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To evaluate the impact of a menu box delivery service tailored to the long-day care (LDC) setting on improving menu compliance with recommendations, children’s diet quality and dietary intake while in care.
A cluster randomised controlled trial in LDC centres randomly assigned to an intervention (menu box delivery) or comparison (menu planning training) group. The primary outcome was child food provision and dietary intake. Secondary outcomes include menu compliance and process evaluation, including acceptability, fidelity and menu cost (per child, per day).
South Australian LDC centres.
Eight LDC centres (n 224 children) provided data.
No differences were observed in serves/d between intervention and comparison centres, for provision (intervention, 0·9 inter-quartile range (IQR) 0·7–1·2; comparison, 0·8 IQR 0·5–1·3) or consumption (intervention, 0·5 IQR 0·2–0·8; comparison, 0·5 IQR 0·3–0·9) of vegetables. Child food provision and dietary intake were similar across both groups for all food groups (P < 0·05). At follow-up, all intervention centres met menu planning guidelines for vegetables, whereas only one comparison centre met guidelines. Intervention centre directors found the menu box delivery more acceptable than cooks. Cost of the intervention was AUD$2·34 greater than comparison centres (intervention, AUD$4·62 (95 % CI ($4·58, $4·67)); comparison, AUD$2·28 (95 % CI ($2·27, $2·30)) per child, per day).
Menu compliance can be improved via a menu delivery service, delivering equivalent impacts on child food provision and dietary intake compared with an online training programme. Further exploration of cooks acceptability and cost is essential before scaling up to implementation.
To inform a package of initiatives to increase children’s vegetable intake while in long day care (LDC) by evaluating the independent and combined effects of three initiatives targeting food provision, the mealtime environment and the curriculum.
Using the Multiphase Optimisation Strategy (MOST) framework, a 12-week, eight-condition (n 7 intervention, n 1 control) randomised factorial experiment was conducted. Children’s dietary intake data were measured pre- and post-initiative implementation using the weighed plate waste method (1× meal and 2× between-meal snacks). Vegetable intake (g/d) was calculated from vegetable provision and waste. The optimal combination of initiatives was determined using a linear mixed-effects model comparing between-group vegetable intake at follow-up, while considering initiative fidelity and acceptability.
LDC centres in metropolitan Adelaide, South Australia.
32 centres, 276 staff and 1039 children aged 2–5 years.
There were no statistically significant differences between any of the intervention groups and the control group for vegetable intake (all P > 0·05). The curriculum with mealtime environment group consumed 26·7 g more vegetables/child/day than control (ratio of geometric mean 3·29 (95 % CI 0·96, 11·27), P = 0·06). Completion rates for the curriculum (> 93 %) and mealtime environment (61 %) initiatives were high, and acceptability was good (4/5 would recommend), compared with the food provision initiative (0–50 % completed the menu assessment, 3/5 would recommend).
A programme targeting the curriculum and mealtime environment in LDC may be useful to increase children’s vegetable intake. Determining the effectiveness of this optimised package in a randomised controlled trial is required, as per the evaluation phase of the MOST framework.
Non-communicable diseases (NCD) such as CVD and type 2 diabetes mellitus are major contributors to the burden of disease. NCD are largely driven by modifiable lifestyle factors including poor diet and insufficient physical activity, and consequently, prevention is a public health priority. Although diet and physical activity levels can be improved via lifestyle interventions, long-term adherence to such interventions remains low, which limits their effectiveness. Thus, it is critical to identify the underlying mechanisms that challenge uptake and adherence to such interventions. The current commentary discusses an important, but underexplored, psychological driver of poor adherence to lifestyle interventions, namely, future discounting, which describes the tendency to prefer smaller, short-term rewards over larger, long-term rewards. For example, in the nutrition domain, future discounting refers to valuing the immediate reward of excessive intake of energy-dense, nutrient-poor, discretionary foods high in salt, sugar, and saturated fat, and insufficient intake of low-energy, nutrient-dense, whole foods such as vegetables. Prominent theoretical models propose that excessive future discounting is a major contributor to the development of unhealthy lifestyle behaviours. Furthermore, a vast body of evidence suggests that future discounting plays a key role in risk of NCD. Thus, the evidence to date supports the idea that future discounting is an important multi-behaviour target for supporting lifestyle behaviour change; however, this approach has been largely neglected in preventive health efforts. Furthermore, this commentary discusses promising techniques (e.g. Episodic Future Thinking) for disrupting future discounting to promote improved adherence to lifestyle interventions aimed at reducing NCD risk.
To prioritise and refine a set of evidence-informed statements into advice messages to promote vegetable liking in early childhood, and to determine applicability for dissemination of advice to relevant audiences.
A nominal group technique (NGT) workshop and a Delphi survey were conducted to prioritise and achieve consensus (≥70 % agreement) on thirty evidence-informed maternal (perinatal and lactation stage), infant (complementary feeding stage) and early years (family diet stage) vegetable-related advice messages. Messages were validated via triangulation analysis against the strength of evidence from an Umbrella review of strategies to increase children’s vegetable liking, and gaps in advice from a Desktop review of vegetable feeding advice.
A purposeful sample of key stakeholders (NGT workshop, n 8 experts; Delphi survey, n 23 end users).
Participant consensus identified the most highly ranked priority messages associated with the strategies of: ‘in-utero exposure’ (perinatal and lactation, n 56 points) and ‘vegetable variety’ (complementary feeding, n 97 points; family diet, n 139 points). Triangulation revealed two strategies (‘repeated exposure’ and ‘variety’) and their associated advice messages suitable for policy and practice, twelve for research and four for food industry.
Supported by national and state feeding guideline documents and resources, the advice messages relating to ‘repeated exposure’ and ‘variety’ to increase vegetable liking can be communicated to families and caregivers by healthcare practitioners. The food industry provides a vehicle for advice promotion and product development. Further research, where stronger evidence is needed, could further inform strategies for policy and practice, and food industry application.
Consumption is driven by children’s sensory acceptance, but little is known about the sensory characteristics of vegetables that children commonly eat. A greater understanding could help design more effective interventions to help raise intakes, thus realising beneficial health effects. This study sought to: (1) Understand the vegetable consumption patterns in children, with and without potatoes, using the Australian and WHO definitions. (2) Describe the sensory characteristics of vegetables consumed by children by age group, level of intake and variety. (3) Determine the vegetable preferences of children, by age group, level of intake and variety.
Analysis of National Nutrition Survey data, combining reported vegetable intake with sensory characteristics described by a trained panel.
A nationally representative sample of Australian children and adolescents aged 2–17·9 years (n 2812).
While consumption increased in older age groups, variety remained constant. Greater variety, however, was associated with higher vegetable consumption. Potato intake increased with consumption, contributing over one-third of total vegetable intake for highest vegetable consumption and for older age groups. Children favoured relatively sweet vegetables and reported lower consumption of bitter vegetables. There were no differences in the sensory properties of vegetables consumed by children in different age groups. After potatoes, carrots, sweetcorn, mixtures, fruiting and cruciferous types were preferred vegetables.
Children tend to prefer vegetables with sensory characteristics consistent with innate taste preferences (sweet and low bitterness). Increasing exposure to a variety of vegetables may help increase the persistently low vegetable consumption patterns of children.
Recent evidence suggests that exercise plays a role in cognition and that the posterior cingulate cortex (PCC) can be divided into dorsal and ventral subregions based on distinct connectivity patterns.
To examine the effect of physical activity and division of the PCC on brain functional connectivity measures in subjective memory complainers (SMC) carrying the epsilon 4 allele of apolipoprotein E (APOE 4) allele.
Participants were 22 SMC carrying the APOE ɛ4 allele (ɛ4+; mean age 72.18 years) and 58 SMC non-carriers (ɛ4–; mean age 72.79 years). Connectivity of four dorsal and ventral seeds was examined. Relationships between PCC connectivity and physical activity measures were explored.
ɛ4+ individuals showed increased connectivity between the dorsal PCC and dorsolateral prefrontal cortex, and the ventral PCC and supplementary motor area (SMA). Greater levels of physical activity correlated with the magnitude of ventral PCC–SMA connectivity.
The results provide the first evidence that ɛ4+ individuals at increased risk of cognitive decline show distinct alterations in dorsal and ventral PCC functional connectivity.
To investigate the relative importance of specific health knowledge and taste on acceptance of Brassica vegetables (broccoli, red and green cabbages, broccolini, cauliflower, Brussels sprouts).
In a sample of adults all reporting medium–high physical activity (as a marker/control of health behaviour) and reporting either low (≤2 portions/d) or high (≥3 portions/d) vegetable intake, half of those with low vegetable consumption (Li group) and half of those with high vegetable consumption (Hi group) received cancer protection information, while the other half did not (Ln and Hn groups), before hedonic (9-point), perceived taste and flavour impact responses (100 mm scales) to samples of six Brassica vegetables were elicited. Additionally, attitudes towards foods for health, pleasure and reward, sociodemographics, intentions to consume the vegetables in the near future and recall of health information were also measured.
Adult males and females (n 200) aged 18–55 years.
Central location testing, Adelaide, Australia.
Information groups Li and Hi reported specific cancer protection information knowledge, in contrast to Ln and Hn groups (P < 0·000). Information independently influenced responses to (the least liked) Brussels sprouts only. Multivariate regression analysis found sensory perception tended to predict liking and intentions to consume Brassica vegetables. For example, broccoli hedonics (adjusted R2 = 0·37) were predicted (P < 0·05) by bitterness (β = −0·38), flavour (β = 0·31), sweetness (β = 0·17) and female gender (β = 0·19) and intentions to consume (adjusted R2 = 0·20) were predicted (P < 0·05) by bitterness (β = −0·38), flavour (β = 0·24), female gender (β = 0·20) and vegetable intake (β = 0·14).
Addressing taste dimensions (while retaining healthy compounds) may be more important than promoting health information in order to increase the popularity of Brassica vegetables.
The mid-infrared wavelength region offers a plethora of possible applications ranging from sensing, medical diagnostics and free space communications, to thermal imaging and IR countermeasures. Hence group IV mid-infrared photonics is attracting more research interest lately. Sensing is an especially attractive area as fundamental vibrations of many important gases are found in the 3 to 14 μm spectral region. To realise group IV photonic mid-infrared sensors several serious challenges need to be overcome. The first challenge is to find suitable material platforms for the mid-infrared. In this paper we present experimental results for passive mid-infrared photonic devices realised in silicon-on-insulator (SOI), silicon-on-sapphire (SOS), and silicon on porous silicon (SiPSi). Although silicon dioxide is lossy in most parts of the mid-infrared, we have shown that it has potential to be used in the 3-4 μm region. We have characterized SOI waveguides with < 1 dB/cm propagation loss. We have also designed and fabricated SOI passive devices such as MMIs and ring resonators. For longer wavelengths SOS or SiPSi structures could be used. An important active device for long wavelength group IV photonics will be an optical modulator. We present relationships for the free-carrier induced electro-refraction and electro-absorption in silicon in the mid-infrared wavelength range. Electro-absorption modulation is calculated from impurity-doping spectra taken from the literature, and a Kramers-Kronig analysis of these spectra is used to predict electro-refraction modulation. We have examined the wavelength dependence of electro-refraction and electro-absorption, and found that the predictions suggest longer-wave modulator designs will in many cases be different than those used in the telecom range.
To examine whether parents offering a sticker reward to their child to taste a vegetable the child does not currently consume is associated with improvements in children's liking and consumption of the vegetable.
A randomized controlled trial evaluated the effectiveness of exposure only (EO) and exposure plus reward (E + R), relative to a control group, on children's liking and consumption of a target vegetable. Assessments were conducted at baseline and 2 weeks from baseline (post-intervention). Follow-up assessments were conducted at 4 weeks and 3 months from baseline.
The study took place in Adelaide, South Australia. Participants were self-selected in response to local media advertisements seeking to recruit parents finding it difficult to get their children to eat vegetables.
Participants were 185 children (110 boys, seventy-five girls) aged 4–6 years and their primary caregiver/parent (172 mothers, thirteen fathers).
The E + R group was able to achieve more days of taste exposure. Both EO and E + R increased liking at post-intervention compared with control and no further change occurred over the follow-up period. All groups increased their intake of the target vegetable at post-intervention. Target vegetable consumption continued to increase significantly over the follow-up period for E + R and control but not for EO.
The findings provide support for the effectiveness of using a sticker reward with a repeated exposure strategy. In particular, such rewards can facilitate the actual tastings necessary to change liking.
The present study aimed to define the complexity of the relationships between the family environment, health behaviours and obesity. A conceptual model that quantifies the relationships and interactions between parent factors, family environment, and certain aspects of children's behaviour and weight status is presented.
Exploratory structural equation modelling was used to quantitatively model the relationships between parent, child and family environmental factors.
Adelaide, South Australia.
Families (n 157) with children aged 5–10 years completed self-reported questionnaires, providing data on parents’ knowledge, diet quality and activity habits; child feeding and general parenting styles; and the food and physical activity environments. Outcome variables included children's fruit and vegetable intake, activity and sedentary habits and weight status.
The proposed model was an acceptable fit (normed fit index = 0·457; comparative fit index = 0·746; root-mean-squared error associated = 0·044). Parents’ BMI (β = 0·32) and nutrition and physical activity knowledge (β = 0·17) had the strongest direct associations with children's BMI Z-score. Parents’ dietary intake and energy expenditure behaviours were indirectly associated with children's behaviour through the creation of the home environment. The physical activity and food environments were associated with children's sedentary (β = −0·44) and activity habits (β = 0·29), and fruit and vegetable intake (β = 0·47), respectively.
A conceptual model that quantifies the complex network of family environment factors influencing children's behaviour and weight status is presented. The model provides a basis for future research on larger representative samples with a view to guiding obesity prevention interventions.
To assess attitudes, predictors of intention, and identify perceived barriers to increasing fruit and vegetable (F&V) intakes.
UK nationwide postal survey utilizing the theory of planned behaviour.
Stratified (by social class and region) random sample of 2020 UK adults providing a modest response rate of 37% (n = 741).
Belief measures (e.g. health, cost, taste, etc.) were strongly associated with overall attitudes which were reported as being largely favourable towards fruit, vegetables and, to a lesser extent, vegetable dishes, and were strongly associated with reported intention to increase consumption. Subjects reported they could increase their consumption, but this was only weakly associated with intention to do so. Approximately 50% of respondents reported an intention to increase intakes. Social pressure was strongly associated with reported intention to increase; however, scores indicated low perceived social pressure to change. Evidence of unrealistic optimism concerning perceived intakes and the perceived high cost of fruit may also act as barriers.
Results from this study suggest a lack of perceived social pressure to increase F&V intakes and suggests that public health efforts require stronger and broader health messages that incorporate consumer awareness of low present consumption.
This study reports results from a randomized controlled intervention trial, focusing on: (1) the identification of successful consumer strategies for increasing fruit and vegetable intakes to the recommended levels of more than five (80 g) portions per day and (2) impact on overall diet and nutrient intakes. Adult men and women (n 170) fulfilling the main recruitment criterion of eating less than five fruit and vegetable portions per day but contemplating increasing intakes were recruited. Complete valid dietary data was provided by 101 intervention (fifty-nine estimated fruit and vegetable intakes, and forty-two simultaneous weighed total dietary and estimated fruit and vegetable intakes) and twenty-four control subjects (weighed total dietary intakes). Intervention advice included the specific association of high fruit and vegetable intake with reduced risk of disease, practicalities, and portion definition with a target intake of greater than five 80 g fruit and vegetable portions per day for 8 weeks. There were significant effects (P < 0·001) on weighed intakes of fruit and vegetables in the intervention group, rising from 324 (se 25) to 557 (se 31) g/d and reflected by validated portion measures at 8 weeks intervention. Successful strategies chosen by ‘achievers’ of the target intake (65% of subjects) were conventional (fruit as a snack, vegetables with main meals etc.) and favoured fruit. There were significant increases in percentage energy from carbohydrate (from sugars not starch), vitamin C, carotenes and NSP and there was a significant decrease in percentage energy from fat for subjects who had high fat intakes (> 35% energy) at baseline. Follow-up self-reported measures at 6 and 12 months indicated mean intakes of 4·5 and 4·6 defined portions/d respectively, suggesting some sustainable effect. In conclusion, the intervention led to significant increases in fruit and vegetable intakes largely via conventional eating habits, with some desirable effects on macro- and micronutrient intakes.
To assess the response of low consumers of fruit and vegetables to a nutrition education intervention programme, data were collected from 104 adults on attitudinal variables related to ‘eating more fruit, vegetables and vegetable dishes’. Questionnaires (based on the theory of planned behaviour) assessing perceived barriers to increasing fruit and vegetable consumption were administered before an action-orientated intervention programme and at the end of the intervention period (8 weeks). Questionnaire scores for belief-evaluations in the intervention groups pre- and post-study indicated that support of family and friends, food costs, time constraints and shopping practicalities (in order to increase intake of fruit, vegetable and vegetable dishes) were barriers to greater consumption of these foodstuffs. Perceived situational barriers to increasing intakes of fruits and vegetables were: limited availability of vegetables, salads and fruit at work canteens, take-aways, friends' houses and at work generally. Following the intervention the number of visits to the shops was perceived as a greater barrier for increasing intakes of fruit and vegetables. Perceived practical opportunities for increasing intakes highlighted drinking fruit juice, taking fruit as a dessert, having fruit as a between-meal snack and eating two portions of vegetables with a meal. About two-thirds of intervention subjects achieved the recommended fruit and vegetable target, but it is concluded that practical issues and situational barriers need to be addressed for the success of future public health campaigns.
Primiparae were randomly assigned to two conditions of routine ultrasound examination at their first antenatal clinic visit: (a) high feedback ultrasound where the monitor screen was visible and the patient was shown the foetal size, shape and movement (N = 67); (b) low feedback ultrasound where the screen was not seen and specific verbal feedback was denied (N = 62). Women were interviewed at 16 weeks gestation. Those receiving high feedback were more likely to report that they had acted on health advice given at the first antenatal visit to reduce their smoking and drinking.
With specially computed detailed tables of equations of state and opacities, the instability strips for δ Scuti stars and Cepheids of population I and RR Lyrae and W Virginis stars of population II have been compared using the linear pulsation theory. Uncertainties in the observed strip locations and sometimes the mode of the observed pulsations do not allow high accuracy in fixing helium contents or the variables masses. Nevertheless, if masses close to those given by evolutionary theory are used, the helium content in population II objects is likely less than Y = 0.25. A helium content of close to zero would put the theoretical blue edge of the instability strip to the red of the observed red edge, and have all the hotter stars which are in the strip as non-pulsating. For population I, Y can be more than 0.3, (more than 0.4 if half evolutionary masses are used), but if a given star has Y less than about 0.2 (full mass) or 0.25 (half mass), it can appear in the dwarf and classical Cepheid strips as non-pulsating.
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