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Cantelmi D, Jardine L, Griffin A, Cooke L. Complex end-of-life decision-making during neonatal retrieval: A retrospective cohort study. J Paediatr Child Health 2024. [PMID: 39394976 DOI: 10.1111/jpc.16696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 09/25/2024] [Accepted: 09/27/2024] [Indexed: 10/14/2024]
Abstract
AIM The aim of this study was to compare patients referred to our retrieval service who were palliated before transfer, versus those transferred who were palliated within 7 days of birth. METHODS We conducted a retrospective chart review of infants referred to our neonatal retrieval service between 1 December 2015 and 31 March 2022 who died during retrieval or within 7 days of referral. Demographic and clinical data were collected from the service database and electronic medical records. RESULTS Data on 60 infants were analysed; 25 (42%) infants were not transported and were palliated at the referring hospital, 35 (58%) infants were transported and later palliated at the accepting hospital. The most common primary diagnoses were prematurity (42%) and hypoxemic ischemic encephalopathy (HIE) (42%). Infants palliated at the referring hospital were more likely than those transported and later palliated to require resuscitation including chest compressions (52% vs. 23%, P = 0.02), management for hypotension (72% vs. 20%, P < 0.001) and management for pneumothorax (28% vs. 0%, P = 0.001) and less likely to require management for seizures (8% vs. 43%, P = 0.003). CONCLUSIONS Palliation at the referring hospital should be considered as an option when escalating care is predicted to not affect outcome. In this cohort the infants least likely to be transported required significant management during stabilisation. Determining the infants for whom transport is non-beneficial remains difficult.
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Holton S, Wright A, Wynter K, Hall L, Wintle J, Lambis E, Cooke L, McNally C, Pavlovski M, Bruce S, Rasmussen B. Health service COVID-19 wellbeing and support initiatives: a mixed-methods evaluation. Occup Med (Lond) 2022; 72:508-514. [PMID: 35815913 PMCID: PMC9278257 DOI: 10.1093/occmed/kqac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Health services implemented a range of initiatives during the COVID-19 pandemic to support employee wellbeing and assist employees to manage the professional and personal challenges they experienced. However, it is not known if such initiatives were acceptable to employees or met their needs. AIMS To evaluate the wellbeing and support initiatives implemented at an Australian health service during the COVID-19 pandemic from the perspectives of employees (both users and non-users) and key stakeholders. METHODS A mixed-methods design (survey, interviews and data audit) to investigate employees' and key stakeholders' perceptions, experiences and use of the wellbeing and support initiatives implemented at a large tertiary metropolitan health service in Melbourne, Australia. RESULTS Ten employees participated in an interview and 907 completed a survey. The initiatives were well used and appreciated by staff. There was no significant difference in the proportion of clinical staff who had used the initiatives compared to non-clinical staff (44% versus 39%; P=0.223). Survey respondents reported the initiatives improved their mental health (n = 223, 8%), ability to cope with COVID-19 related stress and anxiety (n = 206, 79%), do their work (n = 200, 77%) and relationships with colleagues (n = 174, 67%). Staff would like many of the initiatives (with some modifications) to continue after the COVID-19 pandemic. CONCLUSIONS The findings suggest a high level of staff satisfaction with the implemented wellbeing and support initiatives, and confirm the need for, and importance of, developing and implementing initiatives to support health service staff during outbreaks of infectious diseases such as the COVID-19 pandemic.
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Cooper‐Vince CE, Nwaka C, Eddy KT, Misra M, Hadaway NA, Becker KR, Lawson EA, Cooke L, Bryant‐Waugh R, Thomas JJ, Micali N. The factor structure and validity of a diagnostic interview for avoidant/restrictive food intake disorder in a sample of children, adolescents, and young adults. Int J Eat Disord 2022; 55:1575-1588. [PMID: 36324295 PMCID: PMC9641545 DOI: 10.1002/eat.23792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE There is a paucity of validated diagnostic interviews for avoidant/restrictive food intake disorder (ARFID) to aid identification and classification of cases for both clinical and research purposes. To evaluate the factor structure, construct validity, and criterion validity of the Pica ARFID and Rumination Disorder Interview (PARDI; ARFID module), we administered the PARDI to 129 children and adolescents ages 9-23 years (M = 16.1) with ARFID (n = 84), subclinical ARFID (n = 11), and healthy controls (n = 34). METHOD We used exploratory factor analysis to examine the factor structure of the PARDI in children, adolescents, and young adults with an ARFID diagnosis, the Kruskal-Wallis analysis of variance and Spearman correlations to test the construct validity of the measure, and non-parametric receiver operating characteristic curves to evaluate the criterion validity of the PARDI. RESULTS Exploratory factor analysis yielded a 3-factor structure: (1) concern about aversive consequences of eating, (2) low appetite/low interest in food, and (3) sensory sensitivity. Participants with ARFID demonstrated significantly higher levels of sensory sensitivity, low appetite/low-food interest, and concern about aversive consequences of eating symptoms relative to control participants. The construct validity for each PARDI subscale was supported and clinical cutoffs for the low appetite/low interest in food (1.1) and sensory sensitivity subscales (0.6) were established. DISCUSSION These data present evidence for the factor structure and validity of the PARDI diagnostic interview for diagnosing ARFID in children, adolescents, and young adults, supporting the use of this tool to facilitate ARFID clinical assessment and research. PUBLIC SIGNIFICANCE Due to the paucity of validated diagnostic interviews for avoidant/restrictive food intake disorder (ARFID), we evaluated the factor structure and validity of the Pica ARFID and Rumination Disorder Interview (ARFID module). Findings suggest that the interview assesses 3 components of ARFID: concern about aversive consequences of eating, low-appetite, and sensory sensitivity, and that clinical threshold scores on the latter two subscales can be used to advance ARFID assessment.
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Woolford SJ, Curtis EM, D'Angelo S, Mahon P, Cooke L, Cleal JK, Crozier SR, Godfrey KM, Inskip HM, Cooper C, Harvey NC. Placental volume at 11 weeks is associated with offspring bone mass at birth and in later childhood: Findings from the Southampton Women's Survey. Placenta 2020; 99:101-107. [PMID: 32784052 PMCID: PMC7116131 DOI: 10.1016/j.placenta.2020.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate associations between placental volume (PV) at 11 weeks' gestation and offspring bone outcomes at birth, 6 years and 8 years. METHODS 3D ultrasound scanning was used to assess 11 week PV in a subset (n = 236) of the Southampton Women's Survey (a prospective mother-offspring cohort). Maternal anthropometric measures and lifestyle information were obtained pre-pregnancy and at 11 weeks' gestation. Offspring dual-energy x-ray absorptiometry scanning was performed within 2 weeks postnatally and at 6 and 8 years. Linear regression was used to assess associations between PV and bone outcomes, adjusting for offspring age at DXA and sex, and maternal age, height, smoking status, walking speed and triceps skinfold thickness. β are SD change in bone outcome per SD change in PV. RESULTS In adjusted models, 11 week PV was positively associated with bone area (BA) at all time points, with evidence of persisting associations with increasing childhood age (birth: n = 80, β = 0.23 [95%CI = 0.03, 0.42], 6 years: n = 110, β = 0.17 [-0.01, 0.36], 8 years: n = 85, β = 0.13 [-0.09, 0.36]). Similar associations between 11 week PV and bone mineral content (BMC) were observed. Associations with size-corrected bone mineral content were weaker at birth but strengthened in later childhood (birth: n = 78, β = 0.07 [-0.21, 0.35], 6 years: n = 107, β = 0.13 [-0.08, 0.34], 8 years: n = 71, β = 0.19 [-0.05, 0.43]). CONCLUSIONS 11 week PV is associated with DXA bone measures at birth, with evidence of persisting associations into later childhood. Further work is required to elucidate the contributions of placental morphology and function to gestational influences on skeletal development.
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Aries AM, Cooke L, Hunter SM. Mobilisation And Tactile (Sensory) Stimulation For The Foot Post Stroke: Opinions And Perceptions Of Experienced Therapists. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2019.26.6.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Intensive proprioceptive stimulation applied to the paretic hand post-stroke, using a complex hands-on intervention known as mobilisation and tactile stimulation, has reduced motor impairment and improved hand function in sub-acute and chronic stroke. While, anecdotally, mobilisation and tactile stimulation is also applied to the paretic foot to prepare it for standing, its use in stroke rehabilitation and effects on standing and balance have not been evaluated. Therefore, expert clinicians' experiences, opinions and perceptions of using mobilisation and tactile stimulation in routine clinical practice were explored to inform a subsequent feasibility study of mobilisation and tactile stimulation for the paretic foot post-stroke. Methods Following ethical approval, focus groups were undertaken: using purposive sampling, physiotherapists and occupational therapists with >12 months experience of stroke rehabilitation were recruited from a regional special interest group. A pilot study (n=4) and main study (n=7) explored content and application of hands-on therapy for the paretic foot, and the perceived impact of sensory loss on lower limb function. Data were audio-taped and transcribed verbatim. Thematic analysis was undertaken. Results All 11 therapists had previous experience of using mobilisation and tactile stimulation for the foot post-stroke. Three main themes were identified: (1) therapeutic intervention (sub-themes: therapy content, sensation, adjuncts, the foot as an active base of support and preparation for function); (2) 24-hour care; and (3) analysis (sub-themes: outcome measures, response to treatment). The most common adjuncts to mobilisation and tactile stimulation were orthotics and task-specific training. The importance of mobilisation and tactile stimulation in restoring foot alignment, sensory feedback and progression of the patient towards weight bearing and ambulation in the clinical setting was highlighted. Conclusions Mobilisation and tactile stimulation is a complex intervention used in stroke rehabilitation to enhance weight bearing and ambulation post stroke. Further research into its effects on the foot and lower limb is warranted in order to evaluate it and determine its evidence base for inclusion in routine clinical practice. Alternative methods of applying proprioceptive stimulation should also be considered, for example use of textured insoles, and relative effectiveness of these explored in clinical trials.
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Bryant-Waugh R, Micali N, Cooke L, Lawson EA, Eddy KT, Thomas JJ. Development of the Pica, ARFID, and Rumination Disorder Interview, a multi-informant, semi-structured interview of feeding disorders across the lifespan: A pilot study for ages 10-22. Int J Eat Disord 2019; 52:378-387. [PMID: 30312485 PMCID: PMC6453710 DOI: 10.1002/eat.22958] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 08/28/2018] [Accepted: 09/02/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Avoidant/restrictive food intake disorder (ARFID), pica, and rumination disorder (RD) were added to the revised DSM-5 Feeding and Eating Disorders chapter in 2013. We developed a structured interview-the Pica, ARFID, and Rumination Disorder Interview (PARDI)-to assess the presence and severity of these diagnoses for evaluation and treatment planning in clinical and research settings. Here, we describe the development of the PARDI and provide a preliminary report on feasibility, acceptability, reliability, and validity in relation to ARFID. METHOD We created an initial item pool from existing measures of similar constructs and clinical experience. The PARDI includes items assessing the level of endorsement and overall severity of common ARFID features organized into profiles (i.e., sensory sensitivity, lack of interest in eating, and fear of aversive consequences) and algorithms for diagnosing ARFID, pica, and RD. We collected initial psychometric data from participants (10-22 years) with ARFID (n = 39), clinically significant avoidant/restrictive eating (n = 8), and healthy controls (n = 10). RESULTS On average, the PARDI took 39 min to complete and was acceptable to participants. All subscales achieved internal consistency greater ≥0.77, and inter-rater reliability for the ARFID diagnosis was moderate (κ = 0.75). Individuals with ARFID scored significantly higher than healthy controls on ARFID severity and ARFID profiles. DISCUSSION The PARDI appears acceptable to respondents and preliminary evidence of reliability and validity has been demonstrated in an initial sample. Larger-scale validation studies are currently underway. The PARDI is freely available to clinicians and researchers.
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Barker J, Cooke L, Beyers J. Plugging the Gap – Implementing the use of Corstop A.C.E. Stopper© in simple displacement of Balloon Retained Enteral Tubes. Clin Nutr ESPEN 2019. [DOI: 10.1016/j.clnesp.2018.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Smith AD, Fildes A, Forwood S, Cooke L, Llewellyn C. The individual environment, not the family is the most important influence on preferences for common non-alcoholic beverages in adolescence. Sci Rep 2017; 7:16822. [PMID: 29203875 PMCID: PMC5715117 DOI: 10.1038/s41598-017-17020-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 11/13/2017] [Indexed: 11/09/2022] Open
Abstract
Beverage preferences are an important driver of consumption, and strong liking for beverages high in energy (e.g. sugar-sweetened beverages [SSBs]) and dislike for beverages low in energy (e.g. non-nutritive sweetened beverages [NNSBs]) are potentially modifiable risk factors contributing to variation in intake. Twin studies have established that both genes and environment play important roles in shaping food preferences; but the aetiology of variation in non-alcoholic beverage preferences is unknown. 2865 adolescent twins (18-19-years old) from the Twins Early Development Study were used to quantify genetic and environmental influence on variation in liking for seven non-alcoholic beverages: SSBs; NNSBs; fruit cordials, orange juice, milk, coffee, and tea. Maximum Likelihood Structural Equation Modelling established that beverage preferences have a moderate to low genetic basis; from 18% (95% CI: 10%, 25%) for orange juice to 42% (36%, 43%) for fruit cordials. Aspects of the environment that are not shared by twin pairs explained all remaining variance in drink preferences. The sizeable unique environmental influence on beverage preferences highlights the potential for environmental modification. Policies and guidelines to change preferences for unhealthy beverages may therefore be best directed at the wider environment.
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Russell J, Collins A, Fowler A, Karanth M, Saha C, Shyamsundar V, Docherty S, Kirkwood A, Maw K, Cooke L, Hodson A, Shah N, Sadullah S, Grigoropoulos N, Uttenthal B, Follows G. Advanced Hodgkin lymphoma in the east of England cancer network: A 10-year comparative analysis of outcomes for ABVD and escalated-BEACOPP treated patients aged 16 to 59. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Alcock G, Liley HG, Cooke L, Gray PH. Prevention of neonatal late-onset sepsis: a randomised controlled trial. BMC Pediatr 2017; 17:98. [PMID: 28376891 PMCID: PMC5381090 DOI: 10.1186/s12887-017-0855-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 03/31/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Late-onset sepsis (LOS), defined as sepsis occurring after 48 h of age causes substantial mortality and morbidity in very low birth weight infants. Risk factors for LOS include immaturity, intravascular catheters, mechanical ventilation, and prolonged parenteral nutrition (PN). Little attention has been paid to studying the effects of PN administration methods. The aim of the study was to compare a bundle of measures for PN line management incorporating a strict aseptic technique with standard line management on LOS in very low birth weight infants. METHODS Infants <1500 g birth weight who required PN were randomised to either a bundle of a strict aseptic technique for line management together with single use intravascular catheter for PN or a standard technique. The primary outcome was the incidence of LOS in the first 28 days of life. Secondary outcomes were mortality, neonatal morbidities and developmental outcome at 12 months of age. RESULTS There were 126 infants in the aseptic technique group and 123 in the standard technique group. Forty (31.8%) infants in the aseptic technique group and 36 (29.3%) in the standard technique group had an episode of sepsis (p = 0.77). This corresponds to incidences of 15.8 and 14.2 episodes of sepsis per 1000 patient days respectively. Subgroup analyses for infants <1000 g also revealed no difference in the rate of sepsis between the intervention and control groups. (p = 0.43). There were no significant differences in secondary outcomes and development between the groups. CONCLUSION A bundle of measures including strict aseptic technique for parenteral nutrition line management did not result in a reduction in LOS when compared to a standard technique. There is no evidence to recommend this as routine practice. TRIAL REGISTRATION Interdisciplinary Maternal Perinatal Australasian Collaborative Trials (IMPACT) Network, TRN registration number: PT0363. Date: 06/03/2001; Australian New Zealand Clinical Trials Registry (ANZCTR), TRN registration number: ACTRN12617000455369 . Date: 28/03/2017 (retrospectively registered).
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Gibson EL, Cooke L. Understanding Food Fussiness and Its Implications for Food Choice, Health, Weight and Interventions in Young Children: The Impact of Professor Jane Wardle. Curr Obes Rep 2017; 6:46-56. [PMID: 28205158 DOI: 10.1007/s13679-017-0248-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW This review examines the concepts of fussy eating and food neophobia in the context of key determinants of the development of children's food preferences. We discuss the evidence for genetic versus parental and other environmental influences on the ontogeny of these behavioural traits and the implications of current knowledge for interventions that attempt to lessen the impact of these traits on children's diets. Finally, we consider whether these traits increase the risk of a child becoming obese, or alternatively, underweight and malnourished. RECENT FINDINGS Fussy eating and neophobia are related concepts with both genetic and environmental aetiologies. Parent-child correlations and heritability estimates are moderate to high for both traits, but aspects of the family environment remain influential in young children, although no longer in young adults. Parental strategies based around repeat tasting opportunities can improve acceptance of disliked foods in even the fussiest children. Fussy eating and neophobia are not risk factors for obesity but could limit growth in severe cases. Fussy eating and food neophobia are common concerns for parents, though health risks are low. Dissemination of evidence-based strategies to parents that can encourage a more varied diet in young children would be helpful.
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Smith AD, Herle M, Fildes A, Cooke L, Steinsbekk S, Llewellyn CH. Food fussiness and food neophobia share a common etiology in early childhood. J Child Psychol Psychiatry 2017; 58:189-196. [PMID: 27739065 PMCID: PMC5298015 DOI: 10.1111/jcpp.12647] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND 'Food fussiness' (FF) is the tendency to be highly selective about which foods one is willing to eat, and emerges in early childhood; 'food neophobia' (FN) is a closely related characteristic but specifically refers to rejection of unfamiliar food. These behaviors are associated, but the extent to which their etiological architecture overlaps is unknown. The objective of this study was to quantify the relative contribution of genetic and environmental influences to variation in FF and FN in early childhood; and to establish the extent to which they share common genetic and environmental influences. METHOD Participants were 1,921 families with 16-month-old twins from the Gemini birth cohort. Parents completed the Child Eating Behaviour Questionnaire which included three FF items and four FN items. Bivariate quantitative genetic modeling was used to quantify: (a) genetic and environmental contributions to variation in FF and FN; and (b) the extent to which genetic or environmental influences on FF and FN are shared across the traits. RESULTS Food fussiness and FN were strongly correlated (r = .72, p < .001). Proportions of variation in FF were equally explained by genetic (.46; 95% CI: 0.41-0.52) and shared environmental influences (.46; 95% CI: 0.41-0.51). Shared environmental effects accounted for a significantly lower proportion of variation in FN (.22; 95% CI: 0.14-0.30), but genetic influences were not significantly different from those on FF (.58, 95% CI: 0.50-0.67). FF and FN largely shared a common etiology, indicated by high genetic (.73; 95% CI: 0.67-0.78) and shared environmental correlations (.78; 95% CI: 0.69-0.86) across the two traits. CONCLUSIONS Food fussiness and FN both show considerable heritability at 16 months but shared environmental factors, for example the home environment, influenced more interindividual differences in the expression of FF than in FN. FF and FN largely share a common etiology.
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Chambers L, Hetherington M, Cooke L, Coulthard H, Fewtrell M, Emmett P, Lowdon J, Blissett J, Lanigan J, Baseley C, Stanner S. Reaching consensus on a ‘vegetables first’ approach to complementary feeding. NUTR BULL 2016. [DOI: 10.1111/nbu.12220] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Smith AD, Fildes A, Cooke L, Herle M, Shakeshaft N, Plomin R, Llewellyn C. Genetic and environmental influences on food preferences in adolescence. Am J Clin Nutr 2016; 104:446-53. [PMID: 27385609 PMCID: PMC4962164 DOI: 10.3945/ajcn.116.133983] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/31/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Food preferences vary substantially among adults and children. Twin studies have established that genes and aspects of the shared family environment both play important roles in shaping children's food preferences. The transition from childhood to adulthood is characterized by large gains in independence, but the relative influences of genes and the environment on food preferences in late adolescence are unknown. OBJECTIVE The aim of this study was to quantify the contribution of genetic and environmental influences on food preferences in older adolescents. DESIGN Participants were 2865 twins aged 18-19 y from the TEDS (Twins Early Development Study), a large population-based cohort of British twins born during 1994-1996. Food preferences were measured by using a self-report questionnaire of 62 individual foods. Food items were categorized into 6 food groups (fruit, vegetables, meat or fish, dairy, starch foods, and snacks) by using factor analysis. Maximum likelihood structural equation modeling established genetic and environmental contributions to variations in preferences for each food group. RESULTS Genetic factors influenced a significant and substantial proportion of the variation in preference scores of all 6 food groups: vegetables (0.54; 95% CI: 0.47, 0.59), fruit (0.49; 95% CI: 0.43, 0.55), starchy foods (0.32; 95% CI: 0.24, 0.39), meat or fish (0.44; 95% CI: 0.38, 0.51), dairy (0.44; 95% CI: 0.37, 0.50), and snacks (0.43; 95% CI: 0.36, 0.49). Aspects of the environment that are not shared by 2 twins in a family explained all of the remaining variance in food preferences. CONCLUSIONS Food preferences had a moderate genetic basis in late adolescence, in keeping with findings in children. However, by this older age, the influence of the shared family environment had disappeared, and only aspects of the environment unique to each individual twin influenced food preferences. This finding suggests that shared environmental experiences that influence food preferences in childhood may not have effects that persist into adulthood.
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Cooke L, Llewellyn C. Nature and Nurture in Early Feeding Behavior. NESTLE NUTRITION INSTITUTE WORKSHOP SERIES 2016; 85:155-165. [PMID: 27088343 DOI: 10.1159/000439507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Obesity has reached epidemic proportions and research into its prevention is increasingly focusing on the earliest stages of life. Avidity of appetite has been linked to a higher risk of obesity, but studies in infancy were scarce. The Gemini twin cohort was established to investigate genetic and environmental determinants of weight trajectories in early childhood with a focus on appetite and the home environment. Gemini families have been supplying questionnaire data at regular intervals, starting when the twins were 8 months old. Analyses of data on infant appetite and weight have provided a number of important findings. Firstly, a prospective study found that appetite in infancy drives weight gain more strongly than weight drives appetite, although the two processes do coexist. A further study using a subsample of twins discordant for appetite ruled out the possibility of familial confounding, suggesting a causal role for appetite in weight. Heritability estimates for appetitive traits were moderate to high (53-84%). Finally, multivariate analyses indicated that roughly one third of the genes related to weight are also related to appetite and vice versa. Environmental factors affecting appetite in infancy are understudied, but some potential strategies for minimizing over- or underconsumption by at-risk individuals are suggested.
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Fildes A, van Jaarsveld CHM, Cooke L, Wardle J, Llewellyn CH. Common genetic architecture underlying young children's food fussiness and liking for vegetables and fruit. Am J Clin Nutr 2016; 103:1099-104. [PMID: 26864359 PMCID: PMC4807704 DOI: 10.3945/ajcn.115.122945] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 12/30/2015] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Food fussiness (FF) is common in early childhood and is often associated with the rejection of nutrient-dense foods such as vegetables and fruit. FF and liking for vegetables and fruit are likely all heritable phenotypes; the genetic influence underlying FF may explain the observed genetic influence on liking for vegetables and fruit. Twin analyses make it possible to get a broad-based estimate of the extent of the shared genetic influence that underlies these traits. OBJECTIVE We quantified the extent of the shared genetic influence that underlies FF and liking for vegetables and fruit in early childhood with the use of a twin design. DESIGN Data were from the Gemini cohort, which is a population-based sample of twins born in England and Wales in 2007. Parents of 3-y-old twins (n= 1330 pairs) completed questionnaire measures of their children's food preferences (liking for vegetables and fruit) and the FF scale from the Children's Eating Behavior Questionnaire. Multivariate quantitative genetic modeling was used to estimate common genetic influences that underlie FF and liking for vegetables and fruit. RESULTS Genetic correlations were significant and moderate to large in size between FF and liking for both vegetables (-0.65) and fruit (-0.43), which indicated that a substantial proportion of the genes that influence FF also influence liking. Common genes that underlie FF and liking for vegetables and fruit largely explained the observed phenotypic correlations between them (68-70%). CONCLUSIONS FF and liking for fruit and vegetables in young children share a large proportion of common genetic factors. The genetic influence on FF may determine why fussy children typically reject fruit and vegetables.
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Prabhu S, Mattke AC, Anderson B, McBride C, Cooke L, Karl T, Alphonso N. Repair of congenital diaphragmatic hernia during extracorporeal life support: experience with six neonates. ANZ J Surg 2016; 86:711-6. [PMID: 26990599 DOI: 10.1111/ans.13466] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The management of congenital diaphragmatic hernia (CDH) in neonates has evolved considerably over the last three decades. Initial stabilization followed by surgical repair is the current standard of care. A subset fails to achieve adequate oxygenation with medical management, including the use of high frequency oscillation and inhaled nitric oxide. The mortality in this group exceeds 80% without additional management strategies. Extracorporeal life support (ECLS) is a well-established modality for managing these neonates with CDH and has been shown to improve early survival in selected cases. METHODS This is a retrospective analysis of six neonates with CDH who underwent repair during ECLS between September 2011 and November 2014. RESULTS Of 24 admissions with CDH, there were six neonates (25%) who required ECLS. All the six had CDH repair during ECLS. There were no intra-operative bleeding complications. There were no clotting complications related to stopping heparin during CDH repair. There was one hospital death. Five neonates were weaned from ECLS and discharged home. CONCLUSIONS Data from our small cohort of patients illustrate that early survival is possible in extremely compromised neonates who otherwise would have died without ECLS. Our experience demonstrates that CDH repair can safely be performed during ECLS. Use of ECLS, early repair during ECLS, lung protective ventilation strategies and aggressive management of pulmonary hypertension were associated with good early survival. ECLS should be considered as an integral part of therapeutic armamentarium for CDH in neonates.
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Fildes A, Mallan KM, Cooke L, van Jaarsveld CHM, Llewellyn CH, Fisher A, Daniels L. The relationship between appetite and food preferences in British and Australian children. Int J Behav Nutr Phys Act 2015; 12:116. [PMID: 26381382 PMCID: PMC4574466 DOI: 10.1186/s12966-015-0275-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 09/04/2015] [Indexed: 02/01/2023] Open
Abstract
Background Appetitive traits and food preferences are key determinants of children’s eating patterns but it is unclear how these behaviours relate to one another. This study explores relationships between appetitive traits and preferences for fruits and vegetables, and energy dense, nutrient poor (noncore) foods in two distinct samples of Australian and British preschool children. Methods This study reports secondary analyses of data from families participating in the British GEMINI cohort study (n = 1044) and the control arm of the Australian NOURISH RCT (n = 167). Food preferences were assessed by parent-completed questionnaire when children were aged 3–4 years and grouped into three categories; vegetables, fruits and noncore foods. Appetitive traits; enjoyment of food, food responsiveness, satiety responsiveness, slowness in eating, and food fussiness were measured using the Children’s Eating Behaviour Questionnaire when children were 16 months (GEMINI) or 3–4 years (NOURISH). Relationships between appetitive traits and food preferences were explored using adjusted linear regression analyses that controlled for demographic and anthropometric covariates. Results Vegetable liking was positively associated with enjoyment of food (GEMINI; β = 0.20 ± 0.03, p < 0.001, NOURISH; β = 0.43 ± 0.07, p < 0.001) and negatively related to satiety responsiveness (GEMINI; β = -0.19 ± 0.03, p < 0.001, NOURISH; β = -0.34 ± 0.08, p < 0.001), slowness in eating (GEMINI; β = -0.10 ± 0.03, p = 0.002, NOURISH; β = -0.30 ± 0.08, p < 0.001) and food fussiness (GEMINI; β = −0.30 ± 0.03, p < 0.001, NOURISH; β = -0.60 ± 0.06, p < 0.001). Fruit liking was positively associated with enjoyment of food (GEMINI; β = 0.18 ± 0.03, p < 0.001, NOURISH; β = 0.36 ± 0.08, p < 0.001), and negatively associated with satiety responsiveness (GEMINI; β = −0.13 ± 0.03, p < 0.001, NOURISH; β = −0.24 ± 0.08, p = 0.003), food fussiness (GEMINI; β = -0.26 ± 0.03, p < 0.001, NOURISH; β = −0.51 ± 0.07, p < 0.001) and slowness in eating (GEMINI only; β = -0.09 ± 0.03, p = 0.005). Food responsiveness was unrelated to liking for fruits or vegetables in either sample but was positively associated with noncore food preference (GEMINI; β = 0.10 ± 0.03, p = 0.001, NOURISH; β = 0.21 ± 0.08, p = 0.010). Conclusion Appetitive traits linked with lower obesity risk were related to lower liking for fruits and vegetables, while food responsiveness, a trait linked with greater risk of overweight, was uniquely associated with higher liking for noncore foods. Electronic supplementary material The online version of this article (doi:10.1186/s12966-015-0275-4) contains supplementary material, which is available to authorized users.
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Syrad H, Falconer C, Cooke L, Saxena S, Kessel AS, Viner R, Kinra S, Wardle J. Health and happiness is more important than weight': a qualitative investigation of the views of parents receiving written feedback on their child's weight as part of the National Child Measurement Programme. J Hum Nutr Diet 2015; 28:47-55. [PMID: 26295077 PMCID: PMC4340048 DOI: 10.1111/jhn.12217] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The present study aimed to explore parental perceptions of overweight children and associated health risks after receiving National Child Measurement Programme (NCMP) weight feedback. METHODS Fifty-two parents of overweight and obese children aged 4-5 years and 10-11 years enrolled in the NCMP programme in England in 2010-2011 participated in qualitative, semi-structured interviews about their perceptions of their child's weight and health risk after receiving weight feedback. Interviews were audio tape recorded and were conducted either by telephone (n = 9) or in the respondents' homes (n = 41). Interviews were transcribed verbatim and analysed using interpretative thematic analysis. RESULTS Parents who received NCMP written feedback informing them that their child was overweight disregarded the results because they viewed 'health and happiness as being more important than weight'. The feedback was viewed as less credible because it did not consider the individual child's lifestyle.'Broad definitions of healthy' were described that did not include weight,such as reference to the child having good emotional and physical health and a healthy diet. Parents attributed weight to 'inherited/acquired factors' such as genetics or puppy fat, or did not regard their child's 'appearance' as reflecting being overweight. 'Cultural influence' also meant that being overweight was not viewed negatively by some non-white parents. CONCLUSIONS After receiving written weight feedback, parents use methods other than actual weight when evaluating their child's weight status and health risks. Parents' conceptions of health and weight should be considered when communicating with parents, with the aim of bridging the gap between parental recognition of being overweight and subsequent behaviour change.
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Mahadevan D, Johnson N, Pandey M, Chandler J, Cooke L. Novel mutational profiles in relapsed/refractory advanced cancer patients' pre- and post-targeted therapy. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv097.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Fildes A, van Jaarsveld CHM, Llewellyn CH, Fisher A, Cooke L, Wardle J. Nature and nurture in children's food preferences. Am J Clin Nutr 2014; 99:911-7. [PMID: 24477038 DOI: 10.3945/ajcn.113.077867] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Health professionals identify food provision in the home as a key influence on children's food preferences. In contrast, parents often perceive children's food preferences to be inborn. One explanation for this discrepancy could be that environmental and genetic influences vary by food type. OBJECTIVE We assessed genetic and environmental contributions to preferences for a wide variety of foods in a large pediatric twin sample. DESIGN Data were from Gemini, which is a cohort of UK twins born in 2007. Preferences for 114 foods were assessed by parent-completed questionnaire when children were aged 3 y (n = 2686). Foods tried by >75% of respondents were grouped into protein, vegetables, fruit, dairy, starches, and snacks. Quantitative model-fitting analyses were used to assess genetic and environmental influences for each food group. RESULTS The genetic influence was higher for vegetables (54%; 95% CI: 47%, 63%), fruit (53%; 95% CI: 45%, 61%), and protein (48%; 95% CI: 40%, 57%) but lower for starches (32%; 95% CI: 26%, 38%), snacks (29%; 95% CI: 24%, 35%), and dairy (27%; 95% CI: 20%, 35%). In contrast, shared-environment effects were higher for snacks (60%; 95% CI: 54%, 65%), starches (57%; 95% CI: 51%, 62%), and dairy (54%; 95% CI: 47%, 60%) and lower for vegetables (35%; 95% CI: 27%, 42%), fruit (35%; 95% CI: 26%, 43%), and protein (37%; 95% CI: 27%, 45%). Nonshared environment effects were small for all foods (11-19%). CONCLUSIONS Both genetic and environmental effects were significant for all food groups, but genetic effects dominated for more nutrient-dense foods (vegetables, fruit, and protein), whereas shared environmental effects dominated for snacks, dairy, and starches. These findings endorse the view of health professionals that the home environment is the main determinant of children's liking for energy-dense foods implicated in excessive weight gain but suggest that parents are also correct by identifying innate differences in liking, particularly for nutrient-dense foods that parents and health educators try to encourage.
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Breeze J, Poller DN, Gibson D, Tilley EA, Cooke L, Soar E, Repanos C. Rapid on-site assessment of specimens by biomedical scientists improves the quality of head and neck fine needle aspiration cytology. Cytopathology 2013; 25:316-21. [PMID: 24138590 DOI: 10.1111/cyt.12106] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Immediate rapid on-site assessment (ROSA) of fine needle aspiration cytology (FNAC) specimens by biomedical scientists (BMS), the UK equivalent of cytotechnologists, or by pathologists may improve specimen quality and cellular adequacy rates for lymph node, head and neck and thyroid FNAC. The aim of this study was to evaluate the effect of introducing ROSA by BMS in an outpatient clinic setting. METHODS The adequacy rate and sensitivity of histological diagnosis for lymph node, thyroid and salivary gland FNAC samples were determined before and after the introduction of BMS ROSA. The additional financial costs and time required to perform this service were also estimated. RESULTS Thirty-one patients underwent ultrasound (US)-guided FNAC with ROSA and 151 without. ROSA reduced the number of FNAC insufficient in quality for diagnosis from 43% to 19% (P = 0.0194). The estimated additional cost for pathology per patient for ROSA was between £52.05 and £70.74, equivalent to €65.40/US $83.90 and €88.89/US $114.0, respectively, an increase of between 28% and 49% from the original cost. ROSA necessitated an additional 6 minutes clinic time per patient, reducing the number of patients that could be seen in an average clinic from 13 to 10 as well as requiring increased laboratory time for FNAC slide assessment. CONCLUSION ROSA by suitably trained biomedical scientists and with appropriate consultant pathologist support can improve the quality of FNAC sampling for head and neck lesions. Although ROSA resulted in both additional financial and time costs, these are more than likely to be offset by a reduction in patients returning to clinic for repeat FNAC or undergoing unnecessary surgery.
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Fildes A, van Jaarsveld CH, Wardle J, Cooke L. Parent-administered exposure to increase children's vegetable acceptance: a randomized controlled trial. J Acad Nutr Diet 2013; 114:881-888. [PMID: 24091061 PMCID: PMC4037818 DOI: 10.1016/j.jand.2013.07.040] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 07/18/2013] [Indexed: 12/28/2022]
Abstract
Background Repeated taste exposure, in combination with small rewards, has been shown to increase children's acceptance of disliked foods. However, previous studies have used direct contact with researchers or professionals for the implementation of the repeated exposure procedure. If mailed taste exposure instructions to parents produced comparable outcomes, this could be a cost-effective and easily disseminable strategy to promote healthier diets in children. Objective Our randomized controlled study aimed to test the efficacy and acceptability of mailed materials giving instructions on taste exposure as a means of increasing acceptance of vegetables in preschool-aged children. Design Participants were families of 3-year-old twins from the Gemini cohort who took part between March 2011 and April 2012. Families were randomized to a mailed intervention or a no treatment control condition. The intervention involved offering each child 14 daily tastes of a disliked (target) vegetable with a small reward (a sticker) if the child complied. Main outcome measures Outcomes were the child's intake of the target vegetable (number of pieces) and parent reports of the child's liking at two baseline (T1 and T2) and one postintervention (T3) behavior assessment. Results Record sheets with intake and liking data from T1, T2, and T3 were returned for 472 children, of which 442 were complete (94%). Over the intervention period (T2 to T3) intake and liking of the target vegetable increased significantly more in the intervention group than in the control group (intake: odds ratio 12.05, 95% CI 8.05 to 18.03, P<0.001; liking: odds ratio 12.34, CI 7.97 to 19.12, P<0.001). Acceptability of the procedure was very high among parents who completed the protocol. Conclusions Mailed instructions for taste exposure were effective in increasing children's acceptance of an initially disliked vegetable. These results support the value of parent-administered exposure to increase children's vegetable acceptance, and suggest that it can be carried out without direct health professional contact.
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Watt RG, Draper AK, Ohly HR, Rees G, Pikhart H, Cooke L, Moore L, Crawley H, Pettinger C, McGlone P, Hayter AKM. Methodological development of an exploratory randomised controlled trial of an early years' nutrition intervention: the CHERRY programme (Choosing Healthy Eating when Really Young). MATERNAL AND CHILD NUTRITION 2013; 10:280-94. [PMID: 23795857 PMCID: PMC6860218 DOI: 10.1111/mcn.12061] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Good nutrition in the early years of life is vitally important for a child's development, growth and health. Children's diets in the United Kingdom are known to be poor, particularly among socially disadvantaged groups, and there is a need for timely and appropriate interventions that support parents to improve the diets of young children. The Medical Research Council has highlighted the importance of conducting developmental and exploratory research prior to undertaking full-scale trials to evaluate complex interventions, but have provided very limited detailed guidance on the conduct of these initial phases of research. This paper describes the initial developmental stage and the conduct of an exploratory randomised controlled trial undertaken to determine the feasibility and acceptability of a family-centred early years' nutrition intervention. Choosing Healthy Eating when Really Young (CHERRY) is a programme for families with children aged 18 months to 5 years, delivered in children's centres in one urban (Islington) and one rural (Cornwall) location in the United Kingdom. In the development stage, a mixed-methods approach was used to investigate the nature of the problem and options for support. A detailed review of the evidence informed the theoretical basis of the study and the creation of a logic model. In the feasibility and pilot testing stage of the exploratory trial, 16 children's centres, with a sample of 394 families were recruited onto the study. We hope that the methodology, which we present in this paper, will inform and assist other researchers in conducting community-based, exploratory nutrition research in early years settings.
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