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Background: As genetic tests become cheaper, the possibility of their widespread availability mus... more Background: As genetic tests become cheaper, the possibility of their widespread availability must be considered. This study involves a risk score for lung cancer in smokers that is roughly 50% genetic (50% clinical criteria). The risk score has been shown to be effective as a smoking cessation motivator in hospital recruited subjects (not actively seeking cessation services). Methods: This was an RCT set in a United Kingdom National Health Service (NHS) smoking cessation clinic. Smokers were identified from medical records. Subjects that wanted to participate were randomised to a test group that was administered a gene-based risk test and given a lung cancer risk score, or a control group where no risk score was performed. Each group had 8 weeks of weekly smoking cessation sessions involving group therapy and advice on smoking cessation pharmacotherapy and follow-up at 6 months. The primary endpoint was smoking cessation at 6 months. Secondary outcomes included ranking of the risk score and other motivators. Results: 67 subjects attended the smoking cessation clinic. The 6 months quit rates were 29.4%, (10/34; 95% CI 14.1-44.7%) for the test group and 42.9% (12/28; 95% CI 24.6-61.2%) for the controls. The difference is not significant. However, the quit rate for test group subjects with a "very high" risk score was 89% (8/9; 95% CI 68.4-100%) which was significant when compared with the control group (p = 0.023) and test group subjects with moderate risk scores had a 9.5% quit rate (2/21; 95% CI 2.7-28.9%) which was significantly lower than for above moderate risk score 61.5% (8/13; 95% CI 35.5-82.3; p = 0.03). Conclusions: Only the subgroup with the highest risk score showed an increased quit rate. Controls and test group subjects with a moderate risk score were relatively unlikely to have achieved and maintained non-smoker status at 6 months.

BMC Research Notes, 2017

journal of Nutritional and Environmantal Medicine, 2008

Background. In view of plans for dietary fortification with folic acid, there is a need to reasse... more Background. In view of plans for dietary fortification with folic acid, there is a need to reassess the advice being given in primary care. Patients and professionals may assume that fortification will make preconceptional folic acid supplementation unnecessary, but this is unlikely to be correct. Aim. To calculate the intake of total folic acid and folate at conception and to estimate the impact of fortification on the incidence of neural tube defect (NTD) conceptions. Design. An in-depth investigation of dietary folate intake of 18 women and a survey of preconception supplementation in a group of 130 women, including an assessment of the probable impact of mandatory fortification. Method. Dietary folate intake of six infertile women and 12 age-matched fertile controls was assessed using a 7-day weighed diet diary. Mean values for this group were used as an estimate of local dietary folate intake. Questionnaires about periconceptional intake of supplements that included folic acid in their formulation were given to newly pregnant women attending district midwife clinics, a series of women attending an assisted conception unit and a self-help group of lesbians who were either pregnant or planning a pregnancy. Results. Of the 18 women in the dietary study there was suboptimal dietary folate intake in all infertile subjects and in eight of 12 controls. An approximate value for the combined intake of dietary folate and folic acid in the larger survey (n5130) was calculated. We estimated that UK dietary fortification will double the number of pregnancies with adequate total folate intake. From previous data on folic acid intake and NTD births we estimate that this will prevent 226-343 conceptions per year in the UK from developing NTD malformations. Conclusions. Fortification should prevent approximately 226-343 conceptions a year from developing NTDs, but 45% of women will still have an inadequate total folate intake, unless supplementation levels improve.

Journal of Nutritional and Environmantal Medicinee, 2008

Purpose. To compare the nutritional status of infertile women with non-pregnant fertile age-match... more Purpose. To compare the nutritional status of infertile women with non-pregnant fertile age-matched controls and to assess the periconceptional intake of nutritional supplements in pregnancy with an estimation of total micronutrient (diet and supplementary) intake. Design. An assessment of the nutritional status of infertile women and fertile, age-matched nonpregnant controls and a survey of the periconceptional intake of folic acid and other nutritional supplements. Materials and methods. Group 1: a 7-day weighed diet diary and blood tests for magnesium, mineral and pyridoxine status were used to assess the nutritional status of six infertile women and 12 nonpregnant, healthy, age-matched controls. Group 2: the periconceptional dietary intake of folic acid and other nutritional supplements was estimated in 87 pregnant women attending midwife clinics, 36 women attending an assisted conception clinic and 7 women attending a self help group for lesbian pregnancy. Results. In the group of six infertile subjects and 12 fertile controls, there was a non-significant trend for micronutrient intake in the controls to be higher than for the infertile subjects. Comparisons with the UK reference nutrient intake confirmed suboptimal nutrition in all subjects and some controls. Twenty-five per cent of controls and 33% of infertile subjects had subnormal serum selenium consistent with reduced antioxidant defence. There was also a non-significant trend for noncaeruloplasmin copper and cadmium to be higher in the infertile subjects. The combined mean dietary intake for all subjects and controls was similar to the values from the National Diet and Nutrition Survey. Therefore, an approximate value for the total intake of nutrients (diet and supplementation) of the 130 women in the larger survey was calculated using the mean dietary intake of the smaller group as an estimate of the dietary component. This analysis suggested suboptimal total intake for .50% of the subjects for selenium, zinc, magnesium and iodine and borderline total intake for .50% of subjects for vitamins B12, C and E, betacarotene, iron, folate + folic acid and essential fatty acids. Conclusions. Current levels of supplementation with folic acid and other nutrients are failing to compensate for poor mean dietary intake of these nutrients at the time of conception. These nutritional deficiencies are probably important contributory factors in infertility, spontaneous abortion, pregnancy complications and post-partum health problems in the mother and infant (including congenital malformations and postnatal depression).

Archives of nutrition and public health, 2020

Background: Some small secondary care studies have shown benefits from taking probiotics in diver... more Background: Some small secondary care studies have shown benefits from taking probiotics in diverticular disease. We investigated the feasibility of conducting a year-long probiotic study in primary care. Methods: Patients (n=21) with a past history of uncomplicated acute diverticulitis but not currently taking antibiotics were recruited from four general practices. Subjects were asked to take the daily probiotic drink Yakult. Probiotic effects were assessed by comparing clinically diagnosed diverticulitis attacks in the 6 months prior to probiotic intervention with the 0-6 and 6-12 month periods after probiotic intervention commenced. Effects on gastrointestinal symptoms were assessed by validated questionnaires at baseline, 6 and 12 months. Diet diaries were also completed. Results: Two thirds (14/21) of subjects who demonstrated good adherence in taking the daily probiotic improved symptomatically (p=0.025). Clinical presentations with diverticulitis were down 50% during the study period compared with the 12 months period before (7 vs 14 cases; p=0.021). The mean change in gastrointestinal symptom score improved significantly (p <0.001). Diverticulitis episodes did not correlate with body mass index (BMI), diabetic status or dietary fibre. Conclusions: Taking the daily probiotic was associated with a lower rate of clinical presentation with diverticulitis episodes and improvement in gastrointestinal symptoms. Sufficient information is presented to design a definitive trial. However, we recommend inclusion of a method to validate the diagnosis of diverticulitis. It is feasible to recruit and run a study that requires participants to take a daily probiotic drink for a year in a primary care setting.

journal of nutritional and environmental medicine, 2005

Purpose. To determine what advice general practitioners (GPs) are giving on the health benefits o... more Purpose. To determine what advice general practitioners (GPs) are giving on the health benefits of over-the-counter probiotics. Design. A web-based questionnaire. Materials and methods. The questionnaire was posted on the website for the Southwest Thames Faculty of the Royal College of General Practitioners and letters were sent to all Surrey GPs, inviting them to take part. The questionnaire included a variety of clinical scenarios in which probiotic advice might be appropriate. Results. There was a 16.6% response rate. The value of taking probiotics with and after antibiotics was featured in one question and 72% of GPs were aware that this reduces the incidence of diarrhoea. Thirteen clinical scenarios were included in the questionnaire. Six scenarios involved patients taking antibiotics for various types of infection and seven scenarios described other conditions in which probiotic benefits have been claimed. GPs varied in their experience and opinion as to whether advice to take a probiotic would be appropriate in these scenarios, with the choice of the option 'frequently advise' varying from 63% (recurrent vaginal candidiasis) to 1% (to reduce the risk of bowel and bladder cancer). The first four questions were tested on a sample of 40 non-responders who gave similar responses but a smaller bias in favour of probiotic advice. Conclusions. Although this survey was probably biased in favour of giving probiotic advice, the .50% response to the idea of giving probiotics with at least some clinical scenarios suggests that the idea of advising probiotics, when appropriate, has reached the tipping point in general practice.

BMC Family Practice, 2018

Background: When advising patients on diet and health, the general practitioner (GP) makes judgem... more Background: When advising patients on diet and health, the general practitioner (GP) makes judgements based on the evidence available. Since current evidence on diet and cardiovascular disease is conflicted and confusing, we surveyed the current consensus amongst GPs. The aim of this study was to determine the views of GPs on dietary saturated fat, carbohydrates and long chain omega-3 fatty acids in the management of cardiovascular disease. Method: An online questionnaire inviting participants to comment on seven contentious statements on diet and cardiovascular disease. Questionnaire circulated to the 1800 members of South West Thames Faculty of the Royal College of General Practitioners (RCGP). Participants were invited to tick "Agree", "Disagree" or "Not sure" and were encouraged to add comments for each question. The results were analysed with a combination of statistical analysis and thematic analysis of comments. Results: There were 89 responses. Most GPs seem well aware that drug treatment alone is inadequate and that dietary advice is important. However, there was considerable disagreement about the roles of saturated fats and carbohydrates in cardiovascular disease and "Not sure" responses ranged from 12 to 40.7%. The 40. 7% related to a statement on long chain omega-3 fatty acids. Analysis of comments revealed more opinions including an awareness of the need to warn patients about trans-fatty acids. Conclusions: Although the GP response rate was poor, responders do seem to see dietary advice as part of their role but do not consider themselves as experts. Education in this area should have a higher priority.

InTech: Prevention , diagnosis and treatment of lung cancer, 2017

A risk score for lung cancer derived from genetic and clinical data has been shown to motivate sm... more A risk score for lung cancer derived from genetic and clinical data has been shown to motivate smokers to quit. However, smokers with a relatively low (but not insignificant) risk score are more likely to carry on smoking. To understand this observation, the balance between smoking cessation motivators and de-motivators must be understood. A relatively low risk score can act as a de-motivator. Other de-motivators that have been recorded and were observed by researchers involved in this project were: nicotine addiction and fear of withdrawal symptoms, optimism bias, confirmation bias, attentional bias, post-traumatic stress disorder (PTSD), anxieties about smoking cessation and weight gain, side effects of smoking cessation therapy, fatalism, peer pressure and lack of family cohesion. This long list of de-motivators serves to emphasize the complexity of the psychological make-up of the individual smoker. This is illustrated by a set of case histories (anonymised for confidentiality). The future use of a risk score as a smoking cessation motivator is discussed and suggestions are made as to how a risk score could be made more effective including inclusion of scoring for cardiovascular risk.

Nutrition and Health, 2017

The theory that raised blood homocysteine is a major factor in the development of cardiovascular ... more The theory that raised blood homocysteine is a major factor in the development of cardiovascular disease was initially rejected by the medical establishment. Trials of a treatment to lower homocysteine in moderately advanced disease have failed to show benefits (except in those not treated with anti-platelet drug), but there is mounting evidence for a role in treatment of very early disease and as a preventive strategy. Recent evidence has shown that lowering of high blood homocysteine significantly slows cognitive decline and the brain shrinkage associated with Alzheimer's disease. This is a test that should be done more frequently by National Health Service (NHS) general practitioners and private practitioners.

Neural Tube Defects - Role of Folate, Prevention Strategies and Genetics, 2012

BMC pulmonary medicine, 2014

A gene-based estimate of lung cancer risk in smokers has been shown to act as a smoking cessation... more A gene-based estimate of lung cancer risk in smokers has been shown to act as a smoking cessation motivator in hospital recruited subjects. The objective of this trial is to determine if this motivator is as effective in subjects recruited from an NHS primary care unit. Subjects will be recruited by mailings using smoking entries on the GP electronic data-base (total practice population = 32,048) to identify smokers who may want to quit. Smoking cessation clinics based on medical centre premises will run for eight weeks. Clinics will be randomised to have the gene-based test for estimation of lung cancer risk or to act as controls groups. The primary endpoint will be smoking cessation at eight weeks and six months. Secondary outcomes will include ranking of the gene-based test with other smoking cessation motivators. The results will inform as to whether the gene-based test is both effective as motivator and acceptable to subjects recruited from primary care. Registered with Clinica...

British Journal of General Practice, 2011