Search Results (63)

Background: The proportion of the population aged 65 years or older is increasing. Typically, physical activity and health decline with age, which is why action to promote active ageing is a major public health priority, particularly due to health inequalities in older adults. The aim of this study is to assess the effectiveness and cost-effectiveness of the Walk with Me peer-led walking intervention for older adults. Methods: This study is a two-arm, assessor-blind, randomised controlled trial. The intervention is a 12-week peer-led walking intervention based on social cognitive theory. Participants in the control group will receive information on active ageing and healthy nutrition. The study will target 348 community-dwelling older adults, aged 60 years or over living in areas of socio-economic disadvantage communities. Trained peer mentors will deliver the intervention. The primary outcome will be a mean between-group change in moderate-to-vigorous physical activity at 12 months from baseline, measured using an Actigraph accelerometer. Secondary outcomes will include quality of life, mental wellbeing, blood pressure, BMI and waist circumference. An embedded process evaluation will involve focus groups and participant diaries. Discussion: Evidence-based, cost-effective interventions to promote physical activity in older adults living in socio-economically disadvantaged communities are needed to address health inequalities. Full article

Background: Despite dietitians being important members of the multidisciplinary team delivering family therapy for anorexia nervosa (FT-AN), their specific responsibilities and roles are unclear and their involvement in the treatment can be a contentious issue. Methodology: Clinicians (n = 20) experienced in the delivery of FT-AN who were working at a specialist child and adolescent eating disorder service responded to an online survey about their experience of including a dietitian in FT-AN and how they understand the role. Both categorical and open-ended questions were used. Reflexive thematic analysis was used to analyse the qualitative free-text responses of clinician perspectives on the role of the dietitian in FT-AN. Results: All clinicians agreed that dietetics had a role within FT-AN and most frequently sought dietetic involvement in the early phases of FT-AN. Reflexive thematic analysis of responses identified three main themes. These were (1) collaboration is key, (2) confidence as a core consideration and (3) case-by-case approach. These themes evidenced the role of the dietitian within FT-AN and highlighted both the benefits and concerns of this involvement. Conclusions: This study demonstrated that dietitians can take a core role as collaborators within therapy-led teams that facilitate joint working and sharing of expertise. However, dietetic input should be considered on a case-by-case basis, given its potential for creating an over-focus on nutrition and potentially diminishing parental confidence in feeding. When indicated for selected cases, nutritional counselling should be offered in joint sessions with the therapist rather than separately. The findings of the study were limited by the small sample size of participants recruited from a single centre and heterogeneity in the professional background of respondents. Although the integration of dietetics within the multidisciplinary team and the ability of dietitians to individualise patient care can enhance FT-AN treatment, potential benefits and disbenefits should be considered for each case. Full article

Frailty is common among older hospital inpatients. While studies describe frailty prevalence in acute hospitals, it is usually based upon retrospective hospital-coded data or brief screening on admission rather than comprehensive geriatric assessment (CGA). Further, little is known about differences between pre-admission and current frailty status. Given this, we investigated the prevalence of pre-frailty and frailty among adult inpatients in a large university hospital after CGA. Of the 410 inpatients available, 398 were included in the study, with a median age of 70 years; 56% were male. The median length of stay (LOS) at review was 8 days. The point prevalence of frailty was 30% versus 14% for pre-frailty. The median Clinical Frailty Scale score pre-admission was 3/9, which was significantly lower than at review, which was 4/9 (p < 0.001). After adjusting for age and sex, frailty was associated with greater odds of prolonged LOS (odds ratio [OR] 1.7, p = 0.045), one-year mortality (OR 2.1, p = 0.006), and one-year institutionalisation (OR 9, p < 0.001) but not re-admission. Frailty was most prevalent on medical and orthopaedic wards. In conclusion, CGA is an important risk assessment for hospitalised patients. Frailty was highly prevalent and associated with poor healthcare outcomes. Frailty status appears to worsen significantly during admission, likely reflecting acute illness, and it may not reflect a patient’s true frailty level. The development of frailty clinical care pathways is recommended in order to address the poor prognosis associated with a diagnosis of frailty in this setting. Full article

Purpose: Cancer survivors can experience symptoms such as fatigue, pain and distress that persist for many months following treatment. These enduring symptoms often impact on participation in self-care activities, returning to school and/or work, and leisure and social activities. Self-management support is increasingly recognised as a core aspect of cancer survivorship care to reduce the impact of persistent symptoms. The purpose of this study was to examine the feasibility and potential effectiveness of a group-based self-management intervention, OptiMal, to improve the physical and psychological health of cancer survivors. OptiMal is a six-week intervention comprising weekly sessions on fatigue, stress and physical activity, diet and effective communication strategies. Methods: A feasibility randomised control trial was undertaken. Individuals up to two years after cancer treatment were randomised to OptiMal or usual care. Feasibility was examined through recruitment and retention metrics. Potential effectiveness was tested through patient-reported outcomes collected at baseline and three months post-intervention. Descriptive and inferential statistics were used to analyse study data. Results: Recruitment for this study was 32.5% (80/246 eligible individuals) with 77.5% retention at three-month follow-up (82.5% for intervention group and 72.5% for control group). Of those who attended the intervention, 19 (73%) attended all OptiMal sessions, indicating high adherence to the intervention. The majority of participants had breast cancer and were between 12 and 24 months post-treatment. The intervention group (n = 29) had statistically significant greater improvements in anxiety (p = 0.04) and health-related quality of life (health index score: p = 0.023, visual analogue score: p = 0.035) at three months post-intervention than the control group. Conclusions: Recruitment and retention in this study was similar to other cancer trials and the high adherence rate indicates that OptiMal is an acceptable self-management intervention for cancer survivors and warrants further investigation. OptiMal is intended to address symptoms reported across different cancer types. However, a limitation of this study was that the majority of participants had breast cancer, and therefore, generalisability of findings cannot be assumed for other cancer types. Future studies of OptiMal therefore need to use different strategies to recruit survivors of other cancer types. Full article

The efficacy of therapeutic T-cells is limited by a lack of positive signals and excess inhibitory signaling in tumor microenvironments. We previously showed that a constitutively active IL7 receptor (C7R) enhanced the persistence, expansion, and anti-tumor activity of T-cells expressing chimeric antigen receptors (CARs), and C7R-modified GD2.CAR T-cells are currently undergoing clinical trials. To determine if the C7R could also enhance the activity of T-cells recognizing tumors via their native T-cell receptors (TCRs), we evaluated its effects in Epstein–Barr virus (EBV)-specific T-cells (EBVSTs) that have produced clinical benefits in patients with EBV-associated malignancies. EBVSTs were generated by stimulation of peripheral blood T-cells with overlapping peptide libraries spanning the EBV lymphoma antigens, LMP1, LMP2, and EBNA 1, followed by retroviral vector transduction to express the C7R. The C7R increased STAT5 signaling in EBVSTs and enhanced their expansion over 30 days of culture in the presence or absence of exogenous cytokines. C7R-EBVSTs maintained EBV antigen specificity but were dependent on TCR stimulation for continued expansion. C7R-EBVSTs produced more rapid lymphoma control in a murine xenograft model than unmodified EBVSTs and persisted for longer. The findings have led to a clinical trial, evaluating C7R-EBVSTs for the treatment of refractory or relapsed EBV-positive lymphoma (NCT04664179). Full article

This article focuses on targeted programs for low-SES students in two selective universities: Trinity College Dublin, the University of Dublin, Ireland (Trinity Access Programmes/TAP) and the University of Oxford, UK (Lady Margaret Hall Foundation Year/LMH FY). The programs were collaborative developments, as examples of the potential of learning and adaptation across geographical contexts. It poses two questions: (a) How did the admissions processes in both universities change to target low-SES students? (b) How do social and academic support services for low-SES students, provided by two universities, contribute to the development of student capabilities? The article draws on the capability approach as the evaluative lens used to explore the two programs. Findings indicate (a) innovative approaches to socio-economic assessment in both programs, resulting in effective targeting of low-SES students, (b) the scaling of the programs beyond their initial remit and (c) the emergence of specific student capabilities through their engagement in the programs. Full article

In children, diets high in sodium and low in potassium lead to increased blood pressure and risk of cardiovascular disease later in life. This study aimed to describe the major packaged food sources of sodium for New Zealand children aged 5 to 14 years and explored changes in the sodium content of these foods. Descriptive secondary analysis of 24 h dietary recall data from the 2002 National Children Nutrition Survey was undertaken to identify the major sources of sodium for children, and linear regression using Nutritrack data was used to assess changes in the sodium content of these foods from 2013 to 2019. For all NZ children, the major packaged food sources of sodium were white bread (contributing 23.1% to sodium intake),sausages (4.2%), ham (4.0%), canned spaghetti (3.5%) and wholemeal bread (3.2%). The results were comparable when analysed by gender, although boys attained more sodium from wholemeal bread and canned baked beans than girls (3.8% vs. 2.3% and 3.9% vs 1.8%, respectively). By age, white bread was the top contributor to sodium intake (25.6% for children aged 5–6 years and 22.6% for children aged 7–10 years and 11–14 years). Differences by ethnicity show that white bread made sodium contributions of 27.2% for Māori, 32.5% for Pacific and 20.6% for New Zealand European and others (NZEO). Sodium obtained from noodles was also higher among Māori and Pacific children (3.3% and 4.7%, respectively) than NZEO children (2.3%) as was sodium attained from extruded snacks and other crisps (Māori 2.0%, 2.5% Pacific and 0.9% NZEO). From 2013 to 2019, a significant decrease of 0.2 mg/100 g (95% CI: −70.2, −13.5) was found in the sodium content of white bread and whole hams and similar products (−0.4 mg/100 g, 95% CI: −636.2, −151.0) but an increase in the sodium content of noodles (0.2 mg/100 g, CI: 197.7, 703.2) over the same period of time. Understanding the major contributing packaged food sources of sodium and potassium for diverse New Zealand children is essential in protecting against future risk of cardiovascular disease and impetus for future public health initiatives aimed at reducing sodium intake. Full article

Red Sea marine sponges are an important source of biologically active natural products. Therefore, the present study aimed to investigate, for the first time, the components of n-hexane, dichloromethane, and ethyl acetate fractions of Cliona sp. marine sponge collected from the Red Sea, Egypt using UPLC-ESI-MS/MS (Ultra-performance liquid chromatography electrospray ionization tandem mass spectrometry) analysis. The analysis revealed the tentative identification of 23, 16, and 24 compounds from the n-hexane, dichloromethane, and ethyl acetate fractions of Cliona sp., respectively. In addition, the examination of these fractions resulted in the isolation and identification of three sterols and one amino acid. The identification of the isolated compounds was confirmed by 1D and 2D NMR (Nuclear Magnetic Resonance), and MS (Mass spectrometry), and IR (Infrared) spectroscopy. The in vitro cytotoxic, antioxidant, and antimicrobial activities of the total ethanolic extract and its sub-fractions were also evaluated. Interestingly, the ethyl acetate fraction showed potent cytotoxic activity against colon (HCT-116) and human larynx carcinoma (HEP-2) cell lines with IC₅₀ (Half-maximal Inhibitory Concentration) 6.11 ± 0.2 and 12.6 ± 0.9 µg/mL, respectively. However, the dichloromethane fraction showed strong antioxidant activity, with IC₅₀ 75.53 ± 3.41 µg/mL. Notably, the total ethanolic extract showed the strongest antibacterial activity against Staphylococcus aureus and Escherichia coli, with MIC (Minimum Inhibitory Concentration) 62.5 ± 0.82 and 125 ± 0.62 µg/mL, respectively, compared to other fractions. In conclusion, this is the first report on the secondary metabolites content and biological activities of Cliona sp. from the Red Sea, Egypt. It also highlights the need for further research on the most active fractions against various cancer cell lines and resistant bacterial and fungal strains. Cliona sp. extract and its fractions could be a potential source of novel and safe natural drugs with a wide range of medicinal and pharmaceutical applications. Full article

Clionaterpene (1), a new cadinene sesquiterpene, along with six known compounds 2–7 were isolated from the marine sponge Cliona sp. The structure of 1 with absolute configuration was determined by the spectroscopic data (UV, IR, MS, and NMR) and quantum chemical calculation. Compound 1 was the first cadinene sesquiterpene metabolite isolated from this genus. In addition, the cytotoxic and antibacterial activities of these compounds were evaluated. However, none of them exhibited significant inhibition effects. Full article

Population diets have impacts on both human and planetary health. This research aims to optimise a New Zealand (NZ) version of the EAT-Lancet diet and to model the impact of this diet on population health if it was adopted in NZ. The optimisation methods used mathematical equations in Excel to ensure: population diets met the nutritional recommendations; diet-related greenhouse gas (GHG) emissions did not exceed the NZ GHG boundary; and diet costs did not exceed baseline costs of the average diet. The EAT-Lancet diet was also directly mapped onto the NZ adult nutrition survey food groups, as another estimate of a NZ EAT-Lancet diet. Both diets were modelled using a DIET multi-state life-table model to estimate lifetime impacts on quality adjusted life years (QALYs), ethnic health inequities and health system costs. The optimised diet differed greatly from baseline intake with large amounts of fruits and vegetables, some fish but no beef, lamb, pork or poultry. Modelling nationwide adoption of the NZ EAT-Lancet diets generated large health savings (approximately 1.4 million QALYs), and health system cost savings (around NZD 20 billion). A healthy, climate-friendly, cost-neutral diet is possible for NZ and, if adopted, could provide large health gain, cost savings and reductions in ethnic health inequities. Full article

Young adults are frequent consumers of food prepared outside the home (FOH). In a cross-sectional survey, the MYMeals study, we showed FOH provided one-third of meals and snacks for young Australian adults, yet it contributed higher proportions of energy and nutrients of concern, such as saturated fat and sodium. This study aimed to determine the detailed proportional contribution of nutrients of concern from the nine food outlet types captured in the MYMeals study. Young adults residing in New South Wales (NSW), Australia, (n = 1001) used a validated smartphone app to report all types and amounts of food and beverages consumed for three consecutive days, as well as their preparation location. The proportions of daily energy, macronutrients, sodium, total sugars, and saturated fat were calculated for each of the nine following outlet types: bakeries or patisseries, coffee chains, cold-drink chains, fast-food chains, ice creamery or frozen yoghurt outlets, independent cafes or restaurants, pubs (hotels) and clubs, service stations or convenience stores, and others not fitting the above categories. Of all FOH outlet types, independent cafes or restaurants contributed the most energy (17.5%), sodium (20.0%) and saturated fat (17.8%) to the total diet, followed by fast-food chains (12.0% energy, 15.8% sodium, and 12.0% saturated fat) and other outlets, with smaller proportions. For males, the proportion of energy and nutrients contributed by fast-food outlets was higher than for females (14.8% versus 9.8% energy). Menu labelling at independent cafes and restaurants is recommended, comprising, in addition to the energy labels already in use in fast-food restaurants, the labelling of nutrients of concern. The feasibility of this recommendation warrants further exploration. Full article

Effective implementation of nutrition standards in publicly funded institutions can facilitate healthy food and beverage consumption by communities and populations, which can enable improvements in dietary intake and reduce disease burden. This study aimed to understand stakeholder perspectives on the implementation of government nutrition standards in publicly funded institutions in the Australian state of Victoria, as well as to determine enablers and barriers to successful implementation. Pre-interview questionnaires and semi-structured interviews were administered to stakeholders involved in the implementation of nutrition standards in publicly funded institutions in Victoria. The Interactive Systems Framework, which allows understanding of the infrastructure and systems needed to implement policies, was used to design the survey instruments and guide the data analysis. Forty-four stakeholders were interviewed, including program implementers, support personnel and food providers, across public sector hospitals and health services, workplaces, sport and recreation centres and schools. Though translated materials and resources have been developed for end-users to facilitate uptake and implementation, current nutrition standards were perceived to be long and complex, which hindered implementation. The existence of a government-funded implementation support service enabled action by providing technical support, troubleshooting and capacity-building. A specific pathway for successful guideline implementation was determined through the analysis. Opportunities to close the policy-implementation gap were identified. This will be crucial to maximising the impact of nutrition standards on population diets and reducing diet-related disease. Strengthening the guidelines and their governance, streamlining the support system and overcoming barriers within and outside of implementing organisations, are urgently required to propel statewide progress. Full article

In children and other young people, diets high in sodium and low in potassium lead to increases in blood pressure and a higher risk of cardiovascular disease later in life. Our primary objective was to assess daily sodium and potassium intakes in children and young people aged 2–18 years from upper-middle and high-income countries, using gold-standard 24 h urinary sodium and potassium excretion studies. Secondary objectives were to assess: (1) the sodium-to-potassium molar ratio; (2) differences by gender, age, and geographical region; and (3) the sodium concentration in children’s diets. The following databases were searched to identify relevant studies published between 1998 and 2021: Cochrane Database of Systematic Reviews, Embase, Food Science and Technology Abstracts, Google Scholar, MEDLINE and Scopus. Data were pooled using random-effects meta-analysis, and meta-regression was used to quantify heterogeneity. A total of 2592 studies were identified, with 22 meeting the inclusion criteria (n = 5323, 48% girls; mean age 9.7 years). Mean 24 h urinary sodium excretion in boys was 2730 mg/d (95% CI, 2460–3001), potassium excretion was 1564 mg/d (95% CI, 1400–1728), and the sodium-to-potassium molar ratio was 3.2 (95% CI, 2.8–3.6). Corresponding values for girls were 2336 mg/d (95% CI, 2139–2534), 1428 mg/d (95% CI, 1300–1556), and 3.0 (95% CI, 2.6–3.4), respectively. There was a positive association between sodium and potassium excretion and the sodium-to-potassium ratio and age. Geographically, European and Oceanian participants excreted more potassium and had a lower mean sodium-to-potassium ratio than their Asian counterparts. Mean sodium intake in children as young as 5–6 years old exceeded the World Health Organization (WHO) upper limit of 2000 mg/d, while potassium intake was subpar. Public health monitoring, policies, and programmes to reduce dietary sodium and increase potassium intake are essential to protect the future cardiovascular health of children and young people. Full article

Food consumed away from home is contributing an increasing proportion of household food budgets in New Zealand (NZ). This study aimed to benchmark the healthiness of the NZ fast-food supply in 2020. Data on the serving size and nutrient content of products were collected from company websites and in-store visits of 27 fast-food chains. For each fast-food category and type of combo meal, the medians and interquartile ranges were calculated for serving size (g/mL) and energy (kilojoules-kJ), sodium (mg), total sugar (g) and saturated fat (g) per serving. The nutrient contents/servings were benchmarked against the United Kingdom (UK) soft drinks levy thresholds and targets for salt for foods consumed away from home; the NZ daily intake guidelines for energy, sodium and saturated fat; and the WHO recommendation for free sugars. Nutrition information was available for 1777 products and 176 meal combos. More than one in ten drinks would qualify for a UK soft drinks levy, and 47% (n = 1072) of products with sodium data exceeded the relevant UK targets. The categories with the highest median energy and nutrient contents per serving were: burgers (2585 kJ-energy and 1091 mg-sodium), savoury pastries (13 g saturated fat) and milkshakes/smoothies (49 g total sugar). The meal combos represented one meal occasion, but an average combo provided 50% of the daily energy requirement, 89% of the maximum sodium recommendation, 81% of the recommended sugar intake, and 46% of the recommended saturated fat intake. Fast-food products and combo meals in NZ contribute far more energy and negative nutrients to the recommended daily intake targets than is optimal for good health. The NZ Government needs to set reformulation targets and portion-size guidance to reduce the potential impact that increasing fast-food consumption is likely to have on the health of New Zealanders. All fast-food chains need to provide sufficient nutrition information about their products to inform consumers. Full article