A critical realism approach to public health interventions that aim to prevent obesity in selected European countries

The aim of this thesis is to understand the important components of a set of sustainable interventions to prevent obesity at the community level by using realistic evaluation, which draws on the philosophy of critical realism. From the application of a structured set of criteria based on critical realism, three interventions emerged, which were selected as the case studies of my thesis: the ‘Healthy Weight Communities’ project in Scotland, the ‘Bewegung als Investition in Gesundheit’ (Movement as Investment for Health) project in Germany, and the ‘Walking for Health’ project in England. Based on the key concepts of critical realism an interview topic guide was developed, which was tested by the help of the pilot project ‘Paideiatrofi’ in Greece. Key personnel involved in the organisation of each of the three selected interventions were identified and qualitative research and data analysis was carried out. The framework of critical realism and the application of the key concepts of realistic evaluation: ‘generative mechanisms’, ‘context’ and ‘outcomes’, enabled the disentangling of which mechanisms from each case study, were most related to outcomes and under which contexts. A number of common themes emerged from the analysis of the three interventions. Reflecting on these common themes, I connected them to a set of more abstract categories associated with the social structure, the human agency and the emergent outcomes with their distinguished properties. Critical realism and realistic evaluation provided a conceptual guide which allowed me to explain how the effects of the interventions were produced by the interplay between structural conditions and people as agents. The study of the contextual factors and of the generative mechanisms that enabled or constrained the production of certain outcomes, constituted a novel approach to explain how and why the selected interventions worked to prevent obesity

Challenges for health systems seeking to embrace virtual health care for population health

A gradual move to proactive illness prevention requires a strategic shift towards population health management by health care systems. Such a shift becomes necessary to improve outcomes, reduce inequalities and manage costs better, as life expectancy increases and chronic illness becomes more prevalent. Health system digitisation and greater focus on virtual health care (VHC) can contribute to active population health management. For that to happen, health systems need to address and overcome several challenges currently preventing the rapid introduction and scale up of VHC for population health; these include implementing changes in care models and focus on digitally enabled population health approaches; addressing culture and mindset barriers; resolving regulatory bottlenecks; overcoming technical limitations, inter-operability and data security issues; and, finally, aligning stakeholder incentives and expectations

Η επίδραση της δίποδης και με το ένα πόδι προπόνησης με ολόσωμη δόνηση στην ικανότητα εκτέλεσης κατακόρυφου άλματος σε φοιτητές ΣΕΦΑΑ

Σκοπός της εργασίας ήταν να εξεταστεί η επίδραση της προπόνησης με ολόσωμη δόνηση με δίποδη και με το ένα πόδι στήριξη στην ικανότητα εκτέλεσης του κατακόρυφου άλματος. Δεκαπέντε δοκιμαζόμενοι ηλικίας 22.43 ± 2.44 χρόνων, σωματικού βάρους 62.56 ± 10.30 kg, και σωματικού αναστήματος 170.37 ± 8.16 cm, συμμετείχαν εθελοντικά στην παρούσα εργασία. Το πρόγραμμα περιελάμβανε την εκτέλεση δύο διαφορετικών πρωτόκολλων το καθένα από τα οποία περιείχε μία συνεδρία στο οποίο οι ασκούμενοι εκτέλεσαν την ίδια άσκηση και τον ίδιο αριθμό επαναλήψεων. Η πλατφόρμα δόνησης λειτουργούσε με συχνότητα δόνησης 50 Hz και εύρος δόνησης 4 mm. Ανάλογα με την ομάδα ένταξής τους η μία ομάδα εκτέλεσε την άσκηση με ταυτόχρονη στήριξη των ποδιών στην πλατφόρμα δόνησης, ενώ η 2η ομάδα την ίδια άσκηση αλλά με μονή στήριξη του ποδιού πάνω στη πλατφόρμα δόνησης. Πριν την έναρξη αλλά και μετά το τέλος της πειραματικής διαδικασίας όλοι οι δοκιμαζόμενοι, ανεξάρτητα από την ομάδα ένταξης, πραγματοποίησαν ατομική προθέρμανση ελαφριάς έντασης διάρκειας 3-5 λεπτών και στην συνέχεια αξιολογήθηκαν: α) στο κατακόρυφο άλμα από το ημικάθισμα (squat jump), στο κατακόρυφο άλμα με εισαγωγική ταλάντευση (counter movement jump), και γ) άλμα με το κάθε ένα πόδι χωριστά. Η τελική μέτρηση μετά το τέλος του παρεμβατικού προγράμματος πραγματοποιήθηκε αμέσως μετά (post1) και μετά από 8 λεπτά (post 8) με την ίδια σειρά που εκτελέστηκαν και στην αρχική μέτρηση. Σε κάθε μέτρηση οι δοκιμαζόμενοι εκτέλεσαν δύο προσπάθειες, με διάλειμμα μεταξύ των προσπαθειών 60 δευτερόλεπτα, και η καλύτερη χρησιμοποιήθηκε για περαιτέρω στατιστική επεξεργασία. Σύμφωνα με τα αποτελέσματα δεν υπήρξε σημαντική αλληλεπίδραση μεταξύ των πρωτόκολλων και των επιμέρους μετρήσεων στο ύψος του άλματος από το ημικάθισμα ή και από την όρθια θέση, ούτε και στον παράγοντα μετρήσεις. Επίσης, δεν παρατηρήθηκε σημαντική αλληλεπίδραση μεταξύ των πρωτόκολλων και των επιμέρους μετρήσεων στην ταχύτητα απογείωσης κατά την εκτέλεση του άλματος από το ημικάθισμα και από την όρθια θέση, όπως επίσης ούτε και στον παράγοντα μετρήσεις. Παρόλα αυτά το ποσοστό βελτίωσης του ύψους του άλματος αλλά και της ταχύτητας απογείωσης είτε από τη θέση του ημικαθίσματος είτε από την όρθια θέση ήταν διαφορετικό μεταξύ των δύο πρωτόκολλων γεγονός που ενισχύει την άποψη της αποτελεσματικότητας και των δύο πρωτόκολλων είτε αμέσως μετά το τέλος της παρέμβασης είτε μετά την παρέλευση οχτώ λεπτών.N

Evaluating the glucose raising effect of established loci via a genetic risk score.

Recent genome-wide association studies have identified several single nucleotide polymorphisms (SNPs) associated with glucose levels. We tested the hypothesis here whether the cumulative effect of glucose raising SNPs, assessed via a score, is associated with glucose levels. A total of 1,434 participants of Greek descent from the THISEAS study and 1,160 participants form the GOMAP study were included in this analysis. We developed a genetic risk score (GRS), based on the known glucose-raising loci, in order to investigate the cumulative effect of known glucose loci on glucose levels. In the THISEAS study, the GRS score was significantly associated with increased glucose levels (mmol/L) (β ± SE: 0.024 ± 0.004, P = 8.27e-07). The effect of the genetic risk score was also significant in the GOMAP study (β ± SE: 0.011 ± 0.005, P = 0.031). In the meta-analysis of the two studies both scores were significantly associated with higher glucose levels GRS: β ± SE: 0.019 ± 0.003, P = 1.41e-09. Also, variants at the SLC30A8, PROX1, MTNR1B, ADRA2A, G6PC2, LPIN3 loci indicated nominal evidence for association with glucose levels (p < 0.05). We replicate associations of the established glucose raising variants in the Greek population and confirm directional consistency of effects (binomial sign test p = 6.96e-05). We also demonstrate that the cumulative effect of the established glucose loci yielded a significant association with increasing glucose levels

Improving cancer symptom awareness and help-seeking among adults living in socioeconomically deprived communities in the UK using a facilitated health check: A protocol for the Awareness and Beliefs About Cancer (ABACus) Randomised Control Trial

Background Cancer survival is lower in socioeconomically deprived communities, partly due to low awareness of symptoms, negative beliefs and delayed help-seeking. We developed an interactive health check questionnaire facilitated by trained lay advisors. It entails 29 questions about background, lifestyle and health with tailored behaviour change advice. Personalised results are printed using a traffic light (red/amber/green) system, highlighting areas where action should be taken. This is an individually randomised control trial to test effectiveness of the health check on symptom recognition. Methods A total 246 participants aged 40+ years will be recruited from community and healthcare settings in socioeconomically deprived areas of Yorkshire and South Wales. Participants will be randomised to receive the health check or standard care (1:1 ratio). Outcome measures include: adapted Awareness and Beliefs about Cancer (primary outcome), brief State Trait Anxiety Inventory, intentions and motivation to adopt recommended health behaviours (early symptom presentation, cancer screening and lifestyle behaviours), adapted Client Service Receipt Inventory, brief medical history/screening and demographic questionnaire at: baseline; 2-weeks; and 6-months post-randomisation. A purposive sample of intervention sessions will be audio-recorded (n = 24) and half will additionally be observed (n = 12). Semi-structured interviews will take place at 2-weeks (n = 30) and 6-months (n = 15–20) post-randomisation. The primary analysis will compare cancer symptom recognition scores between arms at 2-weeks. Secondary analysis will assess cancer beliefs, barriers/time to presentation, screening and lifestyle behaviours, anxiety and costs. A process evaluation will assess intervention fidelity, dose and contamination

Randomised controlled trial and economic evaluation of a targeted cancer awareness intervention for adults living in deprived areas of the UK

Background: Cancer outcomes are poor in socioeconomically deprived communities, with low symptom awareness contributing to prolonged help-seeking and advanced disease. Targeted cancer awareness interventions require evaluation. Methods: Randomised controlled trial involving adults aged 40+ recruited in community and healthcare settings in deprived areas of South Yorkshire and South-East Wales. Intervention: personalised behavioural advice facilitated by a trained lay advisor. Control: usual care. Follow-up at 2-weeks and 6-months post-randomisation. Primary outcome: total cancer symptom recognition score 2-weeks post-randomisation. Results: 234 participants were randomised. The difference in total symptom recognition at 2-weeks [adjusted mean difference (AMD) 0.6, 95% CI:-0.03, 1.17, p=0.06] was not statistically significant. Intervention participants reported increased symptom recognition (AMD 0.8, 95% CI:0.18, 1.37, p=0.01) and earlier intended presentation (AMD -2.0, 95% CI:-3.02, -0.91, p<0.001) at 6-months. “Lesser known” symptom recognition was higher in the intervention arm (2-weeks AMD 0.5, 95% CI:0.03, 0.97 and 6-months AMD 0.7, 95% CI:0.16, 1.17). Implementation cost per participant was £91.34, with no significant between-groups differences in healthcare resource use post-intervention. Conclusions: Improved symptom recognition and earlier anticipated presentation occurred at longer-term follow-up. The ABACus Health Check is a viable low-cost intervention to increase cancer awareness in socioeconomically deprived communities. Clinical Trial Registration: ISRCTN1687254

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms