Abdominal obesity and metabolic syndrome: exercise as medicine?

Background: Metabolic syndrome is defined as a cluster of at least three out of five clinical risk factors: abdominal (visceral) obesity, hypertension, elevated serum triglycerides, low serum high-density lipoprotein (HDL) and insulin resistance. It is estimated to affect over 20% of the global adult population. Abdominal (visceral) obesity is thought to be the predominant risk factor for metabolic syndrome and as predictions estimate that 50% of adults will be classified as obese by 2030 it is likely that metabolic syndrome will be a significant problem for health services and a drain on health economies.Evidence shows that regular and consistent exercise reduces abdominal obesity and results in favourable changes in body composition. It has therefore been suggested that exercise is a medicine in its own right and should be prescribed as such. Purpose of this review: This review provides a summary of the current evidence on the pathophysiology of dysfunctional adipose tissue (adiposopathy). It describes the relationship of adiposopathy to metabolic syndrome and how exercise may mediate these processes, and evaluates current evidence on the clinical efficacy of exercise in the management of abdominal obesity. The review also discusses the type and dose of exercise needed for optimal improvements in health status in relation to the available evidence and considers the difficulty in achieving adherence to exercise programmes. Conclusion: There is moderate evidence supporting the use of programmes of exercise to reverse metabolic syndrome although at present the optimal dose and type of exercise is unknown. The main challenge for health care professionals is how to motivate individuals to participate and adherence to programmes of exercise used prophylactically and as a treatment for metabolic syndrome

LFA support in a changing climate

With climate change follows an expectation of more extreme weather events, such as droughts, floods and change in seasonal shifts. How climate variability might impact Swedish agriculture and interact with existing policy aiming at keeping agricultural land in production is not well understood. This thesis performs an analysis of the interaction between climate variables such as drought and precipitation indexes and the Less Favoured Areas support policy, abbreviated as LFA, the main EU-policy aiming at keeping agricultural land in production. This is done in order to lay the foundations for an increased understanding of how increased climate shocks may impact the land transformation, the rate by which agricultural land is taken into or out of production, in Sweden. Results found that an increase in droughts was linked to a faster rate of agricultural land transformation, partly counteracted by the LFA support, which decreased the speed of land transformation. However a large share of LFA receiving hectares to overall productive hectares in a municipality was linked to faster rates of land transformation in case

Risk factors in type 2 diabetes with emphasis on blood pressure, physical activity and serum vitamin D

Background Type 2 diabetes is a common chronic disease with a two-fold increased risk for cardiovascular morbidity and mortality and has an increasing prevalence worldwide. This thesis is based on a study conducted in primary health care in Östergötland and Jönköping, Sweden. The aim of the thesis was to evaluate new risk markers to identify patients with high risk of developing cardiovascular disease in middle-aged men and women with type 2 diabetes. Methods Data from the cohort study CArdiovascular Risk in type 2 DIabetes – a Prospective study in Primary care (CARDIPP) was used. In paper III data were also used from CARDIPP-Revisited where all participants in the CARDIPP study were invited four years after the baseline investigation for a re-investigation. In paper IV data were used from CAREFUL which is a control group of 185 subjects without diabetes. The investigation included a standard medical history including data on diabetes duration and on-going medication. Anthropometric data were recorded and both office and ambulatory blood pressure were measured. The patients filled out a detailed questionnaire and physical activity was measured by using waist-mounted pedometers. Pedometer-determined physical activity was classified in four groups: Group 1: <5000 steps/day (‘sedentary’); Group 2: 5000-7499 steps/day (‘low active’); Group 3: 7500-9999 steps/day (‘somewhat active’); Group 4: and ≥10 000 steps/day (‘active’). Blood samples were drawn for routine analyses and also frozen for later analyses. The investigations at the departments of physiology included echocardiography, measurements of the carotid intima-media thickness, applanation tonometry and measurements of  sagittal abdominal diameter. Results Paper 1: Patients with a non-dipping systolic blood pressure pattern showed higher left ventricular mass index and pulse wave velocity (PWV) compared with patients with ≥10% decline in nocturnal systolic blood pressure. Patients with <10% decline in nocturnal systolic blood pressure had higher BMI and sagittal abdominal diameter, lower GFR and higher albumin:creatinine ratio and also higher levels of NT-proBNP than patients with a dipping pattern of the nocturnal blood pressure. Paper 2: The number of steps/day were inversely significantly associated with BMI, waist circumference and sagittal abdominal diameter, levels of CRP, levels of interleukin-6 and PWV. Paper 3: At the 4-year follow-up the change in PWV (ΔPWV) from baseline was calculated. The group with the lowest steps/day had a significantly higher increase in ΔPWV compared with the group with the highest steps/day. The associations between baseline steps/day and ΔPWV remained after further adjustment in a multivariate linear regression statistically significant (p=0.005). 23% of the variation in the study could be explained by our model. Every 1000 extra steps at baseline reduced the change in ΔPWV by 0.103 m/s between baseline and follow-up. Paper 4: Low vitamin D levels were associated with significantly increased risk for premature mortality in men with type 2 diabetes. High levels of parathyroid hormone were associated with significantly increased risk for premature mortality in women with type 2 diabetes. These relationships were still statistically significant also when two other well-established risk markers for mortality, PWV and carotid intima-media thickness, were added to the analyses. Conclusions Ambulatory blood pressure recording can by addressing the issue of diurnal blood pressure variation, explore early cardiovascular organ damage and microvascular complications that goes beyond effects of standardised office blood pressure measurements. Pedometer-determined physical activity may serve as a surrogate marker for inflammation and subclinical organ damage in patients with type 2 diabetes. There is novel support for the durable vascular protective role of a high level of daily physical activity, which is independent of BMI and systolic blood pressure. The use of pedometers is feasible in clinical practice and provides objective information not only about physical activity but also the future risk for subclinical organ damage in middle-aged people with type 2 diabetes. Our results indicate that low vitamin D levels in men or high parathyroid hormone levels in women give independent prognostic information of an increased risk for total mortality

Inclusion of blue mussels in the diet of Black Soldier Fly (Hermentia illucens) : the effect on compost process efficiency

Abstract The management and handling of organic waste in primarily low-income developing cities, due to high urbanization has become a global problem. The main form of waste handling in these cities are landfilling, due to it being the cheapest and easiest option. Not only are nutrients wasted, but landfills of mixed waste create strong emission of greenhouse gasses and a leachate that affects groundwater quality. This major problem in addition to a higher demand for food due to the increase of the world population leaves us two problems to solve; to handle waste and produce food. The Black Soldier Fly (Hermetia illucens) and its larvae can solve both of these problems in one. The organic waste is fed to the fly larvae and the larvae produce biomass (larval weight) and a residue similar to un-mature compost. The larvae can then be fed live to animals or made into pellets to feed animals such as fish, and the residue can be used as fertilizer. However, in order for the larvae to be able to be extruded into pellets or fed live to ex. hens, an optimal protein and fat content of the larvae is needed. A higher protein and lower fat content of the larvae is optimal for both pellet production and to feed to animals. It has previously been found that an inclusion of mussels can lower the fat content and increase the protein content of the larvae. In this article, different amounts of mussels are included in the larvae diet apart from bread and cabbage to see if it has an effect on the compost process efficiency. The experiment is done by larvae being added to different ratios of bread: cabbage: mussels. The larvae are then harvested and process efficiency parameters; BCE (biomass conversion efficiency), survival percentage, material reduction and respiration are calculated. It was found that mussel inclusion was equivalent to a higher feeding load per larva. The BCE of the treatment with a higher feeding load and the treatment with the highest mussel inclusion were the same, meaning that mussel inclusion is equivalent to a diet with high amounts of carbohydrates. Mussel inclusion in the larva diet seems to be beneficial from a BCE standpoint and suits as a substrate as pH and survival was not negatively affected by the mussels

Inclusion of blue mussels in the diet of Black Soldier Fly (Hermentia illucens) : the effect on compost process efficiency

Abstract The management and handling of organic waste in primarily low-income developing cities, due to high urbanization has become a global problem. The main form of waste handling in these cities are landfilling, due to it being the cheapest and easiest option. Not only are nutrients wasted, but landfills of mixed waste create strong emission of greenhouse gasses and a leachate that affects groundwater quality. This major problem in addition to a higher demand for food due to the increase of the world population leaves us two problems to solve; to handle waste and produce food. The Black Soldier Fly (Hermetia illucens) and its larvae can solve both of these problems in one. The organic waste is fed to the fly larvae and the larvae produce biomass (larval weight) and a residue similar to un-mature compost. The larvae can then be fed live to animals or made into pellets to feed animals such as fish, and the residue can be used as fertilizer. However, in order for the larvae to be able to be extruded into pellets or fed live to ex. hens, an optimal protein and fat content of the larvae is needed. A higher protein and lower fat content of the larvae is optimal for both pellet production and to feed to animals. It has previously been found that an inclusion of mussels can lower the fat content and increase the protein content of the larvae. In this article, different amounts of mussels are included in the larvae diet apart from bread and cabbage to see if it has an effect on the compost process efficiency. The experiment is done by larvae being added to different ratios of bread: cabbage: mussels. The larvae are then harvested and process efficiency parameters; BCE (biomass conversion efficiency), survival percentage, material reduction and respiration are calculated. It was found that mussel inclusion was equivalent to a higher feeding load per larva. The BCE of the treatment with a higher feeding load and the treatment with the highest mussel inclusion were the same, meaning that mussel inclusion is equivalent to a diet with high amounts of carbohydrates. Mussel inclusion in the larva diet seems to be beneficial from a BCE standpoint and suits as a substrate as pH and survival was not negatively affected by the mussels

Musical portrait of Alex & Sigge : - about writing music to podcast segments.

I mitt arbete skriver jag musik till utvalda segment ur Alex & Sigges podcast. Jag betraktar dessa självbiografiska segment som filmscener och skapar musiken med hjälp av metoder inom filmkomposition. Utmaningen i arbetet har varit att binda samman och nyansera dessa berättelser genom musik. Resultatet blev fyra kompositioner som gav upphov till en diskussion kring musikens möjligheter inom mediet podcast. I arbetet kommer jag fram till att en metod avsedd för filmkomposition går att applicera på att skriva musik till podcasts.

Sjuksköterskors erfarenheter av att rapportera via SBAR : En allmän litteraturöversikt

Bakgrund: SBAR är ett strukturerat rapporteringsverktyg som sjuksköterskor använder vid bland annat personalbyten. Då sjuksköterskor har omvårdnadsansvar för patienter, bör kommunikationen mellan sjuksköterskor vara god för att förebygga vårdskada. God kommunikation är viktigt för att patienter ska våga berätta om behov, problem och känslor. Genom ökat patientförtroende kan sjuksköterskor upprätta personcentrerat vårdande. Syfte: Syftet var att skapa en översikt av sjuksköterskors erfarenheter att rapportera via SBAR. Metod: En allmän litteraturöversikt enligt Friberg (2022) där två kvalitativa, femkvantitativa samt fem mixade metodartiklar har analyserats. Resultat: Resultatet visade att majoritet av sjuksköterskors erfarenheter av SBAR är att deras kommunikationsförmåga förbättras och att verktyget är tillförlitligt, om sjuksköterskor besitter kompetens i verktygets strukturerade utförande. Sjuksköterskorna erfor ett förbättrat samarbete med annan involverad vårdpersonal och professioner i patientvården samt förbättrad egenförmåga att ge en god rapport. Detta gav sjuksköterskorna en känsla av välbefinnande i sitt vårdarbete. Slutsats: Slutsatsen författarna kunde dra var att sjuksköterskor beroende på egen förmåga, upplever olika aspekter kring användandet av SBAR. Majoriteten av sjuksköterskor anser attSBAR är ett pålitligt och viktigt verktyg i arbetet för patientsäker vård medan andra aspekter visar på att låg efterföljsamhet eller förståelse för mallen kan bidra till en motsatt utveckling. Background: SBAR is a structured reporting tool that nurses use when, among other things, staff changes. As nurses have nursing responsibilities for patients, communication between nurses should be good to prevent nursing injuries. Good communication is important for patients to dare to talk about needs, problems, and feelings. Through increased patient trust, nurses can establish person-centered care. Purpose: The purpose was to create an overview of nurses’ experiences of reporting via SBAR. Method: As per Friberg (2022) literary review where two qualitative, five quantitative and five mixed methods articles have been analyzed. Result: The results showed that most nurses' experiences with SBAR were that their communication skills improved and that the tool were reliable if the nurse’s possessed competence in the tools structured execution. The nurses experienced an improved collaboration with other involved healthcare staff and professions in patient care as well as an improved ability to give a good report. This gave the nurses a sense of well-being in their nursing work. Conclusion: The conclusion the authors could draw was that the nurses, depending on their own abilities, experience different aspects regarding the use of SBAR. Most nurses believe that SBAR is a reliable and valuable tool in the work for patient-safe care, while other aspects show that low compliance or understanding of the model can contribute to the opposite development