A self-help diet and physical activity intervention with dietetic support for weight management in men treated for prostate cancer: pilot study of the Prostate Cancer Weight Management (PRO-MAN) randomised controlled trial.

Overweight and obesity may increase risk of disease progression in men with prostate cancer, but there have been few studies of weight loss interventions in this patient group. In this study overweight or obese men treated for prostate cancer were randomised to a self-help diet and activity intervention with telephone-based dietitian support or a wait-list mini-intervention group. The intervention group had an initial group meeting, a supporting letter from their urological consultant, three telephone dietitian consultations at 4-week intervals, a pedometer and access to web-based diet and physical activity resources. At 12 weeks, men in both groups were given digital scales for providing follow-up weight measurements, and the wait-list group received a mini-intervention of the supporting letter, a pedometer and access to the web-based resources. Sixty-two men were randomised; fifty-four completed baseline and 12-week measurements, and fifty-one and twenty-seven provided measurements at 6 and 12 months, respectively. In a repeated-measures model, mean difference in weight change between groups (wait-list mini-intervention minus intervention) at 12 weeks was -2·13 (95 % CI -3·44, -0·82) kg (P = 0·002). At 12 months the corresponding value was -2·43 (95 % CI -4·50, -0·37) kg (P = 0·022). Mean difference in global quality of life score change between groups at 12 weeks was 12·3 (95 % CI 4·93, 19·7) (P = 0·002); at 12 months there were no significant differences between groups. Results suggest the potential of self-help diet and physical activity intervention with trained support for modest but sustained weight loss in this patient group.

Contrast media and cutaneous reactions. Part 2: Delayed hypersensitivity reactions to iodinated contrast media.

Contrast media (CM) are an indispensable part of modern medical imaging. Adverse reactions to CM are uncommon, but frequently involve cutaneous symptoms. This two-part article reviews adverse events secondary to CM that are relevant to the practising dermatologist. Part 1 covers the classification of CM, immediate hypersensitivity reactions to CM and the newly described condition, gadolinium deposition disease. Given that there has only been two case reports to our knowledge of a delayed adverse reaction to gadolinium-based CM, this second part will focus on cutaneous delayed reactions caused by iodinated CM (ICM). Delayed hypersensitivity reactions to ICM commonly present as maculopapular exanthems, but more rarely, they can manifest as fixed drug eruptions, acute generalized exanthematous pustulosis, drug-related eosinophilia and systemic symptoms, Stevens-Johnson syndrome/toxic epidermal necrolysis, symmetrical drug-related intertriginous and flexural exanthema, graft-versus-host disease, vasculitis and iododerma. Delayed reactions to ICM may be underdiagnosed, as cutaneous symptoms may be attributed to oral medications, particularly if patients are on multiple drugs.

Contrast media and cutaneous reactions. Part 1. Immediate hypersensitivity reactions to contrast media and gadolinium deposition.

Contrast media (CM) are commonly used worldwide to enhance the quality of imaging, which is invaluable for diagnostic accuracy. Adverse reactions to CM are uncommon, but frequently involve cutaneous symptoms. This two-part article reviews adverse events secondary to CM that are relevant to the practising dermatologist. Part 1 will classify CM, address immediate hypersensitivity reactions and review the newly described condition, gadolinium deposition disease. Part 2 will cover the delayed hypersensitivity reactions of iodinated contrast medium including severe cutaneous adverse reactions and iododerma.

Using food intake records to estimate compliance with the Eatwell Plate dietary guidelines.

BACKGROUND: The UK Eatwell Plate is consumer based advice recommending the proportions of five food groups for a balanced diet: starchy foods, fruit and vegetables, dairy foods, nondairy sources of protein and foods and drinks high in fat or sugar. Many foods comprise ingredients from several food groups and consumers need to consider how these fit with the proportions of the Eatwell Plate. This involves disaggregating composite dishes into proportions of individual food components. The present study aimed to match the diets of adults in Scotland to the Eatwell Plate dietary recommendations and to describe the assumptions and methodological issues associated with estimating Eatwell Plate proportions from dietary records. METHODS: Foods from weighed intake records of 161 females and 151 males were assigned to a single Eatwell group based on the main ingredient for composite foods, and the overall Eatwell Plate proportions of each subject's diet were calculated. Food group proportions were then recalculated after disaggregating composite foods. RESULTS: The fruit and vegetables and starchy food groups consumed were significantly lower than recommended in the Eatwell Plate, whereas the proportions of the protein and foods high in fat or sugar were significantly higher. Failing to disaggregate composite foods gave an inaccurate estimate of the food group composition of the diet. CONCLUSIONS: Estimating Eatwell Plate proportions from dietary records is not straightforward, and is reliant on methodological assumptions. These need to be standardised and disseminated to ensure consistent analysis.

A genome-wide association study implicates the APOE locus in nonpathological cognitive ageing.

Cognitive decline is a feared aspect of growing old. It is a major contributor to lower quality of life and loss of independence in old age. We investigated the genetic contribution to individual differences in nonpathological cognitive ageing in five cohorts of older adults. We undertook a genome-wide association analysis using 549 692 single-nucleotide polymorphisms (SNPs) in 3511 unrelated adults in the Cognitive Ageing Genetics in England and Scotland (CAGES) project. These individuals have detailed longitudinal cognitive data from which phenotypes measuring each individual's cognitive changes were constructed. One SNP--rs2075650, located in TOMM40 (translocase of the outer mitochondrial membrane 40 homolog)--had a genome-wide significant association with cognitive ageing (P=2.5 × 10(-8)). This result was replicated in a meta-analysis of three independent Swedish cohorts (P=2.41 × 10(-6)). An Apolipoprotein E (APOE) haplotype (adjacent to TOMM40), previously associated with cognitive ageing, had a significant effect on cognitive ageing in the CAGES sample (P=2.18 × 10(-8); females, P=1.66 × 10(-11); males, P=0.01). Fine SNP mapping of the TOMM40/APOE region identified both APOE (rs429358; P=3.66 × 10(-11)) and TOMM40 (rs11556505; P=2.45 × 10(-8)) as loci that were associated with cognitive ageing. Imputation and conditional analyses in the discovery and replication cohorts strongly suggest that this effect is due to APOE (rs429358). Functional genomic analysis indicated that SNPs in the TOMM40/APOE region have a functional, regulatory non-protein-coding effect. The APOE region is significantly associated with nonpathological cognitive ageing. The identity and mechanism of one or multiple causal variants remain unclear.

Breastfeeding and introduction of complementary foods during infancy in relation to the risk of asthma and atopic diseases up to 10 years.

BACKGROUND: It has been hypothesized that changes in diet during early life may have contributed to the increase in childhood asthma and atopy. The long-term effect of the timing and content of infant feeding on the incidence of asthma and atopic diseases in children is unclear. OBJECTIVE: To investigate the associations between duration of breastfeeding and the timing of introduction of complementary foods during the first 6 months and parental-reported asthma, wheeze and atopic eczema up to 10 years of age. METHODS: Infant feeding practices (breastfeeding and introduction of complementary foods) of 1924 singleton children participating in the Study of Eczema and Asthma To Observe the influence of Nutrition (SEATON) birth cohort were prospectively collected up to 6 months with outcomes (wheeze, atopic eczema and asthma) being assessed at 1, 2, 5 and 10 years. Data were analysed using generalized estimating equations and discrete hazards models with adjustment for confounders. RESULTS: By 6 months, 59% and 35% of mothers had stopped exclusive and total breastfeeding, respectively. Although formula feeding was adversely associated with wheeze in the past 12 months (adjusted OR for no formula feeding: 070, 95% CI 0.50-0.97), and the introduction of biscuits/bread after 5 months of age adversely associated with atopic eczema (adjusted OR 1.34, 95% CI 1.06-1.69), these results lost their statistical significance after adjustment for multiple testing. Stratification of the results by the presence of eczema by 6 months of age and family atopic history did not substantially differ from the results of the whole study population. CONCLUSION AND CLINICAL RELEVANCE: Our results suggest that the nature of infant feeding during the first 6 months seems not to substantially influence the long-term risk of asthma and atopic diseases in children, nor in children at high risk of atopic disease because of a family history of atopic disease.

"It was an education in portion size". Experience of eating a healthy diet and barriers to long term dietary change.

The aim of the study was to explore the expectations and experience of actually eating a healthy diet and using this experience to identify barriers to healthy eating and sustainable dietary change. Fifty participants (19-63 yrs) were provided with a healthy diet (i.e. complied with dietary recommendations) for three consecutive days. Afterwards a semi-structured interview was carried out to explore expectations, experience and barriers to healthy eating. Using a thematic analysis approach eight dominant themes emerged from the interviews. Four related to expectations and experience of healthy eating; realisation of what are appropriate portion sizes, an expectation to feel hungry, surprise that healthy diets comprised normal food, the desire for sweet snacks (e.g. chocolate). This demonstrated there are some misconception about healthy eating and distorted views of portion size. Four more themes emerged relating to barriers to healthy eating; competing priorities, social, peer and time pressure, importance of value for money, a lack of desire to cook. Poor knowledge of healthy eating or a lack of cooking skills were the least common barrier, suggesting that future interventions and policy to improve dietary intakes need to focus on social, cultural and economic issues rather than on lack of knowledge or skills.

Genome-wide association studies establish that human intelligence is highly heritable and polygenic.

General intelligence is an important human quantitative trait that accounts for much of the variation in diverse cognitive abilities. Individual differences in intelligence are strongly associated with many important life outcomes, including educational and occupational attainments, income, health and lifespan. Data from twin and family studies are consistent with a high heritability of intelligence, but this inference has been controversial. We conducted a genome-wide analysis of 3511 unrelated adults with data on 549,692 single nucleotide polymorphisms (SNPs) and detailed phenotypes on cognitive traits. We estimate that 40% of the variation in crystallized-type intelligence and 51% of the variation in fluid-type intelligence between individuals is accounted for by linkage disequilibrium between genotyped common SNP markers and unknown causal variants. These estimates provide lower bounds for the narrow-sense heritability of the traits. We partitioned genetic variation on individual chromosomes and found that, on average, longer chromosomes explain more variation. Finally, using just SNP data we predicted ∼1% of the variance of crystallized and fluid cognitive phenotypes in an independent sample (P=0.009 and 0.028, respectively). Our results unequivocally confirm that a substantial proportion of individual differences in human intelligence is due to genetic variation, and are consistent with many genes of small effects underlying the additive genetic influences on intelligence.

Mediterranean-Type Diet and Brain Structural Change from 73 to 79 Years in the Lothian Birth Cohort 1936.

OBJECTIVES: To test whether Mediterranean-type Diet (MeDi) at age 70 years is associated with longitudinal trajectories of total brain MRI volume over a six-year period from age 73 to 79. DESIGN: Cohort study which uses a correlational design. SETTING: Participants residing in the Lothian region of Scotland and living independently in the community. PARTICIPANTS: A relatively healthy Scottish sample drawn from the Lothian Birth Cohort 1936. MEASUREMENTS: Total brain volume measurements were available at ages 73, 76 and 79 (N ranged 332 to 563). Adherence to the MeDi was based on food frequency questionnaire data collected three years before the baseline imaging scans, and was used in growth curve models to predict the trajectory of total brain volume change. RESULTS: No association was found (p>.05) between adherence to the MeDi at age 70 and total brain volume change from 73 to 79 years in minimally-adjusted (sex) or fully adjusted models controlling for additional health confounders. CONCLUSIONS: Variation in adherence to the MeDi was not predictive of total brain atrophy over a six-year period. This suggests that previous findings of dietary associations with brain volume are not long lasting or become less important as ageing-related conditions account for greater variation in brain volume change. More frequent collection of dietary intake data is needed to clarify these findings.

How reliable is eGFR when calculating drug dosage in acute medical admissions?

BACKGROUND: The Modification of Diet in Renal Disease-derived estimation of glomerular filtration rate (eGFR) is used widely. Although validated in stable chronic kidney disease (CKD) outpatients, it is not known how it performs in those presenting with acute medical illness. AIM: We aimed to compare eGFR with Cockroft Gault (CG) - the renal function assessment tool available prior to eGFR - to assess the difference in clinical outcome that would occur when one over another estimation is used in practice. In particular, we wished to assess whether use of eGFR would have resulted in a change of dose of commonly used acutely administered medications. METHODS: Acute medical admissions presenting to a tertiary hospital between August and December 2008 were included. Serum creatinine concentration, age, sex, height and weight were collected. Renal function was estimated by both estimates. Movement from CKD class 3 to 4 or 5 was measured - a clinically used cut-off point for changes in management. RESULTS: A total of 54 patients was included. eGFR values were higher than those estimated by CG. Almost half of patients categorized as CKD stage 4-5 using CG were only categorized as CKD stage 3 using eGFR. CONCLUSION: Although we did not use a gold standard estimation of GFR, this study shows that estimates of renal function vary in a clinically significant manner. As estimates of GFR are used to adjust drug dosages and to stratify for many other treatments, it is imperative that we find a method of estimating kidney function that is readily available, consistent and accurate.

Optimizing care for acute medical patients: the Australasian Medical Assessment Unit Survey.

AIM: To ascertain the design and operational characteristics of acute Medical Assessment Units (MAU) located within Australasian hospitals, and to compare these with formal standards promulgated by the Internal Medicine Society of Australia and New Zealand (IMSANZ). METHOD: Descriptive study based on responses to questionnaires mailed to clinical and nursing leads of MAU in March 2009 with follow-up reminders over 3months. Hospitals that had an MAU that met predefined criteria were identified from an IMSANZ directory of sites based on recent contact with IMSANZ members and health department personnel and interrogation of hospital websites and attendance lists at recent MAU workshops. RESULTS: Questionnaires were returned from 32 of 50 hospitals (response rate 64%). Most MAU (15/22; 68%) were less than 2years old. MAU were smaller than recommended by IMSANZ. Sixty-eight per cent were located over a 5-min walk from the emergency department (ED). Delay in transfer of patients from the ED to the MAU was common. The medical service to the majority of MAU was provided by General Medicine physicians and cover was reduced at weekends. In the majority of MAU the emphasis on function was facilitating discharge of patients rather than managing patients with high acuity of illness. CONCLUSIONS: Our survey suggests that despite some variation in staffing and procedures, MAU seem to be well established and a promising means of decreasing ED access block. Future comparative study is required to evaluate further the effect of MAU on ED access block and ED length of stay.

H1N1 influenza in an Irish population: patterns of chest radiograph abnormality in patients testing positive.

The winter of 2010/2011 saw a second peak in the number of H1N1 cases detected in Ireland. The purpose of this study was to investigate the radiological characteristics of patients diagnosed during this period. A retrospective analysis of these cases was performed. Chest radiographs were classified as normal or abnormal. A total of 37 patients were included. Of these, 22 (59%) of chest radiographs were abnormal and 15 (41%) were normal. In the 7 paediatric patients, 4 (57%) had a perihilar distribution of disease, 2 (28%) had peripherally based disease with 1 (14%) having a mixed distribution. A series of radiographs was available for 9 patients, 6 of these showed a radiographic deterioration from the initial study. The majority of chest radiographs of patients with confirmed H1N1 infection will be abnormal. In children, disease is more likely to be perihilar in distribution. Chest radiography is an important initial investigation in patients with H1N1 infection and is useful to track progression of disease in the subset of patients requiring hospitalization for severe disease.

The radiological diagnosis and treatment of renal angiomyolipoma-current status.

Angiomyolipomas (AMLs) are the most common benign renal neoplasm and are often discovered incidentally. Due to both an increase in the use of imaging, as well as advances in imaging technology, they are being increasing identified in the general population. As these lesions are benign, there is good evidence that the majority of them can be safely followed up without treatment. However, there is an increasing wealth of information available suggesting there are individuals with AMLs where prophylactic treatment is indicated to prevent complications such as haemorrhage. In such cases, treatment with radiological interventional techniques with subselective particle embolization has superseded surgical techniques in most cases. Even in emergency cases with catastrophic rupture, prompt embolization may save the patient with the additional benefit of renal salvage. Confident identification of a lesion as an AML is important as its benign nature obviates the need for surgery in most cases. The presence of fat is paramount in the confirmatory identification and characterization of these lesions. Although fat-rich AMLs are easy to diagnose, some lesions are fat poor and it is these cases where newer imaging techniques, such as in-phase and out-of-phase magnetic resonance imaging (MRI) may aid in making a confident diagnosis of AML. In this paper, we comprehensively review the imaging techniques in making a diagnosis of AML, including features of both characteristic lesions as well as atypical lesions. In addition, we discuss current guidelines for follow-up and prophylactic treatment of these lesions, as well as the increasing role that the interventional radiologist has to play in these cases.

Posterior reversible encephalopathy syndrome with Lilliputian hallucinations secondary to Takayasu's arteritis.

Posterior Reversible Encephalopathy Syndrome (PRES) is a rare complication of Takayasu's Arteritis. A 54-year-old, right-handed woman presented with Lilliputian visual hallucinations, postprandial abdominal pain, blurred vision and headaches. She then had a tonic-clonic seizure. Neuroimaging revealed characteristic white matter oedema of the occipital lobes, in keeping with PRES. Renal infarcts and abnormalities of the abdominal aorta, subclavian, mesenteric, and internal carotid arteries were demonstrated on further imaging. The combination of hypertension, absent peripheral pulses, postprandial claudication, and imaging abnormalities of the aorta as well as its branches, lead to the diagnosis of PRES secondary to Takayasu's Arteritis. Treatment with oral steroids resulted in complete resolution of the patient's symptoms and abnormalities found on CT and MRI brain imaging. Takayasu's Arteritis is a rare vasculitis, more common in women and PRES is an unusual complication. Symptoms of PRES may include headache, seizures, hallucinations, confusion, and altered consciousness. Risk factors for PRES include; pregnancy, immunosuppression, renal disease, hypertension and rheumatological disorders. Vasogenic oedema in affected lobes, most often occipital, is characteristic of PRES on neuroimaging. Prompt treatment of PRES can avoid catastrophic consequences such as death and can achieve complete resolution of symptoms and imaging abnormalities.

The accuracy of standard multiple sclerosis MRI brain sequences for the diagnosis of optic neuropathy.

BACKGROUND: Detection of optic neuropathy on MRI has potential implications for the diagnosis and management of Multiple Sclerosis (MS). OBJECTIVE: This study assessed the accuracy of T2 sagittal MRI brain for detection of optic neuropathy, compared to coronal STIR orbit. METHODS AND MATERIALS: Retrospective single-center blinded diagnostic accuracy study of 100 consecutive patients who underwent both T2 sagittal brain and coronal STIR orbit MRI. All were performed on 1.5T scanners. T2 sagittal slice thickness was 4 mm for the first 50 patients (group1) and 3 mm for the second 50 (group2). The MRIs were reviewed in a blinded fashion to determine the presence of optic neuropathy. Coronal STIR orbit sequences were considered the diagnostic reference standard. RESULTS: The sensitivity of T2 sagittal brain imaging for ON was 44% in group 1 and 85% in group 2 (p = 0.007). The specificities were 98% and 97% respectively (p = 0.9). Sensitivity was poorest for evaluation of the intraorbital nerve segment (56% grp1, 69% grp2, p = 0.4). CONCLUSION: T2 sagittal MRI brain has high specificity for the detection of optic neuropathy when compared to coronal STIR orbit. Sensitivity is increased when slice thickness is reduced, but remains poor for evaluation of the intraorbital segment.

Changes in the prevalence of asthma, eczema and hay fever in pre-pubertal children: a 40-year perspective.

Surveys of primary schools children in Aberdeen carried out in 1964, 1989, 1994 and 1999 suggested a slowing of the increase in parent-reported wheeze between 1994 and 1999. To assess whether this pattern had continued, questionnaires were distributed to 5712 children aged 7-12 years in the same schools in 2004. A total of 3271 (57.3%) completed questionnaires were returned. As in earlier surveys the results were divided into those for younger children (school years 3-4; age 7-9 years) and older children (school years 5-7; age 9-12 years). Compared with 1999, the 2004 results showed a decrease in the proportion of children with wheeze in the last 3 years from 30.1% to 23.3% (P < 0.001) in the younger group and from 27.6% to 25.1% (P = 0.052) in the older group. There was no significant change in the lifetime prevalence of asthma in either the younger or the older group, but the lifetime prevalence of eczema and hay fever increased by around 10% in both the younger and older groups (all P < 0.001). The differences in the time trends for the different conditions suggest that the causal factors for wheeze and asthma differ from those for other allergic diseases of childhood.

A pilot study to improve sugar and water consumption in Maltese school children.

BACKGROUND: Excessive sugar consumption remains implicated as one of the key dietary factors that has been linked to overweight and obesity in children. Schools have been identified as an important setting for health promotion interventions in children and can be successful in bringing about dietary behavioral change when well designed. OBJECTIVE: The main aim of the study was to conduct a pilot intervention study and assess the possible effects of educational and environmental methodological components on sugar intake and water consumption in Maltese school children. SUBJECTS AND METHODS: Face-to-face educational sessions for children and parents were supported by written materials and provision of free drinking water for children for a 12 week period in the school setting. Two main dietary outcomes were measured: non-milk extrinsic sugars(NMES) intake (measured as g/day) and water consumption (measured as servings/day), measured in the pre- and post-intervention periods. The dietary outcomes were measured at school using the novel online dietary assessment tool, REALITYMALTA™. RESULTS: 55 children, aged 10-11 years, were recruited, and 48 provided diet data at baseline and end. A reduction in mean energy intakes was noted from 7733 kJ/day (SD 2046) to 6809 (SD 2224) kJ/day (p = 0.03), with water servings intake increased and NMES intake decreased but results not statistically significant. Parent attendance at the educational sessions was low. CONCLUSIONS: A larger scale study, including multi-level analysis is recommended. Modifying the content of the intervention and finding ways to increase parent engagement should be considered in future.

Folic acid use in pregnancy and embryo selection.

OBJECTIVE: Folic acid supplement use is recommended in pregnancy to reduce the risk of neural tube defect but concerns have been raised that increasing folic acid intake may select for embryos with genotypes that increase disease risk in the offspring. Our aim was to test for this effect. DESIGN: Observational prospective cohort study. SETTING: Aberdeen Maternity Hospital. POPULATION OR SAMPLE: Women born before the introduction of folic acid advice (1970-80) and carrying singleton pregnancies (n = 1234) and their offspring (n = 1083) born after (2001-03). METHODS: We measured the genotype (MTHFR C677T and A1298C, MTR A2756G, MTRR A66G and TCN G776C) of mothers and their offspring, maternal supplement intake, intake of folate and vitamin B12 from natural foods and maternal blood folate and B12 status at 19 weeks of gestation. MAIN OUTCOME MEASURES: B vitamin related genotype of the offspring. RESULTS: There were no significant differences in any of the five genotype frequencies between mothers and their babies. There was no deviation from Hardy-Weinberg equilibrium in either generation and no change in the frequency of doubly homozygous MTHFR variants (677 TT/1298 CC). The genotype of the offspring was not related to maternal periconceptual supplement use, folate intake from foods or plasma and red cell folate measured at 19 weeks of gestation. CONCLUSIONS: We found no evidence to support the concern that folic acid fortification or supplement use in pregnancy results in selection of deleterious genotypes.

Does taking vitamin, mineral and fatty acid supplements prevent cognitive decline? A systematic review of randomized controlled trials.

BACKGROUND: Observational studies have shown associations between nutritional status and cognition in later life but evidence from intervention studies is unclear. The present study systematically reviewed the evidence on the effect of nutrient supplementation on cognitive function in people aged >or=65 years. METHODS: Databases including MEDLINE and EMBASE were searched up to 1 September 2006. Randomized controlled trials using at least one kind of vitamin, mineral or omega-3 fatty acid, evaluating standardized neuropsychological test(s), were included. There were no restrictions on participants' baseline nutritional status or cognitive function. Quality assessment and data abstraction were conducted by one author and checked by another. RESULTS: Of 4229 articles retrieved, 22 trials (3442 participants) were identified. Many were small, short duration and of poor methodology. Only 16 out of 122 cognitive tests were significantly different between groups. A meta-analysis showed no significant effect of taking B vitamins or antioxidant vitamins on global cognitive function. There was insufficient evidence to evaluate the effect of omega-3 fatty acids on any cognitive domains. CONCLUSION: There was little evidence of a beneficial effect from taking B vitamins or antioxidant supplements on global cognitive function in later life. Larger-scale randomized controlled trials of longer duration in selected age groups are needed.