Search

Cognitive control is a predictor of later‐life outcomes and may underpin higher order executive processes. The present study examines the development of early cognitive control during the first 24‐month. We evaluated a tablet‐based assessment of cognitive control among infants aged 18‐ and 24‐month. We also examined concurrent and longitudinal associations between attentional disengagement, general cognitive skills and cognitive control. Participants (N = 60, 30 female) completed the tablet‐task at 18‐ and 24‐month of age. Attentional disengagement and general cognitive development were assessed at 5‐, 8‐, 12‐, 18‐ and 24‐month using an eye‐tracking measure and the Mullen Scales of Early Learning (MSEL), respectively. The cognitive control task demonstrated good internal consistency, sensitivity to age‐related change in performance and stable individual differences. No associations were found between infant cognitive control and MSEL scores longitudinally or concurrently. The eye‐tracking task revealed that slower attentional disengagement at 8‐month, but faster disengagement at 18‐month, predicted higher cognitive control scores at 24‐month. This task may represent a useful tool for measuring emergent cognitive control. The multifaceted relationship between attention and infant cognitive control suggests that the rapid development of the attentional system in infancy results in distinct attentional skills, at different ages, being relevant for cognitive control development. [ABSTRACT FROM AUTHOR]

Background: We aimed to assess self‐management skills and adherence behaviors in young people post‐liver transplant and compare these with those of young people with autoimmune liver disease and other forms of chronic liver disease. Method: As part of our specialist multidisciplinary clinic, n = 156 young people (aged 16–25 years) completed the Liver Self‐Management Questionnaire (an adaptation of the Developmentally Based Skills Checklist for adolescents post‐liver transplant and modified for us across liver disease type and within the United Kingdom). Those taking medication (n = 128) also completed a service‐designed questionnaire regarding adherence. The statistical significance of group differences was assessed with non‐parametric analyses. Results: Young people post‐liver transplant were less likely to report managing their condition independently than those with autoimmune liver disease or those with other forms of chronic liver disease. They also reported higher adherence (93%) compared to those with autoimmune liver disease (77%) and those with other forms of chronic liver disease (85%). However, the vast majority of self‐management and adherence behaviors were comparable between young people post‐transplant and those with autoimmune liver disease/other forms of chronic liver disease. Conclusion: Our data are in line with existing data from US samples and also extend these findings to include those with other forms of chronic liver disease. These data highlight the importance of individualized care for young adults, regardless of condition type or healthcare setting, and of clinicians managing their expectations regarding what is considered appropriate condition management in early adulthood. [ABSTRACT FROM AUTHOR]

Objectives: A statistical study comparing osteological and ancient DNA determinations of sex was conducted in order to investigate whether there are sex biases in United Kingdom and Irish Neolithic megalithic burials. Materials and Methods: Genetic and osteological information from human individuals from 32 megalithic sites in the UK and Ireland dating from 4000 to 2500 cal. BCE was collected and statistically analyzed to test whether there is a true over‐representation of males at these sites. The published dataset from the study by Sánchez‐Quinto et al. in 2019 was initially analyzed before being refined and included in a larger dataset. Osteological analysis of sex bias was limited to adults with available sex estimations, and genetic analysis limited to published data Results: Two sites consistently returned significant p‐values suggesting a potential over‐representation in osteological males at one site (Knowe of Midhowe, Orkney) and genetic males in the other (Primrose Grange, Ireland). Cumulative statistical analyses point towards a male bias in the representation of sexes in Neolithic megalithic burials, but these results do not reflect the site‐by‐site and regional variation found in this study. Discussion: The interpretation of sex bias, that is, the over‐representation of one sex over another ‐ depends on other socio‐cultural variables (e.g., kinship) and the emphasis placed on statistical significance. The trend towards males being over‐represented in Neolithic megalithic burials is not as clear as previously thought, and requires further testing and data collection to uncover. [ABSTRACT FROM AUTHOR]

It has been shown that disadvantaged groups who endorse system‐justifying beliefs tend to internalize their state of inferiority by expressing ingroup derogation and opposing collective action for change. In the present research, we recruited women – as disadvantaged group – from different countries (the United States, the United Kingdom, Italy) and examined whether their moral conviction against gender inequality, as an absolute stance that does not tolerate any violation, may interact with and overpower system‐justifying beliefs. Results from three studies provided support for our hypotheses. First, when women held strong moral conviction, they expressed higher identification with their disadvantaged ingroup and, in turn, higher collective action intentions, independent of system‐justifying beliefs. Second, when women held weak moral conviction, higher system‐justifying beliefs reduced women's ingroup identification and, in turn, undermined their collective action intentions. This support is found across different contexts of gender inequality (the gender leadership gap, the gender pay gap, and the gender power imbalance), using different methodological approaches (online survey, online experiment, laboratory experiment). Implications, limits, and future directions are discussed. [ABSTRACT FROM AUTHOR]

Objectives: Pre‐exposure prophylaxis (PrEP) is an effective HIV prevention tool for high‐risk men who have sex with men (MSM). However, acceptability and uptake have been variable. This study explored the factors that predict PrEP acceptability in MSM in Leicester, where HIV prevalence is double the national average. Methods: A total of 191 HIV‐negative MSM completed a cross‐sectional survey. Participants provided demographic information, and completed measures of HIV knowledge, perceived HIV risk, engagement in sexual risk behaviour, acquisition of a sexually transmitted infection (STI) in the last 12 months, frequency of HIV testing and PrEP acceptability. Results: Kruskal–Wallis tests showed statistically significant effects of sexual orientation, education level and income, respectively, on HIV knowledge. Gay‐identified individuals possessed greater HIV knowledge than bisexuals. Respondents with General Certificate of Secondary Education (GCSE)‐level education had significantly less HIV knowledge than those educated to postgraduate level. Respondents with income of < £10 000 possessed significantly less HIV knowledge than higher income groups. Structural equation modelling showed that the relationship between HIV knowledge and PrEP acceptability was mediated by perceived HIV risk, engagement in sexual risk behaviour, acquisition of an STI in the past 12 months and frequency of HIV testing. Conclusions: The results reveal socio‐economic inequalities in HIV knowledge and HIV testing, and suggest that MSM who have high levels of HIV knowledge and perceived HIV risk and who regularly test for HIV are most likely to endorse PrEP as personally beneficial. HIV knowledge and accurate risk appraisal should be promoted in MSM. The HIV testing context constitutes an ideal context for promoting PrEP to high‐risk MSM. [ABSTRACT FROM AUTHOR]

Abstract: Background: Childhood nutrition is important in optimising growth, development and future health. The present study compared dietary intakes of Australian children aged 4–8 years with (i) Australian Guide to Healthy Eating (AGHE) food group recommendations and (ii) age‐specific Nutrient Reference Values (NRVs), in addition to (iii) describing food group intakes of children meeting key NRVs. Methods: Data were obtained from a representative sample of children (n = 789) from the National Nutrition and Physical Activity Survey between May 2011 and June 2012. Parent‐reported 24‐h recall dietary data were disaggregated into five core food groups, along with energy‐dense, nutrient‐poor (EDNP) foods, with intakes being compared with AGHE recommendations. Food group intakes were compared for children meeting the NRVs for 10 nutrients used for the development of AGHE food groups. Chi‐squared and t‐tests were performed to determine differences in food group intakes with P < 0.05 considered statistically significant. Results: Only one child met the recommended daily servings for all AGHE core food groups and none met both core and energy‐dense, nutrient‐poor (EDNP) food group recommendations. The lowest level of alignment (percentage meeting recommendations) was for vegetables (4.6%) and the highest was for fruit (47.7%). Mean (SD) daily intake of EDNP foods [4.7 (3.2) serves day−1] accounted for 38.4% of total energy intakes. Children meeting key NRVs (n = 395) consumed greater daily servings of fruit [2.2 (1.7)], dairy [2.2 (1.2)] and EDNP foods [5.0 (3.4)] compared to the total sample (n = 789). Conclusions: Significant discrepancies exist between contemporary dietary patterns of Australian children and national recommendations. Future AGHE revisions should incorporate greater diversity of consumption patterns, including sub‐categories of EDNP foods. [ABSTRACT FROM AUTHOR]

Abstract: Background: Nonresponsive maternal child‐feeding interactions, such as restricting, pressurising and emotional feeding, can affect the ability of a child to self‐regulate intake and increase the risk of becoming overweight. However, despite findings that South Asian and Black children living in the UK are more likely to be overweight, UK research has not considered how maternal child‐feeding style might differ between ethnic groups. The present study aimed to explore variations in maternal child‐feeding style between ethnic groups in the UK, taking into account associated factors such as deprivation and parenting style. Methods: Six hundred and fifty‐nine UK mothers with a child who was aged 5–11 years old completed a questionnaire. Items included ethnicity and demographic data, as well as copies of the Child Feeding Questionnaire, Parental Feeding Styles Questionnaire and Parenting Styles and Dimensions Questionnaire. Results: Significant differences in perceived responsibility (P = 0.002), restriction (P = 0.026), pressure to eat (P = 0.045), instrumental feeding (P = 0.000) and emotional feeding (P = 0.000) were found between the groups. Mothers from South Asian backgrounds reported higher levels of pressure to eat, emotional feeding and indulgent feeding styles, whereas mothers from Chinese backgrounds reported greater perceived responsibility and restriction. Mothers from Black and White British backgrounds were not significantly higher with respect to any behaviour. Maternal child‐feeding style was also associated with deprivation and parenting style, although these did not fully explain the data. Conclusions: Understanding cultural factors behind maternal child‐feeding style, particularly around pressurising and indulgent feeding behaviours, may play an important part in reducing levels of children who are overweight and obese in the UK. [ABSTRACT FROM AUTHOR]

Abstract: Background: During the first 4 months of age, approximately 20% of infants cry a lot without an apparent reason. Most research has targeted the crying, but the impact of the crying on parents, and subsequent outcomes, need to receive equal attention. This study reports the findings from a prospective evaluation of a package of materials designed to support the well‐being and mental health of parents who judge their infant to be crying excessively. The resulting “Surviving Crying” package comprised a website, printed materials, and programme of Cognitive Behaviour Therapy‐based support sessions delivered to parents by a qualified practitioner. It was designed to be suitable for United Kingdom (UK) National Health Service (NHS) use. Methods: Parents were referred to the study by 12 NHS Health Visitor/Community Public Health Nurse teams in one UK East Midlands NHS Trust. Fifty‐two of 57 parents of excessively crying babies received the support package and completed the Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder‐7 anxiety questionnaire, as well as other measures, before receiving the support package and afterwards. Results: Significant reductions in depression and anxiety were found, with numbers of parents meeting clinical criteria for depression or anxiety halving between baseline and outcome. These improvements were not explained by reductions in infant crying. Reductions also occurred in the number of parents reporting the crying to be a large or severe problem (from 28 to 3 parents) or feeling very or extremely frustrated by the crying (from 31 to 1 parent). Other findings included increases in parents' confidence, knowledge of infant crying, and improvements in parents' sleep. Conclusions: The findings suggest that the Surviving Crying package may be effective in supporting the well‐being and mental health of parents of excessively crying babies. Further, large‐scale controlled trials of the package in NHS settings are warranted. [ABSTRACT FROM AUTHOR]

Abstract: Aims: Insulin therapy is indicated for people with Type 1 diabetes mellitus; however, treatment‐related weight gain and hypoglycaemia represent barriers to optimal glycaemic management. This study assessed the health economic value of maintained reductions in HbA1c, BMI and hypoglycaemia incidence among the UK Type 1 diabetes population. Methods: The Cardiff Type 1 Diabetes Model was used to estimate lifetime costs, life‐years and quality‐adjusted life‐years (QALYs) for individuals with Type 1 diabetes at different baseline HbA1c, BMI and hypoglycaemic event rates. Results were discounted at 3.5%, and the net monetary benefit associated with improving Type 1 diabetes management was derived at £20 000/QALY gained. Per‐person outputs were inflated to national levels using UK Type 1 diabetes prevalence estimates. Results: Modelled subjects with an HbA1c of 86 mmol/mol (10.0%) were associated with discounted lifetime per‐person costs of £23 795; £12 649 of which may be avoided by maintaining an HbA1c of 42 mmol/mol (6.0%). Combined with estimated QALY gains of 2.80, an HbA1c of 42 mmol/mol (6.0%) vs. 86 mmol/mol (10.0%) was associated with a £68 621 per‐person net monetary benefit. Over 1 year, unit reductions in BMI produced £120 per‐person net monetary benefit, and up to £197 for the avoidance of one non‐severe hypoglyceamic event. Conclusions: Maintained reductions in HbA1c significantly alleviate the burden associated with Type 1 diabetes in the UK. Given the influence of weight and hypoglycaemia on health economic outcomes, they must also be key considerations when assessing the value of Type 1 diabetes technologies in clinical practice. [ABSTRACT FROM AUTHOR]

Abstract: Background: Low‐carbohydrate diets are becoming increasingly popular, although their dietary quality outside of clinical studies is unknown. A previous study analysed the dietary intake in people consuming a reduced‐carbohydrate diet (<40% calories). However, it is not clear what foods people consume when carbohydrate is reduced to below 26% of total calories. Methods: In the present cross‐sectional study, the dietary and nutrient intake collected via up to five consecutive 24‐h dietary recalls and a food frequency questionnaire of 444 individuals (aged 46‐79 years) consuming <26% of calories from carbohydrate (LCHO) was compared with that of 131 897 individuals consuming ≥45% calories from carbohydrate (NCHO) using the UK Biobank Dataset. Absolute cut‐offs to define the low‐carbohydrate group (<130 g day–1; n = 1953 versus ≥225 g day–1, n = 113 036) were also used. Results: Both NCHO (>45% calories and ≥225 g) groups consumed significantly more high‐sugar, high‐fat snacks [median 6.0, interquartile range (IQR) = 2.0–11.0 and median 6.0, IQR = 3.0–11.8, respectively) compared to the LCHO (<26% calories and <130 g) groups (median 0, IQR = 0–2.8 and median 1, IQR = 0–3.8, respectively) (P < 0.0001). Both LCHO groups reported consuming significantly more red meat, oily fish, nuts and seeds but fewer fruits, vegetables and pulses compared to the NCHO groups. In general, the consumption of oily fish, nuts, seeds and pulses was low across the whole cohort and differences in intake between the LCHO and NCHO groups were small. After adjusting for socio‐economic status, most differences remained. Conclusions: Carbohydrate restriction is associated with both beneficial and potentially deleterious dietary changes compared to a normal carbohydrate intake. [ABSTRACT FROM AUTHOR]

Vegetables are commonly rejected by children, making it is important to consider factors that are associated with children's fussiness with vegetables. The current study aimed to investigate whether fussiness with vegetables is associated with a number of factors including caregiver and child vegetable consumption; caregivers' general feeding practices; and caregivers' vegetable-specific feeding practices. Caregivers ( N = 297) of preschool children completed questionnaire measures of their child's fussiness with vegetables, as well as several caregiver and child factors hypothesised to be associated with children's fussiness with vegetables. Findings indicate that children who are fussier with vegetables consume a smaller quantity of vegetables and that almost all have caregivers who eat a smaller quantity of vegetables. Children's fussiness with vegetables was not significantly related to any general feeding practices used by caregivers. However, children's fussiness with vegetables was significantly associated with the use of several vegetable specific feeding practices. Caregivers of fussier children used more encouragement/pressure to eat with vegetables ( r = 0.14, p = .01), hid vegetables within other foods more often ( r = 0.30, p = <.01), used more food rewards for vegetable consumption ( r = 0.19, p <.01), more other rewards for vegetable consumption ( r = 0.21, p < .01), and compromised more when feeding vegetables ( r = 0.14, p = .01). These findings suggest that rather than caregivers' general feeding practices being related to children's fussiness with vegetables, the specific feeding practices used when vegetables are rejected are more significant. It may therefore be helpful to develop advice for caregivers about which feeding practices to avoid when faced with a child who is fussy about eating vegetables. [ABSTRACT FROM AUTHOR]

Although the fulcrum of service provision for personality disorder (PD) has shifted from hospital-based to psychodynamically- and cognitively-oriented outpatient programmes, very few studies have attempted to compare specialist moderate intensity outpatient programmes with specialist high-intensity residential models, or to explore whether a period of inpatient treatment may be necessary to improve outcome and prognosis. In this article, we prospectively compare changes over a 4-year period in 3 groups of patients with personality disorders ( N = 162) treated in a specialist community-based (CBP, N = 30), a step-down (RT-CBP, N = 87), and a specialist residential programme (RT, N = 45) in psychiatric distress, deliberate self-injury, and suicide attempt using multilevel modelling and multivariate logistic regression analyses. The results showed that percentages of early-dropout were significantly different ( p = .0001) for the 3 programmes (CBP = 13.4%, RT-CBP = 10.2%, and RT = 41.4%). A significant interaction between treatment model and time was found for psychiatric distress ( p = .001), with CBP and RT-CBP achieving more marked changes ( g = 1.20 and g = 0.68, respectively) compared to RT ( g = 0.30) at 48-month follow-up. CBP and RT-CBP were found to significantly reduce impulsive behaviour (deliberate self-injury and suicide attempt) compared to RT. Severity of presentation was not found to be a significant predictor of outcome. Long-term RT showed no advantage over long-term CBP, either as stand-alone or as step-down treatment. Replication may be needed to confirm generalizability of results, and a number of limitations in the study design may moderate the inferences that can be drawn from the results. [ABSTRACT FROM AUTHOR]

Objective To estimate the proportion of patients with axial spondyloarthritis (SpA) in a UK national biologics registry who met criteria for fibromyalgia ( FM), and to delineate the characteristics of these patients. Methods Two cohorts of patients are prospectively recruited from across 83 centers in the UK for the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis ( BSRBR- AS). All patients are required to meet Assessment of SpondyloArthritis international Society ( ASAS) criteria for axial SpA. Patients are either newly starting biologic therapy (biologics cohort) or are naive to treatment with biologic agents (non-biologics cohort) at the time of recruitment, and all patients are followed up prospectively. At recruitment and follow-up, clinical information and measurements are recorded while patients complete the 2011 research criteria for FM and assessments of the level of disease activity and work impact. Results Of the patients registered in the BSRBR- AS, 1,504 (68% male) were eligible for the current analysis, of whom 311 (20.7%) met the 2011 research criteria for FM. Prevalence of FM was similar between patients who fulfilled the modified New York criteria for AS (19.7%) and those who fulfilled ASAS imaging criteria but not the modified New York criteria (25.2%); however, among those who fulfilled only the ASAS clinical criteria, the prevalence of FM was lower (9.5%). Patients who met FM criteria reported significantly worse disease activity, function, global severity scores, and quality of life, and were more likely to have moderate or severe levels of mood disorder and clinically important fatigue. Patients who met FM criteria reported experiencing work impairment around half their working time. Meeting FM criteria was not related to elevated C-reactive protein levels or most extraspinal manifestations, but was associated with a higher likelihood of having received biologic therapy. Conclusion Developing management approaches that would address the significant unmet clinical needs of the 1 in 5 patients with axial SpA who meet criteria for FM should be a research priority. [ABSTRACT FROM AUTHOR]

Background Price promotions are a promising intervention for encouraging healthier food purchasing. We aimed to assess the impact of a targeted direct marketing price promotion combined with healthy eating advice and recipe suggestions on the purchase of selected healthier foods by low income consumers. Methods We conducted a randomised controlled trial ( n = 53 367) of a direct marketing price promotion (Buywell) combined with healthy eating advice and recipe suggestions for low income consumers identified as 'less healthy' shoppers. Impact was assessed using electronic point of sale data for UK low income shoppers before, during and after the promotion. Results The proportion of customers buying promoted products in the intervention month increased by between 1.4% and 2.8% for four of the five products. There was significantly higher uptake in the promotion month ( P < 0.001) for the intervention group than would have been expected on the basis of average uptake in the other months. When product switching was examined for semi-skimmed/skimmed milk, a modest increase (1%) was found in the intervention month of customers switching from full-fat to low-fat milk. This represented 8% of customers who previously bought only full-fat milk. The effects were generally not sustained after the promotion period. Conclusions Short-term direct marketing price promotions combined with healthy eating advice and recipe suggestions targeted at low income consumers are feasible and can have a modest impact on short-term food-purchasing behaviour, although further approaches are needed to help sustain these changes. [ABSTRACT FROM AUTHOR]

Background In order to achieve metabolic stability, dietary treatment of inborn errors of metabolism may require restriction of protein, fat or carbohydrate. Manipulation of dietary intake potentially reduces micronutrient status, and provision of a comprehensive vitamin and mineral supplement becomes an essential adjunct to dietary treatment. Aim To review the efficacy of a new complete vitamin and mineral supplement [Fruitivits, Vitaflo Ltd] in 14 subjects in an open prospective 26-week study. Method All subjects had dietary restrictions: low protein diets (57%, n = 8), regular daytime cornstarch and overnight glucose polymer tube feeds (29%, n = 4), low fat diet (7%, n = 1) and modified Atkins diet (7%, n = 1). Plasma nutritional biochemistry, anthropometry and food frequency questionnaires were collected at week 0, 12 and 26 weeks respectively. Results Five nutritional parameters showed a significant improvement from baseline (week 0) to study end (week 26): folate ( P = 0.01), vitamin E ( P = 0.04), plasma selenium ( P = 0.002), whole blood selenium ( P = 0.04) and total vitamin D ( P = 0.008). All the other nutritional markers did not significantly change. Even with regular monitoring, 37% of the product remained unused. Conclusions Despite improvements in some nutritional markers, overall use of the vitamin and mineral supplement was less than prescribed. New methods are needed to guarantee delivery of micronutrients in children at risk of deficiencies as a result of an essential manipulation of diet in inborn disorders of metabolism. [ABSTRACT FROM AUTHOR]

Background Much of the evidence underlying guidelines for producing accessible information for people with aphasia focuses on client preference for particular design features. There is limited evidence regarding the effects of these features on comprehension. Aims To examine the effects of specific design features on text comprehension. It was hypothesized that font style, letter case and supporting images would all have a significant impact on people with aphasias' ability to comprehend text. Methods & Procedures Participants ( N = 9) read 35 paragraphs and selected the most appropriate word or phrase from a choice of four to finish the final sentence. Reading comprehension was assessed in three conditions: font style, letter case and text with a supporting image. One-way analyses of variance (ANOVAs) with Bonferroni post-hoc tests were used to test the effect of each design feature on reading comprehension. Outcomes & Results People with aphasia comprehended significantly more written information when presented in sans-serif font than in a serif style ( p = .01) and when presented in lower case than in upper case ( p = .03). The inclusion of a single supporting image to illustrate a paragraph of text did not have a significant effect on comprehension. Conclusions & Implications This research supports the premise that font style and letter case have a significant effect on text comprehension, but that illustrating a paragraph of text with a single image may not significantly improve comprehension when text is written at a low readability level. Although it is critical to produce accessible information, improving comprehension is only one rationale for modified text presentation and therefore these results must be viewed in the context of other recommendations. [ABSTRACT FROM AUTHOR]

Background Restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) is an effective dietary treatment for irritable bowel syndrome ( IBS). Patient dietary education is essential but labour intensive. Group FODMAP education may alleviate this somewhat but has not previously been investigated. The present study aimed to investigate the clinical effectiveness of low FODMAP group education in patients with IBS and to explore the cost of a group pathway. Methods Patients with IBS ( n = 364) were assessed for their suitability to attend dietitian-led group education or traditional one-to-one education in a novel group pathway. Clinical effectiveness (global symptom question, symptom prevalence, stool output) were compared at baseline and follow-up using the chi-squared test. The costs of the novel group pathway were assessed using a decision model. Results The global symptom question indicated more patients were satisfied with their symptoms following dietary advice, in both group education [baseline 48/263 (18%) versus follow-up 142/263 (54%), P < 0.001] and one-to-one education [baseline 5/101 (5%) versus follow-up 61/101 (60%), P < 0.001], with no difference between group and one-to-one education at follow-up ( P = 0.271). Overall, there was a significant decrease in symptom severity from baseline to follow-up ( P < 0.001 for both groups) but no difference in symptom response between group and one-to-one education. The cost for the group education pathway for all 364 patients was £31 713.36. Conclusions The present study shows that dietitian-led FODMAP group education is clinically effective and the costs associated with a FODMAP group pathway are worthy of further consideration for routine clinical care. [ABSTRACT FROM AUTHOR]

Background The glycaemic responses of staples differ when eaten as mixed meals. We determined the glycaemic responses and glycaemic index (GI) values for common South Asian carbohydrate rich foods and the effect of adding curried chicken to them as mixed meals. Methods The GI and glycaemic response to staples (basmati rice, pilau rice and chapatti) and mixed meals (pilau rice with chicken curry and chapatti with chicken curry) were measured in healthy volunteers. Paired comparisons in each subject were carried out for staples and their equivalent mixed meals ( n = 9). Results GI values for the mixed meals were significantly lower than the staples alone (41 and 60 for pilau rice with chicken curry and pilau rice alone, P = 0.001; 45 and 68 for chapatti with chicken curry and chapatti alone, P = 0.004). Both, pilau rice and chapatti with chicken curry had a significantly lower glycaemic response than their equivalent staples alone: incremental area under the blood glucose response curves (IAUC) 111.9 mmol min−1 L−1 for pilau rice with curry versus 162.4 mmol min−1 L−1 for pilau rice alone ( P = 0.001) and IAUC 110.1 mmol min−1 L−1 for chapatti with chicken curry versus 183.6 mmol min−1 L−1 for chapatti alone ( P = 0.002). Conclusions Adding fat and protein-containing curries as part of a mixed meal to carbohydrate rich staple foods reduced glycaemic responses, and also changed the GI category. [ABSTRACT FROM AUTHOR]

Background Bioelectrical impedance analysis would be a more practical tool to measure body composition in clinical settings, dietetic practice and epidemiological studies if patients/subjects did not have to fast before measurements. The present study assessed whether the ingestion of food or drink had any biologically significant effect on bioimpedance measurements and body composition by the foot-to-foot method. Methods Fifty-five healthy adults [30 males and 25 females; mean (SD) age 27.7 (7.1) years; mean (SD) body mass index 24 (3.8) kg m−2] were randomly assigned to a 2-day food trial (high-fat meal or high-carbohydrate meal) or a 2-day drink trial (water or high electrolyte drink). Body composition measurements were carried out in the fasting state, immediately after meal consumption and every 30 min for 2 h by the foot-to-foot single frequency bioimpedance technique. Results Bioimpedance increased significantly after the ingestion of food and fluid, although the changes were small. The electrolyte drink, high-fat and high-carbohydrate meals significantly increased the percentage body fat and fat mass. In all cases, the median percentage changes from baseline were approximately 1% in body fat percentage units. Conclusions Although there were statistically significant changes in body composition estimates after food or drink consumption, these were small and within the imprecision of the impedance technique, and so are unlikely to be of clinical significance. The present study suggests that impedance measures of body fatness in clinical settings do not require strict adherence to fasting, and this should increase the opportunities for clinical application. [ABSTRACT FROM AUTHOR]

Background Dietary modification may be important in the prevention and control of chronic adult periodontitis. The role of promoting an adequate consumption of fruits, vegetables and whole grains in chronic periodontitis has not been thoroughly investigated. The main aim of this dietary intervention study was to assess the influence of a customised dietary intervention (aiming to increase the consumption of fruits, vegetables and whole grains) on antioxidant status in adults with chronic periodontitis. Methods Fifty-one participants, aged 30-65 years, were recruited from a UK Dental Hospital and randomly allocated to an intervention or control group. Both groups received normal clinical treatment but customised dietary advice was delivered to the intervention group by a community nutrition assistant. Dietary intakes, anthropometric parameters and biochemical indices with respect to blood and saliva and periodontal indices were evaluated at baseline, as well as at 3 and 6 months post-dietary intervention. Results At 3 and 6 months post-intervention, the intervention group showed a significant ( P < 0.05) increase in plasma total antioxidant capacity measured by Trolox equivalent antioxidant capacity assay compared to the control group. At 3 and 6 months after dietary intervention, the intervention group had significantly higher intakes of fruits and vegetables compared to the control group. The intake of whole grain was significantly higher in the intervention group than in the control group, 6 months post-intervention. No significant differences were observed with respect to periodontal indices between groups. Conclusions It is suggested that dietary advice may help to improve dietary habits and, consequently, the antioxidant status of patients with chronic periodontitis. However, the impact of such intervention on periodontal indices needs further investigation. [ABSTRACT FROM AUTHOR]

Background Weight management interventions can be extended using mobile telephone technology to deliver support in real-time, real-world settings. The present study aimed to determine whether text messaging helped patients maintain or lose weight following a weight-loss programme. Methods In this controlled study, overweight and obese [ body mass index ( BMI) >30 kg m-2 or >28 kg m-2 with co-morbidities] adults who completed a weight-loss programme participated in an additional 12-week text message intervention [ Lifestyle, Eating and Activity Programme ( LEAP) Beep]. Patients were allocated goals for steps, fruit, vegetable and breakfast consumption. Patients regularly 'texted' their progress and received tailored practitioner feedback. Pre/post-intervention body weight, waist circumference ( WC), BMI, quality of life ( QOL), anxiety and depression measurements were compared retrospectively with a control group offered weight checks only. Results Compared to control ( n = 17), the intervention group's ( n = 17) body weight, WC and BMI reduced significantly (−1.6 versus 0.7 kg, P = 0.006; −2.2 versus 1.5 cm, P = 0.0005; −0.6 versus 0.7 kg m-2, P = 0.03, respectively). QOL and depression scores also improved (−6.8 versus 1 point, P = 0.134; −0.2 versus 0.2 points, P = 0.228). No difference was observed in anxiety scores between the groups. Intervention versus control group follow-up attendance improved significantly (4.4 versus 1.7 attendances, P = 0.0005). Conclusions LEAP Beep promoted losses in weight, WC and BMI, and improved QOL parameters and follow-up attendance. Text messaging is a cheap, portable, convenient and innovative medium facilitating goal setting, self-monitoring and information exchange. Further improvements to automation at the same time as maintaining individual support are necessary to ease practitioner burden. Text messaging offers cost-efficient dietetic input, opening up possibilities for practitioner-to-patient support and yields positive weight outcomes following initial weight loss. [ABSTRACT FROM AUTHOR]

Background Coeliac disease is an autoimmune disorder that is considered to affect approximately one in 100 people. In the UK, gluten-free (GF) foods can be prescribed by general practitioners ( GPs) to treat this condition and there are national guidelines on the quantities of GF food an individual should receive on prescription. Information on actual prescribing behaviour by GPs, and how this compares with guideline recommendations, is scarce. The present study aimed to describe GPs prescribing practice of GF foods, within one locality in the UK, comparing this with national guidelines. Methods A retrospective evaluation of GP electronic medical records for all patients with a gluten-sensitive enteropathy diagnosis and/or those prescribed GF food between April 2010 and March 2011 was carried out in 16 GP practices in the west of Scotland, serving a total of 85 667 patients. Results Of 175 (0.18% of the total practice population) patients, 152 were identified with coeliac disease, eight with dermatitis herpetiformis and six with both conditions. A further nine patients received GF foods on prescriptions with no recorded diagnosis. There was a positive association between adherence to the prescribing guidelines and female sex ( P < 0.0001) and (for those with a recorded diagnosis) increasing age ( P = 0.001). There was no significant association between either socio-economic deprivation or co-morbidities and adherence to the prescribing guidelines. Conclusions There was significant under prescribing of GF foods in those identified. Further research is required to establish whether these results are representative of wider practice in the UK. [ABSTRACT FROM AUTHOR]

Background Accurate estimates of energy expenditure are required in clinical nutrition in order to determine the requirements of individuals and to inform feeding regimes. Calorimetry can provide accurate measurements but is often impractical in clinical or community settings; prediction equations are widely used to estimate resting energy expenditure ( REE) but have limited accuracy. A portable, self-calibrating, handheld calorimeter ( HHC) may offer an alternative way of determining REE. The aim of the study was to evaluate whether estimates of REE derived using an HHC are closer to accurate measurements than values calculated using selected prediction equations. Methods REE was measured in 36 healthy adults aged 21-58 years using a flow-through indirect calorimeter ( FIC) and HHC. Estimated REE was calculated using three predictive equations ( Harris & Benedict; Schofield; Henry). Differences in REE between the 'gold standard' values derived using the FIC and those derived using the HHC and equations were examined using paired t-tests and Bland Altman plots. Results Mean REEHHC was significantly lower than mean REEFIC [4556 ± 1042 kJ (1089 ± 249 kcal) versus 6230 ± 895 kJ (1489 ± 214 kcal), P = 0.000] and also significantly lower than mean values calculated using all three equations. The mean difference between REEHHC and REEFIC [1674 ± 908 kJ (400 ± 217 kcal)] was significantly greater ( P = 0.000) than the mean differences between the values calculated using the three prediction equations [272 ± 490 kJ (65 ± 117 kcal) (Harris-Benedict), 264 ± 510 kJ (63 ± 122 kcal) (Schofield), 84 ± 502 kJ (20 ± 120 kcal) (Henry)]. Conclusions The HHC provides estimates of REE in healthy people that are less accurate than those calculated using the prediction equations and so does not provide a useful alternative. [ABSTRACT FROM AUTHOR]

Background With an established, yet avoidable, link between dietary intake and poor health, the nutritional habits of adolescents remains a public health concern. Previous studies report an inverse relationship between dietary intake and socio-economic status ( SES), although few studies have considered the influence of the SES gradient. The present study compared the nutritional profiles of neighbouring schools with pupils from middle to high economic backgrounds. Methods One hundred and ninety pupils from a high SES school ( HSESS) and 159 pupils from a middle SES school ( MSESS) (aged 11-12 years) completed a 63-item validated food frequency questionnaire. Pupils rated their diet quality and this was compared with a composite Healthy Eating Index ( HEI). Results Children attending MSESS consumed significantly higher intakes of energy ( P < 0.001), carbohydrate ( P = 0.001), fat ( P < 0.001) and protein ( P = 0.001). As a percentage of energy contribution, pupils in both schools consumed excess saturated fat ( HSESS, +5% boys, +4% girls; MSESS, +4% both boys and girls) and sugar ( HSESS, +9% boys, +11% girls; MSESS, +10% boys, +11% girls). When HEI was compared with self-report diet quality, 96% HSESS pupils and 94% MSESS pupils over-rated the quality of their diet. Conclusions The present study identified that, although pupils from MSESS consume a significantly higher intake of energy and macronutrient compared to a nearby HSESS, the percentage of energy contribution of saturated fat and sugar is above government recommendations for pupils from both schools. Additionally, the majority of pupils from both schools substantially over-rated their diet quality compared to a HEI. [ABSTRACT FROM AUTHOR]

Background Trainee dietitians, nutritionists, nurses and doctors will direct the future of obesity treatment and prevention. To do so effectively, they must be willing and able to engage empathically with overweight and obese people. The present study aimed to assess weight bias among UK trainee healthcare professionals and to investigate the factors predicting weight bias, both static and potentially modifiable. Methods A self-completed questionnaire collected data on demographics, weight and height, the Fat Phobia Scale ( F-scale), and the Beliefs about Obese People ( BOAP) scale from 1130 students. Results Overall, participants demonstrated significant levels of fat phobia [F-scale score mean ( SD) = 3.8 (0.5)]. Only 1.4% of participants could be said to have expressed 'positive or neutral attitudes' (i.e. achieved a F-scale score ≤ 2.5). Hierarchical multiple regression revealed that lower fat phobia (as measured by the F-scale) was uniquely predicted by a higher self-reported body mass index, being on the Nursing BSc course and a stronger perception that obesity is not under a person's control (as measured by the BOAP scale). Conclusions There are unacceptable levels of weight bias among UK students training to become nurses, doctors, nutritionists and dietitians. The results of the present study suggest that a promising approach for future interventions would be the provision of balanced education about the controllability of obesity, focusing upon genetic and environmental factors, as well as diet and exercise. [ABSTRACT FROM AUTHOR]

Background School lunches potentially provide an important source of nutrients for children, although studies have shown that their food choices are not always associated with health benefits. The present study aimed to evaluate the effects of a kitchen-based intervention on intake from school lunches undertaken in 2005. Methods The three-phase study comprised a pre-intervention observation, the intervention itself and a post-intervention observation. Children aged 12-16 years attending a large, inner-city, secondary school in London were invited to participate. The intervention consisted of small, practical changes to the school menu with the purpose of reducing total and saturated fat and increasing fruit and vegetable consumption. Intake was evaluated using a weighed technique. Results One hundred and eighty and 198 children participated in the pre- and post-intervention phases, respectively. After the intervention, a significant reduction was observed in mean (SD) intake of total fat [44% (8%) versus 40% (9%) total energy, P < 0.01] and of saturated fat [13% (6%) versus 10% (6%), P < 0.01]. The children also ate significantly more fruit and vegetables [12.0 (10.4) g versus 30.0 (30.5) g total weight, P < 0.001]. However, after the intervention, the mean intakes of total and saturated fat, fruit and vegetables were still significantly below the Caroline Walker Trust guidelines for school lunches. Conclusions The present study shows that total and saturated fat and fruit and vegetable intake from school lunches can be significantly improved by a short, kitchen-based intervention. Although the benefits were limited, the results support further work in this area. [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]

Background and Purpose Healthy individuals have a top-down coordination pattern when turning while walking; they first rotate the head, then the shoulders, the pelvis and, finally, the feet. The aim of this study was to compare spatial and temporal characteristics of head and trunk rotation in sitting between people early after stroke and healthy participants, and investigate change over time. Methods This was a pilot, quantitative, longitudinal study. We recruited participants from stroke wards and local groups. People with stroke were assessed at 3, 6 and 12 weeks after stroke. Healthy participants were examined with the same weekly intervals. Participants were in a seated position and were asked verbally to rotate their head and look at a visual signal placed at 90° to the left and to the right of the subject. CODAmotion (Charnwood Dynamics Ltd, Rothley, UK) was used for 3-D motion recording and analysis. Results Healthy participants (two women and four men; mean age 66 years) showed significant rotation of the head before rotation of the shoulders at all three time points; people with stroke (one woman and five men; mean age 71 years) did not show this top-down pattern of movement. There was no significant difference between start times of head and shoulder rotation at 3 ( p = 0.167), 6 ( p = 0.084) and 12 weeks after stroke ( p = 0.062). Conclusions. The results of our pilot study warrant further investigation into the recovery and pattern of axial coordination after stroke. Future studies could provide insight into the mechanisms behind impaired postural control in people after stroke. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Functional constipation is common in childhood; diets in affluent industrialised countries may be a significant contributory factor as a result of inadequate fibre content. Only a few intervention studies have been reported where childhood constipation has been treated by increasing dietary fibre. The present study aimed to demonstrate that dietary fibre intakes of children with constipation can be increased using a specifically-designed behaviour modification technique with a self-monitoring and reward system. Methods: Forty-three children, aged 2-14 years, with functional constipation (defined as less than three bowel movements per week with hard stools and difficulty or delay in defecation) were randomised to one of two treatment groups: Control ( n = 20), receiving general advice on increasing dietary fibre intake, or Intervention ( n = 23), using the intervention tool. Fibre intake, laxative use and stool frequency were assessed at baseline, and at 3, 6 and 12 months, using parent-filled diaries. Results: A behavioural intervention method significantly increases the fibre intakes of children with constipation at 3 months compared to standard dietary treatment ( P = 0.005), remaining so after adjusting for baseline fibre intake ( P = 0.007). Follow-up at 6 and 12 months showed no further increase. No significant benefit in terms of a reduction in laxative use or increased stool frequency associated with additional fibre intake was demonstrated. Conclusions: The findings confirm the difficulties encountered in beginning and maintaining high-fibre diets in children. [ABSTRACT FROM AUTHOR]

Background: Iron-deficiency anaemia is particularly prevalent in pregnancy. The present study aimed to determine whether functional bread containing teff flour (i.e. naturally rich in iron) could be an alternative way of improving iron status. However, before testing whether its consumption can improve pregnancy iron status, the bio-availability of iron was determined in a sample of nonpregnant women. Methods: Fifty-eight women (20-50 years) were recruited from the University. Blood samples were taken at baseline to assess iron status and participants were screened to account for other factors affecting iron status. Twenty-four participants (haemoglobin 9.5-14.0 g dL−1) were recruited to take part in the intervention and allocated to five groups: (i) control bread (CB); (ii) teff bread (TB); (iii) TB + level 1 phytase (TB + P1); (iv) TB + level 2 phytase (TB + P2); or (v) a supplement containing 10 mg of ferrous sulphate. Venous blood samples were taken before the intervention and after 180-210 min, aiming to determine changes in serum iron. Results: Consuming three or four slices of TB provided statistically significantly more iron (7.6 mg) than CB (5.1 mg) ( P < 0.001). Because participants were fasted, serum iron levels declined in all bread groups (average −1.5 μ m), although the smallest reduction was observed in the TB + P2 group (−0.3 μ m). The area-under-the-curve from baseline to 210 min was lower in the TB + P2 (−78.8 μmol min L−1) group compared to the other bread interventions, indicating higher levels of iron absorption in this group. Conclusions: The results obtained in the present study show that TB consumption may help to maintain serum iron levels, especially when phytase is added. The findings from the study also demonstrate there may be potential to further improve the bio-availability of iron from non-haem food sources. [ABSTRACT FROM AUTHOR]

Background: Unhealthy eating patterns in childhood can lead to adverse health conditions, particularly obesity. However, debate remains around the precise eating behaviours that lead to these conditions. The present study aimed to address this lack of evidence by reporting on the eating frequency, breakfast consumption and body mass index (BMI, kg m-2) of youth in the UK. Methods: A total of 264 (133 boys and 131 girls) participants, aged 10-13 years, completed self-report measures of dietary intake via 3-day food/drink diaries (Friday to Sunday). Trained researchers recorded height and weight to calculate the BMI. Diaries were analysed using dietplan 6 nutritional analysis software (Forestfield Software, Horsham, UK) and multivariate linear regression was used to examine any association between breakfast consumption, frequency of eating and BMI. Results: No relationship existed between BMI Z-score, eating frequency and breakfast consumption. However, frequent breakfast consumers had significantly lower mean (SD) BMI Z-scores [0.18 (1.06) versus 0.57 (1.23)] and higher intakes of iron, calcium and vitamin E than those who did not eat breakfast regularly. Those aged ≥11 years consumed breakfast less frequently [0.92 (0.20)] and were less likely to eat regularly [4.6 (1.4)] than those aged ≤10 years. Conclusions: Older boys were the least likely to eat regularly and the least likely to consume breakfast. Promoting the importance of regular eating, particularly breakfast consumption to these boys, may be essential to ensure healthier, long-term eating patterns. Furthermore, the lower breakfast intakes in 11-13-year-olds and higher BMI Z-scores of those who did not eat breakfast regularly should be monitored. [ABSTRACT FROM AUTHOR]

The Low Income Diet and Nutrition Survey described the food consumption and nutrient intake of UK children in low income households in 2003-2005. To describe food consumption and nutrient intake associated with school meals and packed lunches, based on a cross-sectional analysis of 680, 24-h dietary recalls from 311 school children aged 4-11 years. In children from low income households, pupils who took a packed lunch consumed more white bread, fats and oils, crisps and confectionery and fewer potatoes (cooked with or without fat) at lunchtime compared to other pupils. Many of these differences persisted when diet was assessed over the day. For younger pupils (4-7 years), packed lunches provided the least amount of folate, the highest amount of sodium, and the highest average percentage of food energy from fat and saturated fatty acids (SFA) compared to free school meals (FSMs). Over the whole day, in both younger (4-7 years) and older (8-11 years) children, there were no notable differences in energy or nutrient intake between those eating a packed lunch or a school meal. Older children's packed lunches contributed a significantly higher proportion of fat, SFA, calcium and sodium to the day's nutrient intake compared to a FSM. In children from low income households, packed lunches are less likely to contribute towards a 'healthier' diet compared to a school meal. The difference was more apparent in younger children. Key differences were the high consumption of sodium, SFA and non-milk extrinsic sugars by pupils who had packed lunches. [ABSTRACT FROM AUTHOR]

This investigation determined the efficacy of a tart cherry juice in aiding recovery and reducing muscle damage, inflammation and oxidative stress. Twenty recreational Marathon runners assigned to either consumed cherry juice or placebo for 5 days before, the day of and for 48 h following a Marathon run. Markers of muscle damage (creatine kinase, lactate dehydrogenase, muscle soreness and isometric strength), inflammation [interleukin-6 (IL-6), C-reactive protein (CRP) and uric acid], total antioxidant status (TAS) and oxidative stress [thiobarbituric acid reactive species (TBARS) and protein carbonyls] were examined before and following the race. Isometric strength recovered significantly faster ( P=0.024) in the cherry juice group. No other damage indices were significantly different. Inflammation was reduced in the cherry juice group (IL-6, P<0.001; CRP, P<0.01; uric acid, P<0.05). TAS was ∼10% greater in the cherry juice than the placebo group for all post-supplementation measures ( P<0.05). Protein carbonyls was not different; however, TBARS was lower in the cherry juice than the placebo at 48 h ( P<0.05). The cherry juice appears to provide a viable means to aid recovery following strenuous exercise by increasing total antioxidative capacity, reducing inflammation, lipid peroxidation and so aiding in the recovery of muscle function. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the thermal and non-thermal effects of pulsed short wave therapy (PSWT) using high and low dose of PSWT together with placebo and control conditions in healthy subjects. A single-blind, crossover design was employed with 31 subjects who all participated in three conditions: High PSWT (PD 200 μsec, PRR 800 Hz, MP 24 W, 10 minutes), Low PSWT (PD 100 μsec, PRR 200 Hz, MP 3 W, 10 minutes), and Placebo PSWT (PD 20 μsec, PRR 50 Hz, MP 0.05 W, 10 minutes). Fourteen subjects additionally participated in a Control condition (no treatment, 10 minutes). Measurements of skin temperature, blood flow, heart rate, and core temperature were taken before, during, and after the application of PSWT. Data were analyzed using a repeated measures analysis of variance (ANOVA) model with a Bonferroni post-hoc comparison. A significant increase in blood volume and skin temperature with both the high- and low-dose applications during the treatment period was demonstrated. There were significant differences between time periods and between treated and untreated limbs compared with the control condition. The blood flow changes during the low-dose application were not significantly different from placebo. Some subjects were unable to detect significant changes in skin temperature. Significant physiological changes associated with the application of PSWT have been demonstrated, challenging the notion of a lack of effect of this therapy. The study also demonstrated a measurable increase in skin temperature, which was not associated with thermal sensory perception; thus, skin sensation may not be clinically reliable for detecting real changes in temperature. Subjects with a wide age range of ages were deliberately recruited; however, these results may not extrapolate to a patient population who could react differently to the same intervention. Further studies in the clinical environment are therefore needed. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

An abstract of the article "Improving the quality of packed lunches in primary school children," by N. Cooper and C. Jones is presented.

An abstract of the article "The availability and cost of a milk-free diet for cow's milk protein allergy," by S. P. Shah and R. Towell is presented.

An abstract of the article "A text message-based weight management intervention for overweight adults," by E. L. Donaldson and S. Fallows is presented.

The article presents a study which compares the costs of a basket of food that matches with healthy eating guidelines and a standard basket of food in different socioeconomic status (SES) in Great Britain. It examines the difference between the cost of healthy food basket and standard food basket. It notes the findings of the study that show that the cost of the healthy food basket was more expensive than the standard food basket and the difference between the cost of such baskets was small.

The Foresight report (Butland et al., 2007) has identified that risk perception is an area where additional evidence is needed to improve the understanding of obesity. The Department of Health (2009) reports university students as a group vulnerable to weight gain and therefore future programs for obesity could be informed by the knowledge of the target group. The aim of this project was to investigate the knowledge of Coventry University students regarding the health risks associated with obesity. Non-probability convenience sampling was used to recruit 40 participants from Coventry University. Data was collected using a 'pen-and-paper' questionnaire format and the validated Obesity Risk Knowledge-10 scale (ORK-10 scale) was used to assess level of knowledge (Swift 2006). The ORK-10 Scale consists of 10 brief questions covering obesity related co-morbidities such as diabetes, cancer, life expectancy and high blood pressure, with the option of answering true, false or don't know. Each correct answer scored 1 point, therefore a higher score indicated greater knowledge. Socio-demographic data including gender, age, ethnicity, course and faculty were also collected. Because of the small sample size of the study, these independent variables were dichotomised; gender into male and female, age groups into <20 and >20 years, ethnicity into Caucasian and non-Caucasian, course into undergraduate and postgraduate and faculty into health and life sciences compared with other faculties. A Kolmogorov-Smirnov test was used to assess the normality of the distribution of ORK-10 scale scores. The results indicated normal distribution of ORK-10 score for gender, ethnicity, course and faculty groups, supporting the use of a t-test. For comparing scores between age groups, the data was not normally distributed, supporting the use of a nonparametric Mann-Whitney U-test. The study received approval from the Coventry University Ethics Committee. The participant population consisted of 16 males and 24 females, 13 < 20 and 27 > 20 years of age, 25 Caucasians and 15 non-Caucasians, 36 undergraduates and four postgraduates, and 20 in the health and life sciences faculty and 20 in other faculties including engineering and computing, art and design, business, environment and society, and lifelong learning. No significant differences were found in ORK-10 scores between gender ( P = 0.276), ethnicity ( P = 0.179), course ( P = 0.310), or faculty ( P = 0.168). However, a statistically significant difference was found in ORK-10 scores between age groups, participants >20 years of age had a greater level of knowledge (median = 6, interquartile range = 4), compared to those <20 years of age (median = 4, interquartile range = 2), P = 0.031. Significant differences were observed in ORK-10 scores according to age with older students scoring higher. This agrees with the finding of Swift (2006) and may be explained by the increased exposure of this age group to health messages. In contrast to previous findings (Swift 2006), studying health and life sciences was not associated with increased knowledge of health risks. This may be explained by the limited sample size of the study, the students may have been in the early stages of their course, sampling bias may have meant that only students interested in health took part, and the sampling technique may not have been representative of the population. This study found a statistically significant relationship between knowledge of health risk associated with obesity and age of the students. There is a need for further research in this area, and future studies of larger randomly selected students would help to confirm the need for targeted obesity education programs. The results conclude that students <20 years of age should be considered as a target population for future obesity education programs, in order to make a positive impact on heath behaviour and dietary choices. Butland, B., Jebb, S., Kopelman, P., McPherson, K., Thomas, S., Mardell, J., & Parry, V. (2007) Foresight Tackling Obesities: Future Choices - Project Report. 2nd edn.Government Office for Science, Department of Innovation Universities and Skills. Department of Health (2009) Obesity [online] Available at: [Accessed on 13 September 2009]. Swift, J.A., Glazebrook, C. & Macdonald, I. (2006) Validation of a brief, reliable scale to measure knowledge about the health risks associated with obesity. Int. J. Obesity, 661-668. [ABSTRACT FROM AUTHOR]

Individuals at increased cardio-metabolic (CM) risk have a greater chance of developing diabetes mellitus and suffering premature cardiovascular events. The metabolic syndrome (MetS) is a constellation of risk factors which confer increased CM risk. MetS was originally proposed by Reaven (1998) and the currently accepted definition was agreed by AHA/NHLBI,WH,IASIASO (Alberti et al., 2009). More recently, increased liver fat has been proposed as a marker of CM risk. The aims of this study were to evaluate the inter-relationships between percentage liver fat and established CM risk factors and identify those with MetS. This paper presents a secondary analysis of baseline data from a sample ( n = 37) (56 ± 5.32 years), of overweight men who were at increased CM risk but otherwise healthy,, and recruited into a randomised dietary intervention crossover study to investigate how dietary carbohydrate influences the metabolism of plasma lipoproteins in overweight volunteers with moderately high (>10% <20%) and low (<2%) levels of liver fat. Anthropometric and biochemistry measurements were obtained, and from a sub-sample, the percentage of liver fat by magnetic resonance imaging. The participants were also assigned a metabolic score based on the number of indicators of the MetS according to the AHA/NHLBI, WH, IASIASO definition (Alberti, 2009). Non-parametric statistical analyses was used, as not all variables were normally distributed, there were a number of outliers and a small sample size. Pearson Correlation Co-efficients were used to investigate relationships between continuous and categorical variables. The variables were not adjusted for age or BMI because of a small sample size. Statistical significance was set at P ≤ 0.05 and all analyses were carried out using SPSS 16.0. Fifty nine per cent of the participants had MetS ( n = 21). There was evidence of significant, positive associations between the metabolic score for MetS and total cholesterol:HDL-C ratio ( P = 0.030), and between percentage liver fat and plasma glucose and insulin ( P = 0.010 and P = 0.003 respectively). The percentage of liver fat was also notably higher than that reported in other studies (Yamada et al., 2010; Kotronen et al., 2007) and there was positive correlation between the liver enzyme alanine transaminase (ALT) and plasma insulin ( P = 0.012). The strong associations between established risk factors and liver fat suggest that the latter may be clinically useful as a marker for CM risk in MetS. Alberti, K., Eckel, R., Grundy, S. et al. (2009) Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation, 1640-1645. Kotronen, A., Westerbacka, A., Bergholm, R., Pietilainen, K.H. & Yki-Jarvinen, H. (2007) Liver fat in the metabolic syndrome. J. Clin. Endocrinol. Metab. , 3490-3497. Reaven, G. (1998) Insulin resistance and human disease: a short history. J. Basic Clin. Physiol. Pharmacol., 387-406. Yamada, T., Fukatsu, M., Suzuki, S. et al. (2010) Fatty liver predicts impaired fasting glucose and type 2 diabetes mellitus in Japanese undergoing a health checkup. J. Gastroenterol. Hepatol., 352-356. [ABSTRACT FROM AUTHOR]

The rising issue of obesity is associated with increased risk of morbidity and mortality. The prevention and management of obesity has been problematic, due to its complex and multifaceted aetiology (Foresight, 2007). Lifestyle modification is essential for effective and sustainable weight loss, however high attrition rates are common (Foresight, 2007). The aim of this study was to systematically review the evidence for the effectiveness of lifestyle (diet and exercise) programmes, identifying the features of successful lifestyle weight management programmes, and to explore the experiences of individuals who have attended the Hammersmith Hospitals Lifestyle weight management programme, identifying aspects which promote and prevent successful completion of the programme. This study consisted of a systematic review and phenomenological observational study of the Hammersmith hospitals NHS trust Lifestyle weight management clinic. The systematic review involved searching four relevant scientific electronic databases: Medline, Embase, Psychinfo, Cochrane Library; 4314 titles, 346 abstracts and 113 full texts were screened. Eight studies met the predetermined search criteria (Dietitian delivered one to one lifestyle interventions with overweight or obese adults reporting weight change). This systematic review focused on clinically significant (≥5%) weight loss (NHS, 2006) as the measure of efficacy and success of lifestyle weight management programmes. The phenomenological observation involved the Lifestyle clinic; a 6 months individualised care package consisted of diet and exercise advice with behaviour change techniques and motivational interviewing, delivered by a dietitian, to promote overweight/obese adults to reduce weight. Purposeful sampling of patients, who had attended the clinic in the last 12 months, was conducted by contacting and requesting for volunteers. In-depth one-to-one interviews with six participants (four completers, two non-completers) were completed and analysed (Colaizzi, 1978) with the assistance of the computer software nVivo 8, which organised coded statements and themes identified. Ethical approval was given by St Mary's Research Ethics Committee, London. Three of the eight studies reviewed demonstrated ≥5% clinically significant weight loss. Key features of all three successful programmes, and not of the five unsuccessful programmes, included frequent weekly follow ups, compulsory supervised exercise and intense dietary counselling and exercise regimens. The phenomenological observation identified a variety of factors; key promoting factors included regular appointments, realistic targets, recognising responsibility, positive attitude and support from others and dietitian. A key inhibiting factor was difficulty with exercise. Limitations of the study were: the limited number of studies, the heterogeneous nature of the studies, and the restricted applicability of the studies of the review. Recruitment bias restricting ratio of completers to non-completers, limited sample size, and lack of participant validation of the results/conclusions limited the phenomenological observation. Furthermore it was questionable whether the interventions were sustainable; participants believed lack of support after the 6 months and difficulty exercising inhibited success. Recommendations for practice included continuous regular support, supplementary exercise programmes and optional group support; however practical implications involved are cost, time and resources. Further quantitative and qualitative research with greater samples would be essential to validate this study, ensure data saturation and evaluate weight management interventions. Colaizzi, P (1978). Psychological Research As a Phenomenologist Views It: 48-71. In existential phenomenological alternatives for psychology. Ed. M King and R Valle. New York: Oxford University Press. Foresight (2007). Tackling obesities: future choices. . [Accessed on 9 October 2009]. National Health Service (NHS) (2006). Care pathway for the management of overweight and obesity. [Accessed on 10 December 2009]. [ABSTRACT FROM AUTHOR]

The incidence of overweight and obesity in youth is rapidly escalating to epidemic proportions (WHO, 2004). Multi-component interventions have been highlighted as the treatment of choice (NICE, 2006) but the current evidence base is limited and many interventions have not been properly evaluated. The Carnegie International Camp (CIC), an annual, residential, multi-component weight management intervention, has been previously demonstrated to be effective across a range of health outcomes for overweight and obese children and adolescents (Gately et al., 2005). The current study aimed to review the continued effectiveness of the CIC programme through evaluation of the same range of health outcome parameters. Two hundred and ninety young people (aged 8-18 years) were recruited (UK and internationally) for the 2006-2008 CIC programmes. It was not possible to identify a control group or to obtain random samples due to the specific nature of the intervention. Anthropometric and psychological outcome variables were measured on the first (baseline) and last day of each participants stay, and repeated weekly. Outcome variables measured: weight, height, waist circumference, body composition, blood pressure, aerobic fitness and self esteem. Some participants attended successive CIC programmes; only data from participants' first programme attendance were included for analysis. To control for study attrition only complete data sets were included in the analysis. Independent t-tests were utilised to identify group differences at baseline between the participant cohort of the current study (2006-2008) and the 1999-2002 participant cohort evaluated by Gately et al. (2005). Repeated measures tested for the significance of pre-post intervention changes within and between cohorts. Analysis was conducted using SPSS v16.0 with P < 0.05 accepted as significant. The CIC programme and all subsequent analyses were granted full ethical approval by NHS Leeds West Teaching Hospital Research Ethics Committee. One hundred and ninety-three complete data sets were obtained (2006-2008); significant improvements ( P < 0.05) were attained across all outcome variables in this cohort. Comparison with Gately et al. (2005) findings revealed similar changes were achieved in both studies: Similarimprovements across outcome variables were achieved in both cohorts evaluated, demonstrating the continued acute efficacy of the CIC. Direct comparison between different interventions is difficult due to programme heterogeneity, but repetition of existing studies provides benefits such as increased sample size, reduces variation of results and increases confidence in the effects of the experimental factor being examined. The CIC continues to demonstrate an acute effectiveness in producing positive outcomes across a range of physiological and psychological variables associated with overweight and obesity in young people. Similarimprovements across outcome variables were achieved in both cohorts evaluated, demonstrating the continued acute efficacy of the CIC. Direct comparison between different interventions is difficult due to programme heterogeneity, but repetition of existing studies provides benefits such as increased sample size, reduces variation of results and increases confidence in the effects of the experimental factor being examined. The CIC continues to demonstrate an acute effectiveness in producing positive outcomes across a range of physiological and psychological variables associated with overweight and obesity in young people. Gately, P.J., Cooke, C.B., Barth, J.H., Bewick, B.M., Radley, D., & Hill, A.J. (2005) Children's residential weight loss programs can work: a prospective cohort study of short-term outcomes for overweight and obese children. Pediatrics , 73-77. National Institute for Health and Clinical Excellence. (2006) Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children. London: NICE clinical guidance 43. Retrieved February 10, 2009 from . World Health Organisation (2004) Obesity: Preventing and managing the global epidemic. Report of a WHO consultation on obesity. Geneva: WHO. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is a metabolic disorder of multifactorial aetiology which affects approximately 1.9 million adults in the UK. The incidence of type 2 diabetes is increasing with obesity levels, and treatment focuses on achieving and maintaining adequate blood glucose levels and weight management in order to reduce the risk of diabetic complications. As diabetes is progressive, blood glucose often becomes inadequate on maximal dose oral glucose lowering therapy and patients may eventually require insulin as third line therapy. Exenatide is an alternative to insulin; the first drug in the class of incretin mimetics which has been used at Darent Valley Hospital for the past 2 years. This study aimed to audit patient management against the 2009 NICE guidelines and to identify any health benefits following 6 months of Exenatide treatment. A convenience sample of 46 outpatients ( n = 27 male; n = 19 female) in the Dartford and Gravesham area who were or had been taking Byetta, according to a list supplied by the Diabetes team, was utilised for this audit. Patients' medical information was collected from the clinical record system 'Diabeta' and statistical analysis was carried out using SPSS (v17) to investigate changes in weight, body mass index (BMI) and HbA as a marker of drug efficacy (repeated measures ANOVA). Retrospective patient data was also utilised to assess compliance with the NICE guidelines for starting patients on Byetta and continuing treatment at 6 months. At baseline the sample had a mean age of 57 (10.7) years and were predominantly obese [mean BMI 38.8 (8.4) kg m] with poor blood glucose control [mean HbA1c 10.0 (1.2)%]. Mean time since diagnosis was 9 (3.7) years. Overall, a significant reduction in weight was seen after 6 months of treatment ( P < 0.001) with a mean weight loss of 2.8 kg (0.6). BMI was significantly lower after 6 months ( P < 0.001) with a mean reduction of 1.5 kg m (1.9). HbA was also significantly reduced after 6 months ( P < 0.001) with a mean reduction of 1.7% (1.5). Changes in weight, BMI and HbA were not significantly different between genders, time since diagnosis or age. The audit identified that the Diabetes team were following NICE guidelines for the majority of the time. When starting the drug, 100% of patients were commenced as a third line therapy, 96% of patients had a HbA≥7.5%, and 77% had a BMI ≥35 kg m. Eighty seven percent of patients had associated psychological or medical problems and 38% were started on Byetta due to occupational implications of insulin or to promote weight loss. Of those patients that continued the drug after 6 months, 60% had achieved the recommended 1% reduction in HbA and 89% had shown a 3% reduction in weight. After 6 months, Byetta therapy was associated with significant reductions in weight, BMI and HbA, which supports the findings of previous research (Buse et al., 2004; DeFronzo et al., 2005). This audit did not include a control group, and future studies could compare the outcomes of treatment with Byetta against outcomes after conventional treatment. The management of patients on Byetta followed the NICE guidance for the majority of the time. However, data for some patients was missing from 'Diabeta', suggesting that staff were not always recording information after each consultation with the patient. In future, a larger sample size would increase the validity of results, and future audits within the hospital could focus on record keeping. Buse J.B., Henry R.R., Han J. et al. (2004) Effects of exenatide (exendin-4) on glycaemic control over 30 weeks in sulfonylurea-treated patients with type 2 diabetes. Diabetes Care 27, 2628-2635. DeFronzo R.A., Ratner R.E., Han J. et al. (2005) Effects of exenatide (exendin-4) on glycaemic control and weight over 30 weeks in metformin-treated patients with type 2 diabetes. Diabetes Care, 1092-1100. National Institute of Clinical Excellence (NICE) (2009) Type 2 diabetes - newer agents (partial update of CG66). Available online from: [Accessed on August 2010]. [ABSTRACT FROM AUTHOR]

Subjective Global Assessment (SGA) had been recommended by the Renal Association (Wright & Jones 2010) as an appropriate nutritional screening tool for the detection of malnutrition in haemodialysis (HD) patients. However, it has been criticised for being time consuming (Kondrup et al. 2003) and lacking sensitivity (Kalantar-Zadeh et al.1999). The Patient Generated Subjective Global Assessment (PG-SGA) requires the patient to complete part of the screening tool; thus reducing the amount of time the dietitian spends completing it. A recent pilot project showed that, compared to SGA, PG-SGA was able to distinguish significant differences between several independent measurements of nutritional status (demonstrating construct validity) (Hyam et al., 2010). In contrast the Malnutrition Universal Screening Tool (MUST) did not identify risk of malnutrition in HD patients. The aim of the current project was to assess a greater number and range of patients (with respect to nutritional status) using the three tools, in order to confirm whether PG-SGA was the most appropriate nutritional screening tool for use in HD patients. The nutritional status of 65 HD patients ( n = 43 male; n = 22 female) attending two renal units; St Georges and Canterbury, was assessed by one investigator at each unit (KF and RP respectively). There was no exclusion criteria, however investigators aimed to assess a greater proportion of patients with suspected malnutrition (identified by SN and SR) as this group was possibly under-represented in the previous study. Data included SGA, MUST, PG-SGA, grip strength, anthropometric and biochemical parameters. Construct validity was examined using ANOVA to compare differences between the nutritional values of those patients classified by the nutritional screening tools as being at no risk, moderate risk or high risk of malnutrition. Criterion validity was assessed using the kappa statistic to measure the level of agreement between SGA (as the gold standard), PG-SGA, and MUST. SGA classifications of nutritional status were able to distinguish significant differences in: Albumin ( P = 0.03); CRP ( P = 0.023), hand grip strength ( P = 0.001), average daily energy intake ( P = 0.005), protein intake ( P = 0.01) and haemoglobin ( P = 0.0001). PG-SGA only identified significant differences in hand grip strength ( P = 0.008) and mid arm circumference ( P = 0.024). MUST identified differences in current BMI ( P = 0.04), mid arm circumference ( P = 0.005) and CRP ( P = 0.03). A moderate kappa statistic (0.51) was recorded when comparing the level of agreement between PGSGA and SGA classifications of patients. Virtually no agreement was found between SGA and MUST (( = 0.07). The sensitivity of PG-SGA compared to SGA was 89% and the specificity was 50%. When MUST was compared to SGA the sensitivity was 31% and the specificity was 95%. The majority (63%) of patients were unable to complete the PG-SGA; which were then completed with the assistance of the investigators. MUST poorly identify malnourished HD patients (as found previously by Hyam et al., 2010). However in contrast to the pilot study, this current study which included a larger more nutritionally diverse group of patients, indicated that SGA was more sensitive to changes within independent nutritional parameters than PG-SGA. Over half the patients were not able to complete the PGSGA so, contrary to expectations, there were no time savings. SGA appears to be more sensitive to the nutritional status of HD patients than PG-SGA and additionally a large proportion of HD patients find PG-SGA too difficult to complete. MUST is not a sensitive method for detecting malnutrition in this group of patients. Hyam L., JacksonH., Hart K. & EngelB. (2010) Comparison of the new patient generated subjective global assessment with current established methods in haemodialysis patients. J. Hum. Nutr. Diet., 317-331 (abstract). Kalantar-Zadeh K., Don B. R., Rodriguez R. A. & Humphreys M. H. (2001) Serum ferritin is a marker of morbidity and mortality in haemodialysis patients. Am. J. Kidney Dis. , 564-572. Kondrup J., Allison S. P., Elia M., Vellas B. & Plauth M. (2003) ESPEN Guidelines for nutritional screening. Clin. Nutr. , 415-21. Wright M. & Jones C. (2010) Clinical practice guidelines; nutrition in Chronic Kidney Disease. Available online at: [Accessed on 6 August 2010]. [ABSTRACT FROM AUTHOR]

Background: The General Medical Council states that all medical graduates must be able to carry out practical procedures, including peripheral venous cannulation, safely and effectively. Teaching and assessments within primary medical training tend to focus on safety rather than 'effectiveness' or technical competence. This study aimed to develop and evaluate a test of automaticity of peripheral venous cannulation skill, appropriate to the level of a medical student. Methods: Two researchers developed the distracted intravenous access (DIVA) test. Three components are assessed simultaneously: ability to cannulate a plastic arm manikin, performance in an arithmetic test and speed of completion. Volunteers were recruited from three groups: novices (fourth-year medical students), intermediates (foundation year-1 doctors) and experts (anaesthetic and emergency medicine consultants and trainees). Immediately following the test, volunteers completed a questionnaire. Results: Mean scores differed between the three groups: novices (47.7%), intermediates (73.4%), experts (84.4%). Differences were statistically significant (p < 0.0005). The majority of participants found the test to be enjoyable (78%) and useful (76%). More students agreed that the test was fair (78%) than doctors (38%), but this difference was not statistically significant. Discussion: This study presents a feasible method of testing medical students' automaticity when performing peripheral venous cannulation. It has provided evidence of the construct validity and acceptability of the test. The authors suggest that clinical tutors consider offering the test as a formative assessment to final-year medical students in order to familiarise them with the level of proficiency required to perform peripheral venous cannulation when distracted. [ABSTRACT FROM AUTHOR]

An abstract of the article "A retrospective audit of weight loss in bariatric surgery patients," by E. Cooper and L. Watson is presented.

The recruitment pattern of lower limb muscles during cycling is known to alter because of changes in workload and seat height. The effect of foot/pedal position is not well understood but may be useful in the prevention and management of injury. Seven healthy female subjects participated in a study. Three-foot positions on the pedal were tested in a random order: neutral, back and fore. Each subject cycled for 5 minutes at a set cadence and resistance during which 30 seconds of electromyogram data were recorded for gastrocnemius (Gast.) and tibialis anterior (TA). An electrogoniometer was located across the knee to concurrently record pedal revolutions. To test the effect of position, an ANOVA and Tukey's post-hoc were used for Gast. However, the data from the TA were not normally distributed; therefore, a Kruskal-Wallis was used for this muscle instead. No statistical significant relationship was found between foot position and TA activity ( p = 0.128). However, there was a significantly ( p = 0.000) lower level of activity in Gast. when the pedal was placed in the back foot position. Altering the position of the foot on a pedal changes the muscle activity of Gast. This is likely to be caused by the change in moment arm and may be exploited as a strategy to progress resistance during a training programme or as a method of protecting the muscle during a period of recovery. These conclusions should be interpreted with caution because of the small sample size. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]