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Previous research has found that music brings back more vivid and emotional autobiographical memories than various other retrieval cues. However, such studies have often been low in ecological validity and constrained by relatively limited cue selection and predominantly young adult samples. Here, we compared music to food as cues for autobiographical memories in everyday life in young and older adults. In two separate four‐day periods, 39 younger (ages 18–34) and 39 older (ages 60–77) adults recorded their music‐ and food‐evoked autobiographical memories in paper diaries. Across both age groups, music triggered more frequent autobiographical memories, a greater proportion of involuntary memories, and memories rated as more personally important in comparison to food cues. Age differences impacted music‐ and food‐evoked memories similarly, with older adults consistently recalling older and less specific memories, which they rated as more positive, vivid, and rehearsed. However, young and older adults did not differ in the number or involuntary nature of their recorded memories. This work represents an important step in understanding the phenomenology of naturally occurring music‐evoked autobiographical memories across adulthood and provides new insights into how and why music may be a more effective trigger for personally valued memories than certain other everyday cues. [ABSTRACT FROM AUTHOR]

Formula fed infants experience gastrointestinal infections at higher rates than breastfed infants, due in part to bacteria in powdered infant formula (PIF) and bacterial contamination of infant feeding equipment. The United Kingdom National Health Service (UK NHS) has adopted the World Health Organization recommendation that water used to reconstitute PIF is ≥70°C to eliminate bacteria. We used community science methods to co‐design an at home experiment and online questionnaire ('research diary') to explore the safety of PIF preparation compared to UK NHS guidelines. 200 UK‐based parents of infants aged ≤12 months were recruited; 151 provided data on PIF preparation, and 143 were included in the analysis of water temperatures used to reconstitute PIF. Only 14.9% (n = 11) of 74 PIF preparation machines produced a water temperature of ≥70°C compared with 78.3% (n = 54) of 69 kettle users (p < 0.001). The mean temperature of water dispensed by PIF preparation machines was 9°C lower than kettles (Machine M = 65.78°C, Kettle M = 75.29°C). Many parents did not always fully follow NHS safer PIF preparation guidance, and parents did not appear to understand the potential risks of PIF bacterial contamination. Parents should be advised that the water dispensed by PIF preparation machines may be below 70°C, and could result in bacteria remaining in infant formula, potentially leading to gastrointestinal infections. PIF labelling should advise that water used to prepare PIF should be ≥70°C and highight the risks of not using sufficiently hot water, per WHO Europe advice. There is an urgent need for stronger consumer protections regarding PIF preparation devices. Key points: Only 14.9% (n = 11) of 74 PIF preparation machines produced a water temperature of ≥70°C compared with 78.3% (n = 54) of 69 kettle users (p < 0.001).The mean temperature of water dispensed by PIF preparation machines was 9°C lower than kettles (Machine M = 65.78°C, Kettle M = 75.29°C).Most parents routinely washed and sterilised bottles and teats.Many parents did not always fully follow NHS safer PIF preparation guidance, including 21.8% washing their hands half the time or less, and 14.6% regularly pre‐preparing bottles.Most parents did not appear to understand the risks of PIF bacterial contamination. [ABSTRACT FROM AUTHOR]

The conceptual understanding that children display when predicting physical events has been shown to be inferior to the understanding they display when recognizing whether events proceed naturally. This has often been attributed to differences between the explicit engagement with conceptual knowledge required for prediction and the tacit engagement that suffices for recognition, and contrasting theories have been formulated to characterize the differences. Focusing on a theory that emphasizes omission at the explicit level of conceptual elements that are tacitly understood, the paper reports two studies that attempt clarification. The studies are concerned with 6- to 10-year-old children's understanding of, respectively, the direction (141 children) and speed (132 children) of motion in a horizontal direction. Using computer-presented billiards scenarios, the children predicted how balls would move (prediction task) and judged whether or not simulated motion was correct (recognition task). Results indicate that the conceptions underpinning prediction are sometimes interpretable as partial versions of the conceptions underpinning recognition, as the omission hypothesis would imply. However, there are also qualitative differences, which suggest partial dissociation between explicit and tacit understanding. It is suggested that a theoretical perspective that acknowledges this dissociation would provide the optimal framework for future research. [ABSTRACT FROM AUTHOR]

Abstract: Maternal eating behaviours such as cognitive restraint, uncontrolled, and emotional eating styles can have important implications for both maternal own weight, and the weight and eating behaviour of her children. Maternal eating style can affect her feeding interactions with her child, which in turn can influence their weight and eating behaviour. However, despite a body of research examining these relationships, research examining differences in maternal eating behaviour between ethnic groups is sparse with much of the research, particularly in the UK, conducted with White British samples. The aim of the current research was therefore to explore how maternal eating behaviour may differ between ethnic groups in the UK; 659 UK mothers with a child aged 5–11 years completed a self‐report questionnaire. Items included ethnicity, demographic data, and the 3‐factor eating questionnaire to measure maternal cognitive restraint, uncontrolled, and emotional eating. Mothers from Chinese backgrounds were significantly higher in cognitive restraint and lower in emotional and uncontrolled eating compared with all groups. Conversely, mothers from South Asian backgrounds were the highest in emotional and uncontrolled eating and lower in cognitive restraint than all other groups. Black mothers were also higher in uncontrolled eating compared with White British and Chinese mothers. Variations in maternal eating behaviours vary between ethnic groups. Understanding how cultural factors may influence these variations is important, as maternal eating behaviours can influence her own and her child's weight. Maternal eating behaviour may therefore be a contributor to higher levels of overweight among South Asian and Black children living in the UK. [ABSTRACT FROM AUTHOR]

Background There is some evidence that vocabulary intervention is effective for children, although further research is needed to confirm the impact of intervention within contexts of social disadvantage. Very little is known about the effectiveness of interventions to increase adolescent knowledge of cross-curriculum words. Aims To evaluate the effectiveness of an intervention programme designed to develop adolescents' knowledge of cross-curriculum words. Methods & Procedures Participants were 35 adolescents aged between 12 and 14 years who were at risk of educational underachievement with low scores on a range of assessments. Participants received a 10-week intervention programme in small groups, targeting 10 cross-curriculum words (e.g., 'summarize'). This was evaluated using a bespoke outcome measure (the Word Knowledge Profile). The study involved an AABA design, with a repeated baseline, delayed intervention cohort and blind assessment. Intervention included both semantic and phonological information about the target words and involved the adolescents using the words in multiple contexts. Outcomes & Results Results were promising and participants' knowledge of the targeted words significantly increased following intervention. Progress was demonstrated on the Word Knowledge Profile on the item requiring participants to define the word (for the summer intervention group only). This increase in depth of knowledge was seen on taught words but not on matched non-taught words. Conclusions & Implications Cross-curriculum words are not consistently understood by adolescents at risk of low educational attainment within a low socio-economic context. A 10-week intervention programme resulted in some increases to the depth of knowledge of targeted cross-curriculum words. [ABSTRACT FROM AUTHOR]

Background In the UK, the closure of 'long-stay' hospitals was accompanied by the development of community teams (CTs) to support people with intellectual disabilities (IDs) to live in community settings. The self-reported experiences of staff working in such teams have been neglected. Methods Focusing on a single county-wide service, comprising five multi-disciplinary and inter-agency CTs, we measured perceptions among the health care and care management Team members of (1) their personal well-being; (2) the functioning of their team; and (3) the organisation's commitment to quality, and culture. Results Almost three-quarters of the questionnaires were returned (73/101; 72%). The scores of health care practitioners and care managers were very similar: (1) the MBI scores of more than half the respondents were 'of concern'; (2) similarly, almost four in ten respondents' scores on the Vision scale of the TCI were 'of concern'; (3) the perceived commitment to quality (QIIS-II Part 2) was uncertain; and (4) the organisational culture (QIIS-II, Part 1) was viewed as primarily hierarchical. Discussion The perceived absence of a vision for the service, combined with a dominant culture viewed by its members as strongly focussed on bureaucracy and process, potentially compromises the ability of these CTs to respond proactively to the needs of people with IDs. Given the changes in legislation, policy and practice that have taken place since CTs were established, it would be timely to revisit their role and purpose. [ABSTRACT FROM AUTHOR]

Objectives Risk of development of dental fluorosis may increase with even a short-term increase in fluoride (F) intake during tooth formation. Considering the wide variations in F concentrations of different food and drinks, it is important to assess short-term differences in F intake and consequently fractional urinary F excretion (FUFE) in children, which provide an indication of F body burden. Therefore, the aim of this study was to investigate weekly variation in total daily F intake (TDFI) and its sources and fractional urinary F excretion (FUFE) in 4- to 6-year-olds living in a fluoridated area in the UK. Methods Sixty-one children were surveyed twice with a 1-week gap between surveys. Dietary F intake was assessed by 'food-diary' and 'duplicate-plate collection'. Toothbrushing expectorate (saliva/toothpaste) was collected to estimate F intake from toothpaste ingestion. TDFI was calculated from dietary F intake and toothpaste ingestion. Daily urinary F excretion (DUFE) was estimated by collecting 24-h urine samples and FUFE was calculated from DUFE and TDFI [FUFE = (DUFE/TDFI) × 100]. Results The overall mean TDFI, DUFE and FUFE for all children were 0.056 (SD 0.036) mg/kgbw/day, 0.018 (SD 0.007) mg/kgbw/day and 39 (SD 20)%, respectively. The mean (95% CI) difference between the 2 weeks studied was 0.004 (−0.004, 0.011) mg/kgbw/day for TDFI, 0.002 (−0.001, 0.004) mg/kgbw/day for DUFE and 1 (−6, 8)% for FUFE. Conclusions Mean TDFI and FUFE did not vary statistically significantly with week and therefore one set of data collection from a group of children living in a temperate climate could be sufficient to monitor F exposure and F body burden in community prevention programmes for oral health. [ABSTRACT FROM AUTHOR]

Do children attribute mortality and other life‐cycle traits to all minded beings? The present study examined whether culture influences young children's ability to conceptualize and differentiate human beings from supernatural beings (such as God) in terms of life‐cycle traits. Three‐to‐5‐year‐old Israeli and British children were questioned whether their mother, a friend, and God would be subject to various life‐cycle processes: Birth, death, ageing, existence/longevity, and parentage. Children did not anthropomorphize but differentiated among human and supernatural beings, attributing life‐cycle traits to humans, but not to God. Although 3‐year‐olds differentiated significantly among agents, 5‐year‐olds attributed correct life‐cycle traits more consistently than younger children. The results also indicated some cross‐cultural variation in these attributions. Implications for biological conceptual development are discussed. [ABSTRACT FROM AUTHOR]

Many people are confused about the nutritional role of potatoes in a healthy, balanced diet. Starchy foods are often under-regarded by the public and maligned by proponents of low carbohydrate diets, yet carbohydrate should supply around 50% of dietary energy, preferably from sources such as potatoes, pulses and wholegrains. Potatoes provide significant quantities of shortfall micronutrients, yet they do not count as vegetables in 5 A DAY targets. To provide balanced advice, research is needed on potato consumption and its possible nutritional consequences. Therefore we analysed individual dietary records from the N ational D iet and N utrition S urvey 2008-2012 to investigate potato consumption patterns and associations with nutrient intakes. We hypothesised that high consumption of potatoes would be associated with higher total intakes of potassium, B vitamins and fibre. Across the whole population, potatoes provided 7% of energy, 15% of potassium, 13% of dietary fibre (non-starch polysaccharide) and vitamin C, 14% of vitamin B6, 10% of folate, 8% of magnesium and 6% of iron. Both very low and very high consumption of potatoes ( Q1 and Q5) was associated with lower energy and nutrient intakes, compared with average consumers. Lower micronutrient intakes were most pronounced in Q5 (mean 14.8% energy from potatoes), although Q1 had lowest intakes of potassium, vitamin B6 and thiamin. Food intakes suggest a less healthy, varied dietary pattern among high potato consumers. Conversely, low consumers of potatoes had lower intakes of potassium, thiamin and vitamin B6 (all found in potatoes) despite an apparently health-conscious dietary pattern that included higher consumption of fruit, vegetables and fish. Our study suggests that based on current habits, a broad range of potato consumption is compatible with good nutrition, while high reliance on potatoes may be associated with an unbalanced diet. To help raise intakes of shortfall nutrients such as potassium and fibre, consumption of potatoes could be encouraged alongside existing healthy eating messages relating to vegetables, fruit and wholegrain foods. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Eating behavior traits measured in early life predict eating behavior and weight trajectories later in development, and may be associated with certain parental feeding behaviors. Our goal was to investigate the relationship between a range of feeding behaviors, and preschoolers' appetitive traits. Method Four hundred thirty-nine parents of UK 3-5 year olds completed scales measuring authoritarian vs. authoritative forms of limiting (Restriction vs. Monitoring) and promoting (Pressuring vs. Prompting) intake, as well as Emotional and Instrumental Feeding. Parents also completed scales measuring child Food responsiveness and Satiety responsiveness. Child BMI z-scores were calculated based on measured heights and weights. Results Parental Restriction was significantly associated with greater child Food responsiveness ( p < .001), but parental Monitoring was not. Parental Pressuring was significantly associated with greater child Satiety responsiveness ( p < .001), while parental Prompting was not. Parental Instrumental and Emotional feeding were both associated with greater child Food responsiveness ( p < .001). All relationships were independent of child BMI z-score. Discussion Prospective data are needed to determine whether the parent-child feeding relationships identified here promote, or protect against, the development of eating pathology in children. However, our results suggest that cross-sectional associations depend on the style (e.g., authoritarian vs. authoritative), as well as the type of feeding behavior measured. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:705-709) [ABSTRACT FROM AUTHOR]

Background There is limited evidence about the use of cone-beam computed tomography ( CBCT) in paediatric dentistry. Appropriate use of CBCT is particularly important because of greater radiation risks in this age group. Aim To survey the use of CBCT in children and young people in three Dental Hospitals in the United Kingdom ( UK), with special attention paid to aspects of justification and optimisation. Design Retrospective analysis of patient records over a 24-month period, looking at CBCT examinations performed on subjects under 18 years of age. Clinical indications, region of interest, scan field of view (FoV), incidental findings and exposure factors used were recorded. Results There were 294 CBCT examinations performed in this age group, representing 13.7% of all scanned patients. CBCT was used more frequently in the >13 year age group. The most common use was for localisation of unerupted teeth in the anterior maxilla and the detection of root resorption. Optimisation of X-ray exposures did not appear to be consistent. Conclusions When planning a CBCT service for children and young people, a limited FoV machine would be the appropriate choice for the majority of clinical requirements. It would facilitate clinical evaluation of scans, would limit the number of incidental findings and contribute to optimisation of radiation doses. [ABSTRACT FROM AUTHOR]

Background Although many children with Down syndrome experience hearing loss, there has been little research to investigate its impact on speech and language development. Studies that have investigated the association give inconsistent results. These have often been based on samples where children with the most severe hearing impairments have been excluded and so results do not generalize to the wider population with Down syndrome. Also, measuring children's hearing at the time of a language assessment does not take into account the fluctuating nature of hearing loss in children with Down syndrome or possible effects of losses in their early years. Aims To investigate the impact of early hearing loss on language outcomes for children with Down syndrome. Methods & Procedures Retrospective audiology clinic records and parent report for 41 children were used to categorize them as either having had hearing difficulties from 2 to 4 years or more normal hearing. Differences between the groups on measures of language expression and comprehension, receptive vocabulary, a narrative task and speech accuracy were investigated. Outcomes & Results After accounting for the contributions of chronological age and nonverbal mental age to children's scores, there were significant differences between the groups on all measures. Conclusions & Implications Early hearing loss has a significant impact on the speech and language development of children with Down syndrome. Results suggest that speech and language therapy should be provided when children are found to have ongoing hearing difficulties and that joint audiology and speech and language therapy clinics could be considered for preschool children. [ABSTRACT FROM AUTHOR]

Background Comorbidity among developmental disorders such as dyslexia, language impairment, attention deficit/hyperactivity disorder and developmental coordination disorder is common. This study explores comorbid weaknesses in preschool children at family risk of dyslexia with and without language impairment and considers the role that comorbidity plays in determining children's outcomes. Method The preschool attention, executive function and motor skills of 112 children at family risk for dyslexia, 29 of whom also met criteria for language impairment, were assessed at ages 3½ and 4½ years. The performance of these children was compared to the performance of children with language impairment and typically developing controls. Results Weaknesses in attention, executive function and motor skills were associated with language impairment rather than family risk status. Individual differences in language and executive function are strongly related during the preschool period, and preschool motor skills predicted unique variance (4%) in early reading skills over and above children's language ability. Conclusion Comorbidity between developmental disorders can be observed in the preschool years: children with language impairment have significant and persistent weaknesses in motor skills and executive function compared to those without language impairment. Children's early language and motor skills are predictors of children's later reading skills. [ABSTRACT FROM AUTHOR]

Early child development and the impact of parenting on later life are of global concern. The rise in child abuse and maltreatment in Japan suggests that measures to increase self-efficacy and reduce stress would benefit Japanese parents. In this study, we explored if Japanese parents attending a 123 Magic parenting program reported reduced stress and enhanced self-efficacy. Questionnaire data were collected from 49 mothers attending a parenting program conducted in public nursery schools in one prefecture in Japan. There were significant changes in parenting self-efficacy scores ( P < 0.001) and parenting stress scores ( P < 0.01). Focus groups with 16 parents also found that there were benefits to parents in terms of increased confidence and less stress. The findings provide support for the role of public health nurses in delivering group-based parenting support in Japan. [ABSTRACT FROM AUTHOR]

In three studies, we examined whether the anticipation of group-based guilt and shame inhibits in-group favoritism. In Studies 1 and 2, anticipated group-based shame negatively predicted in-group favoritism; in neither study did anticipated group-based guilt uniquely predict in-group favoritism. In Study 3, we orthogonally manipulated anticipated group-based shame and guilt. Here, we found that the shame (but not the guilt) manipulation had a significant inhibitory effect on in-group favoritism. Anticipated group-based shame (but not guilt) promotes egalitarian intergroup behavior. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Neuromuscular electrical stimulation (NMES) has shown to improve skeletal muscle strength and exercise capacity in stable patients with chronic obstructive pulmonary disease (COPD). Variations in NMES protocols are considerable. We aimed to compare changes in muscle strength after high-frequency and low-frequency NMES in patients admitted to hospital with an acute exacerbation of COPD. Methods Patients were referred for inpatient (IP) rehabilitation during hospitalisation for an acute worsening of their COPD. They received 30-minute daily NMES to both quadriceps at a frequency of 35 or 50 Hz. NMES intensity was titrated to patients' tolerance. Isometric quadriceps muscle strength and endurance walking (ESWT) time were measured at baseline and on hospital discharge. Results A total of 10 patients in each treatment group underwent NMES during hospitalisation (mean [SD] age 68.0 [±7.4] years, FEV1 0.99 L [±0.58], FEV1/FVC 47% [± 27%], MRC 5 [IQR ±1]). There were no significant differences in baseline characteristics between groups. Muscle strength (legs combined) increased in both groups regardless of the NMES frequency used (35 Hz - 3.8 ± 4.9; 50 Hz - 3.4 ± 5.5 kg). This was only significant within the 35 Hz group. The change in ESWT also showed a trend to increase in both groups (35 Hz - 109 ± 92.7; 50 Hz - 145.6 ± 94.7). There was no significant difference between groups for either outcome. Conclusion NMES is a feasible intervention to improve muscle strength in a cohort of patients admitted with an exacerbation of COPD. The response appears to be independent of the frequency used and both were well-tolerated. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Fruit and vegetable-rich diets are associated with a reduced cardiovascular disease ( CVD) risk. This protective effect may be a result of the phytochemicals present within fruits and vegetables ( F&V). However, there can be considerable variation in the content of phytochemical composition of whole F&V depending on growing location, cultivar, season and agricultural practices, etc. Therefore, the present study investigated the effects of consuming fruits and vegetables as puree-based drinks ( FVPD) daily on vasodilation, phytochemical bioavailability, antioxidant status and other CVD risk factors. FVPD was chosen to provide a standardised source of F&V material that could be delivered from the same batch to all subjects during each treatment arm of the study. Methods Thirty-nine subjects completed the randomised, controlled, cross-over dietary intervention. Subjects were randomised to consume 200 m L of FVPD (or fruit-flavoured control), daily for 6 weeks with an 8-week washout period between treatments. Dietary intake was measured using two 5-day diet records during each cross-over arm of the study. Blood and urine samples were collected before and after each intervention and vasodilation assessed in 19 subjects using laser Doppler imaging with iontophoresis. Results FVPD significantly increased dietary vitamin C and carotenoids ( P < 0.001), and concomitantly increased plasma α- and β-carotene ( P < 0.001) with a near-significant increase in endothelium-dependent vasodilation ( P = 0.060). Conclusions Overall, the findings obtained in the present study showed that FVPD were a useful vehicle to increase fruit and vegetable intake, significantly increasing dietary and plasma phytochemical concentrations with a trend towards increased endothelium-dependent vasodilation. [ABSTRACT FROM AUTHOR]

Medical Education 2012: 46: 711-721 Context Although medical students receive varied feedback throughout their training programmes, research demonstrates that they frequently perceive it as insufficient. However, supervisors tend to perceive that it is adequate. Students' responses to, and use of, feedback are not clearly understood. The purposes of this study were to investigate how medical students recognise, respond to and utilise feedback, and to determine whether there are maturational differences in understandings of the role of feedback across academic years in medical school. Methods This was a mixed-methods study collecting qualitative (focus group and open-ended questionnaire items) and quantitative (questionnaire) data across the 5 years of an undergraduate programme. Results A total of 68 students participated in 10 focus groups. The questionnaire response rate was 46% (564/1233). Data analysis investigated the students' perceptions of feedback and explored patterns of responses across the continuum of undergraduate medical school stages. Maturational differences among the year cohorts within the programme emerged in three general areas: (i) student perceptions of the purpose of feedback; (ii) student recognition of feedback, and (iii) student perceptions regarding the credibility of feedback providers. Conclusions Junior students generally perceived the receiving of feedback as a passive activity and preferred positive feedback that confirmed their progress and provided reassurance. More senior students viewed feedback as informing their specific learning needs and personal development. They valued immediate informal verbal feedback and feedback from peers and others, as well as that from senior teachers. Exploring students' progressive degrees of engagement with feedback and its relationship with self-esteem are subjects for further study. [ABSTRACT FROM AUTHOR]

The article reports on research which was conducted to investigate the pharmacokinetics of intranasal crushed oxycontin and intravenous oxycodone in nondependent prescription opioid abusers. Researchers evaluated eight healthy volunteers. They found that the intranasal and intravenous methods of delivery of the drugs resulted in the drugs getting into the subjects' bloodstreams faster than if they had been administered in tablet form and that all drug doses were well tolerated by subjects.

There is evidence of a small but significant proportion of adolescents engaging in doping practices. Young athletes face very specific pressures to achieve results as they strive for a career at an elite level. This study used an anonymized questionnaire to survey 403 (12-21 years old) talented young athletes' attitudes toward performance-enhancing substances and supplements. Two-thirds of the sample comprised males. Athletes were generally against the use of doping substances to enhance sporting performance. Within this generally unfavorable view, males tended to express a more permissive attitude toward performance-enhancing methods than females. Those convinced of the necessity of supplementation for sporting success were also more likely to express permissive attitudes. When asked whether they would take a 'magic' drug that, while undetectable, would significantly enhance performance, the overwhelming majority of athletes said 'no,' but many thought others would take the substance. Interestingly, there was a significant association between the projected use of the hypothetical drug by competitors and the individual respondent's willingness to take the hypothetically 'magic' substance. The study offers an insight into young athletes' attitudes toward specific forms of performance enhancement, and the strength of their beliefs in the face of a tempting hypothetical scenario. [ABSTRACT FROM AUTHOR]

Background: The risk of nutritional deficiency in children on restrictive dietary treatments and a lack of ketogenic diet (KD)-specific UK supplements raises concerns about micronutrient status. Vitamin A, E, zinc, selenium and magnesium levels were therefore examined in children with intractable epilepsy treated with the KD. Methods: Plasma vitamins A and E, zinc, selenium and magnesium levels were measured at baseline and after 3, 6 and 12 months on the classical ( n = 46) or medium chain triglyceride (MCT) ( n = 45) KD in children aged 2-16 years, as part of a randomised trial, and pairwise comparisons with baseline were performed. Results: Data were available from 91 children. From baseline to 12 months, mean plasma vitamin A decreased from 1.41 μmol L−1 to 1.13 μmol L−1 in the classical group ( P < 0.001) but increased from 1.52 μmol L−1 to 1.81 μmol L−1 in the MCT group ( P < 0.001). Mean plasma vitamin E increased from 22.7 μmol L−1 to 33.2 μmol L−1 in the classical group ( P < 0.001) and from 22.3 μmol L−1 to 23.3 μmol L−1 in the MCT group ( P < 0.05). No significant change in plasma zinc was seen at 12 months, although mean plasma selenium decreased from 0.95 μmol L−1 to 0.88 μmol L−1 in the group as a whole ( P < 0.05). Mean plasma magnesium decreased from 0.87 mmol L−1 to 0.83 mmol L−1 in the group as a whole ( P < 0.001); when subdivided by KD type, this was limited to the classical group. Conclusions: Changes in plasma vitamins A and E and the decline in magnesium status after 12 months of KD treatment suggest that micronutrient status may be suboptimal in this group and that available formulations for KD supplementation may need reviewing. [ABSTRACT FROM AUTHOR]

Medical Education 2011: 45: 1190-1198 Objectives Workplace-based assessment (WPBA) is an increasingly important part of postgraduate medical training and its results may be used as evidence of professional competence. This study evaluates the ability of WPBA to distinguish UK Foundation Programme (FP) doctors with training difficulties and its effectiveness as a surrogate marker for deficiencies in professional competence. Methods We conducted a retrospective observational study using anonymised records for 1646 trainees in a single UK postgraduate deanery. Data for WPBAs conducted from August 2005 to April 2009 were extracted from the e-portfolio database. These data included all scores submitted by trainees in FP years 1 and 2 on mini-clinical evaluation exercise (mini-CEX), case-based discussion (CbD), direct observation of procedural skills (DOPS) and mini-peer assessment tool (mini-PAT) assessments. Records of trainees in difficulty, as identified by their educational supervisors, were tagged as index cases. Main outcome measures were odds ratios (ORs) for associations between mean WPBA scores and training difficulties. Further analyses by the reported aetiology of the training difficulty (health-, conduct- or performance-related) were performed. Results Of the 1646 trainees, 92 had been identified as being in difficulty. Mean CbD and mini-CEX scores were lower for trainees in difficulty and an association was found between identified training difficulties and average scores on the mini-CEX (OR = 0.54; p = 0.034) and CbD (OR = 0.39; p = 0.002). A receiver operator characteristic curve analysis of mean WPBA scores for diagnosing 'in difficulty' status yielded an area under the curve of 0.64, indicating weak predictive value. There was no statistical evidence that mean scores on DOPS and mini-PAT assessments differed between the two groups. Conclusions Analysis of a large dataset of WPBA scores revealed significant associations between training difficulties and lower mean scores on both the mini-CEX and CbD. Models show that using WPBA scores is, however, not a valid way of screening for trainees in difficulty. Workplace-based assessments have value as formative assessments that prompt supervision, feedback and reflection. They should not be relied upon to certify competence and their use for such ends may reduce their effectiveness in training. Their results should be interpreted in the context of multiple other methods of assessment, with the aim of achieving a genuinely holistic and representative assessment of professional competence. [ABSTRACT FROM AUTHOR]

Medical Education 2011: 45: 1241-1250 Context Doctors do not follow guidance when managing their own health and illness. This behaviour may start at medical school. This study aimed to investigate whether inappropriate responses to illness are an issue for medical students and, if so, to identify the determinants of students' responses to illness. Methods We undertook a qualitative study using framework analysis to explore the views of medical students at two UK medical schools. Results Eight focus groups carried out with 35 medical students identified four main themes in students' cognitions about their intended behaviour: not using usual patient pathways; informal consultation; self-treatment, and keeping going when ill. The reasons or assumptions underlying these beliefs referred to: time and resources, including wider issues such as responsibility to colleagues; stigma and attitudes of others including regulatory bodies; beliefs about themselves in terms of taking on the patient role and issues relating to coping and self-sufficiency; the behaviour and attitudes of peers; patient safety considerations; patients' views about sick doctors; barriers to accessing care; the ease of self-care, and uncertainty about ability to self-care. Conclusions Many different factors related to medical students' beliefs about illness. Conflicts occur among student needs to be seen as competent and dedicated to medicine, to protect personal privacy, to maintain convenience, and to seek care appropriately in order to be fair on colleagues and protect the public. These conflicts were complicated by perceptions of the system, peers and doctors as unsupportive of ill health except by facilitating informal access to care. Beliefs underlying intentions are similar between doctors and medical students, but further research is needed to fully determine how and when these beliefs are formed. [ABSTRACT FROM AUTHOR]

Previous research has shown that regular breakfast cereal consumption is associated with better well-being (subjective reports of health and functioning). Digestive problems are also associated with reduced well-being, and given that consumption of breakfast cereals often improves digestive function, it is possible that the effect of breakfast cereal on well-being reflects better digestion in regular breakfast consumers. The present study examined this issue by conducting secondary analyses of a large community sample ( N = 14,952). Breakfast cereal consumption was measured using a five-point frequency scale (from never to everyday), and digestive disorders were measured by self-reports of problems such as constipation, indigestion and diarrhoea over the last year. Well-being measures included reports of general mental health, depression, anxiety and stress. The results showed that well-being scores (lower stress, anxiety, depression and mental health problems in general) were greater in those who consumed breakfast cereal on most days or every day. Digestive problems were also associated with higher stress levels, greater psychopathology in general and higher anxiety and depression scores. The effects of breakfast cereal consumption and digestive problems were independent, and further research is required to identify the mechanisms underlying these effects. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To assess the patterns of use, subjective effect profile and dependence liability of mephedrone, supported by corroborative urine toxicology. Design Cross-sectional structured telephone interview. Setting UK-based drug users associated with the dance music scene. Participants A total of 100 mephedrone users, recruited through their involvement with the dance music scene. Measurements Assessment of pattern of use, acute and after effects, DSM dependence criteria and gas chromatography-mass spectrometry urinalysis. Findings Mephedrone consumption results in typical stimulant-related subjective effects: euphoria, increased concentration, talkativeness, urge to move, empathy, jaw clenching, reduced appetite and insomnia. Thirty per cent of the sample potentially met criteria for DSM-IV dependence and there was evidence of a strong compulsion to use the drug (47% had used the drug for 2 or more consecutive days). Self-reported recent consumption of mephedrone was confirmed by toxicological analysis in all of the 14 participants who submitted a urine sample. Conclusion Mephedrone has a high abuse and health risk liability, with increased tolerance, impaired control and a compulsion to use, the predominant reported dependence symptoms. [ABSTRACT FROM AUTHOR]

Background: Perioperative oral supplementation has been shown to reduce post-operative complications. However, the use of preoperative standard oral supplements in a cohort of colorectal cancer patients has not been evaluated. The present study examined whether preoperative supplements are beneficial in this group. Methods: In a randomised controlled trial, patients were assigned to receive 400 mL of oral supplement and dietary advice or dietary advice alone. Primary outcome was the number of post-operative complications. One hundred and twenty-five patients were recruited (59 randomised to the intervention group and 66 to the control group) and nine were excluded. Results: In the intervention group, 24 (44%) patients had a complication compared to 26 (42%) in the control group ( P = 0.780). In the intervention and control groups, there were eight (15%) and 16 (25%) surgical site infections, respectively ( P = 0.140) and seven (13%) and 11 (17%) chest infections, respectively ( P = 0.470). Subgroup analysis for hypothesis generation included 83 (71%) weight-losing patients, where there was a significant reduction in surgical site infections using the Buzby definition ( P = 0.034), although this was not the case for the Centre for Disease Control definition ( P = 0.052). Conclusions: There was no evidence that preoperative supplements were beneficial in reducing the number of complications, although there may be some benefit for surgical site infections in selected weight-losing preoperative patients. [ABSTRACT FROM AUTHOR]

Background: Emerging evidence indicates that the consumption of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) may result in symptoms in some patients with irritable bowel syndrome (IBS). The present study aimed to determine whether a low FODMAP diet is effective for symptom control in patients with IBS and to compare its effects with those of standard dietary advice based on the UK National Institute for Health and Clinical Excellence (NICE) guidelines. Methods: Consecutive patients with IBS who attended a follow-up dietetic outpatient visit for dietary management of their symptoms were included. Questionnaires were completed for patients who received standard ( n = 39) or low FODMAP dietary advice ( n = 43). Data were recorded on symptom change and comparisons were made between groups. Results: In total, more patients in the low FODMAP group reported satisfaction with their symptom response (76%) compared to the standard group (54%, P = 0.038). Composite symptom score data showed better overall symptom response in the low FODMAP group (86%) compared to the standard group (49%, P < 0.001). Significantly more patients in the low FODMAP group compared to the standard group reported improvements in bloating (low FODMAP 82% versus standard 49%, P = 0.002), abdominal pain (low FODMAP 85% versus standard 61%, P = 0.023) and flatulence (low FODMAP 87% versus standard 50%, P = 0.001). Conclusions: A low FODMAP diet appears to be more effective than standard dietary advice for symptom control in IBS. [ABSTRACT FROM AUTHOR]

Background: Weight loss in patients with cancer is common and associated with a poorer survival and quality of life. Benefits from nutritional interventions are unclear. The present study assessed the effect of dietary advice and/or oral nutritional supplements on survival, nutritional endpoints and quality of life in patients with weight loss receiving palliative chemotherapy for gastrointestinal and non-small cell lung cancers or mesothelioma. Methods: Participants were randomly assigned to receive no intervention, dietary advice, a nutritional supplement or dietary advice plus supplement before the start of chemotherapy. Patients were followed for 1 year. Survival, nutritional status and quality of life were assessed. Results: In total, 256 men and 102 women (median age, 66 years; range 24-88 years) with gastrointestinal ( n = 277) and lung ( n = 81) cancers were recruited. Median (range) follow-up was 6 (0-49) months. One-year survival was 38.6% (95% confidence interval 33.3-43.9). No differences in survival, weight or quality of life between groups were seen. Patients surviving beyond 26 weeks experienced significant weight gain from baseline to 12 weeks, although this was independent of nutritional intervention. Conclusions: Simple nutritional interventions did not improve clinical or nutritional outcomes or quality of life. Weight gain predicted a longer survival but occurred independently of nutritional intervention. [ABSTRACT FROM AUTHOR]

Background: While there is considerable evidence of income gradients in child and adolescent behaviour problems, evidence relating to children and young people's emotional difficulties is more mixed. Older studies reported no income differentials, while recent reports suggest that adolescents from low-income families are more likely to experience emotional difficulties than their more affluent peers. Methods: We compared the association between low- versus medium-/high-family income and parent-reported emotional difficulties in 15- and 16-year-olds in three large nationally representative cohorts studied in 1974, 1986 and 1999/2004. We then examined whether increases in the income differential could be accounted for by changes in the association of a range of sociodemographic factors (family type or size, maternal education or housing tenure) with either family income or emotional difficulties. Finally, in the most recent cohorts, we considered whether the effects of these sociodemographic variables were mediated by more proximal family factors (maternal distress, stressful life events or family dysfunction). Results: An increasing income differential in adolescent emotional problems emerged over the period, with standardized coefficients for associations with low income increasing from .07 in 1974 and 1986 to .30 in 1999/2004. This was due partially (∼10%) to sociodemographic risk factors for emotional difficulties becoming more strongly associated with low-income families over time, and partially (∼40%) to the increasing impact of these risk factors. In the most recent cohorts, about 40% of the effects of sociodemographic risks appear to have been mediated by more proximal family factors. Conclusions: These findings have implications for our understanding of the health burden of emotional problems, recognition of the health burden associated with inequality and public concern about the consequences of social change. [ABSTRACT FROM AUTHOR]

Background: The low level of response (LR) to alcohol is one of several genetically influenced characteristics that increase the risk for heavy drinking and alcohol problems. Efforts to understand how LR operates through additional life influences have been carried out primarily in modest-sized U.S.-based samples with limited statistical power, raising questions about generalizability and about the importance of components with smaller effects. This study evaluates a full LR-based model of risk in a large sample of adolescents from the United Kingdom. Methods: Cross-sectional structural equation models were used for the approximate first half of the age 17 subjects assessed by the Avon Longitudinal Study of Parents and Children, generating data on 1,905 adolescents (mean age 17.8 years, 44.2% boys). LR was measured with the Self-Rating of the Effects of Alcohol Questionnaire, outcomes were based on drinking quantities and problems, and standardized questionnaires were used to evaluate peer substance use, alcohol expectancies, and using alcohol to cope with stress. Results: In this young and large U.K. sample, a low LR related to more adverse alcohol outcomes both directly and through partial mediation by all 3 additional key variables (peer substance use, expectancies, and coping). The models were similar in boys and girls. Conclusions: These results confirm key elements of the hypothesized LR-based model in a large U.K. sample, supporting some generalizability beyond U.S. groups. They also indicate that with enough statistical power, multiple elements contribute to how LR relates to alcohol outcomes and reinforce the applicability of the model to both genders. [ABSTRACT FROM AUTHOR]