A multi-center prospective study of plant-based nutritional support in adult community-based patients at risk of disease-related malnutrition.

Introduction: There is an emerging need for plant-based, vegan options for patients requiring nutritional support. Methods: Twenty-four adults at risk of malnutrition (age: 59 years (SD 18); Sex: 18 female, 6 male; BMI: 19.0 kg/m2 (SD 3.3); multiple diagnoses) requiring plant-based nutritional support participated in a multi-center, prospective study of a (vegan suitable) multi-nutrient, ready-to-drink, oral nutritional supplement (ONS) [1.5 kcal/mL; 300 kcal, 12 g protein/200 mL bottle, mean prescription 275 mL/day (SD 115)] alongside dietary advice for 28 days. Compliance, anthropometry, malnutrition risk, dietary intake, appetite, acceptability, gastrointestinal (GI) tolerance, nutritional goal(s), and safety were assessed. Results: Patients required a plant-based ONS due to personal preference/variety (33%), religious/cultural reasons (28%), veganism/reduce animal-derived consumption (17%), environmental/sustainability reasons (17%), and health reasons (5%). Compliance was 94% (SD 16). High risk of malnutrition ('MUST' score ≥ 2) reduced from 20 to 16 patients (p = 0.046). Body weight (+0.6 kg (SD 1.2), p = 0.02), BMI (+0.2 kg/m2 (SD 0.5), p = 0.03), total mean energy (+387 kcal/day (SD 416), p < 0.0001) and protein intake (+14 g/day (SD 39), p = 0.03), and the number of micronutrients meeting the UK reference nutrient intake (RNI) (7 vs. 14, p = 0.008) significantly increased. Appetite (Simplified Nutritional Appetite Questionnaire (SNAQ) score; p = 0.13) was maintained. Most GI symptoms were stable throughout the study (p > 0.06) with no serious adverse events related. Discussion: This study highlights that plant-based nutrition support using a vegan-suitable plant-based ONS is highly complied with, improving the nutritional outcomes of patients at risk of malnutrition.

Migrant gardeners, health and wellbeing: exploring complexity and ambivalence from a UK perspective.

There has been increasing interest in how green spaces and gardening contribute to people's physical, mental and social wellbeing, and this interest has increased due to COVID-19. This article explores the particular experiences of migrant gardeners and the implications for their health and wellbeing. It draws on a qualitative research project that involved conducting semi-structured interviews with participants with migration heritage in and around a city in the north of England. The participants were recruited through purposive and snowball sampling; of the 25 participants, some were allotment holders, whilst the rest cultivated crops in their gardens or even on their balcony. Thematic analysis of the interview transcripts generated themes that reflect current definitions of health, encompassing physical, mental and social wellbeing. However, whilst the findings confirm many positive effects of gardening, they also point to some ambivalence in relation to cultivation, outdoor practices and health, with evidence of neutral or even negative effects at times. The article explores the implications of these findings for initiatives to encourage gardening, such as social prescribing, and to address 'green poverty'. An additional finding is that for gardeners with migration heritage, gardening can be understood in terms of cultural wellbeing. Consequently, there is a need to broaden the concept of wellbeing to include this cultural dimension.

Nursing home care for older people in Taiwan: a process of forced choice.

AIM: To generate a substantive theory for understanding the phenomenon of nursing home care for older people in Taiwan. BACKGROUND: Taiwanese culture shows great respect for older people and older people are traditionally cared for at home by their families. However, the older population in Taiwan is rapidly increasing and this demographic shift, together with various socio-economic changes, has resulted in nursing homes becoming a new and significant care option. DESIGN: A grounded theory approach was used to study the residents and relatives from three nursing homes in Taiwan. METHODS: Formal and informal interviews and participant observation data were collected over two months in each nursing home. Forty nursing home residents and 20 of their relatives were recruited. The data were analysed using the constant comparative method and involved the use of theoretical memos and theoretical sampling procedures. RESULTS: The study found that nursing home care for older people in Taiwan is understood to be a process of forced choice, involving three stages; namely, 'becoming a problem', 'making a forced choice' and 'coping with the forced choice'. CONCLUSION: Taiwan is in a state of conflict with regard to providing care for older people, a situation in which the influence of traditional cultural and that of industrialization exist side by side. The consequence of having to relocate older people into nursing homes means that both parties are the victims of this choice. RELEVANCE TO CLINICAL PRACTICE: This conceptual explanation helps us to understand how the Taiwanese respond to the issue of care for older people and how they resolve their main concerns related to it. Subsequently, it is hoped that this will help health care practitioners to provide care more effectively to meet the needs of the Taiwanese with the aim of enhancing the standards of care for older people.

Metabolism of inositol 1,4,5-trisphosphate in Candida albicans: significance as a precursor of inositol polyphosphates and in signal transduction during the dimorphic transition from yeast cells to germ tubes.

The metabolism of inositol 1,4,5-trisphosphate [Ins(1,4,5)P3] was examined in yeast cells and germ tubes of Candida albicans. Methods have been developed for analysis of the two key metabolic enzymes, Ins(1,4,5)P3, kinase and phosphatase. ATP-dependent Ins(1,4,5)P3 kinase activity was detected predominantly in the soluble fraction of cell extracts and exhibited a Km of approximately 9 microM. The apparent Km of Ins(1,4,5)P3 phosphatase for Ins(1,4,5)P3 was approximately 480 microM. The slow rate of dephosphorylation of Ins(1,4,5_P3 to inositol bisphosphate suggests a lower importance of the phosphatase within cells compared to the kinase. Since both yeast cells and germ tubes of C. albicans rapidly phosphorylated Ins(1,4,5)P3 to inositol tetrakisphosphate and inositol penta/hexakisphosphate, it is suggested that Ins(1,4,5)P3 has an important role as a precursor for production of these compounds. A sustained increase in cellular Ins(1,4,5)P3 levels was observed during germ tube formation and, prior to the onset of germination between 1 and 2 incubation, the Ins(1,4,5)P3 content increased up to eightfold. Transient increases in the level of Ins(1,4,5)P3 were also observed during yeast-like growth of C. albicans. The possible role and relative importance of Ins(1,4,5)P3 as a precursor for inositol polyphosphates and in signal transduction involving Ca2+ release from internal stores is discussed.