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Alzheimer’s disease (AD) studies are increasingly targeting earlier (pre)clinical populations, in which the expected degree of observable cognitive decline over a certain time interval is reduced as compared to the dementia stage. Consequently, endpoints to capture early cognitive changes require refinement. We aimed to determine the sensitivity to decline of widely applied neuropsychological tests at different clinical stages of AD as outlined in the National Institute on Aging – Alzheimer’s Association (NIA-AA) research framework.
Amyloid-positive individuals (as determined by positron emission tomography or cerebrospinal fluid) with longitudinal neuropsychological assessments available were included from four well-defined study cohorts and subsequently classified among the NIA-AA stages. For each stage, we investigated the sensitivity to decline of 17 individual neuropsychological tests using linear mixed models.
1103 participants (age = 70.54 ± 8.7, 47% female) were included: n = 120 Stage 1, n = 206 Stage 2, n = 467 Stage 3 and n = 309 Stage 4. Neuropsychological tests were differentially sensitive to decline across stages. For example, Category Fluency captured significant 1-year decline as early as Stage 1 (β = −.58, p < .001). Word List Delayed Recall (β = −.22, p < .05) and Trail Making Test (β = 6.2, p < .05) became sensitive to 1-year decline in Stage 2, whereas the Mini-Mental State Examination did not capture 1-year decline until Stage 3 (β = −1.13, p < .001) and 4 (β = −2.23, p < .001).
We demonstrated that commonly used neuropsychological tests differ in their ability to capture decline depending on clinical stage within the AD continuum (preclinical to dementia). This implies that stage-specific cognitive endpoints are needed to accurately assess disease progression and increase the chance of successful treatment evaluation in AD.
A high-fibre diet is associated with a lower risk for diseases. However, few adults meet the dietary fibre recommendation. Therefore, the effects and acceptance of an algorithm-generated personalised dietary advice (PDA) compared with general advice (GA) on fibre intake were investigated.
A 6-week, single-blind randomised controlled trial with a 3-month follow-up.
PDA was based on habitual intake and provided fibre-rich alternatives using a website; GA contained brochures. Dietary intake was assessed at baseline, week 1, week 6 and 3-month follow-up. Both groups evaluated their advice at week 6. All participants had access to PDA from week 7 until 3-month follow-up.
Two groups of healthy adults: PDA (n 34) and GA (n 47). For 3-month follow-up analysis, participants were re-divided into visitors (n 52) and non-visitors (n 26) of the PDA.
At week 6, energy intake remained stable in both groups, but fibre intake per 1000 kcal increased non-significantly in both groups (PDA = Δ0·5 ± 2·8; GA = Δ0·8 ± 3·1, P = 0·128). Importantly, a significantly higher percentage of PDA participants adhered to the recommendation compared with week 1 (PDA = 21 % increase; GA = 4 % increase, P ≤ 0·001). PDA participants evaluated the advice significantly better compared with GA participants. At 3-month follow-up, fibre intake increased compared with baseline (visitors = Δ2·2 ± 2·6, P < 0·001; non-visitors = Δ1·5 ± 1·9, P = 0·001), but was insignificantly different between groups. Visitors had a decrease and non-visitors had an increase in energy intake (visitors =Δ − 132 ± 525; non-visitors = Δ109 ± 507, P = 0·055).
The algorithm-generated PDA was well accepted and stimulated adherence to the recommendations more than GA, indicating to be a suitable and cost-efficient method for improving dietary fibre intake in healthy adults.
Oil prices fell from around $US110 per barrel in 2014 to less than $US50per barrel at the start of 2017. This put enormous pressure on government budgets within the Gulf Cooperation Council (GCC) region. The focus of GCC economic policies quickly shifted to fiscal reform, including the removal of domestic subsidies on energy products. In this paper, we use a dynamic Computable General Equilibrium (CGE) model to investigate the economic impact of the gradual removal of subsidies on refined petroleum and electricity, with specific reference to the Kingdom of Saudi Arabia (KSA).
Our study shows that removing subsidies eliminates a large distortion in the economy. This improves the efficiency of resource use, so that even though employment and capital in most years fall relative to baseline levels, real GDP rises. In addition, we show that fully-funded compensation payments offset the increases in energy prices, leaving economic welfare of the Saudi-national population little affected. Removing the energy subsidies leads to an improvement in the net volume of trade, while leading to a mixed outcome for industries.
The main objective of this paper is to give an overview of the risks seen in the exploration and production of geothermal energy from the viewpoint of the regulator. The risks are categorised as conventional risks, ultra-deep risks and enhancing factors. These risks are similar to those seen in the oil and gas industry, but the maturity of the geothermal sector in terms of managing such risks is much lower.
Another objective of this paper is to discuss how these risks are managed and mitigated by the sector and the supervisor, State Supervision of Mines (SodM). Portfolio operators developing multiple projects, using skilled employees and embracing continuous improvement are seen as the way forward for the sector to grow safely and sustainably.
This paper concludes that positive developments have started, but a lot of work still needs to be done to ensure safe growth of the geothermal energy sector.
La FFP-CNPP a soutenu l’élaboration, par un groupe de pédopsychiatres, affiliés aux sociétés et associations les plus représentatives, d’un projet de recherche qui s’intitule : évaluation clinique des pratiques intégratives en unité de soins de psychiatrie infanto-juvénile pour des enfants présentant un autisme typique et atypique. Ce projet porté par le CHU de Nantes a été sélectionné et financé dans le cadre des appels à projet 2013 des Preps concernant les évaluations des programmes de santé. Il s’agit d’une recherche multicentrique, en milieu naturel qui a pour objectif d’évaluer et de promouvoir une approche intégrative des soins qui est de plus en plus pratiquée dans nos services. Elle rentre actuellement dans sa phase opérationnelle.
Nous allons au cours de cette intervention :
– résumer brièvement le protocole de l’étude ;
– définir les pratiques intégratives, leur soubassement conceptuel ;
– développer, au regard de la thématique de la session, la prise en compte, dans cette optique intégrative, des manifestations symptomatiques encrées dans le corps de l’enfant dans le domaine sensoriel et moteur, dans celui des émotions angoisse et comportements et dans le domaine somatique.
Nous allons décrire les sources de notre compréhension des particularités des manifestations de l’enfant, les instruments d’évaluation clinique de chaque domaine tant sur le plan subjectif qu’objectif, ainsi que les interventions thérapeutiques et éducatives, ciblées et évolutives s’intégrant dans un projet de soins individualisé.
The primary aim of our study was to determine the prevalence of deliberate self-harm in adolescents using an exact definition of DSH (intentional self-mutilative acts like cutting, burning and suicidal ideation, plans and attempts). Our second aim was to evaluate a wide range of internalizing (withdrawn, somatic complaints, anxiety/depression) and externalizing behavior problems (delinquency, aggression), as well as possible gender differences which may be associated with DSH.
Self-report cross-sectional survey. A representative sample of school students of the 9th grade (n = 5759, mean age = 14.98 (SD=0.73), 49,8% female adolescents) from the Rhein-Neckar-District in Germany has been investigated.
Moderate forms of intentional self-mutilative acts in the previous year was reported by 630 of 5759 (10.9%) school students. Additional 229 (4.0%) students reported repetitive forms of self-mutilation. With regard to suicidal behaviour 14.4% of the adolescents reported suicidal ideas and 7.9% one or more suicidal attempts during their life time. Compared with participants without a history of DSH, adolescents with DSH scored significantly higher on the YSR-subscales of somatic complaints, anxiety and depressive symptoms and delinquent behaviour.
Moderate forms of intentional self-mutilative acts and severe forms as well as suicidal behaviour were found to be associated with pronounced emotional and behavioral problems. In particular female adolescents are at higher risk for DSH in comparison to male adolescents. A better understanding of the associated psychiatric and psychosocial concomitants of deliberate self-harm is an important contribution for the development of prevention and intervention programs.
L’étude présentée s’inscrit dans le cadre des démarches d’évaluation des thérapeutiques en santé mentale, problème d’une grande complexité dès lors qu’il concerne les traitements non médicamenteux. Elle a pour cadre les unités infanto–juvéniles qui ont mis au point des « dispositifs intégratifs », tenant compte des avancées récentes et offrant soins, éducation et approche pédagogique. La méthodologie retenue sera exposée : elle s’appuie sur des études intensives de cas, elle s’intéresse aux changements qui interviennent et aux processus qui les sous-tendent, faisant la part des médiateurs mis en jeu et des modérateurs qui conditionnent l’évolution. Les cliniciens engagés se constituent en réseau, entre eux et avec les chercheurs, dans le cadre d’une étude multicentrique. Cette recherche examine à plusieurs étapes l’évolution sur un an, d’enfants de 3 à 6 ans, présentant un diagnostic d’autisme typique ou atypique (F 84-0 et F 84-1), dès leur entrée dans une unité de soins pratiquant les approches intégratives (CATTP, hôpital de jour) selon des critères cliniques et des outils d’évaluation validés et sélectionnés (dont des outils de processus) et selon le point de vue des familles ; les différents domaines du développement de l’enfant sont examinés, en prenant en compte les particularités de la symptomatologie autistique. Cette recherche, soutenue par la FFP, vise à formuler des hypothèses quant à la corrélation entre les pratiques de soin et l’évolution des enfants, sous l’angle de l’ajustement des interventions ou des particularités cliniques des enfants.
Lorises (family Lorisidae) are primates of the suborder Strepsirrhini. They belong to the infraorder Lorisiformes, together with their sister group, the Galagidae – galagos from sub-Saharan Africa. The systematics of the family Lorisidae have been long debated. Currently two subfamilies are recognised: Perodicticinae, including the two African genera Arctocebus (angwantibos) and Perodicticus (pottos), and Lorisinae, including the two Asian genera Loris (slender lorises) and Nycticebus (slow lorises) (Mittermeier et al., 2013; Rasmussen and Nekaris, 1998; Rowe and Myers, 2016) (1971) based on a series of craniodental features, and, more recently, supported by a cladistic analysis by Rasmussen and Nekaris (1998). Simpson (1967), however, identified several similarities between the two robust forms, Nycticebus and Perodicticus, and the two small-bodied, slender forms, Loris and Arctocebus. A cladistic analysis on craniodental data by Schwartz and Tattersall (1985) supported these two reciprocal monophyletic clades, but other morphological studies failed to identify a clade including both Perodicticus and Nycticebus (Masters and Brothers, 2002). To further complicate the taxonomy of this primate group, karyological studies conducted in the 1970s identified two alternative groups based on the number of chromosomes: Perodicticus and Loris share a diploid number of 2n = 62, while Arctocebus and Nycticebus exhibit a diploid number of 2n = 52 (although some populations of Nycticebus have 2n = 50) (de Boer, 1973; Masters et al., 2005).
Cognitive impairment is a core feature of Huntington's disease (HD), however, the onset and rate of cognitive decline is highly variable. Apathy is the most common neuropsychiatric symptom of HD, and is associated with cognitive impairment. The aim of this study was to investigate apathy as a predictor of subsequent cognitive decline over 2 years in premanifest and early HD, using a prospective, longitudinal design.
A total of 118 premanifest HD gene carriers, 111 early HD and 118 healthy control participants from the multi-centre TRACK-HD study were included. Apathy symptoms were assessed at baseline using the apathy severity rating from the Short Problem Behaviours Assessment. A composite of 12 outcome measures from nine cognitive tasks was used to assess cognitive function at baseline and after 24 months.
In the premanifest group, after controlling for age, depression and motor signs, more apathy symptoms predicted faster cognitive decline over 2 years. In contrast, in the early HD group, more motor signs, but not apathy, predicted faster subsequent cognitive decline. In the control group, only older age predicted cognitive decline.
Our findings indicate that in premanifest HD, apathy is a harbinger for cognitive decline. In contrast, after motor onset, in early diagnosed HD, motor symptom severity more strongly predicts the rate of cognitive decline.
Food phytochemicals are increasingly considered to play a key role in the cardiometabolic health effects of plant foods. However, the heterogeneity in responsiveness to their intake frequently observed in clinical trials can hinder the beneficial effects of these compounds in specific subpopulations. A range of factors, including genetic background, gut microbiota, age, sex and health status, could be involved in these interindividual variations; however, the current knowledge is limited and fragmented. The European network, European Cooperation in Science and Technology (COST)-POSITIVe, has analysed, in a systematic way, existing knowledge with the aim to better understand the factors responsible for the interindividual variation in response to the consumption of the major families of plant food bioactives, regarding their bioavailability and bioefficacy. If differences in bioavailability, likely reflecting differences in human subjects’ genetics or in gut microbiota composition and functionality, are believed to underpin much of the interindividual variability, the key molecular determinants or microbial species remain to be identified. The systematic analysis of published studies conducted to assess the interindividual variation in biomarkers of cardiometabolic risk suggested some factors (such as adiposity and health status) as involved in between-subject variation. However, the contribution of these factors is not demonstrated consistently across the different compounds and biological outcomes and would deserve further investigations. The findings of the network clearly highlight that the human subjects’ intervention studies published so far are not adequate to investigate the relevant determinants of the absorption/metabolism and biological responsiveness. They also emphasise the need for a new generation of intervention studies designed to capture this interindividual variation.
Let M(u), H(u) be the maximal operator and Hilbert transform along the parabola (t, ut2). For U ⊂ (0, ∞) we consider Lp estimates for the maximal functions sup u∈U|M(u)f| and sup u∈U|H(u)f|, when 1 < p ≤ 2. The parabolas can be replaced by more general non-flat homogeneous curves.
To measure fatty acid composition, particularly whole-blood PUFA content, in acutely malnourished children and identify associations with markers of nutritional and health status.
PUFA were assessed in dried blood spots obtained from a cross-sectional study. Nutritional and health status were assessed by anthropometry, haemoglobinopathies, inflammation and blood counts.
The study was conducted with 174 children aged 0·5–18 years with acute malnutrition.
Among total fatty acids (FA), the relative percentage of total PUFA was 20 % FA, with 14 % of the children having very low PUFA (mead acid (MA):arachidonic acid (AA) >0·02, n-6 docosapentaenoic acid:DHA >0·2 and total n-6:n-3 PUFA >10·5). Wasting was not associated with any PUFA. Stunting and low height were consistently positively associated with total PUFA and positively with n-6 PUFA. Height was positively associated with n-3 long-chain PUFA (LCPUFA). The presence of haemoglobinopathies or inflammation was positively associated with MA:AA, but not total PUFA. Elevated blood platelet counts were positively correlated with linoleic acid and appeared to be influenced by anaemia (P = 0·010) and inflammation (P = 0·002). Monocyte counts were high during inflammation (P = 0·052) and correlated positively with n-6 LCPUFA and n-3 LCPUFA.
Children with acute malnutrition or stunting had low PUFA, while elevated platelets and monocytes were associated with high PUFA. In acutely malnourished children, inflammation could lead to elevated blood cell counts resulting in increased whole-blood PUFA which does not reflect dietary intake or nutritional status.
To investigate the effects of providing free fruit and snack vegetables at a university on students’ fruit intake, snack vegetable intake and total vegetable intake.
Free fruit and raw snack vegetables (e.g. bite-sized tomatoes) were provided in a stand in the form of a miniature wooden house located in the central hall of the university’s main building, which students regularly pass through on their way to lectures and the cafeteria. Three interventions tested with a pre-test/post-test design were performed. In these three interventions, small changes to the appearance of the stand were made, such as placing potted plants around it. Demographic characteristics and fruit and vegetable intakes were assessed with questionnaires.
A Dutch university of applied science.
Intervention 1 included 124 students; Intervention 2 included ninety-two students; Intervention 3 included 237 students.
Longitudinal linear regression analyses showed that post-test snack vegetable intake was consistently higher compared with pre-test. In the three interventions, post-test snack vegetable intakes were between 11 and 14 g/d higher than at the pre-test, which is comparable to three bite-sized tomatoes. No differences in fruit intake or total vegetable intake were found. Subgroup analyses showed that, in all three interventions, students with the lowest pre-test fruit intake and total vegetable intake reported the largest increase in fruit intake and snack vegetable intake after the interventions.
Providing free fruit and vegetables to students at their university might be beneficial for those with low habitual intakes.
The composition of diet plays a vital role in maintaining health and may alter the human microbiota. The main focus to date has been on the association between diet and gut microbiota and only few studies have investigated the correlation between diet and the saliva microbiota. Our aim was to investigate whether eating habits and meal patterns are associated with the saliva microbiota. In this study, we included 842 adolescents aged 11–14 years from the Finnish Health in Teens (Fin-HIT) study cohort. Adolescents answered a web-based questionnaire, including information on eating habits, breakfast and dinner patterns at school. Questions related to diet were adapted to the age group. Previously three major eating habits were identified: healthy, unhealthy and fruit and vegetable avoiders. Saliva microbiota profiles were produced by 16S (V3-V4) sequencing on the Illumina HiSeq platform. We found that the regular breakfast eaters had a higher diversity than the irregular breakfast eaters (Shannon index mean 2.27 vs. 2.21, ANCOVA; p-value = 0.026 and inverse Simpsońs index mean 6.21 vs. 5.70, ANCOVA; p-value = 0.004 adjusted for gender, age, language, body mass index (BMI) categories, and sequencing depth). No associations were found between microbiota and eating habit groups, and between microbiota and dinner pattern groups. Microbial composition differed between the regular breakfast and irregular breakfast eaters (Bray-Curtis dissimilarity index, PERMANOVA; p = 0.021), but not between eating habit groups or dinner pattern groups. A high abundance of Prevotella was identified in the fruit and vegetable avoideŕs, irregular breakfast and irregular dinner eaters. Our results indicate that having an irregular breakfast may shape the saliva microbiota diversity. Prevotella may be an indicator of avoiding veggies and skipping meals.
Preschool meals influence the child's growth, development and learning ability. According to the Finnish National Nutrition Council, preschool meals should cover two thirds of the daily energy requirements if the child attends to a full-time childcare. We investigated the contribution of preschool meals on a weekday's total energy and nutrient intake among Finnish preschoolers. A cross-sectional DAGIS Study was conducted in 2015–2016. Altogether 864 3- to 6-year-old children from 66 preschools participated. Parents and early educators kept 3-day food records for the child. To capture the seasonal variation in the diet, 24% of the families also kept an additional 2-day food record. To assess the nutritional contribution of preschool meals, we selected a sub-sample of children based on the criteria that they ate all three meals (breakfast, lunch, afternoon snack) at preschool. This yielded a sub-sample of 557 children, each contributing the data with 1 to 4 full preschool days. Data was analysed using two age groups: 3–4 years (n = 324) and 5–6 years (n = 233). Mean intake of nutrients from different preschool meals and population proportions were calculated. Mean energy intake at preschool was 3.0 ± 0.8 MJ for 3–4-year-olds and 3.5 ± 0.9 MJ for 6–7-year-olds contributing 54% of the total daily energy intake in both age groups. At preschool, lunch was the main single source of energy, protein, and fat. It was also an important source of folate (27% of the total daily intake in the younger and 29 % in the older age group) and of fibre (25% of the total daily intake in both age groups). Most of the added sugar was consumed at home (61% in the younger and 63% in the older age group). Most of the polyunsaturated fatty acid intake occurred at the preschool meals, mostly at lunch. Salt intake at preschool was high (3.2 ± 1.1 g/day and 3.6 ± 1.2 g/day in the younger and older age group, respectively). Cereal products were the main sources of salt at preschool. Preschool meals did not cover two thirds of the daily energy as recommended but preschool food was an important source of fibre, polyunsaturated fatty acids, folate, and vitamin D but also of salt. Salt intake at preschool needs to be tackled by reducing salt in recipes and using low-sodium bread.
As a preconception healthy diet is not only beneficial for couples’ general health but also for their reproductive health, effective interventions are necessary and lacking. In the field of nutrition, the concept of food literacy is emerging. Food literacy is the interrelated combination of knowledge, skills and self-efficacy on food planning, selecting foods, food preparation, eating and evaluating information about food with the ultimate goal of developing a lifelong healthy, sustainable and gastronomic relationship with food. The present study describes the systematic development of a food literacy intervention for couples trying to conceive.
Materials and methods
The development of the food literacy intervention was guided by Intervention Mapping, a protocol for developing theory- and evidence-based health promotion interventions in combination with consulting stakeholders. Decisions during intervention development were based on literature, an observational study evaluating the diet of couples trying to conceive using a food frequency questionnaire (FFQ) and semi-structured interviews and user tests with experts in the field and couples trying to conceive.
An innovative intervention to influence preconception diet and food literacy based on stakeholders opinion, effective behavior change strategies and attractive intervention channels was developed. Regarding needs assessment, the observational study showed that the diet of couples trying to conceive (n = 57) was inadequate (i.e. lack of vegetable intake) and highly correlated between partners. Objectives regarding food literacy were determined by participating experts (n = 12) rating ‘making healthy food choices’ as most important objective. A blended format (i.e. a mobile application in combination with telephone interaction with a health care professional) was selected as intervention channel based on semi-structured interviews with people trying to conceive (n = 17) as they highlighted the importance of support by experts and a time efficient intervention. Knowledge and self-efficacy regarding food literacy were selected as determinants to address. The main behavioral change strategies included in the intervention were tailoring, goal setting and motivational interviewing resulting in tailored goals, tips about food literacy and recipes. Experts (n = 15) and couples trying to conceive (n = 8) evaluated the intervention as easy to use.
This intervention will be evaluated on reproductive and dietary outcomes via a randomized controlled trial in Belgian Fertility clinics among 460 couples trying to conceive. If this theory- and evidence based food literacy intervention proves to be effective on reproductive and dietary outcomes in couples trying to conceive, it will offer vision and practical tools for implementing food literacy interventions in preconception care.
In Finland the recommendation for the use of vitamin D supplement is a daily supplement throughout the year for all children. It is also recommended that fluid milk products and fat spreads are fortified with vitamin D. The purpose of this study was to provide up-to-date data on children's dietary and supplemental intake of vitamin D. We also examined educational level differences in the intake and sources of vitamin D.
A cross-sectional study on the diet in Finnish 3–6-year-old preschool children (the DAGIS Study) was carried out in 2015–2016. Children were recruited in preschools in Southern Finland and in the Southern Ostrobothnia Region (n = 864). The parents reported child's supplement use (brand name, dose, frequency of use) during the last month and their own education level. The highest parental education level (PEL) was used in analysis. Parents and preschool personnel also filled in a 3-day food record for the child. A part of the families also kept an additional 2-day food record, which we sent to capture seasonal variation in the diet. In this analysis we included children (n = 794) with data for supplement use and at least 1-day food record. We calculated dietary intake based on the Fineli food composition database and created a dietary supplement database. We used Kruskal-Wallis test for statistical analysis.
Most of the children in all PELs used vitamin D supplements (low 77%, medium 85%, high 85%). Dietary supplements covered almost half of the total intake in all groups (low 42%, medium 48%, high 47%, p = 0,087). The main dietary sources of vitamin D were fortified fluid milk products, fortified fat spreads and fish dishes. A higher proportion of vitamin D was obtained from fish dishes in families with higher PEL (low 4.3%, medium 4.5%, high 6.1%, p = 0.005), but otherwise there were no differences in the proportions of the main sources. The vitamin D intake from diet and supplements was lowest in families with low PEL but the total intake of vitamin D was adequate in all groups (low 18.3, medium 20.7, high 20.7 μg/day, p = 0.001).
The use of vitamin D fortified fluid milk products and fat spreads and the vitamin D supplementation seem to ensure adequate vitamin D intake in all children, regardless the level of parental education.
Aquaculture is one of the fastest-growing food production sectors in many low-income and food-deficit countries with aquatic ecozones. Yet its specific impact on nutrition and livelihood in local communities, where commercial and/or export-orientated aquaculture activities are developed, is largely unknown.
The present narrative and argumentative review aims to provide an overview of our current understanding of the connections between aquaculture agroecosystems, local and national fish production, fish consumption patterns and nutrition and health outcomes.
The agroecological dynamic in a coastal-estuarine zone, where the aquatic environment ranges from fully saline to freshwater, is complex, with seasonal and annual fluctuations in freshwater supply creating a variable salinity gradient which impacts on aquatic food production and on food production more generally. The local communities living in these dynamic aquatic ecozones are vulnerable to poverty, poor diet and health, while these ecosystems produce highly valuable and nutritious aquatic foods. Policies addressing the specific challenges of risk management of these communities are limited by the sectoral separation of aquatic food production – the fisheries and aquaculture sector, the broader food sector – and public health institutions.
Here we provide an argument for the integration of these factors to improve aquaculture value chains to better address the nutritional challenges in Bangladesh.