Syndromic surveillance for influenza in two hospital emergency departments. Relationships between ICD-10 codes and notified cases, before and during a pandemic

<p>Abstract</p> <p>Background</p> <p>Interest in the use of emergency department (ED) data by syndromic surveillance systems to detect influenza outbreaks has been growing. Evaluations of these systems generally focus on events during influenza seasons. The aims of this study were to identify which emergency department disease codes best correlated with confirmed influenza cases and to determine if these same codes would be useful in the non-influenza season. The 2009 influenza pandemic in Victoria, Australia, provided further opportunity to examine the performance of the syndromic surveillance system during this event.</p> <p>Methods</p> <p>We undertook a retrospective analysis of data from the Victorian Department of Health's pilot syndromic surveillance programme, 'SynSurv'. SynSurv automatically captures patient information as it is entered by ED staff. This information includes patient demographics, their presenting symptoms and a preliminary diagnosis using ICD-10 coding. To determine which codes were best correlated with influenza notifications, weekly counts for each of the ICD-10 diagnosis codes ever used in the dataset were calculated and compared with the corresponding weekly count of confirmed influenza cases. Correlations between these codes and confirmed influenza cases in the non-influenza season were then undertaken. The data covered the period from July 2001 until August 2009 and included the 2009 influenza pandemic.</p> <p>Results</p> <p>There was a marked increase in weekly counts of both laboratory-confirmed influenza cases and relevant ICD-10 codes during the influenza pandemic period. The increase in laboratory confirmed cases was more than four times greater than the previous highest number reported, in 2007, even though the influenza-like-illness activity in the community was considered comparable to 2003 and 2007. We found five ICD-10 codes to be moderately and significantly correlated with influenza cases. None of these codes was correlated with laboratory confirmed influenza notifications outside the influenza season, at least in part because of the small number of influenza cases notified during that period.</p> <p>Conclusions</p> <p>This study suggests that the choice of codes made by ED staff to record a case of influenza-like illness is influenced by their perceptions of how much influenza is circulating at the time. The ability of syndromic surveillance to detect outbreaks early may be impeded because case diagnosis is influenced by what ED staff believes to be occurring in the community.</p

A review of mushrooms as a potential source of dietary vitamin D

When commonly consumed mushroom species are exposed to a source of ultraviolet (UV) radiation, such as sunlight or a UV lamp, they can generate nutritionally relevant amounts of vitamin D. The most common form of vitamin D in mushrooms is D2, with lesser amounts of vitamins D3 and D4, while vitamin D3 is the most common form in animal foods. Although the levels of vitamin D2 in UV-exposed mushrooms may decrease with storage and cooking, if they are consumed before the ‘best-before’ date, vitamin D2 level is likely to remain above 10 µg/100 g fresh weight, which is higher than the level in most vitamin D-containing foods and similar to the daily requirement of vitamin D recommended internationally. Worldwide mushroom consumption has increased markedly in the past four decades, and mushrooms have the potential to be the only non-animal, unfortified food source of vitamin D that can provide a substantial amount of vitamin D2 in a single serve. This review examines the current information on the role of UV radiation in enhancing the concentration of vitamin D2 in mushrooms, the effects of storage and cooking on vitamin D2 content, and the bioavailability of vitamin D2 from mushrooms

In pursuit of vitamin D in plants

Vitamin D deficiency is a global concern. Much research has concentrated on the endogenous synthesis of vitamin D in human skin following exposure to ultraviolet-B radiation (UV-B, 280–315 nm). In many regions of the world there is insufficient UV-B radiation during winter months for adequate vitamin D production, and even when there is sufficient UV-B radiation, lifestyles and concerns about the risks of sun exposure may lead to insufficient exposure and to vitamin D deficiency. In these situations, dietary intake of vitamin D from foods or supplements is important for maintaining optimal vitamin D status. Some foods, such as fatty fish and fish liver oils, certain meats, eggs, mushrooms, dairy, and fortified foods, can provide significant amounts of vitamin D when considered cumulatively across the diet. However, little research has focussed on assessing edible plant foods for potential vitamin D content. The biosynthesis of vitamin D in animals, fungi and yeasts is well established; it is less well known that vitamin D is also biosynthesised in plants. Research dates back to the early 1900s, beginning with in vivo experiments showing the anti-rachitic activity of plants consumed by animals with induced rickets, and in vitro experiments using analytical methods with limited sensitivity. The most sensitive, specific and reliable method for measuring vitamin D and its metabolites is by liquid chromatography tandem mass spectrometry (LC-MS/MS). These assays have only recently been customised to allow measurement in foods, including plant materials. This commentary focuses on the current knowledge and research gaps around vitamin D in plants, and the potential of edible plants as an additional source of vitamin D for humans. © 2017 by the authors; licensee MDPI, Basel, Switzerland

Vitamin D content of australian native food plants and australian-grown edible seaweed

Vitamin D has previously been quantified in some plants and algae, particularly in leaves of the Solanaceae family. We measured the vitamin D content of Australian native food plants and Australian-grown edible seaweed. Using liquid chromatography with triple quadrupole mass spectrometry, 13 samples (including leaf, fruit, and seed) were analyzed in duplicate for vitamin D2, vitamin D3, 25-hydroxyvitamin D2, and 25-hydroxyvitamin D3. Five samples contained vitamin D2: raw wattleseed (Acacia victoriae) (0.03 µg/100 g dry weight (DW)); fresh and dried lemon myrtle (Backhousia citriodora) leaves (0.03 and 0.24 µg/100 g DW, respectively); and dried leaves and berries of Tasmanian mountain pepper (Tasmannia lanceolata) (0.67 and 0.05 µg/100 g DW, respectively). Fresh kombu (Lessonia corrugata) contained vitamin D3(0.01 µg/100 g DW). Detected amounts were low; however, it is possible that exposure to ultraviolet radiation may increase the vitamin D content of plants and algae if vitamin D precursors are present

Predictors of vitamin D-containing supplement use in the Australian population and associations between dose and serum 25-hydroxyvitamin D concentrations

© 2016 by the authors; licensee MDPI, Basel, Switzerland.Despite concerns about vitamin D deficiency in the Australian population, little is known about the prevalence and predictors of vitamin D-containing supplement use. We described the use of vitamin D-containing supplements, and investigated associations between supplemental vitamin D intake and serum 25-hydroxyvitamin D (25(OH)D) concentrations, using a single 24-h dietary recall from the 2011–2013 Australian Health Survey (n = 12,153; ages = 2 years). Multiple regression models were used to investigate predictors of vitamin D-containing supplement use in adults, and associations between dose and serum 25(OH)D concentrations/vitamin D sufficiency (=50 nmol/L), adjusting for potential confounders. The prevalence of vitamin D-containing supplement use was 10%, 6% and 19% in children, adolescents and adults, respectively. Predictors of vitamin D-containing supplement use in adults included being female, advancing age, higher educational attainment, higher socio-economic status, not smoking, and greater physical activity. After adjusting for potential confounders, a 40 IU (1 µg) increase in vitamin D intake from supplements was associated with an increase of 0.41 nmol/L in serum 25(OH)D concentrations (95% CI 0.35, 0.47; p &lt; 0.001). However, the prevalence of vitamin D-containing supplement use was generally low in the Australian population, particularly for single vitamin D supplements, with most supplement users obtaining only low levels of vitamin D from other supplement types

Reported Changes in Dietary Behavior Following a First Clinical Diagnosis of Central Nervous System Demyelination

Background/objectives: Although the current evidence is insufficient to recommend a special diet for people with multiple sclerosis (MS), dietary advice for people with MS is prolific online and in the media. This study aimed to describe dietary changes made in the year following a first clinical diagnosis of central nervous system demyelination (FCD), a common precursor to MS. Subjects/methods: We used follow-up data from the Ausimmune Study, a multicentre matched case-control study examining the environmental risk factors for a FCD. A total of 244 cases (60 male, 184 female) completed a 1-year follow-up interview, which included a question about dietary changes. We described the number and proportion (%) of participants who reported making dietary changes and the type of change made. We investigated independent predictors of making a dietary change using a multivariable logistic regression model. Results: A total of 38% (n = 92) of participants at the 1-year follow-up reported making at least one dietary change over the last year. There were no statistically significant independent associations between any participant characteristic and odds of making a dietary change. Of those who made at least one dietary change, the most common changes were increasing fruit and/or vegetable intake (27%, n = 25) and following a low-fat diet (25%, n = 23). Conclusion: A considerable proportion of the study population reported making at least one dietary change in the year following a FCD, with the majority of changes being toward a healthier diet. Further research is warranted to investigate the reasons behind any dietary changes adopted by people with a FCD or with MS, and whether making a dietary change has benefits for the progression of demyelinating diseases, e.g., to a diagnosis of MS, as well as for general health and well-being.Funding for the Ausimmune Study was provided by the National Multiple Sclerosis Society of the United States of America (NMSS RG 3364A1/2), the National Health and Medical Research Council of Australia (313901) and Multiple Sclerosis Research Australia. LB is funded by a MSWA Postdoctoral Research Fellowship. RL is funded by a National Health and Medical Research Council of Australia Senior Research Fellowship (1107343)

Interpretations of healthy eating after a diagnosis of multiple sclerosis: a secondary qualitative analysis

Purpose: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system that causes debilitating symptoms. Currently, there is insufficient evidence to recommend a special diet for people with MS to slow disease progression and reduce symptoms. Little is known about the dietary choices made by people with MS. This study aimed to explore the interpretations of healthy eating in people recently diagnosed with MS. Objectives were to investigate the types of changes in food choices and to describe the impact of making these changes. Design/methodology/approach: A social constructionist approach applying qualitative secondary analysis of semi-structured interviews was conducted (n = 11). Interviews were transcribed, coded and analysed using a deductive approach. Findings: Participants were mostly female (82%), mean age 47 years and mean time since diagnosis eight months. Four themes emerged from the data: (1) moving in the direction of the dietary guidelines, (2) modifying intake of dietary fat, (3) requiring mental effort and (4) needing input from a dietitian. Practical implications: The directions of food choices and the absence of dietetic input highlighted in this study suggest the need for evidence-based nutrition education that enables people with MS to tailor dietary guidelines according to their preferences. Originality/value: How people interpret healthy eating advice and the impact on making food choice changes is useful for explaining dietary changes in MS. Special diets promoted for MS provide conflicting advice, and the lack of access to dietitians means that additional mental effort is required when interpreting healthy eating messages and diets

A prospective investigation of dietary patterns and internalizing and externalizing mental health problems in adolescents

© 2016 The Authors. Food Science & Nutrition published by Wiley Periodicals, Inc.Investigating protective and risk factors that influence mental health in young people is a high priority. While previous cross-sectional studies have reported associations between diet and mental health among adolescents, few prospective studies exist. The aim of this study was to examine prospective relationships between dietary patterns and mental health among adolescents participating in the Western Australian Pregnancy Cohort (Raine) Study. Self-report questionnaires were used to assess indicators of mental health (Youth Self-Report externalizing/internalizing T-scores) and Western and Healthy dietary patterns (identified using factor analysis) at 14 (2003–2005) and 17 years (2006–2008). Multivariate linear and logistic regression were used to assess relationships between dietary patterns and mental health. Complete data were available for 746 adolescents. In females only, the Western dietary pattern z–score at 14 years was positively associated with greater externalizing behaviors at 17 years (ß = 1.91; 95% CI: 0.04, 3.78) and a greater odds of having clinically concerning externalizing behaviors at 17 years (OR = 1.90; 95% CI: 1.06, 3.41). No other statistically significant associations were observed. Overall our findings only lend partial support to a link between diet and mental health. We found it to be specific to females consuming a Western dietary pattern and to externalizing behaviors. Future research on dietary patterns and mental health needs to consider possible sex differences and distinguish between different mental health outcomes as well as between healthy and unhealthy dietary patterns

Low vitamin D levels are associated with symptoms of depression in young adult males

Objective: Results from studies examining associations between serum 25-hydroxyvitamin D (25(OH)D) concentrations and depressive symptoms are equivocal. We investigated the relationship between serum 25(OH)D concentrations and symptoms of depression, anxiety and stress in a cross-sectional analysis of a population-based sample of young adults participating in the Western Australian Pregnancy Cohort (Raine) Study. Methods: Participants provided a blood sample at the 20-year follow-up (March 2010-April 2012) for the measurement of serum 25(OH)D concentrations. Mental health symptoms were assessed using the 21-item Depression Anxiety Stress Scales (DASS-21). Associations between serum 25(OH)D concentrations and total DASS-21 scores and subscale scores of depression, anxiety and stress were explored in males and females using negative binomial regression, adjusting for age, race, body mass index (BMI) and physical activity (n=735). Models examining subscale scores were also adjusted for the other subscale scores. Results: After adjusting for confounders, an increase in serum 25(OH)D concentrations of 10 nmol/L decreased total DASS-21 scores in males by 9% (rate ratio (RR) 0.91; 95%CI 0.87,0.95; p<0.001) and depression subscale scores in males by 8% (RR 0.92; 95%CI 0.87,0.96; p=0.001). However, in adjusted models there were no significant associations between serum 25(OH)D concentrations and symptoms of anxiety and stress in males. There were no significant associations between serum 25(OH)D concentrations and symptoms of depression, anxiety and stress in females. Conclusions: We found an association between serum 25(OH)D concentrations and symptoms of depression, but not anxiety and stress, in males. Randomised controlled trials are necessary to determine any benefit of vitamin D supplementation in the prevention and treatment of depressive symptoms in young adults

Mapping the citation network on vitamin D research in Australia: a data-driven approach

Vitamin D research can vary geographically, as vitamin D status is influenced by latitude, season, dietary intake, body mass index, ethnicity, and public health initiatives. Over the last two decades, research on vitamin D has increased in Australia, where the potential for sun exposure (a major source of vitamin D) is high. We aimed to identify key topics and gaps in vitamin D research in Australia using a data-driven approach. A literature search limited to Australian studies was conducted in the Web of Science Core Collection database. Citation network analysis was conducted to identify clusters and sub-clusters, depicted using word clouds. Topic analysis of each cluster and sub-cluster was conducted to identify topics and sub-topics, respectively. From 934 publications (over the period 1984–2022), nine topics and 60 sub-topics were identified. The nine topics were: vitamin D in vulnerable populations and its impact on child development; impact of sun exposure and ultraviolet-B radiation on various health conditions; vitamin D and falls and fractures in older adults; vitamin D and its association with health outcomes; vitamin D from sun exposure; testing of vitamin D status in Australia; vitamin D, calcium, and musculoskeletal health; vitamin D status and knee osteoarthritis; and vitamin D status and exercise performance in athletes. There were limited publications on vitamin D in Aboriginal and Torres Strait Islander peoples and dietary vitamin D. We have provided an overview of vitamin D research in Australia. The research trends and knowledge gaps identified can guide future research to better inform public health initiatives in Australia