Health care a casualty in Kenyan crisis

We present an interesting case of recurrent dystonic crises in dopa-responsive dystonia (DRD) likely induced by excessive consumption of aspartame-containing products, in particular sugar-free energy drinks. This has a strong...

The low FODMAPs (fermentable oligo-, di-, monosaccharides, and polyols) diet improves lower gastrointestinal symptoms. Patients suffering from proton pump inhibitor (PPI) refractory gastroesophageal reflux disease (GERD) have limited treatment options. We investigated the efficacy of a low FODMAPs diet in patients with PPI refractory GERD. This multicenter, randomized, open-label study compared the efficacy of a 4-week low FODMAPs diet and usual dietary advice (ie, low-fat diet and head of bed elevation) in patients with symptomatic PPI refractory GERD, defined by a Reflux Disease Questionnaire (RDQ) score >3 and abnormal pH-impedance monitoring on PPIs. The primary endpoint was the percentage of responders (RDQ ≤3) at the end of the diet. Thirty-one patients (55% women, median age 45years) were included, 16 randomized in the low FODMAPs diet group and 15 in the usual dietary advice group. Adherence to the assigned diet was good, with a significant difference in the FODMAPs intake per day between the low FODMAPs diet (2.5g) and the usual dietary advice group (13g) (p<0.001). There was no difference in response rates (RDQ score ≤3) between the low FODMAPs diet (6/16, 37.5%) and usual dietary advice (3/15, 20%) groups (p=0.43). Total RDQ score and dyspepsia subscore decreased significantly over time in both groups (p=0.002), with no difference according to the assigned diet group (p=0.85). Low FODMAPs diet and usual dietary advice have similar but limited beneficial effects on symptoms in patients with PPI refractory GERD.

Recently it was shown that single nucleotide polymorphisms (SNPs) can explain individual variation because of the small changes of the gene expression level and that the 50% decreased expression of an allele might even lead to predisposition to cancer. In this study, we found that a decreased expression of an allele might cause predisposition to genetic disease. Dopa responsive dystonia (DRD) is a dominant disease caused by mutations in GCH1 gene. The sequence analysis of the GCH1 in a patient with typical DRD symptoms revealed two novel missense mutations instead of a single dominant mutation. Family members with either of the mutations did not have any symptoms of DRD. The expression level of a R198W mutant allele decreased to about 50%, suggesting that modestly decreased expression caused by an SNP should lead to predisposition of a genetic disease in susceptible individuals.

The emergence of influencers and extravagant use of social networking sites for various reasons has started shaping life. ‘Linktree – the 2022 creator report’ states 4.62 billion users of the social media, its multiplying drastically each year; if we see percentage wise it is highest in India. As there is no check post during content creation and posting it online loads of unverified information is available online. Objective: This study aims to determine the dependency and aptitude of dental and paramedical youth for their own health care be it physical, mental, dietary, dental and medical advice. Methods: This study assessed the Time of usage of internet, the platform they visit to seek preliminary advice, and their ability to distinguish between factual and or mythical content online. Result: The research found that although the participants perceived of negative impact of usage of social media and the study found out that there are high chances of encountering mythical content online if it was their only source of seeking advice. Study also found that participants have reversed few habits after debunking myths when they consulted a professional. Conclusion: Although factual information may be available which may be helpful, online use of social media platforms for health may be a double edged sword. Keywords: Social Media, Dietary Advice, Health Advice

Large trials assessing oral nutritional supplements (ONS) and dietary advice (DA) in primary care are lacking. This study examined effects of ONS + DA versus DA on intake, weight, QoL, healthcare use and satisfaction in malnourished free-living older people. Three hundred and eight people (71.5 ± 10.7y) were randomised to receive ONS + DA (n154) or DA (n154) for 12 weeks. At baseline, 4, 8, 12 weeks, intake, weight, QoL, healthcare use and satisfaction were measured. ONS + DA group (mean daily intake ONS 480 kcal; 21 g protein; 80% compliance) had significantly greater total energy and protein intakes (+401 kcal/d, p < 0.001; +15 g/d, p < 0.001) and weight gain (+0.8 kg; p < 0.001) compared to DA. QoL improved in both groups over time with a significant improvement in index with ONS + DA (p = 0.009). Significantly more participants found ONS + DA made a difference for them (p = 0.011), but no differences were found between groups using Euroqol. Compared to DA, healthcare use reduced with ONS + DA, (HCP visits by 34%, emergency admissions 50%, LOS 62%). Acceptability of both interventions was high (ONS 96%, DA 95%), with significantly more participants satisfied with ONS (89%) than DA (73%) (p = 0.009). This trial in primary care indicates that ONS are acceptable, make a difference to patients, significantly improve intake and weight, and reduce health care use with potential savings.

A comprehensive review of the literature examined discharge from inpatient psychiatric settings against medical advice (excluding elopements) over the past 50 years. Specifically, definitions, prevalence, predictors, temporal patterns, consequences, and interventions pertaining to such discharge were explored. The authors searched the PubMed and PsycINFO databases and selected articles for review if studies had been conducted in an inpatient setting or included discharge against medical advice as one of the aims or results and if findings were based on formal statistical analyses. Sixty-one articles met the selection criteria. Prevalence of discharge against medical advice ranged from 3 to 51 percent and increased over time. Discharge against medical advice was most commonly predicted by patient factors, such as young age; single marital status; male gender; comorbid diagnosis of personality or substance use disorders; pessimistic attitudes toward treatment; antisocial, aggressive, or disruptive behavior; and history of numerous hospitalizations ending in discharges against medical advice. It was also predicted by provider variables, such as failure to orient patients to hospitalization and failure to establish a supportive provider-patient relationship, and by temporal variables, such as evening and night shifts. Outcomes of patients discharged against medical advice were characterized by poor outcomes in several domains of functioning and more frequent rehospitalizations. Prediction of patients at risk of discharge against medical advice is possible with several defined variables. Awareness of the factors involved in discharge against medical advice should facilitate clinical decision making and the development of successful interventions for high-risk patients.

Introduction: Diabetes is a global health problem. Dietary factors are important and potentially modifiable risk factors, to prevent and control of diabetes. One of these diets is the dietary approaches to stop hypertension (DASH) diet which may be influenced by risk factors for type 2 diabetes. Objectives: The main aim of this study was to investigate the effects of DASH diet versus usual dietary advice (UDA) on glycemic indices.Patients and Methods: In this randomized controlled clinical trial 44 healthy obese and overweight women were randomly assigned to the DASH diet or the UDA for 12 weeks. The fasting blood sugar (FBS), serum fasting insulin (FINS) level, and homeostasis model of insulin resistance (HOMA-IR) were measured at the first and end of the study. Results: There were no significant differences in any glycemic indices between two groups, however, FBS reduced in both DASH and UDA groups. Additionally, HOMA-IR and fasting concentration of insulin increased in UDA group. Conclusion: There was not the difference between recommendations to follow DASH dietary pattern or UDA in glycemic control.

There is increasing experimental evidence for beneficial effects of calorie restriction and intermittent fasting in type 2 diabetes mellitus (T2DM). In humans, prolonged fasting is established as a health-promoting complementary treatment in Europe and claimed to improve metabolism by a complex hormetic response. We aimed to investigate effects of a one-week fasting period compared to usual care in T2DM by means of a pilot trial. Patients with manifest T2DM medically treated with oral hypoglycemic agents and/or insulin were randomly assigned to a 7-day fasting program followed by dietary advice or to usual care and dietary advice only. Fasting was performed according to the method of Buchinger with a nutritional energy intake of 300kcal/day by liquids only and stepwise re-introduction of solid food thereafter. Outcomes were assessed baseline and after 4 months. Of 46 enrolled participants, 32 (n=16 each group) completed the trial and were included for final analyses. Fasting was well accepted, there were no serious adverse events. After 4 months mean weight decreased by 3.5 kg and 2.0 kg in the fasting vs. control group (p=0.03) paralleled by greater reduction of abdominal circumference (p=0.001). Fasting led to a significant decrease of systolic/diastolic blood pressure (p=0.01; p=0.003) and increased quality-of-life (p=0.04), while for HbA1c, insulin and HOMA-index only non-significant improvements were observed. Results of this study suggest that prolonged fasting is feasible and might have beneficial clinical effects. The effectiveness of fasting should be proved in larger confirmatory trials that include intermittent fasting in follow-ups to enable more pronounced and long-term effects.

BACKGROUNDPeroxisome proliferator-activated receptor gamma (PPAR-γ) which controls body weight, glucose homeostasis, and adipocyte differentiation is a valuable candidate gene for insulin resistance (IR). The present study aimed to compare the effects of the Dietary Approaches to Stop Hypertension (DASH) diet and usual dietary advice (UDA) on PPAR-γ gene expression in women at risk for cardiovascular disease (CVD).METHODSThis randomized controlled trial was performed on 44 women aged 20-50 years at risk for CVD (BMI > 25 kg/m2 and low physical activity). Participants were randomly assigned to the UDA (n = 22) or DASH (n = 22) diets for 12 weeks. The DASH diet was rich in fruits, vegetables, whole grains and low-fat dairy products and low in saturated fat, total fat, cholesterol, refined grains and sweets, with a total of 2400 mg/day sodium. The UDA diet was a regular diet with healthy dietary advice. Anthropometric indices and PPAR-γ gene expression were measured and compared between the two groups at the end of the study.RESULTSAfter the intervention, body mass index (BMI) and waist circumference (WC) significantly decreased in the DASH group (P < 0.050) but the results showed no significant differences between the two groups. At the end of the trial, PPAR-γ gene expression was significantly different between the UDA and the DASH diet groups (P = 0.040) and this difference remained significant after adjustment for BMI, and physical activity (P = 0.030).CONCLUSIONThe result of the study showed that the DASH diet significantly decreased the expression of PPAR-γ. This finding was unexpected and future studies on the current topic are therefore recommended.

BackgroundDiabetes has reached epidemic proportions in the United States, particularly among minorities, and if improperly managed can lead to medical complications and death. Healthcare providers play vital roles in communicating standards of care, which include guidance on diabetes self-management. The background of the client may play a role in the patient-provider communication process. The aim of this study was to determine the association between medical advice and diabetes self care management behaviors for a nationally representative sample of adults with diabetes. Moreover, we sought to establish whether or not race/ethnicity was a modifier for reported medical advice received and diabetes self-management behaviors.MethodsWe analyzed data from 654 adults aged 21 years and over with diagnosed diabetes [130 Mexican-Americans; 224 Black non-Hispanics; and, 300 White non-Hispanics] and an additional 161 with 'undiagnosed diabetes' [N = 815(171 MA, 281 BNH and 364 WNH)] who participated in the National Health and Nutrition Examination Survey (NHANES) 2007-2008. Logistic regression models were used to evaluate whether medical advice to engage in particular self-management behaviors (reduce fat or calories, increase physical activity or exercise, and control or lose weight) predicted actually engaging in the particular behavior and whether the impact of medical advice on engaging in the behavior differed by race/ethnicity. Additional analyses examined whether these relationships were maintained when other factors potentially related to engaging in diabetes self management such as participants' diabetes education, sociodemographics and physical characteristics were controlled. Sample weights were used to account for the complex sample design.ResultsAlthough medical advice to the patient is considered a standard of care for diabetes, approximately one-third of the sample reported not receiving dietary, weight management, or physical activity self-management advice. Participants who reported being given medical advice for each specific diabetes self-management behaviors were 4-8 times more likely to report performing the corresponding behaviors, independent of race. These results supported the ecological model with certain caveats.ConclusionsProviding standard medical advice appears to lead to diabetes self-management behaviors as reported by adults across the United States. Moreover, it does not appear that race/ethnicity influenced reporting performance of the standard diabetes self-management behavior. Longitudinal studies evaluating patient-provider communication, medical advice and diabetes self-management behaviors are needed to clarify our findings.

The present work aimed to analyze, through the GlutenFreeDiet digital platform, the evolution over one year of the nutritional status, dietary profile and symptoms present among celiac people on a gluten-free diet (GFD) while receiving individualized dietary advice. Twenty-seven adults and thirty-one celiac children/adolescents participated in the study. This was then followed up by three visits, at diagnosis, and after 3 and 12 months (vt0, vt3 and vt12). Participants filled out dietary and gastrointestinal symptoms questionnaires. All patients received written personalized dietary advice from dietitians who interpreted data from the platform. Results obtained indicated that participants consumed proteins and lipids in excess and carbohydrates in defect. Low intakes of cereals, fruit and vegetables and high meat intakes were observed. However, gluten-free product (GFP) consumption and that of ultra-processed foods was reduced after 1 year in adults. Symptoms decreased after vt3 but recurred in vt12. Changes in ultra-processed foods and GFP intake, but lack of changes in the rest of the parameters suggested that the platform support was not effective enough. Even though the platform represents a useful tool for monitoring celiac patients and giving dietary advice, modules that require more continuous attention and nutritional education of patients should be provided for interventions to be more effective.

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Navratri is one of the most common religious fasts observed among Hindus. A large number of people with diabetes follow Navratris fast irrespective of its health implications, often without proper education and medical advice. The quest for the scientific research on dietary advices for Hindu fasts including Navratris shows paucity of literature comparative to the dietary advices advocated during Ramadan. The eating and physical activity patterns during different fasts vary a lot depending up on social and cultural factors. Even eating pattern is not uniform among all persons following Navratris and is modified as per their region, local culture, and religious beliefs. Dietary advice during Navratris depends upon pattern of fasting, religious beliefs, and local sociocultural factors. In this review, efforts are made to provide pragmatic dietary advice for people with diabetes, modifications in the menus and cooking practices, and timings of the meals for successful blood glucose management during Navratris. This review will also help plan diet and physical activity advice for persons observing other fasts as well.

BackgroundWeight gain accompanies smoking cessation, but dieting during quitting is controversial as hunger may increase urges to smoke. This is a feasibility trial for the investigation of a very low calorie diet (VLCD), individual modest energy restriction, and usual advice on hunger, ketosis, urges to smoke, abstinence and weight gain in overweight smokers trying to quit.MethodsThis is a 3 armed, unblinded, randomized controlled trial in overweight (BMI > 25 kg/m2), daily smokers (CO > 10 ppm); with at least 30 participants in each group. Each group receives identical behavioural support and NRT patches (25 mg(8 weeks),15 mg(2 weeks),10 mg(2 weeks)). The VLCD group receive a 429-559 kcal/day liquid formula beginning 1 week before quitting and continuing for 4 weeks afterwards. The modest energy restricted group (termed individual dietary and activity planning(IDAP)) engage in goal-setting and receive an energy prescription based on individual basal metabolic rate(BMR) aiming for daily reduction of 600 kcal. The control group receive usual dietary advice that accompanies smoking cessation i.e. avoiding feeling hungry but eating healthy snacks. After this, the VLCD participants receive IDAP to provide support for changing eating habits in the longer term; the IDAP group continues receiving this support. The control group receive IDAP 8 weeks after quitting. This allows us to compare IDAP following a successful quit attempt with dieting concurrently during quitting. It also aims to prevent attrition in the unblinded, control group by meeting their need for weight management. Follow-up occurs at 6 and 12 months.Outcome measures include participant acceptability, measured qualitatively by semi-structured interviewing and quantitatively by recruitment and attrition rates. Feasibility of running the trial within primary care is measured by interview and questionnaire of the treatment providers. Adherence to the VLCD is verified by the presence of urinary ketones measured weekly. Daily urges to smoke, hunger and withdrawal are measured using the Mood and Physical Symptoms Scale-Combined (MPSS-C) and a Hunger Craving Score (HCS). 24 hour, 7 day point prevalence and 4-week prolonged abstinence (Russell Standard) is confirmed by CO < 10 ppm. Weight, waist and hip circumference and percentage body fat are measured at each visit.Trial RegistrationCurrent controlled trials ISRCTN83865809

In 2013, the Swedish Council on Health Technology Assessment (SBU) published a report “Dietary treatment of obesity” where low carbohydrate diet (LCD) was established as one of the evidence based diet options in obesity treatment, even without diabetes. No data exists on how much the health care professionals (HCP) in primary care actually are informed of or to which extent they use the knowledge in the new report. We aimed to investigate the HCPs’ current knowledge, attitudes and application of LCD in obesity treatment in primary care. All primary health care centres (PHCC) in Jonkoping County Council (JCC) were invited to participate in this cross sectional descriptive study. HCPs who were working with obese patients were sent an online survey by email from January to March 2014. Data was collected about self-estimated knowledge, clinical practice of dietary advice and attitudes on LCD as well as demographic data and work related information. Chi2 and logistic regression were used to analyse associations between the independent and the outcome variables. Two hundred and seventy-one HCPs completed the survey (70.7 %); 95 % gave dietary advice. Those who gave dietary advice, 49 % were uncertain about evidence based dietary advice; 28 % received education on dietary advice last year; 60 % reported patient requests for LCD; 80 % felt hesitant about LCD; 54 % stated that they have good knowledge about LCD and 47 % recommended LCD. Factors that influenced the advisement on LCD were profession (physician and diabetes nurse), patient requests for LCD (OR 0.46, 95 % CI 0.27-0.77, p = 0.003) and good knowledge (self-estimated) about LCD (OR 0.43, 95 % CI 0.26-0.71, p = 0.001). Recent education on dietary advice affected in a positive way the uncertainty about evidence based dietary advice (OR 0.19, 95 % CI 0.10-0.37, p = 0.0001), the hesitancy about LCD (OR 0.37, 95 % CI 0.20-0.71, p = 0.002) and self- estimated knowledge about LCD (OR 2.67, 95 % CI 1.49-4.80, p = 0.001). HCPs were positive to dietary advisement but had an ambivalent attitude toward LCD as yet another dietary option. This area may be improved with continuous educational training, supposing that this is prioritized. Thus, it is reasonable to believe that LCD will gradually be more common as a tool to deal with obesity in primary care in the future.