Pre-conception and antenatal care in type 2 diabetes.

The UK is experiencing a dramatic increase in prevalence of type 2 diabetes mellitus (T2DM). Consequently there is a corresponding increase in T2DM in pregnancy, with 27% of pregnant women with pre-existing diabetes having T2DM. Although the risks to mother and baby are similar to type 1 diabetes mellitus (T1DM), the approach and management often differ. Pregnant women with T2DM are more likely to be older, multiparous and live in deprived areas. Certain ethic groups are more prone to T2DM and there is a strong association with being overweight and obesity. Furthermore, some surveys have shown that women with T2DM often receive suboptimum care prior to conception and in early pregnancy, particularly in primary care. This paper presents an overview of the multidisciplinary management of T2DM in pregnancy and identifies areas where care may be improved for these women

Attitudes of employees working in public places toward breastfeeding.

Background: The benefits of breastfeeding are well documented but the UK has one of the lowest breastfeeding rates in Europe. Perceptions of social disapproval of breastfeeding in public is one of the main reasons (Acker, 2009; Dyson et al, 2010) why women may choose to bottle feed instead of breastfeeding, or why they may cease breastfeeding early. To better understand the social attitudes toward breastfeeding in public that women may face, the aim of this study is to explore these attitudes and opinions among employees working in public places. Methods: Nine semi-structured interviews were carried out with employees from public places with and without baby-friendly facilities or a breastfeeding policy. Interviews were audiotaped and transcribed verbatim. Transcripts were analyzed qualitatively by sorting and coding data into common themes. Findings: Breastfeeding is viewed as good and natural; however, public breastfeeding still makes some people feel uncomfortable, particularly younger and childless people. Most employees were supportive of women breastfeeding on their premises and their opinions seem unrelated to the facilities offered. Most employees thought breastfeeding facilities should be more widely available but that women should be able to choose whether to use these facilities or not. Breastfeeding education may help to normalize breastfeeding in society and make women feel more comfortable about breastfeeding in public. Conclusions: Most people view public breastfeeding positively; however, there is still a perception that breastfeeding women may feel uncomfortable breastfeeding in public, and private facilities may help to alleviate their anxieties

Dietary supplements in pregnancy

It is well documented that good nutrition during pregnancy is essential for the health of both the fetus and the pregnant woman. Various barriers may prevent pregnant women from consuming all the vital nutrients recommended; this can include poverty, access to food, nausea and vomiting. However, many women may unwittingly elude important nutrients by following restrictive diets, such as vegetarian or vegan diets, often believing that this is a healthy option. Fortification of food and supplementation of key micronutrients, particularly folic acid, vitamin D and iron can help to ensure optimal nutritional status in pregnant women, particularly where diets may be lacking. Globally, Governments and health organisations have issued recommendations and/or started schemes that aim to optimise micronutrient intake in pregnancy, mainly via targeted supplementation. © 2018 TeknoScienze. All rights reserved

Body image dissatisfaction among food-related degree students.

Current western society promotes a strong desirability to be thin. The majority of young females are unhappy with their body shape and wish to be thinner. This can lead to many health problems such as addictive exercising, depression and disordered eating. It is also established that certain groups tend to be more prone to body image dissatisfaction (BID) than others. The purpose of this study was to determine if there was a high prevalence of BID and/or disordered eating among students studying a food-related degree course

A Qualitative Evaluation of an NHS Weight Management Programme for Obese Patients in Liverpool

Purpose – The increasing prevalence of obesity in the UK has been of concern for some time. This is particularly true in Liverpool and in response the Liverpool Weight Management Programme (LWMP) was devised. It offers a service involving dietitians and other expert agencies working towards facilitating dietary and lifestyle changes in obese NHS patients in Liverpool via a 12-week education programme. This qualitative study aims to investigate patients' experiences of the LWMP. Design/methodology/approach – Informed volunteers participated in focus groups exploring their experiences following the programme. Focus groups were audio recorded and transcribed verbatim, then analysed following a thematic approach utilising constant comparison analysis to allow a qualitative view of the LWMP to be formed. Findings – Participants described an increase in immediate self-confidence during the LWMP, as opposed to coercion and pressure experienced elsewhere. The results also show the implementation of dietary changes by participants and favourable opinions towards both the group settings and patient-centred care. Participants also positively described the LWMP regarding the programmes social approach and aspects of programme content; however, there were issues with over-dependence on healthcare professionals. Healthcare professionals also need to recognise that long-term empowerment may still be lacking and that follow-up support and the effectiveness of some areas of programme content need to be considered to ensure patients benefit from sustainable weight management. Originality/value – This paper addresses an identified need for qualitative research in the area of health service weight management programmes and highlights the importance of long-term support in empowering patients by exploring their lived experience of the LWMP

The multidisciplinary management of type 2 and gestational diabetes in pregnancy

The UK is experiencing a dramatic increase in the prevalence of type 2 diabetes mellitus (T2D). Consequently, there is a corresponding increase in diabetes in pregnancy, with 87.5% of pregnancies in the UK complicated by diabetes due to gestational diabetes mellitus (GDM), and 27% of those with pre-existing diabetes having T2D (National Centre for Health and Clinical Excellence (NICE), 2008a). Although the risks to mother and baby are similar to type 1 diabetes (T1D), the approach and management often differ. Women with GDM and T2D are more likely to be older, multiparous and live in deprived areas. Certain ethnic groups are more prone to GDM and T2D, and there is a strong association between being overweight or obese and diabetes. Women who develop GDM in pregnancy also have an increased risk of T2D in later life (Diabetes UK, 2011a). Some surveys, such as the Confidential Enquiry into Maternal and Child Health (CEMACH, 2007a) have shown that women with T2D often receive suboptimum care prior to conception and in early pregnancy. This paper presents an overview of the multidisciplinary management of T2D and GDM in pregnancy and identifies areas where care may be lacking for these women

The Contribution of Registered Dietitians in the Management of Hyperemesis Gravidarum in the United Kingdom.

Hyperemesis Gravidarum (HG) is a condition at the extreme end of the pregnancy sickness spectrum, which can cause poor oral intake, malnutrition, dehydration and weight loss. The aim of this study is to explore the role of Registered Dietitians (RD) in the management of HG in the United Kingdom (UK). A survey was designed and distributed electronically to members of the British Dietetic Association. There were 45 respondents, 76% (n = 34) worked in secondary care hospitals, 11% (n = 5) were in maternal health specialist roles. The most commonly used referral criteria was the Malnutrition Universal Screening Tool (40%, n = 18), followed by second admission (36%, n = 16). However 36% (n = 16) reported no specific referral criteria. About 87% (n = 37) of respondents did not have specific clinical guidelines to follow. Oral nutrition supplements were used by 73% (n = 33) either 'sometimes' or 'most of the time'. Enteral and parenteral nutrition were less commonly used. There was an inconsistent use of referral criteria to dietetic services and a lack of specific clinical guidelines and patient resources. Further training for all clinicians and earlier recognition of malnutrition, alongside investment in the role of dietitians were recommended to improve the nutritional care of those with HG

Daily distribution of carbohydrate, protein and fat intake in elite youth academy soccer players over a 7-day training period

While traditional approaches to dietary analysis in athletes have focused on total daily energy and macronutrient intake, it is now thought that daily distribution of these parameters can also influence training adaptations. Using seven-day food diaries, we quantified the total daily macronutrient intake and distribution in elite youth soccer players from the English Premier League in U18 (n=13), U15/16 (n=25) and U13/14 squads (n=21). Total energy (43.1±10.3, 32.6±7.9, 28.1±6.8 kcal∙kg-1∙day-1), CHO (6±1.2, 4.7±1.4, 3.2±1.3 g∙kg-1∙day-1) and fat (1.3±0.5, 0.9±0.3, 0.9±0.3 g∙kg-1∙day-1) intake exhibited hierarchical differences (PU15/16>U18. Additionally, CHO intake in U18s was lower (P lunch (~0.5 g∙kg-1) > breakfast (~0.3 g∙kg-1). We conclude elite youth soccer players do not meet current CHO guidelines. Although daily protein targets are achieved, we report a skewed daily distribution in all ages such that dinner>lunch>breakfast. Our data suggest that dietary advice for elite youth players should focus on both total daily macronutrient intake and optimal daily distribution patterns

A grounded theory of type 2 diabetes prevention and risk perception

Objective Type 2 diabetes (T2D) prevention programmes should target high‐risk groups. Previous research has highlighted minimal engagement in such services from South Asian (SA) people. Given SA's elevated risk of T2D, there is a need to understand their perceptions, risks, and beliefs about T2D. Design This study aimed to assess T2D risk perception within a community sample of SA people using Grounded Theory methodology. Specifically, health beliefs were assessed, and we explored how these beliefs affected their T2D risk perceptions. Method Twenty SA participants (mean age = 38 years) without a diagnosis of T2D were recruited from community and religious settings across the North West of England. In line with grounded theory (Strauss & Corbin, 1990, Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park: Sage Publications), data collection and analysis coincided. Results The superordinate category of Culturally Situated Risk Perception incorporated a complex psychological understanding of the formation of T2D risk perception, which takes into account the social, cultural, and community‐based environmental factors. This superordinate category was explained via two core categories (1) Diminished Responsibility, informed by sub‐categories of Destiny and Heredity, and (2) Influencing Healthy Lifestyle Behaviours, informed by sub‐categories of Socio‐cultural and Environmental. Conclusion This study investigated risk perception of T2D within the SA community. When considering health prevention in the context of an individual’s culture, we need to consider the social context in which they live. Failure to acknowledge the cultural‐situated T2D risk perception relevant to health promotion and illness messages may account for the issues identified with health care engagement in the SA population

A qualitative study exploring midwives’ perceptions and knowledge of maternal obesity. Reflecting on their experiences of providing healthy eating and weight management advice to pregnant women.

Midwives are responsible for providing advice regarding the complex issues of healthy eating and weight management during pregnancy. This study utilised an inductive data-driven thematic approach in order to determine midwives’ perceptions, knowledge and experiences of providing healthy eating and weight management advice to pregnant women. Semi-structured interviews with 17 midwives were transcribed verbatim and data subjected to thematic analysis. The findings offer insight into the challenges facing midwives in their role trying to promote healthy eating and appropriate weight management to pregnant women. Three core themes were identified: 1) “If they eat healthily it will bring their weight down”: Midwives Misunderstood; 2) “I don’t think we are experienced enough”: Midwives Lack Resources and Expertise, and 3) “BMI of 32 wouldn’t bother me”: Midwives Normalised Obesity. The midwives recognised the importance of providing healthy eating advice to pregnant women and the health risks associated with poor diet and obesity. However, they reported the normalisation of obesity in pregnant women and suggested that this, together with their high workload and lack of expertise, explained the reasons why systematic advice was not in standard antenatal care. In addition, the current lack of UK clinical guidance, and thus possibly lack of clinical leadership, are also preventing delivery of tailored advice. Implementation literature on understanding the barriers to optimal healthcare delivery and informing clinical practice through research evidence needs to be further investigated in this field. This study has recommendations for policy makers, commissioners, service providers and midwives. Keywords: midwives, pregnancy, obesity, healthy eating, qualitative, self-efficac