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

Systematic literature review of determinants of sedentary behaviour in older adults:a DEDIPAC study

BACKGROUND: Older adults are the most sedentary segment of society and high sedentary time is associated with poor health and wellbeing outcomes in this population. Identifying determinants of sedentary behaviour is a necessary step to develop interventions to reduce sedentary time. METHODS: A systematic literature review was conducted to identify factors associated with sedentary behaviour in older adults. Pubmed, Embase, CINAHL, PsycINFO and Web of Science were searched for articles published between 2000 and May 2014. The search strategy was based on four key elements: (a) sedentary behaviour and its synonyms; (b) determinants and its synonyms (e.g. correlates, factors); (c) types of sedentary behaviour (e.g. TV viewing, sitting, gaming) and (d) types of determinants (e.g. environmental, behavioural). Articles were included in the review if specific information about sedentary behaviour in older adults was reported. Studies on samples identified by disease were excluded. Study quality was rated by means of QUALSYST. The full review protocol is available from PROSPERO (PROSPERO 2014: CRD42014009823). The analysis was guided by the socio-ecological model framework. RESULTS: Twenty-two original studies were identified out of 4472 returned by the systematic search. These included 19 cross-sectional, 2 longitudinal and 1 qualitative studies, all published after 2011. Half of the studies were European. The study quality was generally high with a median of 82 % (IQR 69-96 %) using Qualsyst tool. Personal factors were the most frequently investigated with consistent positive association for age, negative for retirement, obesity and health status. Only four studies considered environmental determinants suggesting possible association with mode of transport, type of housing, cultural opportunities and neighbourhood safety and availability of places to rest. Only two studies investigated mediating factors. Very limited information was available on contexts and sub-domains of sedentary behaviours. CONCLUSION: Few studies have investigated determinants of sedentary behaviour in older adults and these have to date mostly focussed on personal factors, and qualitative studies were mostly lacking. More longitudinal studies are needed as well as inclusion of a broader range of personal and contextual potential determinants towards a systems-based approach, and future studies should be more informed by qualitative work

A systematic review of correlates of sedentary behaviour in adults aged 18–65 years: a socio-ecological approach

Background: Recent research shows that sedentary behaviour is associated with adverse cardio-metabolic consequences even among those considered sufficiently physically active. In order to successfully develop interventions to address this unhealthy behaviour, factors that influence sedentariness need to be identified and fully understood. The aim of this review is to identify individual, social, environmental, and policy-related determinants or correlates of sedentary behaviours among adults aged 18-65 years. Methods: PubMed, Embase, CINAHL, PsycINFO and Web of Science were searched for articles published between January 2000 and September 2015. The search strategy was based on four key elements and their synonyms: (a) sedentary behaviour (b) correlates (c) types of sedentary behaviours (d) types of correlates. Articles were included if information relating to sedentary behaviour in adults (18-65 years) was reported. Studies on samples selected by disease were excluded. The full protocol is available from PROSPERO (PROSPERO 2014:CRD42014009823). Results: 74 original studies were identified out of 4041: 71 observational, two qualitative and one experimental study. Sedentary behaviour was primarily measured as self-reported screen leisure time and total sitting time. In 15 studies, objectively measured total sedentary time was reported: accelerometry (n = 14) and heart rate (n = 1). Individual level factors such as age, physical activity levels, body mass index, socio-economic status and mood were all significantly correlated with sedentariness. A trend towards increased amounts of leisure screen time was identified in those married or cohabiting while having children resulted in less total sitting time. Several environmental correlates were identified including proximity of green space, neighbourhood walkability and safety and weather. Conclusions: Results provide further evidence relating to several already recognised individual level factors and preliminary evidence relating to social and environmental factors that should be further investigated. Most studies relied upon cross-sectional design limiting causal inference and the heterogeneity of the sedentary measures prevented direct comparison of findings. Future research necessitates longitudinal study designs, exploration of policy-related factors, further exploration of environmental factors, analysis of inter-relationships between identified factors and better classification of sedentary behaviour domains

A Pilot Study to Evaluate the Introduction of an Interprofessional Problem-based Learning Module

Patient care is complex and demands that health professionals work together effectively. Interprofessional education (IPE) encourages collaboration by educating students from different professions together. This study examined the effectiveness of IPE in terms of changing students’ perceptions of teamwork, professional identity, role, competency and autonomy, and the need for interdisciplinary co-operation. Two multidisciplinary cohorts of health science students (n=51 and n=48) elected to participate in a problem-based learning module (PBL). The module included problems addressing areas of professional identity and cases requiring a multidisciplinary team approach. Evaluation was undertaken using the Readiness for Interprofessional Learning Scale (RIPLS) and the Interdisciplinary Education Perception Scale (IPES). Regarding the RIPLS, both cohorts reported significant (

Lifestyle Interventions to Improve Glycemic Control in Adults with Type 2 Diabetes Living in Low-and-Middle Income Countries: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (RCTs)

Alongside glucose lowering therapy, clinical guidelines recommend lifestyle interventions as cornerstone in the care of people living with type 2 diabetes (T2DM). There is a specific need for an up-to-date review assessing the effectiveness of lifestyle interventions for people with T2DM living in low-and-middle income countries (MICs). Four electronic databases were searched for RCTs published between 1990 and 2020. T2DM, lifestyle interventions, LMICs and their synonyms were used as search terms. Data codebooks were developed and data were extracted. Narrative synthesis and meta-analysis were conducted using random effects models to calculate mean differences (MD) and standardized mean differences (SMD) and 95% confidence intervals (CI). Of 1284 articles identified, 30 RCTs (n = 16,670 participants) met the inclusion criteria. Pooled analysis revealed significant improvement in HBA1c (MD −0.63; CI: −0.86, −0.40), FBG (SMD −0.35; CI: −0.54, −0.16) and BMI (MD −0.5; CI: −0.8, −0.2). In terms of intervention characteristics, those that included promoted self-management using multiple education components (e.g., diet, physical activity, medication adherence, smoking cessation) and were delivered by healthcare professionals in a hospital/clinic setting were deemed most effective. However, when interpreting these results, it is important to consider that most included studies were evaluated as being of low quality and there was a significant amount of intervention characteristics heterogeneity. There is a need for further well-designed studies to inform the evidence base on which lifestyle interventions are most effective for glycemic control in adults with T2DM living in LMICs

Lisää ja enemmän! : Perheiden kokemuksia avoimesta varhaiskasvatustoiminnasta Limingassa

Opinnäytetyön tavoitteena oli kartoittaa, minkälaisia kokemuksia asiakasperheillä on avoimen varhaiskasvatustoiminnan perheryhmistä ja lasten ryhmistä Limingan kunnassa. Tarkoituksena oli myös tutkia, minkälaisia kehittämisehdotuksia perheillä on toiminnalle. Limingan kunta sai tutkimuksen avulla tietoa siitä, onko avoimen varhaiskasvatustoiminnan järjestäminen vastannut sille asetettuihin tavoitteisiin. Tutkimuksen aineisto koottiin lomakekyselyllä kaikilta avoimia varhaiskasvatuspalveluita käyttäneiltä perheiltä. Aineisto analysoitiin sekä määrällisiä menetelmiä käyttäen että luokittelemalla ja teemoittelemalla. Opinnäytetyön tulosten mukaan avoin varhaiskasvatustoiminta on vastannut hyvin sille asetettuihin tavoitteisiin. Vanhemmat arvostavat kovasti omia ja lastensa sosiaalisia suhteita ja ne ovatkin suurin yksittäinen syy avoimeen varhaiskasvatustoimintaan osallistumiselle Limingassa. Vertaisryhmä koetaan tärkeäksi sekä perheryhmässä että lasten leikkitoiminnan ryhmissä. Tutkimustulosten mukaan ryhmässä toimimisen taidot ja kaveritaidot ovat niitä asioita, joiden oppimisen vuoksi liminkalaiset vanhemmat haluavat lastensa osallistuvan avoimeen varhaiskasvatustoimintaan ja näihin taitoihin liittyviin toimintoihin oltiin hyvin tyytyväisiä. Vastaajat olivat tyytyväisiä toimintaan tällaisenaan. Avointa varhaiskasvatustoimintaa toivottiin kuitenkin lisää. Vanhemmat toivovat myös kasvatuskeskusteluja lastentarhanopettajan kanssa sekä kasvatusaiheisia luentoja.The aim of the thesis was to identify what kind of experiences families had of open early childhood education activities for both family groups and children’s groups in the municipality of Liminka. The aim was also to examine what kind of development proposals the families had for the service. With the help of the study the municipality of Liminka received information on how the open early childhood education activities had reached the goals set for them. The research data was collected by using a questionnaire addressed to all the families that had used the open early childhood education services. The data was analysed by using quantitative methods as well as classification and themes. According to the results of the thesis, the open early childhood education services had reached the set targets quite well. The parents highly appreciated their own and their children's social relationships, and this was the biggest single reason for participating in the open early childhood education activities in Liminka. A peer group was considered important both in family groups and in the children's play groups. According to the results, it was because of learning group work and friendship skills that the parents wanted their children to participate in the open early childhood education activities. Moreover, the parents were satisfied with the activities related to these skills. The respondents were satisfied with the services as they were. However, they also wanted more open early childhood education services. The parents also wanted educational discussions with the kindergarten teachers as well as educational lectures

Additional file 2: of An evaluation of the DEXLIFE ‘self-selected’ lifestyle intervention aimed at improving insulin sensitivity in people at risk of developing type 2 diabetes: study protocol for a randomised controlled trial

Participant flow through the recruitment process. (PDF 170 kb

Factors related to the implementation and scale-up of physical activity interventions in Ireland: a qualitative study with policy makers, funders, researchers and practitioners

Background Current literature reports a gap between development of efective interventions to promote physical activity and the systematic uptake into real-world settings. Factors relating to implementation and scale-up of physical activity interventions have been examined, however the perspectives of multiple stakeholders from diferent domains are not well researched. The purpose of this study was to examine the perceived factors related to physical activity intervention implementation and scale-up in diferent domains from diferent stakeholders on the island of Ireland.Methods Practitioners, researchers, funders and policy makers in Ireland were invited to take part in a semi-structured interview exploring factors related to the implementation and scale-up of eleven diferent physical activity interventions. A thematic analysis was conducted to identify factors related to the implementation and scale-up of the included interventions. The data collection and analysis were guided by the Consolidated Framework for Implementation Research.Results Thirty-eight participants took part in the interviews which identifed factors related to 1) intervention planning and practical considerations; 2) organisational structures, stafng and resources related to delivery; 3) refection, evaluation and updating of the intervention; and 4) practical consideration related to scale-up. Furthermore, participants referred to the ongoing commitment, engagement, and support needed throughout the implementation process.Conclusions Future research and practice needs to consider how diferent factors are experienced at diferent implementation stages and by the diferent stakeholder groups involved. The fndings highlight multiple inter-related factors that infuence the implementation and scale-up of physical activity interventions, but also identifes many strategies that can be utilised to aid future successes.</p

Socio-economic determinants of physical activity across the life course: a "dEterminantsof dIet and physical aCtivity" (DEDIPAC) umbrella literature review

Background To date, the scientific literature on socioeconomic correlates and determinants of physical activity behaviours has been dispersed throughout a number of systematic reviews, often focusing on one factor (e.g. education or parental income) in one specific age group (e.g. pre-school children or adults). The aim of this umbrella review is to provide a comprehensive and systematic overview of the scientific literature from previously conducted research by summarising and synthesising the importance and strength of the evidence related to socioeconomic correlates and determinants of PA behaviours across the life course. Methods Medline, Embase, ISI Web of Science, Scopus and SPORTDiscus were searched for systematic literature reviews and meta-analyses of observational studies investigating the association between socioeconomic determinants of PA and PA itself (from January 2004 to September 2017). Data extraction evaluated the importance of determinants, strength of evidence, and methodological quality of the selected papers. The full protocol is available from PROSPERO (PROSPERO2014:CRD42015010616). Results Nineteen reviews were included. Moderate methodological quality emerged. For adults, convincing evidence supports a relationship between PA and socioeconomic status (SES), especially in relation to leisure time (positive relationship) and occupational PA (negative relationship). Conversely, no association between PA and SES or parental SES was found for pre-school, school-aged children and adolescents. Conclusions Available evidence on the socioeconomic determinants of PA behaviour across the life course is probable (shows fairly consistent associations) at best. While some evidence is available for adults, less was available for youth. This is mainly due to a limited quantity of primary studies, weak research designs and lack of accuracy in the PA and SES assessment methods employed. Further PA domain specific studies using longitudinal design and clear measures of SES and PA assessment are required