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Fish consumption is associated with reduced risk of cardiovascular disease (CVD), which may be partly mediated by alterations in plasma lipids, such as high-density lipoprotein cholesterol (HDL-C). However, comprehensive analyses of associations between fatty fish consumption and lipoprotein subclass profile are limited and show inconsistent results. Therefore, the aim of the present exploratory study was to investigate the association between fatty fish consumption and lipoprotein subclass particle concentrations and composition, with emphasis on HDL. We performed a comprehensive plasma metabolite profiling in 517 healthy adults, using a targeted high-throughput nuclear magnetic resonance spectroscopy platform. The participants were divided into tertiles based on consumption of fatty fish, reported through a validated food frequency questionnaire. We compared the concentration of metabolites between the participants in the lowest and highest tertiles of fatty fish consumption. We show that high-consumers of fatty fish (>223 g/week, median intake 294 g/week) had higher particle concentrations and content of total lipids, and phospholipids in large and extra-large HDL particles, and higher content of total cholesterol, free cholesterol, cholesteryl esters and triglycerides in large HDL particles, than low-consumers (<107 g/week, median intake 58 g/week). Using fatty fish consumption as a continuous variable, we found that fatty fish consumption was associated with lower levels of the inflammation marker glycoprotein acetyls. In conclusion, high-consumers of fatty fish, seem to have a more favourable HDL-C-related lipoprotein profile and anti-inflammatory phenotype than low-consumers of fatty fish. Thus, these data support the current Norwegian dietary recommendations for fish consumption regarding CVD risk.
With significant shifts in the dietary recommendations between the 2007 and 2019 Canadian dietary guidelines, such as promoting plant-based food intake, reducing highly processed food intake and advocating the practice of food skills, we compared their differences in guideline development methods.
Two reviewers used twenty-five guided criteria to appraise the methods used to develop the most recent dietary guidelines against those outlined in the 2014 WHO Handbook for Guideline Development.
2007 and 2019 dietary guidelines.
We found that the 2019 guidelines were more evidence-based and met 80 % (20/25) of the WHO criteria. For example, systematic reviews and health organisation authoritative reports, but not industry reports, constituted the evidence base for the dietary recommendations. However, recommendations on food sustainability and food skill practice were driven primarily by stakeholders’ interests. By contrast, less information was recorded about the process used to develop the 2007 guidelines, resulting in 24 % (6/25) consistency with the WHO standards.
Our analysis suggests that a more transparent and evidence-based approach is used to develop the 2019 Canadian dietary guidelines and that method criteria should support further incorporation of nutrition priorities (food sustainability and food skills) in future dietary guideline development.
Drawing on the empirical detail presented in the previous chapters, I bring together the theoretical and policy implications of this study in Chapter 5. In the first part of this chapter, I offer a brief summary of my research findings, and then develop some generalizations on the life-cycles of narratives. In the second section of this chapter, I develop guidelines that may assist practitioners in building effective narratives as vital instruments of public policy and diplomacy.
The coconut crab Birgus latro, the largest terrestrial decapod, is under threat in most parts of its geographical range. Its life cycle involves two biomes (restricted terrestrial habitats near the coast, and salt water currents of the tropical Indian and Pacific Oceans). Its dependence on coastal habitat means it is highly vulnerable to the habitat destruction that typically accompanies human population expansion along coastlines. Additionally, it has a slow reproductive rate and can reach large adult body sizes that, together with its slow movement when on land, make it highly susceptible to overharvesting. We studied the distribution and population changes of coconut crabs at 15 island sites in coastal Tanzania on the western edge of the species' geographical range. Our aim was to provide the data required for reassessment of the extinction risk status of this species, which, despite indications of sharp declines in many places, is currently categorized on the IUCN Red List as Data Deficient. Pemba Island, Zanzibar, in Tanzania, is an important refuge for B. latro but subpopulations are fragmented and exploited by children and fishers. We discovered that larger subpopulations are found in the presence of crops and farther away from people, whereas the largest adult coconut crabs are found on more remote island reserves and where crabs are not exploited. Remoteness and protection still offer hope for this species but there are also opportunities for protection through local communities capitalizing on tourist revenue, a conservation solution that could be applied more generally across the species' range.
Tobacco use is the leading preventable cause of death in developed countries. Millions of smokers are willing to stop, but few of them are able to do so. Clinicians should only use approaches that have demonstrated their efficacy in helping patients to stop smoking. This article summarizes the evidence-based major findings and clinical recommendations for the treatment of tobacco dependence of the French Health Products Safety Agency (AFSSAPS). Clinicians should enquire about the smoking status of each patient and provide information about health consequence of smoking and effective treatments available. These treatments include counseling (mainly individual or social support and behavioral and cognitive therapy) and pharmacological treatment with either nicotine replacement therapy (NRT) or bupropion LP. Pharmacological treatments should be used only for proven nicotine dependence, as assessed by the Fagerstrom test for Nicotine Dependence. The choice of pharmacologic treatment depends of the patient's preference and history and of the presence of contra-indications. The clinician should start with a single agent, but these treatments may be used in combination. Smoking behavior is a chronic problem that requires long-term management and follow-up. Access to intensive treatment combining pharmacological treatment and extensive behavioral and cognitive therapy should be available for highly dependent patients.
Improved physical health care is a pressing need for patients with schizophrenia. It can be achieved by means of a multidisciplinary team led by the psychiatrist. Key priorities should include: selection of antipsychotic therapy with a low risk of weight gain and metabolic adverse effects; routine assessment, recording and longitudinal tracking of key physical health parameters, ideally by electronic spreadsheets; and intervention to control CVD risk following the same principles as for the general population. A few simple tools to assess and record key physical parameters, combined with lifestyle intervention and pharmacological treatment as indicated, could significantly improve physical outcomes. Effective implementation of strategies to optimise physical health parameters in patients with severe enduring mental illness requires engagement and communication between psychiatrists and primary care in most health settings.
The Canadian Multiple Sclerosis Working Group has updated its treatment optimization recommendations (TORs) on the optimal use of disease-modifying therapies for patients with all forms of multiple sclerosis (MS). Recommendations provide guidance on initiating effective treatment early in the course of disease, monitoring response to therapy, and modifying or switching therapies to optimize disease control. The current TORs also address the treatment of pediatric MS, progressive MS and the identification and treatment of aggressive forms of the disease. Newer therapies offer improved efficacy, but also have potential safety concerns that must be adequately balanced, notably when treatment sequencing is considered. There are added discussions regarding the management of pregnancy, the future potential of biomarkers and consideration as to when it may be prudent to stop therapy. These TORs are meant to be used and interpreted by all neurologists with a special interest in the management of MS.
This chapter concludes the comparative study which is undertaken in the book, by drawing together the various recommendations which have been made throughout the chapters, relating to the interplay between class actions and government. Whether preparing the path to the stadium, or being involved in the match as a litigant or beneficiary, the relationship between government and class actions is complex, sensitive, and quite fascinating.
This chapter concludes and provides recommendations for the better integration of the judicial and private mechanisms discussed in previous chapters so that they deliver fairer, clearer, more predictable and UNDRIP-compliant outcomes for indigenous communities. National laws must recognise the special vulnerability of land-connected people to development projects and impose a moratorium on land disturbance until a developer has undertaken a preventative conflict assessment. That assessment must take no longer than state divestment of land and must necessitate a mediation process which interfaces with the layers of race, ethnicity, legacy and postcolonial histories that can relate to land. This chapter considers what this process entails (including the requirement for the legal ability of communities to say no at this point) and methods for dealing with the cost and independence of such a process (blind trusts). Aspects of this assessment could, through a code of practice, then feed into project governance much further upstream and tighten existing documentation at the specific points at which indigenous vulnerability to dispossession is high, as detailed. Other suggestions on institutional culture are made.
The 2019 Nutrition Society Spring Conference, which convened in Dundee, focused on the challenges presented by inter-individual differences in the responses to nutrition and in conducting nutritional research. The programme brought together national and international experts to discuss the collective evidence on inter-individual nutritional responses and impacts on health. Speakers and delegates from across the UK, Europe and the USA debated new methods of conducting research in nutrition and discussed the development of appropriate dietary interventions to maintain health and prevent disease in diverse populations. Symposium 1 focused on the effects of ethnicity on nutrient availability and type 2 diabetes and cardio-metabolic disease. Symposium 2 explored sex differences in nutrient availability and health and metabolism. The final symposium examined genetic and phenotypic variation, nutrition and health. The meeting ended with a panel discussion about how we take research to recommendations and concluded with a need to consider inter-individual differences in planning, conducting and analysing nutritional research.
Learning Health Systems (LHS) iteratively implement and evaluate health improvement projects. Dissemination and implementation (D&I) science is the study of evidence-based practices in real-world settings, a critical tool for LHS. This paper explores intersections between LHS and D&I science in Clinical and Translational Science Awards (CTSAs) institutions and identifies critical components of collaboration. We conducted website scans of 34 CTSAs and their home institutions that had Dissemination, Implementation, and Knowledge Translation (DIKT) Workgroup members. We identified linkages between CTSAs and their institutions’ LHS. We interviewed six CTSA leaders experienced in LHS and D&I sciences. Nearly half of CTSAs identified an LHS structure on their websites, but only one-third indicates CTSA involvement in these efforts. Interviewees identified key components for successful integration of LHS and D&I sciences: leadership, infrastructure, balance between rigor and efficiency, and aligned incentives. The need for research integration in LHS, to improve evaluation and increase knowledge, is an emerging opportunity for D&I scientists and CTSAs. CTSAs that are engaged in D&I science can introduce and/or expand the role of D&I science in LHS. Collaboration between CTSAs and clinical leaders could result in strengthened relationships between clinical and research enterprises, effective and efficient health care delivery, and improved health.
The role of meat in the diet has come under scrutiny recently due to an increased public emphasis on providing healthy diets from sustainable food systems and due to health concerns relating to the consumption of red and processed meat. The present review aimed to summarise dietary guidelines relating to meat, actual meat intakes and the contribution of meat to energy and nutrient intakes of children, teenagers and adults in Europe. The available literature has shown that food-based dietary guidelines for most countries recommend consuming lean meat in moderation and many recommend limiting red and processed meat consumption. Mean intakes of total meat in Europe range from 40 to 160 g/d in children and teenagers and from 75 to 233 g/d in adults. Meat contributes to important nutrients such as protein, PUFA, B vitamins, vitamin D and essential minerals such as Fe and Zn; however, processed meat contributes to significant proportions of saturated fat and Na across population groups. While few data are available on diaggregated intakes of red and processed meat, where data are available, mean intakes in adults are higher than the upper limits recommended by the UK Scientific Advisory Committee on Nutrition (70 g/d) and the World Cancer Research Fund (500 g/week). While there are no recommendations for red and processed meat consumption in children and teenagers, intakes currently range from 30 to 76 g/d. The present review provides a comprehensive overview of the role of meat in the European diet which may be of use to stakeholders including researchers, policy makers and the agri-food sector.
Forensic psychiatry in Europe is a specialty primarily concerned with individuals who have either offended or present a risk of doing so, and who also suffer from a psychiatric condition. These mentally disordered offenders (MDOs) are often cared for in secure psychiatric environments or prisons. In this guidance paper we first present an overview of the field of forensic psychiatry from a European perspective. We then present a review of the literature summarising the evidence on the assessment and treatment of MDOs under the following headings: The forensic psychiatrist as expert witness, risk, treatment settings for mentally disordered offenders, and what works for MDOs. We undertook a rapid review of the literature with search terms related to: forensic psychiatry, review articles, randomised controlled trials and best practice. We searched the Medline, Embase, PsycINFO, and Cochrane library databases from 2000 onwards for adult groups only. We scrutinised publications for additional relevant literature, and searched the websites of relevant professional organisations for policies, statements or guidance of interest. We present the findings of the scientific literature as well as recommendations for best practice drawing additionally from the guidance documents identified. We found that the evidence base for forensic-psychiatric practice is weak though there is some evidence to suggest that psychiatric care produces better outcomes than criminal justice detention only. Practitioners need to follow general psychiatric guidance as well as that for offenders, adapted for the complex needs of this patient group, paying particular attention to long-term detention and ethical issues.
This short concluding chapter looks back over the preceding chapters and pulls together some of the interconnecting themes between them, especially in relation to the different ways psychological writers have used examples - for example to illustrate theory or as a means of discovery. The discussion on the various ways of using examples in psychological writing is not presented as the first step towards a psychology of examples which is currently lacking. There are some speculations why the study of examples has been neglected. The chapter finishes with some recommendations, which are directed towards young academics. These recommendations suggest that they should give descriptive examples more weight, and theory less weight.
Key recommendations of the book. Develop a sustainable, nourishing and resilient global food system founded on ecological or regenerative farming, aquaculture, and urban food production. Replan all of the Earth’s cities so that they recycle all their nutrients and water back into food production and fertile soil, have a sustainable, climate-proof local source of food year-round, and are based on permaculture principles. Re-allocate 20 per cent of world military spending to ‘peace through food’. Understand that sustainable food investment is defence spending, can reduce tensions and so prevent many wars from starting in the first place, and avoid vast movements of refugees which may otherwise overwhelm other regions, countries and cultures. Rewild half the planet through a global movement led by small farmers, former farmers and indigenous peoples, known as Stewards of the Earth, to end the Sixth Extinction of life on Earth. Raise a new generation of food-aware children, who understand how to eat healthily and sustainably, through a Year of Food in every junior school on the planet. Put women in charge of business, politics, government, religion and society for the sake of human civilisation and its survival in the century of its greatest peril.
Using quantitative and qualitative research designs, respectively, two studies investigated why countries make different health technology assessment (HTA) drug reimbursement recommendations. Building on these, the objective of this study was to (a) develop a conceptual framework integrating the factors explaining these decisions, (b) explore their relationship and (c) assess if they are congruent, complementary or discrepant. A parallel convergent mixed methods design was used. Countries included in both previous studies were selected (England, Sweden, Scotland and France). A conceptual framework that integrated and organised the factors explaining the decisions from the two studies was developed. Relationships between factors were explored and illustrated through case studies. The framework distinguishes macro-level factors from micro-level ones. Only two of the factors common to both studies were congruent, while two others reached discrepant conclusions (stakeholder input and external review of the evidence processes). The remaining factors identified within one or both studies were complementary. Bringing together these findings contributed to generating a more complete picture of why countries make different HTA recommendations. Results were mostly complementary, explaining and enhancing each other. We conclude that differences often result from a combination of factors, with an important component relating to what occurs during the deliberative process.
To assess total sugar (TS), added sugar (AS) and free sugar (FS) intakes, dietary sources, adherence to recommendations and determinants of consumption, in a Portuguese national sample.
Cross-sectional study. Dietary assessment was obtained by two food diaries in children aged <10 years and two non-consecutive 24 h recalls for other age groups. TS, AS and FS intakes were estimated by using SPADE software. TS content in food was estimated at the ingredient level. AS content in food was assessed through a systematic methodology and FS was based on the WHO definition.
National Food, Nutrition and Physical Activity Survey (IAN-AF 2015–2016), Portugal.
Representative sample from the Portuguese population, aged from 3 months to 84 years (n 5811).
Mean daily intake and contribution to total energy intake (E%) were 84·3 g/d (18·5 E%) for TS, 32·1 g/d (6·8 E%) for AS and 35·3 g/d (7·5 E%) for FS. Of the population, 76 % adhered to the FS recommendation (FS < 10 E%). The lowest adherence was in children (51·6 %) and adolescents (51·3 %). The main dietary source of TS was fruit across all ages, except in adolescents which was soft drinks. In children, the main dietary sources of FS were yoghurts and sweets, soft drinks in adolescents and table sugar in adults/elderly. FS intake was lower in children with more educated parents and in adults who practised physical activity regularly, and higher among smokers.
Interventions ought to be planned towards decreasing intakes of added and free sugars considering population-specific characteristics.
The concluding chapter draws on findings from preceding chapters to return to the original question: What makes warnings about conflicts in foreign countries persuasive? It argues that existing research in conflict prevention has tended to over-count warnings and exaggerate their persuasiveness. Most analytical products dealing with the political situation in foreign countries did not clearly announce themselves as warnings, or their warning content was highly hedged, opaque or hidden within conventional reporting or current intelligence. At the same time, inside-up warnings are influenced by outside-in warnings and the broader information environment created by media and NGOs. Six ‘first order’ factors are most significant to explain the findings as they shape persuasion paths: diagnostic difficulties specific to each case, the level of political equity at stake in a given country, individual capacities and the credibility of inside-up warners, the degree of engagement of a small group of highly capable and credible outside-in warners, the degree of agenda competition and, finally, the role of pre-existing policy biases. The chapter examines what these findings mean for prospective warners, which questions they should ask themselves, and how they can increase the chances of their warnings being listened to and, perhaps, even heeded.
International law prohibits slavery and slavery-like practices under treaties that have been in force for more than a century. Yet, contemporary forms of slavery are one of the prevailing challenges for the international community, with 40.3 million people in modern slavery on any given day in 2016. The State has been largely overlooked as a perpetrator or accomplice in the global movement to eradicate modern slavery. The hand of the State can however be found in contemporary cases of modern slavery. This article identifies five scenarios of State involvement in modern slavery and aims to uncover and bridge the responsibility gap.
Plant-based diets are considered healthier than many omnivorous diets. However, it is unclear that restriction of animal products necessarily motivates increased consumption of nutrient- and fibre-rich plant-based foods as opposed to energy-dense but nutrient-poor plant-based foods containing refined grains and added sugars and fats. The present study examined FFQ and food record data from ninety-nine individuals in the USA with varying degrees of adherence to the Orthodox Christian tradition of restricting meat, dairy and egg (MDE) products for 48 d prior to Easter to investigate whether restricting MDE products in the absence of explicit nutritional guidance would lead to increased consumption of healthy plant-based foods and greater likelihood of meeting dietary recommendations. Multiple linear regression models assessed changes in major food groups, energy and nutrients in relation to the degree of reduction in MDE consumption. Logistic regression analyses tested the odds of meeting 2015–2020 Dietary Guidelines for Americans on plant-based foods in relation to MDE restriction. Each serving reduction in MDE products was associated with small (approximately 0·1–0·7 serving) increases in legumes, soya products and nuts/seeds (all P values < 0·005). MDE restriction was not associated with higher odds of meeting recommendations on vegetable, fruit or whole-grain intake. Consumption of refined grains and added sugars did not change in relation to MDE restriction but remained above recommended thresholds, on average. These findings demonstrate that a reduction of MDE products for spiritual purposes may result in increases in some nutrient-rich plant-based foods but may not uniformly lead to a healthier dietary composition.