Associations between weight loss history and factors related to type 2 diabetes risk in the Stop Diabetes study.

BACKGROUND: Frequent weight loss attempts are related to maladaptive eating behaviours and higher body mass index (BMI). We studied associations of several type 2 diabetes (T2D) risk factors with weight loss history, defined as the frequency of prior weight loss attempts, among Finnish adults at increased risk for T2D. METHODS: This study (n = 2684, 80% women) is a secondary analysis of the 1-year StopDia lifestyle intervention with digital intervention group, digital intervention + face-to-face counselling group, or control group. The frequency of prior weight loss attempts was categorized into five groups: no attempts/no attempts to lose weight, but trying to keep weight stable/1-2 attempts/3 or more attempts/ continuous attempts. Data on emotional eating and social/emotional nutrition self-efficacy were collected with a digital questionnaire. We assessed baseline differences between categories of weight loss history as well as the intervention effects. RESULTS: Altogether 84% of participants had attempted weight loss. Those with one or more weight loss attempts had higher BMI, larger waist circumference, and more emotional eating compared to 'no attempts' and 'no attempts to lose weight, but trying to keep weight stable' categories. The 'no attempts' category had the highest baseline fasting insulin, whereas it showed the largest decrease in this measure with the intervention. This change in fasting insulin in the 'no attempts' category was significantly different from all the other categories. Emotional nutrition self-efficacy slightly improved in the 'no attempts' category, which was significantly different from its concomitant decrease in the categories '1-2 attempts' and '3 or more attempts'. The intervention group assignment did not affect the results. CONCLUSIONS: Multiple attempts to lose weight may unfavourably affect T2D risk factors as well as lifestyle intervention outcomes. More research is needed on how weight loss frequency could affect T2D risk factors and how to design lifestyle interventions for individuals with frequent previous weight loss attempts.

Baseline characteristics of participants in the Kerala Diabetes Prevention Program: a cluster randomized controlled trial of lifestyle intervention in Asian Indians.

AIMS: To describe the baseline characteristics of participants in the Kerala Diabetes Prevention Program. METHODS: The Kerala Diabetes Prevention Program is a cluster randomized controlled trial of lifestyle intervention for prevention of Type 2 diabetes mellitus in India. Participants in the study were those aged 30-60 years who had an Indian Diabetes Risk Score ≥ 60 and who were without Type 2 diabetes on oral glucose tolerance test. Data on demographic, lifestyle, clinical and biochemical characteristics were collected using standardized tools. RESULTS: A total of 2586 individuals were screened with the Indian Diabetes Risk Score, of these 1529 people (59.1%) had a score ≥ 60, of whom 1209 (79.1%) underwent an oral glucose tolerance test. A total of 202 individuals (16.7%) had undiagnosed Type 2 diabetes and were excluded, and the remaining 1007 individuals were enrolled in the trial (control arm, n = 507; intervention arm, n = 500). The mean participant age was 46.0 ± 7.5 years, and 47.2% were women. The mean Indian Diabetes Risk Score was 67.1 ± 8.4. More than two-thirds (69.0%) had prediabetes and 31.0% had normal glucose tolerance. The prevalence of cardiometabolic risk factors was high, including current tobacco use (34.4% in men), current alcohol use (39.3% in men), no leisure time exercise (98.0%), no daily intake of fruit and vegetables (78.7%), family history of diabetes (47.9%), overweight or obesity (68.5%), hypertension (22.3%) and dyslipidemia (85.4%). CONCLUSIONS: The Kerala Diabetes Prevention Program recruited participants using a diabetes risk score. A large proportion of the participants had prediabetes and there were high rates of cardiometabolic risk factors. The trial will evaluate the effectiveness of lifestyle intervention in a population selected on the basis of a diabetes risk score.

Cardiovascular risk outcome and program evaluation of a cluster randomised controlled trial of a community-based, lay peer led program for people with diabetes.

BACKGROUND: The 2013 Global Burden of Disease Study demonstrated the increasing burden of diabetes and the challenge it poses to the health systems of all countries. The chronic and complex nature of diabetes requires active self-management by patients in addition to clinical management in order to achieve optimal glycaemic control and appropriate use of available clinical services. This study is an evaluation of a "real world" peer support program aimed at improving the control and management of type 2 diabetes (T2DM) in Australia. METHODS: The trial used a randomised cluster design with a peer support intervention and routine care control arms and 12-month follow up. Participants in both arms received a standardised session of self-management education at baseline. The intervention program comprised monthly community-based group meetings over 12 months led by trained peer supporters and active encouragement to use primary health care and other community resources and supports related to diabetes. Clinical, behavioural and other measures were collected at baseline, 6 and 12 months. The primary outcome was the predicted 5 year cardiovascular disease risk using the United Kingdom Prospective Diabetes Study (UKPDS) Risk Equation at 12 months. Secondary outcomes included clinical measures, quality of life, measures of support, psychosocial functioning and lifestyle measures. RESULTS: Eleven of 12 planned groups were successfully implemented in the intervention arm. Both the usual care and the intervention arms demonstrated a small reduction in 5 year UKPDS risk and the mean values for biochemical and anthropometric outcomes were close to target at 12 months. There were some small positive changes in self-management behaviours. CONCLUSIONS: The positive changes in self-management behaviours among intervention participants were not sufficient to reduce cardiovascular risk, possibly because approximately half of the study participants already had quite well controlled T2DM at baseline. Future research needs to address how to enhance community based programs so that they reach and benefit those most in need of resources and supports to improve metabolic control and associated clinical outcomes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12609000469213 . Registered 16 June 2009.

What is setting the stage for abdominal obesity reduction? A comparison between personality and health-related social cognitions.

The present longitudinal study examines whether changes in waist circumference are best predicted by relatively stable and broad personality traits (dispositional optimism and pessimism), by modifiable and domain-specific social cognitions (health-related self-efficacy), or a combination of these. Altogether 385 participants (74% women; 50-65 years) attended the GOAL Implementation Trial, a lifestyle counseling intervention to improve diet and physical activity. Measurements were conducted prior to the intervention (Time 1), and 3 months (Time 2) and 12 months (Time 3) after Time 1. Three different models of the potential interplay between dispositional optimism and pessimism and health-related self-efficacy were tested. The analyses showed that the change in health-related self-efficacy during the intervention (Time 1-Time 2) was negatively related with waist circumference change between Time 1 and Time 3, indicating that increases in self-efficacy during the intervention resulted in reduction in waist circumference over 12 months. However, optimism and pessimism were unrelated to waist circumference change either directly or indirectly through changes in self-efficacy. Interventions enhancing participants' positive health-related expectancies such as self-efficacy are likely to be effective even when participants' dispositional expectancies are pessimistic.

Women's satisfaction with information at breast biopsy in breast cancer screening.

Information needs, satisfaction with information and information sources of women referred for surgical biopsy in mammography screening were explored. Forty-five Finnish women (23 benign and 22 malignant finding) replied to a mailed questionnaire containing fixed-choice and open-ended questions 10 weeks after biopsy. Information was regarded an important form of support. In response to fixed-choice questions the women expressed a general satisfaction with the information received at the hospital, but answers to open questions revealed shortcomings in the ways of being informed. The results underscored the active role of the staff in giving information, in matching the information to women's needs and abilities at the time and in encouraging patients to express their concerns. Up to the point of diagnosis the needs of women with benign and malignant finding were similar. Regardless of diagnosis the women should be provided with reassuring information throughout and after the examination period.

Depressive symptoms in middle-aged women are more strongly associated with physical health and social support than with socioeconomic factors.

The association of socioeconomic factors, health-related factors, and social support with depressive symptoms has been extensively studied. However, most epidemiological studies have focused on a few factors such as marital status, social class, and employment. In this study of middle-aged women we analyzed both univariate and multivariate associations of socioeconomic factors, perceived physical health factors, and social support with self-rated depressive symptoms measured with the Beck Depression Inventory. A nationwide sample (n = 1851) of Finnish women aged 48-50 years was analyzed. Socioeconomic, health-related, and social support factors were all measured with single items. All variables, except level of urbanization, were significantly associated with depressive symptoms in univariate analyses. Multivariate associations were examined with standard multiple regression analyses in three stages: first with the socioeconomic factors, then with socioeconomic and health factors, and finally entering the social support factors into the regression model. In the first model, being either on a sick leave or at home as working status, being divorced, and having low income reached significance. In the second model, being divorced and having poor perceived physical health were the most powerful among the five significant variables. In the last model, explaining 32% of the variance, the most powerful predictors of depressive symptoms were perceived current physical health, satisfaction with received social support, and quality of intimate relationships. For the prevention or intervention of depressive symptoms among middle-aged women in the population subjects with concurrent subjective or objective health problems and poor social support seem to comprise a particularly important target group.

Two distinct groups of non-attenders in an organized mammography screening program.

OBJECTIVE: To find out reasons for non-attendance and to study subgroup differences of the non-attenders in an organized mammography screening program. DESIGN: Prospective for background and psychosocial factors, retrospective for reasons of non-attendance. SETTING: Finnish screening based on personal first round invitations, with 89% attendance rate. PARTICIPANTS: Four hundred thirty six women with both pre-screening response to socioeconomic and psychosocial measures, and post-screening response reporting reasons of non-attendance. MAIN RESULTS: Most common single reason for non-attendance was previous recent mammogram (53%), but also reasons related to practical obstacles, worry and fear, knowledge and attitudes, and organization of screening were mentioned. Two distinct groups of non-attenders were found based on the reasons for non-attendance. Those who did not attend because a mammogram taken elsewhere (ELSE, n = 233) were urban, well-to-do women, who took care of their health by own initiation and felt more susceptible to breast cancer, and also expected mammogram to be painful. Other (real) non-attenders (REAL, n = 155) were less compliant with health recommendations and services, more socially isolated, depressed and anxious than ELSE. Level of depression among REAL was clearly higher (10.80) than the mean value (7.91, SD = 7.28) of the age group, and was also slightly above the cut-off score of 10 indicating mild or moderate depression. Trait anxiety was also markedly higher (40.18) than that of the same age group (37.76, SD = 8.95). CONCLUSIONS: Further research should clarify determinants and consequences of depression and anxiety among real non-attenders. Knowledge gaps and attitudinal barriers among non-attenders require more targeted campaigns.

Information and communication in the context of a clinical trial.

The aim of this study was to determine the communicative needs of the patients in the context of being invited to participate in a clinical trial. A questionnaire was sent to 299 patients with breast cancer randomised in a trial of adjuvant therapy. It was returned by 261 (87%) of them. Ninety-one per cent (231/255) of the patients regarded the information provided as easy or quite easy to understand. However, the method of treatment allocation was unclear to most patients: 51% (128/251) thought that the doctor had chosen the treatment while only 23% (57/251) knew that they had been randomised. Younger and better educated patients had a better understanding. For 55% (125/226) of the patients written information had been helpful in decision making. This correlated highly with the education of the patient. Sixty-eight per cent (174/255) of the patients thought that they had enough time for decision-making. Less educated patients and older patients had needed more time. Eighty-seven per cent (218/251) were happy with their decision to participate. While most patients are satisfied with the information received, there is a poor understanding of how treatment is allocated. Information should be modified for older and less-educated patients. The needs of the patients when offered participation in a clinical trial are clear information, enough time to consider the options and psychological support.

Psychosocial predictors of first attendance for organised mammography screening.

OBJECTIVE: To study psychosocial predictors of attendance at an organised breast cancer screening programme. SETTING: Finnish screening programme based on personal first round invitations in 1992-94, and with 90% attendance rate. METHODS: Attenders (n = 946) belonged to a 10% random sample (n = 1680 women, age 50, response rate 64%) of the target population (n = 16,886), non-attenders (n = 641, 38%) came from the whole target population. Predictors were measured one month before the screening invitation. Measures included items for social and behavioural factors, Breast Cancer Susceptibility Scale, Illness Attitude Scale, Health Locus of Control Scale, Anxiety Inventory, and Depression Inventory. Univariate and multivariate logistic regression analyses were used to predict attendance. RESULTS: Those most likely to attend were working, middle income, and averagely educated women, who had not had a mass mammogram recently, but who regularly visited gynaecologists, attended for Pap smear screening, practised breast self examination, and who did not smoke. Low confidence in their own capabilities in breast cancer prevention, overoptimism about the sensitivity of mammography, and perception of breast cancer risk as moderate were also predictive of attendance. Expectation of pain at mammography was predictive of non-attendance. CONCLUSION: Mammography screening organised as a public health service was well accepted. A recent mammogram, high reliance on self control of breast cancer, and an expectation of pain at mammography deterred attendance at screening. Further information about these factors and health information on screening are needed.