RESUMO
Event boundaries impose structure on how events are stored in long-term memory. Research with young adults has shown that associations within events are stronger than those that cross event boundaries. Recently, this effect was observed in both young and old adults using movie stimuli (Davis, Chemnitz, et al., 2021). Here, we test whether this effect extends to written narratives. Young and old participants read a series of narratives that were interspersed with temporal shifts in the storyline meant to elicit the perception of an event boundary. Later, participants were cued with sentences and were asked to recall the sentence that immediately followed. We expected participants would have worse memory when a cue and correct answer flanked a boundary than when it did not. In Experiment 1, we found that despite older adults' lower performance overall, both age groups had lower accuracy for cues that flanked a boundary, compared to cues that elicited a response from within the same event. Experiment 2 replicated the results from Experiment 1. Our results support past work that did not find age differences in event perception and demonstrate that older and younger adults may store events similarly in long-term memory.
Assuntos
Memória de Longo Prazo , Rememoração Mental , Adulto Jovem , Humanos , Idoso , Memória de Longo Prazo/fisiologia , Rememoração Mental/fisiologia , Sinais (Psicologia) , Idioma , Transtornos da Memória , Envelhecimento/fisiologiaRESUMO
Digital health is transforming the delivery of health care around the world to meet the growing challenges presented by ageing populations with multiple chronic conditions. Digital health technologies can support the delivery of personalised nutrition care through the standardised Nutrition Care Process (NCP) by using personal data and technology-supported delivery modalities. The digital disruption of traditional dietetic services is occurring worldwide, supporting responsive and high-quality nutrition care. These disruptive technologies include integrated electronic and personal health records, mobile apps, wearables, artificial intelligence and machine learning, conversation agents, chatbots, and social robots. Here, we outline how digital health is disrupting the traditional model of nutrition care delivery and outline the potential for dietitians to not only embrace digital disruption, but also take ownership in shaping it, aiming to enhance patient care. An overview is provided of digital health concepts and disruptive technologies according to the four steps in the NCP: nutrition assessment, diagnosis, intervention, and monitoring and evaluation. It is imperative that dietitians stay abreast of these technological developments and be the leaders of the disruption, not simply subject to it. By doing so, dietitians now, as well as in the future, will maximise their impact and continue to champion evidence-based nutrition practice.
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Atenção à Saúde/tendências , Dietética/tendências , Tecnologia Digital , Tecnologia Disruptiva , Prática Clínica Baseada em Evidências/normas , Humanos , Terapia Nutricional/normas , Telemedicina/métodosRESUMO
BACKGROUND: Dietetics practice educators are instrumental in the development of future dietitians. The present study aimed to explore dietetics practice educators' experiences of, and challenges faced in, dietetics workforce preparation. METHODS: This study was guided by interpretive description methodology. Purposive and maximum variation sampling were used to recruit 18 dietetics practice educators from a variety of practice areas and locations across Australia. In-depth, semi-structured interviews were digitally recorded then transcribed verbatim and inductive coding of data was managed with nvivo (QSR International Pty Ltd, Doncaster, VIC, Australia). Multiple researchers analysed the data to develop preliminary themes using template analysis before final themes were identified. RESULTS: Three main themes were developed: nurturing others; seeing the flaws; and soldiering on. Practice educators take great satisfaction in witnessing students develop and are focused on cultivating future practitioners with authentic learning activities. However, they are impacted by perceived shortcomings of the systems in which they operate and consider that broadening the scope of dietetics placements to better align with contemporary practice could benefit graduates and the profession. Despite these challenges, practice educators are pragmatic in getting on with their roles and recognise the advantages gained from student placements. CONCLUSIONS: Despite facing numerous challenges, practice educators derive benefits from their role in workforce preparation. Evidence is required on how students can demonstrate competence in contemporary areas of practice and on how to enable the scope of student placements to be broadened. Such strategies could support practice educators to overcome challenges and help ensure the dietetics profession of tomorrow is relevant and responsive.
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Dietética/educação , Pessoal de Educação/psicologia , Nutricionistas/psicologia , Adulto , Austrália , Competência Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nutricionistas/provisão & distribuição , Pesquisa QualitativaRESUMO
BACKGROUND: Dietetics students are a widely researched group. As emerging dietitians, they can provide valuable insights to inform how dietetics education programmes may be enhanced to meet contemporary healthcare needs. This review aimed to systematically synthesise dietetics students' experiences of dietetics workforce preparation. METHODS: MEDLINE, CINAHL, Embase, PsycINFO, ERIC, Informit and ProQuest Dissertations and Theses Global were searched to identify research published until June 2017. Studies investigating dietetics students' experiences of dietetics workforce preparation, and employing qualitative data collection and analysis methods were included. Data analysis was guided by thematic synthesis, where themes were constructed through an iterative and inductive process. Study quality was appraised using the RATS Qualitative Research Review Guidelines. RESULTS: From the 3301 records identified, five studies met the inclusion criteria and the views of 120 dietetics students from two countries over a 9-year period were synthesised. The overarching theme of 'navigating through the ups and downs' was underpinned by four main themes: enduring hurdles; reconciling expectations; transforming self; and making and breaking connections. Quality appraisal results rated selection bias as being inadequate/inappropriate across all studies. CONCLUSIONS: Dietetics students undertake a transformational journey through dietetics education. They are inspired by seeing what is possible through meaningful encounters with practitioners in diverse settings. However, they are challenged by competitive environments and perceived ideals that are embedded in the profession. Strategies that focus on exposing dietetics students to inspirational practitioners, increasing and celebrating diversity in academic/placement settings, and incentivising collaboration across dietetics education, could act as catalysts to enhance the experience of future dietetics students and the nutrition-related health of those they will serve.
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Competência Clínica , Dietética/educação , Nutricionistas/psicologia , Estudantes/psicologia , Adulto , Feminino , Mão de Obra em Saúde , Humanos , Masculino , Nutricionistas/educação , Nutricionistas/provisão & distribuição , Pesquisa QualitativaRESUMO
BACKGROUND: Rectal prolapse is a disease presentation with a prevalence of about 1%, mainly affecting older women. It usually presents with symptoms of rectal mass, rectal bleeding, fecal incontinence or constipation, with patients frequently feeling socially isolated as a result. Perineal rectosigmoidectomy is associated with lesser morbidity and mortality than the abdominal procedure, but with a much higher recurrence rate. Therefore, this technique is mainly suitable for the frail elderly patient. Specific outcomes in an elderly population have been described in only a few studies. We evaluated the morbidity, mortality, recurrence rate and functional results after this procedure related to age. METHODS: All patients who underwent a perineal rectosigmoidectomy over a 10-year period in two tertiary referral centers were included in the study. American Society of Anesthesiology (ASA) grade, pre- and postoperative symptoms, pathology-reported post-fixation specimen length, length of in-patient stay, 30-day morbidity/mortality, and recurrence were measured. RESULTS: A total of 45 patients underwent a perineal rectosigmoidectomy. Forty-three (95%) were female, with a median age of 82.0 years (IQR 70.5-86.5), ASA grade III and median follow-up of 20 months (range 8.5-45.5 months). Half of the cohort was over 80 years old. Significant symptomatic relief was achieved, predominantly the resolution of rectal mass (8.9% vs. 60.0% preoperatively), fecal incontinence (15.6% vs. 46.7%) and constipation (4.4% vs. 26.7%). The median length of stay was 6 days, while morbidity occurred in 14 patients (31.1%) and recurrence occurred in 6 patients (13%). There were no deaths within 30 days of the procedure and outcomes were comparable in the < 80 and ≥ 80 age group. CONCLUSIONS: Perineal rectosigmoidectomy is safe for older patients with greater comorbidities resulting in good functional results and is associated with low morbidity and mortality.
Assuntos
Colo Sigmoide/cirurgia , Protectomia/efeitos adversos , Protectomia/métodos , Prolapso Retal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Constipação Intestinal/etiologia , Incontinência Fecal/etiologia , Feminino , Idoso Fragilizado , Nível de Saúde , Humanos , Tempo de Internação , Masculino , Períneo , Prolapso Retal/complicações , Recidiva , Avaliação de Sintomas , Centros de Atenção Terciária , Resultado do Tratamento , Reino UnidoRESUMO
BACKGROUND: Change in cognitive ability is a commonly reported adverse effect by breast cancer survivors. The underlying etiology of cognitive complaints is unclear and to date, there is limited evidence for effective intervention strategies. Exercise has been shown to improve cognitive function in older adults and animal models treated with chemotherapy. This proof-of-concept randomized controlled trial tested the effect of aerobic exercise versus usual lifestyle on cognitive function in postmenopausal breast cancer survivors. METHODS: Women, aged 40 to 65 years, postmenopausal, stages I to IIIA breast cancer, and who self-reported cognitive dysfunction following chemotherapy treatment, were recruited and randomized to a 24-week aerobic exercise intervention (EX; n = 10) or usual lifestyle control (CON; n = 9). Participants completed self-report measures of the impact of cognitive issues on quality of life (Functional Assessment of Cancer Therapy-Cognitive version 3), objective neuropsychological testing, and functional magnetic resonance imaging at baseline and 24 weeks. RESULTS: Compared to CON, EX had a reduced time to complete a processing speed test (trail making test-A) (-14.2 seconds, P < .01; effect size 0.35). Compared to CON, there was no improvement in self-reported cognitive function and effect sizes were small. Interestingly, lack of between-group differences in Stroop behavioral performance was accompanied by functional changes in several brain regions of interest in EX compared to CON at 24 weeks. CONCLUSION: These findings provide preliminary proof-of-concept results for the potential of aerobic exercise to improve cancer-related cognitive impairment and will serve to inform the development of future trials.
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Disfunção Cognitiva/terapia , Exercício Físico , Pós-Menopausa , Sobreviventes , Adulto , Idoso , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/psicologia , Disfunção Cognitiva/induzido quimicamente , Disfunção Cognitiva/psicologia , Terapia por Exercício , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Testes Neuropsicológicos , Estudo de Prova de Conceito , Qualidade de Vida , Autorrelato , Resultado do TratamentoRESUMO
PURPOSE: With only 5-10% of breast cancer cases attributed to genetic inheritance, prevention efforts have focused on modifiable risk factors. Physical activity plays a role in reducing breast cancer risk; however, the interaction between physical activity and other modifiable risk factors, such as obesity, has received little attention. METHODS: A systematic review and meta-analysis was conducted of studies examining the relationship between physical activity and breast cancer and how it may be modified by body mass index (BMI). RESULTS: A total of 29 papers were included: 18 were cohort and 11 were case-control studies. Overall, a significant reduction in the relative risk of breast cancer was found in postmenopausal women with high versus low levels of physical activity for women with a BMI <25 kg/m2 (RR 0.85, 95% CI 0.79, 0.92) and ≥25 kg/m2 (RR 0.87, 95% CI 0.81, 0.93) but not ≥30 kg/m2 (RR: 0.93, 95% CI 0.76, 1.13). Physical activity was not associated with a significant reduction in risk of breast cancer in premenopausal women in any BMI group. CONCLUSION: The results of this meta-analysis suggest that physical activity is associated with a larger breast cancer risk reduction among women who are normal weight or overweight than among women who are obese. Since the included studies used diverse methods for assessment of physical activity and categories of BMI, results should be interpreted with caution and additional work is needed.
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Neoplasias da Mama/epidemiologia , Obesidade/complicações , Neoplasias da Mama/prevenção & controle , Estudos de Coortes , Exercício Físico , Feminino , Humanos , Pós-Menopausa , Pré-MenopausaRESUMO
The aim of the study was to describe the effect of fluconazole on the pharmacokinetics of cyclosporin A in healthy dogs when investigated as a single dose and at steady-state. Five healthy adult dogs were used in the study in a crossover design receiving either 5 mg/kg of cyclosporin A (CsA) alone or 5 mg/kg of fluconazole with 2.5 mg/kg of cyclosporin A (CsA/Flu) for 35 days. Pharmacokinetic curves were performed on day 1 and day 35 in addition to sampling trough and suspected peak concentrations (C2) twice weekly with LC/MS/MS. There was no statistically significant difference noted in any pharmacokinetic value (AUC0-inf. [day 1, P = 0.225], AUCtau [day 35, P = 0.225], t½ [day 1, P = 0.279; day 35, P = 0.686], and Cmax [day 1, P = 0.225; day 35, P = 0.225]) between the treatment groups by sampling day. There was a statistically significant increase in AUC (CsA P = 0.043; CsA/Flu P = 0.043) and t½ (CsA P = 0.042, CsA/Flu P = 0.042) over time within each group. There were no significant differences in the Cmax (CsA P = 0.08; CsA/Flu P = 0.08) when comparing day 1 vs. day 35. Steady-state cyclosporine concentrations were achieved by day 10 in both groups. Subjectively, individual variability was noted among the dogs and a much larger sample size would be beneficial in a future study.
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Ciclosporina/farmacocinética , Fluconazol/farmacologia , Animais , Área Sob a Curva , Cães , Imunossupressores , Espectrometria de Massas em TandemRESUMO
AIM: Incomplete colonoscopy occurs in 8-10% of attempted examinations. An incomplete colonoscopy is usually followed by radiological evaluation of the large bowel to complete the colonic assessment. Patients then found to have polyps of > 1 cm represent a significant management dilemma. This study describes our experience using laparoscopy to facilitate complete colonoscopy and polypectomy in patients with fixed angulation and the success of subsequent colonoscopies. METHOD: All patients from 2008 to 2012 with an incomplete colonoscopy because of fixed angulation and with polyps detected by subsequent imaging underwent standard laparoscopy with colonic mobilization by division of adhesions to facilitate direct vision. Completion of colonoscopy and polypectomy, intra-operative complications, postoperative morbidity and successful standard follow-up colonoscopy were studied. RESULTS: Twelve patients underwent the procedure. Complete colonoscopy to caecum was successful in all, with a median of 2 (range 1-5) polyps per patient and a mean polyp size of 22 mm. One iatrogenic enterotomy was repaired immediately, with no sequelae. Ten patients have since undergone colonoscopy under sedation, with complete colonic evaluation possible in nine of the patients. CONCLUSION: Laparoscopic-assisted colonoscopy allows safe polypectomy in patients with incomplete colonoscopy, without the need for segmental resection. This less-invasive procedure yields recovery times similar to those of colonoscopy alone, avoiding the morbidity of a segmental resection with the added benefit of successful routine colonoscopy in the future.
Assuntos
Pólipos do Colo/cirurgia , Colonoscopia/métodos , Laparoscopia/métodos , Adulto , Idoso , Colo/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
BACKGROUND AND AIMS: The elevated cardiovascular (CVD) risk observed in chronic kidney disease (CKD) may be partially alleviated through diet. While protein intake may link to CVD events in this patient population, dietary fiber has shown cardioprotective associations. Nutrients are not consumed in isolation; we hypothesize that CVD events in CKD may be associated with dietary patterns aligned with an excess of dietary protein relative to fiber. METHODS AND RESULTS: Prospective cohort study from the Uppsala Longitudinal Study of Adult Men. Included were 390 elderly men aged 70-71 years with CKD and without clinical history of CVD. Protein and fiber intake, as well as its ratio, were calculated from 7-day dietary records. Cardiovascular events were registered prospectively during a median follow-up of 9.1 (inter-quartile range, 4.5-10.7) years. The median dietary intake of protein and fiber was 66.7 (60.7-71.1) and 16.6 (14.5-19.1) g/day respectively and the protein-to-fiber intake ratio was 4.0 (3.5-4.7). Protein-to-fiber intake ratio was directly associated with serum C-reactive protein levels. During follow-up, 164 first-time CVD events occurred (incidence rate 54.5/1000 per year). Protein-fiber intake ratio was an independent risk factor for CVD events [adjusted hazard ratio, HR per standard deviation increase (95% confidence interval, CI) 1.33 (1.08, 1.64)]. Although in opposing directions, dietary protein [1.18 (0.97, 1.44)], dietary fiber alone [0.81 (0.64, 1.02)], were not significantly associated with CVD events. CONCLUSIONS: An excess of dietary protein relative to fiber intake was associated with the incidence of cardiovascular events in a homogeneous population of older men with CKD.
Assuntos
Doenças Cardiovasculares/epidemiologia , Fibras na Dieta/administração & dosagem , Proteínas Alimentares/efeitos adversos , Insuficiência Renal Crônica/epidemiologia , Idoso , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Registros de Dieta , Proteínas Alimentares/administração & dosagem , Comportamento Alimentar , Avaliação Geriátrica/métodos , Humanos , Incidência , Estudos Longitudinais , Masculino , Avaliação Nutricional , Estado Nutricional , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Proteção , Recomendações Nutricionais , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/fisiopatologia , Medição de Risco , Fatores de Risco , Suécia/epidemiologia , Fatores de TempoRESUMO
BACKGROUND: Rigorously applied exercise interventions undertaken in a research setting result in improved health-related quality of life (hrqol) in cancer survivors, but research to demonstrate effective translation of that research to practice is needed. The objective of the present study was to determine the effect of fee-for-service cancer rehabilitation programs in the community on hrqol and on self-reported physical activity and its correlates. METHODS: After enrolment and 17 ± 4 weeks later, new clients (n = 48) to two fee-for-service cancer rehabilitation programs completed the 36-Item Short Form Health Survey (rand-36: rand Corporation, Santa Monica, CA, U.S.A.), the Godin Leisure-Time Exercise Questionnaire, and questions about physical activity correlates. Normal fee-for-service operations were maintained, including a fitness assessment and individualized exercise programs supervised in a group or one-on-one setting, with no minimum attendance required. Fees were associated with the assessment and with each exercise session. RESULTS: Of the 48 participants, 36 (75%) completed both questionnaires. Improvements in the physical functioning, role physical, pain, and energy/fatigue scales on the rand-36 exceeded minimally important differences and were of a magnitude similar to improvements reported in structured, rigorously applied, and free research interventions. Self-reported levels of vigorous-intensity (p = 0.021), but not moderate-intensity (p = 0.831) physical activity increased. The number of perceived barriers to exercise (p = 0.035) and the prevalence of fatigue as a barrier (p = 0.003) decreased. Exercise self-efficacy improved only in participants who attended 11 or more sessions (p = 0.002). Exercise enjoyment did not change (p = 0.629). CONCLUSIONS: Enrolment in fee-for-service cancer rehabilitation programs results in meaningful improvements in hrqol comparable to those reported by research interventions, among other benefits. The fee-for-service model could be an effective model for delivery of exercise to more cancer survivors.
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BACKGROUND AND AIMS: Indoxyl sulfate (IS) and p-cresyl sulfate (PCS) are uremic toxins derived solely from colonic bacterial fermentation of protein. Dietary fiber may counteract this by limiting proteolytic bacterial fermentation. However, the influence of dietary intake on the generation of IS and PCS has not been adequately explored in chronic kidney disease (CKD). METHODS AND RESULTS: This cross-sectional study included 40 CKD participants (60% male; age 69 ± 10 years; 45% diabetic) with a mean estimated glomerular filtration rate (eGFR) of 24 ± 8 mL/min/1.73 m(2), who enrolled in a randomized controlled trial of synbiotic therapy. Total and free serum IS and PCS were measured at baseline by ultra-performance liquid chromatography. Dietary intake was measured using in-depth diet histories collected by a dietitian. Associations between each toxin, dietary fiber (total, soluble and insoluble), dietary protein (total, and amino acids: tryptophan, tyrosine and phenylalanine), and the protein-fiber index (ratio of protein to fiber) were assessed using linear regression. Dietary fiber was associated with free and total serum PCS (r = -0.42 and r = -0.44, both p < 0.01), but not IS. No significant association was observed between dietary protein and either toxin. The protein-fiber index was associated with total serum IS (r = 0.40, p = 0.012) and PCS (r = 0.43, p = 0.005), independent of eGFR, sex and diabetes. CONCLUSION: Dietary protein-fiber index is associated with serum IS and PCS levels. Such association, beyond fiber and protein alone, highlights the importance of the interplay between these nutrients. We speculate that dietary modification towards a lower protein-fiber index may contribute to lowering IS and PCS.
Assuntos
Indicã/sangue , Insuficiência Renal Crônica/sangue , Idoso , Biomarcadores/sangue , Índice de Massa Corporal , Cresóis/sangue , Estudos Transversais , Fibras na Dieta/administração & dosagem , Proteínas Alimentares/administração & dosagem , Ingestão de Energia , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Ésteres do Ácido Sulfúrico/sangueRESUMO
OBJECTIVE: To compare the energy expenditure of increased lateral trunk lean walking - a suggested method of reducing medial compartment knee joint load - compared to normal walking in a population of older adults with medial knee osteoarthritis (OA). METHOD: Participants completed two randomly-presented treadmill walking conditions: 15 min of normal walking or walking with ten degrees of peak lateral trunk lean. Lateral trunk lean angle was displayed in front of the participant in real-time during treadmill conditions. Energy expenditure (VO2 and METs), heart rate (HR), peak lateral trunk lean angle, knee pain and perceived exertion were measured and differences between conditions were compared using paired t-tests. RESULTS: Twelve participants (five males, mean (standard deviation (SD)) age 64.1 (9.4) years, body mass index (BMI) 28.3 (4.9) kg/m²) participated. All measures were significantly elevated in the lateral trunk lean condition (P < 0.008), except for knee pain (P = 0.22). Oxygen consumption (VO2) was, on average 9.5% (95% CI 4.2-14.7%) higher, and HR was on average 5.3 beats per minute (95% CI 1.7-9.0 bpm) higher during increased lateral trunk lean walking. CONCLUSION: Increased lateral trunk lean walking on a treadmill resulted in significantly higher levels of steady-state energy expenditure, HR, and perceived exertion, but no difference in knee pain. While increased lateral trunk lean has been shown to reduce biomechanical measures of joint loading relevant to OA progression, it should be prescribed with caution given the potential increase in energy expenditure experienced when it is employed.
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Metabolismo Energético/fisiologia , Marcha/fisiologia , Osteoartrite do Joelho/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos/fisiologia , Índice de Massa Corporal , Teste de Esforço , Feminino , Frequência Cardíaca/fisiologia , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Consumo de Oxigênio/fisiologia , Dor/etiologia , Índice de Gravidade de Doença , Caminhada/fisiologia , Suporte de Carga/fisiologiaRESUMO
BACKGROUND: Excess body weight and a sedentary lifestyle are associated with the development of several diseases, including cardiovascular disease, diabetes and cancer in women. One proposed mechanism linking obesity to chronic diseases is an alteration in adipose-derived adiponectin and leptin levels. We investigated the effects of 12-month reduced calorie, weight loss and exercise interventions on adiponectin and leptin concentrations. METHODS: Overweight/obese postmenopausal women (n = 439) were randomized as follows: (i) a reduced calorie, weight-loss diet (diet; N = 118), (ii) moderate-to-vigorous intensity aerobic exercise (exercise; N = 117), (iii) a combination of a reduced calorie, weight-loss diet and moderate-to-vigorous intensity aerobic exercise (diet + exercise; N = 117), and (iv) control (N = 87). The reduced calorie diet had a 10% weight-loss goal. The exercise intervention consisted of 45 min of moderate-to-vigorous aerobic activity 5 days per week. Adiponectin and leptin levels were measured at baseline and after 12 months of intervention using a radioimmunoassay. RESULTS: Adiponectin increased by 9.5% in the diet group and 6.6% in the diet + exercise group (both P ≤ 0.0001 vs. control). Compared with controls, leptin decreased with all interventions (diet + exercise, -40.1%, P < 0.0001; diet, -27.1%, P < 0.0001; exercise, -12.7%, P = 0.005). The results were not influenced by the baseline body mass index (BMI). The degree of weight loss was inversely associated with concentrations of adiponectin (diet, P-trend = 0.0002; diet + exercise, P-trend = 0.0005) and directly associated with leptin (diet, P-trend < 0.0001; diet + exercise, P-trend < 0.0001). CONCLUSION: Weight loss through diet or diet + exercise increased adiponectin concentrations. Leptin concentrations decreased in all of the intervention groups, but the greatest reduction occurred with diet + exercise. Weight loss and exercise exerted some beneficial effects on chronic diseases via effects on adiponectin and leptin.
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Adiponectina/metabolismo , Dieta Redutora/métodos , Exercício Físico/fisiologia , Leptina/metabolismo , Obesidade/terapia , Adiponectina/análise , Idoso , Índice de Massa Corporal , Feminino , Seguimentos , Humanos , Leptina/análise , Pessoa de Meia-Idade , Obesidade/diagnóstico , Sobrepeso/diagnóstico , Sobrepeso/terapia , Pós-Menopausa , Valores de Referência , Medição de Risco , Fatores de Tempo , Resultado do Tratamento , Redução de PesoRESUMO
BACKGROUND: A healthcare professional's aptitude to develop research skills and actively engage in research is necessary to optimise healthcare efficacy. The present study investigated the factors that contribute to research capacity within the Australian dietetic workforce. METHODS: Queensland-based dietitians scored their department and individual skill or success in research on a 10-point scale using an anonymous online survey that incorporated the validated Research Capacity in Context tool. Descriptive statistics were assessed against geographical setting, dietetic experience and the proportion of role (Full Time Equivalent; FTE) designated to research. Research activities were defined by the number of items currently involved in or completed in the past 6 months (n = 11). Factors associated with research activities were assessed by multivariable linear regression. RESULTS: Dietitians (n = 130) identified having a moderate skill or success in 14 research items [mean (SD) 5.1 (1.7)] and perceived that their departments provided a moderate level of research support in 19 research items [mean (SD) 6.1 (2.5)]. Geographical setting, the proportion of role designated to research (FTE) and participation in research activities were associated with individual and department ratings of research skill or success. Research involvement was predicted by the proportion of role (FTE) designated to research (ß = 0.34, t = 4.16, P < 0.001) and years of experience in dietetics (ß = 0.32, t = 2.67, P < 0.009). CONCLUSIONS: A dietitian's capacity for research is related to professional experience and the designation of research in the role description. The findings of the present study will provide a baseline of research capacity and expertise among dietitians, and also inform the strategic development of building research capacity.
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Competência Clínica , Dietética , Nutricionistas , Papel Profissional , Pesquisa , Logro , Coleta de Dados , Emprego , Feminino , Humanos , Masculino , Análise Multivariada , Percepção , QueenslandRESUMO
INTRODUCTION: Technology-based exercise is gaining attention as a promising strategy for increasing physical activity (PA) in older adults with cancer (OACA). However, a comprehensive understanding of the interventions, their feasibility, outcomes, and safety is limited. This scoping review (1) assessed the prevalence and type of technology-based remotely delivered exercise interventions for OACA and (2) explored the feasibility, safety, acceptability, and outcomes in these interventions. METHODS: Studies with participant mean/median age ≥ 65 reporting at least one outcome measure were included. Databases searched included the following: PubMed, CINAHL, Embase, Cochrane Library Online, SPORTDiscus, and PsycINFO. Multiple independent reviewers completed screening and data abstractions of articles in English, French, and Spanish. RESULTS: The search yielded 2339 citations after removing duplicates. Following title and abstract screening, 96 full texts were review, and 15 were included. Study designs were heterogeneous, and sample sizes were diverse (range 14-478). The most common technologies used were website/web portal (n = 6), videos (n = 5), exergaming (n = 2), accelerometer/pedometer with video and/or website (n = 4), and live-videoconferencing (n = 2). Over half (9/15) of the studies examined feasibility using various definitions; feasibility outcomes were reached in all. Common outcomes examined include lower body function and quality of life. Adverse events were uncommon and minor were reported. Qualitative studies identified cost- and time-savings, healthcare professional support, and technology features that encourage engagement as facilitators. CONCLUSION: Remote exercise interventions using technology appear to be feasible and acceptable in OACA. IMPLICATIONS FOR CANCER SURVIVORS: Some remote exercise interventions may be a viable way to increase PA for OACA.
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OBJECTIVE: We examined the effects of an aerobic exercise intervention on adiposity outcomes that may be involved in the association between physical activity and breast cancer risk. DESIGN: This study was a two-centre, two-armed, randomized controlled trial. The 1-year-long exercise intervention included 45 min of moderate-to-vigorous aerobic exercise five times per week, with at least three of the sessions being facility based. The control group was asked not to change their activity and both groups were asked not to change their diet. SUBJECTS: A total of 320 postmenopausal, sedentary, normal weight-to-obese women aged 50-74 years who were cancer-free, nondiabetic and nonhormone replacement therapy users were included in this study. MEASUREMENTS: Anthropometric measurements of height, weight and waist and hip circumferences; dual energy X-ray absorptiometry measurements of total body fat; and computerized tomography measurements of abdominal adiposity were carried out. RESULTS: Women in the exercise group exercised a mean of 3.6 days (s.d.=1.3) per week and 178.5 min (s.d.=76.1) per week. Changes in all measures of adiposity favored exercisers relative to controls (P<0.001). The mean difference between groups was: -1.8 kg for body weight; -2.0 kg for total body fat; -14.9 cm(2) for intra-abdominal fat area; and -24.1 cm(2) for subcutaneous abdominal fat area. A linear trend of greater body fat loss with increasing volume of exercise was also observed. CONCLUSION: A 1-year aerobic exercise program consistent with current public health guidelines resulted in reduced adiposity levels in previously sedentary postmenopausal women at higher risk of breast cancer.
Assuntos
Adiposidade/fisiologia , Exercício Físico/fisiologia , Pós-Menopausa , Absorciometria de Fóton , Idoso , Feminino , Promoção da Saúde , Humanos , Pessoa de Meia-Idade , Atividade Motora , Pós-Menopausa/fisiologia , Fatores de Risco , Resultado do TratamentoRESUMO
PURPOSE: The potential of physical activity to improve function and quality of life of an individual with advanced cancer is now established. The purpose of this survey of oncologic healthcare providers (OHPs) is to understand their attitude towards physical activity for individuals living with bony metastases and to assess requirements to confidently provide physical activity recommendations. METHODS: A web-based survey administered through Qualtrics™ included questions on participant demographics and attitude questions ranked on a Likert scale. Eligibility was a physician or nurse practitioner currently providing care in the cancer care system of a public healthcare system in Canada. 338 participants were identified and invited to participate in this survey. RESULTS: The response rate was 34.6%. The majority of OHPs believed physical activity is important (89%) and safe (82%) in individuals living with bony metastases. OHPs agreed that these individuals looked to them for physical activity recommendations (74%) and that these recommendations would be followed (58%). Yet, 86% of OHPs felt they required more information before they could recommend physical activity to individuals living with bony metastases, and less than half (43%) of OHPs felt confident enough to prescribe physical activity. CONCLUSIONS: OHPs agree that physical activity for individuals living with bony metastatic cancer is beneficial and safe. However, OHPs are not confident in their ability to recommend physical activity to this population. IMPLICATIONS FOR CANCER SURVIVORS: There is a need to create physical activity guidelines for individuals living with bony metastases and improve access to rehabilitation services.
Assuntos
Sobreviventes de Câncer , Neoplasias , Exercício Físico , Pessoal de Saúde , Humanos , Oncologia , Qualidade de VidaAssuntos
Discite/etiologia , Laparoscopia/efeitos adversos , Retocele/cirurgia , Procedimentos Cirúrgicos Urogenitais/efeitos adversos , Parafusos Ósseos/efeitos adversos , Feminino , Humanos , Região Lombossacral , Pessoa de Meia-Idade , Retocele/complicações , Telas Cirúrgicas/efeitos adversos , Procedimentos Cirúrgicos Urogenitais/instrumentaçãoRESUMO
OBJECTIVE: Unlike excisional haemorrhoidectomy, stapled anopexy (SA), which does not involve radical excision, has theoretical advantages, thus offering potential patient benefits. We compared the clinical efficacy, safety and patient acceptability of SA, with closed haemorrhoidectomy (CH). PATIENTS AND METHODS: 182 patients with symptomatic haemorrhoids (grades II, III, IV) were randomly assigned to receive SA or CH and were followed for up to 1 year (6, 12, 24, 48 weeks) after operation. Postoperative pain, symptom control, complications, re-treatment rates, patient satisfaction, and quality of life were compared on an intention-to-treat basis. RESULTS: Postoperative pain in the SA group (n = 91) was significantly lower (p = 0.004, Mann-Whitney U test). At 1 year there were no significant differences in the symptom load, symptom severity or the disease severity between the two groups. Overall complication rates were similar but faecal urgency was reported more frequently following SA (p = 0.093, Fisher's exact test). Despite a similar rate of residual symptoms, prolapse control was better with CH (p = 0.087, Fisher's exact test), and more patients in the SA group required re-treatment for residual prolapse at 1 year (p = 0.037, Fisher's exact test). However, more patients rated SA as an excellent operation at 6 and 12 weeks (p = 0.008 and 0.033, binary logistic regression) and were willing to undergo a repeat procedure if required (p = 0.018, Fisher's exact test). CONCLUSION: Stapled anopexy offers a significantly less painful alternative to excisional haemorrhoidectomy and achieves a higher patient acceptability. Although the overall symptom control and safety are similar in the majority of the patients, the re-treatment rate for recurrent prolapse at 1 year is higher following SA when compared to CH.