Folate status in women of childbearing age with obesity: a review

Several studies have described a positive association between elevated BMI and birth defects risk. Data on plasma concentration of folate in pregnant women with obesity have shown values far below those recommended, regardless of diet, while folate levels should increase before pregnancy to reduce neural tube defects. We report a descriptive review of the most recent studies (from 2005 to 2015) to evaluate folate status through a population of women of childbearing age affected by obesity. The literature contains few studies, which present conflicting results regarding folate status in non-pregnant women of childbearing age affected by obesity, and it appears that there is a modification in folate metabolism, with a reduction in plasma folate levels and an increase in erythrocyte folate uptake. In conclusion, the folate status in women of childbearing age should be assessed by both plasma and erythrocyte levels to start a personalised and more adequate supplementation before conception. Further studies need to be conducted in a larger population, which take into account variables that can affect folate metabolism, such as dietary intake, lifestyle and genetic factors, oral contraceptives or other drug use, previous weight-loss programmes, or a history of bariatric surgery

Living with Parkinson's - Past, present and future: A qualitative study of the subjective perspective

Background: the social impact of Parkinson's is difficult to capture in quantitative research given the condition's variable presentation, so qualitative research is needed to support a person-centred approach. Aims: to describe how people with Parkinson's experience living with their condition over time. Methods: 27 audio-recorded verbatim-transcribed interviews were analysed through the grounded theory method. Findings: past, present and future were the core categories that emerged. Past is the dimension of regretted memories of past life overturned by the communication of diagnosis. Present is the time dimension in which patients concretely experience the hindrances associated with the condition (loss of autonomy, submissive acceptance and social embarrassment), and the resources (search for autonomy, serene or in-progress acceptance, and social support). Future is characterised by both positive visions of tomorrow and negative ones (worry, resignation, denial). Conclusion: these results, highlighting what living with Parkinson's means over time, may contribute to a better tailoring of nursing practice to the person's needs and rhythm, in a perspective of continuous adaptation

Towards proactive active living: Patients with Parkinson's disease experience of a multidisciplinary intensive rehabilitation treatment

BACKGROUND: Non-pharmacological approaches to PD disease management seem to be a growing and promising field of investigation. Indeed interesting new perspectives are forthcoming from studies on physical rehabilitation and on physical exercise. AIM: To qualitatively describe the rehabilitation experience of Parkinson Disease patients taking part in a multidisciplinary intensive rehabilitation treatment (MIRT) consisting of four weeks of physical therapy and exercise, with three daily sessions, five days a week. DESIGN: Data from a qualitative observational study with patients' interviews were analyzed. SETTING: PD inpatients of a Neurorehabilitation Department. POPULATION: Convenient sample of 27 PD patients (13 male, 14 female), mean age 70.3±8.5 and mean disease duration 8.25±6.9 years; Hoehn-Yahr stage 3, hospitalized for the 4-week MIRT. METHODS: Verbatim transcriptions of 27 semi-structured interviews were analysed using the Grounded Theory methodology. RESULTS: Depressive symptoms were present in 55.5% of the patients measured by Geriatric Depression Scale: mild (N.=8; 30.0%), moderate (N.=6; 22.2%), severe (N.=1; 3.7%). The core category Efficacy of active living identified the becoming conscious of the usefulness of a proactive lifestyle to counterattack disease degeneration. The category Satisfaction described patients' satisfaction upon MIRT, resulting in a perceived enhanced functionality (coherently with quantitative functional parameters improvement at discharge) and a rediscovered autonomy. The category Future described the intention to continue the rehabilitation prescription at home embracing a more dynamic lifestyle. Of interest is that the majority in the interview used body related terms and described perceived changes through the body itself. Verbs of perception (to see, to feel, to perceive) were used in a spontaneous way by all inpatients. The inpatients experienced not only through their mind but also by means of body perceptions how a proactive lifestyle could become a means of disease control. CONCLUSIONS: The positive subjective response to rehabilitation described qualitatively in this study, opens perspectives for tailoring interventions focusing also on patients' self, self-efficacy and perceived efficacy of active living. CLINICAL REHABILITATION IMPACT: Patients' proactive disposition may widen the perspective on patients' motivation to rehabilitation. A multidisciplinary intervention may act both on physical and subjective disease aspects; paying attention to patients' subjective feedbacks could contribute reliably to guide for medical decisions in managing tailored and detailed interventions

Epicardial Fat Thickness: threshold values and lifestyle association in male adolescents

Abstract BACKGROUND: Obese adolescents with high proportion of visceral fat are at higher risk of developing the metabolic syndrome. OBJECTIVES: The study aims to investigate if echocardiographic epicardial fat thickness (EF) could be predictive of visceral obesity (VO) early in life and to provide EF threshold values specific for male adolescents. Further aim was to investigate the association between EF, lifestyle and metabolic disease familiarity. METHODS: Anthropometric data were collected from 102 normal weight and overweight, healthy male adolescents (mean age: 14.91 ±  1.98 years); bioelectrical impedance analysis and transthoracic echocardiogram were performed in the same sample. Each participant fulfilled a validated self-administered lifestyle questionnaire. RESULTS: We found higher EF values in sedentary adolescents (P < 0.05), in those who never eat fruit and vegetables (P < 0.05), and in those with overweight mothers (P < 0.05). The strongest independent predictor of EF was waist circumference (P < 0.0001). Using the waist to height ratio as a marker of VO, logistic regression analysis revealed that 1 mm EF gain is responsible for seven times higher VO risk (P < 0.0001). Receiver Operating Characteristic (ROC) analysis showed that the optimal cut-off for EF thickness associated to youth VO is 3.2 mm. CONCLUSION: Ultrasonography EF measurement might be a second-level assessment tool, useful to detect early cardiometabolic damage stage

Medication adherence in the older adults with chronic multimorbidity: a systematic review of qualitative studies on patient’s experience

Purpose: Medication non-adherence represents a socially relevant challenge, particularly when interlinked to multiple chronic diseases and polypharmacy. Non-adherence rates affect treatment efficacy and increase health care costs. The aim of the study was to identify factors influencing medication adherence in the older adults through a systematic review of qualitative studies on patients’ experience. Methods: Two electronic databases were searched for qualitative studies on medication adherence in chronic diseases (hypertension, heart disease, COPD, asthma) involving people aged 65 +. The systematic review was performed according to the PRISMA statement guidelines, employing theoretical frameworks of the ABC Taxonomy of patient adherence and Three Factor model of determinants of behaviour. Results: The initial database search identified 1234 records, of which 39 studies were considered eligible. Most of the studies focused on hypertension and were conducted in English-speaking countries. According to the ABC Taxonomy, Persistence and Implementation were the most often considered phases. Considering the Three Factor model, the most often reported themes were Information and Strategies upon being adherent. Stemming from the review findings and the patients’ narratives, a new integrated model was proposed. It reports the patient’s decisional flowchart describing barriers and facilitators (personal, social and environmental) to adherence. Conclusion: Medication adherence is a complex and multifaceted process. The implementation of theoretical frameworks along with a patient-centred perspective may provide clinicians with useful suggestions for clinical practice, enhancing the patient’s ability to adhere