• Inequalities in dental health: An ecological analysis of the interaction between the effects of water fluoridation and social deprivation on tooth decay in children living in England

      Tocque, Karen; Kennedy, Lynne; University of Chester; KT Intelligence CIC (Academic Journals, 31/07/2015)
      Oral health in England has improved considerably in recent years but continues to show a strong inequalities gradient. This study was aimed at investigating variations in dental decay and elation to social deprivation and local water fluoridation. An ecological analysis using the 2007 and 2008 National Dental Epidemiology Programme survey of 5 year old children in England. Postcode of residence was mapped to census lower super output area (LSOA). LSOAs were assigned a national deprivation quintile and a fluoridation category based upon therapeutic level of 1 mg/L. Multiple logistic regression was applied to determine independent influences on tooth decay. Analysis of covariance (ANCOVA) was used to investigate interactions between fluoridation and deprivation on the mean levels of dental caries. Analysis is based on 142,030 clinical dental examinations, representing 25% of estimated population of 5 year olds in England. Overall, 31% of children had at least one decayed missing or filled tooth (dmft). Multiple logistic regression showed that children living in the most deprived areas were three times more likely to experience tooth decay than those living in affluent areas; whereas children living in fluoridated areas were 1.5 times less likely to have dmft than those living in non-fluoridated areas. Therefore, although both are independently significant, living in the most deprived quintile of social deprivation doubled the impact on the likelihood of dental decay compared to non-fluoridation. ANCOVA showed a strong gradient of increasing mean dmft with increasing social deprivation in both water-fluoridated and non-fluoridated areas, with 3 times more dental decay in more deprived areas than in more affluent areas. In all deprivation quintiles, children living in fluoridated areas have significantly (p < 0.001) lower mean dmft than those living in equivalent deprivation with no water fluoridation. Fluoridated drinking water may moderate dental caries; however, socioeconomic deprivation has a stronger influence on dental decay than local fluoridation of water.
    • The development of vegetarian omega-3 oil in water nanoemulsions suitable for integration into functional food products

      Lane, Katie E.; Li, Weili; Smith, Christopher J.; Derbyshire, Emma J.; Liverpool John Moores University; University of Chester (Elsevier, 31/03/2016)
      Global trends show that habitual omega-3 intakes are short of recommended guidelines, particularly among vegetarians and vegans. The potential health implications of low long chain omega-3 polyunsaturated fatty acid (LCω3PUFA) intakes coupled with concerns about sustainability of fish stocks call for innovative approaches to provide food based solutions to this problem. Nanoemulsions are systems with extremely small droplet sizes that could provide a solution while improving the bioavailability of LCω3PUFA. Oil in water nanoemulsion systems were successfully created using ultrasound with oil loads of up to 50% (w/w) using vegetarian LCω3PUFA oils (flaxseed and algae). Nanoemulsions of 50% (w/w) with mean droplet size measurements of 192 (flaxseed) and 182 nm (algae) using combinations of the emulsifiers Tween 40 and lecithin were prepared. This technique could be applied to create vegetarian LCω3PUFA nanoemulsions suitable for integration into enriched functional food products with the potential to increase LCω3PUFA intake and bioavailability
    • Modulation of Innate and Adaptive Immune Responses by Arabinoxylans

      Fadel, Abdulmannan; Plunkett, Andrew; Li, Weili; Ashworth, Jason J.; Manchester Metropolitan University; University of Chester; Al-Baha University; Al-Ahliyya Amman University; Universiti Putra Malaysia; Istanbul Universitesi (Wiley, 30/11/2017)
      Humans are exposed to harmful pathogens and a wide range of noxious substances every day.The immune system reacts to, and destroys, these pathogens and harmful substances. The immunesystem is composed of innate and adaptive immunity, which liaise to protect the host and maintainhealth. Foods, especially cereals, have been reported to modulate the immune response.Arabinoxylans are nonstarch polysaccharides that have been shown to possess immune-modulatory activities. This review article discusses the fundamentals of the immune system andprovides an overview of the immunomodulatory potential of arabinoxylans in conjunction withtheir structural characteristics and proposed similarities with lipopolysaccharides
    • Antioxidant and genoprotective activity of selected cucurbitaceae seed extracts and LC–ESIMS/MS identification of phenolic components

      Yasir, Muhammad; Sultana, Bushra; Nigam, Poonam S.; Owusu-Apenten, Richard K.; University of Agriculture, Faisalabad, Pakistan; University of California; Ulster University (Elsevier, 30/11/2015)
      Cucurbitaceae are one of most widely used plant species for human food but lesser known members have not been examined for bioactive components. The purpose of this study was to evaluate the antioxidant and genoprotective activities from three cucurbitaceae seeds extracts and to identify phenolic components by LC–ESIMS/MS analysis. From the results, the yield of seeds extract was 20–41% (w/w) and samples had 16–40% total phenols as gallic acid equivalents (GAE). Compared with methanol solvent, using acidified methanol led to increased extraction yield by 1.4 to 10-fold, higher phenolic content (149.5 ± 1.2 to 396.4 ± 1.9 mg GAE/g), higher DPPH radical quenching and enhanced enoprotective activity using the pBR322 plasmid assay. LC–ESI-MS/MS analysis led to identification of 14–17 components, based on authentic standards and comparison with literature reports, as mainly phenolic acids and esters, flavonol glycosides. This may be the first mass spectrometric profiling of polyphenol components from cucurbitaceae seeds.
    • Total Phenols, Antioxidant Capacity and Antibacterial Activity of Manuka Honey Extract.

      Chau, Tsz Ching; Owusu-Apenten, Richard K.; Nigam, Poonam S.; Ulster University; University of Chester; (Science Domain International, 28/10/2017)
      Aims: To evaluate total phenols content (TPC), antioxidant capacity (TAC) and antibacterial activity of Manuka honey extract (MHE) and to compare such properties with those for unfractionated Manuka honey. Study Design: In vitro study. Place and Duration of Study: School of Biomedical Sciences, Ulster University, Coleraine, UK. Between September 2016 and September 2017. Methodology: MHE was prepared by solvent extraction using ethyl acetate. TPC was determined by Folin-Ciocalteu assay. The iron (III) reducing antioxidant capacity (IRAC) method was used to determine TAC. Antibacterial activity was evaluated using disc diffusion assay and 96-well microtiter plate methods with absorbance measured at 600 nm. Results: The TPC for MHE was 30-fold higher than the value for Manuka honey (33420±1685 mg vs. 1018±78 mg GAE/kg) while TAC values were~ 100-times greater (83,198±7064 vs. 793±104 TEAC, respectively). Antibacterial activity assessed by disc diffusion for Manuka honey (18.5 mm on S. aureus and 20 mm on E. coli) was two times greater than for MHE (9mm for both S. aureus and E. coli). The 96-well microtiter plate assay confirmed the greater antibacterial activity for Manuka
    • Effects of ascorbic acid, dehydroascorbic acid and methotrexate on breast cancer cell viability.

      Dosunmu, Yewande; Owusu-Apenten, Richard K.; University of Chester, University of Ulster (Sciencedomain international, 28/10/2017)
      Aims: To examine the effects of ascorbic acid (AA), dehydroascorbic acid (DHA) and methotrexate (MTX) combined treatments on (MDA-MB-231) breast cancer cell viability and intracellular reactive oxygen species (ROS). Study Design: In-vitro method. Place and Duration of Study: Biomedical Sciences Research Institute, University of Ulster, Coleraine, BT52 1SA, United Kingdom. September 2016-2017 Methodology: Cytotoxicity tests were performed with MTX (0.01- 1000 µmol/l) alone or in combination with AA or DHA, for 72 h. Cell viability was measured by 3-4,5 dimethylthiazol-2,5 diphenyl tetrazolium bromide (MTT) or Sulforhodamine B (SRB) assays. Intracellular ROS was measured by 2’,7’-dichlorofluroscein diacetate assay. Results: Treatments of MDA-MB231 cells with single agents, showed dose dependent response with 50% inhibition of cell viability (IC50) of 110.5-201.4 µmol/l (MTX), 2237-5703 µmol/l (AA) or 2474 µmol/l (DHA). Combination studies showed clear synergisms for MTX (~10 µmol/l) and DHA or AA (1100 µmol/l) but weak or no interactions at other concentrations. Three days combination treatment of DHA showed decrease of ROS, which was reversed by MTX (>10 µmol/l). Conclusions: Co-treatment of methotrexate with AA or DHA showed synergism (C1<1.0) and enhanced cytotoxicity of the anti-folate towards MDA-MB-231 breast cancer cells. Intracellular ROS decreased with AA and DHA treatment, which might be useful for reducing MTX-related oxidative stress.
    • Antibacterial activity of Manuka honey and its components: An overview

      Johnston, M; McBride, M; Dahiya, D; Owusu-Apenten, Richard K.; Nigam, Poonam S.; University of Chester, University of Ulster (AIMS Press, 27/11/2018)
      The importance of honey for medicinal purposes is well documented in some of the world’s oldest literature. Honey is well known and studied for its antimicrobial properties. The medicinal properties in honey originate from the floral source used by bees. Manuka honey is a dark monofloral honey rich in phenolic content, and currently it is gaining much attention for its antimicrobial activity. Researchers have found that honey is effective against a wide range of pathogens. The antibacterial potency of Manuka honey was found to be related to the Unique Manuka Factor (UMF) rating, which is correlated with the methylglyoxal and total phenols content. It is reported that different types of Manuka honey have differing effects and Gram-negative bacteria are more resistant than Gram-positive bacteria. Bacterial resistance to honey as antimicrobial agent has yet to be identified, possibly due to the presence of a complex mixture of methylglyoxal and other components. Honey is also reported to alter a bacterium’s shape and size through septal ring alteration, which affects cell morphology and growth. Research has shown that Manuka honey of different UMF values has medicinal properties of interest and it can be beneficial when used as a combination treatment with other antimicrobial agents
    • A FRAP Assay at pH 7 unveils Extra Antioxidant Activity from Green, Black, White and Rooibos Tea but not Apple Tea

      Owusu-Apenten, Richard K.; Wong, C. W.; Cheung, W. S. M.; Lau, Y. Y.; Bolanos de la Torre, Angelica A. S.; University of Chester, University of Ulster (Verizona publisher, 26/06/2015)
      Abstract Aim: Realization of a ferric reducing antioxidant power (FRAP) assay at neutral pH and re-evaluation of tea antioxidant activity for comparisons with the standard FRAP assay. Method: A FRAP assay at neutral pH utilized ferrozine (7.3-(2-Pyridyl)-5, 6-diphenyl-1, 2, 4-triazine-4’, 4’’-disulfonic acid;ferrozine) dye in conjunction with Tris-HCl buffer (0.1M. pH 7.0) with 280 µl of regent addition to 20 µl of tea infusions and absorbance measurements at 562 nm with a microplate reader. Results: The microplate ferrozine FRAP assay (mFzFRAP) gave linear calibrations for ascorbic acid, gallic acid, ammonium ferrous sulphate, (AFS), trolox, cysteine and glutathione (R2 = 0.998 -1.000) with molar absorptivity (measures of sensitivity) similar to literature values. The analytical precision was 5-7% and the minimum detectable concentrations (MDC) were 1.4- 2.8 µM (0.4-0.8 nanomoles). Discussion: Values for FRAP were higher at pH 7.0 compared to pH 4.0 for gallic acid, ascorbic acid, glutathione, and cysteine possibly due to their ionization at high pH. The assay sensitivity for AFS and trolox were unchanged at pH 4.0 and pH 7.0. When assayed at pH 7 the water infusions from green tea, black tea, white tea, and rooibos tea had 200-360% antioxidant activity normally observable at low pH. Conclusion: A FRAP assay at pH 7 unveils extra antioxidant activity for green, black, white and Rooibos teas compared to values from the standard TptzFRAP (pH 3.6) method. As a recommendation, the antioxidant activity of teas and other herbal preparations should be re-evaluated over a wide pH range.
    • Socio-economic causes of undernutrition

      Kennedy, Lynne; Woodall, Alison; University of Chester (John Wiley and Sons, 26/01/2018)
      In this chapter we explore the role of socio-economic factors in the development of under-nutrition in high-income countries, such as the UK, with particular reference to food access and nutrition inequality. For the purpose of this chapter we use the term under-nutrition to refer to the physiological effects of inadequate food supply resulting from the inability to access sufficient quantity and quality of food to meet recommended nutritional requirements; a situation otherwise termed food poverty or food insecurity (See Box 1 for definitions). In affluent societies, hunger and malnutrition coexist alongside obesity and diet-related diseases such as coronary heart disease and diabetes. Before the food system was industrialised in the mid-20th Century, people ate a basic, traditional diet of limited variety. Hunger and under nutrition was common. Today, food is both varied and widely available. Access to cheap, energy-dense and nutrient-poor food is linked with the so-called obesity epidemic and diseases of affluence. Despite this a growing number of people in societies such as the UK experience hunger or malnutrition because of limited access or availability to a nutritionally adequate diet (3, 4, and 5).
    • Release of coumarin encapsulated in chitosan-gelatin irradiated films

      Benbettaïeb, Nasreddine; Chambin, Odile; Assifaoui, Ali; Al-Assaf, Saphwan; Karbowiak, Thomas; Debeaufort, Frédéric; Phillips Hydrocolloids Research Centre, Glyndwr University, Wrexham LL11 2AW, UK (Elsevier, 24/12/2015)
      Chitosan and fish gelatin were used to formulate active biobased films containing an antioxidant (coumarin). After drying, the films were irradiated at 40 and 60 kGy using an electron beam accelerator. The effect of irradiation on the film properties as well as the coumarin release mechanism were investigated and compared with the control. Electron Spin Resonance (ESR) revealed free radical formation during irradiation in films containing coumarin. Antioxidant addition and/or irradiation treatment at a dose of 60 kGy resulted in a shift of amide A and amide B peaks. Furthermore a shift of amide II band was only observed for the control film at the same dose. Irradiation allowed improving the thermal stability of the control films. Both irradiation process and addition of coumarin increased the surface wettability (increase of the polar component of the surface tension). From the water barrier analysis, neither irradiation nor coumarin addition influenced the permeability at the lower RH gradient used (0e30% RH). Using the higher RH gradient (30e84%) induced a rise of the WVP of all films (containing or not coumarin) after irradiation treatment. At 60 kGy, the tensile strength of only the control films increased significantly. Considering coumarin release from the film in aqueous medium, the apparent diffusion coefficient of coumarin is two times reduced after irradiation. Irradiation also allowed to better protect the incorporated antioxidant. Indeed, the amount of coumarin in the non-irradiated film was significantly lowered compared to the initial quantity, which is probably due to chemical reactivity.
    • Effect of Methotrexate and Tea Polyphenols on the Viability and Oxidative Stress in MDA-MB-231 Breast Cancer Cells

      Owusu-Apenten, Richard K.; Kelly, Theresa; University of Ulster (SCIENCEDOMAIN International, 24/03/2015)
      Aim: To determine the effect of tea polyphenols and methotrexate on viability and reactive oxygen species (ROS) in a naturally resistant breast cancer cell line MDA-MB-231. Methodology: MDA-MB-231 cells were selected as a model for methotrexate resistant breast cancer. Drug tests were performed over 72 hours at concentrations 0-100 µM. Pre-treatments were with quercetin (QE) or epigallocatechin gallate (EGCG) for 5 hours followed by methotrexate. Cytotoxicity was measured using the MTT assay or resazurin fluorescence assay. ROS was determined using the 2’, 7’-dichlorofluorescein diacetate assay. Intracellular GSH was measured using the monochlorobimane assay. Results: Methotrexate was cytotoxic to MDA-MB-231 cells with IC50 of 35±4 µM. The IC50 value was 68±9.4 µM with QE and 83±16 µM for EGCG. The pre-treatment with QE and EGCG lowered the IC50 for methotrexate by 28% (P =0.009) and 16% (P=0.2027). Intracellular ROS concentrations increased after treatment with methotrexate, QE or EGCG singly and ROS decreased with combination treatment compared with the response for methotrexate only. There were no significant changes in intracellular GSH. Conclusion: Pretreatment with tea polyphenols partially sensitized breast cancer cells towards methotrexate and decreases intracellular ROS. More research is needed to optimize the sensitizing effect of tea phenols on the breast cancer cell response to methotrexate.
    • Impact of vitamin D supplementation on endothelial and inflammatory markers in adults: A systematic review.

      Agbalalah, Tari; Hughes, Stephen F.; Freeborn, Ellen J.; Mushtaq, Sohail; University of Chester (Elsevier, 23/01/2017)
      This systematic review aims to evaluate randomised controlled trials (RCTs) investigating the effect of vitamin D supplementation on endothelial function and inflammation in adults. An electronic search of published randomised controlled trials, using Cochrane, Pubmed and Medline databases was conducted, with the search terms related to vitamin D and endothelial function. Inclusion criteria were RCTs in adult humans with a measure of vitamin D status using serum/plasma 25(OH)D and studies which administered the intervention through the oral route. Among the 1107 studies retrieved, 29 studies met the full inclusion criteria for this systematic review. Overall, 8 studies reported significant improvements in the endothelial/inflammatory biomarkers/parameters measured. However, in 2 out of the 8 studies, improvements were reported at interim time points, but improvements were absent post-intervention. The remaining 21 trial studies did not show significant improvements in the markers of interest measured. Evidence from the studies included in this systematic review did not demonstrate that vitamin D supplementation in adults, results in an improvement in circulating inflammatory and endothelial function biomarkers/parameters. This systematic review does not therefore support the use of vitamin D supplementation as a therapeutic or preventative measure for CVD in this respect.
    • Effect of pH on the Radical Quenching Capacity of Tea Infusions Using the ABTS•+ Assay

      Chan, Yuk Man; Cheng, Nga Kwan; Nigam, Poonam S.; Owusu-Apenten, Richard K.; University of Chester, University of Ulster (Sciencedomain International, 22/06/2016)
      Aims: The aims of this study were to assess the impact of pH on the free radical quenching activity of tea infusions using a modified 2,2'-azino-bis (3-ethylbenzothiazoline-6-sulphonic acid (ABTS) assay and three antioxidant compounds as reference. Study Design: In-vitro method. Place and Duration of Study: Faculty of Life and Health Science, School of Biomedical Sciences, Ulster University, UK. From Sept 2014 and May 2016. Methodology: Free radical quenching capacity of tea (Earl grey, black tea, Ceylon tea, & green tea) infusions were investigated using persulfate activated ABTS with acetate buffer (pH 4.5) or phosphate buffer saline (pH 7.0) as solvent. Tests were performed using 96-well microplates, 20 µl of sample and 280 µl of ABTS reagent, and calibrated using ascorbic acid, trolox or gallic acid as reference antioxidants. Results: Gallic acid free radical quenching was pH dependent and unsuitable as reference. The free radical quenching capacity of trolox and ascorbic acid was not significantly different at pH 4.5 and pH 7.0. The radical quenching capacity of tea infusions expressed as Trolox Equivalent Antioxidant Capacity (TEAC) or Ascorbic Acid Equivalent Antioxidant Capacity (AAEAC) was greater by 50-300% at pH 7 compared to pH 4.5. Conclusion: The modified ABTS assay is suitable for examining the influence of pH on free radical quenching ability of tea samples. Gallic acid was not a suitable reference compound. The radical quenching capacity of tea infusions increases with rising pH.
    • Sulthiame add-on therapy for epilepsy

      Bresnahan, Rebecca; Martin-McGill, Kirsty; Milburn-McNulty, Philip; Powell, Graham; Sills, Graeme; Marson, Anthony; University of Chester; University of Liverpool; The Walton Centre NHS Foundation Trust; University of Glasgow; Liverpool Health Partners (Wiley, 2019-08-27)
      Background This is an updated version of the Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2015, Issue 10. Epilepsy is a common neurological condition, characterised by recurrent seizures. Most people respond to conventional antiepileptic drugs, however, around 30% will continue to experience seizures, despite treatment with multiple antiepileptic drugs. Sulthiame, also known as sultiame, is a widely used antiepileptic drug in Europe and Israel. We present a summary of the evidence for the use of sulthiame as add-on therapy in epilepsy. Objectives To assess the efficacy and tolerability of sulthiame as add-on therapy for people with epilepsy of any aetiology compared with placebo or another antiepileptic drug. Search methods For the latest update, we searched the Cochrane Register of Studies (CRS Web), which includes the Cochrane Epilepsy Group’s Specialized Register and CENTRAL (17 January 2019), MEDLINE Ovid (1946 to January 16, 2019), ClinicalTrials.gov and the WHO ICTRP Search Portal (17 January 2019). We imposed no language restrictions. We contacted the manufacturers of sulthiame, and researchers in the field to seek any ongoing or unpublished studies. Selection criteria Randomised controlled trials of add-on sulthiame, with any level of blinding (single, double or unblinded) in people of any age, with epilepsy of any aetiology. Data collection and analysis Two review authors independently selected trials for inclusion, and extracted relevant data. We assessed these outcomes: (1) 50% or greater reduction in seizure frequency between baseline and end of follow-up; (2) complete cessation of seizures during follow-up; (3) mean seizure frequency; (4) time-to-treatment withdrawal; (5) adverse effects; and (6) quality of life. We used intention-to-treat for primary analyses. We presented results as risk ratios (RR) with 95% confidence intervals (CIs). However, due to the paucity of trials, we mainly conducted a narrative analysis. Sulthiame add-on therapy for epilepsy (Review) 1 Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. For Preview Only Main results We included one placebo-controlled trial that recruited 37 infants with newly diagnosed West syndrome. This trial was funded by DESITIN Pharma, Germany. During the study, sulthiame was given as an add-on therapy to pyridoxine. No data were reported for the outcomes: 50% or greater reduction in seizure frequency between baseline and end of follow-up; mean seizure frequency; or quality of life. For complete cessation of seizures during a nine-day follow-up period for add-on sulthiame versus placebo, the RR was 11.14 (95% CI 0.67 to 184.47; very low-certainty evidence), however, this difference was not shown to be statistically significant (P = 0.09). The number of infants experiencing one or more adverse events was not significantly different between the two treatment groups (RR 0.85, 95% CI 0.44 to 1.64; very low-certainty evidence; P = 0.63). Somnolence was more prevalent amongst infants randomised to add-on sulthiame compared to placebo, but again, the difference was not statistically significant (RR 3.40, 95% CI 0.42 to 27.59; very low-certainty evidence; P = 0.25). We were unable to conduct meaningful analysis of time-to-treatment withdrawal and adverse effects due to incomplete data. Authors’ conclusions Sulthiame may lead to a cessation of seizures when used as an add-on therapy to pyridoxine in infants with West syndrome, however, we are very uncertain about the reliability of this finding. The included study was small and had a significant risk of bias, largely due to the lack of details regarding blinding and the incomplete reporting of outcomes. Both issues negatively impacted the certainty of the evidence. No conclusions can be drawn about the occurrence of adverse effects, change in quality of life, or mean reduction in seizure frequency. No evidence exists for the use of sulthiame as an add-on therapy in people with epilepsy outside West syndrome. Large, multi-centre randomised controlled trials are needed to inform clinical practice, if sulthiame is to be used as an add-on therapy for epilepsy
    • Nice to know: impact of NICE guidelines on ketogenic diet services nationwide

      Whiteley, Victoria; Martin-McGill, Kirsty; Carroll, Jennifer; Taylor, Hannah; Schoeler, Natasha; Royal Manchester Childrens Hospital; University of Salford; University of Chester; University of Liverpool; University of Plymouth; Sheffield Childrens Hospital; UCL Great Ormond Street Institute of Child Health (Wiley, 2019-08-20)
      Background In 2012, the National Institute for Health and Care Excellence (NICE) Clinical Guidelines for Epilepsies: Diagnosis and Management (CG137) included, for the first time, ketogenic diets (KDs) as a treatment option for drug‐resistant paediatric epilepsy. The recommendation was made to refer children and young people with epilepsy whose seizures have not responded to appropriate anti‐epileptic drugs to a tertiary paediatric epilepsy specialist for consideration of the use of KDs. We aimed to assess the impact of this change in guidance on the numbers of ketogenic centres and patients following KDs for epilepsy in the UK and Ireland. Methods An online survey was circulated to ketogenic dietitians from the UK and Ireland. The results were compared with similar surveys published in 2000 and 2010. Results The number of centres offering KDs for treatment of epilepsy has risen from 22 in 2000, to 28 in 2010, and to 39 in 2017 (77% overall increase). Seven of these centres accept adult referrals, in comparison to only two centres in 2010. Patient numbers have increased from 101 in 2000 to 754 in 2017. In total, 267 patients are waiting to commence KD at 31 centres. Conclusions Over the last 7 years, the number of patients treated with a KD for epilepsy in the UK and Ireland has increased by 647%, with a 77% increase in the number of centres offering KDs. Despite this rapid growth, there is ongoing demand for patients to be considered for dietary therapy, highlighting the need for continued expansion of KD services nationally.
    • Felbamate add‐on therapy for drug‐resistant focal epilepsy

      Shi, Li LI; Bresnahan, Rebecca; Martin-McGill, Kirsty; Dong, JianCheng; Ni, HengJian; Geng, JinSong; Medical School of Nantong University, China; University of Liverpool; University of Chester (John Wiley & Sons, Ltd, 2019-08-01)
      Background This is an updated version of the Cochrane Review previously published in 2017. Epilepsy is a chronic and disabling neurological disorder, affecting approximately 1% of the population. Up to 30% of people with epilepsy have seizures that are resistant to currently available antiepileptic drugs and require treatment with multiple antiepileptic drugs in combination. Felbamate is a second-generation antiepileptic drug that can be used as add-on therapy to standard antiepileptic drugs. Objectives To evaluate the efficacy and tolerability of felbamate versus placebo when used as an add-on treatment for people with drug-resistant focal-onset epilepsy. Search methods For the latest update we searched the Cochrane Register of Studies (CRS Web), MEDLINE, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP), on 18 December 2018. There were no language or time restrictions. We reviewed the reference lists of retrieved studies to search for additional reports of relevant studies. We also contacted the manufacturers of felbamate and experts in the field for information about any unpublished or ongoing studies. Selection criteria We searched for randomised placebo-controlled add-on studies of people of any age with drug-resistant focal seizures. The studies could be double-blind, single-blind or unblinded and could be of parallel-group or crossover design. Data collection and analysis Two review authors independently selected studies for inclusion and extracted information. In the case of disagreements, the third review author arbitrated. Review authors assessed the following outcomes: 50% or greater reduction in seizure frequency; absolute or percentage reduction in seizure frequency; treatment withdrawal; adverse effects; quality of life. Main results We included four randomised controlled trials, representing a total of 236 participants, in the review. Two trials had parallel-group design, the third had a two-period cross-over design, and the fourth had a three-period cross-over design. We judged all four studies to be at an unclear risk of bias overall. Bias arose from the incomplete reporting of methodological details, the incomplete and selective reporting of outcome data, and from participants having unstable drug regimens during experimental treatment in one trial. Due to significant methodological heterogeneity, clinical heterogeneity and differences in outcome measures, it was not possible to perform a meta-analysis of the extracted data. Only one study reported the outcome, 50% or greater reduction in seizure frequency, whilst three studies reported percentage reduction in seizure frequency compared to placebo. One study claimed an average seizure reduction of 35.8% with add-on felbamate while another study claimed a more modest reduction of 4.2%. Both studies reported that seizure frequency increased with add-on placebo and that there was a significant difference in seizure reduction between felbamate and placebo (P = 0.0005 and P = 0.018, respectively). The third study reported a 14% reduction in seizure frequency with add-on felbamate but stated that the difference between treatments was not significant. There were conflicting results regarding treatment withdrawal. One study reported a higher treatment withdrawal for placebo-randomised participants, whereas the other three studies reported higher treatment withdrawal rates for felbamate-randomised participants. Notably, the treatment withdrawal rates for felbamate treatment groups across all four studies remained reasonably low (less than 10%), suggesting that felbamate may be well tolerated. Felbamate-randomised participants most commonly withdrew from treatment due to adverse effects. The adverse effects consistently reported by all four studies were: headache, dizziness and nausea. All three adverse effects were reported by 23% to 40% of felbamate-treated participants versus 3% to 15% of placebo-treated participants. We assessed the evidence for all outcomes using GRADE and found it as being very-low certainty, meaning that we have little confidence in the findings reported. We mainly downgraded evidence for imprecision due to the narrative synthesis conducted and the low number of events. We stress that the true effect of felbamate could likely be significantly different from that reported in this current review update. Authors' conclusions In view of the methodological deficiencies, the limited number of included studies and the differences in outcome measures, we have found no reliable evidence to support the use of felbamate as an add-on therapy in people with drug-resistant focal-onset epilepsy. A large-scale, randomised controlled trial conducted over a longer period of time is required to inform clinical practice.
    • Qualitative Study of the Determinants of Food Choice of International Students and Its Associated Health Risk (P10-080-19).

      Nwaugochi, Ifeanyi; Kennedy, Lynne (2019-06-13)
      Migration to study in an industrialized country is an important time when unhealthy food choice behaviour among students reach its peak. This dietary pattern is linked to increased risk level of developing food-related chronic diseases (F-RCD). During this period, students tends to consume more ultra-processed diet (high in fat, sugar, & energy) and very low in fruits and vegetable. The main objective of this study was to explore the factors influencing food choice and dietary acculturation of international students using qualitative study design to explore their knowledge/perception on nutrition and the link between food, health and F-RCDs. Recent studies have shown dearth on determinants of food choice, dietary acculturation and its associated health challenges of international students. International students were recruited by purposive and snowball sampling through poster advert and international office of the University of Chester.Using an open-ended, semi-structured question guide, focus group interviews was carried out. Focus group data were transcribed verbatim and analysed using manual content analysis and inductive thematic approach.23 participants were recruited into the study comprising 13 undergraduate and 10 postgraduate students (12 males and 11 females) aged 18-25 years from Africa, Asian, and the Caribbean. Factors identified by most international students as being the main determining factor on their food choice includes residency status (as a full or semi-catered student), price, availability, accessibility (location of shop), preservation/storage temperature, UK weather conditions, structure of foods in the UK among others. The results presented here may facilitate the improvements of wellbeing of international students' by promoting healthy food choice, thereby encouraging positive acculturation of these students. This research was funded by the researcher.
    • Chester treadmill police tests as alternatives to 15-m shuttle running

      Morris, Michael; Deery, Elizabeth; Sykes, Kevin; Department of Clinical Sciences & Nutrition, University of Chester, Parkgate Road, Chester CH1 4BJ, UK (Oxford University Press, 2019-04-13)
      Background Police officers require a specific level of aerobic fitness to allow them to complete personal safety training and specialist roles. Officers’ aerobic fitness is assessed using the 15-m multi-stage fitness test (MSFT); however, due to the agility required and risk of injury, two alternative treadmill tests have been designed to predict four of the key minimum VO2 criteria of 35, 41, 46 and 51 ml·kg−1·min−1. Aims To investigate the validity and reliability of Chester Treadmill Police Walk Test (CTPWT) and Chester Treadmill Police Run Test (CTPRT). Methods Seventy-eight UK police officers (18 females) completed the CTPWT (n = 53) or CTPRT (n = 35), or both, generating a total of 88 data sets. To assess reliability, 43 participants returned for a second visit (T2), to repeat the treadmill test. Results Mean differences between predicted and actual VO2 at 35, 41, 46 and 51 ml·kg−1·min−1 were as follows −1.1, −2.1, −0.1 and −1.2 ml·kg−1·min−1. Despite a significant under prediction (p = 0.001), a minimum of 92% of participants were within 10% of target VO2 at all levels. There was no significant difference between actual and predicted VO2 in the CTPRT, at 46 ml·kg−1·min−1 (T1 46.0 ± 1.4 or T2 45.1 ± 1.3 ml·kg−1·min−1). Similarly, there was no significant difference at 51 ml·kg−1·min−1 (T2 50.5 ± 1.4 ml·kg−1·min−1). We observed no differences for gender or trial. Ninety-five per cent limits of agreement were at worst T1–T2 −0.25 ± 4.0 ml·kg−1·min−1. Conclusions The CTPWT and the CTPRT provide a valid and reliable alternative to the 15-m MSFT. Key words Exercise testing; fitness; fitness standards; occupational; police; predictive; treadmill test.
    • Vitamin D3 supplementation for 8 weeks leads to improved haematological status following the consumption of an iron-fortified breakfast cereal: a double-blind randomised controlled trial in iron-deficient women.

      Mushtaq, Sohail; Ahmed Fuzi, Salma F; University of Chester (Cambridge University Press, 2019-03-01)
      The effect of 38 µg (1500 IU) daily vitamin D3 supplementation, consumed with an iron-fortified breakfast cereal for 8 weeks, on haematological indicators in iron-deficient female subjects was investigated. Fifty iron-deficient subjects (plasma ferritin concentration < 20 µg/L; mean age ± SD: 27.4 ± 9.4 years) were randomised to consume an iron-fortified breakfast cereal containing 9 mg of iron daily, with either a vitamin D3 supplement or placebo. Blood samples were collected at baseline, interim (4 weeks) and post-intervention (8 weeks) for measurement of iron and vitamin D status biomarkers. The effect of intervention was analysed using mixed-model repeated measures ANOVA. Significant increases were observed in two main haematological indices: haemoglobin concentration and haematocrit level from baseline to post-intervention in the vitamin D group, but not in the placebo group. The increase from baseline to post-intervention in haemoglobin concentration in the vitamin D group (135 ± 11 to 138 ± 10 g/L) was significantly higher compared to the placebo group (131 ± 15 to 128 ± 13 g/L) (P=0.037). The increase in haematocrit level from baseline to post-intervention was also significantly higher in the vitamin D group (42.0 ± 3.0 to 43.8 ± 3.4%) compared to the placebo group (41.2 ± 4.3 to 40.7 ± 3.6%) (P=0.032). Despite the non-significant changes in plasma ferritin concentration, this study demonstrates that 38 µg supplemental vitamin D, consumed daily, with iron-fortified breakfast cereal led to improvement in haemoglobin concentration and haematocrit levels in women with low iron stores. These findings may have therapeutic implications in the recovery of iron status in iron-deficient populations at a healthcare level.
    • Arabinoxylans from rice bran and wheat immunomodulatory potentials: a review article

      Fadel, Abdulmannan; Plunkett, Andrew; Li, Weili; Ranneh, Yazan; Tessu Gyamfi, Vivian Elewosi; Salmon, Yasser; Nyaranga, Rosemarie Roma; Ashworth, Jason (Emerald, 2018-02-12)