An evaluation of the IDEEA™ activity monitor for estimating energy expenditure

Peer reviewedPublisher PD

Weight outcomes audit for 34,271 adults referred to a primary care/commercial weight management partnership scheme

Copyright © 2011 S. Karger AG, Basel.Peer reviewedPublisher PD

Choosing treatment for localised prostate cancer: A patient-conducted-interview study

Objectives: Treatment choice can be particularly difficult in localised prostate cancer because of the uncertainty involved. Indeed, some men prefer maintaining their masculine identity and quality of life to potentially securing longer-term survival through surgery or radiotherapy. UK health services are now obliged to leave the choice of treatment to the patient and the aim of this study is to improve understanding of patients’ experiences of choosing treatment. Methods: A one-day participative workshop where men of six months post-diagnosis design and conduct audio and video interviews on each other about their experiences of choosing treatment. Results: The findings show that treatment choice is a complex process combining emotional and rational elements. Information gathering and delegation to professional expertise were two key themes that emerged. Conclusions: The findings emphasise that treatment choice for localised prostate cancer is little like the traditional notions of consumerism from which it is derived. Importantly, the results illustrate, from a patient perspective, how health professionals can engage in their roles as information providers and as experts

Measuring the difference between actual and reported food intakes in the context of energy balance under laboratory conditions

Acknowledgements The present study was funded by the Food Standards Agency, UK. The Food Standards Agency had no role in the design, analysis or writing of this article. The authors’ responsibilities were as follows: R. J. S., L. M. O’R. and G. W. H. designed the research; L. M. O’R. and Z. F. conducted the research and analysed the data; G. W. H. performed the statistical analyses; P. R. carried out the DLW analysis; R. J. S. had primary responsibility for the final content; R. J. S., L. M. O’R., Z. F., S. W. and M. B. E. L. wrote the paper.Peer reviewedPublisher PD

The effectiveness of decision aids for pregnancy related decision-making in women with pre-pregnancy morbidity; systematic review and meta-analysis.

INTRODUCTION: Women with pre-existing morbidity arising from medical conditions or previous caesarean section are at higher risk of adverse pregnancy outcomes compared to women without such morbidity. Women often face complex pregnancy-related decision-making that may be characterized by conflicting maternal and perinatal priorities. The aim of this systematic review and meta-analysis was to assess randomised controlled trials of decision aids to evaluate whether they are effective at reducing decisional conflict scores and to evaluate what type of decision aids are most effective for women with pre-existing morbidity in pregnancy. METHODS: We searched Medline (via Ovid), Embase (via Ovid), CINAHL (via EBSCO) from the earliest entries until September 2021. We selected randomised controlled trials comparing patient decision aids for women with pre-existing morbidity with usual clinical practice or a control intervention. Study characteristics and Jadad risk of bias was recorded. Meta-analysis by pre-existing morbidity type was performed using Stata 17 and the data was presented with a Forest Plot. Random effects models were used to calculate summary estimates if there was substantial clinical or statistical heterogeneity and post mean DCS scores were described in a sensitivity analysis and presented as a line graph, to improve clinical interpretation of results.. A narrative synthesis of the selected studies evaluated what type of decision aid works and for in what circumstances. RESULTS: Ten randomised controlled trials, which reported data from 4028 women, were included. Patient decision aids were evaluated in women with pre-existing morbidity who were undertaking pregnancy-related decision-making. Patient decision aids reduced decisional conflict scale scores by an additional - 3.7, 95% Confidence Interval - 5.9% to - 1.6%) compared to the control group. Women with pre-existing medical conditions were more conflicted at baseline and had greater reductions in decisional conflict scale score (mean difference vs. control group: - 6.6%; 95% CI - 9.8% to - 3.3%), in contrast to those with previous caesarean section (mean difference - 2.4%; 95% CI - 4.8% to - 0.1%). There was limited evidence on the effect of decision aids on health outcomes. Decision aids reduced unwanted variation in decision-making support across maternity settings. CONCLUSION: Patient decision aids are effective tools to support personalised care planning and informed decision-making in women with pre-existing morbidity. Women with pre-existing medical morbidity were more conflicted at baseline and were more likely to benefit from decision aids. Adoption of aids in this population may lead to improve adherence and health outcomes, warranting further research

UK military doctors; stigma, mental health and help-seeking: a comparative cohort study

Introduction Studies suggest that medical doctors can suffer from substantial levels of mental ill-health. Little is known about military doctors’ mental health and well-being; we therefore assessed attitudes to mental health, self-stigma, psychological distress and help-seeking among UK Armed Forces doctors. Methods Six hundred and seventy-eight military doctors (response rate 59%) completed an anonymous online survey. Comparisons were made with serving and ex-military personnel (n=1448, response rate 84.5%) participating in a mental health-related help-seeking survey. Basic sociodemographic data were gathered, and participants completed measures of mental health-related stigmatisation, perceived barriers to care and the 12-Item General Health Questionnaire. All participants were asked if in the last three years they had experienced stress, emotional, mental health, alcohol, family or relationship problems, and whether they had sought help from formal sources. Results Military doctors reported fewer mental disorder symptoms than the comparison groups. They endorsed higher levels of stigmatising beliefs, negative attitudes to mental healthcare, desire to self-manage and self-stigmatisation than each of the comparison groups. They were most concerned about potential negative effects of and peer perceptions about receiving a mental disorder diagnosis. Military doctors reporting historical and current relationship, and alcohol or mental health problems were significantly and substantially less likely to seek help than the comparison groups. Conclusions Although there are a number of study limitations, outcomes suggest that UK military doctors report lower levels of mental disorder symptoms, higher levels of stigmatising beliefs and a lower propensity to seek formal support than other military reference group

Implementation of national antenatal hypertension guidelines: a multicentre multiple methods study.

OBJECTIVE:To evaluate the implementation of National Institute for Health and Care Excellence antenatal hypertension guidelines, to identify strategies to reduce incidences of severe hypertension and associated maternal and perinatal morbidity and mortality in pregnant women with chronic hypertension. METHODS:We used a multiple method multisite approach to establish implementation of guidelines and the associated barriers and facilitators. We used a national survey of healthcare professionals (n=97), case notes review (n=55) and structured observations (n=42) to assess implementation. The barriers and facilitators to implementation were identified from semistructured qualitative interviews with healthcare professionals (n=13) and pregnant women (n=18) using inductive thematic analysis. The findings were integrated and evaluated using the Consolidated Framework for Implementation Research. SETTING AND PARTICIPANTS:Pregnant women with chronic hypertension and their principal carers (obstetricians, midwives and physicians), at three National Health Service hospital trusts with different models of care. RESULTS:We found severe hypertension to be prevalent (46% of case notes reviewed) and target blood pressure practices to be suboptimal (56% of women had an antenatal blood pressure target documented). Women were infrequently given information (52%) or offered choice (19%) regarding antihypertensives. Women (14/18) reported internal conflict in taking antihypertensives and non-adherence was prevalent (8/18). Women who were concordant with treatment recommendations described having mutual trust with professionals mediated through appropriate information, side effect management and involvement in decision making. Professionals reported needing updates and tools for target blood pressure setting and shared decision making underpinned by antihypertensive safety and effectiveness research. CONCLUSIONS:Women's non-adherence to antihypertensives is higher than anticipated. Suboptimal information provision around treatment, choice of antihypertensives and target setting practices by healthcare professionals may be contributory. Understanding the reasons for non-adherence will inform education and decision-making strategies needed to address both clinician and women's behaviour. Further research into the effectiveness and long-term safety of common antihypertensives is also required

Procolipase gene : no association with early-onset obesity or fat intake

Copyright 2009 S. Karger AG, Basel.Peer reviewedPublisher PD

Demographic factors do not predict weight loss maintenance in members of a commercial weight loss organisation

Demographic factors are important correlates of predisposition to obesity but much less is known about how they relate to weight loss and its maintenance. This analysis examined the demographic predictors of weight loss maintenance (WLM) in 1428 participants of a slimming organisation, who had been members for a mean_SD of 16_16 months, had lost 13.8%_9.2% weight and were trying to maintain, or increase, their weight loss during a subsequent 6 month study period. Data were collected as part of the DiOGenes study(1). Ethical approval was given by the University of Surrey Ethics Committee. Adults were recruited between August 2006 and July 2008 from Slimming World at group meetings and by email. Participants’ weights (using calibrated scales) were taken from group records at four time points, measurement 1 (M1) at the start of the study period, nominally six months later (measurement 2 (M2)), six months before M1 and when they initially enrolled with Slimming World. Participants were free to continue following the weight-loss programme as they wished during this study, and there was no intervention other than completing the questionnaires. Participants completed a general screening questionnaire at M1 relating to age, gender, marital status, education level achieved, employment status, number of adults and children in the household, monetary expenditure on food, number of siblings, weight history, weight history of parents and siblings, medical history (whether a doctor had told them they have had obesity, diabetes, cancer, high blood pressure, high cholesterol, heart disease or stroke), medical history of parents and siblings, alcohol intake, smoking status, and birth weight. Linear regression analysis was used to identify the associations between questionnaire responses and weight change (as % M1 weight) over the 6 month study period. Mean age was 46.8 years for women, 50.8 years for men; 95% were women. There was no association between age, sex, marital status or family structure and subsequent WLM. Heavier people lost a greater percentage of their weight during the study period than did lighter people (p<0.001), presumably because they had more to lose. People who were unemployed and “other” lost considerably more weight during the study than those who were employed, or not working for other reasons. However, there were only 37 and 58 people in these first two groups respectively. The percentage of respondents who reported being told by a doctor they had medical conditions was as follows: high blood pressure 30%, high cholesterol 16% and obesity 36%. Fewer than 5% of respondents answered yes for the other conditions. Being told by their GP that they were obese, either currently or in the past, significantly correlated with respondents’ WLM (p = 0.007). All significant associations explained a very small percentage of the variance in WLM. No other demographic variables were associated with WLM. In this study demographic measures were used as baseline indicators of subsequent outcome. They did not change in the time course of the study. While demographic factors are likely to be important in predisposing people to weight gain and in accessing the means to lose weight, it is likely that individual changes in eating and activity behaviour are more important in determining successful weight loss and its maintenance. This work was part of the Diet, Obesity and Genes project (www.diogenes-eu.org) funded by the European Commission (contract #: Food-CT-2005- 513946) in the Food Quality and Safety Priority of the Sixth Framework Program