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A Pre-Hospital Patient Education Program Improves Outcomes of Bariatric Surgery. - Obesity surgery
We designed an assessment and education program which was delivered to patients prior to first outpatient appointment for bariatric surgery. We hypothesised that this program would streamline care and would lead to improved weight loss following bariatric surgery.The program incorporates a structured general practitioners (GP) review, a patient information evening and an on-line learning package. It was introduced in September 2012. Patient flow through the program was recorded. Outcomes of the new program were compared with contemporaneously treated patients who did not undertake the pre-hospital program.All 636 patients on the waiting list for first appointment at the Alfred Health bariatric surgery clinic were invited to participate. There were 400 patients ultimately removed from the waiting list for first appointment. Of the remaining 236 patients, 229 consented to participate in the new program. The mean BMI was 47.8â€‰Â±â€‰9.2. The fail to attend first appointment rate dropped from 12 to 2.1Â %. At 12Â months post-bariatric surgery, patients who undertook the new program (nâ€‰=â€‰82) had a mean excess weight loss (EWL) of 41.1â€‰Â±â€‰20.3Â % where as those treated on the standard pathway (nâ€‰=â€‰61) had a mean EWL 32â€‰Â±â€‰18.0Â % (pâ€‰=â€‰0.012).The introduction of a pre-hospital education program has led to an improvement in attendance rates and early weight loss post-bariatric surgery.
Persistent Infections and Immunity in Ruminants to Arthropod-Borne Bacteria in the Family Anaplasmataceae. - Annual review of animal biosciences
Tick-transmitted gram-negative bacteria in the family Anaplasmataceae in the order Rickettsiales cause persistent infection and morbidity and mortality in ruminants. Whereas Anaplasma marginale infection is restricted to ruminants, Anaplasma phagocytophilum is promiscuous and, in addition to causing disease in sheep and cattle, notably causes disease in humans, horses, and dogs. Although the two pathogens invade and replicate in distinct blood cells (erythrocytes and neutrophils, respectively), they have evolved similar mechanisms of antigenic variation in immunodominant major surface protein 2 (MSP2) and MSP2(P44) that result in immune evasion and persistent infection. Furthermore, these bacteria have evolved distinct strategies to cause immune dysfunction, characterized as an antigen-specific CD4 T-cell exhaustion for A. marginale and a generalized immune suppression for A. phagocytophilum, that also facilitate persistence. This indicates highly adapted strategies of Anaplasma spp. to both suppress protective immune responses and evade those that do develop. However, conserved subdominant antigens are potential targets for immunization. Expected final online publication date for the Annual Review of Animal Biosciences Volume 4 is February 15, 2016. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
Assessing the effectiveness of High Intensity Interval Training (HIIT) for smoking cessation in women: HIIT to quit study protocol. - BMC public health
Smoking and physical inactivity are major risk factors for heart disease. Linking strategies that promote improvements in fitness and assist quitting smoking has potential to address both these risk factors simultaneously. The objective of this study is to compare the effects of two exercise interventions (high intensity interval training (HIIT) and lifestyle physical activity) on smoking cessation in female smokers.This study will use a randomised controlled trial design.Women aged 18-55 years who smokeâ€‰â‰¥â€‰5 cigarettes/day, and want to quit smoking.all participants will receive usual care for quitting smoking. Group 1 - will complete two gym-based supervised HIIT sessions/week and one home-based HIIT session/week. At each training session participants will be asked to complete four 4-min (4â€‰Ã—â€‰4 min) intervals at approximately 90Â % of maximum heart rate interspersed with 3- min recovery periods. Group 2 - participants will receive a resource pack and pedometer, and will be asked to use the 10,000 steps log book to record steps and other physical activities. The aim will be to increase daily steps to 10,000 steps/day. Analysis will be intention to treat and measures will include smoking cessation, withdrawal and cravings, fitness, physical activity, and well-being.The study builds on previous research suggesting that exercise intensity may influence the efficacy of exercise as a smoking cessation intervention. The hypothesis is that HIIT will improve fitness and assist women to quit smoking.ACTRN12614001255673 (Registration date 02/12/2014).
Chronic disease risks and use of a smartphone application during a physical activity and dietary intervention in Australian truck drivers. - Australian and New Zealand journal of public health
This study examined chronic disease risks and the use of a smartphone activity tracking application during an intervention in Australian truck drivers (April-October 2014).Forty-four men (mean age=47.5 [SD 9.8] years) completed baseline health measures, and were subsequently offered access to a free wrist-worn activity tracker and smartphone application (Jawbone UP) to monitor step counts and dietary choices during a 20-week intervention. Chronic disease risks were evaluated against guidelines; weekly step count and dietary logs registered by drivers in the application were analysed to evaluate use of the Jawbone UP.Chronic disease risks were high (e.g. 97% high waist circumference [â‰¥94 cm]). Eighteen drivers (41%) did not start the intervention; smartphone technical barriers were the main reason for drop out. Across 20-weeks, drivers who used the Jawbone UP logged step counts for an average of 6 [SD 1] days/week; mean step counts remained consistent across the intervention (weeks 1-4=8,743[SD 2,867] steps/day; weeks 17-20=8,994[SD 3,478] steps/day). The median number of dietary logs significantly decreased from start (17 [IQR 38] logs/weeks) to end of the intervention (0 [IQR 23] logs/week; p<0.01); the median proportion of healthy diet choices relative to total diet choices logged increased across the intervention (weeks 1-4=38[IQR 21]%; weeks 17-20=58[IQR 18]%).Step counts were more successfully monitored than dietary choices in those drivers who used the Jawbone UP.Smartphone technology facilitated active living and healthy dietary choices, but also prohibited intervention engagement in a number of these high-risk Australian truck drivers.Â© 2015 Public Health Association of Australia.
Effect of diagnosis with a chronic disease on physical activity behavior in middle-aged women. - Preventive medicine
Although regular physical activity is an effective secondary prevention strategy for patients with a chronic disease, it is unclear whether patients change their daily physical activity after being diagnosed. Therefore, the aims of this study were to (1) describe changes in levels of physical activity in middle-aged women before and after diagnosis with a chronic disease (heart disease, diabetes, asthma, breast cancer, arthritis, depression); and to (2) examine whether diagnosis with a chronic disease affects levels of physical activity in these women.Data from 5 surveys (1998-2010) of the Australian Longitudinal Study on Women's Health (ALSWH) were used. Participants (N=4840, born 1946-1951) completed surveys every three years, with questions about diseases and leisure time physical activity. The main outcome measure was physical activity, categorized as: nil/sedentary, low active, moderately active, highly active.At each survey approximately half the middle-aged women did not meet the recommended level of physical activity. Between consecutive surveys, 41%-46% of the women did not change, 24%-30% decreased, and 24%-31% increased their physical activity level. These proportions of change were similar directly after diagnosis with a chronic disease, and in the years before or after diagnosis. Generalized estimating equations showed that there was no statistically significant effect of diagnosis with a chronic disease on levels of physical activity in women.Despite the importance of physical activity for the management of chronic diseases, most women did not increase their physical activity after diagnosis. This illustrates a need for tailored interventions to enhance physical activity in newly diagnosed patients.Copyright Â© 2015 Elsevier Inc. All rights reserved.
Independent and combined effects of physical activity and body mass index on the development of Type 2 Diabetes - a meta-analysis of 9 prospective cohort studies. - The international journal of behavioral nutrition and physical activity
The aim of this harmonized meta-analysis was to examine the independent and combined effects of physical activity and BMI on the incidence of type 2 diabetes.Our systematic literature review in 2011 identified 127 potentially relevant prospective studies of which 9 fulfilled the inclusion criteria (total Nâ€‰=â€‰117,878, 56.2Â % female, mean ageâ€‰=â€‰50.0Â years, rangeâ€‰=â€‰25-65 years). Measures of baseline physical activity (low, intermediate, high), BMI-category [BMIâ€‰<â€‰18.4 (underweight), 18.5-24.9 (normal weight), 25.0-29.9 (overweight), 30+ (obese)] and incident type 2 diabetes were harmonized across studies. The associations between physical activity, BMI and incident type 2 diabetes were analyzed using Cox regression with a standardized analysis protocol including adjustments for age, gender, educational level, and smoking. Hazard ratios from individual studies were combined in a random-effects meta-analysis.Mean follow-up time was 9.1Â years. A total of 11,237 incident type 2 diabetes cases were recorded. In mutually adjusted models, being overweight or obese (compared with normal weight) and having low physical activity (compared with high physical activity) were associated with an increased risk of incident type 2 diabetes (hazard ratios 2.33, 95 % CI 1.95-2.78; 6.10, 95 % CI: 4.63-8.04, and 1.23, 95 % CI: 1.09-1.39, respectively). Individuals who were both obese and had low physical activity had 7.4-fold (95 % CI 3.47-15.89) increased risk of type 2 diabetes compared with normal weight, high physically active participants.This harmonized meta-analysis shows the importance of maintaining a healthy weight and being physically active in diabetes prevention.
The Feasibility of Using Questionnaires and Accelerometers to Measure Physical Activity and Sedentary Behavior Among Inpatient Adults With Mental Illness. - Journal of physical activity & health
The aim of this study was to assess the feasibility of using questionnaires and accelerometers to measure physical activity and sedentary behavior among inpatient adults with mental illness.Participants completed a physical activity and sitting time questionnaire and wore an accelerometer for seven consecutive days. Feasibility was assessed in terms of participant engagement, self-reported ease/difficulty of completing study components, extreme self-report data values and adherence to accelerometer wear time criteria. Ease/difficulty ratings were examined by level of distress.177 inpatients were invited to the study, 101 completed the questionnaires and 36 provided valid accelerometry data. Participants found it more difficult to complete sitting time and physical activity questionnaires than to wear the accelerometer during waking hours (z=3.787, p<0.001; z=2.824, p=0.005 respectively). No significant differences were found in ease/difficulty ratings by level of distress for any of the study components. Extreme values for self-reported sitting time were identified in 27% of participants.Inpatient adults with mental illness can engage with self-report and objective methods of measuring physical activity and sedentary behavior. They were initially less willing to participate in objective measurement, which may however be more feasible than self-report measures.
Trapping and desorption of complex organic molecules in water at 20 K. - The Journal of chemical physics
The formation, chemical, and thermal processing of complex organic molecules (COMs) is currently a topic of much interest in interstellar chemistry. The isomers glycolaldehyde, methyl formate, and acetic acid are particularly important because of their role as pre-biotic species. It is becoming increasingly clear that many COMs are formed within interstellar ices which are dominated by water. Hence, the interaction of these species with water ice is crucially important in dictating their behaviour. Here, we present the first detailed comparative study of the adsorption and thermal processing of glycolaldehyde, methyl formate, and acetic acid adsorbed on and in water ices at astrophysically relevant temperatures (20 K). We show that the functional group of the isomer dictates the strength of interaction with water ice, and hence the resulting desorption and trapping behaviour. Furthermore, the strength of this interaction directly affects the crystallization of water, which in turn affects the desorption behaviour. Our detailed coverage and composition dependent data allow us to categorize the desorption behaviour of the three isomers on the basis of the strength of intermolecular and intramolecular interactions, as well as the natural sublimation temperature of the molecule. This categorization is extended to other C, H, and O containing molecules in order to predict and describe the desorption behaviour of COMs from interstellar ices.
Outcomes of high-volume bariatric surgery in the public system. - ANZ journal of surgery
Bariatric surgery has not been widely used in the Australian public health system. As obesity is strongly associated with socio-economic status, excluding its use from the public system will deny many of the most in-need access to a potentially very effective treatment. Alternatively, with rigorous follow-up and behavioural change requirements, highly successful outcomes in the private system may not translate to the public system.The Alfred Hospital rapidly expanded bariatric surgery from 2007. A 6-year prospective follow-up study was conducted with annual review of weight, co-morbidities, retention in follow-up, serum HbA1c, quality of life and patient satisfaction.There were 1453 patients. Procedures were predominantly laparoscopic-adjustable gastric bands (n = 861). Patient details were age 49 Â± 11 years, body mass index 50.7 Â± 11.2â€‰kg/m(2) and weight 139.0 Â± 30.2â€‰kg. There was no mortality, and mean length of stay was 1.1 Â± 1.2 days. Follow-up was 98% (1 year) and 85% (6 years). Weight loss was 22 Â± 13.1â€‰kg (32.8 Â± 18% excess weight loss) at 1 and 30.1 Â± 16.8â€‰kg (60 Â± 28%) at 6 years. The mean number of co-morbidities was 4.2 Â± 1.1 with significant improvements observed. Patient satisfaction was 7.7 Â± 2.3 out of 10. Mental and physical summary scores (SF-36) improved from 41.02 Â± 13.17 to 45.50 Â± 13.27 (P < 0.001) and 33.97 Â± 10.53 to 44.79 Â± 11.19 (P < 0.001).Patients were older, heavier and suffered more co-morbid disease than previously reported cohorts. For the first time, excellent outcomes across a range of key quality domains in a large patient cohort have been reported in the public system. High-volume bariatric surgery in the public system is viable.Â© 2015 Royal Australasian College of Surgeons.
Physical activity and sedentary behaviour among inpatient adults with mental illness. - Journal of science and medicine in sport / Sports Medicine Australia
The aim of this study was to assess levels and patterns of physical activity and sedentary behaviour among inpatient adults with mental illness.Cross-sectional.101 participants completed questionnaires on time spent in walking, moderate- and vigorous-intensity activity in the past week and domain specific sitting time on a usual weekday and weekend day. 36 participants also provided valid accelerometry data. Regression analyses were used to explore associations between MVPA and sedentary behaviour and explanatory variables of gender, age, education, body mass index and psychological distress.Self-report data indicated median of 32min/day (IQR: 14.46-85.71) in weighted MVPA and a median of 761min/day (12.7h) (IQR: 552.43-917.14) in sedentary behaviour. Accelerometry data indicated an average of 115min/day in light activity, 37min/day in MVPA and 664min/day (11.1h) in sedentary behaviour. Bivariate analyses indicated no significant associations between explanatory variables and MVPA and sedentary behaviour.Inpatient adults with mental illness can be physically active, with walking comprising the major component of MVPA time. Inpatient adults with mental illness spend a significant amount of time sitting; intervention strategies could focus on reducing the time spent sitting in general relaxation and doing nothing.Copyright Â© 2015. Published by Elsevier Ltd.
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