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Objective: The purpose of this study was to evaluate the effectiveness of a peer coaching smoking cessation program in a high‐risk Medicaid population. Design and Sample: In this manuscript, we present an evaluation of a pilot program. Participants (N = 138) were recruited out of a larger smoking cessation program administered statewide and funded by the Center for Medicare and Medicaid Services. The participant sample was diverse, with 52% self‐identifying as White, 39% as Black, and 56% Latino ethnicity (any race). Methods: Motivational interviewing techniques were utilized by peer coaches in clinical and community settings to achieve smoking cessation using face‐to‐face, telephone, and text/email encounters over a period of 6 months. Results: There was a statistically significant increase in the number of participants who had quit smoking from program enrollment to discharge (5.1%–18.5%, p = 0.02). Number of peer coaching encounters predicted quitting in program participants. Conclusions: This study adds to the literature that community‐based smoking cessation services led by peer coaches can be effective in a diverse, high‐risk population. [ABSTRACT FROM AUTHOR]

Statistical power, or the "true positive" rate in significance testing, is a valuable and important concept in study design. Poststudy Power Post hoc power (also known as observed power) is, as the name implies, a post hoc concept. Figure 1 illustrates this by showing the 1:1 relationship between observed power and the I P i value of results with a two-sided I z i -test. GLO:8NET/01apr21:pmrj12476-fig-0001.jpg PHOTO (COLOR): 1 The relationship between post hoc power and the observed P value, for a two-sided z-test with an alpha threshold of.05. [Extracted from the article]

The difference in the energy consumption, 19.2 kcal (a 3% reduction), was not statistically significant, as the point of equivalence (0 kcal) was included in the wide 95% confidence interval (CI) (-76.5 to 115.0 kcal). Kosite et al concluded that they were not able to find any clear evidence of an effect of plate size on energy consumption. There is also the possibility that the trial was actually underpowered to see an effect; although a 3% difference in energy intake may not seem like much, Kosite et al believed that, over time, such a difference would still be clinically meaningful regarding weight maintenance. They very clearly stated that although the trial itself did not show a statistically significant effect of a smaller plate size, there may still be a relevant effect in terms of either reducing or increasing energy intake. [Extracted from the article]

Abstract: Background: Necrotising enterocolitis (NEC) is one of the most common life‐threatening emergencies of the gastrointestinal tract in preterm neonates. The present study aimed to determine the efficacy of oropharyngeal colostrum with respect to reducing NEC in preterm neonates. Methods: A literature search was conducted for various randomised control trials by searching the Cochrane Central Register of Controlled Trials, PubMed, EMBASE and ongoing clinical trials. Randomised or quasi‐randomised trials comparing oropharyngeal colostrum versus placebo in neonates (birthweight ≤ 1500 g or gestational age ≤ 32 weeks) were included in the review. The methodological quality of each trial was independently reviewed by the authors. For categorical and continuous variables, typical estimates for relative risk and typical estimates for weighted mean difference were calculated, respectively. A random effect model was assumed for meta‐analysis. Results: In total, four eligible trials were included in the review. Oropharyngeal colostrum therapy was not associated with a statistically significant reduction in the incidence of NEC stage ≥2 [typical relative risk (RR) = 0.64; 95% confidence interval (CI) = 0.27–1.49], mortality from any cause (typical RR = 0.86; 95% CI = 0.15–4.80) and time to reach full feed [typical weighted mean difference (WMD) = −3.26; 95% CI = −8.87 to 2.35]. Duration of hospital stay was significantly less in the control group (typical WMD = 9.77; 95% CI = 3.96–15.59). Conclusions: The current evidence is insufficient for recommending oropharyngeal colostrum as a routine clinical practice in the prevention of NEC. We emphasise the need for large randomised controlled trials with an adequate sample size and validated clinical outcomes in preterm neonates. [ABSTRACT FROM AUTHOR]

Abstract: Improving infant and young child feeding practices is critical for improving growth and reducing child mortality and morbidity. This paper aims to compare predictors of minimum dietary diversity, an important indicator of adequate complementary feeding practices, in Bangladesh in 2011 and 2014. The 2011 and 2014 Bangladesh Demographic and Health Survey were used to examine predictors of minimum dietary diversity among 6–23 months. An additional analysis was conducted for the 18–23‐month group, because a significant increase in meeting minimum dietary diversity recommendations was seen in this age group only. Factors found to be associated with practices were compared across time points. In 2011, minimum dietary diversity was 23.8% and increased to 28.8% in 2014. Among children 18–23 months, in 2011, minimum dietary diversity was 32.5% and increased to 42.8% in 2014. Among all children, wealth, education, exposure to media, and antenatal care were significant predictors of dietary diversity. In the 18–23‐month age group, significant predictors in 2011 were wealth and decision making. In 2014, significant predictors were education and exposure to media. Demographic trends indicated a significant increase in education and exposure to media between 2011 and 2014. As these were significant for minimum dietary diversity in 2014 overall and for 18–23 months, they might be important targets of future interventions, specifically utilizing media channels and tailoring special strategies for women with low education and limited exposure to media. [ABSTRACT FROM AUTHOR]

Physiological or performance tests are routinely utilised to assess athletes’ recovery. At present, the ideal tool to assess recovery remains unknown. Therefore, the aim of this systematic review was to examine the change in creatine kinase (CK) and neuromuscular function as measured via a countermovement jump (CMJ) following a match in the contact codes of football. A comprehensive search of databases was undertaken with RevMan (V 5.3) used for statistical analysis. Our results demonstrated that CK pre- versus post-match (standardised mean difference (SMD) = 0.90, 95% CI = 0.50 to 1.31, p < .0001), CK pre- versus 24 h post-match (SMD = 1.50, 95% CI = 1.12 to 1.88, p < .00001), and CK pre- versus 48 h post-match all increased significantly (SMD = 0.90, 95% CI = 0.50 to 1.31, p < .0001), while CMJ peak power (PP) pre- versus post-match (SMD = −0.59, 95% CI = −1.12 to −0.06, p = .03), and pre- versus 24 h post-match (SMD = −0.80, 95% CI = −1.31 to −0.28, p = .002) decreased significantly. There was a significant relationship between the change in CK and the change in CMJ PP from immediately pre to immediately post (r = −0.924, p = .025), and between CMJ immediately following a match and 24 h CK change (r = −0.983, p = .017). In conclusion, CK levels increase and performance in the CMJ decreases following a match of a contact code of football. The identification of this relationship may allow coaching staff to implement a standalone measure of recovery. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies have suggested that hypertension in HIV‐positive individuals is associated primarily with traditional risk factors such as older age, diabetes and dyslipidaemia. However, controversy remains as to whether exposure to antiretroviral (ARV) drugs poses additional risk, and we investigated this question in the Data Collection on Adverse Events of Anti‐HIV Drugs (D:A:D) cohort. Methods: The incidence of hypertension [systolic blood pressure (BP) > 140 and/or diastolic BP > 90 mmHg and/or initiation of antihypertensive treatment] was determined overall and in strata defined by demographic, metabolic and HIV‐related factors, including cumulative exposure to each individual ARV drug. Predictors of hypertension were identified using uni‐ and multivariable Poisson regression models. Results: Of 33 278 included persons, 7636 (22.9%) developed hypertension over 223 149 person‐years (PY) [incidence rate: 3.42 (95% confidence interval (CI) 3.35–3.50) per 100 PY]. In univariable analyses, cumulative exposure to most ARV drugs was associated with an increased risk of hypertension. After adjustment for demographic, metabolic and HIV‐related factors, only associations for nevirapine [rate ratio 1.07 (95% CI: 1.04–1.13) per 5 years] and indinavir/ritonavir [rate ratio 1.12 (95% CI: 1.04–1.20) per 5 years] remained statistically significant, although effects were small. The strongest independent predictors of hypertension were male gender, older age, black African ethnicity, diabetes, dyslipidaemia, use of lipid‐lowering drugs, high body mass index (BMI), renal impairment and a low CD4 count. Conclusions: We did not find evidence for any strong independent association between exposure to any of the individual ARV drugs and the risk of hypertension. Findings provide reassurance that screening policies and preventative measures for hypertension in HIV‐positive persons should follow algorithms used for the general population. [ABSTRACT FROM AUTHOR]

Abstract: Background: Many children in developed countries do not receive recommended vaccines on time. However, knowledge about factors related to timeliness remains limited. Quantifying the relative impact of parental attitudes compared with socio‐demographic factors for delayed immunization would inform policy responses. Methods: Participants in the nationally representative Longitudinal Study of Australian Children were matched with their vaccination histories in the Australian Childhood Immunisation Register (N = 4,121). Information about the children and their families were collected in face‐to‐face interviews in 2003–2004. We considered whether children had completed the primary course for each recommended antigen due by 6 months old. Children were categorized as either fully immunized, delayed, or totally non‐immunized. The outcome was examined using logistic regression. Population attributable fractions were estimated for key predictors. Results: Delayed immunization was significantly associated with indicators of social disadvantage as well as parental disagreement with immunization. Attributable fractions for delayed immunization included lone motherhood (3.8%; 95% confidence interval CI [0.8, 6.7]), larger family size (39.5%; 95% CI [31.2, 46.8]), residential mobility (3.3%; 95% CI [0.1, 6.5]), lack of private hospital insurance (9.4%; 95% CI [0.7, 17.3]), a medical condition in the child (2.0%; 95% CI [0.2, 3.9]), and parental disagreement with immunization (2.1%; 95% CI [0.3, 3.9]). Conclusions: Parental attitudes accounted for a relatively small percentage of delayed infant immunization. In contrast, many children who did not receive vaccines on time were characterized by social disadvantage, especially larger family size. Researchers and policy‐makers should consider how to make timely immunization easier for busy parents. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to systematically evaluate the effectiveness of low level laser therapy (LLLT) as an adjunct to connective tissue graft (CTG) procedure for the treatment of gingival recession (GR). Materials and Methods: The addressed PICO question was; "In patients with Miller Class I or II recession defects (Population), what is the effect of LLLT as adjunct to CTG (Intervention) in comparison to CTG alone (Comparison) on gingival recession depth (Outcome)" Electronic databases were searched up to December 2017. Primary outcomes included gingival recession depth (GRD), whereas secondary outcomes were width of keratinized tissue (WKT) and relative clinical attachment level gain (RCAL). The weighted mean differences (WMD) of outcomes and 95% confidence intervals (CI) for each variable were calculated using random effect model. Results: Four randomized clinical studies were included. Two studies showed significantly greater improvements with LLLT whereas, 2 studies showed comparable outcomes between LLLT and CTG group. Considering the effects of adjunctive LLLT as compared to CTG, a high degree of heterogeneity for GRD (Q value = 9.40, P = .02, I2 =68.11%) and WKT ((Q value = 16.04, P = .001, I2 =81.31%) was noticed among both the groups. Meta‐analysis showed a statistically significant GRD (WMD= −0.61, 95% CI= −1.23 to 0.004, P = .05) for LLLT + CTG treatment versus CTG alone only. Conclusions: LLLT improves clinical and patient‐centered outcomes of CTG procedures for the treatment of GR remains debatable. However, due to the small number of included studies and high heterogeneity in the laser parameters, precautions must be exercised when interpreting the results of the present systematic review. Clinical Significance: Gingival recessions in dentistry are of major esthetic concern. Minimal gingival recessions can be treated by flap operations, but the predictability and stability of the outcomes is debatable. In the present review, low level laser therapy (LLLT) adjunct to connective tissue graft (CTG) depicted a significant improvement in the predictability and stability of root coverage outcomes compared with CTG alone. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Elevated human chorionic gonadotropin (HCG) and alpha fetoprotein (AFP) have been linked to placental dysfunction and associated morbidities. We aimed to compare the induction of labor with expectant management at term in those pregnancies for the prevention of neonatal and maternal morbidities. Methods: Women with second trimester HCG ≥ 2 and/or AFP ≥ 2 multiples of the median, without additional maternal or fetal complications, from their 38th gestational week were offered the choice of labor induction or expectant management. The primary outcomes were maternal composite outcome (composed of cesarean deliveries, pre‐eclampsia or placental abruption) and neonatal composite outcome (composed of antenatal or neonatal death, Apgar score at 5 min < 7, admission to the neonatal intensive care unit, need for phototherapy, respiratory abnormalities, birth trauma or neonatal infection). Results: Of 305 women, 124 women chose to undergo labor induction, and 181 women chose expectant management. The composite maternal outcome in the expectant management group was twice the rate of the labor induction group, although it did not reach statistical significance (18 [10%] vs 6 [5%]; P = 0.1; relative risk [expectant/induced] 2.04; 95% confidence interval 0.8–5.0). Increased rate of phototherapy led to increased neonatal composite outcomes in the labor induction group compared with the expectant management group (34 [27%] vs 27 [15%], respectively = 0.007). Conclusion: In pregnancies with elevated AFP and/or HCG, early term labor induction initiated a trend towards improvement in maternal outcome but increased the rate of mild neonatal morbidity. The statistical insignificance of the large effect on the maternal outcome might reflect the lack of statistical power. Further research is needed to address this limitation. [ABSTRACT FROM AUTHOR]

Abstract: Background: Despite regular criticisms of null hypothesis significance testing (NHST), a focus on testing persists, sometimes in the belief to get published and sometimes encouraged by journal reviewers. This paper aims to demonstrate known key limitations of NHST using simple nontechnical illustrations. Design: The first illustration is based on simulated data of 20 000 studies that compare two groups for an outcome event. The true effect size (difference in event rates) and sample size (20‐100 per group) were varied. The second illustration used real data from a meta‐analysis on alpha‐blockers for the treatment of ureteric stones. Results: The simulations demonstrated the large between‐study variability in P‐values (range between <.0001 and 1 for most simulation conditions). A focus on statistically significant effects (P < .05), notably in small to moderate samples, led to strongly overestimated effect sizes (up to 240%) and many false‐positive conclusions, that is statistically significant effects that were, in fact, true null effects. Effect sizes also exerted strong between‐study variability, but confidence intervals accounted for this: the interval width decreased with larger sample size, and the percentage of intervals that contained the true effect size was accurate across simulation conditions. Reducing alpha level, as recently suggested, reduced false‐positive conclusions but strongly increased the overestimation of significant effects (up to 320%). Conclusions: Researchers and journals should abandon statistical significance as a pivotal element in most scientific publications. Confidence intervals around effect sizes are more informative, but should not merely be reported to comply with journal requirements. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To assess the predictive ability of a genetic risk score for the incidence of Type 2 diabetes in a general Japanese population. Methods: This prospective case–control study, nested within a Japan Public Health Centre‐based prospective study, included 466 participants with incident Type 2 diabetes over a 5‐year period (cases) and 1361 control participants, as well as 1463 participants with existing diabetes and 1463 control participants. Eleven susceptibility single nucleotide polymorphisms, identified through genome‐wide association studies and replicated in Japanese populations, were analysed. Results: Most single nucleotide polymorphism loci showed directionally consistent associations with diabetes. From the combined samples, one single nucleotide polymorphism (rs2206734 at CDKAL1) reached a genome‐wide significance level (odds ratio 1.28, 95% CI 1.18–1.40; P = 1.8 × 10–8). Three single nucleotide polymorphisms (rs2206734 in CDKAL1, rs2383208 in CDKN2A/B, and rs2237892 in KCNQ1) were nominally significantly associated with incident diabetes. Compared with the lowest quintile of the total number of risk alleles, the highest quintile had a higher odds of incident diabetes (odds ratio 2.34, 95% CI 1.59–3.46) after adjusting for conventional risk factors such as age, sex and BMI. The addition to the conventional risk factor‐based model of a genetic risk score using the 11 single nucleotide polymorphisms significantly improved predictive performance; the c‐statistic increased by 0.021, net reclassification improved by 6.2%, and integrated discrimination improved by 0.003. Conclusions: Our prospective findings suggest that the addition of a genetic risk score may provide modest but significant incremental predictive performance beyond that of the conventional risk factor‐based model without biochemical markers. [ABSTRACT FROM AUTHOR]

Abstract: Aim: We aimed to determine the prospective association between baseline triglyceridaemic–waist phenotypes and diabetic mellitus incidence in individuals with impaired fasting glucose seen in primary care. Methods: A cohort of 1101 participants (84.4% of the recruited individuals) with impaired fasting glucose were recruited from three primary care clinics during regular follow‐ups to monitor their chronic conditions. Baseline triglyceridaemic–waist phenotypes were divided into four groups: (1) normal waistline and triglyceride level (n = 252); (2) isolated central obesity (n = 518); (3) isolated high triglyceride level (n = 80); and (4) central obesity with high triglyceride level (i.e. hypertriglyceridaemic–waist phenotype) (n = 251). The presence of diabetes at follow‐up was determined by fasting plasma glucose (≥ 7.0 mmol/l) and/or 2‐h 75‐g oral glucose tolerance test (≥ 11.1 mmol/l) and/or HbA1c (47.5 mmol/mol; ≥ 6.5%) according to American Diabetes Association diagnostic criteria. Multivariable Cox proportional hazards regressions were established to assess the impact of different triglyceridaemic–waist phenotypes on time to diabetes onset. Results: After a mean follow‐up period of 6.5 months ( sd 4.7 months), the number of diabetes cases was significantly higher in the group with hypertriglyceridaemic–waist phenotype (52.2%) compared with the other three phenotype groups (group 1: 28.2%; group 2: 34.6%; group 3: 30.0%). Only the hypertriglyceridaemic–waist phenotype showed an increased risk of developing diabetes (hazard ratio 1.581, 95% CI 1.172–2.134; P = 0.003) compared with the group with normal waistline and triglyceride level after controlling for confounders. Conclusions: The combination of central obesity and hypertriglyceridaemia is associated with > 50% risk of progression to diabetes within 6 months among individuals with impaired fasting glucose seen in primary care. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The aim of this study was to verify the effects of a multisensory exercise programme on the cognition and functionality of institutionalized older adults. Methods: Forty‐five volunteers were randomly allocated to 2 groups, the multisensory exercise programme (n = 24) and the control group that received no treatment (n = 21). The programme consisted of 3 50‐min sessions of progressive exercises per week for 16 weeks that challenged their strength, balance, coordination, multisensory stimulation, and flexibility in different tasks. Cognition (Montreal Cognitive Assessment), balance (Berg Scale), mobility (Timed Up and Go), and functional performance (Physical Performance Test) were measured preintervention and postintervention. Statistical analyses were performed using Student's t test and 2‐way ANOVA. Results: The multisensory exercise programme showed statistically significant improvements (p < .05) on cognition (effect size [ES]: 0.92), balance (ES: 0.77), mobility (ES: 0.51), and functional performance (ES: 0.86) as compared with the control group, which showed no statistical significant differences at the postintervention time point. Conclusions: The multisensory exercise programme improved the cognition and functionality of institutionalized older adults. The introduction of a motor and multisensory‐based approach in care routines may improve residents' health and engagement to the environment. [ABSTRACT FROM AUTHOR]

Abstract: Background: Although a contributory role of vitamin D levels for the development of chronic hepatitis C has been suggested, the efficacy of vitamin D supplementation in combination with conventional antiviral therapy consisting of pegylated interferon‐α (Peg‐IFN‐α) injection and oral ribavirin (RBV) remains unclear. We investigated its efficacy in the treatment of chronic hepatitis C via a meta‐analysis of randomised controlled trials. Methods: We searched PubMed, EMBASE, the Cochrane Library, ClinicalTrials.gov and the bibliographies of relevant articles to locate additional publications in September 2016. Three evaluators independently reviewed and selected eligible studies based on predetermined selection criteria. Results: Of 522 articles meeting our initial criteria, a total of seven open‐label, randomised controlled trials involving 548 participants, were included in the final analysis. Vitamin D supplementation in combination with Peg‐IFN‐α injection and oral RBV significantly increased the rate of viral response for hepatitis C at 24 weeks after treatment in a random‐effects meta‐analysis (relative risk = 1.30; 95% confidence interval = 1.04–1.62; I2 = 75.9%). Also, its significant efficacy was observed in patients with hepatitis C virus genotype 1, which is known to be refractory to antiviral therapy. Conclusions: In summary, we observed that additional use of vitamin D has a positive effect on sustained viral response rates of patients with chronic hepatitis C infection. However, we cannot establish the efficacy because of substantial heterogeneity, a small sample size and a low methodological quality. [ABSTRACT FROM AUTHOR]

The aim of the study was to determine whether estimates of the speed-duration relationship are affected using different timetrial (TT) field-based testing protocols, where exhaustive times were located within the generally recommended durations of 2-15 min. Ten triathletes (mean ± SD age: 31.0 ± 5.7 years; height: 1.81 ± 0.05 m; body mass: 76.5 ± 6.8 kg) performed two randomly assigned field tests to determine critical speed (CS) and the total distance covered above CS (D'). CS and D' were obtained using two different protocols comprising three TT that were interspersed by 60 min passive rest. The TTs were 12, 7, and 3 min in Protocol I and 10, 5, and 2 min in Protocol II. A linear relationship of speed vs. the inverse of time (s = D'×1/t + CS) was used to determine parameter estimates. Significant differences were found for CS (p = 0.026), but not for D' (p = 0.123). The effect size for CS (d = 0.305) was considered small, while that for D' was considered moderate (d = 0.742). CS was significantly correlated between protocols (r = 0.934; p < 0.001), however, no correlation was found for D' (r = 0.053; p = 0.884). The 95% limits of agreement were ±0.28m s-1and ±73.9 m for CS and D', respectively. These findings demonstrate that the choice of exhaustive times within commonly accepted durations results in different estimates of CS and D', and thus protocols cannot be used interchangeably. The use of a consistent protocol is therefore recommended, when investigating or monitoring the speed-duration relationship estimates in well-trained athletes. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the incidence and risk factors of deep surgical site infection (DSSI) during hospitalisation after closed tibial plateau fractures treated with open reduction and internal fixation (ORIF). We performed this retrospective study at a university‐affiliated hospital with an advanced trauma centre. The data of adult patients with closed tibial plateau fractures treated with ORIF from January 2012 to February 2017 were extracted from the electronic medical records. Demographics, injury‐related and surgery‐related variables of DSSI and non‐DSSI groups were compared by univariate test. Multivariate logistic analysis models were used to investigate the independent risk factors. In total, 676 patients with complete data met the inclusion criteria and were included, and of them, 17 developed DSSI (2.51%) during hospitalisation. Approximately 60% (9/17) of DSSI was caused by Staphylococcus aureus. Compared to the non‐DSSI group, DSSI patients had a significantly longer stay in hospital (25.8 vs 15.2 days). Independent risk factors of DSSI identified by multivariate analysis were higher BMI (>26.0) (OR, 1.58; 95% CI, 1.09 to 3.27; P = 0.032), prolonged surgical duration (>138 min) (OR, 4.26; 95% CI, 1.54 to 11.19; P = 0.005) and current smoking (OR, 3.42; 95% CI, 1.47 to 8.62; P = 0.01). A relatively low incidence rate of DSSI (2.51%) was found in this study, and several significant risk factors were identified. Smoking cessation programmes should be implemented immediately after hospitalisation, especially for obesity and morbid obesity patients. Detailed and comprehensive preoperative assessment and a considerate operative plan should be guaranteed to reduce surgical duration. [ABSTRACT FROM AUTHOR]

Preventing intraoperatively acquired pressure ulcers (IAPUs) in patients undergoing spinal surgery in the prone position using a Relton‐Hall frame is challenging. We investigated the efficacy of soft silicone foam dressings in preventing IAPUs. A prospective dual‐center sham study was conducted among patients undergoing elective spinal surgery in a general hospital and a university hospital in Japan. The incidence of IAPUs that developed when soft silicone foam dressings and polyurethane film dressings were used was compared on two sides in the same patient. IAPUs developed on the chest in 11 of 100 patients (11%). Polyurethane film dressings were associated with a significantly higher rate of IAPUs than soft silicone foam dressings (11 versus 3, P = 0·027). A multivariate logistic regression analysis revealed that a diastolic blood pressure of <50 mmHg (P = 0·025, OR 3·74, 95% confidence interval [CI] 1·18–13·08) and the length of surgery (by 1 hour: P = 0·038, OR 1·61, 95% CI 1·03–2·64) were independently associated with the development of IAPUs. The use of soft silicone foam dressings reduced the risk of IAPUs (P = 0·019, OR 0·23, 95% CI 0·05–0·79) and was more effective than film dressings for preventing IAPUs in spinal surgery patients. [ABSTRACT FROM AUTHOR]

The positive effects of caffeine ingestion on aerobic performance are well-established; however, recent findings are suggesting that caffeine ingestion might also enhance components of anaerobic performance. A commonly used test of anaerobic performance and power output is the 30-second Wingate test. Several studies explored the effects of caffeine ingestion on Wingate performance, with equivocal findings. To elucidate this topic, this paper aims to determine the effects of caffeine ingestion on Wingate performance using meta-analytic statistical techniques. Following a search through PubMed/MEDLINE, Scopus, and SportDiscus®, 16 studies were found meeting the inclusion criteria (pooled number of participants = 246). Random-effects meta-analysis of standardized mean differences (SMD) for peak power output and mean power output was performed. Study quality was assessed using the modified version of the PEDro checklist. Results of the meta-analysis indicated a significant difference (p = .005) between the placebo and caffeine trials on mean power output with SMD values of small magnitude (0.18; 95% confidence interval: 0.05, 0.31; +3%). The meta-analysis performed for peak power output indicated a significant difference (p = .006) between the placebo and caffeine trials (SMD = 0.27; 95% confidence interval: 0.08, 0.47 [moderate magnitude]; +4%). The results from the PEDro checklist indicated that, in general, studies are of good and excellent methodological quality. This meta-analysis adds on to the current body of evidence showing that caffeine ingestion can also enhance components of anaerobic performance. The results presented herein may be helpful for developing more efficient evidence-based recommendations regarding caffeine supplementation. [ABSTRACT FROM AUTHOR]

Aim: Malnutrition has a significant impact on patient outcomes and duration of inpatient stay. However, conducting timely nutrition assessments can be challenging for rural dietitians. A solution could be for allied health assistants (AHAs) to assist with these assessments. The present study aimed to assess the accuracy and confidence of AHAs trained to conduct the subjective global assessment (SGA) compared with dietitians. Methods: A non‐inferiority study design was adopted. Forty‐five adult inpatients admitted to a rural and remote health service were assessed independently by both a trained AHA and dietitian within 24 hours. The order of assessment was randomised, with the second assessor blind to the outcome of the initial SGA. Levels of agreement were examined using kappa and percent exact agreement (PEA; set a priori at ≥80%). Rater confidence after each assessment was assessed using a 10‐point scale. Results: Agreement for overall SGA ratings was high (kappa = 0.84; PEA 84.4%). PEA for individual sub‐components of the SGA ranged from 66.4 to 86.7%. Where discrepancies were identified in global SGA ratings, AHAs provided a more severe rating of malnutrition than dietitians. AHAs reported significantly lower confidence than dietitians (t = 4.49, P < 0.001), although mean confidence for both groups was quite high (AHA=7.5, dietitians = 9.0). Conclusions: Trained AHAs completed the SGA with similar accuracy to dietitians. Using AHAs may help facilitate timely nutrition assessment in rural health services when a dietitian is not physically present. Further investigation is required to determine the benefits of incorporating this extended role into rural and remote health‐care services. [ABSTRACT FROM AUTHOR]

Abstract: Background: Over 200 clinical trials have examined the effect of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplements on risk factors associated with cardiovascular disease. However, an updated analysis of the evidence is lacking. The aim of the present meta‐analysis was to quantify the effect of supplements containing EPA and DHA on risk factors for cardiovascular disease. Methods: An analysis was carried on 171 clinical trials with acceptable quality (Jadad score ≥3) that were identified from a comprehensive electronic search strategy of two databases (Pubmed and Cochrane Library). A random effect model was used to obtain an overall estimate on outcomes of interest. Heterogeneity between trial results was tested for using a standard chi‐squared test. Results: Compared with control, EPA and DHA supplements produced significant reductions of triglycerides of 0.368 mmol L−1 [95% confidence interval (CI) = −0.427 to −0.309], systolic blood pressure of 2.195 mmHg (95% CI = −3.172 to −1.217), diastolic blood pressure of 1.08 mmHg (95% CI = −1.716 to −0.444), heart rate of 1.37 bpm (95% CI = −2.41 to −0.325) and C‐reactive protein of 0.343 mg L−1 (95% CI = −0.454 to −0.232). This analysis indicates an increase in both low‐density lipoprotein cholesterol (mean difference = 0.150 mmol L−1; 95% CI = 0.058–0.243) and high‐density lipoprotein cholesterol (mean difference = 0.039 mmol L−1; 95% CI = 0.024–0.054). The triglyceride‐lowering effect was dose‐dependent. Conclusions: The lipid‐lowering, hypotensive, anti‐arrhythmic and anti‐inflammatory actions of EPA and DHA supplements were confirmed in this analysis of randomised placebo‐control blinded clinical trials. [ABSTRACT FROM AUTHOR]

Recent studies have reported that resistance training in hypoxia (RTH) may augment muscle size and strength development. However, consensus on the effects of RTH via systematic review and meta-analysis is not yet available. This work aimed to systematically review studies which have investigated using RTH versus normoxic resistance training (NRT) to improve muscular size and strength, and to perform a meta-analysis to determine the effect of RTH on these adaptive parameters. Searches were conducted in PubMed, Web of Science and the Cochrane Library from database inception until 17 June 2017 for original articles assessing the effects of RTH on muscle size and strength versus NRT. The effects on outcomes were expressed as standardized mean differences (SMD). Nine studies (158 participants) reported on the effects of RTH versus NRT for muscle cross-sectional area (CSA) (n = 4) or strength (n = 6). RTH significantly increased CSA (SMD = 0.70, 95% confidence intervals (CI) 0.05, 1.35;p = .04) and strength (SMD = 1.88; 95% CI = 1.20, 2.56;p < .00001). However, RTH did not produce significant change in CSA (SMD = 0.24, 95% CI −0.19, 0.68,p = .27) or strength (SMD = 0.20; 95% CI = −0.27, 0.78;p = .23) when compared to NRT. Although RTH improved muscle size and strength, this protocol did not provide significant benefit over resistance training in normoxia. Nevertheless, this paper identified marked differences in methodologies for implementing RTH, and future research using standardized protocols is therefore warranted. [ABSTRACT FROM AUTHOR]

Characterization of the least number of muscle fibers analyzed for a quick and reliable, evaluation of intramuscular fiber conduction velocity (MFCV) is of importance for sport scientists. The aim of this study was to evaluate the reliability of vastus lateralis' intramuscular MFCV measuring either 25 or 50 different muscle fibers per participant, as well as to compare intramuscular MFCV measured in 25 (C25), 50 (C50), or 140 (C140) muscle fibers. Resting vastus lateralis' MFCV was measured in 21 young healthy males (age 22.1±2.4 years) using intramuscular microelectrodes in different days. Test‐retest reliability of MFCV's parameters was calculated for C25 and C50, while MFCV was compared among C25, C50, and C140. Significant differences of MFCV parameters were observed between C25 condition and those of C50 and C140. The differences in MFCV values between conditions C50 and C140 were non‐significant. A close correlation was found for MFCV between C50 and C140 (r=0.884‐0.988, P=.000). All reliability measures of MFCV measured with 50 fibers were high (eg, ICC=0.813‐0.980, P=.000), in contrast to C25 (eg, ICC=0.023‐0.580 P>.05). In conclusion, an average of 50 different fibers per subject is sufficient to provide a quick and reliable intramuscular evaluation of vastus lateralis MFCV. [ABSTRACT FROM AUTHOR]

Maternal capabilities-qualities of mothers that enable them to leverage skills and resources into child health-hold potential influence over mother's adoption of child caring practices, including infant and young child feeding. We developed a survey ( n = 195) that assessed the associations of 4 dimensions of maternal capabilities (social support, psychological health, decision making, and empowerment) with mothers' infant and young child feeding practices and children's nutritional status in Uganda. Maternal responses were converted to categorical subscales and an overall index. Scale reliability coefficients were moderate to strong (α range = 0.49 to 0.80). Mothers with higher social support scores were more likely to feed children according to the minimum meal frequency (odds ratio [OR] [95% confidence interval (CI)] = 1.38 [1.10, 1.73]), dietary diversity (OR [95% CI] = 1.56 [1.15, 2.11]), iron rich foods, (OR [95% CI] = 1.47 [1.14, 1.89]), and minimally acceptable diet (OR [95% CI] = 1.55 [1.10, 2.21]) indicators. Empowerment was associated with a greater likelihood of feeding a minimally diverse and acceptable diet. The maternal capabilities index was significantly associated with feeding the minimum number of times per day (OR [95% CI] = 1.29 [1.03, 1.63]), dietary diversity (OR [95% CI] = 1.44 [1.06, 1.94]), and minimally acceptable diet (OR [95% CI] = 1.43 [1.01, 2.01]). Mothers with higher psychological satisfaction were more likely to have a stunted child (OR [95% CI] = 1.31 [1.06, 1.63]). No other associations between the capabilities scales and child growth were significant. Strengthening social support for mothers and expanding overall maternal capabilities hold potential for addressing important underlying determinants of child feeding in the Ugandan context. [ABSTRACT FROM AUTHOR]

The study aims to examine the individual and combined association of early life factors (birth weight, birth length, and any and exclusive breastfeeding) with attention capacity in adolescents. The study included 421 European adolescents (243 girls), aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence Study. Body weight and length at birth of adolescents were collected from parental records. The duration of any and exclusive breastfeeding were self-reported. The d2 Test of Attention was administered to assess attention capacity. The main results showed that birth weight, birth length, breastfeeding, and exclusive breastfeeding were related to attention capacity in boys ( β ranging from 0.144 to 0.196; all p < .05) after adjustment for age, centre, gestational age, maternal education, family affluence scale, and body mass index. Among boys, differences in attention capacity were found according to tertiles of birth weight and birth length ( p < .05), as well as borderline significant differences across groups of any and exclusive breastfeeding ( p = 0.055 and p = 0.108, respectively) after adjusting for potential confounders. In addition, boys with 3 early life risk factors (low birth weight, low birth length, and <3 months of breastfeeding) had significantly lower scores in attention capacity compared with boys with 0 risk factors (percentile score − 15.88; p = 0.009). In conclusion, early life factors, both separately and combined, may influence attention capacity in male European adolescents. Importantly, the combination of the 3 early life risk factors, low birth weight, low birth length, and <3 months of breastfeeding, even in normal ranges, may provide the highest reduction in attention capacity. [ABSTRACT FROM AUTHOR]

Adding amylase to fortified blended foods can improve energy density, and increase child's energy and nutrient intake. The efficacy of this strategy is unknown for the World Food Programme's Super Cereal Plus (SC+) and Super Cereal (SC) blends. The primary goal of this study was to investigate the increased energy intake from amylase-containing SC+ and SC compared to control porridges in Burkinabe children. Secondly, energy intake from amylase-containing porridges compared to CERELAC®, Vitazom, and eeZeeBAR™ was studied. Thirdly, caregivers' ( n = 100) porridge acceptability was investigated. The design was a randomized double-blind controlled cross-over trial studying the effect of amylase addition to SC+ and SC flours on porridge energy and nutrient intake in healthy Burkinabe children aged 12-23 ( n = 80) and 24-35 months ( n = 40). Amylase added to porridges increased energy density from 0.68 to 1.16 kcal/g for SC+ and from 0.66 to 1.03 kcal/g for SC porridges. Among children aged 12-23 months, mean energy intake from all porridges with amylase (135-164 kcal/meal) was significantly higher compared to control SC+ porridges (84-98 kcal/meal; model-based average). Among children aged 24-35 months, mean energy intakes were also significantly higher from all porridges with amylase added (245-288 kcal/meal) compared to control SC porridges (175-183 kcal/meal). Acceptability of the porridges among caregivers was rated neutral to good, both for amylase-added and non-amylase-containing porridges. These findings suggest that, among 12-35-month-old, adding amylase to fortified blended foods significantly increased energy and consequently nutrient intake per meal by 67% for SC+ and 47% for SC. Moreover, amylase-containing porridges were well accepted by the caregivers. [ABSTRACT FROM AUTHOR]

In formula-fed infants, rapid weight gain during the first week of life is associated with later obesity. To examine the association between weight gain during the first week and overweight at age 2 among infants with various feeding practices and the relationship between exclusive breastfeeding in early infancy and overweight, we enrolled a prospective cohort of healthy mother-infant dyads and followed them for 2 years. We enrolled 450 mother/infant pairs and obtained information on 306 infants at year 2. Weight change during the first week of life and detailed feeding information were collected during the first month of life. Anthropometric measures were collected at 2 years. Overweight was defined as body mass index (BMI) ≥85th percentile for age. At 2 years, 81% had normal weights and 19% were overweight. Maternal pre-pregnancy BMI; infant birth weight; maternal education; and Women, Infants, and Children status were associated with the risk of overweight at age 2. Children who gained more than 100 g during the first week were 2.3 times as likely after adjustment ( p = .02) to be overweight at age 2 compared to infants who lost weight. There was no association between feeding type and BMI, but feeding type was significantly associated with change in weight at week 1 and anthropometric measurements at age 2. Infant weight gain in the first week of life is related to overweight at age 2, and exclusively breastfed infants are least likely to gain ≥100 g. [ABSTRACT FROM AUTHOR]

Early childhood development plays a key role in a child's future health, educational success, and economic status. However, suboptimal early development remains a global challenge. This study examines the influences of quality of the home learning environment (HOME) and child stunting in the first year of life on child development. We used data collected from a randomized controlled trial of preconceptional micronutrient supplementation in Vietnam ( n = 1,458). The Bayley Scales of Infant Development-III were used to assess cognition, language, and motor development domains at 2 years. At 1 year, 14% of children were stunted, and 15%, 58%, and 28% of children lived in poor, medium, and high HOME environments, respectively. In multivariate generalized linear regression models, living in a high HOME environment was significantly associated with higher scores (0.10 to 0.13 SD) in each of the developmental domains. Stunted children scored significantly lower for cognitive, language, and motor development (−0.11 to −0.18), compared to nonstunted children. The negative associations between stunting on development were modified by HOME; the associations were strong among children living in homes with a poor learning environment whereas they were nonsignificant for those living in high-quality learning environments. In conclusion, child stunting the first year of life was negatively associated with child development at 2 years among children in Vietnam, but a high-quality HOME appeared to attenuate these associations. Early interventions aimed at improving early child growth as well as providing a stimulating home environment are critical to ensure optimal child development. [ABSTRACT FROM AUTHOR]

The Baby-Friendly Hospital (BFH) Initiative has led to an increase in breastfeeding rates and duration worldwide. But little is known about whether the beneficial effects persist beyond a facility's designation as a BFH. To investigate the association of BFH designation (current, former, and never) and compliance with Baby-Friendly (BF) practices on breastfeeding in Switzerland, this study combined nationwide survey data on breastfeeding with BFH monitoring data. In this cross-sectional study, 1,326 children were born in 34 current ( N = 508), 28 former ( N = 425), and 34 never designated BFHs ( N = 393). We compared exclusive and any breastfeeding according to BFH designation over the first year of life, using Kaplan-Meyer Survival curves. Logistic regression models were applied to analyse breastfeeding prevalence, and Cox-regression models were used for exclusive (0-6 months) and continued (6-12 months) breastfeeding duration. Average duration of exclusive breastfeeding (13.1 weeks, 95% confidence interval [12.0, 17.4]) and any breastfeeding (32.7 weeks, 95% confidence interval [30.5, 39.2]) were the longest for babies born in currently accredited BFHs. Exclusive breastfeeding was associated with high compliance with monitored BF practices in current BFHs and with the number of BF practices experienced in all hospitals. Continued breastfeeding was significantly longer when babies were born in current BFHs (cessation hazard ratio 0.60, 95% confidence interval [0.42, 0.84]) or in former BFHs (cessation hazard ratio 0.68, 95% confidence interval [0.48, 0.97]). Overall, the results support continued investment into BFHs, because babies born in current BFHs are breastfed the most and the longest, whereas a former BFH designation shows a sustained effect on continued breastfeeding. [ABSTRACT FROM AUTHOR]

Socioeconomic inequalities in child undernutrition remain one of the main challenges in Bangladesh. The social determinants of health are mostly responsible for such inequalities across different population groups. However, no study has examined the relative contribution of different social determinants to the socioeconomic inequality in child undernutrition in Bangladesh. Our objective is to measure the extent of socioeconomic-related inequalities in childhood stunting and identify the key social determinants that potentially explain these inequalities in Bangladesh. We used data for children younger than 5 years of age for this analysis from 2 rounds of Bangladesh Demographic and Health Surveys conducted in 2004 and 2014. We examined the socioeconomic inequality in stunting using the concentration curve and concentration index. We then decomposed the concentration index into the contributions of individual social determinants. We found significant inequality in stunting prevalence. The negative concentration index of stunting indicated that stunting was more concentrated among the poor than among the well-off. Our results suggest that inequalities in stunting increased between 2004 and 2014. Household economic status, maternal and paternal education, health-seeking behavior of the mothers, sanitation, fertility, and maternal stature were the major contributors to the disparity in stunting prevalence in Bangladesh. Equity is a critical component of sustainable development goals. Health policymakers should work together across sectors and develop strategies for effective intersectoral actions to adequately address the social determinants of equity and reduce inequalities in stunting and other health outcomes. [ABSTRACT FROM AUTHOR]

Although iron deficiency (ID) is considered the most frequent micronutrient deficiency in industrialized countries and is associated with impaired neurodevelopment when occurring in early years, accurate recent estimations of its prevalence are lacking. Our objective was to estimate ID prevalence and associated sociodemographic markers in young children in France. The Saturn-Inf national cross-sectional hospital-based survey recruited 3,831 French children <6 years old between 2008 and 2009 to assess lead poisoning prevalence and to establish a biobank. This secondary analysis measured serum ferritinemia (SF) in sera kept frozen at −80 °C for children with sufficient serum aliquots and C-reactive protein <10 mg/L. For the 657 participating children (17% of the Saturn-Inf study), the median age was 3.9 years (interquartile range: 2.2-5.1); 52% were boys. The median SF was 44 μg/L (interquartile range: 28-71). ID prevalence was 2.8% (95% confidence interval [1.7, 4.7]) and 3.2% (95% confidence interval [2.0, 5.1]) with an SF threshold of 10 and 12 μg/L, respectively. Low SF was significantly associated ( p < .05) with mother being a migrant (32 vs. 45 μg/L for a mother born in France) or unemployed (37 vs. 50 μg/L for a mother employed). In this first national cross-sectional hospital-based study in France, ID prevalence was much lower than that in other French and European studies performed in underprivileged populations but close to the lowest values observed in other population-based studies in Europe. [ABSTRACT FROM AUTHOR]

Background The decision to lose weight among adolescents is complex and is guided by a number of body-related factors. This study examined the extent of agreement between actual weight, measured as body mass index, and self-perceived weight and assessed their relative importance in weight loss behaviour among Lebanese adolescents. Methods Data on 278 adolescents aged 13-17 years were drawn from the nationwide Nutrition and Non-Communicable Disease Risk Factor Survey (Lebanon, 2009). Binary multivariable logistic regressions were conducted to test associations with 'effort to lose weight' as the outcome variable, controlling for a number of potential confounders. Results Close to 36% reported trying to lose weight. Around 21% and 13% were overweight and obese, respectively, and 40% and 10% perceived their weight as slightly high and very high, respectively. Inaccurate perceivers, those underestimating or overestimating their weight, constituted 39%, with overall percent agreement between actual and self-perceived weight being 60.8% (kappa statistic = 0.319, 95% CI [0.242, 0.396]). About a third of the overweight adolescents (30.5%) and more than half of the obese (56.8%) underestimated their weight. In the multivariable analysis, self-perceived weight was statistically significant and a stronger predictor of weight loss effort than body mass index (adjusted odds ratios = 14.42 and 6.42 for slightly high and very high perceived weight, respectively, compared to odds ratios = 1.47 and 2.31 for overweight and obese adolescents, respectively). Conclusion Health professionals need to consider self-perceived weight in conjunction with actual weight in their pursuit of weight management goals and in planning prevention programmes that guide weight loss behaviours for adolescents. [ABSTRACT FROM AUTHOR]

Objective Guided self-help treatments based on cognitive-behavior therapy (CBT-GSH) are efficacious for binge eating. With limited availability of CBT-GSH in the community, mobile technology offers a means to increase use of these interventions. The purpose of this study was to test the initial efficacy of Noom Monitor, a smartphone application designed to facilitate CBT-GSH (CBT-GSH + Noom), on study retention, adherence, and eating disorder symptoms compared to traditional CBT-GSH. Method Sixty-six men and women with DSM- 5 binge-eating disorder (BED) or bulimia nervosa (BN) were randomized to receive eight sessions of CBT-GSH + Noom ( n = 33) or CBT-GSH ( n = 33) over 12 weeks. Primary symptom outcomes were eating disorder examination objective bulimic episodes (OBEs), subjective bulimic episodes (SBEs), and compensatory behaviors. Assessments were collected at 0, 4, 8, 12, 24, and 36 weeks. Behavioral outcomes were modeled using zero-inflated negative-binomial latent growth curve models with intent-to-treat. Results There was a significant effect of treatment on change in OBEs (β = −0.84, 95% CI = −1.49, −0.19) favoring CBT-GSH + Noom. Remission rates were not statistically different between treatments for OBEs (βlogit = −0.73, 95% CI = −1.86, 3.27; CBT-GSH-Noom = 17/27, 63.0% vs. CBT-GSH 11/27, 40.7%, NNT = 4.5), but CBT-GSH-Noom participants reported greater meal and snack adherence and regular meal adherence mediated treatment effects on OBEs. The treatments did not differ at the 6-month follow-up. Discussion Smartphone applications for the treatment binge eating appear to have advantages for adherence, a critical component of treatment dissemination. [ABSTRACT FROM AUTHOR]

Background China has the world's highest diabetes prevalence, which along with hypertension and inflammation continues to grow particularly among children. Little is known about the strength of the association of these cardiometabolic risk factors between parents and their children; thus, the potential of household-based strategies to reduce risk is unknown. Objectives The objective of the study is to examine the parent-child association for haemoglobin A1c (HbA1c), blood pressure (BP) and C-reactive protein (CRP) in a large, geographically diverse Chinese sample. Methods In 940 parent-child pairs (children aged 7-17 years) who participated in the 2009 China Health and Nutrition Survey, we measured each individual's HbA1c and CRP using fasting blood and BP. We used sex-specific random-effects linear regression to examine the parent-child association for these risk factors, accounting for within-family clustering. Results Child's HbA1c was positively associated with parental HbA1c. Beta coefficients ranged from 0.06 (95% CI 0.03-0.12) for father-daughter to 0.43 (95% CI 0.28-0.58) for mother-son pairs. We also detected a positive mother-daughter association for BP and positive father-child associations for CRP. Conclusion The statistically significant parent-child association for HbA1c, BP and CRP in Chinese families suggests that household-based interventions could be useful for confronting the high rates of diabetes, hypertension and inflammation in China. [ABSTRACT FROM AUTHOR]

We investigated the long-term implications of infantile thiamine (vitamin B1) deficiency on motor function in preschoolers who had been fed during the first 2 years of life with a faulty milk substitute. In this retrospective cohort study, 39 children aged 5-6 years who had been exposed to a thiamine-deficient formula during infancy were compared with 30 age-matched healthy children with unremarkable infant nutritional history. The motor function of the participants was evaluated with The Movement Assessment Battery for Children (M-ABC) and the Zuk Assessment. Both evaluation tools revealed statistically significant differences between the exposed and unexposed groups for gross and fine motor development ( p < .001, ball skills p = .01) and grapho-motor development ( p = .004). The differences were especially noteworthy on M-ABC testing for balance control functioning ( p < .001, OR 5.4; 95% CI 3.4-7.4) and fine motor skills ( p < .001, OR 3.2; 95% CI 1.8-4.6). In the exposed group, both assessments concurred on the high rate of children exhibiting motor function difficulties in comparison to unexposed group (M-ABC: 56% vs. 10%, Zuk Assessment: 59% vs. 3%, p < .001). Thiamine deficiency in infancy has long-term implications on gross and fine motor function and balance skills in childhood, thiamine having a crucial role in normal motor development. The study emphasizes the importance of proper infant feeding and regulatory control of breast milk substitutes. [ABSTRACT FROM AUTHOR]

Aim The prevalence of disordered eating has been frequently reported in university students; however, the prevalence amongst Australian undergraduate students studying degrees with a focus on nutrition is uncertain. The aims of this study were to: (i) assess eating attitudes and behaviours of students enrolled in nutrition and dietetics, (ii) compare those to students enrolled in another health degree of occupational therapy (OT) and (iii) explore possible relationships between eating attitudes and behaviours and other characteristics of both cohorts. Methods This cross-sectional observational study investigated self-reported anthropometric characteristics, eating attitudes and behaviours and self-esteem using a series of questionnaires. Results Participants included 137 students (119 females, 18 males) with a mean age of 27.1 ± 8.7 years. Fourteen percent of nutrition and dietetics and 11% of OT students had disordered eating attitudes scores that were symptomatic of an eating disorder. Mean eating attitude scores did not differ between the degrees of study. Students in nutrition and dietetics showed significantly higher levels of cognitive restraint and less emotional eating than OT students. Enrolment in the first year of study was the strongest predictor of symptomatic eating attitudes. Conclusions These findings support previously expressed concern about presence of disordered eating in nutrition and dietetics undergraduates. Collaboratively developed support mechanisms for preventing and managing disordered relationships with food would be of benefit to students enrolled in nutrition degrees to ensure ongoing professional integrity. [ABSTRACT FROM AUTHOR]

Objective To assess the therapeutic efficacy of local injections of botulinum toxin type A (Btx-A) in improving blood flow to the hands of patients with Raynaud's phenomenon (RP) secondary to scleroderma. Methods In this randomized, double-blind, placebo-controlled clinical trial, patients with scleroderma-associated RP received Btx-A (50 units in 2.5 ml sterile saline) in one randomly selected hand and sterile saline (2.5 ml) in the opposite hand. Follow-up at 1 and 4 months postinjection included laser Doppler imaging of hands, patient-reported outcomes, and physical examination. We compared outcomes using paired t-tests and population-average generalized models with generalized estimating equations. Results Of 40 patients enrolled, 25 had limited scleroderma and 15 had diffuse scleroderma. From baseline to 1-month follow-up, there was a greater reduction in average blood flow in Btx-A-treated hands compared to placebo-treated hands. The model estimated that this difference was statistically significant (average difference −30.08 flux units [95% confidence interval −56.19, −3.98], P for interaction = 0.024). This difference was mainly influenced by patients with longstanding RP and diffuse scleroderma. Change in blood flow at 4-month follow-up was not significantly different between groups. Clinical measures (QuickDASH, McCabe Cold Sensitivity Score, pain on a visual analog scale, and Raynaud's Condition Score) improved slightly for Btx-A-treated hands. Conclusion Our laboratory-based laser Doppler imaging flow data do not support using Btx-A to treat RP in all scleroderma patients. The secondary clinical outcomes suggest some positive effect, but its clinical meaningfulness is questionable. The role of Btx-A in treating RP should be further studied with more homogeneous patient populations and in unique clinical situations such as acute digital ischemia. [ABSTRACT FROM AUTHOR]

Background The present study aimed to develop a food frequency questionnaire ( FFQ) assessing dietary omega-3 long chain polyunsaturated fatty acid ( n-3 LCPUFA) intake in Australian children and to validate the FFQ against a 7-day food diary. Methods The investigation comprised a cross-sectional and validation study. The study setting was two private primary schools in the in the Illawarra region of New South Wales. Twenty-two Australian children, aged 9-13 years, who were not on a special diet or receiving medical care that limited their food choice in the 3 months prior to recruitment, were recruited into the study. Results A total of 131 items, classified according to seven food group categories, was included in the n-3 LCPUFA FFQ, as identified from published dietary surveys and a supermarket survey. Good correlations between the FFQ and the 7-day food diary were observed for eicosapentaenoic acid ( EPA) [ r = 0.691, 95% confidence interval (CI) = 0.51-0.83, P < 0.001], docosahexaenoic acid ( DHA) ( r = 0.684, 95% CI = 0.45-0.84, P < 0.001) and total n-3 LCPUFA ( r = 0.687, 95% CI = 0.48-0.85, P < 0.001). Bland-Altman plots showed an acceptable limit of agreement between the FFQ and the average 7-day food diary. However, the mean EPA, DHA and total n-3 LCPUFA intakes estimated from the FFQ were significantly higher than those from the average 7-day food diary estimates ( P < 0.001). Conclusions A novel n-3 LCPUFA FFQ that has been developed to estimate dietary n-3 LCPUFA intakes in Australian children has been shown to have relative validity. The FFQ provides a useful contribution to dietary assessment methodology in this age group; however, reproducibility remains to be demonstrated. [ABSTRACT FROM AUTHOR]

Objectives To investigate patterns of Australian GP procedural activity and associations with: geographical remoteness and population size, hours worked in hospitals and in total; and, availability for on-call, Design and participants National annual panel survey (Medicine in Australia: Balancing Employment and Life) of Australian GPs, 2011-2013. Main outcome measures Self-reported geographical work location, hours worked in different settings, and on-call availability per usual week, were analysed against GP procedural activity in anaesthetics, obstetrics, surgery or emergency medicine. Results Analysis of 9301 survey responses from 4638 individual GPs revealed significantly increased odds of GP procedural activity in anaesthetics, obstetrics or emergency medicine as geographical remoteness increased and community population size decreased, albeit with plateauing of the effect-size from medium-sized (population 5000-15 000) rural communities. After adjusting for confounders, procedural GPs work more hospital and more total hours each week than non-procedural GPs. In 2011 this equated to GPs practising anaesthetics, obstetrics, surgery, and emergency medicine providing 8% (95% CI 0, 16), 13% (95% CI 8, 19), 8% (95% CI 2, 15) and 18% (95% CI 13, 23) more total hours each week, respectively. The extra hours are attributable to longer hours worked in hospital settings, with no reduction in private consultation hours. Procedural GPs also carry a significantly higher burden of on-call. Conclusions The longer working hours and higher on-call demands experienced by rural and remote procedural GPs demand improved solutions, such as changes to service delivery models, so that long-term procedural GP careers are increasingly attractive to current and aspiring rural GPs. [ABSTRACT FROM AUTHOR]

Objective Rural exposure during medical school is associated with increased rural work after graduation. How much of the increase in rural workforce by these graduates is due to pre-existing interest and plans to work rurally and how much is related to the extended clinical placement is not known. Design This cohort study compared the employment location of medical graduates who professed no rural interest as undergraduates (negative control), with those who applied but did not participate in Rural Clinical School of Western Australia ( RCSWA) (positive control), and those who applied and participated in RCSWA (participants). Participants All 1026 University of Western Australia students who had an opportunity to apply for a year-long rotation in RCSWA from 2004 to 2010, and who had subsequently graduated by the end of 2011, were included. Main Outcome Measure Graduates' principal workplace location ( AHPRA, Feb 2014). Result The three groups differed significantly in their graduate work locations (χ2 = 39.2, P < 0.001). In multivariate analysis, only being of older age at graduation ( OR 2.28 (95% CI 1.40, 3.72), P = 0.001), being from a rural background ( OR 2.99 (95% CI 1.85, 4.85), P < 0.001), being a recipient of a Medical Rural Bonded Scholarship ( OR 3.36 (95% CI 1.68, 6.73, P = 0.001) and actually participating in the RCSWA remained significantly related to rural work ( OR 3.10 (95% CI 1.95, 4.93), P < 0.001). Conclusion After accounting for other factors relating to rural work, RCSWA graduates were three times more likely to work rurally than either control group. These data suggest that RCSWA has a significant independent effect on rural workforce. [ABSTRACT FROM AUTHOR]

Objective Despite increases in Commonwealth funded general practice (GP) Registrar training positions, workforce trends continue to show geographical maldistribution. This study aimed to identify Registrar attributes which describe a cohort choosing to work in rural practice. Design Cross-sectional self-report questionnaire for socio-demographics, prior training, current training pathway, measures of personality and resilience. Participants and Setting GP Registrars ( N = 452) training in either the general or rural pathways of three Registered Training Providers in three states, or training through the Australian College of Rural and Remote Medicine's independent pathway. Main outcome measure Ordinal logistic regression tested the impact of key variables on the likelihood that Registrars would settle in rural practice. Univariate analysis explored differences between groups and effects of variables. Results A significantly increased interest in rural practice was to found to exist among registrars who were male, identified themselves as being rural, had a partner who identified as being rural, were enrolled in a rural training pathway and had high levels of Cooperativeness. Conclusion We present a discriminating model combining socio-demographics, prior training and personality variables which challenges Australia to rethink Registrar attributes when training for rural general practice. With significant changes about to occur to GP training in Australia, this paper highlights the need for a more holistic approach which considers personal attributes such as Cooperativeness, rural identity and provision of geographically focused rural training pipelines to encourage Registrars to bond to individual rural communities and further develop their personal connectedness to country life and rural medical practice. [ABSTRACT FROM AUTHOR]

Aim The association of sodium (Na) and potassium (K) intake with blood pressure ( BP) is an ongoing debate, especially in central Iran. We aimed to examine the mean Na and K intake, major sources of Na and the relationship between BP and dietary and urinary Na and K. Methods This cross-sectional study was performed in central Iran in 2013-2014. A total of 796 non-hypertensive adults aged >18 years were randomly recruited. The semi-quantitative food frequency questionnaire was used to assess dietary Na and K intake. Moreover, 24-hour urine samples were collected to measure 24-hour urinary Na ( UNa) and K ( UK) as biomarkers. BP was measured twice on each arm using a standard protocol. Results The mean Na and K intake were 4309.6 ± 1344.4 and 2732.7 ± 1050.5 mg/day, respectively. Table and cooking salt were the main sources of Na. Odds ratio ( OR) (95% confidence interval ( CI)) of the crude model in the highest quartile of UNa indicated a significant association with the higher risk of prehypertension ( OR (95% CI): 2.09 (1.09-4.05); P for trend = 0.007). After adjustment for potential confounders, prehypertension was significantly associated with increasing dietary Na/K ratio ( OR (95% CI): 1.28 (1.01-1.57); P for trend = 0.046) and UNa/ UK ratio ( OR (95% CI): 2.15(1.08-4.55); P for trend = 0.029). Conclusions Increasing dietary and urinary Na/K ratios and UNa were associated with elevated BP and prehypertension occurrence. These findings support the necessity of developing a salt reduction programme in our country. [ABSTRACT FROM AUTHOR]

Background Mobile applications (apps) could support diabetes management through dietary, weight and blood glucose self-monitoring, as well as by promoting behaviour change. The present study aimed to evaluate diabetes apps for content, functions and behaviour change techniques ( BCTs). Methods Diabetes self-management apps for Android smartphones were searched for on the Google Play Store. Ten apps each from the following search terms were included; 'diabetes', 'diabetes type 1', 'diabetes type 2', 'gestational diabetes'. Apps were evaluated by being scored according to their number of functions and BCTs, price, and user rating. Results The mean ( SD) number of functions was 8.9 (5.9) out of a possible maximum of 27. Furthermore, the mean ( SD) number of BCTs was 4.4 (2.6) out of a possible maximum of 26. Apps with optimum BCT had significantly more functions [13.8; 95% confidence interval ( CI) = 11.9-15.9] than apps that did not (4.7; 95% CI = 3.2-6.2; P < 0.01) and significantly more BCTs (5.8; 95% CI = 4.8-7.0) than apps without (3.1; 95% CI = 2.2-4.1; P < 0.01). Additionally, apps with optimum BCT also cost more than other apps. In the adjusted models, highly rated apps had an average of 4.8 (95% CI = 0.9-8.7; P = 0.02) more functions than lower rated apps. Conclusions 'Diabetes apps' include few functions or BCTs compared to the maximum score possible. Apps with optimum BCTs could indicate higher quality. App developers should consider including both specific functions and BCTs in 'diabetes apps' to make them more helpful. More research is needed to understand the components of an effective app for people with diabetes. [ABSTRACT FROM AUTHOR]

Objective To investigate the feasibility of using a General Practice registrar ( GPR) to coordinate rural palliative care services. Design A quasi-experimental design was used. Intervention group participants received the GPR service, which involved liaison among the patient, family, General Practitioner, specialist palliative care team and community nurses. Specified risk assessment, care planning and continuity of care were provided. Patients in the comparison group received the standard service. Setting Rural community palliative care. Participants: One hundred and ninety-one rural community palliative care patients (99 intervention and 92 control patients). Main outcome measures: Hospital admissions per 100 patient-days, bed-days per 100 patient-days and proportion of deaths at home. Results Patients receiving standard care were twice as likely to spend ≥8 bed-days in hospital ( OR 2.09 (95% CI 1.10-3.97); P = 0.02) and were more likely to have ≥ 2 admissions to hospital ( OR 3.37 (95% CI 1.83-6.21); P < 0.001), per 100 patient-days than the intervention group after adjusting for diagnosis group (cancer or not) and residence in residential aged care. Controls were significantly less likely to die at home than the intervention group ( OR 0.41 (95% CI 0.20-0.86); P = 0.02). Conclusion This is a small proof of concept pilot study limited by lack of randomisation. The results demonstrate the feasibility of using a GPR to manage continuity of care for rural community palliative care patients. Given the potential confounding factors, further investigation via a larger randomised trial is required. [ABSTRACT FROM AUTHOR]

Background This meta-analysis investigated the association of diet quality indices, as assessed by HEI and AHEI, and the risk of all-cause, cardiovascular and cancer mortality. Methods We used PubMed, ISI Web of Science and Google Scholar to search for eligible articles published before July 2015. A total of 12 cohort studies (38 reports) and one cross-sectional study (three reports) met the inclusion criteria and were included in our meta-analysis. Results The highest level of adherence to the Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI) was significantly associated with a reduced risk of all-cause mortality [relative risk (RR) = 0.77, 95% confidence intterval (CI) = 0.76-0.78], cardiovascular mortality (RR = 0.77, 95% CI = 0.74-0.80) and cancer mortality (RR = 0.83, 95% CI = 0.81-0.86). Egger regression tests provided no evidence of publication bias. Conclusions The present study indicates that high adherence to HEI and AHEI dietary patterns, indicating high diet quality, are associated with reduced risk of all-cause mortality (as well as cardiovascular mortality and cancer mortality). [ABSTRACT FROM AUTHOR]

Deficits in muscles of the lumbo-pelvic region, such as a relatively small multifidus muscle, have been used to predict lower limb injuries in professional football players. Results have been less consistent for the size of the quadratus lumborum ( QL) muscle. Changes in size of the multifidus and QL muscles could be functionally related to each other, and modeling this relationship could improve prediction of lower limb injuries. Ultrasound imaging examinations were performed on male elite football players at the start of the Australian Football League ( AFL) pre-season and playing season. Injury data were obtained from records collected by each club. Results indicated that the cross-sectional area of the multifidus muscle was related to the occurrence of an injury in the pre-season (odds ratio [ OR] = 2.08/cm2 decrease below the mean; OR for dichotomized measure = 12.2) and in the season ( OR = 2.43/cm2). The size of the QL muscle was significantly related to an injury in the pre-season ( OR = 2.12/cm2 increase above the mean; OR for dichotomized measure = 7.26) but not in the season. A significant link was found between the ratio of the multifidus and QL muscles, and the incidence of pre-season ( OR = 14.71) and season injuries ( OR = 5.29). The sensitivity and specificity of the model in the pre-season were 75% and 85.7%, respectively; values for the playing season were 88.4% and 62.5%. A model was developed for prediction of lower limb injuries in football players. Combining size measurements of the multifidus and QL muscles improved predictive power. This information may have clinical implications for injury screening and prevention. [ABSTRACT FROM AUTHOR]

Aim: The impact of sarcopenia on hospitalisation has been under intense investigation; however, little is known about the association between sarcopenia and their costs among hospitalised patients. The aim of the present study was to quantify the association between sarcopenia and hospitalisation costs among older adults. Methods: A cross ‐ sectional study was conducted in 201 hospitalised older adults in a general hospital. Sarcopenia was identified according to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. Muscle mass was assessed by anthropometric measurements, muscle strength through handgrip strength evaluation and physical performance by Timed Up and Go Test. Nutritional status was evaluated using the Mini Nutritional Assessment—Short Form (MNA ‐ SF), and hospital costs were assessed with the Diagnosis Related Groups (DRGs) system. Multivariable logistic regression models were fitted to quantify the association between sarcopenia and hospital costs. Increased hospital costs were considered when a patients′ cost was higher than the mean cost of an average patient (€2396.24). Results: Within this sample, 10.4% sarcopenic, 43.8% at nutritional risk and 14.9% undernourished older adults were identified. After adjustment, sarcopenia (OR = 5.70, 95% CI 1.57 – 20.71) and low muscle strength (OR = 2.40, 95% CI 1.12 – 5.15) were associated with increased hospital costs. Conclusions: Sarcopenia and low muscle strength at hospital admission were independently associated with increased hospital costs. [ABSTRACT FROM AUTHOR]

Background The present study aimed to investigate the association between dietary carbohydrate components and polycystic ovary syndrome ( PCOS) in Iran. Methods In this case-control study, the diagnosis of PCOS was made based on the Rotterdam criteria in hospital clinics. Dietary assessments were performed using a validated semi-quantitative food frequency questionnaire. In total, 281 women with incident PCOS and 472 age-matched controls were assessed. Participants were interviewed through the clinics in Tehran, Iran, from February 2012 until March 2014. Average dietary glycaemic index ( GI) and glycaemic load ( GL) were calculated using GI of Iranian Foods Table and international tables of GI and GL values. We also assessed total dietary carbohydrate, refined grains, whole grains and fibre intakes. Results Participation rates were 97.5% among cases and 96.3% among controls. Mean ( SD) dietary GI values among the controls and cases were 51.8 (4.7) and 59.7 (5.9) ( P = 0.02) and GL values were 155.34 (35.2) and 173.6 (39.1) ( P < 0.001), respectively. The multivariate adjusted odds ratio ( OR) comparing the highest tertile of dietary GI and GL with the lowest tertile were 2.18 [95% confidence interval ( CI) = 1.29-3.81; P-test for trend = 0.012] and 2.39 (95% CI = 1.23-3.01; P-test for trend = 0.001), respectively, with a significant trend. Fibre intake was inversely associated with PCOS ( OR = 0.73; 95% CI = 0.49-0.91; P-test for trend = 0.013). Conclusions The findings of the present study suggest that high dietary GI and GL and low fibre intake are significantly associated with PCOS. [ABSTRACT FROM AUTHOR]

Aim In the treatment of cervical cancer, the extent of lymphadenectomy is a matter of debate. The goal of the current study was to examine the question of whether the number of retrieved lymph nodes (RLN) can influence survival of patients with early stage cervical cancer. Methods The medical records of 180 FIGO stage IB-IIA cervical cancer patients treated with primary radical surgery were reviewed. Patients were divided into two groups: those with ≤ 40 RLN and those with > 40 RLN. Patients were also assigned to either the bulky (tumor size > 4 cm) cervical cancer group or the non-bulky (tumor size ≤ 4 cm) cervical cancer group. Results The number of RLN had a statistically significant effect on both disease-free survival ( P = 0.04) and overall survival ( P = 0.02) of all patients. Patients with > 40 RLN had better prognoses than those with ≤ 40 RLN. In the bulky cervical cancer group, the number of RLN was an independent prognostic factor. In multivariate analysis for the bulky cervical cancer group, > 40 RLN had a significant positive effect on disease-free survival (adjusted hazard ratio, 0.36; 95% confidence interval, 0.13-0.97) and overall survival (adjusted hazard ratio, 0.23; 95% confidence interval, 0.06-0.90). However, number of RLN was not an independent prognostic factor in the non-bulky cervical cancer group. Conclusions A more extensive lymphadenectomy increased the survival of bulky cervical cancer patients. This finding may be helpful in determining surgical extent before surgery for cervical cancer. [ABSTRACT FROM AUTHOR]

Background and purpose The most effective treatment approach to improve walking in people with multiple sclerosis (MS) is not known. The aim of this trial was to assess the efficacy of treadmill training and progressive strength training on walking in people with MS. Methods A single blinded randomized parallel group trial was carried out. Eligible participants were adults with MS with Expanded Disability Status Scale score ≤6. A total of 29 participants were randomized and 28 received the allocated exercise intervention, treadmill ( n = 13) or strength training ( n = 15). Both groups exercised 30 minutes, three times a week for 8 weeks. Primary outcome was The Functional Ambulation Profile evaluated by the GAITRite walkway. Secondary outcomes were walking work economy and balance control during walking, measured by a small lightweight accelerometer connected to the lower back. Testing was performed at baseline and the subsequent week after completion of training. Results Two participants were lost to follow-up, and 11 (treadmill) and 15 (strength training) were left for analysis. The treadmill group increased their Functional Ambulation Profile score significantly compared with the strength training group ( p = .037). A significant improvement in walking work economy ( p = .024) and a reduction of root mean square of vertical acceleration ( p = .047) also favoured the treadmill group. Discussion The results indicate that task-specific training by treadmill walking is a favourable approach compared with strength training to improve walking in persons with mild and moderate MS. Implications for Physiotherapy practice, this study adds knowledge for the decision of optimal treatment approaches in people with MS. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]