The truth behind food and cancer: Simple explanations based on scientific evidence

Background: Specialist oncology dietetic care is lacking in Ireland. This results in knowledge gaps that are filled by unreliable information from unqualified outlets such as the media and alternative-health providers, who promote complementary/alternative medicine (CAM). The aim of this resource is to provide cancer survivors with up-to-date, evidence-based information on cancer and nutrition. Methods: Common myths about nutrition and cancer and the most popular CAM used by Irish cancer survivors were included. National cancer organisations were also reviewed. To ensure readability, content was written according to the National Adult Literacy Agency recommendations, and peer-reviewed by other dietitians. Patient feedback was sought from patient advocates. Funding was secured from Breakthrough Cancer Research to print 20,000 copies for free distribution. Results: ‘The Truth Behind Food and Cancer: Simple Explanations based on Scientific Evidence’ is a coloured printed resource written by dietitians. It discussed popular diet-based CAM and food avoidance patterns practiced by patients with cancer and provides an evidence-based response to myths and unproven dietary strategies. Conclusion: Following a restrictive dietary strategy can place vulnerable cancer patients at an even greater risk of malnutrition and its debilitating effects. Research shows that a significant number of cancer survivors turn to unproven dietary strategies in the absence of dietetic care or reliable resources

Evaluation of an emergency department Falls Pathway for older people: A patient chart review

The number of older adults presenting to EDs following a fall continues to rise, yet falls management often ignores opportunities for secondary falls risk reduction. Advanced Nurse Practitioners (ANPs) in EDs have an important clinical leadership role in improving outcomes for this group of patients. Aim: This study describes the development of an ANP led falls pathway in an ED to improve safe discharge. It evaluates compliance with the pathway and referrals to community falls prevention services. It also draws comparison with baseline practice as recorded in 2014. Methods: The Falls Pathway involves four steps: 1) screening at triage (3 questions), 2) risk stratification (low, medium, high), 3) risk assessment (lying and standing blood pressure (B/P), timed-up and go (TUG), 4-AT for delirium screening, polypharmacy), and 4) referral to community falls services. We undertook a 12-month chart review of all patients aged 65 years or older presenting following a fall to the ANP service in 2018. We compared data to a baseline audit in 2014; descriptive and Chi squared statistics were used to examine the data. Results: The 2018 audit involved 77 patients representing 27% of ANP caseload. A repeat fall occurred in 42% (32/77) of cases and 35% (22/77) reported a fear of falling. The Falls Pathway was initiated in nearly 80% (62/77) of patients and compliance with falls risk assessment ranged from 42% for lying and standing B/P to 75% for TUG. In 2014, a review of 59 patient charts showed 27% (16/59) experienced a repeat fall, but other risk factors such as fear of falling were not recorded. In 2018, the majority of patients (88%) discharged home were referred to community falls prevention services compared to 22% in 2014. Conclusion: The Falls Pathway improved falls risk assessment in the ED, identified opportunities for risk reduction and optimised referral to community falls services. The pathway continues to be a valuable tool but requires resources for ongoing implementation among the wider ED team

Placing ‘sustainability’ in context: narratives of sustainable consumption in Nanjing, China

This article examines how ordinary people practice the notion of ‘sustainable consumption’ in relation to their everyday lives and experiences of the wider environment and how these understandings relate to public discourses of sustainability in contemporary China. The paper is based on an empirical analysis of 129 narrative interviews with local residents in urban Nanjing, collected as part of an interdisciplinary and international comparative research project. It argues that in popular narratives, a combination of ‘being green’ – living a healthy lifestyle which has less impact on the environment – and being rational through qinjian jieyue – by reducing both consumption and waste –is regarded as key to sustainability. Such attitudes align with recent government campaigns to create an environmental-friendly and resource-conserving society. However, the analysis demonstrates how this sustainable way of consumption is restricted by Chinese mianzi and guanxi cultures, the anxieties caused by scares related to food safety, a social welfare system that does not promote a sense of security and a widespread distrust of products made in China which has diffused across society. We argue that studies on discourses and practices of sustainable consumption must strive to take more account of diverse local contexts and sociocultural frameworks

Developing a utility index for the Aberrant Behavior Checklist (ABC-C) for fragile X syndrome

Purpose This study aimed to develop a utility index (the ABC-UI) from the Aberrant Behavior Checklist-Community (ABC-C), for use in quantifying the benefit of emerging treatments for fragile X syndrome (FXS). Methods The ABC-C is a proxy-completed assessment of behaviour and is a widely used measure in FXS. A subset of ABC-C items across seven dimensions was identified to include in health state descriptions. This item reduction process was based on item performance, factor analysis and Rasch analysis performed on an observational study dataset, and consultation with five clinical experts and a methodological expert. Dimensions were combined into health states using an orthogonal design and valued using time trade-off (TTO), with lead-time TTO methods used where TTO indicated a state valued as worse than dead. Preference weights were estimated using mean, individual level, ordinary least squares and random-effects maximum likelihood estimation [RE (MLE)] regression models. Results A representative sample of the UK general public (n = 349; mean age 35.8 years, 58.2 % female) each valued 12 health states. Mean observed values ranged from 0.92 to 0.16 for best to worst health states. The RE (MLE) model performed best based on number of significant coefficients and mean absolute error of 0.018. Mean utilities predicted by the model covered a similar range to that observed. Conclusions The ABC-UI estimates a wide range of utilities from patient-level FXS ABC-C data, allowing estimation of FXS health-related quality of life impact for economic evaluation from an established FXS clinical trial instrument

Victim, perpetrator, and offense characteristics in filicide and filicide-suicide

The purpose of this paper is to provide a critical review of most recent studies of parental and stepparental filicide. A detailed review of the literature revealed the importance of certain demographic, environmental, and psychosocial factors in the commission of child homicide. Our findings indicate that filicides perpetrated by genetic parents and stepparents differ considerably in terms of underlying motivational factors. Data in the literature suggest that biological parents are more likely to choose methods of killing which produce quick and painless death, whereas stepparents frequently kill their wards by beating. Research results demonstrate the victims of maternal filicides to be significantly younger than the victims of paternal filicides. Additionally, filicide–suicide is most often associated with parental psychopathology. Genetic fathers are at the greatest risk of death by suicide after the commission of familicide. These findings are discussed in relation to theoretical frameworks explaining the occurrence of child murder. Further, limitations of reviewed studies and directions for future research are presented

Level of agreement between frequently used cardiovascular risk calculators in people living with HIV

Objectives The aim of the study was to describe agreement between the QRISK2, Framingham and Data Collection on Adverse Events of Anti‐HIV Drugs (D:A:D) cardiovascular disease (CVD) risk calculators in a large UK study of people living with HIV (PLWH). Methods PLWH enrolled in the Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) study without a prior CVD event were included in this study. QRISK2, Framingham CVD and the full and reduced D:A:D CVD scores were calculated; participants were stratified into ‘low’ ( 20%) categories for each. Agreement between scores was assessed using weighted kappas and Bland–Altman plots. Results The 730 included participants were predominantly male (636; 87.1%) and of white ethnicity (645; 88.5%), with a median age of 53 [interquartile range (IQR) 49–59] years. The median calculated 10‐year CVD risk was 11.9% (IQR 6.8–18.4%), 8.9% (IQR 4.6–15.0%), 8.5% (IQR 4.8–14.6%) and 6.9% (IQR 4.1–11.1%) when using the Framingham, QRISK2, and full and reduced D:A:D scores, respectively. Agreement between the different scores was generally moderate, with the highest level of agreement being between the Framingham and QRISK2 scores (weighted kappa = 0.65) but with most other kappa coefficients in the 0.50–0.60 range. Conclusions Estimates of predicted 10‐year CVD risk obtained with commonly used CVD risk prediction tools demonstrate, in general, only moderate agreement among PLWH in the UK. While further validation with clinical endpoints is required, our findings suggest that care should be taken when interpreting any score alone

Introduction and validation of Psychopathic Personality Traits Scale (PPTS) in a large prison sample

Purpose: The aim of this study was to create and validate a brief self-report scale of psychopathic personality traits for research purposes which would grasp the essence of a psychopathic personality, regardless of respondents’ age, gender, cultural background, and criminal history. Methods: The Psychopathic Personality Traits Scale (PPTS), The Measure of Criminal Social Identity, Self-Esteem Measure for Criminals, The Child Sexual Abuse Myth Scale, Attitudes Towards Male Sexual Dating Violence, and Lie Scale were administered to 1,794 prisoners systematically sampled from 10 maximum- and medium-security prisons. Dimensionality and construct validity of the PPTS was investigated using traditional CFA techniques, along with confirmatory bifactor analysis and multitrait-multimethod modelling (MTMM). Seven alternative models of the PPTS were specified and tested using Mplus with WLSMV estimation. Results: MTMM model of PPTS offered the best representation of the data. The results suggest that the PPTS consists of four subscales (affective responsiveness, cognitive responsiveness, interpersonal manipulation, and egocentricity) while controlling for two method factors (knowledge/skills and attitudes/beliefs). Good composite reliability and differential predictive validity was observed. Conclusion: This brief measure of psychopathic traits uncontaminated with behavioural items can be used in the same way among participants with and without criminal history

Effects of an eight-week supervised, structured lifestyle modification programme on anthropometric, metabolic and cardiovascular risk factors in severely obese adults

Background: Lifestyle modification is fundamental to obesity treatment, but few studies have described the effects of structured lifestyle programmes specifically in bariatric patients. We sought to describe changes in anthropometric and metabolic characteristics in a cohort of bariatric patients after participation in a nurse-led, structured lifestyle programme. Methods: We conducted a retrospective, observational cohort study of adults with a body mass index (BMI) ≥40 kgm−2 (or ≥35 kgm−2 with significant co-morbidity) who were attending a regional bariatric service and who completed a single centre, 8-week, nurse-led multidisciplinary lifestyle modification programme. Weight, height, waist circumference, blood pressure, HbA1c, fasting glucose and lipid profiles as well as functional capacity (Incremental Shuttle Walk Test) and questionnaire-based anxiety and depression scores before and after the programme were compared in per-protocol analyses. Results: Of 183 bariatric patients enrolled, 150 (81.9 %) completed the programme. Mean age of completers was 47.9 ± 11.2 years. 34.7 % were male. There were statistically significant reductions in weight (129.6 ± 25.9 v 126.9 ± 26.1 kg, p < 0.001), BMI (46.3 ± 8.3 v 44.9 ± 9.0 kgm−2, p < 0.001), waist circumference (133.0 ± 17.1 v 129.3 ± 17.5 cm in women and 143.8 ± 19.0 v 135.1 ± 17.9 cm in men, both p < 0.001) as well as anxiety and depression scores, total- and LDL-cholesterol and triglyceride levels, with an increase in functional capacity (5.9 ± 1.7 v 6.8 ± 2.1 metabolic equivalents of thermogenesis (METS), p < 0.001) in completers at the end of the programme compared to the start. Blood pressure improved, with reductions in systolic and diastolic blood pressure from 135 ± 16.2 to 131.6 ± 17.1 (p = 0.009) and 84.7 ± 10.2 to 81.4 ± 10.9 mmHg (p < 0.001), respectively. The proportion of patients achieving target blood pressure increased from 50.3 to 59.3 % (p = 0.04). The proportion of patients with diabetes achieving HbA1c <53 mmol/mol increased from 28.6 to 42.9 %, p = 0.02. (Continued on next page)Conclusions: Bariatric patients completing an 8 week, nurse-led structured lifestyle programme had improved adiposity, fitness, lipid profiles, psychosocial health, blood pressure and glycaemia. Further assessment of this programme in a pragmatic randomised controlled trial seems warranted. Keywords: Bariatric, Structured lifestyle modification, Cardiovascular risk, CLANN (Changing Lifestyle with Activity and Nutrition) Programme, Nurse-led, Diabete