Limited sunshine and dietary vitamin D make vitamin D deficiency very common in Ireland. Breastfeeding is the universal recommendation and supplies the best combination of nutrients and bioactive factors for all infants(1). However, maternal diet and nutrition status impacts concentrations of certain nutrients in breastmilk and therefore vitamin D concentrations can be lower than recommended for infants(2,3). This study aimed to determine the vitamin D intakes and food sources of breastfeeding mothers in Ireland.

Data was collected as part of the WellFed study, a 4-week randomised control trial investigating the effectiveness of a food supplement containing a protein hydrolysate and beta glucan (Wellmune®) during lactation on immune and gut health (LS-23-07-OSullivan). Participant vitamin D intakes were assessed using FoodBook24 self-completed 24-hour recalls. Foods were grouped into food groups to determine their contribution to intake as well as the contribution from natural and added vitamin D foods. Data was analysed using IBM SPSS Statistics (version 27).

Dietary analysis of 45 participants indicated that maternal vitamin D intakes were low (6.4 ± 4.6μg/day). Most participants (96%) did not meet the 15μg/day recommendation, despite 56% of participants reporting they consumed some form of vitamin D supplement. Natural vitamin D foods like eggs and egg dishes, fish and fish products, meat and meat products and foods with added vitamin D including breakfast cereals, beverages, and milk and yoghurt were the key food groups contributing to intake, with the majority coming from natural food sources.

Low dietary vitamin D intake is common among breastfeeding women and diet alone is insufficient to achieve the daily vitamin D requirements even when supplements are consumed. As natural food sources of vitamin D are limited and infrequently consumed, recommendations to consume more vitamin D foods may not be successful as a standalone strategy to improve vitamin D status. A combination of approaches including the promotion of vitamin D rich food consumption, supplementation strategies, and the introduction of food fortification policies may be a feasible method for improving vitamin D across the population.

Childhood obesity is a serious public health concern worldwide. One in five children are overweight or obese in Ireland1. Suboptimal growth, either in pregnancy or infancy, can increase the risk of obesity in childhood2. National policy fails to recognise early life exposures as potential contributors to Ireland’s obesity epidemic. This research examines the impact of ‘Labour and Birth’, ‘Birth Weight Status’, and ‘Maternal BMI’ on infant growth in the first weeks of life.

This research is a secondary analysis of data collected as part of the WellFed study, a randomised placebo-controlled trial investigating the effect of a maternal dietary supplement comprised of a milk protein hydrolysate and yeast beta-glucan (Wellmune®) (LS-23-07-OSullivan). The supplement does not influence the present findings. Mother and infant anthropometrics were measured during two study visits, at approximately 4 and 8-weeks postpartum. Participants completed a series of questionnaires to obtain basic demographic, birth and lifestyle data. Infant weight and length percentiles were calculated using the UK-WHO 0-2 years: weight-for-age percentiles and the UK-WHO 0-2 Years: length-for-age percentiles for both males and females. Statistical analysis was performed using IBM SPSS Statistics (version 27).

Data from 51 mother-infant dyads show infants delivered via cesarean section weighed less at the 4-week (4.1± 0.4 vs 4.5± 0.5 kg, p = 0.015) and 8-week follow-up (5.1± 0.5 vs 5.5± 0.6 kg, p = 0.021) and were shorter at the 8-week follow-up (56.3± 1.9 vs 57.7± 2.0 cm, p = 0.030) compared to infants born vaginally. Infants born following induction were significantly heavier at the 8-week follow-up compared to those not-induced (5.8± 0.7 vs 5.2± 0.5 kg, p = 0.006). In this cohort, 40% of infants were classified as large-for-gestational-age (LGA). Across the 8-week study period, 50% of LGA infants dropped two or more growth percentiles.

Observations from this study highlight a high prevalence of LGA infants in this cohort which raises concern for the national prevalence of LGA infants in Ireland. Interventions during labour and birth were shown to influence infant growth in this study. These findings highlight the need for further investigation into the relationship between early life exposures and growth during infancy and childhood. Implementing healthcare policies focusing on reducing the number of elective birthing procedures performed and targeting obesity amongst women of reproductive age are possible measures that can be implemented to help tackle the obesity crisis in Ireland.

Objectives: Evidence is limited on the comparative impact of specific anesthetic agents used in electroconvulsive therapy (ECT) on outcomes in treatment-resistant depression (TRD). Our study aimed to compare the efficacy of methohexital vs propofol by examining the number of treatment sessions needed to transition from acute to maintenance ECT (NTS) (i.e., change from minimum of two to one or fewer treatments per week), missed treatment sessions, and seizure durations.

Methods: We conducted a retrospective cohort study via chart review of patients with TRD receiving ECT from October 2017 to October 2019. We included adult patients (3 18 years) diagnosed with TRD who received at least six ECT sessions. We analyzed our data using multilevel structural equation modeling(MSEM).

Results: We included 149 patients (36.9% or 55/149 were ³ 65 years): 54 were methohexital-treated (mean age 59 ± 17 years; 41% male) and 95 were propofol-treated (mean age 55 ± 17 years; 36% male). No significant differences between methohexital vs propofol groups were found in NTS (mean ± SD: 12.6 ± 6.6 vs 11.5 ± 6.1; p = 0.3) and missed treatment sessions (0.63 ± 1.2 vs 0.69 ± 1.2; p = 0.75). Patients receiving methohexital manifested longer motor (25.5 ± 10.6s vs 19.9 ± 8.4s; p < .001) and electroencephalographic (EEG) seizure durations (42 ± 17.5s vs .9± 13.1s; p < .001) vs propofol. MSEM revealed that (1) methohexital was associated with longer first-session seizure durations (motor seizure: b = 6.28, p < 0.05; EEG seizure: b = 8.03, p < 0.05) and more rapid decline in motor seizure duration across sessions (b = –.38, p < .05) over propofol, while accounting for relevant covariates; (2) regardless of anesthesia used, faster reductions in seizure durations across sessions predicted fewer NTS; and (3) methohexital was associated with fewer NTS adjusted for covariates which were driven by two indirect effects: (a) sharper decline in motor duration across sessions and (b) the association between a sharper decline in motor duration across sessions with fewer missed treatments. The outcomes were not influenced by age, indicating that the findings are relevant to older adults.

Conclusions: Our findings suggest that methoxexital had fewer NTS and longer seizure durations than propofol, indicating better ECT outcomes using methohexital for TRD. Further research is warranted to verify methohexital’s effects on cognitive and additional recovery outcomes within clinical practice.

People with polycystic ovary syndrome (PCOS) have higher weight gain and psychological distress compared to those without PCOS(1). While COVID-19 restrictions led to population level adverse changes in lifestyle, weight gain and psychological distress(2), their impact on people with PCOS is unclear. The aim of this study was to investigate the impact the 2020 COVID-19 restrictions had on weight, physical activity, diet and psychological distress for Australians with PCOS. Australian reproductive-aged women participated in an online survey with assessment of weight, physical activity, diet and psychological distress. Multivariable logistic and linear regression were used to examine associations between PCOS and residential location with health outcomes. On adjusted analysis, those with PCOS gained more weight (2.9%; 95% CI; 0.027–3.020; p = 0.046), were less likely to meet physical activity recommendations (OR 0.50; 95% CI; 0.32–0.79; p = 0.003) and had higher sugar-sweetened beverage intake (OR 1.74; 95% CI 1.10–2.75; p = 0.019) but no differences in psychological distress compared to women without PCOS. People with PCOS were more adversely affected by COVID-19 restrictions, which may worsen their clinical features and disease burden. Additional health care support may be necessary to assist people with PCOS to meet dietary and physical activity recommendations.

Maintaining a healthy weight during pregnancy is critical for both women's and children's health. Excessive gestational weight gain (GWG) can lead to complications such as gestational diabetes, hypertension and caesarean delivery. Insufficient GWG can cause fetal growth restriction and increase infant mortality risk. Additionally, postpartum weight retention raises risk of obesity, type 2 diabetes and other chronic diseases for both mother and child. This review seeks to identify current obstacles in weight management research during and after pregnancy and explore evidence-based strategies to overcome them. Pregnancy offers a window of opportunity for health behaviour changes as women are more receptive to education and have regular contact with health services. Staying within Institute of Medicine's recommended GWG ranges is associated with better maternal and fetal outcomes. Systematic review evidence supports structured diet and physical activity pregnancy interventions, leading to reduced GWG and fewer complications. Health economic evaluation indicates significant returns from implementation, surpassing investment costs due to decreased perinatal morbidity and adverse events. However, the most effective way to implement interventions within routine antenatal care remains unclear. Challenges increase in the postpartum period due to competing demands on women physically, mentally and socially, hindering intervention reach and retention. Flexible, technology-supported interventions are needed, requiring frameworks such as penetration-implementation-participation-effectiveness and template-for-intervention-description-and-replication for successful implementation. Greater research efforts are necessary to inform practice and investigate fidelity aspects through pragmatic implementation trials during the pregnancy and postpartum periods. Understanding the best ways to deliver interventions will empower women to maintain a healthy weight during their reproductive years.

The present paper outlines current issues in the nutritional care of women during pregnancy and potential resources to address them. Globally, overnutrition, undernutrition and nutritional imbalances are widespread among women of reproductive age; increasing the risk of pregnancy complications and non-communicable diseases in both mothers and their children. Most women do not meet dietary guidelines for pregnancy. The World Health Organisation (WHO) recommends nutrition and weight counselling during pregnancy for all women. However, clinical practices focusing on nutrition vary and there is no consensus on which outcomes are most important for pregnancy nutrition interventions, with little consideration for the ‘patient voice’. The International Federation of Gynaecology and Obstetrics (FIGO) nutrition checklist is a clinical practice tool that is available for healthcare professionals that will address this issue. The pregnancy nutrition core outcome set will also support advancement of antenatal nutrition by identifying the most critical nutrition-related outcomes from the perspective of healthcare professionals, researchers and women with experience of pregnancy. While poor nutrition can result in adverse outcomes across women of all weight categories, those with obesity may require specialist care to reduce their risk. Obesity is a chronic, progressive, relapsing disease that has high individual variability in its prognosis. The use of obesity staging systems, which consider mental, physical and functional health, can stratify individuals into risk categories and aid in treatment prioritisation in pregnancy. As the prevalence of obesity continues to rise, an obesity staging approach may support clinicians, especially those in limited resource settings.

In this paper we analyse the limiting conditional distribution (Yaglom limit) for stochastic fluid models (SFMs), a key class of models in the theory of matrix-analytic methods. So far, only transient and stationary analyses of SFMs have been considered in the literature. The limiting conditional distribution gives useful insights into what happens when the process has been evolving for a long time, given that its busy period has not ended yet. We derive expressions for the Yaglom limit in terms of the singularity˜$s^*$ such that the key matrix of the SFM, ${\boldsymbol{\Psi}}(s)$, is finite (exists) for all $s\geq s^*$ and infinite for $s<s^*$. We show the uniqueness of the Yaglom limit and illustrate the application of the theory with simple examples.

Typical enteropathogenic Escherichia coli (tEPEC) infection is a major cause of diarrhoea and contributor to mortality in children <5 years old in developing countries. Data were analysed from the Global Enteric Multicenter Study examining children <5 years old seeking care for moderate-to-severe diarrhoea (MSD) in Kenya. Stool specimens were tested for enteric pathogens, including by multiplex polymerase chain reaction for gene targets of tEPEC. Demographic, clinical and anthropometric data were collected at enrolment and ~60-days later; multivariable logistic regressions were constructed. Of 1778 MSD cases enrolled from 2008 to 2012, 135 (7.6%) children tested positive for tEPEC. In a case-to-case comparison among MSD cases, tEPEC was independently associated with presentation at enrolment with a loss of skin turgor (adjusted odds ratio (aOR) 2.08, 95% confidence interval (CI) 1.37–3.17), and convulsions (aOR 2.83, 95% CI 1.12–7.14). At follow-up, infants with tEPEC compared to those without were associated with being underweight (OR 2.2, 95% CI 1.3–3.6) and wasted (OR 2.5, 95% CI 1.3–4.6). Among MSD cases, tEPEC was associated with mortality (aOR 2.85, 95% CI 1.47–5.55). This study suggests that tEPEC contributes to morbidity and mortality in children. Interventions aimed at defining and reducing the burden of tEPEC and its sequelae should be urgently investigated, prioritised and implemented.

During the past decade, genetics research has allowed scientists and clinicians to explore the human genome in detail and reveal many thousands of common genetic variants associated with disease. Genetic risk scores, known as polygenic risk scores (PRSs), aggregate risk information from the most important genetic variants into a single score that describes an individual’s genetic predisposition to a given disease. This article reviews recent developments in the predictive utility of PRSs in relation to a person’s susceptibility to breast cancer and coronary artery disease. Prognostic models for these disorders are built using data from the UK Biobank, controlling for typical clinical and underwriting risk factors. Furthermore, we explore the possibility of adverse selection where genetic information about multifactorial disorders is available for insurance purchasers but not for underwriters. We demonstrate that prediction of multifactorial diseases, using PRSs, provides population risk information additional to that captured by normal underwriting risk factors. This research using the UK Biobank is in the public interest as it contributes to our understanding of predicting risk of disease in the population. Further research is imperative to understand how PRSs could cause adverse selection if consumers use this information to alter their insurance purchasing behaviour.