Scientific Advisory Committee Research Articles

Hormone Replacement Therapy, Synthetic Progestogens, and Breast Cancer Risk

Background: Hormone Replacement Therapy (HRT) has been associated with an increased risk of breast cancer. The study objective is to evaluate whether the increased risk is dependent on the formulation used. Methods: We carried out a population-based case-control study using data from the United Kingdom Clinical Practice Research Datalink on women age ≥50 years. Incident cases of breast cancer were age-matched (1:10) with controls of comparable follow-up time with no history of breast cancer. Exposures were classified as ever or never for the following HRT formulations: bioidentical estrogens, animal-derived estrogens, micronized progesterone, and synthetic progestin. Logistic regression analyses were performed to estimate the adjusted effect of HRT formulation on breast cancer. Findings: Between 1995-2014, 43,183 breast cancer cases were identified and matched to 431,830 controls. In adjusted analyses, compared with women who never used HRT, its use was associated with an increased risk of breast cancer (OR 1·12, 95% CI 1·09-1·15). Compared with never users, estrogens were not associated with breast cancer: bioidentical estrogens (OR 1·04,1·00-1·09), animal-derived estrogens (OR 1·01, 0·96-1·06), both (OR 0·96, 0·89-1·03). Progestogens appeared differentially associated with breast cancer: micronized progesterone (OR 0·99, 0·55-1·79), synthetic progestin (OR 1·28, 1·22-1·35), both (OR 1·32, 0·30-5·77). Interpretation: While HRT use appears to be associated with an overall increased risk of breast cancer, it appears uniquely in women prescribed formulations containing synthetic progestin. Hence, synthetic progestins should not be given as part of HRT regimens and counseling regarding the risk of breast cancer should consider the effect of formulation used. Funding Information: Supported by a grant from the Canadian Cancer Society, 703041. Declaration of Interests: Haim Abenhaim has no conflicts of interest to declare. Samy Suissa has been a Scientific Advisory Committee Member for Atara Bio, Boehringer-Ingelheim, Briston-Myers-Squibb, Merck, MorphoSys, and Seqirus. He has also been a speaker for AstraZeneca and Novartis. All work was unrelated to this study. Laurent Azoulay received consulting fees from Janssen and Pfizer for work unrelated to this study. Andrea Spence has no conflicts of interest to declare. Nicholas Czuzoj-Shulman has no conflicts of interest to declare. Togas Tulandi has no conflicts of interest to declare. Ethics Approval Statement: The Independent Scientific Advisory Committee of the Clinical Practice Research Datalink and the Research Ethics Board of the Jewish General Hospital, Montreal, Quebec, Canada approved the study.

Cardiovascular and Thyroid Late Effects in Pediatric Patients with Hodgkin Lymphoma Treated with Abvd Protocol

Background: Long-term Hodgkin Lymphoma (HL) survivors are at risk of developing a range of therapy-related complications that may present 10 -15 years after treatment. The goal of this study is to estimate the frequency of cardiovascular diseases and thyroid abnormalities in HL survivors and to determine the contributing risk factors. Methods: We performed a cross-sectional study on 208 HL survivors who were treated at the National Cancer Institute, Cairo University, or at the Children Cancer Hospital Egypt with ABVD chemotherapy ± radiotherapy with a minimum of five years follow up. Findings: The cumulative incidence of cardiac toxicity (CT) at five and nine years were 18·7% ± SD 2·7 and 43·3% ± SD 4·4, respectively. Preexisting cardiac abnormalities, cumulative anthracycline dose, and end of treatment cardiac status are strong predictors for late cardiotoxicity. Hypertension was observed in about 31% of HL survivors. Young age and obesity at the time of treatment are important factors for hypertension. Thyroid abnormalities developed with a 5-year cumulative incidence of 2%± SD 1 while at 9-years the cumulative incidence was 27·9%± SD 4·5. Thyroid dysfunction was observed in 21·2% and thyroid tumors in 1·6%. Subclinical hypothyroidism was the most common thyroid abnormality after HL treatment. Neck radiation therapy and the volume of thyroid gland exposed to radiation are important risk factors. Interpretation: Cardiotoxicity, hypertension, and thyroid dysfunction are frequent late effects following the ABVD regimen especially if combined with radiation therapy. Funding: None to declare. Declaration of Interest: The authors declare that there is no conflict of interest. Ethical Approval: The study was approved by the institutional review board of the NCI-Cairo University and the scientific medical advisory committee of CCHE.

Adverse Childhood Experiences (ACEs) in English Electronic Health Records of Linked Mothers and Children: Validation Study Using a Multistage Risk-Prediction Model

Background: Electronic health records (EHRs) are readily available and increasingly used for identifying adverse childhood experience (ACEs), yet well-developed indicators for ACEs remain limited. We aimed to develop clinically relevant indicators of ACEs for routine EHRs of mothers and children using multi-stage risk prediction models of child maltreatment (CM) and maternal intimate partner violence (mIPV). Methods: We developed a representative population-based birth cohort of 211 ·393 linked mother-child pairs (422·786 total patients) followed from 2-years pre-birth up to 5-years post-birth (2002-2018) across the Clinical Practice Research Datalink (primary care), Hospital Episode Statistics (secondary care), and the Office for National Statistics mortality register. We randomly assigned the cohort into a derivation cohort (2/3 of sample) and a validation cohort by GP practice. The primary outcome (reference standard) was any CM or mIPV in the mother's or child's record from 2-years pre-birth (mIPV only) up to 5-years post-birth. We used 8 prediction models combined with expert ratings to systematically developed indicators. We validated the final indicators by integrating results from machine learning models, survival analyses and clustering analyses in the validation cohort. Findings: We included 63 indicators in six ACE domains: maternal mental health problems (mMHPs), maternal substance misuse (MSM), adverse family environments (AFE), CM, mIPV, and high-risk presentations for CM (HRP-CM) . Excluding the 7 indicators in the reference standard, 56 indicators showed high discriminative validity for family violence (validation cohort, area under the receiver operating characteristic curve: 0·85, 95% CI: 0·84-0·86). The prevalence over the 2-year period before and after birth were 39·1% for any of the 63 ACE indicators, 22·2% for mMHPs, 15·7% for AFE, 8·1% for HRP-CM, 6·9% for MSM, and 3·0% for any CM (2·4%) and mIPV (1·0%). 74·1% of ACEs were recorded only in primary care. Interpretation: We developed and quantified clinically relevant indicators for identifying ACEs using EHRs of mothers and children presenting to health care during pregnancy and early childhood. Details of all ACEs and indicators are publicly available for further evaluation (https:/ACEsinEHRs.com). Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: The study was approved by the MHRA (UK) Independent Scientific Advisory Committee

Developing and Internally Validating a Prognostic Model (P Risk) to Improve the Prediction of Psychosis in a Primary Care Population Using Electronic Health Records: The MAPPED Study

Background: An accurate risk prediction algorithm could improve psychosis outcomes by reducing duration of untreated psychosis. The objective was to develop and validate a risk prediction model for psychosis, for use by family doctors, using linked electronic health records. Methods: A prospective prediction study. Records from family practices were used between 1/1/2010 to 31/12/2017 of 300,000 patients who had consulted their family doctor for any nonpsychotic mental health problem. Records were selected from Clinical Practice Research Datalink Gold, a routine database of UK family doctor records linked to Hospital Episode Statistics, a routine database of UK secondary care records. Each patient had 5 to 8 years of follow up data. Study predictors were consultations, diagnoses and/or prescribed medications, during the study period or historically, for 13 nonpsychotic mental health problems and behaviours, age, gender, number of mental health consultations, social deprivation, geographical location, and ethnicity. The outcome was time to an ICD10 psychosis diagnosis. Findings: 830 individual diagnoses of psychosis were made. Patients were from 216 family practices, mean age was 45.3 years and 43.5% were male. Median follow-up was 6.5 years (IQR 5.6, 7.8). Overall 8-year incidence of psychosis was 45.8 (95% CI 42.8, 49.0)/100,000 person years at risk. A risk prediction model including age, sex, ethnicity, social deprivation, consultations for suicidal behaviour, depression/anxiety and substance abuse, a history of consultations for suicidal behaviour, smoking history and substance abuse and prescribed medications for depression/anxiety/PTSD/OCD and total number of consultations resulted in good discrimination (Harrell’s C=0.77 after internal validation). Identifying patients with predicted risk exceeding 1% over 6 years had sensitivity of 69% and specificity of 71%. Interpretation: An accurate prediction model for risk of psychosis developed from electronic health records could be used to facilitate early detection of psychosis by family doctors. Funding: NIHR, School for Primary Care Research. Declaration of Interest: None of the authors have any declarations of interest to declare. Ethical Approval: Approval was obtained from the CPRD’s Independent Scientific Advisory Committee.

Effectiveness of BNT162b2 mRNA COVID-19 Vaccine Against SARS-CoV-2 Variant Beta (B.1.351) Among Persons Identified Through Contact Tracing in Israel

Background: SARS-CoV-2 variant Beta (B.1.351) was designated as a Variant of Concern (VoC) after becoming the dominant strain in South Africa and spreading internationally. BNT162b2 showed lower levels of neutralizing antibodies against Beta than against other strains raising concerns about effectiveness of vaccines against infections caused by Beta. We estimated BNT162b2 effectiveness against Beta infections in Israel, a country with high vaccine uptake. Methods: The Ministry of Health (MoH) identified Beta cases through mandatory reporting of SARS-CoV-2 cases and whole genome sequencing (WGS) of specimens from vaccination-breakthrough infections, reinfections, arriving international travelers, and a selection of other infected persons. A cohort analysis was conducted of exposure events of contacts of primary Beta cases. WGS was conducted on available PCR-positive specimens collected from contacts. VE estimates with 95% confidence intervals (CIs) against confirmed and probable Beta infections were determined by comparing infection risk between unvaccinated and fully-vaccinated ( > 7 days after the second dose) contacts, and between unvaccinated and partially-vaccinated (Findings: MoH identified 310 Beta cases through Jun 27, 2021. During the study period (Jan 1, 2021 – Mar 25, 2021), 164 non-institutionalized primary Beta cases, with 552 contacts aged > 16 years, were identified. 343/552 (62%) contacts were interviewed and tested. 71/343 (21%) contacts were PCR-positive. WGS was performed on 7/71 (10%) PCR-positive specimens; all were Beta. Among SARS-CoV-2-infected contacts, 48/71 (68%) were symptomatic, 10/71 (14%) hospitalized, and 2/71 (3%) died. Fully-vaccinated VE against confirmed or probable Beta infections was 72% (95% CI -5 - 97%; p =0.04) and against symptomatic confirmed or probable Beta infections was 100% (95% CI 19 - 100%; p =0.01). There was no evidence of protection in partially-vaccinated contacts. Interpretation: Two doses of BNT162b2 conferred protection against Beta infections and disease. Introductions of Beta did not interrupt control of the pandemic in Israel. Funding: None to declare. Declaration of Interest: Frederick Angulo, David Swerdlow, John McLaughlin, Farid Khan, Gabriel Mircus, Kaijie Pan, Jo Southern, and Luis Jodar hold stock and stock options in Pfizer Inc. Marc Lipsitch has provided advice on COVID-19 free of charge to Janssen, Astra-Zeneca, Pfizer, and COVAXX (United Biomedical), as well as to the nonprofit One Day Sooner and has received consulting income or honoraria from Merck, Pfizer, Bristol Meyers Squibb, Janssen, and Sanofi, and institutional research support from Pfizer. He is on the Scientific Advisory Committee of the Coalition for Epidemic Preparedness and Innovations (CEPI). All other authors report no conflicts.Ethical Approval: This study was approved by MoH’s Institutional Review Board (CoR-MoH-080-2021).

Self-Harm Risk in Pregnancy: A Recurrent Events Survival Analysis Using UK Primary Care Data

Aim: To determine if the risk of self-harm changes during pregnancy and the first post-partum year compared to other times in a woman’s life. Methods: Utilising the Clinical Practice Research Datalink, a primary care register, we followed women aged 15 to 45 years from the 1st January 1990 to 31st December 2017. Time was split into: pregnancy, 0-3, 3-6 and 6-12 months post-partum, and any other time outside the perinatal period. Additional time-varying covariates were constructed for: common mental illness (depression/anxiety); addiction (alcohol/drug misuse); serious mental illness (affective/non-affective psychosis); other mental illness (eating/personality disorders); age (15-45 in 5-year bands); and calendar year (1990-2017). UK region and index of multiple deprivation were also included. Utilising a gap-time and stratified Cox model to manage multiple self-harm events, we report unadjusted and adjusted HRs of self-harm associated with pregnancy and the post-partum compared to other periods. Pre-planned interactions examined whether or not effect measures were modified by mental illness exposure, age and birth outcome. Results: The analysis included 2,666,088 women, 1,102,040 pregnancies, 57,791, self-harm events and 14,712,319 person-years of follow-up. Compared to any other time, women were at lowest risk of self-harm during pregnancy (adjHR=0·53, 95%CI 0·49-0·58) and highest risk at 6-12 months post-partum (adjHR=1·08, 95%CI 1·02-1·15). Women with mental illness experienced the greatest self-harm risk reduction in pregnancy (adjHR=0·40, 95%CI 0·36-0·44) and at 6-12 months post-partum (adjHR=0·92, 95%CI 0·87-0·98). Post-partum younger women (15-19 adjHR=1·67, 95%CI 1·48-1·90; 20-24 adjHR=1·27, 95%CI 1·12-1·44) and women who experienced a pregnancy loss (adjHR=1.41, 95%CI 1·21-1·65) or termination (adjHR=1·93, 95%CI 1·72-2·17) were particularly at risk. Conclusion: Overall, pregnancy represents a time of reduced self-harm risk for women. This is especially the case for women with a mental illness. Post-partum, young women represent a vulnerable group who may require additional support. Services aimed at planning for motherhood may have additional psychological benefit in self-harm reduction. Funded by the European Research Council (ref: GA682741) and the National Institute for Health Research (ref: 111905).The study sponsor and funder had no role in the study design, nor the collection, analysis or interpretation of data. Declaration of Interest: None to declare Ethical Approval: The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. The study was approved by the Independent Scientific Advisory Committee (ISAC) for MHRA Database Research (protocol number: 17_187). All observational research using CPRD patient data with approval from ISAC was granted by a Health Research Authority (HRA) Research Ethics Committee (East Midlands—Derby, REC reference number 05/MRE04/87).

Salgının ön safındaki bir aile hekimliği uzmanından olgu sunumu

The World Health Organization China National Office have announced pneumonia cases of unknown etiology from Hubei district of China for the first time on 31st of December 2019. On 7th of January 2020 the etiologic agent has been accepted as a new coronavirus (Covid19) that is not formerly detected in human. World Health Organization classified Covid19 epidemic as “international public health emergency” on the 30th of January, and as a global pandemic on the 11th of March, since Covid19 cases have been detected in 113 countries other than China, where the epidemic has first begun, and because of the expansion of the virus and its severity. Covid19 related studies have been started in our country on the 10th of January 2020 and the first meeting of the T.R. Ministry of Health Scientific Advisory Committee has been realized on 22 January, and due to the preventive measures, the first Covid19 case is seen on 11 March after Europe and Iran, the countries in our neighborhoods. With the case presentations in this article we tried to present a section from the field.

An overview of the Scientific Advisory Committee on Nutrition’s position statement on nutrition and older adults living in the community

An overview of the Scientific Advisory Committee on Nutrition’s position statement on nutrition and older adults living in the community

New approaches for cultural heritage: scientific symposium advisory committee – heritage as urban regeneration tool

PurposeThis presentation intends to illustrate through the example of a few specific cases of urban actions and projects, those instances in which the existence of built heritage leads to the recognition of identity and valuable contribution as a tool to regenerate, promote residence and economic development.Design/methodology/approachIntroducing a conceptual framework for identity and culture it is possible to start the recognition of buildings, spaces, stories that configure own particularity to cities. And those would be the elements that would be configured as tools to involve the actions and transformation of the area. Studying each one of the heritage elements detected it is possible to trace a chorus line that impulse the new activity proposal.FindingsCases presented in this article were really astonishing in terms of impact and provoked many favorable externalities around them. It is possible to confirm that history and stories as good as buildings and determined places can help regeneration with its own promotion and new ideas applied for better results.Originality/valueIn fact, heritage as a concept, cultural tangible and intangible, is a powerful tool to regenerate cities, to promote economical activity and bind communities toward social development.

Forensic Evidence in Arizona: Reforms for Victims and Defendants

This Article identifies the strengths of the current system in Arizona and proposes innovative reforms appropriate for labs that are already leaders in the field. Arizona is particularly well situated to increase its lab independence and to serve additional members of the criminal legal community: namely, defendants and victims. Regarding defendants, this Article recommends greater transparency and accessibility to fundamental scientific lab findings for defense attorneys, similar to the practices of well-known independent crime labs such as the Houston Forensic Science Center. Additionally, the volunteer-run Arizona Forensic Science Advisory Committee can ensure greater integrity for forensic evidence in the courtroom if it is staffed, ideally with a staff attorney. Regarding victims, in a moment of calls to “defund the police,” this Article proposes that police departments shift resources to hire more civilian crime scene investigators. More civilian investigators can increase responsiveness to property crimes for victims and also identify the scope of the property crime problem in regularly impacted neighborhoods. Economically struggling neighborhoods are frequently overpoliced for controlled substances violations, yet law enforcement is simultaneously under-responsive to victims of property crime in these communities.

Violet colorant poses risks to workers

A violet dye used in industrial carpeting, automobile plastics, inks, and other products poses unreasonable risks to workers under several use scenarios, the US Environmental Protection Agency announced Oct. 29 in a revised draft assessment . The assessment is a marked contrast to the agency’s initial version , released in November 2018, concluding that the dye posed no unreasonable risks to human health or the environment. The dye, pigment violet 29 (PV29), is one of the first 10 chemicals that the EPA is evaluating under the 2016 revisions to the Toxic Substances Control Act. The agency aims to complete all 10 assessments by the end of this year. After receiving criticism from a scientific advisory committee and environmental groups about data gaps in its initial PV29 draft assessment, the EPA ordered chemical manufacturers to provide some of the missing information. The agency sent the order in February to Sun Chemical,

Preventing vitamin D deficiency during the COVID-19 pandemic: UK definitions of vitamin D sufficiency and recommended supplement dose are set too low

There is growing evidence linking vitamin D deficiency with risk of COVID-19. It is therefore distressing that there is major disagreement about the optimal serum level for 25-hydroxyvitamin D (25(OH)D) and appropriate supplement dose. The UK Scientific Advisory Committee for Nutrition has set the lowest level for defining sufficiency (10 ng/ml or 25 nmol/L) of any national advisory body or scientific society and consequently recommends supplementation with 10 micrograms (400 IU) per day. We have searched for published evidence to support this but not found it. There is considerable evidence to support the higher level for sufficiency (20 ng/ml or 50 nmol/L) recommended by the European Food Safety Authority and the American Institute of Medicine and hence greater supplementation (20 micrograms or 800 IU per day). Serum 25(OH)D concentrations in the UK typically fall by around 50% through winter. We believe that governments should urgently recommend supplementation with 20-25 micrograms (800-1,000 IU) per day.

Developing a National Research Agenda to Support Healthy Food Retail.

The food retail environment is an important driver of dietary choices. This article presents a national agenda for research in food retail, with the goal of identifying policies and corporate practices that effectively promote healthy food and beverage purchases and decrease unhealthy purchases. The research agenda was developed through a multi-step process that included (1) convening a scientific advisory committee; (2) commissioned research; (3) in-person expert convening; (4) thematic analysis of meeting notes and refining research questions; (5) follow-up survey of convening participants; and (6) refining the final research agenda. Public health researchers, advocates, food and beverage retailers, and funders participated in the agenda setting process. A total of 37 research questions grouped into ten priority areas emerged. Five priority areas focus on understanding the current food retail environment and consumer behavior and five focus on assessing implementation and effectiveness of interventions and policies to attain healthier retail. Priority topics include how frequency, duration, and impact of retailer promotion practices differ by community characteristics and how to leverage federal nutrition assistance programs to support healthy eating. To improve feasibility, researchers should explore partnerships with retailers and advocacy groups, identify novel data sources, and use a variety of study designs. This agenda can serve as a guide for researchers, food retailers, funders, government agencies, and advocacy organizations.

Recent Changes to the US Chemical Regulatory Process: Impacts on Public Health

The chemical regulatory process at the Environmental Protection Agency (EPA) has historically been vulnerable to pressure from chemical manufacturers and trade organizations. This pressure can be applied directly on the EPA’s review of and use of science on a specific chemical or can take the form of influence over the process by which science is used by the agency, including in the development of risk assessments, weight-of-evidence analyses, and hazard determinations or during the peer review process by EPA’s advisory committees. We evaluated the way in which process changes at the EPA made since 2017 have or likely will have impacts on the agency’s ability to use the best available science to inform policies that keep the public safe from chemical exposure. Examples include delays and suspension of work under the Integrated Risk Information System, restricting the advice that the Science Advisory Committee on Chemicals and the Science Advisory Board can provide to the agency, limiting the scope of assessment for chemicals under implementation of the Toxic Substances Control Act (TSCA), and issuing a TSCA systematic review framework that departs from scientific best practices. We found that these process alterations have resulted in insufficiently health-protective assessments and resulting policy decisions and fewer opportunities for members of the public to provide input. These impacts are felt especially for communities of color, low-income communities, and Indigenous communities who are experience an inequitable burden of chemical exposure. The speaker will lay out solutions that the EPA can put in place to address these challenges with the chemical regulatory process and prevent against undue influence from the regulated industry.

Evidence Evaluation Process and Management of Potential Conflicts of Interest: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.

Evidence Evaluation Process and Management of Potential Conflicts of Interest: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.

Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Part 2: Evidence Evaluation and Guidelines Development: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

The 2020 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care is based on the extensive evidence evaluation performed in conjunction with the International Liaison Committee on Resuscitation. The Adult Basic and Advanced Life Support, Pediatric Basic and Advanced Life Support, Neonatal Life Support, Resuscitation Education Science, and Systems of Care Writing Groups drafted, reviewed, and approved recommendations, assigning to each recommendation a Class of Recommendation (ie, strength) and Level of Evidence (ie, quality). The 2020 Guidelines are organized in knowledge chunks that are grouped into discrete modules of information on specific topics or management issues. The 2020 Guidelines underwent blinded peer review by subject matter experts and were also reviewed and approved for publication by the AHA Science Advisory and Coordinating Committee and the AHA Executive Committee. The AHA has rigorous conflict-of-interest policies and procedures to minimize the risk of bias or improper influence during development of the guidelines. Anyone involved in any part of the guideline development process disclosed all commercial relationships and other potential conflicts of interest.

Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

1. Newborn resuscitation requires anticipation and preparation by providers who train individually and as teams. 2. Most newly born infants do not require immediate cord clamping or resuscitation and can be evaluated and monitored during skin-to-skin contact with their mothers after birth. 3. Inflation and ventilation of the lungs are the priority in newly born infants who need support after birth. 4. A rise in heart rate is the most important indicator of effective ventilation and response to resuscitative interventions. 5. Pulse oximetry is used to guide oxygen therapy and meet oxygen saturation goals. 6. Chest compressions are provided if there is a poor heart rate response to ventilation after appropriate ventilation corrective steps, which preferably include endotracheal intubation. 7. The heart rate response to chest compressions and medications should be monitored electrocardiographically. 8. If the response to chest compressions is poor, it may be reasonable to provide epinephrine, preferably via the intravenous route. 9. Failure to respond to epinephrine in a newborn with history or examination consistent with blood loss may require volume expansion. 10. If all these steps of resuscitation are effectively completed and there is no heart rate response by 20 minutes, redirection of care should be discussed with the team and family. It is estimated that approximately 10% of newly born infants need help to begin breathing at birth,1–3 and approximately 1% need intensive resuscitative measures to restore cardiorespiratory function.4,5 The neonatal mortality rate in the United States and Canada has fallen from almost 20 per 1000 live births6,7 in the 1960s to the current rate of approximately 4 per 1000 live births. The inability of newly born infants to establish and sustain adequate or spontaneous respiration contributes significantly to these early deaths and to the burden of adverse neurodevelopmental outcome among survivors. Effective and timely resuscitation …

A 3 Year Longitudinal Prospective Review Examining the Dietary Profile and Contribution Made by Special Low Protein Foods to Energy and Macronutrient Intake in Children with Phenylketonuria.

The nutritional composition of special low protein foods (SLPFs) is controlled under EU legislation for ‘Foods for Special Medical Purposes (FSMP)’. They are designed to meet the energy needs of patients unable to eat a normal protein containing diet. In phenylketonuria (PKU), the macronutrient contribution of SLPFs has been inadequately examined. Aim: A 3-year longitudinal prospective study investigating the contribution of SLPFs to the macronutrient intake of children with early treated PKU. Methods: 48 children (27 boys) with a mean recruitment age of 9.3 y were studied. Semi-quantitative dietary assessments and food frequency questionnaires (FFQ) were collected three to four times/year for 3 years. Results: The mean energy intake provided by SLPFs was 33% (SD ± 8), and this figure was 42% (SD ± 13) for normal food and 21% (SD ± 5) for protein substitutes (PS). SLPFs supplied a mean intake of 40% carbohydrate (SD ± 10), 51% starch (SD ± 18), 21% sugar (SD ± 8), and 38% fat (SD ± 13). Fibre intake met 83% of the Scientific Advisory Committee on Nutrition (SACN) reference value, with 50% coming from SLPFs with added gums and hydrocolloids. Low protein bread, pasta and milk provided the highest energy contribution, and the intake of sweet SLPFs (e.g., biscuits, cakes, and chocolate) was minimal. Children averaged three portions fruit/vegetable daily, and children aged ≥ 12 y had irregular meal patterns. Conclusion: SLPFs provide essential energy in phenylalanine restricted diets. Optimising the nutritional quality of SLPFs deserves more attention.

A systematic review of physical activity and quality of life and well-being.

Maintaining or improving quality of life (QoL) and well-being is a universal goal across the lifespan. Being physically active has been suggested as one way to enhance QoL and well-being. In this systematic review, conducted in part for the 2018 U.S. Health and Human Services Physical Activity Guidelines for Americans Scientific Advisory Committee Report, we examined the relationship between physical activity (PA) and QoL and well-being experienced by the general population across the lifespan and by persons with psychiatric and neurologic conditions. Systematic reviews, meta-analyses, and pooled analyses from 2006 to 2018 were used for the evidence base. Strong evidence (predominantly from randomized controlled trials [RCTs]) demonstrated that, for adults aged 18-65 years and older adults (primarily 65 years and older), PA improves QoL and well-being when compared with minimal or no-treatment controls. Moderate evidence indicated that PA improves QoL and well-being in individuals with schizophrenia and Parkinson's disease, and limited evidence indicated that PA improves QoL and well-being for youth and for adults with major clinical depression or bipolar disorder. Insufficient evidence existed for individuals with dementia because of a small number of studies with mixed results. Future high-quality research designs should include RCTs involving longer interventions testing different modes and intensities of PA in diverse populations of healthy people and individuals with cognitive (e.g., dementia) and mental health conditions (e.g., schizophrenia) to precisely characterize the effects of different forms of PA on aspects of QoL and well-being.