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The current study aimed to assess the nutritional quality of Australian secondary school canteen menus.
Stratified national samples of schools provided canteen menus in 2012–2013 and 2018, which were systematically assessed against a ‘traffic light’ classification system according to the National Healthy School Canteen Guidelines. Items were classified as green (healthiest and recommended to dominate canteen menus), amber (select carefully) or red (low nutritional quality, should not appear on canteen menus), and pricing and promotional strategies were recorded.
Canteen menus from 244 secondary schools (2012–2013 n 148, 2018 n 96).
A total of 21 501 menu items were classified. Forty-nine percent of canteen menus contained at least 50 % green items; however, nearly all (98·5 %) offered at least one red item and therefore did not comply with national recommendations. Snacks and drinks had the least healthy profile of all product sectors, and a large proportion of schools supplied products typically of poor nutritional quality (meat pies and savoury pastries 91·8 %, sugary drinks 89·5 %, sweet baked goods 71·5 %, ice creams 64·1 % and potato chips 44·0 %). Red items were significantly cheaper than green items on average, and many schools promoted the purchase of red items on canteen menus (52·8 %). There were few differences between survey waves.
There is considerable room for improvement in the nutritional quality of canteen menus in Australian secondary schools, including in the availability, pricing and promotion of healthier options. Additional resources and services to support implementation of national guidelines would be beneficial.
Adolescents’ engagement with online social networking platforms is advancing at an exponential rate and research is needed to investigate any impact on young users’ mental health. This study examined appearance-related activity (e.g. looking at photos of friends) on social media and body dissatisfaction among adolescent girls.
Self-report measures of online appearance-related activity, social comparisons to female target groups, internalization of the thin ideal, body dissatisfaction, and self-esteem were administered to 210 girls (mean age = 15.16 years).
Body dissatisfaction was significantly related to (i) time spent engaged in social comparisons and (ii) upward social comparisons with various female targets while online. Evaluating oneself less favorably than the target group of close friends was most strongly associated with poorer body image appraisals. Serial multiple mediation analysis revealed that even after controlling for age and self-esteem, time spent engaged in social comparisons significantly mediated the relationship between online appearance-related activity and body dissatisfaction. This association was then further partially mediated by internalization of the thin ideal, which significantly mediated the relationship between time engaged in social comparisons and body dissatisfaction.
Results are discussed in terms of online social media platforms representing an additional appearance culture environment for adolescent girls. The effects of this on the mental health of vulnerable users and how future research should investigate protective factors that may buffer young girls from the adverse effects of social media are considered.
Introduction: Hemorrhage is the primary cause of death in 39% of trauma patients. In prehospital trauma management, there is debate over pursuing a ‘scoop-and-run’ approach versus early intravenous (IV) fluid therapy. We evaluated the literature regarding the effect of prehospital IV fluid therapy on mortality in adult trauma patients. Methods: A librarian-assisted search was conducted in PubMed, Medline and Embase. The population was adults with blunt and/or penetrating trauma. The intervention was total prehospital IV fluid volume 0-500 mL, and the control was prehospital fluid volume >500 mL. The outcome of interest was in-hospital mortality. Randomized controlled trials (RCTs), cohort and case-matched studies were included. Two reviewers used the Cochrane Risk of Bias (RoB) and Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tools to evaluate biases, and kappa was calculated for inter-rater agreement. A summary relative risk (RR) of in-hospital mortality was calculated and heterogeneity (I2) analysis performed using RevMan 5 software. Results: Four RCT's and eleven observational studies were identified, with n = 15,448 patients. Two RCTs and four observational studies were excluded due to non-English language, and the location or volume of IV fluid administered, leaving eight studies with n = 4,568 patients. Inter-rater agreement was high with the ROBINS-I (unweighted κ=0.8841) and RoB tool (unweighted κ=0.8276). Two studies found decreased mortality, one found increased mortality, and five found no significant relationship to mortality with 0-500 mL prehospital IV fluid. The summary relative risk of mortality with 0-500 mL IV fluid compared to >500 mL IV fluid was not significant (RR = 0.98 [0.87, 1.11]). The heterogeneity for all studies was high (I2 = 84%), but was low (I2 = 0%) with removal of two studies. Conclusion: The majority of studies did not find a relationship between the volume of prehospital IV fluids and in-hospital mortality. Study heterogeneity was low except for two studies: this may be explained by mortality only being recorded at emergency department discharge in one study, and the high rate of penetrating gunshot and stabbing wounds in the other. There is a paucity of high-quality RCTs on the topic, and many studies are at significant risk of bias. Further research is needed to delineate the best approach to IV fluid therapy in adult trauma patients.
To examine demographic and behavioural correlates of frequent consumption of fast food among Australian secondary school students and explore the associations between fast food consumption and social/environmental factors.
Cross-sectional survey using a web-based self-report questionnaire.
Secondary schools across all Australian states and territories.
Students aged 12–17 years participating in the 2012–2013 National Secondary Students’ Diet and Activity survey (n 8392).
Overall, 38 % of students surveyed reported consuming fast food at least weekly. Being male, residing in lower socio-economic areas and metropolitan locations, having more weekly spending money and working at a fast food outlet were all independently associated with consuming fast food once a week or more, as were several unhealthy eating (low vegetable intake and high sugary drink and snack food intake) and leisure (low physical activity and higher commercial television viewing) behaviours and short sleep duration. Frequent fast food consumption and measured weight status were unrelated. Students who agreed they go to fast food outlets with their family and friends were more likely to report consuming fast food at least weekly, as were those who usually ‘upsize’ their fast food meals and believe fast food is good value for money.
These results suggest that frequent fast food consumption clusters with other unhealthy behaviours. Policy and educational interventions that reach identified at-risk groups are needed to reduce adolescent fast food consumption at the population level. Policies placing restrictions on the portion sizes of fast food may also help adolescents limit their intake.
To explore parents’ responses to sponsorship of children’s sport by unhealthy food brands and two alternative pro-health sponsorship options.
Between-subjects online experiment with four sponsorship conditions: (i) non-food branding (control); (ii) unhealthy food branding; (iii) healthier food branding; (iv) public health nutrition campaign branding. Participants were shown a short video and a promotional flyer for a fictional junior sports programme, with sponsor content representing their assigned brand. Afterwards, participants were asked a series of questions assessing their brand awareness, brand attitudes and preference for food sponsor branded products.
Australian parents (n 1331) of children aged 6–9 years.
Compared with the control condition, unhealthy food sponsorship promoted increased awareness, branded product preferences and favourable attitudes towards unhealthy food sponsor brands. Healthier food sponsorship promoted similar effects for healthier food sponsor brands, except there was no significant increase in positive attitudes towards these brands. Sponsorship by public health nutrition campaigns promoted more negative attitudes towards unhealthy food sponsor brands and increased preference for healthier food sponsor branded products. Overall, healthier food sponsors and public health campaign sponsors were perceived to have better programme–sponsor fit and to be more appropriate sponsors of children’s sport than unhealthy food sponsors.
Restrictions on unhealthy food sponsorship of children’s sport are needed to prevent unhealthy food brands from exploiting junior sport sponsorship to enhance their appeal. Sponsorship of children’s sport by healthier food brands or public health nutrition campaigns could help promote healthier food choices among parents.
Appropriate nutrition is vital for growth and cognitive development in childhood. Vitamin D, omega 3, zinc, iodine, and iron are important micronutrients for neurodevelopment(1). National survey data suggest that children in Ireland are not meeting recommended intakes of these key nutrients(2). The aim of this research was to determine mean daily intakes of vitamin D, omega 3, zinc, iodine, and iron among school-aged children and examine the relationship between intakes and academic performance.
Materials and Methods:
Anthropometric and dietary data was collected from pairs of twins. Four-day food diaries were used by parents to record all food, drinks and supplements consumed. Diaries were entered into the analytical software, Nutritics, which provided the nutrient content of foods consumed. Academic performance was assessed using an online questionnaire. Teachers were asked to rank the child's performance in reading, writing, maths and overall performance using a 5-point likert scale, which was then categorised into “Average” and “Above Average”. SPSS V24 was used for statistical analysis.
Data was collected from 51 pairs of twins aged 8–10 years, and 60% of participants were female. Mean nutrient intakes were as follows; vitamin D = 2.34μg (SD = 1.71), omega-3 = 0.68 g (SD = 0.43), zinc = 7.93 mg (SD = 3.56), iodine = 140.82μg (SD = 59.26) and iron = 9.76 mg (SD = 3.050). All children met recommendations for iodine compared to iron (61%), zinc (52%) omega-3 (15%), and vitamin D (11%). Supplements contributed to 68% and 25% of vitamin D and omega 3 intakes. Meat was the largest contributor to zinc and iron. Milk contributed to ~80% of iodine intakes. Intra-twin correlations indicated a strong familial effect on nutrient intakes. Children who were ranked “above average” in all categories had significantly higher zinc and iodine intakes compared to average students.
The findings of this study concurred with previous analysis of nutrient intakes of Irish and UK children. Animal source foods including meat and milk contributed a high proportion to intakes of key nutrients. Children ranked above average in school had higher nutrient intakes. Public health initiatives should emphasise the importance of key nutrients related to cognitive development and subsequent academic outcomes.
Vitamin D deficiency (VDD) is detrimental to bone health, playing an intrinsic role in osteoporosis and rickets. Recently it has been linked to morbidities including inflammation, cardiovascular disease and cognition. The majority (90%) of vitamin D is obtained by the action of UVB light on the skin, this is reduced in northern latitudes (> 42°N), by SPF, darker skin tone, and ageing. Bioavailability is affected by internal factors including obesity and malabsorption. Many developed populations are becoming older and more overweight. It is essential to ascertain the extent of VDD to predict further trends. The aim of this study is to investigate vitamin D status in a population of GP requested samples within the St James Hospital (SJH) catchment area.
Materials & Methods
The SJH catchment area sits at northerly latitude (53°N) and includes rural and urban environments (Dublin City, Dublin County and County Kildare) of various socioeconomic groups. An estimated 60% of the population are overweight/obese, with 20% aged 65 and over. A data-set of total 25(OH)D concentrations (measured by LC-MS/MS) was created from the SJH laboratory information system from GPs requests between the years 2014–2016. Results were tabulated according to geometric mean values for vitamin D in each postal district with percentage of samples deficient (< 30nmol/L), insufficient (30–50nmol/L), and sufficient (> 50 nmol/L). This data was further stratified by age (18–50, > 50 years) and socioeconomic status and analysed by ANOVA.
A total of 15,483 GP samples were received for vitamin D requests in the time period studied. Preliminary results indicate VDD in 15.2% of the population, with 22.4% insufficient. The lowest socioeconomic areas (Dublin 8 and Lucan postal district) were the most consistently deficient (23.5% and 20.4%, respectively). The geometric mean 25(OH)D concentration in the total population was 56.2nmol/L (SD 31.5), with those age 18–50 years more lively to be deficient than those > 50 years (P < 0.0001).
This study indicates that VDD remains prevalent across age and location groups at a northern location. Current trends in developed populations, such as the obesity epidemic and ageing populations, may increase rates of deficiency and burden of diseases. With the extent of vitamin D deficiency becoming better understood, its contributing factors require greater evaluation to understand the potential consequences in the population. As such, further analysis and investigations are planned to explore factors contributing to VDD in this cohort.
Research on psychotic illness is loosening emphasis on diagnostic stringency in favour of including a more dimensionally based conceptualization of psychopathology and pathobiology. However, to clarify these notions requires investigation of the full scope of psychotic diagnoses.
The Cavan–Monaghan First Episode Psychosis Study ascertained cases of first episode psychosis across all 12 DSM-IV psychotic diagnoses via all routes to care: public, private or forensic; home-based, outpatient or inpatient. There was no arbitrary upper age cut-off and minimal impact of factors associated with variations in social milieu, ethnicity or urbanicity. Cases were evaluated epidemiologically and assessed for psychopathology, neuropsychology, neurology, antecedent factors, insight and quality of life.
Among 432 cases, the annual incidence of any DSM-IV psychotic diagnosis was 34.1/100 000 of population and encompassed functional psychotic diagnoses, substance-induced psychopathology and psychopathology due to general medical conditions, through to psychotic illness that defied contemporary diagnostic algorithms. These 12 DSM-IV diagnostic categories, including psychotic disorder not otherwise specified, showed clinical profiles that were consistently more similar than distinct.
There are considerable similarities and overlaps across a broad range of diagnostic categories in the absence of robust discontinuities between them. Thus, psychotic illness may be of such continuity that it cannot be fully captured by operational diagnostic algorithms that, at least in part, assume discontinuities. This may reflect the impact of diverse factors each of which acts on one or more overlapping components of a common, dysfunctional neuronal network implicated in the pathobiology of psychotic illness.
Working in Hong Kong, an international hub blessed with vibrant domestic and expatriate communities, family law practitioners respond to manifold enquiries oft en driven by social and technological change and different cultural expectations. How is Hong Kong's family law evolving to meet the changing needs of this dynamic, multi-faceted community?
Whilst Hong Kong's family law has responded innovatively to some of the challenges brought in recent years, perhaps most notably the Court of Final Appeal's support in LKW v. DD for a move from needs-based ancillary relief to a starting point of equal division of matrimonial property, it is also true to say that change has sometimes been more cautious. For example, consider the very carefully drawn decision of the Court of Final Appeal in W v. Registrar of Marriages on the scope for marriage by a transsexual in their reassigned gender identity.
While earlier resistance to legal recognition of same-sex relationships, parental responsibility in lieu of parental authority, and children as rights-holders rather than the ‘property’ of parents, suggests a tension between a ‘traditional’, hetero-normative, hierarchical concept of family life and a more progressive vision of family life and family law, 2018 saw key developments challenging the dominance of a ‘traditional’ family law. Nonetheless, the question remains: is the pace of change so glacial that any impact is only illusory?
LIMITED LEGAL RECOGNITION OF SAME-SEX RELATIONSHIPS
In 2018, two sets of legal proceedings, each claiming legal recognition of same sex-relationships in relation to spousal benefits, travelled through the courts.
The first case, Leung Chun Kwong v. Secretary for the Civil Service, was an appeal and cross-appeal to the Court of Appeal (CA) from the judgment of the Court of First Instance (CFI). The applicant – a Senior Immigration Officer – employed by the Civil Service and a Hong Kong permanent resident, had legally married his same-sex partner in New Zealand in 2014. Back in Hong Kong, he subsequently claimed financial spousal benefits which were denied. He then sought a judicial review of the decisions against him. The CFI found in his favour in relation to the Secretary for Civil Service's refusal to extend spousal medical and dental benefits to his same-sex husband.
In the last decades of the nineteenth and first decades of the twentieth century, widespread wage labour emerged across the African continent for the first time. The continent's population and economy remained, as it would throughout the twentieth century, largely rural and agrarian. Forced labour, driven by both colonial states and private employers, also remained widespread. However, the growing importance of capitalist mining and agriculture, along with the increasing development of roads, railways and other infrastructure by colonial states, produced a market for wage labour in locations across the continent on an unprecedented scale.
In this same period, European intellectuals were in the midst of a fervent debate on the ‘social question’. The rapid transformation that nineteenthcentury capitalist expansion had initiated called for a reconsideration of welfare, well-being and the very structure of social life. This debate might have seemed distant from the African context at the time. The emerging groups of urban wage workers on the continent were assumed by colonial states to be temporary sojourners from their natural and permanent homes in the countryside. The welfare and social reproduction of African workers were seen as the domain of the rural and traditional. However, as capitalism and colonialism continued to disrupt and dislocate extant forms of social life, this assumption was increasingly exposed as fiction. Already by the 1930s the question of social welfare had been brought to the centre of colonial administrators’ attention through burgeoning nationalist and labour movements across the continent. Since the period of late colonial reforms, through the developmentalism of the post-independence era, and into the more recent focus on poverty reduction, social welfare has remained a central focus of African political debates and policy initiatives.
Social welfare in Africa has had both political and economic dimensions. Waves of contention, advancing demands for independence and democracy, have repeatedly reshaped the relationship between states and citizens. The state provision of welfare first emerged from the colonial authorities, who hoped that improving standards of living would quell growing demands for political transformation. For post-independence states, welfare provided by the government and by private employers was a tool for securing the support of workers, who were among the most organized, and in some cases oppositional, constituencies in the political landscape of many new countries.
Due to concerns over increasing fluoroquinolone (FQ) resistance among gram-negative organisms, our stewardship program implemented a preauthorization use policy. The goal of this study was to assess the relationship between hospital FQ use and antibiotic resistance.
Large academic medical center.
We performed a retrospective analysis of FQ susceptibility of hospital isolates for 5 common gram-negative bacteria: Acinetobacter spp., Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Primary endpoint was the change of FQ susceptibility. A Poisson regression model was used to calculate the rate of change between the preintervention period (1998–2005) and the postimplementation period (2006–2016).
Large rates of decline of FQ susceptibility began in 1998, particularly among P. aeruginosa, Acinetobacter spp., and E. cloacae. Our FQ restriction policy improved FQ use from 173 days of therapy (DOT) per 1,000 patient days to <60 DOT per 1,000 patient days. Fluoroquinolone susceptibility increased for Acinetobacter spp. (rate ratio [RR], 1.038; 95% confidence interval [CI], 1.005–1.072), E. cloacae (RR, 1.028; 95% CI, 1.013–1.044), and P. aeruginosa (RR, 1.013; 95% CI, 1.006–1.020). No significant change in susceptibility was detected for K. pneumoniae (RR, 1.002; 95% CI, 0.996–1.008), and the susceptibility for E. coli continued to decline, although the decline was not as steep (RR, 0.981; 95% CI, 0.975–0.987).
A stewardship-driven FQ restriction program stopped overall declining FQ susceptibility rates for all species except E. coli. For 3 species (ie, Acinetobacter spp, E. cloacae, and P. aeruginosa), susceptibility rates improved after implementation, and this improvement has been sustained over a 10-year period.
be an anisotropic quadratic form defined over a general field
. In this article, we formulate a new upper bound for the isotropy index of
after scalar extension to the function field of an arbitrary quadric. On the one hand, this bound offers a refinement of an important bound established in earlier work of Karpenko–Merkurjev and Totaro; on the other hand, it is a direct generalization of Karpenko’s theorem on the possible values of the first higher isotropy index. We prove its validity in two key cases: (i) the case where
, and (ii) the case where
is quasilinear (i.e., diagonalizable). The two cases are treated separately using completely different approaches, the first being algebraic–geometric, and the second being purely algebraic.
Electronic data capture is essential to advancing family-centered coordinated care in early intervention (EI). The purpose of this paper is to report on EI service coordinator response to piloting an electronic parent-reported outcome (e-PRO) assessment as part of their routine workflow, including lessons learned that may inform future phases of e-PRO implementation.
This second pilot study involved families enrolled in a large EI program (n=1040 families) in concert with their implementation of a statewide quality improvement initiative for care plan development and outcomes reporting. A total of 22 EI service coordinators and supervisors were engaged in 3 phases: initial e-PRO intervention, peer-mentor enhancement, and standard recruitment protocol.
Implementation of the e-PRO intervention and peer-mentoring enhancement yielded low enrollment rates over the first 6 months (n=17). A standard recruitment protocol has resulted in enrollment growth (n=83) towards the targeted enrollment rate (n=832).
This study reports on early insights for building and sustaining a productive academic-community partnership for e-PRO implementation to support family-centered coordinated care. Lessons learned from this academic-community partnership with respect to strategies for enhancing community significance, collaboration, return, and control are discussed as they inform further development of this intervention before scale-up.
To explore children’s responses to sponsorship of community junior sport by unhealthy food brands and investigate the utility of alternative, pro-health sponsorship options.
Between-subjects experiment, with four sponsorship conditions: A, non-food branding (control); B, unhealthy food branding; C, healthier food branding; D, obesity prevention campaign branding.
Online experiment conducted in schools. Participants were shown a junior sports pack for their favourite sport that contained merchandise with branding representing their assigned sponsorship condition. Participants viewed and rated the sports pack, completed a distractor task, then completed questions assessing brand awareness, brand attitudes and preference for food sponsors’ products.
Students in grades 1 to 3 (aged 5–10 years; n 1124) from schools in metropolitan Melbourne, Australia.
Compared with the control condition, there were no significant effects of unhealthy food branding on awareness of, attitudes towards or preference for these brands. Exposure to healthier food branding prompted a significant increase in the proportion of children aware of these brands, but did not impact attitudes towards or preference for these brands. Exposure to either healthier food branding or obesity prevention campaign branding prompted a significant reduction in the proportion of children showing a preference for unhealthy food sponsor products.
The sponsorship of children’s sport by healthier food brands may promote awareness of these brands and healthier sponsorship branding may reduce preferences for some unhealthy food products. Establishing and implementing healthy sponsor criteria in sports clubs could forge healthier sponsorship arrangements and help phase out unhealthy food and beverage sponsors.