Immunosuppressive Therapy and Nutritional Status of Patients after Kidney Transplantation: A Protocol for a Systematic Review.

(1) Background: Kidney transplantation is widely recognized as the most effective method of treating end-stage renal disease. Immunosuppressive therapy plays a pivotal role in the treatment of kidney transplant patients, encompassing all patients (except identical twins), and is administered from organ transplantation until the end of its function. The aim of this systematic review is to identify the evidence of the association between immunosuppressive therapy and nutritional status of patients following kidney transplantation. (2) Methods: This protocol has been designed in line with Preferred Items for Systematic Reviews (PRISMA-P). Our search encompasses several databases, including MEDLINE (via PubMed), EMBASE (Elsevier), Scopus and Web of Science. We intend to include observational studies (cross-sectional, case-control, and cohort designs), randomized controlled trials (RCTs), as well as completed and ongoing non-randomized study designs. We will confine our search to studies published in English within the past decade (from inception to 17 February 2023). Qualitative studies, case studies, and conference reports will be excluded. The selection process will be done in Covidence by two independent reviewers. Data extraction will be conducted using a standardized MS Excel template version 16.0. Quality assessment of included studies will be performed using the Cochrane Risk of Bias tool for randomized trials (RoB2), or the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. Risk-of-bias plots will be generated using the web application Robvis. Relevant data that have been extracted from eligible studies will be presented in a narrative synthesis. We expect the studies to be too heterogeneous to perform subgroup analyses. (3) Conclusion: This systematic review will offer insights into the evidence regarding association between immunosuppressive therapy and nutritional status of adult patients (18 years of age or older) within the initial year following kidney transplantation. To our knowledge, there is no systematic review addressing that question.

Making More Sustainable Food Choices One Meal at a Time: Psychological and Practical Aspects of Meat Reduction and Substitution.

Switching out meat in favour of plant-based alternatives such as meat substitutes is an important step towards eating more sustainably. Here, the aim was to identify and explore the specific barriers experienced by Swedish consumers when replacing meat with more sustainable alternatives. All meat-eating participants in this study reported some interest in reducing their meat consumption. Aspects of home-use and central-location test methods were combined by using a digital conferencing system to host cooking sessions and focus group discussions online, which was shown to be a viable setup even in this hands-on setting. The discussions targeted participants' experience preparing meals using meat substitutes as well as their perceived motivators and barriers to reducing meat consumption. Four themes identified through thematic analysis indicated that meat-eating participants, despite their desire or intent to reduce their meat consumption, experienced barriers relating to the following: internal conflict due to holding multiple positive and negative beliefs about meat simultaneously (ambivalence), justification of eating meat (rationalisation), a desire for variety in and control over their food choices (agency), and sensitivity to the views and expectations of other people and the situational context regarding meat (social and structuralfactors). Possible strategies to support ambivalent individuals in aligning their behaviour with their beliefs instead of vice versa are discussed in the context of the meat paradox. Agency and practical skills, including increasing knowledge in preparing meals with plant-based proteins, likely play a role in bridging this intention-behaviour gap.

Landscaping the evidence of intimate partner violence and postpartum depression: a systematic review.

OBJECTIVE: To assess the evidence of the association between exposure to intimate partner violence (IPV) and postpartum depression. IPV during pregnancy can have immediate and long-term physical and mental health consequences for the family. Therefore, it has been hypothesised that IPV may affect the risk of developing postpartum depression. METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, Global Health Library, Scopus and Google scholar were searched for published studies without restrictions on language, time or study design (up to May 2020). Studies were included if they assessed postpartum depression using the Edinburg Postnatal Depression Scale (cut-off≥10), among women who had been exposed to IPV (emotional, physical and/or sexual abuse). The quality of studies was judged according to the Newcastle-Ottawa scale. RESULTS: A total of 33 studies were included in the review (participants n=131 131). The majority of studies found an association between exposure to IPV and the development of signs of postpartum depression. Overall, studies measured both exposure and outcome in various ways and controlled for a vast number of different confounders. Thirty percent of the studies were set in low-income and lower-middle-income countries while the rest were set in upper-middle-income and high-income countries and the association did not differ across settings. Among the studies reporting adjusted OR (aOR) (n=26), the significant aOR ranged between 1.18 and 6.87 (95% CI 1.12 to 11.78). The majority of the studies were judged as 'good quality' (n=20/33). CONCLUSION: We found evidence of an association between exposure to IPV and the development of signs of postpartum depression. Meta-analysis or individual patient data meta-analysis is required to quantify the magnitude of the association between IPV and postpartum depression. PROSPERO REGISTRATION NUMBER: CRD42020209435.

Identifying barriers to decreasing meat consumption and increasing acceptance of meat substitutes among Swedish consumers.

A key lifestyle change people could make to reduce their environmental impact is to reduce their meat consumption. However, meat is still a staple in many people's diet, and some consumers are reluctant to cut down. Meat substitutes, if accepted as adequate replacements for meat, may offer a suitable alternative without leaving consumers feeling dissatisfied. The aim of the present study was to identify psychological barriers to reducing meat consumption and increasing use of meat substitutes among Swedish consumers. Participants engaged in focus group discussions around purchasing, preparing, and consuming meat and meat substitutes. Four main themes were identified through thematic analysis: uncertainty, scepticism, health, and identity. These are discussed in relation to previous work on the barriers to reducing meat consumption. Strategies to communicate the environmental impact of meat to consumers and effect change through behavioural interventions are considered.

Intimate Partner Violence and Electronic Health Interventions: Systematic Review and Meta-Analysis of Randomized Trials.

BACKGROUND: Intimate partner violence (IPV) is a major public health concern. eHealth interventions may reduce exposure to violence and health-related consequences as the technology provides a safe and flexible space for the target population. However, the evidence is unclear. OBJECTIVE: The goal of the review is to examine the effect of eHealth interventions compared with standard care on reducing IPV, depression, and posttraumatic stress disorder (PTSD) among women exposed to IPV. METHODS: We searched EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, PsycInfo, Scopus, Global Health Library, ClinicalTrials.gov, and International Clinical Trials Registry Platform for published and unpublished trials from inception until April 2019. Trials with an eHealth intervention targeting women exposed to violence were included. We assessed risk of bias using the Cochrane Risk of Bias Tool. Trials that reported effect estimates on overall IPV; physical, sexual, and psychological violence; depression; or posttraumatic stress disorder were included in meta-analyses. RESULTS: A total of 14 trials were included in the review; 8 published trials, 3 unpublished trials and 3 ongoing trials. Of the 8 published trials, 2 were judged as overall low risk of bias trials. The trials reported 23 types of outcomes, and 7 of the trials had outcomes that were eligible for meta-analyses. Our pooled analyses found no effect of eHealth interventions on any of our prespecified outcomes: overall IPV (SMD -0.01; 95% CI -0.11 to 0.08; I2=0%; 5 trials, 1668 women); physical violence (SMD 0.01; 95% CI -0.22 to 0.24; I2=58%; 4 trials, 1128 women); psychological violence (SMD 0.07; 95% CI -0.12 to 0.25; I2=40%; 4 trials, 1129 women); sexual violence (MD 0.36; 95% CI -0.18 to 0.91; I2=0%; 2 trials, 1029 women); depression (SMD -0.13; 95% CI -0.37 to 0.11; I2=78%; 5 trials, 1600 women); and PTSD (MD -0.11; 95% CI -1.04 to 0.82; I2=0%; 5 trials, 1267 women). CONCLUSIONS: There is no evidence from randomized trials of a beneficial effect of eHealth interventions on IPV. More high-quality trials are needed, and we recommend harmonizing outcome reporting in IPV trials by establishing core outcome sets. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42019130124; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=130124.

Intimate partner violence and breastfeeding: a systematic review.

OBJECTIVE: The association between intimate partner violence (IPV) and breastfeeding is unclear. We conducted a systematic review to summarise the evidence of breastfeeding outcomes following exposure to IPV. DESIGN: Systematic review. METHODS: We searched for published studies without study design or language restrictions (up to July 2019) in the following databases: PubMed, Embase, SCOPUS and The Global Health Library. Studies assessing various breastfeeding outcomes (initiation, duration and exclusive breastfeeding) in women exposed to IPV in any form (physical, psychological or sexual) and at any stage (1 year pre-pregnancy, during or post-pregnancy) were included. Two authors independently selected the studies and conducted the quality appraisal by use of the Newcastle-Ottawa Scale. Results were summarised taking precision and quality into account. RESULTS: A total of 16 studies (participants n=414 393) were included and they adjusted for a total of 48 different confounders. The majority of studies were cross-sectional (n=11) and most studies were judged to be fair/low quality. Four out of seven studies found that IPV exposure shortened breastfeeding duration (adjusted ORs/aORs=0.22 (95% CI: 0.05-0.85), 1.18 (95% CI: 1.01-1.37), 5.92 (95% CI: 1.72-27.98), 1.28 (95% CI: 1.18-1.39)). Further, 5/10 studies found that IPV led to early termination of exclusive breastfeeding (aORs=1.53 (95% CI: 1.01-23.1), 0.83 (95% CI: 0.71-0.96), 1.35 (95% CI: 1.07-1.71), 0.17 (95% CI: 0.07-0.4), 1839 (95% CI: 1.61-2911)) and 2/6 studies found that IPV significantly reduced breastfeeding initiation (aORs=2.00 (95% CI: 1.2-3.3), 0.81 (95% CI: 0.7-0.93)). CONCLUSION: IPV exposure appears to associate negatively with some breastfeeding outcomes. Individual patient data meta-analysis is required to quantify the magnitude of the association for specific IPV-outcome combinations. More high-quality studies and definition of core confounders are warranted. PROSPERO REGISTRATION NUMBER: CRD42019129353.

Risk-based screening and intrapartum group B streptococcus polymerase chain reactionresults reduce use of antibiotics during labour.

INTRODUCTION: This study investigated the feasibility of a risk-based screening approach combined with testing of Group B streptococcus (GBS) by polymerase chain reaction (PCR), the effect on use of intrapartum antibiotic prophylaxis (IAP) and the impact on the incidence of early-onset GBS infection (EOGBS). METHODS: During one year, 551 women giving birth at Lillebaelt Hospital, Denmark, having one or more risk factors for EOGBS (previous birth of infant with EOGBS, GBS bacteriuria during current pregnancy, gestational age less than 37 weeks, rupture of membranes greater than 18 hours, and temperature ≥ 38 °C) were tested by a GBS PCR assay intrapartum. IAP was administered when the woman tested positive. RESULTS: Among 2,889 women in labour, 19.1% (n = 551) had one or more risk factors for EOGBS, and 5.1% (n = 146) had both risk factors for EOGBS and a positive intrapartum GBS PCR test. In total, 185 women with risk factors for EOGBS received IAP. If the former risk-based approach had been applied, 551 women giving birth would have received IAP. Implementing IAP based on the GBS PCR results produced a two-thirds reduction of IAP. No children were diagnosed with EOGBS. CONCLUSIONS: The GBS PCR assay was easy to perform and provided test results within 50 minutes. Implementation of risk-based screening combined with intrapartum GBS PCR testing reduces the use of IAP by two thirds compared with risk-based screening alone, thus minimising antibiotic resistance. The study material was too small to evaluate the effect on the incidence of EOGBS. Since EOGBS is a rare disease, more studies are required. FUNDING: The study was supported by Forskningsraadet Lillebaelt Hospital, Udviklingsraadet Lillebaelt Hospital, Johs. M. Klein og Hustrus Mindelegat, the Region of Southern Denmark, Farusa Emballage A/S. TRIAL REGISTRATION: not relevant.

User-documented food consumption data from publicly available apps: an analysis of opportunities and challenges for nutrition research.

BACKGROUND: The need for a better understanding of food consumption behaviour within its behavioural context has sparked the interest of nutrition researchers for user-documented food consumption data collected outside the research context using publicly available nutrition apps. The study aims to characterize the scientific, technical, legal and ethical features of this data in order to identify the opportunities and challenges associated with using this data for nutrition research. METHOD: A search for apps collecting food consumption data was conducted in October 2016 against UK Google Play and iTunes storefronts. 176 apps were selected based on user ratings and English language support. Publicly available information from the app stores and app-related websites was investigated and relevant data extracted and summarized. Our focus was on characteristics related to scientific relevance, data management and legal and ethical governance of user-documented food consumption data. RESULTS: Food diaries are the most common form of data collection, allowing for multiple inputs including generic food items, packaged products, or images. Standards and procedures for compiling food databases used for estimating energy and nutrient intakes remain largely undisclosed. Food consumption data is interlinked with various types of contextual data related to behavioural motivation, physical activity, health, and fitness. While exchange of data between apps is common practise, the majority of apps lack technical documentation regarding data export. There is a similar lack of documentation regarding the implemented terms of use and privacy policies. While users are usually the owners of their data, vendors are granted irrevocable and royalty free licenses to commercially exploit the data. CONCLUSION: Due to its magnitude, diversity, and interconnectedness, user-documented food consumption data offers promising opportunities for a better understanding of habitual food consumption behaviour and its determinants. Non-standardized or non-documented food data compilation procedures, data exchange protocols and formats, terms of use and privacy statements, however, limit possibilities to integrate, process and share user-documented food consumption data. An ongoing research effort is required, to keep pace with the technical advancements of food consumption apps, their evolving data networks and the legal and ethical regulations related to protecting app users and their personal data.

Consumers in a Sustainable Food Supply Chain (COSUS): Understanding Consumer Behavior to Encourage Food Waste Reduction.

Consumers are directly and indirectly responsible for a significant fraction of food waste which, for a large part, could be avoided if they were willing to accept food that is suboptimal, i.e., food that deviates in sensory characteristics (odd shape, discoloration), or that has a best-before date which is approaching or has passed, but that is still perfectly fine to eat. The choice to accept or discard suboptimal food is taken either before or after purchase (hence, in the retail store or in the household). The aim of the European research project COSUS (Consumers in a sustainable food supply chain) was to increase consumer acceptance of suboptimal food, before and after purchase, by implementing targeted strategies that are based on consumer insights, and that are feasible for and acceptable by the food sector. To reach this aim, different methodological approaches were applied to analyze this issue, to experiment with different aspects, and to test the resulting interventions. Each of these approaches was undertaken by competent consortium partners from Denmark, Germany, Norway, Sweden and The Netherlands. The project finally provides validated strategies to promote the distribution and consumption of suboptimal foods, thereby improving resource efficiency in the food chain and contributing to a more sustainable food supply.