Weight assessment and the provision of weight management advice in primary care: a cross-sectional survey of self-reported practice among general practitioners and practice nurses in the United Kingdom.

BACKGROUND: Although primary care settings provide a large-scale and high-reach opportunity for weight management and obesity prevention, the proportion of adults in the United Kingdom (UK) who report receiving weight management advice is limited. This study examines the self-reported frequency of assessing weight and providing weight management advice by General Practitioners (GPs) and Practice Nurses (PNs) working in primary care in the UK, and differences by practitioner characteristics. METHODS: Cross-sectional survey with GPs and PNs in the UK (n = 2020), conducted January-March 2017. A mock consultation exercise assessed what factors led to calculating a patient's Body Mass Index (BMI) and whether weight management advice was given after determining the patient had an obese BMI. For all patients, practitioners were asked how often they calculated BMI, how often they gave weight management advice to patients with an obese BMI, and how often they utilised different advice or referral options (each: Always/Often vs. Less often/Never). Binary logistic regressions examined whether frequency of assessing weight and providing advice was associated with practitioner characteristics. RESULTS: In the mock consultation, physical cues (40%) were most likely to prompt calculation of BMI, and half of practitioners (56%) provided weight management advice after determining the patient had an obese BMI, with GPs less likely to do so than PNs (Odds Ratio [OR] = 0.59, 95% CI: 0.47-0.75). Half of practitioners (58%) said they calculated the BMI of all patients Always/Often, with GPs less likely to do so than PNs (OR = 0.27, 95% CI: 0.21-0.34). Three quarters (78%) said they provided weight management advice to patients with an obese BMI Always/Often, with GPs less likely to do so than PNs (OR = 0.63, 95% CI: 0.47-0.85). Weight management advice was provided more frequently than referrals, particularly suggesting increased physical activity (93%) and diet modification (89%). CONCLUSIONS: Consistent with previous research, the findings suggest that opportunities to provide weight management advice in primary care, including to patients with an obese BMI, are potentially missed. Future research should test alternative mechanisms to increase weight assessment and advice provision, examine the effectiveness of advice frequently given, and seek solutions to reported barriers for providing weight management advice.

Factors associated with the size of the adhesio interthalamica based on 3.0-T magnetic resonance images.

BACKGROUND: Adhesio interthalamica (AI) is a small structure connecting bilateral thalami. PURPOSE: To evaluate the effects of patient age, sex, and lateral diameter of the third ventricle on the long diameter of the AI using multivariate analyses based on magnetic resonance (MR) images obtained with 3.0-T scanners. MATERIAL AND METHODS: This clinical retrospective study included images of 153 patients who underwent MR examination using 3.0-T scanners. The long diameter of the AI and lateral diameter of the third ventricle were measured on images in the mid-sagittal plane and axial plane at the anterior commissure, respectively. Univariate and multivariate analyses were performed. RESULTS: AI was observed in 138 patients (70 men, 68 women; mean age = 63.7 ± 13.7 years; mean AI size =5.34 ± 1.63 mm). By univariate analyses, patient age (r = -0.262, P = 0.002), sex ( P = 0.010), and lateral diameter of the third ventricle (r = -0.642, P < 0.001) were significantly associated with the long diameter of the AI. With multiple linear regression analyses with a stepwise selection of parameters, only the lateral diameter of the third ventricle (estimate = -0.432, P < 0.001) was significantly associated with the long diameter of the AI. The lateral diameter of the third ventricle was longer in patients without AI (15 patients) than in those with AI ( P = 0.006). CONCLUSION: The lateral diameter of the third ventricle was a major factor negatively associated with the long diameter of the AI.

Improving students' ability to perform a standardized foetal biometry plane using ultrasound simulators.

OBJECTIVE: The objective of this study is to assess progress made in the ultrasound (US) measurement of femur length (FL) by students after one hour of training on US obstetric simulators. MATERIALS AND METHODS: Medical residents and midwives registered for the 2016 French national foetal US diploma were invited to a 1-hour US training course with simulators. The time to acquire the FL plane with changing foetal presentation was prospectively measured before and after the training. Every image was recorded, and quality criteria were assessed. RESULTS: Thirty new learners trained in foetal US were evaluated. The time needed to measure the FL was significantly shorter in the post-test versus the pre-test (86s versus 125, P=0.015). The quality criteria were statistically similar before and after training regarding the angle to horizontal (10.0° versus 9.6°, P=0.84) and FL (31.3mm versus 32.0mm, P=0.15). CONCLUSION: The time needed to obtain the FL plane was reduced by 30% after a 1-hour US simulation training session.

An examination of the relationships between service use and alternative measures of obesity among community-dwelling adults in Ireland.

Obesity has received increased attention arising from its increasing prevalence and the implications of obesity-related problems for society and the wider economy. To estimate healthcare and non-healthcare obesity impacts, many studies rely on body mass index (BMI) as a measure of obesity. However BMI is considered to be a noisy measure of total body fat that unlike some other measures does not capture fat distribution. This study uses one such measure, the waist-to-hip ratio, as both an alternative and in conjunction with BMI in the estimation of the relationship between adiposity and health service use. The article uses data from a large-scale study of older adults living in Ireland (the Tilda data set). The findings indicate that studies that include both measures of general and central adiposity may provide a more comprehensive characterisation of the relationship between healthcare service use and adiposity.

Diferencias de estado nutricional, control metabólico y tratamiento de la diabetes tipo 1 en dos décadas / Changes in nutritional state, metabolic control and treatment of type 1 diabetes in the last 20 years

Objetivo: Describir los cambios en las características antropométricas, control metabólico, tratamiento y prevalencia de sobrepeso en los niños diabéticos en los últimos 20 años. Pacientes y métodos: Estudio observacional retrospectivo de dos grupos de niños diagnosticados de DM1 (n=90) realizado en dos cortes transversales, 1986 y finales del año 2007. Las variables estudiadas fueron: edad, años de DM1, sexo; peso, talla, IMC y sus valores Z; HbA1c, unidades NGSP/DCCT (%) e IFCC (mmol/mol), y el tratamiento con insulina (tipo, número de dosis, U/día y U/kg/día). Resultados: En relación con el grupo de 1986, en el grupo de 2007 hay un incremento significativo (p=0,001) en las variables Z-peso y Z-IMC. Hay una relación negativa entre los años de DM1 y la talla (Z-talla) en el grupo de 1986 (p<0,05). La HbA1c es menor en el grupo 2007 (p=0,001), pero la dosis de insulina (U/día y U/kg/día) es similar en ambos grupos. El número de dosis diarias de insulina es mayor en el grupo 2007 (p<0,001) y predomina el uso de análogos de la insulina. No se encontró una relación estadísticamente significativa entre la HbA1c y el tratamiento insulínico (dosis, número de inyecciones y tipo de insulina). La prevalencia de sobrepeso (14,6% vs 2,4%) es significativamente mayor en el grupo de 2007 (p=0,001). Conclusiones: El control metabólico ha mejorado y el uso de múltiples dosis diarias de insulina se ha convertido en la norma, pero ha aumentado la prevalencia de sobrepeso que puede incrementar el riesgo cardiovascular de los niños diabéticos (AU)

Objective: The aim of this study is to describe changes in anthropometric characteristics, metabolic control, treatment and prevalence of overweight in diabetic children (DM1) from 2007 compared with another similar group from 1986. Patients and methods: Observational retrospective study of two groups of diabetic children (n=90). The collection of variables has been made at two cross-sections, 1986 and 2007. The studied variables were: age, years of DM1, sex, weight, height, BMI (and their Z values), HbA1c and treatment with insulin (type, number of doses, IU/day and IU/kg/day). Results: In 2007 group there is a significant increase in Z-weight and Z-BMI (P=0.001) when compared with the 1986 group. There was a negative relationship between the years with DM1 and Z-height (P=0.05) in the 1986 group. The value of HbA1c was lower in the 2007 group (P=0.001), but the dose of insulin (IU/day and IU/kg/day) was similar in both groups. The number of daily doses of insulin was higher in the 2007 group (P<0.001), the use of insulin analogues dominated overall. A statistically significant relationship between HbA1c and treatment with insulin (dose injections, insulin type) was not found. The prevalence of overweight (14.6% vs 2.4%) was significantly higher in the 2007 Group (P=0.001). Conclusions: The metabolic control (HbA1c) had improved and the use of multiple daily doses of insulin has been become the standard, but the prevalence of overweight has increased. We must monitor the emergence of insulin resistance and cardiovascular risk factors in this sensitive population to prevent early cardiovascular disease (AU)

Ontogeny of limb proportions in late through final Jomon period foragers.

This study reports on developmental patterning in the intralimb indices of Late/Final Jomon period (4000-2300 BP) people. Jomon foragers represent the descendants of migrants from Northeast Asia, who arrived in the Japanese Islands around 20,000 BP. Among adults, Jomon brachial indices are elevated and similar to warm adapted, low latitude people, while crural indices are intermediate and similar to people from moderate latitudes. Two hypotheses regarding the development of intralimb indices among Jomon period foragers are tested: (1) intralimb indices of Jomon people maintain predicted ecogeographic relationships over ontogeny; (2) greater evolvability will be observed in the brachial index, while greater developmental constraint will be observed in the crural index. Changes in intralimb proportions in a Jomon skeletal growth series are compared to those in two contrasting samples: Inuit from Point Hope (cold adapted) and Nubians from Kulubnarti (warm adapted). A quadratic equation best describes the ontogeny of brachial and crural indices, with high indices in infancy followed by a decline in childhood and an increase in adolescence. Despite these shifts, ecogeographically predicted differences and similarities in the indices are maintained between samples throughout ontogeny. In addition, radial relative to humeral length is significantly less correlated than tibial relative to femoral length. These results suggest genetic conservation of intralimb indices over the course of development. However, radial and humeral lengths are less correlated than tibial and femoral lengths among Jomon subadults and adults, potentially suggesting greater evolvability of the brachial index and more developmental constraint on the crural index.

The soy isoflavones for reducing bone loss study: 3-yr effects on pQCT bone mineral density and strength measures in postmenopausal women.

Soy isoflavones exert inconsistent bone density-preserving effects, but the bone strength-preserving effects in humans are unknown. Our double-blind randomized controlled trial examined 2 soy isoflavone doses (80 or 120mg/d) vs placebo tablets on volumetric bone mineral density (vBMD) and strength (by means of peripheral quantitative computed tomography) in healthy postmenopausal women (46-63yr). We measured 3-yr changes in cortical BMD (CtBMD), cortical thickness (CtThk), periosteal circumference (PC), endosteal circumference (EC), and strength-strain index (SSI) at 1/3 midshaft femur (N=171), and trabecular BMD (TbBMD), PC, and SSI at 4% distal tibia (N=162). We found no treatment effect on femur CtThk, PC, or EC, or tibia TbBMD or PC. The strongest predictors (negative) of tibia TbBMD and SSI and femur CtBMD were timepoint and bone resorption; whole-body fat mass was protective of SSI. As time since last menstrual period (TLMP) increased (p=0.012), 120-mg/d dose was protective of CtBMD. The strongest predictors of femur SSI were timepoint, bone resorption, and TLMP (protective). Isoflavone tablets were negative predictors of SSI, but 80-mg/d dose became protective as bone turnover increased (p=0.011). Soy isoflavone treatment for 3yr was modestly beneficial for midshaft femur vBMD as TLMP increased and for midshaft femur SSI as bone turnover increased.

The use of three-dimensional ultrasound does not improve training in fetal biometric measurements.

OBJECTIVE: To investigate whether three-dimensional (3D) technology offers any advantage over two-dimensional (2D) ultrasound in fetal biometric measurement training. METHODS: Ten midwives with no hands-on experience in ultrasound were randomized to receive training on 2D or 3D ultrasound fetal biometry assessment. Midwives were taught how to obtain fetal biometric measurements (biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL)) by a trainer. Subsequently, each midwife measured the parameters on another 10 fetuses. The same set of measurements was repeated by the trainer. The percentage deviation between the midwives' and the trainer's measurements was determined and compared between training groups. Time required for completion was recorded. Frozen images were reviewed by another sonographer to assess the image quality using a standardized scoring system. RESULTS: The median time for the complete set of measurements was significantly shorter in the 2D than in 3D group (13.4 min versus 17.8 min, P = 0.03). The mean percentage deviations did not reach statistical significance between the two groups except for FL (3.83% in 2D group versus 2.23% in 3D group (P = 0.046)). There were no significant differences in the quality scores. CONCLUSIONS: This study showed that the only demonstrable advantage of 3D ultrasound was a slightly more accurate measurement of FL, at the expense of a significantly longer time required.

The targeting of nutritionally at-risk children attending a primary health care facility in the Western Cape Province of South Africa.

AIM: The aim of this study was to determine the practices of primary health care (PHC) nurses in targeting nutritionally at-risk infants and children for intervention at a PHC facility in a peri-urban area of the Western Cape Province of South Africa. METHODOLOGY: Nutritional risk status of infants and children <6 years of age was based on criteria specified in standardised nutrition case management guidelines developed for PHC facilities in the province. Children were identified as being nutritionally at-risk if their weight was below the 3rd centile, their birth weight was less than 2500 g, and their growth curve showed flattening or dropping off for at least two consecutive monthly visits. The study assessed the practices of nurses in identifying children who were nutritionally at-risk and the entry of these children into the food supplementation programme (formerly the Protein-Energy Malnutrition Scheme) of the health facility. Structured interviews were conducted with nurses to determine their knowledge of the case management guidelines; interviews were also conducted with caregivers to determine their sociodemographic status. RESULTS: One hundred and thirty-four children were enrolled in the study. The mean age of their caregivers was 29.5 (standard deviation 7.5) years and only 47 (38%) were married. Of the caregivers, 77% were unemployed, 46% had poor household food security and 40% were financially dependent on non-family members. Significantly more children were nutritionally at-risk if the caregiver was unemployed (54%) compared with employed (32%) (P=0.04) and when there was household food insecurity (63%) compared with household food security (37%) (P<0.004). Significantly more children were found not to be nutritionally at-risk if the caregiver was financially self-supporting or supported by their partners (61%) compared with those who were financially dependent on non-family members (35%) (P=0.003). The weight results of the nurses and the researcher differed significantly (P<0.001), which was largely due to the different scales used and weighing methods. The researcher's weight measurements were consistently higher than the nurses' (P<0.00). The researcher identified 67 (50%) infants and children as being nutritionally at-risk compared with 14 (10%) by the nurses. The nurses' poor detection and targeting of nutritionally at-risk children were largely a result of failure to plot weights on the weight-for-age chart (55%) and poor utilisation of the Road to Health Chart. CONCLUSIONS: Problems identified in the practices of PHC nurses must be addressed in targeting children at nutritional risk so that appropriate intervention and support can be provided. More attention must be given to socio-economic criteria in identifying children who are nutritionally at-risk to ensure their access to adequate social security networks.