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The objective of the current study was to identify factors across the socio-ecological model (SEM) associated with adolescents’ sugar-sweetened beverage (SSB) intake.
This cross-sectional study surveyed adolescents using previously validated instruments. Analyses included descriptive statistics, ANOVA tests and stepwise nonlinear regression models (i.e., two-part models) adjusted to be cluster robust. Guided by SEM, a four-step model was used to identify factors associated with adolescent SSB intake – step 1: demographics (i.e., age, gender), step 2: intrapersonal (i.e., theory of planned behaviour (attitudes, subjective norms, perceived behavioural control, behavioural intentions), health literacy, media literacy, public health literacy), step 3: interpersonal (i.e., caregiver’s SSB behaviours, caregiver’s SSB rules) and step 4: environmental (i.e., home SSB availability) level variables.
Eight middle schools across four rural southwest Virginia counties in Appalachia.
Seven hundred ninety seventh grade students (55·4 % female, 44·6 % males, mean age 12 (sd 0·5) years).
Mean SSB intake was 36·3 (sd 42·5) fluid ounces or 433·4 (sd 493·6) calories per day. In the final step of the regression model, seven variables significantly explained adolescent’s SSB consumption: behavioural intention (P < 0·05), affective attitude (P < 0·05), perceived behavioural control (P < 0·05), health literacy (P < 0·001), caregiver behaviours (P < 0·05), caregiver rules (P < 0·05) and home availability (P < 0·001).
SSB intake among adolescents in rural Appalachia was nearly three times above national mean. Home environment was the strongest predictor of adolescent SSB intake, followed by caregiver rules, caregiver behaviours and health literacy. Future interventions targeting these factors may provide the greatest opportunity to improve adolescent SSB intake.
Leo Strauss, in Philosophy and Law (1935), offers Platonic theocracy as a more just and stable political alternative to both liberalism and authoritarianism. Rather than merely a scholastic investigation of medieval Jewish and Islamic philosophy, I read the book as a programmatic endorsement of a morally perfectionist political order: a divinely legitimated and rationally justified “true” or “beautiful” state. Since human beings require political community to suppress their evil inclinations and promote their disposition toward the good, Strauss criticizes liberalism for contending that government should remain neutral regarding good and evil and modern authoritarianism for effectively committing idolatry by politically instrumentalizing theology. I demonstrate that Strauss’s long-neglected book is particularly relevant for our own “postsecular age,” an age when adherents of religious orthodoxy increasingly demand concessions from liberal democracies and resurgent state authoritarianism frequently cloaks itself in religious trappings.
To estimate the total energy and micronutrient intakes of children 9–24 months of age and evaluate the probability of adequacy (PA) of the diet in seven MAL-ED sites.
Cohort study. Food intake was registered monthly using 24-h recalls beginning at 9 months. We estimated PA for thirteen nutrients and overall mean PA (MPA) by site and 3-month periods considering estimated breast milk intake.
Seven sites in Asia, Africa and Latin America.
1669 children followed from birth to 24 months of age.
Median estimated %energy from breast milk ranged from 4 to 70 % at 9–12 months, and declined to 0–39 % at 21–24 months. Iron bioavailability was low for all sites, but many diets were of moderate bioavailability for zinc. PA was optimal for most nutrients in Brazil and South Africa, except for iron and vitamin E (both), calcium and zinc (South Africa). PA for zinc increased only for children consuming a diet with moderate bioavailability. MPA increased 12–24 months as the quantity of complementary foods increased; however, PA for vitamin A remained low in Bangladesh and Tanzania. PA for vitamins D and E and iron was low for most sites and age groups.
MPA increased from 12 to 24 months as children consumed higher quantities of food, while nutrient density remained constant for most nutrients. Ways to increase the consumption of foods containing vitamins D, E and A, and calcium are needed, as are ways to increase the bioavailability of iron and zinc.
This report describes the evaluation of the psychometric and clinimetric properties of nine self-report measures completed by informal care partners of individuals with mild cognitive impairment or dementia in Parkinson’s disease and dementia with Lewy bodies. One hundred thirty-six care partners completed measures on relationship satisfaction, burden, stress, mood, resilience, health, quality of life, and feelings related to care provision. Psychometric properties, such as internal consistency, convergent validity, floor and ceiling effects, completion rate and data missingness, as well as clinimetric properties, such as time to administer, ease of scoring, readability and availability of the scales, were examined. Additionally, the design of the measure development studies was assessed with the 2018 COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) Risk of Bias checklist. Participants were mostly married women (>85%) with a mean age of 69.4 years. The methodological quality of the design of all measure development studies was “inadequate.” Five widely applied measures (Zarit Burden Interview, Hospital Anxiety and Depression Scale, Short Form 12 Health Survey, Relatives’ Stress Scale, and EuroQoL-5D) and two less researched instruments (Brief Resilience Scale and Relationship Satisfaction Scale) had high internal consistency and completion rates, moderate to strong convergent validity, low missingness and floor effects, and excellent clinical utility ratings. Two scales (Dyadic Relationship Scale and Family Caregiving Role) received poor psychometric ratings, and their usage among informal care partners is not recommended. In conclusion, well-validated and widely used measures received strong psychometric and clinimetric ratings. Future studies are required to determine the most reliable, valid and robust caregiver-reported measures.
Subjective measures (SMs) of awareness assume (a) participants can accurately report the implicit/explicit status of their knowledge and (b) the act of reporting does not change that knowledge. However, SMs suffer from nonveridicality (e.g., overreporting of “guess” responses) and reactivity (e.g., prompting rule search). Attempting to improve the validity of “guess” responses, we conducted an exploratory mixed-methods replication of Rebuschat et al. (2013). Participants (N = 30) were randomly assigned to Traditional, True Guess, and NoSMs conditions. True Guess participants were led to believe the computer would replace “guess” responses with random answers. Confirming that SMs are reactive, Traditional and True Guess participants responded more slowly and accurately, with greater awareness of the linguistic target. Moreover, although True Guess participants responded “guess” less frequently, interviews revealed this was due not to greater veridicality, but rather to additional reactivity. We conclude with directions for further research to enhance the validity of SMs.
Spinal muscular atrophy (SMA) is a devastating rare disease that affects individuals regardless of ethnicity, gender, and age. The first-approved disease-modifying therapy for SMA, nusinursen, was approved by Health Canada, as well as by American and European regulatory agencies following positive clinical trial outcomes. The trials were conducted in a narrow pediatric population defined by age, severity, and genotype. Broad approval of therapy necessitates close follow-up of potential rare adverse events and effectiveness in the larger real-world population.
The Canadian Neuromuscular Disease Registry (CNDR) undertook an iterative multi-stakeholder process to expand the existing SMA dataset to capture items relevant to patient outcomes in a post-marketing environment. The CNDR SMA expanded registry is a longitudinal, prospective, observational study of patients with SMA in Canada designed to evaluate the safety and effectiveness of novel therapies and provide practical information unattainable in trials.
The consensus expanded dataset includes items that address therapy effectiveness and safety and is collected in a multicenter, prospective, observational study, including SMA patients regardless of therapeutic status. The expanded dataset is aligned with global datasets to facilitate collaboration. Additionally, consensus dataset development aimed to standardize appropriate outcome measures across the network and broader Canadian community. Prospective outcome studies, data use, and analyses are independent of the funding partner.
Prospective outcome data collected will provide results on safety and effectiveness in a post-therapy approval era. These data are essential to inform improvements in care and access to therapy for all SMA patients.
Tuberculosis (TB) in children is a critical public health issue. In Bohol, Philippines, we found a high tuberculin skin test (TST)-positive prevalence (weighted prevalence = 6.4%) among 5476 children (<15 years) from 184 villages, with geographically isolated communities having prevalence as high as 29%. Therefore, we conducted a geospatial and hot spot analysis to examine the association between villages with high TST-positive prevalence (⩾6.5%) and access to medical care (distance (in kilometres and minutes of travel time) to the municipal Rural Health Units (RHU)), access to healthcare resources (distance to Provincial Health Office (PHO)) and socioeconomic determinants of health. Hot spot analysis revealed significant clusters of TST-positive prevalence in villages farthest from the PHO. Based on univariate analysis, the following variables associated with high prevalence were included in the multivariate model: minutes of travel time to the PHO, distance to the PHO, island villages and total deprivation based on socioeconomic indicators. In the final model, only distance to PHO in minutes was significant (P = 0.005). When evaluated further, greater than 1-hour drive significantly increased risk for TST-positivity (P = 0.003). Distance to healthcare resources likely increases the risk of TB transmission within the community. Expanding TB control efforts to geographically isolated areas is critical.
High-resolution analysis of the ice core from Colle Gnifetti, Switzerland, allows yearly and sub-annual measurement of pollution for the period of highest lead production in the European Middle Ages, c. AD 1170–1220. Here, the authors use atmospheric circulation analysis and other geoarchaeological records to establish that Britain was the principal source of that lead pollution. The comparison of annual lead deposition at Colle Gnifetti displays a strong similarity to trends in lead production documented in the English historical accounts. This research provides unique new insight into the yearly political economy and environmental impact of the Angevin Empire of Kings Henry II, Richard the Lionheart and John.
While religion and democracy have been intertwined since World War II, scholars have made little of the connections between religion and populism, largely conceptualizing religion as a tool of populism. In this paper, however, I argue that Pope Francis' deployment of Catholicism resists such instrumentalization by populist politics, and offers resources for political ills underlying populism. I show that Francis' focus on the people allows him to capitalize on populist currents in global politics, while also reforming those currents into something more constructive than populism. I further explore how his political theology and institutional autonomy render his thought and example relatively impervious to appropriation by political actors.
In this chapter, using historical records and academic commentaries and research, we trace language contact in Cape Town from as far back as 400 CE. We detail how people indigenous to the area, as well as migrants from the rest of Africa and abroad, adapted their speech for social, political and economic reasons, with the result that Dutch, and later Afrikaans and English, gained prominence. After this diachronic account, we focus on two contemporary speech communities in Cape Town, and through interviews and participant observations confirm that while English is considered a prestige language and the key to future success, people still speak vernacular varieties of their own languages and of English. Examination of the linguistic landscape of the city in a number of research articles shows that English (some of it non-standard) is used far more widely in signage than African languages, which are used primarily for stylistic and affective reasons. Finally, we use research into hip-hop and rap performances in the city to argue that in this domain of music, local languages and mixed codes are preferred over English.
The early medieval societies of Byzantium and western Europe that emerged from the late Roman world shared more than a few institutions, traditions and religious experiences. They sometimes rubbed shoulders in ways we overlook. Rome’s clerical elite was so hellenised that the pope who reigned at Charlemagne’s birth spoke Greek as his mother tongue. Under Charlemagne’s grandsons, members of the Byzantine missionary Methodios’ entourage wrote Greek majuscules in the memorial book of a German monastery to record their stay; Methodios was himself a native of Thessaloniki, formerly a Byzantine imperial official in Macedonia and a monk in Bithynia (see above, p. 300). Conversely, Franks served in the Byzantine emperor’s military household and figured at palace banquets.
In this essay I identify two burdens for eliminativist accounts of moral responsibility. I first examine an underappreciated logical gap between two features of eliminativism, the gap between descriptive skepticism and full-blown prescriptive eliminativism. Using Ishtiyaque Haji’s luck-based skepticism as an instructive example, I argue that in order to move successfully from descriptive skepticism to prescriptive eliminativism one must first provide a comparative defense of the conflicting principles that motivate the former. In other words, one must fix the skeptical spotlight. I then present and assess a second burden for eliminativists, they must meet what I call the motivational challenge. In order to meet this second burden, eliminativists must motivate their prescriptive account over preservationist competitors, and I assess two potential strategies for doing so. The first is to offer arguments that appeal to the gains and losses of abandoning our responsibility-related attitudes and practices, and the second is to offer direct arguments that we cannot retain these attitudes and practices. I conclude that the adequacy of either strategy remains at best an open question, but that making these burdens explicit might better position eliminativists to meet their competitors on more equal ground.
Reccopolis, in central Iberia, is the only archaeologically identified town founded by Germanic newcomers on Roman soil during the challenging socio-political and environmental circumstances of the mid to late sixth century AD. Despite archaeological investigations, doubts have persisted concerning the nature and size of Reccopolis. Recent geomagnetic survey, however, has revealed a dense urban fabric, unexpected new royal palace buildings, an extramural suburb and one of the potentially earliest Islamic mosques in Iberia. Reccopolis now stands as an exceptional example of early medieval urbanism that challenges our perceptions of urban development in sixth-century Europe.