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The early colonial period witnessed new scales of connectivity and unprecedented projects of resource extraction across the Spanish Americas. Yet such transformations also drew heavily on preexisting Indigenous landscapes, technologies, and institutions. Drawing together recent discussions in archaeology and geography about mobility and resource materialities, this article takes the early colonial route as a central object of investigation and contributes to new emerging interpretive frameworks that make sense of Spanish colonialism in the Americas as a variable, large-scale, and materially constituted process. Using three case studies—the ruta de Colón on the island of Hispaniola, the routes connecting the southeastern Caribbean islands with mainland South America, and the ruta de la plata in the south-central Andes—we develop a comparative archaeological analysis that reveals divergent trajectories of persistence, appropriation, and erasure in the region's routes and regimes of extraction and mobility during the fifteenth and sixteenth centuries.
To provide insight into the context and public health implications of the South African sugar-sweetened beverage (SSB) tax (Health Promotion Levy; HPL) by describing SSB and added sugar intakes, as well as BMI, 1 year prior to, at the time of and 1 year after implementation of the HPL.
Longitudinal dietary intake was assessed using a quantitative food frequency questionnaire (QFFQ) and BMI was measured via anthropometry.
Soweto, Johannesburg, South Africa.
Adolescents, young adults and middle-aged adults (n 617).
At baseline, median SSB intakes were 36 ml/d, 214 ml/d and 750 ml/d for those in low, medium and high consumption tertiles, respectively. SSB intake decreased by two times/week in medium consumers and seven times/week in high consumers between baseline and 12 months, equivalent to 107 ml/d and 536 ml/d reductions, respectively. These reduced levels were maintained in the following year (i.e. to 24 months). There was an overall decrease in the amount of energy consumed as added sugar in the low (−48 kJ/d), medium (−153 kJ/d) and high (−106 kJ/d) SSB consumption groups between baseline and 24 months; however, the percentage of total energy consumed as added sugar remained relatively consistent (between 10 and 11 %). There were small overall increases in BMI across low (0·6 kg/m2), medium (0·9 kg/m2) and high (1·0 kg/m2) SSB tertiles between baseline and 24 months.
These findings suggest reductions in SSB and added sugar consumption contemporaneous to the introduction of the HPL – particularly for those with higher baseline intakes.
The objective of the current study was to identify challenges of making and sustaining healthy lifestyle changes for families with children/adolescents affected by obesity, who were referred to a multicomponent healthy lifestyle assessment and intervention programme in Aotearoa/New Zealand (NZ).
Secondary qualitative analysis of semi-structured interviews.
Taranaki region of Aotearoa/NZ.
Thirty-eight interviews with parents/caregivers (n 42) of children/adolescents who had previously been referred to a family-focused multidisciplinary programme for childhood obesity intervention, who identified challenges of making healthy lifestyle changes. Participants had varying levels of engagement, including those who declined contact after their referral.
Participant-identified challenges included financial cost, impact of the food environment, time pressures, stress, maintaining consistency across households, independence in adolescence, concern for mental health and frustration when not seeing changes in weight status.
Participants recognised a range of factors that contributed towards their ability to make and sustain change, including factors at the wider socio-environmental level beyond their immediate control. Even with the support of a multidisciplinary healthy lifestyle programme, participants found it difficult to make sustained changes within an obesogenic environment. Healthy lifestyle intervention programmes and families’ abilities to make and sustain changes require alignment of prevention efforts, focusing on policy changes to improve the food environment and eliminate structural inequities.
To explore community perceptions on maternal and child nutrition issues in Sub-Saharan Africa.
Thirty focus groups with men and women from three communities facilitated by local researchers.
One urban (Soweto, South Africa) and two rural settings (Navrongo, Ghana and Nanoro, Burkina Faso) at different stages of economic transition.
Two hundred thirty-seven men and women aged 18–55 years, mostly subsistence farmers in Navrongo and Nanoro and low income in Soweto.
Differences in community concerns about maternal and child health and nutrition reflected the transitional stage of the country. Community priorities revolved around poor nutrition and hunger caused by poverty, lack of economic opportunity and traditional gender roles. Men and women felt they had limited control over food and other resources. Women wanted men to take more responsibility for domestic chores, including food provision, while men wanted more involvement in their families but felt unable to provide for them. Solutions suggested focusing on ways of increasing control over economic production, family life and domestic food supplies. Rural communities sought agricultural support, while the urban community wanted regulation of the food environment.
To be acceptable and effective, interventions to improve maternal and child nutrition need to take account of communities’ perceptions of their needs and address wider determinants of nutritional status and differences in access to food reflecting the stage of the country’s economic transition. Findings suggest that education and knowledge are necessary but not sufficient to support improvements in women’s and children’s nutritional status.
To obtain a community perspective on key nutrition-specific problems and solutions for mothers and children.
A qualitative study comprising nine focus group discussions (FGD) following a semi-structured interview guide.
The township of Soweto in South Africa with a rising prevalence of double burden of malnutrition.
Men and women aged ≥18 years (n 66). Three FGD held with men, six with women.
Despite participants perceived healthy diet to be important, they felt their ability to maintain a healthy diet was limited. Inexpensive, unhealthy food was easier to access in Soweto than healthier alternatives. Factors such as land use, hygiene and low income played a fundamental role in shaping access to foods and decisions about what to eat. Participants suggested four broad areas for change: health sector, social protection, the food system and food environment. Their solutions ranged from improved nutrition education for women at clinic visits, communal vegetable gardens and government provision of food parcels to regulatory measures to improve the healthiness of their food environment.
South Africa’s current nutrition policy environment does not adequately address community-level needs that are often linked to structural factors beyond the health sector. Our findings suggest that to successfully address the double burden of malnutrition among women and children, a multifaceted approach is needed combining action on the ground with coherent policies that address upstream factors, including poverty. Further, there is a need for public engagement and integration of community perspectives and priorities in developing and implementing double-duty actions to improve nutrition.
In precolumbian insular Caribbean archaeological sites, domestic dog (Canis familiaris) remains have been recovered from varied contexts, such as formal burials, in refuse deposits, and as modified artifacts, indicating their complex and multifaceted role within indigenous societies. In this study, isotopic and morphometric analyses provide biochemical and morphological correlations to assess this differential treatment. We examined collagen values (n = 21) of carbon (δ13Cco) and nitrogen (δ15N), and enamel values (n = 81) of carbon (δ13Cen), oxygen (δ18Oen), and strontium (87Sr/86Sr) of dog remains from 16 precolumbian sites. Five comparative parameters were used to assess dietary variations between different groups: buried versus nonburied, local versus nonlocal, Greater versus Lesser Antilles, chronology, and modified versus unmodified remains. The only statistically significant difference in diets was between local and nonlocal dogs. Sufficient data were available to conduct isotopic mixing models using the FRUITS statistical program on four individuals for which depositional and morphological data were available. Results of dietary modeling indicate an unexpectedly heavy reliance on plant foods consistent with intentional feeding. This approach highlights the utility of combining isotope analysis, dietary models, morphometrics, and depositional context to provide comprehensive biographic overviews of individual animals.
Recent research has emphasized the importance of within-person transactions between situational perceptions and borderline symptomatology. The current study extends current evidence by evaluating a broad range of situational perceptions and their transactions with borderline symptomatology across both private and professional contexts. Additionally, it explores whether early experiences of parental harsh punishment and emotional support during childhood, two well-established etiological factors in developmental theories of borderline symptomatology, influence the effect of daily situation perception in adulthood on borderline symptom presentation.
N = 131 young adults (Mage = 20.97, s.d.age = 1.64) completed end-of-day diaries of their borderline symptoms and perceptions of the home and school or work environment for 14 days. During their mid-childhood, reports of maternal strategies of harsh punishment and emotional support were collected.
Findings revealed that on the same day, borderline symptoms were associated with more negative and stressful, and less positive perceptions of both the private and professional context. Additionally, borderline symptoms predicted more negative and stressful perceptions of school/work on subsequent days. Finally, while early harsh punishment predicted overall increases in daily borderline symptoms 10 years later, emotionally supportive parenting in childhood predicted decreases in borderline symptom expression in less positive and more stressful contexts.
The current study points to the importance of managing BPD symptoms to reduce subsequent negative perceptions of the environment, and also indicates the relevance of exploring adult person-situation processes based on early parenting experiences.
In middle-aged and older patients in whom antidepressant use increased in last decades, patterns of use might be of concern The objective of this study was to investigate the patterns of prevalence, incidence and duration of antidepressant use in an ageing population.
All participants (aged > 45 years) from the population-based Rotterdam Study were followed from January 1st 1991 until death, loss to follow-up, or end of the study period (December 31st 2011). Antidepressant drug dispensing, based on pharmacy records, were subdivided into Tricyclic Antidepressants (TCAs), Selective Serotonin Reuptake Inhibitors (SSRIs) and other antidepressants. One-year prevalence, 5-year incidence and duration of antidepressant use were calculated.
Yearly prevalence of antidepressant use increased from 3.9% in 1991 to 8.3% of the population in 2011. The increase in SSRI use was 5.8-fold, whereas use of other antidepressants doubled and TCA use remained stable over time. Incidence of all antidepressants decreased from 23.9 to 14.2 per 1000 person-years between 1992 and 2011. The duration of a first treatment episode increased over time.
Despite the prevalence of antidepressant use increased over time, incidence did not, which is most likely explained by a longer treatment duration and recurrent episodes.
In the past decade, South Africa’s obesity epidemic has increased in both children and adults, and being overweight is becoming the norm. Several contributing factors lead to the normalisation of obesity. One of these is the culturally entrenched likeness of larger body sizes or shapes within a milieu of easily accessible unhealthy food and beverages. This qualitative study advances knowledge about the influence of socio-cultural norms and obesogenic environments on weight under estimation and ‘obesity normalisation’ amongst black South Africans living in an urban setting.
A theory-based qualitative study used focus group discussions (FGDs) with a semi-structured interview guide. FGDs were transcribed verbatim and analysed thematically using a constant comparison method.
Soweto, Johannesburg, South Africa, is a setting which has undergone rapid urbanisation and nutrition transition with ubiquitous availability of processed and fast-foods.
Adults older than 18 years living in Soweto (n 57).
There is a wide misperception about obesity amongst black Africans living in an urban setting in Soweto. Participants who admitted to being fat or overweight did not view themselves as such. This could be attributed to unchanging socio-cultural factors that reinforce the acceptability of bigger bodies and living in obesogenic environment.
Without addressing socio-cultural norms that attribute bigger bodies to beauty and wealth, motivating individuals to address weight gain will prove difficult especially for populations living in obesogenic environments. A multi-faceted strategy is required to address obesity in urban South African settings.
In this study, we generate novel insights regarding bodily ornaments from indigenous societies of late precolonial Greater Antilles. Previous research has highlighted the sociopolitical role of valuable, exotic, and figurative ornaments, yet there are many gaps in our current understanding of these artifacts. Here, we focus on ornaments from five recently excavated sites in the Dominican Republic (AD 800–1600). We used microwear analysis to investigate each ornament and assess its production sequence and use life. These data permitted the definition of morpho-technical groups, which we then compared to depositional contexts and the regional availability of raw materials. We demonstrate that (1) there was small-scale production of ornaments at the sites, (2) the most recurrent morpho-technical groups were likely imported from production centers, and (3) ornaments of the same group could lead different use lives and be deposited through varied processes. We conclude that bodily ornaments had highly diverse biographies involving local and regional interaction networks.
The European conquest and colonization of the Caribbean precipitated massive changes in indigenous cultures and societies of the region. One of the earliest changes was the introduction of new plant and animal foods and culinary traditions. This study presents the first archaeological reconstruction of indigenous diets and foodways in the Caribbean spanning the historical divide of 1492. We use multiple isotope datasets to reconstruct these diets and investigate the potential relationships between dietary and mobility patterns at multiple scales. Dietary patterns are assessed by isotope analyses of different skeletal elements from the archaeological skeletal population of El Chorro de Maíta, Cuba. This approach integrates carbon and nitrogen isotope analyses of bone and dentine collagen with carbon and oxygen isotope analyses of bone and enamel apatite. The isotope results document extreme intrapopulation dietary heterogeneity but few systematic differences in diet between demographic/social groups. Comparisons with published isotope data from other precolonial and colonial period populations in the Caribbean indicate distinct dietary and subsistence practices at El Chorro de Maíta. The majority of the local population consumed more animal protein resources than other indigenous populations in the Caribbean, and their overall dietary patterns are more similar to colonial period enslaved populations than to indigenous ones.
Ontology alignment is an important and inescapable problem for the interconnections of two ontologies stating the same concepts. Ontology alignment evaluation initiative (OAEI) has been taken place for more than a decade to monitor and help the progress of the field and to compare systematically existing alignment systems. As of 2018, the evaluation of systems is partly transitioned to the HOBBIT platform. This paper contains the description of our alignment system, simulated annealing-based ontology matching (SANOM), and its adaption into the HOBBIT platform. The outcomes of SANOM on the HOBBIT for several OAEI tracks are reported, and the results are compared with other competing systems in the corresponding tracks.
Evidence suggests that low birth weight and fetal exposure to extreme maternal undernutrition is associated with cardiovascular disease in adulthood. Hyperemesis gravidarum, a clinical entity characterized by severe nausea and excess vomiting leading to a suboptimal maternal nutritional status during early pregnancy, is associated with an increased risk of adverse pregnancy outcomes. Several studies also showed that different measures related to hyperemesis gravidarum, such as maternal daily vomiting or severe weight loss, are associated with increased risks of adverse fetal pregnancy outcomes. Not much is known about long-term offspring consequences of maternal hyperemesis gravidarum and related measures during pregnancy. We examined the associations of maternal daily vomiting during early pregnancy, as a measure related to hyperemesis gravidarum, with childhood cardiovascular risk factors.
In a population-based prospective cohort study from early pregnancy onwards among 4,769 mothers and their children in Rotterdam, the Netherlands, we measured childhood body mass index, total fat mass percentage, android/gynoid fat mass ratio, preperitoneal fat mass area, blood pressure, lipids, and insulin levels. We used multiple regression analyses to assess the associations of maternal vomiting during early pregnancy with childhood cardiovascular outcomes.
Compared with the children of mothers without daily vomiting during early pregnancy, the children of mothers with daily vomiting during early pregnancy had a higher childhood total body fat mass (difference 0.12 standard deviation score [SDS]; 95% confidence interval [CI] 0.03–0.20), android/gynoid fat mass ratio (difference 0.13 SDS; 95% CI 0.04–0.23), and preperitoneal fat mass area (difference 0.10 SDS; 95% CI 0–0.20). These associations were not explained by birth characteristics but partly explained by higher infant growth. Maternal daily vomiting during early pregnancy was not associated with childhood blood pressure, lipids, and insulin levels.
Maternal daily vomiting during early pregnancy is associated with higher childhood total body fat mass and abdominal fat mass levels, but not with other cardiovascular risk factors. Further studies are needed to replicate these findings, to explore the underlying mechanisms and to assess the long-term consequences.
Health technology assessment (HTA) is a cost-effective resource allocation tool in healthcare decision-making processes; however, its use is limited in low-income settings where countries fall short on both absorptive and technical capacity. This paper describes the journey of the introduction of HTA into decision-making processes through a case study revising the National Essential Medicines List (NEMLIT) in Tanzania. It draws lessons on establishing and strengthening transparent priority-setting processes, particularly in sub-Saharan Africa.
The concept of HTA was introduced in Tanzania through revision of the NEMLIT by identifying a process for using HTA criteria and evidence-informed decision making. Training was given on using economic evidence for decision making, which was then put into practice for medicine selection for the NEMLIT. During the revision process, capacity-building workshops were held with reinforcing messages on HTA.
Between the period 2014 and 2018, HTA was introduced in Tanzania with a formal HTA committee being established and inaugurated followed by the successful completion and adoption of HTA into the NEMLIT revision process by the end of 2017. Consequently, the country is in the process of institutionalizing HTA for decision making and priority setting.
While the introduction of HTA process is country-specific, key lessons emerge that can provide an example to stakeholders in other low- and middle-income countries (LMICs) wishing to introduce priority-setting processes into health decision making.
A tax on sugar-sweetened beverages (SSB) was introduced in South Africa in April 2018. Our objective was to document perceptions and attitudes among urban South Africans living in Soweto on factors that contribute to their SSB intake and on South Africa’s use of a tax to reduce SSB consumption.
We conducted six focus group discussions using a semi-structured guide.
The study was conducted in Soweto, Johannesburg, South Africa, 3 months before South Africa’s SSB tax was implemented.
Adults aged 18 years or above living in Soweto (n 57).
Participants reported frequent SSB consumption and attributed this to habit, addiction, advertising and wide accessibility of SSB. Most of the participants were not aware of the proposed SSB tax; when made aware of the tax, their responses included both beliefs that it would and would not result in reduced SSB intake. However, participants indicated cynicism with regard to the government’s stated motivation in introducing the tax for health rather than revenue reasons.
While an SSB tax is a policy tool that could be used with other strategies to reduce people’s high level of SSB consumption in Soweto, our findings suggest a need to complement the SSB tax with a multipronged behaviour change strategy. This strategy could include both environmental and individual levers to reduce SSB consumption and its associated risks.