Guy's and St Thomas' NHS Foundation Trust

About: Guy's and St Thomas' NHS Foundation Trust is a healthcare organization based out in London, United Kingdom. It is known for research contribution in the topics: Population & Medicine. The organization has 7686 authors who have published 9631 publications receiving 399353 citations. The organization is also known as: Guy's and St Thomas' National Health Service Foundation Trust & Guy's and St Thomas' National Health Service Trust.

Update on risk factors for food allergy.

Abstract: Despite efforts to prevent food allergy (FA) in children, IgE-mediated FAs are increasing in westernized countries. Previous preventive strategies, such as prolonged exclusive breast-feeding and delayed weaning onto solid foods, have recently been called into question. The present review considers possible risk factors and theories for the development of FA. An alternative hypothesis is proposed, suggesting that early cutaneous exposure to food protein through a disrupted skin barrier leads to allergic sensitization and that early oral exposure to food allergen induces tolerance. Novel interventional strategies to prevent the development of FA are also discussed.

The association of obesity with osteoarthritis of the hand and knee in women: a twin study.

Abstract: Objective. To examine the association of obesity and osteoarthritis (OA) at various sites in middle aged women and to estimate the magnitude of the weight difference associated with OA. Methods. A co-twin control study was performed within a population based twin study of women aged 48-70. OA was defined radiologically using site specific features and a standard atlas. Twin pairs discordant for OA disease traits were analyzed. Results. The mean weight differences (95% CI) within twin pairs discordant for different OA traits were : tibiofemoral osteophytes 3.75 (1.29, 6.21) kg ; patellofemoral osteophytes 3.05 (0.96, 5.15) kg ; carpometacarpal (CMC) osteophytes 3.06 (0.83, 5.28) kg. There was no significant difference in weight within twin pairs discordant for osteophytes at the distal interphalangeal (DIP) or proximal interphalangeal (PIP) joints or for joint space narrowing at all sites examined except the patellofemoral joint, 4.73 (1.61, 7.84) kg. For each kg increase in weight the increased likelihood of developing different OA traits [OR (95% CI)] was : tibiofemoral osteophytes 1.14 (1.01-1.28), patellofemoral osteophytes 1.32 (1.09-1.59), patellofemoral narrowing 1.15 (1.01-1.30), and CMC osteophytes 1.09 (1.02-1.17). Conclusion. Obesity is an important risk factor for development of OA at the tibiofemoral and patellofemoral joints of the knee and CMC joints of the hands, with significant increases of 9-13% in risk of OA per kg increase in body weight. This emphasizes the potential importance of even minor weight reduction as a preventive health measure for OA.

Bonsai Trees in Your Head: How the Pavlovian System Sculpts Goal-Directed Choices by Pruning Decision Trees

Abstract: When planning a series of actions, it is usually infeasible to consider all potential future sequences; instead, one must prune the decision tree. Provably optimal pruning is, however, still computationally ruinous and the specific approximations humans employ remain unknown. We designed a new sequential reinforcement-based task and showed that human subjects adopted a simple pruning strategy: during mental evaluation of a sequence of choices, they curtailed any further evaluation of a sequence as soon as they encountered a large loss. This pruning strategy was Pavlovian: it was reflexively evoked by large losses and persisted even when overwhelmingly counterproductive. It was also evident above and beyond loss aversion. We found that the tendency towards Pavlovian pruning was selectively predicted by the degree to which subjects exhibited sub-clinical mood disturbance, in accordance with theories that ascribe Pavlovian behavioural inhibition, via serotonin, a role in mood disorders. We conclude that Pavlovian behavioural inhibition shapes highly flexible, goal-directed choices in a manner that may be important for theories of decision-making in mood disorders.

EAACI Food Allergy and Anaphylaxis Guidelines. Primary prevention of food allergy

Abstract: Food allergy can have significant effects on morbidity and quality of life and can be costly in terms of medical visits and treatments. There is therefore considerable interest in generating efficient approaches that may reduce the risk of developing food allergy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on Prevention and is part of the EAACI Guidelines for Food Allergy and Anaphylaxis. It aims to provide evidence-based recommendations for primary prevention of food allergy. A wide range of antenatal, perinatal, neonatal, and childhood strategies were identified and their effectiveness assessed and synthesized in a systematic review. Based on this evidence, families can be provided with evidence-based advice about preventing food allergy, particularly for infants at high risk for development of allergic disease. The advice for all mothers includes a normal diet without restrictions during pregnancy and lactation. For all infants, exclusive breastfeeding is recommended for at least first 4-6 months of life. If breastfeeding is insufficient or not possible, infants at high-risk can be recommended a hypoallergenic formula with a documented preventive effect for the first 4 months. There is no need to avoid introducing complementary foods beyond 4 months, and currently, the evidence does not justify recommendations about either withholding or encouraging exposure to potentially allergenic foods after 4 months once weaning has commenced, irrespective of atopic heredity. There is no evidence to support the use of prebiotics or probiotics for food allergy prevention.