Sarah Hillier

Case reports of adverse effects of herbal medicinal products (HMPs): a quality assessment.

BACKGROUND Case reports provide essential information on adverse effects. Yet there is little consistency in the quality and format of reporting them. AIM In this study, we aimed to assess the quality of case reports of adverse effect of herbal medicinal products (HMPs) published during three time periods, 1986-1988, 1996-1998, and 2006-2008. METHODS We conducted literature searches in four major databases: Medline, EMBASE, AMED, and CINALH. Each case report was subject to specific inclusion criteria related to the intervention (i.e. herbal medicine) and outcome measurement (i.e. adverse effect). A 21-item scale was used to assess the quality of all included reports. Each report was categorised into low quality (score between 0 and 14), lower medium quality (score between 15 and 21), upper medium quality (score between 22 and 28), and high quality (score between 29 and 42). RESULTS In total, 137 case reports were included. The percentage of high quality case reports rose from 0% in 1986-1988 to 27.9% in 1996-1998 and 34.2% in 2006-2008; conversely, the percentages of low quality case reports dropped from 13.3% in 1986-1988 to 0% in 1996-1998 and 2.5% in 2006-2008. CONCLUSION These findings are consistent with the notion that the quality of case reports is improving. However, due to several caveats, our data should be interpreted with caution.

Women's dietary changes before and during pregnancy: A systematic review

BACKGROUND dietary intake before and during pregnancy has significant health outcomes for both mother and child, including a healthy gestational weight gain. To ensure effective interventions are successfully developed to improve dietary intake during pregnancy, it is important to understand what dietary changes pregnant women make without intervention. AIMS to systematically identify and review studies examining womens dietary changes before and during pregnancy and to identify characteristics of the women making these changes. METHODS a systematic search strategy was employed using three databases (Web of Science, CINAHL and PubMed) in May 2016. Search terms included those relating to preconception, pregnancy and diet. All papers were quality assessed using the Scottish Intercollegiate Guidelines Network methodology checklist for cohort studies.The search revealed 898 articles narrowed to full-text review of 23 studies. In total, 11 research articles were included in the review, describing nine different studies. The findings were narratively summarised in line with the aims of the review. FINDINGS the included studies showed marked heterogeneity, which impacts on the findings. However, the majority report an increase in energy intake (kcal or kJ) during pregnancy. Of the studies that reported changes through food group comparisons, a majority reported a significant increase in fruit and vegetable consumption, a decrease in egg consumption, a decrease in fried and fast food consumption and a decrease in coffee and tea consumption from before to during pregnancy. The characteristics of the women participating in these studies, suggest that age, education and pregnancy intention are associated with healthier dietary changes; however these factors were only assessed in a small number of studies. KEY CONCLUSIONS the 11 included articles show varied results in dietary intake during pregnancy as compared to before. More research is needed regarding who makes these healthy changes, this includes consistency regarding measurement tools, outcomes and time points. IMPLICATIONS FOR PRACTICE Midwives as well as intervention developers need to be aware of the dietary changes women may spontaneously engage in when becoming pregnant, so that care and interventions can build on these.

Changes in Self-esteem in Participants Associated with Weightloss and Maintenance of Commercial Weight Management Programme

Introduction and methods: This study examined associations between weight loss, its maintenance and self-esteem in 292 members of a commercial weight management organisation, Slimming World. Self-esteem was measured with the Rosenberg self-esteem questionnaire adapted to 5-point Likert scales. Associations between dimensions of self-esteem and weight change were examined by correlation and regression using the GENSTAT 5 statistical program. Results: Mean (SD) weight on joining the CWMO was 89.0 (20.0) kg; time taken to reach current weight was 16.3 (13.5) months. Mean (SD) weight change was -15.6 (11.4) kg and BMI change was -5.7 (4.0) (both p < 0.001), maintained for 11.7 (12.8) months. Percent variance in weight change associated with each component of self-esteem is given in parentheses. All weight changes were negative. Participants reported a decrease in sense of failure (3.9%) and an increase in self-respect (3.0%) and self-pride (2.4%). Self-satisfaction (12.8%), feelings of self-achievement (10.6%), positive attitudes towards themselves (9.9%), sense of self-worth (10.6%) and self-efficacy (7.3%) all significantly increased in association with reaching and maintaining their current weight (all p < 0.001). Multiple regression analysis showed that age, gender, height and start weight accounted for 35.4% of the variance in weight change. Self-esteem components of the model accounted for 50.4% of the variance in weight change. Conclusion: Successful weight loss and maintenance was associated with significant reported improvements in self-esteem in members of a Commercial Weight Management Organisation.

Providing weight management via the workplace

Purpose – The purpose of this paper is to assess the feasibility and benefits of providing weight management support via the workplace. Design/methodology/approach – Quasi-experimental design using non-random assignment to a 12-week Slimming World (SW) weight management programme, either within the workplace or at a regular community group. Weight was recorded weekly and a 39-item questionnaire focused on mental and emotional health, self-esteem, dietary habits and physical activity habits administered at baseline, 12 weeks, six and 12 months. Findings – In total, 243 participants enroled (workplace n=129, community n=114) with 138 completers (defined as those weighing-in at baseline and attending at least once within the last four weeks; workplace n=76, community n=62). Completers reported a mean weight change of −4.9 kg±3.4 or −5.7 per cent±3.8. Mental and emotional health scores increased (p < 0.05) from baseline to 12 weeks. Self-worth scores increased (p < 0.05) from baseline to 12 weeks, six and 12 ...

The effects of changes in estradiol and progesterone concentrations during the menstrual cycle on resting metabolic rate

There is some debate as to whether resting metabolic rate (RMR) fluctuates during different phases of the menstrual cycle as a result of changes in estradiol and progesterone concentrations. One reason for this could be the failure to establish accurate menstrual phase definition through biochemical analysis of hormone concentrations. The aim of this study was to investigate RMR at three set time points during the menstrual cycle. Venous blood samples for baseline measurements of estradiol and progesterone were collected every other week day from eight naturally cycling women for one complete menstrual cycle; age 28 (SD 3) years, weight 62.04 (SD 9.75) kg and height 1.69 (SD 0.09) m. Indirect calorimetry using a ventilated hood system (Deltatrac, Datex Instrumentarium Corp., Helsinki, Finland) to calculate RMR was performed on three test sessions during one complete menstrual cycle. In the 24 h period prior to each RMR measurement participants replicated their diet and avoided exercise, caffeine and alcohol. Venous blood samples were taken before each test session to confirm estradiol and progesterone levels. Participants were supine for 30 min to allow initial stabilisation and acclimatisation to the canopy and instrument noise. Respiratory gas exchange data were then collected for a further 30 min and an average RMR was calculated. Data are presented as means (SD). Variables were analysed using oneway repeated measures ANOVA. Significance was accepted at the P<0.05 level.