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1.
Appetite ; 199: 107407, 2024 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-38729580

RESUMEN

Intuitive eating has been found to protect against disordered eating and preserve well-being. Yet, there are methodological (length), conceptual (inconsideration of medical, value-based, and access-related reasons for food consumption), and psychometric (item wording) concerns with its most common measure, the Intuitive Eating Scale-2 (IES-2). To address these concerns, we developed the IES-3 and investigated its psychometric properties with U.S. community adults. Across three online studies, we evaluated the IES-3's factorial validity using exploratory factor analysis (EFA; Study 1; N = 957; Mage = 36.30), as well as confirmatory factor analysis (CFA), exploratory structural equation modeling (ESEM), bifactor-CFA, and bifactor-ESEM (Study 2; N = 1152; Mage = 40.95), and cross-validated the optimal model (Study 3; N = 884; Mage = 38.54). We examined measurement invariance across samples and time, differential item functioning (age, body mass index [BMI], gender), composite reliability, and validity. Study 1 revealed a 12-item, 4-factor structure (unconditional permission to eat, eating for physical reasons, reliance on hunger and satiety cues, body-food choice congruence). In Study 2, a bifactor-ESEM model with a global intuitive eating factor and four specific factors best fit the data, which was temporally stable across three weeks. This model also had good fit in Study 3 and, across Studies 2 and 3, and was fully invariant and lacked measurement bias in terms of age, gender, and BMI. Associations between latent IES-3 factors and age, gender, and BMI were invariant across Studies 2 and 3. Composite reliability and validity (relationships with disordered eating, embodiment, body image, well-being, and distress; negligible relationship with impression management) of the retained model were also supported. The 12-item IES-3 demonstrates strong psychometric properties in U.S. community adults. Research is now needed using the IES-3 in other cultural contexts and social identity groups.


Asunto(s)
Conducta Alimentaria , Intuición , Psicometría , Humanos , Femenino , Masculino , Adulto , Reproducibilidad de los Resultados , Análisis Factorial , Conducta Alimentaria/psicología , Encuestas y Cuestionarios/normas , Persona de Mediana Edad , Adulto Joven , Ingestión de Alimentos/psicología , Índice de Masa Corporal , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Adolescente
2.
Diabetologia ; 66(7): 1273-1288, 2023 07.
Artículo en Inglés | MEDLINE | ID: mdl-37148359

RESUMEN

AIMS/HYPOTHESIS: The Latino population has been systematically underrepresented in large-scale genetic analyses, and previous studies have relied on the imputation of ungenotyped variants based on the 1000 Genomes (1000G) imputation panel, which results in suboptimal capture of low-frequency or Latino-enriched variants. The National Heart, Lung, and Blood Institute (NHLBI) Trans-Omics for Precision Medicine (TOPMed) released the largest multi-ancestry genotype reference panel representing a unique opportunity to analyse rare genetic variations in the Latino population. We hypothesise that a more comprehensive analysis of low/rare variation using the TOPMed panel would improve our knowledge of the genetics of type 2 diabetes in the Latino population. METHODS: We evaluated the TOPMed imputation performance using genotyping array and whole-exome sequence data in six Latino cohorts. To evaluate the ability of TOPMed imputation to increase the number of identified loci, we performed a Latino type 2 diabetes genome-wide association study (GWAS) meta-analysis in 8150 individuals with type 2 diabetes and 10,735 control individuals and replicated the results in six additional cohorts including whole-genome sequence data from the All of Us cohort. RESULTS: Compared with imputation with 1000G, the TOPMed panel improved the identification of rare and low-frequency variants. We identified 26 genome-wide significant signals including a novel variant (minor allele frequency 1.7%; OR 1.37, p=3.4 × 10-9). A Latino-tailored polygenic score constructed from our data and GWAS data from East Asian and European populations improved the prediction accuracy in a Latino target dataset, explaining up to 7.6% of the type 2 diabetes risk variance. CONCLUSIONS/INTERPRETATION: Our results demonstrate the utility of TOPMed imputation for identifying low-frequency variants in understudied populations, leading to the discovery of novel disease associations and the improvement of polygenic scores. DATA AVAILABILITY: Full summary statistics are available through the Common Metabolic Diseases Knowledge Portal ( https://t2d.hugeamp.org/downloads.html ) and through the GWAS catalog ( https://www.ebi.ac.uk/gwas/ , accession ID: GCST90255648). Polygenic score (PS) weights for each ancestry are available via the PGS catalog ( https://www.pgscatalog.org , publication ID: PGP000445, scores IDs: PGS003443, PGS003444 and PGS003445).


Asunto(s)
Diabetes Mellitus Tipo 2 , Salud Poblacional , Humanos , Estudio de Asociación del Genoma Completo , Diabetes Mellitus Tipo 2/genética , Medicina de Precisión , Genotipo , Hispánicos o Latinos/genética , Polimorfismo de Nucleótido Simple/genética
3.
Pediatr Diabetes ; 20232023.
Artículo en Inglés | MEDLINE | ID: mdl-38590442

RESUMEN

Metformin is the first-line treatment for type 2 diabetes (T2D) in youth but with limited sustained glycemic response. To identify common variants associated with metformin response, we used a genome-wide approach in 506 youth from the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study and examined the relationship between T2D partitioned polygenic scores (pPS), glycemic traits, and metformin response in these youth. Several variants met a suggestive threshold (P < 1 × 10-6), though none including published adult variants reached genome-wide significance. We pursued replication of top nine variants in three cohorts, and rs76195229 in ATRNL1 was associated with worse metformin response in the Metformin Genetics Consortium (n = 7,812), though statistically not being significant after Bonferroni correction (P = 0.06). A higher ß-cell pPS was associated with a lower insulinogenic index (P = 0.02) and C-peptide (P = 0.047) at baseline and higher pPS related to two insulin resistance processes were associated with increased C-peptide at baseline (P = 0.04,0.02). Although pPS were not associated with changes in glycemic traits or metformin response, our results indicate a trend in the association of the ß-cell pPS with reduced ß-cell function over time. Our data show initial evidence for genetic variation associated with metformin response in youth with T2D.


Asunto(s)
Diabetes Mellitus Tipo 2 , Metformina , Adulto , Humanos , Adolescente , Metformina/uso terapéutico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/genética , Diabetes Mellitus Tipo 2/complicaciones , Péptido C , Insuficiencia del Tratamiento , Variación Genética , Glucemia , Hipoglucemiantes/uso terapéutico
4.
BMC Womens Health ; 22(1): 396, 2022 09 30.
Artículo en Inglés | MEDLINE | ID: mdl-36180841

RESUMEN

BACKGROUND: Recommendations for the management of pain related to pelvic mesh implants are still under development. One limitation that has impeded progress in this area is that mesh-related pain has not been consistently defined or measured. Here, we reviewed the ways in which pain associated with pelvic mesh implants has been measured, and mapped the ways in which these existing measures capture the construct. METHODS: First, we reviewed existing accounts of the pain associated with pelvic mesh implants to develop a multifaceted construct definition, which includes aspects related to pain intensity, timing, body location, phenomenological qualities, impact/interference with daily living, and patient expectations and beliefs. Next, we reviewed the ways that the construct has been measured in the extant literature. RESULTS: Within 333 eligible studies, 28 different assessments of pain associated with pelvic mesh were identified, and 61% of studies reported using more than one measurement tool. Questionnaire measures included measures designed to assess urological and/or pelvic symptoms, generic measures and unvalidated measures. We did not identify any validated questionnaire measures designed to assess pain associated with pelvic mesh implants. The phenomenological, location, and expectation/belief components of the construct were not captured well by the identified questionnaire measures, and there is no evidence that any of the identified measures have appropriate psychometric properties for the assessment of pain related to pelvic mesh implants. CONCLUSIONS: We recommend further qualitative research regarding women's experiences of pelvic mesh-related pain assessment, and the development of a condition-specific patient reported outcome measure.


Asunto(s)
Prolapso de Órgano Pélvico , Femenino , Procedimientos Quirúrgicos Ginecológicos , Humanos , Prolapso de Órgano Pélvico/cirugía , Dolor Pélvico/etiología , Mallas Quirúrgicas/efectos adversos , Encuestas y Cuestionarios , Resultado del Tratamiento
5.
Community Ment Health J ; 58(7): 1310-1320, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-35076827

RESUMEN

Crisis Intervention Teams (CIT) promote community collaboration to better assist people living with mental illness and/or drug addiction who are in crisis (Mission, n.d.). A core element of the CIT model is the 40 h training focused on increasing law enforcement officers' knowledge of behavioral health issues and use of de-escalation skills in crisis response (CIT International, n.d.). The purpose of this study was to examine the effectiveness of CIT training in a mid-size, Midwestern county on (1) participants' knowledge of mental illness and related concepts, (2) situational anxiety in crisis response, and (3) enhancing perceived comfort with people living with mental illness. This one-group pre-test/posttest study was conducted with four CIT training groups (n = 72) between 2017 and 2019. Findings indicate that participant knowledge and perceived comfort interacting with persons living with a mental illness were improved after the trainings, supporting use of CIT trainings in mid-size and rural communities.


Asunto(s)
Intervención en la Crisis (Psiquiatría) , Trastornos Mentales , Ansiedad , Actitud , Intervención en la Crisis (Psiquiatría)/educación , Humanos , Aplicación de la Ley , Trastornos Mentales/terapia , Policia
6.
Br J Sociol ; 73(4): 885-902, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-35696533

RESUMEN

This article explores how boundary making proceeds after protracted conflict has ended. Drawing on an interview and focus group study in two local areas in Northern Ireland, we identify the diverse forms of everyday boundary work amongst moderates who distance from the ethno-political blocs: everyday universalism, agonism, transformation and cosmopolitanism. Each overcomes closed exclusivist boundaries and identity oppositions, thus providing a clear contrast with the overt political contention and polarization that has followed Brexit in Northern Ireland. Our research shows the internal shape and diversity of the moderate constituency who support peace-building and a less-polarized politics. It also offers an answer to the question how such everyday openness coexists with continued political polarization. We trace the different political perspectives associated with each form of boundary making and argue that this hinders political cohesion amongst moderates.


Asunto(s)
Política , Condiciones Sociales , Unión Europea , Humanos , Irlanda del Norte , Reino Unido
7.
J Psychosoc Nurs Ment Health Serv ; 60(8): 46-51, 2022 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-35191767

RESUMEN

Alcohol and drug misuse continue to result in negative outcomes in the United States. Training nurses in screening, brief intervention, and referral to treatment (SBIRT) has been proposed as one approach to mitigating those harms. Such training can lead to improved attitudes and intention to use SBIRT in clinical practice, but whether those outcomes manifest similarly for distance or face-to-face learning has not been investigated. The current study is a quasi-experimental comparison of face-to-face and distance SBIRT education for undergraduate nursing students performed in Fall 2019. No differences in attitudes or intentions were observed between face-to-face and distance learning approaches. Self-reported competence meaningfully increased in both study arms, and there was some evidence of additional increases in perceived role legitimacy and intention to use SBIRT. To the degree that benefits are observed for SBIRT training, they may not vary between face-to-face and distance learning implementations of the same curriculum. [Journal of Psychosocial Nursing and Mental Health Services, 60(8), 46-51.].


Asunto(s)
Bachillerato en Enfermería , Estudiantes de Enfermería , Trastornos Relacionados con Sustancias , Intervención en la Crisis (Psiquiatría) , Humanos , Tamizaje Masivo , Derivación y Consulta , Estudiantes de Enfermería/psicología , Trastornos Relacionados con Sustancias/prevención & control , Trastornos Relacionados con Sustancias/terapia , Estados Unidos
8.
Support Care Cancer ; 29(8): 4357-4364, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-33416995

RESUMEN

PURPOSE: The aim of this study was to utilise a novel oral assessment tool (the Oral Symptom Assessment Scale/OSAS) to investigate oral symptoms in a cohort of advanced cancer patients receiving specialist palliative care. METHODS: Participants were asked to complete the OSAS, which asks about the presence of 20 oral symptoms in the previous week (and, if present, about the frequency, the severity, and the amount of distress caused by the symptoms). Patients were also asked to complete the Memorial Symptom Assessment Scale - Short Form, and to rate their performance status. RESULTS: Two hundred fifty participants completed the study, and 244 (97.5%) participants reported at least one oral symptom on the OSAS. The median number of oral symptoms reported was five (range, 1 to 18), with dry mouth being the most common symptom (83.5% participants). The total number of oral symptoms was higher in younger participants (p = 0.012), female participants (p = 0.048), and those with a worse performance status (p < 0.001). No other oral symptoms were reported by more than two participants. Statistical analysis identified a number of potential oral symptom clusters. CONCLUSIONS: Oral symptoms (and related oral problems) are common in patients with advanced cancer, and are associated with significant morbidity in this group of patients. TRIAL REGISTRATION: CancerTrials.gov registry reference number: NCT04404920.


Asunto(s)
Boca/patología , Neoplasias/patología , Cuidados Paliativos/métodos , Sialorrea/complicaciones , Xerostomía/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Evaluación de Síntomas , Síndrome
9.
Appetite ; 166: 105588, 2021 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-34224761

RESUMEN

The construct of intuitive eating is most often measured using the 23-item Intuitive Eating Scale-2 (IES-2), but previous studies have typically relied solely on confirmatory factor analysis (CFA) to understand IES-2 dimensionality. In contrast, a bifactor exploratory structural equation modelling (B-ESEM) framework offers a more realistic account of IES-2 multidimensionality. Here, we assessed the psychometric properties of a novel Italian translation using a combination of exploratory factor analysis and B-ESEM. A total of 950 adults completed the IES-2 alongside measures of positive body image, disordered eating, and psychological well-being. Results indicated that a 4-factor B-ESEM model had adequate fit to the data and that fit was improved when the correlated uniqueness of seven negatively worded IES-2 items was accounted for. This model of IES-2 scores showed adequate internal consistency and good test-retest reliability up to three weeks. Evidence of construct validity was good in terms of a global IES-2 factor, and broadly supported in terms of its specific-factors. These results highlight the utility of a B-ESEM framework for understanding the dimensionality of IES-2 scores and may help scholars better understand the extent to which the IES-2 adequately operationalises the construct of intuitive eating.


Asunto(s)
Conducta Alimentaria , Intuición , Adulto , Análisis Factorial , Humanos , Italia , Análisis de Clases Latentes , Psicometría , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
10.
Pers Individ Dif ; 183: 111130, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34931100

RESUMEN

The ongoing coronavirus (COVID-19) pandemic and attendant lockdown mandates may have detrimental effects on body image outcomes, which in turn highlights the importance of identifying protective factors. Here, we examined associations between COVID-19-related stress and body image disturbance, as well as the potential mediating and moderating role of self-compassion. During the third lockdown in the United Kingdom, we asked an online sample of adults (N = 600) to complete measures of COVID-19-related stress, body image disturbance, and self-compassion. Mediation analysis showed that higher COVID-19-related stress was significantly associated with greater body image disturbance, and that this relationship was mediated by self-compassion. In contrast, self-compassion did not significantly moderate the effects of stress on body image disturbance. These results suggest that promoting greater self-compassion may be a viable means of mitigating adverse outcomes from the COVID-19 pandemic on body image disturbance.

11.
J Clin Psychol ; 77(3): 661-682, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33035384

RESUMEN

OBJECTIVE: This study aimed to adapt the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire for younger respondents. METHOD: The language of the MAIA was revised and children aged 7-10 years (n = 212) and adolescents aged 11-17 years (n = 217) completed the questionnaire. RESULTS: The original eight-factor model was tested for fit using confirmatory factor analysis. The model had an acceptable fit in the total sample and younger subsample and overall fit in the older subsample was adequate following modification. Internal consistency was good, except for the Noticing, Not-Distracting and Not-Worrying scales. Results also demonstrated a negative linear relationship between the trusting scale and age, suggesting that youths may lose trust in their body as they age. CONCLUSION: The adapted MAIA can be used with a younger population and, depending on the research question, individual MAIA scales may be selected. The survey is available at https://osher.ucsf.edu/maia.


Asunto(s)
Interocepción , Adolescente , Concienciación , Niño , Análisis Factorial , Humanos , Psicometría , Encuestas y Cuestionarios
12.
Exp Brain Res ; 238(3): 621-629, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32016483

RESUMEN

Previous research utilising a between-subjects design has indicated that the use of noise-dampening ear protectors might enhance interoceptive accuracy (IAcc). In the present study, we further examined this effect using a repeated-measures, within-participants design, and investigated potential mechanisms that might explain the effect. 50 participants completed the heartbeat tracking task (HTT) with and without the use of industrial ear protectors, in a counter-balanced order. Participants were asked to count the number of heartbeats occurring in five discrete time intervals of 25, 35, 45, 55 and 95 s, without feeling for a manual pulse. HTT scores were significantly higher when ear protectors were worn, and the improvement in performance was greatest for participants with lower baseline IAcc. The ear protectors were associated with significantly increased self-reported heartbeat audibility, task-related confidence and concentration, and decreased levels of distractibility. Heartbeat audibility was also correlated with HTT performance when the ear protectors were worn. Because the use of industrial ear defenders resulted in increased heartbeat audibility, this manipulation should not be used to assess causal hypotheses related to changes in IAcc. However, it may serve as a simple, non-invasive manipulation to assess the effects of 'externalised' interoceptive signals.


Asunto(s)
Vías Auditivas/fisiología , Emociones/fisiología , Interocepción/fisiología , Análisis y Desempeño de Tareas , Adulto , Femenino , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Percepción del Tiempo/fisiología , Adulto Joven
13.
J Am Soc Nephrol ; 30(10): 2000-2016, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31537649

RESUMEN

BACKGROUND: Although diabetic kidney disease demonstrates both familial clustering and single nucleotide polymorphism heritability, the specific genetic factors influencing risk remain largely unknown. METHODS: To identify genetic variants predisposing to diabetic kidney disease, we performed genome-wide association study (GWAS) analyses. Through collaboration with the Diabetes Nephropathy Collaborative Research Initiative, we assembled a large collection of type 1 diabetes cohorts with harmonized diabetic kidney disease phenotypes. We used a spectrum of ten diabetic kidney disease definitions based on albuminuria and renal function. RESULTS: Our GWAS meta-analysis included association results for up to 19,406 individuals of European descent with type 1 diabetes. We identified 16 genome-wide significant risk loci. The variant with the strongest association (rs55703767) is a common missense mutation in the collagen type IV alpha 3 chain (COL4A3) gene, which encodes a major structural component of the glomerular basement membrane (GBM). Mutations in COL4A3 are implicated in heritable nephropathies, including the progressive inherited nephropathy Alport syndrome. The rs55703767 minor allele (Asp326Tyr) is protective against several definitions of diabetic kidney disease, including albuminuria and ESKD, and demonstrated a significant association with GBM width; protective allele carriers had thinner GBM before any signs of kidney disease, and its effect was dependent on glycemia. Three other loci are in or near genes with known or suggestive involvement in this condition (BMP7) or renal biology (COLEC11 and DDR1). CONCLUSIONS: The 16 diabetic kidney disease-associated loci may provide novel insights into the pathogenesis of this condition and help identify potential biologic targets for prevention and treatment.


Asunto(s)
Autoantígenos/genética , Colágeno Tipo IV/genética , Diabetes Mellitus Tipo 1/genética , Nefropatías Diabéticas/genética , Estudio de Asociación del Genoma Completo , Membrana Basal Glomerular , Mutación , Estudios de Cohortes , Femenino , Humanos , Masculino
14.
BMC Med Educ ; 20(1): 43, 2020 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-32041588

RESUMEN

BACKGROUND: Motivational interviewing (MI) is a framework for addressing behavior change that is often used by healthcare professionals. Expression of empathy during MI is associated with positive client outcomes, while absence of empathy may produce iatrogenic effects. Although training in MI is linked to increased therapeutic empathy in learners, no research has investigated individual training components' contribution to this increase. The objective of this study was to test whether a self-coding MI exercise using smartphones completed at hour 6 of an 8-h MI training was superior in engendering empathy to training as usual (watching an MI expert perform in a video clip for the same duration at the same point in the training). METHODS: This was a pilot study at two sites using randomization and control groups with 1:1 allocation. Allocation was achieved via computerized assignment (site 1, United Kingdom) or facedown playing card distribution (site 2, United States). Participants were 58 students attending a university class at one of two universities, of which an 8-h segment was dedicated to a standardized MI training. Fifty-five students consented to participate and were randomized. The intervention was an MI self-coding exercise using smartphone recording and a standardized scoring sheet. Students were encouraged to reflect on areas of potential improvement based on their self-coding results. The main outcome measure was score on the Helpful Responses Questionnaire, a measure of therapeutic empathy, collected prior to and immediately following the 8-h training. Questionnaire coding was completed by 2 blinded external reviewers and assessed for interrater reliability, and students were assigned averaged empathy scores from 6 to 30. Analyses were conducted via repeated-measures ANOVA using the general linear model. RESULTS: Fifty-five students were randomized, and 2 were subsequently excluded from analysis at site 2 due to incomplete questionnaires. The study itself was feasible, and overall therapeutic empathy increased significantly and substantially among students. However, the intervention was not superior to the control condition in this study. CONCLUSIONS: Replacing a single passive learning exercise with an active learning exercise in an MI training did not result in a substantive boost to therapeutic empathy. However, consistently with prior research, this study identified significant overall increases in empathy following introductory MI training. A much larger study examining the impact of selected exercises and approaches would likely be useful and informative.


Asunto(s)
Educación de Pregrado en Medicina , Empatía , Entrevista Motivacional , Aprendizaje Basado en Problemas/métodos , Autoevaluación (Psicología) , Humanos , Proyectos Piloto , Reproducibilidad de los Resultados , Teléfono Inteligente , Encuestas y Cuestionarios , Reino Unido , Estados Unidos
15.
Clin Chem ; 64(1): 192-200, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-29295838

RESUMEN

BACKGROUND: A fundamental precept of the carbohydrate-insulin model of obesity is that insulin secretion drives weight gain. However, fasting hyperinsulinemia can also be driven by obesity-induced insulin resistance. We used genetic variation to isolate and estimate the potentially causal effect of insulin secretion on body weight. METHODS: Genetic instruments of variation of insulin secretion [assessed as insulin concentration 30 min after oral glucose (insulin-30)] were used to estimate the causal relationship between increased insulin secretion and body mass index (BMI), using bidirectional Mendelian randomization analysis of genome-wide association studies. Data sources included summary results from the largest published metaanalyses of predominantly European ancestry for insulin secretion (n = 26037) and BMI (n = 322154), as well as individual-level data from the UK Biobank (n = 138541). Data from the Cardiology and Metabolic Patient Cohort study at Massachusetts General Hospital (n = 1675) were used to validate genetic associations with insulin secretion and to test the observational association of insulin secretion and BMI. RESULTS: Higher genetically determined insulin-30 was strongly associated with higher BMI (ß = 0.098, P = 2.2 × 10-21), consistent with a causal role in obesity. Similar positive associations were noted in sensitivity analyses using other genetic variants as instrumental variables. By contrast, higher genetically determined BMI was not associated with insulin-30. CONCLUSIONS: Mendelian randomization analyses provide evidence for a causal relationship of glucose-stimulated insulin secretion on body weight, consistent with the carbohydrate-insulin model of obesity.


Asunto(s)
Carbohidratos de la Dieta/administración & dosificación , Secreción de Insulina/genética , Análisis de la Aleatorización Mendeliana , Obesidad/genética , Obesidad/metabolismo , Índice de Masa Corporal , Estudios de Cohortes , Ayuno , Estudio de Asociación del Genoma Completo , Glucosa/administración & dosificación , Humanos , Resistencia a la Insulina , Modelos Biológicos , Polimorfismo de Nucleótido Simple , Reproducibilidad de los Resultados
16.
Curr Diab Rep ; 18(8): 57, 2018 06 22.
Artículo en Inglés | MEDLINE | ID: mdl-29931398

RESUMEN

PURPOSE OF REVIEW: To provide an update on knowledge the role of genetics in youth-onset type 2 diabetes (T2D). RECENT FINDINGS: The prevalence in youth of T2D, once thought to be exclusively a disease of adults, has increased by over 35% since 2001. Youth with T2D tend to have higher rates of complications, more aggressive disease, with more rapid loss of beta-cell function and a less favorable response to treatment than adults. Obesity is the most important risk factor for T2D, and the rise in childhood overweight and obesity appears responsible for the dramatic increase in T2D in youth. However, some obese children do not develop T2D, consistent with genetic differences in susceptibility to the disease in the setting of obesity and insulin resistance, currently far less well characterized in youth than in adults. Recent studies have begun to show associations of several established adult T2D genetic risk variants with youth-onset T2D and related glycemic quantitative traits, including the strongest known cross-population T2D genetic contributor TCF7L2. Maturity-onset diabetes of the young (MODY), a diabetes subtype distinct from type 1 diabetes (T1D) and T2D, is now known to result from a highly penetrant gene mutation in one of several genes. MODY has been shown to account for or contribute to at least 4.5% of clinically diagnosed T2D, even among those who are overweight or obese, impacting treatment decisions. The recently formed ProDiGY (Progress in Diabetes Genetics in Youth) Consortium is using genome-wide association studies and whole exome sequencing to understand the genetic architecture of T2D in youth, including how it differs from that of adults. The limited amount of research conducted to date on the genetics of youth-onset T2D, which tends to be a more aggressive disease than adult T2D, suggests some overlap with genes involved in adult T2D and a sizeable influence of highly penetrant monogenic diabetes variants. The ProDiGY Consortium is expected to provide a more comprehensive understanding of youth T2D genetics.


Asunto(s)
Diabetes Mellitus Tipo 2/genética , Predisposición Genética a la Enfermedad , Adolescente , Edad de Inicio , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/fisiopatología , Estudio de Asociación del Genoma Completo , Humanos , Mutación/genética , Factores de Riesgo
17.
Palliat Med ; 32(2): 571-580, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-28604265

RESUMEN

BACKGROUND: Education has been highlighted as fundamental in equipping healthcare professionals with essential knowledge and skills to provide good end-of-life care. Multiprofessional educational programmes have a positive influence on knowledge, attitude and confidence but few have sought to understand the longer term impact on care delivery. The European Certificate in Essential Palliative Care is an 8-week home-study-based programme for healthcare professionals and is currently run in nine centres. Successful candidates have undertaken the course from their own countries around the world. This article describes the evaluation of the European Certificate in Essential Palliative Care which has been evolving over 15 years. AIMS: To evaluate the impact an educational intervention has on participants' confidence in palliative care, to determine whether this is sustained over time and explore participants' perception of the influence of the course on confidence. DESIGN: A mixed-method longitudinal approach. SETTING/PARTICIPANTS: A survey using a self-efficacy scale was emailed to 342 candidates who received an educational intervention and semi-structured interviews to a sub-sample of 15 candidates at baseline, 3 and 6 months. RESULTS: At 3 months, candidates had almost 20 times higher odds of being above any given level of confidence than at baseline which was sustained at 6 months. Qualitative analysis identified examples of increased competence and confidence improving palliative care delivery. CONCLUSION: Findings suggest that the European Certificate in Essential Palliative Care improves confidence in palliative care and that this is sustained over time with evidence of confidence in symptom control, communication and a holistic approach in clinical practice.


Asunto(s)
Personal de Salud/educación , Cuidados Paliativos , Autoeficacia , Cuidado Terminal , Adulto , Femenino , Humanos , Entrevistas como Asunto , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Encuestas y Cuestionarios
19.
J Interprof Care ; 29(4): 365-6, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25421453

RESUMEN

Schwartz Centre Rounds® aim to explore the human and emotional impact of everyday work by giving healthcare staff the opportunity to come together in a safe but open environment. We evaluated the experience of introducing Schwartz Centre Rounds in a UK hospice over 1-year using a mixed method approach. These rounds were reported as providing staff with a greater appreciation of the interprofessional approach. Individuals were more actively acknowledged by other colleagues as a result of contributions at rounds with an appreciation of a wider team, spanning the whole organisation. This appeared to relieve feelings of isolation and enhance a sense of shared purpose. Some staff chose not to attend but valued their contribution to the organisation without witnessing the emotional impact of hospice work. Our findings indicate that Schwartz Rounds offer staff the environment to explore the human element of their work and appear to improve interprofessional working.


Asunto(s)
Personal de Salud/psicología , Hospitales para Enfermos Terminales/organización & administración , Relaciones Interprofesionales , Adulto , Actitud del Personal de Salud , Emociones , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Aislamiento Social , Reino Unido
20.
Body Image ; 48: 101655, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38042087

RESUMEN

While scholars have investigated positive body image across diverse populations, extant theory largely excludes those with differing socio-cognitive experiences, such as autistic individuals. Using constructivist grounded theory, this study sought to develop a grounded theory of positive body image in autistic individuals. One-to-one interviews with photo-elicitation were conducted with 20 autistic adults (7 women, 8 men, 5 non-binary/agender; aged 18-53 years) from the United Kingdom. Through a process of open, axial, and focused coding, a grounded theory was developed around a core category of positive body image in autistic adults and was found to comprise six themes: body connection, body acceptance, appreciating body functionality and neurodivergent strengths, having a body-positive protective filter, taking care of the body, and body and appearance neutrality. Our findings suggest that some aspects of positive body image in autistic individuals are consistent with those found in neurotypical adults. However, positive body image in autistic individuals further encompasses both the sensory (i.e., how the body is felt) and aesthetic (i.e., how the body is seen) body. These findings may stimulate research aimed at improving positive body image in autistic populations.


Asunto(s)
Trastorno Autístico , Adulto , Masculino , Humanos , Femenino , Imagen Corporal/psicología , Investigación Cualitativa , Emociones , Reino Unido
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