The temporalities of tracking sitting time: an exploration of the influence of rhythms and biographies on behavioural change in chronically ill adults and office workers

This thesis explores how older adults with chronic obstructive pulmonary disease (COPD), and office workers, experienced sitting while wearing a self-tracking device that prompted them to break up and reduce their sitting time. My thesis draws on public health and social science research on self-tracking, as well as the temporality and rhythms literature, and I argue that sitting can be understood in relation to the wider social, personal, biographical and institutional contexts to which my participants related their experiences of the past, present and future, and their changing habitual routines. Findings were based on two studies, the motivations behind which were to encourage participants to reduce their sitting and to deduce whether wearing a self-tracking device would inspire them to do so. The first study was a qualitative nested study which was part of a multidisciplinary randomised control trial. This study investigated the feasibility of self-tracking and an educational booklet created to reduce sitting in older adults with COPD. The qualitative nested study interviewed 25 patients with COPD, both before and after the study, and the first interviews explored the contexts of their lives and sitting, while the second explored how they managed with the device, educational advice and the study as a whole. The second study interviewed 24 office workers about their experiences with a self-tracking device designed to reduce their sitting. Each participant was interviewed both before and after the two-week study period in interview 1, I explored their lives, their work and their experiences and associations with sitting, and in interview 2 I investigated their experiences with the device and the study as a whole. My four analytic chapters answer the following four questions: how do patients with chronic obstructive pulmonary disease (COPD), and office workers, use a device to self-track their sitting time? What kinds of meanings do patients with COPD and office workers attach to sitting? How do personal and social or institutional temporalities of the past and present, and the rhythms of everyday life, shape participants sitting and self-tracking? And what does the conceptual framework, focusing on meanings, temporalities and rhythms, add to our understanding of health, sitting and self-tracking? The findings of this thesis revealed that the meaning of sitting was different for my two participant groups, in that they were influenced heavily by their experiences with their past, present and future, as well as their daily routines and changes in pace. Therefore, in order to make sense of how these participants understood the meanings of sitting, I adopted a temporality and rhythms framework, which allowed me to make sense of how COPD participants either looked back on their previous lives and reminisced on happy memories, whereby they were mournful and sad about their current lives and changing behaviour, and sitting less was not important to them, or looked toward their futures in anticipation of a healthier life and the ability to do more. The concept of rhythms allowed me to make sense of how some of these participants felt that the self-tracking device and sitting interrupted or did not fit in with their lives and how they often felt that sitting had positive benefits, or where their existing rhythms had been interrupted by their illness and this prevented behavioural change and a reduction in sitting. The concept of rhythms also helped to make sense of those participants who adopted their existing habitual rhythms to encompass sitting less and self-tracking, or those who engaged when their habitual routines coincided with sitting less and self-tracking. In contrast, office workers sitting and self-tracking were related to the workplace, in that they looked back on previous work times when they would make time for their health and take breaks, thus the concept of temporality helped to make sense of this biographical and institutionally dictated time. The concept of rhythms helped to decipher how these participants did not have an issue with health but associated any negative well-being consequences to their increasingly fast-paced and stressful work lives. In addition, their free time was not considered problematic, and so they did not feel the need to change their behaviour or reduce their sitting or self-tracking during this time, as they saw it as an opportunity to gain some form of freedom and do what they wanted to do. Therefore the concept of rhythms provided a way of understanding the different routines of work and home and how the pace of these rhythms differed in speed and intensity. The thesis provides a new perspective on exploring sitting and highlights the importance of exploring both it and self-tracking in relation to the experiences of biographical time (past, present and future) and changing routines. I offer insights into how, by adopting a rhythms and temporality framework, we can make sense of people s experiences of reducing sitting and engaging with self-tracking in order to do so. The thesis brings together literature on public health, self-tracking and place and time, and it argues that by studying the meaning of sitting and adopting a temporality and rhythms framework, the complexity and experience of time and its relationship with chronic illness and work are illuminated, thereby highlighting how time, place and pace are fundamental in understanding sitting and self-tracking

Avaliação de revisões sistemáticas sobre amamentação e saúde da criança a partir de um estudo bibliométrico

Introdução – As revisões sistemáticas são consideradas eficientes para gerar evidências científicas de alto nível para as decisões de saúde. Sua importância se percebe pela crescente produção e utilização nas guias das práticas médicas e recomendações de saúde. Estas recomendações, elaboradas por instituições de reconhecida influência, orientam o comportamento e ações de saúde da população com base nas evidências científicas. É possível que as revisões sistemáticas constituam o material básico para sua elaboração, porém sua qualidade deve ser questionada e avaliada para garantir o valor de tais evidências. Objetivo – Investigar a qualidade metodológica das revisões sistemáticas citadas nas recomendações de saúde de instituições nacionais e internacionais sobre amamentação e saúde da criança. Métodos – Foram identificadas as recomendações do Brasil, Canadá e Estados Unidos e de instituições internacionais nos sites e feita a coleta das revisões citadas. Foi avaliada de forma dupla e cega a qualidade metodológica destas revisões, usando a ferramenta Amstar. Resultados – Trinta revisões estavam citadas nas 101 recomendações selecionadas. Quarenta delas não tinham citado nenhuma revisão sistemática do tema e somente quatro revisões foram citadas em mais de cinco recomendações. Vinte e seis (87%) revisões sistemáticas citadas eram de qualidade média, quatro (13%) baixa e nenhuma de qualidade alta. Conclusão – As revisões sistemáticas foram escassamente citadas nas recomendações e são de qualidade moderada. Poucas revisões se converteram em padrão de citação para o mesmo tema, mas não são atuais e nem de alta qualidade.info:eu-repo/semantics/publishedVersio

Events in Early Life are Associated with Female Reproductive Ageing: A UK Biobank Study.

The available oocyte pool is determined before birth, with the majority of oocytes lost before puberty. We hypothesised that events occurring before birth, in childhood or in adolescence ('early-life risk factors') could influence the size of the oocyte pool and thus the timing of menopause. We included cross-sectional data from 273,474 women from the UK Biobank, recruited in 2006-2010 from across the UK. We analysed the association of early menopause with events occurring before adulthood in 11,781 cases (menopause aged under 45) and 173,641 controls (menopause/pre-menopausal at ≥ 45 years), in models controlling for potential confounding variables. Being part of a multiple birth was strongly associated with early menopause (odds ratio = 1.42, confidence interval: 1.11, 1.82, P = 8.0 × 10(-9), fully-adjusted model). Earlier age at menarche (odds ratio = 1.03, confidence interval: 1.01, 1.06, P = 2.5 × 10(-6)) and earlier year of birth were also associated with EM (odds ratio = 1.02, confidence interval: 1.00, 1.04, P = 8.0 × 10(-6)). We also confirmed previously reported associations with smoking, drinking alcohol, educational level and number of births. We identified an association between multiple births and early menopause, which connects events pre-birth, when the oocyte pool is formed, with reproductive ageing in later life.This research has been conducted using the UK Biobank Resource. This work was generously supported by a Wellcome Trust Institutional Strategic Support Award [WT097835MF to University of Exeter].This is the final version of the article. It first appeared from Nature Publishing Group via http://dx.doi.org/10.1038/srep2471

Type 2 Diabetes Risk Alleles Are Associated With Reduced Size at Birth

OBJECTIVE: Low birth weight is associated with an increased risk of type 2 diabetes. The mechanisms underlying this association are unknown and may represent intrauterine programming or two phenotypes of one genotype. The fetal insulin hypothesis proposes that common genetic variants that reduce insulin secretion or action may predispose to type 2 diabetes and also reduce birth weight, since insulin is a key fetal growth factor. We tested whether common genetic variants that predispose to type 2 diabetes also reduce birth weight. RESEARCH DESIGN AND METHODS: We genotyped single-nucleotide polymorphisms (SNPs) at five recently identified type 2 diabetes loci (CDKAL1, CDKN2A/B, HHEX-IDE, IGF2BP2, and SLC30A8) in 7,986 mothers and 19,200 offspring from four studies of white Europeans. We tested the association between maternal or fetal genotype at each locus and birth weight of the offspring. RESULTS: We found that type 2 diabetes risk alleles at the CDKAL1 and HHEX-IDE loci were associated with reduced birth weight when inherited by the fetus (21 g [95% CI 11-31], P = 2 x 10(-5), and 14 g [4-23], P = 0.004, lower birth weight per risk allele, respectively). The 4% of offspring carrying four risk alleles at these two loci were 80 g (95% CI 39-120) lighter at birth than the 8% carrying none (P(trend) = 5 x 10(-7)). There were no associations between birth weight and fetal genotypes at the three other loci or maternal genotypes at any locus. CONCLUSIONS: Our results are in keeping with the fetal insulin hypothesis and provide robust evidence that common disease-associated variants can alter size at birth directly through the fetal genotype

Using Genetic Variants to Assess the Relationship Between Circulating Lipids and Type 2 Diabetes

Journal ArticleResearch Support, Non-U.S. Gov'tCopyright © 2015 by the American Diabetes Association.This article contains Supplementary Data online at http://diabetes.diabetesjournals.org/lookup/suppl/doi:10.2337/db14-1710/-/DC1.The effects of dyslipidemia on the risk of type 2 diabetes (T2D) and related traits are not clear. We used regression models and 140 lipid-associated genetic variants to estimate associations between circulating HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), and triglycerides and T2D and related traits. Each genetic test was corrected for effects of variants on the other two lipid types and surrogates of adiposity. We used the largest data sets available: 34,840 T2D case and 114,981 control subjects from the DIAGRAM (DIAbetes Genetics Replication And Meta-analysis) consortium and up to 133,010 individuals without diabetes for insulin secretion and sensitivity from the MAGIC (Meta-Analyses of Glucose and Insulin-related traits Consortium) and GENESIS (GENEticS of Insulin Sensitivity) studies. Eight of 21 associations between groups of variants and diabetes traits were significant at the nominal level, including those between genetically determined lower HDL-C (β = -0.12, P = 0.03) and T2D and genetically determined lower LDL-C (β = -0.21, P = 5 × 10(-6)) and T2D. Although some of these may represent causal associations, we discuss why caution must be used when using Mendelian randomization in the context of circulating lipid levels and diabetes traits. In conclusion, we found evidence of links between genetic variants associated with lipids and T2D, but deeper knowledge of the underlying genetic mechanisms of specific lipid variants is needed before drawing definite conclusions about causality based on Mendelian randomization methodology.Knut and Alice Wallenberg FoundationERCSwedish Research CouncilFredrik och Ingrid Thurings StiftelseSwedish Heart-Lung Foundationacknowledges Sydvästra Skånes DiabetesföreningNovo Nordisk FoundationUniversity of TartuEuropean Foundation for the Study of Diabetes New HorizonsAmerican Heart Associatio

The functional "KL-VS" variant of KLOTHO is not associated with type 2 diabetes in 5028 UK Caucasians

BACKGROUND: Klotho has an important role in insulin signalling and the development of ageing-like phenotypes in mice. The common functional "KL-VS" variant in the KLOTHO (KL) gene is associated with longevity in humans but its role in type 2 diabetes is not known. We performed a large case-control and family-based study to test the hypothesis that KL-VS is associated with type 2 diabetes in a UK Caucasian population. METHODS: We genotyped 1793 cases, 1619 controls and 1616 subjects from 509 families for the single nucleotide polymorphism (SNP) F352V (rs9536314) that defines the KL-VS variant. Allele and genotype frequencies were compared between cases and controls. Family-based analysis was used to test for over- or under-transmission of V352 to affected offspring. RESULTS: Despite good power to detect odds ratios of 1.2, there were no significant associations between alleles or genotypes and type 2 diabetes (V352 allele: odds ratio = 0.96 (0.84–1.09)). Additional analysis of quantitative trait data in 1177 healthy control subjects showed no association of the variant with fasting insulin, glucose, triglycerides, HDL- or LDL-cholesterol (all P > 0.05). However, the HDL-cholesterol levels observed across the genotype groups showed a similar, but non-significant, pattern to previously reported data. CONCLUSION: This is the first large-scale study to examine the association between common functional variation in KL and type 2 diabetes risk. We have found no evidence that the functional KL-VS variant is a risk factor for type 2 diabetes in a large UK Caucasian case-control and family-based study

Improved genetic testing for monogenic diabetes using targeted next-generation sequencing

addresses: Institute for Biomedical and Clinical Science, University of Exeter Medical School, Barrack Road, Exeter EX2 5DW, UK. [email protected]: PMCID: PMC3737433types: Journal Article; Research Support, Non-U.S. Gov'tOpen Access ArticleCurrent genetic tests for diagnosing monogenic diabetes rely on selection of the appropriate gene for analysis according to the patient's phenotype. Next-generation sequencing enables the simultaneous analysis of multiple genes in a single test. Our aim was to develop a targeted next-generation sequencing assay to detect mutations in all known MODY and neonatal diabetes genes

Indigenous knowledges and development: a postcolonial caution

As a result of the failure of formal top-down development, there has recently been increased interest in the possibilities of drawing upon the indigenous knowledges of those in the communities involved, in an attempt to produce more effective development strategies. The concept of indigenous knowledge calls for the inclusion of local voices and priorities, and promises empowerment through ownership of the process. However, there has been little critical examination of the ways in which indigenous knowledges have been included in the development process. Drawing upon postcolonial theory, this article suggests that indigenous knowledges are often drawn into development by both theorists and development institutions in a very limited way, failing to engage with other ways of perceiving development, and thus missing the possibility of devising more challenging alternatives