Association of the FTO and ADRB2 genes with body composition and fat distribution in obese women

Objective

The aim of this study was to investigate whether the polymorphisms of the fat mass and obesity-associated gene (FTO, rs9939609:T > A) and the β2-adrenergic receptor gene (ADRB2, rs1042714:Gln > Glu) are associated with weight loss in dieting obese premenopausal women and the association of these SNPs with body weight, body composition and distribution of fat mass.

Methods

75 obese (BMI > 30) premenopausal women participated in the intervention including a 3-month weight reduction period and a subsequent 9-month weight maintenance period. Weight and height were measured and BMI calculated. Body composition and fat mass distribution were assessed by dual energy X-ray absorptiometry.

Results

At baseline, the AA homozygotes of the FTO gene were 10.1 kg heavier (p = 0.031), they had higher BMI (p = 0.038), and greater waist and greater hip circumference (p = 0.08 and p = 0.067, respectively) compared to the TT homozygotes. Gln/Gln carriers of the ADRB2 gene had smaller gynoid fat-% compared with both the Gln/Glu and Glu/Glu carriers (p = 0.050 and p = 0.009, respectively). The Gln homozygotes had also smaller total body fat-% and higher total body lean mass-% than that of the Glu homozygotes (p = 0.018 and p = 0.019, respectively).

Conclusion

FTO genotype was associated with body weight in general, whereas ADRB2 genotype was associated with fat distribution. However, all women in the study group lost weight similarly independently of their genotypes. Neither the FTO nor ADRB2 genotype had statistically significant effect on weight reduction or weight maintenance.     

Changes in body composition following a dietary and lifestyle intervention trial: The postmenopausal health study

Objective

To examine whether dietary changes and the consumption of dairy products fortified with calcium and vitamin D₃ versus the use of a calcium supplement alone could have any effect on anthropometric and body composition indices of postmenopausal women over a 12-month period.

Methods

101 healthy postmenopausal women were randomized to a dietary intervention group (DG: n = 39), receiving approximately 1200 mg of calcium and 7.5 μg of vitamin D₃ per day via fortified dairy products and attending biweekly dietary and lifestyle intervention sessions; a calcium supplemented group (CaG: n = 26) receiving a total of 1200 mg calcium per day; and a control group who continued with their usual diet (CG: n = 36). Dietary, physical activity, anthropometric, body composition and distribution (based on DXA) data were collected at baseline and after 12 months of intervention.

Results

No significant differences were observed in the mean 12-month changes in certain anthropometric (i.e. weight, BMI) and DXA (i.e. total body fat and lean mass) indices between groups. However, the DG was found to have a lower decrease in mid-arm muscle circumference (P < 0.001) and a lower increase in the sum of skinfolds’ thickness (P = 0.042) compared with the CaG and the CG. Furthermore, the DG was also found to have a greater decrease in the percentage of legs’ fat mass (P = 0.025) and a higher increase in the percentage of legs’ lean mass (P = 0.012) compared with the two other groups.

Conclusion

The application of a holistic intervention approach combining nutrition and lifestyle counseling with consumption of fortified dairy products for 12 months was found to have favourable changes in certain anthropometric and body composition indices compared to calcium supplementation alone.     

Childhood adversity and pubertal timing: Understanding the origins of adulthood cardiovascular risk

Objective

To determine whether greater childhood adversity relates to younger menarcheal age; whether younger menarcheal age relates to increased CVD risk; and whether greater childhood adversity relates to increased CVD risk, directly or indirectly (mediated by menarcheal age).

Methods

Among 650 pre-menopausal women (ages 25–45; M = 34.9[5.6]), SEM was performed to estimate relations between childhood adversity, menarcheal age, and CVD risk.

Results

Results supported a covariate-adjusted model (RMSEA = 0.035; CFI = 0.983) in which greater childhood adversity was related to younger menarcheal age (β = −.13, p < .01) and younger menarcheal age was related to greater CVD risk (β = −.18, p < .05). Direct and indirect effects of childhood adversity on CVD risk were non-significant. Re-evaluation of the same model with additional covariate-adjustment for adulthood body composition showed the relation between menarcheal age and CVD risk attenuated (β = −.03, p = .376).

Conclusions

Cross-sectional evidence suggests family-related adversity experiences in childhood confer risk for earlier menarche which, in turn, relates to increased CVD risk in adulthood, possibly via post-pubertal body size.     

Participating in a virtual reality balance exercise program can reduce risk and fear of falls

Objective

The objective of this study was to quantify the effectiveness of virtual reality balance games (VRBG) to decrease risk and fear of falls among women.

Methods

Thirty six community dwelling women aged 56 and above were randomly divided into experimental (exercises using VRBG focus on improving balance) and control (conventional balance exercises) groups. Both groups attended a twice 6 weekly exercise session for an hour. Risk and fear of falls were measured with Physiological Profile Approach (PPA) and Activity Specific Balance Scale (ABC-6). Pre and post intervention differences between the groups were examined using two way repeated measures ANOVA.

Results

Both VRBG and conventional balance exercise groups had significant decrease in PPA (p < 0.001) and ABC-6 (p < 0.01) after the interventions. However, no significant effects were demonstrated between the groups in PPA (p = 0.18) and ABC-6 (p = 0.25) post intervention. Time and group interaction effect were not significant for PPA (p = 0.18) and ABC-6 (p = 0.45).

Conclusions

Practising VRBG can increase balance confidence and decrease risk of falls among community dwelling women.     

Predictors of mental health in post-menopausal women: Results from the Australian healthy aging of women study

Objective

To examine the extent to which socio-demographics, modifiable lifestyle, and physical health status influence the mental health of post-menopausal Australian women.

Methods

Cross-sectional data on health status, chronic disease and modifiable lifestyle factors were collected from a random cross-section of 340 women aged 60–70 years, residing in Queensland, Australia. Structural equation modeling (SEM) was used to measure the effect of a range of socio-demographic characteristics, modifiable lifestyle factors, and health markers (self-reported physical health, history of chronic illness) on the latent construct of mental health status. Mental health was evaluated using the Medical Outcomes Study Short Form 12 (SF-12^®) and Center for Epidemiologic Studies Depression Scale (CES-D).

Results

The model was a good fit for the data (χ² = 4.582, df = 3, p = 0.205) suggesting that mental health is negatively correlated with sleep disturbance (β = −0.612, p < 0.001), and a history of depression (β = −0.141, p = 0.024).While mental health was associated with poor sleep, it was not correlated with most lifestyle factors (BMI, alcohol consumption, or cigarette smoking) or socio-demographics like age, income or employment category and they were removed from the final model.

Conclusion

Research suggests that it is important to engage in a range of health promoting behaviors to preserve good health. We found that predictors of current mental health status included sleep disturbance, and past mental health problems, while socio-demographics and modifiable lifestyle had little impact. It may be however, that these factors influenced other variables associated with the mental health of post-menopausal women, and these relationships warrant further investigation.     

Electrocardiographic abnormalities of left ventricular repolarization: Prognostic implications in hypertensive post-menopausal women

Background

Although repolarization abnormalities on ECG are frequent in post-menopausal hypertensive women, their prognostic value in these women is uncertain.

Methods

We analyzed 908 hypertensive post-menopausal women consecutively included in the PIUMA (Progetto Ipertensione Umbria Monitoraggio Ambulatoriale) study. The median duration of follow-up was 8.6 years (range: 1–21). All women were untreated at entry. Drug treatment during follow-up was adjusted to single individuals. Standard 12-lead ECG was carried out at entry. The Minnesota Coding was used to define minor and major (“typical strain”) repolarization abnormalities.

Design

prospective observational study in essential hypertension.

Results

Mean age at entry was 60 years. At baseline, ECG was normal in 707 women, minor ST-T changes were noted in 152 women, and a typical strain pattern was present in 49 subjects. Predictors of typical strain were age, diabetes and systolic blood pressure (BP). During follow-up there were 119 new cardiovascular (CV) events and 75 all-cause deaths. Typical strain was associated with a threefold higher risk of CV disease (HR: 3.16; 95% CI: 1.59–6.31; p = 0.001) after adjustment for the significant influence of age, diabetes, serum creatinine, systolic BP and HDL-cholesterol. Women with minor LV repolarization abnormalities showed a non-significant excess risk of CV disease when compared with women with normal LV repolarization (HR: 1.25; 95% CI: 0.69–2.26; p = 0.467). Similar results were obtained for all-cause mortality.

Conclusions

Typical strain pattern, an easily detectable marker of altered LV repolarization, identifies post-menopausal hypertensive women at increased risk of CV disease and all-cause mortality.     

Mastery and perceived autonomy support are correlates of Dutch diabetes patients’ self-management and quality of life

Objective

The aim of this study was to assess the associations between type 2 diabetes patients’ mastery and perceived autonomy support and their self-management skills and health-related quality of life (HRQOL).

Methods

A cross-sectional questionnaire survey was conducted among 3352 patients with type 2 diabetes. Key variables were assessed with validated questionnaires.

Results

Patients’ mastery and perceived autonomy support correlated positively with their self-management skills (r = 0.34, p < 0.001; r = 0.37, p < 0.001) and HRQOL (r = 0.37, p < 0.001; r = 0.15, p < 0.001). In the linear regression analysis, mastery and perceived autonomy support were positive correlates of self-management (β = 0.23; p < 0.001; β = 0.25; p < 0.001). Patients with more physical or psychological complications had significantly lower scores on mastery, perceived autonomy support, self-management and HRQOL.

Conclusion

Our results indicate the importance of mastery in relation to diabetes patients’ perceived autonomy support, self-management skills and HRQOL.

Practice implications

Since a greater sense of mastery is likely to increase patients’ autonomous motivation to cope with their disease, interventions can aim to influence patients’ motivational regulation. In addition, we confirmed the need for autonomy support to improve patients’ self-management skills. Professionals can be trained to be autonomy-supportive, which relates to person-centered approaches such as motivational interviewing (MI).     

Effects of a nutritional intervention in obese postmenopausal women on atypical antipsychotics

Objectives

To investigate the effects of a nutritional intervention on the body weight, body composition, blood glucose and lipid levels of obese postmenopausal women taking atypical antipsychotics in Greece.

Study design

In a case–control design, 25 obese postmenopausal women treated with antipsychotic medications and 28 obese healthy comparisons were followed for 3 months. A nutritional program was individually designed for each participant.

Main outcome measures

At baseline and at 3 months of the study, anthropometric, body composition, blood glucose and lipid measurements were performed.

Results

Significant reductions in body weight, body mass index (BMI), fat and waist circumference were found both in the patients and their healthy comparisons from baseline to 3 months (P < 0.05). Patients reduced significantly less their BMI (P = 0.044) and body fat percentage compared to the healthy women (P = 0.023). Waist circumference was significantly reduced in both subject groups, with no significant difference found between them (P = 0.07). Glucose and lipid levels were not altered during the intervention in the patients’ group, while significant changes were observed in the healthy women in total cholesterol (P = 0.016), low density lipoprotein cholesterol (P = 0.022) and triglycerides (P = 0.042).

Conclusions

Obese postmenopausal women on atypical antipsychotic medication appear to respond favorably to a nutritional program. The improvements seen in BMI and body fat are attenuated in the patients compared to their healthy counterparts; moreover no change in lipid levels was found in the patients’ group. These findings suggest that atypical antipsychotics may play an adverse role in fat loss and lipid metabolism in this population.     

Evaluation of a natural health product decision aid: A tool for middle aged women considering menopausal symptom relief

Objective

To evaluate the effectiveness of a self-administered decision aid for menopausal women facing decisions about natural health products.

Study design

This pre-/post-test study included peri- or post-menopausal women, aged 45–64 considering the use of a natural health product for management of menopausal symptoms. They were recruited from a Women's Health Center.

Outcome measures

The primary outcome was decisional conflict and secondary outcomes included knowledge, strength of values, and decision preference.

Results

Of 24 women, the typical participant was 50–64 years of age, Caucasian, married, and well educated. Compared to baseline, after using the decision aid, women's total decisional conflict was reduced from 63% to 24% (p < 0.001) and knowledge improved from 76% to 87% (p = 0.001). Of the 24 women, 10 were unsure of their choice at baseline and 3-post use of the decision aid (p = 0.015). There was a trend for women preferring natural health products (n = 12) to be more likely to rate the non-chemical aspect as important and the cost of the natural health product as less important; women who preferred not to take natural health products (n = 3) rated the non-chemical aspect as less important and the costs as more important.

Conclusions

The natural health product decision aid improved the quality of decisions by enhancing knowledge and reducing decisional conflict. As well, women were more likely to make a choice that was consistent with their values.     

Menopause and modifiable coronary heart disease risk factors: A population based study

Objectives

The aim of our study was to determine the effect of the menopause on various coronary heart disease (CHD) risk factors and on the global risk of CHD in a population based sample of women, making the difference between menopause and age related effects.

Study design

The Third French MONICA cross-sectional survey on cardiovascular risk included 1730 randomly selected women, aged 35–64 years, representative from the general population.

Main outcome measures

Women were defined as post-menopausal (postM; n = 696), peri-menopausal (periM; n = 183) or pre-menopausal (preM; n = 659) based on the date of last menses. Socio-demographic, clinical and biological data were collected. Analyses of variance were used to compare means.

Results

PostM women had significantly higher age-adjusted levels of total cholesterol (6.0 mmol/L in postM vs. 5.7 mmol/L in preM, p < 0.05) and LDL cholesterol (3.9 mmol/L vs. 3.6 mmol/L, p < 0.05). There was no difference in HDL cholesterol or triglyceride levels, glycemia or blood pressure. Further adjustment on body mass index and hormonal treatments did not modify the results. No risk factor was significantly different between periM and postM. However, the Framingham 10-year risk of CHD was higher in postM, as compared with periM (5.1% vs. 5.0%, p < 0.05). In postM women, lipids and the Framingham risk were not associated with elapsed time since menopause.

Conclusions

The CHD risk increases during the sixth decade could be explained not only by estrogen deprivation but also by an effect on lipid profile, which is likely to occur in the peri-menopause period.     

Obesity is associated with a poorer prognosis in women with hormone receptor positive breast cancer

Objective

Whether moderate to severe obesity (body mass index (BMI) ≥ 30 to <40 kg/m²) contributes to breast cancer recurrence and mortality remains uncertain.

Subjects and methods

1199 women, recruited within 12 months of their diagnosis of hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2−) invasive breast cancer completed an enrolment questionnaire and an annual follow-up questionnaire every 12 months for another 5 years. The impact of obesity on time to either local or distant recurrence or new breast cancer, or death due to breast cancer was determined by Cox regression. Women in the most extreme categories of BMI (<18.5 and ≥40) were excluded from the analysis.

Results

Of the 1155 included women, mean age, 58.4 ± 11.6 years, 53.8% had Stage 1 disease and 88.9% received oral adjuvant endocrine therapy (OAET) within 2 years of diagnosis. The likelihood of an event was significantly associated with moderate to severe obesity (HR = 1.71, 95%CI, 1.12–2.62, p = 0.014), disease beyond Stage 1 (HR = 2.87, 95% CI 1.73–4.75, p < 0.001), OAET (HR = 0.26, 95%CI 0.14–0.46, p < 0.001), mastectomy (HR = 3.28, 95%CI 1.98–5.44, p < 0.001) and radiotherapy (HR = 2.12, 95%CI 1.24–3.63, p = 0.006). For Stage 1 disease, only moderate to severe obesity (HR 3.23, 95%CI 1.48–7.03, p = 0.003) and OAET use (HR 0.41, 95%CI 0.17–0.98, p = 0.046) were significantly associated with an event.

Conclusion

Moderate to severe obesity is associated with a poorer invasive breast cancer prognosis; this is also true for women with Stage 1 disease, and is independent of age and treatment.     

Bone metabolism regulators and arterial stiffness in postmenopausal women

Background

Osteoprotegerin (OPG), osteopontin (OPN) and matrix Gla protein (MGP) are markers of bone metabolism but they are also involved in vascular calcification. However, their precise role is not completely understood. Arterial stiffness is considered an independent predictor of cardiovascular events and it may be one of the causes of the increased cardiovascular risk associated with postmenopausal status. Medial and intimal calcification may increase arterial stiffness. The aim of our study was to assess the relationship of OPG, OPN and MGP with aortic pulse wave velocity (aPWV) as a marker of arterial stiffness in postmenopausal women.

Materials and methods

Circulating OPG, OPN and serum total MGP were measured in 144 postmenopausal women using the enzyme-linked immunosorbent assay method. Aortic PWV was determined by an oscillometric method.

Results

Osteoprotegerin correlated with age (p < 0.001, r = 0.27), aPWV (p < 0.001, r = 0.32) and hypersensitive C reactive protein (hsCRP) (p < 0.001, r = 0.37), OPN correlated directly with hsCRP (p < 0.001, r = 0.39) and inversely with high density lipoprotein cholesterol (p = 0.02, r = −0.02). No significant association was found between total MGP and clinical, biochemical and vascular parameters. The correlation between OPG and aPWV persisted even after the adjustment for various potential confounders (p = 0.02, r = 0.19). In multiple regression analysis in the whole study population the most important predictors of aPWV were OPG (β = 0.230, p = 0.006), hsCRP (β = 0.212, p = 0.01) and systolic blood pressure (β = 0.163, p = 0.04). After exclusion of patients treated with statins the independent predictors were hsCRP (β = 0.275, p = 0.005) and OPG (β = 0.199, p = 0.04).

Conclusion

Circulating OPG, but not OPN and total MGP, is associated with aPWV and may be a marker of the increased arterial stiffness and cardiovascular risk in postmenopausal women.     

Serum cathepsin K as a marker of bone metabolism in postmenopausal women treated with alendronate

Context

Cathepsin K is a member of the cysteine protease family that cleaves both helical and telopeptide regions of collagen I, the major type of collagen in bone. Measurement of circulating levels of cathepsin K may be useful to assay the number or function of osteoclasts.

Objective

The aim of the study was to evaluate the role of serum cathepsin K as a biochemical marker of bone metabolism in patients with postmenopausal osteoporosis before and after treatment with alendronate.

Design, setting and participants

The study was a case–control and prospective study with postmenopausal osteoporotic women including a total number of 86 subjects. Serum cathepsin K was determined in 46 women with postmenopausal osteoporosis before and after 3, 6 and 12 months of treatment with alendronate. Basal serum cathepsin K levels were also compared between premenopausal healthy women (n = 20), postmenopausal women without osteoporosis (n = 20) and osteoporotic women. In addition, serum carboxyterminal cross-linked telopeptide of type I collagen (CTX), osteocalcin (OC) and bone-specific alkaline phosphatase (bALP) were measured.

Main outcome measure

Changes in cathepsin K serum levels after alendronate treatment.

Results

Serum cathepsin K levels were higher in postmenopausal women with osteoporosis (9.4 ± 11 pmol/L) compared with healthy postmenopausal women (6.8 ± 8.1 pmol/L; p < 0.01) and premenopausal women (6.3 ± 5.0 pmol/L, p < 0.01). Serum cathepsin K decreases gradually after alendronate treatment (17% at 3 months, 22% at 6 months and 41% at 12 months, p < 0.01). In contrast, the treatment resulted in early and sustained reductions in serum CTX.

Conclusion

We conclude that serum cathepsin K seems to provide additional information on bone metabolism in postmenopausal women treated with alendronate.     

Family involvement is helpful and harmful to patients’ self-care and glycemic control

Objective

We assessed the relationships between supportive and obstructive family behaviors and patients’ diabetes self-care activities and HbA_1C, and potential interaction effects and differences by demographic characteristics.

Methods

In a cross-sectional study, 192 adults with type 2 diabetes completed the Diabetes Family Behavior Checklist-II, the Summary of Diabetes Self-Care Activities, and a glycemic control (HbA_1C) test.

Results

Participants reported similar rates of supportive and obstructive behaviors that were positively correlated (rho = 0.61, p < 0.001). In adjusted analyses, supportive family behaviors were associated with adherence to different self-care behaviors (β = 0.20 to 0.50, p < 0.05), whereas obstructive family behaviors were associated with less adherence to self-care behaviors (β = −0.28 to −0.39, p < 0.01) and worse HbA_1C (β = 0.18, p < 0.05). Supportive behaviors protected against the detrimental effect of obstructive behaviors on HbA_1C (interaction β = −0.22, p < 0.001). Non-Whites reported more supportive and obstructive behaviors than Whites, but race did not affect the relationships between family behaviors and self-care or HbA_1C.

Conclusion

Involving family members in patients’ diabetes management may impede patients’ self-care and compromise their glycemic control unless family members are taught to avoid obstructive behaviors.

Practice implications

Our findings endorse interventions that help family members develop actionable plans to support patients’ self-care and train them to communicate productively about diabetes management.     

Effect of basal metabolic rate on the bone mineral density in middle to old age women in Taiwan

Background

Basal metabolic rate (BMR) reflects a combination of cardiopulmonary function and lean body mass resulting from regular physical activity. Though many studies have examined the relationships between bone mineral density (BMD) and body composition, little is known regarding the relationship between BMD and BMR.

Objective

The purpose of this study was to investigate the relationship between BMR, anthropometric parameters, body composition and BMD in postmenopausal women in Taiwan.

Methods

Two hundred and eighty-nine women between the ages of 40 and 80 years were included in this cross-sectional study. The following parameters were assessed: height, body weight, total body fat (TBF), BMR, waist-to-hip ratio, grip strength, and back strength. Differences in all variables between osteoporotic and non-osteoporotic women (categorized according to decades in age) were calculated using a one-way analysis of variance (ANOVA) and a Bonferroni post-hoc test. Multiple linear regression with a backward stepwise approach was performed to evaluate the relationship between these measurements and BMD.

Results

Among women over 50 years of age, those who were non-osteoporotic had higher BMR, BMI, and body fat by comparison to their osteoporotic counterparts (p < 0.05 for all). Multiple linear regression revealed that BMR and body fat significantly predicted BMD of the femoral neck (adjusted beta coefficients of 0.304 and 0.190, respectively; p < 0.05 for both). BMR and body fat also predicted an increased vertebral BMD (adjusted beta coefficients of 0.310 and 0.141, respectively; p < 0.05 for both).

Conclusion

BMR is closely associated with BMD in elderly persons, and may be a novel target for interventions aimed at preventing the age-related decline in BMD.     

Waist circumference and serum adiponectin levels in obese and non-obese postmenopausal women

Objectives

A proposed missing link between obesity and metabolic disturbances is adiponectin, an adipocyte-derived peptide. Adiponectin is a potent antidiabetic hormone and seems to have a beneficial influence on lipid profile as well. The need to explain the complex physiological roles of this hormone prompted the authors to study the relationship between adiponectin level and obesity – related abnormalities in a homogenous population of postmenopausal women.

Study design

The study involved 272 postmenopausal women aged 50–60 years. Invitations to participate in the study were sent to 4000 randomly chosen women from the Wroclaw city population fulfilling the age criterion. A telephone questionnaire was administered to the group of 1731 women who responded to the invitation and then subjects for the study were selected. Main outcome measures anthropometrical measurements of body fat tissue content and fat tissue distribution assessment were carried out in all the women. Moreover, serum concentrations of adiponectin, glucose, total cholesterol, HDL cholesterol, triglycerides and insulin were measured.

Results

The most frequent (76%) phenotype among the investigated women was obesity (BMI >25) with abnormal (= 80 cm) waist circumference (OAW), Obesity with normal (<80 cm) waist (ONW) and normal weight with abnormal waist (NOAW) were observed in only 5% and 14% of the women, respectively. Non-obese women with normal waist (NONW) were noted in only 5% of the subjects. Serum adiponectin levels in both groups of non-obese women (NOAW and NONW) were significantly higher (p < 0.05) than in the women with obesity or overweight and abnormal waist circumference (OAW group). Adiponectin levels in the women with obesity or overweight and normal waist (ONW) were also higher than in the OAW group; however, this difference was not statistically significant (p = 0.05). In all the women, serum adiponectin level correlated negatively with BMI (r = −0.34, p = 0.0001), total fat (r = −0.28, p = 0.0001), android fat deposit (r = −0.23, p = 0.0001), waist circumference (r = −0.33, p = 0.0001), glucose (r = −0.27, p = 0.0001), triglycerides (r = −0.34, p = 0.0001), and FIRI (r = −0.34, p = 0.0001) and positively with the gynoid/android fat deposit ratio (r = 0.28, p = 0.0001) and HDL cholesterol (r = 0.36, p = 0.0001).

Conclusions

These results confirm that adiponectin could be a marker of the development of menopausal insulin resistance syndrome.     

A self-referral preventive intervention for burnout among Norwegian nurses: One-year follow-up study

Objective

Burnout among nurses is an issue of concern, and preventive interventions are important to implement and evaluate. This study investigated levels and predictors of change in burnout dimensions after an intervention for help-seeking nurses.

Methods

Nurses participating in a self-referral, counseling intervention, from 2004 to 2006 in Norway, were followed with self-reporting assessments. One-year follow-up was completed by 160/172 (93%, 155 women and 5 men).

Results

Mean level of emotional exhaustion (one dimension of burnout, scale 1–5) was significantly reduced from 2.87 (SD 0.79) to 2.52 (SD 0.8), t = 5.3, p < 0.001, to the level found in a representative sample of Norwegian nurses. The proportion of nurses seeking psychotherapy increased after the intervention, from 17.0% (25/147) to 34% (50/147), p < 0.001. Less reduction in emotional exhaustion was independently predicted by reporting a work-related conflict (β −0.53 (SE 0.13), p < 0.001) or by getting a period of sick leave (β −0.28 (SE 0.12), p < 0.05) after the intervention.

Conclusions

A short-term preventive intervention could contribute to reduction of emotional exhaustion in nurses. Work-related conflict and sick leave after the intervention were negatively associated with this reduction.

Practice implications

Preventive interventions to reduce burnout for nurses should be considered, as well as programs for preventing or handling conflicts at work.     

Physicians’ reactions to uncertainty in the context of shared decision making

Objective

Physicians’ reactions towards uncertainty may influence their willingness to engage in shared decision making (SDM). This study aimed to identify variables associated with physician's anxiety from uncertainty and reluctance to disclose uncertainty to patients.

Methods

We conducted a cross-sectional secondary analysis of longitudinal data of an implementation study of SDM among primary care professionals (n = 122). Outcomes were anxiety from uncertainty and reluctance to disclose uncertainty to patients. Hypothesized factors that would be associated with outcomes included attitude, social norm, perceived behavioral control, intention to implement SDM in practice, and socio-demographics. Stepwise linear regression was used to identify predictors of anxiety from uncertainty and reluctance to disclose uncertainty to patients.

Results

In multivariate analyses, anxiety from uncertainty was influenced by female gender (β = 0.483; p = 0.0039), residency status (1st year: β = 0.600; p = 0.001; 2nd year: β = 0.972; p < 0.001), and number of hours worked per week (β = −0.012; p = 0.048). Reluctance to disclose uncertainty to patients was influenced by having more years in formal education (β = −1.996; p = 0.012).

Conclusion

Variables associated with anxiety from uncertainty differ from those associated with reluctance to disclose uncertainty to patients.

Practice implications

Given the importance of communicating uncertainty during SDM, measuring physicians’ reactions to uncertainty is essential in SDM implementation studies.     

Resistance training attenuates fat mass regain after weight loss in ovariectomized rats

Objective

The aim of the present study was to investigate the effects of maintaining only one of the two components of a food restriction (FR) + resistance training (RT) regimen on the regain of body weight and fat mass (liver and adipocytes) in ovariectomized (Ovx) rats.

Methods

Five week Ovx rats were submitted to a weight loss program consisting of a 26% FR combined with RT (OvxFR + RT) for 8 weeks. RT consisted of climbing a 1.5 m vertical grid with a load attached to the tail, 20–40 times with progressively increasing loads 4 times/week. Following this weight loss intervention, OvxFR + RT rats were sub-divided into 3 groups for an additional 5 weeks: 2 groups went back to a normal ad libitum feeding with or without RT and the other group kept only FR.

Results

Combined FR + RT program in Ovx rats led to lower body mass gain, liver triacylglycerol (TAG) levels, and fat mass gain compared to sedentary normally fed Ovx rats (P < 0.01). Stopping both FR and RT over a 5 week period resulted in the regain of body weight, intra-abdominal fat pad weight and liver TAG (P < 0.01). When only FR was maintained, the regain of body and fat pad weight as well as liver and plasma TAG concentrations was completely prevented. However, when only RT was maintained, regain in the aforementioned parameters was attenuated but not prevented (P < 0.05).

Conclusion

It is concluded that following a FR + RT weight loss program, continuation of only RT constitutes an asset to attenuate body weight and fat mass regain in Ovx rats; although the impact is less than the maintaining FR alone. These results suggest that, in post-menopausal women, RT is a positive strategy to reduce body weight and fat mass relapse.     

Correlates and predictors of self-rated health and ambulatory status among elderly women – Cross-sectional and 10 years population-based cohort study

Aim

To investigate the correlates and predictors of self-rated health (SRH) and self-reported ambulatory status (AMB) among elderly women.

Subjects and methods

A random sample of 1620 postmenopausal women aged 53–66 years in 1994 was selected from Osteoporosis Risk Factor and Prevention (OSTPRE) – study cohort in Finland. SRH and AMB were assessed in baseline (1994) and after 10-year follow-up (2004). A prognostic model was developed to predict the probability of good 10-year SRH and AMB.

Results

Full AMB was correlated with and predicted by good SRH (OR = 4.3, p < 0.001). Good quality of life (QoL) was both correlate and predictor of good 10-year SRH (OR = 2.0, p < 0.001) and full AMB (OR = 2.6, p < 0.001). Low BMI was associated with good SRH (OR = 0.97, p < 0.049) and full AMB (OR = 0.92, p < 0.001), good grip strength with good SRH (OR = 2.7, p < 0.001) and ability to squat down with full AMB (OR = 1.7, p = 0.002). Cardiovascular diseases, arthritis and back pain were common significant negative correlates (p < 0.001) of baseline AMB and SRH out of variety of chronic diseases with significant association with either one. The significant (p < 0.05) baseline predictors in final prognostic model for good 10-year SRH included baseline AMB and SRH, QoL, age, BMI, grip strength and psychiatric diseases (C-index = 0.81) and for full 10-year AMB ability to squat, baseline AMB and SRH, QoL, BMI, hypertension and arthritis (C-index = 0.81). These risk scores had better predictive power in comparison to that of baseline SRH and AMB alone (p < 0.001 in univariate Z-score test).

Conclusions

Among elderly women AMB is strongly linked to SRH. SRH and AMB are affected mostly by musculoskeletal, cardiovascular and psychiatric diseases as well as body anthropometry, muscle strength and subjective QoL. The present study provides a novel algorithm for predicting probability of full AMB and good SRH in postmenopausal women.