Intake of total dietary sugar and fibre is associated with insulin resistance among Danish 8-10- and 14-16-year-old girls but not boys. European Youth Heart Studies I and II.

OBJECTIVE: To examine the dietary intake of total sugar, added sugar, non-added sugar and starch as well as dietary fibre and glycaemic index (GI) and their respective associations with insulin resistance. DESIGN: Mixed linear models were used to study both cross-sectional and prospective associations between carbohydrate components and insulin resistance separately in girls and boys. Diet was assessed by a single 24 h recall interview and insulin resistance was calculated using the homoestasis model assessment (HOMA). SETTING: The Danish part of the European Youth Heart Studies (EYHS) I and II. SUBJECTS: Girls and boys at 8-10 and 14-16 years from EYHS I (n 651) and 8-10-year-olds from baseline followed up 6 years later in EYHS II (n 233). RESULTS: Among girls, a difference in dietary total sugar of 43 g/MJ was associated with a 1 sd difference of HOMA and a difference in dietary fibre of -8 g/MJ was associated with a 1 sd difference of HOMA, independent of age, maturity and other confounders (both P = 0.03). No baseline associations were found among boys and no prospective associations were found in either sex. CONCLUSIONS: Dietary intake of total sugar may play an adverse role and fibre may play a beneficial role in concurrent insulin resistance among girls but not boys. Sex differences may be due to differences in maturity, physical activity, food patterns and selective reporting behaviours.

Improving motivation among primary health care workers in Tanzania: a health worker perspective

In Tanzania access to urban and rural primary health care is relatively widespread; yet there is evidence of considerable bypassing of services; questions have been raised about how to improve functionality. The aim of this study was to explore the experiences of health workers working in the primary health care facilities in Kilimanjaro Region; Tanzania; in terms of their motivation to work; satisfaction and frustration; and to identify areas for sustainable improvement to the services they provide. The primary issues arising pertain to complexities of multitasking in an environment of staff shortages; a desire for more structured and supportive supervision from managers; and improved transparency in career development opportunities. Further; suggestions were made for inter-facility exchanges; particularly on commonly referred cases. The discussion highlights the context of some of the problems identified in the results and suggests that some of the preferences presented by the health workers be discussed at policy level with a view to adding value to most services with minimum additional resources