Factors determining the integration of nutritional genomics into clinical practice by registered dietitians

YesPersonalized nutrition has the potential to improve health, prevent disease and reduce healthcare expenditure. Whilst research hints at positive consumer attitudes towards personalized nutrition that draws upon lifestyle, phenotypic and genotypic data, little is known about the degree to which registered dietitians (RD) are engaged in the delivery of such services. This review sought to determine possible factors associated with the integration of the emerging science of Nutritional Genomics (NGx) into the clinical practice setting by practicing registered dietitians. Scope Search of online databases (Pubmed; National Library of Medicine; Cochrane Library; Ovid Medline) was conducted on material published from January 2000 to December 2014. Studies that sampled practicing dietitians and investigated integration or application of NGx and genetics knowledge into practice were eligible. Articles were assessed according to the American Dietetic Association Quality Criteria Checklist. Key findings Application of nutritional genomics in practice has been limited. Reluctance to integrate NGx into practice is associated with low awareness of NGx, a lack of confidence in the science surrounding NGx and skepticism toward Direct to consumer (DTC) products. Successful application to practice was associated with knowledge about NGx, having confidence in the science, a positive attitude toward NGx, access to DTC products, a supportive working environment, working in the clinical setting rather than the public health domain and being in private rather than public practice. Conclusions There is a need to provide RGs with a supportive working environment that provides ongoing training in NGx and which is integrated with clinical practice

Psycho-markers of weight loss. The roles of TFEQ Disinhibition and Restraint in exercise-induced weight loss

yesEating behaviour traits, namely Disinhibition and Restraint, have the potential to exert an effect on food intake and energy balance. The effectiveness of exercise as a method of weight management could be influenced by these traits. Fifty eight overweight and obese participants completed 12-weeks of supervised exercise. Each participant was prescribed supervised exercise based on an expenditure of 500 kcal/session, 5 d/week for 12-weeks. Following 12-weeks of exercise there was a significant reduction in mean body weight ( 3.26 ± 3.63 kg), fat mass (FM: 3.26 ± 2.64 kg), BMI ( 1.16 ± 1.17 kg/m2) and waist circumference (WC: 5.0 ± 3.23 cm). Regression analyses revealed a higher baseline Disinhibition score was associated with a greater reduction in BMI and WC, while Internal Disinhibition was associated with a larger decrease in weight, %FM and WC. Neither baseline Restraint or Hunger were associated with any of the anthropometric markers at baseline or after 12-weeks. Furthermore, after 12-weeks of exercise, a decrease in Disinhibition and increase in Restraint were associated with a greater reduction in WC, whereas only Restraint was associated with a decrease in weight. Post-hoc analysis of the sub-factors revealed a decrease in External Disinhibition and increase in Flexible Restraint were associated with weight loss. However, an increase in Rigid Restraint was associated with a reduction in %FM and WC. These findings suggest that exercise-induced weight loss is more marked in individuals with a high level of Disinhibition. These data demonstrate the important roles that Disinhibition and Restraint play in the relationship between exercise and energy balance.BBSR

Development and psychometric properties of the Carer – Head Injury Neurobehavioral Assessment Scale (C-HINAS) and the Carer – Head Injury Participation Scale (C-HIPS): patient and family determined outcome scales

Objective: Develop and assess the psychometric properties of the Carer - Head Injury Participation Scale (C-HIPS) and its biggest factor the Carer - Head Injury Neurobehavioral Assessment Scale (C-HINAS). Furthermore, the aim was to examine the inter-informant reliability by comparing the self reports of individuals with traumatic brain injury (TBI) with the carer reports on the C-HIPS and the C-HINAS. Method: Thirty-two TBI individuals and 27 carers took part in in-depth qualitative interviews exploring the consequences of the TBI. Interview transcripts were analysed and key themes and concepts were used to construct a 49-item and 58-item patient (Patient - Head Injury Participation Scale [P-HIPS]) and carer outcome measure (C-HIPS) respectively, of which 49 were parallel items and nine additional items were used to assess carer burden. Postal versions of the P-HIPS, C-HIPS, Mayo Portland Adaptability Inventory-3 (MPAI-3), and the Glasgow Outcome Scale-Extended (GOSE) were completed by a cohort of 113 TBI individuals and 80 carers. Data from a sub-group of 66 patient/carer pairs were used to compare inter-informant reliability between the P-HIPS and the C-HIPS, and the P-HINAS and the C-HINAS respectively. Results: All individual 49 items of the C-HIPS and their total score showed good test-retest reliability (0.95) and internal consistency (0.95). Comparisons with the MPAI-3 and GOSE found a good correlation with the MPAI-3 (0.7) and a moderate negative correlation with the GOSE (-0.6). Factor analysis of these items extracted a 4-factor structure which represented the domains 'Emotion/Behavior' (C-FUNAS),'Independence/ Community Living', 'Cognition', and 'Physical'. The C-HINAS showed good internal consistency (0.92), test-retest reliability (0.93), and concurrent validity with one MPAI subscale (0.7). Assessment of inter-informant reliability revealed good correspondence between the reports of the patients and the carers for both the C-HIPS (0.83) and the C-HINAS (0.82). Conclusion: Both the C-HINAS and the C-HIPS show strong psychometric properties. The qualitative methodology employed in the construction stage of the questionnaires provided good evidence of face and content validity. Comparisons between the P-HIPS and the C-HIPS, and the P-HINAS and the C-HINAS indicated high levels of agreement suggesting that in situations where the patient is unable to provide self-reports, information provided by the carer could be used. © 2007 Dove Medical Press Limited. All rights reserved

Relationships among tonic and episodic aspects of motivation to eat, gut peptides, and weight before and after bariatric surgery.

yesBackground The interaction between motivation to eat, eating behaviour traits and gut peptides following gastric bypass (GBP) surgery are not fully understood. Setting Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden. Method Appetite and hormone responses to a fixed liquid pre-load were assessed in 12 obese (BMI 45 ± 1.9 kg/m2) participants immediately before, 3 days, 2 months, and 1 year following gastric by-pass (GBP) surgery. Subjective appetite and plasma levels of ghrelin, leptin, insulin and GLP-1 were measured for a 3-hour postprandial period. Eating behaviour traits were also measured using the TFEQR18. Results There was a decrease in TFEQ Emotional Eating (EE) and Uncontrolled Eating (UE) from pre to 1-year post-surgery, but no significant change in Restraint. In addition, there was a reduction in subjective appetite ratings, and alterations in appetite peptides favouring an anorectic response. Pre-surgery EE was significantly related to fasting and AUC ghrelin; UE was associated with AUC desire to eat while there was a significant association between fasting desire to eat and ghrelin (fasting and AUC). 1 year post-surgery, UE was positively related to fasting insulin and Restraint was negatively associated with GLP-1. UE and subjective hunger were positively correlated, while the relationship between desire to eat and ghrelin remained. Conclusion The relationships amongst subjective appetite ratings, eating behaviour traits and appetite peptides in obese patients both before and at one-year post GBP surgery contribute to the reduction in a propensity to over-eat and weight loss

Pre-melt-season sediment plume variability at Jökulsárlón, Iceland, a preliminary evaluation using in-situ spectroradiometry and satellite imagery

High-latitude atmospheric warming is impacting freshwater cycling, requiring techniques for monitoring the hydrology of sparsely-gauged regions. The submarine runoff of tidewater glaciers presents a particular challenge. We evaluate the utility of Moderate Resolution Imaging Spectroradiometer (MODIS) imagery for monitoring turbid meltwater plume variability in the glacier lagoon Jökulsárlón, Iceland, for a short interval before the onset of the main melt season. Total Suspended Solids concentrations (TSS) of surface waters are related to remotely-sensed reflectance via empirical calibration between in-situ-sampled TSS and reflectance in a MODIS band 1-equivalent wavelength window. This study differs from previous ones in its application to an overturning tidewater glacier plume, rather than one derived from river runoff. The linear calibration improves on previous studies by facilitating a wider range of plume metrics than areal extent, notably pixel-by-pixel TSS values. Increasing values of minimum plume TSS over the study interval credibly represent rising overall turbidity in the lagoon as melting accumulates. Plume extent responds principally to consistently-strong offshore winds. Further work is required to determine the temporal persistence of the calibration, but remote plume observation holds promise for monitoring hydrological outputs from ungauged or ungaugeable systems

Pre-melt-season sediment plume variability at Jokulsarlon, Iceland: a preliminary evaluation using in-situ spectroradiometry and satellite imagery

High-latitude atmospheric warming is impacting freshwater cycling, requiring techniques for monitoring the hydrology of sparsely-gauged regions. The submarine runoff of tidewater glaciers presents a particular challenge. We evaluate the utility of Moderate Resolution Imaging Spectroradiometer (MODIS) imagery for monitoring turbid meltwater plume variability in the glacier lagoon Jökulsárlón, Iceland, for a short interval before the onset of the main melt season. Total Suspended Solids concentrations (TSS) of surface waters are related to remotely-sensed reflectance via empirical calibration between in-situ-sampled TSS and reflectance in a MODIS band 1-equivalent wavelength window. This study differs from previous ones in its application to an overturning tidewater glacier plume, rather than one derived from river runoff. The linear calibration improves on previous studies by facilitating a wider range of plume metrics than areal extent, notably pixel-by-pixel TSS values. Increasing values of minimum plume TSS over the study interval credibly represent rising overall turbidity in the lagoon as melting accumulates. Plume extent responds principally to consistently-strong offshore winds. Further work is required to determine the temporal persistence of the calibration, but remote plume observation holds promise for monitoring hydrological outputs from ungauged or ungaugeable systems

Dying to Talk? Co-producing resources with young people to get them talking about bereavement, death and dying

YesThe Dying to Talk project in Bradford, UK aimed to build resilience in young people around the topic of death, dying and bereavement. Starting conversations early in life could buttress people’s future wellbeing when faced with bereavement and indeed their own mortality. Research indicates that a key feature in young people’s experience of bereavement is ‘powerlessness’ (Ribbens McCarthy, 2007). Drawing on the principles of co-production, young people led the development of the project aimed at encouraging young people to talk about death, using archaeology as a facilitator to those conversations. The partnership between the University of Bradford, the voluntary sector and the young people proved to be a positive and empowering one. It laid the foundations for future collaboration and developed a framework for engaging young people in talking about death, building their resilience for dealing with death and dying in the future – a step towards building a ‘compassionate city’ for young people (Kellehear, 2012)University of Bradford, Higher Education Innovation Fund; AHR

Mothers’ and fathers’ views on the importance of play for their children’s development: gender differences, academic activities, and the parental role

YesBackground: Play is a main driver of children’s cognitive and social development and is crucial for educational success (Ginsburg, 2007). In recent years however, parents and schools are under pressure to prioritise academic targets over play. Aims: The current research investigated parents’ views about three aspects of their children’s play and academic activities. Sample: Predominantly highly educated UK parents (109 mothers and 49fathers) were recruited via social media. Method: Participants were asked to complete an amended online version of the Preschool Play and Learning Questionnaire (Parmar, Harkness, & Super, 2004). The questionnaire consisted of 25 items covering three themes: the importance of play for children’s development, the importance of academic activities, and the importance of parents’ role in their children’s development. The independent variables were the gender of the parent, the gender of their child, and the age group of their child (4 to 7 years, or 8 to 11 years). Results: Parents rated play higher than academic activities or their own roles, but the difference was not noteworthy. However, fathers rated academic activities and the parents’ role significantly higher than mothers did. In addition, parents of girls rated academic activities and their own role, significantly higher than parents of boys. Conclusions: The findings of the current research highlight gender divisions between parents and towards boys and girls regarding the importance of education. Gender roles appear to influence the way parents think about the academic activities their children partake in

Perceptions and experiences of early-adopting registered dietitians in integrating nutrigenomics into practice

yesPurpose - This research explores the perceptions and experiences of early adopters of the technology. Design/Method/Approach - Registered Dietitians (RD´s) (N=14) were recruited from the UK, Canada, South-Africa, Australia, Mexico and Israel. Six qualitative interviews and two focus groups were conducted online using a conference calling platform. Data were recorded, transcribed and thematically analysed. Findings - Early adopters of Nutrigenomics (NGx) were experienced, self-efficacious RD’s who actively sought knowledge of NGx through communication with one another and the broader scientific community. They considered NGx an extension of current practice and believed RD’s had the skills to deliver it. Perceived barriers to widening the application of NGx were linked to skepticism among the wider dietetics community. Proliferation of unregulated websites offering tests and diets was considered ‘pseudoscience’ and detrimental to dietetics fully embracing NGx. The lack of a sustainable public health model for the delivery of NGx was also perceived to hinder progress. Results are discussed with reference to ‘diffusion of innovation theory’. Originality/Value - The views of RD’s who practice NGx have not been previously studied. These data highlight requirements for future dietetic training provision and more inclusive service delivery models. Regulation of NGx services and formal recognition by professional bodies is needed to address the research/practice translation gap