Enablers and barriers to implementing obesity assessments in clinical practice : a rapid mixed-methods systematic review

Objectives This systematic review aims to improve our knowledge of enablers and barriers to implementing obesity-related anthropometric assessments in clinical practice. Design A mixed-methods systematic review. Data sources Medline, Embase and CINAHL to November 2021. Eligibility criteria Quantitative studies that reported patient factors associated with obesity assessments in clinical practice (general practice or primary care); and qualitative studies that reported views of healthcare professionals about enablers and barriers to their implementation. Data extraction and synthesis We used randomeffects meta-analysis to pool ratios for categorical predictors reported in ≥3 studies expressed as pooled risk ratio (RR) with 95% CI, applied inverse variance weights, and investigated statistical heterogeneity (I2 ), publication bias (Egger’s test), and sensitivity analyses. We used reflexive thematic analysis for qualitative data and applied a convergent integrated approach to synthesis. Results We reviewed 22 quantitative (observational) and 3 qualitative studies published between 2004 and 2020. All had ≥50% of the quality items for risk of bias assessments. Obesity assessment in clinical practice was positively associated with patient factors: female sex (RR 1.28, 95% CI 1.10 to 1.50, I2 99.8%, mostly UK/USA), socioeconomic deprivation (RR 1.21, 95% CI 1.18 to 1.24, I2 73.9%, UK studies), non-white race/ ethnicity (RR 1.27, 95% CI 1.03 to 1.57, I2 99.6%) and comorbidities (RR 2.11, 95% CI 1.60 to 2.79, I2 99.6%, consistent across most countries). Obesity assessment was also most common in the heaviest body mass index group (RR 1.55, 95% CI 0.99 to 2.45, I2 99.6%). Views of healthcare professionals were positive about obesity assessments when linked to patient health (convergent with meta-analysis for comorbidities) and if part of routine practice, but negative about their role, training, time, resources and incentives in the healthcare system. Conclusions Our evidence synthesis revealed several important enablers and barriers to obesity assessments that should inform healthcare professionals and relevant stakeholders to encourage adherence to clinical practice guideline recommendations

Eyes, ears and technology : an evaluation of the use of video-conferencing in BPR workshops

Purpose: The purpose of this paper is to evaluate the effectiveness of video-conferencing as a suitable technology for business process reengineering (BPR) training of 12 health sector participants located in Prince Edward Island, Canada. Design/methodology/approach: An action research was adopted. The participants received training from a remote BPR consultant located in Northern Ireland (UK), with the assistance of local moderators. The focus of the study is concerned with the quality of the learning experience and the important role played by local moderators. Findings: Overall, the use of video-conferencing technology provided a valuable learning experience. It was also cost effective and an efficient use of both the consultants' and the participants' time. A key part of the success of the exercise was the role of one of the local moderators who acted as the eyes and ears of the consultant. Originality/value: A general contribution to knowledge is the positioning of the argument developed within the technology diffusion literature. The paper offers important insights into the effective use of video-conferencing technology for BPR training purposes; and Knipe and Lee's evaluation of a video-conferencing experiment in terms of the relationship between the human actors at the remote and local sites is discussed and extended

Redox regulation of ischemic limb neovascularization - What we have learned from animal studies

Mouse hindlimb ischemia has been widely used as a model to study peripheral artery disease. Genetic modulation of the enzymatic source of oxidants or components of the antioxidant system reveal that physiological levels of oxidants are essential to promote the process of arteriogenesis and angiogenesis after femoral artery occlusion, although mice with diabetes or atherosclerosis may have higher deleterious levels of oxidants. Therefore, fine control of oxidants is required to stimulate vascularization in the limb muscle. Oxidants transduce cellular signaling through oxidative modifications of redox sensitive cysteine thiols. Of particular importance, the reversible modification with abundant glutathione, called S-glutathionylation (or GSH adducts), is relatively stable and alters protein function including signaling, transcription, and cytoskeletal arrangement. Glutaredoxin-1 (Glrx) is an enzyme which catalyzes reversal of GSH adducts, and does not scavenge oxidants itself. Glrx may control redox signaling under fluctuation of oxidants levels. In ischemic muscle increased GSH adducts through Glrx deletion improves in vivo limb revascularization, indicating endogenous Glrx has anti-angiogenic roles. In accordance, Glrx overexpression attenuates VEGF signaling in vitro and ischemic vascularization in vivo. There are several Glrx targets including HIF-1α which may contribute to inhibition of vascularization by reducing GSH adducts. These animal studies provide a caution that excess antioxidants may be counter-productive for treatment of ischemic limbs, and highlights Glrx as a potential therapeutic target to improve ischemic limb vascularization

Phenotypic Responses to a Lifestyle Intervention Do Not Account for Inter-Individual Variability in Glucose Tolerance for Individuals at High Risk of Type 2 Diabetes

Background: Lifestyle interventions have been shown to delay or prevent the onset of type 2 diabetes among high risk adults. A better understanding of the variability in physiological responses would support the matching of individuals with the best type of intervention in future prevention programmes, in order to optimize risk reduction. The purpose of this study was to determine if phenotypic characteristics at baseline or following a 12 weeks lifestyle intervention could explain the inter-individual variability in change in glucose tolerance in individuals with high risk for type 2 diabetes.Methods: In total, 285 subjects with normal glucose tolerance (NGT, FINDRISC score > 12), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) were recruited for a 12 weeks lifestyle intervention. Glucose tolerance, insulin sensitivity, anthropometric characteristics and aerobic fitness were measured. Variability of responses was examined by grouping participants by baseline glycemic status, by cluster analysis based on the change in glucose tolerance and by Principal Component Analysis (PCA).Results: In agreement with other studies, the mean response to the 12 weeks intervention was positive for the majority of parameters. Overall, 89% improved BMI, 80% waist circumference, and 81% body fat while only 64% improved fasting plasma glucose and 60% 2 h glucose. The impact of the intervention by glycaemic group did not show any phenotypic differences in response between NGT, IFG, and IGT. A hierarchical cluster analysis of change in glucose tolerance identified four sub-groups of “responders” (high and moderate) and “non-responders” (no response or deteriorated) but there were few differences in baseline clincal and physiological parameters or in response to the intervention to explain the overall variance. A further PCA analysis of 19 clinical and physiological univariables could explain less than half (48%) of total variability.Conclusion: We found that phenotypic characteristics from standard clinical and physiological parameters were not sufficient to account for the inter-individual variability in glucose tolerance following a 12 weeks lifestyle intervention in inidivuals at high risk for type 2 diabetes. Further work is required to identify biomarkers that complement phenotypic traits and better predict the response to glucose tolerance

Multi-ancestry genome-wide association meta-analysis of Parkinson?s disease

Although over 90 independent risk variants have been identified for Parkinson’s disease using genome-wide association studies, most studies have been performed in just one population at a time. Here we performed a large-scale multi-ancestry meta-analysis of Parkinson’s disease with 49,049 cases, 18,785 proxy cases and 2,458,063 controls including individuals of European, East Asian, Latin American and African ancestry. In a meta-analysis, we identified 78 independent genome-wide significant loci, including 12 potentially novel loci (MTF2, PIK3CA, ADD1, SYBU, IRS2, USP8, PIGL, FASN, MYLK2, USP25, EP300 and PPP6R2) and fine-mapped 6 putative causal variants at 6 known PD loci. By combining our results with publicly available eQTL data, we identified 25 putative risk genes in these novel loci whose expression is associated with PD risk. This work lays the groundwork for future efforts aimed at identifying PD loci in non-European populations

Behavior-Based Safety: The Impact of Culture and Leadership on Workplace Injuries and Fatalities

Abstract This paper discusses the impact of unsafe work behaviors that potentially result in workplace injuries and fatalities, and whether the position is management or supervisor, knowing the importance of that position in taking and accepting ownership for the unsafe work behaviors, while not solely placing blame on actions of the individual employee. This paper will also discuss the organizational culture and its impact on employees\u27 perception of safety on all levels of an organization. Employees that are informed, skilled, well-trained, and continuously aware of the importance of safety will not only work more efficiently but will likely become more conscious of both their safe and unsafe behaviors that lead to accidents. Although there is no definitive date, Behavior-based or Behavioral Safety theory was said to have begun with research conducted by Herbert William Heinrich (1886-1962). He was known as an American Industrial Pioneer in the 1930s. During Heinrichs research, he wrote a book entitled Industrial Accident Prevention, A Scientific Approach with a theory known as Heinrich\u27s Law which states: In a workplace, for every accident that causes a significant injury, there are 29 accidents that cause minor injuries and 300 accidents that cause no injuries (Marsden, 2021). Heinrich concluded that 95% of workplace accidents result from unsafe acts or behavior after extensive research” (safetyfabrications.co.uk, 2016). According to EHS Today, Behavior-Based safety is a broad term used to describe how an employee performs during audits, to incorporating a management system designed to change the company culture (Smith., 2018). While interning in the construction industry, my experience was to expect certain risks due to the type of work performed, such as with ironworkers, having only fall protection but nothing to grab hold of or firmly stand on while welding at extreme heights, or firm footing for the workers to resort to in case of a fall. These types of risks were expected and accepted by management and supervisors as a part of the job. Also, having been employed as a line worker in general industry/manufacturing, the job becomes repetitious, and employees become complacent. In many cases, supervisors have witnessed employees taking shortcuts, all for the sake of production and without correcting observed unsafe behaviors. Keywords: Behavior-Based Safety, Safety Compliance, Safety Triangl

α-Hydroxybutyric acid is a selective metabolite biomarker of impaired glucose tolerance

OBJECTIVE Plasma metabolites that distinguish isolated impaired glucose tolerance (iIGT) from isolated impaired fasting glucose (iIFG) may be useful biomarkers to predict IGT, a high-risk state for the development of type 2 diabetes. RESEARCH DESIGN AND METHODS Targeted metabolomics with 23 metabolites previously associated with dysglycemia was performed with fasting plasma samples from subjects without diabetes at time 0 of an oral glucose tolerance test (OGTT) in two observational cohorts: RISC (Relationship Between Insulin Sensitivity and Cardiovascular Disease) and DMVhi (Diabetes Mellitus and Vascular Health Initiative). Odds ratios (ORs) for a one-SD change in the metabolite level were calculated using multiple logistic regression models controlling for age, sex, and BMI to test for associations with iIGT or iIFG versus normal. Selective biomarkers of iIGT were further validated in the Botnia study. RESULTS α-Hydroxybutyric acid (α-HB) was most strongly associated with iIGT in RISC (OR 2.54 [95% CI 1.86-3.48], P value 5E-9) and DMVhi (2.75 [1.81-4.19], 4E-5) while having no significant association with iIFG. In Botnia, a-HB was selectively associated with iIGT (2.03 [1.65-2.49], 3E-11) and had no significant association with iIFG. Linoleoyl-glycerophosphocholine (L-GPC) and oleic acid were also found to be selective biomarkers of iIGT. In multivariate IGT prediction models, addition of α-HB, L-GPC, and oleic acid to age, sex, BMI, and fasting glucose significantly improved area under the curve in all three cohorts. CONCLUSIONS α-HB, L-GPC, and oleic acid were shown to be selective biomarkers of iIGT, independent of age, sex, BMI, and fasting glucose, in 4,053 subjects without diabetes from three European cohorts. These biomarkers can be used in predictive models to identify subjects with IGT without performing an OGTT