Predicting Patient Deterioration: A Review of Tools in the Digital Hospital Setting.

BACKGROUND: Early warning tools identify patients at risk of deterioration in hospitals. Electronic medical records in hospitals offer real-time data and the opportunity to automate early warning tools and provide real-time, dynamic risk estimates. OBJECTIVE: This review describes published studies on the development, validation, and implementation of tools for predicting patient deterioration in general wards in hospitals. METHODS: An electronic database search of peer reviewed journal papers from 2008-2020 identified studies reporting the use of tools and algorithms for predicting patient deterioration, defined by unplanned transfer to the intensive care unit, cardiac arrest, or death. Studies conducted solely in intensive care units, emergency departments, or single diagnosis patient groups were excluded. RESULTS: A total of 46 publications were eligible for inclusion. These publications were heterogeneous in design, setting, and outcome measures. Most studies were retrospective studies using cohort data to develop, validate, or statistically evaluate prediction tools. The tools consisted of early warning, screening, or scoring systems based on physiologic data, as well as more complex algorithms developed to better represent real-time data, deal with complexities of longitudinal data, and warn of deterioration risk earlier. Only a few studies detailed the results of the implementation of deterioration warning tools. CONCLUSIONS: Despite relative progress in the development of algorithms to predict patient deterioration, the literature has not shown that the deployment or implementation of such algorithms is reproducibly associated with improvements in patient outcomes. Further work is needed to realize the potential of automated predictions and update dynamic risk estimates as part of an operational early warning system for inpatient deterioration.

Impact of a health marketing campaign on sugars intake by children aged 5-11 years and parental views on reducing children's consumption.

BACKGROUND: The association between Free Sugars intake and non-communicable diseases such as obesity and dental caries is well documented and several countries are taking measures to reduce sugars intakes. Public Health England (PHE) instigated a range of approaches to reduce sugars, including a national health marketing campaign (Sugar Smart). The campaign aimed to raise awareness of the amount of sugars in foods and drinks and to encourage parents to reduce their children's intake. The aim of this study was to determine whether the campaign was effective in altering dietary behaviour, by assessing any impact of the campaign on sugars intake among children aged 5-11 years. Parental perceptions of the campaign and barriers to reducing sugars intake were also explored. METHODS: Parents of 873 children aged 5-11 years, identified from an existing PHE database, were invited to take part. Dietary information was collected online using Intake24 before, during, and at 1, 10 and 12 months following the campaign. Change in sugars intake was assessed using mixed effects linear regression models. One-to-one telephone interviews were conducted with a purposive sample of parents to explore perceptions of the campaign and identify barriers and facilitators to reducing children's sugars intake. RESULTS: Completion rates for dietary assessment ranged from 61 to 72% across the follow up time points. Qualitative telephone interviews were conducted with 20 parents. Total sugars intake decreased on average by ~ 6.2 g/day (SD 43.8) at peak campaign and the percentage of energy from total sugars significantly decreased immediately and 1 year post campaign. The percentage of energy from Free Sugars significantly decreased across all time points with the exception of the long term follow up at 12-months post campaign. The percentage of energy intake from total fat increased. Parents expressed a willingness to reduce sugars intakes, however, identified barriers including time constraints, the normalisation of sugary treats, and confusing information. CONCLUSIONS: A health marketing campaign had a positive impact in reducing sugars intake but reductions in sugars were not sustained. Parents want to reduce their child's sugars intake but societal barriers and confusion over which sources of sugars to avoid hamper efforts to change.

Development of sedentary behavior across childhood and adolescence: longitudinal analysis of the Gateshead Millennium Study.

BACKGROUND: In many parts of the world policy and research interventions to modify sedentary behavior of children and adolescents are now being developed. However, the evidence to inform these interventions (e.g. how sedentary behavior changes across childhood and adolescence) is limited. This study aimed to assess longitudinal changes in sedentary behavior, and examine the degree of tracking of sedentary behavior from age 7y to 15y. METHODS: Participants were part of the Gateshead Millennium Study cohort. Measures were made at age 7y (n = 507), 9y (n = 510), 12y (n = 425) and 15y (n = 310). Participants were asked to wear an ActiGraph GT1M and accelerometer epochs were defined as sedentary when recorded counts were ≤25 counts/15 s. Differences in sedentary time and sedentary fragmentation were examined using the Friedman test. Tracking was examined using Spearman's correlation coefficients and trajectories over time were assessed using multilevel linear spline modelling. RESULTS: Median daily sedentary time increased from 51.3% of waking hours at 7y to 74.2% at 15y. Sedentary fragmentation decreased from 7y to 15y. The median number of breaks/hour decreased from 8.6 to 4.1 breaks/hour and the median bout duration at 50% of the cumulative sedentary time increased from 2.4 min to 6.4 min from 7y to 15y. Tracking of sedentary time and sedentary fragmentation was moderate from 7y to 15y however, the rate of change differed with the steepest increases/decreases seen between 9y and 12y. CONCLUSION: In this study, sedentary time was high and increased to almost 75% of waking hours at 15y. Sedentary behavior became substantially less fragmented as children grew older. The largest changes in sedentary time and sedentary fragmentation occurred between 9y to 12y, a period which spans the transition to secondary school. These results can be used to inform future interventions aiming to change sedentary behavior.

Low whole grain intake in the UK: results from the National Diet and Nutrition Survey rolling programme 2008-11.

Increased whole grain intake has been shown to reduce the risk of many non-communicable diseases. Countries including the USA, Canada, Denmark and Australia have specific dietary guidelines on whole grain intake but others, including the UK, do not. Data from 1986/87 and 2000/01 have shown that whole grain intake is low and declining in British adults. The aim of the present study was to describe whole grain intakes in the most current dietary assessment of UK households using data from the National Diet and Nutrition Survey rolling programme 2008-11. In the present study, 4 d diet diaries were completed by 3073 individuals between 2008 and 2011, along with details of socio-economic status (SES). The median daily whole grain intake, calculated for each individual on a dry weight basis, was 20 g/d for adults and 13 g/d for children/teenagers. The corresponding energy-adjusted whole grain intake was 27 g/10 MJ per d for adults and 20 g/10 MJ per d for children/teenagers. Whole grain intake (absolute and energy-adjusted) increased with age, but was lowest in teenagers (13-17 years) and younger adults up to the age of 34 years. Of the total study population, 18% of adults and 15% of children/teenagers did not consume any whole-grain foods. Individuals from lower SES groups had a significantly lower whole grain intake than those from more advantaged classifications. The whole grain intake in the UK, although higher than in 2000/01, remains low and below that in the US and Danish recommendations in all age classes. Favourable pricing with increased availability of whole-grain foods and education may help to increase whole grain intake in countries without whole-grain recommendations. Teenagers and younger adults may need targeting to help increase whole grain consumption.

Whole grain intake and its association with intakes of other foods, nutrients and markers of health in the National Diet and Nutrition Survey rolling programme 2008-11.

Epidemiological evidence suggests an inverse association between whole grain consumption and the risk of non-communicable diseases, such as CVD, type 2 diabetes, obesity and some cancers. A recent analysis of the National Diet and Nutrition Survey rolling programme (NDNS-RP) has shown lower intake of whole grain in the UK. It is important to understand whether the health benefits associated with whole grain intake are present at low levels of consumption. The present study aimed to investigate the association of whole grain intake with intakes of other foods, nutrients and markers of health (anthropometric and blood measures) in the NDNS-RP 2008-11, a representative dietary survey of UK households. A 4-d diet diary was completed by 3073 individuals. Anthropometric measures, blood pressure levels, and blood and urine samples were collected after diary completion. Individual whole grain intake was calculated with consumers categorised into tertiles of intake. Higher intake of whole grain was associated with significantly decreased leucocyte counts. Significantly higher concentrations of C-reactive protein were seen in adults in the lowest tertile of whole grain intake. No associations with the remaining health markers were seen, after adjustments for sex and age. Over 70% of this population did not consume the minimum recommend intake associated with disease risk reduction, which may explain small variation across health markers. Nutrient intakes in consumers compared with non-consumers were closer to dietary reference values, such as higher intakes of fibre, Mg and Fe, and lower intakes of Na, suggesting that higher intake of whole grain is associated with improved diet quality.

The effect of childhood infection on hearing function at age 61 to 63 years in the newcastle thousand families study.

OBJECTIVES: It is known that childhood hearing function can become impaired after the occurrence of specific infections. However, evidence on the effect of common childhood infections on adult hearing function is limited. The objective of the study was to identify whether associations exist between the occurrence of common childhood infections in a UK birth cohort and hearing function across different frequencies at age 61 to 63 years. DESIGN: The Newcastle Thousand Families study is a birth cohort of all individuals born in May and June 1947 to mothers resident in Newcastle upon Tyne, United Kingdom. Of the original cohort members who had an audiometry test at age 61 to 63 years, 333 had data available on infections during their first year of life and 296 on infections up to their fifth year of life. These data were analyzed using linear regression in relation to adult hearing function across differing frequencies in isolation. RESULTS: After adjustment for sex, overcrowding in the first year, having had an ear operation, and having worked in a loud environment, significant negative associations were identified between adult hearing and tonsillitis at 250 Hz (p = 0.013), 1 kHz (p = 0.018), 6 kHz (p = 0.012), and 8 kHz (p = 0.033); otorrhea at 4 kHz (p = 0.005), 6 kHz (p = 0.003), and 8 kHz (p = 0.002); bronchitis (two or more episodes) at 2 kHz (p = 0.001), 3 kHz (p = 0.005), 4 kHz (p = 0.009), 6 kHz (p < 0.001), and 8 kHz (p < 0.001); and the total number of severe respiratory infections in the first year at 2 kHz (p = 0.037), 3 kHz (p = 0.049), 4 kHz (p = 0.030), 6 kHz (p < 0.001), and 8 kHz (p = 0.006). That is, individuals who had tonsillitis, bronchitis (twice or more), otorrhea, or a severe respiratory infection (twice or more) in their first year of life were more likely to have impaired adult hearing function than those who did not have any infections in early life. CONCLUSION: The occurrence of some, but not all, childhood infections appears to have an effect on adult hearing function across different frequencies. Reducing the incidence of infectious diseases in early life may reduce subsequent incidence of hearing impairment among adults. However, further research in modern cohorts is needed to clarify the links between infectious childhood diseases and adult hearing function.

Characteristics of young people with long term conditions close to transfer to adult health services.

BACKGROUND: For many young people with long term conditions (LTC), transferring from paediatric to adult health services can be difficult and outcomes are often reported to be poor. We report the characteristics and representativeness of three groups of young people with LTCs as they approach transfer to adult services: those with autism spectrum disorder with additional mental health problems (ASD); cerebral palsy (CP); or diabetes. METHODS: Young people aged 14 years-18 years 11 months with ASD, or those with diabetes were identified from children's services and those with CP from population databases. Questionnaires, completed by the young person and a parent, included the 'Mind the Gap' Scale, the Rotterdam Transition Profile, and the Warwick and Edinburgh Mental Wellbeing Scale. RESULTS: Three hundred seventy four young people joined the study; 118 with ASD, 106 with CP, and 150 with diabetes. Participants had a significant (p < 0.001) but not substantial difference in socio-economic status (less deprived) compared to those who declined to take part or did not respond. Condition-specific severity of participants was similar to that of population data. Satisfaction with services was good as the 'gap' scores (the difference between their ideal and current care) reported by parents and young people were small. Parents' satisfaction was significantly lower than their children's (p < 0.001). On every domain of the Rotterdam Transition Profile, except for education and employment, significant differences were found between the three groups. A larger proportion of young people with diabetes were in a more independent phase of participation than those with ASD or CP. The wellbeing scores of those with diabetes (median = 53, IQR: 47-58) and CP (median = 53, IQR: 48-60) were similar, and significantly higher than for those with ASD (median = 47, IQR: 41-52; p < 0.001). CONCLUSIONS: Having established that our sample of young people with one of three LTCs recruited close to transfer to adult services was representative, we have described aspects of their satisfaction with services, participation and wellbeing, noting similarities and differences by LTC. This information about levels of current functioning is important for subsequent evaluation of the impact of service features on the health and wellbeing of young people with LTCs following transfer from child services to adult services.

Prevalence and validity of self-reported smoking in Indigenous and non-Indigenous young adults in the Australian Northern Territory.

BACKGROUND: In this study, we used data from Australia's Northern Territory to assess differences in self-reported smoking prevalence between the Indigenous and non-Indigenous populations. We also used urinary cotinine data to assess the validity of using self-reported smoking data in these populations. METHODS: The Aboriginal Birth Cohort (ABC) is a prospective study of 686 Aboriginal babies born in Darwin 1987-90. The Top End Cohort (TEC) is a study of non-Indigenous adolescents, all born in Darwin 1987-91. In both studies, participants aged between 16 and 21 years, were asked whether they smoked. Urinary cotinine measurements were made from samples taken at the same visits. RESULTS: Self-reported smoking prevalence was 68% in the ABC and 14% in the TEC. Among the self-reported non-smokers, the median cotinine levels were higher in the ABC (33 ng/ml) than in the TEC (5 ng/ml), with greater percentages of reported non-smokers in the under 50 ng/ml group in the TEC than in the ABC CONCLUSIONS: Prevalence of smoking was much higher in the ABC than in the TEC. The higher cotinine levels in ABC non-smokers may reflect an underestimated prevalence, but is also likely to reflect higher levels of passive smoking. A broader approach encompassing social, cultural and language factors with increased attention to smoking socialisation factors is required.

Population prevalence of ultrasound features of osteoarthritis in the hand, knee and hip at age 63 years: the Newcastle thousand families birth cohort.

BACKGROUND: Musculoskeletal ultrasound has been found to be more sensitive than radiographs in detecting osteophytes. Our objective was to measure the prevalence of features of osteoarthritis (OA), in the dominant hand, knees and hips using ultrasound, within the Newcastle Thousand Families birth cohort. METHODS: Participants were aged 61-63 (mean 63) years. Knee images were scored for presence of osteophytes and effusion. Hip images were scored for the presence of osteophytes and femoral head abnormality. The first carpometacarpal joint, metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints of the index finger (dominant hand) were imaged for osteophytes. RESULTS: Among 311 participants, prevalence of osteophytes at the distal interphalangeal joint was 70% while it was 23%, 10% and 41% for index proximal interphalangeal and metacarpophalangeal and thumb base carpometacarpal joints respectively. Prevalence of knee osteophytes was 30%, hip OA was 41%. Prevalence of knee effusions was 24% (right) and 20% (left). Ultrasound evidence of generalised OA (48%) and isolated hand OA (31%) was common, compared to isolated hip or knee OA (5%) and both hip and knee OA (3%). CONCLUSION: This is the first study to assess prevalence of ultrasound features of OA in a population-based sample. The higher prevalence of hand/hip OA, when compared to previous radiographic studies, supports the hypothesis that ultrasound is more sensitive than radiography in detecting OA, particularly for osteophytes.

Deprivation, timing of preschool infections and H. pylori seropositivity at age 49-51 years: the Newcastle Thousand Families birth cohort.

BACKGROUND: Helicobacter pylori infection is acquired in early childhood and persists for life (or until eradication treatment is taken). Seropositivity of H. pylori at age 49-51 years was assessed in relation to socio-economic deprivation in early life and the timing of other childhood infections common at that time. METHODS: Prospectively collected socio-economic and morbidity data from the Newcastle Thousand Families study, a birth cohort established in 1947. H. pylori IgG seropositivity was assessed at 49-51 years and examined in relation to both whether the individual had been diagnosed with one of measles, mumps or chicken pox, and, if so, the age at first infection. This was done in logistic regression models, allowing adjustment for socio-economic status and housing quality in childhood. RESULTS: Adult H. pylori status was strongly linked to disadvantaged socio-economic status in early life (p ≤ 0.002), unlike measles, mumps and chicken pox which showed no associations. Early measles infection was independently associated with H. pylori seropositivity (p = 0.01). CONCLUSIONS: Of the four infectious diseases that we have studied, it appears that H. pylori differs from the others by the strength of association with socio economic deprivation in early childhood. Our findings further highlight the complex interaction between measles, childhood infections and other non-microbiological factors that occur within a whole population. These data suggest a strong association between H. pylori and deprivation and raise the possibility of an interaction between early measles exposure and increased risk of exposure to H. pylori infection.

Birthweight and fasting glucose and insulin levels: results from the Aboriginal Birth Cohort Study.

OBJECTIVE: To examine the relationships between birthweight, current size, and fasting glucose and fasting insulin levels in Aboriginal adolescents. DESIGN, PARTICIPANTS AND SETTING: Longitudinal prospective study of a Northern Territory Aboriginal birth cohort of 686 Aboriginal babies born at the Royal Darwin Hospital between January 1987 and March 1990, and followed up between December 2006 and January 2008 in over 40 NT locations. MAIN OUTCOME MEASURES: Fasting insulin and glucose levels, adjusted for gestational age, sex and contemporary age. RESULTS: Among the 134 participants with complete data, those with fetal growth restriction (FGR) or low birthweight (LBW) at birth were not overweight at 18 2013s. In these circumstances, birthweight showed a significant positively directed association with fasting glucose levels (P = 0.002). Current weight showed a significant and positively directed association with both fasting insulin (P < 0.001) and fasting glucose levels (P = 0.001), and current height showed a significant and positively directed association with insulin levels (P = 0.006). CONCLUSIONS: Birthweight was only positively associated with fasting glucose levels, with no association with fasting insulin levels. The high-risk combination for type 2 diabetes of LBW or FGR with later overweight or obesity was rare in this adolescent Aboriginal population.

Childhood infections, but not early life growth, influence hearing in the Newcastle thousand families birth cohort at age 14 years.

BACKGROUND: While current research priorities include investigations of age-related hearing loss, there are concerns regarding effects on childhood hearing, for example through increased personal headphone use. By utilising historical data, it is possible to assess what factors may have increased hearing problems in children in the past, and this may be used to inform current public health policies to protect children against hearing loss and in turn reduce the long-term burden on individuals and services that may possible evolve. The aim of this study was to investigate which factors in early life significantly impacted on hearing level in childhood using existing data from the Newcastle Thousand Families Study, a 1947 birth cohort. METHODS: Data on early life factors, including growth, socio-economic status and illness, and hearing at age 14 years were collated for a representative subset of individuals from the cohort (n = 147). Factors were assessed using linear regression analysis to identify associations with hearing thresholds. RESULTS: Males were found to have lower hearing thresholds at 250 Hz, 500 Hz and 1 kHz. Main analyses showed no associations between hearing thresholds and early life growth or socio-economic indicators. An increasing number of ear infections from birth to age 13 years was associated with hearing thresholds at 250Hz (p = 0.04) and 500Hz (p = 0.03), which remained true for females (p = 0.050), but not males (p = 0.213) in sex-specific analysis. Scarlet fever and bronchitis were associated with hearing thresholds at 8 kHz. After adjustment for all significant predictors at each frequency, results remained unchanged. CONCLUSIONS: We found no associations between childhood hearing thresholds and early life growth and socio-economic status. Consistent with other studies, we found associations between childhood infections and hearing thresholds. Current public health strategies aimed at reducing childhood infections may also have a beneficial effect upon childhood hearing.

Differences Between Self-Reported and Objectively Measured Hearing Loss at Age 61-63 Years: The Newcastle Thousand Families Birth Cohort.

PURPOSE: Hearing loss is most prevalent among older adults, yet underestimated by patients, clinicians, and research communities. This study aimed to assess the accuracy of self-reported hearing difficulties among a group of adults aged 61-63 years, against audiometric measures. METHOD: The analysis used a sample (N = 346) of the Newcastle Thousand Families Study birth cohort. Data from audiological examinations and self-reported hearing difficulties were used to compare subjective and objective hearing. Hearing aid use was also assessed. RESULTS: Over 40% of the participants had some level of hearing loss (n = 155, 44.8%), and 31% (n = 133) of these reported having hearing problems during subjective assessment. Only 18 (10%) of those with objectively measured hearing loss reported using hearing aids. CONCLUSIONS: There was an inconsistency between measured and self-perceived hearing loss among adults aged 61-63 years in this cohort. The small number of hearing aid users in the cohort is a concern, in that people in this age group appear not to be getting the help they need. The data also add to the research evidence that people at this age underestimate their hearing loss.

A Randomised Control Trial Investigating the Efficacy of the MapMe Intervention on Parental Ability to Correctly Categorise Overweight in Their Child and the Impact on Child BMI Z-Score Change at 1 Year.

Research suggests parental ability to recognise when their child has overweight is limited. It is hypothesised that recognition of child overweight/obesity is fundamental to its prevention, acting as a potential barrier to parental action to improve their child's health-related behaviours and/or help seeking. The purpose of this study was to investigate the efficacy of an intervention (MapMe) to improve parental ability to correctly categorise their child as having overweight one-month post-intervention, and reduce child body mass index (BMI) z-score 12 months post-intervention. MapMe consists of body image scales of known child BMI and information on the consequences of childhood overweight, associated health-related behaviours and sources of support. We conducted a three-arm (paper-based MapMe, web-based MapMe and control) randomised control trial in fifteen English local authority areas with parents/guardians of 4-5- and 10-11-year-old children. Parental categorisation of child weight status was assessed using the question 'How would you describe your child's weight at the moment?' Response options were: underweight, healthy weight, overweight, and very overweight. Child weight status and BMI z-scores were calculated using objectively measured height and weight data and UK90 clinical thresholds. There was no difference in the percentage of parents correctly categorising their child as having overweight/very overweight (n = 264: 41% control, 48% web-based, and 43% paper-based, p = 0.646). BMI z-scores were significantly reduced for the intervention group at 12 months post-intervention compared to controls (n = 338, mean difference in BMI z-score change -0.11 (95% CI -0.202 to -0.020, p = 0.017). MapMe was associated with a decrease in BMI z-score 12 months post-intervention, although there was no direct evidence of improved parental ability to correctly categorise child overweight status. Further work is needed to replicate these findings in a larger sample of children, investigate mechanisms of action, and determine the use of MapMe as a public health initiative.

Lifecourse predictors of mammographic density: the Newcastle Thousand Families cohort Study.

Dense mammographic patterns are a strong predictor of breast cancer risk. Factors at differing stages of life have been linked to breast cancer risk, although rarely studied simultaneously. We aimed to investigate whether birth weight and factors later in life were associated with mammographic density in the Newcastle Thousand Families Study. The Study originally consisted of all 1142 babies born in May and June 1947 to mothers resident in Newcastle upon Tyne in Northern England. Detailed information was collected prospectively during childhood, including birth weight and socio-economic circumstances. At age 49-51 years, 574 study members completed a 'Health and Lifestyle' questionnaire. Of the 307 surviving women who returned these questionnaires, 199 returned a further questionnaire asking for details of routine mammographic screening, their reproductive and contraceptive history. Mammographic patterns were coded into Wolfe categories. This was analysed, by ordinal logistic regression, in relation to a range of variables at different stages of life. Increased standardised birth weight (odds ratio, OR 1.32 (95% CI 1.02-1.71) P = 0.03) was a significant independent predictor of higher density. Increasing body mass index (BMI) was predictive of lower density (OR 0.86 per Kg/m(2) (95% CI 0.81-0.92) P < 0.001), as was having reached menopause (OR, compared to pre- and peri-menopausal, 0.41 (95% CI 0.23-0.73) P = 0.002). Interactions were seen between menopausal status and both BMI and age at menarche (P = 0.06) on density, although for neither did the direction of association change. After adjustment for factors acting throughout life, we identified a significant association between standardised birth weight and density in adulthood, consistent with previous research suggesting that heavier babies have an increased risk of breast cancer in later life. We also confirmed associations between both BMI and menopausal status.

Explainable machine learning for real-time deterioration alert prediction to guide pre-emptive treatment.

The Electronic Medical Record (EMR) provides an opportunity to manage patient care efficiently and accurately. This includes clinical decision support tools for the timely identification of adverse events or acute illnesses preceded by deterioration. This paper presents a machine learning-driven tool developed using real-time EMR data for identifying patients at high risk of reaching critical conditions that may demand immediate interventions. This tool provides a pre-emptive solution that can help busy clinicians to prioritize their efforts while evaluating the individual patient risk of deterioration. The tool also provides visualized explanation of the main contributing factors to its decisions, which can guide the choice of intervention. When applied to a test cohort of 18,648 patient records, the tool achieved 100% sensitivity for prediction windows 2-8 h in advance for patients that were identified at 95%, 85% and 70% risk of deterioration.

Identification of focus areas for Australian Bat Lyssavirus potential exposure prevention in the Metro North Hospital and Health Service region.

Australian Bat Lyssavirus (ABLV) is a fatal rabies-like disease spread to humans from bats. All people who report bat bites or scratches in Queensland are considered potentially exposed to ABLV and are followed up and treated to prevent ABLV. Preventing members of the public intentionally interacting with bats will reduce the number of potential exposures to ABLV. In order to target public health messaging, this study examines the epidemiology of potential ABLV exposures in Metro North Hospital and Health Service (HHS), a region of Queensland that encompasses metro and rural areas in the south-east of the state. People who intentionally handled bats during the study period were more likely to be adult (93%), male (60%), scratched (51%) by a megabat (72%) and been potentially exposed while rescuing the bat when it was trapped or injured (72%). The number of potential exposures reported in Queensland has increased since 2013; the same year, a Queensland child died of ABLV. Seasonally, exposures are more common during bat breeding and nursing periods when bats are more active (summer to autumn). Although there were more notifications in a band stretching north from the inner city to northern metro suburbs, notification rates were higher in large rural statistical areas in the north of the HHS. These data will be used to develop geographically targeted ABLV prevention messaging for the general public.

Providing evidence to support the development of whole grain dietary recommendations in the United Kingdom.

Observational evidence suggests that increased whole grain (WG) intake reduces the risks of many non-communicable diseases, such as CVD, type 2 diabetes, obesity and certain cancers. More recently, studies have shown that WG intake lowers all-cause and cause-specific mortality. Much of the reported evidence on risk reduction is from US and Scandinavian populations, where there are tangible WG dietary recommendations. At present there is no quantity-specific WG dietary recommendation in the UK, instead we are advised to choose WG or higher fibre versions. Despite recognition of WG as an important component of a healthy diet, monitoring of WG intake in the UK has been poor, with the latest intake assessment from data collected in 2000-2001 for adults and in 1997 for children. To update this information we examined WG intake in the National Diet and Nutrition Survey rolling programme 2008-2011 after developing our database of WG food composition, a key resource in determining WG intake accurately. The results showed median WG intakes remain low in both adults and children and below that of countries with quantity-specific guidance. We also found a reduction in C-reactive protein concentrations and leucocyte counts with increased WG intake, although no association with other markers of cardio-metabolic health. The recent recommendations by the UK Scientific Advisory Committee on Nutrition to increase dietary fibre intake will require a greater emphasis on consuming more WG. Specific recommendations on WG intake in the UK are warranted as is the development of public health policy to promote consumption of these important foods.

The whole grain content of foods consumed in the UK.

This study aimed to assess the whole grain (WG) content of foods consumed in the UK which include ingredients that retain all three structural components of the grain, and contained ⩾10% WG. Dietary data from seven studies with 10,474 UK subjects were examined for foods containing WG. The WG content was then determined from ingredient lists, manufacturers' information and recipes. 372 food descriptors from nine food groups (4.4% of all food codes) contained ⩾10% WG. Of these 372 foods, 31.5% contained ⩾51%, 30.6% 25-50%, and 37.9% 10-24% WG dry matter as eaten. The relatively small number of WG foods identified in the total number of foods consumed confirms the low contribution of WG foods to the overall pattern of foods consumed in the UK. Since foods containing <51% WG accounted for the majority of WG food codes identified, recognising the importance of these foods to WG intake is essential.