Search

In healthy adolescents, cross-sectional studies show either no or negative relationships between serum 25-hydroxyvitamin D [25(OH)D] and calcium (Ca) absorption. Using a 2-period metabolic balance study, the effect of vitamin D supplementation on Ca absorption and retention in adolescent girls was investigated. Eleven girls aged 12-14 y with a mean entry serum 25(OH)D of 35.1 nmol/L consumed a controlled intake (providing 5 μg vitamin D and 1117 mg Ca/d) for two 3-wk metabolic balance periods separated by a 1-wk washout period. Sunlight exposure was minimized by sunscreen with a sun protection factor ≥ 15. After the first metabolic balance period, participants received 25 μg/d cholecalciferol supplementation for 4 wk. Fractional Ca absorption was measured in each metabolic balance period using a stable Ca isotope method. All urine and fecal samples were collected and analyzed to measure net Ca absorption and Ca retention. Paired t tests and correlations were used to analyze the data. Daily supplementation with 25 μg vitamin D resulted in a mean increase in serum 25(OH)D of 13.3 nmol/L (P < 0.01) but a decrease in fractional Ca absorption of 8.3% (P < 0.05) and no significant change in fasting serum 1,25-dihydroxyvitamin D, parathyroid hormone, net Ca absorption, or Ca skeletal retention. In pubertal girls with vitamin D status considered insufficient in adults, vitamin D supplementation of 25 μg/d for 4 wk did not improve fractional Ca absorption, net Ca absorption, or Ca retention. [ABSTRACT FROM AUTHOR]

Macro practice focuses on community-level interventions, such as management, organizing, research, and policy advocacy. Despite social work's deep roots in this type of work, macro practice and macro practitioners often practice without support or connections with other macro practitioners, and are underrepresented in the profession. In 2006, a group of social workers, including academics and practitioners, formed the Association of Macro Practice Social Work (AMPSW). AMPSW works to strengthen the professional identity of macro practitioners, elevate the status of macro social workers, and address common concerns within the social work profession. [ABSTRACT FROM AUTHOR]

Spatial education interventions in the built environment may increase engagement with urban greenspace. This research was a natural experimental study with mixed-method evaluation and repeated cross-sectional design. Twenty-four directional wayfinding signs were installed within an urban park to create a 3 km signposted walking route through the park's amenities in a clockwise direction. Manual counts on one path and bi-directional automated active infrared counts on six paths along the intervention route were conducted at baseline and 12-month follow-up. A QR code accessed intercept survey was open throughout the follow-up phase to capture user experiences, views, and attitudes toward the intervention. There was no consistent difference in manual counts at baseline or 12-month follow-up between intervention and control parks. Automated counts showed no consistent significant change in clockwise footfall between baseline (median automated count range across six counters: 10-130 clockwise counts per day) and follow-up (Autumn to Winter follow-up median automated count range across six counters: 13-103 clockwise counts per day; Spring to Summer follow-up median automated count range across six counters: 13-124 clockwise counts per day). However, 23% (11 out of 48 people) of clockwise travelling route users reported they were following the signs at 12-month follow-up. Intercept survey respondents (n = 27) appeared to be infrequent park users (number of respondents for 'my first visit': 7, and 'one to two times per month: 9), with the new signs making them feel less anxious about exploring unfamiliar areas, while motivating them to walk further than originally planned and helping them to 'take notice' of the landscape. Directional wayfinding for recreational walking appears to help infrequent users engage with urban greenspace., Competing Interests: Declaration of interest The authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Individuals abstaining from alcohol consumption frequently find themselves in contexts encouraging consumption, with limited alternative social interaction opportunities. Conscious clubbing events exclude alcohol and drugs, possibly providing valuable social connections, but little is known about event benefits. Twelve conscious clubbing event attendees and facilitators aged 25-55 from across Europe participated in semi-structured photo-elicitation interviews, which were analysed using thematic analysis. Findings suggested that conscious clubbing appears to enhance health, healing and growth, aiding recovery from substance dependency and trauma. Positioned as a modern ritual, symbolic and ritualistic preparations and experiences promoted storytelling and self-discovery. Connecting through synchronised but unchoreographed movement, participants engaged in powerful journeys and transformative experiences detached from life constraints. Inclusive digital and face-to-face conscious clubbing communities provided a sense of meaning and belonging away from substance use pressures and harms, particularly for those marginalised within society. Findings provide important and in-depth insights, including novel harm prevention implications. Future work should consider participatory barriers, event sustainability and misconceptions to increase event availability and participation.

It is unclear how statin-use influences the adoption of healthy lifestyle choices. It is important to understand the nature of this relationship as this could facilitate targeted public health interventions which could help promote a healthy lifestyle, curb the rise of non-communicable diseases, and facilitate overall health. This study aimed to explore whether statin-use influenced the adoption of healthy lifestyle choices by changing the way urban and semi-urban Nigerians thought about their high cholesterol and their future risk of cardiovascular disease. Structured questionnaires were used to compare the lifestyle behaviours, perceptions of high cholesterol and future risk of cardiovascular disease of statin users and non-statin users recruited in urban and a semi-urban Nigeria. In-depth, face-to-face interviews were used to further explore the relationship between statin-use and the adoption of healthy lifestyle choices, and explore the influence of personal and social factors on this relationship. The odds of adopting a low-fat diet increased as perceived statin-effectiveness increased (OR = 2.33, p<0.05), demonstrating a synergistic relationship between statin-use and the adoption of healthy of lifestyle choices. In addition to this synergistic association, at interview, two other relationships were found between statin use and the adoption of healthy lifestyle choices: an antagonistic relationship fuelled by a strong perception of statin effectiveness and a perceived inability to make healthy lifestyle changes, which favoured statin-use, and an antagonistic relationship fuelled by congruous cause-control beliefs and concerns about medication-use which favoured the adoption of healthy lifestyle choices. The odds of adopting a low-fat diet was 5 times greater in urban dwellers than in semi-urban dwellers (p<0.01). Statin-use influenced the adoption of healthy lifestyle choices in three different ways, which require exploration at clinical consultation. Gender, social obligations, and physical environment also influenced statin-use and the adoption of healthy lifestyle choices., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Coker et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aims and Method: Veganism has increased in popularity in the past decade and, despite being a characteristic protected by law, is often viewed negatively by the general population. Little is known about the attitudes of healthcare professionals despite the potential influence on practice and eating disorder patient care. This is one of the first studies to investigate attitudes toward veganism within specialist eating disorder, general mental health and other professionals., Results: A one-way ANOVA indicated all professionals held positive views toward veganism. General mental health professionals held statistically more positive veganism attitudes than specialist eating disorder and other professionals., Clinical Implications: As one of the first studies to suggest eating disorder professionals are not biased against veganism, it has important clinical practice implications, particularly when exploring motivations for adopting a vegan diet (health, weight loss, environmental or animal welfare concerns) in patients with eating disorders. Implications for further research are provided.

Daratumumab, a CD38-targeting monoclonal antibody, has significantly improved survival rates in multiple myeloma (MM), yet patients who progress on Daratumumab have dismal clinical outcomes with an overall median of less than 10 months. While emerging novel modalities have shown promising results, the current study explores the use of high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) in heavily pretreated Daratumumab-refractory MM patients. We retrospectively investigated the outcome of 69 consecutive patients who received upfront ASCT. The median progression-free survival (PFS) for the entire patient cohort was 7.2 months with a median overall survival (OS) of 19.3 months. For patients with ≥very good partial response (VGPR), median PFS and OS improved to 9 months and 34 months, respectively. Achievement of MRD negativity in ≥VGPR did not further improve the outcome. A better performance status, younger age, longer time interval from initial MM diagnosis/initial ASCT to salvage ASCT and low-risk GEP70 were all associated with improved PFS and OS after salvage ASCT. Our results suggest a role for salvage ASCT in selected heavily pretreated and Daratumumab-refractory patients.

Microangiopathic hemolytic anemia and thrombocytopenia (MAHA-T) is a rare complication of acute pancreatitis (AP). Treatment with therapeutic plasma exchange (TPE) is used at many centers. The natural history of this disease is not well understood. We report a case of acute pancreatitis induced MAHA-T with end organ dysfunction and a normal ADAMTS13 level. Following three TPEs, the patient's clinical status, blood counts and hemolytic markers stabilized. Improvement occurred even after TPE was discontinued. The optimal management of AP-induced MAHA-T is poorly understood. Many centres are reporting good outcomes with the early initiation of TPE. MAHA-T associated with acute pancreatitis is often treated with early initiation of TPE. However, the value of TPE in altering the natural history of the condition is not well understood. Further study is required to understand the role of ADAMTS13 testing to guide treatment, and the role of TPE in management.

Background: Twin anemia-polycythemia sequence (TAPS) is a complication of monochorionic, multiple gestation pregnancies in which blood shunting through placental anastomoses results in chronic anemia in one fetus and chronic polycythemia in another. The outcomes of different treatment modalities for TAPS are not well known., Objective: To determine the outcomes of the intrauterine interventions used to treat TAPS., Study Design: A systematic literature search of MEDLINE, EMBASE, and CENTRAL was performed in June 2016. Primary outcomes were mortality, morbidity, and adverse perinatal outcomes. Data were summarized in the form of weighted means, and statistical difference was determined., Results: Twenty-one articles were identified for inclusion in this review and were composed of 105 cases of TAPS. In the cases presented in the literature, there was no statistically significant difference in mortality, morbidity, or emergent Caesarean section rates between expectant management, intrauterine transfusion (IUT), and laser ablation therapy. Laser ablation therapy and IUT were found to have a significantly lower rate of adverse perinatal outcomes when compared to expectantly managed cases., Conclusions: The literature looking into the treatment of TAPS is very limited, with no randomized controlled trials and only one includable comparative study. Based on the data in the case report and case study literature, there is no mortality difference between any of the treatment modalities. Expectant management may be associated with an increase in adverse perinatal outcomes when compared to laser therapy and IUT. More comparative studies are needed to assist clinicians in adopting an evidence-based approach to the treatment of TAPS., (Copyright © 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.)

Objective: We examine whether patients have a preference for affective (i.e., focused on patient's emotions) or cognitive (i.e., focused on the process that led to the error) apologies that are dependent on the apologizing physician's gender. We hypothesize patients will prefer gender-congruent apologies (i.e., when females offer affective apologies and males offer cognitive apologies)., Methods: We randomly assigned analogue patients (APs: participants instructed to imagine they were a patient) to read a scenario in which a female or male physician makes an error and provides a gender-congruent or incongruent apology. APs reported on their perceptions of the physician and legal intentions., Results: An apology-type and gender congruency effect was found such that APs preferred apologies congruent with the gender of the apologizing physician. An indirect effect of congruency on legal intentions through physician perceptions was confirmed (b=-0.24, p=0.02)., Conclusion: Our results suggest that physician gender plays a role in patient reactions to different apology types., Practice Implications: Apology trainings should incorporate how physician characteristics can influence how patients assess and respond to apologies., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Acute exercise reduces postprandial oxidative stress and glycemia; however, the effects of exercise intensity are unclear. We investigated the effect of acute low-volume high-intensity interval-exercise (LV-HIIE) and continuous moderate-intensity exercise (CMIE) on glycemic control and oxidative stress in overweight and obese, inactive adults. Methods: Twenty-seven adults were randomly allocated to perform a single session of LV-HIIE (9 females, 5 males; age: 30 ± 1 years; BMI: 29 ± 1 kg·m -2 ; mean ± SEM) or CMIE (8 females, 5 males; age: 30 ± 2.0; BMI: 30 ± 2.0) 1 h after consumption of a standard breakfast. Plasma redox status, glucose and insulin were measured. Continuous glucose monitoring (CGM) was conducted during the 24-h period before (rest day) and after exercise (exercise day). Results: Plasma thiobarbituric acid reactive substances (TBARS; 29 ±13%, p < 0.01; mean percent change ±90% confidence limit), hydrogen peroxide (44 ± 16%, p < 0.01), catalase activity (50 ± 16%, p < 0.01), and superoxide dismutase activity (21 ± 6%, p < 0.01) significantly increased 1 h after breakfast (prior to exercise) compared to baseline. Exercise significantly decreased postprandial glycaemia in whole blood (-6 ± 5%, p < 0.01), irrespective of the exercise protocol. Only CMIE significantly decreased postprandial TBARS (CMIE: -33 ± 8%, p < 0.01; LV-HIIE: 11 ± 22%, p = 0.34) and hydrogen peroxide (CMIE: -25 ± 15%, p = 0.04; LV-HIIE: 7 ± 26%; p = 0.37). Acute exercise provided a similar significant improvement in 24-h average glucose levels (-5 ± 2%, p < 0.01), hyperglycemic excursions (-37 ± 60%, p < 0.01), peak glucose concentrations (-8 ± 4%, p < 0.01), and the 2-h postprandial glucose response to dinner (-9 ± 4%, p < 0.01), irrespective of the exercise protocol. Conclusion: Despite elevated postprandial oxidative stress compared to CMIE, LV-HIIE is an equally effective exercise mode for improving 24-h glycemic control in overweight and obese adults.

Recently, shear rate gradients and associated gradients in velocity fluctuations (e.g., granular temperatures or kinetic stresses) have been shown to drive segregation of different-sized particles in a manner that reverses at relatively high solids fractions (〈f〉>0.50). Here we investigate these effects in mixtures of particles differing in material density through computational and theoretical studies of particles sheared in a vertical chute where we vary the solids fraction from 〈f〉=0.2 to 0.6. We find that in sparse flows, 〈f〉=0.2 to 0.4, the heavier (denser) particles segregate to lower shear rates similarly to the heavier (larger) particles in mixtures of particles differing only in size. However, there is no segregation reversal at high f in mixtures of particles differing in density. At all solids fractions, heavier (denser) particles segregate to regions of lower shear rates and lower granular temperatures, in contrast with segregation of different-sized particles at high f, where the heavier (larger) particles segregate to the region of higher shear rates. Kinetic theory predicts well the segregation for both types of systems at low f but breaks down at higher f's. Our recently proposed mixture theory for high f granular mixtures captures the segregation trends well via the independent partitioning of kinetic and contact stresses between the two species. In light of these results, we discuss possible directions forward for a model framework that encompasses segregation effects more broadly in these systems.

Background: Continuity of care is widely acknowledged as important for patients with multi-morbidity but simple, service-orientated indices cannot capture the full impact of continuity in complex care delivery systems. The patient's perspective is important to assess outcomes fully and this is challenging because generic measures of patient-perceived continuity are lacking. We investigate the Chao Perception of Continuity (Chao PC) scale to determine its suitability as a measure of continuity of care for patients with a long-term condition (stroke), and co-morbidity, in a primary care setting., Design and Setting: A questionnaire study embedded in a prospective observational cohort study of outcomes for patients following acute stroke., Participants: 168 community dwelling patients (58% male) mean age 68 years a minimum one year post-stroke. Functional status: Barthel Index mean =16., Intervention: A 23-item questionnaire, the Chao Perception of Continuity (Chao PC) scale, sent by post to their place of residence or administered face to face as part of the final cohort study assessment., Results: 310 patients were invited to participate; 168 (54%) completed a questionnaire. All 23 questionnaire items were entered into a Principal Component Analysis. Emergent factors from the exploratory analysis were (1) inter-personal trust (relational continuity); (2) interpersonal knowledge and information (informational and relational continuity) and (3) the process of care (managerial continuity). The strongest of these was inter-personal trust., Conclusion: The context-specific items in the Chao PC scale are difficult for respondents to interpret in a United Kingdom Primary Care setting resulting in missing data and low response rates. The Chao-PC therefore cannot be recommended for wider application as a general measure of continuity of care without significant modification. Our findings reflect the acknowledged dimensions of continuity and support the concept of continuity of care as a multi-dimensional construct. We demonstrate the overlapping boundaries across the dimensions in the factor structure derived. Trust and interpersonal knowledge are clearly identified as valuable components of any patient-perceived measure of continuity of care.

Purpose: Understanding the heterogeneity in disability after stroke is important to guide treatment and rehabilitation planning. We explored mixture modelling analysis to identify subgroups of stroke disability and factors associated with disability subgroups., Method: Analyses were performed using secondary data from a cohort of 448 stroke patients who participated in a 2-year study of stroke outcomes. Mixture modelling approach was used to determine subgroups of early disability following stroke based on the Barthel Index, General Health Questionnaire (GHQ-28), Frenchay Activities Index and the Nottingham Extended Activities of Daily Living Scale., Results: Five distinct disability groups were identified. Nineteen (4.2%) patients were classified as having very severe disability, 58 (12.9%) severe disability, 133 (29.7%) moderate disability, 198 (44.2%) mild disability and 40 (8.9%) a mood disorder. Compared to the mild group, patients in the "very severe" group were more likely to be elderly and to have had a previous stroke, and less likely to live alone and had a greater risk of mortality 2 years after stroke. Patients in the mood disorder group showed greater dependency in activities of daily living were younger compared to the other groups and had a greater risk of having mood symptoms 2 years after stroke., Conclusion: Mixture modelling of 1-month disability after stroke using a broad range of outcome measures has identified clinically meaningful groups relating to long-term outcomes.

Current research supports the role of metacognitive strategies to enhance reading comprehension. This study measured the effectiveness of online versus face-to-face metacognitive and active reading skills lessons introduced by Biology faculty to college students in a nonmajors introductory biology course. These lessons were delivered in two lectures either online (Group 1: N = 154) or face to face (Group 2: N = 152). Previously validated pre- and post- surveys were used to collect and compare data by paired and independent t-test analysis (α = 0.05). Pre- and post- survey data showed a statistically significant improvement in both groups in metacognitive awareness (p = 0.001, p = 0.003, respectively) and reading comprehension (p < 0.001 for both groups). When comparing the delivery mode of these lessons, no difference was detected between the online and face-to-face instruction for metacognitive awareness (pre- p = 0.619, post- p = 0.885). For reading comprehension, no difference in gains was demonstrated between online and face-to-face (p = 0.381); however, differences in pre- and post- test scores were measured (pre- p = 0.005, post- p = 0.038). This study suggests that biology instructors can easily introduce effective metacognitive awareness and active reading lessons into their course, either through online or face-to-face instruction.

Protistan oyster parasites in the genus Bonamia have been observed in recent years infecting new hosts on five continents, with most of these parasites genetically similar to austral species Bonamia exitiosa and Bonamia roughleyi. Identification of the newly observed parasites as one or another of these described species has been complicated by the fact that B. exitiosa and B. roughleyi are phylogenetically indistinguishable at the small-subunit ribosomal DNA (SSU rDNA) level, with samples of B. roughleyi type material no longer available for genetic re-analyses using more informative internal transcribed spacer (ITS) region DNA sequences. To resolve this issue, we evaluated B. roughleyi in field collections of hosts Saccostrea glomerata and Ostrea angasi (as well as Crassostrea gigas) in New South Wales, Australia in 2006 and 2007, and re-analyzed histological samples from the original description of this parasite species using in situ hybridization. Despite (1) reports of the oyster disease putatively caused by B. roughleyi during the time of collections, (2) the observation of gross lesions characteristic of the disease, and (3) the observation of B. roughleyi cells in association with the lesions, we detected a Bonamia sp. by PCR in just 1/42 O. angasi (2.4%), and 1/608 S. glomerata (0.2%), the latter oyster of which is the type host. SSU rDNA sequences of the amplicons were nearly identical to those of B. exitiosa and B. roughleyi, and phylogenetic analysis of ITS region sequences placed them on a B. exitiosa clade. A Haplosporidium sp. sequence similar to that of H. costale was PCR-amplified from nearly half the S. glomerata and O. angasi, but no Haplosporidium sp. was observed histologically. Our inability to identify a Bonamia sp. sequence in association with the B. roughleyi observed histologically suggests that this parasite is not a Bonamia sp. at all, and should be regarded as B. roughleyi nomen dubium. We conclude that the Bonamia sp. that we and other investigators detected in southeastern Australian S. glomerata and O. angasi was B. exitiosa., (Copyright © 2013 Elsevier Inc. All rights reserved.)

This research examines how women's sexual orientation guides the accuracy of judgements of other women. One hundred ten judges (67 straight and 43 lesbian women) watched videotapes of 9 targets (4 straight and 5 lesbian) and made judgements about the targets' thoughts, emotions, personality, and sexual orientation. Accuracy scores were created for each judge by comparing judgements to criterion data gathered about targets. Straight judges were significantly more accurate at judging thoughts and marginally more accurate at judging emotions compared to lesbian judges. There were no significant differences in judging personality. Straight targets' thoughts and personality were more easily assessed than lesbian targets' while lesbians' emotions were more easily judged than straight targets'. Lesbian judges were more accurate at judging sexual orientation regardless of their tendency to categorize women as lesbian compared to straight judges. Findings support past research on the accurate perception of sexual orientation and contribute to understanding how sexual orientation guides person perception.

Objective: Bowel dysfunction remains a major problem in neonates. Traditional auscultation of bowel sounds as a diagnostic aid in neonatal gastrointestinal complications is limited by skill and inability to document and reassess. Consequently, we built a unique prototype to investigate the feasibility of an electronic monitoring system for continuous assessment of bowel sounds., Method: We attained approval by the Institutional Review Boards for the investigational study to test our system. The system incorporated a prototype stethoscope head with a built-in microphone connected to a digital recorder. Recordings made over extended periods were evaluated for quality. We also considered the acoustic environment of the hospital, where the stethoscope was used. The stethoscope head was attached to the abdomen with a hydrogel patch designed especially for this purpose. We used the system to obtain recordings from eight healthy, full-term babies. A scoring system was used to determine loudness, clarity, and ease of recognition comparing it to the traditional stethoscope. The recording duration was initially two hours and was increased to a maximum of eight hours., Results: Median duration of attachment was three hours (3.75, 2.68). Based on the scoring, the bowel sound recording was perceived to be as loud and clear in sound reproduction as a traditional stethoscope. We determined that room noise and other noises were significant forms of interference in the recordings, which at times prevented analysis. However, no sound quality drift was noted in the recordings and no patient discomfort was noted. Minimal erythema was observed over the fixation site which subsided within one hour., Conclusion: We demonstrated the long-term recording of infant bowel sounds. Our contributions included a prototype stethoscope head, which was affixed using a specially designed hydrogel adhesive patch. Such a recording can be reviewed and reassessed, which is new technology and an improvement over current practice. The use of this system should also, theoretically, reduce risk of infection. Based on our research we concluded that while automatic assessment of bowel sounds is feasible over an extended period, there will be times when analysis is not possible. One limitation is noise interference. Our larger goals include producing a meaningful vital sign to characterize bowel sounds that can be produced in real-time, as well as providing automatic control for patient feeding pumps.

Background: Lifestyle and behaviour change are important factors in the prevention of cardiovascular disease and reduction of premature mortality. Public health initiatives have focused on opportunities for healthcare staff to deliver lifestyle advice routinely in primary and secondary care but there is no consistent approach to onward referrals and the rate of uptake of advice remains low. We do not know if advice is more effective in supporting behaviour change when a systematic approach is taken that includes identification of barriers to change, directing patients toward services, referral to services, and feedback on outcome., Methods and Design: This is a single-centre, randomized, unblinded feasibility trial in an acute hospital setting which aims to assess the feasibility of a definitive trial and provide proof of concept for the systematic delivery of individualized lifestyle advice in patients managed through an acute cardiology in-patient service.Patients will be recruited before discharge and randomized to two groups. A control group will receive the usual lifestyle assessment and referral, while an intervention group will receive the usual assessment plus the new individualized lifestyle assessment and referral. The new assessment will inform assignment of each patient to one of three categories based on personal barriers to change. Patients may be referred to a formal lifestyle-change programme, through the 'Leeds Let's Change' website, or they may be guided in self-management, using goal setting, or they may be assigned to a 'deferment' category, for reassessment at follow-up. These latter patients will be given a contact card for the 'Leeds Let's Change' service., Discussion: Lifestyle change is an important mechanism for improving health and wellbeing across the population but there are widely acknowledged difficulties in addressing lifestyle factors with patients and supporting behaviour change. A systematic approach to assessment would facilitate audit and provide an indicator of the quality of care. The new assessment template has been designed to be quick and easy to use in practice and could, for example, be added to a primary care consultation or form part of a nursing discharge assessment in an acute setting., Trial Registration: Current Controlled Trials ISRCTN41781196.

Background: Management of cardiovascular risk factors includes commitment from patients to adhere to prescribed medications and adopt healthy lifestyles. Unfortunately many fail to take up and maintain the four key healthy behaviours (not smoking, having a balanced diet, limiting alcohol consumption and being more active). Five factors (beliefs, knowledge, transport and other costs, emotions, and friends and family support) are known to predict uptake of lifestyle behaviour change. The key factors influencing maintenance of healthy lifestyles are not known but would be helpful to support the development of relapse prevention programmes for this population. Our review aimed to clarify the main patient perceived factors thought to influence maintenance of changed healthy lifestyles., Methods: We performed a systematic review of qualitative observational studies and applied the principles of content synthesis and thematic analysis to extract reported factors (barriers and facilitators) considered by individuals to be influential in maintaining changed healthy lifestyle behaviours. Factors were then organised into an existing framework of higher order categories which was followed by an analysis of the interrelationships between factors to identify key themes., Results: Twenty two studies met our inclusion criteria. Participants reported barriers and facilitators within 13 categories, the majority of which were facilitators. The most commonly reported influences were those relating to social support (whether provided formally or informally), beliefs (about the self or the causes and management of poor health, and the value of maintaining lifestyle behaviours), and other psychological factors (including attitude, thinking and coping styles, and problem solving skills). Physical activity was the most commonly investigated behaviour in four categories, but overall, the main barriers and facilitators were related to a range of behaviours. Through analysis of the interrelationships between factors within categories, 'social support', 'education and knowledge', and 'beliefs and emotions' were all considered key themes., Conclusions: Our review suggests that for the most part, factors that influence lifestyle change are also important for maintaining healthy behaviours. This indicates that addressing these barriers and facilitators within lifestyle support programmes would also be of value in the longer-term.

Unlabelled: Osteoporotic fracture rates differ according to race with Blacks having up to half the rate of Whites. The current study demonstrates that racial divergence in cortical bone properties develops in early childhood despite lower serum 25-hydroxyvitamin D in Blacks., Introduction: Racial differences in bone structure likely have roots in childhood as bone size develops predominantly during growth. This study aimed to compare cortical bone health within the tibial diaphysis of Black and White children in the early stages of puberty and explore the contributions of biochemical variables in explaining racial variation in cortical bone properties., Methods: A cross-sectional study was performed comparing peripheral quantitative computed tomography-derived cortical bone measures of the tibial diaphysis and biochemical variables in 314 participants (n = 155 males; n = 164 Blacks) in the early stages of puberty., Results: Blacks had greater cortical volumetric bone mineral density, mass, and size compared to Whites (all p < 0.01), contributing to Blacks having 17.0 % greater tibial strength (polar strength-strain index (SSIP)) (p < 0.001). Turnover markers indicated that Blacks had higher bone formation (osteocalcin (OC) and bone-specific alkaline phosphatase) and lower bone resorption (N-terminal telopeptide) than Whites (all p < 0.01). Blacks also had lower 25-hydroxyvitamin D (25(OH)D) and higher 1,25-dihydroxyvitamin D (1,25(OH)2D) and parathyroid hormone (PTH) (all p < 0.05). There were no correlations between tibial bone properties and 25(OH)D and PTH in Whites (all p ≥ 0.10); however, SSIP was negatively and positively correlated with 25(OH)D and PTH in Blacks, respectively (all p ≤ 0.02). Variation in bone cross-sectional area and SSIP attributable to race was partially explained by tibial length, 25(OH)D/PTH, and OC., Conclusions: Divergence in tibial cortical bone properties between Blacks and Whites is established by the early stages of puberty with the enhanced cortical bone properties in Black children possibly being explained by higher PTH and OC.

Patients with chronic kidney disease (CKD) are given calcium carbonate to bind dietary phosphorus, reduce phosphorus retention, and prevent negative calcium balance; however, data are limited on calcium and phosphorus balance during CKD to support this. Here, we studied eight patients with stage 3 or 4 CKD (mean estimated glomerular filtration rate 36 ml/min) who received a controlled diet with or without a calcium carbonate supplement (1500 mg/day calcium) during two 3-week balance periods in a randomized placebo-controlled cross-over design. All feces and urine were collected during weeks 2 and 3 of each balance period and fasting blood, and urine was collected at baseline and at the end of each week. Calcium kinetics were determined using oral and intravenous (45)calcium. Patients were found to be in neutral calcium and phosphorus balance while on the placebo. Calcium carbonate supplementation produced positive calcium balance, did not affect phosphorus balance, and produced only a modest reduction in urine phosphorus excretion compared with placebo. Calcium kinetics demonstrated positive net bone balance but less than overall calcium balance, suggesting soft-tissue deposition. Fasting blood and urine biochemistries of calcium and phosphate homeostasis were unaffected by calcium carbonate. Thus, the positive calcium balance produced by calcium carbonate treatment within 3 weeks cautions against its use as a phosphate binder in patients with stage 3 or 4 CKD, if these findings can be extrapolated to long-term therapy.

Background: Whey protein isolates (WPI) supplementation is known to improve resistance training adaptations. However, limited information is available on the effects of WPI plus carbohydrate (CHO) supplementation on endurance training adaptations., Method: Six endurance trained male cyclists and triathletes (age 29 ± 4 years, weight 74 ± 2 kg, VO2 max 63 ± 3 ml oxygen. kg-1. Min-1, height 183 ± 5 cm; mean ± SEM) were randomly assigned to one of two dietary interventions in a single blind cross over design; CHO or CHO + WPI. Each dietary intervention was followed for 16 days which included the last 2 days having increased CHO content, representing a CHO loading phase. The dietary interventions were iso-caloric and carbohydrate content matched. On completion of the dietary intervention, participants performed an exercise bout, consisting of cycling for 60 min at 70% VO2 max, followed by time trial to exhaustion at 90% VO2 max and recovered in the laboratory for 6 hours. Blood samples and muscle biopsies were taken at various time points at rest and through the exercise trial and recovery., Results: Compared to CHO, CHO + WPI increased plasma insulin during recovery at 180 mins (P < 0.05) and peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1α) mRNA expression at the end of 6 hours of recovery (P < 0.05). Muscle glycogen did not differ between the two trials., Conclusion: This study showed co-ingestion of CHO + WPI may have beneficial effects on recovery and adaptations to endurance exercise via, increased insulin response and up regulation of PGC-1α mRNA expression.

Background: Healthy lifestyles are an important facet of cardiovascular risk management. Unfortunately many individuals fail to engage with lifestyle change programmes. There are many factors that patients report as influencing their decisions about initiating lifestyle change. This is challenging for health care professionals who may lack the skills and time to address a broad range of barriers to lifestyle behaviour. Guidance on which factors to focus on during lifestyle consultations may assist healthcare professionals to hone their skills and knowledge leading to more productive patient interactions with ultimately better uptake of lifestyle behaviour change support. The aim of our study was to clarify which influences reported by patients predict uptake and completion of formal lifestyle change programmes., Methods: A systematic narrative review of quantitative observational studies reporting factors (influences) associated with uptake and completion of lifestyle behaviour change programmes. Quantitative observational studies involving patients at high risk of cardiovascular events were identified through electronic searching and screened against pre-defined selection criteria. Factors were extracted and organised into an existing qualitative framework., Results: 374 factors were extracted from 32 studies. Factors most consistently associated with uptake of lifestyle change related to support from family and friends, transport and other costs, and beliefs about the causes of illness and lifestyle change. Depression and anxiety also appear to influence uptake as well as completion. Many factors show inconsistent patterns with respect to uptake and completion of lifestyle change programmes., Conclusion: There are a small number of factors that consistently appear to influence uptake and completion of cardiovascular lifestyle behaviour change. These factors could be considered during patient consultations to promote a tailored approach to decision making about the most suitable type and level lifestyle behaviour change support.

Low serum 25-hydroxyvitamin D [25 (OH) D] is common in healthy children particularly in blacks. However, serum 25 (OH) D concentrations for optimal bone turnover in children is unknown and few data exist that describe effects of increasing serum 25 (OH) D on bone turnover markers during puberty. The purpose of this study was to determine the relationships between serum 25 (OH) D and changes in serum 25 (OH) D and bone turnover in white and black pubertal adolescents. Bone turnover markers were measured in 318 healthy boys and girls from Georgia (34°N) and Indiana (40°N) who participated in a study of oral vitamin D(3) supplementation (0 to 4000 IU/d). Serum 25 (OH) D, osteocalcin, bone alkaline phosphatase, and urine N-telopeptide cross-links were measured at baseline and 12 weeks. Relationships among baseline 25 (OH) D and bone biomarkers, and between changes over 12 weeks were determined and tested for effects of race, sex, latitude, and baseline 25 (OH) D. Median 25 (OH) D was 27.6 ng/mL (n=318, range 10.1-46.0 ng/mL) at baseline and 34.5 ng/mL (n=302, range 9.7-95.1 ng/mL) at 12 weeks. Neither baseline nor change in 25 (OH) D over 12 weeks was associated with bone turnover. The lack of association was not affected by race, sex, latitude, or baseline serum 25 (OH) D. Serum 25 (OH) D in the range of 10-46 ng/mL appears to be sufficient for normal bone turnover in healthy black and white pubertal adolescents., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Unlabelled: This study aimed to determine dietary vitamin D intake of U.S. Americans and Canadians and contributions of food sources to total vitamin D intake. Total of 7- or 14-d food intake data were analyzed for vitamin D by a proprietary nutrient assessment methodology that utilized food intake data from the Natl. Eating Trends(®) service, portion size data from NHANES 1999-2004, and nutrient values using the Univ. of Minnesota's Nutrition Data System for Research software. Study participants were 7837 U.S. Americans and 4025 Canadians, ≥2-y-old males and females. The main outcome measures were total dietary vitamin D intake, percent contribution of foods to total vitamin D intake, and vitamin D intake by cereal and breakfast consumption habits. ANOVA was used to determine differences in means or proportions by age and gender and according to breakfast consumption habits. Mean vitamin D intake ranged from 152 to 220 IU/d. Less than 2% of participants in all age groups from the United States and Canada met the 2011 Recommended Daily Allowance (RDA) for vitamin D from foods. Milk, meat, and fish were the top food sources for vitamin D for both Americans and Canadians. Ready-to-eat (RTE) cereal was a top 10 source of vitamin D for Americans but not Canadians. Vitamin D intake was higher with more frequent RTE cereal and breakfast consumption in both countries, largely attributable to greater milk intake., Practical Application: Most U.S. Americans and Canadians do not meet the 2011 Inst. of Medicine recommended daily allowance (RDA) for vitamin D for their age groups from foods. Increasing breakfast and cereal consumption may be a useful strategy to increase dietary vitamin D intake to help individuals meet the RDA for vitamin D, particularly by increasing milk intake. However, it is likely that additional food fortification or vitamin D supplementation is required to achieve the RDA., (© 2012 Institute of Food Technologists®)

The Australian Clinical Guidelines for Stroke Management 2010 represents an update of the Clinical Guidelines for Stroke Rehabilitation and Recovery (2005) and the Clinical Guidelines for Acute Stroke Management (2007). For the first time, they cover the whole spectrum of stroke, from public awareness and prehospital response to stroke unit and stroke management strategies, acute treatment, secondary prevention, rehabilitation and community care. The guidelines also include recommendations on transient ischaemic attack. The most significant changes to previous guideline recommendations include the extension of the stroke thrombolysis window from 3 to 4.5 h and the change from positive to negative recommendations for the use of thigh-length antithrombotic stockings for deep venous thrombosis prevention and the routine use of prolonged positioning for contracture management., (© 2012 National Stroke Foundation. Internal Medicine Journal © 2012 Royal Australasian College of Physicians.)

Background: Obesity is associated with hyperparathyroidism and increased bone mass and turnover, but their pathogeneses are unclear., Aims: Our aim was to determine in obesity interrelationships among serum levels of leptin, the mineral-regulating hormones, bone turnover markers, and sclerostin., Methods: This case-control study was performed in 20 women having bariatric surgery and 20 control women matched for race and age. Anthropometrics and fasting serum biochemistries were measured in controls and in bariatric patients the morning of surgery., Results: Body mass index (48.9 vs. 25.4 kg/m(2)), weight (128.6 vs. 71.9 kg), serum leptin (74.6 vs. 25.2 ng/ml), PTH (44.5 vs. 28.8 pg/ml), fibroblast growth factor 23 (FGF23) (42.4 vs. 25.9 pg/ml), and bone alkaline phosphatase (BAP) (25.8 vs. 17.5 U/liter) were higher, but height (162.3 vs. 167.7 cm) and 1,25-dihydroxyvitamin D (1,25D) (39.2 vs. 48.7 pg/ml) were lower in bariatric surgery patients than controls. There was no difference in serum sclerostin, amino-terminal collagen cross-links, 25-hydroxyvitamin D (25D), calcium, phosphate, and creatinine between groups. In the combined sample, leptin was positively related to PTH, FGF23, and BAP but not to 1,25D or sclerostin. Multiple regression analysis demonstrated that PTH was predicted by leptin and Ca (R(2) = 0.39); 1,25D by 25D, FGF23, and phosphate (R(2) = 0.43); FGF23 by leptin and 1,25D (R(2) = 0.27); BAP by leptin, PTH, and Ca (R(2) = 0.39); and sclerostin by leptin and PTH (R(2) = 0.20)., Conclusions: Women having bariatric surgery had higher leptin, PTH, FGF23, and BAP and lower 1,25D than controls. Leptin predicted the serum levels of PTH, 1,25D, and FGF23, the mineral-regulating hormones, and BAP, a bone formation marker, in women with body mass index ranging from 13.9-65.8 kg/m(2). The results suggest that leptin has an endocrine or paracrine effect on PTH and FGF23 production and that PTH may be one of the signals in obesity that leads to increased bone mass.

Children with disabilities are overrepresented in in out-of-home-placement; however, there is little research available on the prevalence of older youth with disabilities in foster care. Using state administrative data, this exploratory study used descriptive statistics and logistic regression analysis to examine the prevalence and demographic make up of older youth with disabilities in one state's out-of-home placement system. Findings indicate that in one state, youth with disabilities are overrepresented in out-of-home placement and differ in their racial and ethnic identities from youth with disabilities who are not in foster care in the same state. Implications for research, policy, and practice are discussed.

Objectives: Emotional distress, including depression, is an important issue for cancer patients and their families. Guidelines recommend the use of antidepressant drugs (ADs) for the management of depression in cancer. This study explores the views of oncology professionals about the inclusion of ADs in treatment plans., Design: Semi-structured interview study. Data were analysed using framework analysis., Setting: A specialist cancer centre and six district general hospitals across the Yorkshire Cancer Network., Participants: 18 randomly selected professionals from lung, breast, urology and colorectal cancer teams: oncologists (n=8), surgeons (n=3), clinical nurse specialists (n=2) and ward nurses (n=5)., Results: Three main themes emerged relating to professionals' attitudes, knowledge and behaviour. Positive attitudes were primarily expressed by nurses. However, negative views were expressed about the potential for over-reliance on ADs, and their use constituting 'giving in'. Doctors reported a lack of confidence in the use of and knowledge about ADs with an associated reluctance to prescribe. The general practitioner (GP) was regarded as the most appropriate professional to prescribe ADs., Conclusions: Cancer professionals highlighted a need for training in the appropriate use of ADs. Further, this research suggests that negative attitudes towards antidepressants may be a factor in their exclusion from treatment plans. The GP is seen to have a key prescribing role for AD therapy; however, it is unclear whether the GPs is asked to do this. This research raises questions about the adequacy of ADs in cancer care and to what extent the GP is able to meet this need.

Beneficial effects of dietary carbohydrate (CHO) on physical and psychological parameters have been demonstrated in athletes. Because affect, or mood, can predict athletic performace, the main objective of this study was to determine the effect of pre-workout CHO on affect in swimmers. College swimmers (n = 37) participated in a randomized crossover experiment of the effects of a pre-workout CHO supplement on vitality and affect. Subjects consumed a CHO supplement or placebo for two days before morning practice. After each morning practice, swimmers completed measures of affect and feelings of vitality. Pearson correlations were performed to describe relationships among variables. Differences in means between the CHO and placebo conditions were determined by paired t-tests. Independent t-tests were used to determine differences in variables between the highest and lowest tertiles of breakfast consumption frequency. All statistical analyses were performed using SAS 9.1.3 (Cary, NC) and statistical signficance was set at α = 0.05. There were no significant differences in affect or feelings of vitality between the CHO supplement and placebo conditions (all p ≥ 0.15). Our results do not support a beneficial effect of CHO supplementation before morning swim practice on affect or feelings of vitality in swimmers. Key pointsPre-workout carbohydrate did not affect post-workout measures of vitality or affect in collegiate swimmers.Avoidance of feeling nauseous/ill' and 'lack of time' were the most frequent reasons reported by swimmers for forgoing breakfast before morning swim practice.A longer trial of carbohydrate supplementation is needed to verify if there is indeed no effect of pre-workout carbohydrate on post-workout measures of vitality or affect in swimmers.

Context: Overweight adolescents have low bone mineral content for weight and are at increased risk for fractures., Objective: The aim was to determine whether overweight and obesity influence the positive relationship between dietary calcium intake and skeletal calcium retention in adolescents., Design: Analysis of pooled data from calcium balance studies in adolescents., Setting: Participants each underwent a 3-wk calcium balance study in a controlled environment., Participants: Participants included 280 White, Black, and Asian boys (n = 73) and girls (n = 207) ages 10-16 yr., Main Outcome Measure: The relationship among body mass index (BMI), calcium intake, and calcium retention was modeled using linear regression., Results: Calcium intake, BMI, sex, race, and age explained 27.9% of the variation in calcium retention. At low calcium intakes, there was no effect of BMI on skeletal calcium retention, but at higher calcium intakes, BMI increased skeletal calcium retention., Conclusions: Greater gains in calcium retention occur with increases in calcium intake in adolescents with higher BMI compared with those with lower BMI. Additional studies are needed to investigate whether increasing calcium intake reduces the increased risk of fracture associated with overweight and obesity in adolescents.

Objective: Increasing calcium bioavailability by decreasing calcium salt particle size in the supplement may be one way to increase calcium absorption. The aim of the study was to compare (1) large versus small particle size CaCO(3) supplements and (2) small particle size CaCO(3) supplement versus placebo on calcium absorption and retention in adolescent girls., Methods: Thirty-one adolescent girls, aged 11 to 14 years, participated in two 3-week calcium balance periods separated by a 1-week washout period. During both balance periods, the subjects consumed a controlled diet containing 804 mg/d calcium. Using a crossover design, one group (n = 19) received an additional ∼600 mg/d calcium of two ∼300-mg calcium doses as either large particle (18 μm; i.e., standard commercial form) or small particle (13.5 μm) CaCO(3). A second group (n = 12) received ∼600 mg/d calcium from small-particle CaCO(3) or placebo., Results: The parathyroid hormone suppression curve, following a challenge, from the first arm of the study indicated that calcium absorption from the small particle size CaCO(3) was less than that from the large particle size CaCO(3). The parathyroid hormone suppression curve from the small particle versus placebo arm indicated that calcium absorption from small particle size CaCO(3) was greater than placebo. Calcium balance (Ca intake - [urine Ca + fecal Ca]) demonstrated that the small particle size CaCO(3) supplement increased Ca retention nearly 2-fold compared with placebo (p < 0.05; 496 ± 213 and 256 ± 94 mg/d, respectively). However, there was no significant difference in Ca retention due to small versus large particle size of CaCO(3) (p > 0.05; 349.1 ± 131.6 and 322.0 ± 194.2 mg/d, respectively)., Conclusions: Dietary supplementation with CaCO(3) is effective in increasing calcium absorption and retention compared with placebo. But there is no advantage of small compared with large particle size CaCO(3) on calcium absorption and retention.