Showing papers by "Andrew R. Gray published in 2018"

Safety and efficacy of maintenance ketamine treatment in patients with treatment-refractory generalised anxiety and social anxiety disorders.

Abstract: Objective:In this maintenance treatment study, we sought to evaluate the effect on anxiety ratings, safety and tolerability of 3 months of weekly ketamine in 20 patients with treatment-refractory D...

24-h movement behaviors from infancy to preschool: cross-sectional and longitudinal relationships with body composition and bone health.

Abstract: New physical activity guidelines for children address all movement behaviors across the 24-h day (physical activity, sedentary behavior, sleep), but how each component relates to body composition when adjusted for the compositional nature of 24-h data is uncertain. To i) describe 24-h movement behaviors from 1 to 5 years of age, ii) determine cross-sectional relationships with body mass index (BMI) z-score, iii) determine whether movement behaviors from 1 to 5 years of age predict body composition and bone health at 5 years. 24-h accelerometry data were collected in 380 children over 5–7 days at 1, 2, 3.5 and 5 years of age to determine the proportion of the day spent: sedentary (including wake after sleep onset), in light (LPA) and moderate-to-vigorous physical activity (MVPA), and asleep (including naps). BMI was determined at each age and a dual-energy x-ray absorptiometry (DXA) scan measured fat mass, bone mineral content (BMC) and bone mineral density (BMD) at 5 years of age. 24-h movement data were transformed into isometric log-ratio co-ordinates for multivariable regression analysis and effect sizes back-transformed. At age 1, children spent 49.6% of the 24-h day asleep, 38.2% sedentary, 12.1% in LPA, and 0.1% in MVPA, with corresponding figures of 44.4, 33.8, 19.8 and 1.9% at 5 years of age. Compositional time use was only related significantly to BMI z-score at 3.5 years in cross-sectional analyses. A 10% increase in mean sleep time (65 min) was associated with a lower BMI z-score (estimated difference, − 0.25; 95% CI, − 0.42 to − 0.08), whereas greater time spent sedentary (10%, 47 min) or in LPA (10%, 29 min) were associated with higher BMI z-scores (0.12 and 0.08 respectively, both p < 0.05). Compositional time use from 1 to 3.5 years was not related to future BMI z-score or percent fat. Although MVPA at 2 and 3.5 years was consistently associated with higher BMD and BMC at 5 years, actual differences were small. Considerable changes in compositional time use occur from 1 to 5 years of age, but there is little association with adiposity. Although early MVPA predicted better bone health, the differences observed had little clinical relevance. ClinicalTrials.gov number NCT00892983 .

Survival analysis of orthodontic retainers.

Abstract: Objective Retainers play a critical role in the long-term success of orthodontic treatment. The aims of this study were to evaluate the survival time of different retainers and to investigate the potential predictors of the retainer failures. Material and methods A total of 591 retainers from 309 patients (between 2003 and 2014) were included in the study, including Hawley retainers (n = 199), vacuum-formed retainers (n = 34), lingual fixed retainers (n = 278), and the COMBO (a combination of two different retainers in the same arch; n = 80). Patient's demographics, retention procedures, time to failure (survival time), and reasons for failures were extracted from patient files. Failure of retainer was defined as any events after which the retainers needed to be replaced or repaired; loss of retainer was treated as a failure because the retainer could not fulfil its role. Survival analyses were performed to compare the survival time between different retainer groups. Results The survival time was the longest for lingual fixed retainers (median 1604 days) and Hawley retainers (1529 days), followed by COMBO (258 days) and vacuum-formed retainers (105 days; overall P < 0.001). No statistical significance of survival time of lingual fixed retainers was found between maxilla (1497 days) and mandible (1604 days; P = 0.341), nor between different types of the COMBO (overall P = 0.078). These results were unchanged before and after adjusting for the age, gender, and socioeconomic status (SES) of the patients. The reasons for failures varied among different retainers: most failures of the Hawley retainers were 'lost' (52.0%), most failures of the lingual fixed retainers were debond (63.5%), and fracture was the most common cause of failure for both vacuum-formed retainers (43.5%) and the COMBO (41.9%). Conclusion Lingual fixed retainers and Hawley retainers had the longest survival times, followed by the COMBO retainers and vacuum-formed retainers. The reasons of failure were mainly mechanical (debond and fracture) and patient-related (loss).

Physical activity and inactivity trajectories associated with body composition in pre-schoolers.

Abstract: Early childhood is characterised by rapid development and is a critical period for the establishment of activity behaviours. We aim to examine how physical activity (PA) and sedentary behaviour (SB) track during the first 5 years of life, and to investigate associations between trajectories and body composition at 5 years of age. A total of 438 participants (50% male) wore an Actical accelerometer for 5 days at at least two of 1, 2, 3.5 and 5 years of age. Spearman correlation coefficients examined PA tracking from age 1 to 5 and trajectories of PA and SB were estimated using discrete mixture modelling. Regression models tested associations between both PA and SB trajectories and body composition measures. Tracking coefficients for PA ranged from r = 0.31–0.51 across the ages, with similar tracking observed for sedentary behaviour (r = 0.21–0.39). Four distinct trajectory patterns were identified separately for PA and SB: consistently low, consistently high, increasing and decreasing. BMI and waist circumference were not significantly associated with PA trajectories, but those in the consistently high activity group had significantly lower % body fat (95% CI) at age 5 (14.3%; 13.5, 15.2) than those in the consistently low (16.8%; 15.6, 18.2) or increasing (15.7%; 14.7, 16.7) groups (P = 0.017). Sedentary behaviour trajectories were not associated with any of the anthropometric measures at age 5 (P > 0.05). Physical activity and sedentary behaviour tracking is broadly similar from infancy to early childhood. Children with consistently higher levels of physical activity have reduced body fat at 5 years of age, although differences are relatively small.

Comparison of Psychosocial Variables Associated With Loneliness in Centenarian vs Elderly Populations in New Zealand.

Abstract: Importance Loneliness is associated with reduced health-related quality of life and increased morbidity and mortality and typically worsens with aging. Objectives To evaluate associations between demographic and psychosocial variables and loneliness, examine any age-specific associations, and compare centenarians (aged ≥100 years) with elderly people (aged 65-99 years). Design, Setting, and Participants In this retrospective, observational, cross-sectional study, previously collected data from all New Zealanders 65 years and older who completed their first international Resident Assessment Instrument–Home Care (interRAI-HC) assessment during the study period (January 1, 2013, to November 27, 2017) were reviewed. Participants were people living independently in the community who were requesting or referred for assessment with a potential need for support services. Main Outcomes and Measures The interRAI-HC is a 236-item, electronically recorded assessment that encompasses a comprehensive range of aspects of an older person’s life, including physical, psychological, and cognitive domains. Eight main items from the interRAI-HC data set were analyzed to describe the population and evaluate the core psychosocial components of aging, namely, age, sex, race/ethnicity, marital status, living arrangements, family support, depression, and loneliness. Loneliness was evaluated by the participants’ response to the assessment statement, “Says or indicates that he/she feels lonely.” Results A total of 73 286 New Zealanders (mean age, 81.4 years; age range, 65-109 years; 41 641 [56.9%] female) participated in the study. The assessments of 191 centenarians (mean [SD] age, 100.9 [1.2] years) and 73 095 elderly people (mean [SD] age, 81.4 [7.6] years) were analyzed. Centenarians vs elderly people were more likely to be female (136 [71.2%] vs 41 488 [56.8%];P Conclusions and Relevance Centenarians are a unique group to study as a model of successful aging. The sample of centenarians in this study appeared to be less lonely than other groups studied internationally. The study identified multiple psychosocial variables that were associated with the risk of loneliness, including living arrangements, family support, and depression. Knowing these variables may help our society address risk factors for loneliness in older people.

Expression of Pseudomonas aeruginosa Antibiotic Resistance Genes Varies Greatly during Infections in Cystic Fibrosis Patients.

Abstract: The lungs of individuals with cystic fibrosis (CF) become chronically infected with Pseudomonas aeruginosa that is difficult to eradicate by antibiotic treatment Two key P aeruginosa antibiotic resistance mechanisms are the AmpC β-lactamase that degrades β-lactam antibiotics and MexXYOprM, a three-protein efflux pump that expels aminoglycoside antibiotics from the bacterial cells Levels of antibiotic resistance gene expression are likely to be a key factor in antibiotic resistance but have not been determined during infection The aims of this research were to investigate the expression of the ampC and mexX genes during infection in patients with CF and in bacteria isolated from the same patients and grown under laboratory conditions P aeruginosa isolates from 36 CF patients were grown in laboratory culture and gene expression measured by reverse transcription-quantitative PCR (RT-qPCR) The expression of ampC varied over 20,000-fold and that of mexX over 2,000-fold between isolates The median expression levels of both genes were increased by the presence of subinhibitory concentrations of antibiotics To measure P aeruginosa gene expression during infection, we carried out RT-qPCR using RNA extracted from fresh sputum samples obtained from 31 patients The expression of ampC varied over 4,000-fold, while mexX expression varied over 100-fold, between patients Despite these wide variations, median levels of expression of ampC in bacteria in sputum were similar to those in laboratory-grown bacteria The expression of mexX was higher in sputum than in laboratory-grown bacteria Overall, our data demonstrate that genes that contribute to antibiotic resistance can be highly expressed in patients, but there is extensive isolate-to-isolate and patient-to-patient variation

First, do no harmony: an examination of attitudes to music played in operating theatres.

Abstract: Aim It is common for music to be played in operating theatres around the world. The benefits or harms of this music on practitioners and patients are not well known. The aim of this paper is to examine the attitudes and perceptions of theatre staff towards the presence of music during operations on the theatre environment. Method This observational study was conducted in a single-centre at a tertiary teaching hospital in New Zealand. Over a two-week period in 2014, the entire theatre staff population were sent an online survey. We gathered data on demographics (eg, age, gender, theatre role), perceived frequency of music being played in operating rooms, types of music, disposition to music in different situations, the perception of an effect on the theatre team, and on with whom the decision to have music played lay with. Appropriate statistical analyses were applied. Results A hundred and six responses were received (45% response rate). 98% of people said that music is played in their operating rooms, with 50% saying it was played more than 50% of the time. 60% liked having it, whereas 30% disliked it. Easy Listening was the genre most played closely followed by Pop and Classical. Easy Listening was the most preferred and classical music the second most. Music was preferred for longer, more familiar and non-urgent procedures, at a low to medium volume, preferably from a CD or MP3 player, though 84% felt it was a distraction in a crisis situation. Surgeons were the most empowered group, and anaesthetic technicians the least when it came to choosing music. Most respondents felt music improved calmness, overall mood, overall team performance and surgeon's performance, though worsened communication. Conclusion This study, while limited in size, demonstrates that theatre staff generally like music in the operating theatre, and most believe it has a positive impact on several aspects of the theatre environment, though a negative influence on communication. There have been no clinical impact studies on patient and this could be an avenue for future research.

Annual Incidence and Phenotypic Presentation of IBD in Southern New Zealand: An 18-Year Epidemiological Analysis.

Abstract: Background The aim of this study was to describe the incidence of inflammatory bowel disease (IBD) and changes in demographic and phenotypic disease presentation in Otago, New Zealand. Methods This study was conducted at Dunedin Hospital and the study period was 1996-2013. Otago residents diagnosed with IBD were identified retrospectively from hospital lists using ICD-10 codes. Diagnosis, and place and date of diagnosis, were confirmed using medical notes and histology reports. Demographic, clinical and diagnostic data were recorded. Age-standardised incidence rates were estimated and trends over time assessed. Multinomial logistic regression was used to assess evidence for any changes in the distribution of disease location for Crohn's disease (CD) cases. Results The diagnosis of IBD was confirmed in 224 males and 218 females, and most were New Zealand European. Of the total number of confirmed IBD cases, 40.0% were ulcerative colitis (UC), 52.1% were CD and 7.9% were IBD unclassified. The age distribution illustrated bimodal peaks at 20-24 years and 65-69 years. Incidence rates varied from year to year, but there was no statistically significant change over the 18-year study period. The estimated age-standardised IBD incidence varied between 5.8/100,000 in 2006 and 29.8/100,000 in 2012. The incidence rates for UC and CD were 2.8/100,000 and 1.8/100,000, respectively, in 2006 and 6.3/100,000 and 21.8/100,000, respectively, in 2012. There were no significant phenotypic changes in CD patients over the study period. Conclusions The IBD incidence in Otago, New Zealand, is high compared to many other countries. Annual age-standardised incidence rates vary, highlighting the limitations of single-year incidence data.

Outcomes and Factors Influencing Response to an Individualized Multidisciplinary Chronic Disease Management Program for Hip and Knee Osteoarthritis

Abstract: Background The objective of the study was to investigate the effectiveness of, and factors associated with, response to a chronic disease management program for patients with hip and knee osteoarthritis (OA). Methods Over a 2-year period (2012-2014), 218 patients (97 hip OA; 121 knee OA) were managed with an individualized program of interventions that could include education, physiotherapy, orthotics, occupational therapy, or dietitian referral. Changes in Oxford Hip Score or Oxford Knee Score and Short Form-12 (SF-12) Physical and Mental Component Summary Score (PCS, MCS) were analyzed by joint affected, both unadjusted, and gender and age adjusted. A further analysis also adjusted for body mass index. Results At mean 12-month follow-up, patients with knee OA had a statistically significant improvement in Oxford Knee Score and PCS, while patients with hip OA had a statistically significant deterioration in all 3 scores. There was evidence that these changes differed between joints for Oxford and PCS scores. Older age was associated with worse outcomes for Oxford scores. Higher body mass index was associated with worse outcomes for Oxford and PCS scores. Patients with hip OA (35%) were more likely to deteriorate to a clinically significant extent (5 points) for Oxford scores than those with knee OA. Gender was not associated with outcomes. Patients with hip OA (54%) were more likely than those with knee OA (24%) to have subsequently had surgery (P Conclusions Patients with knee OA were more likely to improve with a chronic disease management plan than patients with hip OA and efforts should be directed to them.

Protocol, and practical challenges, for a randomised controlled trial comparing the impact of high intensity interval training against standard care before major abdominal surgery: study protocol for a randomised controlled trial

Abstract: Risk factors, such as the number of pre-existing co-morbidities, the extent of the underlying pathology and the magnitude of the required operation, cannot be changed before surgery. It may, however, be possible to improve the cardiopulmonary fitness of the patient with an individualised exercise program. We are performing a randomised controlled trial (RCT) assessing the impact of High Intensity Interval Training (HIIT) on preoperative cardiopulmonary fitness and postoperative outcomes in patients undergoing major abdominal surgery. Consecutive eligible patients undergoing elective abdominal surgery are being randomised to HIIT or standard care in a 1:1 ratio. Participants allocated to HIIT will perform 14 exercise sessions on a stationary cycle ergometer, over a period of 4–6 weeks before surgery. The sessions, which are individualised, aim to start with ten repeated 1-min blocks of intense exercise with a target of reaching a heart rate exceeding 90% of the age predicted maximum, followed by 1 min of lower intensity cycling. As endurance improves, the duration of exercise is increased to achieve five 2-min intervals of high intensity exercise followed by 2 min of lower intensity cycling. Each training session lasts approximately 30 min. The primary endpoint, change in peak oxygen consumption (Peak VO2) measured during cardiopulmonary exercise testing, is assessed at baseline and before surgery. Secondary endpoints include postoperative complications, length of hospital stay and three clinically validated scores: the surgical recovery scale; the postoperative morbidity survey; and the SF-36 quality of life score. The standard deviation for changes in Peak VO2 will be assessed after the first 30 patients and will be used to calculate the required sample size. We want to assess if 14 sessions of HIIT is sufficient to improve Peak VO2 by 2 mL/kg/min in patients undergoing major abdominal surgery and to explore the best clinical endpoint for a subsequent RCT designed to assess if improving Peak VO2 will translate into improving clinical outcomes after surgery. Australian New Zealand Clinical Trials Registry, ACTRN12617000587303 . Registered on 26 April 2017.

Estimation of jaw-opening forces in adults.

Abstract: OBJECTIVES To estimate maximum jaw-opening forces in healthy participants of diverse ancestry and to estimate whether opening forces are associated with sex, age and anthropometric parameters such as height, weight and BMI. SETTING AND SAMPLE POPULATION One hundred and forty-nine participants aged 20-60 years with overall good oral and general health. Exclusion criteria included myofascial or neck pain, symptomatic temporomandibular joint disorders (TMD), current orthodontic treatment or the absence of a natural dentition. MATERIAL AND METHODS Jaw-opening forces were measured with an adjustable rigid extra-oral device connected to a 1000 N load cell. Seven attempts were recorded, with 10 seconds interval. Median force values were obtained after discarding the first and last attempt. The height and weight of each participant were measured and recorded, alongside age, sex and ethnicity. RESULTS Men had greater maximum opening force median values than women (P < .001). Median (IQR) values for women were 41.16 N (30.44) and 79.00 N for men (63.86). Jaw-opening force values were poorly associated with biological and anthropometric parameters. CONCLUSION In this study, which included a large sample of participants of broad age range and from a demographically diverse background, jaw-opening force values were greater in males than in females; however, force values were poorly associated with biological and anthropometric parameters. Future studies should explore the potential of this method as a screening tool for TMJ disorders and other conditions.

Lactating Canadian Women Consuming 1000 µg Folic Acid Daily Have High Circulating Serum Folic Acid Above a Threshold Concentration of Serum Total Folate.

Abstract: Background Consumption of high-dose folic acid supplements is common throughout pregnancy and lactation in several countries, including Canada, Brazil, and the United States, and may lead to high levels of circulating unmetabolized folic acid. Objective The objective of the study was to characterize serum and whole-blood folate forms in Canadian lactating women regularly consuming a daily high-dose folic acid supplement. Methods One-hundred and seventeen Canadian lactating women aged between 18 and 42 y, with a geometric mean ± SD prepregnancy body mass index (kg/m2) of 23.1 ± 1.2, were enrolled in a vitamin D supplementation trial between 13 and 22 wk of gestation. As part of the trial, the women received a daily multivitamin containing 1000 µg folic acid throughout pregnancy and lactation until 8 wk postpartum. At 8 wk postpartum, serum folate forms, including folic acid and RBC total folate, were determined from nonfasted blood samples. Differences in median folate vitamer concentrations among quintiles of serum total folate status were assessed by the Wald test and quantile regression methods. A breakpoint in the relation between serum folic acid and serum total folate was modeled with the use of the segmented package in R. Results Median serum total folate concentration among participants was 79.3 nmol/L (5th-95th percentile 30.7-186 nmol/L) and median RBC folate concentration was 2790 nmol/L (5th-95th percentile 1330-4850 nmol/L). There was a breakpoint in the relation between serum total folate and serum folic acid at 78.5 nmol/L (95% CI: 67.9, 89.1 nmol/L), below which serum folic acid was not associated with serum total folate, and above which serum folic acid increased 0.78 nmol/L (95% CI: 0.70, 0.86 nmol/L; P Conclusions These data demonstrate the potential for high serum folic acid concentrations proportional to overall folate concentrations in lactating women with serum total folate >80 nmol/L taking high-dose supplemental folic acid. This study was registered at clinicaltrials.gov as NCT01112891.

The risk of non-melanoma skin cancer in New Zealand in inflammatory bowel disease patients treated with thiopurines.

Abstract: Background and Aim New Zealand (NZ) has one of the highest rates of non-melanoma skin cancers (NMSC) in the world. Thiopurine use in Inflammatory Bowel Disease (IBD) patients has been shown to increase NMSC risk. This study aimed to investigate the possible increase of NMSC risk in thiopurine-treated IBD patients in NZ despite the high background rate. Methods IBD patients treated with thiopurines and healthy controls were recruited across two different latitude centers in NZ. Consented participants completed a questionnaire to identify additional risk factors, and were examined for suspicious skin lesions. These were photographed and the pictures evaluated by a dermatologist. Data was compared between centers and between groups with NMSC incidence and thiopurine – associated relative risks estimated. Results 171 thiopurine-exposed IBD patients and 201 controls were recruited. 27/390 photographs (26 participants) showed suspicious lesions (17 exposed, 9 controls) as determined by the dermatologist. Estimated NMSC incidence was 24.7-34.3/1000 patient-years (thiopurine-exposed, depending on classification of unconfirmed suspicious lesions) and 7-14/1000 patient-years (control). The relative risk of NMSC among thiopurine exposed was 2.38 – 2.97 (p≤ 0.014), which remained significant after individually adjusting for potential confounders. We estimated the NMSC risk to increase 5.4%-6.6% per 6 months of thiopurine use (p< 0.001). Low compliance in avoiding NMSC risk factors in the exposed group was observed. Conclusions We found a 2 to 3-fold increase in NMSC incidence in IBD patients treated with thiopurines in New Zealand, despite the high background incidence rate.

A comparison of perceptions of nuts between the general public, dietitians, general practitioners, and nurses.

Abstract: Background Nut consumption at the population level remains low despite the well-documented benefits of their consumption, including their cardioprotective effects Studies have suggested that advice from health professionals may be a means to increase nut consumption levels Understanding how nuts are perceived by the public and health professionals, along with understanding the public's perceptions of motivators of and deterrents to consuming nuts, may inform the development of initiatives to improve on these low levels of consumption The aim of this cross-sectional study was to compare perceptions of nuts among three groups of health professionals (dietitians, general practioners, and practice nurses) and the general public in New Zealand (NZ), along with motivators of and deterrents to consuming nuts amongst the general public and their experiences of receiving advice around nut consumption Methods The NZ electoral roll was used to identify dietitians, general practitioners (GPs), and practice nurses, based on their free-text occupation descriptions, who were then invited to complete a questionnaire with 318, 292, and 149 respondents respectively 1,600 members of the general public were randomly selected from the roll with 710 respondents Analyses were performed using chi-squared tests to look at differences in categorical variables and linear regression for differences in other variables between the four survey groups Results Although there were significant differences between the four groups regarding the perceptions of nuts, in general there was agreement that nuts are healthy, high in protein and fat, are filling, and some nuts are high in selenium We noted frequent agreement that the general public participants would consume more if nuts: improved health (67%), were more affordable (60%), or improved the nutrient content (59%) and balance of fats (58%) within their diets Over half the respondents reported they would eat more nuts if they were advised to do so by a dietitian or doctor, despite less than 4% reporting they had received such advice The most frequently selected deterrents to increasing nut consumption were: cost (67%), potential weight gain (66%), and leading to eating too much fat (63%) Discussion It is concerning that so few among the general public report receiving advice to consume more nuts from health professionals, especially given their apparent responsiveness to such advice Health professionals could exploit the motivators of nut consumption, while also addressing the deterrents, to promote nut intake These factors should also be addressed in public health messages to encourage regular nut consumption among the public Educational initiatives could also be used to improve the nutritional knowledge of GPs and practice nurses with regard to nuts, although even dietitians were unsure of their knowledge in some cases

Genetic investigation into an increased susceptibility to biliary atresia in an extended New Zealand Māori family.

Abstract: Biliary atresia (BA), a fibrosing disorder of the developing biliary tract leading to liver failure in infancy, has an elevated incidence in indigenous New Zealand (NZ) Māori. We investigated a high rate of BA in a group of children (n = 12) belonging to a single Māori iwi (or ‘tribe’, related through a remote ancestor). Population and geographical data was used to estimate the rate of BA in Māori sub-groups, and a pedigree linking most of the affected children was constructed from oral and documented history. Array genotyping was used to examine hypotheses about the inheritance of a possible genetic risk factor, and the history of the affected population, and Exome Sequencing to search for candidate genes. Most of these affected children (n = 7) link to a self-reported pedigree and carry a 50-fold increase in BA risk over unrelated Māori (χ2 = 296P 0.63). Genome-wide quantitation of intervals of contiguous, homozygous-by-state markers reached a similar conclusion (F (2,399) = 1.99, P = 0.138). Principal component analysis and investigation with STRUCTURE found no evidence of increased allele frequency of either a recessive variant, or additive, low-risk variants due to reproductive isolation. To identify candidate causal factors, Exome Sequencing datasets were scrutinised for shared rare coding variants across 8 affected individuals. No rare, non-synonymous, phylogenetically conserved variants were common to 6 or more affected children. The substantially elevated risk for development of BA in this subgroup could be mediated by genetic factors, but the iwi exhibits no properties indicative of recent or remote reproductive isolation. Resolution of any risk loci may rely on extensive genomic sequencing studies in this iwi or investigation of other mechnaisms such as copy number variation.

The role of parent and child self-regulation in children's glycemic control.

Abstract: Objective Type 1 diabetes mellitus (T1DM) is a lifelong, metabolic disorder, typically arising in childhood and adolescence Despite recent advances in diabetes management techniques, glycemic control remains substandard for many individuals This study examined the role of parental and child self-regulation in predicting effective glycemic control in children and adolescents with Type 1 diabetes mellitus (T1DM) Method Sixty-three families (with children aged 3-18 years) with T1DM participated Child, maternal, and paternal measures of temperament, including surgency (behavioral self-regulation), negative affect (emotional selfregulation), and effortful control (cognitive self-regulation) were collected, along with demographic information and haemoglobin A1c (glycemic control) Results Higher parental and child effortful control was associated with better glycemic control Higher child negative emotionality was associated with poorer glycemic control No significant interactions between child and parent measures were identified Conclusions Both parental and child self-regulation play an independent role in glycemic control, and serve as targets for intervention in improving diabetes management in children and adolescents (PsycINFO Database Record

Red Meat Consumption and Serum Lipids and Fatty Acids in Toddlers: Secondary Outcomes of a Randomized Controlled Trial.

Abstract: The aim of the study was to examine the effects of promoting increased lean red meat consumption on serum concentrations of total and high-density lipoprotein (HDL) cholesterol, and serum fatty acid composition, among toddlers. In a 20-week randomized controlled trial healthy 12 to 20-month-old children were assigned to: red meat (n = 90; parents were encouraged to add 56 g/day of lean red meat to their toddler's usual diet), or control (n = 90) groups. Food and nutrient intakes were assessed with 3-day weighed food records (baseline, week 4, and week 20). Serum was analyzed for total and HDL cholesterol concentrations, and fatty acid composition (baseline and week 20). At week 20, relative to control, the red meat group had higher intakes of red meat, all meat, and carbohydrate; and lower intakes of milk, energy, cholesterol, and total, saturated, and monounsaturated fat (P = 0.043 for energy, all others P ≤ 0.002). No effects associated with the intervention were found for total cholesterol, HDL cholesterol, total to HDL cholesterol ratio, or serum fatty acid composition (all P ≥ 0.059) aside from pentadecanoic acid (P = 0.047). An ∼3-fold increase in lean red meat intake, from ∼10 to ∼30 g/day, resulted in no consistent changes in serum lipids or fatty acid composition, suggesting that the addition of ∼2 tablespoons/day of lean red meat to toddlers' diets will likely not adversely affect serum lipids or serum fatty acids.

Self-Reflected Well-Being via a Smartphone App in Clinical Medical Students: Feasibility Study

Abstract: Background: Well-being in medical students has become an area of concern, with a number of studies reporting high rates of clinical depression, anxiety, burnout, and suicidal ideation in this population. Objective: The aim of this study was to increase awareness of well-being in medical students by using a smartphone app. The primary objective of this study was to determine the validity and feasibility of the Particip8 app for student self-reflected well-being data collection. Methods: Undergraduate medical students of the Dunedin School of Medicine were recruited into the study. They were asked to self-reflect daily on their well-being and to note what experiences they had encountered during that day. Qualitative data were also collected both before and after the study in the form of focus groups and “free-text” email surveys. All participants consented for the data collected to be anonymously reported to the medical faculty. Results: A total of 29 participants (69%, 20/29 female; 31%, 9/29 male; aged 21-30 years) were enrolled, with overall median compliance of 71% at the study day level. The self-reflected well-being scores were associated with both positive and negative experiences described by the participants, with most negative experiences associated with around 20% lower well-being scores for that day; the largest effect being “receiving feedback that was not constructive or helpful,” and the most positive experiences associated with around 20% higher scores for that day. Conclusions: The study of daily data collection via the Particip8 app was found to be feasible, and the self-reflected well-being scores showed validity against participant’s reflections of experiences during that day.

The effects of 'activating' almonds on consumer acceptance and gastrointestinal tolerance.

Abstract: Purpose Recommendations to soak nuts prior to consumption to reduce phytate concentrations and improve gastrointestinal tolerance have received much attention in the popular press. This is despite no supporting scientific evidence for the practice. There is also a lack of information about how soaking nuts might affect consumer acceptability. This study primarily assessed the effects of soaking almonds on consumer acceptance and secondly assessed effects on gastrointestinal tolerance. Methods In this 8-week randomised crossover trial, 76 participants were allocated in balanced order to receive 30 g/day of four different preparations of almonds for 12 days: whole unsoaked, whole soaked, sliced unsoaked, and sliced soaked. Ratings of overall liking, desire to consume, and likelihood of future consumption, and severity of gastrointestinal symptoms were measured daily on visual analogue scales. The phytate concentrations were measured in all four nut types using high-performance liquid chromatography. Results Mean acceptance ratings of all nut types were above the neutral point indicating they were acceptable. However, sliced soaked almonds were rated significantly lower overall for all three acceptance scales compared to the other treatments (all P ≤ 0.003). The sliced unsoaked almonds were rated lower than both whole nut treatments (all P ≤ 0.006), while there were no significant differences between the two whole nut treatments (all P ≥ 0.511). Gastrointestinal symptoms were minimal, but flatulence was rated significantly higher for all time points combined for soaked whole nuts compared to unsoaked whole nuts (P = 0.005). Compared to the whole unsoaked nuts (mean [SD] 531 [9] mg/100 g), phytate concentration was higher for the whole soaked almonds (563 [38] mg/100 g, P = 0.016), with no evidence of a difference for the sliced soaked almonds (548 [27] mg/100 g, P = 0.197) and no difference between the soaked forms (P = 0.262). Conclusions This research supports previous results suggesting nuts, including different forms, are an acceptable food. They are also well tolerated gastrointestinally, but soaking does not improve gastrointestinal tolerance or acceptance as claimed in the lay literature.