A school-based obesity control programme: Project Energize. Two-year outcomes

Chokeberries are a rich source of anthocyanins, which may contribute to the prevention of obesity and the metabolic syndrome. The aim of the present study was to determine if an extract from chokeberries would reduce weight gain in rats fed a fructose-rich diet (FRD) and to explore the potential mechanisms related to insulin signalling, adipogenesis and inflammatory-related pathways. Wistar rats were fed a FRD for 6 weeks to induce insulin resistance, with or without chokeberry extract (CBE) added to the drinking-water (100 and 200 mg/kg body weight, daily: CBE100 and CBE200). Both doses of CBE consumption lowered epididymal fat, blood glucose, TAG, cholesterol and LDL-cholesterol. CBE consumption also elevated plasma adiponectin levels and inhibited plasma TNF-α and IL6, compared with the control group. There were increases in the mRNA expression for Irs1, Irs2, Pi3k, Glut1, Glut4 and Gys1, and decreases in mRNA levels of Gsk3β. The protein and gene expression of adiponectin and Pparγ mRNA levels were up-regulated and Fabp4, Fas and Lpl mRNA levels were inhibited. The levels of gene expression of inflammatory cytokines, such as Il1β, Il6 and Tnfα were lowered, and protein and gene expression of ZFP36 (zinc finger protein) were enhanced in the epididymal adipose tissue of the rats that consumed the CBE200 extract. In summary, these results suggest that the CBE decreased risk factors related to insulin resistance by modulating multiple pathways associated with insulin signalling, adipogenesis and inflammation.     

The complexity of obesity and life after bariatric surgery: a public health issue

The high incidence of obese people submitted to bariatric surgery as treatment for obesity has prompted the need to carry out a survey to ascertain the repercussions of this treatment on the health of a group of individuals subjected to such surgery. Data were collected via in-depth interviews, focusing on identification of the background to the situation that led to the decision to submit to obesity surgery and the quality of daily life after treatment. The analysis showed that the constant difficulties and frustrations in combating obesity and the expectation of the definitive cure led to the decision to submit to surgery in that group. However, life after surgery was characterized as a continuous process of challenges with further hurdles in order to learn how to live again on a day-to-day basis and return to full health. This also presents challenges for the health team as it involves greater investment in public health, improvement strategies for prevention and control of obesity of the population and comprehensive care actions for those individuals. Such complexity requires interdisciplinary expertise with an approach in line with the emotional and socio-cultural issues of this population group.     

Screening for breast cancer: candidacy and compliance

This paper is concerned with understanding why some women accept their invitation for free screening mammography and others do not. Free screening mammography is offered to women aged 50-64 in Britain. Uptake of invitations is about twice as high in leafy suburbs than in inner-city areas. Low uptake in inner-city areas has been attributed to "problems" of black and minority ethnic women. The research reported here was carried out in Hackney, an inner city London borough with an ethnically diverse and socially deprived population. Hackney also has the lowest uptake of screening mammography in the country. Twenty focus groups were held. Participants included white, black and minority ethnic women. Eight focus groups were conducted in English; 12 in other languages. Some methodological issues raised by undertaking qualitative research in several languages are considered. The research demonstrates how the inclusion of white women in research which operationalises ethnicity minimizes the risk of developing an analysis focusing on "problems" of black and minority ethnic women and encourages the development of general themes which may apply to all women. The analysis focuses on candidacy, that is, women's assessment of risk of their disease, and compliance, that is, the explanations respondents volunteered for accepting or refusing an invitation to attend for mammography. Candidacy and ethnicity emerge as similar constructs, manipulated by women to make claims about their risk of breast cancer. Other, non-medical reasons were given for compliance which serve as a warning about assuming that, when women accept their invitation, they do so for same the reasons the architects of the National Health Service Breast Screening Programme had in mind.     

Living The Discipline on a stem cell transplant unit: spiritual care outcomes among bone marrow transplant survivors

An oncology chaplain details, using The Discipline for Pastoral Care Giving, common themes in the spiritual journeys of stem cell/bone marrow transplantation survivors, and helpful chaplain interventions.     

Retention: An unresolved workforce issue affecting rural occupational therapy services

Failure to retain health professionals in rural areas contributes to the poor health status of these communities through an inability to deliver reliable and consistent services. Considerable attention has been focused on factors affecting recruitment of health professionals. Far less is known about factors affecting the retention of occupational therapists. This was the focus of this study. Ethnographic interviews were used to explore the experiences of 10 occupational therapists who had left rural practice. Six themes emerged from the participants' experiences, from when they first considered rural practice to reflections following their departure from it. These themes were initial appeal, facing the challenge, rural practice issues, the social sphere, reasons for leaving and the value of rural experience. These factors gave rise to a proposed Model of Retention Equilibrium, which suggests that retention can be improved by addressing the imbalance between incentives to leave and incentives to stay. The model provides a useful framework for occupational therapists contemplating rural practice, as well as for health services managers responsible for service delivery in rural areas.     

Combating childhood obesity: a survey of laws affecting the built environments of low-income and minority children

Childhood overweight and obesity have reached epidemic proportions, with nearly one of every three children in the USA being affected. That factors in the built environment are closely correlated to childhood obesity has become increasingly evident. Negative built environment factors disproportionately affect poor and minority children. This paper examines the current research on the state of childhood overweight and obesity and surveys the built environment factors that have been linked to the problem. Analyzing the built environment from a legal perspective, this paper identifies how zoning, legislation, public/private partnerships, and contracts are being used at the local, state, and federal levels to combat the epidemic of childhood obesity. Using these tools, local, state, and federal government agencies are increasing access to healthy food, decreasing the density of unhealthy food sources, and increasing physical activity resources for children. Whereas some of the programs are geared toward minority and low-income children, many apply to children across the socioeconomic and demographic spectrum.     

Treating obesity in children and adolescents: a review.

Researchers and health practitioners are becoming increasingly concerned with the problems associated with obesity among children and adolescents. Obesity tends to persist into adulthood and to be associated with a variety of physical and psychological problems. Treatment approaches used to date are generally impotent, but some promising short-term results have been achieved with some forms of dietary counseling, exercise programs, total environmental management, and behavior therapy. But even with these strategies, clinically significant weight loss is rare and advances during treatment are rarely maintained. Radical departures from current treatment strategies are needed in the form of more structured and intensive treatments, family involvement, and training in problem solving. Closer adherence to sound scientific methodology might at least provide a foundation from which more effective treatments might be developed.