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A multi-disciplinary expert group met to discuss vitamin D deficiency in the UK and strategies for improving population intakes and status. Changes to UK Government advice since the 1st Rank Forum on Vitamin D (2009) were discussed, including rationale for setting a reference nutrient intake (10 µg/d; 400 IU/d) for adults and children (4+ years). Current UK data show inadequate intakes among all age groups and high prevalence of low vitamin D status among specific groups (e.g. pregnant women and adolescent males/females). Evidence of widespread deficiency within some minority ethnic groups, resulting in nutritional rickets (particularly among Black and South Asian infants), raised particular concern. Latest data indicate that UK population vitamin D intakes and status reamain relatively unchanged since Government recommendations changed in 2016. Vitamin D food fortification was discussed as a potential strategy to increase population intakes. Data from dose–response and dietary modelling studies indicate dairy products, bread, hens’ eggs and some meats as potential fortification vehicles. Vitamin D3 appears more effective than vitamin D2 for raising serum 25-hydroxyvitamin D concentration, which has implications for choice of fortificant. Other considerations for successful fortification strategies include: (i) need for ‘real-world’ cost information for use in modelling work; (ii) supportive food legislation; (iii) improved consumer and health professional understanding of vitamin D’s importance; (iv) clinical consequences of inadequate vitamin D status and (v) consistent communication of Government advice across health/social care professions, and via the food industry. These areas urgently require further research to enable universal improvement in vitamin D intakes and status in the UK population.
Policy decisions and the practice of public health nutrition need to be based on solid evidence, developed through rigorous research studies where objective measures are used and results that run counter to dogma are not dismissed but investigated. In recent years, enhancements in study designs, and methodologies for systematic reviews and meta-analysis, have improved the evidence-base for nutrition policy and practice. However, these still rely on a full appreciation of the strengths and limitations of the measures on which conclusions are drawn and on the thorough investigation of outcomes that do not fit expectations or prevailing convictions. The importance of ‘hard facts’ and ‘misfits’ in research designed to advance knowledge and improve public health nutrition is illustrated in this paper through a selection of studies from different stages in my research career, focused on the nutritional requirements of resource-poor populations in Africa and Asia.
For many people, micronutrient requirement means the amount needed in the diet to ensure adequacy. Dietary reference values (DRV) provide guidance on the daily intake of vitamins and minerals required to ensure the needs of the majority in the population are covered. These are developed on estimates of the quantity of each micronutrient required by the average person, the bioavailability of the micronutrient from a typical diet and the interindividual variability in these amounts. Sex differences are inherent in the requirements for many micronutrients because they are influenced by body size or macronutrient intake. These are reflected in different DRV for males and females for some micronutrients, but not all, either when data from males and females are combined or when there is no evidence of sex differences. Pregnancy and lactation represent times when micronutrient requirements for females may differ from males, and separate DRV are provided. For some micronutrients, no additional requirement is indicated during pregnancy and lactation because of physiological adaptations. To date, little account has been taken of more subtle sex differences in growth and maturation rates, health vulnerabilities and in utero and other programming effects. Over the years, the MRC Nutrition and Bone Health Group has contributed data on micronutrient requirements across the lifecourse, particularly for calcium and vitamin D, and shown that supplementation can have unexpected sex-specific consequences that require further investigation. The present paper outlines the current issues and the need for future research on sex differences in micronutrient requirements.
The El Cañizar de Villarquemado pollen record covers the last part of MIS 6 to the Late Holocene. We use Tolerance-Weighted Averaging Partial Least Squares (TWA-PLS) to reconstruct mean temperature of the coldest month (MTCO) and growing degree days above 0°C (GDD0) and the ratio of annual precipitation to annual potential evapotranspiration (MI), accounting for the ecophysiological effect of changing CO2 on water-use efficiency. Rapid summer warming occurred during the Zeifen-Kattegat Oscillation at the transition to MIS 5. Summers were cold during MIS 4 and MIS 2, but some intervals of MIS 3 had summers as warm as the warmest phases of MIS 5 or the Holocene. Winter temperatures declined from MIS 4 to MIS 2. Changes in temperature seasonality within MIS 5 and MIS 1 are consistent with insolation seasonality changes. Conditions became progressively more humid during MIS 5, and MIS 4 was also humid, although MIS 3 was more arid. Changes in MI and GDD0 are anti-correlated, with increased MI during summer warming intervals. Comparison with other records shows glacial-interglacial changes were not unform across the circum-Mediterranean region, but available quantitative reconstructions are insufficient to determine if east-west differences reflect the circulation-driven precipitation dipole seen in recent decades.
This Position Paper from the Academy of Nutrition Sciences is the first in a series which describe the nature of the scientific evidence and frameworks that underpin nutrition recommendations for health. This first paper focuses on evidence which underpins dietary recommendations for prevention of non-communicable diseases. It considers methodological advances made in nutritional epidemiology and frameworks used by expert groups to support objective, rigorous and transparent translation of the evidence into dietary recommendations. The flexibility of these processes allows updating of recommendations as new evidence becomes available. For CVD and some cancers, the paper has highlighted the long-term consistency of a number of recommendations. The innate challenges in this complex area of science include those relating to dietary assessment, misreporting and the confounding of dietary associations due to changes in exposures over time. A large body of experimental data is available that has the potential to support epidemiological findings, but many of the studies have not been designed to allow their extrapolation to dietary recommendations for humans. Systematic criteria that would allow objective selection of these data based on rigour and relevance to human nutrition would significantly add to the translational value of this area of nutrition science. The Academy makes three recommendations: (i) the development of methodologies and criteria for selection of relevant experimental data, (ii) further development of innovative approaches for measuring human dietary intake and reducing confounding in long-term cohort studies and (iii) retention of national nutrition surveillance programmes needed for extrapolating global research findings to UK populations.
Most techniques for pollen-based quantitative climate reconstruction use modern assemblages as a reference data set. We examine the implication of methodological choices in the selection and treatment of the reference data set for climate reconstructions using Weighted Averaging Partial Least Squares (WA-PLS) regression and records of the last glacial period from Europe. We show that the training data set used is important because it determines the climate space sampled. The range and continuity of sampling along the climate gradient is more important than sampling density. Reconstruction uncertainties are generally reduced when more taxa are included, but combining related taxa that are poorly sampled in the data set to a higher taxonomic level provides more stable reconstructions. Excluding taxa that are climatically insensitive, or systematically overrepresented in fossil pollen assemblages because of known biases in pollen production or transport, makes no significant difference to the reconstructions. However, the exclusion of taxa overrepresented because of preservation issues does produce an improvement. These findings are relevant not only for WA-PLS reconstructions but also for similar approaches using modern assemblage reference data. There is no universal solution to these issues, but we propose a number of checks to evaluate the robustness of pollen-based reconstructions.
Early childhood education and care (ECEC) policies and services in Canada exhibit marked gaps in access, creating ‘childcare deserts’ and distributional disadvantages. Cognate family policies that support children and families, such as parental leave and child benefits, are also underdeveloped. This article examines the current state of ECEC services in Canada and the reasons behind the uncoordinated array of services and policy, namely, a liberal welfare state tradition that historically has encouraged private and market-based care, a comparatively decentralised federal system that militates against coordinated policy-making, and a welfare state built on gendered assumptions about care work. The article assesses recent government initiatives, including the federal 2017 Multilateral Framework on Early Learning and Child Care, concluding that existing federal and provincial initiatives have limited potential to bring about paradigmatic third-order change.
Antonia Potter Prentice, Co-managing partner of Athena, which provides specialist advice, policy analysis and project management on peace and security issues.,
Camille Marquis Bissonnette, Doctoral candidate in International Law at Université Laval, Quebec City, Canada.
To be powerful and influential, one can argue, requires not just representation but presence, and not just presence, but meaningful, empowered presence. In 2016, there were only ten women serving as heads of states and nine serving as heads of government, and women held only 22 % of seats in parliaments around the world. Despite huge effort and promotion, women candidates for the top jobs at the United Nations (UN) and the US Government failed to prevail. Peace processes, in particular, as they “provide key opportunities for major reforms that transform institutions, structures, and relationships in societies affected by conflict or crises,” are instrumental for women's empowerment and for their consideration in the construction of their post-conflict society. According to a study by UN Women based on 31 major peace processes occurring between 1992 and 2011, women represented 2.4 % of chief mediators (although the UN itself has never appointed a woman as chief mediator), 4 % of peace agreement signatories, and 9 % of negotiators in formal peace processes. Most of the time, this low representation of women in peace negotiations is the result of passive – as opposed to deliberate – exclusion, but as some feminist writers have clearly underlined, gender-neutrality often corresponds to gender-blindness. Traditionally, women are very much involved in informal peace negotiations at the grassroots level and within civil society initiatives, and in particular in disarmament processes; this contribution is now widely documented and recognized. But as is well known, women's participation in formal peace negotiations remains very marginal. Moreover, even when women are included, their viewpoints are often sidelined, as they are perceived to lack relevant qualifications, credibility or simply power.
Many hypotheses have been proposed to explain the dramatic underrepresentation of women in formal peace processes, starting with a lack of women in the traditional institutional “pipelines” to mediation and negotiation. For example, women are still a minority within governments and armies, and in the military and political wings of armed groups, and yet the belligerents ‘ representatives are generally perceived to be the most crucial actors in peacemaking – at least in the prevailing concept of peace-making – to the expense of other groups, mostly civil society.
The purpose of the study was to identify self-perceived gaps in gerontological competencies among recreation staff in long-term care homes in Ontario. Two sets of gerontological competencies, in an online survey, were distributed to recreation staff working in 500 long-term care homes. There were 487 recreation staff members who completed the questionnaire. The questionnaire contained questions regarding staff’s current competencies and competencies that they recalled learning prior to entering the workforce. Factors that were perceived to contribute to confidence in gerontological competencies were experience, continuing education, in-service training sessions, and education. Understanding the gaps in gerontological competencies is required for enhancing therapeutic recreation education and continuing education.
In long-term care facilities (LTCF), registered nurses (RNs) perform both clinical and supervisory roles as part of a team aiming to provide high-quality care to residents. The residents have several co-morbidities and complex care needs. Unfortunately, new RNs receive minimal preparation in gerontology and supervisory experience during their program, leading to low retention rates and affecting resident outcomes. This qualitative study explored factors that influence supervisory performance of new RNs in LTCF from the perspective of 24 participants from Ontario, Canada. Data were collected through individual interviews, followed by a directed content analysis. Three levels of influences were identified: personal influences, organizational influences, and external influences. Each level presented with sub-elements, further describing the factors that impact the supervisory performance of the new RN. To retain new RNs in LTC, organizations must provide additional gerontological education and mentoring for new RNs to flourish in their supervisory roles.
Knowledge regarding association of dietary branched-chain amino acid (BCAA) and type 2 diabetes (T2D), and the contribution of BCAA from meat to the risk of T2D are scarce. We evaluated associations between dietary BCAA intake, meat intake, interaction between BCAA and meat intake and risk of T2D. Data analyses were performed for 74 155 participants aged 50−79 years at baseline from the Women’s Health Initiative for up to 15 years of follow-up. We excluded from analysis participants with treated T2D, and factors potentially associated with T2D or missing covariate data. The BCAA and total meat intake was estimated from FFQ. Using Cox proportional hazards models, we assessed the relationship between BCAA intake, meat intake, and T2D, adjusting for confounders. A 20 % increment in total BCAA intake (g/d and %energy) was associated with a 7 % higher risk for T2D (hazard ratio (HR) 1·07; 95 % CI 1·05, 1·09). For total meat intake, a 20 % increment was associated with a 4 % higher risk of T2D (HR 1·04; 95 % CI 1·03, 1·05). The associations between BCAA intake and T2D were attenuated but remained significant after adjustment for total meat intake. These relations did not materially differ with or without adjustment for BMI. Our results suggest that dietary BCAA and meat intake are positively associated with T2D among postmenopausal women. The association of BCAA and diabetes risk was attenuated but remained positive after adjustment for meat intake suggesting that BCAA intake in part but not in full is contributing to the association of meat with T2D risk.
A story titled “The Impressionists” that was published in 1897 should have something to say about art, but does it? The sixth installment in Rudyard Kipling's Stalky & Co. series, “The Impressionists” follows the antics of M'Turk, Stalky, and Beetle, three cunning boys at a dreary English military preparatory school. Suspecting these boys of cheating on their schoolwork, housemaster Mr. Prout turns them out of their private study into the main house dormitory. For revenge, and hoping to win back their room, Stalky & Co. become agents provocateurs. They start a fight in their house and manage to involve the other housemasters’ houses: “Under cover of the confusion the three escaped to the corridor, whence they called in and sent up passers-by to the fray. ‘Rescue, King's! King's! King's! Number Twelve form-room! Rescue, Prout's – Prout's! Rescue, Macrea's! Rescue, Hartopp's!’” (102). The three boys then allow Mr. Prout to overhear a conversation that makes money-lending seem common practice in the houses: “‘Where's that shillin’ you owe me?’ said Beetle suddenly. Stalky could not see Prout behind him, but returned the lead without a quaver. ‘I only owed you ninepence, you old usurer’” (103). Stalky & Co. rile up the other boys by telling ghost stories and spreading slanderous ditties; they turn the house against the prefects and undermine Mr. Prout's authority; and in the end they win back their room, but they are also found out by the headmaster, who mixes corporeal punishment with his admonishments: “There is a limit – one finds it by experience, Beetle – beyond which it is never safe to pursue private vendettas, because – don't move – sooner or later one comes – into collision with the – higher authority, who has studied the animal. Et ego – M'Turk, please – in Arcadia vixi” (117). The boys take the headmaster's attentions as a compliment, and they take his advice. Never again do they stake the school's peace in the pursuit of their own ends.