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To understand the dietary patterns of adults and explore their association with iodine nutritional levels and thyroid function in adults.
Design:
We randomly collected 5 ml of adult urine samples and measured urinary iodine concentration by cerium arsenate-catalyzed spectrophotometry. A serum sample of 5 ml was collected for the determination of free triiodothyronine (FT3), free thyroxine (FT4) and thyrotropin (TSH), and diet-related information was collected through a food frequency questionnaire. Dietary patterns were extracted by principal component analysis and the relationship between dietary patterns and iodine nutrition levels and thyroid function was explored.
Settings:
A cross-sectional study involving adults in Xinjiang, China was conducted.
Participants:
A total of 435 adults were enrolled in the study.
Results:
The overall median urinary iodine of the 435 respondents was 219.73 μg/L.The dietary patterns were PCA1 (staple food pattern), PCA2 (fruit, vegetable, and meat pattern), PCA3 (fish, shrimp, and legume pattern), and PCA4 (Dairy-based protein pattern). The correlation analyses showed that PCA1 and PCA3 were positively correlated with the urinary iodine concentration (UIC). The results of the multivariable analysis showed that PCA1, Q1, Q2, and Q3 were associated with an increased risk of iodine deficiency compared with Q4 [ (OR): 260.41 (95%CI: 20.16, 663.70)], 59.89 (5.64, 335.81), and 2.01 (0.15, 26.16), respectively]. In PCA2, Q3 was associated with an increased risk of iodine deficiency compared with Q4 [OR: 0.16 (0.05, 0.53)]. In PCA3, Q3 was associated with an increased risk of iodine deficiency compared with Q4 [OR: 0.23 (0.06, 0.90)]. In PCA4, Q1 was associated with an increased risk of iodine deficiency compared with Q4 [OR: 31.30 (4.88, 200.64)].
Conclusion:
This study demonstrated that of the four dietary patterns, the least dependent staple food pattern (Q1) had a higher risk of iodine deficiency compared to the most dependent staple food pattern (Q4). However, the current evidence on the effect of dietary patterns on thyroid function needs to be validated by further longitudinal studies that include long-term follow-up, larger sample sizes, and repeated measures.
To evaluate whether changes in starch intake (in terms of amount and food sources) were associated with increments in dental caries among adults.
Design:
This is an 11-year longitudinal study (2000–2011) with duplicate assessments for all variables. A 128-item FFQ was used to estimate intake of starch (g/d) and six starch-rich food groups (potatoes, potato products, roots and tubers, pasta, wholegrains and legumes). Dental caries was assessed through clinical examinations and summarised using the number of decayed, missing and filled teeth (DMFT score). The relationship between quintiles of starch intake and DMFT score was tested in linear hybrid models adjusting for confounders.
Setting:
Northern and Southern regions of Finland.
Participants:
922 adults, aged 30–88 years.
Results:
Mean starch intake was 127·6 (sd: 47·8) g/d at baseline and 120·7 (55·8) g/d at follow-up. Mean DMFT score was 21·7 (6·4) and 22·4 (6·2) at baseline and follow-up. Starch intake was inversely associated with DMFT score cross-sectionally (rate ratio for highest v. lowest quintile of intake: –2·73, 95 % CI –4·64, –0·82) but not longitudinally (0·32, 95 % CI –0·12, 0·76). By food sources, the intakes of pasta (–2·77, 95 % CI –4·21, –1·32) and wholegrains (–1·91, 95 % CI –3·38, –0·45) were negatively associated with DMFT score cross-sectionally but not longitudinally (0·03, 95 % CI –0·33, 0·39 and –0·10, 95 % CI –0·44, 0·24, respectively).
Conclusion:
Changes in the amount and sources of starch intake were not associated with changes in dental caries. Further studies should be conducted in different settings and age groups while focusing on starch digestibility and specific sources of starch.
Depression is strongly associated with risk for suicidal behaviors. However, depression is a highly heterogeneous condition (i.e. there are more than 200 combinations of DSM-5-TR depressive symptoms to correspond to a depression diagnosis). Limited research to date has taken an empirical approach to see how people cluster together based on their classification of depressive symptoms and whether people in certain classes are more likely to report suicide outcomes than other classes. This analysis leverages the National Survey on Drug Use and Health and examines classes of depressive symptoms to explore differences in suicide-related outcomes by class among adults endorsing depressive symptoms (n = 41 969).
Methods
We used latent class analysis (LCA) to identify classes of individuals’ DSM-5 depressive symptoms presentation and then explored differences in suicide-related outcomes (i.e. suicide plans, suicide attempts) by the resulting classes.
Results
A four-class model was determined to optimize the fit criteria. Class 3 (high depressive symptoms) had significantly greater rates of suicide-related outcomes, followed by class 1 (high depressed mood and moderate worthlessness), with classes 4 and 2 having significantly lower rates of suicide-related outcomes.
Conclusions
The use of LCA provided valuable findings on the importance of leveraging both a multi-faceted assessment of depressive symptoms to identify cases where a high number of depressive symptoms are endorsed, and review of the specific symptoms endorsed. Worthlessness, in particular, may be of particular value to focus on within the context of suicide prevention.
Bone conduction hearing implants are a well-established method of hearing rehabilitation in children and adults. This study aimed to review any changes in provision in England.
Methods
The total number of bone conduction hearing implantations performed was analysed from 2012 to 2021 utilising Hospital Episode Statistics data for England.
Results
The total number of procedures has increased by 58 per cent. One-stage bone conduction hearing implantations in adults accounts for the largest proportion of this increase (93 per cent of the total). The number performed in children has remained stable and accounts for 73 per cent (n = 433) of all two-stage procedures.
Conclusion
The data show that bone conduction hearing implant surgery is becoming increasingly popular, particularly in adults. This has correlated with the increase in availability, national recommendations and choice of devices.
CHD are among the most common congenital defects. Due to the chronic nature of CHD, patients face various risk factors that threaten their mental health. However, a comprehensive understanding of the medical and social predictors of mental health issues in adults with CHD is lacking. This study aims to investigate the prevalence of anxiety and depression in adults with CHD.
Methods:
This cross-sectional descriptive study focused on adults with CHD in Kerman, Iran. The participants completed demographic information alongside two psychological assessment tools: the Beck Anxiety Inventory (BAI) and the Depression Anxiety Stress Scales (DASS)-21. The data were analyzed using SPSS 26.
Findings:
The mean age of the participants was 29.94 ± 12.36 years, and 63.8% were female. According to the DASS, 73.4% did not have depression, 61% did not have anxiety, and 76.2% did not have stress. In total, 19% had mild stress, and 4.8% had moderate stress. According to the BAI, 27.6% did not have anxiety. Individual characteristics were not significantly associated with depression. However, gender, age, and type of surgery were significantly associated with anxiety. Cyanosis was significantly associated with stress.
Conclusion:
The results show that mental disorders like depression, anxiety, and stress are highly prevalent in adults with CHD. The prevalence depends on individual factors such as age, gender, and disease severity. Therefore, it is recommended that mental disorders in this population be evaluated and treated accurately.
To evaluate the outcomes of reinnervation techniques for the treatment of adult unilateral vocal fold paralysis and bilateral vocal fold paralysis.
Methods
A literature review was conducted in the Embase and Medline databases in English, with no limitations on the publication date. The outcome parameters of interest included visual, subjective perceptual, acoustic, aerodynamic analysis and electromyography. A meta-analysis with a random-effects model and inverse variance was calculated.
Results
The systematic Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach resulted in 27 studies, totalling 803 patients (747 unilateral cases and 56 bilateral cases). Thyroid cancer and/or surgery had caused unilateral vocal fold paralysis in 74.8 per cent of cases and bilateral vocal fold paralysis in 69.6 per cent of cases. Statistically significant improvements in patients were observed for voice, deglutition and decannulation (bilateral vocal fold paralysis). Meta-analysis of 10 reinnervation techniques was calculated for the maximum phonation time of 184 patients.
Conclusion
Reinnervation was shown to improve voice, swallowing and decannulation, but studies lacked control groups, limiting generalisability. Larger studies with controls are needed.
This study aimed to evaluate the sensory processing abilities of adults with acquired hearing loss and determine whether their sensory processing patterns differ from those of the general population and adults with normal hearing.
Method
The study evaluated the sensory processing functions of 30 adults with acquired hearing loss using the Adolescent/Adult Sensory Profile and compared them with the sensory processing functions of 30 adults with normal hearing.
Results
The results showed that individuals with hearing loss have a significantly higher sensitivity to stimuli related to motion, vision, activity and touch, exhibiting a low-registration sensory pattern and a sensation-avoiding pattern that differed from those of most individuals.
Conclusion
Assessing sensory processing profiles can help identify specific sensory difficulties and inform individualised treatment plans. The study highlights the importance of considering sensory processing patterns in the management of hearing loss to improve overall well-being and quality of life for adults with hearing loss.
We aimed to investigate the effectiveness of n-3 fatty acids supplementation on the risk of developing depression, depressive symptoms and remission of depression. We searched PubMed, Scopus and Web of Science from inception to December 2022 to find randomised trials of n-3 fatty acids supplementation in adults. We conducted random-effects meta-analyses to estimate standardised mean differences (SMD) and 95 % CI for continuous outcomes and risk difference and 95 % CI for binary outcomes. A total of sixty-seven trials were included. Each 1 g/d n-3 fatty acids supplementation significantly improved depressive symptoms in adults with and without depression (moderate-certainty evidence), with a larger improvement in patients with existing depression. Dose–response analyses indicated a U-shaped effect in patients with existing depression, with the greatest improvement at 1·5 g/d. The analysis showed that n-3 fatty acid supplementation significantly increased depression remission by 19 more per 100 in patients with depression (low-certainty evidence). Supplementation with n-3 fatty acids did not reduce the risk of developing depression among the general population, but it did improve the severity of depression among patients with existing depression.
Despite observed ethnic differences in eating patterns and obesity, evidence in China is limited. This study examined ethnic differences in eating patterns and their associations with weight outcomes among multi-ethnic adults in West China. A cross-sectional survey collected self-reported data on demographics, eating behaviours, weight and height in 2021. Principal component analysis and multivariate regression were conducted to identify eating patterns and examine their associations with weight outcomes. In total, 4407 subjects aged ≥ 18 years were recruited across seven provinces in West China. Four eating patterns were identified: ‘meat-lover’ – characterised by frequent consumption of meat and dairy products, ‘indulgent’ – by frequent intakes of added salt, sugar, alcohol and pickled food, ‘diversified-eating’ – by frequently consuming food with diversified cooking methods and eating out and ‘nutri-health-concerned’ – by good food hygiene behaviours and reading food labels. Ethnic differences in eating patterns were observed. Compared with Han, Hui were less likely to exhibit meat-lover or diversified-eating patterns; Tibetans were less likely to have meat-lover or nutri-health-concerned patterns; Mongolians were more likely to have indulgent pattern. BMI was positively associated with meat-lover pattern in both genders (exp(β): 1·029; 95 % CI: 1·001, 1·058 for men; 1·018; 1·000, 1·036 for women) and negatively associated with nutri-health-concerned pattern in women (0·983; 0·966, 1·000). Mongolians were two times more likely to be overweight/obese than Han (OR: 3·126; 1·688, 5·790). Considerable ethnic differences existed in eating patterns in West China. Mongolians were more likely to be overweight/obese, which was associated with their indulgent eating patterns. Ethnic-specific healthy eating intervention programs are needed.
This study aims to explore the association between coffee consumption and the prevalence of hearing loss in American adults based on a national population-based survey.
Design:
Cross-sectional analysis of reported audiometric status and coffee intake from the 2003–2006 National Health and Nutrition Examination Survey (NHANES). Multivariate logistic regression, forest plots and restricted cubic spline (RCS) analyses were used to explore the associations and dose–response relationships between coffee consumption frequency and hearing loss.
Setting:
The USA.
Participant:
This study included 1894 individuals aged ≥ 20 from the 2003–2006 NHANES.
Results:
In this study, the prevalence of speech-frequency hearing loss (SFHL) and high-frequency hearing loss (HFHL) among the participants was 35·90 % and 51·54 %, respectively. Compared with those who no consumed coffee, non-Hispanic White who consumed ≥ 4 cups/d had higher prevalence of SFHL (OR: 1·87; 95 % CI: 1·003. 3·47). And a positive trend of coffee consumption frequency with the prevalence of HFHL was found (Ptrend = 0·001). This association of HFHL was similar for participants aged 20–64 (Ptrend = 0·001), non-Hispanic White (Ptrend = 0·002), non-noise exposure participants (Ptrend = 0·03) and noise-exposed participants (Ptrend = 0·003). The forest plots analysis found that the association between 1 cup-increment of daily coffee consumption and the prevalence of HFHL was statistically significant in males. RCS model supported a positive linear association of coffee consumption with SFHL (P for overall association = 0·02, P for nonlinearity = 0·48) and a positive non-linear association of coffee consumption with HFHL (P for overall association = 0·001, P for nonlinearity = 0·001).
Conclusion:
Our findings suggested that coffee consumption was associated with higher prevalence of hearing loss. Further cohort studies in larger population are needed to investigate these findings.
Despite the worldwide burden of mental illness and recent interest in global approaches to address this, progress on increasing awareness, lessening stigma, reducing the treatment gap, and improving research and training in mental health has been slow. In 2018, the North East England South Asia Mental health Alliance (NEESAMA) was developed as a collaboration between high-income (global north) and low- to middle-income (global south) countries to address this slow progress. This paper outlines how the joint priority areas for research, training and service delivery were identified across the life course (child and adolescent, adults and older people) between partner organisations spanning Afghanistan, Bangladesh, India, Nepal, Pakistan, Sri Lanka and the UK. It describes the progress to date and proposes a way forward for similar alliances to be forged.
The normal-weight obesity (NWO) is highly associated with an increased risk for chronic non-communicable diseases and intricately linked to diet quality. Therefore, we assessed the consumption of ultra-processed and non-ultraprocessed foods of 224 Brazilian adults with NWO (n 159) and without NWO (n 65, non-NWO) in a cross-sectional study. For that, three dietary recalls were applied and categorised according to the NOVA classification. Individuals with NWO showed lower energy intake from the ‘fresh or minimally processed food’ group, specifically for rice (P = 0⋅037), beans (P = 0⋅002) and fruits (P = 0⋅026), as well as lower consumption of dietary fibre (P < 0⋅05) compared with non-NWO subjects. Total consumption of ultra-processed foods did not differ between groups; however, individuals with NWO had a higher energy intake from processed meats compared with the non-NWO group (54⋅1 ± 73⋅5 × 32⋅5 ± 50⋅8 kcal; P = 0⋅023). Energy and added sugar from ultra-processed foods (OR 1⋅02, CI 95 % 1⋅00–1⋅04, P = 0⋅0100) and total fat from non-ultra-processed foods (OR 1⋅09, CI 95 % 1⋅01–1⋅18; P = 0⋅0100) were associated with the presence of NWO. In conclusion, non-NWO individuals consumed more non-ultra-processed foods compared with the NWO group. Overall, there were no differences in the consumption of ultra-processed foods between the two groups. Important associations between food compounds and the presence of NWO were observed, emphasising the importance of fresh and minimally processed foods as the basis of the diet.
One-carbon nutrients play an important role in epigenetic mechanisms and cellular methylation reactions. Inadequate intake of these nutrients is linked to metabolic perturbations, yet the current intake levels of these nutrients have rarely been studied in Asia. This cross-sectional study surveyed the usual dietary intake of one-carbon nutrients (folate, choline and vitamins B2, B6 and B12) among Thai university students aged 19–30 years (n 246). Socioeconomic background, health information, anthropometric data and 24-h dietary recall data were collected. The long-term usual intake was estimated using the multiple-source method. The average usual intake levels for men and women were (mean ± sd) 1⋅85 ± 0⋅95 and 2⋅42 ± 8⋅7 mg/d of vitamin B2, 1⋅96 ± 1⋅0 and 2⋅49 ± 8⋅7 mg/d of vitamin B6, 6⋅20 ± 9⋅5 and 6⋅28 ± 12 μg/d of vitamin B12, 195 ± 154 and 155 ± 101 μg dietary folate equivalent/d of folate, 418 ± 191 and 337 ± 164 mg/d of choline, respectively. Effect modification by sex was observed for vitamin B2 (P-interaction = 0⋅002) and choline (P-interaction = 0⋅02), where every 1 mg increase in vitamin B2 and 100 mg increase in choline intake were associated with a 2⋅07 (P = 0⋅01) and 0⋅81 kg/m2 (P = 0⋅04) lower BMI, respectively, in men. The study results suggest that Thai young adults meet the recommended levels for vitamins B2, B6 and B12. The majority of participants had inadequate folate intake and did not achieve recommended intake levels for choline. The study was approved by the Ethics Committee at the Faculty of Medicine, Chiang Mai University. This trial was registered at www.thaiclinicaltrials.gov (TCTR20210420007).
To examine the trajectories of BMI in Indonesian adults from 1993 to 2014, investigating different patterns by sex and birth cohort.
Design:
Longitudinal study: secondary data analysis of the Indonesian Family Life Survey, a large-scale population-based longitudinal study, had their height and weight measured up to five times throughout the 21-year study period (1993–2014). The change in BMI across time was estimated using group-based trajectory models, then differences by sex and birth cohort were investigated using random effect (mixed) models.
Setting:
Thirteen out of twenty-seven provinces in Indonesia.
Participants:
Indonesian adults aged 19 years and older (n 42 537) were included in the analysis.
Results:
Mean BMI in adults increased between 1993 (21·4 kg/m2) and 2014 (23·5 kg/m2). The group-based trajectory model found three distinct groups with mean BMI increasing more rapidly in the most recent time periods. The first group (56·7 % of participants) had a mean BMI entirely within the normal weight range; the second group (34·7 %) started in the normal weight category and were obese, on average by the end of the study period; and the third group (8·6 %) were always in the obese category, on average. The shape of these three trajectories differed by gender (P < 0·001) and birth cohort (P < 0·001).
Conclusions:
The mean BMI among Indonesian adults has increased between 1993 and 2014, driven by those in the most recent birth cohorts. Our findings support the urgent need for targeted overweight and obesity prevention and intervention programmes in Indonesia.
The surgical treatment of transposition of the great arteries, ventricular septal defect, and significant left ventricular outflow tract obstruction continues to evolve. The survival of an unrepaired transposition of the great arteries into late adulthood is a rarity. Even when large intracardiac shunts are present, it remains a lethal cyanotic CHD if it is not surgically corrected soon after birth. We present our experience of two cases, both of whom underwent a single-stage arterial switch operation and an aortic valve replacement for this defect.
Edited by
James Law, University of Newcastle upon Tyne,Sheena Reilly, Griffith University, Queensland,Cristina McKean, University of Newcastle upon Tyne
Language is fundamental to success in many life domains, and children showing vulnerabilities in their language development may be at risk of poorer lifelong outcomes. This chapter synthesises evidence from longitudinal population-based and community samples to describe the long-term psychosocial outcomes associated with a history of language problems. Notably, this chapter centres on the outcomes of late talkers and children with developmental language disorder (DLD). The chapter begins by profiling the outcomes experienced when language difficulties are identified at a single point in the child’s development. Next, the influence of changes in language profiles over time on the long-term psychosocial outcomes is considered. Throughout the chapter, outcomes are explored across key areas including literacy and numeracy, educational and vocational attainment, emotional and behavioural functioning, social connections, and mental health and well-being. The studies presented show that while heterogeneity exists, children with language problems at one point in development are at increased risk of difficulties in other domains of life, and these adverse outcomes can persist into adulthood.
For infants born in the contemporary era of neonatal care, little is known about adult mental health outcomes of extremely preterm birth (EP; <28 weeks' gestation) or extremely low birthweight (ELBW; <1000 g). This study aimed to compare attention deficit hyperactivity disorder (ADHD), anxiety, mood, and substance use disorder prevalence in young adults born EP/ELBW and normal birthweight (NBW; >2499 g) controls, and to compare change in prevalence of mental health symptoms and disorders from 18 to 25 years.
Methods
Participants were a prospective geographical cohort of 297 consecutive survivors born EP/ELBW during 1991–1992 and 260 NBW controls. At age 25 years, 174 EP/ELBW and 139 NBW participants completed the Adult ADHD Rating Scale, Structured Clinical Interview for DSM-IV Disorders, Beck Anxiety Inventory, and Center for Epidemiologic Studies Depression Scale-Revised. Data from follow-up at 18 years were also utilized. Multiple imputation was used to account for attrition.
Results
Mental health outcomes at 25 years were similar between groups: prevalence rates were ADHD 7% v. 5%; anxiety 32% v. 27%; mood 38% v. 35%; substance use 12% v. 14% in the EP/ELBW and NBW groups, respectively. In both groups, ADHD declined between 18 and 25 years [odds ratio (OR) per year = 0.87, 95% confidence interval (CI) 0.79–0.95], and generalized anxiety disorder and major depressive episode became more common (OR 1.22, 95% CI 1.10–1.35 per year; OR 1.20, 95% CI 1.10–1.30 respectively).
Conclusions
This contemporary EP/ELBW cohort has comparable young adult mental health outcomes to controls, and similar patterns of change in mental health from late adolescence.
The optimal treatment of adult craniopharyngioma (CP) remains controversial. Although benign, these tumors tend to recur locally. The choice between gross total resection (GTR) versus subtotal resection (STR) with adjuvant or delayed radiotherapy (RT) is debated. The objective of this study is to review our experience with adult CPs over a 20-year period and identify an optimal management strategy.
Methods:
From 1999 to 2020, we reviewed all patients diagnosed with CP at our institution. We collected data regarding tumor characteristics, treatments, and toxicity. Disease progression was defined as growth on imaging. Descriptive statistics were used to assess patient characteristics. The Kaplan Meier method was used to assess progression-free survival (PFS) and corresponding 95% confidence intervals (CI) from the time since treatment initiation.
Results:
Twenty-four patients with a median age of 50 were included in this study. The median follow-up was 85 months. Seven patients had initial GTR, 10 STR, and 7 STR + RT. The overall 5-year PFS was 56% (95% CI: 38–83%): 100% in the STR + RT group, 69% in the GTR group, and 18% in the STR group (p = 0.01). Of the 17 patients initially treated with surgery alone, 3 with GTR and 6 with STR required salvage RT at a median of 46 months, with no further progression after salvage RT.
Conclusions:
Our study underscores the importance of RT for local control and suggests that STR + RT should be considered a viable option in the management of these tumors as it may be associated with improved PFS compared to surgery alone.
Malnutrition is common in the acute care setting. Despite the existence of a plethora of screening tools, many malnourished patients remain undiagnosed and untreated, in part due to competing responsibilities for screening staff, under- or over-referral to dietetics services, and inadequate dietetics resources. Better identification of patients at risk of malnutrition would enable optimised care provision and streamlined care pathways. This narrative review of reviews aimed to collate and synthesise literature documenting nutritional risk factors in adult hospital inpatients, to generate a comprehensive list of nutritional risk indicators from high methodological quality review articles. Six electronic databases were searched (Medline, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Joanna Briggs Institute Database, Embase and Scopus) using a systematic search strategy. Three researchers screened the resulting 5889 citations, identifying 59 reviews summarising original studies that investigated associations between indicators and measures of malnutrition, undernutrition or nutritional risk. After quality appraisal by two researchers, using the American Dietetic Association Quality Criteria Checklist for Review Articles, seven reviews were classified as high quality, identifying fifty-seven unique indicators of nutritional risk (disease status/condition – twenty-three; eating/appetite/digestion – twelve; type of diet – five; cognition/psychology/social factors – five; medication-related – two; miscellaneous – ten). This is the first comprehensive list of nutritional risk factors in adult hospital inpatients, derived from only the highest methodological quality reviews. This list contributes to the development of practice and evidence-informed systems-level approaches to the identification of nutritional risk in the acute care setting.