Effects of rare kidney diseases on kidney failure: a longitudinal analysis of the UK National Registry of Rare Kidney Diseases (RaDaR) cohort.

BACKGROUND: Individuals with rare kidney diseases account for 5-10% of people with chronic kidney disease, but constitute more than 25% of patients receiving kidney replacement therapy. The National Registry of Rare Kidney Diseases (RaDaR) gathers longitudinal data from patients with these conditions, which we used to study disease progression and outcomes of death and kidney failure. METHODS: People aged 0-96 years living with 28 types of rare kidney diseases were recruited from 108 UK renal care facilities. The primary outcomes were cumulative incidence of mortality and kidney failure in individuals with rare kidney diseases, which were calculated and compared with that of unselected patients with chronic kidney disease. Cumulative incidence and Kaplan-Meier survival estimates were calculated for the following outcomes: median age at kidney failure; median age at death; time from start of dialysis to death; and time from diagnosis to estimated glomerular filtration rate (eGFR) thresholds, allowing calculation of time from last eGFR of 75 mL/min per 1·73 m2 or more to first eGFR of less than 30 mL/min per 1·73 m2 (the therapeutic trial window). FINDINGS: Between Jan 18, 2010, and July 25, 2022, 27 285 participants were recruited to RaDaR. Median follow-up time from diagnosis was 9·6 years (IQR 5·9-16·7). RaDaR participants had significantly higher 5-year cumulative incidence of kidney failure than 2·81 million UK patients with all-cause chronic kidney disease (28% vs 1%; p<0·0001), but better survival rates (standardised mortality ratio 0·42 [95% CI 0·32-0·52]; p<0·0001). Median age at kidney failure, median age at death, time from start of dialysis to death, time from diagnosis to eGFR thresholds, and therapeutic trial window all varied substantially between rare diseases. INTERPRETATION: Patients with rare kidney diseases differ from the general population of individuals with chronic kidney disease: they have higher 5-year rates of kidney failure but higher survival than other patients with chronic kidney disease stages 3-5, and so are over-represented in the cohort of patients requiring kidney replacement therapy. Addressing unmet therapeutic need for patients with rare kidney diseases could have a large beneficial effect on long-term kidney replacement therapy demand. FUNDING: RaDaR is funded by the Medical Research Council, Kidney Research UK, Kidney Care UK, and the Polycystic Kidney Disease Charity.

Do physical symptoms predict psychological issues in patients with cancer?: the Memorial Symptom Assessment Scale-Short Form.

OBJECTIVES: This study aimed to determine if individual physical symptoms were predictive of psychological disorders. METHODS: This study was a secondary analysis of data from two studies which used the Memorial Symptom Assessment Scale-Short Form (MSAS-SF) to assess both physical and psychological symptoms. Correlation between individual symptoms and the validated psychological subscale (MSAS-PSYCH) were performed using Spearman's coefficient. Linear regression analysis was performed to assess whether correlated symptoms predicted the presence of psychological disorders. RESULTS: 1507 patients' data were analysed. The physical symptoms of pain, lack of energy, drowsiness, dizziness, constipation, 'feeling bloated' and 'I don't look like myself' were correlated with MSAS-PSYCH. Other physical symptoms existed independently to psychological symptoms. None of these physical symptoms were independently predictive of a mood disorder. CONCLUSIONS: This study presents a large data set evaluating psychological symptom correlations. There are certain physical symptoms which correlate with mood disorders, but these are not independently predictive. It is not known whether the correlative data are cause or effect. Comprehensive assessment remains essential to assess all problems. TRIAL REGISTRATION NUMBER: The trial registered was at National Institute for Health Research Clinical Research Network Portfolio (Central Portfolio Management System (CPMS) ID 30723) Integrated Research Application System Identification (IRAS) ID 198753.

Genetic discrimination by insurance companies in Aotearoa New Zealand: experiences and views of health professionals.

AIMS: Genetic discrimination in insurance is a significant clinical, research and consumer issue. Recently, the Australian life insurance industry introduced a partial moratorium on the use of genetic test results. However, in Aotearoa New Zealand, both life and health insurers can still use genetic results legally to discriminate against applicants. We aimed to document experiences and concerns of New Zealand-based health professionals (HPs) around the potential misuse of genetic test results for insurance purposes. METHODS: We administered an online survey to New Zealand HPs who discuss genetic testing with patients, their experiences regarding the use of genetic test results in insurance and views on regulation. RESULTS: Twenty-three New Zealand HPs responded, 15 of whom worked in genetics clinics, representing >60% of the total New Zealand clinical genetics workforce. Eleven respondents reported having patients who experienced adverse outcomes related to insurance based on genetic results. Respondents reported patients sometimes/often delayed (n=11) or refused (n=4) genetic testing due to insurance concerns. Over 80% of those who answered (n=17/21) believe insurers' use of genetic results should be legally regulated. CONCLUSION: New Zealand HPs have concerns about insurance companies using genetic test results in underwriting, including the effect on patients, and strongly believe government legislation is required.

Decision-making in palliative care: patient and family caregiver concordance and discordance-systematic review and narrative synthesis.

BACKGROUND: Decision-making in palliative care usually involves both patients and family caregivers. However, how concordance and discordance in decision-making manifest and function between patients and family caregivers in palliative care is not well understood. OBJECTIVES: To identify key factors and/or processes which underpin concordance and/or discordance between patients and family caregivers with respect to their preferences for and decisions about palliative care; and ascertain how patients and family caregivers manage discordance in decision-making in palliative care. METHODS: A systematic review and narrative synthesis of original studies published in full between January 2000 and June 2021 was conducted using the following databases: Embase; Medline; CINAHL; AMED; Web of Science; PsycINFO; PsycARTICLES; and Social Sciences Full Text. RESULTS: After full-text review, 39 studies were included in the synthesis. Studies focused primarily on end-of-life care and on patient and family caregiver preferences for patient care. We found that discordance between patients and family caregivers in palliative care can manifest in relational conflict and can result from a lack of awareness of and communication about each other's preferences for care. Patients' advancing illness and impending death together with open dialogue about future care including advance care planning can foster consensus between patients and family caregivers. CONCLUSIONS: Patients and family caregivers in palliative care can accommodate each other's preferences for care. Further research is needed to fully understand how patients and family caregivers move towards consensus in the context of advancing illness.

Symptom prevalence and severity in palliative cancer medicine.

OBJECTIVES: To establish symptom prevalence and associated distress in a large cohort of UK patients with cancer referred to a palliative care team. METHODS: This is a secondary analysis of two large data sets of patients with advanced cancer. Each patient had completed the Memorial Symptom Assessment Scale-Short Form to assess 32 symptoms and related distress. Data frequencies were conducted in Excel. RESULTS: 1507 patients were recruited. The most common symptoms were lack of energy (89%), pain (83%), feeling drowsy (77%) and dry mouth (70%). 67% of patients had psychological symptoms, with 31% of all patients having significant psychological distress. CONCLUSIONS: Symptom burden is significant in palliative patients with cancer. Structured symptom assessment with access to relevant supportive services is recommended.

Opioid-induced constipation: a stepwise treatment algorithm feasibility study.

BACKGROUND: Opioid-induced constipation (OIC) is frequently undertreated in patients with advanced cancer. Our hypothesis is that the use of a stepwise treatment algorithm, supported by regular patient-reported outcome measures, should improve the management of OIC. The aim of this feasibility study was to determine whether a definitive study could be successfully completed. METHODS: Patients with OIC (Rome Foundation diagnostic criteria positive), and a Bowel Function Index (BFI) score of ≥30, were recruited to the study. The study involved weekly assessments, and decisions about management were based on the current BFI score (and the tolerability of the current treatment). Management was based on a four-step treatment algorithm, developed from recent international guidelines. RESULTS: One hundred patients entered the study, and 79 patients completed the study. Fifty-seven (72%) participants responded to treatment, with 34 (43%) participants having a 'complete' response (ie, final BFI<30) and 23 (29%) participants having a 'partial' response (ie, change in BFI≥12). In participants with a complete response, 73.5% were prescribed conventional laxatives, 12% were prescribed a peripherally acting mu-opioid receptor antagonist (PAMORA) and 14.5% were prescribed a PAMORA and conventional laxative. DISCUSSION: The feasibility study suggests that a definitive study can be successfully completed. However, we will amend the methodology to try to improve participant recruitment, participant retention and adherence to the treatment algorithm. The feasibility study also suggests that the use of the BFI to monitor OIC, and the use of a treatment algorithm to manage OIC, can result in clinically important improvements in OIC.Trial registration number NCT04404933.

Group 2 innate lymphoid cells protect mouse heart from myocardial infarction injury via interleukin 5, eosinophils, and dendritic cells.

AIMS: Group 2 innate lymphoid cells (ILC2s) regulate adaptive and innate immunities. In mouse heart, production of myocardial infarction (MI) increased ILC2 accumulation, suggesting a role for ILC2 in cardiac dysfunction post-MI. METHODS AND RESULTS: We produced MI in ILC2-deficeint Rorafl/flIl7rCre/+ mice and in Icosfl-DTR-fl/+Cd4Cre/+ mice that allowed diphtheria toxin-induced ILC2 depletion. Genetic or induced deficiency of ILC2 in mice exacerbated cardiac dysfunction post-MI injury along with increased myocardial accumulation of neutrophils, CD11b+Ly6Chi monocytes, and CD4+ T cells but deficiency of eosinophils (EOS) and dendritic cells (DC). Post-MI hearts from genetic and induced ILC2-deficient mice contained many more apoptotic cells than those of control mice, and Rorafl/flIl7rCre/+ mice showed thinner and larger infarcts and more collagen-I depositions than the Il7rCre/+ mice only at early time points post-MI. Mechanistic studies revealed elevated blood IL5 in Il7rCre/+ mice at 1, 7, and 28 days post-MI. Such increase was blunted in Rorafl/flIl7rCre/+ mice. Administration of recombinant IL5 reversed EOS losses in Rorafl/flIl7rCre/+ mice, but IL5 did not correct the DC loss in these mice. Adoptive transfer of ILC2, EOS, or DC from wild-type mice, but not ILC2 from Il5-/- mice improved post-MI cardiac functions in Rorafl/flIl7rCre/+ recipient mice. EOS are known to protect cardiomyocytes from apoptosis. Here we showed that DC acted like EOS in blocking cardiomyocyte apoptosis. Yet, ILC2 or IL5 alone did not directly affect cardiomyocyte apoptosis or TGF-ß (transforming growth factor-ß)-induced cardiac fibroblast Smad signalling. CONCLUSION: This study revealed an indirect cardiac reparative role of ILC2 in post-MI hearts via the IL5, EOS, and DC mechanism.

Food trade among Pacific Island countries and territories: implications for food security and nutrition.

BACKGROUND: There is growing attention to intra-regional trade in food. However, the relationship between such trade and food and nutrition is understudied. In this paper, we present an analysis of intra-regional food trade in the Pacific region, where there are major concerns regarding the nutritional implications of international food trade. Using a new regional database, we examine trends in food trade among Pacific Island Counties and Territories (PICTs) relative to extra-regional trade. RESULTS: Intra-regional trade represents a small, but increasing proportion of total imports. The major food group traded within the Pacific is cereal grains and flour, which represented 51% of total intra-regional food trade in 2018. Processed and prepared foods, sweetened or flavoured beverages, processed fish, and sugar and confectionary are also traded in large quantities among PICTs. Trade in root crops is negligible, and overall intra-regional trade of healthy foods is limited, both in terms of tonnage and relative to imports from outside the region. Fiji remains the main source of intra-regional imports into PICTs, particularly for non-traditional staple foods. CONCLUSIONS: This study highlights the growth in trade of staple foods intra-regionally, indicating a role for Fiji (in particular) in regional food security. Within this overall pattern, there is considerable opportunity to enhance intra-regional trade in traditional staple foods, namely root crops. Looking forward, the current food system disruption arising from the COVID-19 pandemic and associated policy measures has highlighted the long-term lack of investment in agriculture, and suggests an increased role for regional approaches in fostering trade in healthy foods.

Tracing innovation pathways behind fisheries co-management in Vanuatu.

Co-management approaches have become a core part of coastal fisheries policy and planning practice in Vanuatu. With a long history of supporting community based fisheries management (CBFM), we trace its evolution in Vanuatu to understand how new structures and processes become adopted at scale. A theory of scaling for CBFM guides the analysis of regime shifts over time. We discuss planning for sustained spread under a national programme by categorising multiple drivers of change through three intervention pathways focussed, respectively, on developing (i) an enabling environment, (ii) institutional and individual capacity, and (iii) focussed innovative action in smaller targeted constituencies. Whilst we argue that local fisheries co-management institutions balance competing interests, and so differ amongst places, we also recognise the importance of connectivity and continuity. The realisation of a national programme therefore requires patchworks of siloed projects to be knitted together into coordinated programmatic approaches that strategically integrate activities.

Feasibility of intraoperative angioembolization for trauma patients using C-arm digital subtraction angiography.

PURPOSE: Hemodynamically unstable trauma patients who would benefit from angioembolization (AE) typically also require emergent surgery for their injuries. The critical decision of transferring a patient to the operating room versus the interventional radiology (IR) suite can be bypassed with the advent of intra-operative AE (IOAE). Previously limited by the availability of costly rooms termed RAPTOR (resuscitation with angiography, percutaneous techniques and open repair) suites, it has been suggested that using C-arm digital subtraction angiography (DSA) is a comparable alternative. This case series aims to establish the feasibility and safety of IOAE. METHODS: We conducted a retrospective analysis of all trauma patients at our level 1 trauma center who underwent IOAE with a concomitant surgical intervention from January 2011 to May 2019. Descriptive analyses were conducted. RESULTS: A total of 49 patients (80% male, 44 ± 17 years, 92% blunt) underwent IOAE using the C-arm DSA during the study period. All but one patient underwent exploratory laparotomy, 56% of which underwent an additional surgical procedure (ex. exploratory thoracotomy, orthopedic). Either Gelfoam® (Pfizer, New York, USA) (90%), coils (2.0%), or a combination (8.2%) were used for embolization. Internal iliac embolization was performed in 88% of cases (59% bilateral). IOAE was successful in all but four cases (8.2%) and thirty-day mortality was 31%. CONCLUSION: IOAE appears to be a feasible and safe management option in severe trauma patients with the advantage of concurrent operative intervention and ongoing active resuscitation with good success in hemorrhage control.

A theory of scaling for community-based fisheries management.

Community-based approaches to fisheries management has emerged as a mainstream strategy to govern dispersed, diverse and dynamic small scale fisheries. However, amplifying local community led sustainability outcomes remains an enduring challenge. We seek to fill a theoretical gap in the conceptualization of 'scaling up community-based fisheries management'. We draw on literature of agriculture innovations to provide a framework that takes into account process-driven and structural change occurring across multiple levels of governance, as well as different phases of scaling. We hypothesize that successful scaling requires engagement with all aspects of a governing regime, coalescing a range of actors, and therefore, is an enterprise that is larger than its parts. To demonstrate where the framework offers value, we illustrate the development of community-based fisheries management in Vanuatu according to the framework's main scaling dimensions.

Large-sample-size assessment of socioeconomic predictors of community-level resource management occurrence.

Community-level resource management efforts are cornerstones in ensuring sustainable use of natural resources. Yet, understanding how community characteristics influence management practices remains contested. With a sample size of ≥725 communities, we assessed the effects of key community (i.e., socioeconomic) characteristics (human population size and density, market integration, and modernization) on the probability of occurrence of fisheries management practices, including gear, species, and spatial restrictions. The study was based in Solomon Islands, a Pacific Island country with a population that is highly dependent on coastal fisheries. People primarily dwell in small communities adjacent to the coastline dispersed across 6 island provinces and numerous smaller islands. We used nationally collected data in binomial logistic regression models to examine the likelihood of management occurrence, given socioeconomic context of communities. In contrast to prevailing views, we identified a positive and statistically significant association between both human population size and market integration and all 3 management practices. Human population density, however, had a statistically significant negative association and modernization a varied and limited association with occurrence of all management practices. Our method offers a way to remotely predict the occurrence of resource management practices based on key socioeconomic characteristics. It could be used to improve understanding of why some communities conduct natural resource management activities when statistical patterns suggest they are not likely to and thus improve understanding of how some communities of people beat the odds despite limited market access and high population density.

Los esfuerzos por manejar los recursos a nivel comunitario son pilares para garantizar el uso sustentable de los recursos naturales. Aun así, el conocimiento sobre cómo las características comunitarias influyen sobre las prácticas de manejo todavía está en discusión. Con un tamaño de muestra de ≥725 comunidades, evaluamos los efectos de las características (tamaño y densidad poblacional humana, integración del mercado y modernización) comunitarias (es decir, socioeconómicas) clave sobre la probabilidad de incidencia de las prácticas de manejo de las pesquerías, incluyendo el equipamiento, las especies y las restricciones espaciales. El estudio se ubicó en las Islas Salomón, un país isleño del Pacífico con una población altamente dependiente de las pesquerías costeras. En este país, las personas habitan principalmente en comunidades pequeñas adyacentes a la costa y dispersas en las seis provincias isleñas y en numerosas islas más pequeñas. Usamos datos recolectados en todo el país en unos modelos de regresión logística binomial para examinar la probabilidad de incidencia del manejo, dado el contexto socioeconómico de las comunidades. Contrario a las opiniones predominantes, identificamos una asociación positiva y estadísticamente significativa entre el tamaño poblacional humano y la integración del mercado y entre las tres prácticas de manejo. La densidad poblacional humana, sin embargo, tuvo una asociación negativa estadísticamente significativa y la modernización una asociación variada y limitada con la incidencia de las prácticas de manejo. Nuestro método ofrece una manera para predecir remotamente la incidencia de las prácticas de manejo de recursos con base en características socioeconómicas importantes. El método podría utilizarse para incrementar el conocimiento sobre cómo algunas comunidades llevan a cabo actividades de manejo de recursos naturales cuando los patrones estadísticos sugieren lo contrario y así mejorar el entendimiento de cómo algunas comunidades humanas superan todos los pronósticos a pesar del acceso limitado al mercado y la alta densidad poblacional. Evaluación de Muestras de Gran Tamaño de Pronosticadores Socioeconómicos de la Incidencia del Manejo de Recursos a Nivel Comunitario.

What is evidence as evidence is used? A case of dualism?

How 'evidence' is conceptualised, generated and deployed in meso-level policy implementation on the ground is critical to health delivery. Using the case of a large-scale health service reconfiguration in northwest England, this study began as a narrative investigation into how different data types and sources are prioritised as NHS administrative structures change over time. During the research, one unpopular reconfiguration decision, the downgrading of a hospital, was challenged using judicial review. Suddenly, a key decision was being based not upon 'facts and data' type evidence but upon evidence of adherence to administrative procedure. This transferred focus away from the ever-shifting categories and hierarchies of data 'types' towards an emphasis on process. By comparing two deliberative contexts-committee and judicial review-this article proposes that evidence can be understood as simultaneously entity and process. As health service reconfigurations continue in response to austerity, integration agendas, evolving organisational landscapes, and demographic and political change, it is increasingly important to recognise the different meanings and uses of evidence.

A Typology of Food Environments in the Pacific Region and Their Relationship to Diet Quality in Solomon Islands.

Extensive literature describes the importance of food environments (FEs) as a driver of food choices and nutrition outcomes; yet existing FE frameworks do not adequately capture the diversity of FEs relevant to the Pacific Region. This limits identification of opportunities in food systems to reduce the multiple burden of malnutrition. We present a conceptual typology of FEs including six primary FEs relevant in the Pacific; wild; cultivated; kin and community; informal retail; formal retail; and food aid and services. We then apply this typology to food acquisition data from Solomon Islands 2012/13 Household Income and Expenditure Survey and analyse the relationship between FEs and diet quality. The cultivated FE accounts for 60% of the quantity of food acquired nationally, followed by wild (15%), kin and community (9%), and formal and informal retail FEs (8% each), with wide variation between urban and rural households, provinces and wealth groups. Reliance on different FEs is a significant predictor of diet quality and affirms the importance of subsistence fisheries and agriculture, and community and kinship networks. Integration of a FE typology such as the one presented here in commonly conducted household expenditure surveys offers significant opportunity to advance our understanding of food system leverage points to improve nutrition and health.

Aquatic Foods and Nutrition in the Pacific.

National rates of aquatic food consumption in Pacific Island Countries and Territories are among the highest in the world, yet the region is suffering from extensive levels of diet-related ill health. The aim of this paper is to examine the variation in consumption patterns and in nutrient composition of aquatic foods in the Pacific, to help improve understanding of their contribution to food and nutrition security. For this examination we analysed nutrient composition data and trade data from two novel region-specific databases, as well as consumption data from national and village level surveys for two Melanesian case studies, Vanuatu and Solomon Islands. Results demonstrated that consumption depends on availability and the amount and type of aquatic food consumed, and its contribution to nutrition security varies within different geographic and socio-demographic contexts. More data is needed on locally relevant species and consumption patterns, to better inform dietary guidelines and improve public health both now and into the future. Advice on aquatic food consumption must consider the nutrient composition and quantity of products consumed, as well as accessibility through local food systems, to ensure they contribute to diverse and healthy diets.

Sensory Abilities of Horses and Their Importance for Equitation Science.

Vision, hearing, olfaction, taste, and touch comprise the sensory modalities of most vertebrates. With these senses, the animal receives information about its environment. How this information is organized, interpreted, and experienced is known as perception. The study of the sensory abilities of animals and their implications for behavior is central not only to ethology but also to animal welfare. Sensory ability, perception, and behavior are closely linked. Horses and humans share the five most common sensory modalities, however, their ranges and capacities differ, so that horses are unlikely to perceive their surroundings in a similar manner to humans. Understanding equine perceptual abilities and their differences is important when horses and human interact, as these abilities are pivotal for the response of the horse to any changes in its surroundings. This review aims to provide an overview of the current knowledge on the sensory abilities of horses. The information is discussed within an evolutionary context and also includes a practical perspective, outlining potential ways to mitigate risks of injuries and enhance positive horse-human interactions. The equine sensory apparatus includes panoramic visual capacities with acuities similar to those of red-green color-blind humans as well as aural abilities that, in some respects exceed human hearing and a highly developed sense of smell, all of which influence how horses react in various situations. Equine sensitivity to touch has been studied surprisingly sparingly despite tactile stimulation being the major interface of horse training. We discuss the potential use of sensory enrichment/positive sensory stimulation to improve the welfare of horses in various situations e.g. using odors, touch or sound to enrich the environment or to appease horses. In addition, equine perception is affected by factors such as breed, individuality, age, and in some cases even color, emphasizing that different horses may need different types of management. Understanding the sensory abilities of horses is central to the emerging discipline of equitation science, which comprises the gamut of horse-human interactions. Therefore, sensory abilities continue to warrant scientific focus, with more research to enable us to understand different horses and their various needs.

COVID-19 and Pacific food system resilience: opportunities to build a robust response.

The unfolding COVID-19 pandemic has exposed the vulnerability of the Pacific food system to externalities and has had far-reaching impacts, despite the small number of COVID-19 cases recorded thus far. Measures adopted to mitigate risk from the pandemic have had severe impacts on tourism, remittances, and international trade, among other aspects of the political economy of the region, and are thus impacting on food systems, food security and livelihoods. Of particular concern will be the interplay between loss of incomes and the availability and affordability of local and imported foods. In this paper, we examine some of the key pathways of impact on food systems, and identify opportunities to strengthen Pacific food systems during these challenging times. The great diversity among Pacific Island Countries and Territories in their economies, societies, and agricultural potential will be an important guide to planning interventions and developing scenarios of alternative futures. Bolstering regional production and intraregional trade in a currently import-dependent region could strengthen the regional economy, and provide the health benefits of consuming locally produced and harvested fresh foods - as well as decreasing reliance on global supply chains. However, significant production, processing, and storage challenges remain and would need to be consistently overcome to influence a move away from shelf-stable foods, particularly during periods when human movement is restricted and during post-disaster recovery.

Malnutrition in rural Solomon Islands: An analysis of the problem and its drivers.

Solomon Islands, like many Pacific Island nations, suffer from the burden of malnutrition. External drivers including population growth, declining agriculture and fisheries productivity and global food trade have contributed to the transition to greater reliance on imported foods. Globally, diets are recognized as both a cause of and solution to the burden of malnutrition. Using a mixed-method approach this study assessed nutritional status and key determinants of malnutrition among women and young children in rural Solomon Island communities. Quantitative 24-hour recall surveys identified diets of women and young children in these communities to be very limited in diversity. Typical daily diets comprised of fish, sweet potato (and/or rice) and slippery cabbage (a leafy green) usually boiled in coconut milk or baked. Participatory research using problem tree and biocultural approaches identified basic determinants of poor diets and opportunities to address these challenges. We highlight three domains of opportunity to improve diets across multiple scales; 1) improve nutrition-sensitive agriculture and fisheries to produce and distribute diverse, productive and nutrient rich foods; 2) nutrition education and empowerment, focusing on the first 1000 days of life, to influence and inform choices regarding food consumption; and 3) reducing the consumption of imported, energy-rich nutrient poor foods through national and regional policies. These multi-scale domains highlight that food system approaches that strengthen integrated policy and empower people are essential for healthy and sustainable diets in Solomon Islands and more broadly in the Pacific region.

Alcohol and drug use disorders in patients with cancer and caregivers: effects on caregiver burden.

BACKGROUND: The estimated prevalence of alcohol use disorders in patients with advanced cancer is reported as 4%-38%. There are limited data regarding alcohol and drug use disorders in caregivers of patients with cancer and the effects on other issues. AIM: To establish the prevalence of alcohol and drug use disorders in a large cohort of patients with advanced cancer and their caregivers.To evaluate the relationship between alcohol and drug use disorders and patient symptoms and caregiver burden. DESIGN: The patient with cancer and caregiver completed the Alcohol Use Disorders Identification Tool, CAGE questionnaire and Drug Abuse Screening Test. The patient completed the Memorial Symptom Assessment Scale-Short Form, and the caregiver completed the Zarit Burden Questionnaire.Statistical analysis compared cases and non-cases of alcohol and drug use disorders with symptom and burden score. SETTING/PARTICIPANTS: Patients with cancer, and their caregivers, were recruited from 11 UK sites, 6 hospices and 5 hospitals. RESULTS: Five hundred and seven patients and their caregivers were recruited. Twenty-seven patients (5%) and 44 caregivers (9%) screened positively for alcohol use disorders on the Alcohol Use Disorders Identification Tool. Thirty patients (6%), and 16 caregivers (3%), screened positively for drug abuse problems on the Drug Abuse Screening Test.There was a significantly higher carer burden score in caregivers screening positively for alcohol and drug abuse problems. CONCLUSIONS: The prevalence of alcohol use disorders in patients with cancer and caregivers was lower than reported in previous studies. Caregiver burden scores were significantly higher in carers screening positively for alcohol and drug use disorders. TRIAL REGISTRATION NUMBER: Trial registered National Institute for Health Research Clinical Research Network Portfolio (CPMS ID 30723) IRAS ID 198753.

Clinical nurse specialist prescribing in a cancer centre supportive and palliative care team.

OBJECTIVE: To provide insight into the prescribing practices of three independent nurse prescribers (INPs)/clinical nurse specialists (CNSs) working in a supportive and palliative care team (SPCT) in a district general hospital and a specialist tertiary cancer centre in the UK. METHODS: A prospective review of all consultations and the prescribing activity arising from the consultations (and reasons for non-prescribing following a consultation) of 3 INPs/CNSs between 1 August 2018 and 31 October 2018. RESULTS: Four hundred ninety-three consultations were undertaken on 186 individual patients. Two hundred forty-seven consultations representing 50% resulted in changes to a prescription, and 123 of those consultations representing 50% of prescriptions written resulted in the prescribing of an opioid for moderate-to-severe pain. CONCLUSIONS: This service evaluation demonstrates the potential for INPs in SPCTs to provide comprehensive symptom control while enabling CNSs to practice with a greater degree of autonomy leading to enhanced job satisfaction. On the basis of our experience, we would encourage all palliative care CNSs to undergo training to become INPs (if available).