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To examine demographic and dietary correlates of consumption of a variety of fruits and vegetables (FV) among Texas adolescents. Different types of FV are needed for adequate dietary intake of vitamins and phytochemicals for proper development and functioning throughout the lifespan.
Cross-sectional analysis from the Texas Surveillance of Physical Activity and Nutrition (Texas SPAN) data comparing consumption of a variety of fruit and vegetables by gender, race/ethnicity, and region (Texas-Mexico border/non-border).
Middle, high schools in Texas
8th, 11th grade Texas adolescents (n=9,056 representing N=659,288) mean age 14.8 years.
Within this sample, mean fruit and vegetable variety scores (0-7) ranged from 2.47-2.65. Boys consumed a significantly greater variety of fruit than girls (m=1.12 compared to 1.04). Adolescents in non-border regions consumed a greater variety of vegetables and FV compared to those in border regions. FV variety was associated with healthier eating in the full sample, particularly in the highest Socioeconomic Status (SES) tertile. Within the highest SES tertile, a one-unit increase in variety of fruit, vegetable, and FV was associated with significant increases (p<0.001) in a healthy eating measure, the SPAN Healthy Eating Index: Fruit variety (β=1.33, SE=.29), Vegetable variety (β=0.90, SE=0.28), and FV Variety (β=.81, SE=0.19).
Consumption of a greater variety of FV appears to be associated with a healthier overall diet. Associations of FV variety with healthy eating were most significant in the highest SES tertile. These findings support the need to further examine consuming a variety of FV within healthy eating behavior.
Aggression and violent incidents are a major concern in psychiatric in-patient care. Nutritional supplementation has been found to reduce aggressive incidents and rule violations in forensic populations and children with behavioural problems.
To assess whether multivitamin, mineral and n-3 polyunsaturated fatty acid supplementation would reduce the number of aggressive incidents among long-stay psychiatric in-patients.
The trial was a pragmatic, multicentre, randomised, double-blind placebo-controlled study. Data were collected from 25 July 2016 to 29 October 2019, at eight local sites for mental healthcare in The Netherlands and Belgium. Participants were randomised (1:1) to receive 6-month treatment with either three supplements containing multivitamins, minerals and n-3 polyunsaturated fatty acid, or placebo. The primary outcome was the number of aggressive incidents, determined by the Staff Observation Aggression Scale – Revised (SOAS-R). Secondary outcomes were patient quality of life, affective symptoms and adverse events.
In total, 176 participants were randomised (supplements, n = 87; placebo, n = 89). Participants were on average 49.3 years old (s.d. 14.5) and 64.2% were male. Most patients had a psychotic disorder (60.8%). The primary outcome of SOAS-R incidents was similar in supplement (1.03 incidents per month, 95% CI 0.74–1.37) and placebo groups (0.90 incidents per month, 95% CI 0.65–1.19), with a rate ratio of 1.08 (95% CI 0.67–1.74, P = 0.75). Differential effects were not found in sensitivity analyses on the SOAS-R or on secondary outcomes.
Six months of nutritional supplementation did not reduce aggressive incidents among long-stay psychiatric in-patients.
We developed an implementation plan to integrate diagnostic testing for coronavirus disease 2019 (COVID-19) into a public school system. Implementation barriers were identified and strategies were mapped to overcome them.
A COVID-19 diagnostic testing program leveraging a public–private partnership was developed for a public school system.
A suburban school district and a local hospital during the 2020–2021 academic year.
Using Consolidated Framework for Implementation Research (CFIR) constructs and evidenced-based implementation strategies, the program was designed as a “closed system” and was adapted based on stakeholder feedback. Implementation barriers and facilitators were identified and mapped to CFIR constructs to provide insights into factors influencing program adoption.
Preimplementation stages of engagement, feasibility, and readiness planning were completed. The program did not progress to implementation due to multiple factors, including changes in school leadership (inner setting and process-level constructs), improved access to outside testing, and lack of an existing paradigm for in-school testing (external constructs). Limited support from key stakeholders and opinion leaders was also a barrier (process-level construct).
Although this locally initiated program did not progress beyond the preimplementation stage, the processes developed and barriers identified may be useful to inform planning efforts in other testing programs within public school systems. Future programs may consider incorporating multiplex diagnostic testing for influenza in addition to COVID-19. With relaxation of infection control measures, the prevalence of other respiratory viruses will increase. Actionable results will be needed to inform decisions about closures and quarantines.
This essay explores the views of Neoplatonic commentators (e.g. Proclus and the anonymous Prolegomena to Platonic Philosophy) on the relation between Plato’s ethical philosophy and the literary format of the Platonic dialogue. It focuses in particular on the role of visualisation in the process of moral education. The Neoplatonists praise Plato’s dialogues for their 'vividness' (enargeia). They hold that the vivid depiction of good characters (e.g. Socrates) promotes imitation of similar manners, whereas the equally vivid depiction of bad characters (e.g. the ambitious Alcibiades) invites critical self-examination. The Neoplatonists develop their view in part in response to the Stoics, who had argued that moral education should be restricted to the teaching of bare moral rules. The difference between the Stoic and Platonic view on the importance of literature in moral education can be explained from their differing views on the constitution of the human soul. Whereas (most) Stoics hold that the entire soul is rational, the Platonic tradition acknowledges the non-rational aspect of the human soul and holds that moral education should address both the rational and non-rational. Modern psychological research corroborates the Platonic position on the human soul and the need for (literary) examples in moral education.
The purpose of the current study was to examine the validity of an FFQ utilised in the Food Retail: Evaluating Strategies for a Healthy Austin (FRESH Austin) study, designed to evaluate changes in the consumption of fruits and vegetables (FV) in diverse low-income communities in Austin, TX.
The FRESH Austin FFQ was validated against three 24-h dietary recalls (24hDR). All dietary assessments were administered (in-person or by telephone) by trained investigators.
Recruitment was conducted at sites within the geographic areas targeted in the FRESH Austin recruitment. People at a community health clinic, a local health centre and a YMCA within the intervention area were approached by trained and certified data collectors, and invited to participate.
Among fifty-six participants, 83 % were female, 46 % were non-White, 24 % had income < $25 K/year and 30 % spoke only/mostly Spanish at home.
The FFQ and average of three 24hDR produce similar estimates of average total servings/d across FV (6·68 and 6·40 servings/d, respectively). Correlations produced measures from 0·01 for ‘Potatoes’ and 0·59 for ‘Other Vegetables’. Mean absolute percentage errors values were small for all FV, suggesting the variance of the error estimates was also small. Bland–Altman plots indicate acceptable levels of agreement between the two methods.
These outcomes indicate that the FRESH FFQ is a valid instrument for assessing FV consumption. The validation of the FRESH Austin FFQ provides important insights for evaluating community-based efforts to increase FV consumption in diverse populations.
Arctic mining has a bad reputation because the extractive industry is often responsible for a suite of environmental problems. Yet, few studies explore the gap between untouched tundra and messy megaproject from a historical perspective. Our paper focuses on Advent City as a case study of the emergence of coal mining in Svalbard (Norway) coupled with the onset of mining-related environmental change. After short but intensive human activity (1904–1908), the ecosystem had a century to respond, and we observe a lasting impact on the flora in particular. With interdisciplinary contributions from historical archaeology, archaeozoology, archaeobotany and botany, supplemented by stable isotope analysis, we examine 1) which human activities initially asserted pressure on the Arctic environment, 2) whether the miners at Advent City were “eco-conscious,” for example whether they showed concern for the environment and 3) how the local ecosystem reacted after mine closure and site abandonment. Among the remains of typical mining infrastructure, we prioritised localities that revealed the subtleties of long-term anthropogenic impact. Significant pressure resulted from landscape modifications, the import of non-native animals and plants, hunting and fowling, and the indiscriminate disposal of waste material. Where it was possible to identify individual inhabitants, these shared an economic attitude of waste not, want not, but they did not hold the environment in high regard. Ground clearances, animal dung and waste dumps continue to have an effect after a hundred years. The anthropogenic interference with the fell field led to habitat creation, especially for vascular plants. The vegetation cover and biodiversity were high, but we recorded no exotic or threatened plant species. Impacted localities generally showed a reduction of the natural patchiness of plant communities, and highly eutrophic conditions were unsuitable for liverworts and lichens. Supplementary isotopic analysis of animal bones added data to the marine reservoir offset in Svalbard underlining the far-reaching potential of our multi-proxy approach. We conclude that although damaging human–environment interactions formerly took place at Advent City, these were limited and primarily left the visual impact of the ruins. The fell field is such a dynamic area that the subtle anthropogenic effects on the local tundra may soon be lost. The fauna and flora may not recover to what they were before the miners arrived, but they will continue to respond to new post-industrial circumstances.
Maternal psychopathology during pregnancy is associated with negative outcomes in offspring. Increased placental transfer of maternal cortisol may contribute to mediate this association. Hair cortisol concentrations (HCCs) appear to be a good biomarker of long-term prenatal stress exposure. Little is known about the associations between severe maternal psychopathology and perinatal infant HCCs.
We assessed HCCs in the perinatal period in mother–infant dyads with and without severe psychiatric disorders.
We examined group differences in HCCs of mother–infant dyads (n = 18) subjected to severe maternal psychiatric disorders versus healthy control dyads (n = 27). We assessed the correlation of HCCs between mother and infant within both groups, and the association between current maternal symptoms and HCCs in patient dyads.
Median (interquartile range) and distribution of HCC differed in patients compared with control mothers (U = 468.5, P = 0.03). HCCs in infants of patients did not differ from control infants (U = 250.0, P = 0.67). Subsequently, we found that HCCs within healthy control dyads were correlated (n = 27, r 0.55 (0.14), P = 0.003), but were not within patient dyads (n = 18, r 0.082 (0.13), P = 0.746). HCCs in infants of patients showed a positive correlation with maternal symptoms (n = 16, r = 0.63 (0.06), P = 0.008).
These preliminary findings suggest that infant HCC reflect perinatal stress exposure. In infants, these early differences could influence lifetime hypothalamic–pituitary–adrenal axis functioning, which might be associated with increased susceptibility to later disease.
Behavioral and psychological symptoms of dementia (BPSD) are very prevalent among individuals with dementia living in residential aged care. The development and implementation of new non-pharmacological interventions to reduce BPSD requires knowledge on the current perception and clinical practice of the care staff. We analyzed clinical care notes to examine the way residential aged care staff reported and managed BPSD in their daily clinical practice.
We examined semi-structured care notes relating to the presentation and management of behaviors of 76 older residents (67% female; aged 67-101; 75% with formal dementia diagnosis) prior to participating in the Australian BPSDPLUS Program. As part of standard clinical practice in three residential aged care facilities, staff document the presentation and management of behaviors amongst residents. Using an inductive thematic analytical approach, we analyzed the reported data in the one and a half months prior to commencing participation in the BPSDPLUS Program. Care notes were coded and analyzed by two independent assessors and they discussed themes until consensus was reached.
A total of 465 behavior charts were completed in the one and a half months prior to the commencement of the BPSDPLUS Program. The number of behavioral charts varied widely across residents (Mean=7.3, range 0–93). Behaviors such as refusal of care, repetitive verbal behaviors, and wandering were most often mentioned, while apathy and affective and psychotic symptoms were seldomly reported. When confronted with BPSD, the clinical care notes indicated that care staff tend to respond in a reactive manner by reassuring, redirecting, or distracting the resident. Furthermore, it seems that staff did not routinely investigate potential underlying causes of the BPSD.
These results suggest that the residential care staff primarily detected and responded to externalizing behaviors, while more internalizing behaviors were not reported. Potential underrecognition of internalizing behaviors, as well as the fact that the staff did not routinely examine causes of BPSD are vital observations for the development and implementation of nonpharmacological interventions and care programs targeting BPSD in residential aged care.
Behavioral and psychological symptoms in dementia (BPSD) have great impact on the daily lives of Alzheimer’s disease (AD) patients and their caregivers. Timely recognition and treatment of these symptoms may benefit quality of life, caregiver burden, and delay disease progression. In this qualitative study we examine the experiences of memory clinic physicians with the recognition and management of BPSD in early stages of AD.
Semi-structured interviews were held with 8 physicians (5 neurologists, 3 geriatricians) employed at memory clinics of academic or general hospitals in the Netherlands. Two independent researchers coded verbatim transcripts of the interviews, followed by a consensus meeting on preliminary themes. In the upcoming months, additional interviews will be conducted until data saturation is reached.
Preliminary results indicate substantial variability in how memory clinic physicians recognize and diagnose BPSD in AD. Themes are: 1. Prevalence of BPSD in early stages of AD; e.g. ‘BPSD is more often present in late stages of AD […]’ vs. ‘I see this often, very often, I think these are the main problems people with AD face’). 2. Systematic assessment; some physicians consider it part of their clinical work-up to assess behavioral changes while other physicians do not touch upon BPSD. 3. Barriers for assessment; e.g. a lack of time, and not being able to observe BPSD occurring at home in a memory clinic setting. Treatment and management of BPSD in AD also differed greatly. Themes are 1. Treatment type; Two physicians discussed using a person-centered non-pharmacological approach, others refer patients with BPSD to daycare, a case manager or psychiatrist, or treat ‘problematic’ behaviors with psychotropic drugs. 2. Capabilities; some physicians experience managing BPSD in AD as very difficult, while others are confident about their capabilities. The majority suggests that collaboration with GPs or case managers may benefit treating these complex symptoms.
There are remarkable differences in the recognition and management of BPSD in patients with AD visiting memory clinics in the Netherlands. Considering the potential benefit of early recognition and treatment, a first crucial step is discussing standardization of recognition and management of BPSD in memory clinics.
Most studies on improving hand hygiene compliance (HHC) focus on clinical wards. The 5 Moments of Hand Hygiene, as stated by the WHO, are less easy to identify in an outpatient setting or procedure rooms. Therefore, observing compliance of these moments in an outpatient clinic or among healthcare workers (HCWs) in the operating room (OR), is far more difficult. Nonetheless, proper hand hygiene in the OR is of utmost importance to prevent postoperative wound infection. Objective: We developed and implement a scoring instrument with simplified moments of hand hygiene for nonsterile HCWs in the OR. Methods: All 13 hospitals of the Antibiotic Resistance Network Southwest Netherlands were asked to submit their guidelines on hand hygiene in the OR. These guidelines were, after discussion, combined into 1 guideline, describing different hand hygiene areas for different groups of nonsterile HCWs in the OR. After asking for feedback and incorporating these adjustments, the guideline was converted into a policy document. Based on this document, a paper scoring instrument was developed to observe HHC in the OR in a uniform way across all hospitals. The Erasmus University Medical Center Rotterdam, the Netherlands (Erasmus MC) acted as a pilot hospital where the implementation of the scoring instrument was studied. Results: The policy document has been approved by the infection committees of all 13 hospitals. The preliminary data of the pilot in the Erasmus MC, although still ongoing, are as follows. Hand hygiene in the OR was observed at 4 different time points. The anesthetist was observed once during 4 procedures in 3 different ORs. At the other 3 time points, the OR assistants (ie, OR nurses and circulating nurses) were observed during 4 procedures in 4 different ORs. Hand hygiene moments were easy to identify; the paper scoring instrument could be used to record observations of HHC in the OR. Conclusions: The guideline with the simplified moments of hand hygiene for nonsterile HCWs in the OR has been successfully implemented. The pilot test in the Erasmus MC already showed that, after defining the hand hygiene moments in the OR, the HHC in the OR is easier to observe and record using the scoring instrument. Moreover, the instrument has provided clarity for HCWs regarding the moments ate which they should disinfect their hands.
Neurodegenerative diseases (NDDs), such as Alzheimer’s disease, frontotemporal dementia, dementia with Lewy bodies, and Huntington’s disease, inevitably lead to impairments in higher-order cognitive functions, including the perception of emotional cues and decision-making behavior. Such impairments are likely to cause risky daily life behavior, for instance, in traffic. Impaired recognition of emotional expressions, such as fear, is considered a marker of impaired experience of emotions. Lower fear experience can, in turn, be related to risk-taking behavior. The aim of our study was to investigate whether impaired emotion recognition in patients with NDD is indeed related to unsafe decision-making in risky everyday life situations, which has not been investigated yet.
Fifty-one patients with an NDD were included. Emotion recognition was measured with the Facial Expressions of Emotions: Stimuli and Test (FEEST). Risk-taking behavior was measured with driving simulator scenarios and the Action Selection Test (AST). Data from matched healthy controls were used: FEEST (n = 182), AST (n = 36), and driving simulator (n = 18).
Compared to healthy controls, patients showed significantly worse emotion recognition, particularly of anger, disgust, fear, and sadness. Furthermore, patients took significantly more risks in the driving simulator rides and the AST. Only poor recognition of fear was related to a higher amount of risky decisions in situations involving a direct danger.
To determine whether patients with an NDD are still fit to drive, it is crucial to assess their ability to make safe decisions. Measuring emotion recognition may be a valuable contribution to this judgment.
Comorbidity has profound implications in both the clinical field and research, yet little is known about the prevalence and structure of comorbid mental disorders. This article aims not only to present data on the prevalence of mental disorders and comorbidity, but also to explore relationships between comorbid mental disorders by using a network approach.
Data used in this cross-sectional study are part of a prospective cohort study within penitentiary psychiatric centers (PPCs) in the Netherlands. It includes DSM diagnoses of 5,257 unique male patients incarcerated in one of the PPC's. Prevalence rates of mental disorders and comorbidity were calculated, the network of comorbid DSM diagnoses was constructed using regression coefficients.
Schizophrenia spectrum and substance-related disorders were most prevalent within this sample (56.7 and 43.1%, respectively), and over half of all patients were diagnosed with a comorbid disorder (56.9%). Four distinctive groups of disorders emerged from the network analysis of DSM diagnoses: substance use, impulsivity, poor social skills, and disruptive behaviors. Psychotic disorders were considered as a separate group as it was unconnected to other disorders.
Comorbid mental disorders can be described, at least in part, as connected networks. Underlying attributes as well as direct influences of mental disorders on one another seem to be affecting the presence of comorbidity. Results could contribute to the understanding of a possible causal relation between psychopathology and criminal behavior and the development of treatment programs targeting groups of disorders.
Psychiatric services providing care for patients and their families confronted with a first psychotic episode need to be sensitive towards patients’ and families’ preferences. Ten patients, ten family members and ten professional caregivers composed a list of 42 preferences in the treatment for a first psychotic episode. In total 99 patients, 100 family members and 263 professional caregivers evaluated these preferences, thus producing an order of priorities. There appears to be considerable agreement among the groups of respondents regarding their top ten priorities, especially concerning information on diagnosis and medication. However, we found important differences between groups of respondents. The results suggest that in psychiatric services great attention should be given to psycho-education and early outpatient intervention.
In the Netherlands, seclusion is historically the measure of first choice in dealing with aggressive incidents. In 2010, the Mediant Mental Health Trust in Eastern Netherlands introduced a policy prioritising the use of enforced medication to manage aggressive incidents over seclusion. The main goal of the study was to investigate whether prioritising enforced medication over seclusion leads to a change of aggressive incidents and coercive measures.
The study was carried out with data from 2764 patients admitted between 2007 and 2013 to the hospital locations of the Mediant Mental Health Trust in Eastern Netherlands, with a catchment area of 500,000 inhabitants. Seclusion, restraint and enforced medications as well as other coercive measures were gathered systematically. Aggressive incidents were assessed with the SOAS-R. An event sequence analysis was preformed, to assess the whether seclusion, restraint or enforced medication were used or not before or after aggressive incidents.
Enforced medication use went up by 363% from a very low baseline. There was a marked reduction of overall coercive measures by 44%. Seclusion hours went down by 62%. Aggression against staff or patients was reduced by 40%.
When dealing with aggression, prioritising medication significantly reduces other coercive measures and aggression against staff, while within principles of subsidiarity, proportionality and expediency.
While the role of consultants in the policy process has long been a concern for scholars of public administration, public management and political science, empirical studies of policy-related consulting are scarce, with little quantitative data. The country-level case studies in this book shed light for the first time on a number of important but as yet under-researched questions. The first is the actual extent of the use of government consulting in a number of countries, and what have been cross-time developments: to what extent has the use of consultants grown over time, and what are the (political, fiscal-economic, society, policy-related) factors that explain greater or lesser growth in a particular country or sector? The second is the question of what role(s) consultants play in the public sector and how large is the share of these consultants in policy work (policy analysis, policy advice, implementation and evaluation).
Demands made by the UK government for external policy support are big business, where the highest spend on consultants has been calculated at £2 billion in 2003–2004 (NAO 2006), and currently major consultancy firms are active in bidding for six months of Brexit work with a price tag of £1.5 million (Martin 2017). At the same time, the focus has been on review and retrenchment, with a fall in spending to £1.8b in 2005–2006 (NAO 2006), whereby ‘the government is determined to make every taxpayer penny count’ and the ‘Cabinet Office is working to help departments reduce reliance on everything from expensive consultants to print cartridges’ (Gov.uk ). Thus, it seems there is recognition of a contribution to public policy that is beyond ‘in-house’ capacity: ‘when used correctly and in the appropriate circumstances … [they] … can provide great benefit to clients – achieving things that clients do not have the capacity or capability to do themselves’ (NAO 2006: 4).
The use of external consultants by the public sector has been an increasingly relevant area of focus for almost three decades, for both government bodies (ANAO 2001; House of Commons Committee of Public Accounts (UK) 2010) and academics (Bakvis 1997; Perl and White 2002; Saint-Martin 2005; Speers 2007; Howlett, Migone and Seck 2014; Howlett and Migone 2014). This is due to both the costs and the role of private sector entities in shaping policy capacity and policy choice. Aside from the most recent contributions, the main focus has been the financial impact of contracting out this function rather than on understanding how external sources have affected the capacity of departments and other government units (Riddell 2007). There are various reasons for this trend.