Role of Eating Behavior and Stress in Maintenance of Dietary Changes During the PREVIEW Intervention.

OBJECTIVE: To examine whether eating behavior and perceived stress predict the maintenance of self-reported dietary change and adherence to dietary instructions during an intervention. DESIGN: A secondary analysis of the behavior maintenance stage (6-36 months) of the 3-year PREVIEW intervention (PREVention of diabetes through lifestyle Intervention and population studies in Europe and around the World). PARTICIPANTS: Adults (n = 1,311) with overweight and prediabetes at preintervention baseline. VARIABLES MEASURED: Eating behavior (Three-Factor Eating Questionnaire), stress (Perceived Stress Scale), and dietary intake (4-day food records on 4 occasions) were reported. ANALYSIS: Associations between predictors and dietary outcomes were examined with linear mixed-effects models for repeated measurements. RESULTS: Eating behaviors and stress at 6 months did not predict the subsequent change in dietary outcomes, but higher cognitive restraint predicted lower energy intake, and both higher disinhibition and hunger predicted higher energy intake during the following behavior maintenance stage. In addition, higher disinhibition predicted higher saturated fat intake and lower fiber intake, and higher hunger predicted lower fiber intake. Stress was not associated with energy intake or dietary quality. Eating behaviors and stress were not consistently associated with adherence to dietary instructions. CONCLUSIONS AND IMPLICATIONS: Higher cognitive restraint predicted lower energy intake (food quantity), but disinhibition and hunger were also associated with dietary quality.

Longitudinal Associations of Dietary Sugars and Glycaemic Index with Indices of Glucose Metabolism and Body Fatness during 3-Year Weight Loss Maintenance: A PREVIEW Sub-Study.

BACKGROUND: Dietary sugars are often linked to the development of overweight and type 2 diabetes (T2D) but inconsistencies remain. OBJECTIVE: We investigated associations of added, free, and total sugars, and glycaemic index (GI) with indices of glucose metabolism (IGM) and indices of body fatness (IBF) during a 3-year weight loss maintenance intervention. DESIGN: The PREVIEW (PREVention of diabetes through lifestyle Intervention and population studies in Europe and around the World) study was a randomised controlled trial designed to test the effects of four diet and physical activity interventions, after an 8-week weight-loss period, on the incidence of T2D. This secondary observational analysis included pooled data assessed at baseline (8), 26, 52, 104 and 156 weeks from 514 participants with overweight/obesity (age 25-70 year; BMI ≥ 25 kg⋅m-2) and with/without prediabetes in centres that provided data on added sugars (Sydney and Helsinki) or free sugars (Nottingham). Linear mixed models with repeated measures were applied for IBF (total body fat, BMI, waist circumference) and for IGM (fasting insulin, HbA1c, fasting glucose, C-peptide). Model A was adjusted for age and intervention centre and Model B additionally adjusted for energy, protein, fibre, and saturated fat. RESULTS: Total sugars were inversely associated with fasting insulin and C-peptide in all centres, and free sugars were inversely associated with fasting glucose and HbA1c (Model B: all p < 0.05). Positive associations were observed between GI and IGM (Model B: fasting insulin, HbA1c, and C-peptide: (all p < 0.01), but not for added sugars. Added sugar was positively associated with body fat percentage and BMI, and GI was associated with waist circumference (Model B: all p < 0.01), while free sugars showed no associations (Model B: p > 0.05). CONCLUSIONS: Our findings suggest that added sugars and GI were independently associated with 3-y weight regain, but only GI was associated with 3-y changes in glucose metabolism in individuals at high risk of T2D.

The effect of the right care, right place, right time (R3) initiative on Medicare health service use among older affordable housing residents.

OBJECTIVE: To determine the effect of an affordable housing-based supportive services intervention, which partnered with health and community service providers, on Medicare health service use among residents. DATA SOURCES: Analyses used aggregated fee-for-service Medicare claims data from 2017 to 2020 for beneficiaries living in 34 buildings in eastern Massachusetts. STUDY DESIGN: Using a quasi-experimental design, a "difference-in-differences" framework was employed to isolate changes in outcomes, focusing on changes in pre- and post-intervention health service use across two stages of the intervention. Phase 1 encompassed the initial implementation period, and Phase 2 introduced a strategy to target residents at high risk of poor health outcomes. Key health service outcomes included hospitalizations, 30-day hospital readmission, and emergency department use. DATA COLLECTION: Medicare claims data for 10,412 individuals were obtained from a Quality Improvement Organization and aggregated at the building level. PRINCIPAL FINDINGS: Analyses for Phase 1 found that hospital admission rates, emergency department admissions and payments, and hospital readmission rates grew more slowly for intervention sites than comparison sites. These findings were strengthened after the introduction of risk-targeting in Phase 2. Compared to selected control buildings, residents in intervention buildings experienced significantly lower rates of increases in inpatient hospitalization rates (-16% vs. +6%), hospital admission days (-25% vs. +29%), average hospital days (-12% vs. +14%), hospital admission payments (-22% vs. +33%), and 30-day hospital readmission rates (-22% vs. +54%). When accounting for the older age of the intervention residents, the size of the decline recorded in emergency department admissions was 6.7% greater for the intervention sites than the decline in comparison sites. CONCLUSIONS: A wellness-focused supportive services intervention was effective in reducing select health service use. The introduction of risk-targeting further strengthened this effect. Age-friendly health systems would benefit from enhanced partnerships with affordable housing sites to improve care and reduce service use for older residents.

Associations of quantity and quality of carbohydrate sources with subjective appetite sensations during 3-year weight-loss maintenance: Results from the PREVIEW intervention study.

BACKGROUND & AIMS: The association of quantity and quality of carbohydrate sources with appetite during long-term weight-loss maintenance (WLM) after intentional weight loss (WL) is unclear. We aimed to investigate longitudinal associations of quantity and quality of carbohydrate sources with changes in subjective appetite sensations during WLM. METHODS: This secondary analysis evaluated longitudinal data from the 3-year WLM phase of the PREVIEW study, a 2 × 2 factorial (diet-physical activity arms), multi-center, randomized trial. 1279 individuals with overweight or obesity and prediabetes (25-70 years; BMI≥25 kg m-2) were included. Individuals were merged into 1 group to assess longitudinal associations of yearly changes in appetite sensations. Quantity and quality of carbohydrate sources including total carbohydrate, glycemic index (GI), glycemic load (GL), and total dietary fiber were assessed via 4-day food diaries at 4 timepoints (26, 52, 104, and 156 weeks) during WLM. Visual analog scales were used to assess appetite sensations in the previous week. RESULTS: During WLM, participants consumed on average 160.6 (25th, 75th percentiles 131.1, 195.8) g·day-1 of total carbohydrate, with GI 53.8 (48.7, 58.8) and GL 85.3 (67.2, 108.9) g day-1, and 22.3 (17.6, 27.3) g·day-1 of dietary fiber. In the available-case analysis, multivariable-adjusted linear mixed models with repeated measures showed that each 30-g increment in total carbohydrate was associated with increases in hunger (1.36 mm year-1, 95% CI 0.77, 1.95, P < 0.001), desire to eat (1.10 mm year-1, 0.59, 1.60, P < 0.001), desire to eat something sweet (0.99 mm year-1, 0.30, 1.68, P = 0.005), and weight regain (0.20%·year-1, 0.03, 0.36, P = 0.022). Increasing GI was associated with weight regain, but not associated with increases in appetite sensations. Each 20-unit increment in GL was associated with increases in hunger (0.92 mm year-1, 0.33, 1.51, P = 0.002), desire to eat (1.12 mm year-1, 0.62, 1.62, P < 0.001), desire to eat something sweet (1.13 mm year-1, 0.44, 1.81, P < 0.001), and weight regain (0.35%·year-1, 0.18, 0.52, P < 0.001). Surprisingly, dietary fiber was also associated with increases in desire to eat, after adjustment for carbohydrate or GL. CONCLUSIONS: In participants with moderate carbohydrate and dietary fiber intake, and low to moderate GI, we found that higher total carbohydrate, GL, and total fiber, but not GI, were associated with increases in subjective desire to eat or hunger over 3 years. This study was registered as ClinicalTrials.gov, NCT01777893.

Factors that potentially influence successful weight loss for adults with intellectual disabilities: A qualitative comparison.

BACKGROUND: People with intellectual disabilities are more at risk of obesity than the general population. Emerging literature indicates that multicomponent interventions are most effective, however, individual results are variable and little research exists as to why this is the case. METHODS: Focus groups were conducted to explore lived experiences between two groups of adults with intellectual disabilities; an overweight group (n = 6) and a group identified as successful in losing weight (n = 6). Similarities and differences were explored across four domains. Transcripts were produced and analysed using Theoretical Thematic Analysis. RESULTS: Similarities included service centre supports, basic food knowledge and issues restricting independence. The successful weight loss group had also internalised health messages, engaged with external reinforcement programmes, responded to positive feedback and demonstrated healthier dietary habits. CONCLUSION: Weight management interventions would benefit from understanding the influence that internalisation of health messages, effective reinforcement systems and positive feedback can have on supporting the adoption of healthier habits.

The PREVIEW intervention study: Results from a 3-year randomized 2 x 2 factorial multinational trial investigating the role of protein, glycaemic index and physical activity for prevention of type 2 diabetes.

AIM: To compare the impact of two long-term weight-maintenance diets, a high protein (HP) and low glycaemic index (GI) diet versus a moderate protein (MP) and moderate GI diet, combined with either high intensity (HI) or moderate intensity physical activity (PA), on the incidence of type 2 diabetes (T2D) after rapid weight loss. MATERIALS AND METHODS: A 3-year multicentre randomized trial in eight countries using a 2 x 2 diet-by-PA factorial design was conducted. Eight-week weight reduction was followed by a 3-year randomized weight-maintenance phase. In total, 2326 adults (age 25-70 years, body mass index ≥ 25 kg/m2 ) with prediabetes were enrolled. The primary endpoint was 3-year incidence of T2D analysed by diet treatment. Secondary outcomes included glucose, insulin, HbA1c and body weight. RESULTS: The total number of T2D cases was 62 and the cumulative incidence rate was 3.1%, with no significant differences between the two diets, PA or their combination. T2D incidence was similar across intervention centres, irrespective of attrition. Significantly fewer participants achieved normoglycaemia in the HP compared with the MP group (P < .0001). At 3 years, normoglycaemia was lowest in HP-HI (11.9%) compared with the other three groups (20.0%-21.0%, P < .05). There were no group differences in body weight change (-11% after 8-week weight reduction; -5% after 3-year weight maintenance) or in other secondary outcomes. CONCLUSIONS: Three-year incidence of T2D was much lower than predicted and did not differ between diets, PA or their combination. Maintaining the target intakes of protein and GI over 3 years was difficult, but the overall protocol combining weight loss, healthy eating and PA was successful in markedly reducing the risk of T2D. This is an important clinically relevant outcome.

The effect of fake tan on hand hygiene practice.

Hand hygiene is the single most important measure in reducing the spread of infection. The aim of this study was to assess the uptake of fake tan in nursing students and evaluate the impact of wearing fake tan on hand hygiene training lotion removal during handwashing with soap and water. Of the 217 participants recruited, 21% wore fake tan. Statistical analysis revealed no significant difference between fake tan and non-fake tan wearers. Consequentially, no guidelines regarding the wearing of fake tan in clinical practice are currently required.

The Effect of Normobaric Hypoxic Confinement on Metabolism, Gut Hormones, and Body Composition.

To assess the effect of normobaric hypoxia on metabolism, gut hormones, and body composition, 11 normal weight, aerobically trained (O2peak: 60.6 ± 9.5 ml·kg(-1)·min(-1)) men (73.0 ± 7.7 kg; 23.7 ± 4.0 years, BMI 22.2 ± 2.4 kg·m(-2)) were confined to a normobaric (altitude ≃ 940 m) normoxic (NORMOXIA; PIO2 ≃ 133.2 mmHg) or normobaric hypoxic (HYPOXIA; PIO was reduced from 105.6 to 97.7 mmHg over 10 days) environment for 10 days in a randomized cross-over design. The wash-out period between confinements was 3 weeks. During each 10-day period, subjects avoided strenuous physical activity and were under continuous nutritional control. Before, and at the end of each exposure, subjects completed a meal tolerance test (MTT), during which blood glucose, insulin, GLP-1, ghrelin, peptide-YY, adrenaline, noradrenaline, leptin, and gastro-intestinal blood flow and appetite sensations were measured. There was no significant change in body weight in either of the confinements (NORMOXIA: -0.7 ± 0.2 kg; HYPOXIA: -0.9 ± 0.2 kg), but a significant increase in fat mass in NORMOXIA (0.23 ± 0.45 kg), but not in HYPOXIA (0.08 ± 0.08 kg). HYPOXIA confinement increased fasting noradrenaline and decreased energy intake, the latter most likely associated with increased fasting leptin. The majority of all other measured variables/responses were similar in NORMOXIA and HYPOXIA. To conclude, normobaric hypoxic confinement without exercise training results in negative energy balance due to primarily reduced energy intake.

Developing professional identity in nursing academics: the role of communities of practice.

This paper analyses the current standing of nursing within the wider United Kingdom (UK) higher education (HE) environment and considers the development of academic identity within the sector, introducing a technology mediated approach to professional learning and development. A community of practice (CoP) is a way of learning based on collaboration among peers. Individuals come together virtually or physically, with a common purpose, defined by knowledge rather than task [Wenger, E., 1998. Communities of Practice: Learning, Meaning and Identity, sixth ed. Cambridge University Press, Cambridge]. In 2008, a small team of academics at Glasgow Caledonian University, School of Nursing, Midwifery and Community Health created and implemented iCoP, a project undertaken to pilot an international CoP, where novices and expert academics collaborated to debate and discuss the complex transition from clinician to academic. Although not intended as a conventional research project, the developmental journey and emerging online discussion provide an insight into the collective thoughts and opinions of a multi-national group of novice academics. The article also highlights the key challenges, problems and limitations of working in an international online arena with professionals who traditionally work and thrive in a face to face, real time environment.

Nurse-Physician Collaborative Partnership: a rural model for the chronically ill.

INTRODUCTION: Accessibility and quality of primary health care services in rural areas are challenging issues, particularly for the elderly and those with chronic or complex medical conditions. The objective of the Nurse-Physician Collaborative Partnership was to implement and evaluate a collaborative partnership between homecare nurses and family physicians in the rural Trochu-Delburne-Elnora area of Alberta. METHODS: Overall, 37 patients were enrolled in a shared care plan, which included comprehensive biopsychosocial assessment, early intervention, health education and self-management. Patient and provider outcomes were assessed using quantitative and qualitative data collected at baseline, 6 months and 12 months. RESULTS: Results showed that patients made improvements in activities of daily living and robust cognitive status. In interviews, patients reported improvements in psychological well-being, knowledge of disease processes and confidence to manage health issues. Patients' use of acute health care services decreased, showing a 51% reduction in the number of days in hospital, a 32% reduction in emergency department visits and a 25% reduction in hospital admissions. Total acute service costs, excluding program costs, decreased by 40% from an average of $15,485 to $9,313 per person (p < or = 0.05). CONCLUSION: Based on these results, policy initiatives that incorporate the shared care model developed in this project may be considered. To our knowledge, this type of evaluation has not previously been conducted in a rural Canadian setting.

Calgary Diversion Program: A Community-based Alternative to Incarceration for Mentally Ill Offenders.

BACKGROUND: The management of mentally ill people committing minor criminal offences has been a social concern in Canada for more than thirty years. Processing of these individuals through the Justice system results in a well-known 'revolving door' syndrome. One approach to this problem is the diversion of these offenders from the Justice system to the network of health and social services that can address their overall well-being. A lack of empirical evidence on diversion programs has been identified as a main roadblock to their acceptance. AIMS OF THE STUDY: To describe outcomes and service utilization of clients using the Calgary Diversion Program, a community-based alternative to incarceration for persons with serious mental disorders who commit minor offences. METHODS: The study employed mixed quantitative and qualitative methods, and used a quasi-experimental design with the clients serving as their own controls. The Calgary Diversion Program was formed in 2002, with this study spanning client enrollment (n=179) from 2002-2003. RESULTS: Before to after program enrolment comparisons found justice system complaints, charges and court appearances to have been reduced between 84% and 91% in those clients that participated successfully in the program, while at the same time found reductions of between 25% and 48% of acute services. Both quantitative and qualitative results indicated a high degree of satisfaction on the part of both providers and clients. Statistically significant improvement in the Brief Psychiatric Rating Scale values between baseline and three months after program entry were observed, while quality of life measurement showed statistically significant improvements in six of nine indicators. Acute health care and justice system costs were compared for the nine months prior to referral and the nine months following referral, with an average reduction in total costs of CAD 1,721 per client. DISCUSSION: The findings presented in this paper are the first significant contribution to empirical research on diversion programs in Canada. The study suggests improved outcomes, support from clients and providers, and reduced overall costs. However, the nature of the study design limits firm conclusions to be made. Longer term follow-up is a key area for future research. IMPLICATION FOR HEALTH POLICIES: This results identified through the study, as well as the accompanying information on the Calgary program's implementation and functioning, are an important building block in moving towards a strategy to address a long-standing social concern. In an era of cost-consciousness, policy makers need to consider programs that not only have the opportunity to improve patient outcomes, but as well show promise in reducing health and other social service costs.