• Factors influencing the prescribing behaviour of independent prescriber optometrists: a qualitative study using the Theoretical Domains Framework

      Spillane, Daniel; Courtenay, Molly; Chater, Angel M.; Family, Hannah; Whitaker, Angela; Acton, Jennifer H. (Wiley, 2021-02-20)
      Purpose: Whilst the number of independent prescriber optometrists in the United Kingdom is increasing, there is limited evidence describing the experiences of these individuals. The Theoretical Domains Framework (TDF) provides an evidence-based approach to understand determinants of behaviour. This conceptual framework can enable mapping to the COM-B behaviour change model and the wider Behaviour Change Wheel to develop interventions to optimise behaviourchange and healthcare processes more systematically. The study aimed to use the TDF to identify the factors that influence independent prescribing behaviour, and to map these findings to the COM-B system to elucidate the relevant intervention functions, in order to identify the support required by optometrist prescribers. Methods: Using a qualitative design, semi-structured interviews based on the TDF were undertaken with independent prescriber optometrists. Thematic analysis was used to identify themes inductively, which were then deductively mapped to the TDF and then linked to the COM-B. Results: Sixteen participants (9 male; median age 45 years, range 28–65 years), based in community (n = 10) and hospital (n = 6) settings, were interviewed. Eleven of the TDF domains were found to influence prescribing behaviour. Findings highlighted the need for good communication with patients (TDF domain: Skills, COM-B: Capability); confidence (TDF domain: Beliefs about capabilities, COM-B: Motivation); good networks and relationships with other healthcare professionals, e.g., general practitioners (TDF domain: Social influences, COM-B: Opportunity; TDF domain: Social/professional role and identity, COM-B: Motivation); the need for appropriate structure for remuneration (TDF domain: Reinforcement, COM-B: Motivation; TDF domain: Social/professional role and identity, COM-B: Motivation); and the provision of professional guidelines (TDF domain: Knowledge, COM-B: Capability; TDF domain: Environmental context and resources, COM-B Opportunity). Conclusions: Having identified theory-derived influencers on prescribing decisions by optometrists, the findings can be used to develop a structured intervention, such as a support package to help optimise prescribing by optometrists, with the ultimate goal of eye care quality improvement.
    • Antimicrobial stewardship: a competency framework to support the role of nurses

      Courtenay, Molly; Chater, Angel M.; Cardiff University; University of Bedfordshire (RCN Publishing, 2021-02-14)
      Antimicrobial resistance is a global threat that has prompted a global response. One strategy used to tackle antimicrobial resistance is known as antimicrobial stewardship, its main goal being to optimise antibiotic use and avoid unnecessary antibiotic prescribing. There is an increase in the number of nurse prescribers as well as in the percentage of antibiotics dispensed in primary care precribed by non-medical prescribers such as nurses. Nurses, both prescribers and non-prescribers, play an important role in antimicrobial stewardship, including during the COVID-19 pandemic. To be able to fulfil that role, nurses need the right knowledge, skills, resources and behaviours. This article explores the role of nurses in antimicrobial stewardship and describes a competency framework designed to underpin it.
    • Replacing sugary snacks with fruit, nuts and seeds at nurses’ stations within a UK oncology unit: a pilot intervention study

      Thomas, Robert; Williams, Madeleine; Smit, Graham; Chater, Angel M.; Bedford Hospital NHS Trust; University of Bedfordshire (2021-02-02)
      Aim - This real-world service intervention study evaluated NHS staff weight and subjective happiness over a three-month period, by replacing processed, sugary foodstuffs with fruit, nuts and seeds. Method - Forty four staff at the Primrose Oncology Unit, Bedford Hospital, volunteered to abstain from cakes, biscuits, sweets, sugary drinks and chocolates whilst at work between June 2019 and September 2019. Participants’ weight and subjective happiness scores were recorded at baseline, three months (completion) and five months (post-completion). Fresh and dried fruit, and bags of raw nuts and seeds were made available to all staff (including those not participating). Participants resumed their usual diet outside of working hours. One hundred consecutive patients attending the department during the intervention were asked whether removing sugary food from public view was a positive move and whether it would have a likely influence on their future eating habits. Results - At five months, twenty (46%) participants lost weight >1kg (average 3.01 kg), seven participants gained >1kg (average 2.23 kg), and 17 remained the same weight (T-test p< 0.03). Average happiness score increased from 21.65 to 23.44 (+6.6%), T-test p< 0.04). Amongst those who lost >1kg weight, average happiness score increased from 21.54 to 23.75 (+9.3%), p<0.03. In those who gained >1 kg weight, average happiness score decreased from 22.28 to 21.43 (-3.8%), p< 0.08. There was a 13.1% difference in the happiness score in those loosing >1kg compared to those gaining >1kg in weight p< 0.001). 94 (94%) patients indicated that this initiative gave a good impression and ninety seven (97%) indicated that the initiative would encourage them to reduce sugar in their own diet. Conclusion - The results demonstrated a statistically significant reduction in weight loss and increase in mood in just under half of the participants. Whilst this level of weight loss was similar to the best designed weight loss programmes, a larger study is required to validate these results.
    • Reflecting on the Stage 2 Health Psychology independent training route: a survey of trainee and graduate experiences of employability

      Bull, Eleanor; Newman, Kristina; Cassidy, Tony; Anderson, Niall; Chater, Angel M. (British Psychological Society, 2021-02-02)
      ‘This is a pre-publication version of the following article: [Bull E, Newman K, Cassidy T, Anderson N, Chater A (2020) 'Reflecting on the Stage 2 Health Psychology independent training route: a survey of trainee and graduate experiences of employability', Health Psychology Update, (in press).]’ A couple of the most common questions we may encounter from psychology students thinking about their career choices are: “What roles are there in health psychology?” and “How do I become a health psychologist?” Our discipline has made many advances into diverse spheres of employment, which then often leads to a response: “How long have you got?!” Health psychologists offer their knowledge and skills in psychological intervention, research, training and consultancy to improve health and wellbeing in a wealth of different settings, working at all levels from one-to-one with patients/clients/healthcare professionals, to groups, whole communities and populations. An increasingly wide range of stakeholders are recognising that they may benefit from collaborating with and employing a Health Psychologist, with Health Psychologists working in health and social care, education, culture, justice, and military, as well as working within global health partnerships through volunteering collaboratives (e.g. Byrne-Davis et al. 2017). The development of the Health Psychology and Public Health Network (HPPHN: Chater, 2014; McManus, 2014; Chater & McManus, 2016; renamed the Behavioural Science and Public Health Network, BSPHN in 2018) is also importantly strengthening our links with public health colleagues and creating new opportunities. Recent initiatives have also had success in raising the profile of Health Psychologists working in diverse areas, nationally and internationally. Some of these include Health Psychology Update’s new ‘Teaching, training and consultancy’ section (Cross, 2020), accounts of trainees’ experiences (e.g. Smith, 2018), the British Psychological Society (BPS) Division of Health Psychology’s (DHP) social media hashtag #DayInLifeOfHealthPsychology, the Oral History of UK Health Psychology project (Quinn, Morrison & Chater, 2020) and the BPS DHP Scotland’s case studies of Health Psychologists. Reflecting this diversity, in the UK there are currently several different options for training in health psychology.
    • Health psychology, behavioural science, and Covid-19 disease prevention

      Chater, Angel M.; Whittaker, Ellie; Lewis, Lesley; Arden, Madelynne A.; Byrne-Davis, Lucie; Chadwick, Paul; Drury, John; Epton, Tracy; Hart, Jo; Kamal, Atiya; et al. (British Psychological Society, 2021-02-02)
      ‘This is a pre-publication version of the following article: [Chater A, Whittaker E, Lewis L, Arden MA, Byrne-Davis L, Chadwick P, Drury J, Epton T, Hart J, Kamal A, McBride E, O'Connor D, Shorter G, Swanson V, Armitage C (2021) 'Health psychology, behavioural science, and Covid-19 disease prevention', Health Psychology Update, (in press).]’ In March 2020 the president of the British Psychological Society (BPS) reached out to member networks to join forces on a BPS COVID-19 co-ordinating group. Members of this group were tasked to lead different work-streams highlighting psychology’s role during the pandemic. One work-stream focused on ‘Behavioural Science and Disease Prevention’. It was clear that understanding behaviour and anticipating public responses to changes in policies, public messaging and guidelines would be key to improving health outcomes. This work-stream focused on developing clear guidance to prevent the spread of COVID-19 and identifying psychological evidence to promote best practice in the design of sustainable behavioural interventions. This includes both immediate infection control behaviours aimed at reducing virus transmission, such as hand washing, physical-distancing and self-isolation, and behaviours that may have been influenced during the pandemic, such as physical activity, eating behaviour, substance use and healthcare use, which will have far reaching impacts on future health. This article provides an overview of the core guidance and practical examples of its application in a public health setting.
    • A rapid systematic review of public responses to health messages encouraging vaccination against infectious diseases in a pandemic or epidemic

      Lawes-Wickwar, Sadie; Ghio, Daniela; Tang, Mei Yee; Keyworth, Chris; Stanescu, Sabina; Westbrook, Juliette; Jenkinson, Elizabeth; Kassianos, Angelos P.; Scanlan, Daniel; Garnett, Natalie; et al. (MDPI, 2021-01-20)
      Public health teams need to understand how the public responds to vaccination messages in a pandemic or epidemic to inform successful campaigns encouraging the uptake of new vaccines as they become available. A rapid systematic review was performed by searching PsycINFO, MEDLINE, healthevidence.org, OSF Preprints and PsyArXiv Preprints in May 2020 for studies including at least one health message promoting vaccine uptake of airborne-, droplet- and fomite-spread viruses. Included studies were assessed for quality using the Mixed Methods Appraisal Tool (MMAT) or the Assessment of Multiple Systematic Reviews (AMSTAR), and for patient and public involvement (PPI) in the research. Thirty-five articles were included. Most reported messages for seasonal influenza (n = 11; 31%) or H1N1 (n = 11; 31%). Evidence from moderate to high quality studies for improving vaccine uptake included providing information about virus risks and vaccination safety, as well as addressing vaccine misunderstandings, offering vaccination reminders, including vaccination clinic details, and delivering mixed media campaigns across hospitals or communities. Behavioural influences (beliefs and intentions) were improved when: shorter, risk-reducing or relative risk framing messages were used; the benefits of vaccination to society were emphasised; and beliefs about capability and concerns among target populations (e.g., vaccine safety) were addressed. Clear, credible, messages in a language target groups can understand were associated with higher acceptability. Two studies (6%) described PPI in the research process. Future campaigns should consider the beliefs and information needs of target populations in their design, including ensuring that vaccine eligibility and availability is clear, and messages are accessible. More high quality research is needed to demonstrate the effects of messaging interventions on actual vaccine uptake.
    • Health-Based Physical Education – a framework for promoting active lifestyles in children and young people. Part 2: Health-Based Physical Education in practice

      Sammon, Paul; Bowler, Mark (Association for Physical Education, 2020-11-19)
      Building on part 1, where we introduced a new pedagogical model for Health-Based Physical Education (HBPE), the primary aim of this article is to illustrate how the model may be implemented in the PE curriculum to help support all children and young people to develop positive physical activity behaviours. Specifically, we consider the model’s critical features for teaching and learning, followed by some key planning considerations, including learning intentions, assessment strategies and how the model can potentially be modified to reflect specific contexts during implementation.
    • Health-Based Physical Education – a framework for promoting active lifestyles in children and young people. Part 1: Introducing a new pedagogical model for Health-Based Physical Education

      Bowler, Mark; Sammon, Paul; (Assocation for Physical Education, 2020-11-19)
      HBPE is one framework that can support physical educators to promote young people’s positive physical activity attitudes and behaviours. In part 1, we present a rationale for new ‘PE-for-health pedagogies’ (Armour & Harris, 2013) – new ways of teaching about physical activity. We subsequently justify the foundations of HBPE, including the model’s major theme and goals, and the underlying theories and important assumptions for practitioners. In part 2, we provide a range of practical examples and identify key considerations to illustrate how HBPE can be effectively applied to help promote positive physical activity behaviour.
    • Parents’ expectations and experiences of the 6-week baby check: a qualitative study in primary care

      Gilworth, Gill; Milton, Sarah; Chater, Angel M.; Nazareth, Irwin; Roposch, Andreas; Green, Judith; King's College London; University of Bedfordshire; University College London (Royal College of General Practitioners, 2020-11-18)
      Background The Newborn and Infant Physical Examination (NIPE) programme requires all babies to have a comprehensive health check at 6–8 weeks of age. These are typically completed by GPs. Although person-centred care has achieved prominence in maternity care policy in recent years, there is limited empirical evidence on what parents and/or carers expect from the check, and how far experiences meet their needs. Aim  To explore the expectations and experiences of parents attending their GP for a baby check. Design & setting A qualitative study was undertaken in primary care in London. Method Content analysis was undertaken of transcripts of semi-structured interviews. Interviews were conducted with a total of 16 participants (14 mothers and two fathers) who had recently attended for a 6-week check for their baby. Results Despite the availability of plentiful sources of general advice on infants’ health and development, a thorough check by a trusted GP was an important milestone for most parents. They had few specific expectations of the check in terms of what examinations were undertaken, but even experienced parents anticipated reassurance about their baby’s normal development. Many also hoped for reassurance about their own parenting. Parents appreciated GPs who explained what they were doing during the examination; space to raise any concerns; and combined mother and baby checks. Referrals to secondary care were generally experienced as reassuring rather than a source of anxiety. Conclusion The baby check meets needs beyond those of the NIPE screening programme. Protecting the time for a thorough consultation is important for parents at what can be a vulnerable time.
    • Relationships between highly skilled golfers’ clubhead velocity and vertical ground reaction force asymmetry during vertical jumps and an isometric mid-thigh pull

      Wells, Jack E.T.; Mitchell, Andrew C.S.; Charalambous, Laura H.; Fletcher, Iain M.; University of Bedfordshire (Wolters Kluwer, 2020-10)
      Clubhead velocity (CHV) is a commonly measured variable within golf due to strong associations with increased drive distance. Previous research has revealed significant relationships between CHV and vertical ground reaction force (vGRF) variables during bilateral tasks including a countermovement jump (CMJ), squat jump (SJ), drop jump (DJ) and isometric mid-thigh pull (IMTP). Asymmetries have been linked to performance outcomes in a number of sports, however few studies have assessed asymmetries within golf. The current study, therefore, examined the relationships between CHV and vGRF asymmetries for CMJ positive impulse, SJ positive impulse, DJ positive impulse and IMTP peak force (PF). Furthermore, the level of agreement for asymmetries between protocols were assessed via Kappa coefficients. Fifty highly skilled (handicap ≤5) male golfers attended laboratory and range-based testing sessions. Positive impulse and PF were measured using a dual force platform system, with CHV measured using a TrackMan 3e launch monitor. There was no significant relationship (r = -0.14 to 0.22) between CHV and each of the vGRF asymmetry measures. Of the golfers tested, 26 had a ‘real’ asymmetry in the CMJ, 18 had a ‘real’ asymmetry in the SJ, 25 had a ‘real’ asymmetry in the DJ and 27 had a ‘real’ asymmetry in the IMTP.  Kappa coefficients indicated that asymmetries rarely favoured the same limb (k = 0.06 to 0.39) with asymmetries varying for individual golfers between protocols. As such, asymmetries are nether beneficial or detrimental to CHV, but are inherently individual and dependent on the task.
    • Prolonged cycling exercise alters neural control strategy, irrespective of carbohydrate dose ingested

      Newell, Michael; Macgregor, Lewis J.; Galloway, Stuart D.R.; Hunter, Angus M. (Wiley, 2020-08-26)
      The interactions between CHO dosage and neuromuscular regulation following fatiguing endurance exercise are not well understood. Fifteen well‐trained male cyclists completed 4 experimental trials of 120‐min submaximal cycling (95% lactate threshold) during which water (0 g CHO·h−1) or CHO beverages (20, 39, or 64 g CHO·h−1) were consumed every 15 minutes, at a rate of 1 L·h−1, followed by a work‐matched time trial ~30 minutes. Maximal voluntary contraction (MVC), M‐wave twitch potentiation and torque, motor unit recruitment and firing rate were recorded pre‐ and post‐cycling. Time trial performance improved following 39 and 64 versus 0 and 20 g CHO·h−1, with no effect of CHO dose on any pre‐ to post‐neuromuscular function measures. Pre‐ to post‐cycling exercise: (1) MVC, and M‐wave amplitude and duration declined by −21.5 Nm, and −4.9 mV and −7.1 ms, respectively; (2) peak evoked torque remained unchanged; (3) Firing rate of early‐ and mid‐recruited motor units increased by 0.93 pps and 0.74 pps, respectively, with no change in later‐recruited motor units. Thus, central drive to early‐ and mid‐recruited motor units increases as a result of endurance cycling, due to a likely fatigue compensatory mechanism. However, CHO availability does not appear to influence increased neuromuscular drive.
    • Gender, age and physical activity representation in children's colouring books (Representación del género, la edad y la actividad física en libros para colorear infantiles)

      Martínez Bello, Vladimir; Hill, Joanne; ; Universidad de Valencia; University of Bedfordshire (Revistas Universidad de León, 2020-06-24)
      Despite publishing houses recognizing the importance of ensuring equal representation of all people in curricular materials and scholars also noting their importance in teaching children gendered behaviours, it is still common to find stereotypically gendered non-coeducational curriculum materials in the international market. The aim of this study is to determine the representation of female and male characters in the illustrations of six colouring books published in the United Kingdom entitled “Books for Girls” and “Books for Boys”. A quantitative content analysis, and a supporting qualitative discourse analysis were carried out. This paper examines the effect of constructing gender difference in children’s colouring books. Gender bias in early childhood education poses the risk of perpetuating a manifestation of inequality.
    • Randomised controlled feasibility study of the MyHealthAvatar-Diabetes smartphone app for reducing prolonged sitting time in Type 2 diabetes mellitus

      Bailey, Daniel Paul; Mugridge, Lucie; Dong, Feng; Zhang, Xu; Chater, Angel M.; Brunel University; University of Bedfordshire; University of Strathclyde (MDPI, 2020-06-19)
      This study evaluated the feasibility and acceptability of a self-regulation smartphone app for reducing prolonged sitting in people with Type 2 diabetes mellitus (T2DM). This was a two-arm, randomised, controlled feasibility trial. The intervention group used the MyHealthAvatar-Diabetes smartphone app for 8 weeks. The app uses a number of behaviour change techniques aimed at reducing and breaking up sitting time. Eligibility, recruitment, retention, and completion rates for the outcomes (sitting, standing, stepping, and health-related measures) assessed trial feasibility. Interviews with participants explored intervention acceptability. Participants with T2DM were randomised to the control (n = 10) and intervention groups (n = 10). Recruitment and retention rates were 71% and 90%, respectively. The remaining participants provided 100% of data for the study measures. The MyHealthAvatar-Diabetes app was viewed as acceptable for reducing and breaking up sitting time. There were preliminary improvements in the number of breaks in sitting per day, body fat %, glucose tolerance, attitude, intention, planning, wellbeing, and positive and negative affect in favour of the intervention group. In conclusion, the findings indicate that it would be feasible to deliver and evaluate the efficacy of the MyHealthAvatar-Diabetes app for breaking up sitting time and improving health outcomes in a full trial.
    • Physical activity for the benefit of mental health outcomes in young people: a focus on parental bereavement

      Chater, Angel M.; Williams, Jane; Shorter, Gillian; Howlett, Neil; University of Bedfordshire; University of Ulster; University of Hertfordshire (BASES, 2020-06-13)
      First published in The Sport and Exercise Scientist, Issue 64, Summer 2020. Published by the British Association of Sport and Exercise Sciences - www.bases.org.uk”
    • Determinants of weekly sitting time: construct validation of an initial COM-B model and comparison of its predictive validity with the Theory of Planned Behaviour

      Howlett, Neil; Schulz, Joerg; Trivedi, Daksha; Troop, Nicholas A.; Chater, Angel M.; University of Hertfordshire; University of Bedfordshire (Taylor & Francis, 2020-05-14)
      Objective: In relation to sitting behaviour, to investigate which theoretical domains best formed the Capability, Opportunity, and Motivation constructs of the COM-B, and compare the predictive validity to the Theory of Planned Behaviour (TPB), taking habit strength into consideration. Design: Using a prospective design, 186 adults completed measures capturing domains from the Theoretical Domains Framework for the three COM-B constructs, and habit strength, which were examined using a formative measurement model. Predictive validity was then compared to the TPB. Main Outcome Measures: Self-reported sitting behaviour. Results: Self-monitoring (behavioural regulation domain) formed Capability; subjective norm (social influences domain) formed Opportunity; intention (intentions domain), positive affect (emotion domain), and perceived behavioural control (beliefs about capabilities domain), formed Motivation. The COM-B strongly predicted sitting behaviour (27% variance explained), with Capability, Opportunity, and habit strength as key drivers. The TPB explained a large amount of variance (23%) in sitting behaviour, with intention and habit strength as key drivers. Conclusions: The behavioural regulation domain of Capability, the social influences domain of Opportunity, and habit strength were important drivers of sitting behaviour, with comparable variance predicted in the COM-B and TPB. Future research should consider this approach to conceptualise the COM-B for specific populations and behaviours.
    • Effects of exercise, cognitive, and dual-task interventions on cognition in type 2 diabetes mellitus: a systematic review and meta-analysis

      Cooke, Samuel; Pennington, Kyla; Jones, Arwel; Bridle, Christopher; Smith, Mark F.; Curtis, Ffion; (Public Library of Science, 2020-05-14)
      Introduction Previous evidence has shown significant effects of exercise, cognitive and dual-task training for improving cognition in healthy cohorts. The effects of these types of interventions in type 2 diabetes mellitus is unclear. The aim of this research was to systematically review evidence, and estimate the effect, of exercise, cognitive, and dual-task interventions on cognition in type 2 diabetes mellitus. Method Electronic databases including PubMed, EMBASE, CINAHL, PsycINFO, SPORTDiscus, and MEDLINE were searched for ongoing and completed interventional trials investigating the effect of either an exercise, cognitive or dual-task intervention on cognition in type 2 diabetes mellitus. Results Nine trials met the inclusion criteria–one dual-task, two cognitive, and six exercise. Meta-analyses of exercise trials showed no significant effects of exercise on measures of executive function (Stroop task, SMD = -0.31, 95% CI -0.71–0.09, P = 0.13, trail making test part A SMD = 0.28, 95% CI -0.20–0.77 P = 0.25, trail making test part B SMD = -0.15, 95% CI -0.64–0.34 P = 0.54, digit symbol SMD = 0.09, 95% CI -0.39–0.57 P = 0.72), and memory (immediate memory SMD = 0.20, 95% CI -0.28–0.69, P = 0.41 and delayed memory SMD = -0.06, 95% CI -0.55–0.42, P = 0.80). A meta-analysis could not be conducted using cognitive or dual-task data, but individual trials did report a favourable effect of interventions on cognition. Risk of bias was considered moderate to high for the majority of included trials. Conclusions Meta-analyses of exercise trials identified a small effect size (0.31), which whilst not significant warrants further investigation. Larger and more robust trials are needed that report evidence using appropriate reporting guidelines (e.g. CONSORT) to increase confidence in the validity of results.
    • Let’s talk about death openly: when the world is grieving, please don’t walk on eggshells.

      Chater, Angel M.; University of Bedfordshire (British Psychological Society, 2020-05-13)
      A blog on bereavement and physical activity Health Psychologist Angel Chater has spoken openly about bereavement over the last two decades. Here, she urges society to recognise and be open about loss.
    • Behavioural science and disease prevention: psychological guidance.

      Chater, Angel M.; Arden, Maddy; Armitage, Chris; Byrne-Davis, Lucie; Chadwick, Paul; Drury, John; Hart, Jo; Lewis, Lesley; McBride, Emily; Perriard-Abdoh, Saskia; et al. (British Psychological Society, 2020-04-14)
      Psychology is crucial to reducing the spread of Covid-19 as it enables us to understand and change behaviour and anticipate people’s responses to changes in policy and guidelines. Behaviours are key to preventing infection and improving outcomes.
    • Acute effects of breaking up prolonged sedentary time on cardiovascular disease risk markers in adults with paraplegia

      Bailey, Daniel Paul; Withers, Thomas M.; Goosey-Tolfrey, Victoria L.; Dunstan, David W.; Leicht, Christof A.; Champion, Rachael B.; Charlett, Opie P.; Ferrandino, Louise; (John Wiley and Sons, 2020-04-03)
      Elevated levels of cardiovascular disease (CVD) risk markers are highly prevalent in people with a spinal cord injury (SCI). Breaking up prolonged sedentary time with short, regular bouts of physical activity can reduce postprandial glucose and lipid levels in able-bodied individuals. The effects in people with paraplegia are unknown. The study aims were to examine the acute postprandial glucose (primary aim), lipid, blood pressure, and psychological responses (secondary aims) to breaking up prolonged sedentary time in individuals with paraplegia. This was a randomized crossover design trial. Fourteen participants with paraplegia (age 51 +- 9 years, trunk fat mass 44.3 +- 7.7%) took part in the following two, 5.5-hour conditions: (1) uninterrupted sedentary time (SED), and (2) sedentary time interrupted with 2 minutes of moderate-intensity arm crank ergometer physical activity every 20 minutes (SEDACT). Standardized breakfast and lunch test meals were consumed during each condition. The outcomes were compared between conditions using linear mixed models. Glucose area under the curve (AUC) was significantly lower during the lunch postprandial period in SED-ACT vs SED (incremental AUC 1.9 [95% CI 1.0, 2.7) and 3.0 [2.1, 3.9] mmol/L∙2.5 hour, respectively, P = .015, f = 0.34). There were no differences between conditions for the breakfast or total 5.5 hours postprandial periods (P > .05). Positive affect was higher in SED-ACT than SED (P = .001). Breaking up prolonged sedentary time acutely attenuates lunch postprandial glucose and improves positive affect in people with paraplegia. This may have clinical relevance for reducing CVD risk and improving psychological well-being in this population.
    • Evidence-based policy making for health promotion to reduce the burden of non-communicable diseases in Moldova

      Sécula, Florence; Erismann, Séverine; Cerniciuc, Carolina; Chater, Angel M.; Shabab, Lion; Glen, Fiona; Curteanu, Ala; Serbulenco, Aliona; Silitrari, Natalia; Demiscan, Daniela; et al. (BMC (part of Springer Nature), 2020-03-06)
      The Republic of Moldova faces several concurrent health challenges most notably an increase in chronic non-communicable diseases, spiralling health care costs and widening health inequalities. To accelerate progress in their resolution there is a need for new and innovative health promotion and behaviour change communication interventions. The Ministry of Health, Labour and Social Protection in collaboration with the newly created National Agency for Public Health held a conference on the occasion of the Moldovan National Day of Health Promotion on 14th March 2018 in which national and invited international experts exchanged their views on (1) best practice examples of behaviour change interventions, health promotion activities and lessons learned from the UK and elsewhere; and (2) possible ways forward for Moldova to implement cost-effective and evidence-based intersectoral health promotion programmes. The experts provided recommendations on implementing behaviour change interventions to reduce and prevent obesity; on the creation of a favourable tobacco control environment to reduce smoking prevalence; and on how physical activity programme design can benefit from health psychology research. All these strategies could foster health promotion activities and ultimately contribute to improving the health outcomes of the Moldovan population.