Adolescent dietary patterns are associated with lifestyle family psycho-social factors

Background/ Objectives: Dietary intake during adolescence contributes to lifelong eating habits and the development of early risk factors for disease in adulthood. Few studies have examined the dietary patterns of adolescents and the social and environmental factors that may affect them during this life stage. The present study describes dietary patterns in a cohort of adolescents and examines their associations with socioeconomic factors, as well as parental and adolescent risk factor behaviours. Design: A semi quantitative FFQ was used to assess study adolescents’ usual dietary intake over the previous year. Information was collected on family functioning and various socio economic and risk factor variables via questionnaire. Adolescents visited the clinic for anthropometric measurements. Setting: The Western Australian Pregnancy Cohort Study (Raine Study), Perth, Western Australia. Subjects: Adolescents (n 1631) aged 14 years from a pregnancy cohort study. Results: Factor analysis identified two distinct dietary patterns that differed predominantly in fat and sugar intakes. The ‘Western’ pattern consisted of high intakes of take away foods, soft drinks, confectionery, French fries, refined grains, full fat dairy products and processed meats. The ‘Healthy’’ pattern included high intakes of whole grains, fruit, vegetables, legumes and fish. ANOVA showed that the ‘Western’ dietary pattern was positively associated with greater television viewing and having a parent that smoked, and was inversely associated with family income. The ‘Healthy’’ pattern was positively associated with female gender, greater maternal education, better family functioning and being in a two parent family, and was inversely associated with television viewing. Conclusions: This study suggests that both lifestyle factors and family psycho social environment are related to eating patterns in Australian adolescents

Effects of home-based prehabilitation on pre and postoperative outcomes following total hip and knee arthroplasty: a systematic review and meta-analysis

AimsThe aim of this study was to determine the effectiveness of home-based prehabilitation on pre and postoperative outcomes in participants awaiting total knee (TKA) and hip arthroplasty (THA).MethodsA systematic review with meta-analysis of randomised controlled trials (RCTs) of prehabilitation interventions for TKA and THA. MEDLINE, CINAHL, ProQuest, Pubmed, Cochrane Library and Google Scholar databases were searched from inception to October 2022. Evidence was assessed by the PEDro scale and the Cochrane risk-of-bias (ROB2) tool. ResultsTwenty-two RCTs (1601 participants) were identified with good overall quality and low risk of bias. Prehabilitation significantly improved pain prior to TKA (mean difference (MD) -1.02: p = 0.00), with non-significant improvements for function before (MD -0.48; p = 0.06) and after TKA (MD -0.69, p = 0.25). Small preoperative improvements were observed for pain (MD -0.02; p = 0.87) and function (MD-0.18; p = 0.16) prior to THA but no post THA effect was found for pain (MD 0.19; p = 0.44) and function (MD 0.14; p= 0.68). A trend favouring usual care for improving quality of life (QoL) prior to TKA (MD 0.61; p = 0.34), but no effect on QoL prior (MD 0.03; p = 0.87) or post THA (MD -0.05; p = 0.83) was found. Prehabilitation significantly reduced hospital length of stay (LOS) for TKA (MD -0.43 days; p < 0.00) but not for THA (MD, -0.24; p = 0.12). Compliance was only reported in 11 studies and was excellent with a mean value of 90.5%.ConclusionsPrehabilitation interventions improve pain and function prior TKA and THA, and reduce hospital LOS, though it is unclear if these effects enhance outcomes postoperatively

Role of public and private funding in the rising caesarean section rate:a cohort study

Objective: The caesarean section rates have been rising in the developed world for over two decades. This study assessed the involvement of the public and private health sectors in this increase. Design: Population-based, retrospective cohort study. Setting: Public and private hospitals in Western Australia. Participants: Included in this study were 155 646 births to nulliparous women during 1996-2008. Main outcome measures: Caesarean section rates were calculated separately for four patient type groups defined according to mothers' funding source at the time of birth (public/private) and type of delivery hospital ( public/private). The average annual per cent change (AAPC) for the caesarean section rates was calculated using joinpoint regression. Results: Overall, there were 45 903 caesarean sections performed (29%) during the study period, 24 803 in-labour and 21 100 prelabour. Until 2005, the rate of caesarean deliveries increased most rapidly on average annually for private patients delivering in private hospitals (AAPC=6.5%) compared with public patients in public hospitals (AAPC=4.3%, p&lt;0.0001). This increase could mostly be attributed to an increase in prelabour caesarean deliveries for this group of women and could not be explained by an increase in breech deliveries, placenta praevia or multiple pregnancies. Conclusions: Our results indicate that an increase in the prelabour caesarean delivery rate for private patients in private hospitals has been driving the increase in the caesarean section rate for nulliparous women since 1996. Future research with more detailed information on indication for the prelabour caesarean section is needed to understand the reasons for these findings

Effects of home-based prehabilitation on pre and postoperative outcomes following total hip and knee arthroplasty: a systematic review and meta-analysis

AimsThe aim of this study was to determine the effectiveness of home-based prehabilitation on pre and postoperative outcomes in participants awaiting total knee (TKA) and hip arthroplasty (THA).MethodsA systematic review with meta-analysis of randomised controlled trials (RCTs) of prehabilitation interventions for TKA and THA. MEDLINE, CINAHL, ProQuest, Pubmed, Cochrane Library and Google Scholar databases were searched from inception to October 2022. Evidence was assessed by the PEDro scale and the Cochrane risk-of-bias (ROB2) tool. ResultsTwenty-two RCTs (1601 participants) were identified with good overall quality and low risk of bias. Prehabilitation significantly improved pain prior to TKA (mean difference (MD) -1.02: p = 0.00), with non-significant improvements for function before (MD -0.48; p = 0.06) and after TKA (MD -0.69, p = 0.25). Small preoperative improvements were observed for pain (MD -0.02; p = 0.87) and function (MD-0.18; p = 0.16) prior to THA but no post THA effect was found for pain (MD 0.19; p = 0.44) and function (MD 0.14; p= 0.68). A trend favouring usual care for improving quality of life (QoL) prior to TKA (MD 0.61; p = 0.34), but no effect on QoL prior (MD 0.03; p = 0.87) or post THA (MD -0.05; p = 0.83) was found. Prehabilitation significantly reduced hospital length of stay (LOS) for TKA (MD -0.43 days; p < 0.00) but not for THA (MD, -0.24; p = 0.12). Compliance was only reported in 11 studies and was excellent with a mean value of 90.5%.ConclusionsPrehabilitation interventions improve pain and function prior TKA and THA, and reduce hospital LOS, though it is unclear if these effects enhance outcomes postoperatively

Neonatal complications in public and private patients:a retrospective cohort study

OBJECTIVE: To use propensity score methods to create similar groups of women delivering in public and private hospitals and determine any differences in mode of delivery and neonatal outcomes between the matched groups. DESIGN: Population-based, retrospective cohort study. SETTING: Public and private hospitals in Western Australia. PARTICIPANTS: Included were 93 802 public and 66 479 private singleton, term deliveries during 1998-2008, from which 32 757 public patients were matched with 32 757 private patients on the propensity score of maternal characteristics. MAIN OUTCOME MEASURES: Neonatal outcomes were compared in the propensity score-matched cohorts using conditional logistic regression, adjusted for antenatal risk factors and mode of delivery. Outcomes included Apgar score <7 at 5 min, neonatal resuscitation (endotracheal intubation or external cardiac massage) and admission to a neonatal special care unit. RESULTS: No significant differences in maternal characteristics were found between the propensity score-matched groups. Private patients were more likely than their matched public counterparts to undergo prelabour caesarean section (25.2% vs 18%, p<0.0001). Public patients had lower rates of neonatal unit admission (AOR 0.67, 95% CI 0.62 to 0.73) and neonatal resuscitation (AOR 0.73, 95% CI 0.56 to 0.95), but higher rates of low Apgar scores at 5 min (AOR 1.31, 95% CI 1.06 to 1.63) despite adjustment for antenatal factors. Additional adjustment for mode of delivery reduced the resuscitation risk (AOR 0.86, 95% CI  0.63 to 1.18) but did not significantly alter the other estimates. CONCLUSIONS: Propensity score methods can be used to generate comparable groups of public and private patients. Despite the rates of low Apgar scores being higher in public patients, the rates of special care admission were lower. Whether these findings stem from differences in paediatric services or clinical factors is yet to be determined

Endemic persistence of a highly contagious pathogen : foot-and-mouth disease in its wildlife host

Extremely contagious pathogens are a global biosecurity threat because of their high burden of morbidity and mortality, as well as their capacity for fast-moving epidemics that are difficult to quell. Understanding the mechanisms enabling persistence of highly transmissible pathogens in host populations is thus a central problem in disease ecology. Through a combination of experimental and theoretical approaches, we investigated how highly contagious foot-and-mouth disease viruses persist in the African buffalo, which serves as their wildlife reservoir. We found that viral persistence through transmission among acutely infected hosts alone is unlikely. However, the inclusion of occasional transmission from persistently infected carriers reliably rescues the most infectious viral strain from fade-out. Additional mechanisms such as antigenic shift, loss of immunity, or spillover among host populations may be required for persistence of less transmissible strains.DATA AND MATERIALS AVAILABLITY : Code for our parameter analyses and model simulations are available on Github (https://github.com/SimonGubbins/FMDVInBuffalo/tree/1.0.0 and https://github.com/janmedlock/FMDV/tree/Science_publication) and archived at ZenodoSUPPLEMENTARY MATERIAL 1 : Materials and Methods; Supplementary Text S1 to S6; Figs. S1 to S13; Tables S1 to S7; References (54–83).SUPPLEMENTARY MATERIAL 2 : MDAR Reproducibility Checklist.USDA-NIFA AFRI and by the UK Biotechnology and Biological Sciences Research Council.http://www.sciencemag.orghj2022Microbiology and Plant PathologyVeterinary Tropical Disease

Comparison of outcomes following a cytological or histological diagnosis of malignant mesothelioma

Background: Survival with the epithelioid subtype of malignant mesothelioma (MM) is longer than the biphasic or sarcomatoid subtypes. There is concern that cytology-diagnosed epithelioid MM may underdiagnose the biphasic subtype. This study examines survival differences between patients with epithelioid MM diagnosed by cytology only and other subtypes diagnosed by histology. Methods: Demographics, diagnosis method, MM subtype and survival were extracted from the Western Australia (WA) Mesothelioma Registry, which records details of all MM cases occurring in WA. Results: A total of 2024 MM cases were identified over 42 years. One thousand seven hundred forty-four (86.2%) were male, median (IQR) age was 68.6 (60.4–77.0) years. A total of 1212 (59.9%) cases were identified as epithelioid subtype of which 499 (41.2%) were diagnosed using fluid cytology only. Those with a cytology-only diagnosis were older than the histology group (median 70.2 vs 67.6 years, P<0.001), but median survival was similar (cytology 10.6 (5.5–19.2) vs histology 11.1 (4.8–19.8) months, P=0.727) and Cox regression modelling adjusting for age, sex, site and time since first exposure showed no difference in survival between the different diagnostic approaches. Conclusions: Survival of cytologically and histologically diagnosed epithelioid MM cases does not differ. A diagnostic tap should be considered adequate to diagnose epithelioid MM without need for further invasive testing

Interpregnancy intervals and adverse birth outcomes in high-income countries: An international cohort study.

BACKGROUND: Most evidence for interpregnancy interval (IPI) and adverse birth outcomes come from studies that are prone to incomplete control for confounders that vary between women. Comparing pregnancies to the same women can address this issue. METHODS: We conducted an international longitudinal cohort study of 5,521,211 births to 3,849,193 women from Australia (1980-2016), Finland (1987-2017), Norway (1980-2016) and the United States (California) (1991-2012). IPI was calculated based on the time difference between two dates-the date of birth of the first pregnancy and the date of conception of the next (index) pregnancy. We estimated associations between IPI and preterm birth (PTB), spontaneous PTB, and small-for-gestational age births (SGA) using logistic regression (between-women analyses). We also used conditional logistic regression comparing IPIs and birth outcomes in the same women (within-women analyses). Random effects meta-analysis was used to calculate pooled adjusted odds ratios (aOR). RESULTS: Compared to an IPI of 18-23 months, there was insufficient evidence for an association between IPI 24 month IPIs. CONCLUSIONS: We found consistently elevated odds of adverse birth outcomes following long IPIs. IPI shorter than 6 months were associated with elevated risk of spontaneous PTB, but there was insufficient evidence for increased risk of other adverse birth outcomes. Current recommendations of waiting at least 24 months to conceive after a previous pregnancy, may be unnecessarily long in high-income countries

The CDKL5 disorder is an independent clinical entity associated with early-onset encephalopathy

The clinical understanding of the CDKL5 disorder remains limited, with most information being derived from small patient groups seen at individual centres. This study uses a large international data collection to describe the clinical profile of the CDKL5 disorder and compare with Rett syndrome (RTT). Information on individuals with cyclin-dependent kinase-like 5 (CDKL5) mutations (n=86) and females with MECP2 mutations (n=920) was sourced from the InterRett database. Available photographs of CDKL5 patients were examined for dysmorphic features. The proportion of CDKL5 patients meeting the recent Neul criteria for atypical RTT was determined. Logistic regression and time-to-event analyses were used to compare the occurrence of Rett-like features in those with MECP2 and CDKL5 mutations. Most individuals with CDKL5 mutations had severe developmental delay from birth, seizure onset before the age of 3 months and similar non-dysmorphic features. Less than one-quarter met the criteria for early-onset seizure variant RTT. Seizures and sleep disturbances were more common than in those with MECP2 mutations whereas features of regression and spinal curvature were less common. The CDKL5 disorder presents with a distinct clinical profile and a subtle facial, limb and hand phenotype that may assist in differentiation from other early-onset encephalopathies. Although mutations in the CDKL5 gene have been described in association with the early-onset variant of RTT, in our study the majority did not meet these criteria. Therefore, the CDKL5 disorder should be considered separate to RTT, rather than another variant