Trial to encourage adoption and maintenance of a Mediterranean diet (TEAM-MED): Protocol for a randomised feasibility trial of a peer support intervention for dietary behaviour change in adults at high cardiovascular disease risk

© 2018 by the authors. Licensee MDPI, Basel, Switzerland. Adoption of a Mediterranean diet (MD) reduces cardiovascular disease (CVD) risk. However, interventions to achieve dietary behaviour change are typically resource intensive. Peer support offers a potentially low-cost approach to encourage dietary change. The primary objective of this randomised controlled trial is to explore the feasibility of peer support versus a previously tested dietetic-led intervention to encourageMDbehaviour change, and to test recruitment strategies, retention and attrition in order to inform the design of a definitive trial. A total of 75 overweight adults at high CVD risk who do not follow a MD (Mediterranean Diet Score (MDS ≤3)) will be randomly assigned to either: a minimal intervention (written materials), a proven intervention (dietetic support, written materials and key MD foods), or a peer support intervention (group-based community programme delivered by lay peers) for 12 months. The primary end-point is change in MDS from baseline to 6 months (adoption of MD). Secondary end-points include: change in MDS from 6 to 12 months (maintenance of MD), effects on nutritional biomarkers and CVD risk factors, fidelity of implementation, acceptability and feasibility of the peer support intervention. This study will generate important data regarding the feasibility of peer support for ease of adoption of MD in an ‘at risk’ Northern European population. Data will be used to direct a larger scale trial, where the clinical efficacy and cost-effectiveness of peer support will be tested

The VLT-FLAMES Tarantula Survey

A spectroscopic analysis has been undertaken for the B-type multiple systems (excluding those with supergiant primaries) in the VLT-FLAMES Tarantula Survey (VFTS). Projected rotational velocities, vesini, for the primaries have been estimated using a Fourier Transform technique and confirmed by fitting rotationally broadened profiles. A subset of 33 systems with vesini ≤ 80 km s-1 have been analysed using a TLUSTY grid of model atmospheres to estimate stellar parameters and surface abundances for the primaries. The effects of a potential flux contribution from an unseen secondary have also been considered. For 20 targets it was possible to reliably estimate their effective temperatures (Teff) but for the other 13 objects it was only possible to provide a constraint of 20 000 ≤ Teff ≤ 26 000 K – the other parameters estimated for these targets will be consequently less reliable. The estimated stellar properties are compared with evolutionary models and are generally consistent with their membership of 30 Doradus, while the nature of the secondaries of 3 SB2 system is discussed. A comparison with a sample of single stars with vesini ≤ 80 km s-1 obtained from the VFTS and analysed with the same techniques implies that the atmospheric parameters and nitrogen abundances of the two samples are similar. However, the binary sample may have a lack of primaries with significant nitrogen enhancements, which would be consistent with them having low rotational velocities and having effectively evolved as single stars without significant rotational mixing. This result, which may be actually a consequence of the limitations of the pathfinder investigation presented in this paper, should be considered as a motivation for spectroscopic abundance analysis of large samples of binary stars, with high quality observational data

Trial to Encourage Adoption and Maintenance of a MEditerranean Diet (TEAM-MED): a randomised pilot trial of a peer support intervention for dietary behaviour change in adults from a Northern European population at high cardiovascular disease risk.

Adhering to a Mediterranean Diet (MD) is associated with reduced cardiovascular disease (CVD) risk. This study aimed to explore methods of increasing MD adoption in a non-Mediterranean population at high risk of CVD, including assessing the feasibility of a developed peer support intervention. The Trial to Encourage Adoption and Maintenance of a MEditerranean Diet (TEAM-MED) was a 12-month pilot parallel group RCT involving individuals aged ≥40 y, with low MD adherence, who were overweight, and had an estimated CVD risk ≥20% over ten years. It explored three interventions, a peer support group, a dietician-led support group and a minimal support group to encourage dietary behaviour change and monitored variability in Mediterranean Diet Score (MDS) over time and between the intervention groups, alongside measurement of markers of nutritional status and cardiovascular risk. 118 individuals were assessed for eligibility, and 75 (64%) were eligible. After 12 months there was a retention rate of 69% (PSG 59%; DSG 88%; MSG 63%). For all participants, increases in MDS were observed over 12 months (p<0.001), both in original MDS data and when imputed data were used. Improvements in BMI, HbA1c levels, systolic and diastolic blood pressure in the population as a whole. This pilot study has demonstrated that a non-Mediterranean adult population at high CVD risk can make dietary behaviour change over a 12-month period towards a MD. The study also highlights the feasibility of a peer support intervention to encourage MD behaviour change amongst this population group and will inform a definitive trial

The VLT-FLAMES Tarantula Survey XXVIII. Nitrogen abundances for apparently single dwarf and giant B-type stars with small projected rotational velocities

Previous analyses of the spectra of OB-type stars in the Magellanic Clouds have identified targets with low projected rotational velocities and relatively high nitrogen abundances; the evolutionary status of these objects remains unclear. The VLT-FLAMES Tarantula Survey obtained spectroscopy for over 800 early-type stars in 30 Doradus of which 434 stars were classified as B-type. We have estimated atmospheric parameters and nitrogen abundances using tlusty model atmospheres for 54 B-type targets that appear to be single, have projected rotational velocities, ve sin i ≤ 80 km s−1 and were not classified as supergiants. In addition, nitrogen abundances for 34 similar stars observed in a previous FLAMES survey of the Large Magellanic Cloud have been re-evaluated. For both samples, approximately 75-80% of the targets have nitrogen enhancements of less than 0.3 dex, consistent with them having experienced only small amounts of mixing. However, stars with low projected rotational velocities, ve sin i ≤ 40 km s−1 and significant nitrogen enrichments are found in both our samples and simulations imply that these cannot all be rapidly rotating objects observed near pole-on. For example, adopting an enhancement threshold of 0.6 dex, we observed five and four stars in our VFTS and previous FLAMES survey samples, yet stellar evolution models with rotation predict only 1.25±1.11 and 0.26±0.51 based on our sample sizes and random stellar viewing inclinations. The excess of such objects is estimated to be 20-30% of all stars with current rotational velocities of less than 40 km s−1 . This would correspond to ∼2-4% of the total non-supergiant single B-type sample. Given the relatively large nitrogen enhancement adopted, these estimates constitute lower limits for stars that appear inconsistent with current grids of stellar evolutionary models. Including targets with smaller nitrogen enhancements of greater than 0.2 dex implies larger percentages of targets that are inconsistent with current evolutionary models, viz. ∼70% of the stars with rotational velocities less than 40 km s−1 and ∼6-8% of the total single stellar population. We consider possible explanations of which the most promising would appear to be breaking due to magnetic fields or stellar mergers with subsequent magnetic braking

Survey on schizophrenia treatment in Mexico: perception and antipsychotic prescription patterns

BACKGROUND: Since the introduction of antipsychotics, especially the so called atypicals, the treatment of schizophrenia has shown important improvements. At the present time, it is preferred to label clozapine and other antipsychotics sharing similar profiles as second-generation antipsychotics (SGAs). These medications have been proposed by some experts as a first line treatment for schizophrenia. It is critical to have reliable data about antipsychotic prescription in Mexico and to create management guidelines based on expert meetings and not only on studies carried out by the pharmaceutical industry. Only this approach will help to make the right decisions for the treatment of schizophrenia. METHODS: A translated version of Rabinowitz's survey was used to evaluate antipsychotic prescription preferences and patterns in Mexican psychiatrists. The survey questionnaire was sent by mail to 200 psychiatrists from public institutions and private practice in Mexico City and Guadalajara, Mexico. RESULTS: Recommendations for antipsychotics daily doses at different stages of the treatment of schizophrenia varied widely. Haloperidol was considered as the first choice for the treatment of positive symptoms. On the contrary, risperidone was the first option for negative symptoms. For a patient with a high susceptibility for developing extrapyramidal symptoms (EPS), risperidone was the first choice. It was also considered that SGAs had advantages over typical antipsychotics in the management of negative symptoms, cognitive impairment and fewer EPS. Besides, there was a clear tendency for prescribing typical antipsychotics at higher doses than recommended and inadequate doses for the atypical ones. CONCLUSIONS: Some of the obstacles for the prescription of SGAs include their high cost, deficient knowledge about their indications and dosage, the perception of their being less efficient for the treatment of positive symptoms and the resistance of some Mexican physicians to change their prescription pattern. It is necessary to reach a consensus, in order to establish and standardize the treatment of schizophrenia, based on the information reported in clinical trials and prevailing economic conditions in Mexico

Multiethnic meta-analysis identifies ancestry-specific and cross-ancestry loci for pulmonary function

Nearly 100 loci have been identified for pulmonary function, almost exclusively in studies of European ancestry populations. We extend previous research by meta-analyzing genome-wide association studies of 1000 Genomes imputed variants in relation to pulmonary function in a multiethnic population of 90,715 individuals of European (N = 60,552), African (N = 8429), Asian (N = 9959), and Hispanic/Latino (N = 11,775) ethnicities. We identify over 50 additional loci at genome-wide significance in ancestry-specific or multiethnic meta-analyses. Using recent fine-mapping methods incorporating functional annotation, gene expression, and differences in linkage disequilibrium between ethnicities, we further shed light on potential causal variants and genes at known and newly identified loci. Several of the novel genes encode proteins with predicted or established drug targets, including KCNK2 and CDK12. Our study highlights the utility of multiethnic and integrative genomics approaches to extend existing knowledge of the genetics of l

Genetic Sharing with Cardiovascular Disease Risk Factors and Diabetes Reveals Novel Bone Mineral Density Loci.

Bone Mineral Density (BMD) is a highly heritable trait, but genome-wide association studies have identified few genetic risk factors. Epidemiological studies suggest associations between BMD and several traits and diseases, but the nature of the suggestive comorbidity is still unknown. We used a novel genetic pleiotropy-informed conditional False Discovery Rate (FDR) method to identify single nucleotide polymorphisms (SNPs) associated with BMD by leveraging cardiovascular disease (CVD) associated disorders and metabolic traits. By conditioning on SNPs associated with the CVD-related phenotypes, type 1 diabetes, type 2 diabetes, systolic blood pressure, diastolic blood pressure, high density lipoprotein, low density lipoprotein, triglycerides and waist hip ratio, we identified 65 novel independent BMD loci (26 with femoral neck BMD and 47 with lumbar spine BMD) at conditional FDR < 0.01. Many of the loci were confirmed in genetic expression studies. Genes validated at the mRNA levels were characteristic for the osteoblast/osteocyte lineage, Wnt signaling pathway and bone metabolism. The results provide new insight into genetic mechanisms of variability in BMD, and a better understanding of the genetic underpinnings of clinical comorbidity