Review of Bringing Narnia Home: Lessons from the Other Side of the Wardrobe

A review of Devin Brown, Bringing Narnia Home: Lessons from the Other Side of the Wardrobe (Nashville, 2015). xii + 131 pages. $12.99. ISBN: 9781426791628

Case Presentation for Percutaneous Transluminal Coronary Angioplasty and Coronary Artery Disease

CASE HISTORY: The patient is a 70-year old who presented in September 2016 to a rural based cardiac and pulmonary rehabilitation program with occasional exertional hypotension and dizziness. He tolerated exercise well completing 550 meters in 6 minutes without symptoms. He consistently walked approximately 1 mile a day and reported occasional lightheadedness/dizziness with walking. He also was able to complete 12 minutes of interval training at 5-6 METs on the Sci-Fit with no symptoms, normal HR, SaO2, and BP response to exercise. He was not taking any medication. PHYSICAL EXAM: Patient came in with initial measurements as follows: weight- 212 lbs, height- 72 in, BMI- 28 kg∙m-2, resting heat rate- 77bpm, resting BP- 120/70mmHg, 95 SaO2 and a Duke Activity Status Index score of 27.4. DIFFERENTIAL DIAGNOSES: Exertional hypotension; arthritis; celiac disease. TESTS & RESULTS: Patient had CT performed that was negative for injury. In January while on vacation, he reported severe chest tightness and was admitted to the ER. He was referred for angiogram which showed 90 percent blockage of the right coronary artery. A stent was inserted, and he was prescribed Carvediol, Lisinopril, Pravastatin, Plavix, and Nitroglycerin. FINAL DIAGNOSIS: Coronary artery disease, percutaneous transluminal coronary angioplasty. DISCUSSION: Coronary heart disease is the process of damaged coronary arteries becoming hardened and narrow which causes a decrease in oxygen-rich blood flow to the heart. Coronary heart disease is usually caused by the build-up of plaque in the arteries. Percutaneous transluminal coronary angioplasty is a procedure in which blocked coronary arteries are opened to allow unobstructed blood flow to the heart. After sent placement, he returned to exercise with us. We performed a submaximal walk test with 12-ECG and noted multifocal PVCs (\u3e20 percent of cycles) at HR of 95-100. He tolerated exercise well, and did not report dizziness. The ventricular ectopy persisted at HR above 105, so for the following week he was given an exercise prescription of 1 mile at HR of 100-105. The patient then mentioned he smoked half a cigar in the mornings and the other half in the evenings. OUTCOME OF THE CASE: We had a discussion with the patient about his diagnosis and how we will proceed further with his treatment. We also advised him to not smoke a cigar before he came to cardiac rehab in the mornings. The next exercise session we noted only three unifocal PVCs for the entire workout. We have reviewed the importance of cardiovascular exercise as well as resistance exercise for his recovery and improvement. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: Patient was told by physician to wear a cardiac event monitor for 30 days. He is performing 20 minutes of walking at 3.0 mph/2% grade and 15 minutes of steady state training at 4-5 METs on the Sci-fit

Does diet mediate associations of volume and bouts of sedentary time with cardiometabolic health indicators in adolescents?

Objective: Examine the mediating role of diet in the relationship between volume and duration of sedentary time with cardiometabolic health in adolescents. Methods: Adolescents (12-19 years) participating in the 2003/04 and 2005/06 U.S. National Health and Nutrition Examination Survey (NHANES) were examined. Cardiometabolic health indicators were body mass index z-scores (zBMI) (n 5 1,797) and metabolic syndrome (MetS) (n 5 812). An ActiGraph hip-worn accelerometer was used to derive total sedentary time and usual sedentary bout duration. Dietary intake was assessed using two 24-hour dietary recalls. Mediation analyses were conducted to examine five dietary mediators [total energy intake, discretionary foods, sugar-sweetened beverages (SSB), fruits and vegetables, and dietary quality] of the relationship between total sedentary time and usual sedentary bout duration with zBMI and MetS. Results: Total sedentary time was inversely associated with zBMI (b 5 21.33; 95% CI 22.53 to 20.13) but attenuated after adjusting for moderate-to-vigorous physical activity. No significant associations were observed between usual sedentary bout duration with zBMI or either sedentary measure with MetS. None of the five dietary variables mediated any of the relationships examined. Conclusions: Further studies are needed to explore associations of specific time periods (e.g., after school) and bout durations with both cardiometabolic health indicators and dietary behaviors

ShopSmart 4 Health - protocol of a skills-based randomised controlled trial promoting fruit and vegetable consumption among socioeconomically disadvantaged women

BackgroundThere is a need for evidence on the most effective and cost-effective approaches for promoting healthy eating among groups that do not meet dietary recommendations for good health, such as those with low incomes or experiencing socioeconomic disadvantage. This paper describes the ShopSmart 4 Health study, a randomised controlled trial conducted by Deakin University, Coles Supermarkets and the Heart Foundation, to investigate the effectiveness and cost-effectiveness of a skill-building intervention for promoting increased purchasing and consumption of fruits and vegetables amongst women of low socioeconomic position (SEP).Methods/designShopSmart 4 Health employed a randomised controlled trial design. Women aged 18&ndash;60 years, holding a Coles store loyalty card, who shopped at Coles stores within socioeconomically disadvantaged neighbourhoods and met low-income eligibility criteria were invited to participate. Consenting women completed a baseline survey assessing food shopping and eating habits and food-related behaviours and attitudes. On receipt of their completed survey, women were randomised to either a skill-building intervention or a wait-list control condition. Intervention effects will be evaluated via self-completion surveys and using supermarket transaction sales data, collected at pre- and post-intervention and 6-month follow-up. An economic evaluation from a societal perspective using a cost-consequences approach will compare the costs and outcomes between intervention and control groups. Process evaluation will be undertaken to identify perceived value and effects of intervention components.DiscussionThis study will provide data to address the currently limited evidence base regarding the effectiveness and cost-effectiveness of skill-building intervention strategies aimed at increasing fruit and vegetable consumption among socioeconomically disadvantaged women, a target group at high risk of poor diets.<br /

Is the perception of time pressure a barrier to healthy eating and physical activity among women?

Objectives To describe the proportion of women reporting time is a barrier to healthy eating and physical activity, the characteristics of these women and the perceived causes of time pressure, and to examine associations between perceptions of time as a barrier and consumption of fruit, vegetables and fast food, and physical activity.Design A cross-sectional survey of food intake, physical activity and perceived causes of time pressure.Setting A randomly selected community sample.Subjects A sample of 1580 women self-reported their food intake and their perceptions of the causes of time pressure in relation to healthy eating. An additional 1521 women self-reported their leisure-time physical activity and their perceptions of the causes of time pressure in relation to physical activity.Results Time pressure was reported as a barrier to healthy eating by 41 % of the women and as a barrier to physical activity by 73 %. Those who reported time pressure as a barrier to healthy eating were significantly less likely to meet fruit, vegetable and physical activity recommendations, and more likely to eat fast food more frequently.Conclusions Women reporting time pressure as a barrier to healthy eating and physical activity are less likely to meet recommendations than are women who do not see time pressure as a barrier. Further research is required to understand the perception of time pressure issues among women and devise strategies to improve women&rsquo;s food and physical activity behaviours

Understanding determinants of nutrition, physical activity and quality of life among older adults : the Wellbeing, Eating and Exercise for a Long Life (WELL) study

Background : Nutrition and physical activity are major determinants of health and quality of life; however, there exists little research focusing on determinants of these behaviours in older adults. This is important, since just as these behaviours vary according to subpopulation, it is likely that the determinants also vary. An understanding of the modifiable determinants of nutrition and physical activity behaviours among older adults to take into account the specific life-stage context is required in order to develop effective interventions to promote health and well-being and prevent chronic disease and improve quality of life. Methods : The aim of this work is to identify how intrapersonal, social and environmental factors influence nutrition and physical activity behaviours among older adults living in urban and rural areas. This study is a cohort study of adults aged 55-65 years across urban and rural Victoria, Australia. Participants completed questionnaires at baseline in 2010 and will complete follow-up questionnaires in 2012 and 2014. Self-report questionnaires will be used to assess outcomes such as food intake, physical activity and sedentary behaviours, anthropometry and quality of life. Explanatory variables include socioeconomic position, and measures of the three levels of influence on older adults\u27 nutrition and physical activity behaviours (intrapersonal, social and perceived environmental influences). Discussion : Obesity and its determinant behaviours, physical inactivity and poor diet are major public health concerns and are significant determinants of the quality of life among the ageing population. There is a critical need for a better understanding of the determinants of nutrition and physical activity in this important target group. This research will provide evidence for the development of effective policies and programs to promote and support increased physical activity and healthy eating behaviours among older adults. <br /

Nutrition promotion approaches preferred by Australian adolescents attending schools in disadvantaged neighbourhoods: a qualitative study

BACKGROUND: Links between socioeconomic disadvantage and unhealthy eating behaviours among adolescents are well established. Little is known about strategies that might support healthy eating among this target group. This study aimed to identify potential strategies and preferred dissemination methods that could be employed in nutrition promotion initiatives focussed on improving eating behaviours among socioeconomically disadvantaged adolescents. METHODS: Semi-structured interviews were conducted in 2011 among 22 adolescents (12-15 years) recruited from secondary schools in disadvantaged neighbourhoods in Victoria, Australia. RESULTS: Strategies suggested by adolescents to support healthy eating included increasing awareness about healthy eating; greater cooking involvement; greater parental and peer support; frequent family meal participation; greater parental and peer role-modelling of healthy eating; increased availability of healthy foods and decreased availability of unhealthy foods in homes and schools. Adolescents preferred electronic media, adolescent-specific recipe books, and school-based methods for distributing nutrition promotion messages and strategies. CONCLUSIONS: A number of suggested strategies and methods identified in the present investigation have been employed with success in previous nutrition promotion interventions targeting socioeconomically disadvantaged adolescents. The present study also contributes novel insights into potential strategies and methods that could be employed in initiatives aiming to improve eating behaviours in this vulnerable group, and particularly highlights the importance of incorporating strategies involving parents and modifying the home food environment