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Inappropriate use of antibiotics is among the key drivers of antimicrobial resistance (AMR). Antibiotic use in Northern Ireland (NI) is the highest in the UK and approximately 80% is prescribed in primary care. Little information however exists about the patient and prescriber factors driving this. We described the trend in NI primary care total antibiotic prescribing 2010–2019 and conducted a cross-sectional study using a random sample of individuals registered with an NI GP on 1st January 2019. We used multilevel logistic regression to examine how sociodemographic factors and urinary catheter use was associated with the likelihood of being prescribed an antibiotic during 2019, adjusting for clustering at GP practice and GP federation levels. Finite mixture modelling (FMM) was conducted to determine the association between the aforementioned risk factors and quantity of antibiotic prescribed (defined daily doses). The association between age and antibiotic prescription differed by gender. Compared to males 41–50 years, adjusted odds of prescription were higher for males aged 0–10, 11–20 and 51 + years, and females of any age. Catheter use was strongly associated with antibiotic prescription (aOR = 6.82, 95% CI 2.50–18.64). Socioeconomic deprivation and urban/rural settlement were not associated in the multilevel logistic analysis. GP practices and federations accounted for 1.24% and 0.12% of the variation in antibiotic prescribing respectively. FMM showed associations between larger quantities of antibiotics and being older, male and having a catheter. This work described the profile of individuals most likely to receive an antibiotic prescription in NI primary care and identified GP practice as a source of variation; suggesting an opportunity for reduction from effective interventions targeted at both individuals and general practices.
Iodine deficiency has been demonstrated in UK women, which is of concern as iodine is required for fetal brain development during pregnancy. Plant-based diets are increasingly popular, especially with young females, which may affect iodine intake as the main dietary sources are dairy and fish; plant-based products are naturally low in iodine. We, therefore, aimed to (i) assess the iodine fortification of milk-, yoghurt-, cheese- and fish-alternative products available in UK supermarkets and (ii) model the impact that substitution with such products would have on iodine intake using portion-based scenarios. A cross-sectional survey of retail outlets was conducted in 2020 and nutritional data was extracted from food labels. We identified 300 products, including plant-based alternatives to: (i) milk (n=146), (ii) yoghurt (n=76), (iii) cheese (n=67), and (iv) fish (n=11). After excluding organic products (n=48), which cannot be fortified, only 28% (n=29) of milk alternatives and 6% (n=4) of yoghurt alternatives were fortified with iodine, compared to 88% (n=92) and 73% (n=51) respectively with calcium. No cheese alternative was fortified with iodine but 55% were fortified with calcium. None of the fish-alternatives were iodine-fortified. Substitution of three portions of dairy (milk/yoghurt/cheese) per day with unfortified alternatives would reduce iodine provision by 97.9% (124 vs. 2.6 µg) and substantially reduce the contribution to adult intake recommendations (83 vs. 1.8%). Our study highlights that the majority of plant-based alternatives are not iodine-fortified and that use of unfortified alternatives in place of dairy and fish may put consumers at risk of iodine deficiency.
Older adults (≥65 years) are the fastest growing population group. Thus, ensuring nutritional well-being of the ‘over-65s’ to optimise health is critically important. Older adults represent a diverse population – some are fit and healthy, others are frail and many live with chronic conditions. Up to 78% of older Irish adults living independently are overweight or obese. The present paper describes how these issues were accommodated into the development of food-based dietary guidelines for older adults living independently in Ireland. Food-based dietary guidelines previously established for the general adult population served as the basis for developing more specific recommendations appropriate for older adults. Published international reports were used to update nutrient intake goals for older adults, and available Irish data on dietary intakes and nutritional status biomarkers were explored from a population-based study (the National Adult Nutrition Survey; NANS) and two longitudinal cohorts: the Trinity-Ulster and Department of Agriculture (TUDA) and the Irish Longitudinal Study on Ageing (TILDA) studies. Nutrients of public health concern were identified for further examination. While most nutrient intake goals were similar to those for the general adult population, other aspects were identified where nutritional concerns of ageing require more specific food-based dietary guidelines. These include, a more protein-dense diet using high-quality protein foods to preserve muscle mass; weight maintenance in overweight or obese older adults with no health issues and, where weight-loss is required, that lean tissue is preserved; the promotion of fortified foods, particularly as a bioavailable source of B vitamins and the need for vitamin D supplementation.
Patent ductus arteriosus stenting for ductal-dependent pulmonary blood flow is a technically challenging neonatal procedure to maintain a stable pulmonary circulation. Pre-procedural computed tomography imaging aids in outlining ductal origin, insertion, size, course and curvature. Computed tomography imaging may add value to procedural outcomes and reduce overall procedural morbidity in neonatal patent ductus arteriosus stenting. We conducted a single centre retrospective chart review of neonates with ductal-dependent pulmonary blood flow who underwent patent ductus arteriosus stenting between January 1, 2014 and June 31, 2020. We compared patients variables between patients who underwent pre-procedural computed tomography imaging to those who did not. A total of 64 patients were referred for patent ductus arteriosus stenting with 33 (52%) obtaining pre-procedural computed tomography imaging. Average age [19 days; range 1–242 days (p = 0.85)] and weight [3.3 kg (range 2.2–6.0 kg; p = 0.19)] was not significantly different between the groups. A diagnosis of pulmonary atresia was made in 42 out of 64 (66%) patients prior to patent ductus arteriosus stenting. The cohort with pre-intervention computed tomography imaging had a significant reduction in the total number of access sites (1.2 versus 1.5; p = 0.03), contrast needed (5.9 versus 8.2 ml/kg; p = 0.008), fluoroscopy (20.7 versus 38.8 minutes; p = 0.02) and procedural time (83.4–128.4 minutes; p = 0.002) for the intervention. There was no significant difference in radiation burden between the groups (p = 0.35). Pre-procedural computed tomography imaging adds value by aiding interventional planning for neonatal patent ductus arteriosus stenting. A statistically significant reduction in the number of access sites, contrast exposure, as well as fluoroscopic and procedural time was noted without significantly increasing the cumulative radiation burden.
Currently, there is considerable emphasis on the relationship between dietary sugar consumption and various health outcomes, with some countries and regions implementing national sugar reduction campaigns. This has resulted in significant efforts to quantify dietary sugar intakes, to agree on terms to describe dietary sugars and to establish associated recommendations. However, this information is infrequently collated on a global basis and in a regularised manner. The present review provides context regarding sugar definitions and recommendations. It provides a global review of the available data regarding dietary sugar intake, considering forms such as total, free and added sugars. A comprehensive breakdown of intakes is provided by age group, country and sugar form. This analysis shows that free sugar intakes as a percentage of total energy (%E) are the highest for children and adolescents (12–14%E) and the lowest for older adults (8%E). This trend across lifecycle stages has also been observed for added sugars. The available data also suggest that, while some reductions in sugar intake are observed in a few individual studies, overall intakes of free/added sugars remain above recommendations. However, any wider conclusions are hampered by a lack of detailed high-quality data on sugar intake, especially in developing countries. Furthermore, there is a need for harmonisation of terms describing sugars (ideally driven by public health objectives) and for collaborative efforts to ensure that the most up-to-date food composition data are used to underpin recommendations and any estimates of intake or modelling scenarios.
This article reflects on the contribution of qualitative longitudinal research (QLR) to understandings of homeless peoples’ experiences of support service interventions in an era of austerity in the UK. It brings into ‘analytic conversation’ data from qualitative longitudinal evaluations of homeless support projects operated by voluntary sector organisations in Scotland. With fieldwork spanning 2014-2019, the analysis expands the analytical potential of pooling small-scale studies through an interrogation of individuals’ ‘journeys’ through homelessness services and their rough path to ‘home’. By reflecting on our substantive findings, the article explores the added value and challenges of a longitudinal approach. It concludes that while QLR can deliver deep insight into lives lived by vulnerable populations and potentially reduce the distance between policy makers and those affected, its benefits must be balanced against pragmatism and the ethical responsibilities associated with the method.
Magnetoencephalography (MEG) has emerged as an important tool in the study of mood disorders. Although electroencephalography (EEG) is much more widely utilized, largely due to its low cost and ease of use, MEG has the distinct advantage of enabling accurate localization of brain structures. Although a full discussion of the methodology of MEG is beyond the scope of this brief chapter, we will present a brief overview of the technique and refer the reader to several excellent volumes (1–3) for more information.