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To examine associations between diet and risk of developing gastro-oesophageal reflux disease (GERD).
Prospective cohort with a median follow-up of 15·8 years. Baseline diet was measured using a FFQ. GERD was defined as self-reported current or history of daily heartburn or acid regurgitation beginning at least 2 years after baseline. Sex-specific logistic regressions were performed to estimate OR for GERD associated with diet quality scores and intakes of nutrients, food groups and individual foods and beverages. The effect of substituting saturated fat for monounsaturated or polyunsaturated fat on GERD risk was examined.
A cohort of 20 926 participants (62 % women) aged 40–59 years at recruitment between 1990 and 1994.
For men, total fat intake was associated with increased risk of GERD (OR 1·05 per 5 g/d; 95 % CI 1·01, 1·09; P = 0·016), whereas total carbohydrate (OR 0·89 per 30 g/d; 95 % CI 0·82, 0·98; P = 0·010) and starch intakes (OR 0·84 per 30 g/d; 95 % CI 0·75, 0·94; P = 0·005) were associated with reduced risk. Nutrients were not associated with risk for women. For both sexes, substituting saturated fat for polyunsaturated or monounsaturated fat did not change risk. For both sexes, fish, chicken, cruciferous vegetables and carbonated beverages were associated with increased risk, whereas total fruit and citrus were associated with reduced risk. No association was observed with diet quality scores.
Diet is a possible risk factor for GERD, but food considered as triggers of GERD symptoms might not necessarily contribute to disease development. Potential differential associations for men and women warrant further investigation.
There is a large treatment gap for common mental disorders in rural areas of low-income countries. We tested the Friendship Bench as a brief psychological intervention delivered by village health workers (VHWs) in rural Zimbabwe.
Rural women identified with depression in a previous trial received weekly home-based problem-solving therapy from VHWs for 6 weeks, and joined a peer-support group. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and Shona Symptom Questionnaire (SSQ). Acceptability was explored through in-depth interviews and focus group discussions. The proportion of women with depression pre- and post-intervention was compared using McNemar's test.
Ten VHWs delivered problem-solving therapy to 27 women of mean age 33 years; 25 completed six sessions. Women valued an established and trustful relationship with their VHW, which ensured confidentiality and prevented gossip, and reported finding individual problem-solving therapy beneficial. Peer-support meetings provided space to share problems, solutions and skills. The proportion of women with depression or suicidal ideation on the EPDS declined from 68% to 12% [difference 56% (95% confidence interval (CI) 27.0–85.0); p = 0.001], and the proportion scoring high (>7) on the SSQ declined from 52% to 4% [difference 48% (95% CI 24.4–71.6); p < 0.001] after the 6-week intervention.
VHW-delivered problem-solving therapy and peer-support was acceptable and showed promising results in this pilot evaluation, leading to quantitative and qualitative improvements in mental health among rural Zimbabwean women. Scale-up of the Friendship Bench in rural areas would help close the treatment gap for common mental disorders.
Since the 1950s, historians of the eighteenth- and nineteenth-century Church of England have generally maintained that the Sacramental Test Act (1828), the Roman Catholic Relief Act (1829) and the Reform Act (1832) amounted to a ‘constitutional revolution’, in which Anglican political hegemony was decisively displaced. This theory remains the dominant framework for understanding the effect of legislation on the relationship between church and state in pre-Victorian England. This article probes the validity of the theory. It is argued that the legislative reforms of 1828–32 did not drastically alter the religious composition of parliament, which was already multi-denominational, and that they incorporated clauses which preserved the political dominance of the Church of England. Additionally, it is suggested that Anglican apprehensions concerning the reforming measures of those years were derived from an unfounded belief that these reforms would ultimately result in changes to the Church of England's formularies or in disestablishment, rather than from the actual laws enacted. Accordingly, the post-1832 British parliamentary system did not in the short term militate against Anglican interests. In light of this reappraisal, these legislative reforms may be better understood as an exercise in ‘constitutional adjustment’ as opposed to a ‘constitutional revolution’.
Until the past half-century, all agriculture and land management was framed by local institutions strong in social capital. But neoliberal forms of development came to undermine existing structures, thus reducing sustainability and equity. The past 20 years, though, have seen the deliberate establishment of more than 8 million new social groups across the world. This restructuring and growth of rural social capital within specific territories is leading to increased productivity of agricultural and land management systems, with particular benefits for those previously excluded. Further growth would occur with more national and regional policy support.
The Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) cohort study of the Canadian Consortium on Neurodegeneration in Aging (CCNA) is a national initiative to catalyze research on dementia, set up to support the research agendas of CCNA teams. This cross-country longitudinal cohort of 2310 deeply phenotyped subjects with various forms of dementia and mild memory loss or concerns, along with cognitively intact elderly subjects, will test hypotheses generated by these teams.
The COMPASS-ND protocol, initial grant proposal for funding, fifth semi-annual CCNA Progress Report submitted to the Canadian Institutes of Health Research December 2017, and other documents supplemented by modifications made and lessons learned after implementation were used by the authors to create the description of the study provided here.
The CCNA COMPASS-ND cohort includes participants from across Canada with various cognitive conditions associated with or at risk of neurodegenerative diseases. They will undergo a wide range of experimental, clinical, imaging, and genetic investigation to specifically address the causes, diagnosis, treatment, and prevention of these conditions in the aging population. Data derived from clinical and cognitive assessments, biospecimens, brain imaging, genetics, and brain donations will be used to test hypotheses generated by CCNA research teams and other Canadian researchers. The study is the most comprehensive and ambitious Canadian study of dementia. Initial data posting occurred in 2018, with the full cohort to be accrued by 2020.
Availability of data from the COMPASS-ND study will provide a major stimulus for dementia research in Canada in the coming years.
One of the most important spheres of activity in the early nineteenth-century Church of England was the establishment and support of schools for the poor. The primary agent of such activity was the National Society. Founded in 1811 by clergymen and philanthropists, this organization aimed to maintain Anglicanism as the ‘National Religion’ by instructing as many poor children as possible in church doctrine under clerical supervision. By 1837, almost a million children across England were being educated in Anglican charitable institutions. This remarkable effort has largely been the province of educational historians. Yet it was also a political enterprise. The creation of a national system of education along exclusively Anglican lines represented an assertive intervention in the contemporary debate about the relationship between church and nation-state. Using a wide range of neglected sources, this article discusses how such political concerns were manifested at a local level in National Society schools’ teaching, rituals and use as venues for political activism. It is argued that these aspects of the society's work afforded the church a powerful political platform. This analysis informs our broader understanding of the ways in which churches’ involvement in mass education has sustained religiously inflected conceptions of nationhood.
On a visit to Malta in 1838, Queen Adelaide expressed severe disappointment that the British colony did not possess a purpose-built Anglican place of worship. She determined to fund the building of one at her personal expense and within six years the grandiose neoclassical church of St Paul's, Valletta, was completed. This imposing structure occupied an ambiguous position in a colony where the British government was pledged to maintain Roman Catholicism. St Paul's was ostensibly intended for the existing Anglican population in Malta. However, the church was perceived by both evangelicals and Roman Catholics as a potential instrument of propagating Protestantism. In examining the basis for these perceptions, this article suggests that St Paul's was part of a larger effort, driven by high church clergy connected with the Society for Promoting Christian Knowledge (SPCK), to influence the Maltese towards greater sympathy with the Anglican tradition, while avoiding overt proselytizing. The concomitant establishment of the diocese of Gibraltar in 1842 was, it is argued, key to this enterprise. The analysis advanced here has important implications for our understanding of Anglicanism in an imperial context, the contribution of royal patronage to this process and the conflict between religious and governmental imperatives.
Between 1998 and 2011 we monitored the winter ranging behaviour of eight female Saker Falcons Falco cherrug fitted with satellite-received transmitters. Our tracking revealed that the winter home range area occupied by individual Saker Falcons varied greatly (median = 166 km2, range = 5-18,469 km2). A random forest model showed that Saker Falcons wintering on the Qinghai-Tibetan Plateau preferentially occupied areas with rich grassland (cover > 50%) on high altitude plateaus (4,000–5,000 m asl) with low levels of anthropogenic influence. Plant biomass in rich grasslands can support high winter densities of plateau pikas Ochotona curzoniae, which likely explains the preference exhibited by Saker Falcons for grassland cover > 50%. Factors influencing the abundance and distribution of this ‘keystone’ prey species are likely to have an effect on Saker Falcons and other predatory species. A key element of rangeland management on the Qinghai-Tibetan plateau has been the establishment of extensive protected areas as part of a strategy to balance economic and social development with the requirement of sustainably managing water resources, maintaining rangelands for pastoralists and conserving biological diversity. Wide ranging predatory species, such as the Saker Falcon, can be useful indicators of biodiversity in protected areas and act as ‘sentinels’ for anthropogenic changes that may impact many different taxa.
Gingivostomatitis is a common, painful pediatric presentation, and yet, few studies are available to guide management. We aimed to describe pediatric emergency physicians’ current practice patterns, with respect to analgesic use in children with acute gingivostomatitis, in order to inform future studies.
A national survey was conducted at all 15 national academic pediatric centres.
Electronic surveys were distributed to pediatric emergency physicians using a modified Dillman protocol; non-respondents received paper surveys via post. Data were collected regarding demographic characteristics, clinical behaviour, factors that may influence practice, and future directions.
Response rate was 74% (150/202). Most physicians (72%) preferred the combination of acetaminophen and ibuprofen to either agent alone (ibuprofen 19%, acetaminophen 7%). The preferred second-line analgesics were oral morphine (48%, 72/150) and compounded topical formulas (42%, 64/150). The most commonly cited compounded agent was Benadryl plus Maalox (23%, 35/150). Clinical experience with a medication had the greatest influence on practice pattern, with 52% (78/149) strongly agreeing. The most commonly cited barrier to adequate analgesia was difficulty in the administration of topical or oral medication to children.
As with many other painful conditions, the combination of acetaminophen and ibuprofen was preferred, followed by either agent alone. Oral morphine and topical compounded agents were also frequently prescribed. Regardless of patient age, physicians preferred oral morphine as a second-line agent to treat pain from severe gingivostomatitis. Future research will focus on determining which analgesic and route (oral or topical) is the most effective and best-tolerated choice.
The present study evaluated the extent to which child-care centre menus prepared in advance correspond with food and beverage items served to children. The authors identified centre and staff characteristics that were associated with matches between menus and what was served.
Menus were collected from ninety-five centres in New York City (NYC). Direct observation of foods and beverages served to children were conducted during 524 meal and snack times at these centres between April and June 2010, as part of a larger study designed to determine compliance of child-care centres with city health department regulations for nutrition.
Child-care centres were located in low-income neighbourhoods in NYC.
Overall, 87 % of the foods and beverages listed on the menus or allowed as substitutions were served. Menu items matched with foods and beverages served for all major food groups by >60 %. Sweets and water had lower match percentages (40 and 32 %, respectively), but water was served 68 % of the time when it was not listed on the menu. The staff person making the food and purchasing decisions predicted the match between the planned or substituted items on the menus and the foods and beverages served.
In the present study, child-care centre menus included most foods and beverages served to children. Menus planned in advance have potential to be used to inform parents about which child-care centre to send their child or what foods and beverages their enrolled children will be offered throughout the day.
The present study compared foods and beverages provided to and consumed by children at child-care centres in New York City (NYC) with national nutrition recommendations.
The study used survey, observational and centre record data collected from child-care centres. Food and beverage intakes from two days of observation and amounts of energy and nutrients were estimated using the US National Cancer Institute’s Automated Self-Administered 24 h Recall system.
Meal and snack time at 108 child-care centres in low-income communities in NYC.
Children aged 3–4 years old in classrooms selected by the directors of the participating child-care centres.
Foods and beverages provided to and consumed by children (n 630) met >50 % of the Dietary Reference Intake (DRI) for most nutrients. Intakes of fibre and vitamins D and E were <30 % of the DRI. Foods and beverages provided >50 % of the recommended average daily intake amounts for total grains, fruits and fruit juices, and dairy, but <50 % of the recommended amounts for whole grains, protein foods and vegetables. Intake of oils was below the allowance for energy levels, but foods and beverages with solid fats and added sugars exceeded the limits by 68 %.
Providing more whole grains, vegetables and low-fat dairy and fewer foods with solid fats and added sugars may improve children’s diet quality when at child-care centres. Centre staff may need training, resources and strategies in order to meet the nutrition recommendations.
We report a large number of raptors electrocuted on recently erected electricity distribution lines in the open landscapes of the Mongolian steppe and Qinghai-Tibetan plateau, China. Upland Buzzards Buteo hemilasius and Saker Falcons Falco cherrug, characteristic raptors of these bioregions, were among those found to be electrocuted. Raptor electrocution was a consequence of poorly designed hardware configurations on anchor poles along surveyed lines on the Qinghai-Tibetan Plateau and, additionally, on line poles in the Mongolian steppe. The design flaws were upright pin-insulators on earthed crossarms and the use of jump wires that passed over crossarms via pin insulators on anchor poles. Targeted mitigation of anchor poles could significantly reduce the incidence of electrocution on the lines surveyed on the Qinghai-Tibetan Plateau, whilst all poles on the lines surveyed in the Mongolian steppe require remediation to make them safe for raptors. The Mongolian steppe and the Qinghai-Tibetan Plateau are bioregions that hold the largest breeding and wintering populations of the globally threatened Saker Falcon. The existing and growing network of dangerous electricity distribution lines in these regions may potentially impact the Saker Falcon population, thus we suggest that preventative and/or mitigation measures are implemented.
This volume publishes a selection of the papers first presented during the Society for Post-Medieval Archaeology's conference Engaging the Recent Past in 2010. This introductory paper seeks to situate the other contributions, placing them in the context of wider processes including the rise of Community Archaeology and the development of an explicit political consciousness in archaeology. Concepts of multivocality and memory are discussed, as are the practices of public participation. The paper argues that a more critical stance needs to be taken towards public engagement in archaeology, and this is discussed in relation to concepts of power and social learning. The paper advocates a move beyond limited participation (confined to particular activities, such as participatory site identification and recording, and to the context of particular projects) and it advocates a move towards participatory governance. Here, the archaeological professional is repositioned as a collaborator engaging with others, including relevant public constituencies and the relevant authorities, in the social process of creating knowledge about the past and defining how historic environments and relationships will be protected, managed or transformed in the future.
This volume arises from the Society for Post-Medieval Archaeology conference Engaging the Recent Past: Public, Political Post-Medieval Archaeology (Glasgow, September 2010). The focus of the conference was the contemporary context of post-medieval archaeology: the values, politics and ethics associated with the recent past, and the practices through which we engage with and construct that past. Contributors to the conference considered these issues in relation to the post-medieval and contemporary archaeologies of the U.K., Ireland and a number of other countries, and they promoted positions founded in a variety of philosophical, political and practice traditions.
This paper will demonstrate, through recent fieldwork and political engagements in Bristol, UK, the potential for a new kind of political archaeology, not based around supporting political parties or facilitating community engagement as ends in themselves, but around creating new kinds of knowledge that can be used to influence politics and politicians at the highest levels.
INTRODUCTION: BIG P, SMALL p
The phrase ‘archaeology is a political act’ is oft repeated, but as with any such definitive phrase when used in academia each word of it has multiple meanings. For instance ‘is’. Well, it is not always. Archaeology can be a political act and archaeology sometimes is a political act, but this is not a universal truth. Likewise, the word archaeology can be taken different ways itself. There is academic archaeology, private sector archaeology, public archaeology, uses of archaeology in the heritage industry and so on, all intrinsically connected, but each with nuances different enough to render universality meaningless.
In this paper, I wish to put forward the possibility that contemporary forms of archaeological thought and investigation can play a role in redefining the ways in which politicians engage with ordinary people and everyday situations. Rather than limiting themselves to facilitating community engagement or lobbying politicians in relation to heritage legislation, I will suggest that archaeologists can move towards using their unique perspectives on contemporary and historic environments to change the very way in which the connection between archaeology and politics is conceived, using archaeological investigation to understand the nature of contemporary politics and feeding this back into the wider system of policy making instead of merely working within the confines of existing heritage legislation.
Heritage, memory, community archaeology and the politics of the past form the main strands running through the papers in this volume. The authors tackle these subjects from a range of different philosophical perspectives, with many drawing on the experience of recent community, commercial and other projects. Throughout, there is a strong emphasis on both the philosophy of engagement and with its enactment in specific contexts; the essays deal with an interest in the meaning, value and contested nature of the recent past and in the theory and practice of archaeological engagements with that past.
Chris Dalglish is a lecturer in archaeology at the University of Glasgow. Contributors: Julia Beaumont, David Bowsher, Terry Brown, Jo Buckberry, Chris Dalglish, James Dixon, Audrey Horning, Robert Isherwood, Robert C Janaway, Melanie Johnson, Siân Jones, Catriona Mackie, Janet Montgomery, Harold Mytum, Michael Nevell, Natasha Powers, Biddy Simpson, Matt Town, Andrew Wilson