These are abstracts of articles published in Cardiometabolic Risk and Weight Management
Vol 2, Issue 1
Health Trainers - a new force for change?
Cannabinoid receptors in health and disease
Cardiometabolic risk in the South Asian community
Large but unseen: bariatric patients and manual handling
A toolkit for change
Reader Survey October 2006
Karan Thomas, BSc, Physical Activity Specialist, National Obesity Forum and Freelance Training Consultant, Manchester, UK.
Health trainers are a new workforce, recruited from the community, who will work in NHS organisations such as local authorities, businesses, voluntary and community settings. The aim is to improve the health of the general population by encouraging improvements in lifestyle behaviours and tackling health inequalities. In this editorial, physical activity specialist, Karan Thomas, discusses the potential that these new healthcare professionals have improve lifestyle behaviours and health inequalities and what needs to be considered if the success of this initiative is to be ensured.
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Roger Pertwee, MA, DPhil, DSc (Oxon), Professor of Neuropharmacology, School of Medical Sciences, Institute of Medical Sciences, University of Aberdeen, Aberdeen, Scotland.
Mammalian tissues express at least two types of cannabinoid receptor, CB1 and CB2. Endogenous agonists for cannabinoid receptors also exist. Known as endocannabinoids, these, together with their receptors, constitute the 'endocannabinoid system' - the discovery of which has led to the development of CB1 and CB2 selective agonists and antagonists. Research has also provided evidence that the endocannabinoid system becomes hyperactive in certain diseases and that this alleviates the unwanted symptoms of some disorders but gives rise to unwanted symptoms in others. This review provides a concise description of recent advances in the understanding of the endocannabinoid system and discusses the actual or potential therapeutic applications of drugs that mimic, augment or block the actions of endogenously released endocannabinoids.
- The endocannabinoid (EC) system consists of cannabinoid receptors and endogenous compounds (endocannabinoids) that can activate these receptors.
- The EC system upregulates in certain diseases, as indicated by an increase in endocannabinoid tissue levels, in cannabinoid receptor density and/or in cannabinoid receptor signalling.
- There is evidence that this upregulation sometimes leads to reduction in symptoms (e.g. pain relief or reduced spasticity) or slows disease progression (e.g. inhibition of cancer cell proliferation and tumour growth).
- There also appear to be disorders in which upregulation of the endocannabinoid system has undesirable consequences, e.g. obesity.
- There is currently considerable interest in exploiting the therapeutic potential of drugs that mimic or augment 'protective' effects of endogenously released endocannabinoids and of drugs that block unwanted effects of such release.
- Dronabinol, nabilone and a cannabis-based extract (Sativex) are all agents that activate cannabinoid receptors. They are currently used clinically as anti-emetics, appetite stimulants or to relieve neuropathic pain in adults with multiple sclerosis.
- Rimonabant, a cannabinoid CB1 receptor antagonist, has recently been licensed as an anti-obesity agent.
- Future research may lead to further advances in our understanding of the EC system, with the potential to treat a wide range of disorders.
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AH Barnett, BSc (Hons), MD, FRCP, Professor of Medicine and Consultant Physician, University of Birmingham and Birmingham Heartlands and Solihull NHS Trust (Teaching), Birmingham, England.
Around 25% of South Asian adults in the UK have type 2 diabetes and the levels of cardiovascular disease are 30-40% higher compared with the indigenous white Caucasian population. The causes are multifactorial and include a tendency towards abdominal obesity with associated insulin resistance. The latter is strongly related to an increased risk of glucose intolerance, diabetes, cardiovascular disease and lipid abnormalities. Recent research has shown that management requires multiple cardiometabolic risk factor interventions that are culturally sensitive and community-based.
- People of South Asian origin living in the UK have a higher risk of cardiometabolic risk and premature mortality than their white Caucasian counterparts.
- The reasons for this increased risk are unknown, but are likely to be multifactorial.
- Multiple cardiovascular risk factor interventions are important for people of South Asian extraction with type 2 diabetes and include the need for polypharmacy, lifestyle changes and diet.
- Drugs used to treat people with diabetes should include statins, antihypertensives and low dose aspirin.
- Meeting the health needs of the South Asian population requires a culturally sensitive, community-based approach that takes into account customs, religious practices, lifestyle, food and language.
- The UK Asian Diabetes Study (UKADS), based in Birmingham and Coventy, is evaluating the importance of 'enhanced' care in patients of South Asian extraction with type 2 diabetes.
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Ken Cookson, RGN, RMN, Dip RSA, Manual Handling Manager/Advisor, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK.
Manual handling of bariatric patients is an important consideration for primary care and acute hospital trusts, especially in view of current legislation and the increasing levels of adult and childhood obesity. In this article, Ken Cookson, Manual Handling Manager/Advisor, discusses some of the issues that need to be addressed, including safe handling, providing appropriate equipment and ensuring dignified care.
- Bariatric patients pose a number of medical and nursing challenges. Safe handling and dignified care are important considerations.
- There can be implicit bias by healthcare professionals against obese people and unintentional discrimination if equipment appropriate for their size is not available.
- Equipment can fail if the safe working load is exceeded.
- The ability to carry out appropriate investigations may be limited if the equipment is inappropriate for the patient's size.
- Legislation requires employers to provide a safe working environment. Failure to do this can result in injury and/or litigation.
- When replacing equipment, such as scanners, the ergonomic aspects, weight and aperture limits should be considered in addition to technical specification.
- A collaborative approach is necessary to provide a seamless, ergonomic, who systems approach to care for bariatric patients.
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'Lightening the Load: tackling overweight and obesity' is a new toolkit designed to help healthcare professionals develop local strategies to reduce overweight and obesity in children and adults. It has been produced by the National Heart Forum, a UK charity that focuses on the primary prevention of coronary heart disease, in association with the Faculty of Public Health, the Royal College of Physicians' standard setting body for public health specialists.
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MEP would like to thank readers of Cardiometabolic Risk and Weight Management who took the time to complete the reader survey sent out with the October 2006 issue.
The key findings were:
Prize Draw Winner
- The majority of responses were from primary care professionals: 58% GPs, 3% practice nurses. Surveys were also received from hospital doctors, nurse practitioners, diabetes nurse specialists and dieticians.
- 63% of responders always and 24% sometimes shared their copy
- 94% of responders indicated that the journal was very useful or quite useful in helping their understanding of cardiometabolic risk and weight management
- 87% of responders said that the journal had improved or sometimes improved treatment of patients
- 73% of responders read the whole or most of articles in full
- 47% read all or most of the articles in each issue
- The most useful sections of the journal were considered to be review articles (41%) and best practice summaries (47%)
- Disease management and treatment strategies were the subject areas of most interest to responders. Political comment was of least interest
- A number of subjects were suggested for future issues. These will be considered by the journal's editorial board
- Most responders read the BMJ as well as a variety of other popular weekly, monthly or quarterly medical journals focusing on diabetes, cardiology and primary care. Cardiometabolic Risk and Weight Management compared well with these, with 60% of responders scoring it as being of about the same interest and 25% considering it to be more interesting than other journals.
All valid reader surveys received by MEP Ltd were entered into a prize draw to win a personalised Montblanc pen. The winner is Dr Ee Lin Lim from Gateshead.
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