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Background and Objectives: The effects of muscle meat and vegetable intake on body fat mass remain unclear in the general population. This study aimed to investigate the association of body fat mass and fat distribution with a muscle meat-vegetable intake (MMV) ratio. Methods and Study Design: In total, 29,271 participants aged 18–80 years were recruited from the Shaanxi cohort of the Regional Ethnic Cohort Study in Northwest China. The associations of muscle meat, vegetable and MMV ratio, as the independent variable, with body mass index (BMI), waist circumference, total body fat percentage (TBF) and visceral fat (VF), as dependent variables were evaluated by gender-specific linear regression models. Results: There was 47.9% of men whose MMV ratio was greater than or equal to 1 and this figure was about 35.7% for women. For men, higher muscle meat intake was associated with higher TBF (standardized coefficient [ß], 0.508; 95% CI, 0.187–0.829), higher vegetable intake was associated with lower VF (ß, -0.109; 95% CI, -0.206 – -0.011), and higher MMV ratio was associated with higher BMI (ß, 0.195; 95% CI, 0.039–0.350) and VF (ß, 0.523; 95% CI, 0.209–0.838). For women, both higher muscle meat consumption and MMV ratio were associated with all fat mass markers, but vegetable intake was not correlated with body fat mass markers. The positive association of MMV on body fat mass was more pronounced in higher MMV ratio group, with both men and women. The intake of pork, mutton and beef was associated positively with fat mass markers but no such association was observed for poultry or seafood. Conclusions: An increased intake of muscle meat or a higher MMV ratio was associated with increased body fat, especially among women, and such impact may mainly be attributed to increasing intake of pork, beef and mutton. The dietary MMV ratio could be thus a useful parameter for nutritional intervention. [ABSTRACT FROM AUTHOR]

Background Polypharmacy represents a growing public health concern for its associations with drug-related adverse events, poor adherence, medication errors and increased healthcare costs. Aim To assess the occurrence of polypharmacy prescribing and to identify the correlates in terms of doctors and patients characteristics in rural Western China. Methods 20⇔125 prescriptions were collected from 680 primary health clinics in villages from 40 counties in 10 provinces of Western China. Two outcome variables are used in the analysis: number of drug items prescribed and use of five or more drugs (polypharmacy). A multilevel Poisson regression model and a multilevel logistic regression model were employed to examine the socio-economic, demographic determinants of the above two outcome variables, respectively. Results The average drug number per prescription was 2.36, and the percentage of polypharmacy was 5.8%. The odds for polypharmacy were higher for village doctors with a heavier workload than those with less workload (OR=1.70; 95% CI 1.26 to 2.29). Patients with injections prescribed had higher odds for polypharmacy than patients without injections (OR=4.61; 95% CI 3.93 to 5.42). Village doctor's workload, subsidy for doctors from government and injection in prescriptions, patient's age and gender were also significant predictors of number of drug items prescribed in the studied areas. Conclusions Polypharmacy seems to be associated with the village doctors' and patients' background and government policy. Intervention studies are needed to promote rational use of drugs in rural China. [ABSTRACT FROM AUTHOR]

Background Antibiotic-associated diarrhoea (AAD) occurs most frequently in older (>65 years) inpatients exposed to broad-spectrum antibiotics. When caused by Clostridium difficile, AAD can result in life-threatening illness. Although underlying disease mechanisms are not well understood, microbial preparations have been assessed in the prevention of AAD. However, studies have been mostly small single-centre trials with varying quality, providing insufficient data to reliably assess effectiveness. We aimed to do a pragmatic efficacy trial in older inpatients who would be representative of those admitted to National Health Service (NHS) and similar secondary care institutions and to recruit a sufficient number of patients to generate a definitive result. Methods We did a multicentre, randomised, double-blind, placebo-controlled, pragmatic, efficacy trial of inpatients aged 65 years and older and exposed to one or more oral or parenteral antibiotics. A computer-generated randomisation scheme was used to allocate participants (in a 1:1 ratio) to receive either a multistrain preparation of lactobacilli and bifidobacteria, with a total of 6 x 1010 organisms, one per day for 21 days, or an identical placebo. Patients, study staff, and specimen and data analysts were masked to assignment. The primary outcomes were occurrence of AAD within 8 weeks and C difficile diarrhoea (CDD) within 12 weeks of recruitment. Analysis was by modified intention-to- treat. This trial is registered, number ISRCTN70017204. Findings Of 17420 patients screened, 1493 were randomly assigned to the microbial preparation group and 1488 to the placebo group. 1470 and 1471, respectively, were included in the analyses of the primary endpoints. AAD (including CDD) occurred in 159 (10-8%) participants in the microbial preparation group and 153 (10-4%) participants in the placebo group (relative risk [RR] 104; 95% CI 0-84-1-28; p=0-71). CDD was an uncommon cause of AAD and occurred in 12 (0-8%) participants in the microbial preparation group and 17 (1-2%) participants in the placebo group (RR 0-71; 95% CI 0-34-1-47; p=0-35). 578 (19-7%) participants had one or more serious adverse event; the frequency of serious adverse events was much the same in the two study groups and none was attributed to participation in the trial. Interpretation We identified no evidence that a multistrain preparation of lactobacilli and bifidobacteria was effective in prevention of AAD or CDD. An improved understanding ofthe pathophysiology of AAD is needed to guide future studies. [ABSTRACT FROM AUTHOR]

Background: WHO estimates exposure to air pollution from cooking with solid fuels is associated with over 4 million premature deaths worldwide every year including half a million children under the age of 5 years from pneumonia. We hypothesised that replacing open fires with cleaner burning biomass-fuelled cookstoves would reduce pneumonia incidence in young children.Methods: We did a community-level open cluster randomised controlled trial to compare the effects of a cleaner burning biomass-fuelled cookstove intervention to continuation of open fire cooking on pneumonia in children living in two rural districts, Chikhwawa and Karonga, of Malawi. Clusters were randomly allocated to intervention and control groups using a computer-generated randomisation schedule with stratification by site, distance from health centre, and size of cluster. Within clusters, households with a child under the age of 4·5 years were eligible. Intervention households received two biomass-fuelled cookstoves and a solar panel. The primary outcome was WHO Integrated Management of Childhood Illness (IMCI)-defined pneumonia episodes in children under 5 years of age. Efficacy and safety analyses were by intention to treat. The trial is registered with ISRCTN, number ISRCTN59448623.Findings: We enrolled 10 750 children from 8626 households across 150 clusters between Dec 9, 2013, and Feb 28, 2016. 10 543 children from 8470 households contributed 15 991 child-years of follow-up data to the intention-to-treat analysis. The IMCI pneumonia incidence rate in the intervention group was 15·76 (95% CI 14·89-16·63) per 100 child-years and in the control group 15·58 (95% CI 14·72-16·45) per 100 child-years, with an intervention versus control incidence rate ratio (IRR) of 1·01 (95% CI 0·91-1·13; p=0·80). Cooking-related serious adverse events (burns) were seen in 19 children; nine in the intervention and ten (one death) in the control group (IRR 0·91 [95% CI 0·37-2·23]; p=0·83).Interpretation: We found no evidence that an intervention comprising cleaner burning biomass-fuelled cookstoves reduced the risk of pneumonia in young children in rural Malawi. Effective strategies to reduce the adverse health effects of household air pollution are needed.Funding: Medical Research Council, UK Department for International Development, and Wellcome Trust. [ABSTRACT FROM AUTHOR]

Background: Health anxiety is common in medical settings and can be treated successfully by cognitive behaviour therapy. However it is not clear who might be best placed to deliver this therapy. Objectives: In a planned secondary analysis of data from a randomised trial of adapted cognitive behaviour therapy for health anxiety we compared outcomes of therapy delivered by nurses and other professional groups. Design: A randomised controlled trial with two treatment arms, 5–10 sessions of cognitive behaviour therapy adapted health anxiety or standard care. Setting: Cardiology, endocrine, gastroenterology, neurological and respiratory clinics in six general hospitals in the UK covering urban, suburban and rural areas. Participants: Medical patients attending the clinics who had pathological health anxiety and also scored for a diagnosis of hypochondriasis. Methods: Patients were randomised to one of two treatment arms, 5–10 sessions of cognitive behaviour therapy adapted health anxiety or standard care delivered by naive therapists (not randomised) who were trained in advance before delivering the treatment. Independent assessment of outcomes by researchers masked to allocation status at 3 m, 6 m, 12 m and 24 m. Results: 444 patients were randomised in the trial, 219 to cognitive behaviour therapy adapted health anxiety and 225 to standard care. 373 (84%) completed assessments after two years. Those treated by nurses (n = 66) had improvement in health anxiety, generalised anxiety and depression outcomes that were significantly better and twice as great as those of the professional groups of assistant psychologists (n = 87) and graduate workers (n = 66) (P < 0.01 over all time points). The number needed to treat to show superiority of nurse-delivered treatment over other treatment delivery was 4 at 6 months and 6 at one year. Conclusion: General nurses, after suitable training, are very effective therapists for patients with health anxiety in medical clinics and should be the therapists of choice for patients in these settings. [ABSTRACT FROM AUTHOR]

A response from the author of the article "Lactobacilli and Bifidobacteria in the Prevention of Antibiotic-Associated Diarrhoea and Clostridium difficile Diarrhoea in Older Inpatients (PLACIDE): A Randomised, Double-Blind, Placebo-Controlled, Muilticentre Trial" published in the journal in 2013 is presented.