Promotion of physical activity in primary care: knowledge and practice of general practitioners and physiotherapists

Aim

Being physically active has many proven health benefits and promoting physical activity to patients in primary care is an important component of public health programmes. This study examined the knowledge and practices of general practitioners and physiotherapists in the promotion of physical activity in primary care.

Subject and methods

A cross-sectional population survey was conducted in Ireland to establish participants’ knowledge of physical activity guidelines and current practice in the promotion of physical activity. A total of 342 general practitioners (response rate 65 %; n?=?543) and 89 physiotherapists (response rate 88 %; n?=?101) responded to the survey.

Results

More physiotherapists (50.5 %; n?=?45) than general practitioners (28 %; n?=?97) correctly reported the minimal physical activity guidelines (X²?=?16.56, p?<?.005, df?=?1). General practitioners reported screening physical activity opportunistically (41 %; n?=?139) and when related to a patient’s presenting complaint (37 %; n?=?126). Physiotherapists reported screening physical activity routinely (34 %; n?=?30) and when related to the presenting complaint (28 %; n?=?25). With the exception of overweight patients, general practitioners were more likely than physiotherapists to promote physical activity to patients with known cardiovascular risk factors such as hypertension (X²?=?49.65, p?<?.001, df?=?2) and hypercholesterolemia (X²?=?32.58, p?<?.001, df?=?2). Physiotherapists, however, were more likely to promote physical activity to healthy populations (X²?=?9.91; p?<?.01, df?=?2). Education and advice was the intervention most frequently used (general practitioners 76 %; n?=?258, physiotherapists 97 %; n?=?86).

Conclusion

Despite high levels of awareness of physical activity promotion amongst general practitioners and physiotherapists, there is scope to improve physical activity promotion particularly to healthy populations and ongoing challenges to incorporate evidence based interventions into routine care.     

Validity of self-reported BMI in older adults and an adjustment model

Study objectives

To determine reporting bias of self-reported vs. measured anthropometrics (body weight, height, body mass index, BMI), and to adjust self-reported BMI regarding the bias.

Methods

We compared self-reported with measured anthropometrics utilizing 659 control persons (age mean 68; range 37 to 80 years) from a case-control stroke study. The Bland-Altman approach examined the agreement between self-reported and measured values. A linear model was applied to correct the bias dependent on sex, age and self-reported BMI.

Results

Under-reporting of weight and over-reporting of height was found. On average, this resulted in lower self-reported BMIs by 1.0 kg/m² in men, 1.2 kg/m² in women (p?<?0.001). Bias correction of self-reported BMIs was derived from self-reported BMI (p?<?0.001), age (p?<?0.001), age-BMI interaction (p?<?0.001) and sex (p?<?0.05). Under-estimation of correct BMI resulted in the under-estimation of an overweight prevalence, with relatively low sensitivity regarding self-reported values (88 %). Our estimates should be recalibrated, if applied to other studies.

Conclusion

Self-reported anthropometric measures are systematically biased despite high correlations with measured values. A correction removes the average bias and improves accuracy.     

The effect of family-based multidisciplinary cognitive behavioral treatment on health-related quality of life in childhood obesity

Purpose

To evaluate the effect of multidisciplinary treatment on obesity and health-related quality of life (HRQOL).

Methods

Obese children were randomized to a multidisciplinary lifestyle treatment, including medical, nutritional, physical, and psychological counseling during 3?months, (n?=?40, BMI-SDS; 4.2?±?0.7, age; 13.3?±?2.0) or standard care, including an initial advice on nutrition and physical activity by the pediatrician (n?=?39, BMI-SDS; 4.3?±?0.7, age; 13.1?±?1.9). At baseline, after 3?months of treatment and at 12?months follow-up, data were collected for BMI-SDS and a European validated questionnaire for assessing HRQOL (DISABKIDS).

Results

A significantly reduced BMI-SDS was found for the intervention group after 3?months treatment (4.0?±?0.9 vs. 4.2?±?0.7, P?=?0.02) and at 12?months follow-up (3.8?±?1.1 vs. 4.2?±?0.7, P?=?0.03). HRQOL in the intervention group was significantly improved at 12?months follow-up and unchanged in the obese control group. Agreement between child and parent report was moderate (67?C85%), with parents reporting a lower HRQOL for their obese children than children themselves in both groups.

Conclusion

Multidisciplinary treatment is effective in reducing BMI-SDS and improving HRQOL after 12?months follow-up.     

A comparative analysis of TLR5 polymorphism and clinical parameters in typhoid patients and asymptomatic typhoid carriers

Aim

Typhoid fever is a serious health problem in tropical and developing countries. Although asymptomatic typhoid carriers show no clinical signs, they can spread infection to others. This study investigated the Toll like receptor 5 (TLR5) polymorphism and various clinical parameters in typhoid patients and asymptomatic typhoid carriers.

Subjects and methods

TLR5 gene was amplified in typhoid patients (n?=?15), asymptomatic carriers (n?=?10) and healthy control subjects (n?=?10) by polymerase chain reaction (PCR). A restriction fragment length polymorphism (RFLP) analysis of TLR5 gene was performed with restriction enzyme (Ddel). Clinical parameters such as total leukocyte, platelets, C-reactive protein (CRP), and adenosine de-aminase (ADA) were estimated. A correlative analysis of TLR5 gene polymorphism and clinical parameters was performed.

Results

Typhoid fever patients had significantly (p?<?0.05) reduced total leukocyte and platelet counts when compared to asymptomatic carriers and control subjects. Typhoid patients showed significantly (p?<?0.05) reduced ADA activity, while elevated CRP level when compared to carriers and controls. TLR5 gene was amplified in all individuals, but only two typhoid patients showed TLR5 gene polymorphism (TLR5 ^392STOP). There was no significant correlation between TLR5 gene polymorphism and clinical parameters studied in typhoid patients.

Conclusion

The TLR5 gene polymorphism seems to be not associated with susceptibility to typhoid fever.     

A quasi-randomized group trial of a brief alcohol intervention on risky single occasion drinking among secondary school students

Objectives

To show the effectiveness of a brief group alcohol intervention. Aims of the intervention were to reduce the frequency of heavy drinking occasions, maximum number of drinks on an occasion and overall weekly consumption.

Methods

A cluster quasi-randomized control trial (intervention n?=?338; control n?=?330) among 16- to 18-year-old secondary school students in the Swiss Canton of Zürich. Groups homogeneous for heavy drinking occasions (5+/4+ drinks for men/women) consisted of those having medium risk (3–4) or high risk (5+) occasions in the past 30?days. Groups of 8–10 individuals received two 45-min sessions based on motivational interviewing techniques.

Results

Borderline significant beneficial effects (p?<?0.10) on heavy drinking occasions and alcohol volume were found 6?months later for the medium-risk group only, but not for the high-risk group. None of the effects remained significant after Bonferroni corrections.

Conclusions

Group intervention was ineffective for all at-risk users. The heaviest drinkers may need more intensive treatment. Alternative explanations were iatrogenic effects among the heaviest drinkers, assessment reactivity, or reduction of social desirability bias at follow-up through peer feedback.     

Health disparities between immigrant and Danish cleaners

Purpose

It is unknown whether immigrants working in the cleaning industry have a poorer health and work ability than cleaners from the native population. The main aim was to investigate differences in objective and self-reported health measures between immigrant and Danish cleaners.

Methods

Three hundred and fifty-one cleaners, consisting of 166 Danes (88% women) and 179 immigrants (74% women) (6 with unknown ethnicity), from 9 workplaces in Denmark participated in the study. Health and work ability were obtained by objective (e.g., BMI and blood pressure) and self-reported measures (e.g., work ability, self-rated health, and musculoskeletal symptoms). In order to investigate differences between Danish and immigrant cleaners, logistic regression analyses and General Linear Models were performed.

Results

When controlling for age, sex, workplace, job seniority, and smoking, more Danish compared with immigrant cleaners were current smokers (42% vs. 28%, p?p?p?p?p?p?p?p?p?p?Conclusions Although the health of the cleaners was alarmingly poor, the immigrant cleaners generally had a poorer self-reported health and work ability than the Danish cleaners. These findings highlight the need for occupational health actions among cleaners, particularly tailored to the immigrant subpopulation.     

Perceptions of the food environment are associated with fast-food (not fruit-and-vegetable) consumption: findings from multi-level models

Objectives

Diets low in fruits and vegetables and/or high in fast foods are associated with obesity and chronic diseases. Such diets may relate to different aspects of neighborhood food environments. We sought to evaluate if people??s perceptions of their neighborhood food environment are associated with reported fruit-and-vegetable and fast-food consumption.

Methods

Cross-sectional analysis of a community health survey from Philadelphia, PA and four surrounding suburban counties (n?=?10,450 individuals). We used mixed-effects multi-level Poisson models, nesting individuals within neighborhoods??i.e. census tracts (n?=?991).

Results

Negative perceptions of the food environment (perceived difficulty finding fruits and vegetables, having to travel outside of one??s neighborhood to get to a supermarket, and perceived poor grocery quality) were each directly associated with fast-food consumption (incident rate ratios [IRRs] 1.31, 1.06, 1.20; p?Conclusions Perceived difficulty finding or accessing produce and high-quality groceries may support the eating of more fast food. Neighborhoods where food-environment perceptions are worst might benefit from interventions to improve availability, accessibility, and quality of healthy foods, towards shifting consumption away from fast foods.     

A sodium-bicarbonated mineral water reduces gallbladder emptying and postprandial lipaemia: A randomised four-way crossover study

Background

Sodium-bicarbonated mineral waters are reported to have beneficial digestive and hypocholesterolaemic properties. The aim of the study was to investigate the effects of consumption of a sodium-bicarbonated mineral water (BW) with or without a meal, compared to a low mineral content water as the control water (CW), on postprandial serum triacylglycerols (TAG), cholecystokinin (CCK) and gallbladder volume.

Methods

The study design was a four-way randomised controlled crossover trial. Healthy adult men and women (>18 and <40?years, TAG <2.82?mmol/L) consumed 0.5?L of CW?+?standard meal; 0.5?L of BW?+?standard meal; and 0.5?L of CW without meal or 0.5?L of BW without meal.

Results

BW consumed without meal had no significant effect on the study parameters compared to CW. However, BW with meal induced a lower concentration of serum TAG at 30?min (p?=?0.01) and 60?min (p?=?0.03) postprandial times, lower CCK concentrations at 30?min (p?=?0.002), and higher gallbladder volume at 30?min (p?=?0.03), 60?min (p?=?0.01) and 120?min (p?=?0.04). Gallbladder ejection fraction was lower with the BW (p?=?0.03), whilst area under the curve and peak contraction amplitude (lowest gallbladder volume) were higher (p?=?0.01, p?=?0.02, respectively) compared to the CW.

Conclusion

Consumption of BW with a meal induces lower levels of CCK and reduces gallbladder emptying and postprandial TAG levels. It is proposed that this sodium-bicarbonated mineral water could be used as part of the habitual diet by the general population in order to reduce cardiovascular risk.     

The impact of a recent relapse on patient-reported outcomes in subjects with multiple sclerosis

Purpose

In this study, we estimate the impact of a recent relapse on physical and mental health in subjects with relapsing-remitting multiple sclerosis (RRMS) using validated patient-reported outcome (PRO) measures.

Methods

Subjects enrolled in the Comprehensive Longitudinal Investigation of MS at the Brigham and Women??s Hospital with RRMS were eligible for enrollment. Subjects with a clinical visit within 45?days of a relapse were identified and divided into groups based on whether the relapse occurred before (recent relapse) (n?=?59) or after the visit (pre-relapse) (n?=?31). A group of subjects with no relapses was also identified (remission) (n?=?336). PRO measures in these three groups were compared. All outcomes were compared using a t test and linear regression controlling for age, disease duration, sex, and EDSS.

Results

Subjects with a recent relapse had significantly worse functioning on several physical and mental health scales compared to subjects in remission even after adjusting for potential confounders. Subjects with a recent relapse also showed significant deterioration on PRO measures over 1?year compared to subjects in remission (P?<?0.05 for each comparison). Subjects in the pre-relapse group were not significantly different than subjects in remission.

Conclusions

Clinical relapses have a measurable effect on PRO in subjects with RRMS.     

Moderate effects of apple juice consumption on obesity-related markers in obese men: impact of diet–gene interaction on body fat content

Purpose

The effect of polyphenol-rich cloudy apple juice (CloA) consumption on plasma parameters related to the obesity phenotype and potential effects of interactions between CloA and allelic variants in obesity candidate genes were assessed in obese men.

Methods

In this controlled, randomized, and parallel study, n?=?68, non-smoking, non-diabetic men with a BMI ≥27?kg/m² received 750?mL/day CloA (802.5?mg polyphenols) or 750?mL/day control beverage (CB, isocaloric equivalent to CloA) for 4?weeks. Further, study participants were genotyped for single-nucleotide polymorphisms in PPARγ (rs1801282), UCP3 (rs1800849), IL-6 (rs1800795), FABP2 (rs1799883), INSIG2 (rs7566605), and PGC1 (rs8192678) genes. At the beginning and at the end of intervention plasma lipids, distinct adipokines and cytokines as well as anthropometric parameters were determined.

Results

CloA compared to CB had no significant effect on plasma lipids, plasma adipokine and cytokine levels, BMI, and waist circumference. However, CloA consumption significantly reduced percent body fat compared to CB (? % body fat: CloA: ?1.0?±?1.3 vs. CB: ?0.2?±?0.9, p?Conclusion The observed diet–gene interaction might be a first indication for the impact of individual genetic background on CloA-mediated bioactivity on obesity-associated comorbidities.     

Clustering of chronic disease behavioral risk factors among adolescents in Crete (Greece): associations with biological factors and cardiorespiratory fitness levels

Aim

To assess the clustering of behavioral risk factors (BRFs) for chronic noncommunicable diseases and their association with biological factors and cardiorespiratory fitness levels among adolescents in Crete, Greece.

Subjects and methods

Among 589 adolescents aged 14.0–16.6 years, five BRFs (smoking, physical inactivity, sedentary behavior, alcohol consumption, high body weight) were estimated, and a clustering score of 0, 1, 2 or 3+?BRFs was calculated. Biological factors (blood pressure, blood glucose, serum lipids) and cardiorespiratory fitness were also assessed, and their associations with BRFs were examined.

Results

Physical inactivity was the most prevalent risk factor (48.2 %), whereas smoking was the least prevalent (8.7 %). Approximately 11.4 % of the adolescents displayed none of the five BRFs, while 19.5 % displayed 3?+?factors (boys: 23.2 %, girls: 16.3 %, p?>?0.05). High body weight was related to almost all biological factors (p?p?p?=?0.001) and triglycerides (73.5 vs. 58.9 mg/dl, p?=?0.006), and lower levels of HDL-cholesterol (47.1 vs. 53.5 mg/dl, p?p?p?Conclusion Physical inactivity was the most prevalent individual risk factor, while one-fifth of the Cretan adolescents had an extended clustering of BRFs. Systolic BP, lipid levels and cardiorespiratory fitness were related to BRF clustering. Public health providers should adopt measures to improve these factors when designing health-care programs aimed at adolescents.     

The impact of functional constipation on quality of life of middle-aged Black Americans: a prospective case–control study

Purpose

To quantify the impact of constipation on health-related quality of life (HRQoL) in Black Americans.

Methods

Case?Ccontrol design. Black subjects referred for colon cancer screening with a Bristol Stool Score of 3?C5 for >75% of bowel movements served as controls. Frequency-matched functional constipation subjects had to fulfill Rome III criteria. Both groups completed demographic and health surveys. Short Form-36 assessed HRQoL.

Results

We recruited 102 constipated patients and 100 controls. The groups were well matched demographically. After adjustment for comorbidities, SF-36 scores for vitality, bodily pain, social functioning, and role-emotional were significantly lower in constipated patients. Unadjusted physical and mental component summary scores (PCS and MCS) were significantly higher in the control group (47.1?±?10.6 vs. 43.3?±?8.6; P?=?0.005 and 50.6?±?12.4 vs. 43.4?±?11.8; P?<?0.001, respectively). After adjustment for comorbidities, PCS differences were no longer significant (P?=?0.54); however, MCS differences were significant (P?=?0.004). Marginal mean scores for the MCS for controls and constipated subjects were 49.9?±?1.2 and 43.6?±?1.2, respectively. The presence of a comorbidity was independently associated with PCS (P?<?0.001) and MCS (P?=?0.026) results.

Conclusions

Functional constipation has a significant impact on HRQoL in middle-aged Black Americans, particularly in regard to mental well-being.     

Bias in protein and potassium intake collected with 24-h recalls (EPIC-Soft) is rather comparable across European populations

Purpose

We investigated whether group-level bias of a 24-h recall estimate of protein and potassium intake, as compared to biomarkers, varied across European centers and whether this was influenced by characteristics of individuals or centers.

Methods

The combined data from EFCOVAL and EPIC studies included 14 centers from 9 countries (n?=?1,841). Dietary data were collected using a computerized 24-h recall (EPIC-Soft). Nitrogen and potassium in 24-h urine collections were used as reference method. Multilevel linear regression analysis was performed, including individual-level (e.g., BMI) and center-level (e.g., food pattern index) variables.

Results

For protein intake, no between-center variation in bias was observed in men while it was 5.7% in women. For potassium intake, the between-center variation in bias was 8.9% in men and null in women. BMI was an important factor influencing the biases across centers (p?<?0.01 in all analyses). In addition, mode of administration (p?=?0.06 in women) and day of the week (p?=?0.03 in men and p?=?0.06 in women) may have influenced the bias in protein intake across centers. After inclusion of these individual variables, between-center variation in bias in protein intake disappeared for women, whereas for potassium, it increased slightly in men (to 9.5%). Center-level variables did not influence the results.

Conclusion

The results suggest that group-level bias in protein and potassium (for women) collected with 24-h recalls does not vary across centers and to a certain extent varies for potassium in men. BMI and study design aspects, rather than center-level characteristics, affected the biases across centers.     

Different effects of area of residency in atopic disorders and spirometric indices in children

Aim

The aim of this study is to compare two distinctly different residential types of environment—an industrial and a rural—and to evaluate their effect on children’s spirometric indices and current atopic disorders.

Subject and methods

Schoolchildren attending the 5th and 6th grades of Oinofyta (industrial area) and Makrakomi (rural area) elementary schools participated in the study, by means of a parental-completed questionnaire and a spirometry test performance.

Results

The prevalence of hay fever, allergic conjunctivitis, eczema, wheezing and dry cough in the last 12?months among children, was higher in the rural residential area. Statistically significant associations were found for allergic conjunctivitis (p?=?0.027) and for FEV₁/FVC (Forced Expiratory Volume in 1?sec/ Forced Vital Capacity, Tiffeneau) and FEF75 (Forced Expiratory Flow 75?%) values <?90?% (p?=?0.014, p?=?0.011 respectively). After controlling for potential confounders, we found that reported eczema and FEV₁ value <90?% were more prevalent in the industrial area of residency.

Conclusion

Residential area and associated factors play an important role in the manifestation of atopic disorders and history of atopy in children.     

Does a small difference in iodine status among children in two regions of Belgium translate into a different prevalence of thyroid nodular diseases in adults?

Purpose

To explore whether there are regional differences in iodine status and in prevalence of thyroid diseases in the two main regions of Belgium.

Methods

A national survey of iodine status among children was performed in 1998. The raw data of this survey were reanalyzed to explore regional differences. The total number of thyroidectomies, carried out for multinodular goiter or solitary nodules, was obtained from the Minimal Clinical Summary hospital discharge database. Percentage of people with thyroid diseases going to the general practitioner or the specialist was assessed by means of data about the number of adults using anti-thyroid medications. Food consumption patterns were explored using national food consumption data.

Results

In Flanders, median urinary iodine concentration (UIC) was higher than in Wallonia, 84?μg/L (n?=?1,316) and 78?μg/L (n?=?1,268), respectively (p?Conclusion Iodine status in children was found slightly different in both regions of the country. This finding is in agreement with a higher incidence of thyroidectomies and more extensive use of anti-thyroid medications in the adult population in the region with the lowest iodine excretion.     

Serum and lipoprotein sitostanol and non-cholesterol sterols after an acute dose of plant stanol ester on its long-term consumption

Purpose

Chronic inhibition of cholesterol absorption with large doses of plant stanol esters (staest) alters profoundly cholesterol metabolism, but it is unknown how an acute inhibition with a large staest dose alters the postprandial serum and lipoprotein cholesterol precursor, plant sterol, and sitostanol contents.

Methods

Hypercholesterolemic subjects, randomly and double-blind divided into control (n?=?18) and intervention groups (n?=?20), consumed experimental diet without and with staest (plant stanols 8.8?g/day) for 10?weeks. Next morning after a fasting blood sample (0 h), the subjects had a breakfast without or with staest (4.5?g of plant stanols). Blood sampling was repeated 4?h later. Lipoproteins were separated with ultracentrifugation, and sterols were measured with gas–liquid chromatography.

Results

In 0-h chylomicrons and VLDL, plant sterols were lower in staest than in controls. Postprandially, cholestenol (cholesterol synthesis marker) was reduced in chylomicrons in staest compared with controls (?0.13?±?0.04?μg/dL vs. 0.01?±?0.08?μg/dL, P?P?Conclusions Chronic cholesterol absorption inhibition with large amount of plant stanol esters decreases plant sterols in triglyceride-rich lipoproteins. Acute plant stanol ester consumption increases sitostanol content in triglyceride-rich lipoproteins but suggests to decrease the risk of plant sterol and plant stanol accumulation into vascular wall by chylomicrons.     

Effects of a 9-month resistance training intervention on quality of life,sense of coherence,and depressive symptoms in older adults: randomized controlled trial

Purpose

(1) To determine the effects of a 9-month resistance training intervention on quality of life, sense of coherence, and depressive symptoms in older adults, and (2) to compare effects between different training frequencies.

Methods

Men and women aged 65–75 (N?=?106) were randomized to four groups according to training frequency: training groups RT1 (n?=?26), RT2 (n?=?27), and RT3 (n?=?28) and non-training control group (n?=?25). All training groups attended supervised resistance training twice a week for 3 months. For the following 6 months, they continued training with different frequencies (1, 2 or 3 times per week). Psychological functioning was measured by quality of life (WHOQOL-Bref), sense of coherence (Antonovsky’s SOC-13), and depressive symptoms (Beck’s Depression Inventory II). Measurements were conducted at baseline and 3 and 9 months after baseline. The effects of the intervention were analyzed using generalized estimating equations (GEE).

Results

After 3 months, there was an intervention effect on environmental quality of life (group?×?time p?=?.048). Between 3 and 9 months, environmental quality of life decreased among RT1 compared to RT2 and RT3 (group?×?time p?=?.025). Between baseline and 9 months, environmental quality of life increased in RT2 compared to all other groups (group?×?time p?=?.011). Sense of coherence increased in RT2 compared to the control group and RT3 (group?×?time p?=?.032).

Conclusion

Resistance training is beneficial for environmental quality of life and sense of coherence. Attending resistance training twice a week seems to be the most advantageous for these aspects of psychological functioning.

     

Gender differences among homeless people in Tehran,Iran

Aim

Gender differences among homeless people may affect the frequency of their risky behaviours. This study was conducted to evaluate the behaviour patterns of homeless men and women in Tehran and compare the probable differences.

Subject and methods

In this study, 593 homeless people were recruited from five centres that house homeless people in Tehran, the capital city of Iran. A researcher-designed questionnaire was used to study behavioural patterns.

Results

In this study, homeless people (513 males and 80 females, all Iranian nationals) were enrolled in the study from June to August 2012. Mean age and mean duration of homelessness among women (35.46 and 12.68 months) were lower than those among men (42.74 and 56.85 months) (p?=?0.001). Although lifetime history of incarceration in men was higher than in women (p?=?0.002), mean duration of imprisonment in the last 10 years in men (21.25 months) and women (17.76 months) was not statistically different (p?=?0.07). Accommodation locality in the past 6 months varied between men and women. Women were current drug users more often than men were (61.53 % versus 45.26 %) (p?=?0.02). The type of drug consumption in women (methamphetamine) differed from that of men (opium and heroin). More men had a history of injecting drugs than did women (30.02 % versus 12.30 %) (p?=?0.003). Condom use at the last sexual encounter was reported to be higher in women compared to men (74.60 % versus 26.62 %) (p?=?0.001).

Conclusion

This study showed notable differences in behaviour patterns between homeless men and women and also indicated that homeless people in Tehran exhibit many risky behaviours.