Evaluation of diet pattern and weight gain in postmenopausal women enrolled in the Women’s Health Initiative Observational Study

Abstract It is unclear which of four popular contemporary diet patterns is best for weight maintenance among postmenopausal women. Four dietary patterns were characterised among postmenopausal women aged 49–81 years (mean 63·6 ( sd 7·4) years) from the Women’s Health Initiative Observational Study: (1) a low-fat diet; (2) a reduced-carbohydrate diet; (3) a Mediterranean-style (Med) diet; and (4) a diet consistent with the US Department of Agriculture’s Dietary Guidelines for Americans (DGA). Discrete-time hazards models were used to compare the risk of weight gain (≥10 %) among high adherers of each diet pattern. In adjusted models, the reduced-carbohydrate diet was inversely related to weight gain (OR 0·71; 95 % CI 0·66, 0·76), whereas the low-fat (OR 1·43; 95 % CI 1·33, 1·54) and DGA (OR 1·24; 95 % CI 1·15, 1·33) diets were associated with increased risk of weight gain. By baseline weight status, the reduced-carbohydrate diet was inversely related to weight gain among women who were normal weight (OR 0·72; 95 % CI 0·63, 0·81), overweight (OR 0·67; 95 % CI 0·59, 0·76) or obese class I (OR 0·63; 95 % CI 0·53, 0·76) at baseline. The low-fat diet was associated with increased risk of weight gain in women who were normal weight (OR 1·28; 95 % CI 1·13, 1·46), overweight (OR 1·60; 95 % CI 1·40, 1·83), obese class I (OR 1·73; 95 % CI 1·43, 2·09) or obese class II (OR 1·44; 95 % CI 1·08, 1·92) at baseline. These findings suggest that a low-fat diet may promote weight gain, whereas a reduced-carbohydrate diet may decrease risk of postmenopausal weight gain

Evaluation of a simple low-cost intervention to empower people with chronic kidney disease to reduce their dietary salt intake : OxCKD1, a multi-center randomized controlled trial

Background To evaluate the efficacy of a simple low-cost intervention to empower people with CKD to reduce their dietary salt intake. Methods A randomized controlled trial in primary and secondary care comparing the OxSalt care bundle intervention versus standard care for 1 month. Participants were people with CKD and an eGFR >20 ml/min per 1.73 m2 and were recruited from primary and secondary care. The primary outcome was a reduction in dietary salt intake, as assessed by 24-hour urinary sodium excretion, after 1 month of the intervention. Results Two hundred and one participants were recruited. Dietary salt intake, as assessed from 24-hour urine sodium excretion, fell by 1.9 (±2.9) g/d in the intervention group compared with 0.4 (±2.7) g/d in the control group (P < 0.001). Salt intake was still reduced to a lesser extent over the following year in the intervention group. Conclusions A short, low-cost, easily delivered intervention empowers people with CKD to reduce their dietary salt intake

Using the AUA CPD Framework: a practical guide to success

This guide has been developed to help you get the best from the AUA’s CPD Framework. We start by explaining some of the history, and then outline what we mean by a behavioural framework, before we go on to demonstrate how it can be used in the workplace. Using real examples from projects undertaken in the higher education sector in the UK, we demonstrate how the CPD Framework can be used by the individual, as part of a team project or incorporated into institutional strategy

A s i o r a p h

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Improving the identification of hydrologically sensitive areas using LiDAR DEMs for the delineation and mitigation of critical source areas of diffuse pollution

Identifying critical source areas (CSAs) of diffuse pollution in agricultural catchments requires the accurate identification of hydrologically sensitive areas (HSAs) at highest propensity for generating surface runoff and transporting pollutants. A new GIS-based HSA Index is presented that improves the identification of HSAs at the sub-field scale by accounting for microtopographic controls. The Index is based on high resolution LiDAR data and a soil topographic index (STI) and also considers the hydrological disconnection of overland flow via topographic impediment from flow sinks. The HSA Index was applied to four intensive agricultural catchments (~ 7.5–12 km2) with contrasting topography and soil types, and validated using rainfall-quickflow measurements during saturated winter storm events in 2009–2014. Total flow sink volume capacities ranged from 8298 to 59,584 m3 and caused 8.5–24.2% of overland-flow-generating-areas and 16.8–33.4% of catchment areas to become hydrologically disconnected from the open drainage channel network. HSA maps identified ‘breakthrough points’ and ‘delivery points’ along surface runoff pathways as vulnerable points where diffuse pollutants could be transported between fields or delivered to the open drainage network, respectively. Using these as proposed locations for targeting mitigation measures such as riparian buffer strips reduced potential costs compared to blanket implementation within an example agri-environment scheme by 66% and 91% over 1 and 5 years respectively, which included LiDAR DEM acquisition costs. The HSA Index can be used as a hydrologically realistic transport component within a fully evolved sub-field scale CSA model, and can also be used to guide the implementation of ‘treatment-train’ mitigation strategies concurrent with sustainable agricultural intensification

Determinants of urogenital schistosomiasis among pregnant women and its association with pregnancy outcomes, neonatal deaths and child growth.

BACKGROUND: Schistosoma haematobium is a parasitic helminth which causes urogenital pathology. The impact of urogenital schistosomiasis during pregnancy on birth outcomes and child growth is poorly understood. METHODS: Risk factors for urogenital schistosomiasis were characterized among 4,437 pregnant women enrolled in a cluster-randomised community-based trial in rural Zimbabwe. Infection was defined via urine microscopy (≥1 S. haematobium egg) and urinalysis (haematuria). Associations between infection and pregnancy outcomes were assessed in case-control analyses using conditional logistic regression. The association of maternal infection with birthweight and length-for-age Z scores (LAZ) at 1 and 18 months of age were assessed using generalised estimating equations. RESULTS: Urogenital schistosomiasis (egg-positive and/or haematuria-positive) was detected in 26.8% of pregnant women. Risk factors significantly associated with infection were: maternal age, education, marital status and religion; household drinking water source and latrine; study region; and season. Urogenital schistosomiasis was not significantly associated with adverse pregnancy outcomes (miscarriage, stillbirth, preterm, small-for-gestational age), birthweight, neonatal death or LAZ. CONCLUSIONS: Including pregnant women in anti-helminthic treatment programs would benefit a large number of women in rural Zimbabwe. However, clearance of the low intensity infections that predominate in this context is unlikely to have additive benefits for pregnancy outcomes or child growth

Antenatal and delivery practices and neonatal mortality amongst women with institutional and non-institutional deliveries in rural Zimbabwe: observational data from a cluster randomized trial

Abstract Background Despite achieving relatively high rates of antenatal care, institutional delivery, and HIV antiretroviral therapy for women during pregnancy, neonatal mortality has remained stubbornly high in Zimbabwe. Clearer understanding of causal pathways is required to inform effective interventions. Methods This study was a secondary analysis of data from the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial, a cluster-randomized community-based trial among pregnant women and their infants, to examine care during institutional and non-institutional deliveries in rural Zimbabwe and associated birth outcomes. Results Among 4423 pregnant women, 529 (11.9%) delivered outside a health institution; hygiene practices were poorer and interventions to minimise neonatal hypothermia less commonly utilised for these deliveries compared to institutional deliveries. Among 3441 infants born in institutions, 592 (17.2%) were preterm (< 37 weeks gestation), while 175/462 (37.9%) infants born outside health institutions were preterm (RR: 2.20 (1.92, 2.53). Similarly, rates of stillbirth [1.2% compared to 3.0% (RR:2.38, 1.36, 4.15)] and neonatal mortality [2.4% compared to 4.8% (RR: 2.01 1.31, 3.10)] were higher among infants born outside institutions. Among mothers delivering at home who reported their reason for having a home delivery, 221/293 (75%) reported that precipitous labor was the primary reason for not having an institutional delivery while 32 (11%), 34 (12%), and 9 (3%), respectively, reported distance to the clinic, financial constraints, and religious/personal preference. Conclusions Preterm birth is common among all infants in rural Zimbabwe, and extremely high among infants born outside health institutions. Our findings indicate that premature onset of labor, rather than maternal choice, may be the reason for many non-institutional deliveries in low-resource settings, initiating a cascade of events resulting in a two-fold higher risk of stillbirth and neonatal mortality amongst children born outside health institutions. Interventions for primary prevention of preterm delivery will be crucial in reducing neonatal mortality in Zimbabwe. Trial registration The trial is registered with ClinicalTrials.gov, number NCT01824940