Assessing the relative validity of the Scottish Collaborative Group FFQ for measuring dietary intake in adults

Acknowledgements: The authors would like to thank Jacqueline Burr and Lindsey Shaw for collecting the data for this study. Data coding and entry for the food diaries was completed by Dr Lindsey Masson. The authors would also like to acknowledge the Scottish Health Survey Team, the Scottish Government and the National Centre for Social Research for their support in conducting this research. Financial support: This work was supported by funding from the Rural and Environment Science and Analytical Services Division (RESAS) programme of the Scottish Government (J.L.H., L.C.A.C., S.W. and G.Mc.N.). The RESAS programme had no role in the design, analysis or writing of this article. Conflict of interest: None. Authorship: J.L.H., L.C.A.C., S.W. and G.Mc.N. were responsible for the design of the study and formulated the research question. L.C.A.C. and S.W. carried out the study. J.L.H. completed the literature review, conducted the statistical analysis and drafted the initial paper. All authors were responsible for drafting and revising the manuscript and have approved the final version. Ethics of human subject participation: This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects were approved by the Rowett Human Studies Ethical Review Panel. Written informed consent was obtained from all participants.Peer reviewedPostprintPostprintPostprintPostprintPostprintPostprintPostprintPostprin

\u27Physical Activity 4 Everyone\u27 school-based intervention to prevent decline in adolescent physical activity levels: 12 month (mid-intervention) report on a cluster randomised trial

Background: Adolescence is a recognised period of physical activity decline, particularly among low-income communities. We report the 12-month (midpoint) effects of a 2-year multicomponent physical activity intervention implemented in disadvantaged secondary schools. Methods: A cluster randomised trial was undertaken in 10 secondary schools located in disadvantaged areas in New South Wales, Australia. Students in Grade 7 were recruited, with follow-up in Grade 8. The intervention was guided by socioecological theory and included seven physical activity strategies, and six implementation adoption strategies. The primary outcome was mean minutes of moderate-to-vigorous physical activity (MVPA) per day assessed using Actigraph GT3X accelerometers. Outcome data were analysed using repeated measures linear mixed models. Results: At baseline, 1150 (93%) students participated in the data collection (mean age 12 years, 48% boys) and 1050 (79%) students participated at 12-month follow-up. By the 12-month follow-up, the six implementation adoption strategies had been used to support schools to deliver four of the seven physical activity elements. There was a significant group-by-time interaction for mean minutes of MVPA per day in favour of the intervention group (adjusted difference between groups at follow-up=3.85 min, 95% CI (0.79 to 6.91), p≤0.01), including significantly more vigorous physical activity (2.45 min, p≤0.01), equating to 27 min more MVPA per week. Summary: At 12-month follow-up, the intervention had reduced the decline in physical activity among adolescents from disadvantaged schools. The intervention may assist students to meet physical activity guidelines

The Physical Activity 4 Everyone Cluster Randomized Trial : 2-Year Outcomes of a School Physical Activity Intervention Among Adolescents

Acknowledgments The Physical Activity 4 Everyone intervention trial was funded by the New South Wales Ministry of Health through the New South Wales Health Promotion Demonstration Research Grants Scheme and conducted by Hunter New England Population Health (a unit of the Hunter New England Local Health District), in collaboration with the University of Newcastle and University of Wollongong. Infrastructure support was provided by Hunter Medical Research Institute. The research team acknowledges the importance of making research data publically available. Access to the accelerometer data from this study may be made available to external collaborators following the development of data transfer agreements. Further results arising from the study can be found at www.goodforkids.nsw.gov.au/high-schools/. No financial disclosures were reported by the authors of this paper.Peer reviewedPublisher PD

Automated virtual reality therapy to treat agoraphobic avoidance and distress in patients with psychosis (gameChange): a multicentre, parallel-group, single-blind, randomised, controlled trial in England with mediation and moderation analyses

BackgroundAutomated delivery of psychological therapy using immersive technologies such as virtual reality (VR) might greatly increase the availability of effective help for patients. We aimed to evaluate the efficacy of an automated VR cognitive therapy (gameChange) to treat avoidance and distress in patients with psychosis, and to analyse how and in whom it might work.MethodsWe did a parallel-group, single-blind, randomised, controlled trial across nine National Health Service trusts in England. Eligible patients were aged 16 years or older, with a clinical diagnosis of a schizophrenia spectrum disorder or an affective diagnosis with psychotic symptoms, and had self-reported difficulties going outside due to anxiety. Patients were randomly assigned (1:1) to either gameChange VR therapy plus usual care or usual care alone, using a permuted blocks algorithm with randomly varying block size, stratified by study site and service type. gameChange VR therapy was provided in approximately six sessions over 6 weeks. Trial assessors were masked to group allocation. Outcomes were assessed at 0, 6 (primary endpoint), and 26 weeks after randomisation. The primary outcome was avoidance of, and distress in, everyday situations, assessed using the self-reported Oxford Agoraphobic Avoidance Scale (O-AS). Outcome analyses were done in the intention-to-treat population (ie, all participants who were assigned to a study group for whom data were available). We performed planned mediation and moderation analyses to test the effects of gameChange VR therapy when added to usual care. This trial is registered with the ISRCTN registry, 17308399.FindingsBetween July 25, 2019, and May 7, 2021 (with a pause in recruitment from March 16, 2020, to Sept 14, 2020, due to COVID-19 pandemic restrictions), 551 patients were assessed for eligibility and 346 were enrolled. 231 (67%) patients were men and 111 (32%) were women, 294 (85%) were White, and the mean age was 37·2 years (SD 12·5). 174 patients were randomly assigned to the gameChange VR therapy group and 172 to the usual care alone group. Compared with the usual care alone group, the gameChange VR therapy group had significant reductions in agoraphobic avoidance (O-AS adjusted mean difference –0·47, 95% CI –0·88 to –0·06; n=320; Cohen's d –0·18; p=0·026) and distress (–4·33, –7·78 to –0·87; n=322; –0·26; p=0·014) at 6 weeks. Reductions in threat cognitions and within-situation defence behaviours mediated treatment outcomes. The greater the severity of anxious fears and avoidance, the greater the treatment benefits. There was no significant difference in the occurrence of serious adverse events between the gameChange VR therapy group (12 events in nine patients) and the usual care alone group (eight events in seven patients; p=0·37).InterpretationAutomated VR therapy led to significant reductions in anxious avoidance of, and distress in, everyday situations compared with usual care alone. The mediation analysis indicated that the VR therapy worked in accordance with the cognitive model by reducing anxious thoughts and associated protective behaviours. The moderation analysis indicated that the VR therapy particularly benefited patients with severe agoraphobic avoidance, such as not being able to leave the home unaccompanied. gameChange VR therapy has the potential to increase the provision of effective psychological therapy for psychosis, particularly for patients who find it difficult to leave their home, visit local amenities, or use public transport.FundingNational Institute of Health Research Invention for Innovation programme, National Institute of Health Research Oxford Health Biomedical Research Centre

Investigation of hospital discharge cases and SARS-CoV-2 introduction into Lothian care homes

Background The first epidemic wave of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Scotland resulted in high case numbers and mortality in care homes. In Lothian, over one-third of care homes reported an outbreak, while there was limited testing of hospital patients discharged to care homes. Aim To investigate patients discharged from hospitals as a source of SARS-CoV-2 introduction into care homes during the first epidemic wave. Methods A clinical review was performed for all patients discharges from hospitals to care homes from 1st March 2020 to 31st May 2020. Episodes were ruled out based on coronavirus disease 2019 (COVID-19) test history, clinical assessment at discharge, whole-genome sequencing (WGS) data and an infectious period of 14 days. Clinical samples were processed for WGS, and consensus genomes generated were used for analysis using Cluster Investigation and Virus Epidemiological Tool software. Patient timelines were obtained using electronic hospital records. Findings In total, 787 patients discharged from hospitals to care homes were identified. Of these, 776 (99%) were ruled out for subsequent introduction of SARS-CoV-2 into care homes. However, for 10 episodes, the results were inconclusive as there was low genomic diversity in consensus genomes or no sequencing data were available. Only one discharge episode had a genomic, time and location link to positive cases during hospital admission, leading to 10 positive cases in their care home. Conclusion The majority of patients discharged from hospitals were ruled out for introduction of SARS-CoV-2 into care homes, highlighting the importance of screening all new admissions when faced with a novel emerging virus and no available vaccine

SARS-CoV-2 Omicron is an immune escape variant with an altered cell entry pathway

Vaccines based on the spike protein of SARS-CoV-2 are a cornerstone of the public health response to COVID-19. The emergence of hypermutated, increasingly transmissible variants of concern (VOCs) threaten this strategy. Omicron (B.1.1.529), the fifth VOC to be described, harbours multiple amino acid mutations in spike, half of which lie within the receptor-binding domain. Here we demonstrate substantial evasion of neutralization by Omicron BA.1 and BA.2 variants in vitro using sera from individuals vaccinated with ChAdOx1, BNT162b2 and mRNA-1273. These data were mirrored by a substantial reduction in real-world vaccine effectiveness that was partially restored by booster vaccination. The Omicron variants BA.1 and BA.2 did not induce cell syncytia in vitro and favoured a TMPRSS2-independent endosomal entry pathway, these phenotypes mapping to distinct regions of the spike protein. Impaired cell fusion was determined by the receptor-binding domain, while endosomal entry mapped to the S2 domain. Such marked changes in antigenicity and replicative biology may underlie the rapid global spread and altered pathogenicity of the Omicron variant

Dietary intake and physical activity behaviour change for weight gain prevention in mid-age Australian women

Research Doctorate - Doctor of Philosophy (PhD)The rising prevalence of overweight and obesity, the health and financial consequences associated with weight gain, and the modest and often unsustainable weight loss from obesity treatment interventions mean that it is now considered more effective to prevent obesity in healthy weight and overweight populations. Mid-age women (45-54 years) are at high risk of weight gain and studies indicate women will likely continue to gain weight and increase their waist circumference post menopause unless effective weight gain prevention initiatives are implemented. Despite this, there is limited evidence for weight control interventions in women about to undergo the menopause transition, with only one published study. The primary purpose of this thesis was to determine the effectiveness of a 12-month health professional Motivational Interviewing (MI) intervention aiming to improve dietary intake and physical activity behaviours for weight gain prevention in non-obese, mid-age women. This thesis explored the use of MI, a client-centred, guiding counselling style, for dietary and physical activity behaviour change. Three research studies were undertaken to meet these aims. The first study was a systematic review of evidence for diet and physical activity behaviour change in response to MI interventions in comparison to an attention control. Two of the five articles reporting on dietary behaviour change found a significant positive effect on fat and percent energy from fat favouring MI. None of the six articles reporting on physical activity found any difference between MI and an attention control. Due to the limited number of studies and the poor methodological quality of the included studies, there is not yet sufficient evidence to conclude that MI enhances diet and physical activity behaviour change above an attention control, although the results from two studies suggest a positive effect. More high quality studies that objectively measure diet and physical activity, evaluate and report MI fidelity and compare the MI intervention to an attention control are required. The second and major study was the ‘40 Something’ parallel-group Randomised Controlled Trial (RCT) which tested the effectiveness of a 12 month MI health professional intervention (MI; n=28) for weight gain prevention in non-obese, mid-age women in comparison to a self-directed intervention (SDI; n=26) that received tailored written materials. The study followed participants for an additional 12 months to assess effect maintenance. At 12 months, the MI group weighed 65.6 kg (95% CI 64.5, 66.8) which was significantly different (p=0.034) from the SDI group who weighed 67.4 kg (95% CI 66.2, 68.6). When stratified by baseline BMI category, the MI group lost significantly more weight (-2.6kg, 95% CI -3.9, -1.2) than the SDI group (-0.1 kg 95% CI -1.2, 1.0 p=0.002) for the healthy weight women. The overweight women lost weight regardless of whether they were allocated to the MI (-3.5kg, 95% CI -6.1, -1.0) or SDI group (SDI=-2.3, 95% CI -4.1, -0.5) with no between group difference (p=0.467). At 12 months, the MI group had diets significantly more nutrient dense for iron (p=0.01) and potassium (p=0.04), and consumed more fruit servings (p=0.02) than the SDI women. Women who achieved their weight control goals consumed significantly more fruit servings (+0.76 serves/day, p=0.02) and less meat/meat alternatives (-0.34 serves/day, p<0.01) than women who did not achieve weight control. There were no significant group by time effects found for physical activity. In a mediation analysis assessing whether compliance to 10 weight control recommendations mediated weight loss, step count compliance was found to significantly mediate the 12 and 24 month effect on weight (12 months AB=-0.74, 95%CI=-1.95, -0.14; 24 months AB=-1.06, 95%CI=-2.56, -0.36). Compliance to the vegetable serving recommendation was also found to significantly mediate the effect on weight at 24 months (AB=-0.54, 95%CI=-1.50, -0.04). A challenge of employing any counselling style in dietetic practice is ensuring that the professional standards are upheld whilst also employing the most effective counselling method. The final study was an examination of United States, Canadian, European and Australian dietetic scope of practice statements, competency standards and evidenced-based weight management guidelines for congruency with MI principles and strategies. Two of the four MI concepts, partnership and compassion, were consistent with scope of practice statements and competency standards. Reference to acceptance was evident in European and Canadian standards, whereas evoking intrinsic motivation was absent from all standards. The majority of MI strategies were supported by international evidenced-based guidelines. The findings presented in this research thesis provide evidence of the effectiveness of a health professional consultation intervention for weight gain prevention and improving diet quality in mid-age women soon to experience menopause. Encouraging women to take 10,000 steps and eat five vegetable servings per day may be a promising strategy to achieve long-term weight control at mid-life. While there is substantial evidence showing the effectiveness of MI on a variety of health outcomes, more high quality studies that examine the effect of MI on diet and physical activity behaviour change are needed. The study also found that training in MI is compatible with international dietetic practice standards and could be a valuable asset to dietetic research and practice. The results of the thesis have implications for mid-age women, the dietetic profession and behavioural researchers, and provide both clinical practice and research recommendations for weight gain prevention and motivational interviewing