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The aim of the study was to determine the main factors (sociodemographic, anthropometric, lifestyle and health status) associated with high Na excretion in a representative population of Chile.
Na excretion (g/d), a valid marker of Na intake, was determined by urine analysis and Tanaka’s formulas. Blood pressure was measured by trained staff and derived from the mean of three readings recorded after 15 min rest. The associations of Na excretion with blood pressure and the primary correlates of high Na excretion were determined using logistic regression.
Chileans aged ≥15 years.
Participants (n 2913) from the Chilean National Health Survey 2009–2010.
Individuals aged 25 years or over, those who were obese and those who had hypertension, diabetes or metabolic syndrome were more likely to have higher Na excretion. The odds for hypertension increased by 10·2 % per 0·4 g/d increment in Na excretion (OR=1·10; 95 % CI 1·06, 1·14; P < 0·0001). These findings were independent of major confounding factors.
Age, sex, adiposity, sitting behaviours and existing co-morbidities such as diabetes were associated with higher Na excretion levels in the Chilean population. These findings could help policy makers to implement public health strategies tailored towards individuals who are more likely to consume high levels of dietary salt.
Regulatory impact analyses (RIAs) weigh the benefits of regulations against the burdens they impose and are invaluable tools for informing decision makers. We offer 10 tips for nonspecialist policymakers and interested stakeholders who will be reading RIAs as consumers.
1.Core problem: Determine whether the RIA identifies the core problem (compelling public need) the regulation is intended to address.
2.Alternatives: Look for an objective, policy-neutral evaluation of the relative merits of reasonable alternatives.
3.Baseline: Check whether the RIA presents a reasonable “counterfactual” against which benefits and costs are measured.
4.Increments: Evaluate whether totals and averages obscure relevant distinctions and trade-offs.
5.Uncertainty: Recognize that all estimates involve uncertainty, and ask what effect key assumptions, data, and models have on those estimates.
6.Transparency: Look for transparency and objectivity of analytical inputs.
7.Benefits: Examine how projected benefits relate to stated objectives.
8.Costs: Understand what costs are included.
9.Distribution: Consider how benefits and costs are distributed.
10.Symmetrical treatment: Ensure that benefits and costs are presented symmetrically.
The referendum vote for Remain in Scotland and Northern Ireland and the small majority for Leave in Wales immediately attracted much attention to the position of the devolved governments on Brexit negotiations and to the impact of Brexit on their jurisdictions. As the core of devolved powers relate to social policy, identifying the impact of leaving the EU on aspects of social policy is highly significant. This article examines the impact of EU programmes, funding, directives and regulations as delivered in recent years, noting the nature of the participation of the devolved administrations in EU decision making. The post-referendum concerns of the devolved governments and their approaches to Brexit and Brexit negotiations are explained. Also discussed are the likely major changes as well as possible changes that will take place in the operation of devolution after Brexit.
Care-home residents with dementia can experience behavioural and psychological symptoms such as aggression, agitation, anxiety, wandering, calling out and sexual disinhibition. Care-home staff have a duty to keep residents safe. However, residents with dementia can pose particular challenges in this area. In this paper, we draw on a study which explored how care-home staff manage dementia-related behaviours. In-depth ethnographic case studies at four separate care homes were conducted in England. These involved interviews with 40 care-home staff and 384 hours of participant observation. Our analysis showed that some residents with dementia experience behaviours which can either create risks for, or negatively impact on, themselves and/or other residents or staff members. It emerged that the consequences of the behaviours, rather than the behaviours themselves, created difficulties for staff. To cope with the risk and impact of behaviours, staff employed multiple strategies such as surveillance, resident placement, restrictions and forced care. Using the data, we explore how actions taken by staff to manage the risk and impact of behaviours in these communal settings relate to residents’ human rights. Our findings have particular relevance for care-home staff who need support and guidance in this area, for service development worldwide and for the global ageing population whose valued human rights may become under threat, if they require long-term care.
Eating less frequently is associated with increased obesity risk in older children but data are potentially confounded by reverse causation, where bigger children eat less often in an effort to control their weight. Longitudinal data, particularly in younger children, are scarce. We aimed to determine whether eating frequency (meals and snacks) at 2 years of age is associated with past, current or subsequent BMI.
Cohort analysis of a randomised controlled trial. Eating frequency at 2 years of age was estimated using 48 h diaries that recorded when each child ate meals and snacks (parent-defined) in five-minute blocks. Body length/height and weight were measured at 1, 2 and 3·5 years of age. Linear regression assessed associations between the number of eating occasions and BMI Z-score, before and after adjustment for potential confounding variables.
Prevention of Overweight in Infancy (POI) study, Dunedin, New Zealand.
Children (n 371) aged 1–3·5 years.
On average, children ate 5·5 (sd 1·2) times/d at 2 years of age, with most children (88–89 %) eating 4–7 times/d. Eating frequency at 2 years was not associated with current (difference in BMI Z-score per additional eating occasion; 95 % CI: −0·02; −0·10, 0·05) or subsequent change (0·02; −0·03, 0·06) in BMI. Similarly, BMI at age 1 year did not predict eating frequency at 2 years of age (difference in eating frequency per additional BMI Z-score unit; 95 % CI: −0·03; −0·19, 0·13).
Number of eating occasions per day was not associated with BMI in young children in the present study.
Loneliness is a significant health risk for older people, linked with bereavement, living alone and declining health. Previous research suggests loneliness is common amongst residents of English retirement housing, who show a relatively high incidence of these factors. This invites the question, what can providers of retirement housing do to help their residents avoid loneliness, thus remaining healthier and less likely to need care services? Through a survey of 326 retirement-estate managers, we investigate the role of staff and residents' groups in developing organised social activities for residents in retirement housing, and the potential of these activities for generating social contacts which may provide a pathway to avoid loneliness. The survey was informed by a literature review with two objectives: firstly, to consider the nature and causes of loneliness amongst older people and how these apply to retirement housing residents; secondly, to identify good practice models of previous interventions designed to widen social interactions for older people or provide emotional support. The sample was drawn from the all-England property portfolio of a major provider of retirement housing for people over 55. The sampled estates, mostly social rented but including some with a mixture of leasehold and rented dwellings, represent a sector also described as sheltered or supported housing, which has over 550,000 dwellings in the United Kingdom. It is characterised by having some form of staff support for people who are frail, immobile or isolated, such that they may occasionally need help available on call. In the literature review, we consider how different kinds of social contact can help develop friendships and meet social support needs, in retirement housing and elsewhere – in particular, organised group activities (clubs, classes, etc.) and specific interventions designed to address loneliness. The fieldwork suggests that organised activities in retirement housing have considerable potential to meet residents' social support needs, but that this potential is often not fully realised. A wider range of activities is needed, which may require the support of housing management staff, volunteers and community organisations.
To examine overweight and obesity (OWOB), changes in prevalence and potential risk factors in Barbadian children.
A cross-section of students were weighed and measured. The WHO BMI-for-age growth references (BAZ), the International Obesity Task Force cut-offs and the US Centers for Disease Control and Prevention growth percentiles were used to determine OWOB prevalence. Harvard weight-for-height-for-age growth standards were used to estimate differences in OWOB prevalence from 1981 to 2010. Samples of parents and students were interviewed to describe correlates of OWOB.
Public-school students (n 580) in class 3.
Based on WHO BAZ, the overall prevalence of OWOB was 34·8 % (95 % CI 30·9, 38·7 %). A trend of higher OWOB prevalence was seen for girls across cut-offs, with significant sex differences noted using the International Obesity Task Force cut-offs. According to Harvard growth standards, OWOB has increased dramatically, from 8·52 % to 32·5 %. Children were more likely to be OWOB when annual household income was below BBD 9000 (OR=2·69; 95 % CI 1·21, 5·99). Eating dinner with the family every night was associated with a lower prevalence of OWOB (OR=0·56; 95 % CI 0·36, 0·87).
The sharp increase of OWOB rates in Barbados warrants attention. Sex disparities in OWOB prevalence may emerge at a young age. Promoting family meals may be a feasible option for OWOB prevention. Understanding familial and sociodemographic factors influencing OWOB will be useful in planning successful intervention or prevention programmes in Barbados.
To investigate: (i) the percentage of the New Zealand (NZ) population reporting fast food/takeaway food and restaurant/café food per day; (ii) examine demographic factors associated with their use; (iii) quantify their contribution to energy intake; and (iv) describe the specific types of foods reported from both sources.
Twenty-four hour diet recalls from the cross-sectional 2008/09 NZ Adult Nutrition Survey were used to identify fast-food and restaurant-food consumers.
Adults aged 15 years and older (n 4721).
Overall 28 % reported consuming at least one fast food and 14 % a restaurant food within the 24 h diet recall. Fast-food consumption was not associated with level of education or an area-based measure of socio-economic status, but a higher education was positively associated with restaurant-food consumption. Individual factors such as ethnicity, household size, age, sex and marital status were found to be important influences on the use of fast food and restaurant food. Fast-food consumption was more prevalent among participants living in urban areas, young adults (19–30 years) and Māori compared with NZ European and Others. The most frequently reported fast foods were bread-based dishes, potatoes (including fries) and non-alcoholic beverages.
Given the high reported consumption of fast food by young adults, health promotion initiatives both to improve the nutritional quality of fast-food menus and to encourage healthier food choices would likely make a large impact on the overall diet quality of this group.
The seeds of contemporary black theology of liberation were nurtured in the USA on July 31, 1966, when the ad hoc National Committee of Negro Churchmen (NCNC) published its “Black Power” statement in the New York Times. Forty-eight black pastors and church administrators in the NCNC from fifteen different denominations and church offices claimed compatibility between Jesus Christ's words and practice and black American culture. Likewise, they asserted a correlation between Jesus' preferential option for the poor and the need for poor and working-class blacks to have power. Restated, Jesus incarnated in black folk culture and revealed himself in black political power.
Similarly, the contemporary foundation for Aboriginal theology (AT) in Australia emerged in the 1960s. Akin to the motivation of black pastors who crafted black theology of liberation, Aboriginal pastors were tired of white (British-descended) churchmen and missionaries telling the indigenous people they were subhuman. Aboriginal people were fed up with white people (mis)speaking with authority on the indigenous people while labeling their culture as primitive and uncivilized.
More positively, in the 1960s a small group of Aboriginal pastors elevated their culture as an authentic site of the ancestors' and Jesus' revelation. And that sacred culture required Aboriginal people to pursue the right of self-determination or political empowerment. Unknown to many outside of Aboriginal communities, these pastors (and many indigenous people today) referred to themselves as black people working with Jesus against structures of white supremacy in the white (British-descended) church in Australia.
In analysing governance and social policy in Northern Ireland in the period of devolution 1999–2002 Eithne McLaughlin described and predicted the dominance of a lowest common denominator approach to the formulation of social policies. This paper examines the period of restored devolution 2007–11 using this thesis. It identifies the trends in the development of social policies after 2007 and examines social policy-making by the government under five categories. Having established the reasons for this complex approach to social policy formulation, consideration is also given to the outcomes of the policy process.
The increasingly large sample size requirements of modern adult mental
health research suggests the need for a data collection and diagnostic
application that can be used across a broad range of clinical and
To develop a data collection and diagnostic application that can be used
across a broad range of clinical and research settings.
We expanded and redeveloped the OPCRIT system into a broadly applicable
diagnostic and data-collection package and carried out an interrater
reliability study of this new tool.
OPCRIT+ performed well in an interrater reliability study with relatively
inexperienced clinicians, giving a combined, weighted kappa of 0.70 for
OPCRIT+ showed good overall interrater reliability scores for diagnoses.
It is now incorporated in the electronic patient record of the Maudsley
and associated hospitals. OPCRIT+ can be downloaded free of charge at
Background: Cognitive Behaviour Therapy (CBT) of anxiety disorders is usually delivered in weekly or biweekly sessions. There is evidence that intensive CBT can be effective in phobias and obsessive compulsive disorder. Studies of intensive CBT for posttraumatic stress disorder (PTSD) are lacking. Method: A feasibility study tested the acceptability and efficacy of an intensive version of Cognitive Therapy for PTSD (CT-PTSD) in 14 patients drawn from consecutive referrals. Patients received up to 18 hours of therapy over a period of 5 to 7 working days, followed by 1 session a week later and up to 3 follow-up sessions. Results: Intensive CT-PTSD was well tolerated and 85.7 % of patients no longer had PTSD at the end of treatment. Patients treated with intensive CT-PTSD achieved similar overall outcomes as a comparable group of patients treated with weekly CT-PTSD in an earlier study, but the intensive treatment improved PTSD symptoms over a shorter period of time and led to greater reductions in depression. Conclusions: The results suggest that intensive CT-PTSD is a feasible and promising alternative to weekly treatment that warrants further evaluation in randomized trials.
In the beginning, God created the world. In the center was a small island rich in food, vegetation, minerals and life. To the rest of the world, the creatures there seemed very unusual, because the humans who inhabited this world were black. They were a very spiritual people. They had Dreaming stories, telling of their deep spirituality, and one of their stories speaks of a great white spirit that came and walked this land at the beginning of time. (In this case, white does not refer to the color of the skin, but to the spirit world because in our culture white signifies death.) This great white spirit then handed down to our ancestors the laws which we were to follow. This spirit is believed to be God, and our laws are similar to the biblical ones. We were to share everything equally; we were to love our sisters and brothers; we were not to steal; we were to care for the land, and to respect every living thing. So, in general, these people were a very loving, caring and sharing people.
For over 60,000 years, these people lived in peace and harmony with the land, maintaining the God-given integrity of the land. Unlike Europeans who migrated from one continent to another, the Aboriginal people never moved from the land that they were born to. The Aboriginals never believed that they owned the land, but rather that the land owned them.
Then one day, in 1788, came the invasion of white people. At first Aboriginals were welcoming.
The aim of this paper is to describe the experience of community pharmacists participating in a pilot of an information prescription service aimed at children and their parents, in the wider context of factors relevant to the adoption of new services in community pharmacies.
Information prescriptions (IP) are conceived to signpost patients to information and advice that will increase self-efficacy. The Department of Health for England has supported IP development with a national programme of pilots, only one of which incorporated distribution of IP through community pharmacies. The new contract for community pharmacy, implemented in 2005, formalized cognitive services, including information-giving about medicines and health, and positioned signposting as a core activity. There are, however, concerns about the impact of such services on the capacity of community pharmacy.
Qualitative semi-structured telephone interviews were conducted with key informants: seven pharmacists in four IP pilot community pharmacies in England (‘IP pharmacists’), and 22 other pharmacy and medicines information stakeholders. Two interviews were conducted with each IP pilot pharmacist (before and during the pilot), and one with all other stakeholders.
IP pharmacists, and other stakeholders, identified a number of benefits for parents of children with long-term conditions in receiving IP, and hoped that most parents would welcome the service. Many anticipated operational challenges consistent with those of other new cognitive community pharmacy services, such as medicines use review. Pharmacists completing IP for parents found it satisfying and straightforward. Recruitment of parents to the pilot, however, fell below IP pharmacists’ expectations. The lack of interest in the service from parents, who are assumed to be generally welcoming of information about their child’s condition, was both surprising and disappointing to them. IP should be integrated into a wider, integrated medicines and information strategy.
How can the ‘social capital’ inherent in social networks provide contacts through which older people access practical and emotional support? What is the relative importance of kin and non-kin, and of participation in organisations and informal ties such as contacts with neighbours? Following a brief contextualisation that draws on previous literature, this paper addresses these questions through analysis of British Household Panel Survey (BHPS) data. It examines the extent to which people feel they can count on emotional and practical support from friends and relatives. A dependent variable was created that measures the outcome of the ‘social capital’ residing in a respondent's social network. Relatively poor support was found amongst elders who were childless or had been continuously without a partner; relatively rich support was found amongst those who had frequent contact with other people, who interacted frequently with neighbours, and who regarded their neighbourhood as a positive social environment. Being active in organisations had less effect on social support than informal social contacts. Amongst many different forms of organisational activity, the only ones that had a positive association with social support were being in contact with others through religious activities, and engaging in sports clubs. The social support of working-class elders, even those ‘well networked’ in formal or informal ways, was strengthened less by their social capital than was that of the professional and managerial occupational groups.
Few studies have examined the rates of physical disorders in those with
To examine self-reported physical disorders in people with recurrent
depression compared with a psychiatrically healthy control group.
As part of a genetic case-control association study, 1546 participants
with recurrent depression and 884 controls were interviewed about
lifetime ever treatment for 16 different physical health disorders.
The cases group had a significantly higher frequency of 14 physical
disorders and more obesity than the control group. After controlling for
age, gender, body mass index (BMI) and multiple testing, those in the
cases group had significantly higher rates of gastric ulcer, rhinitis/hay
fever, osteoarthritis, thyroid disease, hypertension and asthma.
People with recurrent depression show high rates of many common physical
disorders. Although this can be partly explained by BMI, shared
aetiological pathways such as dysfunction of the hypothalamic–pituitary
axis may have a role.
This paper considers whether sex composition of existing children in Australian families is an important factor in parity progression. Using census data from 1981, 1986, 1991, 1996 and 2001, women are linked with their co-resident children, allowing investigation of family sex composition and its changing impact over time on the propensity to have another child. The study finds that parents are much more likely to have a third and fourth birth if existing children are all of the same sex, indicating a strong preference for children of both sexes. This increased propensity has added around three per cent to the fertility of recent cohorts. The paper concludes with a discussion of the potential impact of sex-selection technologies on fertility. The authors argue that future widespread use of reliable sex-selection technologies might act to increase fertility in the short term, but would lead to a long-term reduction in fertility.