UK Adult Research Articles

Nutritional and Metabolic Characteristics of UK Adult Phenylketonuria Patients with Varying Dietary Adherence.

The nutritional and metabolic characteristics of adult phenylketonuria (PKU) patients in the UK with varying dietary adherence is unknown. In other countries, nutritional and metabolic abnormalities have been reported in nonadherent patients compared to adherent counterparts. A pooled analysis of primary baseline data from two UK multi-centre studies was therefore performed to establish whether this is true from a UK perspective. Adult PKU patients who had provided 3-day food records and amino acid blood samples were included and grouped according to dietary adherence (adherent; n = 16 vs. nonadherent; n = 14). Nonadherent patients consumed greater amounts of natural protein compared to adherent patients (61.6 ± 30.7 vs. 18.3 ± 7.7 g/day; q < 0.001). In contrast, the contribution of protein substitutes to total protein intake was lower in nonadherent compared to adherent patients (3.9 ± 9.2 g/day vs. 58.6 ± 10.2 g/day; q < 0.001). Intakes of iron, zinc, vitamin D3, magnesium, calcium, selenium, iodine, vitamin C, vitamin A and copper were significantly lower in nonadherent compared to adherent patients and were below UK Reference Nutrient Intakes. Similarly, intakes of thiamin, riboflavin, niacin, vitamin B6 and phosphorus were significantly lower in nonadherent compared to adherent patients but met the UK Reference Nutrient Intakes. Phenylalanine concentrations in nonadherent patients were significantly higher than adherent patients (861 ± 348 vs. 464 ± 196 µmol/L; q = 0.040) and fell outside of European treatment target ranges. This study shows the nutritional and metabolic consequences of deviation from phenylalanine restriction and intake of PKU protein substitutes in nonadherent adult PKU patients. Collectively, these data further underlie the importance of life-long adherence to the PKU diet.

Psychotic symptoms and sensory impairment: Findings from the 2014 adult psychiatric morbidity survey

PurposeHearing and visual impairment have been associated with psychosis. Mechanisms behind this are poorly understood. We tested whether i) self-reported hearing and visual impairments are associated with psychotic symptoms in the 2014 UK Adult Psychiatric Morbidity Survey; ii) the odds of having psychotic symptoms vary with self-perceived degree of impairments; and iii) reduced social functioning partially explains these associations. MethodsWe analysed cross-sectional data using logistic regression. Hearing and visual impairment were the exposures, and screening positive on the Psychosis Screening Questionnaire was the outcome. We used structural equation modelling to assess mediation by social functioning, measured by the Social Functioning Questionnaire. ResultsPsychotic symptoms were strongly associated with visual impairment (Adjusted Odds Ratio (AOR) 1.81, 95% Confidence Intervals (CI) 1.33 to 2.44), especially moderate visual impairment (AOR 2.75, 95% CI 1.78 to 4.24, p < .001). Psychotic symptoms were associated with a severe degree of hearing impairment (AOR 4.94, 95% CI 1.66 to 14.67, p = .004), and weakly associated with hearing impairment overall (AOR 1.50, 95% CI 1.10 to 2.04, p = .010). Social functioning accounted for approximately 50% of associations with both types of sensory impairment, but the confidence intervals around these estimates were broad. ConclusionsOur findings suggest an association between psychosis and visual impairment, with the strongest evidence for moderate visual impairment; the findings also support a linear relationship between psychosis and degree of hearing impairment. Social functioning may mediate these relationships and be a potential target for intervention, alongside sensory correction. These should be investigated longitudinally.

Reductions in Methicillin-resistant Staphylococcus aureus, Clostridium difficile Infection and Intensive Care Unit-Acquired Bloodstream Infection Across the United Kingdom Following Implementation of a National Infection Control Campaign.

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile infections declined across the UK National Health Service in the decade that followed implementation of an infection control campaign. The national impact on intensive care unit (ICU)-acquired infections has not been documented.MethodsData on MRSA, C. difficile, vancomycin-resistant Enterococcus (VRE), and ICU–acquired bloodstream infections (UABSIs) for 1 189 142 patients from 2007 to 2016 were analyzed. Initial coverage was 139 ICUs increasing to 276 ICUs, representing 100% of general adult UK ICUs.ResultsICU MRSA and C. difficile acquisitions per 1000 patients decreased between 2007 and 2016 (MRSA acquisitions, 25.4 to 4.1; and C. difficile acquisitions, 11.1 to 3.5), whereas VRE acquisitions increased from 1.5 to 5.9. There were 13 114 UABSIs in 1.8% of patients who stayed longer than 48 hours on ICU. UABSIs fell from 7.3 (95% confidence interval [CI], 6.9–7.6) to 1.6 (95% CI, 1.5–1.7)/1000 bed days. Adjusting for patient factors, the incidence rate ratio was 0.21 (95% CI, 0.19–0.23, P < .001) from 2007 to 2016. The greatest reduction, comparing rates in 2007/08 and 2015/16, was for MRSA (97%), followed by P. aeruginosa (81%), S. aureus (79%) and Candida spp (72%), with lower reductions for the coliforms (E. coli 57% and Klebsiella 49%).ConclusionsLarge decreases in ICU-acquired infections occurred across the UK ICU network linked with the first few years of a national infection control campaign, but rates have since been static. Further reductions will likely require a new intervention framework.

Association between birth weight and refractive error in adulthood: a Mendelian randomisation study

BackgroundPathological myopia is one of the leading causes of blindness globally. Lower birth weight (BW) within the normal range has been reported to increase the risk of myopia, although findings...

The Persistence of Pneumococcal Conjugate Vaccine Types 3, 19A, and 19F in the UK Adult Population

To the Editor—Using nasal wash samples and conventional microbiological cultures, Adler et al [1] detected pneumococcal colonization in 6.6% of healthy adult study participants (28 of 427), sampled 5 years after the introduction of infant immunization with 13-valent pneumococcal conjugate vaccine (PCV13) in the United Kingdom. Although the majority were non-PCV13 (nonvaccine type) serotypes, 3 PCV13 (vaccine type [VT]) serotypes (3, 19A, and 19F) were detected, serotype 3 being the most common VT identified (in 5 of 28 participants [17.9%]). The study participants were nonsmokers without major comorbid conditions or contact with children <5 years old.

The Effect of Framed Health Messages on Intention to Take Antivirals for Pandemic Influenza: A Vignette-Based Randomised Controlled Trial

During the last influenza pandemic, adherence to antivirals was suboptimal. This study investigated the effect of manipulating the wording of written health messages on intentions to use antivirals as prophylaxis for pandemic influenza.After reading a hypothetical pandemic flu scenario, adult UK residents (N = 216) were randomly allocated to one of the four conditions, defined by a 2 × 2 (agency assignment × attribute framing) factorial design. Each condition presented messages describing the pandemic flu using linguistic expressions that assigned agency to either humans (HA: human agency) or the virus itself (VA: virus agency), whilst describing the antivirals side effects in terms of the chances of either experiencing (NF: negative framing) or not experiencing side effects (PF: positive framing). Intentions to use the antivirals and potential mediating factors were measured.Mean adherence intentions were high in all conditions with no significant differences between them. Higher perceived susceptibility, anticipated regret, self-efficacy, trust, and low response costs were found to predict adherence intentions. The VA messages increased perceived severity, the PF messages increased self-efficacy, whilst VA*PF affected response efficacy. The evidence did not support the hypothesis that the VA and PF framings can increase adherence intentions compared to the HA and NF messages, respectively.

Cyclic di-nucleotides – what is their role in biofilm formation and pathogenicity of Fusobacterium nucleatum?

Introduction Cyclic di-nucleotides (CDNs) act as important second messengers in bacteria, regulating multiple cellular functions, including biofilm formation. Fusobacterium nucleatum is a key player in disease-associated biofilms in periodontitis (gum disease). Previous studies revealed the importance of CDNs in the virulence of other dental pathogens such as Porphyromonas gingivalis, but their function in F. nucleatum virulence remains elusive. Here, we aim to elucidate their importance in the pathogenicity of F. nucleatum. Methods Using bioinformatics, we identified a putative dual adenylyl/guanylyl cyclase in the genome of F. nucleatum ATCC 23726, the only currently genetically tractable strain. Consequently this target gene was deleted from the chromosome. Wild-type and mutant strains were grown in single- and multi-species biofilms, the amount of biomass quantified by crystal-violet assay and the biofilm topography analysed using scanning electron microscopy. Additionally, intracellular CDNs were quantified using LC-MS/MS. Results Differences in biofilm formation comparing wild-type, mutant and further F. nucleatum subspecies will be presented. Furthermore the level of CDN production of those strains will be shown. Conclusions Disease-associated biofilms in periodontitis affect over 50 % of the adult UK population. The disease can be debilitating, potentially leading to tooth loss and the bacteria involved have also been associated with systemic diseases such as cardiovascular disease, arthritis or certain types of cancer. Understanding the involvement of CDNs in the pathogenicity of F. nucleatum and its interaction with various periodontal pathogens might provide new insights into prevention and treatment of periodontitis and other conditions.

Ratio Format Shapes Health Decisions: The Practical Significance of the "1-in-X" Effect.

Prior research found that "1-in-X" ratios led to higher and less accurate subjective probability than "N-in-X*N" ratios or other formats, even though they featured the same mathematical information. It is unclear, however, whether the effect transfers into health decisions, and the practical significance of the effect is undetermined. Based on previous findings and risk communication theories, we hypothesized that the 1-in-X effect would occur and transfer into relevant decisions. We also tested whether age, gender, and education differences would moderate the 1-in-X effect on decision making. We conducted 3 well-powered experiments ( n = 1912) using a sample from the general adult UK population to test our hypotheses, estimated the effect, and excluded a possible methodological explanation for such a transfer. In hypothetical scenarios, participants decided whether to travel to Kenya given the chance of contracting malaria (experiment 1) and whether to take recommended steroids given the side effects (experiments 2 and 3). Across the experiments, we replicated a small to medium 1-in-X effect on the perceived probability (Hedge's g = -0.36; 95% confidence interval [CI], -0.47 to -0.24; z = -6.18; P < 0.001) and found a small effect on subsequent decisions (odds ratio = 1.32; 95% CI, 1.10-1.59; z = 2.99; P = 0.003). The perceived probability fully mediated the effect of the ratio format on decision. Age, gender, and education did not moderate the 1-in-X effect on decision. We argue that a high prevalence of 1-in-X ratios in medical communication makes these small changes clinically relevant. Therefore, to communicate information accurately, 1-in-X ratios should not be used or at least used cautiously in medical communication.

Population-Based Study Comparing the USA with Other Western Countries' Total Mortality 1989-91 V 2013-15 in Context of Health Expenditure: Plus Contrast of USA and UK Child (0-4) and Adult (55-74) and the 24 Who Global Diagnostic Mortality Rates

Background: This population-based study examines how effective is the USA health system compared to twenty Other Western Countries (OWC) in reducing total mortality between 1989-91 and 2013-15 within the context of national fiscal health investment and directly compares current USA and UK children's (0-4) and adult (55-74) death rates, and, the 24 global WHO diagnostic categories mortality rates. Methodology: All mortality data is drawn from WHO, updated June 2018, using average world standard population the Age-Standardised-Death-Rates (ASDR) per million (pm).to examine total mortality of the USA and the OWC over the period. The fiscal context draws upon World Bank data, updated July 2018, which is the national percentage GDP-Expenditure-on-Health (%GDPEH). Findings: America had highest average %GDPEH at 13.39%, Britain the lowest at 7.60%. Every OWC had significantly greater reduced ASDR than USA over the period. If the USA had matched Britain's ASDR there would be 488,453 fewer deaths. UK child and adults rates at 855pm and 10,568pm, with America's 1,249pm and 12,544pm were 46% and 19% higher than UK. Of the 24 global diagnostic category deaths the USA had sixteen higher category mortalities than Britain, notable lower UK rates were for Circulatory Disease Deaths by 24%, Endocrine Disorders 70%, External Deaths 53%, Genitourinary 44%, Infectious Disease 65%, Neurological deaths 13% and Peri-natal deaths 34%. Conversely, America had lower rates than Britain for Neoplasms by 11%, Respiratory 12% and Digestive Disorder deaths 11%. Interpretation: America had the highest health expenditure but the highest total death rate. Direct comparison between the USA and the UK shows America achieved proportionally less with relatively more, whilst Britain achieved proportionally more with comparatively less. These results strongly indicate that America does not get a good return on its fiscal investment in health, which should be considered in current USA debate about health care. Funding: None. Declaration of Interest: The authors have no vested or other interest in the study.

Knowledge, Attitudes and Perceptions towards Vitamin D in a UK Adult Population: A Cross-Sectional Study.

The prevalence of vitamin D deficiency in the United Kingdom is high, despite updated Scientific Advisory Committee on Nutrition (SACN) guidelines. Therefore, our aims were to identify population knowledge, attitudes and perceptions of vitamin D supplementation and factors contributing to supplement use in a UK adult population. A cross-sectional study was performed between April–June 2018 using a newly designed piloted questionnaire. Scores for knowledge were calculated as a percentage (Boland et al. 2015). Logistic regression analysis was used to predict supplement use. 209 participants (82% female), mean (±SD) age 34.9 (±12.3) completed the questionnaire. The mean (±SD) vitamin D knowledge score was 56.6% (±19.9%); only 48% were concerned about their vitamin D concentration and 57% did not take vitamin D. Most participants (86%) wished to learn more about vitamin D. Knowledge score (OR 2.5; p = 0.01; 95% CI 1.2–5.3), concern (OR 2.1; p = 0.03; 95% CI 1.0–4.2) and location (OR 0.3; p = 0.006; 95% CI 0.1–0.7) predicted supplemented use. Individuals living in England had 2.9 (95% CI 1.4–6.3) lower odds of taking vitamin D than those living in Scotland. As a result of these findings, this study suggests that vitamin D supplementation and fortification, alongside education strategies, may be an effective method for improving UK vitamin D health; however, more research is warranted.

The UK Adult Film Performer Project – a case for being pro-performer voice

This forum piece is an introduction to a mixed-methods study being conducted at the Public Health Institute, Liverpool John Moores University, UK on the experiences of those working in the UK adult...

Building a Weight of Evidence to Prevent Cancer in Later Life

Background: Obesity is the largest preventable risk factor for cancer in the UK after smoking. Being overweight as an adult is linked to 13 types of cancer, and overweight children are more likely to become overweight adults. Routine data shows that around one in three children leave primary school in the UK (aged 12) overweight or obese, with the children from the most deprived communities twice as likely to be so. Cancer Research UK is campaigning for restrictions on the marketing of foods high in salt sugar and fat (HFSS foods) to children as part of a comprehensive population level strategy to prevent obesity-related cancers in the future. Aim: To undertake a mixed methods program of research aimed at building a body of evidence to directly inform policy to address childhood obesity. Methods: Individual studies included: a national cross-sectional survey to investigate obesity and cancer awareness in the UK adult population; a modeling study to predict future obesity-related cancer cases; and qualitative and quantitative studies to explore obesity-linked behaviors and exposure to HFSS marketing in children. A narrative synthesis of results from individual studies was conducted to identify key themes and develop recommendations for policy. Results: Cancer was not at the forefront of people's minds when thinking about obesity, with only 26% of UK adults reporting (unprompted) awareness of the link. However, results from modeling identified that the projected impact of obesity on cancer is high: if current trends continue it will lead to a further 670,000 cases in the UK over the next 20 years. Qualitative research identified a high awareness of junk food marketing in children aged 8-19. This influenced their behavior using a variety of persuasive marketing techniques, including catchy slogans and jingles, celebrity endorsements or by referencing youth culture. Logistic regression modeling associated commercial TV screen time with an increased risk of high junk food consumption (OR 1.8, P = 0.002). Furthermore, recalling one extra broadcast advert predicted a significant increase in HFSS consumption, approximately 18,000 extra calories/person/year. Conclusion: These linked studies have informed Cancer Research UK's campaign on obesity, and results have been used to inform work with the media, coalition building and influencing. Findings that HFSS food marketing influenced children's consumption behaviors were published on the charity's lobbying day in parliament where the research was discussed with almost 170 members of parliament. To achieve further HFSS marketing restrictions, research evidence is essential to making the case for policy change and this approach from a large UK cancer charity could inform similar efforts in other countries.

THUR 150 Treatment and outcomes in primary angiitis of the CNS (PACNS)

BackgroundPACNS is a rare and heterogeneous disorder with many uncertainties regarding management and outcomes. Published adult UK series total just 20 patients.MethodHospital record search of an adult tertiary neurosciences centre identified 14 cases of PACNS from 1033 potential cases over 20 years.ResultsAll 14 cases were ‘definite’ by Calabrese Criteria (1988), confirmed by brain biopsy in 8/14 and by angiography in 6/14.The median age of onset was 52 years and most presented with focal deficits (86%), headache (36%) and cognitive change (29%). MRI showed multifocal deep white matter change in 86% and infarcts in 50%. Gadolinium enhancement was seen in 43%. Two patients had solitary ring-enhancing lesions and one patient had signs of cord ischaemia. CSF was abnormal in 90%.All patients received corticosteroids, 11/14 cyclophosphamide, 3/14 Mycophenolate Mofetil, 3/14 Methotrexate and 2/14 Azathioprine. At 13.3 months median follow-up, all but the two patients with solitary lesions remained on immunosuppression. Clinical relapses occurred in 30% and radiological relapse in one case despite immunosuppression.Only 62% had a favorable outcome (mRS 0–2). One patient died as a direct consequence of PACNS and one patient died due to co-morbidities.ConclusionPACNS remains a treatable neuroinflammatory disease with poor outcomes.

Chapter 6 Adequacy of Haemodialysis in UK Adult Patients in 2016: National and Centre-specific Analyses

BACKGROUND Outcome in patients treated with haemodialysis (HD) is influenced by the delivered dose of dialysis. The UK Renal Association (RA) publishes clinical practice guidelines which include recommendations for dialysis dose. The urea reduction ratio (URR) is a widely used measure of dialysis dose. AIM To determine the extent to which patients received the recommended dose of HD in the UK. METHODS All seventy-two UK renal centres submitted data to the UK Renal Registry (UKRR). Two groups of patients were included in the analyses: the prevalent patient population on 31st December 2010 and the incident patient population for 2010. Centres returning data on 65%) increased from 56% in 1998 to 86% in 2010. There was persistent variation observed between centres, with 19 centres attaining the RA clinical practice guideline in >90% of patients and 39 centres attaining the guideline in 70-90%. The overall proportion of prevalent patients with a URR >65% has continued to improve over time. CONCLUSIONS The delivered dose of HD for patients with established renal failure has increased over the last decade. Whilst the majority of UK patients achieved the target URR there was considerable variation between centres in the percentage of patients achieving the guideline.

Chapter 7 Haemoglobin, Ferritin and Erythropoietin in UK Adult Dialysis Patients in 2016: National and Centre-specific Analyses

Chapter 7 Haemoglobin, Ferritin and Erythropoietin in UK Adult Dialysis Patients in 2016: National and Centre-specific Analyses

Chapter 8 Biochemical Variables in UK Adult Dialysis Patients in 2016: National and Centre-specific Analyses

Chapter 8 Biochemical Variables in UK Adult Dialysis Patients in 2016: National and Centre-specific Analyses

The Association between Mental Wellbeing, Levels of Harmful Drinking, and Drinking Motivations: A Cross-Sectional Study of the UK Adult Population.

Mental well-being and excessive alcohol consumption each represent a significant public health concern, and evidence suggests an association between them. Furthermore, drinking motivations associated with harmful drinking have been studied, but not systematically in the UK population. A representative sample of 6174 UK adults aged 18–75 were surveyed online. Low risk drinkers were found to have higher mental well-being than hazardous, harmful, and, probable, dependence drinkers. Using a hierarchical multiple regression analysis, it was found that just over 5% of the variance in well-being scores was accounted for by the level of harmful drinking and drinking motivation; the most significant contribution was drinking to cope. Among people drinking to cope, those drinking in more harmful ways were statistically significantly more likely to have low well-being compared to less harmful drinkers. In the UK adult population there is a clear association between poor mental well-being and harmful drinking. Furthermore, coping was a significant motivation to drink for many with low mental well-being. While mental well-being was found to be directly linked with levels of harmful drinking, the motivation for drinking was a stronger predictor of mental well-being.

Airway Clearance Following Lung Transplant: Current UK Practice

The key role of respiratory physiotherapy and rehabilitation in the post-operative management of lung transplant recipients is widely acknowledged. Despite literature to support the safety and efficacy of respiratory physiotherapy in other diseases, there is limited evidence to inform best practice following lung transplant. There are no guidelines and minimal collaboration between specialist centres. This study describes current respiratory physiotherapy practice following lung transplant in adult and paediatric UK centres.

Residential greenness and prevalence of major depressive disorders: a cross-sectional, observational, associational study of 94 879 adult UK Biobank participants

Increased urbanisation and the associated reduced contact of individuals with natural environments have led to a rise in mental disorders, including depression. Residential greenness, a fundamental component of urban design, has been shown to reduce the public health burden of mental disorders. The present study investigates the association between residential green exposure and prevalence of major depressive disorders using a large and diverse cross-sectional dataset from the UK Biobank. In this cross-sectional, observational, associational study, we used baseline data from the UK Biobank cohort of participants aged 37-73 years from across the UK. Environmental exposure data were derived from a modelled and linked built environment database. Residential greenness was assessed with a 0·5 m resolution Normalised Difference Vegetation Index, which is derived from spectral reflectance measurements in remotely sensed colour infrared data and measured within geocoded dwelling catchments. Other environment metrics included street-level movement density, terrain, and fine particulate exposures. A series of logistic models examined associations between residential greenness and odds of major depressive disorder after adjusting for activity-influencing environments and individual covariates. Of 122 993 participants with data on major depressive disorder, the study analytical sample comprised 94 879 (77·1%) participants recruited across ten UK Biobank assessment centres between April 29, 2009, and Oct 1, 2010. A protective effect of greenness on depression was consistently observed, with 4·0% lower odds of major depressive disorder per interquartile increment in Normalised Difference Vegetation Index greenness (odds ratio 0·960, 95% CI 0·93-0·99; p=0·0044). Interaction analyses indicated that the beneficial effects of greenness were more pronounced among women, participants younger than 60 years, and participants residing in areas with low neighbourhood socioeconomic status or high urbanicity. The results point to the benefits of well designed green environments on mental health. Further longitudinal studies are needed to decipher causal pathways. In the UK, policies aimed at optimising allocation and design of green spaces might help preserve psychological ecosystem services, thereby, improving the mental wellbeing of populations and enhancing the mental capital of cities. University of Hong Kong, UK Biobank, and the UK Economic & Social Research Council.

Assessing "chaotic eating" using self-report and the UK Adult National Diet and Nutrition Survey: No association between BMI and variability in meal or snack timings.

Although regular meal timings are recommended for weight loss, no study has characterised irregularity in the timing of eating occasions or investigated associations with body-mass index (BMI). Here, we characterise "chaotic eating" as the tendency to eat at variable times of day. In two studies, we used a novel measure to explore the relationship between BMI and chaotic eating. In Study 1 (N = 98) we measured BMI and used a self-report measure to assess the usual range of times that meals and snacks are consumed over a seven-day period, as well as meal and snack frequency. A separate meal and snack 'chaotic eating index' was derived from the number of possible thirty-minute snack- or meal-slots, divided by the frequency of these eating events. After adjusting for age, gender, and dietary habits (Three-Factor Eating Questionnaire) we found no relationship between BMI and chaotic eating of meals (β = -0.07, p = 0.73) or snacks (β = -0.10, p = 0.75). In Study 2, we calculated the same chaotic eating index (meals and snacks) using data from the UK National Diet and Nutrition Survey of adults 2000-2001 (seven-day diet diaries; N = 1175). Again, we found little evidence that BMI is associated with chaotic eating of meals (β = 0.16, p = 0.27) or snacks (β = 0.15, p = 0.12). Together, these results suggest that irregular eating timings do not promote weight gain and they challenge guidelines that recommend regularity in meal timings for weight loss.