An evaluation of impairment, mobility and quality of life in Polio survivors, change in muscle strength over time and the effects of an arm ergometry aerobic exercise programme.

Many Polio survivors report new problems, including new muscle weakness, fatigue, decreased mobility and pain (Halstead, 2004). There is a lack of consensus regarding the rate of decline in muscle strength and function of Polio survivors (Stolwijk-Swuste et al., 2005), the reasons for the new symptoms such as fatigue and the cause of declining mobility. As a result of their disability many Polio survivors report significant barriers to physical activity (Becker and Stuifbergen, 2004) and the prevalence of lifestyle related health risk factors is high (Gawne et al., 2003), which provides further risk of disease burden and disability. A number of research questions were identified and three studies addressing these questions are presented in the thesis. Polio survivors attending Beaumont hospital have had their muscle strength assessed using fixed dynamometry since 1999. A longitudinal study of the rate in decline in muscle strength was completed, including patients who had attended for assessment for at least four years. A slow rate of decline in strength over a period of between four and twelve years in the 65 Polio survivors was identified. The rate of decline identified, of between one and two percent was similar to that reported in normal ageing. The second study sought to assess the presence of motor fatigue, its relationship with subjective fatigue and investigate whether motor fatigue was a contributing factor to decreased mobility. In addition, a range of impairments, mobility and quality of life were assessed in 30 Polio survivors and 30 age and sex matched healthy controls. Significant differences between the groups in muscle strength, subjective fatigue, mobility, pain and quality of life were identified. Motor fatigue was assessed by analysing the rate of decline in Maximum Voluntary Isometric Contraction over 30 seconds and Polio survivors had significantly greater motor fatigue in hand grip but not in lower limb muscle groups. Motor fatigue was not related to subjective fatigue or to mobility. Relationships between impairments and quality of life were identified, and pain, fatigue and elevated energy cost of walking were associated with worse quality of life. Muscle strength was significantly associated with mobility. The third study sought to develop an aerobic exercise programme, which was designed to overcome the barriers to exercise reported by Polio survivors. The effects of a home-based arm ergometry programme were investigated in a randomised controlled trial of 55 Polio survivors. Changes in physical fitness, assessed using a submaximal fitness test, fatigue, pain, activity and quality of life were not significantly better in the intervention group at follow-up compared with the control group. However, Polio survivors, allocated to the intervention group had significantly lower blood pressure at follow-up. Compliance with the programme was excellent and participants completed exercise sessions of approximately 20 minutes three times per week. There were no overall adverse effects on fatigue, pain or muscle strength. Participants perceived the programme to be of benefit. Although the changes in physical fitness and impairments related to the late-onset sequelae of Polio were not significant the programme did allow otherwise inactive Polio survivors to access aerobic exercise and experience the associated health benefits

The effects of a home-based arm ergometry exercise programme on physical fitness, fatigue and activity in polio survivors: protocol for a randomised controlled trial.

ABSTRACT: BACKGROUND: Many Polio survivors have reduced mobility, pain and fatigue, which make access to conventional forms of aerobic exercise difficult. Inactivity leads to increased risk of health problems, many of which are prevalent among Polio survivors. Aerobic exercise programmes in Polio survivors should utilise stable muscle groups and should be designed to minimise exacerbation of pain and fatigue. A home-based arm ergometry aerobic exercise programme may represent an affordable and accessible exercise modality, incorporating exercise prescription principles in this group.Methods/design: This is a prospective, single blinded, randomised controlled trial. There are two arms; exercise intervention using arm ergometers and control. Polio survivors meeting eligibility criteria will be recruited and randomly allocated to intervention or control groups. Participants allocated to the intervention group will receive a small arm ergometer and a polar heart rate monitor. They will carry out a home-based moderate intensity (50-70% HRMax) aerobic exercise programme for eight weeks, following instruction by the treating physiotherapist. Assessments will occur at baseline and after eight weeks and will include tests of physical fitness, activity, energy cost of walking, fatigue and quality of life. Clinically feasible assessment tools including the Six Minute Arm Test, the Physical Activity Scale for People with Physical Disabilities questionnaire, the Physiological Cost Index, Fatigue Severity Scale and the SF-36v2 will be utilised. DISCUSSION: The efficacy of a home-based arm ergometry programme in Polio survivors will be examined. No previous trial has examined such a programme using a wide range of outcome measures pertinent to Polio survivors. This study will provide new information on the impact of arm ergometry on physical fitness, activity, body composition, fatigue, pain, muscle strength, and health related quality of life. Also, the study will provide information, which at present is lacking, on safety of aerobic exercise in Polio, as potential negative outcomes of activity including loss of muscle strength, increased pain and fatigue will be closely monitored.Trial registration: Clinicaltrials.gov identifier: NCT01271530

Use of Bacteriocins to Improve Cheese Quality and Safety

End of Project ReportThe objectives of this project were to generate, characterise and exploit a range of novel bacteriocin producing starter cultures to improve both the safety and the quality of fermented dairy foods. The main conclusions were as follows: Lacticin 3147 is a broad spectrum bacteriocin which inhibits a wide range of Gram-positive bacteria including lactobacilli, clostridia and Listeria. The bacteriocin has been purified by chromatographic procedures and has been shown to be composed of two peptides, both of which are required for biological activity. The mechanism of action of lacticin 3147 has been elucidated. The entire plasmid encoding lacticin 3147 has been sequenced and the bacteriocin in distinct from any previously characterised lactococcal bacteriocin. The Food Grade introduction of the bacteriocin genes into cheese starters was carried out. Lacticin 3147 producing starters have been used to control the pathogen Listeria monocytogenes on the surface of mould ripened cheese. Lacticin 3147 producing starters have been used to control the non-starter lactic acid bacteria complement in Cheddar cheese during the ripening process. A novel starter system using a bacteriocin (lactococcin)- producing adjunct has been designed which gives increased cell lysis during Cheddar cheese manufacture while ensuring that efficient acid production is not compromised. In summary these studies have found that naturally occurring antimicrobials such as bacteriocins have a wide range of applications in the food industry for improving both the quality and safety of fermented dairy products.Department of Agriculture, Food and the Marin

Infant formula feeding practices in a prospective population based study

Background: It is recommended that formula-fed infants are given standard whey-based infant formula throughout the first year of life, unless otherwise advised by healthcare professionals. To our knowledge it has not yet been explored if parents are using a whey-based infant formula throughout the first 12 months of life. Reasons for parental choice of formula are also unknown. Therefore, the objective of this paper was to describe parental administration of whey-based and non whey-based infant formula in the first year of life. Methods: Data collected as part of the Cork BASELINE Birth Cohort Study examined infant feeding practices at 2, 6 and 12 months of age. Descriptive analysis explored infant feeding practices and parental reasons for changing from a whey-based to a non whey-based infant formula. Multiple logistic regression investigated parental and infant characteristics associated with the use of whey-based infant formula. Results: In total, 62.4%, 40.4% and 12.8% parent(s) at 2, 6 and 12 months, respectively, gave their infant whey-based infant formula. No parental or infant characteristic was found to consistently influence the use of whey-based infant formula. The most common reason reported by parent(s) for changing their infant’s formula to a non whey-based formula was that they perceived their baby as being hungry. Conclusion: The majority of parent(s) commence their infants on whey-based formula, but most change to non whey-based formula before 12 months of age. Parental perception of infant satiety and not healthcare advice was the most common reason for changing from a whey-based to a non whey-based infant formula. Additional research is now required to investigate the effect of whey-based and non whey-based infant formula on infant growth

Seizure burden and neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy.

Aim: To examine the relationship between electrographic seizures and long-term outcome in neonates with hypoxic-ischemic encephalopathy (HIE). Method: Full-term neonates with HIE born in Cork University Maternity Hospital from 2003 to 2006 (pre-hypothermia era) and 2009 to 2012 (hypothermia era) were included in this observational study. All had early continuous electroencephalography monitoring. All electrographic seizures were annotated. The total seizure burden and hourly seizure burden were calculated. Outcome (normal/abnormal) was assessed at 24 to 48 months in surviving neonates using either the Bayley Scales of Infant and Toddler Development, Third Edition or the Griffiths Mental Development Scales; a diagnosis of cerebral palsy or epilepsy was also considered an abnormal outcome. Results: Continuous electroencephalography was recorded for a median of 57.1 hours (interquartile range 33.5-80.5h) in 47 neonates (31 males, 16 females); 29 out of 47 (62%) had electrographic seizures and 25 out of 47 (53%) had an abnormal outcome. The presence of seizures per se was not associated with abnormal outcome (p=0.126); however, the odds of an abnormal outcome increased over ninefold (odds ratio [OR] 9.56; 95% confidence interval [95% CI] 2.43-37.67) if a neonate had a total seizure burden of more than 40 minutes (p=0.001), and eightfold (OR: 8.00; 95% CI: 2.06-31.07) if a neonate had a maximum hourly seizure burden of more than 13 minutes per hour (p=0.003). Controlling for electrographic HIE grade or treatment with hypothermia did not change the direction of the relationship between seizure burden and outcome. Interpretation: In HIE, a high electrographic seizure burden is significantly associated with abnormal outcome, independent of HIE severity or treatment with hypothermia

Iron deficiency during the first 1,000 days of life: are we doing enough to protect the developing brain?

Iron is essential for the functioning of all cells and organs, most critically for the developing brain in the fundamental neuronal processes of myelination, energy and neurotransmitter metabolism. Iron deficiency, especially in the first 1,000 days of life, can result in longlasting, irreversible deficits in cognition, motor function and behaviour. Pregnant women, infants and young children are most vulnerable to iron deficiency, due to their high requirements to support growth and development, coupled with a frequently inadequate dietary supply. An unrecognised problem is that even if iron intake is adequate, common pregnancy-related and lifestyle factors can affect maternal-fetal iron supply in utero, resulting in an increased risk of deficiency for the mother and her fetus. While preterm birth, gestational diabetes mellitus and intrauterine growth restriction are known risk factors, more recent evidence suggests that maternal obesity and delivery by Caesarean section further increase the risk of iron deficiency in the newborn infant, which can persist into early childhood. Despite the considerable threat that early-life iron deficiency poses to long-term neurological development, life chances and a countryâ s overall social and economic progress, strategies to tackle the issue are non-existent, too limited or totally inappropriate. Prevention strategies, focused on improving the health and nutritional status of women of reproductive age are required. Delayed cord clamping should be considered a priority. Better screening strategies to enable the early detection of iron deficiency during pregnancy and early-life should be prioritised, with intervention strategies to protect maternal health and the developing brain

Validation of a touchscreen assessment tool to screen for cognitive delay at 24 months

Aim: To validate a touchscreen assessment as a screening tool for mild cognitive delay in typically developing children aged 24 months. Method: Secondary analysis of data was completed from an observational birth cohort study (The Cork Nutrition & Microbiome Maternal–Infant Cohort Study [COMBINE]), with children born between 2015 and 2017. Outcome data were collected at 24 months of age, at the INFANT Research Centre, Ireland. Outcomes were the Bayley Scales of Infant and Toddler Development, Third Edition cognitive composite score and a language-free, touchscreen-based cognitive measure (Babyscreen). Results: A total of 101 children (47 females, 54 males) aged 24 months (mean = 24.25, SD = 0.22) were included. Cognitive composite scores correlated with the total number of Babyscreen tasks completed, with moderate concurrent validity (r = 0.358, p < 0.001). Children with cognitive composite scores lower than 90 (1 SD below the mean, defined as mild cognitive delay) had lower mean Babyscreen scores than those with cognitive scores equal to or greater than 90 (8.50 [SD = 4.89] vs 12.61 [SD = 3.68], p = 0.001). The area under the receiver operating characteristic curve for the prediction of a cognitive composite score less than 90 was 0.75 (95% confidence interval = 0.59–0.91; p = 0.006). Babyscreen scores less than 7 were equivalent to less than the 10th centile and identified children with mild cognitive delay with 50% sensitivity and 93% specificity. Interpretation: Our 15-minute, language-free touchscreen tool could reasonably identify mild cognitive delay among typically developing children