Delivery of healthcare provider’s lifestyle advice and lifestyle behavioural change in adults who were overweight or obese in pre-diabetes management in the USA: NHANES (2013–2018)

ObjectiveThe purpose of this study is to examine the association between delivery of healthcare provider’s advice about lifestyle management and lifestyle behavioural change in pre-diabetes management in adults who were overweight or obese.DesignThis cross-sectional study included adults with body mass index (BMI) ≥25 kg/m2 and reporting pre-diabetes in USA. Outcomes included the prevalence of receiving provider’s advice on lifestyle management and patterns of practicing lifestyle change. The association between delivery of provider’s advice and lifestyle-related behavioural change in pre-diabetes management was examined.SettingUS Continuous National Health and Nutrition Examination Survey (2013–2018).ParticipantsA total of 1039 adults with BMI ≥25 kg/m2 reported pre-diabetes.ResultsOf eligible adults with pre-diabetes, 76.8% received provider’s advice about lifestyle change. The advice group showed higher proportions of ongoing lifestyle change than no advice group, including weight reduction/control (80.1% vs 70.9%, p=0.018), exercise (70.9% vs 60.9%, p=0.013) and diet modifications (83.8% vs 61.8%, p<0.001). After adjustment, those receiving provider’s advice were more likely to increase exercise (OR 1.63, 95% CI 1.12 to 2.38) and modify diet (OR 3.0, 95% CI 1.82 to 4.96).ConclusionOver 75% of US adults who were overweight or obese and reported pre-diabetes received healthcare provider’s advice about reducing the risk of diabetes through lifestyle change. Provider’s advice increased the likelihood of lifestyle-related behavioural change to exercise and diet.

Improving clinical paediatric research and learning from COVID-19: recommendations by the Conect4Children expert advice group

Background The COVID-19 pandemic has had a devastating impact on multiple aspects of healthcare, but has also triggered new ways of working, stimulated novel approaches in clinical research and reinforced the value of previous innovations. Conect4children (c4c, www.conect4children.org) is a large collaborative European network to facilitate the development of new medicines for paediatric populations, and is made up of 35 academic and 10 industry partners from 20 European countries, more than 50 third parties, and around 500 affiliated partners. Methods We summarise aspects of clinical research in paediatrics stimulated and reinforced by COVID-19 that the Conect4children group recommends regulators, sponsors, and investigators retain for the future, to enhance the efficiency, reduce the cost and burden of medicines and non-interventional studies, and deliver research-equity. Findings We summarise aspects of clinical research in paediatrics stimulated and reinforced by COVID-19 that the Conect4children group recommends regulators, sponsors, and investigators retain for the future, to enhance the efficiency, reduce the cost and burden of medicines and non-interventional studies, and deliver research-equityWe provide examples of research innovation, and follow this with recommendations to improve the efficiency of future trials, drawing on industry perspectives, regulatory considerations, infrastructure requirements and parent–patient–public involvement. We end with a comment on progress made towards greater international harmonisation of paediatric research and how lessons learned from COVID-19 studies might assist in further improvements in this important area.

Physical activity on prescription in patients with hip or knee osteoarthritis: A randomized controlled trial

Objective: To evaluate whether physical activity on prescription, comprising five sessions, was more effective in increasing physical activity than a one-hour advice session after six months. Design: Randomized, assessor-blinded, controlled trial. Setting: Primary care. Subjects: Patients with clinically verified osteoarthritis of the hip or knee who undertook less than 150 minute/week of moderate physical activity, and were aged 40–74 years. Interventions: The advice group ( n = 69) received a one-hour session with individually tailored advice about physical activity. The physical activity on prescription group ( n = 72) received individually tailored physical activity recommendations with written prescription, and four follow-ups during six months. Main measures: Patients were assessed at baseline and six months: physical activity (accelerometer, questionnaires); fitness (six-minute walk test, 30-second chair-stand test, maximal step-up test, one-leg rise test); pain after walking (VAS); symptoms (HOOS/KOOS); and health-related quality of life (EQ-5D). Results: One hundred four patients had knee osteoarthritis, 102 were women, and mean age was 60.3 ± 8.3 years. Pain after walking decreased significantly more in the prescription group, from VAS 31 ± 22 to 18 ± 23. There was no other between groups difference. Both groups increased self-reported activity minutes significantly, from 105 (95% CI 75–120) to 165 (95% CI 135–218) minute/week in the prescription group versus 75 (95% CI 75–105) to 150 (95% CI 120–225) in the advice group. Also symptoms and quality of life improved significantly in both groups. Conclusion: Individually tailored physical activity with written prescription and four follow-ups does not materially improve physical activity level more than advice about osteoarthritis and physical activity. Trial registration: ClinicalTrials.gov (NCT02387034).

Influence of Dietary Advice Including Green Vegetables, Beef, and Whole Dairy Products on Recurrent Upper Respiratory Tract Infections in Children: A Randomized Controlled Trial

Background: Since no treatment exists for children suffering from upper respiratory tract infections (URTIs) without immunological disorders, we searched for a possible tool to improve the health of these children. Aim: We evaluated whether dietary advice (based on food matrix and food synergy), including standard supportive care, can decrease the number and duration of URTIs in children with recurrent URTIs. Design and Setting: This study was a multicenter randomized controlled trial in two pediatric outpatient clinics in the Netherlands, with 118 children aged one to four years with recurrent URTIs. The dietary advice group received dietary advice plus standard supportive care, while the control group received standard supportive care alone for six months. The dietary advice consisted of green vegetables five times per week, beef three times per week, 300 mL whole milk per day, and whole dairy butter on bread every day. Portion sizes were age-appropriate. Results and Conclusion: Children in the dietary advice group had 4.8 (1.6–9.5) days per month with symptoms of an URTI in the last three months of the study, compared to 7.7 (4.0–12.3) in the control group (p = 0.028). The total number of URTIs during the six-month study period was 5.7 (±0.55) versus 6.8 (±0.49), respectively (p = 0.068). The use of antibiotics was significantly reduced in the dietary advice group, as well as visits to a general practitioner, thereby possibly reducing healthcare costs. The results show a reduced number of days with symptoms of a URTI following dietary advice. The number of infections was not significantly reduced.

Assessment of Construct Validity of a Tool to Measure the Quality of Brief Advice for Dietary Sodium Reduction by Health Care Providers (P16-056-19)

Objectives To test the construct validity of the Sodium Advice Score (SAS). The SAS is a tool developed to measure the quality of brief advice provided by health care providers (HCP) about dietary sodium reduction. The validation of this tool will support its implementation in a behavioural intervention trial. Methods Thirty English speaking patients with a diagnosis of hypertension and no memory impairments were recruited from a primary care clinic in Ontario, Canada. Patients were randomized to a high quality dietary sodium advice group or to a low quality dietary sodium advice group. Each intervention was delivered by a registered dietitian and took no longer than 5–7 minutes for high quality advice and 1–2 minutes for low quality advice. After the dietary sodium advice was provided the patient completed the SAS tool (< 5 minutes). Frequency, type and duration of advice was assessed by the SAS tool, which had a maximum score of 16. Therefore, the high quality advice had an expected SAS score of 16. The low quality advice had an expected SAS score of 5. Results Patients included were 71.3 ± 7.9 years old and 53% were male. Overall, 43% and 47% of patients had received previous counseling from a dietitian and family doctor, respectively. Mean daily sodium intakes of 2593 ± 1403 mg/day and 3040 ± 2283 mg/day were similar between high and low quality advice groups. The mean SAS score was 6.9 ± 3.6 (range: 2 to 14) in the low quality advice group and 14.5 ± 1.5 (range: 10 to 16) in the high quality advice group. The high quality advice scores observed were statistically similar to the expected scores (P = 0.001), however the low advice scores were not. Overall, the low quality advice score was significantly lower than the high quality advice score (P < 0.000). Conclusions The SAS tool showed evidence of construct validity as it can differentiate between high and low quality sodium reduction advice provided by HCPs. It can be used as a valid tool for measuring quality of brief sodium reduction advice by HCPs in future research. Funding Sources Heart and Stroke Foundation of Canada.

Gender Issues in Intergroup Communication

Gender is conceptualized as a social construct rather than biologically determined. Gender shapes communication in intergroup contexts. Gender influences communication in assorted domains, such as nonverbal behavior and emotion, language, friendship, self-disclosure, social support and advice, group decision making, leadership emergence, gaming, and aggression. Considering gender-based communication in each of these domains provides insight into the manner in which gender-based communication is conceptualized and understood. Gender is a meaningful factor, but not the sole determinant, of communication because other factors can moderate gender’s influence.

The effects of dietary advice and vouchers on the intake of fruit and fruit juice by pregnant women in a deprived area: a controlled trial

ObjectiveTo examine the effectiveness of two methods of increasing fruit and fruit juice intake in pregnancy: midwives' advice and vouchers exchangeable for juice.DesignPregnant women were randomly allocated to three groups: a control group, who received usual care; an advice group, given advice and leaflets promoting fruit and fruit juice consumption; and a voucher group, given vouchers exchangeable for fruit juice from a milk delivery firm. Dietary questionnaires were administered at ~16, 20 and 32 weeks of pregnancy. Serum β-carotene was measured at 16 and 32 weeks.SettingAn antenatal clinic in a deprived area.SubjectsPregnant women aged 17 years and over.ResultsThe study comprised 190 women. Frequency of fruit consumption declined during pregnancy in all groups, but that of fruit juice increased substantially in the voucher group. Serum β-carotene concentration increased in the voucher group, from 106.2 to 141.8 μmol l− 1in women with measurements on both occasions (P = 0.003), decreased from 120.0 to 99.8 μmol l− 1in the control group (P = 0.005), and was unchanged in the advice group.ConclusionsPregnant women drink more fruit juice if they receive vouchers exchangeable for juice supplied by the milk delivery service. Midwives' advice to eat more fruit has no great effect. Providing vouchers for fruit juice is a simple method of increasing its intake in a deprived population and may be useful for other sections of the community.

Brief Psychotherapy in the Treatment of Anorexia Nervosa

Thirty out-patients with severe anorexia nervosa were randomly allocated to either 12 sessions of dietary advice or 12 sessions of combined individual and family psychotherapy. At one-year follow-up both groups showed significant overall improvement, and the dietary advice group showed significant weight gain. A similar mean weight gain for the psychotherapy patients did not reach statistical significance, but this group made significant improvements in sexual and social adjustment.