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Background Weight gain and obesity are common after kidney transplantation, particularly during the first year. Obesity is a risk factor for the development of new-onset diabetes after transplantation, and is associated with reduced graft survival. There is a lack of evidence for effective interventions to prevent weight gain after kidney transplantation. Methods/Design The effect of INTE nsive N utrition interventions on weight gain after kidney T ransplantation (INTENT) trial is a single-blind (outcomes assessor), randomised controlled trial to assess the effect of intensive nutrition interventions, including exercise advice, on weight gain and metabolic parameters in the first year after transplantation. Participants will be randomised during the first post-transplant month to either standard care (four visits with a renal dietitian over twelve months) or intensive nutrition intervention (eight visits with a renal dietitian over the first six months, four visits over the second six months, and three visits over the first six months with an exercise physiologist). In the intensive intervention group, nutrition counselling will be provided using motivational interviewing techniques to encourage quality engagement. Collaborative goal setting will be used to develop personalised nutrition care plans. Individualised advice regarding physical activity will be provided by an exercise physiologist. The primary outcome of the study is weight at six months after transplant, adjusted for baseline (one month post-transplant) weight, obesity and gender. Secondary outcomes will include changes in weight and other anthropometric measures over 12 months, body composition (in vivo neutron activation analysis, total body potassium, dual-energy X-ray absorptiometry, and bioelectrical impedance), biochemistry (fasting glucose, lipids, haemoglobin A1c and insulin), dietary intake and nutritional status, quality of life, and physical function. Discussion There are currently few randomised clinical trials of nutrition interventions after kidney transplantation. The INTENT trial will thus provide important data on the effect of intensive nutrition interventions on weight gain after transplant and the associated metabolic consequences. Additionally, by assessing changes in glucose metabolism, the study will also provide data on the feasibility of undertaking larger multi-centre trials of nutrition interventions to reduce the incidence or severity of diabetes after transplantation. Trial registration Australian New Zealand Clinical Trials Registry Number: ACTRN12614000155695

Learning and memory, as fundamental components of human cognition, are heritable traits that are highly variable between individuals and within populations. Investigation into the genetic basis of cognition is a prominent area of research, with genetic associations being previously reported for a wide range of cognitive phenotypes. Here we utilise a genome-wide association study (GWAS) approach to evaluate the contribution of genetic variation to learning and memory phenotypes in a comprehensively phenotyped, well-characterised, healthy, and unrelated cohort of individuals (n = 613). Cognitive phenotypes were assessed using nine comprehensive test batteries consisting of twenty-one cognitive performance assessments including IQ, five measures for visual and verbal learning, and fifteen measures for semantic, working, episodic and prospective memory. Principal component analysis was utilised to amalgamate correlated test scores into additional new cognitive phenotypes. Our study identified genome wide significant associations for 13 loci across all phenotypes. A novel association was identified between the rs817826 SNP at 9q31.2 and verbal learning discrimination (p = 2.71 × 10 − 9 ). GWAS of cognitive PCs identified three variants in the vicinity of thiamine (Vitamin B 1 ) transporter gene SLC19A3 (most significant SNP rs12105620, p = 2.17 × 10 − 9 ), a 3’ UTR variant in PPARD (rs9658167, p  = 1.47 × 10 − 8 ), and an intronic variant in RBFOX1 (rs17138790, p  = 4.24 × 10 − 8 ) associated with the cognitive PC related to visual and verbal learning. The cognitive PC relating to prospective and retrospective memory revealed a locus containing a synonymous variant in NXPE3 (rs2305990, p  = 6.56 × 10 − 9 ) and intronic variants in RD3 (rs17189035, p  = 2.71 × 10 − 8 ) and WLS/GNG12-AS1 (rs17130484, p  = 4.13 × 10 − 8 ). Pathway analysis identified olfactory, vitamin A, and cadherin pathways as being significantly overrepresented across multiple cognitive domains. The novel associations identified provide candidates for further investigation and necessitate replication in similarly characterised independent cohorts.

Aims/hypothesisThe aim of this work was to define metabolic correlates and pathways of diabetes pathogenesis in young adults during a subclinical latent phase of diabetes development.MethodsWe studied 2083 young adults of Black and White ethnicity in the prospective observational cohort Coronary Artery Risk Development in Young Adults (CARDIA) study (mean ± SD age 32.1 ± 3.6 years; 43.9% women; 42.7% Black; mean ± SD BMI 25.6 ± 4.9 kg/m2) and 1797 Framingham Heart Study (FHS) participants (mean ± SD age 54.7 ± 9.7 years; 52.1% women; mean ± SD BMI 27.4 ± 4.8 kg/m2), examining the association of comprehensive metabolite profiles with endophenotypes of diabetes susceptibility (adipose and muscle tissue phenotypes and systemic inflammation). Statistical learning techniques and Cox regression were used to identify metabolite signatures of incident diabetes over a median of nearly two decades of follow-up across both cohorts.ResultsWe identified known and novel metabolites associated with endophenotypes that delineate the complex pathophysiological architecture of diabetes, spanning mechanisms of muscle insulin resistance, inflammatory lipid signalling and beta cell metabolism (e.g. bioactive lipids, amino acids and microbe- and diet-derived metabolites). Integrating endophenotypes of diabetes susceptibility with the metabolome generated two multi-parametric metabolite scores, one of which (a proinflammatory adiposity score) was associated with incident diabetes across the life course in participants from both the CARDIA study (young adults; HR in a fully adjusted model 2.10 [95% CI 1.72, 2.55], p<0.0001) and FHS (middle-aged and older adults; HR 1.33 [95% CI 1.14, 1.56], p=0.0004). A metabolite score based on the outcome of diabetes was strongly related to diabetes in CARDIA study participants (fully adjusted HR 3.41 [95% CI 2.85, 4.07], p<0.0001) but not in the older FHS population (HR 1.15 [95% CI 0.99, 1.33], p=0.07).Conclusions/interpretationSelected metabolic abnormalities in young adulthood identify individuals with heightened diabetes risk independent of race, sex and traditional diabetes risk factors. These signatures replicate across the life course.

A time-tested, landmark approach to health promotion and communication projects and everything that goes into making them successful. For more than 40 years, the PRECEDE-PROCEED model, developed in the early 1970s by Lawrence W. Green and first published as a text in 1980 with Marshall W. Kreuter, Sigrid G. Deeds, and Kay B. Partridge, has been effectively applied worldwide to address a broad range of health issues: risk factors like tobacco and lack of exercise, social determinants of health such as lack of access to transportation and safe housing, and major disease challenges like heart disease and guinea worm disease. In Health Program Planning, Implementation, and Evaluation, Green and his team of senior editors and chapter authors combine their expertise to offer a high-level guide to public health programming. This guide aligns with foundational public health competencies required by increasingly rigorous certification and accreditation standards. Driven by the coronavirus pandemic and a looming climate crisis, the book addresses the rapid changes in modern-day conceptions of disease prevention and health promotion. Today's public health practitioners and researchers are often called upon to address a complex web of factors, including population inequities, that influence health status, from biology to social and structural determinants. Program and policy solutions to population health challenges require systematic planning, implementation, and evaluation. Providing students with knowledge, skills, and a range of tools, the book recognizes new approaches to communication and fresh methods for reaching a greater diversity of communities. The authors highlight the importance of starting the population health planning process with an inclusive assessment of the social needs and quality-of-life concerns of the community. They explain how to assess health problems systematically in epidemiological terms and address the behavioral a ...

This phenomenological study explored the meaning of wheelchair rugby participation as expressed by five athletes. Themes emerged from their stories about perceived positive outcomes in physical health, psychosocial well-being, expression of an athlete identity, and hold meaning related to playing a full contact sport. The study findings demonstrate the importance and value of sport participation for persons with tetraplegia. These findings support the use of adapted sport as an impactful intervention when working with persons with spinal cord injury. [PUBLICATION ABSTRACT]

This study compared the effects of a concurrent flow resistance (CFR) device versus a concurrent pressure threshold resistance (CPTR) device on lung function and aerobic capacity in wheelchair rugby (WR) athletes with tetraplegia. Using a 9-week pretest-posttest control group design, 24 male athletes were matched by lesion level, injury completeness, and rugby classification before random assignment to 1 of 3 groups: (a) CPTR, (b) CFR, or (c) control (CON). Maximum voluntary ventilation (MVV), maximum inspiratory pressure (MIP), and 1-mile time trial performance (TT) were measured. Significantly greater improvements were observed in time trial performance for CPTR versus CON (p = .038) and in MVV for CFR versus CPTR (p = .027). The results support the use of training with a CFR device in order to improve overall lung function, and to a lesser extent, with a CPTR device to improve cardiorespiratory endurance. Any effect that a training device may have on the cardiorespiratory endurance of WR athletes is worthy of consideration. [PUBLICATION ABSTRACT]