Effects of an eight-week supervised, structured lifestyle modification programme on anthropometric, metabolic and cardiovascular risk factors in severely obese adults

Background: Lifestyle modification is fundamental to obesity treatment, but few studies have described the effects of structured lifestyle programmes specifically in bariatric patients. We sought to describe changes in anthropometric and metabolic characteristics in a cohort of bariatric patients after participation in a nurse-led, structured lifestyle programme. Methods: We conducted a retrospective, observational cohort study of adults with a body mass index (BMI) ≥40 kgm−2 (or ≥35 kgm−2 with significant co-morbidity) who were attending a regional bariatric service and who completed a single centre, 8-week, nurse-led multidisciplinary lifestyle modification programme. Weight, height, waist circumference, blood pressure, HbA1c, fasting glucose and lipid profiles as well as functional capacity (Incremental Shuttle Walk Test) and questionnaire-based anxiety and depression scores before and after the programme were compared in per-protocol analyses. Results: Of 183 bariatric patients enrolled, 150 (81.9 %) completed the programme. Mean age of completers was 47.9 ± 11.2 years. 34.7 % were male. There were statistically significant reductions in weight (129.6 ± 25.9 v 126.9 ± 26.1 kg, p < 0.001), BMI (46.3 ± 8.3 v 44.9 ± 9.0 kgm−2, p < 0.001), waist circumference (133.0 ± 17.1 v 129.3 ± 17.5 cm in women and 143.8 ± 19.0 v 135.1 ± 17.9 cm in men, both p < 0.001) as well as anxiety and depression scores, total- and LDL-cholesterol and triglyceride levels, with an increase in functional capacity (5.9 ± 1.7 v 6.8 ± 2.1 metabolic equivalents of thermogenesis (METS), p < 0.001) in completers at the end of the programme compared to the start. Blood pressure improved, with reductions in systolic and diastolic blood pressure from 135 ± 16.2 to 131.6 ± 17.1 (p = 0.009) and 84.7 ± 10.2 to 81.4 ± 10.9 mmHg (p < 0.001), respectively. The proportion of patients achieving target blood pressure increased from 50.3 to 59.3 % (p = 0.04). The proportion of patients with diabetes achieving HbA1c <53 mmol/mol increased from 28.6 to 42.9 %, p = 0.02. (Continued on next page)Conclusions: Bariatric patients completing an 8 week, nurse-led structured lifestyle programme had improved adiposity, fitness, lipid profiles, psychosocial health, blood pressure and glycaemia. Further assessment of this programme in a pragmatic randomised controlled trial seems warranted. Keywords: Bariatric, Structured lifestyle modification, Cardiovascular risk, CLANN (Changing Lifestyle with Activity and Nutrition) Programme, Nurse-led, Diabete

The resource boom's underbelly: Criminological impacts of mining development

Australia is currently in the midst of a major resources boom. Resultant growing demands for labour in regional and remote areas have accelerated the recruitment of non resident workers, mostly contractors, who work extended block rosters of 12-hour shifts and are accommodated in work camps, often adjacent to established mining towns. Serious social impacts of these practices, including violence and crime, have generally escaped industry, government and academic scrutiny. This paper highlights some of these impacts on affected regional communities and workers and argues that post-industrial mining regimes serve to mask and privatize these harms and risks, shifting them on to workers, families and communities

Editorial: Organising health research systems as a key to improving health: the World Health Report 2013 and how to make further progress

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.The World Health Report 2013 provides a major boost to the health research community and, in particular, to those who believe that health research will make its greatest impact on improving health when it is organised through a systems approach. The World Health Report 2013, Research for Universal Health Coverage, starts with three key messages. Firstly, that universal health coverage, with full access to high-quality services, needs research evidence if it is to be achieved; second, all nations should conduct and use research; and finally, the report states that systems are needed to develop national research agendas, to raise funds, to strengthen research capacity, and to make effective use of research findings. Each of these themes is elaborated in the report and supported by extensive references. In this editorial, we first outline the key messages from the World Health Report 2013 and highlight the contributions made by papers from our journal, Health Research Policy and Systems. In addition, we discuss very recent papers that advance some issues even further. In particular, we consider new evidence both on how to achieve financial protection for those who use health services, and on whether healthcare professionals and organisations who engage in research provide an improved healthcare performance. Finally, we propose additional perspectives that add to the impressive body of evidence and analyses presented in the report. Specifically, we suggest that considering the needs of various stakeholders, as attempted in the UK, in parallel with analysing how to fulfil essential functions, should boost the prospects of successfully building and strengthening health research systems. This is important because research is vital for achieving universal health coverage, and consequently for improving the health of millions of people

State Supremacy in Decline

This paper discusses the dynamics of the international pharmaceutical industry, and how these are creating problems for the Australian government in its efforts to manage change within the regulated domestic industry. The paper argues that regulatory reform and industry development policy have eroded the capacity of the federal government to maintain the pricing regime associated with the Pharmaceutical Benefits Scheme (PBS) since 1950. The bargaining strength of the transnational firms which dominate the pharmaceutical industry in Australia is increasing; current global rationalisation of manufacturing and of R&D make threats to relocate more credible than in the past.