Effectiveness of dietary interventions in mental health treatment : A rapid review of reviews

Aim This rapid review of reviews aimed to determine the extent of research undertaken on the effectiveness of dietary interventions for individuals with a mental disorder. Methods Three databases (MEDLINE, Embase, Cochrane Reviews and Cochrane Trials) were searched to February 2021 for systematic reviews including experimental studies assessing the effectiveness of dietary interventions with physical or mental health related outcomes in adults or children with one or more of: severe mental illness, depression or anxiety, eating disorders, or substance use disorder. Results are presented descriptively. Results The number of included reviews was 46 (67% in severe mental illness, 20% in depression and anxiety, 7% in eating disorders, and 7% in substance use disorders). Most reviews were published since 2016 (59%), and included studies conducted in adults (63%). Interventions in the eating disorders and severe mental illness reviews were predominantly education and behaviour change, whereas interventions in the substance use disorders, and depression and anxiety reviews were predominantly supplementation (e.g. omega-3). Twenty-eight and twelve of the reviews respectively reported mental health and dietary outcomes for one or more included studies. Most reviews in severe mental illness, and depression and anxiety reported conclusions supporting the positive effects of dietary intervention, including positive effects on weight-related or mental health outcomes, and on mental health outcomes, respectively. Conclusions A larger number of systematic reviews were identified which evaluated dietary interventions in individuals with severe mental illness, and depression and anxiety, compared with substance use disorders, and eating disorders. Dietary intervention is an important component of the treatment that should be available to individuals living with mental disorders, to support their physical and mental health

Seven years of coordinated Chandra–NuSTAR observations of SN 2014C unfold the extreme mass-loss history of its stellar progenitor

We present the results from our 7 yr long broadband X-ray observing campaign of SN 2014C with Chandra and NuSTAR. These coordinated observations represent the first look at the evolution of a young extragalactic SN in the 0.3–80 keV energy range in the years after core collapse. We find that the spectroscopic metamorphosis of SN 2014C from an ordinary type Ib SN into an interacting SN with copious hydrogen emission is accompanied by luminous X-rays reaching L x ≈ 5.6 × 1040 erg s−1 (0.3–100 keV) at ∼1000 days post-explosion and declining as L x ∝ t −1 afterwards. The broadband X-ray spectrum is of thermal origin and shows clear evidence for cooling after peak, with T(t)≈20keV(t/tpk)−0.5 . Soft X-rays of sub-keV energy suffer from large photoelectric absorption originating from the local SN environment with NHint(t)≈3×1022(t/400days)−1.4cm−2 . We interpret these findings as the result of the interaction of the SN shock with a dense (n ≈ 105 − 106 cm−3), H-rich disk-like circumstellar medium (CSM) with inner radius ∼2 × 1016 cm and extending to ∼1017 cm. Based on the declining NHint(t) and X-ray luminosity evolution, we infer a CSM mass of ∼(1.2 f–2.0 f)M⊙ , where f is the volume filling factor. We place SN 2014C in the context of 121 core-collapse SNe with evidence for strong shock interaction with a thick circumstellar medium. Finally, we highlight the challenges that the current mass-loss theories (including wave-driven mass loss, binary interaction, and line-driven winds) face when interpreting the wide dynamic ranges of CSM parameters inferred from observations

Utilization of endogenous fatty acid stores for energy production in bovine preimplantation embryos

Although current embryo culture media are based on carbohydrate metabolism of embryos, little is known about metabolism of endogenous lipids. L-carnitine is a β-oxidation cofactor absent in most culture media. The objective was to investigate the influence of L-carnitine supplementation on bovine embryo development. Abattoir-derived bovine cumulus oocyte complexes were cultured and fertilized. Post-fertilization, presumptive zygotes were transferred into a basic cleavage medium ± carbohydrates (glucose, lactate and pyruvate) ± 5 mm L-carnitine and cultured for 4 days in vitro. In the absence of carbohydrates during culture, embryos arrested at the 2- and 4-cell stages. Remarkably, +L-carnitine increased development to the morula stage compared to +carbohydrates alone (P < 0.001). The beneficial effects of L-carnitine were further demonstrated by inclusion of carbohydrates, with 14-fold more embryos reaching the morula stage after culture in the +carbohydrates +L-carnitine group compared to the +carbohydrates group (P < 0.05). Whereas there was a trend for +L-carnitine to increase ATP (P = 0.09), ADP levels were higher and ATP: ADP ratio were 1.9-fold lower (main effect, P < 0.05) compared to embryos cultured in -L-carnitine. Therefore, we inferred that +L-carnitine embryos were more metabolically active, with higher rates of ATP-ADP conversion. In conclusion, L-carnitine supplementation supported precompaction embryo development and there was an additive effect of +L-carnitine +carbohydrates on early embryo development, most likely through increased β-oxidation within embryos.Melanie L. Sutton-McDowall, Deanne Feil, Rebecca L. Robker, Jeremy G. Thompson, Kylie R. Dunnin

The Pediatric Cell Atlas:Defining the Growth Phase of Human Development at Single-Cell Resolution

Single-cell gene expression analyses of mammalian tissues have uncovered profound stage-specific molecular regulatory phenomena that have changed the understanding of unique cell types and signaling pathways critical for lineage determination, morphogenesis, and growth. We discuss here the case for a Pediatric Cell Atlas as part of the Human Cell Atlas consortium to provide single-cell profiles and spatial characterization of gene expression across human tissues and organs. Such data will complement adult and developmentally focused HCA projects to provide a rich cytogenomic framework for understanding not only pediatric health and disease but also environmental and genetic impacts across the human lifespan

Interprofessional relationships in healthcare practice

The quality, resourcing and accessibility of healthcare is a key issue facing societies in the 21st century. Despite the system delivery focus of these factors it is critical to remember that healthcare is a human service and as such, people need to be placed at the centre of healthcare systems and processes. To do this we need to improve the way that people are valued and involved in healthcare practices. Professional relationships lie at the heart of such practices. This book illuminates and challenges professional healthcare relationships. The authors examine the nature, context and purpose of healthcare relationships, explore models through which these relationships are enacted, developed and critiqued, and provide narratives of health practice relationships in action. These narratives reveal how health practice relationships are experienced and created in real-world situations. The various chapters generate a range of implications and recommendations for healthcare practice and systems and for the education of health professionals. This is a book for practitioners, educators, clients, members of the community, advocacy and agency groups, regulatory bodies and those with power to shape the future direction of healthcare

Health outcomes of eating disorder clients in a rural setting

Current expert consensus on the treatment for eating disorders recommends an individualised multidisciplinary ‘triad’ approach from the disciplines of medicine, psychology and dietetics.1 The proportion of eating disorder clients in rural and remote areas is unknown, and rural based treatment services are limited.2,3 On average, 50% of patients treated for an eating disorder achieve a good outcome.4 A good outcome for anorexia nervosa (AN), bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS) has been defined as achieving a weight between 10 and 15% of ideal body weight (IBW).

Discharge to inpatient rehabilitation following arthroplasty is a strong predictor of persistent opioid use 90 days after surgery: a prospective, observational study

Abstract Background Total knee and hip arthroplasty are considered a clinically and cost-effective intervention, however, persistent pain post-surgery can occur, and some continue to take opioid medications long-term. One factor which has infrequently been included in prediction modelling is rehabilitation pathway, in particular, one which includes inpatient rehabilitation. As discharge to inpatient rehabilitation post-arthroplasty is common practice, we aimed to identify whether rehabilitation pathway (discharge to in-patient rehabilitation or not) predicts continued use of opioids at 3 months (90 days) post- total knee arthroplasty (TKA) and total hip arthroplasty (THA) whilst controlling for other covariates. Methods The study was nested within a prospective observational study capturing pre-operative, acute care and longer-term data from 1900 osteoarthritis (OA) patients who underwent primary TKA or THA. The larger study involved a part-random, part-convenience sample of 19 high-volume hospitals across Australia. Records with complete pre-and post-operative analgesic (35 days and 90 days) use were identified [1771 records (93% of sample)] and included in logistic regression analyses. Results Three hundred and thirteen people (17.8%) reported ongoing opioid use at 90 days post-operatively. In the adjusted model, admission to inpatient rehabilitation after surgery was identified as an independent and significant predictor of opioid use at 90-days. Inpatient rehabilitation was associated with almost twice the odds of persistent opioid use at 90-days compared to discharge directly home (OR = 1.9 (1.4, 2.5), p < .001). Conclusion The inpatient rehabilitation pathway is a strong predictor of longer-term opioid use (90 days) post-arthroplasty, accounting for many known and possible confounders of use including sex, age, insurance status, major complications, smoking status and baseline body pain levels. Trial registration The study was nested within a prospective cohort observational study capturing pre-operative, acute-care and longer-term data from patients undergoing primary TKA or THA for osteoarthritis (ClinicalTrials.gov NCT01899443)

Exploring the eating disorder curricula of accredited university dietetic programs in Australia and New Zealand

Abstract Background Dietitians are viewed as integral members of the multidisciplinary treatment team for people with eating disorders (EDs). However, low levels of perceived confidence, competence, and willingness to practice in this clinical area, have been reported by dietitians and student dietitians. As the extent of ED-specific knowledge and skills-based training within tertiary accredited dietetic programs is currently unknown, this research aimed to: (1) obtain insights into the current ED-specific knowledge base and training content of dietetic curricula in both Australian and New Zealand universities; (2) understand the perspectives of course convenors regarding the role of dietitians in ED treatment and their employment opportunities; and (3) identify gaps and opportunities for improving university programs and the dietetic workforce. Methods Course convenors (or their nominated representative) of Australian and New Zealand accredited dietetic programs were invited to participate in a semi-structured virtual interview. A purpose-built question guide was developed to explore the inclusion and/or integration of ED-specific content into the curricula, and the perspectives of course convenors toward the role of dietitians in the treatment of EDs, and their employment opportunities. The interviews were audio recorded, transcribed verbatim, and analysed qualitatively using inductive thematic analysis. Results Thirteen participants who represented 14 universities and 19 individual accredited dietetic programs, were interviewed, with some participants representing more than one university. Three dominant themes emerged: (1) varying ED-specific content and training in dietetic programs; (2) unclear dietitian's role in the treatment of EDs, and (3) contrasting views regarding ED clinical practice and employment. Conclusions ED-specific content was embedded within all the dietetic programs investigated in this study. However, this content was generally limited to an introductory level, with notable variations found between the depth of content and the type of training provided. Risk-mitigation skill development, such as screening for EDs, and early identification of symptoms, also varied between programs. Therefore, it is recommended that ED-specific skill development and knowledge is enhanced within Australian and New Zealand university programs, to support effective, safe, and timely care for people with EDs. This research has implications for current and future university dietetic program development and the broader dietetic workforce