Salivary iodide concentration (SIC) has emerged as a promising non-invasive alternative for assessing iodine status(1). However, the influence of saliva collection method on biomarker reliability remains unclear. This study compared unstimulated and stimulated saliva collection methods and evaluated their associations with urinary iodine indices to identify the most reliable approach for iodine quantification.

Twenty-nine healthy adults provided unstimulated and stimulated saliva samples two hours post-evening meal, alongside a 24-hour urine sample. The 24-h urinary iodine concentration (24 h UIC; µg/L) was measured and corrected for creatinine (24 h UI/Cr; µg/gCr). The SIC (µg/L) and protein (mg/mL) were analysed, and from these, secretion rates (µg/min; mg/min) and the protein-normalised iodide ratio (SI/P; µg/g) were calculated. Within-subject repeatability was assessed in a subgroup (n=8) across three non-consecutive days using the coefficient of variation (%CV).

Unstimulated saliva showed higher median iodide (94.4 vs 59.4 µg/L; p < 0.001), protein (2.36 vs 1.90 mg/mL; p < 0.001), and SI/P (35.99 vs 29.45 µg/g; p = 0.046) concentrations than stimulated saliva, whereas flow rate was significantly higher under stimulation (1.78 vs 1.14 mL/min; p < 0.001). Despite these concentration differences, total iodide and protein secretion per minute were comparable between methods (iodide: 0.10 vs 0.10 µg/min; protein: 3.58 vs 2.94 mg/min; both p > 0.1). For unstimulated saliva, both SIC and SI/P correlated significantly with 24 h UIC (r = 0.403, p = 0.033; r = 0.429, p = 0.020, respectively) and 24 h UI/Cr (r = 0.584, p = 0.001; r = 0.592, p < 0.001).For stimulated saliva, both also correlated significantly with 24 h UI/Cr (r = 0.475, p = 0.012; r = 0.404, p = 0.041) and 24 h UIC before correction (r = 0.417, p = 0.027), but this association was no longer significant after correction (r = 0.357, p = 0.068). Across both methods, correlations with 24 h urinary iodine excretion (24 h UIE) ranged from r = 0.20 to 0.33 and were not significant, except for the salivary iodide secretion rate, which was associated significantly with 24 h UIE under stimulated conditions only (r = 0.488, p = 0.009). Across 3-days, stimulated saliva showed lower %CV than unstimulated for SIC (31.6% vs 39.0%), SI/P (34.0% vs 44.9%), and iodide secretion rate (33.1% vs 47.9%), with variability comparable to urinary biomarkers (UIC = 30.4%; UIE = 34.7%).

Overall, although total iodide secretion was comparable between methods, stimulated saliva showed stronger methodological performance, supporting its use as the preferred protocol for reliable salivary iodine assessment. Both methods demonstrated moderate correlations with 24 h UIC and 24 h UI/Cr; however, for stimulated saliva, the association with 24 h UIC was significant only before protein correction. The stimulated, swab-based method yielded greater sample volume and lower intra-individual variability, and notably, the salivary iodide secretion rate under stimulated conditions was the only parameter to correlate significantly with 24 h UIE.

As disasters intensify alongside population aging, Japan has introduced welfare evacuation shelters for individuals requiring care. Following the 2024 Noto Peninsula Earthquake, Umyu-dosora was designated as one such shelter; however, data on its actual use remain limited. This study aimed to assess demand for welfare evacuation shelters by examining temporal trends in resident numbers after the disaster.

Data on evacuees’ admission and discharge dates at Umyu-dosora were extracted from a cloud-based Kintone database, covering January-March 2024. Records with missing admission or discharge dates were excluded.

Among the 83 evacuees with identifiable records, the most common age group for both sexes was 70-79 years. Age or sex data were unavailable for 22 individuals. The shelter began operating on January 8, 2024. Resident numbers peaked at over 40 in late January, stabilized at approximately 30 throughout February, and gradually declined by late March. The facility continued to accommodate some evacuees even after assuming its original function as a group home for individuals with mental illness.

The high demand for evacuation support for individuals requiring long-term care during the first month after the Noto Peninsula Earthquake underscores the need for the planned establishment of welfare shelters.

Vitamin D deficiency is considered to increase risk of musculoskeletal disorders, hinder standing balance and impair immunity(1). The prevalence of low vitamin D status is endemic among UK night shift workers, exceeding 30% and 45% in men and women, respectively(2). However, knowledge and attitudes to vitamin D supplementation among shift workers in the UK have not been well captured. This study aimed to examine awareness of vitamin D among UK adult shift workers, and assess current practices related to vitamin D supplementation.

An anonymous online cross-sectional survey was developed following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES)(3) and disseminated via social media. Adaptive questioning and branching techniques facilitated the collection of categorical-level data across a maximum of 59 non-compulsory questions, including multiple choice, free text, and Likert scale formats. Responses were captured across a 5-week period between March-April 2025. Data was self-reported. Data analysis involved descriptive statistics and Fisher’s exact test for comparison across groups.

In total, 52 shift workers responded to the survey (37% female; 37% male; 1.9% non-binary; 24% gender not disclosed). Most participants reported working an irregular shift pattern (44%), followed by fixed (29%), rotating (21%) or other (6%) shift pattern. Of 45 complete responses, 53% (n=24) reported taking a vitamin D supplement, of which the dose ranged from 5µg/d to >100µg/d. The most commonly reported supplement dose was 25µg/d (25%; n=6/24); 4 participants could not identify the dose of the supplement. Only 42% (n=10/24) of participants reported taking the supplement daily. The higher proportion of vitamin D supplement use in females (67%; n=12/18) compared to males (42%; n=8/19) was not statistically significant (P=0.19). Of those taking a vitamin D supplement, the majority had been taking the supplement for ≥4 months (58%; n=14/24). Few participants (12%; n=5/43) reported changing vitamin D supplement use since starting shift work. Although 65% (n=30/46) reported awareness of potential health benefits of vitamin D, only 2 participants correctly identified 10µg/d as the Recommended Nutrient Intake (RNI) value for vitamin D in the UK. Of 10 participants who reported social media as a source of vitamin D information, 3 reported social media as the only information source. Only 1 (of 43) participant reported receiving guidance on vitamin D within the workplace. Of 21 participants who reported having a previous blood test for nutrition-related concerns, 71% (n=15) reported vitamin D deficiency.

Self-reported vitamin D supplement use is common among UK shift workers, but awareness of recommended intake and workplace guidance is limited. Addressing this gap through targeted workplace education could help to ensure safe and effective supplementation practices among UK shift workers, and could potentially improve organisational safety and performance outcomes through reduced musculoskeletal disorders and sickness absence.

To evaluate medications, surgical procedures, demographics and co-morbidities in Ménière’s disease using TriNetX.

Retrospective cohort analysis.

Among 117,059 Ménière’s disease patients, common medications were corticosteroids benzodiazepines, diuretics and antacids. Surgical procedures were rare: cochlear implantation (1 percent), endolymphatic sac surgery (1 percent), labyrinthectomy (0.3 percent) and vestibular nerve section (0.1 percent). Surgical patients were older (mean 68.4 vs 66 years, p < 0.001), more often male (44.3 percent vs 34.6 percent) and less likely to be Asian (1.6 percent vs 8.3 percent) or African American (2.0 percent vs 4.4 per cent). Co-morbidities included musculoskeletal diseases, metabolic disorders, hypertension, anxiety and/or depression, gastro-oesophageal reflux disease, thyroid disordersand migraine. Melanoma prevalence (6 percent) was 12–15 times higher than in the US population.

Ménière’s disease treatment is dominated by corticosteroids, benzodiazepines and diuretics, with rare surgical procedures. Surgical patients are older, more often male and less likely to be Asian or African American. Co-morbidities include musculoskeletal diseases, hypertension, gastroesophageal reflux disease, thyroid disorders, migraine and higher melanoma prevalence, warranting further research.

To evaluate the relative effectiveness of voluntary social distancing appeals versus mandated lockdowns in reducing population mobility during the COVID-19 pandemic, using India as a developing country case study.

This study analyzed daily mobility data from Google’s Community Mobility Reports across six location categories between February 16 and May 31, 2020. A geographic-level regression model was employed to isolate voluntary mobility changes during India’s 14-hour voluntary Janta Curfew prior to the mandatory nationwide lockdown. The model controlled for pandemic severity, health infrastructure, and socioeconomic factors.

Conservative estimates indicate that voluntary measures accounted for a substantial proportion of overall mobility declines, ranging from 27% to 71% depending on the location. The most pronounced voluntary reductions occurred in retail and recreational centers, parks, and transit stations.

Timely and targeted non-mandated appeals can achieve meaningful behavioral change, complementing formal restrictions. These findings offer critical guidance for health promotion policy, demonstrating that voluntary public compliance can be a viable, flexible strategy for pandemic management, particularly in resource-limited settings where strict mandates may cause severe socioeconomic strain.

The global food system is responsible for ~26% of greenhouse gas emissions, 70% of freshwater use, and occupies nearly 50% of habitable land(1). This makes food production a significant driver of environmental degradation. Consequently, the concept of sustainable diets has gained significant attention in recent years as policymakers and researchers seek to mitigate these impacts. Systems approaches provide a promising framework for addressing the complex, interconnected factors influencing diet sustainability(2). However, studying sustainable diets as part of a complex system presents significant challenges, as it requires capturing dynamic interactions between environmental, economic, and social factors(3). A variety of systems approaches have been used to model these interactions, but there has been no review evaluating their application in this field. This study presents a scoping review(4) to answer the following research question: What methods have been employed in systems approaches to examine the factors influencing sustainable diets in sustainable dietary research?

A comprehensive search was conducted across MEDLINE, SCOPUS, Web of Science, and Swansea University library database, identifying eligible peer-reviewed studies, that applied systems methods to sustainable diets/food systems. 43 papers were included.

In this review, the results for systems methodologies were separated into formal methods and framing approaches as these two broad types of approaches emerged after analysing the results. For formal methods, the predominant methodology applied to sustainable diet was agent-based modelling (n = 15), followed by systems mapping (n = 6), simulation modelling (n = 6), systems dynamic (n = 4). The least common methodological categories were network analysis (n = 3), multi-criteria decision making (n = 1) and optimisation modelling (n = 1). For framing approaches, systems thinking and systems framing had four eligible studies each. Out of the 43 studies that met the criteria, 18 used participatory methods.

Further findings indicated that while systems approaches offer valuable insights into the complexity of adherence to a sustainable diet, their application is often misaligned, particularly in accounting for diverse regions and socio-economic contexts. However, the application of systems approaches in the field of sustainable diets remains in its infancy, with research largely focused on descriptive analyses rather than more advanced methodologies.

To progress there is a need to further refine systems methodologies, enhance their applicability across different contexts, and set a systematic research agenda that encompasses the design, implementation, and evaluation of systems-level interventions to drive meaningful change.

Considering the significant impact of communication skills on healthcare outcomes, effective communication is essential in delivering dietetic care. However, traditional methods of feedback to students on their communications skills may not fully capture non-verbal or empathic dimensions of interaction(1). Video-based feedback has demonstrated value in healthcare training(2). It is essential to understand how different types of video feedback are received and how the integration of video recording technology is perceived as affecting consultation simulation activities. Point-of-view technology are high-quality hands-free devices that record user perspective video. This research aimed to explore student and actor perceptions and experiences of using point-of-view (POV) technology in simulations and subsequent POV video-feedback processes.

Students participated in simulated communication with a patient actor while wearing POV technology during the consultation and could then re-watch their consultation. This multi-method qualitative study used in-person focus groups with first-year MSc Dietetics students who had used POV devices in a simulated consultation and/or an assessment, and semi-structured online interviews with simulated patient actors who had worn the devices. They were conducted in March 2025. Focus groups and interviews were facilitated by trained researchers with no prior relationship with the students or patient actors, transcribed and analysed using Braun and Clarke’s six-phase inductive thematic analysis in NVivo(3). Ethical approval was received from King’s College London (LRS/DP-24/25-46586; MRA-24/25-48479).

17 students across three focus groups and 5 patient actors participated. Overlapping and distinct perspectives from students and actors were generated across five themes. 1) Appropriateness and fit for learning context: students valued the immersive perspective of POV recordings over conventional room-based recording method, enhancing relevance for dietetic practice. 2) Technical and usability issues: both groups reported challenges with device comfort, stability, and camera angle, although actors generally found the device soon “just became part of the role.” 3) Reflective learning value: recordings were viewed as enhanced reflection and were particularly beneficial for developing awareness of non-verbal behaviours such as body language, empathy, and patient-centred communication. 4) Authenticity of simulation: actors reported minimal disruption to role-play, though some noted increased student self-consciousness. 5) Implementation considerations: both groups recommended structured orientation, ergonomic refinements, and clear guidance on data use to optimise acceptability and sustainability.

This study demonstrates that POV video feedback is a feasible and pedagogically valuable approach for enhancing communication skills in dietetics education. Dual student and patient actor’s perspectives capture relational and non-verbal elements often overlooked in traditional feedback approaches, supporting students’ self-reflection and empathy development. However, technical and ergonomic refinements, alongside early integration and clear data governance, are essential for wider adoption. The findings contribute novel insights into simulation-based dietetic education and highlight POV technology as a promising approach for strengthening communication skill training prior to clinical placements.

Malnutrition continues to pose a significant public health concern in The Gambia(1), where dietary diversity remains limited and nutrient-dense indigenous crops such as millet(2), baobab(3), mango(4), and hibiscus(5) are underutilised. This study investigated the feasibility of developing millet-based functional snack bars incorporating Gambian ingredients to address dietary gaps, reduce food waste, and strengthen sustainable food systems. The objectives were to:(1) examine snacking behaviours and motivations among Gambian adults;(2) formulate and nutritionally analyse four millet-based snack bar variants;(3) assess their sensory acceptability among UK-based adults; and(4) explore Gambian consumers’ perceptions of front-of-pack (FoP) nutrition labelling. It was hypothesised that incorporating Gambian ingredients into snack bars would enhance nutritional value while maintaining sensory qualities, and that culturally adapted FoP labelling could improve consumer acceptability.

A four-phase mixed-methods design was employed:(1) an online Snacking Behaviour Survey (SBS) among Gambian adults (n: 21);(2) formulation and nutritional analysis of four snack bar variants - Control (V1: millet, nuts, seeds, dried fruit), Functional (V2: millet + baobab, mango, hibiscus), Reduced-fat (V3), and Reduced-sugar (V4);(3) sensory evaluation among UK-based adults (n: 40); and(4) an online Nutrition Label Survey (NLS) with Gambian consumers (n:11). Quantitative data were analysed using descriptive statistics and non-parametric Friedman and Wilcoxon tests with significance set at p < 0.05.

SBS results indicated high consumer interest in healthier snacks, with 90.5% expressing interest and 76.1% prioritising healthfulness in snack choices. Snacking behaviour was influenced by convenience, affordability, and cultural familiarity. Nutritional analysis confirmed that V3 achieved a 46% fat reduction and V4 achieved a 46% sugar reduction as compared to V1, surpassing the 30% reduction threshold required for UK/EU “reduced” nutrition claims. Sensory evaluation revealed statistically significant differences (p < 0.001) in taste, sweetness, and satisfaction across variants. Mean taste scores (five-point scale) were highest for V1 (4.2 ± 0.5), moderate for V2 (3.5 ± 0.5) and V3 (3.4 ± 0.6), and lowest for V4 (2.1 ± 0.6). Despite its favourable nutrient profile, V4 was least preferred, highlighting the sensory challenges of sugar reduction. NLS data indicated strong interest in nutrition information but limited comprehension of FoP traffic-light coding. Consumer acceptability was primarily driven by taste, texture, and ingredient familiarity rather than label interpretation.

Millet-based snack bars incorporating Gambian crops demonstrate potential to enhance dietary diversity, utilise indigenous ingredients, and promote sustainable food innovation. Modest reformulation with functional ingredients (V2) improved nutritional value without compromising sensory appeal, while fat reduction (V3) proved more feasible than sugar reduction (V4). Culturally adapted labelling and consumer education are essential to maximise public health impact(6). The findings support the United Nations Sustainable Development Goals 2 and 3 by promoting climate-resilient crops and reducing free sugar consumption within sustainable nutrition systems.

Social media (SM) has become a primary source of nutrition information for adolescents in the UK(1). However, widespread nutrition misinformation on these platforms poses a significant public health concern for adolescents, influencing dietary habits, body image, and health outcomes(2,3). The complex relationship between adolescents and SM nutrition content is underexplored. The aim of this study was to explore the relationship between SM use and nutrition-related practices among secondary school students in London.

A mixed-methods study design was used with a sample of London adolescents (n=24, aged 16-18+) recruited from three secondary schools/colleges across London. Questionnaires and four focus groups were used for data collection. Quantitative data from the questionnaire was analysed using SPSS, while qualitative data was thematically analysed.

Of the 24 participants (54% female), a majority (61%) used SM as their primary source for nutrition information, with TikTok (68%) and fitness influencers (57%) being the most popular platform and account type, respectively. Although 71% had encountered nutrition misinformation, few consistently verified the nutrition qualifications of creators (13%), and most didn’t routinely fact-check (54%). The majority of participants altered their diet (79%) and purchased nutrition-related products (71%) in response to SM content. A total of 71% reported being influenced by brands and influencers in their nutrition choices. Females spent significantly more time on SM (p<.001), were more likely to fact-check (p<.001) and reported more negative feelings related to body image pressures (p=.014). Meanwhile, 90% of males reported positive feelings and utilised intuition as a form of fact-checking.

The study found that SM had a pervasive influence on participants’ nutrition-related practices, and they often sought advice from non-expert sources. The participants’ awareness of nutrition misinformation did not consistently lead them to fact-check content or credentials. These findings suggest that the current nutrition education in schools should incorporate digital and emotional literacy into the nutrition curriculum, equipping adolescents with the skills to navigate online nutrition misinformation and body image pressures.

Cardiovascular disease (CVD) is a leading cause of death in the UK, and cardiac rehabilitation (CR) is recommended post-myocardial infarction to improve outcomes. However, uptake remains low due to referral barriers, logistical challenges, and limited resources. Poor diet is a modifiable risk factor for CVD, yet access to tailored nutrition support within CR is limited. NICE guidance recommends personalised dietary advice as part of CR(1), and remote delivery of personalised nutrition may offer a scalable solution to improve diet quality and support equitable CR access. eNutriCardio is a novel web-based personalised nutrition advice (PNA) tool adapted from the validated eNutri web-app(2), originally developed for the general population(3). This study investigated the effectiveness of eNutriCardio in improving diet quality in UK NHS patients offered CR.

Patients eligible for CR completed a validated food frequency questionnaire (FFQ) via eNutriCardio shortly after their cardiac event or procedure. Participants were randomised to receive either usual care (including CR programme) (control) or usual care plus eNutriCardio PNA (intervention). The PNA was tailored to individual FFQ responses and an 11-component diet quality score (DQS), providing food-based recommendations to improve their three lowest scoring DQS components, where a higher score reflects greater adherence to UK dietary guidance. Intervention participants received coaching emails at weeks 2, 4 and 8, prompting participants to set and reflect on healthy eating intentions. After 12 weeks, both groups repeated the FFQ and provided feedback. An independent samples t-test compared change in overall DQS between groups (primary outcome). Targeted analysis (paired samples t-tests) explored whether change in DQS differed between PNA components that intervention participants intended to change versus components they either did not intend to change nor received advice about. The study was registered with ClinicalTrials.gov (ID: NCT05449769) and conducted according to the principles outlined in the Declaration of Helsinki.

Twenty-seven participants were included in the present analysis (intervention: n=13; control: n=14). Baseline characteristics were not significantly different between groups: mean age 61 years (SD 8), 82% male, and mean BMI 27.9 kg/m2 (SD 5.4). Intervention participants showed a 54% greater increase in total DQS (+21.2 points, out of 100) compared with control participants (+9.8 points) after 12 weeks (p=0.036). Within the intervention group, changes in DQS component scores were 80% higher for components participants intended to change versus those without intentions or advice (p≤0.001). No significant difference in BMI change was observed. All intervention participants agreed that eNutriCardio PNA helped them eat healthier and should be offered to all CR-eligible patients.

Adding eNutriCardio PNA to usual care improved diet quality significantly more than usual care alone in NHS patients offered CR. This digital tool may enhance CR by offering a remote, personalised nutrition solution for patients unable to attend in-person programmes.