Current Advice Research Articles

Short- and medium-term effects of light to moderate alcohol intake on glycaemic control in diabetes mellitus: a systematic review and meta-analysis of randomized trials.

People with diabetes are told that drinking alcohol may increase their risk of hypoglycaemia. To report the effects of alcohol consumption on glycaemic control in people with diabetes mellitus. Medline, EMBASE and the Cochrane Library databases were searched in 2015 to identify randomized trials that compared alcohol consumption with no alcohol use, reporting glycaemic control in people with diabetes. Data on blood glucose, HbA1c and numbers of hypoglycaemic episodes were pooled using random effects meta-analysis. Pooled data from nine short-term studies showed no difference in blood glucose concentrations between those who drank alcohol in doses of 16-80 g (median 20 g, 2.5 units) compared with those who did not drink alcohol at 0.5, 2, 4 and 24 h after alcohol consumption. Pooled data from five medium-term studies showed that there was no difference in blood glucose or HbA1c concentrations at the end of the study between those who drank 11-18 g alcohol/day (median 13 g/day, 1.5 units/day) for 4-104 weeks and those who did not. We found no evidence of a difference in number of hypoglycaemic episodes or in withdrawal rates between randomized groups. Studies to date have not provided evidence that drinking light to moderate amounts of alcohol, with or without a meal, affects any measure of glycaemic control in people with Type 2 diabetes. These results suggest that current advice that people with diabetes do not need to refrain from drinking moderate quantities of alcohol does not need to be changed; risks to those with Type 1 diabetes remain uncertain.

How Should Defined Contribution Retirement Plans Be Organized?

Americans have a tough time saving for their retirement. To make matters worse, the move from defined benefit (DB) to defined contribution plans (DC) over the years has required greater investor sophistication, discipline, and sound investment advice. Unfortunately, the current rules regarding investment advice for defined contribution plans do not address the two critical deficiencies of the current system, namely opacity and conflicts of interest. We propose that one-master standard be instituted along with strict transparency requirements to control the conflicts of interest and improve retirement savings advice. We also recommend that only passive, well-diversified index funds for stocks and bonds should qualify as retirement vehicles.

Recurrent patent infections with Toxocara canis in household dogs older than six months: a prospective study.

BackgroundTo reduce environmental contamination with Toxocara canis eggs, the current general advice is to deworm all dogs older than six months on average four times a year. However, only a small proportion of non-juvenile household dogs actually shed T. canis eggs, and some dogs shed eggs more frequently than others. The identification of these frequent shedders and the associated risk factors is an important cornerstone for constructing evidence-based deworming regimens. The purpose of this study is to identify risk factors associated with recurrence of periods of shedding Toxocara eggs in a cohort of household dogs older than six months.MethodsWe performed a prospective study (July 2011 to October 2014) on shedding Toxocara eggs in a cohort of 938 household dogs older than six months from all over the Netherlands. The median follow-up time was 14 months. Monthly, owners sent faecal samples of their dogs for Toxocara testing and completed a questionnaire. Dogs were dewormed only after diagnosis of a patent infection (PI). Survival analysis was used to assess factors influencing the time to first diagnosed PIs (FPI) and the time to recurrent PIs (RPI).ResultsThe overall prevalence of PIs was 4.5 %, resulting in an estimated average incidence of 0.54 PIs/dog/year. No PI was diagnosed in 67.9 % of the dogs, 17.5 % of the dogs went through only one PI and 14.6 % had > 1 PI. Prevalence of PIs always peaked during wintertime. Increased hazards for first diagnosed PIs were associated with coprophagy, geophagy, walking off-leash for ≥ 80 % of walking time, reported worms in the faeces, feeding a commercial diet and suffering from urologic or respiratory conditions. Median time to reinfection was nine months. Factors associated with increased hazards for recurrent PIs were taking corticosteroids, changing dog’s main purpose, and proxies for veterinary care-seeking behaviours.ConclusionsWe concluded that targeted anthelmintic treatments in household dogs may be feasible as PIs tend to (re)occur in specific periods and in groups of dogs at high risk. Moreover, recurrent PIs appear to be influenced more by factors related to impaired immunity than environmental exposure to Toxocara eggs.Electronic supplementary materialThe online version of this article (doi:10.1186/s13071-016-1816-7) contains supplementary material, which is available to authorized users.

Magmaris preliminary recommendation upon commercial launch: a consensus from the expert panel on 14 April 2016.

Bioresorbable scaffolds represent an exciting milestone in the development of coronary stent technology with the potential to substantially improve the management of patients with coronary artery disease. In an attempt to provide first recommendations for the technology, experienced experts involved in the first-in-man studies met in Zurich on the 14 April 2016 in order to reach consensus on a responsible market introduction. This document will be updated regularly as new information from clinical trials becomes available and should be understood as a review of current data, opportunities, expectations, advice, and recommendations for future investigations.

The Quality and Accuracy of Mobile Apps to Prevent Driving After Drinking Alcohol.

BackgroundDriving after the consumption of alcohol represents a significant problem globally. Individual prevention countermeasures such as personalized mobile apps aimed at preventing such behavior are widespread, but there is little research on their accuracy and evidence base. There has been no known assessment investigating the quality of such apps.ObjectiveThis study aimed to determine the quality and accuracy of apps for drink driving prevention by conducting a review and evaluation of relevant mobile apps.MethodsA systematic app search was conducted following PRISMA guidelines. App quality was assessed using the Mobile App Rating Scale (MARS). Apps providing blood alcohol calculators (hereafter “calculators”) were reviewed against current alcohol advice for accuracy.ResultsA total of 58 apps (30 iOS and 28 Android) met inclusion criteria and were included in the final analysis. Drink driving prevention apps had significantly lower engagement and overall quality scores than alcohol management apps. Most calculators provided conservative blood alcohol content (BAC) time until sober calculations. None of the apps had been evaluated to determine their efficacy in changing either drinking or driving behaviors.ConclusionsThis novel study demonstrates that most drink driving prevention apps are not engaging and lack accuracy. They could be improved by increasing engagement features, such as gamification. Further research should examine the context and motivations for using apps to prevent driving after drinking in at-risk populations. Development of drink driving prevention apps should incorporate evidence-based information and guidance, lacking in current apps.

Exploration of Zika Virus Travel-related Transmission and a Review of Travel Advice to Minimise Health Risks to UK Travellers

The World Health Organization (WHO) on 1 February 2016 declared the Zika virus outbreak is a global public health emergency. Zika virus is thought to have led to more than 11,000 deaths and nearly 4,000 cases of microcephaly in Brazil since the start of the outbreak in May 2015. WHO predicted that, in 2016, as many as four million people may be infected with the virus. [1] Health experts have warned that the risk of transmitting Zika virus in the United Kingdom (UK) is very high because South America has become an increasingly popular tourist destination for UK travellers. [2] Given the declaration of Zika virus outbreak as a global public health emergency, this study explores Zika virus travel-related transmission and review current travel advice to minimise health risks to UK travellers. The evidence from our initial literature review showed that there is a paucity of research information on the recent Zika virus outbreak. Thus, the evidence used in this study was gathered from surveillance reports published by the European Centre for Disease Prevention and Control (ECDC), the United States Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). Public Health England (PHE), Fitfortravel (NHS Scotland) and NHS Choices reports were reviewed for Zika virus outbreak alerts and travel advice. The study finds that Zika virus, which originated in East Africa, is now transmitted in South and North American countries and the Caribbean islands through travel and, to prevent the disease epidemic in the UK, health care professionals are required by PHE to offer advice to travellers to and from the Zika-affected countries. [3] As travel advice is likely to change as more information becomes available, we recommend that professionals supplying this service should be checking on the National Travel Health Network and Centre (NaTHNaC) website to stay abreast of the latest Zika virus updates.

Swaddling and the Risk of Sudden Infant Death Syndrome: A Meta-analysis.

Swaddling is a traditional practice of wrapping infants to promote calming and sleep. Although the benefits and risks of swaddling in general have been studied, the practice in relation to sudden infant death syndrome remains unclear. The goal of this study was to conduct an individual-level meta-analysis of sudden infant death syndrome risk for infants swaddled for sleep. Additional data on sleeping position and age were provided by authors of included studies. Observational studies that measured swaddling for the last or reference sleep were included. Of 283 articles screened, 4 studies met the inclusion criteria. There was significant heterogeneity among studies (I(2) = 65.5%; P = .03), and a random effects model was therefore used for analysis. The overall age-adjusted pooled odds ratio (OR) for swaddling in all 4 studies was 1.58 (95% confidence interval [CI], 0.97-2.58). Removing the most recent study conducted in the United Kingdom reduced the heterogeneity (I(2) = 28.2%; P = .25) and provided a pooled OR (using a fixed effects model) of 1.38 (95% CI, 1.05-1.80). Swaddling risk varied according to position placed for sleep; the risk was highest for prone sleeping (OR, 12.99 [95% CI, 4.14-40.77]), followed by side sleeping (OR, 3.16 [95% CI, 2.08-4.81]) and supine sleeping (OR, 1.93 [95% CI, 1.27-2.93]). Limited evidence suggested swaddling risk increased with infant age and was associated with a twofold risk for infants aged >6 months. Heterogeneity among the few studies available, imprecise definitions of swaddling, and difficulties controlling for further known risks make interpretation difficult. Current advice to avoid front or side positions for sleep especially applies to infants who are swaddled. Consideration should be given to an age after which swaddling should be discouraged.

Living well beyond 70 now and in the future requires older age-specific nutrition guidelines – Current advice falls short

Living well beyond 70 now and in the future requires older age-specific nutrition guidelines – Current advice falls short

BMI upon discharge from hospital and its relationship with survival: an observational study utilising linked patient records.

Current advice for patients being discharged from hospital suggests a body mass index of 18.5 to 24 kgm-2, although this aspirational target may often not be achieved. We examined the relationship between body mass index on discharge from hospital and subsequent mortality over a maximum follow-up of 3.8 years. We conducted a survival analysis using linked hospital records data with national hospital episode statistics and national death certification data. The analysis included adult patients who were admitted to University Hospitals Birmingham NHS Foundation Trust for a period of over 24 h during 2011, excluding day cases and regular day case attenders. The relationship between body mass index and mortality at medium term was estimated separately in both men and women, after accounting for case-mix. For both males and females, the relationship between body mass index at discharge and the loge hazard of death was strongly non-linear (p = 0.0002 for females and p < 0.0001 for males) and predictive (both p < 0.0001). In all models, the optimal body mass index range associated with best survival was 25 to 35 kgm-2, with a sharp increase in risk for lower body mass index. There was little evidence to support current aspirational body mass index targets in the discharge population. Hospitals should ensure adequate nutrition especially among those with a reduced body mass index.

Early Eating Behaviours and Food Acceptance Revisited: Breastfeeding and Introduction of Complementary Foods as Predictive of Food Acceptance.

Current dietary advice for children is that they should eat at least five portions of fruit and vegetables a day (Department of Health. National Diet and Nutrition Survey, 2014). However, many parents report that children are reluctant to eat vegetables and often fail to comply with the five-a-day rule. In fact, in surveys carried out in areas in the UK, the number of children eating according to the five-a-day rule has been found to be as low as 16 % (Cockroft et al. Public Health Nutr 8(7):861–69, 2005). This narrative review looks at those factors which contribute to food acceptance, especially fruit and vegetables, and how acceptance might be enhanced to contribute to a wider dietary range in infancy and later childhood. The questions we address are whether the range of foods accepted is determined by the following: innate predispositions interacting with early experience with taste and textures, sensitive periods in infancy for introduction, breastfeeding and the pattern of introduction of complementary foods. Our conclusions are that all of these factors affect dietary range, and that both breastfeeding and the timely introduction of complementary foods predict subsequent food acceptance.

Interaction Between Dietary Vitamin K Intake and Anticoagulation by Vitamin K Antagonists: Is It Really True?: A Systematic Review.

Educational advice is often given to patients starting treatment with vitamin K Antagonists (VKAs). A great emphasis is made on nutritional information. Common belief is that dietary vitamin K intake could counteract the anticoagulant effect by VKAs and for many years, patients have been discouraged to consume vitamin-K-rich foods, such as green leafy vegetables.The objective of this study is to summarize the current evidence supporting the putative interaction between dietary vitamin K intake and changes in INR with the VKAs.Data sources are MEDLINE via PubMed and Cochrane database.All clinical studies investigating the relationship between dietary vitamin K and measures of anticoagulation were included. We excluded all studies of supplementation of vitamin K alone.We performed a systematic review of the literature up to October 2015, searching for a combination of “food,” “diet,” “vitamin K,” “phylloquinone,” “warfarin,” “INR,” “coagulation,” and “anticoagulant.”Two dietary interventional trials and 9 observational studies were included. We found conflicting evidence on the effect of dietary intake of vitamin K on coagulation response. Some studies found a negative correlation between vitamin K intake and INR changes, while others suggested that a minimum amount of vitamin K is required to maintain an adequate anticoagulation. Median dietary intake of vitamin K1 ranged from 76 to 217 μg/day among studies, and an effect on coagulation may be detected only for high amount of vitamin intake (>150 μg/day).Most studies included patients with various indications for VKAs therapy, such as atrial fibrillation, prosthetic heart valves, and venous thromboembolism. Thus, INR target was dishomogeneous and no subanalyses for specific populations or different anticoagulants were conducted. Measures used to evaluate anticoagulation stability were variable.The available evidence does not support current advice to modify dietary habits when starting therapy with VKAs. Restriction of dietary vitamin K intake does not seem to be a valid strategy to improve anticoagulation quality with VKAs. It would be, perhaps, more relevant to maintain stable dietary habit, avoiding wide changes in the intake of vitamin K.

Beneficial effects of a red wine polyphenol extract on high-fat diet-induced metabolic syndrome in rats.

Individuals with metabolic syndrome (MS) show several metabolic abnormalities including insulin resistance, dyslipidaemia, and oxidative stress (OS). Diet is one of the factors influencing the development of MS, and current nutritional advice emphasises the benefits of fruit and vegetable consumption. Here, we assessed the effects of naturally occurring antioxidants, red wine polyphenols (RWPs), on MS and OS. Wistar rats (n=20) weighing 200-220g received a high-fat diet (HFD) for 2months before they were divided into two groups that received either HFD only or HFD plus 50mg/kg RWPs in their drinking water for an additional 2months. A control group (n=10) received a normal diet (ND) for 4months. Rats receiving HFD increased body weight over 20% throughout the duration of the study. They also showed increased blood levels of C-peptide, glucose, lipid peroxides, and oxidised proteins. In addition, the HFD increased OS in hepatic, pancreatic, and vascular tissues, as well as induced pancreatic islet cell hyperplasia and hepatic steatosis. Addition of RWPs to the HFD attenuated these effects on plasma and tissue OS and on islet cell hyperplasia. However, RWPs had no effect on blood glucose levels or hepatic steatosis. RWPs showed an antioxidant mechanism of action against MS. This result will inform future animal studies exploring the metabolic effects of RWPs in more detail. In addition, these findings support the use of antioxidants as adjunctive nutritional treatments for patients with diabetes.

Qualitative critical incident study of patients’ experiences leading to emergency hospital admission with advanced respiratory illness

ObjectivesThe high volume of emergency admissions to hospital is a challenge for health systems internationally. Patients with lung cancer and chronic obstructive pulmonary disease (COPD) are frequently admitted to hospital...

Dietary intake of subjects with diabetes is inadequate in Switzerland: the CoLaus study.

To characterize the dietary intake of subjects aged 40-80years according to self-reported diabetes and presence of an anti-diabetic diet. Cross-sectional study conducted between 2009 and 2012 on 4289 participants (2274 women) living in Lausanne. Of the 299 (7%) participants with self-reported diabetes, only 151 (51%) reported an anti-diabetic diet. Compared to participants not reporting diabetes, participants with self-reported diabetes (with or without a diet) had a higher consumption of artificial sweeteners (0.3±0.7 vs. 0.4±0.8 and 0.8±1.0 times/day) and a lower consumption of honey/jam (mean±standard deviation: 0.5±0.5 vs. 0.4±0.4 and 0.4±0.4 times/day) or sugar (0.6±0.9 vs. 0.4±0.7 and 0.2±0.5 times/day) for participants not reporting diabetes, participants with self-reported diabetes not on a diet and on a diet, respectively. Compared to participants not on a diet, participants on a diet had a higher consumption of vegetables (1.8±1.3 vs. 1.4±1.0 portions/day), while no differences were found regarding all other food groups and nutrients. Participants with self-reported diabetes on a diet had a higher consumption of meat (5.6±3.6 vs. 4.8±2.9 portions/week) and a lower consumption of simple carbohydrates (21.0±7.9 vs. 23.5±8.4% total energy intake) than participants not reporting diabetes. People with diabetes eat less simple carbohydrates, but do not comply with current advice on fish, nuts, fruits and vegetables. Improvement of the dietary intake in persons with diabetes in Switzerland is needed.

On selecting business/HR tests: A psychometrician’s insights

This article aims to offer succinct and current practical advice on efficiently ‘screening’ the market and selecting appropriate tests, based on relevance, practicality, and quality. Subsequently, advice on finding the information necessary to evaluate available tests is offered.

New Developments in Intimate Partner Violence and Management of Its Mental Health Sequelae.

Intimate partner violence (IPV) is a global public health and human rights problem that causes physical, sexual and psychological harms to men and women. IPV includes physical aggression, sexual coercion, psychological abuse and/or controlling behaviours perpetrated by a current or previous intimate partner in a heterosexual or same-sex relationship. IPV affects both men and women, but women are disproportionately affected with nearly one third reporting IPV during their lifetime. Physical and sexual harms from IPV include injury, increased risk for sexually transmitted diseases, pregnancy complications and sometimes death. Psychological consequences include depression, anxiety, posttraumatic stress disorder, substance abuse, impulsivity and suicidality and non-specific physical complaints thought to be related to the traumatic nature and chronic stress of IPV. Children who witness IPV are also negatively impacted in the short and long term. This paper reviews prevalence, risk factors, adverse effects and current evidence-based mental health treatment advice for IPV victims.

Should women abstain from alcohol throughout pregnancy?

Everyone agrees that current advice on alcohol is inconsistent and confusing, but whereas <b>Mary Mather</b> and <b>Kate Wiles</b> conclude we should move to a clear recommendation to abstain, <b>Patrick O’Brien</b>...

Brain blood flow and hyperventilation on cold water immersion: can treading water help control these symptoms of cold shock?

Cold-water immersion (CWI) elicits the cold shock response (CSR). The hyperventilatory component of the CSR causes a decrease in cerebral blood flow velocity (CBFv) potentially causing sensations of dizziness and increasing the risk of becoming unconscious and consequently drowning [1]. In these early minutes of CWI the current advice is to 'float first' and remain stationary [2] yet this strategy may not have any effect on ventilation and therefore brain CBFv. We tested the hypothesis that leg only exercise could offset the reduction in CBFv in a resting CWI (H1) and be absent in warm water immersion.

Nutritional Modulation of Gene Expression: Might This be of Benefit to Individuals with Crohn's Disease?

The incidence of inflammatory bowel diseases (IBD), including Crohn’s disease (CD), is increasing worldwide, especially in young children and adolescents. Although hospitalized patients are usually provided with enteral or parenteral support, continuing care typically requires a trial-and-error approach to suppressing symptoms and maintaining disease remission. Current nutritional advice does not differ from general population guidelines. International collaborative studies have revealed 163 distinct genetic loci affecting susceptibility to IBD, in some of which host–microbe interactions can be seen to play an important role. The nature of these loci enables a rationale for predicting nutritional requirements that may not be evident through standard therapeutic approaches. Certain recognized nutrients, such as vitamin D and long-chain omega-3 polyunsaturated fatty acids, may be required at higher than anticipated levels. Various phytochemicals, not usually considered in the same class as classic nutrients, could play an important role. Prebiotics and probiotics may also be beneficial. Genomic approaches enable proof of principle of nutrient optimization rather than waiting for disease symptoms to appear and/or progress. We suggest a paradigm shift in diagnostic tools and nutritional therapy for CD, involving a systems biology approach for implementation.

Is latex allergy still a problem?

This article provides current advice relating to the use of gloves and latex allergy, and gives advice for the safe management of those affected