Cardiometabolic diseases, including type 2 diabetes (T2DM) and cardiovascular disease (CVD), are common. Approximately one in three deaths annually are caused by CVD in Aotearoa New Zealand (AoNZ)(1). The Mediterranean dietary pattern is associated with a reduced risk of cardiometabolic disease in epidemiological and interventional studies(2,3). However, implementing the Mediterranean diet into non-Mediterranean populations can be challenging(4). Some of these challeanges include facilitating consumption of unfamiliar foods and the cultural and social context of food consumption. AoNZ produces a rich source of high-quality foods consistent with a Mediterranean dietary pattern. He Rourou Whai Painga is collaborative project combining contributions from food industry partners into a Mediterranean Diet pattern and providing foods, recipes and other support to whole household/whānau. The aim was to test if a New Zealand food-based Mediterranean diet (NZMedDiet) with behavioural intervention improves cardiometabolic health and wellbeing in individuals at risk. This presentation will review the background to the research, the process of forming a collaboration between researchers and the food industry, the design and implementation of a complex study design (see protocol paper)(5), with results from the initial randomised controlled trial. We conducted several pilot studies(6,7,8) to inform the final design of the research, which was a combination of two randomised controlled trials (RCT 1 and 2) and a longitudinal cohort study. RCT-1 compared 12-weeks of the NZMedDiet to usual diet in participants with increased cardiometabolic risk (metabolic syndrome severity score (MetSSS) >0.35). The intervention group were provided with food and recipes to meet 75% of their energy requirements, supported by a behavioural intervention to improve adherence. The primary outcome measure was MetSSS after 12 weeks. Two hundred individuals with mean (SD) age 49.9 (10.9)yrs with 62% women were enrolled with their household/whānau. After 12 weeks, the mean (SD) MetSSS was 1.0 (0.7) in the control (n = 98) and 0.8 (0.5) in the intervention (n = 102) group; estimated difference (95% CI) of -0.05 (-0.16 to 0.06), p=0.35. A Mediterranean diet score (PyrMDS) was greater in the intervention group 1.6 (1.1 to 2.1), p<0.001, consistent with a change to a more Mediterranean dietary pattern. Weight reduced in the NZMedDiet group compared with control (-1.9 kg (-2.0 to -0.34)), p=0.006 and wellbeing, assessed by the SF-36 quality of life questionnaire, improved across all domains p<0.001. In participants with increased cardiometabolic risk, food provision with a Mediterranean dietary pattern and a behavioural intervention did not improve a metabolic risk score but was associated with reduced weight and improved quality of life.

This collection gathers thirteen contributions by a number of historians, friends, colleagues and/or students of Jinty’s, who were asked to pick their favourite article by her and say a few words about it for an event held in her memory on 15 January 2025 at King’s College London. We offer this collection in print now for a wider audience not so much because it has any claim to be exhaustive or authoritative, but because taken all together these pieces seemed to add up to a useful retrospective on Jinty’s work, its wider context, and its impact on the field over the decades. We hope that, for those who know her work well already, this may be an opportunity to remember some of her classic (and a few less classic) articles, while at the same time serving as an accessible introduction to her research for anyone who knew her without necessarily knowing about her field, as well as for a new and younger generation of readers.

Background: Ocular point-of-care ultrasound (POCUS) may be a clinically useful method to evaluate shunt dysfunction for children with hydrocephalus in the emergency department (ED). We assessed whether a change in optic nerve sheath diameter (ONSD) from prior asymptomatic baseline is associated with shunt failure. Methods: This prospective single center cohort study included asymptomatic shunted children (age 0-18 years). Baseline ocular POCUS was performed in the outpatient neurosurgery clinic; a second POCUS was performed if the patient subsequently presented to the ED with symptoms of shunt failure. Shunt failure was defined by intraoperative confirmation of inadequate CSF flow through the shunt within 96 hours from ED presentation. Results: The primary outcome of intra-operatively confirmed shunt failure occurred in 14/76 (18%) ED patient presentations. ΔONSD in patients with and without shunt failure was 0.89mm and 0.16mm respectively; the mean difference was 0.73mm (95%CI: 0.34-1.12), p=0.0012. The area under the receiver operating characteristic curve was 0.86, with an optimal cutoff of ≥+0.4mm, corresponding to sensitivity of 0.93, specificity of 0.73, PPV of 0.43, NPV of 0.98. Conclusions: ΔONSD was strongly associated with shunt failure. We found ΔONSD of <+0.4 in symptomatic children with CSF shunts may identify a population that had low likelihood of true shunt failure.

Recommendations for immunisation practices in children with single ventricle CHD are lacking. A survey of 53 heart centres received responses from 40 centres (33 complete and 7 partial) revealing variability in immunisation recommendations. Only 11% have a written protocol. Immunisations were delayed before cardiopulmonary bypass in 94% (32/34) and after cardiopulmonary bypass in 97% (30/31), with 34% (13/38) re-dosing some immunisations post cardiopulmonary bypass. Further research is needed to develop guidelines.

Sustainable diets should promote good health for both the planet and the individual. While there is a clear association between lower environmental impact diets and better health outcomes, intervention studies are needed to determine the range of dietary changes and to understand inter-individual differences in response. Individuals having different responses to dietary interventions are underpinned by a variety of genetic, phenotypic and behavioural factors. The aim of this review is to apply the findings from previous literature examining inter-individual variation and phenotypic response to the future of sustainable healthy diets. Despite changing diets or improving diet quality, physiological responses are varied in randomised controlled trials. To better understand response, individuals can be grouped based on shared baseline characteristics or by their shared response to an intervention. Studies grouping individuals by shared characteristics use a metabolic phenotyping or metabotyping approach which demonstrates that some phenotypes are more predisposed to respond to a particular intervention. Tailoring dietary advice to metabolic phenotype shows promise for improving health and diet quality. However, more evidence is needed to understand the complexity that will come with whole dietary change in the context of sustainable healthy diets. We envisage a future where metabolic phenotyping is an integral element for prescribing personalised nutrition advice for sustainable healthy diets.

This study aimed to assess the impact of hypertensive disorders of pregnancy on infant neurodevelopment by comparing 6-month and 2-year psychomotor development outcomes of infants exposed to gestational hypertension (GH) or preeclampsia (PE) versus normotensive pregnancy (NTP). Participating infants were children of women enrolled in the Postpartum Physiology, Psychology and Paediatric (P4) cohort study who had NTPs, GH or PE. 6-month and 2-year Ages and Stages Questionnaires (ASQ-3) scores were categorised as passes or fails according to domain-specific values. For the 2-year Bayley Scales of Infant and Toddler Development (BSID-III) assessment, scores > 2 standard deviations below the mean in a domain were defined as developmental delay. Infants (n = 369, male = 190) exposed to PE (n = 75) versus GH (n = 20) and NTP (n = 274) were more likely to be born small for gestational age and premature. After adjustment, at 2 years, prematurity status was significantly associated with failing any domain of the ASQ-3 (p = 0.015), and maternal tertiary education with increased cognitive scores on the BSID-III (p = 0.013). However, PE and GH exposure were not associated with clinically significant risks of delayed infant neurodevelopment in this study. Larger, multicentre studies are required to further clarify early childhood neurodevelopmental outcomes following hypertensive pregnancies.

Shift workers in Australia constitute approximately 16% of the workforce, with nearly half working a rotating shift pattern(1). Whilst poor dietary habits of shift workers have been extensively reported, along with increased risk of metabolic health conditions such as obesity, cardiovascular disease and diabetes compared to non-shift workers(2,3,4), studies on shift working populations rarely control for individual and lifestyle factors that might influence dietary profiles. While rotating shift work schedules have been linked with higher energy intake than daytime schedules(5), little is known about the impact of different night shift schedules (e.g., fixed night vs rotating schedules) on the diets of shift workers, including differences in 24-hour energy intake and nutrient composition. This observational study investigated the dietary habits of night shift workers with overweight/obesity and compared the impact of rotating and fixed night shift schedules on dietary profiles. The hypothesis was posited, that shift workers’ diets overall would deviate from national nutrition recommendations, and those working rotating shift schedules compared with fixed night schedules would have higher energy consumption. Participants were from the Shifting Weight using Intermittent Fasting in night shift workers (SWIFt) trial, a randomised controlled weight loss trial, and provided 7-day food diaries upon enrolment. Mean energy intakes (EI) and the percentage of EI from macronutrients, fibre, saturated fat, added sugar, alcohol, and the amount of sodium were evaluated against Australian adult recommendations. Total group and subgroup analysis of fixed night vs rotating schedules’ dietary profiles were conducted, including assessment of plausible and non-plausible energy intake reporters. Hierarchical regression analysis were conducted on nutrient intakes, controlling for individual and lifestyle factors of age, gender, BMI, physical activity, shift work exposure, occupation and work schedule. Overall, night shift workers (n = 245) had diets characterised by high fat/saturated fat/sodium content and low carbohydrate/fibre intake compared to nutrition recommendations, regardless of shift schedule type. Rotating shift workers (n = 121) had a higher mean 24-hour EI than fixed night workers (n = 122) (9329 ± 2915 kJ vs 8025 ± 2383 kJ, p < 0.001), with differences remaining when only plausible EI reporters were included (n = 130) (10968 ± 2411 kJ vs 9307 ± 2070 kJ, p < 0.001). These findings highlight poor dietary choices among this population of shift workers, and higher energy intakes of rotating shift workers, which may contribute to poor metabolic health outcomes often associated with working nightshift.

Approximately 15% of Australia’s workforce are shift workers, who are at greater risk for obesity and related conditions, such as type 2 diabetes and cardiovascular disease.(1,2,3) While current guidelines for obesity management prioritise diet-induced weight loss as a treatment option, there are limited weight-loss studies involving night shift workers and no current exploration of the factors associated with engagement in weight-loss interventions. The Shifting Weight using Intermittent Fasting in night shift workers (SWIFt) study was a randomised controlled trial that compared three, 24-week weight-loss interventions: continuous energy restriction (CER), and 500-calorie intermittent fasting (IF) for 2-days per week; either during the day (IF:2D), or the night shift (IF:2N). This current study provided a convergent, mixed methods, experimental design to: 1) explore the relationship between participant characteristics, dietary intervention group and time to drop out for the SWIFt study (quantitative); and 2) understand why some participants are more likely to drop out of the intervention (qualitative). Participant characteristics included age, gender, ethnicity, occupation, shift schedule, number of night shifts per four weeks, number of years in shift work, weight at baseline, weight change at four weeks, and quality of life at baseline. A Cox regression model was used to specify time to drop out from the intervention as the dependent variable and purposive selection was used to determine predictors for the model. Semi-structured interviews at baseline and 24-weeks were conducted and audio diaries every two weeks were collected from participants using a maximum variation sampling approach, and analysed using the five steps of framework analysis.(4) A total of 250 participants were randomised to the study between October 2019 and February 2022. Two participants were excluded from analysis due to retrospective ineligibility. Twenty-nine percent (n = 71) of participants dropped out of the study over the 24-week intervention. Greater weight at baseline, fewer years working shift work, lower weight change at four weeks, and women compared to men were associated with a significant increased rate of drop out from the study (p < 0.05). Forty-seven interviews from 33 participants were conducted and 18 participants completed audio diaries. Lack of time, fatigue and emotional eating were barriers more frequently reported by women. Participants with a higher weight at baseline more frequently reported fatigue and emotional eating barriers, and limited guidance on non-fasting days as a barrier for the IF interventions. This study provides important considerations for refining shift-worker weight-loss interventions for future implementation in order to increase engagement and mitigate the adverse health risks experienced by this essential workforce.

In recent decades there has been an increased interest in the Mediterranean diet’s (MedDiet) protective capacity against age-related diseases. The MedDiet is comprised of wholefoods, with moderate to high dietary fat and a kilojoule intake of approximately 9,300kJ(1). The Mediterranean Diet Adherence Screener (MEDAS) has allowed for rapid assessment of MedDiet adherence across intervention and cohort studies globally(2). However, well-established reductions in older adults’ energy requirements often present a barrier to full MedDiet adherence(3,4). We sought to create an energy-adjusted MEDAS (E-MEDAS) for use in populations with reduced energy requirements, with a secondary analysis to determine that the strength of the relationship between E-MEDAS adherence and cardiometabolic biomarkers is not diminished through energy-adjustment. Baseline data from independently living, 60–90 year old participants enrolled in the MedWalk clinical trial were used. Estimated energy requirements (EER) were calculated for all participants (n = 161) using gender and age specific Schofield Equations, multiplied by a physical activity level (PAL) we derived from a novel method to calculate PAL’s from Actigraph and IPAQ-E data. Three distinct energy categories of E-MEDAS criteria were identified, with evenly reduced cutoff criteria across all food components. Participants with a completed MEDAS (n = 157) had their MedDiet adherence re-scored according to the reduced criteria cutoffs. Spearman’s rank correlation coefficient analyses, with 95% confidence intervals constructed by accelerated bias-corrected bootstrapping, were used to determine the strength and direction of association between both MEDAS and E-MEDAS adherence scores and 8 cardiometabolic biomarkers. The newly calculated E-MEDAS categories included Category 3 (corresponding to the original MEDAS) with a range of 9100–10500kJ (n = 30), Category 2 with a range of 7700–9100kJ (n = 81) and Category 1 with a range of 6300–7700kJ (n = 44). There was a significant (p < 0.05) weak negative correlation between the re-scored E-MEDAS and 5 cardiometabolic biomarkers; BMI (rs = −0.228, BCa 95% CI [−0.388, −0.074]), WHR (rs = −0.189, BCa 95% CI [−0.352, −0.027]), LDL (rs = −0.174, BCa 95% CI [−0.347, 0.009]), Total:HDL Ratio (rs = −0.288, BCa 95% CI [−0.429, −0.127]), Trigs (rs = −0.235, BCa 95% CI [−0.373, −0.079]. In contrast, the original MEDAS score resulted in a significant (p < 0.05) weak negative correlation in only 3 cardiometabolic biomarkers; WHR (rs = −0.167, BCa 95% CI [−0.317, −0.011]), Total:HDL Ratio (rs = −0.205, BCa 95% CI [−0.354, −0.049], and Trigs (rs = −0.217, BCa 95% CI [−0.360, −0.054]). Ultimately, we have successfully developed two categories of E-MEDAS, using a novel calculation of PALs, for use in individuals with reduced EERs. E-MEDAS scores showed a modest increase in the strength of relationship with five cardiometabolic biomarkers, indicating that reducing serves of individual components, while maintaining the overall dietary pattern does not negate the protective capacity of a MedDiet.

Are women legislators punished for not supporting women’s substantive policy interests? We test these gendered expectations. We marshal an original content analysis of cable news coverage and two survey experiments testing voters’ assessment of hypothetical legislators on the issues of abortion and equal pay. We find that voters rate both women and men legislators positively for supporting women’s issues and negatively evaluate legislators of both genders when they do not support women’s interests. We also find that women voters negatively evaluate women legislators who act against women’s interests at a greater rate than men voters. While we do not find evidence of voters holding women legislators to gendered expectations, we do find that legislators, regardless of their gender, have strategic incentives to promote women’s substantive representation. Our results suggest that voters care more about the substantive representation of women’s political interests than who supports those interests.

Community-engaged research is essential to advance the implementation of evidence-based practices, but engagement quality is rarely assessed. We evaluated community health centers’ (CHCs) experiences partnering with the Implementation Science Center for Cancer Control Equity (ISCCCE) using an online survey of 59 CHC staff. Of 38 respondents (64.4% response rate), most perceived their engagement positively, with over 92% feeling respected by ISCCCE collaborators and perceiving projects as beneficial. Limited staff time and resources were the main challenges identified. This study suggests the utility of gathering feedback to evaluate community research engagement and inform adaptations of research processes to optimize partnership quality.

An American researcher examines how the requirements of political assimilation have threatened the unique culture of China's Tai minority, and the Tai response.

In 1997 I arrived on China's southwest borders planning to spend a year researching ethnic minority folklore. The only problem, as I discovered when I arrived, was that there didn't appear to be any.