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Severe mental illness (SMI) is thought to be associated with lower diet quality and adverse eating behaviours contributing towards physical health disparities. A rigorous review of the studies looking at dietary intake in psychotic disorders and bipolar disorder is lacking.
To conduct a systematic, comprehensive evaluation of the published research on dietary intake in psychotic disorders and bipolar disorder.
Six electronic databases were searched for studies reporting on dietary intakes in psychotic disorders and bipolar disorder. Dietary-assessment methods, and dietary intakes, were systematically reviewed. Where possible, data was pooled for meta-analysis and compared with healthy controls.
In total, 58 eligible studies were identified. People with SMI were found to have significantly higher dietary energy (mean difference 1332 kJ, 95% CI 487–2178 kJ/day, P = 0.002, g = 0.463) and sodium (mean difference 322 mg, 95% CI 174–490 mg, P < 0.001, g = 0.414) intake compared with controls. Qualitative synthesis suggested that higher energy and sodium intakes were associated with poorer diet quality and eating patterns.
These dietary components should be key targets for preventative interventions to improve weight and other physical health outcomes in people with SMI.
Declaration of interest
S.B.T. and E.T. have clinical dietitian appointments within the South Eastern Sydney Local Health District and do not receive any further funding.
The Infrared Astronomical Satellite (IRAS) has detected many galaxies in the infrared (IR), most of which have fairly steep 25μ to 60μ spectra. Many quasars and active galaxies exhibit a significantly flatter spectrum in the infrared. Several studies, for example, DeGrijp et al. (1985) used this characteristic to select a subsample of “warm” objects from the IRAS PSC (1985).
Nutrition interventions would appear fundamental for weight management and cardiometabolic risk reduction in people experiencing severe mental illness (SMI). Comprehensive evaluation of nutrition interventions is lacking.
To subject randomised controlled trials of nutrition interventions in people with SMI to systematic review and meta-analysis, and to measure anthropometric and biochemical parameters and nutritional intake.
An electronic database search identified trials with nutrition intervention components. Trials were pooled for meta-analysis. Meta-regression analyses were performed on anthropometric moderators.
Interventions led to significant weight loss (19 studies), reduced body mass index (17 studies), decreased waist circumference (10 studies) and lower blood glucose levels (5 studies). Dietitian-led interventions (6 studies) and studies delivered at antipsychotic initiation (4 studies) had larger effect sizes.
Evidence supports nutrition interventions as standard care in preventing and treating weight gain among people experiencing SMI.
Our objective was to estimate the per-infection and cumulative mortality and cost burden of multidrug-resistant (MDR) Acinetobacter healthcare-associated infections (HAIs) in the United States using data from published studies.
We identified studies that estimated the excess cost, length of stay (LOS), or mortality attributable to MDR Acinetobacter HAIs. We generated estimates of the cost per HAI using 3 methods: (1) overall cost estimates, (2) multiplying LOS estimates by a cost per inpatient-day ($4,350) from the payer perspective, and (3) multiplying LOS estimates by a cost per inpatient-day from the hospital ($2,030) perspective. We deflated our estimates for time-dependent bias using an adjustment factor derived from studies that estimated attributable LOS using both time-fixed methods and either multistate models (70.4% decrease) or matching patients with and without HAIs using the timing of infection (47.4% decrease). Finally, we used the incidence rate of MDR Acinetobacter HAIs to generate cumulative incidence, cost, and mortality associated with these infections.
Our estimates of the cost per infection were $129,917 (method 1), $72,025 (method 2), and $33,510 (method 3). The pooled relative risk of mortality was 4.51 (95% CI, 1.10–32.65), which yielded a mortality rate of 10.6% (95% CI, 2.5%–29.4%). With an incidence rate of 0.141 (95% CI, 0.136–0.161) per 1,000 patient-days at risk, we estimated an annual cumulative incidence of 12,524 (95% CI, 11,509–13,625) in the United States.
The estimates presented here are relevant to understanding the expenditures and lives that could be saved by preventing MDR Acinetobacter HAIs.
Severe mental illness is characterised by a 20-year mortality gap due to cardiometabolic disease. Poor diet in those with severe mental illness is an important and modifiable risk factor. The present study aimed to (i) examine baseline nutritional intake in youth with first-episode psychosis (FEP), (ii) evaluate the feasibility and acceptability of nutritional intervention early in FEP and (iii) to evaluate the effectiveness of early dietary intervention on key nutritional end points. Participants were recruited over a 12-month period from a community-based programme specifically targeting young people aged 15–25 years with newly diagnosed FEP. Individual dietetic consultations and practical group sessions were offered as part of a broader lifestyle programme. Dietary assessments were conducted before and at the end of the 12-week intervention. Participants exceeded recommended energy and Na intakes at baseline. Retention within the nutrition intervention was 67 %, consistent with other interventions offered to FEP clients. There was a 47 % reduction in discretionary food intake (−94 g/d, P<0·001) and reductions in daily energy (−24 %, P<0·001) and Na (−26 %, P<0·001) intakes. Diet quality significantly improved, and the mean change was 3·6 (95 % CI 0·2, 6·9, P<0·05), although this finding was not significant after Bonferroni’s correction. Increased vegetable intake was the main factor contributing to improved diet quality. Nutrition intervention delivered shortly after initiation of antipsychotic medication is feasible, acceptable and effective in youth with FEP. Strategies to prevent weight gain and metabolic decline will contribute to prevent premature cardiometabolic disease in this vulnerable population.
Analysis of post-mortem buoyancy loss in Nautilus shells suggests that extensive nekroplanktonic drifting occurs infrequently. Most shells do not reach the surface but settle to the sea floor, after a short period of ascent. This occurs because the rate of water influx into the phragmocone due to ambient hydrostatic pressure is sufficiently rapid in most cases to overcome positive buoyancy before the shell reaches the surface. The resulting geographic distribution of Nautilus shells would therefore mirror the distribution of the live animals. Thus, post-mortem drift in Nautilus cannot be used as a basis for questioning the validity of cephalopod paleobiogeography. Estimate of influx rates in ammonoid siphuncles indicates that many, if not most, ammonoid shells also would not become nekroplanktonic. This is especially true for small (<5 cm diameter) shells. Cephalopod paleobiogeographic investigation appears less subject to criticism stemming from the supposed obfuscating effects of post-mortem drift than previously thought.
Despite overwhelming evidence demonstrating a persisting gap in life expectancy between those with psychotic illness and the general population, there has been no widespread implementation of interventions to improve the physical wellbeing of people with psychotic illness. This article explores opportunities to ‘Bridge the Gap’ in life expectancy. We describe an Australian evidence-based intervention that has substantially improved the physical health of young people recently commenced on antipsychotic medication. Further epidemiological research, accompanied by cultural change within mental health services, is an essential precursor to the implementation of effective and sustainable lifestyle interventions. There are other relatively neglected areas of physical wellbeing for people with psychotic illness, such as screening and diagnosis of malignancies, which need more research and clinical attention. While there has been progress with intervention development and evaluation, translation of evidence-based short-term intervention studies into feasible and sustainable system-wide changes within routine mental health service settings remains a challenge. Developing an implementation framework to support such change is an urgent priority so as to bridge the persisting premature mortality in people living with psychotic illness.
Injectable bone grafts with strength exceeding that of trabecular bone could improve the clinical management of a number of orthopedic conditions. Ceramic/polymer composites have been investigated as weight-bearing bone grafts, but they are typically weaker than trabecular bone due to poor interfacial bonding. We hypothesized that entrapment of surface-initiated poly(ε-caprolactone) (PCL) chains on 45S5 bioactive glass (BG) particles within an in situ-formed polymer network would enhance the mechanical properties of reactive BG/polymer composites. When the surface-initiated PCL molecular weight exceeded the molecular weight between crosslinks of the network, the compressive strength of the composites increased 6- to 10-fold. The torsional strength of the composites exceeded that of human trabecular bone by a factor of two. When injected into femoral condyle defects in rats, the composites supported new bone formation at 8 weeks. The initial bone-like strength of BG/polymer composites and their ability to remodel in vivo highlight their potential for development as injectable grafts for repair of weight-bearing bone defects.
Two factors that can degrade native plant community composition and structure, and hinder restoration efforts, are invasive species and chronic overbrowsing by ungulates such as white-tailed deer. Beginning in 2007, the effectiveness, costs, and impacts of Japanese barberry control treatments and herbivory on nonnative and native plant communities was examined at eight study areas over 4 to 5 yr. Prescribed burning and mechanical mowing by wood shredder or brush saw were utilized as initial treatments to reduce the aboveground portion of established barberry and were equally effective. Without a follow-up treatment, barberry had recovered to 56 to 81% of pretreatment levels 50 to 62 mo after initial treatment. Follow-up treatments in mid-summer to kill new sprouts included directed heating and foliar herbicide applications. Relative to untreated controls, follow-up treatments lowered barberry cover 50 to 62 mo after initial treatment by at least 72%. Although all follow-up treatments were equally effective, the labor cost of directed heating was four times higher than for herbicide applications. Follow-up treatment type (directed heating vs. herbicide) had minimal impact on species other than barberry. White-tailed deer herbivory had a larger impact on other species than did barberry control treatments. Native grass and fern cover was higher outside of exclosures. Areas inside exclosures had higher cover of Oriental bittersweet and multiflora rose, but not Japanese barberry. Thus, recovery of native communities will require more than simply removing the dominant invasive species where deer densities are high. Excellent reduction of Japanese barberry cover can be achieved using either directed heating or herbicides as follow-up treatments in a two-step process, but other invasive plants may become a problem when barberry is removed if deer populations are low.