da adoção deste modelo pelo Brasil. Como enfoque metodológico foi utilizada a triangulação de dados combinando entrevista, observação e questionário. Integraram o estudo 32 membros da equipe profissional. A estrutura organizacional, o método de trabalho, as visitas domiciliares e os recursos de saúde envolvidos na assistência foram descritos. O modelo investigado apresenta evidências de eficiência e efetividade e mostra-se versátil para ser adaptado ao Brasil para atender as necessidades de saúde da população. Sem dúvida, a melhoria da qualidade de vida e segurança são benefícios sociais de grande relevância que emergem desta modalidade de cuidado.The purpose of this paper was to describe the organization of the Advanced Home Care Program provided in a region of Sweden and to discuss some benefits and implications of this model adoption in Brazilian settings. Data triangulation as interview, observation and questionnaire was used. Thirty two professionals participated in this study. The organizational structure, working method, home visits, and related health resources were described. The investigated model presented both clear effectiveness and versatility; therefore feasible to be adopted in Brazilian settings improving their population health care. Doubtless, the improvement of life quality and security are the best benefits this model of care can provide

What stains a process of water protection? : a study of the assumptions that underline agricultural and management actors’ views of water protection

Denna studies syfte är att identifiera och undersöka de underliggande antaganden som färgar problemrepresentationer i vattenskyddsprocesser. Målet är att tolka antaganden om de agrara och förvaltande parternas syn på naturresurserna, deras ansvars- samt rollfördelning inom ramarna för vattenskydd. Frågeställningarna som används har varit; vad identifierar parterna som ”problem”; vilka antaganden utgör grunden för dessa representationer av problem? Den diskursanalytiska metod som används under studien utgår från Carol Bacchis (2009) ramverk ”What’s the problem representet to be?”. Uppsatsen utgår från empiriskt material från vattenskyddsprocessen vid Svartån i Örebro, med kompletterande analyser av nationella styrdokument. Under arbetet har sam-spelet mellan agrara och förvaltande aktörer legat i fokus. Studien har visat att aktörernas samspel färgas av deras respektive natursyner, vilka ligger till grund för de skillnader som går att identifiera inom aktörernas diskurser. Den slutsats som dras till följd av analysen är att aktörerna skulle kunna dra fördel av att se sin bild av vattenskyddsprocesser som en del av en diskurs. Att göra detta hade kunnat ge aktörerna en djupare förståelse för varandra, och på vad det är som influerar synen på förvaltning och brukande av naturresursen så som vatten.The purpose of this study is to identify and investigate how underlining as-sumptions stains problem representations within the processes of water pro-tection. The goal is to interpret the assumptions of agricultural and manage-ment actors’ views within the frames of water protection. The questions of the study have been; what do the actors identify as “problems”; what assumptions underlines these representations of problems? The method of discourse anal-ysis that is applied within the study is Carol Bacchis (2009) “What’s the prob-lem represented to be?”. The thesis is based on empirical material from the process of adopting a water protection area around Svartån in Örebro, with supplementary analyzes of national governance documents. While analyzing, the interaction between agricultural and managing actors’ have been within focus. The study has found that the actors’ interaction is stained by their sep-arate view on conception of nature, which underline the differences that can be identified within the actor’s discourses. The conclusion drawn from the analysis is that the actors could benefit from viewing their interpretation of water protection processes as parts of dis-courses. By doing this the actors could gain a deeper understanding of each other, and of what influences the view of governing and use of resources like water

Parent-of-origin-specific allelic associations among 106 genomic loci for age at menarche.

Age at menarche is a marker of timing of puberty in females. It varies widely between individuals, is a heritable trait and is associated with risks for obesity, type 2 diabetes, cardiovascular disease, breast cancer and all-cause mortality. Studies of rare human disorders of puberty and animal models point to a complex hypothalamic-pituitary-hormonal regulation, but the mechanisms that determine pubertal timing and underlie its links to disease risk remain unclear. Here, using genome-wide and custom-genotyping arrays in up to 182,416 women of European descent from 57 studies, we found robust evidence (P < 5 × 10(-8)) for 123 signals at 106 genomic loci associated with age at menarche. Many loci were associated with other pubertal traits in both sexes, and there was substantial overlap with genes implicated in body mass index and various diseases, including rare disorders of puberty. Menarche signals were enriched in imprinted regions, with three loci (DLK1-WDR25, MKRN3-MAGEL2 and KCNK9) demonstrating parent-of-origin-specific associations concordant with known parental expression patterns. Pathway analyses implicated nuclear hormone receptors, particularly retinoic acid and γ-aminobutyric acid-B2 receptor signalling, among novel mechanisms that regulate pubertal timing in humans. Our findings suggest a genetic architecture involving at least hundreds of common variants in the coordinated timing of the pubertal transition