Socioeconomic status and the effect of prolonged pandemic confinement on anthropometric and glycaemic outcomes in adults with type 2 diabetes mellitus

AIM

This systematic review and meta-analysis aimed to investigate the impact of COVID19 lockdown on the anthropometric and glycaemic outcomes of adults with type 2 diabetes mellitus (T2DM) and assess whether socioeconomic status (SES) was relevant to these changes.

METHODS

A search of three databases was conducted. Meta-analyses using random effects models were undertaken to combine anthropometric and glycaemic measures pre- and post-confinement. Subgroup analyses according to SES were also conducted.

RESULTS

This systematic review of 19 articles demonstrated that prolonged pandemic-related confinement is associated with a deterioration in both anthropometric and glycaemic outcomes among adults with T2DM. Furthermore, SES was found to be relevant to these changes. Specifically, BMI (kg/m2) showed an increase in mean difference of 0.72 (95% CI; 0.13, 1.31; p<0.05) between pre and post lockdown cohorts. High income countries displayed a greater increase in BMI compared to their lower middle-income counterparts. Regarding, fasting blood glucose (FBG), a statistically significant difference was observed in the upper middle-income group (mean difference: 5.10; 95% CI: 2.92, 7.27), and high-income group (mean difference: 6.03; 95% CI: 0.04, 12.02). There were no significant changes to weight, waist circumference, or HbA1C over the lockdown period.

CONCLUSION

Our findings suggest adults with T2DM may have received less effective care over the lockdown period, particularly in high income countries. Clinics and care providers may need to adopt more intensive contact and treatment plans in the post lockdown period to prevent lasting impacts on disease progression and metabolic sequelae.

Mushrooms: a food-based solution to vitamin D deficiency to include in dietary guidelines

Vitamin D deficiency and insufficiency is a public health issue, with low dietary vitamin D intakes a contributing factor. Rates of vitamin D deficiency are 31% in Australia, and up to 72% in some regions globally. While supplementation is often prescribed as an alternative to additional sun exposure, complementary approaches including food-based solutions are needed. Yet, food-centric dietary guidelines are not always adequate for meeting vitamin D needs. Edible mushrooms such as Agaricus bisporus can produce over 100% of vitamin D recommendations (10 μg/day, Institute of Medicine) per 75 g serve (18 μg) on exposure to UV-light, with the vitamin D2 produced showing good stability during cooking and processing. However, mushrooms are overlooked as a vitamin D source in dietary guidelines. Our dietary modelling shows that four serves/week of UV-exposed button mushrooms can support most Australian adults in meeting vitamin D recommendations, and UV-exposed mushrooms have been found to increase vitamin D status in deficient individuals. While recent evidence suggests some differences between vitamin D2 and vitamin D3 in physiological activities, vitamin D2 from mushrooms can be part of a larger solution to increasing dietary vitamin D intakes, as well as an important focus for public health policy. Mushrooms exposed to UV represent an important tool in the strategic toolkit for addressing vitamin D deficiency in Australia and globally. Health authorities lead the recognition and promotion of mushrooms as a natural, vegan, safe, and sustainable vitamin D food source.

Efficacy of anti-VEGF monotherapy versus anti-VEGF therapy with subthreshold micropulse laser (SML) in the management of diabetic macular oedema (DMO): a systematic review and meta-analysis

BACKGROUND

Intravitreal injection anti-vascular endothelial growth factor (IVI anti-VEGF) therapy serves as the primary treatment for centre involving diabetic macular oedema (DMO). Conventional laser therapy (CLT) adjunct has proven beneficial; however, it is not widely used due to significant risks of retinal scarring. Subthreshold micropulse laser (SML) therapy has, however, emerged as a comparable alternative to combination therapy, offering a distinct advantage by mitigating the risk of retinal scarring.

METHODS

A search of six databases was conducted. A meta-analysis of mean differences was performed including subgroup analyses where appropriate. Primary outcome was the number of injections at 12-14 months; secondary outcomes were changes in central macular thickness (CMT) and best corrected visual acuity (BCVA) at 6-8 months and 12-14 months.

RESULTS

A total of ten papers including six randomised clinical trials and four retrospective clinical studies were included in our study, capturing 563 eyes of 478 patients. Overall, the risk of bias was moderate for these studies. Significantly fewer anti-VEGF therapy injections were administered in the combination therapy versus anti-VEGF monotherapy patients at 12-14 months who had poor visual acuity (6/18 Snellen or worse) at baseline, mean difference - 2.25 (95% CI; - 3.35, - 1.15; p < 0.05). Combination therapy was not associated with significantly fewer intravitreal injections in patients with a higher visual acuity (6/15 Snellen or better) at baseline. Our analysis also showed significant improvements to both BCVA and CMT were reached at 6 - 8 month post-baseline at the 95% confidence intervals: - 1.13 (- 2.09, - 0.16) and - 4.04 (- 7.59, - 0.50). These improvements remained statistically significant at 12-14 months: - 0.94 (- 1.67, - 0.20) and - 1.92 (- 3.52, - 0.32) respectively with combination therapy.

CONCLUSION

Our findings demonstrate that combination therapy (SML + IVI anti-VEGF) is associated with fewer intravitreal injections. We report a better BCVA and a reduction in CMT at 6 and 12 months from baseline with combination treatment compared to the IVI anti-VEGF monotherapy comparator. SML is a proven non-scarring cost-effective therapy for DMO that should be readily available in the medical retinal therapy as it may reduce the burden of care.

Does incorporating high intensity interval training in physical education classes improve fitness outcomes of students? A cluster randomized controlled trial

The aim of this study was to determine the efficacy of a high intensity interval training (HIIT) intervention lasting 12 weeks on fitness (cardiorespiratory fitness, muscular strength, muscular endurance, power, speed, flexibility, and balance) and adiposity of 10- to 15-year-old students implemented during their physical education (PE). The focus of this study was to compare two approaches to increasing fitness level among school-aged children, one approach focusing on regular PE sessions in accordance with the curriculum and another one on regular PE classes augmented by HIIT. A cluster-randomized controlled trial was conducted (February-May 2022, Zagreb, Croatia). The total number of students across both groups was 207. General linear models were used to compare fitness and adiposity changes in both groups based on Eurofit test battery. A significant effect of the HIIT intervention was present for the 20-meter shuttle run test (p = 0.001; d = 0.31). The effect of the intervention compared to the control was estimated as an additional 181.2 m, 95 %CI (70.4 to 292.0). An additional intention-to-treat (ITT) analysis showed that the effect of the HIIT intervention on 20-meter shuttle run test remained statistically significant (p = 0.011), though the magnitude of the estimated effect was reduced from 181.2 m; SE = 55.4 to 119.6 m; SE = 46.4. Whilst it appears HIIT had the opposite of the expected effect on body fat percentiles, the effect on body composition was inconsistent. The intervention is registered at the Australian New Zealand Clinical Trials Registry (ANZCTR) [ACTRN12622000209796].

Relationship between discretionary food intake and sex, body image, health, and geographical remoteness among Indigenous Australian adolescents

AIM

Determine the discretionary energy intake of Indigenous Australian adolescents and its relationship with sex, body image, health, and geographical remoteness.

METHODS

Cross-sectional data from the 2012 to 2013 National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (n = 264, 15-17 years). Dietary data were collected using an Automated Multiple-Pass Method, anthropometric data by trained interviewers; self-perceived measures of body weight, level of satisfaction with current weight, and self-assessed health were self-reported. General linear models were used to investigate predictors.

RESULTS

Discretionary energy intake contributed 35.4% and 54.2% of total energy intake for males and females, respectively, primarily from the sub-groups: soft drinks; pastries; potatoes; sugar, honey and syrups; cordials; and potato snacks. Discretionary energy intake was associated with higher energy intake (p < 0.001) and self-perceived body weight (p = 0.022), while sex had significant interactions with self-assessed health (p_sex  = 0.005), satisfaction with current weight (p_sex  < 0.001), and geographical remoteness (p_sex  = 0.007). Contribution of discretionary energy intake to total energy intake was greatest for males with an increased risk of metabolic complications (50% vs. 37%; p > 0.05), those who perceived themselves to be overweight (56% vs. 27%; p < 0.001), and those who were dissatisfied with their weight (56% vs. 19%; p < 0.001), compared to females. No differences were found by dieting status, risk of metabolic complications, and under-reporting of energy intake.

CONCLUSIONS

Discretionary energy intake was excessive among Indigenous Australian adolescents and had relationships with self-perceived health, weight satisfaction, and geographical remoteness, which was moderated by sex. To successfully reduce discretionary food intake among Indigenous Australian adolescents, further research is required to develop sex specific and culturally appropriate strategies.

Patterns of discretionary food intake among Australian children and their association with socio-demographic, lifestyle, and adiposity measures

AIM

Australian children consume 35% of energy from discretionary food and beverages which increases their risk of non-communicable diseases like type 2 diabetes. Despite this concerning statistic, broad analysis of the profile of discretionary food intake has not been fully undertaken. This study asks: what is the discretionary food and beverage intake profile, contribution to nutrient intakes, and associations with demographic and health characteristics?

METHODS

Cross-sectional data from the 2011-12 National Nutrition and Physical Activity Survey (n = 2812, 2-18 years) were used to profile discretionary food consumption. Dietary intake was assessed by 24-h recall. General linear models tested the difference in respondent characteristics by age group, sex, and quartiles of discretionary food energy contribution.

RESULTS

Ninety-nine percent of respondents consumed discretionary foods, 74% exceeded the maximum discretionary food recommended serves. Among 10 eating occasions available to select: snack, dinner, lunch and morning tea appeared to contribute 76% of discretionary food energy, with snack and dinner contributing 24% each. Age and frequency of discretionary food consumption were positively associated with energy intake from discretionary foods (p < 0.001); while sex, socio-economic status, physical activity and body composition had no association. High discretionary food consumers chose specific discretionary food items in a large quantity (1.0-3.5-serves/discretionary food) compared to low discretionary food consumers (0.4-1.4-serves/discretionary food).

CONCLUSIONS

Nearly all Australian children and adolescents consumed discretionary food daily. No demographic or anthropometric characteristics beyond increasing age were associated with higher discretionary food. Targeted public health policy and community interventions are required to focus on addressing the largest contributors to discretionary food intake in terms of equivalent serve sizes, popularity, and eating occasion.

Using artificial intelligence for personal protective equipment guidance for healthcare workers in the COVID-19 pandemic and beyond

Background Current procedures for effective personal protective equipment (PPE) usage rely on the availability of trained observers or ‘buddies’ who, during the COVID-19 pandemic, are not always available. The application of artificial intelligence (AI) has the potential to overcome this limitation by assisting in complex task analysis. To date, AI use for PPE protocols has not been studied. In this paper we validate the performance of an AI PPE system in a hospital setting. Methods A clinical cohort study of 74 healthcare workers (HCW) at a 144-bed University teaching hospital. Participants were recruited to use the AI system for PPE donning and doffing. Performance was validated by the current gold standard double-buddy system across seven donning and ten doffing steps based on local infection control guidelines. Results The AI-PPE platform was 98.9% sensitive on doffing and 85.3% sensitive on donning, when compared to remediated double buddy. On average, buddy correction of PPE was required 3.8 ± 1.5% of the time. The average time taken to don was 240 ± 51.5 seconds and doff was 241 ± 35.3 seconds. Conclusion This study demonstrates the ability of an AI model to analyse PPE donning and doffing with real-time feedback for remediation. The AI platform can identify complex multi-task PPE donning and doffing in a single validated system. This AI system can be employed to train, audit, and thereby improve compliance whilst reducing reliance on limited HCW resources. Further studies may permit the development of this educational tool into a medical device with other industry uses for safety.

Safety and tolerance assessment of milk fat globule membrane-enriched infant formulas in healthy term Chinese infants: a randomised multicenter controlled trial

Background

Milk fat globule membrane (MFGM), natural to breast milk, is essential for neonatal development, but lacking from standard infant formulas.

Objectives

To evaluate the safety and tolerability of MFGM supplementation in formula for infants 0 to 12 months.

Methods

In a prospective, multicentre, double-blind, randomized trial, healthy term infants were randomized to a standard formula (SF, n = 104) or an MFGM-enriched formula (MF, n = 108) for 6 months and a corresponding follow-on formula until 12 months. Exclusively breast-fed infants (n = 206) were recruited as the reference group (BFR). Tolerance and safety events were recorded continuously. Anthropometric measurements were assessed at enrolment, 42 days and 4, 6, 8 and 12 months.

Results

Infants (n = 375) completed the study with average dropout of < 20%. Stool frequency, color, and consistency between SF and MF were not significantly different throughout, except the incidence of loose stools in MF at 6 months being lower than for SF (odds ratio 0.216, P < 0.05) and the frequency of green-colored stools at 12 months being higher in MF (CI 95%, odds ratio 8.92, P < 0.05). The BFR had a higher frequency of golden stools and lower rate of green stools (4–6 months) than the two formula-fed groups (P < 0.05). SF displayed more diarrhoea (4.8%) than MF (1%) and BFR (1%) at the 8-month visit (P < 0.05). BFR (0–1%) had significantly less (P < 0.05) lower respiratory infections than MF (4.6–6.5%) and SF (2.9–5.8%) at 6- and 8-months, respectively. Formula intake, frequency of spit-up/vomiting or poor sleep were similar between SF and MF. Growth rate (g/day) was similar at 4, 6, 8 and 12 months between the 3 groups, but growth rate for BFR was significantly higher than for SF and MF at 42 days (95% CI, P = 0.001).

Conclusions

MFGM-enriched formula was safe and well-tolerated in healthy term infants between 0 and 12 months, and total incidences of adverse events were similar to that for the SF group. A few differences in formula tolerance were observed, however these differences were not in any way related to poor growth.

Efficacy and safety of endoscopic sleeve gastroplasty and laparoscopic sleeve gastrectomy with 12+ months of adjuvant multidisciplinary support

Background

The laparoscopic sleeve gastrectomy (LSG) and the incisionless endoscopic sleeve gastroplasty (ESG) weight loss procedures require further investigation of their efficacy, safety and patient-centered outcomes in the Australian setting.

Methods

The aim was to examine the 6- and 12-month weight loss efficacy, safety, and weight-related quality of life (QoL) of adults with obesity who received the ESG or LSG bariatric procedure with 12+ months of adjuvant multidisciplinary pre- and postprocedural support. Data were from a two-arm prospective cohort study that followed patients from baseline to 12-months postprocedure from a medical center in Queensland. Percent excess weight loss (%EWL) was the primary outcome. Secondary outcomes were body composition (fat mass, fat-free mass, android:gynoid ratio, bone mineral content) via dual energy X-ray absorptiometry, weight-related QoL, lipid, glycemic, and hepatic biochemistry, and adverse events.

Results

16 ESG (19% attrition; 81.2% female; aged:41.4 (SD: 10.4) years; BMI: 35.5 (SD: 5.2) kg/m²) and 45 LSG (9% attrition; 84.4% female; aged:40.4 (SD: 9.0) years; BMI: 40.7 (SD: 5.6) kg/m²) participants were recruited. At 12-months postprocedure, ESG %EWL was 57% (SD: 32%; p < 0.01) and LSG %EWL was 79% (SD: 24%; p < 0.001). ESG and LSG cohorts improved QoL (19.8% in ESG [p > 0.05]; 48.1% in LSG [p < 0.05]), liver function (AST: − 4.4 U/L in ESG [p < 0.05]; − 2.7 U/L in LSG [p < 0.05]), HbA1c (− 0.5% in ESG [p < 0.05]; − 0.1% in LSG [p < 0.05]) and triglycerides (− 0.6 mmol/L in ESG [p > 0.05]; − 0.4 mmol/L in LSG [P < 0.05]) at 12-months. Both cohorts reduced fat mass (p < 0.05). The ESG maintained but LSG decreased fat-free mass at 6-months (p < 0.05); and both cohorts lost fat-free mass at 12-months (p < 0.05). There were no adverse events directly related to the procedure. The ESG reported 25% mild-moderate adverse events possibly related to the procedure, and the LSG reported 27% mild-severe adverse events possibly related to the procedure.

Conclusions

In this setting, the ESG and LSG were safe and effective weight loss treatments for obese adults alongside multidisciplinary support. Patients who elected the ESG maintained fat-free mass at 6-months but both cohorts lost fat-free mass at 12-months postprocedure. Patients who elected the LSG had large and significant improvements to weight-related quality of life. Further well-powered studies are required to confirm these findings.

Trial registration

This study was registered prospectively at the Australia New Zealand Clinical Trials Registry on 06/03/2018, Registration Number ACTRN12618000337279.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01629-7.

Neurodevelopmental outcomes of healthy Chinese term infants fed infant formula enriched in bovine milk fat globule membrane for 12 months - A randomized controlled trial

BACKGROUND AND OBJECTIVES

Human milk fat globule membrane (MFGM) has multifunctional health benefits. We evaluated neurodevelopment and growth of healthy term infants fed bovine milk-derived MFGM-enriched formula (MF) over 12 months.

METHODS AND STUDY DESIGN

A prospective, multi-center, double-blind, randomized trial was conducted in Fuzhou, China. Healthy term infants (n=212), aged <14 days, were assigned randomly to be fed MF or a standard formula (SF) for 6 months and then switched to stage 2 MF and SF formula until 12 months. A reference group (n=206) contained healthy breastfed infants (BFR). Neurodevelopment was assessed with Bayley-III Scales.

RESULTS

At 12 months, the composite social emotional (+3.5) and general adaptive behaviour (+5.62) scores were significantly higher in MF than SF (95% CIs 0.03 to 6.79 and 1.78 to 9.38; p=0.048 and 0.004, respectively). Mean cognitive (+2.86, 95% CIs -1.10 to 6.80, p=0.08), language (+0.39, 95% CIs -2.53 to 3.30, p=0.87) and motor (+0.90, 95% CIs -2.32 to 4.13, p=0.49) scores tended to be higher in MF than SF, but the differences between the two groups were not significant. BFR scored higher on Bayley-III than either MF or SF at 6 and 12 months. Cognitive scores were significantly higher in BFR than SF (95% CI 0.05 to 7.20; p=0.045), but not MF (p=0.74) at 6 months. Short-term memory was significantly higher in MF than SF at 12 months (95% CI 1.40 to 12.33; p=0.002). At 4 months, serum gangliosides were significantly higher in MF and BFR than SF (95% CI 0.64 to 13.02; p=0.025). Milk intake, linear growth, body mass and head circumference were not significantly different between formula-fed groups.

CONCLUSIONS

MFGM supplementation in early life supports adequate growth, increased serum gangliosides concentration and improves some measures of cognitive development in Chinese infants.

Nutrient Dense, Low-Cost Foods Can Improve the Affordability and Quality of the New Zealand Diet-A Substitution Modeling Study

The high prevalence of non-communicable disease in New Zealand (NZ) is driven in part by unhealthy diet selections, with food costs contributing to an increased risk for vulnerable population groups. This study aimed to: (i) identify the nutrient density-to-cost ratio of NZ foods; (ii) model the impact of substituting foods with a lower nutrient density-to-cost ratio with those with a higher nutrient density-to-cost ratio on diet quality and affordability in representative NZ population samples for low and medium socioeconomic status (SES) households by ethnicity; and (iii) evaluate food processing level. Foods were categorized, coded for processing level and discretionary status, analyzed for nutrient density and cost, and ranked by nutrient density-to-cost ratio. The top quartile of nutrient dense, low-cost foods were 56% unprocessed (vegetables, fruit, porridge, pasta, rice, nuts/seeds), 31% ultra-processed (vegetable dishes, fortified bread, breakfast cereals unfortified <15 g sugars/100 g and fortified 15-30 g sugars/100 g), 6% processed (fruit juice), and 6% culinary processed (oils). Using substitution modeling, diet quality improved by 59% and 71% for adults and children, respectively, and affordability increased by 20-24%, depending on ethnicity and SES. The NZ diet can be made healthier and more affordable when nutritious, low-cost foods are selected. Processing levels in the healthier, modeled diet suggest that some non-discretionary ultra-processed foods may provide a valuable source of low-cost nutrition for food insecure populations.

Diet and Economic Modelling to Improve the Quality and Affordability of the Australian Diet for Low and Medium Socioeconomic Households

Food costs are a barrier to healthier diet selections, particularly for low socioeconomic households who regularly choose processed foods containing refined grains, added sugars, and added fats. In this study, the objectives were to: (i) identify the nutrient density-to-cost ratio of Australian foods; (ii) model the impact of substituting foods with lower nutrient density-to-cost ratio with those with the highest nutrient density-to-cost ratio for diet quality and affordability in low and medium socioeconomic households; and (iii) evaluate food processing levels. Foods were categorized, coded for processing level, analysed for nutrient density and cost, and ranked by nutrient density-to-cost ratio. The top quartile of nutrient dense, low-cost foods included 54% unprocessed (vegetables and reduced fat dairy), 33% ultra-processed (fortified wholegrain bread and breakfast cereals <20 g sugars/100 g), and 13% processed (fruit juice and canned legumes). Using substitution modelling, diet quality improved by 52% for adults and 71% for children across all households, while diet affordability improved by 25% and 27% for low and medium socioeconomic households, respectively. The results indicate that the quality and affordability of the Australian diet can be improved when nutritious, low-cost foods are selected. Processing levels in the healthier modelled diets suggest that some ultra-processed foods may provide a beneficial source of nutrition when consumed within national food group recommendations.

Australian Orthodontists Utilization and Attitude Toward a Government Funded Cleft Scheme

OBJECTIVES

To (1) survey Australian orthodontists about their involvement with a government-funded scheme for patients with clefts, the Medicare Cleft Lip and Cleft Palate Scheme (MCLCPS) and (2) investigate their attitude toward treating patients with clefts and their training in this respect.

DESIGN

A 13-question online survey was distributed to members of the Australian Society of Orthodontists. The survey gathered information regarding respondent demographics, the number of MCLCPS-eligible patients seen in the past 12 months and usual billing practices.

RESULTS

A total of 96 complete responses were obtained. About 70% of respondents had treated MCLCPS-eligible patients in the past 12 months and 55% saw between 2 and 5 patients during this time. The likelihood of treating patients with clefts increased by a factor of 4.8 (95% CI: 1.2-18.9) if practicing outside of a capital city and 1.5 times for each decade increase in orthodontist's age (95% CI: 1.0-2.2). The MCLCPS was utilized by 81% of orthodontists with 26% of these respondents accepting rebate only. Most orthodontists felt their university training could have better prepared them to treat patients with clefts. A minority of orthodontists felt that a rebate increase would make them more likely to treat these patients.

CONCLUSIONS

Australian orthodontists who treat patients with clefts tend to be older and work outside of capital cities. The decision to treat these patients tends to not be financially motived. Specialty orthodontic training programs could improve the preparedness of their graduates to treat patients with clefts.

An Analysis of the Mineral Composition of Pink Salt Available in Australia

Little is known about the mineral composition of pink salt. The aim of this study was to evaluate for the first time the mineral composition of pink salt available for purchase in Australia and its implications for public health. Pink salt samples were purchased from retail outlets in two metropolitan Australian cities and one regional town. Color intensity, salt form, and country of origin were coded. A mass spectrometry scan in solids was used to determine the amount of 25 nutrients and non-nutritive minerals in pink salt (n = 31) and an iodized white table salt control (n = 1). A wide variation in the type and range of nutrients and non-nutritive minerals across pink salt samples were observed. One pink salt sample contained a level of lead (>2 mg/kg) that exceeded the national maximum contaminant level set by Food Standards Australia New Zealand. Pink salt in flake form, pink salt originating from the Himalayas, and darker colored pink salt were generally found to contain higher levels of minerals (p < 0.05). Despite pink salt containing nutrients, >30 g per day (approximately 6 teaspoons) would be required to make any meaningful contribution to nutrient intake, a level that would provide excessive sodium and potential harmful effects. The risk to public health from potentially harmful non-nutritive minerals should be addressed by Australian food regulations. Pink salt consumption should not exceed the nutrient reference values for Australia and New Zealand guidelines of <5 g of salt per day.

Singing as an adjunct therapy for children and adults with cystic fibrosis

BACKGROUND

Cystic fibrosis is a genetically inherited, life-threatening condition that affects major organs. The management of cystic fibrosis involves a multi-faceted daily treatment regimen that includes airway clearance techniques, pancreatic enzymes and other medications. Previous studies have found that compliance with this intensive treatment is poor, especially among adolescents. Because of both the nature and consequences of the illness and the relentless demands of the treatment, many individuals with cystic fibrosis have a poor quality of life. Anecdotal reports suggest that singing may provide both appropriate exercise for the whole respiratory system and a means of emotional expression which may enhance quality of life. This is an update of a previously published review.

OBJECTIVES

To evaluate the effects of singing as an adjunct therapy to standard treatment on the quality of life, morbidity, respiratory muscle strength and pulmonary function of children and adults with cystic fibrosis.

SEARCH METHODS

We searched the Group's Cystic Fibrosis Trials Register and the Cochrane Central Register of Controlled Trials. Date of latest search: 07 January 2019.We also searched major allied complementary data bases, and clinical trial registers. Additionally, we handsearched relevant conference proceedings and journals. Date of latest search: 28 March 2019.

SELECTION CRITERIA

Randomised controlled trials in which singing (as an adjunct intervention) is compared with either a control intervention (for example, playing computer games or doing craft activities) or no singing in people with cystic fibrosis.

DATA COLLECTION AND ANALYSIS

Results of searches were reviewed against pre-determined criteria for inclusion. Only one eligible trial was available for analysis.

MAIN RESULTS

Since only one small study (n = 40) was included, no meta-analysis could be performed. The included randomised controlled study was of parallel design and undertaken at two paediatric hospitals in Australia. The study evaluated the effects of a singing program on the quality of life and respiratory muscle strength of hospitalised children with cystic fibrosis (mean age 11.6 years, 35% male). While the singing group received eight individual singing sessions, the control group participated in preferred recreational activities, such as playing computer games or watching movies. This study was limited by a small sample size (51 participants) and a high drop-out rate (21%). There were no differences between the groups at either post-intervention or follow-up; although by the end of treatment there were some improvements in some of the domains of the quality of life questionnaire Cystic Fibrosis Questionnaire-Revised (e.g. emotional, social and vitality domains) for both singing and control groups. For the respiratory muscle strength indices, maximal expiratory pressure at follow-up (six to eight weeks post-intervention) was higher in the singing group, mean difference 25.80 (95% confidence interval 5.94 to 45.66). There was no difference between groups for any of the other respiratory function parameters (maximal inspiratory pressure, spirometry) at either post-intervention or follow-up. No adverse effects were observed in the singing group; adverse events for the control group were not reported in the paper.

AUTHORS' CONCLUSIONS

There is insufficient evidence to determine the effects of singing on quality of life or on the respiratory parameters in people with cystic fibrosis. However, there is growing interest in non-medical treatments for cystic fibrosis and researchers may wish to investigate the impact of this inexpensive therapy on respiratory function and psychosocial well-being further in the future.

Australian children and adolescents who were drinkers of plain and flavored milk had the highest intakes of milk, total dairy, and calcium

Dairy is important for children and adolescents' bone development and nutritional needs, and it is not known how the type of milk consumed relates to overall dietary intakes. This study assessed the hypothesis that Australian children and adolescents who drink milk have greater milk, dairy, and micronutrient intakes compared to those who consume milk in other ways or avoid milk. A secondary analysis using day 1 data from the 2011-2012 National Nutrition and Physical Activity Survey was performed (n = 2812, 2-18 years). Children were classified as plain or flavored milk drinkers, other milk drinkers (eg, smoothies, milkshakes), nondrinkers of milk (eg. on cereal), or milk avoiders. Intakes of total dairy, milk, calcium, free sugars, and sugar-sweetened beverages were determined and adjusted for confounders. Milk consumption was popular (81%), and the majority (63%) of milk consumers were drinkers, and of those, 46% were plain, 32% were flavored, and 21% were other milk drinkers. Flavored and plain milk drinkers had higher total daily milk (480, 95% confidence interval [CI] 459-501 and 445, 95% CI 427-462 g, respectively), dairy (2.8, 95% CI 2.7-2.9 and 2.6, 95% CI 2.5-2.7 servings, respectively), and calcium (1049 ± 18 and 980 ± 15 mg, respectively) intakes than all other groups. Plain milk drinkers (10.7%, SD 6.2%) had a lower proportion of daily energy from free sugars than all other groups, but there was no difference in free sugars intake between plain and flavored milk drinkers, and there were no differences in anthropometric measures across groups. Plain and flavored milk drinkers and nondrinkers of milk had the lowest prevalence of sugar-sweetened beverages intake (P < .001). Plain milk drinkers followed by flavored milk drinkers had the most favorable milk, dairy, and nutrient intakes.

Simultaneous analysis of neopterin, kynurenine and tryptophan by amine-HPLC shows minor oxidative stress from short-term exhaustion exercise

Introduction: Neopterin, kynurenine and tryptophan can be used to measure activation of monocytes and macrophages during immunological events such as exercise inducing inflammation. Endurance exercise and high-impact sports have shown significant increases in these biomarkers. Measurement is typically conducted by high-performance liquid chromatography (HPLC) using C18 or SCX columns. However, kynurenine and tryptophan are not measured simultaneously to neopterin using these separation systems. Here we have used an amine column for separation and simultaneous determination of neopterin, kynurenine and tryptophan.

Methods: Optimization and validation for the amine-HPLC method was conducted using plasma from 43 participants subjected to a short maximal exercise bicycling regime or rest period. The order of exercise and rest was randomized and separated by a 3-5 week washout period.

Results: Using an amine column developed with ammonium acetate formic acid (33%) and acetonitrile (72%) provided optimal separation and run time for analysis. Neopterin increased significantly post-exercise and subsided to baseline by 30 minutes. Total neopterin remained elevated until 60 minutes following exercise.

Conclusion: Amine-HPLC can be used for simultaneous determination of kynurenine, tryptophan and neopterin in plasma. Short intense exercise causes a significant increase in plasma neopterin suggesting a prolonged activation of monocytes and macrophages.

Breakfast Choice Is Associated with Nutrient, Food Group and Discretionary Intakes in Australian Adults at Both Breakfast and the Rest of the Day

Breakfast choice is correlated with daily nutrient intakes, but this association may not be solely explained by the breakfast meal. We profiled breakfast consumer groups among Australian adults and compared the role that breakfast versus the rest of the day had on daily intakes of the Five Food Groups, discretionary foods, and nutrients. Breakfast groups were breakfast cereal consumers, non-cereal breakfast consumers, and breakfast skippers. One-day dietary recall data from the 2011⁻2012 National Nutrition and Physical Activity Survey were analysed (n = 9341, ≥19 years), as well as socio-demographic and anthropometric measures. Twelve per cent of adults were breakfast skippers, 41% were breakfast cereal consumers, and 47% were non-cereal breakfast consumers. Females were more likely to have a non-cereal breakfast than males, and the non-cereal breakfast was predominantly bread-based. Breakfast skipping decreased with age (p < 0.001), while breakfast cereal consumption increased with age (p < 0.001). Breakfast skippers were more likely to be male, had a lower socio-economic status, and lower physical activity levels (p < 0.001). Breakfast skippers had the highest mean body mass index (BMI) and waist circumference (p < 0.001), the lowest intake of wholegrain foods, fruits and vegetables, and the highest intake of discretionary foods (p < 0.001). Breakfast cereal consumers had the lowest mean BMI and waist circumference (p < 0.001) and had healthier diets at both breakfast and throughout the rest of the day. They were the most likely to meet the daily recommended serves for grain foods, fruit, dairy, and vegetables, had the highest wholegrain food intake, and the lowest discretionary intake (p < 0.001). Additionally, breakfast cereal consumers had the most favourable daily nutrient intakes, including the lowest added sugars intakes. Differences in daily diet between breakfast groups were attributed to differences in food choices both at breakfast and throughout the rest of the day.

The effect of low-level laser therapy on orthodontically induced root resorption: a pilot double blind randomized controlled trial

Background

The effect of low-level laser therapy (LLLT) on accelerating orthodontic tooth movement has been extensively studied; however, there is limited knowledge on the use of LLLT on orthodontic root resorption.

Objective

To investigate the effect of LLLT on orthodontically induced inflammatory root resorption (OIIRR) and to compare the difference between pulsed and continuous LLLT on OIIRR.

Trial design

Double-blind, single-centre 3-arm parallel split-mouth randomized controlled trial.

Participants

Twenty adolescent patients who required bilateral maxillary first premolar (MFP) orthodontic extractions were recruited from the Sydney Dental Hospital between October 2014 and December 2014.

Intervention

All MFPs were tipped buccally for 28 days to induce OIIRR. The experimental premolars (n = 20) received LLLT and the control premolars (n = 20) received placebo-laser on days 0, 1, 2, 3, 7, 14, and 21. Ten experimental premolars received LLLT via continuous delivery and 10 received pulsed delivery.

Laser parameter

AlGaAs diode laser of 808 nm wavelength, 0.18 W power, 1.6 J per point, and duration of 9s for continuous mode and 4.5 s for pulsed mode.

Outcome

The difference in root resorption crater volume between LLLT and placebo-laser and continuous or pulsed laser delivery after 28 days.

Randomization

Randomization was computer-generated, with allocation concealment by opaque sequentially numbered sealed envelopes.

Blinding

The participants and operator were blinded.

Results

Eighty-eight patients were screened and 20 patients were randomized. Forty premolars were analysed. LLLT resulted in 23 per cent less root resorption compared to the placebo (P = 0.026). Pulsed laser delivery resulted in 5 per cent less root resorption than continuous; however, this was not statistically significant (P = 0.823). No harm was observed.

Conclusion

Teeth treated with LLLT had less total root resorption than placebo-laser. Furthermore, there was minimal difference between pulsed or continuous delivery of LLLT.

Trial Registration

Clinical Trials Registry (ACTRN12616000829415).

Protocol

The protocol was not published before trial commencement.

The extent of root resorption and tooth movement following the application of ascending and descending magnetic forces: a prospective split mouth, microcomputed-tomography study

Objective

Various factors have been examined in the literature in an attempt to reduce the incidence and severity of root resorption. The purpose of the present investigation is to test the null hypothesis that there is no difference in relation to force level using gradually increasing (ascending) and decreasing (descending) orthodontic force generated by magnets on the severity of Orthodontically Induced Inflammatory Iatrogenic Root Resorption (OIIRR) and amount of tooth movement.

Methods

Twenty maxillary first premolars from 10 patients were subjected to ascending (25-225 g, magnets in attraction) and descending (225 to 25 g, magnets in repulsion) buccal forces using a split mouth design over an 8-week period. Polyvinyl siloxane impressions were taken at week 0, 4, and 8 to record the tooth movement. After 8 weeks, the teeth were extracted, scanned, with micro-CT in 16.9 µm resolution, and the root resorption craters were localized circumferentially and quantified at each level of the root.

Results

The total volume of OIIRR with ascending force was 1.20 mm3, and with descending force was 1.25 mm3, and there was no statistically significant difference between them. OIIRR on the palatal surface (0.012 mm3) was significantly less than on the buccal surface (0.057 mm3) and than on the mesial surface (0.035 mm3). There is no statistically significant difference in the degree of OIIRR between different level of the root (cervical, middle, and apical) at different surfaces. Moreover, the amount of tooth movement, at 0-, 4-, and 8-week interval, secondary to an ascending and descending force application was not statistically significant.

Conclusions

There is no short-term (8 weeks) statistically significant difference between orthodontic ascending and descending forces, from 25 to 225 g and from 225 to 25 g, respectively, in term of severity and location of OIIRR as well as the amount of tooth movement. The buccal surface of the root showed highest degree of OIIRR compared to other root's surfaces.

Zinc status at baseline is not related to acute changes in serum zinc concentration following bouts of running or cycling

Zinc status is implicated in physiological functions related to exercise performance and physical activity. We have previously demonstrated significant changes in serum zinc concentrations following a bout of aerobic exercise, suggestive of a relationship between zinc metabolism and exercise-related functions. In the present study, we aim to determine the association between pre-exercise serum zinc concentration and immediate changes in serum zinc concentration following an aerobic exercise bout. We have previously conducted a systematic literature search of PubMed, Web of Science, Scopus and SPORTDiscus, for studies that investigated the acute effects of aerobic exercise on zinc biomarkers. In the current study, we undertook a secondary analysis using mixed effects meta-regression modelling to determine the relationship between baseline serum zinc concentration and the change in serum zinc concentration immediately after exercise. Meta-regression models revealed no significant relationship between baseline serum zinc concentration and the change in serum zinc concentration following a bout of exercise when all comparisons were included (slope -0.11 ± 0.07 [standard error]; P > 0.05). When comparisons were stratified by exercise modality, no significant relationships were observed for exercise bouts involving cycling or running. The current analyses were limited by the available literature and low statistical power of the meta-regression models. Based on the current available data, the present analysis revealed limited evidence for a relationship between pre-exercise serum zinc concentration and immediate changes in serum zinc levels following a bout of aerobic exercise. Subgroup meta-regression analyses stratified by the mode of exercise bouts did not differ from the overall results. This suggests that zinc status at baseline is not related to acute changes in serum zinc concentration following bouts of aerobic exercise.

Lower Serum Zinc Concentration Despite Higher Dietary Zinc Intake in Athletes: A Systematic Review and Meta-analysis

BACKGROUND

Zinc is an essential trace element that has been implicated in numerous biological functions, including immunity, energy metabolism and antioxidative processes. Recent evaluations of the literature have provided evidence of significant acute changes in zinc metabolism following a bout of aerobic exercise.

OBJECTIVE

The aim of this study was to determine the zinc status of trained athletes compared with control populations, as described in cross-sectional studies.

DESIGN

We conducted a systematic literature search of the PubMed, Scopus, SPORTDiscus and Cochrane Library electronic databases from inception to 28 January 2016 to identify cross-sectional studies that determined the zinc status of athletes compared with a control population. Meta-analysis of the differences in serum zinc concentration and dietary zinc intake between groups were conducted.

RESULTS

Twelve studies were included in the systematic review. Of the included studies, nine and eight studies provided sufficient data for the meta-analysis of serum zinc concentration and dietary zinc intake, respectively. Serum zinc concentration was significantly lower in athletes [- 0.93 μmol/L, 95% confidence interval (CI) - 1.62 to - 0.23] despite significantly higher dietary zinc intake compared with the control population (2.57 mg/day, 95% CI 0.97-4.16). Data on erythrocyte and urinary zinc from the included studies were insufficient for meta-analysis.

CONCLUSIONS

Despite higher total dietary zinc intake, athletes generally have lower serum zinc concentration, which suggests that athletes have higher requirement of zinc than those who are physically inactive. Further investigations of zinc metabolism during exercise and dietary zinc requirement in active populations are needed to establish evidence-based recommendations.

The physiologic and phenotypic significance of variation in human amylase gene copy number

Background

Salivary α-amylase gene (AMY1) copy number (CN) correlates with the amount of salivary α-amylase, but beyond this, the physiologic significance is uncertain.

Objective

We hypothesized that individuals with higher AMY1 CN would digest starchy foods faster and show higher postprandial responses and lower breath hydrogen excretion compared with those with low CN.

Design

Four linked studies were conducted. In Study 1, we genotyped 201 healthy subjects with the use of real-time quantitative polymerase chain reaction and determined glucose tolerance, insulin sensitivity, salivary α-amylase activity, body mass index (BMI), and macronutrient intake. In Study 2, a pool of 114 subjects tested 6 starchy foods, 3 sugary foods, 1 mixed meal, and 2 reference glucose solutions, containing either 50 or 25 g of available carbohydrate. In Study 3, we compared glycemic and insulin responses to starchy foods with responses to glucose in 40 individuals at extremes of high and low CN. In Study 4, we compared breath hydrogen and methane responses over 8 h in 30 individuals at extremes of CN.

Results

AMY1 CN correlated positively with salivary α-amylase activity (r = 0.62, P < 0.0001, n = 201) but not with BMI, glucose tolerance, or insulin sensitivity. However, CN was strongly correlated with normalized glycemic responses to all starchy foods (explaining 26-61% of interindividual variation), but not to sucrose or fruit. Individuals in the highest compared with the lowest decile of CN produced modestly higher glycemia (+15%, P = 0.018), but not insulinemia, after consuming 2 starchy foods. Low-CN individuals displayed >6-fold higher breath methane levels in the fasting state and after starch ingestion than high-CN individuals (P = 0.001), whereas hydrogen excretion was similar.

Conclusions

Starchy foods are digested faster and produce higher postprandial glycemia in individuals with high AMY1 CN. In contrast, having low CN is associated with colonic methane production. This trial was registered at www.anzctr.org.au as ACTRN12617000670370.

Glycaemic Index of Maternal Dietary Carbohydrate Differentially Alters Fto and Lep Expression in Offspring in C57BL/6 Mice

Maternal diet and gestational hyperglycaemia have implications for offspring health. Leptin (LEP) and fat mass and obesity-associated (FTO) alleles are known to influence body fat mass in humans, potentially via effects on appetite. We hypothesized that expression of Fto, Lep, and other appetite-related genes (Argp, Npy, Pomc, Cart, Lepr) in the offspring of female mice are influenced by the glycaemic index (GI) of carbohydrates in the maternal diet. C57BL/6 mice were randomly assigned to low or high GI diets and mated with chow-fed males at eight weeks of age. Male pups were weaned at four weeks and randomly divided into two groups, one group following their mother's diet (LL and HH), and one following the standard chow diet (LC and HC) to 20 weeks. Fto expression was 3.8-fold higher in the placenta of mothers fed the high GI diet (p = 0.0001) and 2.5-fold higher in the hypothalamus of 20-week old offspring fed the high GI (HH vs. LL, p < 0.0001). By contrast, leptin gene (Lep) expression in visceral adipose tissue was 4.4-fold higher in four-week old offspring of low GI mothers (LC vs. HC, p < 0.0001) and 3.3-fold higher in visceral adipose tissue of 20-week old animals (LL vs. HH, p < 0.0001). Plasma ghrelin and leptin levels, and hypothalamic appetite genes were also differentially regulated by maternal and offspring diet. These findings provide the first evidence in an animal model that maternal high GI dietary carbohydrates that are digested and absorbed faster may contribute to programming of appetite in offspring.

Physical properties of root cementum: Part 27. Effect of low-level laser therapy on the repair of orthodontically induced inflammatory root resorption: A double-blind, split-mouth, randomized controlled clinical trial

INTRODUCTION

The purpose of this 2-arm-parallel split-mouth trial was to investigate the effect of low-level laser therapy (LLLT) on the repair of orthodontically induced inflammatory root resorption (OIIRR).

METHODS

Twenty patients were included in this study, with 1 side randomly assigned to receive LLLT, and the other side served as a sham. Eligibility criteria included need for bilateral maxillary first premolar extractions as part of fixed appliance treatment. OIIRR was generated by applying 150 g of buccal tipping force on the maxillary first premolars for 4 weeks. After the active force was removed, the teeth were retained for 6 weeks. LLLT commenced with weekly laser applications using a continuous beam 660-nm, 75-mW aluminum-gallium-indium-phosphorus laser with 1/e² spot size of 0.260 cm², power density of 0.245 W/cm², and fluence of 3.6 J/cm². Contact application was used at 8 points buccally and palatally above the mucosa over each tooth root for 15 seconds with a total treatment time of 2 minutes. After 6 weeks, the maxillary first premolars were extracted and scanned with microcomputed tomography for primary outcome OIIRR calculations. Subgroup analysis included assessment per root surface, per vertical third, and sites of heaviest compressive forces (buccal-cervical and palato-apical). Randomization was generated using www.randomization.com, and allocation was concealed in sequentially numbered, opaque, sealed envelopes. Blinding was used for treatment and outcome assessments. Two-tailed paired t tests were used to determine whether there were any statistically significant differences in total crater volumes of the laser vs the sham treated teeth.

RESULTS

Total crater volumes were 0.746 mm³ for the laser treated teeth and 0.779 mm³ for the sham. There was a mean difference of 0.033 ± 0.39 mm³ (95% CI, -0.21 to 0.148 mm³) greater resorption crater volume in the sham group compared with the laser group; this was not statistically significant (P = 0.705). No harm was observed.

CONCLUSIONS

No significant difference was found between LLLT and sham control groups in OIIRR repair.

A pilot study of laser energy transmission through bone and gingiva

BACKGROUND

The use of low-level laser therapy is growing in the field of dentistry especially in orthodontics to speed up tooth movement and in implantology to aid osseointegration. In these dental applications, the laser energy needs to penetrate through the periodontium to the target site to stimulate photobiomodulation. The percentage of energy loss when laser is transmitted through the periodontium has not been previously studied. With the use of an 808-nanometer diode laser, the aim was to investigate the percentage loss of laser energy when transmitted through the periodontium to the extraction socket.

METHODS

The percentage energy loss of an 808-nm diode laser through the periodontium was measured in 27 tooth sockets by using a specifically designed photodiode ammeter.

RESULTS

For each millimeter of increased bone thickness there was 6.81% reduction in laser energy (95% confidence interval, 5.02% to 8.60%). The gingival thickness had no statistically significant effect on energy penetration.

CONCLUSION

Energy penetration depends markedly on bone thickness and is independent of gingival thickness.

PRACTICAL IMPLICATIONS

To the best of the authors' knowledge, this study is one of the first to investigate laser penetration through the periodontium. Evidence from this study showed that laser energy penetration through the periodontium is markedly affected by bone thickness but less so by gingival thickness. Clinicians need to be aware of the biological factors that could affect laser energy penetration to the target site and adjust their laser dosages accordingly. These findings may guide dental practitioners in selecting the appropriate laser dosage parameters for low-level laser therapy.

Dietary Fibre Intake in Australia. Paper I: Associations with Demographic, Socio-Economic, and Anthropometric Factors

Dietary fibre is important for regular laxation and reduces chronic disease risk. The National Health and Medical Research Council outlines daily fibre intake targets, yet the proportion of the population that meets these targets is unknown. Using the 2011⁻2012 National Nutrition and Physical Activity Survey, we profiled fibre intake among Australian children and adults. Data from one-day dietary recalls were analysed (n = 12,153, ≥2 years) as well as demographic and anthropometric factors. The median fibre intake was 18.2 g (interquartile range [IQR] 13.2⁻25.0) in children and 20.7 g (IQR 14.3⁻28.7) in adults. We found that 42.3% (95% CI 40.5⁻44.1%) of children and 28.2% (95% CI 27.3⁻29.1%) of adults met the Adequate Intake (AI), and less than 20% of adults met the Suggested Dietary Target (SDT) to reduce the risk of chronic disease. Older children (aged 14⁻18 years), girls, young adults (19⁻30 years), males, and those of lower socio-economic status were less likely to meet the AI (p < 0.001). Those with a higher energy intake were more likely to meet the AI. Anthropometric measures were not associated with fibre intake or the likelihood of meeting the AI. Fibre is a nutrient of concern in Australian diets, with most children and adults falling short of recommendations. Adolescents, girls, young adults, men, and those of lower socio-economic status were less likely to meet the recommendations and may benefit most from public health interventions.

Physical properties of root cementum: Part 26. Effects of micro-osteoperforations on orthodontic root resorption: A microcomputed tomography study

INTRODUCTION

Studies have demonstrated the potential efficacy of micro-osteoperforations in accelerating tooth movement by amplifying the expression of inflammatory markers. The aim of this investigation was to examine the effects of micro-osteoperforations on orthodontic root resorption with microcomputed tomography.

METHODS

This prospective controlled clinical trial involved 20 subjects requiring extraction of the maxillary first premolars as part of their orthodontic treatment. A buccal tipping force of 150 g was applied to both premolars. Using the Propel appliance (Propel Orthodontics, San Jose, Calif), micro-osteoperforations were applied at a depth of 5 mm on the mesial and distal aspects in the midroot region of the experimental side of the first premolar root; the contralateral side served as the control. After 28 days, both premolars were extracted. The teeth were scanned under microcomputed tomography, and the volumes of root resorption craters were calculated and compared.

RESULTS

Premolars treated with micro-osteoperforation exhibited significantly greater average total amounts of root resorption than did the control teeth (0.576 vs 0.406 mm³). The total average volumetric root loss of premolars treated with micro-osteoperforation was 42% greater than that of the control teeth.

CONCLUSIONS

This 28-day trial showed that micro-osteoperforations resulted in greater orthodontic root resorption. However, these results should be verified in patients who are undergoing full-length orthodontic treatment.

The public perception of orthodontic treatment performed by general dentists and specialist orthodontists

Background

In Australia, orthodontic treatment may be performed by either a general dental practitioner (GDP) or a specialist orthodontist. However, the titles ‘specialist’ and ‘orthodontist’ are restricted to dentists who have undertaken an additional three years of full-time training in an accredited institution. Considering the increase in popularity of GDP orthodontic courses, an assessment was worthwhile of the public’s understanding of the difference between a specialist orthodontist and a GDP who provides orthodontic treatment.

Methods

Two thousand and six Australian adults registered with a survey organisation and completed an online questionnaire. Participants were chosen to reflect age and state demographic data provided by the 2016 Australian Census. The survey questions examined the respondents’ understanding regarding the difference between a GDP and a specialist orthodontist related to training and qualifications. Furthermore, factors influencing respondents’ preferences for choosing an orthodontic practitioner as well as demographic data were collected.

Results

Sixty-six percent of respondents felt that a dentist who provided orthodontic treatment must also be a specialist orthodontist whilst 27% were unsure. Seventy-four percent of respondents felt that a specialist orthodontist was the most qualified person to provide orthodontic treatment. The most popular factor in deciding which type of practitioner to see for orthodontic treatment was whether they were a specialist, followed closely by cost. A GDP was more likely to be chosen as an orthodontic practitioner by respondents who were male, less educated, had a lower income or had seen a GDP for orthodontic treatment in the past.

Conclusion

Although the respondents generally appeared to appreciate the value of seeing a specialist for orthodontic treatment, a significant proportion did not appear to understand the difference between a specialist orthodontist and a GDP. The present findings support further education of the public.

The metal content of generic orthodontic brackets compared with proprietary brackets

Background

With minimal manufacturer information, a variety of ‘generic’ orthodontic brackets are available online from overseas distributors. The present study investigated the metal composition of generic orthodontic brackets compared with two well-known ‘proprietary’ brands.

Materials and methods

Ranging in price from AU$2.99 to $65, five sets of different generic brackets were obtained directly from China via eBay (G1, G2…G5). Proprietary brackets were obtained from American Orthodontics (P1) and Rocky Mountain Orthodontics (P2). The 11, 12, 13 and 14 brackets from each set were liquefied in an acid solution and subjected to trace element analysis using inductively coupled plasma mass spectrometry (ICP-MS) and inductively coupled plasma optical emission spectroscopy (ICP-OES) with respect to nickel, chromium, iron, copper, molybdenum, manganese, cadmium, mercury, arsenic and lead. Statistical analysis investigated the compositional consistency within and between each brand.

Results

The composition of P1 and P2 agreed with the manufacturer’s data. The generic groups typically had low molybdenum and higher copper content and approximated either 17-4 or AISI304 stainless steels or a combination of both. No relationship between brand and consistency of manufacture could be identified. The cheapest bracket contained lead.

Conclusions

Generic and proprietary brackets showed differences in their metal composition that may have biocompatibility implications.

Weekday snacking prevalence, frequency, and energy contribution have increased while foods consumed during snacking have shifted among Australian children and adolescents: 1995, 2007 and 2011-12 National Nutrition Surveys

Background

There are limited data on the evolution of eating habits, including snacking, in Australia. This study aimed to understand snacking trends among Australian children over three previous National Nutrition Surveys.

Methods

Data were analysed from a single weekday 24-h recall in the National Nutrition Surveys 1995, 2007, 2011–12 among children 2-16y (n = 8258). A snacking occasion was defined as an eating occasion that occurred between meals based on time of day.

Results

The percentage of children snacking increased over time (92.5 ± 0.5(SE) % in 1995, 98.1 ± 0.3% in 2007, and 95.8 ± 0.4% in 2011–12) (P < 0.001), particularly among those having four or more snacking occasions (7.1 ± 0.5% in 1995, 17.9 ± 0.6% in 2007, and 18.5 ± 0.8% in 2011–2) (P < 0.001). The mean number of snacking occasions increased from 2.0 ± 0.0 in 1995, to 2.5 ± 0.0 in 2007 and 2011–12 (P < 0.001). The energy contribution from snacking increased from 24.1 ± 0.3% in 1995 to 27.7 ± 0.3% in 2007 and 30.5 ± 0.4% in 2011–12 (P < 0.001), while the energy from discretionary food during snacking decreased from 56.5 ± 0.7% in 1995 to 47.3 ± 0.5% in 2007 and 47.9 ± 0.7% in 2011–12 (P < 0.001). There were differences in the top foods consumed during snacking: non-alcoholic beverages were prominent contributors in 1995 but not in 2007 or 2011, and pome fruit was the second top energy contributor during snacking in 2007 and 2011 but only fourth in 1995.

Conclusions

Snacking is a prominent dietary pattern that has increased over time in frequency and energy contribution. Foods and beverages consumed during snacking occasions include a mix of core foods and discretionary foods, and while the contribution of discretionary foods has decreased, there is still an opportunity to encourage consumption of more nutrient dense foods during snacking.

Electronic supplementary material

The online version of this article (10.1186/s12937-017-0288-8) contains supplementary material, which is available to authorized users.

Breakfast and Breakfast Cereal Choice and Its Impact on Nutrient and Sugar Intakes and Anthropometric Measures among a Nationally Representative Sample of Australian Children and Adolescents

There is limited evidence in Australia that compares the nutritional impact of a breakfast cereal breakfast to a non-cereal breakfast, and includes the type of cereal. This study investigated the impact of breakfast choice and the total sugar content of breakfast cereal on nutrient intakes and anthropometric measures among Australian children and adolescents. Data from 2 to 18-year-old in the 2011–2012 National Nutrition and Physical Activity Survey were used (n = 2821). Participants were classified as breakfast cereal consumers (minimally pre-sweetened (MPS) or pre-sweetened (PS)), non-cereal breakfast consumers, or breakfast skippers. Foods consumed for breakfast, foods added to the cereal bowl, and the impact of breakfast choice on daily nutrient intakes and anthropometric measures were determined. Although only 9% of children skipped breakfast, 61% of skippers were aged 14–18 years. Among breakfast consumers, 49% had breakfast cereal, and 62% of these exclusively consumed MPS cereal. Breakfast skippers had a higher saturated fat intake than breakfast cereal consumers, and lower intakes of dietary fibre and most micronutrients (p < 0.001). Compared with non-cereal breakfast consumers, breakfast cereal consumers had similar added and free sugars intakes, lower sodium, and higher total sugars, carbohydrate, dietary fibre, and almost all other micronutrients (p < 0.001). The only difference in nutrient intakes between MPS and PS cereal consumers was higher folate among PS consumers. No associations between anthropometric measures and breakfast or breakfast cereal choice were found. The highest prevalence of breakfast skipping was among 14–18-year old. Breakfast cereal consumers had higher intakes of dietary fibre and most micronutrients compared with non-cereal breakfast consumers and skippers, and almost no differences were found between MPS and PS cereal consumers.

Quantifiable effects of regular exercise on zinc status in a healthy population-A systematic review

Zinc is an essential mineral of which its functions have potential implications on exercise performance and beneficial adaptations of physical activity. While the effects of aerobic exercise on zinc metabolism acutely have been well described, the effect of long-term exercise training on zinc status remains unclear. The present review aims to determine the effects of exercise training on markers of zinc status in an apparently healthy adult population. We conducted a systematic literature search on PubMed, Scopus, SPORTDiscus and Cochrane Library from inception to 28 January 2016 to identify interventional or cohort studies that investigated the effects of exercise training on indices of zinc status. Pairwise comparisons of mean differences in within-group change were calculated and summarised visually in forest plots. Six studies satisfied the inclusion criteria for the systematic review, of which 5 studies included data on changes in serum zinc concentrations and 3 studies provided changes in dietary zinc intake. Two comparisons showed significantly higher increase of serum zinc concentrations in the exercise group compared to control, while one comparison reported significantly lower change in serum zinc for the exercising group. The exercise groups consumed significantly higher dietary zinc compared to controls in two comparisons. The present review revealed an incomplete evidence base in evaluating the effect of long-term exercise training on markers of zinc status. Further well-designed investigations are required to elucidate the relationship for establishment of dietary recommendation in populations who are continuing exercise interventions.

The Role of Frequency in Learning Morphophonological Alternations: Implications for Children With Specific Language Impairment

PURPOSE

The aim of this article was to explore how the type of allomorph (e.g., past tense buzz[d] vs. nod[əd]) influences the ability to perceive and produce grammatical morphemes in children with typical development and with specific language impairment (SLI).

METHOD

The participants were monolingual Australian English-speaking children. The SLI group included 13 participants (mean age = 5;7 [years;months]); the control group included 19 children with typical development (mean age = 5;4). Both groups performed a grammaticality judgment and elicited production task with the same set of nonce verbs in third-person singular and past tense forms.

RESULTS

Five-year-old children are still learning to generalize morphophonological patterns to novel verbs, and syllabic /əz/ and /əd/ allomorphs are significantly more challenging to produce, particularly for the SLI group. The greater phonetic content of these syllabic forms did not enhance perception.

CONCLUSIONS

Acquisition of morphophonological patterns involving low-frequency allomorphs is still underway in 5-year-old children with typical development, and it is even more protracted in SLI populations, despite these patterns being highly predictable. Children with SLI will therefore benefit from targeted intervention with low-frequency allomorphs.

The Cross-Sectional Association between Consumption of the Recommended Five Food Group "Grain (Cereal)", Dietary Fibre and Anthropometric Measures among Australian Adults

The Australian Dietary Guidelines recommended "grain (cereal)" core food group includes both refined and whole grain foods, but excludes those that are discretionary (i.e., cakes). We investigated the association between daily serves from the "grain (cereal)" group and its effect on fibre and adiposity. Data from Australian adults in the 2011-2012 National Nutrition and Physical Activity Survey were used (n = 9341). Participants were categorised by serves of core grain foods and general linear models were used to investigate the effect of demographic, socioeconomic, and dietary covariates on waist circumference, body mass index (BMI) and fibre intake. Compared to core grain avoiders (0 serves), high consumers (6+ serves/day) were: more likely male and socially advantaged, had a healthier dietary pattern, less likely dieting, overweight or obese, and were at lower risk of metabolic complications. After adjustment for age, sex and energy intake, there was an inverse relationship between core grain serves intake and BMI (p < 0.001), waist circumference (p = 0.001) and a positive relationship with fibre (p < 0.001). Model adjustments for diet and lifestyle factors resulted in a smaller difference in waist circumference (p = 0.006) and BMI (p = 0.006). Core grain serves was significantly associated with higher fibre, but marginally clinically significant for lower adiposity.

Interrelationships among mediators of cellular zinc homeostasis in healthy and type 2 diabetes mellitus populations

SCOPE

The involvement of zinc in multiple physiological systems requires tight control of cellular zinc concentration. This study aims to explore the relationships among selected mediators of cellular zinc homeostasis in an apparently healthy (AH) population and a cohort with type 2 diabetes mellitus (T2DM).

METHODS AND RESULTS

Baseline data of three trials forming two cohorts, AH (n = 70) and T2DM (n = 42), were used for multivariate analyses to identify groupings within ten zinc transporter and metallothionein (MT) gene expressions, stratified by health status. Multiple regression models were used to explore relationships among zinc transporter/MT groupings and plasma zinc. Gene expression of zinc transporters and MTs, with the exception of ZnT6, were significantly lower in the T2DM cohort (p < 0.01). Cluster analysis showed that the groupings of zinc transporters and MTs were largely similar between the two cohorts, with the exception for ZnT1 and ZIP7. Zinc transporters and MTs were significant determinants of plasma zinc (r² = 0.48, p = 0.001) in the AH cohort, but not in the T2DM cohort.

CONCLUSION

The current study suggests altered cellular zinc homeostasis in T2DM and supports the use of multiple zinc transporters and MTs groupings to further understand zinc homeostasis in health and T2DM.

Effects of hybrid-Hyrax, Alt-RAMEC and miniscrew reinforced heavy Class III elastics in growing maxillary retrusive patients. A four-year follow-up pilot study

Introduction

The aim of this study was to evaluate the short- and long-term effects of hybrid-Hyrax, Alt-RAMEC and applied, miniscrew reinforced, heavy intermaxillary elastics on a modified lingual arch in growing skeletal Class III patients.

Methods

Fifteen subjects (seven male, eight female) were included, with an average age of 12.52 ± 0.94 years, of cervical vertebrae maturation (CVM) stage CS2-CS4 and skeletal Class III malocclusions due to a retrognathic maxilla. Nine weeks of Alt-RAMEC were followed by eight to nine weeks of maxillary protraction with heavy 400 gm Class III elastics worn 24 h/day. Treatment was finalised with orthodontic fixed appliances. Cone beam computed tomographic (CBCT) scans were taken initially (T1), at the end of maxillary protraction (T2) and four years after active orthopaedic treatment (T3). Cephalometric measurements were performed on reconstructed lateral cephalograms and the differences between time intervals were calculated using an analysis of variance (ANOVA).

Results

A positive overjet was achieved in all but one subject. From T1 to T2, A point advanced 3.12 ± 3.42 mm and from T2 to T3 advanced a further 2.21 ± 3.49 mm. Significant initial increases in SNA of 1.05° ± 1.10° (p = 0.004), ANB of 2.71° ± 1.01° (p = 0.00), Wits of 4.49 ± 2.21 mm (p = 0.00) and overjet of 4.90 ± 1.66 mm (p = 0.00) were accomplished and maintained without significant changes in the vertical dimension. Upper and lower incisor inclinations were not affected by the protraction protocol but significantly increased (U1-PP: 8.39° ± 5.59°) between T2 and T3. SNB decreased initially by 1.67° ± 1.34° (p = 0.00) but relapsed due to residual mandibular growth and a counterclockwise rotation of the mandibular plane.

Conclusion

The hybrid-Hyrax Alt-RAMEC combined with miniscrew reinforced heavy Class III elastics resulted in a favourable and stable Class III correction.

Factors Affecting Measurement of Salivary Cortisol and Secretory Immunoglobulin A in Field Studies of Athletes

AIMS

Biological and lifestyle factors, such as daily rhythm, caffeine ingestion, recent infection, and antibiotic intake, have been shown to influence measurements of salivary cortisol (SC) and secretory immunoglobulin A (sIgA). Current methodology in unsynchronized, field-based biomarker studies does not take these effects into account. Moreover, very little is known about the combined effects of biological and lifestyle factors on SC and sIgA. This study supports development of a protocol for measuring biomarkers from saliva collected in field studies by examining the individual and combined effects of these factors on SC and sIgA.

METHOD

At three time points (start of the pre-season; start of playing season; and end of playing season), saliva samples were collected from the entire squad of 45 male players of an elite Australian Football club (mean age 22.8 ± 3.5 years). At each time, point daily rhythm and lifestyle factors were determined via a questionnaire, and concentrations of both SC and sIgA via an enzyme linked immuno-sorbent (ELISA) assay of saliva samples. In addition, player times to produce 0.5 mL of saliva were recorded.

RESULTS

Analysis of covariance of the data across the three time points showed that daily rhythm had a more consistent effect than the lifestyle factors of caffeine ingestion, recent infection, and antibiotic intake on SC, but not on sIgA. Data for sIgA and SC concentrations were then adjusted for the effects of daily rhythm and lifestyle factors, and correlational analysis of the pooled data was used to examine the relative effects of these two sources of influence on sIgA and SC. With the exception of time to produce saliva, the biological measures of stress were affected by players' daily rhythms. When daily rhythm was taken into account the group of lifestyle factors did not have an additional effect.

DISCUSSION

It is recommended that future studies measuring SC and sIgA make additional adjustments for the daily rhythm, in particular time since first sight of daylight, as small measurement errors of biomarkers can confound discrimination among study participants.

Immediate Effects of Aerobic Exercise on Plasma/Serum Zinc Levels: A Meta-analysis

BACKGROUND

Zinc is involved in numerous metabolic roles, including energy metabolism, immunity, and antioxidative effects. Zinc losses during exercise, in particular through sweat, are well documented. However, conflicting results have been reported for changes in circulating and tissue zinc concentration as a result of exercise. The purpose of this article is to quantify the immediate effect of aerobic exercise on plasma or serum zinc levels, in healthy participants.

METHODS

We conducted a systematic review of peer-reviewed articles published up to December 20, 2014, to identify studies that investigated the acute effects of exercise on selected indices of zinc status. Meta-analyses were conducted to determine the change in serum zinc concentration immediately after a bout of aerobic exercise.

RESULTS

Forty-five studies were included in the systematic literature review. Of the included studies, sufficient data were available from 34 studies (providing 46 comparisons) to quantify the change in serum zinc concentration after exercise. Serum zinc concentration was significantly higher immediately after exercise (0.45 ± 0.12 μmol·L(-1), P < 0.001; mean ± SE). Secondary analyses showed greater increase in serum zinc for untrained individuals and exercise sessions that involved running or maximal intensity. Insufficient data were available to determine the effects of exercise on urinary, sweat, and erythrocyte zinc.

CONCLUSIONS

The present systematic review and meta-analysis indicated significant increase in serum zinc concentration immediately after an aerobic exercise session, suggesting acute perturbations in zinc homeostasis. Further research is required to ascertain the long-term effects of exercise on zinc metabolism and potential consequences for dietary zinc requirement for physically active populations.

Singing as an adjunct therapy for children and adults with cystic fibrosis

BACKGROUND

Cystic fibrosis is a genetically inherited, life-threatening condition that affects major organs. The management of cystic fibrosis involves a multi-faceted daily treatment regimen that includes airway clearance techniques, pancreatic enzymes and other medications. Previous studies have found that compliance with this intensive treatment is poor, especially among adolescents. Because of both the nature and consequences of the illness and the relentless demands of the treatment, many individuals with cystic fibrosis have a poor quality of life. Anecdotal reports suggest that singing may provide both appropriate exercise for the whole respiratory system and a means of emotional expression which may enhance quality of life. This is an update of a previously published review.

OBJECTIVES

To evaluate the effects of singing as an adjunct therapy to standard treatment on the quality of life, morbidity, respiratory muscle strength and pulmonary function of children and adults with cystic fibrosis.

SEARCH METHODS

We searched the Group's Cystic Fibrosis Trials Register and the Cochrane Central Register of Controlled Trials. Date of latest search: 18 February 2016.We also searched major allied complementary data bases, and clinical trial registers. Additionally, we handsearched relevant conference proceedings and journals. Date of latest search: 18 February 2016.

SELECTION CRITERIA

Randomised controlled trials in which singing (as an adjunct intervention) is compared with either a control intervention (for example, playing computer games or doing craft activities) or no singing in people with cystic fibrosis.

DATA COLLECTION AND ANALYSIS

Results of searches were reviewed against pre-determined criteria for inclusion. Only one eligible trial was available for analysis.

MAIN RESULTS

Since only one small study (n = 40) was included, no meta-analysis could be performed. The included randomised controlled study was of parallel design and undertaken at two paediatric hospitals in Australia. The study evaluated the effects of a singing program on the quality of life and respiratory muscle strength of hospitalised children with cystic fibrosis (mean age 11.6 years, 35% male). While the singing group received eight individual singing sessions, the control group participated in preferred recreational activities, such as playing computer games or watching movies. This study was limited by a small sample size (51 participants) and a high drop-out rate (21%). There were no significant differences between the groups at either post-intervention or follow up; although by the end of treatment there were some within-group statistically significant increases for both singing and control groups in some of the domains of the quality of life questionnaire Cystic Fibrosis Questionnaire-Revised (e.g. emotional, social and vitality domains). For the respiratory muscle strength indices, maximal expiratory pressure at follow up (six to eight weeks post-intervention) was higher in the singing group, mean difference 25.80 (95% confidence interval 5.94 to 45.66). There was no significant difference between groups for any of the other respiratory function parameters (maximal inspiratory pressure, spirometry) at either post-intervention or follow up.

AUTHORS' CONCLUSIONS

There is insufficient evidence to determine the effects of singing on quality of life or on the respiratory parameters in people with cystic fibrosis. However, there is growing interest in non-medical treatments for cystic fibrosis and researchers may wish to investigate the impact of this inexpensive therapy on respiratory function and psychosocial well-being further in the future.

Impact of Breakfast Skipping and Breakfast Choice on the Nutrient Intake and Body Mass Index of Australian Children

Recent data on breakfast consumption among Australian children are limited. This study examined the impact of breakfast skipping and breakfast type (cereal or non-cereal) on nutrient intakes, likelihood of meeting nutrient targets and anthropometric measures. A secondary analysis of two 24-h recall data from the 2007 Australian National Children’s Nutrition and Physical Activity Survey was conducted (2–16 years; n = 4487) to identify (a) breakfast skippers and (b) breakfast consumers, with breakfast consumers further sub-divided into (i) non-cereal and (ii) cereal consumers. Only 4% skipped breakfast and 59% of skippers were 14–16 years. Breakfast consumers had significantly higher intakes of calcium and folate, and significantly lower intakes of total fat than breakfast skippers. Cereal consumers were more likely to meet targets and consume significantly higher fibre, calcium, iron, had significantly higher intakes of folate, total sugars and carbohydrate, and significantly lower intakes of total fat and sodium than non-cereal consumers. The prevalence of overweight was lower among breakfast consumers compared to skippers, and among cereal consumers compared to-cereal consumers (p < 0.001), while no significant differences were observed for mean body mass index (BMI), BMI z-score, waist circumference and physical activity level across the categories. Breakfast and particularly breakfast cereal consumption contributes important nutrients to children’s diets.

The envelope of an oscillatory process and its upcrossings

Let X(t) be a real-valued stochastic process with sample functions which are almost surely continuously differentiable. We say that X(t) has an upcrossing at level u at time t if X(t) = u, X′(t) > 0.