•Nudging is a may be a potential solution to improve diabetes control.•No systematic review of nudging diabetic patients into improving their health behavior has been done yet.•Studies included ...utilized framing, reminders, gamification, social modeling and social influence.•Potentially used to develop a framework to guide the design of nudge intervention.
Diabetes is a chronic disease associated with a variety of complications, and nudging may be a potential solution to improve diabetes control. Since nudging is a new concept, no review of literature on nudging diabetic patients into improving their health behaviour has been done. Therefore, we aim to collate a list of nudge intervention and determine the context in which nudging is successful.
We adopted a two-arm search strategy comprising the search of literature databases and snowballing using relevant search terms. We summarized patient characteristics, the nudge intervention, according to nudging strategies, delivery mode and their outcomes. The conditions present in effective nudge interventions were assessed and reported.
We retrieved 11,494 studies from our searches and included 33. An additional five studies were added through snowballing. Studies included utilized framing (n=5), reminders (n=10), gamification (n=2), social modelling (n=5) and social influence (n=16). Studies on reminders and gamification were more likely to have a statistically significant outcome. The targeted health behaviours identified were medication adherence, physical activity, diet, blood glucose monitoring, foot care, self-efficacy, HbA1c and quality of life. Of these, studies with adherence to medication, foot care practice and quality of life as targeted health behaviours were more likely to show a statistically significant outcome.
Nudging has shown potential in changing health behaviour of patients with diabetes in specific context. We identified two possible factors (delivery mode and patient characteristics) that may affect the effectiveness of nudge intervention.
Objective
Caesarean section (CS) interrupts mother‐to‐newborn microbial transfer at birth. Beyond the neonatal period, the impact of CS on offspring gut microbiota and their short‐chain fatty acids ...(SCFAs) remains unclear. Here, we examine birth delivery mode (CS versus vaginal delivery) with the infant gut microbiota and faecal SCFAs measured 3 and 12 months after birth.
Design
Longitudinal study.
Setting
North Carolina.
Population
In 2013–15, we enrolled pregnant women and followed up their offspring for 12 months. We asked a subset of participants, enrolled over a 3‐month period, to provide faecal samples at the 3‐ and 12‐month follow‐up visits.
Methods and main outcomes
We sequenced the 16S rRNA V4 region with Illumina MiSeq and quantified SCFA concentrations using gas chromatography. We examined delivery mode with differential abundance of microbiota amplicon sequence variants (ASVs) using beta‐binomial regression and faecal SCFAs using linear regression. We adjusted models for confounders.
Results
Of the 70 infants in our sample, 25 (36%) were delivered by CS. Compared with vaginal delivery, CS was associated with differential abundance of 14 infant bacterial ASVs at 3 months and 13 ASVs at 12 months (all FDR P < 0.05). Of note, CS infants had a higher abundance of the potential pathobionts Clostridium neonatale (P = 0.04) and Clostridium perfringens (P = 0.04) and a lower abundance of potentially beneficial Bifidobacterium and Bacteroides spp. (both P < 0.05) at 3 months. Other ASVs were differentially abundant at 12 months. Infants delivered by CS also had higher faecal butyrate concentration at 3 months (P < 0.005) but not at 12 months.
Conclusions
Caesarean section was associated with increased butyrate excretion, decreased Bifidobacterium and Bacteroides spp., and more colonisation of the infant gut by pathobionts at 3 months of age. CS was also associated with altered gut microbiota composition, but not faecal SCFAs, at 12 months.
Tweetable
Caesarean section delivery was associated with increased butyrate excretion, decreased Bifidobacterium, and increased colonisation of the infant gut by pathobionts at 3 months of age.
Tweetable
Caesarean section delivery was associated with increased butyrate excretion, decreased Bifidobacterium, and increased colonisation of the infant gut by pathobionts at 3 months of age.
Background
Family childcare homes (FCCHs) are the second largest provider of childcare in the United States, yet little is known about how this setting influences children's physical activity, ...particularly related to the physical environment. Thus, the purpose of this study was to determine what aspects of the FCCH physical environment facilitate or hinder children's physical activity.
Methods
Data were collected from 166 FCCH providers and 496 preschool‐aged children in 2013–2014 as part of the Keys to Healthy FCCHs study. Children's moderate‐to‐vigorous physical activity (MVPA) was measured using Actigraph GT3X+ accelerometers. Wear data from the childcare day were isolated, and cut‐points were applied in order to calculate children's minutes of MVPA per hour. FCCH‐level estimates of child MVPA per hour were calculated. Indoor and outdoor physical environment characteristics were assessed during a 2‐day observation using the Environment and Policy Assessment and Observation modified for FCCHs. General linear models were used to examine the relationship between indoor, portable play equipment, and outdoor FCCH physical environment characteristics and children's MVPA per hour.
Results
Only indoor play space was significantly associated with children's MVPA (β = 0.33; p = .034), indicating that when provided with more indoor space for active play, children were more physically active. No significant associations were noted between portable play equipment or the outdoor environment and children's MVPA.
Conclusions
Indoor space was the only physical environment characteristic associated with children's MVPA, suggesting that teaching FCCH providers how to best utilize their indoor play space for active play may be a way to promote children's physical activity. Futures studies should explore the impact of other environmental characteristics of the FCCH (e.g., provider practices and policies) on children's physical activity.
The aim of this study was to evaluate how a fish bone hydrolysate (FBH) from blue whiting (Micromesistius poutassou) fish bones may improve muscle astaxanthin (Ax) deposition in Atlantic salmon ...(Salmo salar). Fish (1.7 kg) were reared in 12 net-pens and fed with one of four practical formulated diets for 78 days. All diets (D) were balanced to meet dietary phosphorus (P) requirement (8 g kg−1 P): the control diet (D1) and diet D4 were added CaPO4 as P source, diets D2 and D3 were added P from a spray dried FBH ingredient at 2.1 and 4.2%, respectively, and D2 was further balanced with CaPO4. Diet D4 was added K2SO4 to study potential impacts of sulfate in H2SO4 used for mineral hydrolysis. An in vitro cell culture trial with hepatocytes (600 g salmon) was performed to study the effects of FBH on Ax uptake and transport. The soluble fish bone compounds significantly increased specific muscle Ax retention (mg kg−1 weight gain) by 35% (P < 0.05) in fish fed D3, possibly explained by improved Ax digestibility (ns) followed by increased circulating Ax and a tendency towards increased tissue Ax deposition (ns). Reduced metabolic turnover of Ax was indicated, with about 10% more of absorbed Ax retained in muscle of fish fed D3. The in vitro trial showed no direct impact of FBH on hepatic Ax uptake. However, the FBH ingredient altered the muscle connective tissue by stimulating the production of proteoglycans and their sulfated glycosaminoglycans (GAGs) significantly. This study suggests that hydrolysed compounds from fish bones may improve Ax utilization in salmon, and that they may have an impact on the functional properties of the muscle.
•Sulphuric acid extraction and use of nutrients in fish bones increase utilization of available marine resources•Sulphuric acid extracted fish bone compounds improve astaxanthin utilization in Atlantic salmon•Extracted fish bone compounds stimulate production of proteoglycans and their sulfated glycosaminoglycans (GAGs) in muscle
This objective of this study was to use empirical data to assess cross-sectional variation singular and changes over time in community efficacy for non-communicable diseases (NCDs) management (COEN) ...and to examine individual factors associated with changes in COEN.
This was a longitudinal observational study.
Participants with hypertension and diabetes were randomly selected from 12 communities from three cities in eastern China, and a baseline survey and a 1-year follow-up were conducted. The COEN scale has five dimensions: community physical environment (CPE), behavioral risk factors (BRF), mental health and social relationships (MHSR), community health management (CHM), and community organisations and activities (COA). Mixed-effects models were used to investigate the change in COEN over time and the association between individual factors and changes in COEN.
COEN scores showed significant variation singular among the 12 communities (P < 0.001) at the baseline. In the mixed-effects model, CPE (β coefficient: 1.62, P < 0.001), BRF (0.90, P < 0.001), MHSR (0.86, P < 0.001), CHM (0.46, P < 0.001), and total scores (β = 3.57, P < 0.001) increased significantly over time. The changes in COEN were associated with individual characteristics (e.g., older, men, more educated).
Cross-sectional variations and changes over time in COEN demonstrated the utility of a sensitive instrument. Factors such as age, gender, marriage, education level, and employment may affect the financial and social resources assignment for NCD management. Our findings suggest that further high-quality studies are needed to better evaluate the effect of community empowerment on the prevention and control of NCDs.
Sufficient firmness is essential for consumer appreciation and the suitability for processing of fish fillets. The objective of this study was to investigate the effect of functional amino acids (AA) ...on fillet texture and muscle development of Atlantic salmon. Triplicate net pens of 105 g salmon were fed a standard diet, or the same diet with added 15 g/kg arginine or 15 g/kg glutamate during a 5‐month rearing period. The growth rate and FCR (0.91–0.92) showed no significant dietary effects (body weight 864–887 g). Glutamate supplementation resulted in delayed postmortem glycogen degradation (pH drop) and rigour development, along with improved fillet firmness and intercellular myofibre integrity. An in vitro study with salmon myosatellite cells showed that exogenous glutamine or arginine increased the expression of muscle growth markers (myog, tnnl2, myl) at both 8 and 16°C culture temperature. The expression of a marker for proteolysis (ctsb), myl and myog were highest for the glutamine treatment at 16°C. Significant interaction between exogenous AA and temperature indicated elevated AA requirement when growth is accelerated. It is concluded that AA from the glutamate family are vital for fillet firmness. The dispensable glutamine and glutamate appear more critical compared to arginine, particularly during high‐performance periods.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Summary
Background
Obesity prevention in young children is a public health priority. In the USA, nearly 10% of children less than 5 years of age are obese, and most attend some form of out‐of‐home ...child care. While a number of interventions have been conducted in early care and education settings, few have targeted the youngest children in care or the less formal types of child care like family child care homes. Additionally, only two previous studies provided recommendations to help inform future interventions.
Methods
This paper presents lessons learned from two distinct intervention studies in early care and education settings to help guide researchers and public health professionals interested in implementing and evaluating similar interventions. We highlight two studies: one targeting children ages 4 to 24 months in child care centres and the other intervening in children 18 months to 4 years in family child care homes. We include lessons from our pilot studies and the ongoing larger trials.
Results
To date, our experiences suggest that an intervention should have a firm basis in behaviour change theory; an advisory group should help evaluate intervention materials and plan for delivery; and realistic recruitment goals should recognize economic challenges of the business of child care. A flexible data collection approach and realistic sample size calculations are needed because of high rates of child (and sometimes facility) turnover. An intervention that is relatively easy to implement is more likely to appeal to a wide variety of early care and education providers.
Conclusions
Interventions to prevent obesity in early care and education have the potential to reach large numbers of children. It is important to consider the unique features and similarities of centres and family child care homes and take advantage of lessons learned from current studies in order to develop effective, evidence‐based interventions.
Atlantic salmon were fed one of four diets with increasing levels (11-58%of total fatty acids (FAs)) of n-3 highly unsaturated FAs (HUFAs) in order to investigate the effect on muscle and ...mitochondrial membrane lipids and their susceptibility to oxidative stress. The high n-3 eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) groups contained lower percentages of sphingomyelin and cardiolipin in total muscle than the intermediate n-3 HUFA group. Cardiolipin and sphingomyelin are particularly susceptible to peroxidation, and a reduced percentage of these lipids showed that mitochondrial membranes had been damaged by oxidation. The intermediate n-3 HUFA group had the highest level of mitochondrial integrity and tendencies of lower thiobarbituric acid reactive substances (TBARS) level than the other dietary groups. The high caspase-3 activity, in addition to casp3a and bax gene expression levels, in the n-3 DHA group also suggests that some degree of oxidative stress had occurred. Electron microscopy images showed a higher degree of myofibre-myofibre detachment in fish fed the high HUFA diets than in fish fed the intermediate n-3 HUFA diet. Our findings show that intermediate levels of n-3 HUFAs in salmon diets gave the best protection against oxidative damage of mitochondrial membranes and muscle structure.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
The Southern Province of Sri Lanka is endemic with dengue, with frequent outbreaks and occurrence of severe disease. However, the economic burden of dengue is poorly quantified. Therefore, we ...conducted a cost analysis to assess the direct and indirect costs associated with hospitalized patients with dengue to households and to the public healthcare system.
From June 2017-December 2018, we prospectively enrolled children and adults with acute dengue hospitalized at the largest, public tertiary-care (1800 bed) hospital in the Southern Province, Sri Lanka. We administered a structured questionnaire to obtain information regarding direct costs spent by households on medical visits, medications, laboratory testing, and travel for seeking care for the illness. Indirect costs lost by households were estimated by identifying the days of work lost by patients and caregivers and school days lost by children. Direct hospital costs were estimated using gross costing approach and adjusted by multiplying by annual inflation rates in Sri Lankan rupees and converted to US dollars.
A total of 1064 patients with laboratory-confirmed dengue were enrolled. The mean age (SD) was 35.9 years (15.6) with male predominance (66.2%). The mean durations of hospitalization for adults and paediatric patients were 3.86 (SD = 1.51) and 4 (SD = 1.32) days, respectively. The per-capita direct cost borne by the healthcare system was 233.76 USD, and was approximately 14 times greater than the per-capita direct cost borne by households (16.29 USD, SD = 14.02). The per-capita average number of loss of working days was 21.51 (SD = 41.71), with mean per-capita loss of income due to loss of work being 303.99 USD (SD = 569.77), accounting for over 70% of average monthly income. On average, 10.88 days (SD = 10.97) of school days were missed due to the dengue episode. School misses were expected to reduce future annual income of affected children by 0.44%.
Dengue requiring hospitalization had a substantial economic burden on the public healthcare system in Sri Lanka and the affected households. These findings emphasize the importance of strengthening dengue control activities and improved use of hospital-based resources for care to reduce the economic impact of dengue in Sri Lanka.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
We evaluated weight changes in obese patients at 6‐months after they ended participation in a 12‐month randomised controlled trial in which they received daily placebo, zonisamide 200 mg or ...zonisamide 400 mg, in addition to lifestyle counselling. Of the originally randomised 225 patients, 218 completed month‐12 when study interventions were discontinued. For the 154 patients who returned for 6‐month follow‐up off‐treatment, weight changes between month‐12 and month‐18 for placebo (n = 53), zonisamide 200 mg (n = 49) and zonisamide 400 mg groups (n = 52) were 0.5 kg 95% confidence interval (CI), −0.8 to 1.8; 0.7%, 1.5 kg (0.2–2.8; 1.6%; p = 0.26 vs. placebo) and 2.4 kg (1.1–3.7; 2.6%; p = 0.04 vs. placebo), respectively. Our results suggest that although zonisamide 400 mg daily for 12‐months resulted in greater weight loss than with placebo, weight regain after discontinuation of interventions was greater in the zonisamide 400 mg group than placebo group.
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