Kay Jones

Severely obese people with diabetes experience impaired emotional well-being associated with socioeconomic disadvantage: Results from diabetes MILES – Australia

AIM To examine the emotional well-being of severely obese Australians with type 2 diabetes, along with markers of social and economic disadvantage, using the Diabetes MILES - Australia dataset. METHODS Diabetes MILES - Australia was a national survey of 3338 adults with diabetes that focused on psychosocial issues; 1795 had type 2 diabetes and reported BMI. We extracted data regarding depression (PHQ-9), anxiety (GAD-7), obesity- and diabetes-related comorbidities, and demographics. The severely obese group (SOG) (BMI ≥ 35; median BMI=41.6) constituted 530 (30%) of the type 2 diabetes respondents and was matched with 530 controls (CG) (BMI<35; median BMI=28.2). Within- and between-group trends were examined. RESULTS The SOG had higher depression scores (median (IQR) 6.0 (3-12)) than CG (5.0 (2-10)); p<0.001, and were more likely to report moderate-severe depressive symptoms (37% versus 27%; p<0.001). The groups did not differ on anxiety. The SOG, compared with the CG, were more likely to live alone (21% versus 17%), receive a disability pension (21% versus 15%), earn ≤

First australian Experiences With an Oral Volume Restriction Device to Change Eating Behaviors and assist With Weight Loss

40.000/year (51% versus 41%; all p<0.05), and were less likely to be employed (46% versus 53%), university or higher educated (17% versus 26%), or have health insurance (50% versus 60%; all p ≤ 0.01). Moderate-severe depression was positively associated with cumulative stressors of severe obesity, socioeconomic disadvantage, and obesity- and diabetes-related comorbidity. CONCLUSIONS Severely obese people living with type 2 diabetes have cumulative stressors related to health, disability, demographic and socioeconomic factors, and impaired emotional well-being.

Adapting lung cancer symptom investigation and referral guidelines for general practitioners in Australia: reflections on the utility of the ADAPTE framework.

Eating behaviors impact satiety and caloric intake so should be considered in any weight‐loss program. A novel custom‐made oral device has been designed to be worn in the upper palate while eating in order to slow eating‐rate and aid weight loss. The aim of this study was to assess the devices potential impact on weight‐loss and gain first impressions among overweight/obese Australians. Twenty participants (M: 6, F: 14, mean age 36 years, BMI 27–33 kg/m2) were enrolled in a 4‐month open‐label trial. Each received a device and nutritionist‐delivered diet plan. Weight, compliance, and acceptability were assessed fortnightly. Anthropometry, biochemical and clinical outcomes were measured at baseline and 16 weeks. Sixteen participants completed the study. Mean weight‐loss was 4.9 ± 0.9 kg, or 5.2 ± 0.9% initial bodyweight (P < 0.001, n = 20, intention‐to‐treat). There were no significant adverse events (AEs), but 65% of participants required device adjustment by the dentist. Compliance (defined as >5 uses/week) was achieved by 80% of participants and correlated positively with weight‐loss (R = 0.68, P = 0.001). All reported that the device was comfortable and reduced bite‐size, promoted chewing and slowed eating‐rate. Most observed either no change, or increased satiety, despite reduced meal sizes. For most, speech difficulties discouraged device use in social settings. All reported greater awareness of food choices, portion sizes and eating‐rate. Subjective control of dietary behaviors, measured by the Three Factor Eating Questionnaire (TFEQ), improved significantly. The device should be explored as an adjunct to dietary composition change in weight‐management programs, to assist patients to modify eating behaviors and achieve successful weight‐loss.

The CDM-Net Project: The Development, Implementation and Evaluation of a Broadband-Based Network for Managing Chronic Disease

RATIONALE The ADAPTE framework was established to enhance efficiency in guideline development and to facilitate adaptation of high-quality clinical practice guidelines for a local context. It offers guideline developers a systematic methodology for guideline adaptation; however, the feasibility and usability of the process has not been widely evaluated. AIM A pragmatic approach was undertaken throughout the evaluation of the ADATPE process throughout the development of a guide for general practitioners in Australia regarding the initial investigation of symptoms of lung cancer. At each step of the framework all members of the project team leading the development process reflected on the steps outlined in the ADAPTE. The reflections were collated into a lesson-learned log and analysed following completion of the project. RESULTS Several opportunities for improvement were identified to improve usability and practicability of the ADAPTE framework. These items were both specific, in response to using steps and tools, and general issues concerned with the overall ADAPTE framework. Key challenges to using ADAPTE, highlighted in this study, were the lack of clarity about efficiency of the guideline adaptation process, level of assumed knowledge and expertise, and requirement of resources. In response to these challenges, modifications to the ADAPTE have been recommended. CONCLUSION The ADAPTE framework offers an attractive alternative to de novo guideline synthesis in circumstances where high-quality, compatible guidelines already exist. Pending further evaluation, the modifications identified in this study may be applied to future versions of ADAPTE to improve usability and feasibility of the framework.

GPs, families and children's perceptions of childhood obesity

Background. In Australia most chronic disease management is funded by Medicare Australia through General Practitioner Management Plans (GPMPs) and Team Care Arrangements (TCAs). Identified barriers may be reduced effectively using a broadband-based network known as the Chronic Disease Management Service (CDMS). Aims. To measure the uptake and adherence to CDMS, test CDMS, and assess the adherence of health providers and patients to GPMPs and TCAs generated through CDMS. Methods. A single cohort before and after study. Results. GPMPs and TCAs increased. There was no change to prescribed medicines or psychological quality of life. Attendance at allied health professionals increased, but decreased at pharmacies. Overall satisfaction with CDMS was high among GPs, allied health professionals, and patients. Conclusion. This study demonstrates proof of concept, but replication or continuation of the study is desirable to enable the impact of CDMS on diabetes outcomes to be determined.

Severe obesity and diabetes self-care attitudes, behaviours and burden: implications for weight management from a matched case-controlled study. Results from Diabetes MILES--Australia

BACKGROUND Childhood obesity has a high risk of becoming a chronic disease requiring life-long weight management. Evidence based guidelines were developed and distributed to GPs throughout Australia by the NHMRC, but current application falls short. Measuring height and weight, and calculating BMI for children appears to be rare. Some general practitioners (GPs) perceive significant barriers to managing this patient cohort, and patients report not having confidence in their GPs. AIM To explore perceptions and experiences of treating childhood obesity of (i) GPs, (ii) families involved in a childhood obesity study in general practiceâ?? and (iii) families not involved in the project, but who had concerns about childhood obesity. METHODOLOGY Supported by the literature, a semi-structured schedule was developed to address the aims. Ten GPs and eight families involved, and four families previously not involved in the project participated in interviews in 2009. All family interviews were audio-taped and transcribed verbatim. Data were thematically analyzed. FINDINGS Five themes emerged: (1) raising the topic, (2) frustrations experienced by GPs and families, (3) support available for GPs to provide to families and/or anticipated by families, (4) successes from involvement in the project and (5) sustaining improvements â?? the GPsâ?? and familys perspectives. DISCUSSION AND CONCLUSION All acknowledged that childhood obesity is a sensitive issue with both GPs and parents preferring the other to raise the topic. GPs reported successes in practice and patient management such as improved patient records. For families, the GPs dedication and support were major factors sought.

Chaperones for intimate examinations in family medicine: findings from a pilot study in Melbourne, Australia:

To investigate whether diabetes self‐care attitudes, behaviours and perceived burden, particularly related to weight management, diet and physical activity, differ between adults with Type 2 diabetes who are severely obese and matched non‐severely obese control subjects.

Medical versus surgical interventions for the metabolic complications of obesity in children.

Background The use of medical chaperones during clinical examinations is important whether one practises as a specialist, nurse, medical student or generalist. Chaperone use in general practice remains largely unknown in most countries across the world and, what is known is limited to a handful of countries. Their use in Australian general practice remains unknown. Objective To explore the attitudes and practices of a cohort of general practitioners in urban Melbourne regarding the use of chaperones in their daily clinical practice. Methods Self-administered postal questionnaire to pilot group of general practitioners in urban Melbourne, Australia. Main outcome measures: Frequency of chaperone use; views on chaperone use itself; preferred choice for the role of chaperone; main reasons for using chaperones. Results The majority (95% respondents) had never or occasionally used a chaperone. The use of chaperones correlated with general practitioner gender – male general practitioners were more likely to use a chaperone. General practitioners preferred choice as chaperone was the practice nurse. There was no association found between chaperone use and the respondents’ age, practice size or the availability of a practice nurse. The most highly rated influence by general practitioners for using a chaperone was because of anticipated patient embarrassment and/or distress. Conclusion This is the first step in understanding attitudes and experiences of general practitioners in general practice in Australia. The results of a larger, national study would provide further insight into this important issue taking into account the realities of general practice in Australia and relationship between general practitioners and patients.

The Attitudes and Practices of General Practitioners about the Use of Chaperones in Melbourne, Australia

The global epidemic of obesity has not spared children. Although prevention of obesity is commendable, we cannot hide from the pressing need to identify, assess, and actively manage children seriously afflicted by obesity and its associated conditions. Sustained weight loss (or, for children, lowering of body mass index standard deviation score) delivers major health benefit, but in children has been difficult to achieve. In adults, the success of the diabetes prevention programs using practical lifestyle interventions is indisputable. Medical therapy, although currently limited in it scope, provides some promise for older children. There is now accumulating evidence, generally of poor quality that surgical interventions (laparoscopic adjustable gastric banding and Roux-en-Y gastric bypass) provide excellent sustained weight loss and improvement in comorbidity and quality of life in selected older children. Their benefits in adults are well demonstrated. Surgery comes with risk, both immediate and in the future, as does severe obesity. Carefully weighing risk and benefit is challenging for the individual and for health service providers. Careful health outcomes research with registries and well-conducted trials will provide better direction in the future. In the meantime, we should move forward ethically and cautiously in providing more intensive obesity management in children.

Infant gastro-oesophageal reflux disease (GORD): Australian GP attitudes and practices.

Introduction. To consider the use of medical chaperones during certain clinical examinations is important whether one practises as a specialist, nurse, medical student, or generalist. Chaperones have been used by doctors conducting intimate examinations for many years but their true extent remains largely unknown. Until recently, there was no national guidance in Australia. Aim. To explore the attitudes and practices of general practitioners (GP) regarding their use of chaperones in urban Melbourne, Australia. Method. Qualitative two focus groups involving seventeen GPs from two locations. Discussions were audio-taped, transcribed verbatim and analysed. Results. Common themes and subthemes emerged which were grouped into three main areas: (a) practitioner-related, (b) patient-related and (c) practice related. Discussion. This is the first study from an Australian primary care perspective to gauge the attitudes and experiences of GPs on their use of chaperones. It will provide vital information to inform the next step of extending this research to a national GP audience. From an international perspective, this study provides an excellent template for other primary care clinicians to conduct research in this important field of doctor-patient relationship.