A qualitative investigation into the follow-up support offered to patients after an NHS obesity weight management programme in Liverpool

The prevalence of obesity has been increasing in Liverpool over the last 20 years(1). In response a weight management programme was devised by Liverpool Community Health using existing related services. The service involves dietitians working towards facilitating dietary and lifestyle changes in local obese NHS patients via a 12 week education programme. Follow up support is highlighted in the literature as a required element for success in weight management, however there is a lack of existing qualitative research focussing on this area(2). This study investigated patients’ lived experiences of the programme; specifically regarding follow up support. Participants (n 16) were recruited from the programme to engage in a semi-structured focus group after their final education session with an emphasis on post-programme support. Data was audio-recorded, transcribed verbatim and analysed using constant comparison analysis. A coding frame was developed until saturation was reached. The table outlines themes which emerged from the data and future recommendations. Regardless of many positive comments, participants frequently complained about a lack of follow up support from the programme and from family and friends. Some explained how they were often insulted and belittled by those closest to them and were vehemently against involving these people in their weight management. Follow up weigh-in groups based around peer support were suggested, however these were also met with criticism as participants mentioned they would be unhappy to engage unless sessions were run by a dietitian or qualified health professional. Despite favourable remarks concerning the social elements of the programme and the acquisition of new skills and knowledge, many participants still felt unable to continue without suitable follow up support and excessive practitioner dependence, therefore deflecting accountability for their health away from themselves. The results show that for changes made during programme to be sustainable, patients need a robust, post-programme support network where they become responsible for their own actions and are encouraged to set and work towards their own goals. Proposed solutions to this are the introduction of online support programmes, follow up dietitian phone calls and weight management support inventories to assess the level of social support needed(3). Furthermore, NHS Community Food Workers have also been effective in offering individualised support for behaviour changes and may too be useful for assisting with follow up sessions(4)

The influence of continuous subcutaneous insulin infusion therapy vs. multiple daily injections upon the diet of those with Type 1 diabetes: A food diary investigation

There exist a number of therapeutic options for the management of Type 1 diabetes (T1D). Multiple daily injections (MDI) are one such treatment and involve 4-5 daily subcutaneous injections of insulin. This frequently used approach is widely regarded as an effective method of controlling glycaemia; however, if a patient continues to suffer disabling episodes of hypoglycaemia, or if HbA1c remains above 8.5% continuous subcutaneous insulin infusion (CSII) may instead be recommended1. This therapy employs a small programmable pump device to facilitate the administration of insulin to the patient via a cannula. Various advantages of CSII have been documented compared to MDI, including improvements in glycaemic control and reduced incidence of both hypoglycaemia and the dawn phenomenon. An additional attribute, characterised by the flexible nature of the therapy, is that a liberalised diet may be enjoyed by patients, which in turn may infer potential nutrition and quality of life aberrations. This phenomenon is surprisingly under researched and further investigations to inform both treatment and risk would therefore be beneficial. Following ethical approval and informed consent patients with T1D using either CSII or MDI from the Royal Liverpool Hospital were asked to complete a 5 day weighed food diary. Dietplan 6 software was used to process the responses and demographic data from participants’ medical records were added to the dataset. All data were then interrogated using descriptive statistics and any non-normal data were transformed logarithmically before further enquiry with t-tests or analysed non-parametrically with Mann-Whitney-U-tests. The sample comprised of 20 patients (35% male, 65% female) with 11 using CSII and 9 using MDI. The patients’ mean age was 49±16 years and the majority were overweight or obese (72.7% CSII, 55.6% MDI). Nutrient Amount per day (CSII group) Amount per day (MDI group) % energy intake per day (CSII group) % energy intake per day (MDI group) Energy 1866.6 Kcal 2110.5 Kcal N/A N/A Protein 69.0 g/day 89.9 g/day 14.8 17.0 Total CHO 232.3 g/day 251.8 g/day 46.7 44.7 Total sugars 99.8 g/day 88.6 g/day 20.0 15.7 Total fat 73.5 g/day 80.1 g/day 35.4 34.2 Saturated fat 31.6 g/day 29.8 g/day 15.2 12.7 Table. Selected food diary results from patients using CSII and MDI compared to reference nutrient intakes. Results showed mean energy intake was below the reference nutrient intake (RNI) for the CSII group; potentially suggestive of underreporting (Table)3. Patients using both CSII and MDI consumed protein above the RNI; however, this macronutrient contributed towards 14.8% of the daily energy intake of patients using CSII and 17.0% of those using MDI3. Total carbohydrate (CHO) consumption was below the RNI of 50%; however, it should be noted that consumption of total sugars was above the RNI for males and females in both groups4. Previous research by the authors suggesting habitual fruit consumption, particularly in those using CSII, may explain this5. Total fat and saturated fat consumption was mostly synonymic with RNI’s. Although no statistically significant associations were seen between any of the variables and the diets of the two populations appeared largely homogenous it is reassuring that no detrimental changes occurred. Despite this further analysis of total energy, protein and CHO quality is warranted

Spin-dependent (magneto)transport through a ring due to spin-orbit interaction

Electron transport through a one-dimensional ring connected with two external leads, in the presence of spin-orbit interaction (SOI) of strength \alpha and a perpendicular magnetic field is studied. Applying Griffith's boundary conditions we derive analytic expressions for the reflection and transmission coefficients of the corresponding one-electron scattering problem. We generalize earlier conductance results by Nitta et al. [Appl. Phys. Lett. 75, 695 (1999)] and investigate the influence of \alpha, temperature, and a weak magnetic field on the conductance. Varying \alpha and temperature changes the position of the minima and maxima of the magnetic-field dependent conductance, and it may even convert a maximum into a minimum and vice versa.Comment: 19 pages, 9 figure

Orbital effect of in-plane magnetic field on quantum transport in chaotic lateral dots

We show how the in-plane magnetic field, which breaks time-reversal and rotational symmetries of the orbital motion of electrons in a heterostructure due to the momentum-dependent inter-subband mixing, affects weak localisation correction to conductance of a large-area chaotic lateral quantum dot and parameteric dependences of universal conductance fluctuations in it.Comment: 4 pages with a figur

Low density lipoprotein quality and discordance with apolipoprotein B in intensively controlled Type 1 diabetes: Any relationship with nutrition?

Type 1 diabetes (T1D) is partly characterised by a higher prevalence of cardiovascular disease (CVD). Despite low density lipoprotein cholesterol (LDL-C) being a commonly treated target, apolipoprotein B (Apo B) has been shown to be a superior predictor of CVD and discordance between these two markers may predispose patients to altered risk(1). The distribution of LDL-C also contributes to these risks, with LDL III & IV fractions possessing greater atherogenic potential(2). Few studies have investigated LDL-C quality and its discordance with Apo B in relation to the nutritional intake of patients with intensively controlled Type 1 diabetes. The aim of this study was to address this dearth of research. Following ethical approval and informed consent 28 patients (32 % male; 68 % female) (mean age 48 ± 15) were asked to complete a food frequency questionnaire (FFQ), donate a sample of blood and allow the authors access to their medical records to determine HbA1c. The initial FFQ responses were processed using FETA software. The blood sample was analysed for LDL-C, constituent subfractions and Apo B. All data were interrogated using descriptive statistics. Dichotomous dependent variables pertaining to LDL-C and Apo B were compared using McNemar’s test and correlations between dietary variables were determined with Spearman’s rho test. Significant differences were shown between LDL-C categories when compared to Apo B (p = 0·039) and the majority of patients (46·4 %) presented LDL-C >2·0 mmol/L and Apo B >80 mg/dL (Fig. 1). Although not discordant, these findings still suggest an increased risk according to recommendations(3). Closer inspection of results revealed that individuals with raised LDL-C typically had an abundance of LDL I & II fractions which may somewhat reduce this risk (Fig. 2). Spearman’s correlation applied to the whole population produced no relationship between diet and LDL-C or Apo B; however, when focussing on the predominant ‘at risk’ cluster significant and strong relationships between LDL-C and total carbohydrate (R2 = 0·835; p = <0·001) and sucrose (R2 = 0·758; p = 0·003) were found. No hypoglycaemia data were collected and the authors tentatively speculate that these relationships may be a consequence of its treatment. In the light of the small sample size a further more comprehensive investigation with an appropriately powered sample would be beneficial

An investigation into the eating behaviours of adult patients with Type 1 diabetes using continuous subcutaneous insulin infusion therapy compared to those using multiple daily injections

Multiple daily injections (MDI) are an intensive method of administering an external source of basal and bolus insulin for patients with Type 1 diabetes (T1D). This therapy requires 4-5 injections per day, is regarded as an effective method of achieving glycaemic control and is commonly used. If HbA1c remains above 8.5% or if a patient is experiencing disabling hypoglycaemic episodes continuous subcutaneous insulin infusion (CSII) therapy may be recommended1. CSII provides flexible insulin administration via a small, electronic pump unit and has been associated with various benefits when compared to MDI, including increased glycaemic control, reduced occurrence of hypoglycaemia and improvements in the dawn phenomenon1,2. Furthermore, the flexible nature of CSII potentially allows patients to enjoy a liberalised diet compared to those using the relatively structured MDI regime2. There is a dearth of evidence focussing on the eating behaviours of these patients and research into this area would be useful to inform both treatment and the evaluation of risk. Following ethical approval and informed consent patients with T1D using either CSII or MDI from the Royal Liverpool Hospital were asked to complete an EPIC-Norfolk food frequency questionnaire (FFQ). Responses were processed using FETA software and demographic data from participants’ medical records were added. All data were initially analysed using descriptive statistics. Any data not normally distributed were transformed logarithmically and t-tests and Mann-Whitney-U-tests were then carried out. The study population consisted of 60 patients (33.3% male, 66.7% female) with 40 using CSII and 20 using MDI and a mean age of 48±16 years. The majority of patients were overweight or obese (71.4% CSII, 57.1% MDI), however energy intake was below the reference nutrient intake (RNI) for both CSII and MDI groups. Patients using both CSII and MDI consumed protein above the RNI for males and females3. Despite this protein contributed towards 18.6% of the daily energy intake of patients using CSII and 19.0% of those using MDI. Total carbohydrate (CHO) consumption was below the RNI of 50%, however it should be noted that consumption of total sugars was above the RNI for males and females in both groups. This may be partly explained by the consumption of fruit which was also higher in those using CSII. Total fat and saturated fat consumption was marginally above the RNI’s. There were no statistically significant associations between any variables and the diets of the two populations appear largely homogenous, despite slight deviations of some nutrients from RNI’s. Further analysis of total energy, protein and CHO quality is warranted

UV-written Bragg gratings in a flat-fiber platform as a bending and twisting sensor

High demand on structural health monitoring has encouraged the development of smart structure geometries to be more effective and competitive [1]. One of the technologies that has been integrated into these structures is the fiber Bragg grating (FBG) [2]. The FBG is a mature technology that has seen many applications, particularly the field of sensing where it has many advantages such as immunity to electromagnetic field, long lifetime, high sensitivity, lightweight and low loss. There are several types of optically based physical sensors. Most of which are fabricated in a standard dimension silica optical fiber which due to its cylindrical structure are unable to independently measure twist. Here we demonstrate a bending and twist sensor fabricated in a flat-fiber substrate. A Y-splitter and a series of Bragg gratings along the 50 mm length provides a differential signal providing distinction between bend and twist within the sample

Meat, fish, and ovarian cancer risk: Results from 2 Australian case-control studies, a systematic review, and meta-analysis

Background: Variation in meat and fish intakes has been associated with a risk of some cancers, but evidence for ovarian cancer is limited and inconsistent. Objective: We examined the association between intakes of total meat, red meat, processed meat, poultry, and fish and ovarian cancer risk. Design: Data came from 2 Australian population-based case-control studies conducted 10 y apart. Analyses included a total of 2049 cases and 2191 control subjects. We obtained dietary information via a food-frequency questionnaire. We estimated multivariable-adjusted odds ratios (ORs) for each study by using logistic regression and combined results of the 2 studies by using random-effects models. We also assembled the published evidence in a systematic review and meta-analysis. Results: Although there was no association between total or red meat intake and ovarian cancer risk, women with the highest intake of processed meat had a significantly increased risk of ovarian cancer in the 2 case-control studies (combined OR: 1.18; 95 CI: 1.15, 1.21) and the meta-analysis 7 studies; pooled relative risk (RR): 1.20; 95% CI: 1.07, 1.34. In contrast, a frequent intake of poultry was associated with borderline significant reductions in risk in the 2 case-control studies (combined OR: 0.83; 95% CI: 0.67, 1.03) and the meta-analysis including 7 additional studies (pooled RR: 0.90; 95% CI: 0.79, 1.01). High fish intake was associated with a significantly reduced risk in the 2 case-control studies (combined OR: 0.76; 95% CI: 0.62, 0.94) and a smaller borderline significant reduction in the meta-analysis (6 additional studies; pooled RR: 0.84; 95% CI: 0.68, 1.03). Conclusion: Our results suggest that low consumption of processed meat and higher consumption of poultry and fish may reduce the risk of ovarian cancer. © 2010 American Society for Nutrition