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Dietary diversity during infancy and the association with childhood food allergen sensitization Authors: Kate Maslin PhD1,2, Kaci Pickett MSc3, Suzanne Ngo3,4 MD, William Anderson3,4 MD, Taraneh Dean PhD2,5, Carina Venter PhD2,3,4School of Nursing and Midwifery, University of Plymouth, Plymouth, UK.The David Hide Asthma and Allergy Centre, St. Mary’s Hospital, Isle of Wight, UKUniversity of Colorado School of Medicine, Colorado, USAAllergy and Immunology Section, Children’s Hospital Colorado, Colorado, USAUniversity of Brighton, Brighton, UKRunning title: Dietary diversity and food sensitization

Background Diet diversity (DD) during infancy may prevent food allergies (FA), possibly by exposing the gastrointestinal microbiota to diverse foods and nutrients. Objective To investigate the association between 4 different measures of DD during infancy and development of FA over the first decade of life. Methods A birth cohort born between 2001 and 2002 were followed prospectively, providing information on sociodemographic, environmental, and dietary exposures. Information on age of introduction of a range of foods and food allergens was collected during infancy. Children were assessed for FA at 1, 2, 3, and 10 years. DD was defined using 4 measures in the first year of life: the World Health Organization definition of minimum DD at 6 months, as food diversity (FD) and fruit and vegetable diversity (FVD) at 3, 6, and 9 months, and as food allergen diversity (FAD) at 3, 6, 9, and 12 months. Results A total of 969 pregnant women were recruited at 12-week gestation. A total of 900, 858, 891, and 827 offspring were assessed at 1, 2, 3, and 10 years. Univariate analysis showed that World Health Organization DD (P = .0047), FD (P = .0009), FAD (P = .0048), and FVD (P = .0174) at 6 months and FD (P = .0392), FAD (P = .0233), and FVD (.0163) at 9 months significantly reduced the odds of FA over the first decade of life. DD measures at 3 months were not associated with FA, but only 33% of the cohort had solid foods introduced by this age. Conclusion Increased infant DD, as measured by 4 different methods, decreased the likelihood of developing FA.

Background - The potential role of ω-3 long chain polyunsaturated fatty acid (LCPUFA) supplementation during pregnancy on subsequent risk of obesity outcomes in the offspring is not clear and there is a need to synthesise this evidence.Objective - A systematic review and meta-analysis of randomised controlled trials (RCTs), including the most recent studies, was conducted to assess the effectiveness of ω-3 LCPUFA interventions during pregnancy on obesity measures, e.g. BMI, body weight, fat mass in offspring.Methods - Included RCTs had a minimum of 1-month follow-up post-partum. The search included CENTRAL, MEDLINE, SCOPUS, WHO’s International Clinical Trials Reg., E-theses and Web of Science databases. Study quality was evaluated using the Cochrane Collaboration’s risk of bias tool.Results - Eleven RCTs, from ten unique trials, (3644 children) examined the effectiveness of ω-3 LCPUFA maternal supplementation during pregnancy on the development of obesity outcomes in offspring. There were heterogeneities between the trials in terms of their sample, type and duration of intervention and follow-up. Pooled estimates did not show an association between prenatal intake of fatty acids and obesity measures in offspring.Conclusion - These results indicate that maternal supplementation with ω-3 LCPUFA during pregnancy does not have a beneficial effect on obesity risk. Due to the high heterogeneity between studies along with small sample sizes and high rates of attrition, the effects of ω-3 LCPUFA supplementation during pregnancy for prevention of childhood obesity in the long-term remains unclear. Large high-quality RCTs are needed that are designed specifically to examine the effect of prenatal intake of fatty acids for prevention of childhood obesity. There is also a need to determine specific sub-groups in the population that might get a greater benefit and whether different ω-3 LCPUFA, i.e. eicosapentaenoic (EPA) vs. docosahexanoic (DHA) acids might potentially have different effects.

Background - Prevalence, incidence and natural history of food hypersensitivity (FHS) and its trends in an unselected cohort of older children are unclear.Methods - A birth cohort born on the Isle of Wight (UK) between 2001 and 2002 was followed up prospectively. Children were clinically examined and skin prick tested at set times and invited for food challenges when indicated. At 10 years of age, children were also invited for a blood test.Results - A total of 969 children were recruited at 12 weeks of pregnancy, and 92.9%, 88.5%, 91.6% and 85.3% were assessed at 1, 2, 3 and 10 years. Prevalence of sensitization to any allergen over 10 years was 186 of 969 (19.2%; 95% CI: 16.84–21.8) and 108 of 969 (11.2%; 95% CI: 9.31–13.29) children were sensitized to at least one predefined food allergen. Excluding wheat (due to cross-reactivity with pollen), 40 of 969 (4.1%; 95% CI: 3.19–5.32) children were sensitized to a predefined food allergen. Using food challenges and/or a good clinical history, the cumulative incidence of food hypersensitivity (FHS) in the first decade of life was 64 of 947 (6.8%, 95% CI: 5.2–8.4), while the prevalence of FHS at 10 years was 30 of 827 (3.6%, 95% CI: 2.54–5.15). The vast majority, 25 of 827 (3.0%, 95% CI: 1.8–4.2), suffered from IgE-mediated food allergy, while 5 of 827 (0.6%, 95% CI: 0.07–1.3) had non-IgE-mediated food allergy/food intolerance.Conclusions - By the age of 10 years, 6.8% of children suffered from FHS based on food challenges and a good clinical history. There was a large discrepancy between reported and diagnosed FHS.

Allergic diseases have increased worldwide in the last 2 decades, with children suffering the highest burden of the condition. The ω-3 long-chain poly-unsaturated fatty acid (LCPUFA) possesses anti-inflammatory properties that could lead to a reduction in inflammatory mediators in allergies.A systematic review and meta-analysis of the most recent follow-ups of randomized clinical trials (RCTs) was conducted to assess the effectiveness of ω-3 LCPUFA supplementation started during pregnancy on allergic outcomes in offspring.The RCTs with a minimum of 1-month follow-up post gestation were eligible for inclusion. The CENTRAL, MEDLINE, SCOPUS, WHO's International Clinical Trials Register, E-theses, and Web of Science databases were searched. Study quality was evaluated using the Cochrane Collaboration's risk of bias tool.Ten RCTs (3,637 children), from 9 unique trials, examined the effectiveness of ω-3 LCPUFA supplementation started during pregnancy on the development of allergic outcomes in offspring. Heterogeneities were seen between the trials in terms of their sample, type, and duration of intervention and follow-up. Pooled estimates showed a significant reduction in childhood "sensitization to egg" (relative risk [RR] = 0.54, 95% confidence interval [CI] = 0.32-0.90), and "sensitization to peanut" (RR = 0.62, 95% CI = 0.40-0.96). No statistical differences were found for other allergic outcomes (eg, eczema, asthma/wheeze).These results suggest that intake of ω-3 LCPUFA started during pregnancy can reduce the risk of sensitization to egg and peanut; however, the evidence is limited because of the small number of studies that contributed to the meta-analyses. The current evidence on the association between supplementation with ω-3 LCPUFA started during pregnancy and allergic outcomes is weak, because of the risk of bias and heterogeneities between studies.

Background - Exclusion diets for the management of food allergy pose a risk of nutritional deficiencies and inadequate growth in children, yet less is known about their effect in adolescents and adults. The present study aimed to compare the dietary intake of adolescents and adults with food allergies with that of a control group.Methods - A food allergic and a control group were recruited from Portsmouth and the Isle of Wight in the UK. Participants were recruited from a food allergy charity, allergy clinics, a local school and university, and previous research studies. Macro and micronutrient intake data were obtained using a 4-day estimated food diary. Sociodemographic and anthropometric data was collected via a constructed questionnaire.Results - This cross-sectional study included 81 adolescents (48 food allergic and 33 controls) aged 11-18 years and 70 adults aged 19-65 years (23 food allergic and 47 controls). Overall, 19 (22.8%) adolescents and 19 (27.1%) adults took dietary supplements, with no difference according to food allergic status. Adolescents with food allergy had higher intakes of niacin and selenium than adolescents without (P < 0.05). This difference persisted when dietary supplements were removed from the analysis. Adults with food allergies had higher intakes of folate and zinc than those without (P < 0.05); however, this difference did not persist when dietary supplements were removed from the analysis. Across all participants, the intake of several micronutrients was suboptimal. There was no difference in protein or energy intake, or body mass index, according to food allergic status.Conclusions - The dietary intake of food allergic participants was broadly similar and, in some cases, better than that of control participants. However, suboptimal intakes of several micronutrients were observed across all participants, suggesting poor food choices.

Patients with advanced cancer often suffer from cachexia, a debilitating and complex extreme weight loss syndrome which is also associated with shorter survival times. A pragmatic randomised controlled trial was conducted to determine whether an oral nutritional supplement containing the omega-3 fatty acid eicosapentaenoic acid (EPA) was able to improve quality of life and survival times of patients with advanced solid tumour cancer in a mixed tumour cancer type population.

BackgroundAtopic eczema (AE) is a chronic, itchy, inflammatory skin condition that affects the quality of life of children and their families. The role of specialist clothing in the management of AE is poorly understood.ObjectivesTo assess the effectiveness and cost-effectiveness of silk garments for the management of AE in children with moderate to severe disease.DesignParallel-group, observer-blind, randomised controlled trial of 6 months’ duration, followed by a 2-month observational period. A nested qualitative study evaluated the beliefs of trial participants, health-care professionals and health-care commissioners about the use of silk garments for AE.SettingSecondary care and the community in five UK centres.ParticipantsChildren aged 1–15 years with moderate or severe AE.InterventionsParticipants were randomised (1 : 1 using online randomisation) to standard care or standard care plus 100% silk garments made from antimicrobially protected knitted sericin-free silk [DermaSilkTM(AlPreTec Srl, San Donà di Piave, Italy) or DreamSkinTM(DreamSkin Health Ltd, Hatfield, UK)]. Three sets of garments were supplied per participant, to be worn for up to 6 months (day and night). At 6 months the standard care group received the garments to use for the remaining 2-month observational period.Main outcome measuresPrimary outcome – AE severity using the Eczema Area and Severity Index (EASI) assessed at 2, 4 and 6 months, by nurses blinded to treatment allocation. EASI scores were log-transformed for analysis. Secondary outcomes – patient-reported eczema symptoms (Patient Oriented Eczema Measure); global assessment of severity (Investigator Global Assessment); quality of life of the child (Atopic Dermatitis Quality of Life, Child Health Utility – 9 Dimensions), family (Dermatitis Family Impact Questionnaire) and main carer (EuroQoL-5 Dimensions-3 Levels); use of standard eczema treatments (e.g. emollients, topical corticosteroids); and cost-effectiveness. The acceptability and durability of the clothing, and adherence to wearing the garments, were assessed by parental/carer self-report. Safety outcomes – number of skin infections and hospitalisations for AE.ResultsA total of 300 children were randomised (26 November 2013 to 5 May 2015): 42% female, 79% white, mean age 5 years. The primary analysis included 282 out of 300 (94%) children (n = 141 in each group). Garments were worn for at least 50% of the time by 82% of participants. Geometric mean EASI scores at baseline, 2, 4 and 6 months were 8.4, 6.6, 6.0, 5.4 for standard care and 9.2, 6.4, 5.8, 5.4 for silk clothing, respectively. There was no evidence of difference between the groups in EASI score averaged over all follow-up visits adjusted for baseline EASI score, age and centre (ratio of geometric means 0.95, 95% confidence interval 0.85 to 1.07;p = 0.43). This confidence interval is equivalent to a difference of –1.5 to 0.5 in the original EASI scale units. Skin infections occurred in 39 out of 141 (28%) and 36 out of 142 (25%) participants for standard care and silk clothing groups, respectively. The incremental cost per QALY of silk garments for children with moderate to severe eczema was £56,811 from a NHS perspective in the base case. Sensitivity analyses supported the finding that silk garments do not appear to be cost-effective within currently accepted thresholds.LimitationsKnowledge of treatment allocation may have affected behaviour and outcome reporting for some of the patient-reported outcomes.ConclusionsThe addition of silk garments to standard AE care is unlikely to improve AE severity, or to be cost-effective compared with standard care alone, for children with moderate or severe AE. This trial adds to the evidence base to guide clinical decision-making.Future workNon-pharmacological interventions for the management of AE remain a research priority among patients.Trial registrationCurrent Controlled Trials ISRCTN77261365.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 16. See the NIHR Journals Library website for further project information.

Background The role of clothing in the management of eczema (also called atopic dermatitis or atopic eczema) is poorly understood. This trial evaluated the effectiveness and cost-effectiveness of silk garments (in addition to standard care) for the management of eczema in children with moderate to severe disease. Methods and findings This was a parallel-group, randomised, controlled, observer-blind trial. Children aged 1 to 15 y with moderate to severe eczema were recruited from secondary care and the community at five UK medical centres. Participants were allocated using online randomisation (1:1) to standard care or to standard care plus silk garments, stratified by age and recruiting centre. Silk garments were worn for 6 mo. Primary outcome (eczema severity) was assessed at baseline, 2, 4, and 6 mo, by nurses blinded to treatment allocation, using the Eczema Area and Severity Index (EASI), which was log-transformed for analysis (intention-to-treat analysis). A safety outcome was number of skin infections. Three hundred children were randomised (26 November 2013 to 5 May 2015): 42% girls, 79% white, mean age 5 y. Primary analysis included 282/300 (94%) children (n = 141 in each group). The garments were worn more often at night than in the day (median of 81% of nights [25th to 75th centile 57% to 96%] and 34% of days [25th to 75th centile 10% to 76%]). Geometric mean EASI scores at baseline, 2, 4, and 6 mo were, respectively, 9.2, 6.4, 5.8, and 5.4 for silk clothing and 8.4, 6.6, 6.0, and 5.4 for standard care. There was no evidence of any difference between the groups in EASI score averaged over all follow-up visits adjusted for baseline EASI score, age, and centre: adjusted ratio of geometric means 0.95, 95% CI 0.85 to 1.07, (p = 0.43). This confidence interval is equivalent to a difference of −1.5 to 0.5 in the original EASI units, which is not clinically important. Skin infections occurred in 36/142 (25%) and 39/141 (28%) of children in the silk clothing and standard care groups, respectively. Even if the small observed treatment effect was genuine, the incremental cost per quality-adjusted life year was £56,811 in the base case analysis from a National Health Service perspective, suggesting that silk garments are unlikely to be cost-effective using currently accepted thresholds. The main limitation of the study is that use of an objective primary outcome, whilst minimising detection bias, may have underestimated treatment effects. Conclusions Silk clothing is unlikely to provide additional benefit over standard care in children with moderate to severe eczema. Trial registration Current Controlled Trials ISRCTN77261365, In a randomized controlled trial, Kim Suzanne Thomas and colleagues examine the effectiveness of silk garments vs. standard care for treating eczema in children., Author summary Why was this study done? Prior to this trial, evidence on the use of silk garments for the management of eczema was limited. Three randomised controlled trials (RCTs) had been conducted, but these were small (74 participants in total) and at risk of bias. The existing evidence was insufficient to guide clinical practice on the use of silk clothing in the management of eczema, and no cost-effectiveness analyses had been undertaken. What did the researchers do and find? We conducted a pragmatic, observer-blind RCT that recruited 300 children with moderate to severe eczema and followed them for six months. Participants were randomised to receive standard eczema care plus silk clothing (100% sericin-free silk garments; DermaSilk or DreamSkin) or standard care alone. After six months, there was no evidence of a difference between the groups in eczema severity (Eczema Area and Severity Index score) assessed by research nurses; the 95% confidence interval ranged from 1.5 points favouring silk clothing to 0.5 points favouring standard care, which is not a clinically important difference. Even if the potential small benefit of silk garments was genuine, our analysis suggests that they are unlikely to be cost-effective within currently accepted thresholds, with an incremental cost per quality-adjusted life year of £56,811. What do these findings mean? The CLOTHES Trial is the first large, independent RCT to have evaluated silk garments for the management of eczema. The results of this trial suggest that silk garments are unlikely to provide additional clinical or economic benefits over standard care for children with moderate to severe eczema. These results provide robust evidence for health commissioners and prescribers to make informed clinical decisions.

In previous years, the cornerstone of the management of Cow's Milk Allergy (CMA) was solely based on the strict avoidance of all cow's milk (CM) and foods containing CM from the patient's diet [1]. More recently, the importance of baked milk (BM) introduction into the diet of children with CMA has become well-recognised as a part of CMA management. Current research suggests that 75% of children become tolerant to baked/heated forms of CM such as muffin and waffles before they become tolerant to pure/uncooked forms of CM [2].

Background - Understanding food choice behavior in adolescence is important because many core eating habits may be tracked into adulthood. The food choices of at least 2.3% of teenagers living in the United Kingdom are determined by food allergies. However, the effect of food allergies on eating habits in teenagers has not yet been studied.Objective - To provide an understanding of how teenagers with food allergies make food choice decisions and how these differ from those of non–food-allergic teenagers.Methods - One focus group discussion with non–food-allergic teenagers (n = 11) and 14 semistructured interviewers (7 with food-allergic and 7 with non–food-allergic teenagers) were performed (age range, 12-18 years). The focus group discussion and interviews were audiorecorded, transcribed verbatim, and analyzed using thematic content analysis.Results - Teenagers from both groups (food-allergic and non–food-allergic) named sensory characteristics of foods as the main reason for choosing them. Some food-allergic teenagers downplayed their allergy and frequently engaged in risk-taking behavior in terms of their food choices. However, they reported difficulties in trying new foods, especially when away from home. Parental control was experienced as protective by those with food allergies, whereas non–food-allergic teenagers felt the opposite. Most teenagers, including food-allergic ones, expressed the wish to eat similar foods to their friends. Other themes did not vary between the 2 groups.Conclusion - Food-allergic teenagers strive to be able to make similar food choices to their friends, although differences to non–food-allergic teenagers exist. It is important to address these differences to improve their dietary management.

BackgroundResearch investigating the association of infant dietary factors with later health outcomes often relies on maternal recall. It is unclear what the effect of recall bias is on the accuracy of the information obtained. The present study aimed to determine the extent of recall bias on the accuracy of infant feeding and food allergen data collected 10 years later.MethodsMothers were recruited from a prospective birth cohort from the Isle of Wight. When their child was 10 years of age (2011/2012), mothers were requested to complete a retrospective infant feeding questionnaire asking the same questions as those solicited in 2001/2002.ResultsIn total, 125 mothers participated. There was substantial agreement for recollection of any breastfeeding (κ = 0.79) and the duration of breastfeeding from 10 years earlier (r = 0.84). Some 94% of mothers recalled accurately that their child had received formula milk. The exact age at which formula milk was first given was reliably answered (r = 0.63). The brand of formula milk was poorly recalled. Recall of age of introduction of solid food was not reliable (r = 0.16). The age of introduction of peanuts was the only food allergen that was recalled accurately (86%).ConclusionsThe present study highlights the importance of maternal recall bias of infant feeding practices over 10 years. Recall related to breastfeeding and formula feeding were reliable, whereas recalls related to age of introduction of solid or allergenic foods, apart from peanut, were not. Caution should be applied when interpreting studies relying on dietary recall.

Background Taste exposure in infancy is known to predict food preferences later in childhood. This is particularly relevant in children with cows’ milk allergy who consume a substitute formula and/or a cows’ milk exclusion (CME) diet early in life. This prospective study aimed to show whether there is a long-term effect of consuming a substitute formula and CME diet on taste preferences and dietary intake.Methods Children were predominantly recruited from two large birth cohort studies in the UK. Two groups were recruited: an experimental group of children who had consumed a CME diet during infancy and a control group who had consumed an unrestricted diet during infancy. Parents completed a food neophobia questionnaire and an estimated prospective food diary. Children completed a taste preference test and their growth was assessed.Results One hundred and one children with a mean age of 11.5 years were recruited (28 CME and 73 controls). Children in the CME group had a significantly higher preference for bitter taste than those in the control group (P < 0.05). There were significant differences between the groups with respect to the intake of some micronutrients, including riboflavin, iodine, sodium and selenium. Food neophobia did not differ between groups. Some 28% of the CME group were overweight/obese compared to 15% of the control group; however, this difference was not statistically significant.Conclusions Consuming a substitute formula and/or a CME diet in infancy has a long-term effect on the preference for bitter taste. Differences exist with respect to the intake of some micronutrients, but not macronutrients. There was a nonsignificant trend towards being overweight and obese in children in the CME group.

Background Allergic diseases have increased worldwide in the last 2 decades, with children suffering the highest burden of the condition. The ω-3 long-chain poly-unsaturated fatty acid (LCPUFA) possesses anti-inflammatory properties that could lead to a reduction in inflammatory mediators in allergies. Objective A systematic review and meta-analysis of the most recent follow-ups of randomized clinical trials (RCTs) was conducted to assess the effectiveness of ω-3 LCPUFA supplementation started during pregnancy on allergic outcomes in offspring. Methods The RCTs with a minimum of 1-month follow-up post gestation were eligible for inclusion. The CENTRAL, MEDLINE, SCOPUS, WHO's International Clinical Trials Register, E-theses, and Web of Science databases were searched. Study quality was evaluated using the Cochrane Collaboration's risk of bias tool. Results Ten RCTs (3,637 children), from 9 unique trials, examined the effectiveness of ω-3 LCPUFA supplementation started during pregnancy on the development of allergic outcomes in offspring. Heterogeneities were seen between the trials in terms of their sample, type, and duration of intervention and follow-up. Pooled estimates showed a significant reduction in childhood “sensitization to egg” (relative risk [RR] = 0.54, 95% confidence interval [CI] = 0.32-0.90), and “sensitization to peanut” (RR = 0.62, 95% CI = 0.40-0.96). No statistical differences were found for other allergic outcomes (eg, eczema, asthma/wheeze). Conclusion These results suggest that intake of ω-3 LCPUFA started during pregnancy can reduce the risk of sensitization to egg and peanut; however, the evidence is limited because of the small number of studies that contributed to the meta-analyses. The current evidence on the association between supplementation with ω-3 LCPUFA started during pregnancy and allergic outcomes is weak, because of the risk of bias and heterogeneities between studies.

Background: falls disproportionately affect older people, who are at increased risk of falls and injury. This pilot study investigates shock-absorbing flooring for fall-related injuries in wards for frail older people.Methods: we conducted a non-blinded cluster randomised trial in eight hospitals in England between April 2010 and August 2011. Each site allocated one bay as the ‘study area’, which was randomised via computer to intervention (8.3-mm thick Tarkett Omnisports EXCEL) or control (2-mm standard in situ flooring). Sites had an intervention period of 1 year. Anybody admitted to the study area was eligible. The primary outcome was the fall-related injury rate. Secondary outcomes were injury severity, fall rate and adverse events.Results: during the intervention period, 226 participants were recruited to each group (219 and 223 were analysed in the intervention and control group, respectively). Of 35 falls (31 fallers) in the intervention group, 22.9% were injurious, compared with 42.4% of 33 falls (22 fallers) in the control group [injury incident rate ratio (IRR) = 0.58, 95% CI = 0.18–1.91]. There were no moderate or major injuries in the intervention group and six in the control group. The fall IRR was 1.07 (95% CI = 0.64–1.81). Staff at intervention sites raised concerns about pushing equipment, documenting one pulled back.Conclusions: future research should assess shock-absorbing flooring with better ‘push/pull’ properties and explore increased faller risk. We estimate a future trial will need 33,480–52,840 person bed-days per arm.Trial registration: ClinicalTrials.gov (ID: NCT00817869); UKCRN (ID: 5735).

The timing of introduction of solid food on the subsequent development of food allergy is under debate and the role of concurrent breastfeeding is unclear. The aim of the present study was to investigate the role of solid food introduction whilst concurrently breastfeeding on food allergy outcome, with a specific focus on cows’ milk allergy. Prospectively collected infant feeding data from a birth cohort were analysed. Participants with histories suggestive of food allergy underwent diagnostic food challenges. Children with food allergy were matched to control participants for age and sex. Mann–Whitney U tests, χ2, Fisher exact tests and logistic regression calculations were undertaken. A total of thirty-nine food-allergic children and seventy-eight matched controls were identified, including twenty-two cows’ milk-allergic children and forty-four matched controls. The control group introduced solid food earlier than the food-allergic group (P

Background & objectives: The age at which menopause naturally occurs may reflect nutritional and \ud environmental circumstances as well as genetic factors. In this study we examined natural menopause as \ud a marker of women’s health at the population level in India and in some major States.\ud Methods: Data from the Indian District Level Household Survey (DLHS) carried out during 2007-2008 \ud covering 643,944 ever-married women aged 15-49 yr were used; women of older ages were not included \ud in this survey. Since not all women in this age group had achieved natural menopause at the time of \ud survey, Cox proportional hazard regression models were employed to obtain the median age of women \ud reporting a natural menopause, excluding those who underwent hysterectomy. Hazard ratios (HRs) were \ud estimated for key socio-economic and reproductive variables that could potentially affect the age at \ud natural menopause

BackgroundThe aim of this study was to explore the natural history of peanut allergy in childhood in two birth cohorts from the same geographical region in the South of England.MethodsThe FAIR birth cohort was established on the Isle of Wight (UK) between 2001-2002 (n = 969). Children were followed up prospectively, skin prick tested (SPT) to peanut allergens at 1, 2, 3 and 10 years and food challenges performed. The Isle of Wight (IOW) Birth cohort was established in 1989 (n = 1456). SPTs were performed at 1, 2, 4 and 10 years. Peanut allergy was based on positive SPT and a good clinical history.ResultsIn the FAIR cohort, the prevalence of sensitization to peanut was 0.4%, 2.0%, 2.0% and 2.4% at 1,2,3 and 10 years respectively. At 10 years of age, 12/828 (1.5%) children were diagnosed with peanut allergy. One child (8%) outgrew her peanut allergy between 3 and 10 years and two children (15%) presented with new onset peanut allergy. Over the first ten years of life, 13/934 (1.4%) children were diagnosed with peanut allergy. In the IOW cohort, 6/1034 (0.58%) were diagnosed with peanut allergy at 10 years. We found no significant differences between the FAIR and the IOW birth cohort for any of the time points studied.ConclusionPeanut allergy appears to be stable over the first ten years of life in our cohorts. There was no significant difference in peanut sensitization or clinical peanut allergy between 1989 and 2001.

Accurate information on the prevalence of food allergy facilitates a more evidence-based approach to planning of allergy services and can identify important geographic variations.To conduct a systematic review to assess the age-specific prevalence of fish and shellfish allergy worldwide.Searches were conducted using Web of Science and PubMed. Population-based cross-sectional studies and cohort studies that examined the prevalence of fish and shellfish allergy (IgE mediated and non-IgE mediated) at an identifiable point in time were eligible for inclusion in the study. Reviewers extracted general study information and study design, type of food allergy considered, food(s) assessed, method of diagnosis, sampling strategy, and sample characteristics. Raw data were extracted and percentage prevalence and 95% confidence intervals calculated.A total of 7,333 articles were identified of which 61 studies met the inclusion criteria and were included in this review. The prevalence of fish allergy ranged from 0% to 7% and the prevalence of shellfish allergy from 0% to 10.3%, depending on the method of diagnosis. Where food challenges were used, the prevalence for fish allergy was found to be 0% to 0.3% and for shellfish allergy was 0% to 0.9%.Few studies have established the prevalence of fish or shellfish allergy using the gold standard double-blind, placebo-controlled challenge criteria, with most instead relying on self-reported questionnaire-based methods. The limited data available suggest that fish allergy prevalence is similar worldwide; however, shellfish allergy prevalence may be higher in the Southeast Asia region.

The Double Blind Placebo Controlled Food Challenge (DBPCFC) is considered the gold standard for food allergy diagnosis (1, 2). It is recommended that active and placebo challenge foods for DBPCFCs are sufficiently blinded in terms of smell, flavour and texture. Difficulties arise with children undergoing DBPCFCs as they may refuse to eat the challenge food or struggle to eat the large volumes required to adhere to internationally recommended dosages (2). This article is protected by copyright. All rights reserved

BackgroundAsthma affects more than 5 million patients in the United Kingdom. Nearly 500,000 of these patients have severe asthma with severe symptoms and frequent exacerbations that are inadequately controlled with available treatments. The burden of severe asthma on the NHS is enormous, accounting for 80 % of the total asthma cost (£1 billion), with frequent exacerbations and expensive medications generating much of this cost.Of those patients with severe asthma, 70 % are sensitised to indoor aeroallergens, and the level of exposure to allergens determines the symptoms; patients exposed to high levels are therefore most at risk of exacerbations and hospital admissions.The LASER trial aims to assess whether a new treatment, temperature controlled laminar airflow (TLA) delivered by the Airsonett™ device, can reduce the frequency of exacerbations in patients with severe allergic asthma by reducing exposure to aeroallergens overnight.MethodsThis multicentre study is a placebo-controlled, blinded, randomised controlled, parallel group trial. A total of 222 patients with a new or current diagnosis of severe allergic asthma will be assigned with a random element in a 1:1 ratio to receive either an active device for one year or a placebo device. The primary outcome is the frequency of severe asthma exacerbations occurring over a 12-month period, defined in accordance with the American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines. Secondary outcomes include changes in asthma control, lung function, asthma-specific and global quality of life for participants and their carers, adherence to intervention, healthcare resource use and costs, and cost-effectiveness. Qualitative interviews will be conducted to elicit participant’s and their partner’s perceptions of the treatment.DiscussionEffective measures of allergen avoidance have, to date, proved elusive. The LASER trial aims to address this. The study will ascertain whether home-based nocturnal TLA usage over a 12-month period can reduce the frequency of exacerbations and improve asthma control and quality of life as compared to placebo, whilst being cost-effective and acceptable to adults with poorly controlled, severe allergic asthma. The results of this study will be widely applicable to the many patients with allergic asthma both in the UK and internationally.Trial registrationCurrent controlled trials ISRCTN46346208 (Date assigned 22 January 2014).

Parents play an important role in developing young children's food choices. They influence children's eating environments through the foods they make available, their own eating behavior, and the quality of their interactions with children in eating contexts.

Background: A disease-specific health-related quality of life (HRQL) scale enables the impact of current and new interventions on the HRQL of teenagers with food hypersensitivity (FHS) to be evaluated. No such scale exists for teenagers with FHS living in the UK. This research aimed to develop and validate a disease-specific HRQL scale for this group, thus facilitating HRQL measurement in this population. Methods: A preliminary 51-item questionnaire was generated from interviews with 21 teenagers with FHS, the coverage and acceptability of which was refined in pre- and pilot testing (N = 102). On the basis of the field test data (N = 299), principal components analysis identified those items best measuring HRQL. Results: The final 34-item You and Your Food Allergy scale covered five domains: social well-being and independence, support, day-to-day activities, family relations and emotional well-being. The whole scale displayed excellent internal consistency (Cronbach’s α = 0.92) and test–retest reliability (ICC = 0.87). The scale correlated as hypothesised with a generic HRQL scale (PedsQL) and discriminated by disease severity, providing evidence for its construct validity. Conclusions: The You and Your Food Allergy scale is the first HRQL scale to have been developed and validated with UK teenagers with FHS. Subject to further evaluation of its psychometric properties, its development has important applications in future research into the HRQL of teenagers with FHS. Short and easy-to-complete, the scale has been designed to appeal to teenagers and is likely to be useful to facilitate discussion of HRQL issues.

Background: Commercially produced infant food has a different taste profile and nutritional content to homemade baby food and its consumption is now very widespread. This change in early food experience may lead to a reduced dietary variety and a decreased microbial load exposure.Objective: The purpose of this study was to gain insight into parental perceptions of complementary feeding, specifically opinions of commercially produced baby food, using qualitative research methods. Methods: Four focus group discussions took place (n = 24), with mothers of infants aged 4-7 months. Half of participants were first time mothers and a third had experience weaning infants with symptoms of cows' milk allergy. Participants were prompted with questions about complementary feeding and shown several different products to stimulate discussion. Results: Thematic analysis of focus groups indicated that three distinctive groups of mothers exist; "relaxed", "concerned" and "balanced", which may be influenced by parity, socioeconomic status and previous experience of weaning. The majority of mothers commenced the weaning process using homemade foods, but transitioned to include commercial baby foods after 3-6 weeks. Commercial baby food was perceived as more convenient to homemade baby food by the majority and as superior and "safer" by some mothers. Although there were concerns raised about the identity of ingredients, few concerns were expressed regarding nutritional quality or allergen content, even by mothers with experience of weaning an infant with food allergic symptoms. Conclusion: Overall complementary feeding was viewed as a natural process with the goal of enjoyment of food and development of a broad palate. Opinions on readymade baby food were influenced by parity, education level and previous experience of weaning

Children's speech and language difficulties affect more than their communication skills, impacting on their experience at school, relationships, and later employment opportunities. These wider sequelae, arguably, contribute to a child's quality of life (QoL), which is routinely measured in the care and research of other childhood conditions, but no measures exist for children's communication needs. Using a psychometric approach, a new QoL measure for children with speech, language, and communication needs was developed. Pretesting produced a clinically acceptable measure, which was then completed by 303 children and young people with speech, language, and communication needs (SLCNs) in a field test. This field test provided a psychometric basis for the reduction of items in the measure into statistically coherent subscales. The “Paediatric Speech and Language QoL” Scale (Ped SaL QoL) appears to be an acceptable, reliable, and valid measure of condition specific QoL for children with SLCNs. It would seem to have potential for use in both clinical practice and investigations of treatments in speech and language therapy. Further testing in larger, more representative samples of children with SLCNs is needed to further establish its reliability and validity and its potential for use as an outcome measure in clinical trials.

Background: This article investigated the prevalence of peanut allergy in three cohorts of children born in the same geographical location, Isle of Wight, UK and seeks to determine whether the prevalence of peanut allergy has changed between 1994 and 2004. Methods: Three cohorts of children (age 3-4 years) born on the Isle of Wight, were assessed for peanut allergy and the outcomes compared: Cohort A: Born in 1989; reviewed at 4 years of age (n = 2181). Cohort B: Born between 1994 and 1996; reviewed between 3 and 4 years of age (n = 1273). Cohort C: Born between 2001 and 2002; reviewed at 3 years of age (n = 891). Results: Peanut sensitization increased significantly from 1.3% in Cohort A to 3.3% (P = 0.003) in Cohort B before falling back to 2.0% in Cohort C (P = 0.145). Similarly, clinical peanut allergy increased significantly from 0.5% in Cohort A to 1.4% (P = 0.023) in Cohort B, with a subsequent fall to 1.2% in Cohort C (P = 0.850). Conclusions: Our data from three cohorts of 3- to 4-year-old children born in the same geographical area shows that peanut allergy prevalence has changed over time. Peanut sensitization and reported allergy in children born in 1994-1996 increased from 1989 but seems to have stabilized or slightly decreased since the late 1990s, although not significant.

Teenagers are a high-risk group for food-hypersensitivity fatalities, engage in risk-taking behaviours and may experience impaired quality of life. Understanding their experience is important to inform their care. This study aimed to describe the lived experiences of teenagers with food hypersensitivity. Individual semi-structured interviews were conducted with 21 teenagers (13-18 yr) with food hypersensitivity to a variety of foods and analysed using a phenomenological approach. Teenagers described living with (or coming to know) food hypersensitivity (FHS) as a way of life but still found living with food hypersensitivity to be burdensome. A necessary part of living with food hypersensitivity was coping with associated burden; a variety of coping strategies were employed to this effect. Teenagers described ways in which the burden of living with food hypersensitivity was alleviated or exacerbated by others. Management of food hypersensitivity was based on an assessment of acceptable risk resulting in varying levels of precaution taking. Teenagers' understanding of their FHS and ability to cope with it needs to be regularly assessed. Educational support may be required to ensure they take an appropriate level of precautions to minimize the chance of future reactions while not over compromising their quality of life. Psychological support may be required to help them to utilize healthy adaptive strategies to cope with the stresses of living with FHS. This approach is also likely to facilitate the smooth handover of responsibility from parent to teenager.

Weight loss and eating-related disorders are commonly seen in patients with advanced cancer. Using a qualitative approach this study set out to explore how nurses currently manage weight loss and eating difficulties in everyday practice as well as exploring what guides their decision-making with regard to choice of nutritional interventions and support strategies employed. Fourteen semi-structured interviews were conducted with nurses from both hospital and community settings. Analysis of the findings revealed that many nurses use an unplanned and reactive style of nutritional management. The findings provide useful insights and potential explanations to an area where, to date, there has been little published research.

Background: Prevalence and incidence of food hypersensitivity (FHS) and its trends in early childhood are unclear. Methods: A birth cohort born on the Isle of Wight (UK) between 2001 and 2002 was followed-up prospectively. Children were clinically examined and skin prick tested at set times and invited for food challenges when indicated. Results: Nine hundred and sixty-nine children were recruited and 92.9%, 88.5% and 91.9% of them respectively were assessed at 1, 2 and 3 years of age. Prevalence of sensitization to foods was 2.2%, 3.8% and 4.5% respectively at these ages. Cumulatively, 5.3% [95% confidence interval (CI): 3.9-7.1] children were sensitized to a food. Using open food challenge and a good clinical history, the cumulative incidence of FHS was 6.0% (58/969, 95% CI: 4.6-7.7). Based on double-blinded, placebo-controlled, food challenge (DBPCFC) and a good clinical history, the cumulative incidence was 5.0% (48/969, 95% CI: 3.7-6.5). There is no evidence to suggest that the incidence of FHS has increased, comparing these results with previous studies. Overall, 33.7% of parents reported a food-related problem and of these, 16.1% were diagnosed with FHS by open challenge and history and 12.9% by DBPCFC and history. Main foods implicated were milk, egg and peanut. Conclusions: By the age of 3 years, 5-6% of children suffer from FHS based on food challenges and a good clinical history. There were large discrepancies between reported and diagnosed FHS. Comparing our data with a study performed in the USA more than 20 years ago, there were no significant differences in the cumulative incidence of FHS.

BACKGROUND: There is a paucity of longitudinal studies of allergen sensitization in childhood. OBJECTIVE: To investigate the pattern of sensitization in early childhood. METHODS: A nested cohort of children (n = 543) were followed up from birth and given a skin prick test (SPT) at 1, 2, and 3 years of age. A detailed clinical history was obtained. RESULTS: The prevalences of sensitization to aeroallergens were 1.3%, 6.4%, and 10.7% at 1, 2, and 3 years of age. The figures for food allergens were 2.8%, 3.9%, and 3.7%. There was a statistically significant increase in the prevalence of sensitization to >or=1 allergen between years 1 and 2 (P < .001) and years 2 and 3 (P = .032). Among those with a positive SPT at 1 year, 29% tested positive to additional allergens at 2 years (P = .0054). Sensitization to milk or egg at 1 year was a predictor for increased sensitization to peanut at 3 years (odds ratio, 34.8; P < .0001). Sensitization to egg at 1 year was associated with increased sensitization to aeroallergens at 3 years (odds ratios, house dust mite, 27.1, P < .001; cat, 8.9, P < .01; grass, 11.8, P = .005). For peanut and cat allergens, wheal size increases with the age of the child (P = .009 and P = .017, respectively). CONCLUSION: Sensitization to allergens as demonstrated by positive SPT tends to increase with age, and this change can be detected in the first 3 years of life. CLINICAL IMPLICATIONS: The high predictive value for early sensitization and a linear increase in SPT reactivity provide an opportunity for early intervention.

Background In 1998, the UK government issued precautionary advice that pregnant or breast-feeding women with a family history of atopy, may wish to avoid eating peanuts during pregnancy and lactation. This study aimed to assess the compliance with this recommendation and investigate its impact upon peanut sensitization. Methods A total of 858 children born immediately after the advice were followed for 2 years and assessed for peanut sensitization. A standardized questionnaire was used to ascertain history of atopy and maternal exposure to peanuts during pregnancy. Following parental consent children were skin prick tested to assess sensitization to peanuts. Results Sixty-five per cent of mothers had avoided peanuts during pregnancy. Forty-two per cent of the mothers had heard about the government advice, and half modified their diet as a consequence. Neither maternal nor family history of atopy had any significant effect on peanut consumption. Parity did play a role, and mothers having their first child were twice as likely to change their diet (P < 0.001). Mothers of 77% of the children sensitized to peanuts had avoided peanuts during pregnancy. In this cohort study maternal consumption of peanut during pregnancy was not associated with peanut sensitization in the infant. Conclusions The majority of mothers in this cohort avoided peanut consumption during pregnancy. It is likely that either the government advice is misunderstood by mothers, or that those who communicate the advice have not fully explained who it is targeted at.

Background - Eczema is a chronic, itchy skin condition that can have a large impact on the quality of life of patients and their families. People with eczema are often keen to try out non-pharmacological therapies like silk therapeutic garments that could reduce itching or the damage caused by scratching. However, the effectiveness and cost-effectiveness of these garments in the management of eczema has yet to be proven. The CLOTHES Trial will test the hypothesis that ‘silk therapeutic garments plus standard eczema care’ is superior to ‘standard care alone’ for children with moderate to severe eczema.Methods/Design - Parallel group, observer-blind, pragmatic, multi-centre randomised controlled trial of 6 months’ duration. Three hundred children aged 1 to 15 years with moderate to severe eczema will be randomised (1:1) to receive silk therapeutic garments plus standard eczema care, or standard eczema care alone. Primary outcome is eczema severity, as assessed by trained and blinded investigators at 2, 4 and 6 months (using the Eczema Area and Severity Index (EASI)). Secondary outcomes include: patient-reported eczema symptoms (collected weekly for 6 months to capture long-term control); global assessment of severity; quality of life of the child, family and main carer; use of standard eczema treatments (emollients, corticosteroids applied topically, calcineurin inhibitors applied topically and wet wraps); frequency of infections; and cost-effectiveness. The acceptability and durability of the clothing will also be assessed, as will adherence to wearing the garments. A nested qualitative study will assess the views of a subset of children wearing the garments and their parents, and those of healthcare providers and commissioners. Randomisation uses a computer-generated sequence of permuted blocks of randomly varying size, stratified by recruiting hospital and child’s age (< 2 years; 2 to 5 years; > 5 years), and concealed using a secure web-based system. The sequence of treatment allocations will remain concealed until randomisation and data collection are complete.Recruitment is taking place from November 2013 to May 2015, and the trial will be completed in 2016. Full details of results will be published in the National Institute for Health Research Journal series.Trial registration - Current Controlled Trials ISRCTN77261365 (registered 11 November 2013).

During the past few decades there has been a steady increase in the prevalence of noncommunicable diseases, including allergic disease. Changing lifestyle and subsequent diet may explain this increase seen in the prevalence of atopic disease. Epidemiologic evidence also suggests that diet may be key in the prevention of allergic disease. [1] There are 3 important characteristics in terms of the maternal diet that have been investigated for the prevention of allergic disease: (1) the role of particular nutrients, such as vitamins (A, D, and E), zinc, and fatty acids; (2) the role of particular foods, such as fruits and vegetables and fish; and (3) the total dietary intake, such as a Mediterranean diet or a healthy diet. Research using the healthy eating index tool, specific to the pregnancy diet, found no association between overall healthy eating score and recurrent wheeze in infants at the age of 3 years. [2] However, maternal intake of celery and citrus fruit specifically has been associated with an increased risk of sensitization to food allergens in 2-year-olds. [3] One case-control study found no effect of consumption of fish, butter, and margarine on the development of atopic sensitization in the offspring of allergic mothers; however, a protective effect of fish intake (2–3 times a week or more) was identified in the nonallergic mothers' group with the risk of food sensitization in the offspring reduced by greater than a third. [4] Thus, the question is whether the associations seen are due to the individual nutrients or foods or whether it is part of an overall nutritional composition of the weaning diet. In this study, we aimed to investigate whether maternal diet, specifically seafood intake during pregnancy, is associated with the infant's allergic outcomes in a well-characterized birth cohort with allergy at 3 and 10 years of age.

BackgroundThe few studies measuring health-related quality of life (HRQL) in food hypersensitivity (FHS) have found significantly reduced HRQL in patients and their families, particularly in the areas of family and social activities, emotional issues and family economy. One aspect that has not been studied is the effect of suspected FHS (food allergy/intolerance) vs. diagnosed FHS [based on a food challenge or a positive skin prick test (SPT) and good clinical history] on HRQL. Therefore, the aim of this study was to investigate the HRQL in children with a proven diagnosis of FHS vs. those with reported FHS.MethodsWe have utilized the 10-yr old follow-up cohort of the Food Allergy and Intolerance Research (FAIR) study from the Isle of Wight and assessed the child's HRQL with the Food Allergy Quality of Life Questionnaire – Parent form (FAQLQ-PF) which measures HRQL using four domains: food anxiety, emotional impact, social and dietary limitation.ResultsWhen comparing the two groups of children (proven FHS vs. perceived FHS), no difference in HRQL was found, although food anxiety showed a p-value of (p = 0.062). This was also the case when correcting for all confounding factors identified.ConclusionWe have found that having a clear diagnosis of FHS is not an independent predictor of HRQL. Future studies are required comparing two more similar groups. We also need to focus more on the effect of continuous input from the multidisciplinary team on HRQL and which particular factors of FHS management affect HRQL.

BackgroundProfessional dietetic input is essential to ensure that children with diagnosed food allergies have an individualized avoidance plan and nutritionally adequate diet. However, it is not clear what dietary information and support parents require.ObjectiveTo explore what information and support parents of children with food allergies require from a dietary consultation.MethodsFocus groups were conducted with 17 mothers who attend an allergy center for dietary advice for their food allergic child. A number of issues around food allergy dietary advice needs were explored and analyzed using thematic analysis.ResultsSix themes were identified. The mothers described how they sought to protect their child from harm, to maintain normality for their child, and to promote child independence. They described needing to become an expert in their child's food allergy and fight their corner when needed. The dietitian supported their needs by ensuring their child's diet was safe and nutritionally adequate and giving information and support to help them provide a normal life for their child. Dietitians also taught mothers about food allergy and provided advocacy and emotional support.ConclusionMothers of children with food allergies want to understand how to provide a nutritionally adequate, allergen-safe diet while maintaining a normal life. Hence, mothers value a range of support from dietitians, including monitoring their child's health and providing information, practical advice and support, and emotional support.

Evidence-based practice (EBP) ensures that clinical health management decisions are based on valid, reliable and relevant evidence determined by sound research and evaluation. It is a key element of both the clinical governance and clinical effectiveness agendas. Clearly, there is a need to provide adequate educational and professional attributes to meet this increasing demand. The aim of this research was to identify and map all UK postgraduate courses that focus on EBP within health- and social-care services. Electronic searching of internet databases and all UK postgraduate electronic prospectuses using the broad term ‘evidence based’ was undertaken. Course details and prospectuses were obtained and reviewed, where available. In total, 12 postgraduate courses were identified. These could be broadly categorized into two distinct groups: five courses focused on health-care sciences designed for multidisciplinary health professionals and seven targeted clinical specialities. UK universities therefore provide relatively few courses in EBP. Two models of EBP education appear to be developing, which either specifically target EBP as a separate component of the curriculum or integrate into existing subjects. Further evaluation is needed to determine the relative merits of each.

Background: The true impact of speech and language difficulties (SaLD) on children's lives and the effectiveness of intervention is unknown. Within other fields of paediatric healthcare, clinicians and policy‐makers are increasingly emphasizing the utility of Health‐Related Quality of Life (HRQoL) studies and measures. SaLT has a variety of measures to assess and treat children's ‘quantity’ of life, but also requires measures that allow it to measure and even target their Quality of Life. Aims: To provide novel, primary data on the HRQoL of children with speech and/or language difficulties. Methods & Procedures: The study used a qualitative methodology to begin the process of developing knowledge about HRQoL in children with SaLD. Focus group interviews were held with parents and professional carers of children with SaLD, and participants were encouraged to reflect on their experiences and beliefs around HRQoL issues for these children. The discussions within these groups were tape‐recorded and analysed using the principles of grounded theory and content analysis. Outcomes & Results: Analysis of tape‐recorded data identified ten descriptive themes related to children with SaLDs HRQoL. These themes were labelled: Inclusion; Behaviour and reactions of others; Education and awareness; Friendships and family relations; Schooling; The child's needs; Dependence/independence; Quality of care; Choice and potential; and Variability. The results can be seen as lying on a spectrum, with factors outside of the child at one pole, the individual child's characteristics at the other, and the interaction between the child and significant others in the middle. A number of the themes reflected a common belief, across all groups, that the HRQoL of children with SaLD is influenced by the behaviours, attitudes and beliefs of people surrounding them. In addition, participants' beliefs that the quality of a child's social integration, relationships and care are also related to their HRQoL. Conclusions: These are encouraging results, indicating that children with SaLD experience HRQoL issues associated with their communication impairments. The results support the suggestion that speech and language therapists should ensure that their assessments and interventions account for both a child's impairment and also factors related to well‐being reflected in the themes presented here. However, this was also a small‐scale study and consequently further research of this type, with a larger and more varied population, is necessary so that HRQoL issues for all clinical sub‐groups of children with SaLD can be explored.

The continued expansion of the intermediate care initiative has resulted in the use of alternative care settings, such as nursing and care homes, for the delivery of rehabilitative interventions for older people. In this paper, we report on the findings from the second stage of a national survey of rehabilitation schemes that use care home settings. The survey reveals a wide range of approaches and standards, leading us to ask whether there is a gap between policy goals, good practice and actual service provision. The care home rehabilitation schemes were selected on the basis that they offered, as a minimum, rehabilitation to improve an older person's physical status.

The aim of this study was to explore and compare the experiences of tilt-in-space wheelchair use and conventional wheelchair use in severely disabled clients with multiple sclerosis and significant spasticity.The research design was a descriptive qualitative approach, using in-depth audio-taped interviews in clients' homes carried out over a 9-month period. A total of 23 clients (7 tilt-in-space wheelchair users and 16 conventional wheelchair users) were recruited from three adjacent district wheelchair services in South-East England. The criteria for recruitment were that the clients were severely disabled with multiple sclerosis, had significant spasticity and were full-time wheelchair users, usually requiring hoisting. Their carers were also interviewed.The majority of tilt-in-space wheelchair users (6 out of 7) reported that their chairs were comfortable compared with only half of those in conventional wheelchairs (8 out of 16). The positive aspects of tilt-in-space wheelchair provision included comfort, improved postural support, enhanced seating stability, relief of pressure and being able to rest sitting out of bed for prolonged periods, often for more than 6 hours a day. One person reported improved catheter drainage and another reported reduced spasms. The negative aspects of tilt-in-space wheelchairs included their bulky size and lack of manoeuvrability compared with conventional wheelchairs. All the wheelchair users had experienced difficulty with transport and many had relied on family and friends to help with the purchase of expensive adapted vehicles. In conclusion, the majority of the tilt-in-space users were satisfied with their wheelchair, particularly in terms of comfort.

Background: Allergy to peanut is common. However, it is not known whether the prevalence of sensitization and clinical allergy to peanut is increasing. Objective: We sought to determine any change in the prevalence of peanut sensitization and reactivity in early childhood in 2 sequential cohorts in the same geographic area 6 years apart. Methods: Of 2878 children born between September 1, 1994, and August 31, 1996, living on the Isle of Wight, 1273 completed questionnaires, and 1246 had skin prick tests at the age of 3 to 4 years. Those with positive skin prick test responses to peanut were subjected to oral peanut challenges, unless there was a history of immediate systemic reaction. These data were compared with information on sensitization and clinical allergy to peanut available from a previous cohort born in 1989 in the same geographic area. Results: There was a 2-fold increase in reported peanut allergy (0.5 % [6/1218] to 1.0 % [13/1273]), but the difference was nonsignificant (P = .2). Peanut sensitization increased 3-fold, with 41 (3.3 %) of 1246 children sensitized in 1994 to 1996 compared with 11 (1.1 %) of 981 sensitized 6 years ago (P = .001). Of 41 sensitized children in the current study, 10 reported a convincing clinical reaction to peanut, and 8 had positive oral challenge results, giving an overall estimate of peanut allergy of 1.5% (18/1246). Conclusions: Sensitization to peanut had increased between 1989 and 1994 to 1996. There was a strong but statistically nonsignificant trend for increase in reported peanut allergy.

Evidence-based medicine (EBM) is defined by David Sackett as ‘the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients’. In the last two decades there has been a paradigm shift in the way clinical decisions are made. This gradual shift has focused our minds more on critical examination and evaluation of the clinical evidence. As a result, nowadays less often we rely solely on content expertise, unsystematic clinical experience and intuition. In order to be practitioners of EBM, clinicians need good evidence, which is based on robust study design, is updated regularly and is easily accessible. The Cochrane Library has as its slogan: ‘The best single source of reliable evidence about the effects of health care’. So where is the Cochrane Library? and who was Cochrane? The Cochrane Library is not a place but an electronic database compiled by the Cochrane Collaboration.���

Background Sensitization to dust mites predisposes to asthma and allergic rhinitis, and prevention of this sensitization might reduce the rising prevalence of these disorders. Objective To test the effectiveness of dust mite avoidance measures on the development of sensitization to dust mites in children. Methods As part of a multicentre study (Study of Prevention of Allergy in Children of Europe), 242 children, aged 5–7 years, in three European countries (United Kingdom, Greece and Lithuania), were randomized to prophylactic group (n = 127) and control group (n = 115). At randomization these children were required to have a family history of atopy and positive skin test to an aeroallergen but not to house dust mite. Children in the prophylactic group were provided with dust mite impermeable mattress covers and advice on environmental measures to reduce exposure to dust-mite allergen. Control group children were given non-specific advice. After 12 months a standardized questionnaire was completed and skin prick tests were performed. Results Ten children in the prophylactic group and 19 in the control group were lost to follow-up. Three of 117 (2.56%) children in the prophylactic group and nine of 96 (9.38%) in the control group developed sensitization to dust mites. Logistic regression analysis confirmed an independent effect of prophylactic measures (adjusted odds ratio (OR): 0.14, 95% confidence interval (CI): 0.03–0.79, P = 0.03). Fifteen children need to be treated to prevent sensitization in one child. Conclusion Dust mite sensitization can be reduced in school age children with simple mite avoidance measures.

This study set out to evaluate the feasibility and acceptability of routine early ultrasound (12-14 weeks) within a district general hospital (DGH) for identifying high-risk and abnormal pregnancies. This was a pilot study for screening by ultrasound examination all women who presented to their community midwife before 12 weeks' gestation. The study involved 991 women who presented clinically pregnant before 12 weeks' gestation between May 1998 and May 1999. Women were offered routinely two ultrasound examinations during their pregnancy, the first at 12-14 weeks' gestation and the second at 20-21 weeks' gestation. The main outcome measures were: range and number of abnormal/high-risk pregnancies identified during an ultrasound scan at 12-14 weeks' gestation; range and number of abnormalities diagnosed during scans at later gestations; outcomes of the pregnancies; questionnaires assessing how the women viewed early pregnancy ultrasound as a method of screening. Nine hundred and eighty-four (99%) women accepted the offer of an early ultrasound scan at 12-14 weeks' gestation; of these 840(85%) women accepted screening for trisomy 21 (T21) by fetal nuchal translucency thickness (NT) and maternal age (fetal medicine foundation risk assessment programme) and this was completed successfully in 797(80%) of cases. Twenty-four women (2%) had a failed pregnancy and where necessary an ERPC was performed following a planned admission. Thirty pregnancies (3%) were diagnosed as abnormal or having high risk of abnormality at the early scan. A major abnormality was confirmed before the expected anomaly scan at 20 weeks in five (17%) pregnancies; all of these patients opted for an elective termination. Twenty-six (3%) pregnancies had a diagnosis of abnormality at their anomaly scan. Of these, three pregnancies were diagnosed as major abnormalities with two resulting in termination of the affected pregnancy before 24 weeks' gestation. Eight hundred and thirty-seven women (85%) completed questionnaires, 833 women (84.5%) were satisfied with the counselling they received before the ultrasound scan and 827 women (84%) answered that they would accept an early pregnancy scan if offered during their next pregnancy. Early pregnancy ultrasound at 12-14 weeks' gestation can be used as an effective method of identifying and screening for major abnormalities of pregnancy within a DGH setting, but it is appropriate to use this in conjunction with an anomaly scan at around 20 weeks' gestation. Women found this method of screening acceptable.

Background - Allergic diseases have seen a rise worldwide with children suffering the highest burden. Thus early prevention of allergic diseases is a public health priority. Objective - To synthesise the evidence from randomised controlled trials (RCTs) assessing the efficacy of vitamin interventions during pregnancy on developing allergic diseases in offspring. Methods - We searched CENTRAL, MEDLINE, SCOPUS, WHO’s Int. Clin. Trials Reg., E-theses and Web of Science. Study quality was evaluated using the Cochrane’s risk of bias tool. Included RCTs had a minimum of 1-month follow-up post gestation.Results - A total of five RCTs met the inclusion criteria, including 2456 children that used vitamins C+E (one study), vitamin C (one study) and vitamin D (three studies) compared with placebo/control. Two studies were judged to have a high risk of bias for performance bias or high rate of loss to follow-up. All were rated as low risk of bias for blinding of outcome assessment. We did not perform meta-analysis with vitamin C or C+E studies due to high heterogeneity between the two included studies. However we did conduct a meta-analysis with trials on vitamin D (including 1493 children) and the results showed an association between prenatal intake of vitamin D and the risk of developing recurrent wheeze in offspring (RR=0.812, 95 % CI=0.67-0.98). Conclusion - The current evidence suggests that prenatal supplementation of vitamin D, might have a beneficial effect on recurrent wheezing in children. Longer-term follow-up of these studies are needed to ascertain whether this observed effect is a sustained. There is lack of evidence on the effect of other vitamins for prevention of respiratory and/or allergic outcomes.

Background: While the prevalence of asthma in children is decreasing or remaining the same, time-trends in the prevalence of rhinitis in children are not known. Understanding sensitisation trends may help inform about trends in asthma and rhinitis prevalence.Objective: To assess time -trends of wheeze, rhinitis and aero-allergen sensitisation prevalence at 10 years of age we compared two birth cohorts established 12 years apart. To gain insight into differences in disease prevalence we assessed association of family-history, early life exposures and sensitisation with wheeze and rhinitis in each cohort.Methods: The IoW (Isle-of-Wight) and FAIR (Food-Allergy-and-Intolerance-Research) unselected birth cohorts were established in 1989 and 2001 in IoW. Identical ISAAC questionnaire and Skin Prick test data were collected and compared at 10 years of age.Results: Over the 12 year period from 2001 to 2012, prevalence of lifetime-wheeze, current-wheeze, and those ever-treated-for-asthma decreased by 15.9% (45.5-vs-29.6,pConclusion: Contrasting changes were noted with falling wheeze and HDM sensitisation but rising rhinitis and grass sensitisation prevalence. Changing prevalence of aero-allergen sensitisations may explain the different time trends observed in these cohorts.