Browsing Clinical Sciences and Nutrition by Publisher "Springer"
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Assessment of serum total 25-hydroxyvitamin D assay commutability of Standard Reference Materials and College of American Pathologists Accuracy-Based Vitamin D (ABVD) Scheme and Vitamin D External Quality Assessment Scheme (DEQAS) materials: Vitamin D Standardization Program (VDSP) Commutability Study 2An interlaboratory study was conducted through the Vitamin D Standardization Program (VDSP) to assess commutability of Standard Reference Materials® (SRMs) and proficiency testing/external quality assessment (PT/EQA) samples for determination of serum total 25-hydroxyvitamin D [25(OH)D] using ligand binding assays and liquid chromatography-tandem mass spectrometry (LC-MS/MS). A set of 50 single-donor serum samples were assigned target values for 25-hydroxyvitamin D2 [25(OH)D2] and 25-hydroxyvitamin D3 [25(OH)D3] using reference measurement procedures (RMPs). SRM and PT/EQA samples evaluated included SRM 972a (four levels), SRM 2973, six College of American Pathologists (CAP) Accuracy-Based Vitamin D (ABVD) samples, and nine Vitamin D External Quality Assessment Scheme (DEQAS) samples. Results were received from 28 different laboratories using 20 ligand binding assays and 14 LC-MS/MS methods. Using the test assay results for total serum 25(OH)D (i.e., the sum of 25(OH)D2 and 25(OH)D3) determined for the single-donor samples and the RMP target values, the linear regression and 95% prediction intervals (PIs) were calculated. Using a subset of 42 samples that had concentrations of 25(OH)D2 below 30 nmol/L, one or more of the SRM and PT/EQA samples with high concentrations of 25(OH)D2 were deemed non-commutable using 5 of 11 unique ligand binding assays. SRM 972a (level 4), which has high exogenous concentration of 3-epi-25(OH)D3, was deemed non-commutable for 50% of the LC-MS/MS assays.
Communities and neighbourhoodsSummary There is growing consensus that the places where people live and the various social processes, relationships and psycho-social concepts associated with strong healthy communities and neighbourhoods make an important contribution to health. Where you live makes a considerable difference; people living in more affluent communities for example are more likely to experience better self-reported health and wellbeing. This is particularly evident in current theoretical and policy debates concerning the salutogenic and so-called strength or assets based approach to health; healthy communities have various social and physical resources available, which if they can recognise, share and utilise, can result in stronger SOC, increasing their ability to cope and thrive. Within health promotion we actively encourage communities to organise themselves for better health and well-being. The concept of ‘community’ is both complex and subjective and difficult to define. So we start by conceptualising the definitions, dimensions and meanings of community – beyond a physical location - underpinning this chapter. There are several ideas linking the community or neighbourhood as a setting, including community as a place to live, connectedness (social capital) and social action (the development of a strong SOC). The evidence is variable in quality and furthermore, few studies explicitly apply the theory of salutogenesis when they study health and wellbeing in the community context. The body of this chapter is devoted therefore to summarising the available research about salutogenic and asset-based community interventions, drawing upon examples from empirical work. In doing so, we will highlight debates emerging around the concepts of a salutogenic framework and health assets in relation to community and neighbourhood. As such, we are specifically interested in examining the resources (and/or assets) of communities and neighbourhoods and the associated processes enabling these resources to be accessed for the benefit of the community’s health and wellbeing.
Ketogenic diets as an adjuvant therapy for glioblastoma (KEATING): a randomized, mixed methods, feasibility studyPurpose We conducted a feasibility study to investigate the use of ketogenic diets (KDs) as an adjuvant therapy for patients with glioblastoma (GBM), investigating (i) trial feasibility; (ii) potential impacts of the trial on patients’ quality of life and health; (iii) patients’ perspectives of their decision-making when invited to participate in the trial and (iv) recommending improvements to optimize future phase III trials. Methods A single-center, prospective, randomized, pilot study (KEATING), with an embedded qualitative design. Twelve newly diagnosed patients with GBM were randomized 1:1 to modifed ketogenic diet (MKD) or medium chain triglyceride ketogenic diet (MCTKD). Primary outcome was retention at three months. Semi-structured interviews were conducted with a purposive sample of patients and caregivers (n=15). Descriptive statistics were used for quantitative outcomes and qualitative data were analyzed thematically aided by NVivo. Results KEATING achieved recruitment targets, but the recruitment rate was low (28.6%). Retention was poor; only four of 12 patients completed the three-month diet (MCTKD n=3; MKD n=1). Participants’ decisions were intuitive and emotional; caregivers supported diet implementation and infuenced the patients’ decision to participate. Those who declined made a deliberative and considered decision factoring diet burden and quality of life. A three-month diet was undesirable to patients who declined and withdrew. Conclusion Recruitment to a KD trial for patients with GBM is possible. A six-week intervention period is proposed for a phase III trial. The role of caregiver should not be underestimated. Future trials should optimize and adequately support the decision-making of patients.