Guideline for UK midwives/health visitors to use with parents of infants at risk of developing childhood overweight/obesity

A guideline for members of the health visiting team to use with parents of infants at risk of overweight/obesity has been developed. The guideline contains recommendations about identification of infants at risk as well as a number of strategies that could be used for prevention of overweight/obesity. The guideline needs to be applied alongside health visitors’ professional judgement. It is not intended to replace normal UK clinical practice which is guided by the Healthy Child Programme and complements existing guidance such as the Framework for Action for tackling obesity

Development of an evidence-based practice guideline for UK public health nurses (health visitors) to use with parents of infants at risk of obesity

Introduction: Evidence about effective interventions that reduce obesity risk during infancy is needed. This project aimed to systematically review published Randomised Controlled Trials (RCTs) of behavioural and non-behavioural interventions which address potential risk factors for obesity to inform a guideline for UK health visitors. Methods: A multiprofessional Guideline Development Group (GDG) was convened to undertake a systematic review, based on the National Institute for Health and Clinical Excellence (NICE) guidelines. Findings from the review were used to develop a guideline which was subsequently externally reviewed by national experts and practitioners. Results: We identified 28 RCTs reporting behavioural and non-behavioural interventions delivered during infancy with breastfeeding and/or weight outcomes measured during the first two years of life. A number of on-going studies were also identified. Inclusion criteria for intervention studies included parental breastfeeding intentions and first time parents. Good evidence exists for breastfeeding promotion and support interventions. Evidence exists for parental education around responsive feeding, aspects of infant diet and soothing/sleep expectations. These behavioural components informed the guideline. Despite good evidence that infants fed lower protein formula milk gained less weight compared to milk with higher protein levels, it was not possible to incorporate the evidence from the non-behavioural studies into the guideline. Conclusion: Further research is needed to establish clinically effective interventions for obesity prevention during infancy. Continuous dialogue between commissioners, policy makers, health visitors and parents is essential to ensure existing UK policies are not a barrier to implementing obesity prevention strategies in the first year of life

Identification and characterisation of a novel adhesin Ifp in Yersinia pseudotuberculosis

BACKGROUND: In order to identify new virulence determinants in Y. pseudotuberculosis a comparison between its genome and that of Yersinia pestis was undertaken. This reveals dozens of pseudogenes in Y. pestis, which are still putatively functional in Y. pseudotuberculosis and may be important in the enteric lifestyle. One such gene, YPTB1572 in the Y. pseudotuberculosis IP32953 genome sequence, encodes a protein with similarity to invasin, a classic adhesion/invasion protein, and to intimin, the attaching and effacing protein from enteropathogenic (EPEC) and enterohaemorraghic (EHEC) Escherichia coli. RESULTS: We termed YPTB1572 Ifp (Intimin family protein) and show that it is able to bind directly to human HEp-2 epithelial cells. Cysteine and tryptophan residues in the C-terminal region of intimin that are essential for function in EPEC and EHEC are conserved in Ifp. Protein binding occurred at distinct foci on the HEp-2 cell surface and can be disrupted by mutation of a single cysteine residue at the C-terminus of the protein. Temporal expression analysis using lux reporter constructs revealed that ifp is expressed at late log phase at 37°C in contrast to invasin, suggesting that Ifp is a late stage adhesin. An ifp defined mutant showed a reduction in adhesion to HEp-2 cells and was attenuated in the Galleria mellonella infection model. CONCLUSION: A new Y. pseudotuberculosis adhesin has been identified and characterised. This Ifp is a new member in the family of invasin/intimin outer membrane adhesins

Health visitors’ perception of their role in the universal childhood immunisation programme and their communication strategies with parents

Aim: This study explored health visitors’ perception of their role in the universal childhood immunisation programme with particular emphasis on influencing factors and communication strategies. Background: The majority of parents’ consent to immunisation, but some find decision-making in this area difficult and have unmet information needs. In the United Kingdom, health visitors routinely provide immunisation information for parents, whereas general practitioners (GPs) and practice nurses tend to administer vaccines and respond to parents/carers’ questions. Research has investigated health professionals’ views and knowledge about immunisation, but less is understood about health visitors’ role and how they communicate with parents. Method: Following the Local Research Ethics and Research Governance permissions, all health visitors (n5120) working in one county in the United Kingdom were invited to participate in the study. Semistructured interviews (n522) were undertaken using a prompt guide. The interviews were transcribed verbatim. Thematic analysis using an iterative approach was used to explore the data facilitated by NVIVOTM software. Findings: Five themes emerged from the interviews. These were health visitors’professional role; identity and perceived barriers and communication strategies, parents’ right to choose, confidence in measles, mumps, and rubella (MMR) vaccination and communicating with migrant families about immunisation. There were differences between the health visitors in their perceptions of their roles, skills and knowledge and communication strategies. Health visitors perceived that GPs and practice nurses took a paternalistic approach to the provision of immunisation information, while they used a parental decision making model. Health visitors reported a loss of professional confidence following the MMR crisis. Conclusion: Given the evidence that some parents find it difficult to gain the information they need about immunisation and health visitors’ acknowledgement that their usual communication models were not effective during the MMR crisis, we feel specific communication skills training is needed to enable health professionals to provide parents with appropriate decision support

Early years' prevention of childhood obesity: the challenges facing UK health visitors

Objectives A number of modifiable risk factors are associated with the development of childhood obesity. These are lower breast feeding duration, early weaning onto solid foods, parental response to infant temperament and parental control over food intake. This study explored parents’ beliefs concerning their infant’s size and growth and their receptiveness to intervention aimed at reducing the risk of childhood obesity. Method Six focus groups were undertaken in a range of different demographic areas, with parents of infants less than one year old. The focus groups were audio-recorded, transcribed verbatim and subjected to thematic analysis using an interpretative, inductive approach. Results 38 parents (n=36 female, n=2 male), age range 19-45 years (mean 30.1 years, SD 6.28) participated in the focus groups. Half the sample were overweight (n=12) or obese (n=8). Five main themes were identified. These were a) rationalisation for infant’s larger size, b) parents’ understanding of breastfed infants’ growth and age-related behaviour; c) parents’ understanding of infant growth, developmental norms and feeding practices, d) belief that nothing can be done about overweight/obese infants and e) intentions and behaviour in relation to a healthy diet. Conclusions Some risk factors for childhood obesity are potentially modifiable. Parents are receptive to prevention prior to weaning and need better support with best practice in infant feeding. This should focus on helping them understand the physiology of breast feeding, the rationale around weaning at 6 months and how to recognise that hunger is only one explanation for infant distress and behaviour change

Abstracts from the NIHR INVOLVE Conference 2017

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Significant benefits of AIP testing and clinical screening in familial isolated and young-onset pituitary tumors

Context Germline mutations in the aryl hydrocarbon receptor-interacting protein (AIP) gene are responsible for a subset of familial isolated pituitary adenoma (FIPA) cases and sporadic pituitary neuroendocrine tumors (PitNETs). Objective To compare prospectively diagnosed AIP mutation-positive (AIPmut) PitNET patients with clinically presenting patients and to compare the clinical characteristics of AIPmut and AIPneg PitNET patients. Design 12-year prospective, observational study. Participants & Setting We studied probands and family members of FIPA kindreds and sporadic patients with disease onset ≤18 years or macroadenomas with onset ≤30 years (n = 1477). This was a collaborative study conducted at referral centers for pituitary diseases. Interventions & Outcome AIP testing and clinical screening for pituitary disease. Comparison of characteristics of prospectively diagnosed (n = 22) vs clinically presenting AIPmut PitNET patients (n = 145), and AIPmut (n = 167) vs AIPneg PitNET patients (n = 1310). Results Prospectively diagnosed AIPmut PitNET patients had smaller lesions with less suprasellar extension or cavernous sinus invasion and required fewer treatments with fewer operations and no radiotherapy compared with clinically presenting cases; there were fewer cases with active disease and hypopituitarism at last follow-up. When comparing AIPmut and AIPneg cases, AIPmut patients were more often males, younger, more often had GH excess, pituitary apoplexy, suprasellar extension, and more patients required multimodal therapy, including radiotherapy. AIPmut patients (n = 136) with GH excess were taller than AIPneg counterparts (n = 650). Conclusions Prospectively diagnosed AIPmut patients show better outcomes than clinically presenting cases, demonstrating the benefits of genetic and clinical screening. AIP-related pituitary disease has a wide spectrum ranging from aggressively growing lesions to stable or indolent disease course

Genetic variants in novel pathways influence blood pressure and cardiovascular disease risk.

Blood pressure is a heritable trait influenced by several biological pathways and responsive to environmental stimuli. Over one billion people worldwide have hypertension (≥140 mm Hg systolic blood pressure or  ≥90 mm Hg diastolic blood pressure). Even small increments in blood pressure are associated with an increased risk of cardiovascular events. This genome-wide association study of systolic and diastolic blood pressure, which used a multi-stage design in 200,000 individuals of European descent, identified sixteen novel loci: six of these loci contain genes previously known or suspected to regulate blood pressure (GUCY1A3-GUCY1B3, NPR3-C5orf23, ADM, FURIN-FES, GOSR2, GNAS-EDN3); the other ten provide new clues to blood pressure physiology. A genetic risk score based on 29 genome-wide significant variants was associated with hypertension, left ventricular wall thickness, stroke and coronary artery disease, but not kidney disease or kidney function. We also observed associations with blood pressure in East Asian, South Asian and African ancestry individuals. Our findings provide new insights into the genetics and biology of blood pressure, and suggest potential novel therapeutic pathways for cardiovascular disease prevention