Determinants of diabetes knowledge in a cohort of Nigerian diabetics

BACKGROUND: One of the consequences of the generational paradigm shift of lifestyle from the traditional African model to a more "western" standard is a replacement of communicable diseases by non-communicable or life style related diseases like diabetes. To address this trend, diabetes education along with continuous assessment of diabetes related knowledge has been advocated. Since most of the Nigerian studies assessing knowledge of diabetes were hospital-based, we decided to evaluate the diabetes related knowledge and its sociodemographic determinants in a general population of diabetics. METHODS: Diabetics (n = 184) attending the 2012 world diabetes day celebration in a Nigerian community were surveyed using a two part questionnaire. Section A elicited information on their demographics characteristics and participation in update courses, and exercise, while section B assessed knowledge of diabetes using the 14 item Michigan Diabetes Research and Training Centre's Brief Diabetes Knowledge Test. RESULTS: We found that Nigerian diabetics had poor knowledge of diabetes, with pervasive fallacies. Majority did not have knowledge of "diabetes diet", "fatty food", "free food", effect of unsweetened fruit juice on blood glucose, treatment of hypoglycaemia, and the average duration glycosylated haemoglobin (haemoglobin A1) test measures blood glucose. Attaining tertiary education, falling under the 51-60 years age group, frequent attendance at seminars/updates and satisfaction with education received, being employed by or formerly working for the government, and claiming an intermediate, or wealthy income status was associated with better knowledge of diabetes. CONCLUSION: Nigerian diabetics' knowledge of diabetes was poor and related to age, level of education, satisfaction with education received, employment status and household wealth

Sedentary Behaviour in Hospitalised Older People: A Scoping Review

Background: Sedentary behaviour (SB) can delay hospitalised older adults’ recovery from acute illness and injuries. Currently, there is no synthesis of evidence on SB among hospitalised older people. This scoping review aimed to identify and map existing literature on key aspects of SB among hospitalised older adults, including the prevalence, measurement and intervention strategies for SB and sedentary behaviour bouts (SBBs) as well as healthcare professionals, patients and carers’ perspectives on interventions. Methods and analysis: Several electronic databases were searched between January 2001 and September 2020. The Joanna Briggs Institute (JBI) framework was used to conduct this scoping review. Results: Out of 1824 articles, 21 were included comprising 16 observational studies, 3 randomised controlled trials, 1 comparative study, and 1 phase-1 dose-response study. The sample size ranged from 13 to 393, with all 1435 participants community-dwelling before hospitalisation. Only two studies focused on measuring SB and SBBs as a primary outcome, with others (n = 19) reporting SB and SBB as a sub-set of physical activity (PA). Older adults spent an average of 86.5%/day (20.8 h) sedentary. Most studies (n = 15 out of 21) measured SB and SBB using objective tools. Conclusion: Hospitalised older people spent most of their waking hours sedentary. Studies explicitly focused on SB and SBB are lacking, and the perspectives of patients, carers and healthcare professionals are not clarified. Future hospital-based studies should focus on interventions to reduce SB and SBB, and the perspectives of healthcare professionals, patients and carers’ taken into account

Sedentary behaviour and physical activity in hospitalised older people

Reducing sedentary behaviour of hospitalised older people has gained increased interest because of the adverse consequences of immobility in hospital and the benefits of physical activity, vital for recovery from illness and avoiding functional decline post-hospitalisation. This PhD focuses on reducing sedentary behaviour whilst increasing physical activity amongst older people in hospital. It includes 1) a narrative review of the qualitative literature relating to the perspectives about physical activity in hospitalised older patients among older patients, carers and clinicians; and 2) a scoping review exploring the prevalence and assessment of sedentary behaviour, as well as interventions (including perspectives of the interventions) to reduce sedentary behaviour among hospitalised older people. The reviews revealed that qualitative studies have predominantly focused on ambulation or mobility as a domain of physical activity rather than broader physical activity or other domains such as physical function and self-care. Additionally, there is a dearth of qualitative or intervention studies about sedentary behaviour in older inpatients. The views of carers of older patients regarding sedentary behaviour and physical activity are lacking but should be considered as this will better inform the development of interventions. To address identified gaps in the literature, research conducted as part of this PhD included: a) non-directional interviews with (i) older patients, (ii) carers and (iii) clinicians; and b) a focus group study with clinicians on experiences of hospitalised older patients as well as strategies for reducing sedentary behaviour and increasing physical activity in older inpatients. Findings from this thesis have identified solutions from (i) older patients, (ii) carers and iii) clinicians to reduce sedentary behaviour and increase physical activity in hospital. These include integrating and coordinating physical activity into routine clinical care, empowering patients and their carers to initiate and sustain physical activity through education and communication, making the hospital environment activity-friendly and improving collaboration between clinicians regarding reducing sedentariness and increasing physical activity. Importantly, older patients, carers and clinicians identified several psychological consequences of sedentary behaviour on older patients, including loss of motivation and confidence, depression, anger and anxiety. These findings have important clinical implications for reducing prolonged sitting and lying periods and increasing physical activity during hospitalisation. This thesis provides two key messages for clinicians and policymakers. Firstly, despite the dynamic nature of clinical care, older people can be more active if physical activity is integrated into routine care and personalised according to patient’ ability, clinicians collaborate effectively, and carers are involved in supporting patients to be active. Secondly, sedentary behaviour has negative consequences on the psychological health of older patients, emphasising the need to encourage physical activity in this cohort.Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 202

Optimal dose and type of physical activity to improve functional capacity and minimise adverse events in acutely hospitalised older adults: A systematic review with dose-response network meta-analysis of randomised controlled trials

Objective: To identify the optimal dose and type of physical activity to improve functional capacity and reduce adverse events in acutely hospitalised older adults. Design: Systematic review and Bayesian model-based network meta-analysis. Data sources: Four databases were searched from inception to 20 June 2022. Eligibility criteria for selecting studies: Randomised controlled trials that assessed the effectiveness of a physical activity-based intervention on at least one functional outcome in people aged ≥50 years hospitalised due to an acute medical condition were included. Pooled effect estimates (ie, standardised mean differences for functional capacity and the ratio of means for adverse events) were calculated using random treatment effects network meta-analysis models. Results: Nineteen studies (3842 participants) met the inclusion criteria. Approximately 100 Metabolic Equivalents of Task per day (METs-min/day) (~40 min/ day of light effort or ~25 min/day of moderate effort activities) was the minimal dose to improve the functional capacity of acute hospitalised older adults (standardised mean difference (SMD)=0.28, 95% credible interval (CrI) 0.01 to 0.55). The optimal dose was estimated at 159 METs-min/day (~70 min/day of light effort or ~40 min/day of moderate effort activities; SMD=0.41, 95% CrI 0.08 to 0.72). Ambulation was deemed the most efficient intervention, and the optimal dose was reached at 143 METs-min/day (~50 min/day of slow-paced walking; SMD=0.76, 95% CrI 0.35 to 1.16), showing a high evidential power (87.68%). The minimal effective ambulation dose was estimated at 74 METs-min/day (~25 min/day of slow-paced walking; SMD=0.25, 95% CrI 0.01 to 0.41). Physical activity interventions resulted in a decrease in the rate of adverse events compared with usual care at discharge (ratio of means=0.96, 95% CrI 0.95 to 0.97; median time 7 days). Conclusions: This meta-analysis yielded low to moderate evidence supporting the use of in-hospital supervised physical activity programmes in acutely hospitalised older adults. As little as ~25 min/day of slow-paced walking is sufficient to improve functional capacity and minimise adverse events in this population.</p

Optimal dose and type of physical activity to improve functional capacity and minimise adverse events in acutely hospitalised older adults: a systematic review with dose-response network meta-analysis of randomised controlled trials

Objective: To identify the optimal dose and type of physical activity to improve functional capacity and reduce adverse events in acutely hospitalised older adults. Design: Systematic review and Bayesian model-based network meta-analysis. Data sources: Four databases were searched from inception to 20 June 2022. Eligibility criteria for selecting studies: Randomised controlled trials that assessed the effectiveness of a physical activity-based intervention on at least one functional outcome in people aged ≥50 years hospitalised due to an acute medical condition were included. Pooled effect estimates (ie, standardised mean differences for functional capacity and the ratio of means for adverse events) were calculated using random treatment effects network meta-analysis models. Results: Nineteen studies (3842 participants) met the inclusion criteria. Approximately 100 Metabolic Equivalents of Task per day (METs-min/day) (~40 min/ day of light effort or ~25 min/day of moderate effort activities) was the minimal dose to improve the functional capacity of acute hospitalised older adults (standardised mean difference (SMD)=0.28, 95% credible interval (CrI) 0.01 to 0.55). The optimal dose was estimated at 159 METs-min/day (~70 min/day of light effort or ~40 min/day of moderate effort activities; SMD=0.41, 95% CrI 0.08 to 0.72). Ambulation was deemed the most efficient intervention, and the optimal dose was reached at 143 METs-min/day (~50 min/day of slow-paced walking; SMD=0.76, 95% CrI 0.35 to 1.16), showing a high evidential power (87.68%). The minimal effective ambulation dose was estimated at 74 METs-min/day (~25 min/day of slow-paced walking; SMD=0.25, 95% CrI 0.01 to 0.41). Physical activity interventions resulted in a decrease in the rate of adverse events compared with usual care at discharge (ratio of means=0.96, 95% CrI 0.95 to 0.97; median time 7 days). Conclusions: This meta-analysis yielded low to moderate evidence supporting the use of in-hospital supervised physical activity programmes in acutely hospitalised older adults. As little as ~25 min/day of slow-paced walking is sufficient to improve functional capacity and minimise adverse events in this population.</p