980 resultados para Weight-loss
Resumo:
Background : The Beck Depression Inventory (BDI) is one of the most commonly used instruments to assess depression in persons with obesity. While it has been validated in normal and psychiatric populations, in obese populations, its validity remains uncertain. This study aimed to investigate the validity and reliability of the BDI-IA and BDI-II in severely obese bariatric surgery candidates.
Methods : Consecutive new candidates at a bariatric surgery clinic were invited to participate in the study by their consulting surgeon. All candidates were assessed using the Structured Clinical Interview for DSM-IV Disorders (SCID-I); 118 completed the BDI-IA and 83 completed the BDI-II. Two hundred one patients (response rate, 88 %) participated in the study. The current sample (82 % female) had an average body mass index of 42.83 ± 6.34 and an average age of 45 ± 12 years.
Results : Based on the SCID-I, 54 candidates (26.9 %) met the criteria for a mood disorder, with 37 meeting the criteria for current major depressive disorder. Individuals diagnosed with a clinical mood disorder had significantly higher scores on the BDI (BDI-IA, 23.59 ± 9.69 vs. 12.76 ± 8.29; BDI-II, 22.93 ± 5.22 vs. 11.25 ± 8.44). Our results indicated that, as a screening tool for a clinical mood disorder, the BDI-II had an optimal cutoff of 13, with a sensitivity of 100 and specificity of 67.75.
Conclusions : Results indicated that the BDI-IA should not be used as a tool to measure depressive symptomatology in obese bariatric surgery candidates. No cutoff was identified with adequate sensitivity and specificity, and over 20 % of patients were misclassified. As a screening tool for a clinical mood disorder, the BDI-II was adequate; however, prevalence rates were significantly overestimated.
Resumo:
Background : The Beck Depression Inventory (BDI) has been frequently employed as a measure of depression in studies of obesity, with the majority of studies reporting an improvement in scores following weight loss. Given the potential similarity in obesity-related and depressive symptoms, it is uncertain whether all components of depression would improve equally with weight loss.
Method : The study included obese patients who had undergone laparoscopic adjustable gastric banding (LAGB) surgery and had completed BDIs at baseline and 1 year after surgery. Two groups of patients were included, a general background group (N = 191, mean age = 41 ± 9, mean BMI = 43 ± 8) and a group identified as experiencing elevated depressive symptoms based on BDI scores ≥23 (EDS group; (N = 67, mean age = 40 ± 9, mean BMI = 45 ± 7).
Results : Overall, BDI scores fell for both groups, background group at baseline 17 ± 9–8 ± 7 at 1 year and for the EDS group at baseline 30 ± 5–14 ± 10 at 1 year. Patient scores on the negative self-attitude subscale were significantly greater than the two other subscales and showed the greatest improvement 1 year following LAGB. Preexisting antidepressant therapy had little or no association on the BDI scores or on its change following weight loss.
Conclusion : High rates of depression are continually reported in obesity, as is a remarkable decrease in depressive symptoms following weight loss. Negative attitudes towards one’s self appears to be driving elevated BDI scores rather than the overlap in physical symptoms between obesity and depression.
Resumo:
Background : The Beck Depression Inventory (BDI) is frequently employed as measure of depression in studies of obesity. The aim of the study was to assess the factorial structure of the BDI in obese patients prior to bariatric surgery.
Methods : Confirmatory factor analysis was conducted on the current published factor analyses of the BDI. Three published models were initially analysed with two additional modified models subsequently included. A sample of 285 patients presenting for Lap-Band® surgery was used.
Results : The published bariatric model by Munoz et al. was not an adequate fit to the data. The general model by Shafer et al. was a good fit to the data but had substantial limitations. The weight loss item did not significantly load on any factor in either model. A modified Shafer model and a proposed model were tested, and both were found to be a good fit to the data with minimal differences between the two. A proposed model, in which two items, weight loss and appetite, were omitted, was suggested to be the better model with good reliability.
Conclusions : The previously published factor analysis in bariatric candidates by Munoz et al. was a poor fit to the data, and use of this factor structure should be seriously reconsidered within the obese population. The hypothesised model was the best fit to the data. The findings of the study suggest that the existing published models are not adequate for investigating depression in obese patients seeking surgery.
Resumo:
Background
Worldwide, type 2 diabetes (T2DM) prevalence has more than doubled over two decades. In Australia, diabetes is the second highest contributor to the burden of disease. Lifestyle modification programs comprising diet changes, weight loss and moderate physical activity, have been proven to reduce the incidence of T2DM in high risk individuals.
As part of the Council of Australia Governments, the State of Victoria committed to develop and support the diabetes prevention program ‘Life! Taking action on diabetes’ (Life!) which has direct lineage from effective clinical and implementation trials from Finland and Australia. The Melbourne Diabetes Prevention Study (MDPS) has been set up to evaluate the effectiveness and cost-effectiveness of a specific version of the Life! program.
Methods/design
We intend to recruit 796 participants for this open randomized clinical trial; 398 will be allocated to the intervention arm and 398 to the usual care arm. Several methods of recruitment will be used in order to maximize the number of participants. Individuals aged 50 to 75 years will be screened with a risk tool (AUSDRISK) to detect those at high risk of developing T2DM. Those with existing diabetes will be excluded. Intervention participants will undergo anthropometric and laboratory tests, and comprehensive surveys at baseline, following the fourth group session (approximately three months after the commencement of the intervention) and 12 months after commencement of the intervention, while control participants will undergo testing at baseline and 12 months only.
The intervention consists of an initial individual session followed by a series of five structured-group sessions. The first four group sessions will be carried out at two week intervals and the fifth session will occur eight months after the first group session. The intervention is based on the Health Action Process Approach (HAPA) model and sessions will empower and enable the participants to follow the five goals of the Life! program.
Discussion
This study will determine whether the effect of this intervention is larger than the effect of usual care in reducing central obesity and cardiovascular risk factors and thus the risk of developing diabetes and cardiovascular disease. Also it will evaluate how these two options compare economically.
Resumo:
In 2003, the National Heart Foundation of Australia published a position statement on psychosocial risk factors and coronary heart disease (CHD). This consensus statement provides an updated review of the literature on psychosocial stressors, including chronic stressors (in particular, work stress), acute individual stressors and acute population stressors, to guide health professionals based on current evidence. It complements a separate updated statement on depression and CHD.
Perceived chronic job strain and shift work are associated with a small absolute increased risk of developing CHD, but there is limited evidence regarding their effect on the prognosis of CHD. Evidence regarding a relationship between CHD and job (in)security, job satisfaction, working hours, effort-reward imbalance and job loss is inconclusive.
Expert consensus is that workplace programs aimed at weight loss, exercise and other standard cardiovascular risk factors may have positive outcomes for these risk factors, but no evidence is available regarding the effect of such programs on the development of CHD.
Social isolation after myocardial infarction (MI) is associated with an adverse prognosis. Expert consensus is that although measures to reduce social isolation are likely to produce positive psychosocial effects, it is unclear whether this would also improve CHD outcomes. Acute emotional stress may trigger MI or takotsubo ("stress") cardiomyopathy, but the absolute increase in transient risk from an individual stressor is low. Psychosocial stressors have an impact on CHD, but clinical significance and prevention require further study.
Awareness of the potential for increased cardiovascular risk among populations exposed to natural disasters and other conditions of extreme stress may be useful for emergency services response planning. Wider public access to defibrillators should be available where large populations gather, such as sporting venues and airports, and as part of the response to natural and other disasters.
Resumo:
Background:
Methods:
A total of 176 pregnant women from Melbourne, Victoria filled out a questionnaire battery containing demographic questions and the Body Attitudes Questionnaire at 16, 24, and 32 weeks during pregnancy. A comparison group of 148 non-pregnant women also completed the questionnaire battery at Time 1. Evaluations of the psychometric properties of the BAQ consisted of a series of measurement invariance tests conducted within a structural equation modelling framework.
Results:
Although the internal consistency and factorial validity of the subscales of the BAQ were established across time and also in comparisons between pregnant and non- pregnant women, measurement invariance tests showed non-invariant item intercepts across pregnancy and also in comparison with the non-pregnant subgroup. Inspection of modification indices revealed a complex, non-uniform pattern of differences in item intercepts across groups.
Conclusions:
Collectively, our findings suggest that comparisons of body dissatisfaction between pregnant and non-pregnant women (at least based on the BAQ) are likely to be conflated by differential measurement biases that serve to undermine attempts to accurately assess level of body dissatisfaction. Researchers should be cautious in assessments of body dissatisfaction among pregnant women until a suitable measure has been established for use in this population. Given the fact that body dissatisfaction is often associated with maladaptive behaviours, such as unhealthy eating and extreme weight loss behaviours, and with ante-and post-natal depression, that have serious negative implications for women’s health and well-being, and potentially also for the unborn foetus during pregnancy, developing a suitable body image screening tool, specific to the perinatal period is clearly warranted.
Resumo:
Objective
The Australian lifestyle intervention program Life! is only the second reported, large-scale diabetes prevention program. This paper describes the genesis and the successful establishment of Life! and its key outcomes for participants and implementation.
Research
Design and Methods Life!, a behavior change intervention, comprises six group sessions over eight months. The Victorian Department of Health funded Diabetes Australia-Victoria to implement the program. Experience of the Greater Green Triangle diabetes prevention implementation trial was used for intervention design, workforce development, training and infrastructure. Clinical and anthropometric data from participants, used for program evaluation, was recorded on a central database.
Results
Life! has a state-wide workforce of 302 trained facilitators within 137 organizations. 29,000 Victorians showed interest in Life! and 15,000 individuals have been referred to the program. In total, 8,412 participants commenced a Life! program between October 2007 and June 2011. 37% of the original participants completed the eight month program. Participants completing sessions one to five lost an average of 1·4 kg weight (p<0·001) and waist circumference of 2·5cm (p<0.001). Those completing six sessions lost an average of 2·4 kg weight (p<0·001) and waist circumference of 3·8 cm (p<0·001). The weight loss of 2.4 kg represents 2.7% of participants’ starting body weight.
Conclusion
The impact of Life! is attributable to applying available evidence for the systems design of the intervention, and collaboration between policy makers, implementers and evaluators using the principles of continuous quality improvement to support successful, large scale recruitment and implementation.
Resumo:
Objective : To explore associations among quality indicators (QI; e.g. pressure ulcers, falls and/or fractures, physical restraint, use of multiple medications, unplanned weight loss) of the Victorian Public Sector Residential Aged Care Services (VPSRACS) with other demographic and health-related factors.
Methods : Data for 380 residents over a 3-month period were extracted retrospectively from client databases at four VPSRAC facilities.
Results : Four significant logistic regression models were developed. The strongest models related to falls and polypharmacy. Significant associations for these models included the following: (1) residents with a higher body mass index were 6% less likely (95% confidence interval (CI) 1%–11%) to fall, whereas high levels of cognitive impairment increased the risk of falling by 8% (95% CI 2%–14%); (2) being ambulant with a gait aid more than doubled the risk of falling compared with non-ambulant residents (95% CI 19%–546%); and (3) higher cognitive impairment was associated with a 6% (95% CI 1%–11%) reduction in the likelihood of polypharmacy.
Conclusions : Identification of significant relationships between the VPSRACS QI and other demographic and health-related factors is a preliminary step towards a more in-depth understanding of the factors that influence the QI and predict adverse events.
Resumo:
Objective
Emerging evidence suggests that psychosocial stress may influence weight gain. The relationship between stress and weight change and whether this was influenced by demographic and behavioral factors was explored.
Design and Methods
A total of 5,118 participants of AusDiab were prospectively followed from 2000 to 2005. The relationship between stress at baseline and BMI change was assessed using linear regression.
Results
Among those who maintained/gained weight, individuals with high levels of perceived stress at baseline experienced a 0.20 kg/m2 (95% CI: 0.07-0.33) greater mean change in BMI compared with those with low stress. Additionally, individuals who experienced 2 or ≥3 stressful life events had a 0.13 kg/m2 (0.00-0.26) and 0.26 kg/m2 (0.14-0.38) greater increase in BMI compared with people with none. These relationships differed by age, smoking, and baseline BMI. Further, those with multiple sources of stressors were at the greatest risk of weight gain.
Conclusion
Psychosocial stress, including both perceived stress and life events stress, was positively associated with weight gain but not weight loss. These associations varied by age, smoking, obesity, and multiple sources of stressors. Future treatment and interventions for overweight and obese people should consider the psychosocial factors that may influence weight gain.
Resumo:
While physical activity, energy restriction and weight loss are the cornerstone of type 2 diabetes management, less emphasis is placed on optimizing skeletal muscle mass. As muscle is the largest mass of insulin-sensitive tissue and the predominant reservoir for glucose disposal, there is a need to develop safe and effective evidence-based, lifestyle management strategies that optimize muscle mass as well as improve glycaemic control and cardiometabolic risk factors in people with this disease, particularly older adults who experience accelerated muscle loss.
Resumo:
A developing concept is that antidepressant strategies which combine multiple mechanisms of action may have advantages over agents with single mechanisms. Duloxetine is a novel potent dual reuptake inhibitor of noradrenaline and serotonin. The antidepressant efficacy of duloxetine is reviewed in three trials. Results that emerge confirm the acute efficacy of the agent in major depressive disorder. In particular, remission rates in the comparative trials are higher with duloxetine than with either paroxetine or fluoxetine. Duloxetine appears to have specific efficacy in patients with somatic symptoms and there is some clinical evidence of analgesic properties. Modest weight loss was consistently described in the three acute trials and modest weight gain was seen in an open label follow-up study. Duloxetine was well-tolerated in all three trials with similar patterns of adverse events. No significant safety issues emerged from these trials.
Resumo:
This paper aimed to systematically evaluate the mental health and well-being outcomes observed in previous community-based obesity prevention interventions in adolescent populations.
Resumo:
The degumming process to remove sericin decreases silk fiber strength; however, the impact of degumming on the mechanical properties of regenerated silk biomaterials has not been established. This study investigated the effect of degumming temperature, time, alkaline component and alkaline concentration on the mechanical properties of silk fibroin films. Sericin removal was estimated using weight loss; 10 samples with 12.2–29.4% weight loss were then further characterized in terms of fiber mechanical properties, fiber surface morphology, molecular weight distribution and film tensile strength. A negative correlation was found between weight loss and fiber tensile strength. This loss of fiber strength under harsher degumming conditions had a direct impact on the tensile strength of regenerated films. Mild degumming conditions (weight loss of 12.2%) led to higher film strength (8.9 MPa), whereas aggressive degumming conditions (with 29.4% weight loss) resulted in significantly weaker films (4.3 MPa). The presence of some residual sericin, after mild degumming, is likely to affect the mechanical properties of the regenerated silk films. These results will assist in the development of materials with mechanical and biocompatibility properties tuned to specific biomedical applications.
