Exploring factors having an impact on attitudes and motivations towards volunteering in the undergraduate nursing student population − a comparative study of the UK and Ghana

Volunteering in the undergraduate nursing student population is impacted by the curriculum. • Structured volunteering can positively impact uptake of student volunteering. • Nursing students in Ghana and the UK report barriers to volunteering. • Economic conditions in a country impact uptake of volunteering

Does neurocognitive training have the potential to improve dietary self-care in type 2 diabetes? Study protocol of a double blind randomised controlled trial

Dietary self-care is a key element of self-management in type 2 diabetes. It is also the most difficult aspect of diabetes self-management. Adhering to long-term dietary goals and resisting immediate food desires requires top-down inhibitory control over subcortical impulsive and emotional responses to food. Practising simple neurocognitive tasks can improve inhibitory control and health behaviours that depend on inhibitory control, such as resisting alcohol consumption. It is yet to be investigated, however, whether neurocognitive training can improve dietary self-care in people with type 2 diabetes. The aim of this randomised controlled trial is to investigate whether web-based neurocognitive training can improve the ability of people with type 2 diabetes to resist tempting foods and better adhere to a healthy dietary regime

Does working memory training improve dietary self-care in type 2 diabetes mellitus? Results of a double blind randomised controlled trial

Aims: Controlling food intake despite adequate knowledge remains a struggle for many people with type 2 diabetes. The present study investigated whether working memory training can reduce food intake and improve glycaemic control. It also examined training effects on cognition, food cravings, and dietary self-efficacy and self-care. Methods: In a double-blind multicentre parallel-group randomised controlled trial, adults with type 2 diabetes mellitus were randomly allocated to receive 25 sessions of either active (n = 45) or control (n = 36) working memory training. Assessments at baseline, post-training and 3-month follow-up measured cognition, food intake (primary outcomes), glycaemic control (HbA1c) and cholesterol (secondary outcomes). Semi-structured interviews assessed participants’ experiences of the training. Results: Intention-to-treat ANOVAs (N = 81) showed improved non-trained updating ability in active compared to control training from pre-test (active M = 34.37, control M = 32.79) to post-test (active M = 31.35, control M = 33.53) and follow-up (active M = 31.81, control M = 32.65; g2 = 0.05). There were no overall effects of training on other measures of cognition, food intake, HbA1c, cholesterol, food cravings and dietary self-efficacy and self-care. In post-hoc analyses, those high in dietary restraint in the active training group showed a greater reduction in fat intake pre to post-test compared to controls. Interviews revealed issues around acceptability and performance of the training. Conclusions: Transfer of working memory training effects to non-trained behaviour were limited, but do suggest that training may reduce fat intake in those who are already motivated to do so. Trial registration: Current Controlled Trials ISRCTN22806944

Dampened Transient Actuation of Hydrogels Autonomously Controlled by pH-Responsive Bicontinuous Nanospheres

The fabrication of a soft actuator with a dampened actuation response is presented. This was achieved via the incorporation into an actuating hydrogel of urease-loaded pH-responsive bicontinuous nanospheres (BCNs), whose membrane was able to regulate the permeability and thus conversion of fuel urea into ammonia. The dampened response of these nanoreactors to the enzymatically induced pH change was translated to a pH-responsive soft actuator. In hydrogels composed of a pH-responsive and nonresponsive layer, the transient pH gradient yielded an asymmetric swelling behavior, which induced a bending response. The transient actuation profile could be controlled by varying the external fuel concentrations. Furthermore, we showed that the spatial organization of the BCNs within the actuator had a great influence on the actuation response. Embedding the urease-loaded nanoreactors within the active, pH-responsive layer resulted in a reduced response due to local substrate conversion in comparison to embedding them within the passive layer of the bilayer hydrogel. Finally, we were able to induce transient actuation in a hydrogel comprising two identical active layers by the immobilization of the BCNs within one specific layer. Upon addition of urea, a local pH gradient was generated, which caused accelerated swelling in the BCN layer and transient bending of the device before the pH gradient was attenuated over time.</p

Food cue reactivity, obesity, and impulsivity:are they associated?

Heightened reactivity to food-associated cues and impulsive responding to these cues may be important contributors to the obesity epidemic. This article reviews the evidence for a role of food cue reactivity and impulsivity in food intake, body mass index, and weight-loss success. Inconsistencies in defining and measuring these constructs create difficulties in interpreting findings; however, evidence does support their role in obesity. The relationship between food cue reactivity and impulsivity may depend on the measurement used, but some studies have demonstrated that interactions between these constructs rather than direct effects are important in accounting for food intake pattern. Thus, multimodal assessment of both constructs is recommended. Future research would benefit from standardized definitions, measures, procedures, and reporting to enhance comparisons across studies. Implications for therapy are discussed and suggestions for further research are provided

Responsiveness and interpretability of the pain subscale of the Knee and Hip Osteoarthritis Outcome Scale (KOOS and HOOS) in osteoarthritis patients according to COSMIN guidelines

BACKGROUND: The pain subscales of the Knee and Hip Osteoarthritis Outcome Scores (KOOS and HOOS) are among the most frequently applied, patient reported outcomes to assess pain in osteoarthritis patients and evaluation of the results after Total Knee Arthroplasty (TKA) and Total Hip Arthroplasty (THA). For the evaluation of change over time it is essential to know the responsiveness and interpretability of these measurement instruments. Aim of this study is to investigate responsiveness and interpretability of the KOOS and HOOS pain subscales in patients with knee or hip OA and patients after TKA and THA as recommended by COSMIN guidelines. COSMIN stands for COnsensus based Standards for the selection of health Measurement Instruments. COSMIN recommends methods for assessing responsiveness similar to those assessing validity, using extensive hypothesis testing to assess criterion validity and construct validity of the change score.DESIGN: This clinimetric study was conducted using data obtained from the Duloxetine in OsteoArthritis (DOA) trial. Primary knee or hip osteoarthritis patients were included. During the study, half of the participants received pre-operative targeted treatment with duloxetine, and all participants received TKA or THA. Patients filled out a set of patient-reported outcomes at several time points.METHODS: Using the criterion validity approach the change scores of the KOOS and HOOS pain subscales directly after duloxetine treatment but before TKA and THA were correlated to the Patient Global Improvement anchor-question (PGI-I). Receiver Operating Characteristic curves (ROC curves) were obtained. Using the construct validity approach, hypothesis testing was conducted investigating the correlation between change scores in the KOOS and HOOS pain subscale with change scores in other questionnaires six months after TKA and THA. For interpretability, an anchor-based approach was used to consider the Minimally Important Change (MIC) of the KOOS and HOOS pain subscale. We compared the outcomes after duloxetine treatment and six months after TKA and THA in order to investigate any response shift.RESULTS: Ninety-three participants (53 knee patients and 41 hip patients) were included. Mean change was 4.3 and 4.6 points after conservative treatment for knee and hip OA patients respectively and 31.7 and 48.8 points after TKA and THA respectively. The KOOS and HOOS pain subscales both showed a gradual increase in change scores over the different categories of improvement on the PGI-I, with an Area Under the Curve of 0.72 (95% CI 0.527-0.921) and 0.79 (95% CI 0.588-0.983) respectively. Of the predefined hypotheses, 69% were confirmed for both subscales. The MICs were between 12.2 to 37.9 for the KOOS pain subscale, and between 11.8 to 48.6 for the HOOS pain subscale, depending on whether the PGI-I was administered after conservative treatment, or six months after TKA and THA.CONCLUSIONS: This study endorses the responsiveness of the KOOS and HOOS pain subscales in patients with knee or hip OA and patients after TKA and THA based on construct and criterion validity approaches. The KOOS pain subscale might be able to detect the MIC at an individual level after arthroplasty, but both the KOOS and HOOS pain subscales were not able to do so after conservative treatment. This study is the first to report a considerable response shift in MIC of the KOOS and HOOS pain subscales. This should be taken into consideration when evaluating MIC of the KOOS and HOOS pain subscale after conservative versus operative treatment. Future research should present more reference data regarding MIC scores after different treatments.</p

CD4 testing at clinics to assess eligibility for Antiretroviral therapy

BackgroundIn 2011, the Ministry of Health raised the CD4 threshold for antiretroviral therapy (ART) eligibility from &lt;250 cells/&#956;l and &lt;350 cells/&#956;l, but at the same time only 8.8% of facilities in Malawi with HIV services provided CD4 testing. We conducted a record review at 10 rural clinics in Thyolo District to assess the impact of introducing CD4 testing on identifying patients eligible for ART.Methods:We abstracted CD4 counts of all ART-na&#239;ve, HIV-infected patients with WHO clinical stages 1 and 2 and an initial CD4 test between May 2008 and June 2009. At four clinics, we also abstracted CD4 counts of patients not initially eligible for ART who were retested before April 2010.ResultsOf 1,113 patients tested, the initial CD4 was &#8220;&#8804;250 cells/&#956;l&#8221; and &#8220;&#8804;350 cells/&#956;l&#8221; in 534 (48.0%). Of 203 patients with follow-up results, the most recent CD4 was &#8804;250 cells/&#956;l in 34 (24.5%), and &#8804;350 cells/&#956;l in 64 (46.0%).ConclusionsCD4 testing in rural clinics is feasible and identifies many patients eligible for ART who would not be identified without CD4 testing. CD4 testing needs to be scaled-up to identify patients eligible for ART. ART services need to be scaled-up concurrently to meet the resulting increased demand