Development of food photographs for use with children aged 18 months to 16 years:comparison against weighed food diaries – The Young Person’s Food Atlas (UK)

Traditional dietary assessment methods, used in the UK, such as weighed food diaries impose a large participant burden, often resulting in difficulty recruiting representative samples and underreporting of energy intakes. One approach to reducing the burden placed on the participant is to use portion size assessment tools to obtain an estimate of the amount of food consumed, removing the need to weigh all foods. An age range specific food atlas was developed for use in assessing children’s dietary intakes. The foods selected and portion sizes depicted were derived from intakes recorded during the UK National Diet and Nutrition Surveys of children aged 1.5 to 16 years. Estimates of food portion sizes using the food atlas were compared against 4-day weighed intakes along with in-school / nursery observations, by the research team. Interviews were conducted with parents the day after completion of the diary, and for children aged 4 to 16 years, also with the child. Mean estimates of portion size consumed were within 7% of the weight of food recorded in the weighed food diary. The limits of agreement were wide indicating high variability of estimates at the individual level but the precision increased with increasing age. For children 11 years and over, agreement with weighed food diaries, was as good as that of their parents in terms of total weight of food consumed and of intake of energy and key nutrients. The age appropriate food photographs offer an alternative to weighed intakes for dietary assessment with children

Barriers and facilitators to participating in cardiac rehabilitation and physical activity in a remote and rural population: A cross-sectional survey

Background: Cardiac disease requires ongoing active management which may include attendance at formal cardiac rehabilitation (CR) and increased physical activity (PA). However, uptake rates are sub-optimal. This study aimed to identify factors associated with attendance at CR and PA in a rural Scottish population.Methods: A cross-sectional postal survey assessing factors potentially associated with attending CR and participating in PA. Data were also collected from hospital electronic medical records. Binary logistic and ordinal regressions were used to identify barriers and facilitators to participation.Results: The cohort consisted of 840 participants referred to the CR department of a regional Scottish hospital. After applying the inclusion/exclusion criteria, 567 patients were sent a questionnaire. The number of returned questionnaires was 295 (52.0%). Responders were predominantly male (75.9%), with a mean age of 68.7 years. At the multivariate level, the only factor associated with CR attendance was a lack of perceived need (odds ratio [OR] 0.02, 95% confidence interval [CI] 0.01–0.06). Analyses of PA associations identified self-efficacy as the only significant facilitator (OR 1.29, 95% CI 1.05–1.59), and a lack of willpower as the only barrier (OR 0.42, 95% CI 0.18–0.97). Other factors were linked to CR attendance and PA at a univariate level only.Conclusions: This study characterised CR and PA participation, and explored demographic, medical, and psychological factors associated with both activities — with the most important being perceived need, self-efficacy and willpower. These findings may be beneficial in clinical practice by targeting these factors to increase CR attendance and PA levels

Barriers and facilitators to participating in cardiac rehabilitation and physical activity in a remote and rural population : A cross-sectional survey

The authors are grateful to the staff of the Research, Development and Innovation offices, who assisted in the distribution and collection of questionnaires, and the Cardiac Rehabilitation staff. The authors would like to thank all patients involved in this study. Funding: DC was funded by Highlands and Islands Enterprise (project number HMS 9353763)Peer reviewedPublisher PD

Predictors of unfavourable treatment outcome in patients diagnosed with drug-resistant tuberculosis in the Torres Strait / Papua New Guinea border region

Drug-resistant tuberculosis (DR-TB) is an ongoing challenge in the Torres Strait Islands (TSI) / Papua New Guinea (PNG) border region. Treatment success rates have historically been poor for patients diagnosed with DR-TB, leading to increased transmission. This study aimed to identify variables associated with unfavourable outcome in patients diagnosed with DR-TB to inform programmatic improvements. A retrospective study of all DR-TB cases who presented to Australian health facilities in the Torres Strait between 1 March 2000 and 31 March 2020 was performed. This time period covers four distinct TB programmatic approaches which reflect Australian and Queensland Government decisions on TB management in this remote region. Univariate and multivariate predictors of unfavourable outcome were analysed. Unfavourable outcome was defined as lost to follow up, treatment failure and death. Successful outcome was defined as cure and treatment completion. In total, 133 patients with resistance to at least one TB drug were identified. The vast majority (123/133; 92%) of DR-TB patients had pulmonary involvement; and of these, 41% (50/123) had both pulmonary and extrapulmonary TB. Unfavourable outcomes were observed in 29% (39/133) of patients. Patients living with human immunodeficiency virus, renal disease or diabetes (4/133; 4/133; 3/133) had an increased frequency of unfavourable outcome (p <0.05), but the numbers were small. Among all 133 DR-TB patients, 41% had a low lymphocyte count, which was significantly associated with unfavourable outcome (p <0.05). We noted a 50% increase in successful outcomes achieved in the 2016–2020 programmatic period, compared to earlier periods (OR 5.3, 95% Confidence Interval [1.3, 20.4]). Being a close contact of a known TB case was associated with improved outcome. While DR-TB treatment outcomes have improved over time, enhanced surveillance for DR-TB, better cross border collaboration and consistent diagnosis and management of comorbidities and other risk factors should further improve patient care and outcomes

Critical Consideration of Tuberculosis Management of Papua New Guinea Nationals and Cross-Border Health Issues in the Remote Torres Strait Islands, Australia

The international border between Australia and Papua New Guinea (PNG) serves as a gateway for the delivery of primary and tertiary healthcare for PNG patients presenting to Australian health facilities with presumptive tuberculosis (TB). An audit of all PNG nationals with presumptive TB who presented to clinics in the Torres Strait between 2016 and 2019 was conducted to evaluate outcomes for PNG patients and to consider the consistency and equity of decision-making regarding aeromedical evacuation. We also reviewed the current aeromedical retrieval policy and the outcomes of patients referred back to Daru General Hospital in PNG. During the study period, 213 PNG nationals presented with presumptive TB to primary health centres (PHC) in the Torres Strait. In total, 44 (21%) patients were medically evacuated to Australian hospitals; 26 met the evacuation criteria of whom 3 died, and 18 did not meet the criteria of whom 1 died. A further 22 patients who met the medical evacuation criteria into Australia were referred to Daru General Hospital of whom 2 died and 10 were lost to follow-up. The cross-border movement of people from PNG into Australia is associated with an emergent duty of care. Ongoing monitoring and evaluation of patient outcomes are necessary for transparency and justice

Development of a regional glycerol dialkyl glycerol tetraether (GDGT)-temperature calibration for Antarctic and sub-Antarctic lakes

A regional network of quantitative reconstructions of past climate variability is required to test climate models. In recent studies, temperature calibration models based on the relative abundances of sedimentary glycerol dialkyl glycerol tetraethers (GDGTs) have enabled past temperature reconstructions in both marine and terrestrial environments. Nevertheless, to date these methods have not been widely applied in high latitude environments due to poor performance of the GDGT–temperature calibrations at lower temperatures. To address this we studied 32 lakes from Antarctica, the sub-Antarctic Islands and Southern Chile to: 1) quantify their GDGT composition and investigate the environmental controls on GDGT composition; and 2) develop a GDGT–temperature calibration model for inferring past temperatures from Antarctic and sub-Antarctic lakes. GDGTs were found in all 32 lakes studied and in 31 lakes branched GDGTs (brGDGTs) were the dominant compounds. Statistical analyses of brGDGT composition in relation to temperature, pH, conductivity and water depth showed that the composition of brGDGTs is strongly correlated with mean summer air temperature (MSAT). This enabled the development of the first regional brGDGT–temperature calibration for use in Antarctic and sub-Antarctic lakes using four brGDGT compounds (GDGT-Ib, GDGT-II, GDGT-III and GDGT-IIIb). A key discovery was that GDGT-IIIb is of particular importance in cold lacustrine environments. The addition of this compound significantly improved the model's performance from r2=0.67r2=0.67, RMSEP-LOO (leave-one-out) = 2.23 °C, RMSEP-H (h-block) = 2.37 °C when applying the re-calibrated global GDGT–temperature calibration to our Antarctic dataset to r2=0.83r2=0.83, RMSEP-LOO = 1.68 °C, RMSEP-H = 1.65 °C for our new Antarctic calibration. This shows that Antarctic and sub-Antarctic, and possibly other high latitude, palaeotemperature reconstructions should be based on a regional GDGT–temperature calibration where specific compounds can be identified and included to improve model performance. Finally, downcore temperature reconstructions using the new Antarctic brGDGT–temperature calibration were tested in sub-Antarctic Fan Lake from South Georgia providing a proof of concept for the new calibration model in the Southern Hemisphere

The prevalence of headache disorders in Postural Tachycardia Syndrome: A systematic review and meta-analysis of the literature

BACKGROUND: Headache is a common presentation of postural tachycardia syndrome, yet robust prevalence data is lacking. OBJECTIVES: To undertake a systematic review and meta-analysis to estimate the prevalence of headache disorders in postural tachycardia syndrome, and to explore the potential shared pathophysiological mechanisms that underpin these conditions as well as treatment options. METHODS: Three databases were searched for publications evaluating prevalence of migraine (primary outcome) and general and orthostatic headache (secondary outcomes) in patients with postural tachycardia syndrome. Two independent reviewers selected studies and extracted data. A random-effects meta-analysis calculated the pooled prevalence of migraine in postural tachycardia syndrome. A narrative literature review explored the pathophysiology and treatment options for concurrent headache disorders and postural tachycardia syndrome. RESULTS: Twenty-three articles met inclusion criteria. Estimated pooled prevalence of migraine in postural tachycardia syndrome was 36.8% (95% CI 2.9-70.7%). Various shared pathophysiological pathways for these conditions, as well as proposed treatment strategies, were identified.Limitations: Heterogeneity of study design, populations, and methodology for identifying headache disorders and postural tachycardia syndrome limited the generalisability of results. CONCLUSIONS: Migraine is a commonly reported comorbidity in POTS, however the true prevalence cannot be determined from the current literature. Further studies are required to assess this comorbidity and investigate the underlying mechanisms, as well as identify effective treatment strategies

Autonomic symptoms in migraine: Results of a prospective longitudinal study

OBJECTIVES: To assess the prevalence and burden of autonomic symptoms in migraine, and determine the relationship with migraine frequency. BACKGROUND: Autonomic symptoms in migraine have been theorized to occur in the setting of inter-ictal sympathetic hypoactivity and hyper-sensitivity. There is limited data prospectively assessing cranial and extra-cranial autonomic symptoms with a validated instrument, or longitudinal data on the relationship between migraine disease activity and autonomic symptoms. METHODS: Patients attending a single tertiary academic center were recruited into a prospective cohort study between September 2020 and June 2022. In addition to standard clinical care, they completed several surveys including the Composite Autonomic Symptom Scale (COMPASS-31) questionnaire, a validated survey of autonomic symptoms. RESULTS: A total of 43 patients (66.7% female, median age 42, IQR 17) were included in the final analysis. There was a baseline 20 monthly headache days (MHD) (IQR 21.7), and 65.1% of the population had chronic migraine by ICHD-3 criteria. A significantly elevated weighted COMPASS-31 score was reported in 60.5% of respondents (mean 30.3, SD 13.3) at baseline. After 12 months treatment, significant improvements were reported in migraine frequency (median MHD 20–8.7) and disability (median Migraine Disability Assessment Score 67–48), but not in autonomic symptoms (mean score 30.3, SD 11.2). CONCLUSIONS: Autonomic symptoms were frequently reported in patients with migraine. However, they did not correlate with headache frequency or reversion to episodic frequency. Further study is required to elucidate specific approaches and treatments for autonomic symptoms, and further evaluate the underlying pathophysiological mechanisms

The identification of Staphylococcus aureus factors required for pathogenicity and growth in human blood

Staphylococcus aureus is a human commensal but also has devastating potential as an opportunist pathogen. S. aureus bacteraemia is often associated with an adverse outcome. To identify potential targets for novel control approaches we have identified S. aureus components that are required for growth on human blood. An ordered transposon mutant library was screened, identifying 9 genes involved specifically in haemolysis or growth on human blood agar compared to the parental strain. Three genes (purA, purB and pabA) were subsequently found to be required for pathogenesis in the zebrafish embryo infection model. The pabA growth defect was specific to the red blood cell component of human blood, showing no growth difference compared to the parental strain on human serum, human plasma, sheep or horse blood. PabA is required in the tetrahydrofolate (THF) biosynthesis pathway. The pabA growth defect was found to be due to a combination of loss of THF-dependent dTMP production by the enzyme ThyA and an increased demand for pyrimidines in human blood. Our work highlights pabA and the pyrimidine salvage pathway as potential targets for novel therapeutics and suggests a previously undefined role for a human blood factor in the activity of sulphonamide antibiotics