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1.
Med Educ ; 50(12): 1211-1213, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27873403

RESUMEN

The development of verbal communication skills is an important aspect of medical education as accurate assessment in part relies on effectively obtaining information from patients. When assessing children of different cultural or ethnic backgrounds, young medics may find effective verbal communication difficult because they lack understanding about what children are really like. Animal noises are a likely tool with which to successfully engage with young children. However, these differ by culture and it is unclear whether young New Zealand medical students will be adept at effectively engaging and communicating with foreign children via this mode of communication. We therefore assessed whether medical students in our country were able to accurately reproduce animal noises from different cultures. Six current medical students from New Zealand (with English as their first language) were assessed on their ability to reproduce animal noises from three different foreign languages: Dutch, Arabic and Danish. The animals selected were duck, cow, dog, frog, pig and sheep. Students were played recordings of the foreign-language animal noises, and were then rated on a scale of 1-5 (1 = poor, 5 = outstanding) on their ability to reproduce the noise. Arabic animal noises were reproduced more convincingly than those in the other languages (mean score: 3.8), of which animal noises in Danish were worst (mean score: 3.1). Perhaps unsurprisingly, sheep noises were reproduced best (mean score: 4.7), whereas pig noises were the least convincing (mean score: 2.2). Findings indicate that New Zealand medical students are likely to be better than average at reproducing animal noises in the languages examined, and are perhaps socially and genetically predisposed to replicating sheep noises successfully. They are therefore likely to make good paediatric registrars and fabulous au pairs. The study highlights the more serious issues of multicultural understanding and tolerance of other cultures, and provides a novel paediatric engagement tool for those young medics who do not really 'get' children.


Asunto(s)
Comparación Transcultural , Pediatría/métodos , Estudiantes de Medicina , Animales , Bovinos , Comunicación , Perros , Educación de Pregrado en Medicina , Humanos , Nueva Zelanda , Ovinos , Porcinos , Ingenio y Humor como Asunto
2.
BMC Public Health ; 15: 861, 2015 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-26341820

RESUMEN

BACKGROUND: Physical activity plays a critical role in health, including for effective weight maintenance, but adherence to guidelines is often poor. Similarly, although debate continues over whether a "best" diet exists for weight control, meta-analyses suggest little difference in outcomes between diets differing markedly in macronutrient composition, particularly over the longer-term. Thus a more important question is how best to encourage adherence to appropriate lifestyle change. While brief support is effective, it has on-going cost implications. While self-monitoring (weight, diet, physical activity) is a cornerstone of effective weight management, little formal evaluation of the role that self-monitoring technology can play in enhancing adherence to change has occurred to date. People who eat in response to hunger have improved weight control, yet how best to train individuals to recognise when true physical hunger occurs and to limit consumption to those times, requires further study. METHODS/DESIGN: SWIFT (Support strategies for Whole-food diets, Intermittent Fasting, and Training) is a two-year randomised controlled trial in 250 overweight (body mass index of 27 or greater) adults that will examine different ways of supporting people to make appropriate changes to diet and exercise habits for long-term weight control. Participants will be randomised to one of five intervention groups: control, brief support (monthly weigh-ins and meeting), app (use of MyFitnessPal with limited support), daily self-weighing (with brief monthly feedback), or hunger training (four-week programme which trains individuals to only eat when physically hungry) for 24 months. Outcome assessments include weight, waist circumference, body composition (dual-energy x-ray absorptiometry), inflammatory markers, blood lipids, adiponectin and ghrelin, blood pressure, diet (3-day diet records), physical activity (accelerometry) and aerobic fitness, and eating behaviour. SWIFT is powered to detect clinically important differences of 4 kg in body weight and 5 cm in waist circumference. Our pragmatic trial also allows participants to choose one of several dietary (Mediterranean, modified Paleo, intermittent fasting) and exercise (current recommendations, high-intensity interval training) approaches before being randomised to a support strategy. DISCUSSION: SWIFT will compare four different ways of supporting overweight adults to lose weight while following a diet and exercise plan of their choice, an aspect we believe will enhance adherence and thus success with weight management. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12615000010594. Registered 8th January 2015.


Asunto(s)
Estilo de Vida , Sobrepeso/terapia , Proyectos de Investigación , Absorciometría de Fotón , Adiponectina/sangre , Adulto , Australia , Presión Sanguínea , Índice de Masa Corporal , Peso Corporal , Pesos y Medidas Corporales , Dieta , Ejercicio Físico , Conducta Alimentaria , Femenino , Ghrelina/sangre , Humanos , Mediadores de Inflamación/sangre , Lípidos/sangre , Masculino , Persona de Mediana Edad , Aptitud Física , Circunferencia de la Cintura
3.
Crit Care Explor ; 3(3): e0368, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33786444

RESUMEN

OBJECTIVES: To explain and demonstrate a new approach for rapidly developing a decision-support tool for prioritizing patients with coronovirus 2019 disease for admission to ICUs. DESIGN: An expert group used multi-criteria decision analysis methods to specify criteria and weights, representing their relative importance, for prioritizing patients with coronovirus 2019 disease with respect to likely clinical benefit. Specialized multi-criteria decision analysis software, implementing the "Potentially All Pairwise RanKings of all possible Alternatives" method to determine the weights, was used. Social equity considerations for prioritizing patients were also identified as important. SETTING: The prioritization tool was developed in New Zealand. SUBJECTS: An expert group comprising specialists from intensive care medicine and nursing, Maori (New Zealand's indigenous population) health, infectious diseases, and neonatology was formed. The group's work was supported by health economists and decision analysts and overseen by an ethicist and a senior representative from the New Zealand Ministry of Health. INTERVENTIONS: Multi-criteria decision analysis to create a prioritization tool. MEASUREMENTS AND MAIN RESULTS: The prioritization tool comprised eight criteria with respect to likely clinical benefit. In decreasing order of importance (weights in parentheses): Sequential Organ Failure Assessment score (15.7%), preexisting cardiovascular conditions (15.7%), functional capacity (15.7%), age (12.4%), preexisting respiratory conditions (11.1%), immunocompromised (11.1%), body mass index (9.2%), and other relevant medical conditions (9.2%). Two social equity considerations were also included in the overarching decision framework to be used alongside the clinical criteria: prioritizing Maori and Pacific people (and, potentially, other at-risk groups), and healthcare and other frontline workers. CONCLUSIONS: The criteria and weights in the prioritization tool can be easily revised as new evidence emerges. The approach for developing the tool could be used in other countries whose ICUs are at risk of being overwhelmed by the coronavirus disease 2019 pandemic to rapidly develop their own prioritization tools. In the event that future crises threaten to overload ICUs, other prioritization tools could also be rapidly developed.

4.
Am J Clin Nutr ; 111(3): 503-514, 2020 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-31879752

RESUMEN

BACKGROUND: Intermittent fasting (IF) and Paleolithic (Paleo) diets produce weight loss in controlled trials, but minimal evidence exists regarding long-term efficacy under free-living conditions without intense dietetic support. OBJECTIVES: This exploratory, observational analysis examined adherence, dietary intake, weight loss, and metabolic outcomes in overweight adults who could choose to follow Mediterranean, IF, or Paleo diets, and standard exercise or high-intensity interval training (HIIT) programs, as part of a 12-mo randomized controlled trial investigating how different monitoring strategies influenced weight loss (control, daily self-weighing, hunger training, diet/exercise app, brief support). METHODS: A total of 250 overweight [BMI (in kg/m2) ≥27] healthy adults attended an individualized dietary education session (30 min) relevant to their self-selected diet. Dietary intake (3-d weighed diet records), weight, body composition, blood pressure, physical activity (0, 6, and 12 mo), and blood indexes (0 and 12 mo) were assessed. Mean (95% CI) changes from baseline were estimated using regression models. No correction was made for multiple tests. RESULTS: Although 54.4% chose IF, 27.2% Mediterranean, and 18.4% Paleo diets originally, only 54% (IF), 57% (Mediterranean), and 35% (Paleo) participants were still following their chosen diet at 12 mo (self-reported). At 12 mo, weight loss was -4.0 kg (95% CI: -5.1, -2.8 kg) in IF, -2.8 kg (-4.4, -1.2 kg) in Mediterranean, and -1.8 kg (-4.0, 0.5 kg) in Paleo participants. Sensitivity analyses showed that, due to substantial dropout, these may be overestimated by ≤1.2 kg, whereas diet adherence increased mean weight loss by 1.1, 1.8, and 0.3 kg, respectively. Reduced systolic blood pressure was observed with IF (-4.9 mm Hg;  -7.2, -2.6 mm Hg) and Mediterranean (-5.9 mm Hg; -9.0, -2.7 mm Hg) diets, and reduced glycated hemoglobin with the Mediterranean diet (-0.8 mmol/mol; -1.2, -0.4 mmol/mol). However, the between-group differences in most outcomes were not significant and these comparisons may be confounded due to the nonrandomized design. CONCLUSIONS: Small differences in metabolic outcomes were apparent in participants following self-selected diets without intensive ongoing dietary support, even though dietary adherence declined rapidly. However, results should be interpreted with caution given the exploratory nature of analyses. This trial was registered with the Australian New Zealand Clinical Trials Registry as ACTRN12615000010594 at https://www.anzctr.org.au.


Asunto(s)
Dieta Mediterránea , Dieta Paleolítica , Terapia por Ejercicio , Sobrepeso/dietoterapia , Adulto , Australia , Presión Sanguínea , Ejercicio Físico , Ayuno/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sobrepeso/fisiopatología , Sobrepeso/terapia , Pérdida de Peso , Adulto Joven
5.
Pediatr Obes ; 15(9): e12650, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32372572

RESUMEN

BACKGROUND: Although sleep duration is a risk factor for obesity in young children, less is known about other aspects of sleep health, including bedtime, on obesity risk. OBJECTIVE: To determine whether bedtime is associated with body mass index (BMI) z-score or obesity risk in children ages 2 to 5 years, and to determine if associations are independent of sleep duration. METHODS: Cohort analyses were undertaken using three early life obesity prevention trials (POI, INSIGHT, Healthy Beginnings) and a longitudinal cohort study (HOME). Bedtime was assessed by questionnaire and BMI through clinical measurement between 2 and 5 years in 1642 children. Adjusted regression models examined whether BMI z-score and obesity (BMI z-score ≥ 2) were associated with bedtime, nocturnal sleep time and 24-hour sleep time. A discrete mixture model categorized children into bedtime trajectory groups across time points. RESULTS: Bedtime was inconsistently associated with BMI z-score. Although each hour later of bedtime was associated with greater odds of obesity at ages 3 (OR; 95% CI: 1.05; 1.003, 1.10) and 5 (1.35; 1.08, 1.69) years, odds were attenuated after adjustment for nocturnal or 24-hour sleep time. Longer nocturnal sleep duration at 2 years was associated with lower odds of obesity (OR 0.90; 0.86, 0.94), as was longer 24-hour sleep duration at 3 years in girls (0.70; 0.62, 0.78). BMI z-score and odds of obesity were not significantly different between 'early to bed' and 'late to bed' trajectory groups. CONCLUSIONS: Timing of bedtime appears inconsistently related to obesity in young children, possibly via influencing overall sleep duration.


Asunto(s)
Índice de Masa Corporal , Obesidad Infantil/epidemiología , Sueño , Preescolar , Femenino , Humanos , Estudios Longitudinales , Masculino , Oportunidad Relativa , Obesidad Infantil/prevención & control , Factores de Riesgo , Encuestas y Cuestionarios , Factores de Tiempo
7.
Med Sci Sports Exerc ; 50(9): 1818-1826, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-29683919

RESUMEN

PURPOSE: Although high-intensity interval training (HIIT) and moderate-intensity continuous exercise have comparable health outcomes in the laboratory setting, effectiveness studies in real-world environments are lacking. The aim of this study was to determine the effectiveness of an unsupervised HIIT program in overweight/obese adults over 12 months. METHODS: Two hundred and fifty overweight/obese adults could choose HIIT or current exercise guidelines of 30 min·d moderate-intensity exercise. HIIT participants received a single training session and were advised to independently perform HIIT three times per week using a variety of protocols. Mixed models, with a random effect for participant, compared differences in weight, body composition, blood pressure, aerobic fitness, physical activity, and blood indices at 12 months, adjusting for relevant baseline variables. RESULTS: Forty-two percent (n = 104) of eligible participants chose HIIT in preference to current guidelines. At 12 months, there were no differences between exercise groups in weight (adjusted difference HIIT vs conventional = -0.44 kg; 95% confidence interval [CI] = -2.5 to 1.6) or visceral fat (-103 cm; -256 to 49), although HIIT participants reported greater enjoyment of physical activity (P = 0.01). Evidence of adherence to ≥2 sessions per week of unsupervised HIIT (from HR monitoring) declined from 60.8% at baseline to 19.6% by 12 months. Participants remaining adherent to HIIT over 12 months (23%) were more likely to be male (67% vs 36%, P = 0.03), with greater reductions in weight (-2.7 kg; -5.2 to 0.2) and visceral fat (-292 cm; -483 to -101) than nonadherent participants. CONCLUSIONS: HIIT was well accepted by overweight adults, and opting for HIIT as an alternative to standard exercise recommendations led to no difference in health outcomes after 12 months. Although regular participation in unsupervised HIIT declined rapidly, those apparently adherent to regular HIIT demonstrated beneficial weight loss and visceral fat reduction. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12615000010594), retrospectively registered.


Asunto(s)
Entrenamiento de Intervalos de Alta Intensidad , Obesidad/terapia , Sobrepeso/terapia , Adulto , Presión Sanguínea , Composición Corporal , Peso Corporal , Ejercicio Físico , Femenino , Humanos , Grasa Intraabdominal , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Pérdida de Peso
8.
Nutrients ; 9(11)2017 Nov 17.
Artículo en Inglés | MEDLINE | ID: mdl-29149038

RESUMEN

Monitoring blood glucose prior to eating can teach individuals to eat only when truly hungry, but how adherence to 'hunger training' influences weight loss and eating behaviour is uncertain. This exploratory, secondary analysis from a larger randomized controlled trial examined five indices of adherence to 'hunger training', chosen a priori, to examine which adherence measure best predicted weight loss over 6 months. We subsequently explored how the best measure of adherence influenced eating behavior in terms of intuitive and emotional eating. Retention was 72% (n = 36/50) at 6 months. Frequency of hunger training booklet entry most strongly predicted weight loss, followed by frequency of blood glucose measurements. Participants who completed at least 60 days of booklet entry (of recommended 63 days) lost 6.8 kg (95% CI: 2.6, 11.0; p < 0.001) more weight than those who completed fewer days. They also had significantly higher intuitive eating scores than those who completed 30 days or less of booklet entry; a difference (95% CI) of 0.73 (0.12, 1.35) in body-food choice congruence and 0.79 (0.06, 1.51) for eating for physical rather than emotional reasons. Adherent participants also reported significantly lower scores for emotional eating of -0.70 (-1.13, -0.27). Following hunger training and focusing on simply recording ratings of hunger on a regular basis can produce clinically significant weight loss and clinically relevant improvements in eating behaviour.


Asunto(s)
Conducta Alimentaria , Hambre , Pérdida de Peso , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad
9.
Obesity (Silver Spring) ; 25(9): 1490-1498, 2017 09.
Artículo en Inglés | MEDLINE | ID: mdl-28703448

RESUMEN

OBJECTIVE: To determine the effectiveness of various monitoring strategies on weight loss, body composition, blood markers, exercise, and psychosocial indices in adults with overweight and obesity following a 12-month weight loss program. METHODS: Two hundred fifty adults with BMI ≥ 27 were randomized to brief, monthly, individual consults, daily self-monitoring of weight, self-monitoring of diet using MyFitnessPal, self-monitoring of hunger, or control over 12 months. All groups received diet and exercise advice, and 171 participants (68.4%) remained at 12 months. RESULTS: No significant differences in weight, body composition, blood markers, exercise, or eating behavior were apparent between those in the four monitoring groups and the control condition at 12 months (all P ≥ 0.053). Weight differences between groups ranged from -1.1 kg (-3.8 to 1.6) to 2.2 kg (-1.0 to 5.3). However, brief support and hunger training groups reported significantly lower scores for depression (difference [95% CI]: -3.16 [-5.70 to -0.62] and -3.05 [-5.61 to -0.50], respectively) and anxiety (-1.84, [-3.67 to -0.02]) scores than control participants. CONCLUSIONS: Although adding a monitoring strategy to diet and exercise advice did not further increase weight loss, no adverse effects on eating behavior were observed, and some monitoring strategies may even benefit mental health.


Asunto(s)
Sobrepeso/terapia , Pérdida de Peso , Programas de Reducción de Peso/métodos , Adulto , Ansiedad , Composición Corporal , Índice de Masa Corporal , Peso Corporal , Consejo , Depresión , Dieta , Ejercicio Físico , Conducta Alimentaria , Femenino , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Obesidad/terapia
10.
Med Sci Sports Exerc ; 51(2): 390, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30649096
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