The psychosocial aspects of obesity: a quantitative & qualitative study

This Health Services Research PhD, funded by the Chief Scientist Office (CSO), investigated the psychosocial aspects of obesity in a community sample of men and women aged 30-60 living in deprived and affluent areas of Greater Glasgow. The study incorporated a mixed method design and combined a community health survey and semi-structured interviews with a purposively selected sub-sample of questionnaire respondents. 52% of the participants who completed the questionnaire were either overweight or obese and 16% were defined as obese. Obesity and body image were not significant predictors of poor psychological health. Furthermore, low self-esteem was the most significant predictor of poor psychological health for both men and women. The quantitative and qualitative findings demonstrate that obese individuals are aware of their current weight status and express a desire to lose weight. Potential motivating factors for weight loss included health concerns, appearance, special occasions and psychological factors such as increased self-esteem and self-confidence. Participants were knowledgeable about the causes of obesity and had absorbed and understood health promotion messages regarding healthy eating and physical activity. However, they identified a number of barriers, which prevented them from fully implementing health promotion advice. The qualitative findings suggest the possibility of a cyclical relationship between dieting depression and emotional eating. In addition, the findings demonstrate that weight cycling – losing and regaining weight – was a common experience for the interviewees. As weight cycling is a potentially damaging health problem, it might be more appropriate to encourage obese individuals to maintain a stable weight and improve their health by re-focusing the issue on fitness rather than fatness

Irish Chefs and Restaurants in the Geography of “Local” Food Value Chains

Restaurant chefs and owners have a potentially influential role to play in promoting the use of local foods and supporting producers. Indeed chefs are taste makers, and their conceptualization of local food can influence consumers’ perceptions, knowledge and geographical awareness. Yet their role is not well documented in research literature. In-depth interviews were conducted with seven purposively selected chefs in Galway City, Ireland, who are seeking to develop a local cuisine. Menus, websites, and statements of philosophy were also analyzed. Attention focused on the definition of local food, sources of supply, how local food is used in cuisine, and how it is presented on menus. Common themes among restaurants include the geographic stretching of local food to include artisan products, issues of seasonality and variability in supply, and questions about the authenticity of promoting the use of local foods. There are opportunities for building linkages between chefs and local producers, to promote authentic use of locally sourced foods. Recommendations are made for five strategies to build a sustainable local food geography, based on strengthening the farmer- to-chef shortened value chain

Experiences of binge eating among clients attending a weight management service

Objectives: Binge Eating Disorder (BED) is prevalent in individuals with morbid obesity and it can impact on weight loss treatment outcomes. This study used Leventhal's selfregulatory model of illness behaviour as a framework for eight semi-structured interviews in order to gain an insight into participants' experiences of obesity and binge eating. Design: Interpretative Phenomenological Analysis (IP A) was used to explore participants' experiences of obesity and binge eating in a small sample of participants attending a weight managment service. Methods: Semi-structured interviews were conducted with eight participants who had BED and were attending a specialist weight management service for weight loss treatment. The interview transcripts were analysed using IPA. Results: Two superordinate themes emerged from the analysis and an analytic narrative was constructed under the headings 'struggle with weight loss' and 'standing in the way of control.' The concept of control was central to both of the emergent themes as the participants perceived a lack of control over their eating and their ability to lose weight. Conclusions: The results revealed that there was a complex and cyclical relationship between weight loss attempts and binge eating. A number of implications for clinical practice and future research are outlined

A systematic review of the abdominal surgeon’s personality: exploring common traits in western populations

The personality traits commonly seen in abdominal surgeons remains undefined, and its potential influence on decision-making and patient outcomes underexplored. This systematic review identified studies on abdominal surgeons who had undergone validated personality testing, with assessment of decision-making and post-operative patient outcomes. The study protocol was registered on PROSPERO (University of York, UK (CRD42019151375)). MEDLINE, Embase, PsycInfo and Cochrane Library databases were searched using the keywords: surgeon; surgeon personality; outcomes. All study designs were accepted including adult visceral surgeons published in English. Five articles from 3056 abstracts met our inclusion criteria and one article was identified from hand searches with two reviewers screening studies. Bias was assessed using the Newcastle-Ottawa scale. Six studies included 386 surgeons. Studies assessing personality using the Five Factor Model (four studies, 329 surgeons) demonstrated higher levels of conscientiousness (self-discipline, thoughtfulness), extraversion (sociability, emotional expression) and openness (creative, conventional) in surgeons versus population norms. Surgeon characterisation of agreeableness and emotional stability was less clear, with studies reporting mixed results. Post-operative outcomes were reported by only one study. Further exploration of the influence of surgeon personality and its influence on decision-making is necessary to deliver patient-centred care and targeted non-technical skills training for surgeons

Physician associates working in secondary care teams in England: Interprofessional implications from a national survey

Physician associates (PAs) are a new type of healthcare professional to the United Kingdom; however, they are well established in the United States (where they are known as physician assistants). PAs are viewed as one potential solution to the current medical workforce doctor shortage. This study investigated the deployment of PAs within secondary care teams in England, through the use of a cross-sectional electronic, self-report survey. The findings from 14 questions are presented. Sixty-three PAs working in a range of specialties responded. A variety of work settings were reported, most frequently inpatient wards, with work generally taking place during weekdays. Both direct and non-direct patient care activities were reported, with the type of work undertaken varying at times, depending on the presence or absence of other healthcare professionals. PAs reported working within a variety of secondary care team staffing permutations, with the majority of these being interprofessional. Line management was largely provided by consultants; however day-to-day supervision varied, often relating to different work settings. A wide variation in ongoing supervision was also reported. Further research is required to understand the nature of PAs' contribution to collaborative care within secondary care teams in England

Systematic Identification of Placental Epigenetic Signatures for the Noninvasive Prenatal Detection of Edwards Syndrome

Background: Noninvasive prenatal diagnosis of fetal aneuploidy by maternal plasma analysis is challenging owing to the low fractional and absolute concentrations of fetal DNA in maternal plasma. Previously, we demonstrated for the first time that fetal DNA in maternal plasma could be specifically targeted by epigenetic (DNA methylation) signatures in the placenta. By comparing one such methylated fetal epigenetic marker located on chromosome 21 with another fetal genetic marker located on a reference chromosome in maternal plasma, we could infer the relative dosage of fetal chromosome 21 and noninvasively detect fetal trisomy 21. Here we apply this epigenetic-genetic (EGG) chromosome dosage approach to detect Edwards syndrome (trisomy 18) in the fetus noninvasively. Principal Findings: We have systematically identified methylated fetal epigenetic markers on chromosome 18 by methylated DNA immunoprecipitation (MeDIP) and tiling array analysis with confirmation using quantitative DNA methylation assays. Methylated DNA sequences from an intergenic region between the VAPA and APCDD1 genes (the VAPAAPCDD1 DNA) were detected in pre-delivery, but not post-delivery, maternal plasma samples. The concentrations correlated positively with those of an established fetal genetic marker, ZFY, in pre-delivery maternal plasma. The ratios of methylated VAPA-APCDD1(chr18) to ZFY(chrY) were higher in maternal plasma samples of 9 male trisomy 18 fetuses than those of 27 male euploid fetuses (Mann-Whitney test, P = 0.029). We defined the cutoff value for detecting trisomy 18 fetuses as mean+1.96 SD of the EGG ratios of the euploid cases. Eight of 9 trisomy 18 and 1 of 27 euploid cases showed EGG ratios higher than the cutoff value, giving a sensitivity of 88.9% and a specificity of 96.3%. Conclusions: Our data have shown that the methylated VAPA-APCDD1 DNA in maternal plasma is redominantly derived from the fetus. We have demonstrated that this novel fetal epigenetic marker in maternal plasma is useful for the noninvasive detection of fetal trisomy 18. © Tsui et al.published_or_final_versio

High resolution and contrast 7 tesla MR brain imaging of the neonate

IntroductionUltra-high field MR imaging offers marked gains in signal-to-noise ratio, spatial resolution, and contrast which translate to improved pathological and anatomical sensitivity. These benefits are particularly relevant for the neonatal brain which is rapidly developing and sensitive to injury. However, experience of imaging neonates at 7T has been limited due to regulatory, safety, and practical considerations. We aimed to establish a program for safely acquiring high resolution and contrast brain images from neonates on a 7T system.MethodsImages were acquired from 35 neonates on 44 occasions (median age 39 + 6 postmenstrual weeks, range 33 + 4 to 52 + 6; median body weight 2.93 kg, range 1.57 to 5.3 kg) over a median time of 49 mins 30 s. Peripheral body temperature and physiological measures were recorded throughout scanning. Acquired sequences included T2 weighted (TSE), Actual Flip angle Imaging (AFI), functional MRI (BOLD EPI), susceptibility weighted imaging (SWI), and MR spectroscopy (STEAM).ResultsThere was no significant difference between temperature before and after scanning (p = 0.76) and image quality assessment compared favorably to state-of-the-art 3T acquisitions. Anatomical imaging demonstrated excellent sensitivity to structures which are typically hard to visualize at lower field strengths including the hippocampus, cerebellum, and vasculature. Images were also acquired with contrast mechanisms which are enhanced at ultra-high field including susceptibility weighted imaging, functional MRI, and MR spectroscopy.DiscussionWe demonstrate safety and feasibility of imaging vulnerable neonates at ultra-high field and highlight the untapped potential for providing important new insights into brain development and pathological processes during this critical phase of early life