Monday, January 19, 2015

Sleep Apnea And Quality Of Life In Iceland

Laugarvatn Fontana Geothermal Baths, Iceland

Laugarvatn Fontana Geothermal Baths, Iceland

This week, I am in Reykjavik on behalf of the Icelandic Medical Association to speak at their 2015 Annual Conference.

Despite its proverbial rugged outdoorsy lifestyle with ample time spent in natural hot spring spas and saunas (both of which I enjoyed yesterday, thanks to my excellent hosts), Iceland has a significant obesity problem of its own – reason enough for this problem to be taken seriously (I will be meeting with the Icelandic health minister and his staff to discuss this issue later this week).

There is indeed a small but active obesity research community in Iceland with growing experience in the management of this disease.

One important contribution, for e.g. is the recent paper by Erla Bjornsdottir and colleagues from the University of Iceland, published in the Journal of Sleep Research, that examines the impact of two years of treatment vs. non treatment of moderate to severe obstructive sleep apnea (OSA) on quality of life in over 800 overweight or obese individuals newly diagnosed with this condition.

The comparator group consisted of 750 randomly selected Icelanders. The researchers also compared users and non-users of CPAP treatment within the individuals diagnosed with sleep apnea.

Overall, as one might expect, the quality of life (measured by the SF-12 questionnaire) of untreated individuals with OSA was markedly worse that of the general population, even when matched for age, body mass index, gender, smoking, diabetes, hypertension and cardiovascular disease.

Surprisingly, however, despite a positive trend towards improvement in physical quality of life from baseline to follow-up in users and the most obese individuals, there were no significant overall differences between full and non-users.

This is particularly surprising as I have often seen dramatic changes in the quality of life and general well-being in patients with OSA, who started on CPAP treatment in my practice (but I guess anecdotes are always tempered by averages).

Based on their findings, the researchers conclude that the co-morbidities of obstructive sleep apnea, such as obesity, insomnia and daytime sleepiness (often not fully controlled by CPAP), appear to have a substantial effect on life qualities and may need to be taken into account and addressed with additional interventions.

The message here, I believe, is that despite its effectiveness for better control of breathing, simply putting patients on CPAP and hoping for the best may not be quite enough to improve the substantially reduced quality of life associated with this disorder.

@DrSharma
Reykjavik, Iceland

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Wednesday, November 12, 2014

5As of Obesity Management in Primary Care

sharma-obesity-5as-booklet-coverThis week I am again touring Ontario to train health professionals in the 5As of Obesity Management (Kingston, Ottawa, St. Catherines).

It is heartening to see the tremendous interest in this topic and how the message about obesity as a chronic disease resonates with health practitioners, few of who have any prior training in obesity management.

It is particularly rewarding to see how well the Canadian Obesity Network’s 5As of Obesity Management framework is received and embraced by those working in the front lines of primary care, as this is exactly the audience for which this framework is intended.

Regular readers may recall that the 5As of Obesity Management framework was developed by the Canadian Obesity Network in an elaborate undertaking involving scores of primary care providers, experts and patients from across Canada. The tools were modelled using the latest in health information design technology and extensively field tested to ensure their applicability and adaptability to primary care practice.

Rather than overloading the tools with intricate algorithms, we opted for a rather general but insightful set of principles and recommendations designed to facilitate professional interactions that seek to identify and address the key drivers and consequence of weight gain as well as help tackle the key barriers to weight management.

Indeed, the 5As of Obesity Management are steeped in a deep understanding of the complex multi-factorial nature of obesity as a chronic (often progressive) disease for which we simply have no cure.

The framework recognizes that health cannot be measured on a scale, BMI is a poor measure of health and that obesity management should be aimed at improving the overall health and well being of those living with obesity rather than simply moving numbers on the scale.

Research on the use of the 5As in primary practice has already shown significant improvements in the likelihood of obesity being addressed in primary practice.

A large prospective randomized trial on the implementation of the 5As of Obesity Management framework in primary care (the 5AsT trial) is currently underway with early results showing promising results.

I, for one, will continue promoting this framework as the basis for obesity counselling and management in primary care – at least until someone comes up with something that is distinctly better.

If you have experience with this approach or have attended one of the many education sessions on the 5As of Obesity Management offered by the Canadian Obesity Network, I’d certainly like to hear about it.

To view an introductory video on the 5As of Obesity Management click here

@DrSharma
Ottawa, ON

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Friday, October 24, 2014

Social Network Analysis of the Obesity Research Boot Camp

bootcamp_pin_finalRegular readers may recall that for the past nine years, I have had the privilege and pleasure of serving as faculty of the Canadian Obesity Network’s annual Obesity Research Summer Bootcamp.

The camp is open to a select group of graduate and post-graduate trainees from a wide range of disciplines with an interest in obesity research. Over nine days, the trainees are mentored and have a chance to learn about obesity research in areas ranging from basic science to epidemiology and childhood obesity to health policy.

Now, a formal network analysis of bootcamp attendees, published by Jenny Godley and colleagues in the Journal of Interdisciplinary Healthcare, documents the substantial impact that this camp has on the careers of the trainees.

As the analysis of trainees who attended this camp over its first 5 years of operation (2006-2010) shows, camp attendance had a profound positive impact on their career development, particularly in terms of establishing contacts and professional relationships.

Thus, both the quantitative and the qualitative results demonstrate the importance of interdisciplinary training and relationships for career development in obesity researcher (and possibly beyond).

Personally, participation at this camp has been one of the most rewarding experiences of my career and I look forward to continuing this annual exercise for years to come.

To apply for the 2015 Bootcamp, which is also open to international trainees – click here.

@DrSharma
Toronto, ON

ResearchBlogging.orgGodley J, Glenn NM, Sharma AM, & Spence JC (2014). Networks of trainees: examining the effects of attending an interdisciplinary research training camp on the careers of new obesity scholars. Journal of multidisciplinary healthcare, 7, 459-70 PMID: 25336965

 

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Thursday, October 2, 2014

Shifting To Wellness

Practice Consultant at Association of New Brunswick Licensed Practical Nurses

Christie Ruff, Practice Consultant at Association of New Brunswick Licensed Practical Nurses

Yesterday, at the annual conference of the Canadian Occupational Health Nurses in Saint John, New Brunswick, I was delighted to hear a presentation by Christie Ruff, a nursing practice consultant for the Province of New Brunswick, who spoke on the impact of sleep and shift work on health and wellness.

As Ruff pointed out, shift work is “officially” defined as any work that happens on a regular basis outside of 8.00 am to 5.00 pm, Mondays to Fridays. Work includes any of the work you take home, any checking of work related e-mails or even carrying a pager so you can be reached.

Based on this definition, the vast majority of the working population is doing shift work. Yet, virtually none of us have any formal “education” on how best to deal with the many problems that regular shift work poses for our health and well-being.

One program that addresses this issue is a program called “Shifting to Wellness“, developed at Keyanu College in Fort MacMurray, Alberta, and provides a two-day workshop for employees, who work shifts. Ruff has been a Master Trainer for this program for over 10 years.

The program looks in detail at how better understanding natural circadian rhythms, can allow shift workers to better cope with burden of shift work – from catching up on sleep to healthy eating and physical activity patterns.

From an employer perspective, this is far from trivial. Shift workers are far more prone to making mistakes and having accidents (or simply clicking the “send” button a moment too soon). Many major workplace disasters were the direct result of workplace fatigue, inattention and errors made by shift workers often fatigued from lack of sleep.

Indeed, the presentation included a comprehensive review of the stages of sleep and how these are affected (and may be corrected) in shift workers.

The “crankiness” and “irritability” of shift workers is directly related to their lack of REM sleep, as is their higher rates of depression and decreased ability to deal with stressors.

These factors also affect other aspects including personal relationships and decisions.

As readers will be well aware, lack of sleep has also been linked to appetite and hunger as well as metabolic health.

No doubt, learning more about sleep, fatigue and how to address these issues is something that any health professional working in obesity prevention or management needs to pursue to better serve their clients (and themselves).

@DrSharma
Saint John

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Thursday, August 28, 2014

Call For Abstracts: Canadian Obesity Summit, Toronto, April 28-May 2, 2015

COS2015 toronto callBuilding on the resounding success of Kananaskis, Montreal and Vancouver, the biennial Canadian Obesity Summit is now setting its sights on Toronto.

If you have a professional interest in obesity, it’s your #1 destination for learning, sharing and networking with experts from across Canada around the world.

In 2015, the Canadian Obesity Network (CON-RCO) and the Canadian Association of Bariatric Physicians and Surgeons (CABPS) are combining resources to hold their scientific meetings under one roof.

The 4th Canadian Obesity Summit (#COS2015) will provide the latest information on obesity research, prevention and management to scientists, health care practitioners, policy makers, partner organizations and industry stakeholders working to reduce the social, mental and physical burden of obesity on Canadians.

The COS 2015 program will include plenary presentations, original scientific oral and poster presentations, interactive workshops and a large exhibit hall. Most importantly, COS 2015 will provide ample opportunity for networking and knowledge exchange for anyone with a professional interest in this field.

Abstract submission is now open – click here

Key Dates

  • Notification of abstract review: January 8, 2015
  • Call for late breaking abstracts open: Jan 12-30, 2015
  • Notification of late breaking abstracts and handouts and slides due : Feb 27, 2015
  • Early registration deadline: March 3, 2015

For exhibitor and sponsorship information – click here

To join the Canadian Obesity Network – click here

I look forward to seeing you in Toronto next year!

@DrSharma
Montreal, QC

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In The News

Diabetics in most need of bariatric surgery, university study finds

Oct. 18, 2013 – Ottawa Citizen: "Encouraging more men to consider bariatric surgery is also important, since it's the best treatment and can stop diabetic patients from needing insulin, said Dr. Arya Sharma, chair in obesity research and management at the University of Alberta." Read article

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