Síndrome metabólica em profissionais de enfermagem que atuam na assistência oncológica: prevalência e fatores associados / Síndrome metabólico en profesionales de enfermería que actúan en la asistencia oncológica: prevalencia y factores asociados / Metabolic syndrome in nursing professionals working in oncology care: prevalence and associated factors

RESUMO Objetivo: avaliar a prevalência da síndrome metabólica e os fatores associados em profissionais de enfermagem que atuam em oncologia. Método: estudo transversal com 231 profissionais de enfermagem, de um centro de alta complexidade em oncologia do Estado do Rio de Janeiro, Brasil, entre junho de 2013 e junho de 2015. Realizou-se entrevista para coleta de dados sociodemográficos, profissionais, antecedentes pessoais, hábitos e estilos de vida e condições de saúde. Foram realizadas medida da circunferência da cintura, peso, altura, pressão arterial casual e Monitorização Ambulatorial da Pressão Arterial, além da glicemia plasmática de jejum, triglicerídeos e lipoproteína de alta densidade. Avaliou-se a síndrome metabólica de acordo com a I Diretriz Brasileira de Diagnóstico e Tratamento da Síndrome Metabólica. Regressão de Poisson com variância robusta foi realizada, sendo a presença da síndrome metabólica ou não o desfecho. Resultados: a prevalência da síndrome metabólica foi de 25,1% e esta condição se associou ao maior tempo de formação profissional (4,0%; IC95%:1,05-1,07), à maior pressão diastólica na Monitorização Ambulatorial da Pressão Arterial do período de sono (3,0%; IC95%:1,01-1,05), presença de sobrepeso (2,84%; IC95%:1,93-6,70) e obesidade (4,94%; IC95%:2,08-11,77). Conclusões: observou-se alta prevalência da síndrome metabólica nos profissionais avaliados, e associação com excesso de peso e alteração da pressão no período de sono. Os resultados apontam para necessidade de intervenções para controle de fatores de risco para doenças crônicas não transmissíveis na população estudada.

RESUMEN Objetivo: evaluar la prevalencia del síndrome metabólico y los factores asociados en profesionales de enfermería que actúan en oncología. Método: estudio transversal con 231 profesionales de enfermería, de un centro de alta complejidad en oncología del Estado de Rio de Janeiro, Brasil, entre junio de 2013 y junio de 2015. Se realizó entrevista para recolección de datos sociodemográficos, profesionales, antecedentes personales, hábitos y estilos de vida y condiciones de salud. Fueron realizadas medida de la circunferencia de la cintura, peso, altura, presión arterial casual y Monitoreo Ambulatorio de Presión Arterial, además de la glucemia plasmática de ayuno, triglicéridos y lipoproteína de alta densidad. Se evaluó el síndrome metabólico de acuerdo con la I Directriz Brasileña de Diagnóstico y Tratamiento del Síndrome Metabólico. Fue realizada Regresión de Poisson con varianza robusta, siendo la presencia del síndrome metabólico, o no, el resultado. Resultados: la prevalencia del síndrome metabólico fue de 25,1% y esta condición se asoció al mayor tiempo de formación profesional (4,0%; IC95%:1,05-1,07), a la mayor presión diastólica en elMonitoreo Ambulatorio de Presión Arterial del período de sueño (3,0%; IC95%:1,01-1,05); presencia de sobrepeso (2,84%; IC95%:1,93-6,70) y obesidad (4,94%; IC95%:2,08-11,77). Conclusiones: se observó alta prevalencia del síndrome metabólico en los profesionales evaluados, y asociación con exceso de peso y alteración de la presión en el período de sueño. Los resultados señalan la necesidad de intervenciones para el control de factores de riesgo para enfermedades crónicas no transmisibles en la población estudiada.

ABSTRACT Objective: to evaluate the prevalence of metabolic syndrome and associated factors in nursing professionals working in oncology. Method: cross-sectional study with 231 nursing professionals from a high complexity oncology center in the State of Rio de Janeiro, Brazil, between June 2013 and June 2015. An interview was carried out to collect sociodemographic, professional, personal history, habits and lifestyles, and health conditions data. Waist circumference, weight, height, casual blood pressure, and Ambulatory Blood Pressure Monitoring were performed, in addition to fasting plasma glucose, triglycerides, and high-density lipoprotein. Metabolic syndrome was evaluated according to the I Brazilian Guideline for the Diagnosis and Treatment of Metabolic Syndrome. Poisson regression with robust variance was performed, the outcome being the presence or not of metabolic syndrome. Results: there was a 25.1% prevalence of metabolic syndrome and this condition was associated with longer professional training (4.0%; 95%CI: 1.05-1.07), with higher diastolic pressure in Ambulatory Blood Pressure Monitoring during sleep (3.0%; 95%CI:1.01-1.05), overweight (2.84%; 95%CI:1.93-6.70), and obesity (4.94%; IC95%: 2.08-11.77). Conclusions: there was a high prevalence of metabolic syndrome among the evaluated professionals, and an association between excess weight and changes in pressure during sleep. The results point to the need for interventions to control risk factors for chronic non-communicable diseases in the studied population.

Improving rates of metabolic monitoring on an inpatient psychiatric ward.

OBJECTIVES: Cardiovascular disease is the leading cause of premature death in patients with mental illness. Metabolic syndrome is a cluster of co-occurring cardiovascular risk factors, seen in high frequency in severe mental illness. Despite ease of diagnosis, monitoring is often poor across psychiatric populations. This report details a quality improvement initiative undertaken on an inpatient psychiatric ward to improve rates of metabolic monitoring. METHODS: Four key interventions were developed: (1) A nurse-led intervention, where nurses were upskilled in performing metabolic monitoring, (2) Education was provided to all staff, (3) Introduction of a suite of interventions to improve metabolic risk and (4) Ongoing consumer involvement. A pre-post intervention study design was used to measure effectiveness, with an audit of metabolic monitoring rates performed 12 months after the intervention began. RESULTS: Rates of weight and height monitoring both increased from 46.0% to 69.5% (p=0.0185) and body mass index (BMI) recordings increased from 33% to 63% (p=0.0031). Rates of waist circumference monitoring increased from 44.2% to 65.2% (p=0.0498). Blood pressure (BP) measurements increased from 88.5% to 100% (p=0.0188). Lipid monitoring rates improved from 23% to 69.5% (p=0.001). Rates of glucose monitoring increased from 74% to 82.5% (p=0.8256), although this was not statistically significant. CONCLUSIONS: We found that metabolic monitoring improved following these simple interventions, with a statistically significant increase in measurement rates of weight, BP, height, lipids, BMI and waist circumference (p<0.05). Overall monitoring of glucose also improved, although not to significant levels. The intervention was acceptable to both patients and staff.

Oncology nurses' knowledge and awareness on metabolic syndrome in cancer survivors and the perceived barriers to the provision of related care: A mixed-method study.

OBJECTIVE: To identify oncology nurses' level of knowledge and awareness of metabolic syndrome (MetS) in cancer survivors and the perceived barriers to the provision of MetS-related care. METHODS: In this mixed-method study, 196 participants responded to a structured modified questionnaire that included items pertaining to MetS-related knowledge and awareness. Concurrently, 24 semi-structured interviews were conducted. A qualitative survey and quantitative interview were conducted between October 2018 and December 2018. RESULTS: While oncology nurses had a high level of knowledge of MetS in terms of its individual components, they failed to accurately differentiate MetS cases from non-MetS ones. Further, they showed a high level of awareness of MetS-related care for cancer survivors but did not apply their knowledge in clinical settings. In the qualitative survey, the nurses cited various factors pertaining to their perceived barriers to the provision of MetS-related care, including the fact that cancer survivors are distinguished by the specificity of the subject and inpatient environmental constraints. CONCLUSIONS: Oncology nurses had a high level of knowledge of MetS but failed to accurately identify MetS cases. Thus, their level of knowledge should be improved, and strategies are needed to overcome the perceived barriers to the provision of MetS-related care.

A nurse-led lifestyle intervention using mobile application versus booklet for adults with metabolic syndrome-Protocol for a randomized controlled trial.

AIMS: To compare the effect of a lifestyle intervention programme using mobile application versus booklet for adults with metabolic syndrome (MetS) living in the community. DESIGN: A multisite randomized controlled trial with three parallel arms, namely metabolic syndrome app group, booklet group, and control group. METHODS: The research study has been supported by the Health and Medical Research fund in Hong Kong in 2019. The protocol was approved by the study university and the selected community centres. Three hundred and sixty subjects will be recruited from community centres and randomized into either one arm. Inclusion criteria are those adult with MetS, able to use a smart phone. All participants received a 30-min health educational session. App group participants will receive a mobile application while booklet group participants will receive a specific booklet of MetS care and the control group receive a placebo booklet only. The primary outcomes comprises of body weight. The secondary outcomes include total physical exercise, cardiometablolic risk factors, cardiovascular endurance, self-efficacy for exercise, and stress level. Data will be collected at baseline, weeks 4, 12, and 24. SPSS and generalized estimating equations model will be employed for data analysis. DISCUSSION: Metabolic syndrome is a common health problem associated with the heightened risk of cardiovascular disease and the risks are potentially amenable to lifestyle intervention. The results will compare the relative effectiveness of a lifestyle intervention using an app versus a booklet on physical and psychological outcomes for adults with MetS. IMPACT: What problem will the study address? The results will inform the healthcare professional and nurses about the effective way for health promotion, to enhance patient's lifestyle modification and exercise sustainability that will be beneficial to the clients' health.

Terminologia especializada de enfermagem para o cuidado de pessoas com síndrome metabólica / Terminología especializada de enfermería para el cuidado a la persona con síndrome metabólica / Specialized nursing terminology for the care of people with metabolic syndrome

RESUMO Objetivo Construir uma terminologia especializada de enfermagem para o cuidado de pessoas com síndrome metabólica na Atenção Primária à Saúde. Método Estudo metodológico, realizado a partir da identificação dos conceitos de enfermagem para o cuidado à pessoa com a síndrome, validação dos conceitos com enfermeiros especialistas e mapeamento cruzado com os conceitos primitivos da CIPE® 2017. Resultados Dos conceitos extraídos, 489 envolveram as necessidades psicobiológicas, psicossociais e psicoespirituais. Destes, 441 conceitos foram validados e submetidos ao mapeamento e à análise de similaridade e abrangência, a qual possibilitou eliminação de conceitos considerados sinônimos, culminado em 389 conceitos relacionados às necessidades de pessoas com síndrome metabólica, em que 43,7% dos conceitos validados não constavam na versão 2017 da CIPE®. Do total de conceitos constantes e não constantes, 42,3% foram classificados no eixo Ação, seguido do eixo Foco (34,9%). Conclusão e implicações para a prática Com o alcance do objetivo, têm-se o avanço no conhecimento sobre a utilização da CIPE®, com uma proposta de uniformização da linguagem profissional para o cuidado de pessoas com síndrome metabólica, com potencial para incrementar sistemas de informação da Atenção Primária à Saúde com indicadores do cuidado de enfermagem para pessoas com agregação de fatores de risco cardiovascular.

RESUMEN Objetivo Construir una terminología especializada en enfermería para el cuidado de personas con síndrome metabólico en Atención Primaria de Salud Método Estudio metodológico, basado en la identificación de conceptos de enfermería para el cuidado de personas con síndrome, validación de conceptos con enfermeros expertos y mapeo cruzado con los primeros conceptos de CIPE® 2017. Resultados De los conceptos extraídos, 489 involucraron las necesidades psicobiológicas, psicosociales y espirituales. De estos, 441 conceptos fueron validados y sometidos a mapeo y análisis de similitud y exhaustividad, lo que permitió la eliminación de conceptos considerados sinónimos, que culminaron en 389 conceptos relacionados con las necesidades de las personas con síndrome metabólico, de los cuales el 43.7% de los conceptos validados no constaban en la versión 2017 de la CIPE®. Del total de conceptos constantes y no constantes, el 42,3% se clasificó en el eje Acción, seguido del eje Enfoque (34,9%). Conclusión e implicaciones para la práctica con el logro del objetivo, existe un avance en el conocimiento sobre el uso de CIPE®, con una propuesta para estandarizar el lenguaje profesional para la atención de personas con síndrome metabólico, con el potencial de mejorar los sistemas de información de Atención Primaria de Salud con indicadores de atención de enfermería para personas con agregación de factores de riesgo cardiovascular.

ABSTRACT Objective To build a specialized nursing terminology for the care of people with metabolic syndrome in Primary Health Care. Method Methodological study, based on the identification of nursing concepts for the care of people with the syndrome, validation of concepts with nurses experts, and cross-mapping with the early concepts of ICNP® 2017. Results Of the concepts extracted, 489 involved psychobiological, psychosocial, and psycho-spiritual needs. Of these, 441 concepts were validated and subjected to mapping and analysis of similarity and comprehensiveness, which allowed the elimination of concepts considered synonyms, culminating in 389 concepts related to the needs of people with metabolic syndrome, in which 43.7% of validated concepts were not contained in the 2017 version of the ICNP®. Of the constant and non-constant concepts, 42.3% were classified in the Action axis, followed by the Focus axis (34.9%). Conclusion and implications for practice With the achievement of the objective, there is the advance in knowledge about the use of ICNP®, with a proposal to standardize professional language for the care of people with metabolic syndrome, with the potential to increase Primary Health Care information systems with indicators of nursing care for people with aggregation of cardiovascular risk factors.

Health Effects of an Individualized Lifestyle Intervention for People with Psychotic Disorders in Psychiatric Outpatient Services: A Two Year Follow-up.

People with psychotic disorders experience to a great extent avoidable physical illnesses and early mortality. The aim of the study was to investigate the potential effects for this group of participating in a lifestyle intervention. A multi-component nurse-led lifestyle intervention using quasi-experimental design was performed. Changes in biomedical and clinical measurements, self-reported health, symptoms of illness and health behavior were investigated. Multilevel modeling was used to statistically test differences in changes over time. Statistically significant changes were found in physical activity, HbA1c and waist circumference. A lifestyle intervention for people with severe mental illness can be beneficial for increasing physical activity.

Effectiveness of a community-based nurse-led lifestyle-modification intervention for people with serious mental illness and metabolic syndrome.

The development of metabolic syndrome negatively affects the quality of life of people with serious mental illness. Experts agree on the need to evaluate the physical health of patients and intervene in modifiable risk factors, with emphasis on the promotion of healthy lifestyles. Interventions should include nutritional counselling and physical activity. This 24-week randomized trial evaluated the effects of a community-based nurse-led lifestyle-modification intervention in people with serious mental illness meeting metabolic syndrome criteria, and its impact on health-related quality of life and physical activity. Sixty-one participants from two community mental health centres were randomly assigned to the intervention or control group. The intervention consisted of weekly group sessions, with 20 min of theoretical content and 60 min of nurse-led physical activity. Postintervention results between groups showed no differences in weight, waist circumference, fasting glucose, and systolic blood pressure. Differences in body mass index, triglyceride concentrations, and diastolic blood pressure were found to be significant (P = 0.010, P = 0.038, and P = 0.017). Participants who performed the intervention reported an increase in physical activity, which did not occur in the control group (P = 0.035), and also reported better health status (P < 0.001). Our intervention showed positive effects reducing participants' cardiovascular and metabolic risks and improving their physical activity and quality of life. To our knowledge, this is the first clinical trial led and carried out by mental health nurses in community mental health centres which takes into account the effects of a lifestyle intervention on every metabolic syndrome criterion, health-related quality of life, and physical activity.

Metabolic Syndrome: conceptual analysis in the nursing context. / Síndrome metabólica: análise conceitual no contexto da enfermagem.

OBJECTIVE: to analyze the metabolic syndrome concept and to identify its essential features, antecedents, and outcomes within the context of nursing. METHOD: conceptual analysis, based on the methodological steps of a model. We carried out an integrative review by accessing four databases online: Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences Literature, and Índice Bibliográfico Español en Ciencias de la Salud. RESULTS: the essential features most frequently involved the diagnostic criteria of metabolic syndrome. Inadequate nutrition and physical inactivity were highlighted as the most common antecedents of the syndrome, and the outcomes were occurrences of cardiovascular disease and diabetes mellitus type 2. As implication, we highlight relevant empirical data to the broad definition of the concept. CONCLUSION: we could analyze the concept under study regarding essential features, antecedents, and outcomes, operationally defining it as a potential nursing phenomenon, which demands health care focusing on reducing risks and morbidity and mortality for cardiovascular diseases.

A Retrospective Chart Review of Screening on the Prevalence of Metabolic Syndrome (MetS) in an Irish Community Mental Health Service.

Individuals who are treated with antipsychotic medications are at risk of developing metabolic syndrome (MetS). The comorbidity of a severe mental illness (SMI) and a physical illness has a major impact on the quality of life of these individuals. We conducted a retrospective chart review (RCR) of 214 individuals with a diagnosis of schizophrenia who had been receiving antipsychotic medications for at least 6 months, in five clinical settings in an Irish community mental health service. The aim was to determine the presence of MetS to assist in improving screening practices and directing future practice. The National Cholesterol Education Program High Blood Cholesterol Adult Treatment Panel 111 (NCEP ATP 111) metabolic diagnostic criteria were utilised to determine prevalence. After examining 214 charts we observed that waist circumference varied from 68 to 142 cm, elevated waist circumference over the recommended parameters was recorded in 145 charts. Forty-five percent (n = 98) had blood pressure (BP) readings over 130/85. The range for body mass index (BMI)'s varied from 16 to 54, BMIs over 25 was recorded in 44% (n = 95) of charts. Elevated triglycerides (TG) were recorded in 37% (n = 80) and 45% (n = 97) had reduced HDL-C levels. Elevated glucose levels were found in 25% (n = 54) of the charts examined. The chart review found an overall prevalence rate of 44% (n = 94) for this sample. Regular audit of screening data used for the presence of MetS in individuals with SMI is essential in the detection of physical comorbidities and to improving the quality of life and prevention of premature deaths.

Plan de cuidados a una mujer con obesidad mórbida / Care plan for a woman with morbid obesity

Se presenta el caso de una mujer de 48 años de edad con obesidad mórbida diagnosticada desde los 23 años, aparentemente sin manejo terapéutico bien definido. Presentó antecedentes de síndrome metabólico. Se abordó el caso con una valoración general y la verificación de los datos del Índice de Masa Corporal y pruebas bioquímicas. Se emplearon las taxonomías North American Nursing Diagnosis As-sociation (NANDA), Nursing Intervention Classification (NIC) y Nursing Outcomes Classification (NOC) para guiar el plan de intervención a lo largo de un año. Se midieron objetivamente los indicadores antropométricos y bioquímicos en la medición basal, a los 6 meses y un año después del contacto inicial. Conforme pasaron los meses, los resultados propuestos denotaron una mejoría. Las cifras del Índice de Masa Corporal disminuyeron así como los marcadores de presión arterial, perfil de lípidos, química sanguínea y hemoglobina glucosilada

We present the case of a 48-year-old woman with morbid obesity diagnosed since the age of 23, apparently without a well-defined therapeutic management. She presented a history of metabolic syndrome. The case was addressed starting with a general assessment verifying data on Body Mass Index and biochemical tests. The North American Nursing Diagnosis Association (NANDA), Nursing Intervention Classification (NIC) and Nursing Outcomes Classification (NOC) taxonomies were used to guide the intervention plan over a year. The anthropometric and biochemical indicators were objectively measured in the basal measurement, at 6 months and one year after the initial contact. As the months passed, the proposed results showed improvement. The figures of Body Mass Index decreased and also did the markers of blood pressure, lipid profile, blood chemistry and glycosylated hemoglobin

Síndrome metabólica: análise conceitual no contexto da enfermagem / Metabolic Syndrome: conceptual analysis in the nursing context / Síndrome metabólica: análisis conceptual en el contexto de la enfermería

Objetivo analisar o conceito síndrome metabólica e identificar respectivos atributos essenciais, antecedentes e consequentes no contexto da enfermagem. Método análise conceitual, a partir dos passos metodológicos de um modelo. Realizou-se revisão integrativa, por meio de acesso on-line a quatro bases de dados: Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online, Literatura Latino-Americana em Ciências da Saúde e Índice Bibliográfico Español en Ciencias de la Salud. Resultados os atributos essenciais mais frequentes envolveram os critérios diagnósticos da síndrome metabólica. Alimentação inadequada e sedentarismo destacaram-se como antecedentes mais comuns da síndrome, e os consequentes foram ocorrências de doenças cardiovasculares e diabetes mellitus tipo 2. Como implicação, tem-se o destaque de relevantes dados empíricos para definição ampla do conceito. Conclusão foi possível analisar o conceito em estudo no que concerne aos atributos essenciais, antecedentes e consequentes, definindo-o operacionalmente como potencial fenômeno de enfermagem que demanda cuidados direcionados para redução do risco e da morbimortalidade por doenças cardiovasculares.

Objective to analyze the metabolic syndrome concept and to identify its essential features, antecedents, and outcomes within the context of nursing. Method conceptual analysis, based on the methodological steps of a model. We carried out an integrative review by accessing four databases online: Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online, Latin American and Caribbean Health Sciences Literature, and Índice Bibliográfico Español en Ciencias de la Salud. Results the essential features most frequently involved the diagnostic criteria of metabolic syndrome. Inadequate nutrition and physical inactivity were highlighted as the most common antecedents of the syndrome, and the outcomes were occurrences of cardiovascular disease and diabetes mellitus type 2. As implication, we highlight relevant empirical data to the broad definition of the concept. Conclusion we could analyze the concept under study regarding essential features, antecedents, and outcomes, operationally defining it as a potential nursing phenomenon, which demands health care focusing on reducing risks and morbidity and mortality for cardiovascular diseases.

Objetivo analizar el concepto síndrome metabólica e identificar respectivos atributos esenciales, antecedentes y consecuentes en el contexto de la enfermería. Método análisis conceptual, desde los pasos metodológicos de un modelo. Se realizó la revisión integrativa, por medio de acceso online a cuatro bases de datos: Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online, Literatura Latinoamericana en Ciencias de la Salud y Índice Bibliográfico Español en Ciencias de la Salud. Resultados los atributos esenciales más frecuentes involucraron los criterios diagnósticos del síndrome metabólica. Alimentación inadecuada y sedentarismo se destacaron como antecedentes más comunes del síndrome, y los consecuentes fueron ocurrencias de enfermedades cardiovasculares y diabetes mellitus tipo 2. Como implicación, se tiene el destaque de relevantes datos empíricos para la definición amplia del concepto. Conclusión ha sido posible analizar el concepto en estudio en el que concierne a los atributos esenciales, antecedentes y consecuentes, definiéndolo operacionalmente como potencial fenómeno de enfermería que demanda cuidados direccionados para la reducción del riesgo y de la morbimortalidad por enfermedades cardiovasculares.

Effectiveness of the I2AO2 interdisciplinary programme led by nurses on metabolic syndrome and cardiovascular risk: a randomized, controlled trial.

Objective To evaluate the effectiveness of an interdisciplinary programme led by nurses in relation to metabolic syndrome (MS) and cardiovascular risk (CVR). Methods This randomized, controlled, clinical trial included 74 patients diagnosed with MS (experimental group [EG], n = 37; control group [CG], n = 37). The intervention consisted of a 12-month interdisciplinary programme (pre-test, 6 months of intervention, 12 months of intervention, and 1-year follow-up post-intervention) coordinated by nursing. Results We found a progressive and significant reduction for all clinical, biochemical, and anthropometric parameters analysed at different time points. In the EG, remission of MS by 48.1% in the short term was observed (83.8% in the medium term) and maintained at 1 year post-intervention. In the CG, the prevalence of MS increased by 2.7% from the initial evaluation to study completion. A similar trend was observed for CVR. In the EG, 100% of subjects had a moderate-low risk of CVR at 1 year post-intervention, whereas the CG had CVR in all categories. Conclusion An interdisciplinary, nurse-led programme improves participants' metabolic and cardiovascular health, while maintaining long-term effects. Our findings suggest an important role of the professional nurse as a nexus between the patient, different professionals, and the community.

The Effect of Nutrition and Sleep Habits on Predisposition for Metabolic Syndrome in Greek Children.

PURPOSE: To investigate the effect of lifestyle habits in childhood Metabolic Syndrome (MTS). DESIGN AND METHODS: Descriptive correlation study with 480 participants (5-12 years old) using a specially designed questionnaire was conducted. Anthropometric and biochemical analyses were performed. RESULTS: Fifteen percent of children exhibited predisposition for MTS. Regarding sleep habits, logistic regression analysis (LRA) showed that hour of sleep -before 22:00- was associated with decreased waist circumference (WC%) (p = .026). Midday siesta was negatively correlated with systolic (SBP) (p = .001) and diastolic blood pressure (DBP) (p = .046). In children without MTS, lack of sleep and night time sleep was positively correlated with DBP (p = .044) and fasting blood glucose (FBG) (p = .005). Regarding nutrition habits, fast food consumption was positively correlated with SBP (p = .006) and meat consumption was positively correlated with both Body Mass Index% (BMI%) (p = .038) and WC% (p = .023). LRA showed that fruit (p = .001) and legume (p = .040) consumption was associated with decreased FBG; fish consumption with decreased Low Density Lipoprotein (LDL) cholesterol (p = .031), vegetable (p = .054) and cereal consumption (p = .012) with decreased DBP. In children with MTS, fruits were associated with increased FBG (p = .034). In children without MTS, meat consumption was associated with increased LDL (p = .024), cereal with increased WC% (p = .002) and olive products with increased High Density Lipoprotein (HDL) cholesterol and BMI% (p = .037). CONCLUSIONS: The adoption of both balanced diet and sleep habits seemed to be crucial for the prevention of MTS. PRACTICE IMPLICATIONS: Clinical health nurses could develop and implement preventive intervention programs in order to avoid metabolic complications in adulthood.

Nurse health and lifestyle modification versus standard care in 40 to 70 year old regional adults: study protocol of the Management to Optimise Diabetes and mEtabolic syndrome Risk reduction via Nurse-led intervention (MODERN) randomized controlled trial.

BACKGROUND: Metabolic syndrome (MetS), the clustering of multiple leading risk factors, predisposes individuals to increased risk for developing type 2 diabetes and/or cardiovascular disease (CVD). Cardio-metabolic disease risk increases with greater remoteness where specialist services are scarce. Nurse-led interventions are effective for the management of chronic disease. The aim of this clinical trial is to determine whether a nurse-implemented health and lifestyle modification program is more beneficial than standard care to reduce cardio-metabolic abnormalities and future risk of CVD and diabetes in individuals with MetS. METHODS: MODERN is a multi-centre, open, parallel group randomized controlled trial in regional Victoria, Australia. Participants were self-selected and individuals aged 40 to 70 years with MetS who had no evidence of CVD or other chronic disease were recruited. Those attending a screening visit with any 3 or more risk factors of central obesity, dyslipidemia (high triglycerides or low high density lipoprotein cholesterol) elevated blood pressure and dysglycemia were randomized to either nurse-led health and lifestyle modification (intervention) or standard care (control). The intervention included risk factor management, health education, care planning and scheduled follow-up commensurate with level of risk. The primary cardio-metabolic end-point was achievement of risk factor thresholds to eliminate MetS or minimal clinically meaningful changes for at least 3 risk factors that characterise MetS over 2 year follow-up. Pre-specified secondary endpoints to evaluate between group variations in cardio-metabolic risk, general health and lifestyle behaviours and new onset CVD and type 2 diabetes will be evaluated. Key outcomes will be measured at baseline, 12 and 24 months via questionnaires, physical examinations, pathology and other diagnostic tests. Health economic analyses will be undertaken to establish the cost-effectiveness of the intervention. DISCUSSION: The MODERN trial will provide evidence for the potential benefit of independent nurse-run clinics in the community and their cost-effectiveness in adults with MetS. Findings will enable more nurse-led clinics to be adopted outside of major cities and encompassing other chronic diseases as a key primary preventative initiative. TRIAL REGISTRATION: MODERN is registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12616000229471 ) on 19 February 2016 (retrospectively registered). Secondary identifiers: MODERN is an investigator-initiated trial funded by the National Health and Medical Research Council of Australia from 2014 to 2017 via a Project Grant (ID No. APP1069043) and was approved by the Australian Catholic University Human Research Ethics Committee (Project No: 2014 244 V) and the Department of Health Human Research Ethics Committee (Project No:38/2014) for the release of Medicare claims information.

Improving Metabolic Syndrome Screening on Patients on Second Generation Antipsychotic Medication.

AIM: This quality improvement project aims at stressing the importance of screening for metabolic syndrome (MS) on patients with serious mental illness (SMI) managed with second generation antipsychotic (SGA) medication. METHOD: One hundred charts of patients who were on SGA (n=100) were randomly selected from more than 1000 charts for the purpose of this project with (n=50) charts for pre-intervention and (n=50) charts for post intervention. A chi-square test of independence was calculated comparing the frequency of labs and vital done in pre-intervention and post-intervention period. RESULTS: A significant interaction was found [χ2(2)=32.67, p<.001] indicating that providers were more likely to order labs in postintervention (62%) than in pre-intervention (22%). No significant relationship was found for vital signs [χ2(1)=.542, p>.05]. The use of the screening and monitoring tool showed that gaps exist in the screening for MS among patients on SGA. IMPLICATION TO PRACTICE: Advanced health nurse practitioners are well placed to take the lead in screening, monitoring, and implementing the necessary measures to address MS among patients with serious mental illness.

Effectiveness of community-based exercise intervention programme in obese adults with metabolic syndrome.

AIMS AND OBJECTIVES: The objective of this study was to change the anthropometric, clinical, biochemical indicators and the rate of metabolic syndrome among obese adults in community. BACKGROUND: Obesity is an indicator of metabolic syndrome and cardiometabolic diseases. Obesity increases national health care expenditure in Taiwan. The high prevalence of obesity is not only a public health issue but also an economic problem. Changes in lifestyle can help to prevent metabolic syndrome for individuals with obesity. DESIGN: A randomised controlled trial was applied. METHODS: In this randomised controlled trial by location, 136 metabolically abnormal obese individuals were included. The related indicators with metabolic syndrome were measured at baseline and after six months. The experimental group participated in a six-month community-based programme including provided exercise environments, exercise skills and volunteers' reminding. The control group was only provided environment and skills. RESULTS: One hundred and thirty-one participants completed this trail. In comparison with the baseline, the intervention group showed a significant increase in high-density lipoprotein cholesterol (2·34 mg/dl), and decrease in body weight (1·09 kg), waist circumference (3·63 cm), systolic blood pressure (10·52 mmHg), diastolic blood pressure (5·21 mmHg), fasting blood glucose (5·84 mg/dl) and body mass index (0·74 kg/m(2) ). In the control group, significant decrease in body mass index and waist circumference were discovered. Compared to the changes between the two groups, the results showed there were significant differences in waist circumference, systolic blood pressure, diastolic blood pressure and high-density lipoprotein cholesterol. CONCLUSIONS: The community-based intervention could help to improve high-density lipoprotein cholesterol, reduce body weight, body mass index, waist circumference, blood pressure and fasting blood glucose in metabolically abnormal obese. RELEVANCE TO CLINICAL PRACTICE: This community-based programme helped metabolically abnormal obese individuals become metabolically healthy. In the future, community nurses will work with village heads and volunteers. They can encourage residents in the communities to have healthy lifestyle. As a result, the goal of this programme will be successfully achieved with less time and effort.

Mobile Apps Providing Tailored Nursing Interventions for Patients with Metabolic Syndrome.

OBJECTIVES: This study developed and evaluated four mobile applications (apps) that provide tailored nursing recommendations for metabolic syndrome management. METHODS: Mobile apps for obesity, gestational diabetes, hypertension, and hyperlipidemia management were developed according to the system development life cycle and evaluations by experts and users. RESULTS: Six lifestyle management and five disease-specific knowledge domains were extracted. Functions such as 'Log in' and 'Record data using diary' to be used in all of the apps were extracted, while disease-specific functions were also extracted, including 'Determine the goal' to be used in the obesity app. The proficiency and efficiency of the algorithms ranged from 69.0 to 100.0. In a heuristics evaluation all of the problems were resolved and all of the usability scores exceeded 3.5 out of 5. CONCLUSION: This study demonstrates that metabolic syndrome can be effectively managed using special functions provided by smartphones, such as automatic feedback, alerts, diaries, and social media integration. Future work will include integrating and harmonizing these four apps in order to improve their semantic interoperability.

Nursing Care for Lifestyle Behavioral Change.

The purpose of this pilot study was to determine if metabolic risk factors can be stabilized or improved with weekly motivational interviewing/coaching and medical follow-up care focused on lifestyle behavioral change in individuals with serious mental illness. Individuals were followed for 18 weeks following discharge from an inpatient psychiatric service. All individuals were prescribed an antipsychotic medication and had at least two risk factors for metabolic syndrome. Weight, waist circumference, blood pressure, LDLs, triglycerides, and blood glucose levels were evaluated during the study period. In addition, each individual selected a lifestyle behavior to improve over the 18-week period. Weekly motivational interviewing, and staggered health promotion appointments were designed to keep individuals focused on health and behavior change. While some individuals showed improvement, others showed deterioration in the physiological markers for metabolic syndrome. Only a small number completed the 18-week study. The nature of current psychiatric care is focused on rapid stabilization and discharge; individuals with serious mental illness may have difficulty focusing on lifestyle behavioral change while transitioning to independent living following an acute exacerbation of mental illness.

Metabolic Syndrome Screening and Assertive Community Treatment: A Quality Improvement Study.

Metabolic syndrome defines a collection of cardiometabolic illnesses that predict risk for poor physical health and early death and is highly prevalent among those with serious mental illness. Despite recommendations for routine monitoring, those with serious mental illness frequently do not receive physical health screenings. We conducted a quality improvement (QI) project to increase rates of metabolic syndrome screening in three New York City Assertive Community Treatment (ACT) teams. The project, conducted from December 2010 to May 2011, involved educational sessions for staff and consumers and a systematic screening protocol. We collected complete metabolic syndrome screening measurements for 71% of participating ACT consumers. We found metabolic risk to be nearly universal among participants, with over half diagnosed with metabolic syndrome. We also found high rates of previously undiagnosed hypertension, diabetes, and dyslipidemia. We describe the resources and obstacles we encountered in our QI project to make systematic metabolic screening a routine part of ACT care. This QI project suggests that ACT teams can take a leadership role in screening their consumers for physical health issues, aligning with recent policy trends to better integrate behavioral health and primary care services.