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Initiatives to optimise preconception health are emerging following growing recognition that this may improve the health and well-being of women and men of reproductive age and optimise health in their children. To inform and evaluate such initiatives, guidance is required on indicators that describe and monitor population-level preconception health. We searched relevant databases and websites (March 2021) to identify national and international preconception guidelines, recommendations and policy reports. These were reviewed to identify preconception indicators. Indicators were aligned with a measure describing the prevalence of the indicator as recorded in national population-based data sources in England. From 22 documents reviewed, we identified 66 indicators across 12 domains. Domains included wider (social/economic) determinants of health; health care; reproductive health and family planning; health behaviours; environmental exposures; cervical screening; immunisation and infections; mental health, physical health; medication and genetic risk. Sixty-five of the 66 indicators were reported in at least one national routine health data set, survey or cohort study. A measure of preconception health assessment and care was not identified in any current national data source. Perspectives from three (healthcare) professionals described how indicator assessment and monitoring may influence patient care and inform awareness campaign development. This review forms the foundation for developing a national surveillance system for preconception health in England. The identified indicators can be assessed using national data sources to determine the population’s preconception needs, improve patient care, inform and evaluate new campaigns and interventions and enhance accountability from responsible agencies to improve preconception health.
Despite continuous growth in demand for organic food and farm products, US domestic supply is not keeping pace. Increasing domestic supply requires, in part, that more farms transition to certified organic production. This in turn requires a better understanding of the transition process. This paper reports on a national survey of farmers transitioning to organic certification through participation in the United States Department of Agriculture's (USDA) Natural Resources Conservation Service (NRCS) Environmental Quality Incentives Program Organic Initiative (EQIP-OI). Our analysis focuses on what motivates farmers to undertake transition to organic certification and what obstacles they confront in the process. The survey population included farmers in the midst of the transition process and farmers who began transition but decided not to pursue organic farming, allowing us to compare both groups to farmers who successfully transitioned to certified organic. Because farmers do not control all of the factors that influence their success, we use a ‘spheres of influence’ framework to analyze obstacles at four levels: the farm, local and regional infrastructure, the marketplace and policy. Our results improve our understanding of the transition process and apply to a wide range of stakeholders and service providers who support farmers in different ways, through crop research, infrastructure development, market development and policy.
ABSTRACT IMPACT: We hope to provide a more nuanced understanding of the type-III IFN system, thereby exploring its therapeutic potential in the realm of infectious diseases. OBJECTIVES/GOALS: The role of IFNLR1 receptor dynamics and plasticity in regulating the type-III IFN response is largely unknown. As a specific, powerful component of innate immunity, understanding how the type-III IFN system is regulated could lead to the development of novel therapeutic targets and strategies to face a multitude of viral illnesses. METHODS/STUDY POPULATION: To facilitate our investigation, we will generate doxycycline-inducible FLAG-tagged IFNLR1-expression plasmids representing all known transcriptional variants. These plasmids will allow us to: 1) Evaluate the effect of IFNLR1 surface abundance on the type-III IFN transcriptional profile and 2) Assess the extent of IFNLR1-FLAG co-localization with several notable intracellular structures using immunofluorescence, before and after stimulation with IFNL3. RESULTS/ANTICIPATED RESULTS: We have successfully generated three IFNLR1-FLAG transcriptional variants and confirmed inducible-expression and function in vitro. We are currently assessing the role of surface abundance, internalization, differential isoform expression, and trafficking. DISCUSSION/SIGNIFICANCE OF FINDINGS: By completing this study, we hope to provide a more nuanced understanding of the type-III IFN system, thereby exploring its therapeutic potential in the realm of infectious diseases.
Extant research addressing implicit factors related to intervention decisions made by parents of children with autism spectrum disorder (ASD) is limited and findings have been inconsistent. In the present study, 74 parents of preschoolers with ASD were surveyed regarding intervention use. The possible relationships between implicit parent factors (education level, age, causal beliefs about ASD, complementary and alternative medicine [CAM] use, and family income) and child factors (time since diagnosis, and perceived severity of ASD), and the number and type of interventions used were examined. Consistent with previous research, only a small number of significant relationships were found, including that family income, parent use of CAM, mother’s education, parent belief in an unknown aetiology of ASD, and time since child’s diagnosis were all related to the number of interventions used. Some specific findings of previous research were not replicated in the present study (e.g., neither beliefs in environmental aetiology of ASD nor parent education levels were related to the use of specific CAM interventions), indicating that factors affecting decision-making may not be consistent across samples. Nevertheless, future research including an expanded range of possible implicit factors with more diverse samples may provide a more accurate predictive model of parent decision-making.
A pilot study of the effectiveness of guided access to websites that provide information on intervention options for children with autism spectrum disorder (ASD) was conducted with 12 parents of preschool-aged children with ASD. Guided access to reliable websites that included information about the efficacy of interventions for ASD (Raising Children Network, 2006–2014; Research Autism, 2006–2014) was provided in the format of a DVD presentation. The guidelines for choosing interventions provided on the Raising Children Network (2009) website were reiterated and assistance was provided with navigation and interpretation of the sites. Participants reported the guided access to reliable websites as useful and also reported an increased level of confidence in making intervention decisions after using the package. However, the guided access did not appear to influence the factors that parents considered important in decision-making, their understanding of the level of research support for interventions, nor their desire to use different interventions. Implications for future research and attempts to disseminate information to parents are discussed.
Extant research on sources of information about interventions used by parents of children with autism spectrum disorder (ASD) has provided a general overview of sources used. However, it has provided little insight into why parents view certain sources as reliable or trustworthy, or how useful parents found the information provided to them by the sources and why. This paper provides a qualitative analysis of interviews conducted with 12 Australian parents of preschool-age children with ASD. Participants discussed the factors related to their perceptions of the reliability and trustworthiness of sources used, as well as the usefulness of the information provided. Parent ratings of the reliability of sources were influenced by factors including the firsthand experience of other parents, the parent's relationship with the source, and their beliefs about the sources’ intentions. A number of parents reported that sources provided either information of limited use or an overwhelming amount of information. Considerable variation was reported in the usefulness of information provided to parents. Recommendations regarding research and practice are offered.
People with intellectual disabilities have a high risk of osteoporosis and fractures, which could partly be as a result of vitamin D deficiency.
To compare the serum vitamin D (25(OH)D) levels of 155 patients with intellectual disabilities under psychiatric care and 192 controls, investigate potential risk factors for vitamin D deficiency in people with intellectual disabilities and assess available treatments.
Cross-sectional observational study followed by treatment evaluation.
Almost twice as many patients with intellectual disabilities had vitamin D deficiency (25(OH)D <50 nmol/l) compared with controls (77.3% v. 39.6%, P<0.0001). In the intellectual disabilities group, winter season (P<0.0001), dark skin pigmentation (P<0.0001), impaired mobility (P = 0.002) and obesity (P = 0.001) were independently associated with lower serum 25(OH)D. In most patients, 800 IU colecalciferol daily normalised 25(OH)D levels.
Vitamin D deficiency is highly prevalent in people with intellectual disabilities, partly because of insufficient exposure to sunlight. Screening and treatment strategies, aiming to reduce these patients' high fracture risk, should be introduced. Similar strategies may be required in other psychiatric populations at risk for fractures and with a tendency to spend excessive time indoors.
With the increasing number of treatment and intervention options for parents of children with autism spectrum disorders (ASD) in recent years, the number and types of interventions that parents are choosing to use has become of interest. In the present paper, the authors review 41 articles (describing 42 studies) presenting quantitative data on intervention choices of parents of children with ASD. Speech therapy was the most commonly reported intervention for both current and lifetime use. Across the studies, parents were reported to be using a variety of interventions, from those with strong empirical support, such as applied behaviour analysis (ABA), to others that lacked such support, such as dietary interventions. Some differences in the data presented across studies may be attributed to the range of different methodologies used to collect the data. Recommendations for future research, including those related to collecting treatment usage data more consistently, are discussed.
Despite frequent use, little is known about the metabolic and endocrine side-effects of antipsychotics in individuals with intellectual disability.
To compare indices of obesity, glucose, lipids and prolactin between antipsychotic-treated and antipsychotic-naive individuals with intellectual disability and also between participants with intellectual disability and controls from the general population.
Observational study comparing 138 antipsychotic-treated and 64 antipsychotic-naive participants with intellectual disability in one National Health Service trust with general population controls.
Antipsychotic treatment comprised: risperidone 48%, olanzapine 18%, thioxanthenes 10%, other 24%; monotherapy 95% of participants; mean treatment duration 8 years; median daily chlorpromazine equivalent dose 108mg (range 16–667). Metabolic indices were the same or more favourable in the intellectual disability group than the general population control group but overweight/obesity and type 2 diabetes were more prevalent in the women in the intellectual disability group than the control group. Metabolic indices were similar, statistically or clinically, between the antipsychotic-treated and the antipsychotic-naive groups but there was a non-significant trend towards a higher rate of type 2 diabetes in the antipsychotic group. A total of 100% and 70% of participants on amisulpride/sulpiride and risperidone respectively had hyperprolactinaemia, with secondary hypogonadism in 77% and 4% of affected women and men.
Antipsychotics, on average, did not increase metabolic risk, although the existence of a susceptible subgroup at risk of diabetes cannot be excluded. Some antipsychotics induced hyperprolactinaemic hypogonadism, requiring active management. However, our findings suggest that antipsychotics at the low doses routinely prescribed for people with intellectual disability are generally safe in relation to metabolic adverse effects, even if efficacy remains poorly defined.
To compare the effects of hospital cleaning agents and germicides on the survival of epidemic Clostridium difficile strains.
We compared the activity of and effects of exposure to 5 cleaning agents and/or germicides (3 containing chlorine, 1 containing only detergent, and 1 containing hydrogen peroxide) on vegetative and spore forms of epidemic and non-epidemic C. difficile strains (3 of each). We carried out in vitro exposure experiments using a human fecal emulsion to mimic conditions found in situ.
Cleaning agent and germicide exposure experiments yielded very different results for C. difficile vegetative cells, compared with those for spores. Working-strength concentrations of all of the agents inhibited the growth of C. difficile in culture. However, when used at recommended working concentrations, only chlorine-based germicides were able to inactivate C. difficile spores. C. difficile epidemic strains had a greater sporulation rate than nonepidemic strains. The mean sporulation rate, expressed as the proportion of a cell population that is in spore form, was 13% for all strains not exposed to any cleaning agent or germicide, and it was significantly increased by exposure to cleaning agents or germicides containing detergent alone (34%), a combination of detergent and hypochlorite (24%), or hydrogen peroxide (33%). By contrast, the mean sporulation rate did not change substantially after exposure to germicides containing either a combination of detergent and dichloroisocyanurate (9%) or dichloroisocyanurate alone (15%).
These results highlight differences in the activity of cleaning agents and germicides against C. difficile spores and the potential for some of these products to promote sporulation.
It is apparent from epidemiological studies that the timing of maternal nutrient restriction has a major influence on outcome in terms of predisposing the resulting offspring to adult obesity. The present review will consider the extent to which maternal age, parity and nutritional restriction at defined stages of gestation can have important effects on fat deposition and endocrine sensitivity of adipose tissue in the offspring. For example, in 1-year-old sheep the offspring of juvenile mothers have substantially reduced fat deposition compared with those born to adult mothers. Offspring of primiparous adult mothers, however, show increased adiposity compared with those born to multiparous mothers. These offspring of multiparous ewes show retained abundance of the brown adipose tissue-specific uncoupling protein 1 at 1 month of age. A stimulated rate of metabolism in brown fat of these offspring may act to reduce adipose tissue deposition in later life. In terms of defined windows of development that can programme adipose tissue growth, maternal nutrient restriction targetted over the period of maximal placental growth results in increased adiposity at term in conjunction with enhanced abundance of mRNA for the insulin-like growth factor-I and -II receptors. In contrast, nutrient restriction in late gestation, coincident with the period of maximal fetal growth, has no major effect on adiposity but results in greater abundance of specific mitochondrial proteins, i.e. voltage-dependent anion channel and/or uncoupling protein 2. These adaptations may increase the predisposal of these offspring to adult obesity. Increasing maternal nutrition in late gestation, however, can result in proportionately less fetal adipose tissue deposition in conjunction with enhanced abundance of uncoupling protein 1.
Previous studies have shown that prolactin administration to pregnant rats results in offspring with enhanced abundance of the brown adipose tissue-specific uncoupling protein (UCP) 1. The present study therefore aimed to determine whether a similar effect was observed after birth and if the sex of the animal further influenced the responsiveness of brown adipose tissue mitochondria to prolactin administration. Daily prolactin injections were therefore commenced at 15, 35 or 60 days of age and continued for 4 days. The abundance of UCP1 was unchanged with age in females but decreased between 15 and 35 days in males and was lower in males than females by 60 days of age. Cytochrome c abundance remained unchanged with postnatal age in both males and females and was consistently higher in males at each sampling age. Prolactin decreased the abundance of UCP1 and cytochrome c when administered to female rats at 35 and 60 days of age, but had no effect at 15 days. In contrast, prolactin had no effect on UCP1 in male rats at any age, but did stimulate the abundance of cytochrome c at 15 days of age. In conclusion, the administration of prolactin to postnatal rats over the period in which maturation of the hypothalamic-pituitary axis and brown adipose tissue function is occurring did not enhance UCP1 abundance. In females, prolactin actually caused a reduction in UCP1 suggesting that in rats it is only prior to birth that prolactin has a stimulatory role on brown adipose tissue development. Experimental Physiology (2003) 88.4, 527-531.
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