FMHS

Aim To examine the personal attitudes and practice of health professionals regarding childhood vaccinations in order to provide guidance to local professional education strategies. Methods A questionnaire was circulated to those involved in the implementation of the childhood immunisation schedule in the Rotorua District. Responses were stratified: a) community vs hospital; b) nurses, midwives, doctors, others. Results 85 % responded, of whom 94 % supported vaccinations. 91 % considered science the most important basis for recommendations; 91 % considered current scientific support adequate. 11 % thought immunisations held unacceptable dangers; 17 % were unsure. 41 % of nurses, 45 % of midwives, and 21 % of doctors were unsure whether the MMR vaccine was associated with autism or Crohn’s disease. Professional training, reading and personal experience were identified most often as having an influence on opinions, while the media and Internet ranked least often. Amongst respondents wh...

Background: Individuals with pre-diabetes are commonly overweight and benefit from dietary and physical activity strategies aimed at decreasing body weight and hyperglycemia. Early insulin resistance can be estimated via the triglyceride glucose index {TyG = Ln [TG (mg/dl) × fasting plasma glucose (FPG) (mg/dl)/2]} and the hypertriglyceridemic-high waist phenotype (TyG-waist), based on TyG x waist circumference (WC) measurements. Both indices may be useful for implementing personalized metabolic management. In this secondary analysis of a randomized controlled trial (RCT), we aimed to determine whether the differences in baseline TyG values and TyG-waist phenotype predicted individual responses to type-2 diabetes (T2D) prevention programs.Methods: The present post-hoc analyses were conducted within the Prevention of Diabetes through Lifestyle intervention and population studies in Europe and around the world (PREVIEW) study completers (n = 899), a multi-center RCT conducted in eight...

The objective of this study was to assist individuals with type 2 diabetes (T2D) better manage blood glucose control using food. Given that white rice is a commonly consumed staple food for Asian cultures, the aim of this study was to develop a nutritious and easy-to-prepare alternative meal using culturally tailored ingredients. Methods: A 'rice mix' comprising 60% white rice and 40% a mix of legumes, nuts and seeds was developed. Eighty-one participants of Asian ethnicity and with T2D were screened with 13 subjects randomised and given the rice mix or white rice (control) as an evening meal. Blood glucose responses were compared between meals and to the American Diabetes Association guidelines together with responses to satiety and desire-to-eat questions. Results: Over a 3-hour period following consumption, blood glucose concentrations were 21% (95% CI: 6, 36) lower for the rice mix compared with white rice (P < 0.001). The mean length of time that blood glucose exceeded 10 mmol/L was 30 minutes (95% CI: 6, 54) less; and the maximum glycaemic increment above 10 mmol/L was 1.4 mmol/L (95% CI: 0.3, 2.5) less; for the rice mix compared with the white rice. There was no effect on appetite as satiety was not different between meals, although there was a lesser desire to eat fatty foods after consuming the rice mix (P = 0.02). Conclusions: The rice mix as an alternative to white rice could be a practical self-help approach to improve blood glucose control in people with T2D. Using education and culturally tailored ingredients may help overcome barriers to dietary change.

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Type 2 diabetes (T2D) incidence is increasing worldwide, driven by a rapidly changing environment and lifestyle and increasing rates of overweight and obesity. Prevention of diabetes is key and is most likely achieved through prevention of weight gain and/or successful long-term weight loss maintenance. Weight loss is readily achievable but there is considerable challenge in maintaining that weight loss over the long term. Lower-fat carbohydrate-based diets are widely used for T2D prevention. This is supported primarily by 3 successful long-term interventions, the US Diabetes Prevention Program, the Finnish Diabetes Prevention Study, and the Chinese Da Qing Study, but evidence is building in support of novel higher-protein (>20% of energy) diets for successful weight loss maintenance and prevention of T2D. Higher-protein diets have the advantage of having relatively low energy density, aiding longer-term appetite suppression, and preserving lean body mass, all central to successful weight loss and prevention of weight regain. Here, we review the carbohydrate-based intervention trials and present mechanistic evidence in support of increased dietary protein for weight loss maintenance and a possible novel role in prevention of dysglycemia and T2D.

Carcinoma of the prostate is the most commonly diagnosed malignancy and the third leading cause of mortality in New Zealand men, making it a significant health issue in this country. Global distribution patterns suggest that diet and lifestyle factors may be linked to the development and progression of this cancer. Twenty men with diagnosed prostate cancer adhered to a Mediterranean diet, with specific adaptations, for three months. Prostate-specific antigen, C-reactive protein and DNA damage were evaluated at baseline and after three months of following the diet. Dietary data were collated from diet diaries and an adaptation of a validated Mediterranean diet questionnaire. A significant reduction in DNA damage compared to baseline was apparent, with particular benefit noted for overall adherence to the diet (p = 0.013), increased intake of folate (p = 0.023), vitamin C (p = 0.007), legumes (p = 0.004) and green tea (p = 0.002). Higher intakes of red meat and dairy products were inversely associated with DNA damage (p = 0.003 and p = 0.008 respectively). The results from this small feasibility study suggest that a high-antioxidant diet, modelled on Mediterranean traditions, may be of benefit for men with prostate cancer. Protection against DNA damage appears to be associated with the diet implemented, ostensibly due to reduction in reactive oxidant species. These findings warrant further exploration in a longer trial, with a larger cohort.

Carcinoma of the prostate is the most commonly diagnosed malignancy and the third leading cause of mortality in New Zealand men, making it a significant health issue in this country. Global distribution patterns suggest that diet and lifestyle factors may be linked to the development and progression of this cancer. Twenty men with diagnosed prostate cancer adhered to a Mediterranean diet, with specific adaptations, for three months. Dietary data, prostate-specific antigen, C-reactive protein and DNA damage were evaluated at baseline after three months of following the diet. A significant reduction in DNA damage compared to baseline was apparent, with particular benefit noted for overall adherence to the diet (p = 0.013), increased intake of folate (p = 0.023), vitamin C (p = 0.007), legumes (p = 0.004) and green tea (p = 0.002). Higher intakes of red meat and dairy products were inversely associated with DNA damage (p = 0.003 and p = 0.008 respectively). This small study demonstrate...

Background: The association between fibromyalgia and irritable bowel syndrome is well-established. Alterations in the composition and diversity of the gut microbiome in irritable bowel syndrome have been reported, however, this association is poorly understood in fibromyalgia. Our aim was to summarise the research reporting on the gastrointestinal microbiome and its biomarkers in people with fibromyalgia. Methods: A systematic review of published original research reporting on the gastrointestinal microbiota and its biomarkers in adults with a diagnosis of fibromyalgia was undertaken. Results: From 4771 studies, 11 met our inclusion criteria and were separated into four main groups: papers reporting Helicobacter pylori; other gut bacterial markers; metabolomics and other biomarkers, which included intestinal permeability and small intestinal bacterial overgrowth. Conclusion: The results suggest there is a paucity of quality research in this area, with indications that the gut microbiota may play a role in fibromyalgia within the emerging field of the gut-musculoskeletal axis. Further investigations into the relationship between the gut microbiota, gut dysfunction and fibromyalgia are warranted.

The measurement of hydrogen–methane breath gases is widely used in gastroenterology to evaluate malabsorption syndromes and bacterial overgrowth. Laboratories offering breath testing provide variable guidance regarding oral hygiene practices prior to testing. Given that oral dysbiosis has the potential to cause changes in breath gases, it raises concerns that oral hygiene is not a standard inclusion in current breath testing guidelines. The aim of this study was to determine how a pre-test mouthwash may impact hydrogen–methane breath test results. Participants presenting for breath testing who had elevated baseline gases were given a chlorhexidine mouthwash. If a substantial reduction in expired hydrogen or methane occurred after the mouthwash, breath samples were collected before and after a mouthwash at all breath sample collection points for the duration of testing. Data were evaluated to determine how the mouthwash might influence test results and diagnostic status. In 388 conse...

Background:Fibromyalgia and functional gastrointestinal disorders (FGID) including irritable bowel syndrome (IBS) are common conditions presenting in clinical settings and are more prevalent in women. While the relationship between IBS and fibromyalgia has been demonstrated, a review of the prevalence of the broader group of FGID in adults with fibromyalgia has not been undertaken. The aim of this review was to systematically review the published literature, identifying the comorbidity of FGID in people with fibromyalgia, and to discuss the clinical implications, limitations of current research and areas of interest for future researchMethods:Medline, Embase, CINAHL and Web of Science were searched during June 2019. Results were screened for original research articles meeting established criteria for identification of FGID in adults diagnosed with fibromyalgia.Results:A total of 14 studies involving 1340 adults with fibromyalgia, 363 healthy controls and 441 adults with other pathol...

Carcinoma of the prostate is the most commonly diagnosed malignancy and the third leading cause of mortality in New Zealand men, making it a significant health issue in this country. Global distribution patterns suggest that diet and lifestyle factors may be linked to the development and progression of this cancer. Twenty men with diagnosed prostate cancer adhered to a Mediterranean diet, with specific adaptations, for three months. Prostate-specific antigen, C-reactive protein and DNA damage were evaluated at baseline and after three months of following the diet. Dietary data were collated from diet diaries and an adaptation of a validated Mediterranean diet questionnaire. A significant reduction in DNA damage compared to baseline was apparent, with particular benefit noted for overall adherence to the diet (p = 0.013), increased intake of folate (p = 0.023), vitamin C (p = 0.007), legumes (p = 0.004) and green tea (p = 0.002). Higher intakes of red meat and dairy products were inv...

Supplemental material, sj-pdf-1-tag-10.1177_1756284820977402 for A systematic review of the association between fibromyalgia and functional gastrointestinal disorders by Sharon Erdrich, Jason A. Hawrelak, Stephen P. Myers and Joanna E. Harnett in Therapeutic Advances in Gastroenterology

The measurement of hydrogen-methane breath gases is widely used in gastroenterology to evaluate malabsorption syndromes and bacterial overgrowth. Laboratories offering breath testing provide variable guidance regarding oral hygiene practices prior to testing. Given that oral dysbiosis has the potential to cause changes in breath gases, it raises concerns that oral hygiene is not a standard inclusion in current breath testing guidelines. The aim of this study was to determine how a pre-test mouthwash may impact hydrogen-methane breath test results. Participants presenting for breath testing who had elevated baseline gases were given a chlorhexidine mouthwash. If a substantial reduction in expired hydrogen or methane occurred after the mouthwash, breath samples were collected before and after a mouthwash at all breath sample collection points for the duration of testing. Data were evaluated to determine how the mouthwash might influence test results and diagnostic status. In 388 consecutive hydrogen-methane breath tests, modifiable elevations occurred in 24.7%. Administration of a chlorhexidine mouthwash resulted in significantly (p ≤ 0.05) reduced breath hydrogen in 67% and/or methane gas in 93% of those consenting to inclusion. In some cases, this modified the diagnosis. Mean total gas concentrations pre-and post-mouthwash were 221.0 ppm and 152.1 ppm (p < 0.0001) for hydrogen, and 368.9 ppm and 249.8 ppm (p < 0.0001) for methane. Data suggest that a single mouthwash at baseline has a high probability of returning a false positive diagnosis. Variations in gas production due to oral hygiene practices has significant impacts on test interpretation and the subsequent diagnosis. The role of oral dysbiosis in causing gastrointestinal symptoms also demands exploration as it may be an underlying factor in the presenting condition that was the basis for the referral. Hydrogen-methane breath testing is a widely used diagnostic tool, based on the science that these gases are byproducts of saccharide fermentation by gut microorganisms, rather than human metabolism. Glucose, lactose, and fructose are normally absorbed in the small intestine. Increased gas production following their ingestion is associated with malabsorption or premature fermentation due to excessive bacteria in the small intestine. Hydrogen and methane gas are absorbed from the gastrointestinal tract, exhaled via the lungs and are thus measurable in breath. Increased gas production following ingestion of fructose or lactose are used to detect malabsorption of carbohydrates. Similarly, increases in expired breath gases in response to ingestion of non-digestible lactulose, or glucose are used to predict small intestinal bacterial overgrowth (SIBO) 1-4. In-depth discussion on the methodology and interpretation of breath testing was published in 2009 5 and a shorter summary in 2011 6. The concept that expired breath gases may be influenced by the oral microbiome is not yet an integrated component of breath testing guidelines, even though oral dysbiosis has been implicated in oral and non-oral diseases 7. To improve the accuracy of breath testing, a 1-day preparatory low-residue diet and water-only overnight fast is required. After collection of a baseline breath sample, the challenge substrate (usually lactulose, glucose, fructose, or lactose) is administered, and subsequent samples of breath are collected at predetermined intervals for the duration of the test period. Interpretation of results varies between testing facilities, which is an issue that the North American Consensus sought to address in their 2017 guideline 8. Neither this guideline 8 nor any other in the reviewed breath testing literature, sets a clear definition for normal baseline gases. In practice, a variety of breath patterns is seen 9-13 , the meaning of which is unclear. These include markedly elevated hydrogen and/or methane, which may remain high throughout testing or may subsequently decrease, sometimes immediately following ingestion of the test substrate.

Oral health is vital to general health and well-being for all ages, and as with other chronic conditions, oral health problems increase with age. There is a bi-directional link between nutrition and oral health, in that nutrition affects the health of oral tissues and saliva, and the health of the mouth may affect the foods consumed. Evidence suggests that a healthy diet generally has a positive impact on oral health in older adults. Although studies examining the direct link between oral health and protein intake in older adults are limited, some have explored the relationship via malnutrition, which is also prevalent among older adults. Protein–energy malnutrition (PEM) may be associated with poor oral health, dental caries, enamel hypoplasia, and salivary gland atrophy. This narrative review presents the theoretical evidence on the impact of dietary protein and amino acid composition on oral health, and their combined impact on overall health in older adults.

Background Fibromyalgia a common idiopathic condition affecting around 1.4% of adults globally. Its signature symptom is chronic widespread pain, with a constellation of somatic and psychological symptoms. Fibromyalgia is associated with significant reductions in quality of life, yet to date there is no biochemical marker for its diagnosis. Previous studies have indicated a strong association with gastrointestinal dysfunction, and more recently, alterations to the gut microbiome. No studies have examined the inter-relationship between fibromyalgia, gastrointestinal dysfunction, and the microbiome. This prospective observational case-controlled study will gather data on gastrointestinal function, dietary intake, fermentation patterns of ingested carbohydrates, and symptoms commonly associated with fibromyalgia. These will be evaluated alongside human gene expression and metatranscriptomic analysis of the oral and faecal microbiome. Methods Adult women aged ≥18 years diagnosed with fi...