Differences in Gastrointestinal Symptoms, Stress, and Lifestyle Factors in Adults With and Without Irritable Bowel Syndrome After Consumption of Gluten and Inulin

Background: Gluten and inulin type fibers have been shown to impact satiety, breath hydrogen, GI symptoms, and properties of different food products. Stress is often thought to play a role in breath hydrogen and gastrointestinal symptoms. Additional lifestyle factors are often related to increased GI symptoms including fiber consumption, increased high-intensity exercise, higher rates of anxiety, and disrupted sleep behaviors. Furthermore, individuals with irritable bowel syndrome (IBS) often display differences in GI symptoms based on consumption of gluten and inulin and lifestyle factors. Objective: The objective of this panel will be to describe the findings from a year-long study examining the impact of consumption of gluten and inulin (a FODMAP) on gastrointestinal (GI) symptoms, breath hydrogen, satiety, perceived stress, cortisol levels, and a variety of lifestyle factors including anxiety, diet, physical activity, and sleep in adults with and without IBS. Methods: A blinded, randomized, controlled crossover design was conducted with 24 non-IBS participants. Fasted participants consumed a control low FODMAP smoothie and treatment smoothies that consisted of the low FODMAP base (control) with gluten (5g) or inulin (5g). Cortisol and breath hydrogen were measured at baseline (0), 1, 2, and 3 hours. GI symptoms were measured at baseline (0), 0.5, 1, 1.5, 2, 3, 12, and 24 hours. VAS was collected at baseline (0), 10 min, 30 min, 1, 1.5, 2, and 3 hours. Perceived stress, State and Trait Anxiety, and Physical activity were measured for each treatment. Dietary intake and Sleep were analyzed at one time point as these measures assessed behaviors over the past 30 days. Salimetrics ELISA assays were used to determine cortisol values. Variables were analyzed by the Area Under the Curve using the trapezoidal rule, Spearman rho correlation coefficients, Independent T-tests, Repeated Measures ANOVA, and Simple-Effects Tests with significance set at p\u3c.05. Results: There were no differences between non-IBS and IBS groups in any diet variable, including fruits, vegetables, fiber, dairy, added sugar, whole grains, physical activity variables, or sleep (p\u3e0.05). There were no differences in state-somatic, trait-somatic, trait-cognitive, or trait-total in either treatment for non-IBS and IBS groups (p\u3e0.05), except for the inulin treatment had a difference in state-cognitive between non-IBS and IBS groups (MD=3.5714; p=0.035) with the IBS group having more state-cognitive anxiety. The IBS group had more total GI symptoms to begin with (p=.001), however, there were no differences in change in breath hydrogen between treatments or groups (p\u3e0.05). More details will be provided during the panel discussion. Conclusion: In this sample of participants, the restriction of gluten and inulin in the diet (at 5 grams) is not warranted for those with and without IBS, as neither treatment produced a significant increase in breath hydrogen or GI symptoms for either group. In those with IBS, there were increased GI symptoms to start with, indicating more GI distress but not related to the consumption of gluten or inulin at the 5-gram level

Examination of Gastrointestinal Symptoms, Stress, and Lifestyle Factors With the Consumption of Gluten and Inulin in Healthy Adults

Background: Gluten and inulin type fibers have been shown to impact satiety, breath hydrogen, GI symptoms, and properties of different food products. Stress is often thought to play a role in breath hydrogen and gastrointestinal symptoms. Additional lifestyle factors are often related to increased GI symptoms including fiber consumption, increased high-intensity exercise, higher rates of anxiety, and disrupted sleep behaviors. Objective: The objective of this panel will be to describe the findings from a year-long study examining the impact of consumption of gluten and inulin (a FODMAP) on sensory attributes, satiety, gastrointestinal (GI) symptoms, breath hydrogen, perceived stress, cortisol levels, and a variety of lifestyle factors including anxiety, diet, physical activity, and sleep. Methods: A blinded, randomized, controlled crossover design was conducted with 24 non-IBS participants. Fasted participants consumed a control low FODMAP smoothie and treatment smoothies that consisted of the low FODMAP base (control) with gluten (5g) or inulin (5g). Cortisol and breath hydrogen were measured at baseline (0), 1, 2, and 3 hours. GI symptoms were measured at baseline (0), 0.5, 1, 1.5, 2, 3, 12, and 24 hours. VAS was collected at baseline (0), 10 min, 30 min, 1, 1.5, 2, and 3 hours. Sensory analysis was completed after the first initial sips of smoothie consumption. Perceived stress, State and Trait Anxiety, and Physical activity were measured for each treatment. Dietary intake and Sleep were analyzed at one time point as these measures assessed behaviors over the past 30 days. Salimetrics ELISA assays were used to determine cortisol values. Variables were analyzed by the Area Under the Curve using the trapezoidal rule, Spearman rho correlation coefficients, and Repeated Measures ANOVA with significance set at p\u3c.05. Results: Main findings include no differences in breath hydrogen measurements and very little changes in GI symptoms when consuming five grams of gluten or inulin. Lifestyle variables overall did not correlate with breath hydrogen or GI symptoms. There were significant differences found for cortisol values in the control versus inulin and control versus gluten treatment groups. Additional findings will be discussed in detail during the panel. Conclusion: In healthy adults, consumption of five grams of gluten or inulin did not increase GI symptoms nor breath hydrogen levels indicating there is high tolerance of gluten consumption and inulin consumption. Lifestyle variables did not appear to play a large role in the relationship to GI symptoms. More research is needed to understand the relationship with cortisol and consumption of gluten or inulin

[In Press] Using citizen science to engage the public in monitoring workplace breastfeeding support in Australia

Issue addressed: Returning to work is a major barrier to continued breastfeeding. While many large organisations in Australia have policies to support breastfeeding and expressing at work, it is not known how these are implemented in practice, what support is available in smaller workplaces or to what extent workplace support meets the needs of breastfeeding mothers. Methods: This pilot study trialled a citizen science approach where members of the public provided photographs and descriptions of breastfeeding facilities and support within their workplaces. The study was promoted through community networks and social media, and data were submitted via an online survey. Data were analysed inductively to identify key themes. Results: Thirty‐seven participants provided data on breastfeeding support in their workplace. Three key themes were identified: physical features and facilities; workplace culture; and organisational and occupational characteristics. There was considerable variation in workplace support and around half of the participants indicated that they had to use communal, poorly equipped and/or unhygienic spaces to breastfeed or express at work. Conclusion: While some employers have taken important steps towards supporting mothers to combine breastfeeding and work, there is room for improvement. Through this pilot study, we have demonstrated the feasibility and value of using a citizen science approach to obtain data from a range of workplaces along with perceptions of workplace characteristics that support or hinder breastfeeding and expressing at work. So what?: Citizen science is a useful approach to capturing data on workplace support for breastfeeding and could be scaled up to enable ongoing monitoring. The findings raise important issues around the interpretation and implementation of current legislation to support mothers in the workplace

Embedding physical activity within community home support services for older adults in Ireland: a qualitative study of barriers and enablers

INTRODUCTION: In Ireland, over 55,000 older adults are supported in their community by formal home support, amounting to an estimated 23 million care hours annually. There is a growing need to move beyond care, to more proactive approaches to maintain physical function. In a feasibility study, we delivered the “Care to Move” (CTM) program through existing home support services. This qualitative study aimed to explore the experience and perceptions of Health Care Assistants (HCAs), who were trained in and delivered the CTM program. METHODS: We conducted semi-structured telephone interviews with 22 HCAs [mean age 49.0 ± 10.7 years and female 21/22] involved in the delivery of the program with older adults [n = 35, mean age 82.8 (7.8) years]. Interview transcripts were coded and analyzed thematically to capture barriers and enablers to program delivery. RESULTS: Barriers and enablers were identified under three themes i) the CTM approach ii) the home support setting, iii) older adults and physical activity, with iv) delivering care in a crisis and v) future directions further identified. Overall, there was a positive perception of the program’s focus on “movement prompts and motivators”, the “fit” within home support services, and the training provided. Practical challenges of limited time and the task-orientated nature of home support were reported as recurring barriers for CTM. Many HCAs commented on the value and perceived positive benefits of the program for their clients. Though negative perceptions of older adults’ motivation or ability to engage with physical activity were noted. Risk, such as injury or pain, was identified but was not a dominant theme. CONCLUSION: Our findings suggest that embedding physical activity initiatives within home support services could be feasible. Restructuring of services, engaging HCAs, and moving beyond traditional “task-oriented” care models to more personalised proactive approaches may facilitate this initiative and support aging in place

Enhancing existing formal home care to improve and maintain functional status in older adults: protocol for a feasibility study on the implementation of the Care to Move (CTM) programme in an Irish healthcare setting

An increasing ageing population leads to greater demand for care services to help maintain people in their own homes. Physical activity programmes have been shown to improve older adults’ functional capacity, enabling the older adult to live independently and maintain functional status. There has been a lack of quality research conducted around physical activity within the landscape of home care services. We describe a feasibility study of implementing the Care to Move (CTM) programme in older adults receiving low-level home care. A Phase 1 mixed-methods feasibility study design will explore the recruitment, attrition, retention, costs to deliver and data loss. It will also explore the acceptability and impact of the CTM programme on older adults and thematic analysis of data collected from older people, home care workers and relevant stakeholders through use of semi-structured interviews and focus groups. We will measure functional status and fall outcomes in older adults receiving low levels of home care, facilitating this population to continue living independently at home and providing data currently not known around this group

A qualitative study of older adults’ experiences of embedding physical activity within their home care services in Ireland

Purpose: Physical activity has been shown to improve older adults’ functional capacity, independence, and quality of life. Ina feasibility study, we embedded a movement approach within older adults existing home care services through “Care to Move”(CTM). The aim of this qualitative study is to explore older adults’ experiences of CTM within their home care support services and to identify the strengths and barriers of engaging in CTM from the perspective of the older recipient. Materials and Methods: We conducted semi-structured telephone interviews with 13 older adults and one informal carer. Topics covered included participants’ overall experiences of CTM, changes to their overall activity and participation, aspects of CTM that they found valuable and issues that were challenging. Interview transcripts were coded and analyzed thematically to capture barriers and facilitators to the approach delivery. Results: Four themes were developed: i) “I have good days and bad days”, ii) “safety and security is the name of the game”, iii) “we’re a team as it stands’, iv) “it’s [COVID-19] depressing for everybody at the moment”. Older adults identified benefits of CTM engagement including improvements in physical and psychological wellbeing. However, subjective frailty and self-reported multi?morbidity influenced overall engagement. Participants expressed concerns around the logistics of delivering CTM and competing care staff interests. The broader role of care staff in supporting CTM was highlighted, as well as the emotional support that staff provided to older adults. Care staff continuity was identified as a barrier to ongoing engagement. The impact of COVID-19 on older adults physical and mental health negatively impacted the delivery of the approach. Conclusion: Our findings suggest that embedding CTM within home care services is feasible and that older adults enjoyed engaging in CTM. Addressing care staff continuity and adopting individual approaches to CTM delivery may enhance the implementation of services </p

Enhancing existing formal home care to improve and maintain functional status in older adults: results of a feasibility study on the implementation of Care to Move (CTM) in an Irish healthcare setting

Care to Move (CTM) provides a series of consistent ‘movement prompts’ to embed into existing movements of daily living. We explored the feasibility of incorporating CTM approaches in home care settings. Methods: Feasibility study of the CTM approach in older adults receiving home care. Recruitment, retention and attrition (three time points), adherence, costs to deliver and data loss analyzed and differentiated pre and post the COVID-19 pandemic. Secondary outcomes, including functional status, physical activity, balance confidence, quality of life, cost to implement CTM. Results: Fifty-five home care clients (69.6% of eligible sample) participated. Twenty were unable to start due to COVID-19 disruptions and health issues, leaving 35 clients recruited, mostly women (85.7%), mean age 82.8 years. COVID-19 disruption impacted on the study, there was 60% retention to T2 assessments (8-weeks) and 13 of 35 (37.1%) completed T3 assessments (6-months). There were improvements with small to medium effect sizes in quality of life, physical function, balance confidence and self-efficacy. Managers were supportive of the roll-out of CTM. The implementation cost was estimated at EUR 280 per carer and annual running costs at EUR 75 percarer. Conclusion: Embedding CTM within home support services is acceptable and feasible. Data gathered can power a definitive trial. </p