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Childhood obesity is a global issue. Excessive weight gain in early pregnancy is independently associated with obesity in the next generation. Given the uptake of e-health, our primary aim was to pilot the feasibility of an e-health intervention, starting in the first trimester, to promote healthy lifestyle and prevent excess weight gain in early pregnancy. Methods: Women were recruited between 8 and 11 weeks gestation and randomised to the intervention or routine antenatal care. The intervention involved an e-health program providing diet, physical activity and well-being advice over 12 weeks.
Women (n = 57, 43.9% overweight/obese) were recruited at 9.38 ± 1.12 (control) and 9.06 ± 1.29 (intervention) weeks’ gestation, mainly from obstetric private practices (81.2%). Retention was 73.7% for the 12-week intervention, 64.9% at birth and 55.8% at 3 months after birth.
No difference in gestational weight gain or birth size was detected. Overall treatment effect showed a mean increase in score ranking the perceived confidence of dietary change (1.2 ± 0.46, p = 0.009) and score ranking readiness to exercise (1.21 ± 0.51, p = 0.016) over the intervention. At 3 months, infants weighed less in the intervention group (5405 versus 6193 g, p = 0.008) and had a lower ponderal index (25.5 ± 3.0 versus 28.8 ± 4.0 kg/m3) compared with the control group.
Conclusion and Discussion:
A lifestyle intervention starting in the first-trimester pregnancy utilising e-health mode of delivery is feasible. Future studies need strategies to target recruitment of participants of lower socio-economic status and ensure maximal blinding. Larger trials (using technology and focused on early pregnancy) are needed to confirm if decreased infant adiposity is maintained.
Physiology is the study of the functions of the body, its organs and the cells of which they are composed. It is often said that physiology concerns itself with maintaining the status quo or ‘homeostasis’ of bodily processes. However, even normal physiology is not constant, changing with development (childhood, pregnancy and ageing) and environmental stresses (altitude, diving and exercise). Physiology might be better described as maintaining an ‘optimal’ internal environment; many diseases are associated with the disturbance of this optimal environment.
The central venous pressure (CVP) waveform is measured using a central venous catheter positioned just above the right atrium (RA), within the superior vena cava. Starting from mid-diastole, key features of the normal CVP waveform are (Figure 38.1).
Ageing involves processes not only of physical but also of psychological and social change. Increasing numbers of elderly people are undergoing elective and emergency surgery, with post-operative complications being more common in the older population. It is important to understand the normal changes that occur with advancing age so that anaesthetic techniques can be modified and to allow early identification of anaesthetic and surgical complications.
In 2003, the completion of the Human Genome Project resulted in the sequencing of every human gene and subsequently heralded the ‘age of the genome’. Whilst the knowledge of genetics has revolutionised medicine, the phenotypic significance of most genes remains poorly understood. This will be a major focus of physiological research in the future.
It comes as no surprise that there are major endocrine changes during pregnancy. These endocrine changes are the driving force for many of the other physiological and anatomical changes associated with pregnancy.
The stress response is a complex neuroendocrine response to physiological stress. The most commonly encountered stressors are trauma, burns, surgery and critical illness; the magnitude of the neuroendocrine response is directly related to the magnitude of the stressor. In addition to its metabolic effects, the stress response leads to activation of the immunological and haematological systems.
The O2 cascade concept draws together areas of respiratory physiology covered in the previous few chapters. In an examination setting, it allows the examiner to assess your knowledge of more than one topic within a single question.
Water is the most abundant component of the human body. On average, 60% of the body is composed of water (this value varies with sex, body habitus and age). Body water is distributed between the two major body compartments: intracellular and extracellular. For the average 70‑kg man.
High altitude has no consensus definition. It is most commonly defined as corresponding to >2500 m above sea level, where most individuals begin to show physiological adaptations. Long-term habitation at high altitude is possible – 100 million people live at altitudes >2500 m. Extreme altitude is defined as >6000 m – Mount Everest is 8848 m high. Humans are able to adapt their physiology to survive for short periods of time at extreme altitude, but long-term habitation is impossible.
The rate and character of the arterial pulse has been used for millennia for the diagnosis of a wide range of disorders. Perhaps more useful, however, is the direct cannulation of an artery, which allows quantitative information to be extracted.
The word ‘acid’ is derived from the Latin acidus, meaning sour. Early chemists defined an acid as a chemical substance whose aqueous solution tastes sour, changes the colour of litmus paper to red and reacts with certain metals to produce the flammable gas, hydrogen. Likewise, a base is a chemical substance whose aqueous solution tastes bitter, changes the colour of litmus paper to blue and reacts with acids to produce a salt.
The basic filtration unit of the kidney is the renal corpuscle, consisting of a glomerulus surrounded by a Bowman’s capsule. The high glomerular capillary hydrostatic pressure forces a fraction of the plasma (i.e. water and solutes) through the capillary wall and into the Bowman’s space. This filtration barrier is composed of three layers.
Metabolism refers to the whole range of biochemical reactions that occur within living organisms. Metabolism broadly encompasses anabolism (the building up of larger molecules from smaller ones) and catabolism (their breaking down into smaller entities with the extraction of energy).