Whey protein lowers blood pressure and improves endothelial function and lipid biomarkers in adults with prehypertension and mild hypertension: results from the chronic Whey2Go randomized 1,2 controlled trial

Background: Cardiovascular diseases (CVDs) are the greatest cause of death globally, and their reduction is a key public-health target. High blood pressure (BP) affects 1 in 3 people in the United Kingdom, and previous studies have shown that milk consumption is associated with lower BP. Objective: We investigated whether intact milk proteins lower 24-h ambulatory blood pressure (AMBP) and other risk markers of CVD. Design: The trial was a double-blinded, randomized, 3-way–crossover, controlled intervention study. Forty-two participants were randomly assigned to consume 2 × 28 g whey protein/d, 2 × 28 g Ca caseinate/d, or 2 × 27 g maltodextrin (control)/d for 8 wk separated by a 4-wk washout. The effects of these interventions were examined with the use of a linear mixed-model ANOVA. Results: Thirty-eight participants completed the study. Significant reductions in 24-h BP [for systolic blood pressure (SBP): −3.9 mm Hg; for diastolic blood pressure (DBP): −2.5 mm Hg; P = 0.050 for both)] were observed after whey-protein consumption compared with control intake. After whey-protein supplementation compared with control intake, peripheral and central systolic pressures [−5.7 mm Hg (P = 0.007) and −5.4 mm Hg (P = 0.012), respectively] and mean pressures [−3.7 mm Hg (P = 0.025) and −4.0 mm Hg (P = 0.019), respectively] were also lowered. Flow-mediated dilation (FMD) increased significantly after both whey-protein and calcium-caseinate intakes compared with control intake [1.31% (P < 0.001) and 0.83% (P = 0.003), respectively]. Although both whey protein and calcium caseinate significantly lowered total cholesterol [−0.26 mmol/L (P = 0.013) and −0.20 mmol/L (P = 0.042), respectively], only whey protein decreased triacylglycerol (−0.23 mmol/L; P = 0.025) compared with the effect of the control. Soluble intercellular adhesion molecule 1 and soluble vascular cell adhesion molecule 1 were reduced after whey protein consumption (P = 0.011) and after calcium-caseinate consumption (P = 0.039), respectively, compared with after control intake. Conclusions: The consumption of unhydrolyzed milk proteins (56 g/d) for 8 wk improved vascular reactivity, biomarkers of endothelial function, and lipid risk factors. Whey-protein supplementation also lowered 24-h ambulatory SBP and DBP. These results may have important implications for public health. This trial was registered at clinicaltrials.gov as NCT02090842

The voice of the infant: towards understanding the excess infant mortality in Queensland

Background: Queensland’s infant mortality rate (IMR) is higher than other Australian jurisdictions and the disparity is under-researched, particularly for Sudden Unexpected Deaths in Infancy (SUDI). Informed by Triple Risk and Adverse Childhood Events (ACEs) constructs, and with a focus on shared infant sleep, this thesis analyses risk factors to identify opportunities for prevention. Methods: Three analytical chapters include: extraction and reconfiguration of reported demographic data to compare international and Australian jurisdictions; multivariate analysis of linked administrative data (a six-year Queensland births cohort) to analyse pre-natal risk factors for infant death; and analysis of findings from a series of SUDI and post-neonatal deaths, incorporating reviews by the Queensland Paediatric Quality Council expert panel. Results: I confirmed that Queensland’s IMR was significantly higher than the rest of Australia for neonatal, post-neonatal, ill-defined, and non-Indigenous deaths, but not Indigenous deaths. Perinatal factors significantly associated with acquired cause of death after multivariate analysis (young motherhood, higher birth order, smoking in pregnancy, late antenatal care, preterm gestation, maternal obesity, Male infant), were identifiable but not modifiable by mid-pregnancy. Indigeneity and residence in low socio-economic areas were not associated with acquired cause of death after adjustment for other factors. Correcting for post-conceptional age at SUDI shifts the peak incidence to age less than 44-weeks post-conception. Death scene description, post-mortem investigation, and clinico-pathological correlation were inadequate in more than 30 percent of SUDI cases. After panel review, deaths attributed to suffocation and undetermined causes increased, acknowledging the contributory role of unsafe sleep in almost all SUDI, and the rarity of other sufficient causes. SUDI occurred in the setting of high levels of multigenerational social adversity. Conclusion: SUDI is an important contributor to Queensland’s excess infant mortality. The vulnerability to SUDI of infants born before 40-weeks gestation provides a new focus for prevention. The association of maternal pre-natal risk factors with maternal ACEs is consistent with the multifactorial genesis of SUDI and warrants further research. Opportunities for prevention are hampered by inadequate death investigation. SUDI occur in families experiencing multigenerational adversity, for whom engagement and support may help to mitigate highly prevalent risk factors including unsafe sleep

Implementation and strength of root cause analysis recommendations following serious adverse events involving paediatric patients in the Queensland public health system between 2012 and 2014

This study evaluates the implementation rate and strength of the recommendations developed in all root cause analyses (RCAs) performed following serious clinical incidents involving children that have resulted in permanent harm or death in Queensland public hospitals over a 3-year period.Severity assessment classification 1 events were identified from a Queensland Paediatric Quality Council database of paediatric clinical incidents that occurred in Queensland between 1 January 2012 and 31 December 2014. There were 150 recommendations extracted from RCAs pertaining to the 42 serious adverse events involving paediatric patients.Of the recommendations, 82% were implemented; 33% of recommendations were classified as stronger, 33% as intermediate and 34% weaker in terms of their potential to improve patient safety.This study describes the implementation of recommendations and classifies them in terms of potential to prevent patient harm and save lives. Future research is needed to determine if the RCA process does indeed prevent harm

Epidemiology of Australian influenza-related paediatric intensive care unit admissions, 1997-2013

Backgroun

Epidemiology of pertussis-related paediatric intensive care unit (ICU) admissions in Australia, 1997-2013: An observational study

Objective: To review the epidemiology of pertussis-related intensive care unit (ICU) admissions across Australia, over a 17-year period

Diagnostic testing in influenza and pertussis related paediatric intensive care unit admissions,Queensland, Australia, 1997-2013

Severe respiratory infections make up a large proportion of Australian paediatric intensive care unit (ICU) admissions each year. Identification of the causative pathogen is important and informs clinical management. We investigated the use of polymerase chain reaction (PCR) in the ICU-setting using data collated by the Australian and New Zealand Paediatric Intensive Care (ANZPIC) Registry from five ICUs in Queensland, Australia. We describe diagnostic testing use among pertussis and influenza-related paediatric ICU admissions between 01 January 1997 and 31 December 2013