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The main objective of “Lifebrain” is to identify the determinants of brain, cognitive and mental (BCM) health at different stages of life. By integrating, harmonising and enriching major European neuroimaging studies across the life span, we will merge fine-grained BCM health measures of more than 5000 individuals. Longitudinal brain imaging, genetic and health data are available for a major part, as well as cognitive and mental health measures for the broader cohorts, exceeding 27,000 examinations in total. By linking these data to other databases and biobanks, including birth registries, national and regional archives, and by enriching them with a new online data collection and novel measures, we will address the risk factors and protective factors of BCM health. We will identify pathways through which risk and protective factors work and their moderators. Exploiting existing European infrastructures and initiatives, we hope to make major conceptual, methodological and analytical contributions towards large integrative cohorts and their efficient exploitation. We will thus provide novel information on BCM health maintenance, as well as the onset and course of BCM disorders. This will lay a foundation for earlier diagnosis of brain disorders, aberrant development and decline of BCM health, and translate into future preventive and therapeutic strategies. Aiming to improve clinical practice and public health we will work with stakeholders and health authorities, and thus provide the evidence base for prevention and intervention.
The relationship between depression and sexual behaviour among men who have sex with men (MSM) is poorly understood.
To investigate prevalence and correlates of depressive symptoms (Patient Health Questionnaire-9 score ≥10) and the relationship between depressive symptoms and sexual behaviour among MSM reporting recent sex.
The Attitudes to and Understanding of Risk of Acquisition of HIV (AURAH) is a cross-sectional study of UK genitourinary medicine clinic attendees without diagnosed HIV (2013–2014).
Among 1340 MSM, depressive symptoms (12.4%) were strongly associated with socioeconomic disadvantage and lower supportive network. Adjusted for key sociodemographic factors, depressive symptoms were associated with measures of condomless sex partners in the past 3 months (≥2 (prevalence ratio (PR) 1.42, 95% CI 1.17–1.74; P=0.001), unknown or HIV-positive status (PR 1.43, 95% CI 1.20–1.71; P<0.001)), sexually transmitted infection (STI) diagnosis (PR 1.46, 95% CI 1.19–1.79; P<0.001) and post-exposure prophylaxis use in the past year (PR 1.83, 95% CI 1.33–2.50; P<0.001).
Management of mental health may play a role in HIV and STI prevention.
This paper reports on a project conducted with representatives of indigenous Māori organizations that are active in New Zealand land-based sectors. The primary aim of the research was to assist these organizations in thinking about their current and future positioning with regard to climate change. Using Peter Checkland’s Soft Systems Methodology as a broad framework for the research, the paper first seeks to capture some of the likely issues that enable and constrain strategic activity in the climate change arena. It then uses various soft systems modelling tools to research and structure a debate to consider the desirability and feasibility of particular interventions.
Customary land is commonly perceived as a barrier to economic development and indigenous entrepreneurship in Pacific Island countries. We turn this proposition on its head, arguing that customary land provides a solid foundation for indigenous entrepreneurs who wish to achieve social, cultural and environmental, as well as economic, goals for their businesses. Furthermore, we assert that appropriate tools are needed to measure the success of indigenous businesses on customary land, as conventional tools have a narrow focus on economics that fails to capture the more holistic, sustainable development goals that indigenous people hope to achieve through their businesses. The indicators we utilise relate to socio-cultural, economic and environmental sustainability. The tool’s usefulness was scrutinized through pre-testing on two indigenous businesses in Fiji; this revealed that culturally oriented tools are essential if the sustainability of indigenous business is to be measured in terms that are meaningful to Pacific communities.
Governmental development strategies focus on entrepreneurship as a major resource for the economic development of indigenous peoples. While initiatives and programs are locally based, there is a debate in the academic literature about how contextual factors affect the identification of indigenous entrepreneurship. The purpose of this paper is to analyze and integrate indigenous entrepreneurship literature to identify the main indigenous entrepreneurship models. Thus, a systematic literature review was conducted. In total, 25 relevant articles were identified in selected electronic databases and manual searches of Australian Business Deans Council ranked journals from January 1, 1995 to the end of 2016. Using a systematic analysis of sociocultural contexts and locations, the paper proposed that a typology of contextualized indigenous entrepreneurship models was possible, that were classified as urban, remote and rural. The parameters of these models, and their potential theoretical and practical applications to the study and practice of indigenous entrepreneurship ecosystems were also outlined.
This paper explores the influence of institutions on indigenous entrepreneurship within the muttonbird economy of Ngāi Tahu (a New Zealand Māori tribe). It determines that colonisation removed the traditional Ngāi Tahu institution of executive authority which once regulated muttonbird exchange. Without this regulatory function whānau (family) birders compete against each other at their own expense and to the benefit of traders. As a consequence the birders are constrained in applying their birding knowledge and abilities to realise market opportunity. Furthermore, declining returns and harvesting pressure is in some cases reducing the financial and natural capital of whānau, whilst threats to continuing birding culture potentially undermines the socio-human capital contained within inherited traditions and the maintaining of kinship connections. It is argued that the development of a contemporary executive authority to regulate exchange and market product may reinvigorate entrepreneurial birding activities.
Art centres fulfil many functions in remote regions as a source of Indigenous identity and creativity; as a link to the global art market; as centres for community engagement and participation; and as a source of social capital providing a range of services for local communities. They are dependent on funding from State and Federal authorities and they are identified as one of the success stories in remote community development. However, they face an uncertain future in the light of their multiple functions and their position as both a source of traditional identity and a link to an external art market. The article highlights the challenges faced by government in the evaluation of their effectiveness and contribution; and in particular discusses the suitability of the hybrid economy model as a representation of their functions.
With the widespread shift from models of welfare to business-led development, capacity development offers a useful lens from which to consider the emergence of Indigenous social enterprise as a business-led development approach. We explore capacity development from the international development literature and identify capacity development principles in the context of an Indigenous social enterprise in remote northeast Arnhem Land. Here, Aboriginal Australians continue to experience poverty and marginalisation. This paper provides an ethnographic example of the relationship between Indigenous social enterprise and capacity development. Identifying principles of capacity development in this rich context reveals the remit of the Indigenous social enterprise privileges environmental stewardship and cultural maintenance.
This paper explores the emancipatory impulse of Indigenous social innovation and social enterprise. Indigenous approaches to solving social disparities reflect a perpetual search for innovative ways to change the circumstances of Māori. Power is an understudied dimension of social innovation and social enterprise. This paper explores the power dynamics that structure the disadvantage and marginalisation that cause populations to be underserved by markets and that limit their access to resources. We highlight that it is not power per se that enables social change: rather, it is power shifts. Through a single, richly contextualised case study of a well-known Māori social innovator, Dr Lance O’Sullivan, we reveal and illustrate the nuances of Indigenous entrepreneurship in the Far North of Aotearoa New Zealand. The case epitomises the transformative impact a social entrepreneur can have on the provision of healthcare amid market and policy failures.
Indigenous entrepreneurs represent a growing segment of the business community in many countries, but face sometimes stark challenges in starting and running enterprises. The success of indigenous entrepreneurs matters because they draw upon their indigeneity as sources of inspiration and innovation, contribute to the collective wellbeing of indigenous peoples, and some represent world class exemplars of sustainable ways of doing business. While enterprise assistance for entrepreneurs is widely accepted as a worthwhile use of public funds few guidelines exist to help policy makers and providers understand the needs of indigenous entrepreneurs and how best to respond. In this paper, we use the theoretical lens of entrepreneurial identity to provide insight into this challenging context. Taking an identity perspective may enable us to tease out how identifying as a Māori entrepreneur can enable and also hinder change in this community context. In doing so we lay foundations for future empirical work.
Traditionally, personalised nutrition was delivered at an individual level. However, the concept of delivering tailored dietary advice at a group level through the identification of metabotypes or groups of metabolically similar individuals has emerged. Although this approach to personalised nutrition looks promising, further work is needed to examine this concept across a wider population group. Therefore, the objectives of this study are to: (1) identify metabotypes in a European population and (2) develop targeted dietary advice solutions for these metabotypes. Using data from the Food4Me study (n 1607), k-means cluster analysis revealed the presence of three metabolically distinct clusters based on twenty-seven metabolic markers including cholesterol, individual fatty acids and carotenoids. Cluster 2 was identified as a metabolically healthy metabotype as these individuals had the highest Omega-3 Index (6·56 (sd 1·29) %), carotenoids (2·15 (sd 0·71) µm) and lowest total saturated fat levels. On the basis of its fatty acid profile, cluster 1 was characterised as a metabolically unhealthy cluster. Targeted dietary advice solutions were developed per cluster using a decision tree approach. Testing of the approach was performed by comparison with the personalised dietary advice, delivered by nutritionists to Food4Me study participants (n 180). Excellent agreement was observed between the targeted and individualised approaches with an average match of 82 % at the level of delivery of the same dietary message. Future work should ascertain whether this proposed method could be utilised in a healthcare setting, for the rapid and efficient delivery of tailored dietary advice solutions.
It is postulated that knowledge of genotype may be more powerful than other types of personalised information in terms of motivating behaviour change. However, there is also a danger that disclosure of genetic risk may promote a fatalistic attitude and demotivate individuals. The original concept of personalised nutrition (PN) focused on genotype-based tailored dietary advice; however, PN can also be delivered based on assessment of dietary intake and phenotypic measures. Whilst dietitians currently provide PN advice based on diet and phenotype, genotype-based PN advice is not so readily available. The aim of this review is to examine the evidence for genotype-based personalised information on motivating behaviour change, and factors which may affect the impact of genotype-based personalised advice. Recent findings in PN will also be discussed, with respect to a large European study, Food4Me, which investigated the impact of varying levels of PN advice on motivating behaviour change. The researchers reported that PN advice resulted in greater dietary changes compared with general healthy eating advice, but no additional benefit was observed for PN advice based on phenotype and genotype information. Within Food4Me, work from our group revealed that knowledge of MTHFR genotype did not significantly improve intakes of dietary folate. In general, evidence is weak with regard to genotype-based PN advice. For future work, studies should test the impact of PN advice developed on a strong nutrigenetic evidence base, ensure an appropriate study design for the research question asked, and incorporate behaviour change techniques into the intervention.
Individual response to dietary interventions can be highly variable. The phenotypic characteristics of those who will respond positively to personalised dietary advice are largely unknown. The objective of this study was to compare the phenotypic profiles of differential responders to personalised dietary intervention, with a focus on total circulating cholesterol. Subjects from the Food4Me multi-centre study were classified as responders or non-responders to dietary advice on the basis of the change in cholesterol level from baseline to month 6, with lower and upper quartiles defined as responder and non-responder groups, respectively. There were no significant differences between demographic and anthropometric profiles of the groups. Furthermore, with the exception of alcohol, there was no significant difference in reported dietary intake, at baseline. However, there were marked differences in baseline fatty acid profiles. The responder group had significantly higher levels of stearic acid (18 : 0, P=0·034) and lower levels of palmitic acid (16 : 0, P=0·009). Total MUFA (P=0·016) and total PUFA (P=0·008) also differed between the groups. In a step-wise logistic regression model, age, baseline total cholesterol, glucose, five fatty acids and alcohol intakes were selected as factors that successfully discriminated responders from non-responders, with sensitivity of 82 % and specificity of 83 %. The successful delivery of personalised dietary advice may depend on our ability to identify phenotypes that are responsive. The results demonstrate the potential use of metabolic profiles in identifying response to an intervention and could play an important role in the development of precision nutrition.
To characterise clusters of individuals based on adherence to dietary recommendations and to determine whether changes in Healthy Eating Index (HEI) scores in response to a personalised nutrition (PN) intervention varied between clusters.
Food4Me study participants were clustered according to whether their baseline dietary intakes met European dietary recommendations. Changes in HEI scores between baseline and month 6 were compared between clusters and stratified by whether individuals received generalised or PN advice.
Individuals in cluster 1 (C1) met all recommended intakes except for red meat, those in cluster 2 (C2) met two recommendations, and those in cluster 3 (C3) and cluster 4 (C4) met one recommendation each. C1 had higher intakes of white fish, beans and lentils and low-fat dairy products and lower percentage energy intake from SFA (P<0·05). C2 consumed less chips and pizza and fried foods than C3 and C4 (P<0·05). C1 were lighter, had lower BMI and waist circumference than C3 and were more physically active than C4 (P<0·05). More individuals in C4 were smokers and wanted to lose weight than in C1 (P<0·05). Individuals who received PN advice in C4 reported greater improvements in HEI compared with C3 and C1 (P<0·05).
The cluster where the fewest recommendations were met (C4) reported greater improvements in HEI following a 6-month trial of PN whereas there was no difference between clusters for those randomised to the Control, non-personalised dietary intervention.
To characterise participants who dropped out of the Food4Me Proof-of-Principle study.
The Food4Me study was an Internet-based, 6-month, four-arm, randomised controlled trial. The control group received generalised dietary and lifestyle recommendations, whereas participants randomised to three different levels of personalised nutrition (PN) received advice based on dietary, phenotypic and/or genotypic data, respectively (with either more or less frequent feedback).
Seven recruitment sites: UK, Ireland, The Netherlands, Germany, Spain, Poland and Greece.
Adults aged 18–79 years (n 1607).
A total of 337 (21 %) participants dropped out during the intervention. At baseline, dropouts had higher BMI (0·5 kg/m2; P<0·001). Attrition did not differ significantly between individuals receiving generalised dietary guidelines (Control) and those randomised to PN. Participants were more likely to drop out (OR; 95 % CI) if they received more frequent feedback (1·81; 1·36, 2·41; P<0·001), were female (1·38; 1·06, 1·78; P=0·015), less than 45 years old (2·57; 1·95, 3·39; P<0·001) and obese (2·25; 1·47, 3·43; P<0·001). Attrition was more likely in participants who reported an interest in losing weight (1·53; 1·19, 1·97; P<0·001) or skipping meals (1·75; 1·16, 2·65; P=0·008), and less likely if participants claimed to eat healthily frequently (0·62; 0·45, 0·86; P=0·003).
Attrition did not differ between participants receiving generalised or PN advice but more frequent feedback was related to attrition for those randomised to PN interventions. Better strategies are required to minimise dropouts among younger and obese individuals participating in PN interventions and more frequent feedback may be an unnecessary burden.
Cognitive impairment (CI) that arises in some older adults limits independence and decreases quality of life. Cognitive stimulation programs delivered by professional therapists have been shown to help maintain cognitive abilities, but the costs of such programming are prohibitive. The present study explored the feasibility and efficacy of using long-term care homes' volunteers to administer a cognitive stimulation program to residents.
Thirty-six resident participants and 16 volunteers were alternately assigned to one of two parallel groups: a control group (CG) or stimulation group (SG). For eight weeks, three times each week, CG participants met for standard “friendly visits” (casual conversation between a resident and volunteer) and SG participants met to work through a variety of exercises to stimulate residents’ reasoning, attention, and memory abilities. Resident participants were pre- and post-tested using the Weschler Abbreviated Scale of Intelligence–Second Edition, Test of Memory, and Learning-Senior Edition, a modified Letter Sorting test (LS), Clock Drawing Test (CDT), and the Action Word Verbal Fluency Test.
Two-way analyses of covariance (ANCOVA) controlling for dementia diagnosis indicated statistically greater improvements in the stimulation participants than in the control participants in Immediate Verbal Memory, p = 0.011; Non-Verbal Memory, p = 0.012; Learning, p = 0.016; and Verbal Fluency, p = 0.024.
The feasibility and efficiency of a volunteer-administered cognitive stimulation program was demonstrated. Longitudinal studies with larger sample sizes are recommended in order to continue investigating the breadth and depth volunteer roles in the maintenance of the cognitive abilities of older adults.