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To examine the rates of antipsychotic prescribing in the Irish paediatric and young adult population enrolled in the Irish General Medical Services Scheme pharmacy claims database from the Health Service Executive Primary Care Reimbursement Services database, with a focus on age and sex differences. To examine concomitant prescribing of certain other related medicines in this population.
Methods:
Data were obtained from the Irish General Medical Services (GMS) scheme pharmacy claims database from the Health Service Executive (HSE) – Primary Care Reimbursement Services (PCRS). Participants included children aged <16 years and youth aged 16–24 years availing of medicines under the HSE-PCRS GMS scheme between January 2005 and December 2015. Outcome measures included prescribing rates of antipsychotics from 2005 to 2015, differences in prescribing rates between different ages and sexes, and percentage of concomitant prescriptions for antidepressants, psychostimulants, anxiolytics and hypnosedatives.
Results:
Overall the trend in prescribing rates of antipsychotic medications was stable at 3.94/1000 in 2005 compared with 3.97/1000 in 2015 for children <16 years, and 48.37/1000 eligible population in 2005 compared to 39.64/1000 in 2015 for those aged 16–24. There was a significant decrease in prescribing rates for males in the 16–24 age group.
Conclusions:
While rates of antipsychotic prescribing have decreased or remained stable over the timeframe of the study, we did find a significant proportion of this population were prescribed antipsychotics. This study also shows that co-prescribing of antidepressants increased and highlights the need for guidelines for antipsychotic prescribing in children and youth in terms of clinical indication, monitoring, co-prescribing and treatment duration.
Overconsumption of free sugars, particularly from sugar-sweetened beverages (SSB), has potential negative health impacts. Implementation of a range of public health strategies is needed to reduce intakes of free sugars, including reducing portion sizes, promoting healthier dietary choices and reformulating foods and beverages. Although low-calorie sweeteners (LCS) are a useful tool for reducing energy intake and control glucose response when consuming sweet foods and drinks, several opinions persist about the adverse health effects of LCS, many of which are based on poor, little or no scientific evidence. This symposium report summarises key messages of the presentations and related discussions delivered at a scientific symposium at the 13th European Nutrition Conference (FENS 2019). These presentations considered the scientific evidence and current recommendations about the use and potential benefits of LCS for human health, with a particular focus on current evidence in relation to body weight and glycaemic control. Many of the studies to date on LCS have focused on low-calorie sweetened beverages (LCSB); however, the psychological and behavioural factors influencing consumer beliefs and consumption of LCSB need to be further explored. Current recommendations for LCS use are described, including the conclusions from a recent expert consensus report identifying the challenges that remain with LCS research. Finally, existing knowledge gaps and future actions are described, as well as two large ongoing research projects: SWITCH and SWEET.
To determine clinical consensus and non-consensus in regard to evidence-based statements about feeding infants with complex CHD, with a focus on human milk. Areas of non-consensus may indicate discrepancies between research findings and practice, with consequent variation in feeding management.
Materials and Methods:
A modified Delphi survey validated key feeding topics (round 1), and determined consensus on evidence-based statements (rounds 2 and 3). Patients (n=25) were an interdisciplinary group of clinical experts from across the United States of America. Descriptive analysis used SPSS Statistics (Version 26.0). Thematic analysis of qualitative data provided context for quantitative data.
Results:
Round 1 generated 5 key topics (human milk, developing oral feeding skills, clinical feeding practice, growth failure, and parental concern about feeding) and 206 evidence-based statements. The final results included 110 (53.4%) statements of consensus and 96 (46.6%) statements of non-consensus. The 10 statements of greatest consensus strongly supported human milk as the preferred nutrition for infants with complex CHD. Areas of non-consensus included the adequacy of human milk to support growth, need for fortification, safety, and feasibility of direct breastfeeding, issues related to tube feeding, and prevention and treatment of growth failure.
Conclusions:
The results demonstrate clinical consensus about the importance of human milk, but reveal a need for best practices in managing a human milk diet for infants with complex CHD. Areas of non-consensus may lead to clinical practice variation. A sensitive approach to these topics is needed to support family caregivers in navigating feeding concerns.
The neurodevelopmental model of schizophrenia includes the etiological impact of fetal brain stressors possibly connected with birth seasonality. Specification of social class of origin (SES) as a related risk factor remains unexamined as does type of schizophrenia as an outcome variable. The objective of this study was to test for an interconnection between SES, type of schizophrenia and seasonality of birth.
Methods
Patients (N = 436) from a United States psychiatric hospital were separated into deficit/nondeficit presentation and bifurcated into poor/nonpoor SES. Birth seasonality was assessed by months hypothetically connected with winter-related trimesters of gestation.
Results
Results showed that there is a significant difference (p = 0.0411) in the monthly birth patterns of poor vs. nonpoor patients and that the difference connects with the likelihood of deficit vs. nondeficit schizophrenia. Specifically, an elevated proportion of patients with deficit schizophrenia were born to impoverished women who likely conceived in January. Findings were confirmed by multiple levels of statistical assessment including log linear analysis.
Conclusion
The resultant model suggests the environmental location (lower SES) and timing (winter conception) of adult schizophrenia with poor outcome (deficit).
Individualised behavioural interventions are known to promote development, enhance skills and communication and reduce rigid and stereotypical patterns in children with autism spectrum disorder especially if they start in early pre-school age and are offered in high intensity. In many countries, however, these interventions are not available to families with autistic children. This may be due to lack of funding, lack of qualified staff and/or insufficient traditions of evidence-based procedures in institutions working with autistic children.
Facing this situation, the European Union Leonardo Transfer of Innovation Programm funded the adaptation and localisation of a highly successful Northern Irish multimedia tool for England and Scotland, Norway, Spain and Germany.
The multimedia package consists of a brochure with basic information on ASD, diagnostics and intervention. In addition, a DVD offers expert interviews, parents' testimonials and an introduction to autism specific behavioural therapy, well established as Autism Applied Behaviour Analysis in the anglo-american countries. An accompanying CD-ROM contains additional background information and practical tools for therapy implementation.
It can be used by parents, kindergarten and school special needs staff and therapeutic institutions for education and for therapy planning and evaluation. In Germany, Spain, Norway and the UK it is offered free of charge under EU funding.
Individualised behavioural interventions are known to promote development, enhance skills and communication and reduce rigid and stereotypical patterns in children with autism spectrum disorder especially if they start in early pre-school age and are offered in high intensity. In many countries, however, these interventions are not available to families with autistic children. This may be due to lack of funding, lack of qualified staff and/or insufficient traditions of evidence-based procedures in institutions working with autistic children.
Facing this situation, the European Union Leonardo Transfer of Innovation Programm funded the adaptation and localisation of a highly successful Northern Irish multimedia tool for England and Scotland, Norway, Spain and Germany.
The multimedia package consists of a brochure with basic information on ASD, diagnostics and intervention. In addition, a DVD offers expert interviews, parents’ testimonials and an introduction to autism specific behavioural therapy, well established as Autism Applied Behaviour Analysis in the anglo-american countries. An accompanying CD-ROM contains additional background information and practical tools for therapy implementation.
It can be used by parents, kindergarten and school special needs staff and therapeutic institutions for education and for therapy planning and evaluation. In Germany, Spain, Norway and the UK it is offered free of charge under EU funding.
Sleep has been shown to impact on both physical and mental health, and sleep problems present a considerable burden for individuals and society. There appears to be a complex bidirectional relationship between sleep disturbance and psychiatric symptoms, each potentially influencing the other. In particular, sleep disorders have been associated with more severe symptoms and are predictive of relapse in those with psychotic disorders. This article discusses the relationship between psychosis and insomnia, sleep apnoea, nightmares, circadian rhythm abnormalities and the impact of medications on these relationships. We also discuss the clinical implications of the relationship between sleep disturbance and psychotic disorders along with potential targets for intervention.
A consensus workshop on low-calorie sweeteners (LCS) was held in November 2018 where seventeen experts (the panel) discussed three themes identified as key to the science and policy of LCS: (1) weight management and glucose control; (2) consumption, safety and perception; (3) nutrition policy. The aims were to identify the reliable facts on LCS, suggest research gaps and propose future actions. The panel agreed that the safety of LCS is demonstrated by a substantial body of evidence reviewed by regulatory experts and current levels of consumption, even for high users, are within agreed safety margins. However, better risk communication is needed. More emphasis is required on the role of LCS in helping individuals reduce their sugar and energy intake, which is a public health priority. Based on reviews of clinical evidence to date, the panel concluded that LCS can be beneficial for weight management when they are used to replace sugar in products consumed in the diet (without energy substitution). The available evidence suggests no grounds for concerns about adverse effects of LCS on sweet preference, appetite or glucose control; indeed, LCS may improve diabetic control and dietary compliance. Regarding effects on the human gut microbiota, data are limited and do not provide adequate evidence that LCS affect gut health at doses relevant to human use. The panel identified research priorities, including collation of the totality of evidence on LCS and body weight control, monitoring and modelling of LCS intakes, impacts on sugar reduction and diet quality and developing effective communication strategies to foster informed choice. There is also a need to reconcile policy discrepancies between organisations and reduce regulatory hurdles that impede low-energy product development and reformulation.
Both obesity and type 2 diabetes mellitus have been associated with excessive free sugar consumption. Increasingly, LCS are used to replace free sugar to reduce the energy density of the diet, whilst maintaining diet palatability. However, while experimental data suggest a beneficial effect of LCS on weight management and glycaemic control, data from free-living populations are contradictory and primarily use reported intakes of low-calorie sweetened beverages as a marker of overall LCS consumption. Therefore, a dietary assessment tool that reliably assesses overall LCS consumption and is applicable in large-scale epidemiological studies is desirable. This study aimed to validate an LCS-focused food frequency questionnaire (FFQ) for assessing habitual dietary intake of the LCS using the method of triads. Healthy adults were recruited at Ulster University, Coleraine (n = 120). A 65-item FFQ and a 4-day food diary (FD) were used to assess dietary intake of LCS with amounts based on maximum permitted levels for foods and beverages as per EU legislation. A novel urinary biomarker approach, developed by this research group, was used to objectively assess consumption of 5 commonly used LCS(1). The method of triads was used to validate the FFQ by evaluating the correlations between the FFQ, FD and the urinary biomarkers (reference method). A total of 110 participants (51 males, 59 females) completed all analyses. Median (IQR) total LCS consumption estimated from the FFQ, FD and urinary biomarker was 116.8 (24.9–303.3) mg/d, 27.8 (0.0–247.3) mg/d and 5.0 (0.6–34.9) mg/d respectively. Moderate correlations were observed between the FD and urinary biomarker (r = 0.471; P < 0.001) and between the FFQ and FD (r = 0.471; P < 0.001). There was a low correlation between the FFQ and urinary biomarker (r = 0.291; P < 0.001). Using the method of triads, the overall validity co-efficient for the FFQ was moderate (0.54). These preliminary results indicate potential for this LCS-focused FFQ as a method of assessing LCS consumption in free-living populations. However, as maximum permitted levels of LCS in foods and beverages were used to estimate LCS consumption from the FFQ and FD, they are likely to significantly overestimate actual LCS intakes as compared to the more reliable biomarker approach. Therefore, the FFQ ability to categorise individuals into low-, medium- and high LCS consumers will be tested. Further analysis is ongoing to assess the completeness of urine collections using PABA analysis and will also focus on individual LCS intake.
Osteoporosis was not a public health concern in black South African (SA) women, until recently when it was reported that the prevalence of vertebral fractures was 9.1% in black compared to 5.0% in white SA women. Accordingly, this study aimed to measure bone mineral density (BMD) of older black SA women and to investigate its association with risk factors for osteoporosis, including strength, muscle and fat mass, dietary intake and objectively measured physical activity (PA).
Methods and materials
Older black SA women (age, 68 (range; 60–85 years) n = 122) completed sociodemographic and quantitative food frequency questionnaires (QFFQ), fasting venous blood samples (25-hydroxycholecalciferol: Vitamin D-25), 24 h urine collection (estimate protein intake), grip strength and PA monitoring (activPAL). Dual-energy x-ray absorptiometry (DXA) scans of the hip (femoral neck and total) and lumbar spine determined BMD and whole-body scans for fat and fat-free soft tissue mass (FFSTM). WHO classifications were used to determine osteopenia (t-score -2.5 to -1), and osteoporosis (t-score < -2.5).
Results
At the lumbar spine 34.4% of the women (n = 42) had osteopenia and 19.7% (n = 24) had osteoporosis. Osteopenia at the left femoral neck was 32% (n = 40) and osteoporosis was 13.1% (n = 16) of participants. The total left hip BMD indicated osteopenia in 27.9% (n = 34) and osteoporosis in 13.1% (n = 16) of participants. Multinomial regression revealed no differences in age (y) or frequency of falls in the past year between all groups (p = 0.727). Compared to those with normal BMD, participants with osteoporosis at the hip neck and lumbar spine were shorter, weighed less and had a lower body mass index (BMI) (all p < 0.05). When adjusted for height, the osteoporotic group (hip neck and lumbar spine) had lower trunk fat (% whole body), FFSTM (kg) and grip strength (kg), compared to those with normal BMD (p < 0.05). Only protein intake (g; 24 h urine analyses) was lower in women with osteoporosis (all sites) compared to those with normal BMD. Fat, carbohydrate and micronutrient intakes (relative to total daily energy intake), and vitamin D concentrations were not associated with BMD (all sites). Number of daily step count and stepping time (min) were inversely associated with BMI (p < 0.05), but not with BMD (all sites; p > 0.05).
Discussion
A high prevalence of osteopenia and osteoporosis was evident at the lumbar spine and hip in older black SA women. This study highlights the importance of strength, body composition, and protein intake in maintaining BMD and preventing the development of osteoporosis in older women.
The term ‘sweeteners’ encompasses both nutritive and non-nutritive sweeteners, which when added to food/beverages, can enhance the flavour and other functional properties of food/beverage products. This review considers how dietary biomarker approaches may enhance current understanding of nutritive sweetener (namely free sugars) and non-nutritive or low-energy sweetener (LES) intakes and how these may impact health. Recent public health strategies to reduce free sugar consumption will help contribute to challenging sugar intake targets. Robust evaluation is needed to determine the effectiveness of these approaches to reducing free sugar consumption. LES provides a sweet taste without the addition of appreciable energy and can help maintain the palatability of reformulated products. All LES undergo rigorous safety evaluations prior to approval for use. Whilst intervention data suggest LES can be beneficial for health (relating to weight status and glycaemic control), debate persists on their use and findings from population-based research are mixed, in part because of potential contributing factors such as reverse causality. Additionally, assessments often consider only certain sources of LES (e.g. LES-beverages) and/or LES as a homogeneous group despite differing biological fates, thus not adequately capturing intakes of individual LES or allowing for reliable estimation of overall intakes. Urinary biomarker approaches developed/investigated for sweetener consumption have the potential to overcome existing limitations of dietary data by providing more objective intake data, thereby enhancing population-based research. In conclusion, such biomarker approaches to the concomitant study of free sugars and LES intakes are timely and represent interesting developments in an area of significant public health interest.
We use deep Chandra and HST data to uniquely classify the X-ray binary (XRB) populations in M81 on the basis of their donor stars and local stellar populations (into early-type main sequence, yellow giant, supergiant, low-mass, and globular cluster). First, we find that more massive, redder, and denser globular clusters are more likely to be associated with XRBs. Second, we find that the high-mass XRBs (HMXBs) overall have a steeper X-ray luminosity function (XLF) than the canonical star-forming galaxy XLF, though there is some evidence of variations in the slopes of the sub-populations. On the other hand, the XLF of the prototypical starburst M82 is described by the canonical powerlaw (αcum ∼ 0.6) down to LX ∼ 1036 erg s−1. We attribute variations in XLF slopes to different mass transfer modes (Roche-lobe overflow versus wind-fed systems).
We consider the problem of a rigid plate, inclined at an angle
$\unicode[STIX]{x1D6FC}\in (0,\unicode[STIX]{x03C0}/2)$
to the horizontal, accelerating uniformly from rest into, or away from, a semi-infinite strip of inviscid, incompressible fluid under gravity. Following on from Gallagher et al. (J. Fluid Mech., vol. 841, 2018, pp. 109–145) (henceforth referred to as GNB), it is of interest to analyse the well-posedness and stability of the principal flow with respect to perturbations in the initially horizontal free surface close to the plate contact point. In particular we find that the solution to the principal unperturbed problem, denoted by [IBVP] in GNB, is well-posed and stable with respect to perturbations in initial data in the region of interest, localised close to the contact point of the free surface and the plate, when the plate is accelerated with dimensionless acceleration
$\unicode[STIX]{x1D70E}\geqslant -\cot \,\unicode[STIX]{x1D6FC}$
, while the solution to [IBVP] is ill-posed with respect to such perturbations in the initial data, when the plate is accelerated with dimensionless acceleration
$\unicode[STIX]{x1D70E}<-\cot \,\unicode[STIX]{x1D6FC}$
. The physical source of the ill-posedness of the principal problem [IBVP], when
$\unicode[STIX]{x1D70E}<-\cot \,\unicode[STIX]{x1D6FC}$
, is revealed to be due to the leading-order problem in the innermost region localised close to the initial contact point being in the form of a local Rayleigh–Taylor problem. As a consequence of this mechanistic interpretation we anticipate that, when the plate is accelerated with
$\unicode[STIX]{x1D70E}<-\cot \,\unicode[STIX]{x1D6FC}$
, the inclusion of weak surface tension effects will restore well-posedness of the problem [IBVP] which will, however, remain temporally unstable.
The free surface and flow field structure generated by the uniform acceleration (with dimensionless acceleration
$\unicode[STIX]{x1D70E}$
) of a rigid plate, inclined at an angle
$\unicode[STIX]{x1D6FC}\in (0,\unicode[STIX]{x03C0}/2)$
to the exterior horizontal, as it advances (
$\unicode[STIX]{x1D70E}>0$
) or retreats (
$\unicode[STIX]{x1D70E}<0$
) from an initially stationary and horizontal strip of inviscid incompressible fluid under gravity, are studied in the small-time limit via the method of matched asymptotic expansions. This work generalises the case of a uniformly accelerating plate advancing into a fluid as studied by Needham et al. (Q. J. Mech. Appl. Maths, vol. 61 (4), 2008, pp. 581–614). Particular attention is paid to the innermost asymptotic regions encompassing the initial interaction between the plate and the free surface. We find that the structure of the solution to the governing initial boundary value problem is characterised in terms of the parameters
$\unicode[STIX]{x1D6FC}$
and
$\unicode[STIX]{x1D707}$
(where
$\unicode[STIX]{x1D707}=1+\unicode[STIX]{x1D70E}\tan \unicode[STIX]{x1D6FC}$
), with a bifurcation in structure as
$\unicode[STIX]{x1D707}$
changes sign. This bifurcation in structure leads us to question the well-posedness and stability of the governing initial boundary value problem with respect to small perturbations in initial data in the innermost asymptotic regions, the discussion of which will be presented in the companion paper Gallagher et al. (J. Fluid Mech. vol. 841, 2018, pp. 146–166). In particular, when
$(\unicode[STIX]{x1D6FC},\unicode[STIX]{x1D707})\in (0,\unicode[STIX]{x03C0}/2)\times \mathbb{R}^{+}$
, the free surface close to the initial contact point remains monotone, and encompasses a swelling jet when
$(\unicode[STIX]{x1D6FC},\unicode[STIX]{x1D707})\in (0,\unicode[STIX]{x03C0}/2)\times [1,\infty )$
or a collapsing jet when
$(\unicode[STIX]{x1D6FC},\unicode[STIX]{x1D707})\in (0,\unicode[STIX]{x03C0}/2)\times (0,1)$
. However, when
$(\unicode[STIX]{x1D6FC},\unicode[STIX]{x1D707})\in (0,\unicode[STIX]{x03C0}/2)\times \mathbb{R}^{-}$
, the collapsing jet develops a more complex structure, with the free surface close to the initial contact point now developing a finite number of local oscillations, with near resonance type behaviour occurring close to a countable set of critical plate angles
$\unicode[STIX]{x1D6FC}=\unicode[STIX]{x1D6FC}_{n}^{\ast }\in (0,\unicode[STIX]{x03C0}/2)$
(
$n=1,2,\ldots$
).
We present our latest 3D model atmospheres for carbon-enhanced metal-poor (CEMP) stars computed with the CO5BOLD code. The stellar parameters are representative of hot turn-off objects (Teff ~ 6250 K, log g = 4.0, [Fe/H]=−3). The main purpose of these models is to investigate the role of 3D effects on synthetic spectra of the CH G-band (4140-4400 Å), the CN BX-band (3870-3890 Å), and several UV OH transitions (3122-3128 Å). By comparison with the synthetic spectra from standard 1D model atmospheres (assuming local thermodynamic equilibrium, LTE), we derive 3D abundance corrections for carbon and oxygen of up to −0.5 and −0.7 dex, respectively.
Aberrant microbiota composition and function have been linked to several pathologies, including type 2 diabetes. In animal models, prebiotics induce favourable changes in the intestinal microbiota, intestinal permeability (IP) and endotoxaemia, which are linked to concurrent improvement in glucose tolerance. This is the first study to investigate the link between IP, glucose tolerance and intestinal bacteria in human type 2 diabetes. In all, twenty-nine men with well-controlled type 2 diabetes were randomised to a prebiotic (galacto-oligosaccharide mixture) or placebo (maltodextrin) supplement (5·5 g/d for 12 weeks). Intestinal microbial community structure, IP, endotoxaemia, inflammatory markers and glucose tolerance were assessed at baseline and post intervention. IP was estimated by the urinary recovery of oral 51Cr-EDTA and glucose tolerance by insulin-modified intravenous glucose tolerance test. Intestinal microbial community analysis was performed by high-throughput next-generation sequencing of 16S rRNA amplicons and quantitative PCR. Prebiotic fibre supplementation had no significant effects on clinical outcomes or bacterial abundances compared with placebo; however, changes in the bacterial family Veillonellaceae correlated inversely with changes in glucose response and IL-6 levels (r −0·90, P=0·042 for both) following prebiotic intake. The absence of significant changes to the microbial community structure at a prebiotic dosage/length of supplementation shown to be effective in healthy individuals is an important finding. We propose that concurrent metformin treatment and the high heterogeneity of human type 2 diabetes may have played a significant role. The current study does not provide evidence for the role of prebiotics in the treatment of type 2 diabetes.
To evaluate if n-3 polyunsaturated fatty acids (PUFAs) and lipid levels are associated with episodes of self-harm or depression over a 10-year period.
Methods
We included 40 individuals who self-harmed and 40 controls. Episodes of self-harm and depression were ascertained and levels of depression, impulsivity, suicidal ideation and plasma lipid levels measured at baseline and at 10-year follow-up.
Results
Further episode(s) of self-harm occurred in 26% of cases. Omega-3 PUFAs or lipids were not predictive of depressive or self-harm episodes. Baseline eicosapentaenoic acid levels were modestly correlated with suicidal ideation at follow-up and dihomo-γ-linolenic acid and arachidonic acid were modestly correlated with motor impulsivity at follow-up in cases.
Conclusions
Despite significant negative correlations at baseline between plasma lipids, n-3 PUFAs and psychopathology, these levels were not predictive of clinical outcome over a 10-year period. Further research however is required due to the relatively low sample size and the risk of selection bias due to loss to follow-up in this study.