Nahal Mavaddat

The authors have done a commendable job of bringing together some of the important elements of what constitutes Narrative Medicine and have made a reasonably compelling case that it should be of equal benefit to healthcare in low-resource, high-patie...

Background: Chronic diseases such as type 2 diabetes mellitus and cardiovascular disease and their cardiometabolic risk factors require management, which includes lifestyle interventions. Rural and remote residents are disproportionately affected by these conditions compared to their urban counterparts. Studies have examined barriers to chronic disease and cardiometabolic risk factor management in urban environments, but rural perspectives remain underexplored, especially in Western Australia (WA) with its vast geography. This study examined rural general practitioners’ (GPs) views on barriers and facilitators to chronic disease and cardiometabolic care in rural WA through lifestyle management. Methods: This qualitative study used semi-structured interviews with 15 rural WA GPs recruited via rural networks using convenience and snowball sampling. Braun and Clarke’s reflexive thematic analysis was used to identify patterns and themes within the qualitative data that addressed the study questions. Results: According to rural general practitioners, major barriers to chronic disease and cardiometabolic risk care included geographic isolation, socioeconomic disadvantage and an obesogenic food environment in rural areas, as well as severe time and financial constraints for GPs and workforce shortages with a high turnover and lack of accessible allied health professionals. Facilitators included co-located multidisciplinary teams, case management/health coaching, better remuneration for complex consultations involving preventive care and upstream policy measures, such as improving healthy food affordability and availability. Conclusion: Rural patients face systemic, geographic and socioeconomic barriers that are substantially greater than those in urban settings; these barriers impact GPs caring for their patients with chronic disease and cardiometabolic risk factors. Targeted solutions to these barriers such as attention to workforce issues, investment in lifestyle coaching approaches and having dedicated case managers, could reduce rural–urban inequities in chronic disease outcomes.

Background Junior doctor training is stressful and associated with significant challenges, including poor mental health and burnout. Mindfulness-based interventions (MBI) are increasingly being offered within junior doctor education programs to support junior doctor wellbeing, with online platforms for delivery attracting interest. Methods This mixed-method randomised waitlist control trial was conducted with junior doctors across two hospitals in Western Australia. The intervention was an 8-week online mindfulness training program, with usual training as control. Outcome measures were changes from baseline to program completion (8 weeks) and then 1-month follow-up for self-reported surveys of trait mindfulness, perceived stress, self-compassion, occupational stress, and work engagement. Intervention and control participants completed surveys at all three time points. Semi-structured interviews and focus groups were conducted with participants at program completion. Results Seventy-two (35 intervention, 37 control) junior doctors were randomised. Seventeen did not complete the baseline measures. Data for the remaining 55 participants (28 Intervention, 27 Control) were retained for analysis. Most intervention participants formally practiced mindfulness 2 to 3 times per week for 5–7 minutes. For the intervention group, perceived stress increased at program completion (-1.4, 95% CI − 2.6, -0.3, p = 0.0151) while work engagement was decreased (-2.9, CI − 5.6, -0.2, p = 0.0355) at final follow-up. There were no significant changes in any of the outcomes for the control group at any follow-up point. Thirteen intervention and 8 control participants undertook semi-structured interviews about their experience. Despite lack of positive quantitative findings, benefits reported regarding the program during interview included: improved self-awareness, emotion regulation, self-compassion and work productivity, as well as professional and personal relationships. Barriers to participation in the program included limited time, work stress, and challenges with elements of the intervention. Conclusion This novel online mindfulness training program was not associated with improvements in measured outcomes including trait mindfulness, perceived stress, self-compassion, occupational stress or work engagement for participating junior doctors. This contrasts with our qualitative findings suggesting that junior doctors experience wellbeing benefits from participating, and with the results of our similar trial in medical students. Organisational factors such as stressful workplaces and time limitations likely minimised the impact of the mindfulness intervention in this group.

Background/Objectives: Metabolic syndrome (MetSy) comprises a cluster of risk factors—including obesity, dyslipidaemia, hypertension, and impaired glucose metabolism—that increase the risk of cardiovascular disease, type 2 diabetes, and other conditions. There are close ties between the complications and outcomes of obesity and MetSy. The practical value of MetSy as a distinct diagnosis in primary care remains uncertain. This study aimed to explore general practitioners’ (GPs) perspectives on the utility of MetSy for diagnosing and managing patients in light of evolving concepts in the field of metabolic health. Methods: A qualitative study design was employed, with semi-structured interviews conducted among 15 GPs in rural Western Australia. Participants were recruited via GP networks with convenience and snowball sampling. Transcribed interviews were thematically analysed using Braun and Clarke’s reflexive approach, with iterative coding, theme identification, and member checking to ensure trustworthiness. Results: GPs generally recognized MetSy as a constellation of risk factors that heighten the risk of cardiovascular disease. Insulin resistance was frequently identified as a unifying pathophysiological driver. Nevertheless, most participants did not routinely diagnose MetSy in clinical practice, rather focusing on treating individual component conditions (e.g., obesity, hypertension, dyslipidaemia) due to readily available disease-specific guidelines. Only a minority of GPs actively used the MetSy concept for patient education to highlight interconnected risks and the potential benefits of holistic lifestyle interventions. Paucity of dedicated MetSy management guidelines and uncertainty around diagnostic criteria further hindered routine application of the syndrome in practice. Conclusions: While GPs are aware of MetSy and its broad implications, few use it as a distinct clinical tool. Development of tailored guidelines and expanded educational resources would empower GPs to integrate a more holistic, MetSy-focused approach to patient care.

Time-restricted eating (TRE) has gained attention as an effective approach for weight management and overall well-being by focusing on limiting the eating window, rather than reducing calories. This study explores the biopsychosocial impacts of TRE in free-living individuals using a qualitative design. Twenty-one adults (aged 27–60 years) from Western Australia who had practised TRE for at least three months were purposively recruited, and semi-structured interviews were conducted. The data were analysed using a thematic analysis to identify key themes. The participants reported a range of benefits, including weight loss, reduced joint pain, better digestion, improved mental clarity, increased energy, and a more positive body image. Socially, TRE facilitated simplified daily routines but also introduced challenges, such as disruptions to social interactions and family meal dynamics. Some mixed and negative impacts were reported, including changes in sleep and exercise patterns. These findings highlight TRE’s potential as a holistic dietary intervention. Further research, particularly well-controlled, randomised controlled trials and longitudinal studies, is needed to confirm these insights and guide their appropriate application in clinical and public health settings.

Background: Time-restricted eating (TRE) shows promise for managing weight and metabolic issues, yet its application in real-world healthcare settings remains underexplored. This study aims to assess the real-world utilisation and short-term outcomes of TRE in clinical practice. Methods: This observational study used a retrospective chart review of 271 adults who attended a metabolic specialist clinic between 2019 and 2023. Descriptive statistics and multivariable logistic regression were used to identify factors associated with TRE adoption, while paired sample t-tests evaluated changes in outcomes among those who received TRE advice. Results: Among the 271 patients, 76% were female, 90% Caucasian, and 94% overweight/obese. Of all patients, 47.2% received TRE advice, mainly using the 16:8 method, alongside additional dietary guidance for 60% of patients. Working status and baseline metabolic profiles were the only factors significantly associated with TRE adoption. Among those who followed TRE, 81% experienced modest but significant reductions in weight (−1.2 kg, p < 0.01), BMI (−0.4 kg/m², p < 0.01), and waist circumference (−3.7 cm, p < 0.01). Conclusions: This study highlights TRE as a feasible and practical dietary strategy for improving metabolic health in healthcare settings. However, further research and improved data capture are needed to explore long-term adherence, potential adverse effects, and the effectiveness of TRE across diverse patient populations.

Background: Western Australia's response to the COVID-19 pandemic was swift and effective in implementing public health protections and preventing the spread of the virus for the first 2 years. However, healthcare staff continued to be at increased risk of mental health concerns. Aims: To investigate the longitudinal patterns of post-traumatic stress symptoms (PTSS), depression and anxiety among healthcare workers in Western Australia, and the risk and protective factors associated with changes in status during the first wave. Method: Participants comprised 183 healthcare staff working at tertiary hospitals and major clinics across Perth, for whom longitudinal data were available. Questionnaire data were collected before Western Australia's first major COVID-19 community wave in early 2022 and following the first wave in late 2022. Online surveys comprised validated measures assessing psychological symptoms, risk and protective factors, and original measures of workplace factors. Results: Overall rates of PTSS, depression and anxiety remained stable across the two assessment points. However, latent growth models revealed that those with lower PTSS, depression or anxiety symptoms at baseline reported a larger increase in symptoms over time, and those with higher symptoms at baseline had a smaller decline over time, indicating a ‘catch-up’ effect. Workplace stressors, sleep difficulties and trauma exposure were key risk factors for changes in psychological symptoms from baseline, and workplace and social supports played protective roles. Conclusions: Improvements in systemic workplace factors are needed to support healthcare workers’ mental health during periods of acute stress, even in settings with high levels of emergency preparedness.

Background: Obesity and related metabolic health disorders are major clinical problems that have become increasingly prevalent worldwide. Aim: This before-after study examined the impact of therapeutic carbohydrate restriction (TCR) in managing metabolic health and promoting weight loss in a clinical setting using indirect calorimetry (IC). Setting: Data were collected from medical records obtained from a specialised allied health clinic focusing on metabolic health. Methods: The study analysed retrospective data from 202 overweight or obese participants (77% female, mean age 47.3) who received TCR as part of a behavioural modification programme involving multiple visits where their lifestyle, body composition and respiratory quotient (RQ), a key indicator of fat oxidation were recorded. Results: The study found that TCR improved fat oxidation in 84% of participants at short term visit (around 2 weeks), with an average weight loss of 1.8 kg. At medium term visit (around 12 weeks), 82% of participants maintained an increase in fat oxidation rate, with an average weight loss of 3.9 kg. In addition, among those with recorded body composition and waist circumference, 71% of weight lost was from fat, with an average reduction of 4.9 cm in waist measurements. Conclusion: This real-world study suggests that personalised TCR guided by IC can be an effective strategy for improving metabolic flexibility to help manage excess weight and related co-morbidities in a free-living population. Further research is needed to examine the long-term effects of TCR using this approach. Contribution: The utilisation of IC allows for the examination of individual shifts and improvements in metabolism among patients undergoing TCR.