Low sodium haemodialysis reduces interdialytic fluid consumption but paradoxically increases post-dialysis thirst

Background Interdialytic weight gain (IDWG) can be reduced by lowering the dialysate sodium concentration ([Na]) in haemodialysis patients. It has been assumed that this is because thirst is reduced, although this has been difficult to prove. We compared thirst patterns in stable haemodialysis patients with high and low IDWG using a novel technique and compared the effect of low sodium dialysis (LSD) with normal sodium dialysis (NSD). Methods Eight patients with initial high IDWG and seven with low IDWG completed hourly visual analogue ratings of thirst using a modified palmtop computer during the dialysis day and the interdialytic day. The dialysate [Na] was progressively reduced by up to 5 mmol/l over five treatments. Dialysis continued at the lowest attained [Na] for 2 weeks and the measurements were repeated. The dialysate [Na] then returned to baseline and the process was repeated. Results Baseline interdialytic day mean thirst was higher than the dialysis day mean for the high IDWG group (49.9±14.0 vs 36.2±16.6) and higher than the low weight gain group (49.9±14.0 vs 34.1±14.6). This trend persisted on LSD, but there was a pronounced increase in post-dialysis thirst scores for both groups (high IDWG: 46±13 vs 30±21; low IDWG: 48±24 vs 33±18). The high IDWG group demonstrated lower IDWG during LSD than NSD (2.23±0.98 vs 2.86±0.38 kg; P<0.05). Conclusions Our results indicate that patients with high IDWG experience more intense feelings of thirst on the interdialytic day. LSD reduces their IDWG, but paradoxically increases thirst in the immediate post-dialysis period

The Home Environment Interview and associations with energy balance behaviours and body weight in school-aged children - a feasibility, reliability, and validity study.

BACKGROUND: The home environment is thought to influence children's weight trajectories. However, few studies utilise composite measures of the home environment to examine associations with energy balance behaviours and weight. The present study aimed to adapt and update a comprehensive measure of the obesogenic home environment previously developed for pre-schoolers, and explore associations with school-aged children's energy balance behaviours and weight. METHODS: Families from the Gemini cohort (n = 149) completed the Home Environment Interview (HEI) via telephone when their children were 12 years old. The HEI comprises four composite scores: one for each domain (food, activity and media) of the environment, as well as a score for the overall obesogenic home environment. The primary caregiver also reported each child's height and weight (using standard scales and height charts), diet, physical activity and sedentary screen-based behaviours. A test-retest sample (n = 20) of caregivers completed the HEI a second time, 7-14 days after the initial interview, to establish test-retest reliability. RESULTS: Children (n = 298) living in 'higher-risk' home environments (a 1 unit increase in the HEI obesogenic risk score) were less likely to consume fruits (OR; 95% CI = 0.40; 0.26-0.61, p < 0.001), and vegetables (0.30; 0.18-0.52, p < 0.001), and more likely to consume energy-dense snack foods (1.71; 1.08-2.69, p = 0.022), convenience foods (2.58; 1.64-4.05, p < 0.001), and fast foods (3.09; 1.90-5.04, p < 0.001). Children living in more obesogenic home environments also engaged in more screen-time (β (SE) = 4.55 (0.78), p < 0.001), spent more time playing video games (β (SE) = 1.56 (0.43), p < 0.001), and were less physically active (OR; 95% CI = 0.57; 0.40-0.80, p < 0.01). Additionally, there was a positive association between higher-risk overall home environment composite score and higher BMI-SDS (β (SE) = 0.23 (0.09), p < 0.01). This finding was mirrored for the home media composite (β (SE) = 0.12 (0.03), p < 0.001). The individual home food and activity composite scores were not associated with BMI-SDS. CONCLUSION: Findings reveal associations between the overall obesogenic home environment and dietary intake, activity levels and screen-based sedentary behaviours, as well as BMI in 12 year olds. These findings suggest that the home environment, and in particular the home media environment, may be an important target for obesity prevention strategies

POVRAT RAVNOTEŽE: LEKCIJE IZ SLUČAJEVA U OKVIRU PILOT-PROJEKTA KOJI FINANCIRA EU U BRITANSKOJ REGIJI THAMES VALLEY, KOJI OMOGUĆUJE RESTORATIVNU PRAVDU NA ZAHTJEV ŽRTVE

This article describes lessons learned from a pilot project that delivers Restorative Justice (RJ) to victims of crime referred by agencies supporting victims and victim self-referrals. The project involves a partnership of agencies in the Thames Valley, working as part of a wider European Collaboration, to extend RJ services to victims at the post-sentencing level. We provide access to RJ for victims, whilst protecting their rights and preventing re-victimisation, in accordance with EU directive 2012/29/EU (European Commission, 2012). The context and methodology of our pilot project are explained. Lessons learned from practice through team case discussion and supervision are then identified and described. The cases are then summarised in a table which outlines their key features and acts as a point of reference in relation to the lessons learned. Cases are ongoing at the time of writing. The lessons may not always be clear cut and finalised. We hope that this approach will demonstrate the process of learning from experience and practice as the project develops. Whilst ours is not a rigorously scientific approach, we hope it offers readers a chance to understand the dilemmas and issues presented by a model which starts from a victim’s request for RJ. The authors are the project manager and the RJ Facilitators involved in delivering the service. Independent evaluation, involving interviews with victims, referrers and offenders who have participated in the pilot project, follows at a later stage.Ovaj članak opisuje lekcije naučene iz pilot-projekta koji restorativnu pravdu omogućuje žrtvama zločina na koje upućuju agencije za pomoć žrtvama te žrtvama koje se same prijave za takav program. Projekt uključuje partnerstvo agencija u regiji Thames Valley, koje djeluju u sklopu šire europske suradnje, kako bi se usluge restorativne pravde za žrtve proširile na razini nakon izricanja kazne. Žrtvama omogućujemo pristup restorativnoj pravdi, dok štitimo njihova prava i sprečavamo ponovnu viktimizaciju, u skladu s Direktivom 2012/29/EU (Europska komisija 2012.). Objašnjeni su kontekst i metodologija našeg pilot-projekta, a potom su kroz timske rasprave o slučajevima i nadzor identificirane i opisane lekcije naučene iz prakse. Slučajevi su zatim sažeti u tablici koja navodi njihove ključne značajke i djeluje kao referentna točka u vezi s naučenim lekcijama. U vrijeme pisanja članka, slučajevi su u tijeku. Lekcije se ne mogu uvijek jasno definirati i finalizirati. Vjerujemo da će ovaj pristup pokazati proces učenja iz iskustva i prakse kako se projekt bude razvijao. Iako naš pristup nije strogo znanstven, nadamo se da čitateljima nudi priliku da razumiju dileme i pitanja predstavljene modelom koji počinje zahtjevom žrtve za restorativnom pravdom. Autori su voditelj projekta i voditelji restorativne pravde uključeni u izvršavanje usluga. Neovisna procjena, koja uključuje intervjue sa žrtvama, posrednicima i počiniteljima koji su sudjelovali u pilot-projektu, slijedi u kasnijoj fazi

Short term (14 days) consumption of insoluble wheat bran fibre-containing breakfast cereals improves subjective digestive feelings, general wellbeing and bowel function in a dose dependent manner

This study investigated whether increasing insoluble (predominantly wheat bran) fibre over 14 days improves subjective digestive feelings, general wellbeing and bowel function. A single centre, multi-site, open, within subjects design with a 14 day non-intervention (baseline) monitoring period followed by a 14 day fibre consumption (intervention) period was performed. 153 low fibre consumers (<15 g/day AOAC 985.29) completed a daily symptom diary for 14 days after which they consumed one bowl of ready-to-eat breakfast cereal containing at least 5.4 g fibre (3.5 g from wheat bran) for 14 days and completed a daily symptom diary. Significant improvements were demonstrated in subjective perception of bowel function (e.g., ease of defecation) and digestive feelings (bloating, constipation, feeling sluggish and digestive discomfort). Significant improvements were also found in subjective perception of general wellbeing (feeling less fat, more mentally alert, slim, happy and energetic whilst experiencing less stress, mental and physical tiredness, difficulty concentrating and fewer headaches). In general, improvements in study outcomes increased with increasing cereal/fibre consumption. However, consuming an additional minimum 5.4 g of fibre (3.5 g wheat bran) per day was shown to deliver measurable and significant benefits for digestive health, comfort and wellbeing. Encouraging consumption of relatively small amounts of wheat bran could also provide an effective method of increasing overall fibre consumption

Examining techniques for measuring the effects of nutrients on mental performance and mood state

PURPOSE: Intake of specific nutrients has been linked to mental states and various indices of cognitive performance although the effects are often subtle and difficult to interpret. Measurement of so-called objective variables (e.g. reaction times) is often considered to be the gold standard for assessing outcomes in this field of research. It can, however, be argued that data on subjective experience (e.g. mood) are also important and may enrich existing objective data. The aim of this review is to evaluate methods for measuring mental performance and mood, considering the definition of subjective mood and the validity of measures of subjective experience. METHODS: A multi-stakeholder expert group was invited by ILSI Europe to come to a consensus around the utility of objective and subjective measurement in this field, which forms the basis of the paper. Therefore, the present review reflects a succinct overview of the science but is not intended to be a systematic review. RESULTS: The proposed approach extends the traditional methodology using standard 'objective' measurements to also include the consumers' subjective experiences in relation to food. Specific recommendations include 1) using contemporary methods to capture transient mood states; 2) using sufficiently sensitive measures to capture effects of nutritional intervention; 3) considering the possibility that subjective and objective responses will occur over different time frames; and 4) recognition of the importance of expectancy and placebo effects for subjective measures. CONCLUSIONS: The consensus reached was that the most informative approach should involve collection and consideration of both objective and subjective data

Victims in Restorative Justice at Post-sentencing level. A Manual

The content of this manual evolved from the research project ‘Restorative Justice at post-sentencing level; supporting and protecting victims’ carried out by an international European team from Belgium, Croatia, Germany, Portugal, Spain and the United Kingdom. This manual is one of several project publications. The target group of this manual consists of those who are, in the widest sense, related to the work with victims of crime but also those, who are interested in Restorative Justice. This manual describes how victims of crime and therewith offenders and the community can be supported in various different ways. Therefore, the awareness of their needs is central at the outset. Furthermore, it aims to provide understanding of the individual process of coping and may therefore also lead to more self-awareness. If the victim is interested and prepared, it is possible to carry out Restorative Justice procedures in all types of crime and at all levels of seriousness, as long as it fits the person’s needs. The different steps to gain understanding of the situation of a victim and to provide support, as well as to empower in order to deal with what has occurred, are described in this manual. The different phases, before, during and after a restorative process, will be outlined as well as various RJ-procedures, from indirect victim-offendermediation to conferencing and possible techniques to apply during these procedures. That an atmosphere of trust is essential during the whole process appears evident as it is a basic principle of all Restorative Justice procedures. In order to provide better orientation, each sub-section is initiated with a number of key issues, which are then elaborated in a short text and concluded with a precise recommendation for practitioners to apply in the work with victims. More experienced practitioners can use this manual as a book of reference and concentrate on the recommendation whereas those, who have had less contact with victims in their work, can use it as an additional guide. In the final section, some case studies from the project partners England, Schleswig-Holstein, Portugal and Croatia give an exemplary insight into the restorative work carried out, from the victim perspective only

Improving selection of markers in nutrition research: evaluation of the criteria proposed by the ILSI Europe Marker Validation Initiative

The conduct of high-quality nutrition research requires the selection of appropriate markers as outcomes, for example as indicators of food or nutrient intake, nutritional status, health status or disease risk. Such selection requires detailed knowledge of the markers, and consideration of the factors that may influence their measurement, other than the effects of nutritional change. A framework to guide selection of markers within nutrition research studies would be a valuable tool for researchers. A multidisciplinary Expert Group set out to test criteria designed to aid the evaluation of candidate markers for their usefulness in nutrition research and subsequently to develop a scoring system for markers. The proposed criteria were tested using thirteen markers selected from a broad range of nutrition research fields. The result of this testing was a modified list of criteria and a template for evaluating a potential marker against the criteria. Subsequently, a semi-quantitative system for scoring a marker and an associated template were developed. This system will enable the evaluation and comparison of different candidate markers within the same field of nutrition research in order to identify their relative usefulness. The ranking criteria of proven, strong, medium or low are likely to vary according to research setting, research field and the type of tool used to assess the marker and therefore the considerations for scoring need to be determined in a setting-, field- and tool-specific manner. A database of such markers, their interpretation and range of possible values would be valuable to nutrition researchers

Assessment of the quality and content of website health information about herbal remedies for menopausal symptoms

Objective: To assess quality, readability and coverage of website information about herbal remedies for menopausal symptoms. Study design: A purposive sample of commercial and non-commercial websites was assessed for quality (DISCERN), readability (SMOG) and information coverage. Main outcome measures: Non-parametric and parametric tests were used to explain variability of these factors across types of websites and to assess associations between website quality and information coverage. Results: 39 sites were assessed. Median quality and information coverage scores were 44/80 and 11/30 respectively. The median readability score was 18.7, similar to UK broadsheets. Commercial websites scored significantly lower on quality (p=0.014), but there were no statistical differences for information coverage or readability. There was a significant positive correlation between information quality and coverage scores irrespective of website provider (r=0.69, p<0.001, n=39). Conclusion: Overall website quality and information coverage is poor and the required reading level high

A randomised trial of the effect of omega-3 polyunsaturated fatty acid supplements on the human intestinal microbiota

Objective; Omega-3 polyunsaturated fatty acids (PUFAs) have anticolorectal cancer (CRC) activity. The intestinal microbiota has been implicated in colorectal carcinogenesis. Dietary omega-3 PUFAs alter the mouse intestinal microbiome compatible with antineoplastic activity. Therefore, we investigated the effect of omega-3 PUFA supplements on the faecal microbiome in middle-aged, healthy volunteers (n=22). Design A randomised, open-label, cross-over trial of 8 weeks’ treatment with 4 g mixed eicosapentaenoic acid/docosahexaenoic acid in two formulations (soft-gel capsules and Smartfish drinks), separated by a 12-week ‘washout’ period. Faecal samples were collected at five time-points for microbiome analysis by 16S ribosomal RNA PCR and Illumina MiSeq sequencing. Red blood cell (RBC) fatty acid analysis was performed by liquid chromatography tandem mass spectrometry. Results; Both omega-3 PUFA formulations induced similar changes in RBC fatty acid content, except that drinks were associated with a larger, and more prolonged, decrease in omega-6 PUFA arachidonic acid than the capsule intervention (p=0.02). There were no significant changes in α or β diversity, or phyla composition, associated with omega-3 PUFA supplementation. However, a reversible increased abundance of several genera, including Bifidobacterium, Roseburia and Lactobacillus was observed with one or both omega-3 PUFA interventions. Microbiome changes did not correlate with RBC omega-3 PUFA incorporation or development of omega-3 PUFA-induced diarrhoea. There were no treatment order effects. Conclusion; Omega-3 PUFA supplementation induces a reversible increase in several short-chain fatty acid-producing bacteria, independently of the method of administration. There is no simple relationship between the intestinal microbiome and systemic omega-3 PUFA exposure. Trial registration number; ISRCTN18662143

The relationship between obesity and cognitive health and decline

The relationship between obesity and cognitive impairment is important given the globally ageing population in whom cognitive decline and neurodegenerative disorders will carry grave individual, societal and financial burdens. This review examines the evidence for the link between obesity and cognitive function in terms of both the immediate effects on cognitive performance, and effects on the trajectory of cognitive ageing and likelihood of dementia. In mid-life, there is a strong association between obesity and impaired cognitive function. Anthropometric measures of obesity are also associated with reduced neural integrity (e.g. grey and white matter atrophy). Increasing age coupled with the negative metabolic consequences of obesity (e.g. type 2 diabetes mellitus) are likely to significantly contribute to cognitive decline and incidence of dementia. Stress is identified as a potential risk factor promoting abdominal obesity and contributing to impaired cognitive function. However, the potentially protective effects of obesity against cognitive decline in older age require further examination. Finally, surgical and whole diet interventions, which address obesity may improve cognitive capacity and confer some protection against later cognitive decline. In conclusion, obesity and its comorbidities are associated with impaired cognitive performance, accelerated cognitive decline and neurodegenerative pathologies such as dementia in later life. Interventions targeting mid-life obesity may prove beneficial in reducing the cognitive risks associated with obesity