Recommendation to include hydroxyethyl (meth)acrylate in the British baseline patch test series.

BACKGROUND: (Meth)acrylates are potent sensitizers and a common cause of allergic contact dermatitis (ACD). The frequency of (meth)acrylate ACD has increased with soaring demand for acrylic nails. A preliminary audit has suggested a significant rate of positive patch tests to (meth)acrylates using aimed testing in patients providing a clear history of exposure. To date, (meth)acrylates have not been routinely tested in the baseline patch test series in the U.K. and Europe. OBJECTIVES: To determine whether inclusion of 2-hydroxyethyl methacrylate (2-HEMA) 2% in petrolatum (pet.) in the baseline series detects cases of treatable (meth)acrylate ACD. METHODS: During 2016-2017, 15 U.K. dermatology centres included 2-HEMA in the extended baseline patch test series. Patients with a history of (meth)acrylate exposure, or who tested positive to 2-HEMA, were selectively tested with a short series of eight (meth)acrylate allergens. RESULTS: In total 5920 patients were consecutively patch tested with the baseline series, of whom 669 were also tested with the (meth)acrylate series. Overall, 102 of 5920 (1·7%) tested positive to 2-HEMA and 140 (2·4%) to at least one (meth)acrylate. Had 2-HEMA been excluded from the baseline series, (meth)acrylate allergy would have been missed in 36 of 5920 (0·6% of all patients). The top (meth)acrylates eliciting a positive reaction were 2-HEMA (n = 102, 1·7%), 2-hydroxypropyl methacrylate (n = 61, 1·0%) and 2-hydroxyethyl acrylate (n = 57, 1·0%). CONCLUSIONS: We recommend that 2-HEMA 2% pet. be added to the British baseline patch test series. We also suggest a standardized short (meth)acrylate series, which is likely to detect most cases of (meth)acrylate allergy.

DNA barcoding and real-time PCR detection of Bactrocera xanthodes (Tephritidae: Diptera) complex.

Immature fruit fly stages of the family Tephritidae are commonly intercepted on breadfruit from Pacific countries at the New Zealand border but are unable to be identified to the species level using morphological characters. Subsequent molecular identification showed that they belong to Bactrocera xanthodes, which is part of a species complex that includes Bactrocera paraxanthodes, Bactrocera neoxanthodes and an undescribed species. To establish a more reliable molecular identification system for B. xanthodes, a reference database of DNA barcode sequences for the 5'-fragment of COI gene region was constructed for B. xanthodes from Fiji, Samoa and Tonga. To better understand the species complex, B. neoxanthodes from Vanuatu and B. paraxanthodes from New Caledonia were also barcoded. Using the results of this analysis, real-time TaqMan polymerase chain reaction (PCR) assays for the detection of B. xanthodes complex and for the three individual species of the complex were developed and validated. The assay showed high specificity for the target species, with no cross-reaction observed for closely related organisms. Each of the real-time PCR assays is sensitive, detecting the target sequences at concentrations as low as ten copies µl-1 and can be used as either singleplex or multiplex formats. This real-time PCR assay for B. xanthodes has been successfully applied at the borders in New Zealand, leading to the rapid identification of intercepted Tephritidae eggs and larvae. The developed assays will be useful biosecurity tools for rapid detection of species in the B. xanthodes complex worldwide.

Infant adiposity following a randomised controlled trial of a behavioural intervention in obese pregnancy.

OBJECTIVES: Randomised controlled trials are required to address causality in the reported associations between maternal influences and offspring adiposity. The aim of this study was to determine whether an antenatal lifestyle intervention, associated with improvements in maternal diet and reduced gestational weight gain (GWG) in obese pregnant women leads to a reduction in infant adiposity and sustained improvements in maternal lifestyle behaviours at 6 months postpartum. SUBJECTS AND METHODS: We conducted a planned postnatal follow-up of a randomised controlled trial (UK Pregnancies Better Eating and Activity Trial (UPBEAT)) of a complex behavioural intervention targeting maternal diet (glycaemic load (GL) and saturated fat intake) and physical activity in 1555 obese pregnant women. The main outcome measure was infant adiposity, assessed by subscapular and triceps skinfold thicknesses. Maternal diet and physical activity, indices of the familial lifestyle environment, were assessed by questionnaire. RESULTS: A total of 698 (45.9%) infants (342 intervention and 356 standard antenatal care) were followed up at a mean age of 5.92 months. There was no difference in triceps skinfold thickness z-scores between the intervention vs standard care arms (difference -0.14 s.d., 95% confidence interval -0.38 to 0.10, P=0.246), but subscapular skinfold thickness z-score was 0.26 s.d. (-0.49 to -0.02; P=0.03) lower in the intervention arm. Maternal dietary GL (-35.34; -48.0 to -22.67; P<0.001) and saturated fat intake (-1.93% energy; -2.64 to -1.22; P<0.001) were reduced in the intervention arm at 6 months postpartum. Causal mediation analysis suggested that lower infant subscapular skinfold thickness was partially mediated by changes in antenatal maternal diet and GWG rather than postnatal diet. CONCLUSIONS: This study provides evidence from follow-up of a randomised controlled trial that a maternal behavioural intervention in obese pregnant women has the potential to reduce infant adiposity and to produce a sustained improvement in maternal diet at 6 months postpartum.

Nutrient intakes and compliance with nutrient recommendations in children aged 1-4 years in Ireland.

BACKGROUND: The early childhood years represent a period of rapid growth and development characterised by unique requirements for energy and individual nutrients. METHODS: The present study uses data from the National Pre-School Nutrition Survey, a nationally representative sample of Irish children (1-4 years) (n = 500), aiming to estimate energy and nutrient intakes across age and compliance with recommendations (UK and European). A 4-day weighed food-record was used to collect dietary data and statistical modelling (National Cancer Institute method) was applied to estimate usual nutrient intakes. RESULTS: Intakes of carbohydrate [48-50% energy (E)], protein (15-16%E), total fat (32-34%E), dietary fibre (2.5 g MJ-1 ), α-linolenic acid (0.45%E) and most micronutrients were in good compliance with recommendations. However, intakes of long chain polyunsaturated fatty acids (LCPUFA) (65-80 mg) were low and significant proportions of children had inadequate intakes (< estimated average requirement) of vitamin D and iron. Small proportions of children with intakes exceeding the upper level for retinol, folic acid, zinc, copper and iodine, are unlikely to give rise to adverse health effects. Mean intakes of free sugars (12%E) and salt (3.1 g day-1 ) exceeded recommendations and increased with age, whereas mean intake of saturated fat (15%E) decreased with age. By the age of 4 years, patterns established for intakes of salt, saturated fat and free sugars were unfavourable and similar to those observed in the diets of older children. CONCLUSIONS: Further research is needed to identify dietary strategies that improve the quality of the diet in young children, particularly in relation to excess of saturated fat, free sugars and salt, as well as inadequacy of iron, vitamin D and LCPUFA.

Dietary strategies for achieving adequate vitamin D and iron intakes in young children in Ireland.

BACKGROUND: Inadequate intakes of vitamin D and iron have been reported in young children in Ireland. The present study aimed to identify the main foods determining vitamin D and iron intakes and to model the impact of dietary strategies to improve adequacy of these micronutrients in young children. METHODS: The present study is based on the Irish National Pre-School Nutrition Survey (NPNS), which estimated food and nutrient intakes in a representative sample (n = 500) of children (aged 1-4 years) using a 4-day weighed food record. Dietary strategies were modelled using DaDiet© software (Dazult Ltd, Co. Kildare, Republic of Ireland) and the usual intake distribution, prevalence of inadequate intakes and risk of excessive intakes were estimated using the National Cancer Institute method. RESULTS: Fortified foods and nutritional supplements were the key foods influencing the intakes of vitamin D and iron. Adding a 5 µg day-1 vitamin D supplement, fortifying cow's milk (CM) with vitamin D or replacing CM with growing-up milk (GUM) would modestly increase intakes of vitamin D. A combined strategy of fortifying CM with vitamin D or replacing CM with GUM plus a 5 µg day-1 vitamin D supplement would increase mean intakes of vitamin D (from 3.5 µg day-1 at baseline to ≥11 µg day-1 ) and substantially reduce the prevalence of inadequate intakes (from >95% to 12-36%). Fortifying CM with iron or replacing CM with GUM would increase mean intakes of iron (from 7.3 mg day-1 to >10 mg day-1 ), achieving adequate intakes across all ages. CONCLUSIONS: Based on real food consumption data in a representative sample of Irish children, we have shown that through targeted dietary strategies adequate intakes of iron are achievable and intakes of vitamin D could be greatly improved.

Effect of Ramipril on Urinary Protein Excretion in Maintenance Renal Transplant Patients Converted to Sirolimus.

This prospective, randomized, double-blind, placebo-controlled study evaluated the effects of ramipril on urinary protein excretion in renal transplant patients treated with sirolimus following conversion from a calcineurin inhibitor. Patients received ramipril or placebo for up to 6 weeks before conversion and 52 weeks thereafter. Doses were increased if patients developed proteinuria (urinary protein/creatinine ratio ≥0.5); losartan was given as rescue therapy for persistent proteinuria. The primary end point was time to losartan initiation. Of 295 patients randomized, 264 met the criteria for sirolimus conversion (ramipril, 138; placebo, 126). At 52 weeks, the cumulative rate of losartan initiation was significantly lower with ramipril (6.2%) versus placebo (23.2%) (p < 0.001). No significant differences were observed between ramipril and placebo for change in glomerular filtration rate from baseline (p = 0.148) or in the number of patients with biopsy-confirmed acute rejection (13 vs. 5, respectively; p = 0.073). One patient in the placebo group died due to cerebrovascular accident. Treatment-emergent adverse events were consistent with the known safety profile of sirolimus and were not potentiated by ramipril co-administration. Ramipril was effective in reducing the incidence of proteinuria for up to 1 year following conversion to sirolimus in maintenance renal transplant patients.

Nutritional quality of the school-day diet in Irish children (5-12 years).

BACKGROUND: The European Commission has identified schools as a priority setting for health promotion, including nutrition education and intervention. The present study examined the school-day diet of Irish primary-school children with the aim of identifying opportunities for dietary improvement. METHODS: Data from The National Children's Food Survey (2003-2004) were used to establish a dataset of school-days. Dietary intake data were collected from 594 children (5-12 years) using a 7-day weighed food-record. The nutritional quality of the diet was examined for the total school-day and for food eaten 'before school', 'at school' and 'after school'. RESULTS: Examination of dietary intake on school-days has highlighted nutritional imbalances for intakes of fat, saturated fat, added sugars, sodium and dietary fibre (DF). Mean energy (E) intake for the overall school-day was 7.1 MJ, with 16% of energy provided from food eaten 'before school', 33%E from food eaten 'at school' and 53% of energy from food eaten 'after school'. Relative to the overall school-day, food eaten 'before school' was lower in saturated fat and sodium, and higher in DF and many micronutrients. Food eaten 'at school' was relatively high in added sugars and sodium; lower in DF and micronutrients; and similar in saturated fat compared to the overall school-day. Food eaten 'after school' was relatively high in DF and vitamin A; similar in saturated fat, magnesium and sodium; and lower in added sugars and other micronutrients compared to the overall school-day. CONCLUSIONS: To improve the overall nutritional quality of the school-day diet, food eaten at school should be targeted.

Water intakes and dietary sources of a nationally representative sample of Irish adults.

BACKGROUND: Despite evidence that even mild dehydration is associated with various morbidities, water intake estimates in free-living populations are lacking. The present study aimed to estimate water intakes and dietary sources in a nationally representative sample of the Irish adult population. METHODS: A 4-day semi-weighed food record was used to collect dietary intake data from 1500 free-living adults aged 18-90 years in the Irish National Adult Nutrition Survey (NANS) (2008-2010) from which water intake was estimated. To enable fluid intake estimation, additional questions on how water and milk were consumed were incorporated. Total water intake was calculated as drinking water plus water from other beverages and food moisture. RESULTS: The mean (SD) daily total water intake for Irish adults was 2.31 (0.92) L day(-1) [males 2.52 (1.00) L day(-1) ; females 2.09 (0.79) L day(-1)]. Intakes were lowest in elderly adults, as well as in those with less education, a lower social class, less energy expenditure and a higher body mass index and body fat percentage. In total, 67% of water came from beverages and 33% came from food moisture. Alcoholic beverages and teas individually contributed to total water intake in amounts similar to the drinking water contribution. CONCLUSIONS: These data may be used as a foundation for further research in the area of the effect of under consumption of water on health outcomes to guide public health messages regarding adequate water intakes.

A systematic review of community pharmacy interventions to improve peri- and post-menopausal health.

Menopause is defined as the permanent cessation of menstruation due to loss of ovarian follicular function. Symptoms include mood disorders, vaginal atrophy, hot flashes and night sweats and can emerge during a gradual transition period called perimenopause. Community pharmacies are well placed to deliver a wide range of healthcare services, including supporting and educating menopausal women; however, to date, no systematic review has assessed the effectiveness of community pharmacy-led interventions in improving peri- and post-menopausal health. In accordance with PRISMA guidelines we evaluated community pharmacy-led interventions that targeted women in peri- or post-menopause. Electronic searches in EMBASE, MEDLINE, CINAHL and Cochrane Library were conducted on 13th February 2023. Additionally, we examined the included studies references and citation lists using Google Scholar. A total of 915 articles were identified and screened against the inclusion criteria. Two studies were included; one identified post-menopausal women at risk of developing osteoporosis (OP), and one evaluated the outcomes of a community pharmacy-based menopause education programme. Study one found 11 (11%) post-menopausal women were at risk of developing OP based on quantitative ultrasound screening offered by community pharmacists and referred to their physician. Study two reported that women had access to adequate personalised menopause counselling and increased knowledge of menopause topics because of the educational programme within community pharmacies. Both studies were of low quality. The lack of included studies reflects the need for high-quality research to determine whether community pharmacy-led interventions are feasible, effective and acceptable, to improve health outcomes of peri- or post-menopausal women.

Identification by 16S rRNA gene sequencing of an Actinomyces hongkongensis isolate recovered from a patient with pelvic actinomycosis.

A case of Actinomyces hongkongensis pelvic actinomycosis in an adult woman is described. Conventional phenotypic tests failed to identify the Gram-positive bacillus isolated from a fluid aspirate of a pelvic abscess. The bacterium was identified by 16S rRNA gene sequencing and analysis using the SmartGene Integrated Database Network System software.

Inflammatory bowel disease and thromboembolism. Is inflammation at the centre of the clot?

Thromboembolic events are well recognised in patients with inflammatory bowel disease (IBD). We present three cases which highlight the need for vigilance with respect to this complication. We also propose that consideration be given to re-evaluating disease activity in those patients who develop thromboembolic complications.

Strength of hip muscles and bradykinesia contribute to walking speed over a long distance, but not a short distance, in people with mild Parkinson's disease: An observational study.

BACKGROUND: Bradykinesia and postural instability contribute to walking limitations in people with Parkinson's disease (PD), but the contribution of muscle strength to walking speed has not been examined extensively. RESEARCH QUESTION: Does strength of the major lower limb muscles contribute to walking speed over short and long distances in people with PD? METHOD: na. DESIGN: A cross-sectional, observational study. PARTICIPANTS: 50 people with mild PD. OUTCOME MEASURES: Maximum isometric strength of the flexors and extensors of the lower limb was measured using hand-held dynamometry. Flexed posture, postural instability and bradykinesia were measured using the MDS-UPDRS part III. Walking speed was measured during the 10-m Walk Test and 6-min Walk Test. RESULTS: Univariate analysis revealed that age, bradykinesia, flexed posture, and hip, knee and ankle weakness were all significantly correlated with walking speed over short and long distances. Multiple regression analysis revealed that age, bradykinesia, flexed posture and weakness of the hip and knee muscles together accounted for 47% of the variance in walking speed over a short distance, with age (R2 = 0.11, p = 0.003) making a significant independent contribution. Age, bradykinesia, flexed posture and strength of the hip and knee muscles together accounted for 56% of the variance in walking speed over a long distance. Age (R2 = 0.12, p = 0.001), weakness of the hip muscles (R2 = 0.12, p = 0.001) and bradykinesia (R2 = 0.04, p = 0.04) made significant, independent contributions to the variance in walking speed over a long distance. SIGNIFICANCE: In people with mild PD, weakness of the hip muscles and bradykinesia only make a significant relative contribution to walking speed over a long distance. Therefore, in people with normal walking speed over a short distance the 6-min Walk Test could be measured to more effectively identify the impact of motor impairments on walking.

Prevalence of healthcare-associated infections in public hospitals in New Zealand, 2021.

BACKGROUND: There are no contemporary data on healthcare-associated infections (HAIs) in New Zealand. AIMS: To determine the epidemiology of HAIs, prevalence of medical devices, and microbiology of HAIs in adults in public hospitals in New Zealand. METHODS: Point prevalence survey. Surveyors reviewed patients aged ≥18 years using the HAI definitions of the European Centres for Disease Prevention and Control. Device use and microbiology of HAIs were recorded. FINDINGS: In total, 5468 patients were surveyed; 361 patients (6.6%) had 423 HAIs (7.7 HAIs per 100 patients). The most common HAIs were: surgical site infections (N=104, 25%), urinary tract infections (N=80, 19%), pneumonia (N=75, 18%) and bloodstream infections (N=55, 13%). Overall, 3585 patients (66%) had at least one device, with 2922 (53%) patients having a peripheral intravenous catheter. Sixty-nine (16%) HAIs were device-associated. On multi-variable analysis, independent risk factors for HAIs included the presence of a peripheral [odds ratio (OR) 2.0] or central (OR 5.7) intravenous catheter and clinical service. HAI rates were higher in surgical patients (OR 1.8), intensive care unit patients (OR 2.6) and rehabilitation/older persons' health patients (OR 2.4) compared with general medicine patients (P≤0.01 for all groups). In total, 301 organisms were identified. Clostridioides difficile infection was uncommon, accounting for 1.7% of all HAIs. Forty-two isolates (14%) were drug-resistant, and most (N=33, 79%) were Enterobacterales. CONCLUSION: This study established the most common HAIs and their risk factors in New Zealand. The high prevalence of device use underscores the need to ensure that proven multi-modal prevention interventions are in place. However, as less than half of HAIs are device- or surgery-associated, other intervention strategies will be required to reduce their burden.

A study exploring the knowledge, attitudes and practices of young people regarding dengue fever and the extent of community involvement in vector control of the disease in Trinidad and Tobago.

OBJECTIVE: This study intends to explore young people's knowledge, attitudes and practices regarding dengue fever in Trinidad and Tobago. METHODS: Interviews and focus groups were carried out with young people studying at the University of Trinidad and Tobago. Thematic analysis was then conducted on these scripts and recommendations for improvement were made. RESULTS: All participants had some knowledge about dengue fever; however the extent of this knowledge varied greatly. Participants knew most about the mode of spread and symptoms. All participants did something at home as a means of vector control of the disease; ensuring no stagnant water was present in containers in the yard was the most popular method of vector control. All participants were aware that the government sprayed the neighbourhoods against mosquitoes; however the majority thought they did not do this often enough. CONCLUSION: Following the results of this study, three recommendations were made: the government should spray on a more regular basis, particularly just before the rainy season; a pilot study should take place investigating whether a fining scheme would improve vector control and dengue fever health education should be improved.