Effectiveness of a healthcare-based mobile intervention on sedentary patterns, physical activity, mental well-being and clinical and productivity outcomes in office employees with type 2 diabetes: study protocol for a randomized controlled trial

Background: Prolonged sedentary time is associated with an increased incidence of chronic disease including type 2 diabetes mellitus (DM2). Given that occupational sedentary time contributes signifcantly to the total amount of daily sedentariness, incorporating programmes to reduce occupational sedentary time in patients with chronic disease would allow for physical, mental and productivity benefts. The aim of this study is to evaluate the short-, medium- and long-term efectiveness of a mHealth programme for sitting less and moving more at work on habitual and occupational sedentary behaviour and physical activity in ofce staf with DM2. Secondary aims. To evaluate the efectiveness on glycaemic control and lipid profle at 6- and 12-month follow-up; anthropometric profle, blood pres‑ sure, mental well-being and work-related post-intervention outcomes at 3, 6 and 12months. Methods: Multicentre randomized controlled trial. A sample size of 220 patients will be randomly allocated into a control (n=110) or intervention group (n=110), with post-intervention follow-ups at 6 and 12months. Health professionals from Spanish Primary Health Care units will randomly invite patients (18–65 years of age) diagnosed with DM2, who have sedentary ofce desk-based jobs. The control group will receive usual healthcare and information on the health benefts of sitting less and moving more. The intervention group will receive, through a smartphone app and website, strategies and real-time feedback for 13weeks to change occupational sedentary behaviour. Variables: (1) Subjective and objective habitual and occupational sedentary behaviour and physical activity (Workforce Sit‑ ting Questionnaire, Brief Physical Activity Assessment Tool, activPAL3TM); 2) Glucose, HbA1c; 3) Weight, height, waist circumference; 4) Total, HDL and LDL cholesterol, triglycerides; (5) Systolic, diastolic blood pressure; (6) Mental well being (Warwick-Edinburgh Mental Well-being); (7) Presenteeism (Work Limitations Questionnaire); (8) Impact of work on employees´ health, sickness absence (6th European Working Conditions Survey); (9) Job-related mental strain (Job Content Questionnaire). Diferences between groups pre- and post- intervention on the average value of the vari‑ ables will be analysed. Discussion: If the mHealth intervention is efective in reducing sedentary time and increasing physical activity in ofce employees with DM2, health professionals would have a low-cost tool for the control of patients with chronic disease.The study was funded by Fondo de Investigación Sanitaria, Instituto de Salud Carlos III (PI17/01788) and the predoctoral research grant Isabel Fernández 2020 from the Spanish Society of Family and Community Medicine (semFYC). The funders had no role in the design, analysis, data interpretation or writing of the manuscript

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

Organitzacions saludables: fem salut, fem ioga

Organitzacions saludables; Ioga; Salut públicaOrganizaciones saludables; Yoga; Salud públicaHealthy organizations; Yoga; Public healthAmb l’objectiu de dissenyar un programa fonamentat en la promoció d’organitzacions saludables a través d’una intervenció específica de ioga, es va crear la Comunitat de Pràctica (CoP) Fem salut, fem ioga. Perquè una organització esdevingui saludable ha de permetre als treballadors conciliar la vida laboral amb la familiar, promoure horaris raonables, difondre la cura de la salut amb l’exemple, facilitar un bon ambient laboral i fer prevaldre el treball en equip inter i multidisciplinari i la cooperació per assolir les fites establertes, en alineació amb els objectius de l’empresa. També ha d’animar els treballadors a participar en obres socials i fer educació en salut, tant per als empleats com per als grups amb què es relaciona. Una de les maneres més habituals de promocionar una organització saludable és crear programes adreçats als treballadors que continguin accions concretes, com pot ser, per exemple, la implementació d’un programa de pràctica de ioga. Les malalties causades pels entorns laborals acostumen a estar relacionades amb problemes osteoarticulars (cervicàlgies, lumbàlgies...) i amb la gestió de l’estrès5,6. La pràctica del ioga pot ajudar a prevenir aquest tipus de problemes o a minimitzar-ne els efectes. Com a resultat final es va definir, implementar i avaluar una intervenció pilot de ioga a l’entorn laboral (en aquest cas, institucions governamentals) per a fomentar organitzacions saludables.Con el objetivo de diseñar un programa fundamentado en la promoción de organizaciones saludables a través de una intervención específica de yoga, se creó la Comunidad de Práctica (CoP) Hacemos salud, hacemos yoga. Para que una organización sea saludable debe permitir a los trabajadores conciliar la vida laboral con la familiar, promover horarios razonables, difundir el cuidado de la salud con el ejemplo, facilitar un buen ambiente laboral y primar el trabajo en equipo inter y multidisciplinar y la cooperación para alcanzar las metas establecidas, en alineación con los objetivos de la empresa. También debe animar a los trabajadores a participar en obras sociales y hacer educación en salud, tanto para los empleados como para los grupos con los que se relaciona. Una de las formas más habituales de promocionar una organización saludable es crear programas dirigidos a los trabajadores que contengan acciones concretas, como puede ser, por ejemplo, la implementación de un programa de práctica de yoga. Las enfermedades causadas por los entornos laborales suelen estar relacionadas con problemas osteoarticulares (cervicalgias, lumbalgias...) y con la gestión del estrés5,6. La práctica del yoga puede ayudar a prevenir este tipo de problemas o minimizar sus efectos. Como resultado final se definió, implementó y evaluó una intervención piloto de yoga en el entorno laboral (en este caso, instituciones gubernamentales) para fomentar organizaciones saludables.In order to design a program based on the promotion of organizations health through a specific yoga intervention, the Community of Practice (CoP) We do health, we do yoga. For an organization to be healthy, it must allow workers to reconcile work and family life, promote reasonable hours, disseminate health care by example, facilitate a good work environment, and prioritize inter and multidisciplinary teamwork and cooperation. to achieve the established goals, in alignment with the objectives of the company. It should also encourage workers to participate in social projects and health education, both for employees and for the groups with which they are related. One of the most common ways to promote a healthy organization is to create programs aimed at workers that contain specific actions, such as, for example, the implementation of a yoga practice program. Illnesses caused by work environments are usually related to osteoarticular problems (neck pain, low back pain...) and stress management5,6. The practice of yoga can help prevent these types of problems or minimize their effects. As a final result, a pilot yoga intervention was defined, implemented and evaluated in the work environment (in this case, government institutions) to promote healthy organizations

Neutral pathways and heat flux widths in vertical- and horizontal-target EDGE2D-EIRENE simulations of JET

This paper further analyses the EDGE2D-EIRENE simulations presented by Chankin et al (2017 Nucl. Mater. Energy 12 273), of L-mode JET plasmas in vertical-vertical (VV) and Vertical-horizontal (VH) divertor configurations. As expected, the simulated outer divertor ionisation source peaks near the separatrix in VV and radially further out in VH. We identify the reflections of recycled neutrals from lower divertor tiles as the primary mechanism by which ionisation is concentrated on the outer divertor separatrix in the VV configuration. These lower tile reflection pathways (of neutrals from the outer divertor, and to an even greater extent from the inner divertor) dominate the outer divertor separatrix ionisation. In contrast, the lower-tile-reflection pathways are much weaker in the VH simulation and its outer divertor ionisation is dominated by neutrals which do not reflect from any surfaces. Interestingly, these differences in neutral pathways give rise to strong differences in the heat flux density width λq at the outer divertor entrance: λq = 3.2 mm in VH compared to λq = 11.8 mm in VV. In VH, a narrow channel exists in the near scrape-off-layer (SOL) where the convected heat flux, driven by strong Er × B flow and thermoelectric current, dominates over the conducted heat flux. The width of this channel sets λq and is determined by the radial distance between the separatrix and the ionisation peak in the outer divertor

Investigation into the formation of the scrape-off layer density shoulder in JET ITER-like wall L-mode and H-mode plasmas

The low temperature boundary layer plasma (Scrape-Off-Layer or SOL) between the hot core and the surrounding vessel determines the level of power-loading, erosion and implantation of material surfaces, and thus the viability of tokamak-based fusion as an energy source. This study explores mechanisms affecting the formation of flattened density profiles, so-called ‘density shoulders’, in the low-field side (LFS) SOL, which modify ion and neutral fluxes to surfaces – and subsequent erosion. There is evidence against local enhancement of ionization inducing shoulder formation. We find that increases in SOL parallel resistivity, Λdiv (=[L||νei Ωi ]/cs Ωe), postulated to lead to shoulder growth through changes in SOL turbulence characteristics, correlates with increases in upstream SOL shoulder amplitude, As only under a subset of conditions (D2-fuelled L-mode density scans with outer strike point on the horizontal target). Λdiv fails to correlate with As for cases of N2 seeding or during sweeping of the strike point across the horizontal target. The limited correlation of Λdiv with As was also found for H-mode discharges. Thus, while Λdiv above a threshold of ~1 may be necessary for shoulder formation and/or growth, another shoulder mechanism is required. More significantly we find that in contrast to parallel resistivity, outer divertor recycling as quantified by the total outer divertor Balmer Dα emission, I-Dα, does scale with shoulder amplitude where Λdiv does and even where Λdiv fails. Divertor recycling could lead to SOL density shoulder formation through: a) reducing the parallel to the field flow (loss) of ions out of the SOL to the divertor; and b) changes in radial electric fields which lead to ExB poloidal flows as well as potentially affecting the SOL turbulence birth characteristics. Thus changes in divertor recycling may be the sole process in bringing about SOL density shoulders or in tandem with parallel resistivity

Observations and modelling of ion cyclotron emission observed in JET plasmas using a sub-harmonic arc detection system during ion cyclotron resonance heating

Peer reviewe