This new edition of Ann Bowling's well-known and highly respected text has been thoroughly revised and updated to reflect key methodological developments in health research. It is a comprehensive, easy to read, guide to the range of methods used to study and evaluate health and health services. It describes the concepts and methods used by the main disciplines involved in health research, including: demography, epidemiology, health economics, psychology and sociology.The research methods described cover the assessment of health needs, morbidity and mortality trends and rates, costing health services, sampling for survey research, cross-sectional and longitudinal survey design, experimental methods and techniques of group assignment, questionnaire design, interviewing techniques, coding and analysis of quantitative data, methods and analysis of qualitative observational studies, and types of unstructured interviewing. With new material on topics such as cluster randomization, utility analyses, patients' preferences, and perception of risk, the text is aimed at students and researchers of health and health services. It has also been designed for health professionals and policy makers who have responsibility for applying research findings in practice, and who need to know how to judge the value of that research.

Research Methods in Health. Investigating health and health services

Protecting the health of the athlete is a goal of the International Olympic Committee (IOC). The IOC convened an expert panel to update the 2005 IOC Consensus Statement on the Female Athlete Triad. This Consensus Statement replaces the previous and provides guidelines to guide risk assessment, treatment and return-to-play decisions. The IOC expert working group introduces a broader, more comprehensive term for the condition previously known as ‘Female Athlete Triad’. The term ‘Relative Energy Deficiency in Sport’ (RED-S), points to the complexity involved and the fact that male athletes are also affected. The syndrome of RED-S refers to impaired physiological function including, but not limited to, metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular health caused by relative energy deficiency. The cause of this syndrome is energy deficiency relative to the balance between dietary energy intake and energy expenditure required for health and activities of daily living, growth and sporting activities. Psychological consequences can either precede RED-S or be the result of RED-S. The clinical phenomenon is not a ‘triad’ of the three entities of energy availability, menstrual function and bone health, but rather a syndrome that affects many aspects of physiological function, health and athletic performance. This Consensus Statement also recommends practical clinical models for the management of affected athletes. The ‘Sport Risk Assessment and Return to Play Model’ categorises the syndrome into three groups and translates these classifications into clinical recommendations.

https://bjsm.bmj.com/content/bjsports/48/7/491.full.pdf

The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S)

The medical effects of modest weight reduction (approximately 10% or less) in patients with obesity-associated medical complications were reviewed. The National Library of Medicine MEDLINE database and the Derwent RINGDOC database were searched to identify English language studies that examined the effects of weight loss in obese patients with serious medical complications commonly associated with obesity (non-insulin dependent diabetes mellitus (NIDDM or type II), hypertension, hyperlipidemia, hypercholesterolemia, and cardiovascular disease). Studies in which patients experienced approximately 10% or less weight reduction were selected for review. Studies indicated that, for obese patients with NIDDM, hypertension or hyperlipidemia, modest weight reduction appeared to improve glycemic control, reduce blood pressure, and reduce cholesterol levels, respectively. Modest weight reduction also appeared to increase longevity in obese individuals. In conclusion, a large proportion of obese individuals with NIDDM, hypertension, and hyperlipidemia experienced positive health benefits with modest weight loss. For patients who are unable to attain and maintain substantial weight reduction, modest weight loss should be recommended; even a small amount of weight loss appears to benefit a substantial subset of obese patients.

Beneficial health effects of modest weight loss.

The role of social media in higher education classes (real and virtual) – A literature review

The prevalence of obesity in combination with sarcopenia (the age-related loss of muscle mass and strength or physical function) is increasing in adults aged 65 years and older. A major subset of adults over the age of 65 is now classified as having sarcopenic obesity, a high-risk geriatric syndrome predominantly observed in an ageing population that is at risk of synergistic complications from both sarcopenia and obesity. This Review discusses pathways and mechanisms leading to muscle impairment in older adults with obesity. We explore sex-specific hormonal changes, inflammatory pathways and myocellular mechanisms leading to the development of sarcopenic obesity. We discuss the evolution, controversies and challenges in defining sarcopenic obesity and present current body composition modalities used to assess this condition. Epidemiological surveys form the basis of defining its prevalence and consequences beyond comorbidity and mortality. Current treatment strategies, and the evidence supporting them, are outlined, with a focus on calorie restriction, protein supplementation and aerobic and resistance exercises. We also describe weight loss-induced complications in patients with sarcopenic obesity that are relevant to clinical management. Finally, we review novel and potential future therapies including testosterone, selective androgen receptor modulators, myostatin inhibitors, ghrelin analogues, vitamin K and mesenchymal stem cell therapy.

Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies.

Nutritional issues for young athletes: children and adolescents

Coaches are important figures of influence with potential to create environments that influence athlete health and performance outcomes. Ideally, coaches provide supportive environments that lead to performance optimisation and long-term health. Coaches who employ language and behaviours that overemphasise body composition and/or provide misinformed nutrition advice may predispose athletes to low energy availability (LEA) and the associated health consequences. Having a clear understanding of current knowledge, attitudes and beliefs of coaches with regard to LEA is required to guide future coach education/support initiatives to optimise athlete health and performance. Thus, the aim of this investigation was to systematically review published literature regarding coach knowledge, attitudes/beliefs and behaviours of LEA. Data from 20 eligible studies was extracted into predetermined categories according to coach ‘knowledge‘; ‘attitudes/ beliefs’; and ‘behaviours’ regarding LEA/Relative Energy Deficiency in Sport/Female Athlete Triad and/or eating disorders and/or disordered eating. Any single study could provide outcomes to inform one or multiple of these categories. The majority of results were drawn from studies conducted prior to LEA being defined as a concern for athlete health, which limited our understanding of the contemporary knowledge, attitudes/eliefs and behaviours of coaches on this important issue. That said, indications of gaps in coach knowledge and the employment of inappropriate attitudes/beliefs and behaviours regarding issues associated with LEA were evident. An opportunity exists for key stakeholders to develop comprehensive coach education frameworks, which equip coaches with the adequate capability, opportunity and motivation to support athlete health and avoid the consequences of LEA.

A review exploring coach knowledge, attitudes/beliefs and behaviours towards low energy availability in athletes

Motor racing is a physically and mentally demanding sport, associated with a high degree of risk for drivers. Hence, driving simulation provides a safe alternative to explore the impact acute physiological perturbations (e.g. heat stress or dehydration) on a driver's performance. This study aimed to determine sensitive and reliable simulated driving performance parameters that could be employed in future driving performance studies. Thirty-six healthy males (age: 26.5 ± 8.1 y, body mass: 75.6 ± 12.2 kg, mean ± SD) completed a single experimental trial involving four simulated motor-racing drives (2 initial drives and 2 repeat drives) separated by a 1 h period. Drives were conducted under two conditions, with one condition (wearing Fatal Vision Goggles (FVG)) designed to impair driving performance by distorting vision. Sensitivity was assessed by comparing Normal vs FVG outcomes and reliability was determined by comparing initial vs repeat drives for the same condition. Measures of driving performance included lap time (LT), sector-time (ST) for one section of the track, position displacement to a marker on the first track corner (PD), and vehicle Speed at PD. Results indicated that LT and ST were reliable and sensitive performance measures to a visual disturbance. However, PD was neither sensitive nor reliable and Speed at PD was not sensitive as driving performance measures to the study conditions. Overall, this study demonstrates two sensitive and reliable performance measures (LT and ST) that can be used to assess simulated motor-racing performance in future investigations.

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Sensitive and Reliable Measures of Driver Performance in Simulated Motor-Racing.

Objective Research into cognitive performance during a hangover has produced equivocal findings. This study investigated the reliability of inducing hangover symptoms and effects on cognitive performance (including applied tasks) under standardised conditions. Method Twenty-one participants (13 M; 24 ± 3 years) completed two identical trials, involving alcohol consumption and an overnight laboratory stay. Outcome measures included: hangover severity (a single-item 'Hangover' rating, and a sum of hangover symptoms [Overall Symptoms Score (OSS)]), cognitive function (trail making test), simulated driving (standard deviation of lateral position; lane crossings), and typing performance. Spearman's correlations were used to assess reliability between trials for all participants, and when ratings of 'Hangover' were consistent. Results Participants demonstrated reliable 'Hangover' rating change from baseline (Trial A: 2.0 [2.0]; Trial B: 2.0 [2.0], rho = 0.680, p = 0.001), but not for OSS (Trial A: 8.0 [12.0]; Trial B: 5.0 [9.0], rho = 0.309, p = 0.173). Performance in cognitive/applied tasks (range rho = 0.447-0771) was consistent, except simulated driving (range rho = 0.035-0.272), however the impairment was trivial. The subgroup analysis did not reveal substantial changes in reliability. Conclusion A single 'Hangover' rating was a reliable way of determining 'mild' to 'moderate' hangover severity. The present data could be used to assist the methodological design of future hangover research.

Consistency of hangover experiences after a night of drinking: A controlled laboratory study

Background A large evidence-practice gap exists regarding provision of nutrition to patients following surgery. The aim of this study was to evaluate the processes supporting the implementation of an intervention designed to improve the timing and adequacy of nutrition following bowel surgery. Methods A mixed-method pilot study, using an integrated knowledge translation (iKT) approach, was undertaken at a tertiary teaching hospital in Australia. A tailored, multifaceted intervention including ten strategies targeted at staff or patients were co-developed with knowledge users at the hospital and implemented in practice. Process evaluation outcomes included reach, intervention delivery and staffs' responses to the intervention. Quantitative data, including patient demographics and surgical characteristics, intervention reach, and intervention delivery were collected via chart review and direct observation. Qualitative data (responses to the intervention) were sequentially collected from staff during one-on-one, semi-structured interviews. Quantitative data were summarized using median (IQR), mean (SD) or frequency(%), while qualitative data were analysed using content analysis. Results The intervention reached 34 patients. Eighty-four percent of nursing staff received an awareness and education session, while 0% of medical staff received a formal orientation or awareness and education session, despite the original intention to deliver these sessions. Several strategies targeted at patients had high fidelity, including delivery of nutrition education (92%); and prescription of oral nutrition supplements (100%) and free fluids immediately post-surgery (79%). Prescription of a high energy high protein diet on postoperative day one (0%) and oral nutrition supplements on postoperative day zero (62%); and delivery of preoperative nutrition handout (74%) and meal ordering education (50%) were not as well implemented. Interview data indicated that staff regard nutrition-related messages as important, however, their acceptance, awareness and perceptions of the intervention were mixed. Conclusions Approximately half the patient-related strategies were implemented well, which is likely attributed to the medical and nursing staff involved in intervention design championing these strategies. However, some strategies had low delivery, which was likely due to the varied awareness and acceptance of the intervention among staff on the ward. These findings suggest the importance of having buy-in from all staff when using an iKT approach to design and implement interventions.

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Assessment of an integrated knowledge translation intervention to improve nutrition intakes among patients undergoing elective bowel surgery: a mixed-method process evaluation.

Ben Desbrow

Papers

Nutritional issues for young athletes: children and adolescents

A review exploring coach knowledge, attitudes/beliefs and behaviours towards low energy availability in athletes

Sensitive and Reliable Measures of Driver Performance in Simulated Motor-Racing.

Consistency of hangover experiences after a night of drinking: A controlled laboratory study

Assessment of an integrated knowledge translation intervention to improve nutrition intakes among patients undergoing elective bowel surgery: a mixed-method process evaluation.