A qualitative study exploring pregnant women's weight-related attitudes and beliefs in UK: the BLOOM study

BACKGROUND

There is little information on the individual cognitive, perceptual and psychosocial factors that influence the lifestyle behaviours of pregnant women. This study explored pregnant women's weight-related attitudes and beliefs during pregnancy.

METHODS

Nineteen pregnant women with different pre-pregnancy BMIs and in their third trimester were purposefully sampled for face-to-face interviews. Topics covered included lifestyles, sources of information, feelings about their bodies, and level of control over themselves and their bodies. Systematic thematic content analysis was used to identify recurrent themes.

RESULTS

Women perceived their bodies as fragmented into 'my pregnancy' (the bump) and 'me' (rest of my body). This fragmentation was the key driver of their weight-related attitudes and beliefs and influenced their dietary and physical activity behaviours. Consuming healthy foods was necessary for 'my pregnancy' to provide the ideal gestational environment. Simultaneously, pregnancy was perceived as a time to relax previously set rigid rules around diet and physical activity, allowing women to consume unhealthy foods and lead sedentary lifestyles. Women faced emotional conflicts between limiting weight gain for 'me', and being perceived as acting morally by gaining enough weight for 'baby'. Although 'bump' related weight gain was acceptable, weight gain in other parts of their body was viewed negatively and implied lack of self-control. Conflict was often alleviated, and weight-related behaviours validated, by seeking practical and reputable information for weight management. Women felt that their midwives provided detailed information on what they should not do during pregnancy, but were rarely given information about what they should do in relation to diet and physical activity for weight management. Consequently, women often used information from a variety of sources which they filtered using 'common sense'.

CONCLUSIONS

This study has identified that a central concept to pregnant women's diet and physical activity beliefs during pregnancy is the fragmentation of self into 'me' and 'my pregnancy'. This fragmentation influenced beliefs about diet and physical activity, and control and acceptability of gestation weight gain on different parts of the body. Future interventions and antenatal care should take this fragmentation into consideration when providing pregnant women with advice, information and support relating to their diet and physical activity behaviours.

Short-term trajectories of use of a caloric-monitoring mobile phone app among patients with type 2 diabetes mellitus in a primary care setting

BACKGROUND

Self-management plays an important role in maintaining good control of diabetes mellitus, and mobile phone interventions have been shown to improve such self-management. The Health Promotion Board of Singapore has created a caloric-monitoring mobile health app, the "interactive Diet and Activity Tracker" (iDAT).

OBJECTIVE

The objective was to identify and describe short-term (8-week) trajectories of use of the iDAT app among patients with type 2 diabetes mellitus in a primary care setting in Singapore, and identify patient characteristics associated with each trajectory.

METHODS

A total of 84 patients with type 2 diabetes mellitus from a public primary care clinic in Singapore who had not previously used the iDAT app were enrolled. The app was demonstrated and patients' weekly use of the app was monitored over 8 weeks. Weekly use was defined as any record in terms of food entry or exercise workout entry in that week. Information on demographics, diet and exercise motivation, diabetes self-efficacy (Diabetes Empowerment Scale-Short Form), and clinical variables (body mass index, blood pressure, and glycosylated hemoglobin/HbA1c) were collected at baseline. iDAT app use trajectories were delineated using latent-class growth modeling (LCGM). Association of patient characteristics with the trajectories was ascertained using logistic regression analysis.

RESULTS

Three iDAT app use trajectories were observed: Minimal Users (66 out of 84 patients, 78.6%, with either no iDAT use at all or use only in the first 2 weeks), Intermittent-Waning Users (10 out of 84 patients, 11.9%, with occasional weekly use mainly in the first 4 weeks), and Consistent Users (8 out of 84 patients, 9.5%, with weekly use throughout all or most of the 8 weeks). The adjusted odds ratio of being a Consistent User, relative to a Minimal User, was significantly higher for females (OR 19.55, 95% CI 1.78-215.42) and for those with higher exercise motivation scores at baseline (OR 4.89, 95% CI 1.80-13.28). The adjusted odds ratio of being an Intermittent-Waning User relative to a Minimal User was also significantly higher for those with higher exercise motivation scores at baseline (OR 1.82, 95% CI 1.00-3.32).

CONCLUSIONS

This study provides insight into the nature and extent of usage of a caloric-monitoring app among patients with type 2 diabetes and managed in primary care. The application of LCGM provides a useful framework for evaluating future app use in other patient populations.

Cross-validation of a non-exercise measure for cardiorespiratory fitness in Singaporean adults

INTRODUCTION

Cardiorespiratory fitness (CRF) is an independent predictor of voluminous health outcomes and can be measured using non-exercise fitness assessment (NEFA) equations. However, the accuracy of such equations in Asian populations is unknown. The objective of this study was to cross-validate the NEFA equation, developed by Jurca et al in 2005, in the adult Singaporean population.

METHODS

A total of 100 participants (57 men, 43 women; aged 18-65 years) were recruited, and their maximal oxygen consumption (VO2 max) was measured in the laboratory by indirect calorimetry. The participants also completed the NEFA questionnaire, which helps to predict VO2 max with the NEFA equation. The relationship between NEFA-predicted and laboratory-measured VO2 max values was analysed.

RESULTS

Overall, our study demonstrated a high correlation between the NEFA-predicted and laboratory-measured VO2 max values (r = 0.83). The Pearson's correlation coefficient values for the men and women in the study were 0.61 and 0.77, respectively. To improve the accuracy of the predictive equation, we transformed the original equation developed by Jurca et al into new equations that would allow estimation of VO2 max with and without resting heart rate as a variable.

CONCLUSION

The modified NEFA equations accurately estimated CRF and may be applied to the majority of adult Singaporeans. With this, health practitioners and researchers are now able to assess CRF levels at both the individual and population levels in either the primary care, fitness or research setting.

Australian Anaesthetists’ Practice of Sedation for Gastrointestinal Endoscopy in Adult Patients

A wide spectrum of practice in sedation for gastrointestinal endoscopy in adult patients is documented overseas, but a current profile of the practice of Australian anaesthetists is unavailable. We therefore surveyed 200 Fellows of the Australian and New Zealand College of Anaesthetists on the choice of drugs and monitoring, use of analgesic throat spray and prophylactic intravenous fluids and the depth of sedation for gastrointestinal endoscopy. Our response rate was 57% and endoscopy formed a significant part of most respondents’ practices. Propofol was used for almost all procedures, in combination with midazolam alone (14%), fentanyl alone (6%), midazolam and fentanyl (61%), another drug (15%) or no adjuvant(4%). The majority of patients received prophylactic intravenous fluids for endoscopic retrograde cholangio-pancreatography (83%) and colonoscopy (64%), but not for gastroscopy (20%). All patients received supplemental oxygen and monitoring with pulse oximetry. However, over 20% of patients having gastroscopy or colonoscopy did not have noninvasive blood pressure monitoring. A maximum depth of sedation during which the patient was unresponsive to painful stimulation (commensurate with general anaesthesia) was targeted by 54% of respondents. Significant variations exist in the practice of sedation and monitoring for endoscopy in adult patients by anaesthetists in Australia.

High affinity association of myo-inositol trisphosphates with phytase and its effect upon the catalytic potential of the enzyme

A neutral phytase from germinating mung bean (Vigna radiata) seeds dephosphorylates myo-inositol hexakisphosphate sequentially to myo-inositol. The enzyme also binds with higher affinity to myo-inositol trisphosphates (1,4,5), (2,4,5), and (1,3,4) isomers without catalysis. The high affinity complex elicits Ca(2+) mobilization in vitro from microsomes/vacuoles via the formation of a ternary complex with the receptor for Ins(1,4,5)P(3). As a sequel to our previous report, we have carried out a detailed characterization of the two sites and examined the mutual interactions between them. Presaturation of the high affinity site leads to an increase in the affinity of the enzyme for phytic acid and its rate of dephosphorylation as well. From the products of limited tryptic cleavage of phytase, two peptides, each with one activity, have been isolated. The larger peptide ( approximately 66 kDa) contains the catalytic site, and the smaller peptide ( approximately 5 kDa) has the high affinity myo-inositol trisphosphate-binding site. The interaction between the dual activities of phytase has been observed also at the level of the two peptides. A sequence homology search using N-terminal 12 amino acid residues of the 5-kDa fragment has revealed significant homology with the Homer class of proteins implicated in signaling pathways involving metabotropic glutamate receptor and myo-inositol 1,4,5-trisphosphate receptor. These results indicate a second role of phytase in Ca(2+) mobilization during germination of mung been seed via a salvage pathway that involves allosteric activation by myo-inositol trisphosphate.

Effect of myo-inositol(1,4,5)trisphosphate on the hydrolysis of phytic acid by phytase

Phytase is a monomeric enzyme of molecular mass 160 kDa which catalyzes the hydrolysis of phytic acid (D-myo inositol hexakisphosphate, InsP6) in a stepwise manner to myo-inositol. The enzyme-InsPn (n = 1-6) interaction at the catalytic site has a dissociation constant in the micro molar range. There also exists in the enzyme, a non-catalytic site specific for InsP3 with dissociation constant in the nano molar range. We have probed the effect of the high affinity InsP3 binding on the dissociation constant (Kd) of the phytase-InsP6 interaction and the kinetics of hydrolysis. These studies demonstrate the effect exerted by the high affinity InsP3 binding on the catalytic site of the enzyme.

Complete nucleotide sequence of clover yellow mosaic virus RNA

The entire genomic RNA of clover yellow mosaic virus was sequenced from cDNA clones and run-off cDNA transcripts. The genomic RNA is 7015 nucleotides in length [excluding a 3' poly(A) tail], with six open reading frames (ORFs) greater than 150 nucleotides in length. The first five ORFs encode proteins of Mr 191K, 26K, 12K, 6.5K and 28K, respectively. The sixth ORF lies completely within ORF1 and codes for a protein of Mr 14K. The capsid protein coding region (Mr 23K) is found within ORF5 which encodes the Mr 28K protein. Proteins encoded by ORFs 1 to 3 and ORF5 show strong homology with proteins of other potexviruses, especially papaya mosaic virus.

The kinetic complexity of Acetabularia chloroplast DNA

The kinetic complexity of Acetabularia cliftonii chloroplast DNA is 1.52 +/- 0.26 . 10(9) daltons, compared to 0.2 .10(9) daltons for Chlamydomonas chloroplast DNA. There is an average of three genomes per chloroplast. The unusually large size of the Acetabularia genome may reflect the ancient evolutionary history of this organism.

Metabolism and distribution of cyclohexanecarboxylic Acid, a plant growth stimulant, in bush bean

A foliar spray of 10 mm cyclohexanecarboxylic acid (CHC), a component of the growth stimulant naphthenic acid, to primary leaves of 14-day-old plants of bush bean, Phaseolus vulgaris L., cv Top Crop, resulted in increased vegetative growth and pod production. One minute after the application of 0.5 mm CHC-7-(14)C (CHC(*)) to a primary leaf, CHC(*) was present within it. The chief conversion of the CHC(*) in the leaf during the interval 15 minutes to 4 hours after the acid had been applied appeared to be CHC(*) to its glucose conjugate (CHC(*)-G), and during 4 to 48 hours, CHC(*)-G to CHC(*)-aspartate and an unknown metabolite. Radioactivity was confined to the leaf for at least 1 hour, but by the 12th hour was detected throughout the plant. In the interval 1 to 4 weeks after CHC(*) application, the mean percentage distribution of radioactivity was: treated leaf, 65.3; roots, 18.8; stem, 7.7; trifoliate leaves, 5.9; flower buds-flowers-pods, 2.3. During this period CHC(*)-G was the most prominent metabolite in all organs; no free CHC(*) was detected. Light favored the movement of CHC(*) conjugates out of the leaf; glucose fed to dark-grown plants substituted for light to some extent but aspartate was relatively ineffective, suggesting the dependence of outward movement on ATP. The presence of the glucose and aspartate conjugates of the acid in all organs of CHC-treated plants and the absence of free CHC from them suggest that one or both conjugates, rather than the acid itself, are involved in growth stimulation.