Quantifying beliefs regarding telehealth: Development of the Whole Systems Demonstrator Service User Technology Acceptability Questionnaire

Introduction: Telehealth (TH) is a potential solution to the increased incidence of chronic illness in an ageing population.The extent to which older people and users with chronic conditions accept and adhere to using assistive technologies is a potential barrier to mainstreaming the service. This study reports the development and validation of the Whole Systems Demonstrator (WSD) Service User Technology Acceptability Questionnaire (SUTAQ). Methods: Questionnaires measuring the acceptability of TH, quality of life, well-being and psychological processes were completed by 478 users of TH. The 22 acceptability items were subject to principal components analysis (PCA) to determine sub-scales. Scale scores, relationships between scales and other patient reported outcome measures (PROMs), and group differences on scales were utilised to check the reliability and validity of the measure. Results: PCAs of SUTAQ items produced 6 TH acceptability scales: enhanced care, increased accessibility, privacy & discomfort, care personnel concerns, kit as substitution, and satisfaction. Scale scores indicated, individuals with long term conditions held beliefs. Significant correlations within these beliefs and between these scales and additional PROMs were coherent and the SUTAQ subscales were able to predict those more likely to refuse TH. Discussion: The SUTAQ is an instrument that can be used to measure user beliefs about the acceptability of TH, and has the ability to discriminate and predict individual differences in beliefs and behaviour. Measuring acceptability beliefs of TH users can provide valuable information to direct and target provision of services to increase uptake and maintain use of TH

Further explorations of illness uncertainty: Carer’s experiences of Parkinson’s disease

Objective: Dominant models of illness uncertainty define uncertainty as ‘an inability to determine the meaning of illness-related events’. Recent research has shown patient uncertainty to be multidimensional encompassing personal issues indirectly affected by illness. The nature of carer uncertainty has yet to be fully explored. The present study aimed to investigate the nature of illness uncertainty in the carers of patients with Parkinson’s disease (PD). Design: Eighteen carers of a spouse with PD participated in semi-structured interviews. Transcripts were thematically analysed, statements were coded as uncertain if they reflected ‘a lack of certainty, or a state of limited knowledge, understanding or worry regarding an existing or future outcome’. Results: The domains of uncertainty expressed by carers closely fitted the five domain framework of patient uncertainty: symptoms and prognosis, medical management, self-management, social functioning and impact. An additional ‘carer-role’ domain was identified. Conclusions: Carer uncertainty about PD went beyond issues directly related to the illness. The findings have implications for research into uncertainty suggesting that widely used measures may not be accurately capturing the nature of carer uncertainty about chronic illness. The breadth of uncertainty reported has implications for the provision of appropriate support to improve caregiver well-being

A High-Protein Diet With Resistance Exercise Training Improves Weight Loss and Body Composition in Overweight and Obese Patients With Type 2 Diabetes

OBJECTIVE: To evaluate the effects of two low-fat hypocaloric diets differing in the carbohydrate-to-protein ratio, with and without resistance exercise training (RT), on weight loss, body composition, and cardiovascular disease (CVD) risk outcomes in overweight/obese patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 83 men and women with type 2 diabetes (aged 56.1 ± 7.5 years, BMI 35.4 ± 4.6 kg/m2) were randomly assigned to an isocaloric, energy-restricted diet (female subjects 6 MJ/day, male subjects 7 MJ/day) of either standard carbohydrate (CON; carbohydrate:protein:fat 53:19:26) or high protein (HP; 43:33:22), with or without supervised RT (3 days/week) for 16 weeks. Body weight and composition, waist circumference (WC), and cardiometabolic risk markers were assessed. RESULTS: Fifty-nine participants completed the study. There was a significant group effect (P ≤ 0.04) for body weight, fat mass, and WC with the greatest reductions occuring in HP+RT (weight [CON: −8.6 ± 4.6 kg, HP: −9.0 ± 4.8 kg, CON+RT: −10.5 ± 5.1 kg, HP+RT: −13.8 ± 6.0 kg], fat mass [CON: −6.4 ± 3.4 kg, HP: −6.7 ± 4.0 kg, CON+RT: −7.9 ± 3.7 kg, HP+RT: −11.1 ± 3.7 kg], and WC [CON: −8.2 ± 4.6 cm, HP: −8.9 ± 3.9 cm, CON+RT: −11.3 ± 4.6 cm, HP+RT: −13.7 ± 4.6 cm]). There was an overall reduction (P < 0.001) in fat-free mass (−2.0 ± 2.3 kg), blood pressure (−15/8 ± 10/6 mmHg), glucose (−2.1 ± 2.2 mmol/l), insulin (−4.7 ± 5.4 mU/l), A1C (−1.25 ± 0.94%), triglycerides (−0.47 ± 0.81 mmol/l), total cholesterol (−0.67 ± 0.69 mmol/l), and LDL cholesterol (−0.37 ± 0.53 mmol/l), with no difference between groups (P ≥ 0.17). CONCLUSIONS: An energy-restricted HP diet combined with RT achieved greater weight loss and more favorable changes in body composition. All treatments had similar improvements in glycemic control and CVD risk markers.Thomas P. Wycherley, Manny Noakes, Peter M. Clifton, Xenia Cleanthous, Jennifer B. Keogh and Grant D. Brinkwort

Weight loss maintenance in women 3 years after following a 12-week structured weight loss program

Crown copyright © 2007 Published by Elsevier on behalf of the Asia Oceania Association for the Study of ObesitySummaryStructured weight loss programs such as those using meal replacements are associated with both short-term and long-term weight loss, but the effectiveness of structured weight loss programs using whole foods has not been established. The primary aim of the present study was to retrospectively establish self-reported weight status in women, 3 years after participation in a 12-week food based structured weight loss program monitored by dietitians. The secondary aim was to determine which factors were associated with successful weight loss maintenance. Eighty-five of the 100 participants who completed the 12-week program participated in an 18-question telephone interview which included self-reported weight. Weight loss from baseline was 3.8 (S.D. 5.5) kg (4.4 (S.D. 6.1) %) (P < 0.001). Overall, 61% of participants weighed less than at baseline, 13% had gained weight, and the remaining 26% had maintained their baseline weight. From baseline, 37 (44%) participants had a clinically important weight loss of ≥ 5%, and were, on average, 9.8 (S.D. 4.2) % lighter (P < 0.001). The remaining 48 (56%) participants (weight loss < 5%) were not significantly different to their weight at baseline (P = 0.77). We conclude that a food based structured weight loss program monitored by dietitians, as defined by this intervention, was associated with long-term weight loss maintenance.:Xenia Cleanthous, Manny Noakes, Jennifer B. Keogh, Philip Mohr and Peter M. Cliftonhttp://www.elsevier.com/wps/find/journaldescription.cws_home/707820/description#descriptio

Kernel and wavelet density estimators on manifolds and more general metric spaces

We consider the problem of estimating the density of observations taking values in classical or nonclassical spaces such as manifolds and more general metric spaces. Our setting is quite general but also sufficiently rich in allowing the development of smooth functional calculus with well localized spectral kernels, Besov regularity spaces, and wavelet type systems. Kernel and both linear and nonlinear wavelet density estimators are introduced and studied. Convergence rates for these estimators are established, which are analogous to the existing results in the classical setting of real-valued variables

Increased thiamine intake may be required to maintain thiamine status during weight loss in patients with type 2 diabetes

During weight loss, erythrocyte thiamine pyrophosphate (TPP) decreased (221±52 to 195±39 nmol/L, P<0.05) on a diet with adequate thiamine (1.1 mg/day) but was unchanged (217±55 vs 218±52 nmol/L, NS) on a high thiamine diet (2.8 mg/day). Attention to thiamine status may be required in patients with diabetes after weight loss.Jennifer B. Keogh, X. Cleanthous, T.P. Wycherley, G.D. Brinkworth, M. Noakes, Peter M. Clifto

A pilot comprehensive lifestyle intervention program (CLIP) - Comparison with qualitative lifestyle advice and simvastatin on cardiovascular risk factors in overweight hypercholesterolaemic individuals

Background and aimsEscalating costs of pharmaceuticals for cardiovascular management highlight the need to develop effective lifestyle intervention programs to reduce reliance on these agents. The aim of this pilot study was to evaluate the efficacy of a Comprehensive Lifestyle Intervention Program (CLIP) compared with qualitative lifestyle advice (L) and Simvastatin plus qualitative lifestyle (S+L) on cardiovascular risk factors.Methods and resultsSixty-five overweight adults with hypercholesterolemia were randomised to either L (qualitative advice on diet, exercise), S+L (20 mg/day Simvastatin plus L) or CLIP (6500 kJ structured menu plan: conventional and functional foods contributing 0.05, all). Blood pressure changes were not different between groups.ConclusionsThe structured CLIP program was more effective than qualitative lifestyle advice in improving weight, waist circumference and LDL-cholesterol without adverse effects on plasma carotenoids over a 6 week period. This program may therefore assist in comprehensive risk factor management, although the sustainability of these benefits needs confirmation.X. Cleanthous, M. Noakes, G.D. Brinkworth, J.B. Keogh, G. Williams, P.M. Clifto

Oh So Sweet: A Comparative Investigation of Retail Market Composition of Sweetened and Flavoured Beverages in Singapore and Australia

The consumption of sugar and non-nutritive sweeteners has been associated with poor health outcomes. The aim of this paper was to provide a comparison of the range of sweetened or flavoured beverages between two high-income countries in the Asia-Pacific region: Australia and Singapore. Following the FoodTrackTM methodology, nutrition, labelling, and price data were collected from major Australian and Singaporean supermarket chains and convenience stores. The nutrient profiles of products were tested for differences using Kruskal–Wallis and Mann–Whitney U tests. The greatest number of products collected in Australia were from the ‘carbonated beverages’ category (n = 215, 40%), and in Singapore the greatest number of products were from the ‘tea and coffee ready-to-drink’ category (n = 182, 35%). There were more calorically sweetened beverages in Singapore compared with Australia (n = 462/517 vs. n = 374/531, p p = 0.009). In Australia, 52% of sweetened or flavoured beverages displayed a front-of-pack nutrient signposting logo, compared with 34% of sweetened or flavoured beverages in Singapore. These findings also indicate that the consumption of just one serving of calorically sweetened carbonated beverages or energy drinks would exceed the WHO maximum daily free sugar recommendations