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We have recently been funded by the UK Prevention Research Partnership (UKPRP) to develop a UK school food network. The overarching aim is to build a community working towards a more health-promoting food and nutrition system in UK schools (primary and secondary). Here we describe the current status of school food research, including a review of the literature supporting the Health Promoting Schools approach and outline the opportunities for intervention and innovation establishment of the network presents. Key potential school food research themes are described, and their prioritisation within the network, as well as network activities that have been planned, with the ultimate ambition of reducing socioeconomic diet-related inequalities, and, consequently, non-communicable disease risk.
As the pathophysiology of COVID-19 emerges, this paper describes dysphagia as a sequela of the disease, including its diagnosis and management, hypothesised causes, symptomatology in relation to viral progression, and concurrent variables such as intubation, tracheostomy and delirium, at a tertiary UK hospital.
During the first wave of the COVID-19 pandemic, 208 out of 736 patients (28.9 per cent) admitted to our institution with SARS-CoV-2 were referred for swallow assessment. Of the 208 patients, 102 were admitted to the intensive treatment unit for mechanical ventilation support, of which 82 were tracheostomised. The majority of patients regained near normal swallow function prior to discharge, regardless of intubation duration or tracheostomy status.
Dysphagia is prevalent in patients admitted either to the intensive treatment unit or the ward with COVID-19 related respiratory issues. This paper describes the crucial role of intensive swallow rehabilitation to manage dysphagia associated with this disease, including therapeutic respiratory weaning for those with a tracheostomy.
Patients with co-occurring anorexia nervosa and autism respond differently to eating disorder treatments. Previous interviews with patients with both conditions and clinicians working in eating disorder services has highlighted service and treatment adaptations might be beneficial and could improve outcomes for these individuals.
The aim of this study was to explore carers’ experiences of current treatment approaches for people with autism who have anorexia nervosa, and their views on how these can be improved.
Ten carers of a loved one diagnosed with autism and anorexia nervosa were interviewed using a semi-structured interview schedule and the transcripts were analysed with thematic analysis.
Four key themes emerged from the interviews: the role of autism in anorexia nervosa, carers’ problems with clinical services, the impact on carers and suggestions for future improvements.
Carers agreed that autism played a significant role in the development and maintenance of their daughters’ anorexia nervosa. However, this comorbidity does not appear to be appropriately addressed in current treatment provisions. They described several difficulties, including problems getting an autism diagnosis and the perception that eating disorder services did not accept or adapt around the condition. This resulted in feelings of frustration and isolation for families, a scenario exacerbated by a perceived lack of support or specific resources for carers of individuals on the autism spectrum. Clinical recommendations on the basis of the current and previous studies are outlined.
Most scholarship addressing implementation gaps of violence against women (VAW) laws focuses on countries with high levels of violence in the lives of women—accompanied by weak policing and judicial responses. These studies tend to argue that the most egregious forms of political or social violence explain this gap. However, there has been little attention to countries with lower levels of gender-based violence and relatively responsive state institutions. We analyze the application of VAW laws in Costa Rica, with a focus on the impact of adjacent laws, or laws that are seemingly unrelated to VAW laws but are applied in tandem with and often in conflict with VAW laws. Based on a decade of fieldwork in Costa Rica, we argue that adjacent laws on land, labor, and immigration can be leveraged in ways that undermine the interpretation and implementation of VAW laws. These failures constitute legal violence: the normalized but cumulatively injurious effects of laws that can result in various forms of violence. While legal violence causes implementation gaps in almost every country, our case study reveals that the underlying sociolegal system upon which these laws rest contributes to a significant gap between VAW laws and practice.
David Denison’s ‘minigraph’ contribution to volume IV of the Cambridge History of the English Language (Denison 1998, CHEL IV) is widely acknowledged as a landmark achievement in the study of late Modern English (lModE) syntax. Denison himself introduced it as a ‘provisional’ survey of relatively unexplored territory: ‘syntactic change in late Modern English is only just beginning to get its share of serious scholarly attention’ (1998: 92).
Online self-reported 24-h dietary recall systems promise increased feasibility of dietary assessment. Comparison against interviewer-led recalls established their convergent validity; however, reliability and criterion-validity information is lacking. The validity of energy intakes (EI) reported using Intake24, an online 24-h recall system, was assessed against concurrent measurement of total energy expenditure (TEE) using doubly labelled water in ninety-eight UK adults (40–65 years). Accuracy and precision of EI were assessed using correlation and Bland–Altman analysis. Test–retest reliability of energy and nutrient intakes was assessed using data from three further UK studies where participants (11–88 years) completed Intake24 at least four times; reliability was assessed using intra-class correlations (ICC). Compared with TEE, participants under-reported EI by 25 % (95 % limits of agreement −73 % to +68 %) in the first recall, 22 % (−61 % to +41 %) for average of first two, and 25 % (−60 % to +28 %) for first three recalls. Correlations between EI and TEE were 0·31 (first), 0·47 (first two) and 0·39 (first three recalls), respectively. ICC for a single recall was 0·35 for EI and ranged from 0·31 for Fe to 0·43 for non-milk extrinsic sugars (NMES). Considering pairs of recalls (first two v. third and fourth recalls), ICC was 0·52 for EI and ranged from 0·37 for fat to 0·63 for NMES. EI reported with Intake24 was moderately correlated with objectively measured TEE and underestimated on average to the same extent as seen with interviewer-led 24-h recalls and estimated weight food diaries. Online 24-h recall systems may offer low-cost, low-burden alternatives for collecting dietary information.
IUI is often the first intervention offered for unexplained or mild to moderate male infertility and appears to be a safe method to prevent HIV transmission. Pregnancy and delivery rates per cycle remained stable for years. Factors influencing IUI results and studies evaluating if first line IVF rather than IUI could be a better option for couples with unexplained or mild male infertility will be discussed.
Increased risks compared to spontaneous conceptions have been described. However, data on comparison with IVF is limited and points to similar or lower perinatal risks. Multiple pregnancies are responsible for most of perinatal morbidities and are dependent on the use and aggressiveness of ovarian stimulation. Cost efficiency appears to be influenced by the indication, associated medications and perinatal complications mainly related to multiple pregnancies. While currently IUI with ovarian stimulation seems cost-effective, further studies are needed to confirm it in settings with advanced ART techniques.
Australia established the first national ART registries in the world in 1983, collating treatment and outcome data on the just over 200 pregnancies achieved in Australia from IVF. New Zealand clinics soon followed, contributing data to the registry in 1984. The registry, now known as the Australian and New Zealand Assisted Reproductive Technology Database (ANZARD), is an example of successful cooperation and collaboration between clinicians, fertility clinics, universities and regulators. Under a fertility clinic’s licensing agreement all ART treatment cycles are required to be report to ANZARD, ensuring complete ascertainment is achieved. The data from the registry have been publicly reported without interruption on an annual basis by the National Perinatal Epidemiology and Statistics Unit (NPESU), formally the NPESU for over 30 years, and made widely available to consumers, policy makers and researchers. The ANZARD annual report includes over 80 descriptive tables including age-specific success rates from successive treatment cycles. One of ANZARD’s important achievements has been in supporting the fertility sector in Australia and New Zealand to reduce the multiple birth rate to become one of the lowest in the world, with rates consistently below 5%. ANZARD continues to evolve towards more automated data collection and reporting platforms, and periodic changes to the data dictionary to accommodate changing patient demographics, and scientific and clinical practice.
The increasing complexity and variation in ART laboratory and clinical practice, together with a recognition of the importance of patient-centered outcomes, makes ART registries a central resource for informing patients, regulators and governments about the performance of ART treatment. The sequential nature of ART treatment gives rise to a multitude of possible numerators and denominators for measuring treatment outcomes. Which combination of these is the most appropriate and important depends on the stakeholder perspective and the purpose of the measure. ART registries are used in a number of countries to measure ART performance, particularly for reporting at a fertility clinic level. While health data transparency generally leads to better decision making, the process of measurement itself has the potential to both positively and negatively alter the behavior of clinics and clinicians. Finally, personalized patient predictor tools developed using large registry datasets are becoming common and are likely to become an important tool to assist clinicians in counselling patients about their individual chances of ART success.
Safety of medical treatments implies all their side and long-term effects on patients. With reference to ART, subjects involved are mothers and their children.
Since the early application of IVF, operators have agreed on the importance of monitoring these new techniques in order to build and maintain trust towards them.
Collecting data regarding assisted reproduction techniques worldwide is of the utmost usefulness to ensure safety and quality of treatments provided, to detect potential problems, as well as to implement practices aimed at reducing risks and improving outcomes.
Nowadays, well-functioning registries have been set up in most countries. Regulations and guidelines for the monitoring of all clinical and laboratory aspects of assisted reproduction techniques have been issued, also based on data collected so far.
Currently available evidence should be the basis for a further improvement of medical and laboratory practices.
Infertility affects an estimated 80 million individuals worldwide, or 10–15% of couples of reproductive age. The number of assisted reproductive technology (ART) cycles in the United States more than doubled between 2000 and 2013. In 2015, about 1.7% of all live births in the United States were the result of this technology. In the US, studies of the long-term outcomes of ART involve the challenge of linking databases, in which one database has information on the treatment parameters, and the other database captures the outcomes of interest. This chapter discusses the linkage efforts, methodologies, and resulting research in the US by the Society for Assisted Reproductive Technology (SART) and the Centers for Disease Control and Prevention (CDC), and the health linkages routinely performed in the Nordic countries. Strengths and limitations of these approaches are also discussed.
Choosing ART treatment is a major life decision. Patients have a fundamental right to patient-centered healthcare that respects their unique needs, preferences and values.
At the heart of a patient’s question about success rates is the need to know whether they can be assured of the best chance of taking home a healthy baby.
However, choosing a clinic based solely on reported success rates can create unrealistic expectations, as pregnancy rates vary tremendously, depending on the type of treatment, the age and cause of infertility. ‘League Tables’ comparing the performance of one clinic to another can be misleading.
More than 25 years’ experience from patients’ organizations suggest that many pursue ART without fully understanding the risks and potential complications. The format of ART surveillance reports varies considerably and are usually written for a scientific audience.
Therefore, ART surveillance data should be available in a format that is unbiased, understandable and meaningful.
While many countries recognize the importance of collecting and using ART data, ART surveillance systems and other ART data collection tools, such as registries or repositories, vary according to ownership, reporting responsibility, type of data being reported, information being reported, data quality and validation activities, public reporting of success rates, reporting requirements, and data protection around the world. However, there is a need for ART surveillance systems to be simple, flexible, acceptable, representative, timely, and stable as well as to have high data quality, sensitivity, and positive predictive values. This chapter will explore each of these areas as they relate to ART surveillance.
ART was pioneered in Africa in the 1980’s. Subsequently, ART centres emerged around the continent, mostly by specialists acquiring skills abroad. Despite this, ART activity remains scant in most African countries and absent in several others.
Historically, ART surveillance in Africa has been similarly scant and fragmented. Recently however, the African Network and Registry for ART (ANARA) has been established with the vision to reduce the high burden of infertility in Africa through ART; and its mission to bring together ART centres within and across countries and to collect data pertaining to availability, utilization, effectiveness and safety of ART. First registry data, collected from 40 centres in 13 countries, and will be published shortly. ANARA protects the anonymity of centres and patients and the ownership of data.
The successful establishment of ANARA is rooted in a collaborative spirit of engagement with ART centres and other stakeholders, developmental assistance from both the Latin American and World Registry, and the importance of data in reducing the burden of infertility in Africa.
Asia is composed of more than 40 countries where about 60% of the global population live. Since Asia is the largest and geographically variable continent, where cultural and social backgrounds are very diverse in every part of this area, it is almost impossible to describe the whole area in one chapter. Rapid decline of birth rates in multiple countries, particularly in eastern Asia, drew wide public attention and promoted the treatment and care for infertile couples. Particularly, assisted reproductive technology (ART) has significantly spread in many Asian countries and its growth is still ongoing. Although ART registries were established in several Asian countries many years ago, there is no Asian regional registry because of this diverse situation of this area.
Nation-specific registries of ART treatments were established in the United States, Canada, and Mexico in 1985, 1999 and 1995 respectively. In the United States, reporting became mandatory in 1992, and 94% of nearly the 500 clinics report. In Canada, reporting is voluntary and all but one clinic is currently reporting. In Mexico, a small proportion (about 20%) of over 50 clinics report to their country’s registry. Initially these registries contained summaries of each clinic’s overall outcomes, but all have now become cycle-specific. While all registries have systems in place to ensure quality of data, prospective reporting and annual data validations are mandatory only in the United States. All registries have adjusted their online data collections systems to capture changes in clinical practice patterns. Clinic-specific ART reports are available online in all North American countries. Information from these registries has been valuable for research and to develop treatment guidelines; most significantly, guidelines regarding the number of embryos to transfer has led to a dramatic reduction in multiple pregnancy rates.