A haemodialysis nutritional screening tool for nurses : a pilot study

The purpose of the study was to pilot a nurse-performed nutritional screening tool (NST) for dialysis patients in order to identify nutritionally at-risk patients. Haemodialysis (HD) patients are at risk of nutritional-related problems. Nutritional screening by nurses may assist in the early recognition of and response to these problems. An NST was developed using 9 screening parameters. (BMI, weight change, poor appetite, GI symptoms, albumin, pre-dialysis urea, K+, PO4++, HbA1c). The NST was compared with Standard Dietitian Assessment (SDA). 44 HD patients were screened with the NST and then with SDA. The tool showed sensitivity of 0.7 (95%CI+/- 0.21) and a specificity of 0.77 (95%CI+/-0.16). Reliability was low (alpha = .18). Alpha increased to 0.32 if pre-dialysis urea was removed from the tool and increased to 0.48 if weight loss, appetite, K+ and PO4++ were used alone. The pilot study showed a low reliability of the NST compared with SDA. With further analysis and modifications, the NST has the potential to assist nutritional screening by nurses in dialysis centres that have limited dietetic access.

Socio-cultural influences on eating practices among female adolescents in Fiji

This thesis examined the sociocultural influences on food and eating practices for both Indigenous-Fijian and Indo-Fijian female adolescents. Findings confirmed the prevalence of traditional customs related to feasting and fasting practices. Weight-change behaviours related to food practices were predicted largely by family and religious influences.

Changing the future of obesity : science, policy, and action

The global obesity epidemic has been escalating for four decades, yet sustained prevention efforts have barely begun. An emerging science that uses quantitative models has provided key insights into the dynamics of this epidemic, and enabled researchers to combine evidence and to calculate the effect of behaviours, interventions, and policies at several levels—from individual to population. Forecasts suggest that high rates of obesity will affect future population health and economics. Energy gap models have quantified the association of changes in energy intake and expenditure with weight change, and have documented the effect of higher intake on obesity prevalence. Empirical evidence that shows interventions are effective is limited but expanding. We identify several cost-effective policies that governments should prioritise for implementation. Systems science provides a framework for organising the complexity of forces driving the obesity epidemic and has important implications for policy makers. Many parties (such as governments, international organisations, the private sector, and civil society) need to contribute complementary actions in a coordinated approach. Priority actions include policies to improve the food and built environments, cross-cutting actions (such as leadership, healthy public policies, and monitoring), and much greater funding for prevention programmes. Increased investment in population obesity monitoring would improve the accuracy of forecasts and evaluations. The integration of actions within existing systems into both health and non-health sectors (trade, agriculture, transport, urban planning, and development) can greatly increase the influence and sustainability of policies. We call for a sustained worldwide effort to monitor, prevent, and control obesity.

Projected socioeconomic disparities in the prevalence of obesity among Australian adults

Objective: To project prevalence of normal weight, overweight and obesity by educational attainment, assuming a continuation of the observed individual weight change in the 5-year follow-up of the national population survey, the Australian Diabetes, Obesity and Lifestyle study (AusDiab; 2000–2005).

Methods: Age-specific transition probabilities between BMI categories, estimated using logistic regression, were entered into education-level-specific, incidence-based, multi-state life tables. Assuming a continuation of the weight change observed in AusDiab, these life tables estimate the prevalence of normal weight, overweight and obesity for Australian adults with low (secondary), medium (diploma) and high (degree) levels of education between 2005 and 2025.

Results: The prevalence of obesity among individuals with secondary level educational attainment is estimated to increase from 23% in 2000 to 44% in 2025. Among individuals with a degree qualification or higher, it will increase from 14% to 30%. If all current educational inequalities in weight change could be eliminated, the projected difference in the prevalence of obesity by 2025 between the highest and lowest educated categories would only be reduced by half (to a 6 percentage point difference from 14 percentage points).

Conclusion: We predict that almost half of Australian adults with low educational status will be obese by 2025. Current trends in obesity have the potential to drive an increase in the absolute difference in obesity prevalence between educational categories in future years.

Implications: Unless obesity prevention and management strategies focus specifically on narrowing social inequalities in obesity, inequalities in health are likely to widen.

The role of objective and subjective evaluation in the production and marketing of goats for meat

Objective and subjective evaluations of goats for meat production are related to important determinants of production and profitability. The most important attributes in assessment of goats for market are: live weight; body condition score; and the age of goats. As goats grow, their carcass and body organs increase in weight in proportion to the empty body weight. For farmers and field workers the linear regression approach for estimating carcass weight by measuring live weight is the most suitable as it accounts for 88 to 97% of the variation in carcass, offal and boneless meat weight. Live weight scales or heart girth tapes should be used and the risks and errors associated with these methods are summarized. The proportion of a live goat that is the carcass, known as dressing percentage, increases from 35% to about 50% as goats grow. The usefulness and errors associated with dressing percentage in field estimation are discussed. A valuable subjective method for estimating the nutritional status of goats is the use of body condition scoring as it accounts for 60 to 67% of the variation in live weight change, carcass weight and fat reserves of goats. A method for body condition scoring and a similar fat scoring system are explained. Body condition score is also associated with mortality risk and reproductive performance of goats. The number of permanent incisors in the lower jaw of goats is a method of estimating the age of goats but is biased by differences in live weights of goats. The value and role of ultrasound scanning the carcasses of goats is summarized. For the marketing of kid meat no permanent incisors should have erupted. Other useful practices for the successful marketing of goat meat are discussed including: knowing market specifications and chemical withholding periods; animal health; prevention of bruising; identification of goats; size of consignments; timeliness; provision of paperwork. A checklist is provided. The use of subjective and objective assessment techniques in evaluating goats for meat production will provide the best results. Where only subjective assessment techniques are available they will provide satisfactory performance provided the skills have been learnt and are applied.

Nutrition screening by nurses in dialysis

Aims and objectives : To determine whether a nurse-completed dialysis nutritional screening tool improves referral rates for nutritional support and compare nutrition sensitive biochemical indices, mortality rates and patient-centred quality of life outcomes between referred and non-referred dialysis patients.

Background : People with chronic kidney disease requiring dialysis are nutritionally at risk. Nutrition screening has been shown to identify dialysis patients who are nutritionally at risk to refer to dietitian expertise.

Design : Prospective cluster-randomised control trial.

Methods : Monthly nurse-completed nutrition screening was completed for six consecutive months using a validated four-item instrument measuring weight change, serum phosphate, serum potassium and appetite. Participants (n = 81) were haemodialysis patients from four satellite haemodialysis centres in one Australian metropolitan health service. Primary outcome measure was rate of referral to dietetic services for nutrition support for intervention vs. control groups at six months. Secondary outcome measures were blood pressure, biochemical indices and mortality for referred vs. non-referred patients at six and nine months, and generic and dialysis-specific quality of life for referred vs. non-referred at nine months was examined.

Results : There were three times as many dietetic referrals in the intervention group than in the control group (26·3 vs. 9·3%). Serum phosphate increased significantly more in the referred patients than the non-referred patients. There were no clinically significant changes between groups in quality of life, blood pressure, mortality rates or other biochemical indices at either six or nine months.

Conclusion : Nurse-completed nutritional screening can lead to appropriate dietetic referrals for nutritional support by nutritional expert clinicians.

Relevance to clinical practice : This study is the first to demonstrate that monthly systematic nurse-completed nutritional screening can facilitate appropriate dietetic referrals that may lead to increased nutritional care for people in satellite dialysis centres.

Psychosocial stress is positively associated with body mass index gain over 5 years : evidence from the longitudinal AusDiab study

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.

BMI and all-cause mortality in older adults: a meta-analysis

Whether the association between body mass index (BMI) and all-cause mortality for older adults is the same as for younger adults is unclear.

Lifetime and fleece quality traits associated with the occurrence of entangled mohair staples

Staple entanglement in mohair fleeces occurs when adhesions form between longer and faster growing fibres and shorter and slower growing fibres. This results in accentuated crimp of the longer fibres and an "apparently" reduced staple length. The appearance in the fleece of Angora goats of staple entanglements can lead to the downgrading of the mohair to poorer style and shorter length grades, resulting in up to 60% price reductions. This study examined how staple entanglement score (SES) is related to lifetime factors of Angora goats, and how this relationship can be explained by variations in animal size and fleece attributes. SES was scored using a five-point scale: 5, long free fibres easily separated as no adhesions; 4, some adhesions between fibres; 3, some effort to separate fibres as many adhesions; 2, many adhesions, staple fibres entangled, shortening of staple; 1, very entangled and shortened staple. Measurements were made over 9 shearing periods on a population of Angora castrated males (wethers) goats representing the current range and diversity of genetic origins in Australia, including South African, Texan and interbred admixtures of these and Australian sources. Data on genetic origin, sire, dam, date of birth, dam age, birth weight, birth parity, weaning weight, live weight, fleece growth and fleece attributes were recorded. Two restricted maximum likelihood (REML) models were developed to relate SES with age, animal lifetime factors, fleece quality attributes and live weight. One model allowed fleece quality and live weight traits in the model and the other excluded these traits. Staple entanglement was almost eliminated in mohair harvested from goats shorn every 3. months but was common in mohair from goats shorn twice or once per year. SES was less in goats of Texan genetic background, and was generally less in winter grown mohair. SES was higher for mohair with low fibre curvature (FC, 10°/mm) and a high clean washing yield (CWY, 90%) compared with mohair with low FC and lower CWY (80%), and compared with all mohair with high FC (18°/mm). The response of SES to shearing regime, genetic background, shearing season, age of goat and a response to dam age were almost identical whether or not an adjustment was made for CWY and FC. There was a moderate amount of variability due to sires and individuals. We can conclude that a large part of these effects observed, namely breed, dam age, sire, and a component of the FC and CWY effects, are genetic. Mohair producers can manage the genetic effects by careful selection of sires, especially avoiding those with low CWY or high FC, and avoiding sires with higher levels of staple entanglement or that have produced progeny with higher levels of staple entanglement. Also, unidentified environmental effects are affecting staple entanglement, although a lack of a live weight change effect on entanglement indicates that this effect might not be due to nutrition. © 2013 Elsevier B.V.

Challenges of diabetes prevention in the real world : results and lessons from the Melbourne diabetes prevention study

OBJECTIVE: To assess effectiveness and implementability of the public health programme Life! Taking action on diabetes in Australian people at risk of developing type 2 diabetes.

RESEARCH DESIGN AND METHODS: Melbourne Diabetes Prevention Study (MDPS) was a unique study assessing effectiveness of Life! that used a randomized controlled trial design. Intervention participants with AUSDRISK score ≥15 received 1 individual and 5 structured 90 min group sessions. Controls received usual care. Outcome measures were obtained for all participants at baseline and 12 months and, additionally, for intervention participants at 3 months. Per protocol set (PPS) and intention to treat (ITT) analyses were performed.

RESULTS: PPS analyses were considered more informative from our study. In PPS analyses, intervention participants significantly improved in weight (-1.13 kg, p=0.016), waist circumference (-1.35 cm, p=0.044), systolic (-5.2 mm Hg, p=0.028) and diastolic blood pressure (-3.2 mm Hg, p=0.030) compared with controls. Based on observed weight change, estimated risk of developing diabetes reduced by 9.6% in the intervention and increased by 3.3% in control participants. Absolute 5-year cardiovascular disease (CVD) risk reduced significantly for intervention participants by 0.97 percentage points from 9.35% (10.4% relative risk reduction). In control participants, the risk increased by 0.11 percentage points (1.3% relative risk increase). The net effect for the change in CVD risk was -1.08 percentage points of absolute risk (p=0.013).

CONCLUSIONS: MDPS effectively reduced the risk of diabetes and CVD, but the intervention effect on weight and waist reduction was modest due to the challenges in recruiting high-risk individuals and the abbreviated intervention.

Empowering primary care to tackle the obesity epidemic: the Counterweight Programme

Subjects: Obese patients (body mass index greater than or equal to30 kg/m2) or BMIgreater than or equal to28 kg/m2 with obesity-related comorbidities in 80 general practices.

Intervention: The model consists of four phases: (1) audit and project development, (2) practice training and support, (3) nurse-led patient intervention, and (4) evaluation. The intervention programme used evidence-based pathways, which included strategies to empower clinicians and patients. Weight Management Advisers who are specialist obesity dietitians facilitated programme implementation.

Main outcome measures: Proportion of practices trained and recruiting patients, and weight change at 12 months.

Results: By March 2004, 58 of the 62 (93.5%) intervention practices had been trained, 47 (75.8%) practices were active in implementing the model and 1549 patients had been recruited. At 12 months, 33% of patients achieved a clinically meaningful weight loss of 5% or more. A total of 49% of patients were classed as 'completers' in that they attended the requisite number of appointments in 3, 6 and 12 months. 'Completers' achieved more successful weight loss with 40% achieving a weight loss of 5% or more at 12 months.

Conclusion: The Counterweight programme provides a promising model to improve the management of obesity in primary care.

Sponsorship: Educational grant-in-aid from Roche Products Ltd.

Evaluation of the Counterweight Programme for obesity management in primary care: a starting point for continuous improvement

Background Evaluation for obesity management in primary care is limited, and successful outcomes are from intensive clinical trials in hospital settings.

Aim To determine to what extent measures of success seen in intensive clinical trials can be achieved in routine primary care. Primary outcome measures were weight change and percentage of patients achieving ≤5% loss at 12 and 24 months.

Design of study Prospective evaluation of a new continuous improvement model for weight management in primary care.

Setting Primary care, UK.

Method Primary care practice nurses from 65 UK general practices delivered interventions to 1906 patients with body mass index (BMI) ≥30 kg/m2 or ≥28 kg/m2 with obesity-related comorbidities.

Results Mean baseline weight was 101.2 kg (BMI 37.1 kg/m2); 25% of patients had BMI ≥40 kg/m2 and 74% had ≥1 major obesity-related comorbidity. At final data capture 1419 patients were in the programme for ≥12 months, and 825 for ≥24 months. Mean weight change in those who attended and had data at 12 months (n = 642) was −3.0 kg (95% CI = −3.5 to −2.4 kg) and at 24 months (n = 357) was −2.3 kg (95% CI = −3.2 to −1.4 kg). Among attenders at specific time-points, 30.7% had maintained weight loss of ≥5% at 12 months, and 31.9% at 24 months. A total of 761 (54%) of all 1419 patients who had been enrolled in the programme for >12 months provided data at or beyond 12 months.

Conclusion This intervention achieves and maintains clinically valuable weight loss within routine primary care.

Impacto da variabilidade de peso no controle matebólico de pacientes transplantados cardíacos

Heart transplantation (HT) represents one of the greatest advances in medicine over the last decades. It is indicated for patients with severe heart disease unresponsive to clinical treatment and conventional surgery, poor short-term prognosis and a 1- year mortality rate over 40%. HT has improved survival worldwide (80% in the first year, 70% in five years and 60% in ten years). However, the procedure has been associated with weight change and increased risk of secondary conditions such as diabetes, hypertension, dyslipidemia and obesity due to immunosuppressive therapy following transplantation. The objective of this study was to determine the impact of weight change on the metabolic stability of HT patients. The study was retrospective with data collected from the records of 82 adult patients (83% male; average age 45.06±12.04 years) submitted to HT between October 1997 and December 2005 at a transplantation service in Ceará (Brazil). The selected outcome variables (biopathological profile, weight and body mass index―BMI) were related to biochemical and metabolic change. The results were expressed in terms of frequency, measures of central tendency, Student s t test and Pearson s correlation coefficients. The analysis showed that following HT the average global BMI increased from 23.77±3.68kg/m2 to 25.48±3.92kg/m2 in the first year and to 28.38±4.97kg/m2 in the fifth. Overweight/obese patients (BMI ≥ 25 kg/m2) had higher average levels of glucose, total cholesterol, low-density lipoprotein and triglycerides than patients with eutrophy/malnutrition (BMI < 25 kg/m2). In conclusion, overweight/obese patients were likely to present higher average levels of glucose, triglycerides, total cholesterol and fractions than patients with eutrophy/malnutrition, indicating a direct and significant relation between nutritional status and weight change in the metabolic profile of HT patients

A elasticidade da pobreza em relação ao crescimento e à desigualdade de renda no nordeste rural brasileiro de 1995 a 2009: uma análise comparativa

This work aims to analyze how the growth in average income and the change in inequality in income distribution have impacted rural poverty in the Northeast in the period 1995 to 2009. Under the approach in Kakwani (1993) e Duclos and Araar (2006), and under the assumption of log-normality of income per capita, exposed in Bourguignon (2002) and Hoffmann (2005), are calculated growth and inequality elasticities of poverty to FGT poverty measures in order to observe the behavior of the sensitivity of poverty to changes in average household income and the change in income distribution / Gini index. Concurrently, decomposes the changes in measures of poverty (proportion of poor) between growth and distribution components (first proposed by Datt and Ravallion, 1992) to assess the effect of weight change and the effect of income inequality change change on poverty. Regarding the estimation of elasticities of poverty and growth and inequality elasticities of the two methodologies used in this work - under the assumption of lognormal distribution of income and FGT measures under the by Kakwani (1993) andDuclos e Araar (2006) - though do not result in identical values, to corroborate same results, ie the long-term decline in rural poverty from 1995 to 2009 the Northeast and the greater sensitivity of the Northeast Rural Poverty, observed in this same period, income growth and change in inequality. The weight of growth and change in inequality in changing the Northeast rural poverty identified that most of the decline in rural poverty is linked to growth in average income. This result coincides with results found by Kraay (2005) for a group of countries

Comparação de sistemas de avaliação de dietas para bovinos no modelo de produção intensiva de carne. Suplementação do pasto para vacas na estação seca

Foram utilizadas 30 vacas da raça Canchim com 50 meses de idade e peso corporal médio de 471 kg, que receberam suplemento alimentar durante a estação seca de 1998, objetivando avaliar a precisão no desempenho estimado por diferentes sistemas de avaliação de dietas. Os suplementos, à base de silagem de milho, milho, polpa cítrica peletizada, farelo de algodão, farelo de soja e soja integral, seguiram as recomendações do Sistema de Proteína Metabolizável (MP); do Sistema de Proteína e Carboidratos Líquidos de Cornell (CNCPS); e do Sistema de Proteína Digestível no Intestino (PDI), para manutenção do peso corporal. A variação diária de peso corporal obtida não diferiu entre os tratamentos CNCPS, MP e PDI, com médias de 0,34; 0,33; e 0,19 kg/cab, respectivamente. Quando a produção de carne constituiu-se no objetivo único do sistema produtivo, a análise econômica revelou saldo de R$22,00; R$-44,73; e R$47,27/ha/ano, para os sistemas CNCPS, MP e PDI, respectivamente. Concluiu-se que os suplementos avaliados pelos sistemas proporcionaram resultados de desempenho animal compatíveis com os estimados.