40 research outputs found
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Ethnic inclusivity and preventative health research in addressing health inequalities and developing evidence base.
Work ability as a major determinant of clinical nurses’ quality of life.
Aims and objectives. To examine quality of life determinants among clinical nurses in Croatia with an emphasis on their work ability. Background. An important personnel management challenge is to explore factors that stimulate or hinder the development of individual work ability and quality of life throughout a career. Design. A cross-sectional study. Methods. The study was performed during [2007][2008] 3) for the environmental domain. Conclusions. Satisfactory work ability was a major quality of life determinant in all WHOQL-BREF domains with the highest odds ratio for the physical domain. Maintaining clinical nurses' work ability is an important issue, because it is foundational for the quality of life of the workforce. Relevance to clinical practice. Our study provides quantified estimates of the extent to which a satisfactory WAI score predicts a better score in physical, psychosocial, social relationships and environmental domain of nurses' quality of life. Therefore, maintaining or improving nurses' work ability remains the essential aim of hospital managers
The Cambridge Intensive Weight Management Programme Appears to Promote Weight Loss and Reduce the Need for Bariatric Surgery in Obese Adults
Objectives: To investigate the impact of the Cambridge Intensive Weight Management Programme (IWMP) on weight change, eligibility for bariatric surgery, HbA1c, and blood pressure.Design: Prospective non-randomized intervention.Setting: The IWMP is a multi-disciplinary weight loss intervention for severely obese patients to avoid or optimize their physiological state thus enabling bariatric surgery. It uses dietary interventions, pharmacotherapy, and physical activity along with behavior change counseling.Participants: Severely obese patients (Body Mass Index, BMI≥40 kg/m2).Interventions: IWMP is a prospective intervention conducted in a National Health Service Tier 3 obesity service. It includes 3 phases of 8 weeks each: weight loss, weight stabilization, and weight maintenance. In each phase, patients adhered to a prescribed dietary regime and attended regular clinic visits. Data included in this analysis are from those who enrolled in IWMP between 2009 and 2013.Primary and secondary measures: The primary outcome was weight change between baseline and completion of the programme. Secondary outcomes included changes in blood pressure, HbA1c and eligibility for bariatric surgery pre-assessment. Changes in outcomes were compared by age, sex, smoking status, and employment.Results: Of n = 222 eligible patients, complete data were available for n = 141 patients (63.5%). At baseline, the mean (SD) BMI was 49.7 (9.2) kg/m2 for women, and 47.9 (7.2) kg/m2 for men. Mean (SD) weight change for women was −18.64 (8.36) kg and −22.46 (10.98) kg for men. N = 97 (69%) of patients achieved ≥10% weight loss. Individuals aged ≤ 50 years lost significantly more weight than those aged >50 years [mean (SD) weight loss: 22.18 (10.9) kg vs. 18.32 (7.92) kg, p = 0.020]. Changes in weight were non-significant by smoking status or employment. Median (IQR) change in systolic and diastolic blood pressure was −6 (−14.6) mmHg and 0 (−8.6) mmHg (non-significant), respectively. There was ~50% reduction in the need for bariatric surgery.Conclusions: For the majority of the patients, IWMP is promoting weight loss and allowing for avoidance of, or optimization before, bariatric surgery
Do markers of adiposity and glycaemia mediate the association between low carbohydrate diet and cardiovascular risk factors: findings from the UK National Diet and Nutrition Survey (NDNS) 2008–2016
Time for nutrition in medical education.
AIM: To synthesise a selection of UK medical students' and doctors' views surrounding nutrition in medical education and practice. METHODS: Information was gathered from surveys of medical students and doctors identified between 2015 and 2018 and an evaluation of nutrition teaching in a single UK medical school. Comparative analysis of the findings was undertaken to answer three questions: the perceived importance of nutrition in medical education and practice, adequacy of nutrition training, and confidence in current nutrition knowledge and skills. RESULTS: We pooled five heterogeneous sources of information, representing 853 participants. Most agreed on the importance of nutrition in health (>90%) and in a doctor's role in nutritional care (>95%). However, there was less desire for more nutrition education in doctors (85%) and in medical students (68%). Most felt their nutrition training was inadequate, with >70% reporting less than 2 hours. There was a preference for face-to-face rather than online training. At one medical school, nutrition was included in only one module, but this increased to eight modules following an increased nutrition focus. When medical students were asked about confidence in their nutrition knowledge and on advising patients, there was an even split between agree and disagree (p=0.869 and p=0.167, respectively), yet few were confident in the UK dietary guidelines. Only 26% of doctors were confident in their nutrition knowledge and 74% gave nutritional advice less than once a month, citing lack of knowledge (75%), time (64%) and confidence (62%) as the main barriers. There was some recognition of the importance of a collaborative approach, yet 28% of doctors preferred to get specialist advice rather than address nutrition themselves. CONCLUSION: There is a desire and a need for more nutrition within medical education, as well as a need for greater clarity of a doctor's role in nutritional care and when to refer for specialist advice. Despite potential selection bias and limitations in the sampling frame, this synthesis provides a multifaceted snapshot via a large number of insights from different levels of training through medical students to doctors from which further research can be developed
Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes: a secondary analysis of routine clinic data including HbA1c, weight and prescribing over 6 years.
BACKGROUND: In a single general practice (GP) surgery in England, there was an eightfold increase in the prevalence of type 2 diabetes (T2D) in three decades with 57 cases and 472 cases recorded in 1987 and 2018, respectively. This mirrors the growing burden of T2D on the health of populations round the world along with healthcare funding and provision more broadly. Emerging evidence suggests beneficial effects of carbohydrate-restricted diets on glycaemic control in T2D, but its impact in a 'real-world' primary care setting has not been fully evaluated. METHODS: Advice on a lower carbohydrate diet was offered routinely to patients with newly diagnosed and pre-existing T2D or prediabetes between 2013 and 2019, in the Norwood GP practice with 9800 patients. Conventional 'one-to-one' GP consultations were used, supplemented by group consultations, to help patients better understand the glycaemic consequences of their dietary choices with a particular focus on sugar, carbohydrates and foods with a higher Glycaemic Index. Those interested were computer coded for ongoing audit to compare 'baseline' with 'latest follow-up' for relevant parameters. RESULTS: By 2019, 128 (27%) of the practice population with T2D and 71 people with prediabetes had opted to follow a lower carbohydrate diet for a mean duration of 23 months. For patients with T2D, the median (IQR) weight dropped from of 99.7 (86.2, 109.3) kg to 91.4 (79, 101.1) kg, p<0.001, while the median (IQR) HbA1c dropped from 65.5 (55, 82) mmol/mol to 48 (43, 55) mmol/mol, p<0.001. For patients with prediabetes, the median (IQR) HbA1c dropped from 44 (43, 45) mmol/mol to 39 (38, 41) mmol/mol, p<0.001. Drug-free T2D remission occurred in 46% of participants. In patients with prediabetes, 93% attained a normal HbA1c. Since 2015, there has been a relative reduction in practice prescribing of drugs for diabetes leading to a T2D prescribing budget £50 885 per year less than average for the area. CONCLUSIONS: This approach to lower carbohydrate dietary advice for patients with T2D and prediabetes was incorporated successfully into routine primary care over 6 years. There were statistically significant improvements in both groups for weight, HbA1c, lipid profiles and blood pressure as well as significant drug budget savings. These results suggest a need for more empirical research on the effects of lower carbohydrate diet and long-term glycaemic control while recording collateral impacts to other metabolic health outcomes
Physical activity, sedentary time and gain in overall and central body fat: 7-year follow-up of the ProActive trial cohort
Objective: The objective of this study is to examine the independent associations of time spent in moderate-to-vigorous physical activity (MVPA) and sedentary (SED-time), with total and abdominal body fat (BF), and the bidirectionality of these associations in adults at high risk of type 2 diabetes.
Design and subjects: We measured MVPA (min per day) and SED-time (h per day) by accelerometry, and indices of total (body weight, fat mass (FM), BF% and FM index) and abdominal BF (waist circumference (WC)) using standard procedures in 231 adults (41.3±6.4 years) with parental history of type 2 diabetes (ProActive UK) at baseline, 1-year and 7-year follow-up. Mixed effects models were used to quantify the independent associations (expressed as standardised β-coefficients (95% confidence interval (CI))) of MVPA and SED-time with fat indices, using data from all three time points. All models were adjusted for age, sex, intervention arm, monitor wear time, follow-up time, smoking status, socioeconomic status and MVPA/SED-time.
Results: MVPA was inversely and independently associated with all indices of total BF (for example, 1 s.d. higher MVPA was associated with a reduction in FM, β=−0.09 (95% CI: −0.14, −0.04) s.d.) and abdominal BF (for example, WC: β=−0.07 (−0.12, −0.02)). Similarly, higher fat indices were independently associated with a reduction in MVPA (for example, WC: β=−0.25 (−0.36, −0.15); FM: β=−0.27 (−0.36, −0.18)). SED-time was positively and independently associated with most fat indices (for example, WC: β=0.03 (−0.04, 0.09); FM: β=0.10 (0.03, 0.17)). Higher values of all fat indices independently predicted longer SED-time (for example, WC: β=0.10 (0.02, 0.18), FM: β=0.15 (0.07, 0.22)).
Conclusions: The associations of MVPA and SED-time with total and abdominal BF are bidirectional and independent among individuals at high risk for type 2 diabetes. The association between BF and MVPA is stronger than the reciprocal association, highlighting the importance of considering BF as a determinant of decreasing activity and a potential consequence. Promoting more MVPA and less SED-time may reduce total and abdominal BF
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Sumatriptan, a serotonin 5HT 1B receptor agonist, acutely reduces insulin secretion and sensitivity and glucose effectiveness in overweight humans: A double‐blinded placebo‐controlled cross‐over trial
Funder: Diabetes Research and Wellness Foundation; doi: http://dx.doi.org/10.13039/501100000273Aim: Evidence from mouse models suggests that brain serotonergic pathways control blood glucose. We hypothesized that sumatriptan (5HT1B‐receptor agonist) would alter glucose homeostasis in humans. Materials and Methods: We conducted a two‐visit random‐order double‐blinded placebo‐controlled cross‐over trial in 10 overweight adults that were otherwise healthy. Participants received sumatriptan (single dose, 100 mg) or placebo before undergoing a 60‐min intravenous glucose tolerance test, followed by a 120‐min hyperinsulinaemic euglycaemic clamp. Results: Glucose excursion was greater during intravenous glucose tolerance test with sumatriptan compared with placebo [iAUC0‐60 min 316 (268‐333) vs. 251 (197‐319) min/mmol/L p = .047]. This was probably explained by a combination of reduced circulating insulin levels [iAUC0‐10 min 1626 (1103‐2733) vs. 2336 (1702‐3269) min/pmol/L, p = .005], reduced insulin sensitivity [M/I‐value 2.11 (1.15, 4.05) vs. 3.03 (1.14, 4.90) mg/kg/min per pmol/L, p = .010] and glucose effectiveness [SG 0.17 (0.12, 0.21) vs. 0.22 (0.18, 0.65)/min, p = .027]. Conclusions: 5HT1B receptors have a glucoregulatory role in humans, probably acting on insulin secretion, insulin sensitivity and glucose effectiveness