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Recomendations on non-pharmacological interventions in women with PCOS to reduce body weight and improve metabolic disorders [Zalecenia dotyczące postępowania niefarmakologicznego u kobiet z PCOS celem zmniejszenia masy ciała i poprawy zaburzeń metabolicznych].
Dutkowska, A, Konieczna, A, Breska-Kruszewska, J, Sendrakowska, M, Kowalska, I, Rachoń, D
Endokrynologia Polska. 2019;(2):198-212
Abstract
Women with PCOS are characterised by ovarian hyperandrogenism, which, apart from fertility problems, hirsutism, acne, and androgenic alopecia, also leads to the development of central (android) obesity and its adverse metabolic consequences. Additionally, women with PCOS have intrinsic insulin resistance (IR) with its consequent hyperinsulinaemia, which leads to the development of atherosclerosis, arterial hypertension, and type 2 diabetes mellitus (T2DM), which give rise to cardiovascular disease (CVD), being the main cause of death among women. Although there are several publications on the topic of life-style changes in women with PCOS to normalise body weight and thus to reduce the adverse metabolic consequences of obesity, such as T2DM and CVD, the number of randomised studies that would enable the formation of strong recommendations is very limited. Nevertheless, taking into consideration the pathophysiology, any intervention implementing healthy dietary habits leading to the reduction of body weigh should be the core of non-pharmacological treatment in women with PCOS. The aim of the given recommendations herein is to point out and systemise the interventions on lifestyle change in women with PCOS as well as to form a practical guideline for the health care specialists, dieticians, and mental-therapists (psychologist) who take care of women with this syndrome.
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National policies to prevent obesity in early childhood: Using policy mapping to compare policy lessons for Australia with six developed countries.
Esdaile, E, Thow, AM, Gill, T, Sacks, G, Golley, R, Love, P, Wen, LM, Rissel, C
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2019;(11):1542-1556
Abstract
Interventions for obesity prevention in early childhood (first 5 years of life) are likely to have a significant preventive health impact. This mapping review identified recommended policy options for the Australian Federal Government (AFG) by comparing countries with similar population, income, and language to Australia. Policies were mapped in six countries using two matrices. The first matrix examined policy context, describing obesity prevention governance. The second matrix examined policy content, compared with global recommendations. Policies were grouped into downstream (healthcare), midstream (lifestyle and settings), and upstream (determinants of health, including food and built environments). Results identified variance in obesity governance across the six countries including policy coherence, leadership, institutional drivers, and overlapping responsibility across different levels of government. While countries tended to have more downstream or midstream policies, upstream policies were more likely when countries had invested in system-wide approaches to obesity such as developing a national obesity strategy, having separate food/nutrition and physical activity plans, and a dedicated preventive health agency. This study recommends a range of initiatives for the AFG to strengthen policies for the prevention of obesity in early childhood, including prioritising the development of a national food/nutrition strategy.
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The effect of youths as change agents on cardiovascular disease risk factors among adult neighbours: a cluster randomised controlled trial in Sri Lanka.
Chandraratne, N, Yamaguchi, M, Indrawansa, S, Gunawardena, N, Kuwahara, K, Islam, Z, Kawasaki, Y, Mizoue, T, Samarasinghe, D
BMC public health. 2019;(1):893
Abstract
BACKGROUND Mobilising non-professional health workers has been successful in improving community health, but the effectiveness of an education program targeting youths in a community-based approach remains unclear. The objective of this study was to investigate the effect of an intervention with youth on cardiovascular disease risk factors of community adults. METHODS A 12-month cluster randomised trial was conducted in a semi-urban area of Colombo in Sri Lanka. Facilitators trained youth club members aged 15-29 years to assess cardiovascular disease risk factors and take actions in the community to address relevant issues. The control group received no intervention. Body weight and blood pressure as primary outcomes and lifestyle of adults as secondary outcomes were measured pre- and post-intervention. Multilevel linear and logistic regressions were used to assess the effects of the intervention on changes in continuous and binary outcomes, respectively, from baseline to endpoint. RESULTS Of 512 participants at baseline, 483 completed the final assessment after the intervention. Regarding primary outcomes, the intervention group showed a significantly greater decrease in body weight after intervention than the control group. The mean (95% confidence interval) difference of body weight change for intervention versus control group was - 2.83 kg (- 3.31, - 2.35). There was no statistically significant difference in blood pressure between the two groups. Turning to the secondary outcomes, in diet, the intervention group had a higher probability of consuming at least one serving/day of fruits (p = 0.02) and a lower probability of consuming snacks twice/day or more (p < 0.001) than the control group. CONCLUSIONS An intervention employing youths as change agents was effective in lowering body weight among community adults in Sri Lanka. TRIAL REGISTRATION Trial registration number: SLCTR/2017/002 , Name of registry: Sri Lanka Clinical Trials Registry, Date of registration: 19th January 2017, Date of enrolment of the first participant to the trial: 1st February 2017.
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[Effects of Spouse-Participated Health Coaching for Male Office Workers with Cardiocerebrovascular Risk Factors].
Kang, SH, Hwang, SY
Journal of Korean Academy of Nursing. 2019;(6):748-759
Abstract
PURPOSE This study aimed to examine the effect of spouses participating in health coaching on stage of the change, health behaviors, and physiological indicators among male office workers with cardiocerebrovascular disease (CVD) risk factors and compare the findings with trainers who provided health coaching only to workers. METHODS A quasi-experimental pretest-posttest design was used. Convenience sampling was used to recruit participants from a manufacturing research and development company in the city of Gyeonggi province. The health coaching program for the experimental group (n=26) included individual counseling sessions according to workers' stage of change, and provision of customized health information materials on CVD prevention to workers and their spouses for 12 weeks through mobile phone and email. RESULTS After 12 weeks of intervention, the total score for health behavior, and scores on the sub-areas of exercise and health checkups significantly improved in the experimental group, but there were no significant differences in the scores of stage of the change and physical indicators. The results of a paired t-test showed a significant decrease in the body mass index, abdominal circumference, systolic blood pressure, diastolic blood pressure, total cholesterol and triglyceride values, and a significant increase in the high-density lipoprotein cholesterol value in the experimental group after the intervention. CONCLUSION To improve the health of male workers with CVD risk factors in the workplace, sharing health information with their spouses has proven to be more effective than health coaching for only workers. Therefore, it is important to develop strategies to encourage spousal participation when planning workplace health education for changing health-related behaviors.
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Assessment of Quality and Readability of Internet Dietary Information on Irritable Bowel Syndrome.
Alfaro-Cruz, L, Kaul, I, Zhang, Y, Shulman, RJ, Chumpitazi, BP
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2019;(3):566-567
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Diet plays an important role for patients with irritable bowel syndrome (IBS). For medical conditions such as IBS, the Internet is a primary source of health information.1 However, recent evidence suggests that Internet health information may have several flaws including being extremely discrepant, of poor quality, and inaccurate.2 Therefore, our objectives were to evaluate both the quality and reading level of Internet dietary recommendations for both pediatric and adult IBS.
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Effects of Culturally Tailored Nutrition Education on Dietary Quality of Hispanic Mothers: A Randomized Control Trial.
Hammons, AJ, Hannon, BA, Teran-Garcia, M, Barragan, M, Villegas, E, Wiley, A, Fiese, B, ,
Journal of nutrition education and behavior. 2019;(10):1168-1176
Abstract
OBJECTIVE To assess whether participation in a culturally tailored nutrition education program increases diet quality of Hispanic mothers. DESIGN A randomized controlled trial. SETTING Community centers and universities. PARTICIPANTS Sixty-five mothers (35 in experimental group, 30 in control group) completed pre- and postworkshop surveys. Eligibility criteria included being of Mexican or Puerto Rican descent and having a child between the ages of 6 and 18 years who could participate in the workshops with the parent. INTERVENTION Families in the experimental group participated in a 6-week workshop series that included weekly nutrition education classes. MAIN OUTCOME MEASURE Diet quality was assessed by the Rate Your Plate questionnaire. ANALYSIS Repeated measures ANOVA was used to compare differences between the experimental and control groups. A Wilcoxon signed rank test was conducted to test for significant shifts in categorization pre- and postprogram. RESULTS There was a significant change in diet quality categorization after participating in the workshops (P < .001, effect size 0.39). No changes were found in the control group. CONCLUSIONS AND IMPLICATIONS Abriendo Caminos was effective at increasing the diet quality of Hispanic mothers who participated the most in the program. More research is needed in this at-risk population to determine the relationships among nutrition knowledge, diet quality, and achievement of healthy weight.
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Protocol for systematic reviews of school-based food and nutrition education intervention for adolescent health promotion: Evidence mapping and syntheses.
de Medeiros, GCBS, de Azevedo, KPM, Garcia, DÁ, de Oliveira Segundo, VH, de Sousa Mata, ÁN, de Siqueira, KSDP, Fernandes, AKP, Santos, RPD, de Brito Trindade, DDB, de Oliveira Lyra, C, et al
Medicine. 2019;(35):e16977
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BACKGROUND Nutrition is an important modifiable factor in combating overweight and obesity among adolescents. School has been indicated as an effective environment for influencing eating behavior; however, recent reviews assessing school-based interventions specifically for adolescents are scarce. Therefore, we propose the present systematic review with the aim to comprehensively review the quantitative and qualitative literature on the effects of school-based food and nutrition education interventions on adolescent health promotion through healthy eating habits. METHODS We will search MEDLINE/PubMed, Embase, Scopus, ERIC, ScienceDirect, Web of Science, Cochrane, LILACS, and ADOLEC. We will include randomized controlled trials (RCT), non-RCT, and controlled before-after studies. Risk of bias will be assessed using the EPOC Risk of Bias Tool for RCT, Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool for non-RCT or controlled before-after, as well as the Critical Appraisal Skills Program (CASP) checklist for qualitative studies. We will analyze the overall strength of the evidence for each outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. Two independent researchers will conduct all evaluations and any disagreements will be consulted with a third reviewer. Data analysis and synthesis will be analyzed by the RevMan 5.3 software. We will conduct the study in accordance with the guideline of the Preferred Reporting Items for Systematic Review and Meta-analyses Protocols. RESULT This review will evaluate the effects of school-based food and nutrition education interventions on adolescent health promotion through healthy eating habits. The primary outcome will be changes in adolescent food consumption. Secondary outcomes will be biological parameters (e.g., body mass index (BMI), waist circumference (WC), body composition, etc); biochemical parameters (e.g., glycemia, triglycerides, total cholesterol, etc); qualitative evidences that support or explain the effect of school-based food and nutrition education interventions on adolescent food consumption. CONCLUSION The findings of this systematic review will summarize the latest evidence of the effects of school-based food and nutrition education interventions on adolescent health promotion. The findings will be an available reference for school-based interventions and other further research. REGISTRATION PROSPERO CRD42019116520.
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Offline Digital Education for Postregistration Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration.
Posadzki, P, Bala, MM, Kyaw, BM, Semwal, M, Divakar, U, Koperny, M, Sliwka, A, Car, J
Journal of medical Internet research. 2019;(4):e12968
Abstract
BACKGROUND The shortage and disproportionate distribution of health care workers worldwide is further aggravated by the inadequacy of training programs, difficulties in implementing conventional curricula, deficiencies in learning infrastructure, or a lack of essential equipment. Offline digital education has the potential to improve the quality of health professions education. OBJECTIVE The primary objective of this systematic review was to evaluate the effectiveness of offline digital education compared with various controls in improving learners' knowledge, skills, attitudes, satisfaction, and patient-related outcomes. The secondary objectives were (1) to assess the cost-effectiveness of the interventions and (2) to assess adverse effects of the interventions on patients and learners. METHODS We searched 7 electronic databases and 2 trial registries for randomized controlled trials published between January 1990 and August 2017. We used Cochrane systematic review methods. RESULTS A total of 27 trials involving 4618 individuals were included in this systematic review. Meta-analyses found that compared with no intervention, offline digital education (CD-ROM) may increase knowledge in nurses (standardized mean difference [SMD]=1.88; 95% CI 1.14 to 2.62; participants=300; studies=3; I2=80%; low certainty evidence). A meta-analysis of 2 studies found that compared with no intervention, the effects of offline digital education (computer-assisted training [CAT]) on nurses and physical therapists' knowledge were uncertain (SMD 0.55; 95% CI -0.39 to 1.50; participants=64; I2=71%; very low certainty evidence). A meta-analysis of 2 studies found that compared with traditional learning, a PowerPoint presentation may improve the knowledge of patient care personnel and pharmacists (SMD 0.76; 95% CI 0.29 to 1.23; participants=167; I2=54%; low certainty evidence). A meta-analysis of 4 studies found that compared with traditional training, the effects of computer-assisted training on skills in community (mental health) therapists, nurses, and pharmacists were uncertain (SMD 0.45; 95% CI -0.35 to 1.25; participants=229; I2=88%; very low certainty evidence). A meta-analysis of 4 studies found that compared with traditional training, offline digital education may have little effect or no difference on satisfaction scores in nurses and mental health therapists (SMD -0.07; 95% CI -0.42 to 0.28, participants=232; I2=41%; low certainty evidence). A total of 2 studies found that offline digital education may have little or no effect on patient-centered outcomes when compared with blended learning. For skills and attitudes, the results were mixed and inconclusive. None of the studies reported adverse or unintended effects of the interventions. Only 1 study reported costs of interventions. The risk of bias was predominantly unclear and the certainty of the evidence ranged from low to very low. CONCLUSIONS There is some evidence to support the effectiveness of offline digital education in improving learners' knowledge and insufficient quality and quantity evidence for the other outcomes. Future high-quality studies are needed to increase generalizability and inform use of this modality of education.
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Outcomes of a Weight Loss Intervention to Prevent Diabetes Among Low-Income Residents of East Harlem, New York.
Mayer, VL, Vangeepuram, N, Fei, K, Hanlen-Rosado, EA, Arniella, G, Negron, R, Fox, A, Lorig, K, Horowitz, CR
Health education & behavior : the official publication of the Society for Public Health Education. 2019;(6):1073-1082
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There is a need for diabetes prevention efforts targeting vulnerable populations. Our community-academic partnership, the East Harlem Partnership for Diabetes Prevention, conducted a randomized controlled trial to study the impact of peer led diabetes prevention workshops on weight and diabetes risk among an economically and racially diverse population in East Harlem, New York. We recruited overweight/obese adults from more than 50 community sites and conducted oral glucose tolerance testing and completed other clinical assessments and a health and lifestyle survey. We randomized prediabetic participants to intervention or delayed intervention groups. Intervention participants attended eight 90-minute peer-led workshop sessions at community sites. Participants in both groups returned for follow-up assessments 6 months after randomization. The main outcomes were the proportion of participants who achieved 5% weight loss, percentage weight loss, and change in the probability of developing diabetes over the next 7.5 years according to the San Antonio Diabetes Prediction Model. We enrolled 402 participants who were mainly female (85%), Latino (73%) or Black (23%), foreign born (64%), and non-English speaking (58%). At 6 months, the intervention group lost a greater percentage of their baseline weight, had significantly lower rise in HbA1c (glycated hemoglobin), decreased risk of diabetes, larger decreases in fat and fiber intake, improved confidence in nutrition label reading, and decrease in sedentary behavior as compared with the control group. Thus, in partnership with community stakeholders, we created an effective low-resource program that was less intensive than previously studied programs by incorporating strategies to engage and affect our priority population.
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Rationale and Design of an Online Educational Program Using Game-Based Learning to Improve Nutrition and Physical Activity Outcomes Among University Students in the United Kingdom.
Belogianni, K, Ooms, A, Ahmed, H, Nikoletou, D, Grant, R, Makris, D, Moir, HJ
Journal of the American College of Nutrition. 2019;(1):23-30
Abstract
OBJECTIVE To assess the impact of an online game-based educational program on nutrition knowledge and dietary and physical activity habits among university students in the United Kingdom. DESIGN Randomized controlled trial with pre- and postintervention comparisons. SETTING Two higher education settings in London, UK. SUBJECTS Current undergraduate and postgraduate students of two universities (n = 88) aged 18-34 years are randomly allocated to an intervention (n = 44) or a control group (n = 44). INTERVENTION The intervention group will receive access to an educational website and online quizzes with gamification elements, including information about healthy eating and physical activity. The control group will receive no information. Duration of the intervention will be 10 weeks. MEASURES OF OUTCOME Primary outcome is nutrition knowledge. Secondary outcomes include dietary and activity habits. Nutrition knowledge and dietary and activity habits will be assessed using questionnaires. Weekly steps will be counted using pedometers. Assessment of anthropometric and metabolic risk factors will take place. ANALYSIS Quantitative analysis will investigate changes in nutrition knowledge between the two groups of the study population. Linear regression analysis will be used, if the data follow the normal distribution (otherwise binomial regression analysis), to examine whether field of study, residence status, body mass index (BMI), and demographic factors affect nutrition knowledge. Associations between changes in knowledge and dietary and physical activity behavior will be assessed by correlations. CONCLUSIONS/IMPLICATIONS The study will provide insights with regard to the design and use of online game-playing as a cost-effective approach to improve nutritional knowledge among university students.