The vast majority of malnutrition in the UK occurs in the community (1) , but little is known about its true prevalence in General Practice and the health care use associated with it. This study aimed to establish the prevalence of malnutrition in people visiting their General Practitioner (GP) and whether it is related to health outcomes and increased healthcare use.A nutritional survey was conducted between November 2010 and May 2011 in six practices across Southampton. Of the 970 randomly selected subjects who were invited to participate, 62 % (n 601) agreed (main reason for non-participation was fear of missing their appointment). Of these, 455 were visiting the GP or nurse and, therefore, formed the study population. The remaining subjects (n 146) were friends, relatives or carers accompanying the patients. Subjects were invited to have their height and weight measured and to provide information about unintentional weight loss, the number of GP visits, wounds, infections requiring antibiotics, dietetic input, or use of any form of oral nutritional support, all during the preceding six months. The rank of index of multiple deprivation score (MDS) was established for each practice using its postcode (2) ; MDS ranged from 1 (most deprived) to 32482 (least deprived), and malnutrition risk was assessed by applying the 'MUST' criteria to the collected data (3) .All practices were located in areas of higher deprivation ranked between 4474-14811 with a mean rank of 8138 (SD°4158), which was below the mean (and median) value of 16241 for England (P < 0.001), and the proportion of the adult population registered with the practices that was ‡ 65 years (14.1%) was significantly lower (P < 0.001) than the proportion aged ‡ 65 years in England (19.7%) (4) .The patients visiting the GP had a mean age of 41.8 (SD°18.3) years, weight 73.9 (SD°17.1) kg, and body Mass Index (BMI) 26.3 (SD°5.3) kg/m 2 . The overall prevalence of malnutrition was 10.8 % (95 % CI 8.2%, 14.0%), with no significant difference between practices. It comprised of 6.2 % at medium risk and 4.6 % at high risk; 7.7% (n 35) of subjects scored at step 1 BMI, 2.2 % (n 10) scored at step 2 unintentional weight loss and 0.9 % (n 4) scored at both step 1 and 2, and no subjects (n 0) scored at step 3 acute disease score effect.Compared to people at low risk of malnutrition, those 'at risk' (medium + high risk) had more infections requiring antibiotics (16.7% vs 24.5%), slightly more GP visits in the previous 6 months (60.6% vs 65.3 %) and more unhealed wounds (2.2% vs 8.2%), with the latter difference being statistically significant (P < 0.05). None of the subjects identified as 'at risk' of malnutrition were receiving dietetic input or any form of oral nutritional support.This survey highlights that: (i) the prevalence of malnutrition in people visiting their GP (10.8%; 95 % CI 8.2%, 14.0%) is similar to that previously estimated in General Practice (10 %) (1) ; (ii) malnutrition is associated with adverse health outcomes and is under-treated. As the practices...
Introduction Hepatitis C virus (HCV) recurrence post liver transplant (LT) is universal. Sustained virological response (SVR) rates post LT with pegylated interferon (PEG-IFN) and ribavirin (RIB) range between 26% and 50% and are associated with significant side effects. Single nucleotide polymorphisms (SNPs) rs12979860 near the IL28B gene predict response to treatment. Strong immune T helper type 1 responses towards HCV determine also play an inte-
Background: The pre‐conception and pregnancy period continues to gain recognition as an ideal opportunity to optimise the health of the mother‐to‐be, as women become more conscious of food and health related issues at this time (Anderson, 2001). Adhering to a well balanced diet and healthy lifestyle will help ensure optimal health for both mother and baby (Anderson, 2001). The aim of this study was to investigate the diets and lifestyles of a sample of pregnant women in Northern Ireland and to assess adherence to government guidelines. Methods: A total of 1600 pregnant women attending antenatal clinics at Royal Jubilee Maternity Hospital, Belfast, participated in this nutritional study from October 2001 to April 2006. Women recruited were enrolled in the Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) study described elsewhere (HAPO, 2008). Women over 18 years old, approximately 29 weeks gestation (range: 24–35 weeks) were recruited. Participants completed a validated (Hill, 2005) food frequency questionnaire (FFQ) that consisted of a list of 44 items covering all main foods consumed locally. Anthropometric information was also collected at this time, self reported weight approximately three months prior to this pregnancy and height was recorded during the hospital visit. The FFQ responses were coded using standard survey design technique. Various statistical techniques were employed, including Chi squared tests, Analysis of Variance (anova) and Pearson's correlations. Ethical approval for this nutritional study was obtained by Queen's University of Belfast and the University of Ulster filter committee. Results: Of those women that participated in the study (n = 1600), 33% were overweight (23%) or obese (10%) prior to this pregnancy. Only 11% (n = 176) of women consumed five or more portions of fruit and vegetables daily; a greater proportion of these women were older (P < 0.0005), married (P < 0.0005) and non‐smokers (P < 0.0005). 35% of the women achieved an estimated intake of 700 mg of calcium. Overall, the mean calcium intake was 560 mg (251.12). Chocolate bars and biscuits were the most popular snack food, eaten by 86% (n = 1378) at least once a week; women that were more likely to eat chocolate as a snack were younger (P < 0.0005). 24% of women smoked during their pregnancy and 26% consumed alcohol at some stage during the pregnancy. Discussion: A considerable proportion of women were overweight or obese prior to this pregnancy; obesity is associated with an increased risk of developing complications such as gestational diabetes, pre‐eclampsia and also obstetrical complications. The study also showed that few women consumed the five or more portions of fresh fruit and vegetables daily which was less than that reported in a previous survey of women in NI, in which 31% met the five a day requirement (DHSSPS, 2007). The rate of smoking in the current study was comparable with other studies conducted in pregnant women; Mouratidou et al. (2006) reported a 28% smoking rate amongst pregnant women. Conclus...
Introduction Cirrhotics have complex acquired derangements of haemostasis. Routine coagulation tests suggest a hypocoagulable profile, resulting in frequent administration of blood components for prophylaxis and treatment of bleeding. Rotational thromboelastography (ROTEM Ò ), unlike standard coagulation tests, provides a real-time measurement of clot formation, strength and stability in whole blood and may more accurately reflect in vivo coagulation. We aimed to (1) identify the key derangements in the haemostatic pathways in patients with cirrhosis; (2) determine the prevalence of overt hyperfibrinolysis and whether this could be improved with anti-fibrinolytics. Methods We used ROTEM Ò to investigate: (1) Clotting time (CT) and maximum clot firmness (MCF) in stable, non-bleeding cirrhotics compared to healthy volunteers; (2) The presence of overt hyperfibrinolysis and whether this could be reversed by spiking blood samples ex vivo with the antifibrinolytic aprotinin (APTEM test). Overt hyperfibrinolysis was defined by a maximum lysis (ML) of >15% and by comparing the clot lysis index at 60 min between EXTEM and APTEM parameters. Results 106 adult cirrhotics and 28 healthy volunteers were enrolled after informed consent. Median EXTEM CT was shorter in cirrhotics than controls (51s vs 58s, p<0.01) and the clotting time shortened as Child-Pugh score increased in severity (52s Child A, 49s, Child B, 47s Child C). In cirrhotics there was strong correlation between EXTEM MCF with both platelet count (r¼0.801, p<0.0001) and fibrinogen levels (r¼0.653, p<0.0001), as well as fibrinogen and FIBTEM MCF (r¼0.641, p<0.0001). 25% (26/106) of cirrhotics had evidence of overt hyperfibrinolysis. After spiking samples from cirrhotics with aprotinin, hyperfibrinolysis was completely reversed (ML<15%) in 50% (13/26) cases and partially reversed in 50% (13/26) cases. There was a significant reduction in the median ML between EXTEM and APTEM clot profiles (13 vs 11, p<0.001). D-dimer levels increased with increasing disease severity (Child A-894, Child B-1835, Child C-5281). Conclusion Cirrhotics have a hypercoagulable clotting time, despite prolonged PT, APTT and thrombocytopenia supporting the concept of re-balanced haemostasis. Use of ROTEM Ò may avoid unnecessary and potentially harmful transfusion of pro-coagulant blood components in cirrhotics. The high prevalence of overt hyperfibrinolysis in cirrhosis requires further elucidation and clinical studies to investigate the potential role of anti-fibrinolytics in the prophylaxis of variceal bleeding.
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