Life course building epidemiology: An alternative approach to the collection and analysis of carbon emission data

Developing policy for the reduction of the carbon emissions due to buildings requires models for energy usage that incorporate social, behavioural, and environmental factors in addition to the physical properties and technical specifications of the buildings. Marked parallels exist with some of the more intractable public health issues, such as rising levels of obesity. Recently, health researchers have recognized the importance of taking a broader life-course approach to epidemiology in order to examine the degree that long-term health outcomes are set in early life and the extent that these may be mediated or mitigated by subsequent growth and development, as well as by intervention strategies. Life course epidemiology as applied in building science, where energy usage is treated as analogous to poor health outcomes, provides an alternative approach for the construction of causal models that allow for complex interactions between social and technical factors as well as long term effects. It can provide a useful framework for the successful management and analysis of longitudinal studies and may prove particularly effective in identifying the type, timing, and targeting of intervention strategies to produce optimal outcomes in terms of absolute reductions of carbon emissions and resilience of building performance to external stresses, such as those imposed by climate change. An example based on a study in Milton Keynes (London), which is currently in progress, is used to illustrate the way causal models may help elucidate the complex interactions between factors that influence energy usage

Is there an optimal diet for weight management and metabolic health?

Individuals can lose body weight and improve health status on a wide range of energy (calorie) restricted dietary interventions. In this paper, we have reviewed the effectiveness of the most commonly utilized diets, including low-fat, low-carbohydrate and Mediterranean approaches in addition to commercial slimming programmes, meal replacements and newly-popularized intermittent fasting diets. We also consider the role of artificial sweeteners in weight management. Low-fat diets tend to improve LDL-cholesterol most, whilst lower-carbohydrate diets may preferentially improve triglycerides and HDL-cholesterol, however differences between diets are marginal. Weight loss improves almost all obesity related co-morbidities and metabolic markers, regardless of the macronutrient composition of the diet, but individuals do vary in preferences and ability to adhere to different diets. Optimizing adherence is the most important factor for weight loss success, and this is enhanced by regular professional contact and supportive behavioral change programs. Maintaining weight losses in the long-term remains the biggest challenge, and is undermined by an ‘obesogenic’ environment and biological adaptations that accompany weight loss

Health Interventions and Risky Behaviour

This paper reviews the extent to which policy interventions can affect risky behaviours such as smoking, drinking and diet. The justification for such intervention is typically a market failure, broadly defined. The types of market failure typically encountered are discussed. First and second best interventions are examined and there is a review of the efficacy of such interventions with respect to Ireland.Risky behaviour, market failure

Designing a physical activity parenting course : parental views on recruitment, content and delivery

Background Many children do not engage in sufficient levels of physical activity (PA) and spend too much time screen-viewing (SV). High levels of SV (e.g. watching TV, playing video games and surfing the internet) and low levels of PA have been associated with adverse health outcomes. Parenting courses may hold promise as an intervention medium to change children’s PA and SV. The current study was formative work conducted to design a new parenting programme to increase children’s PA and reduce their SV. Specifically, we focussed on interest in a course, desired content and delivery style, barriers and facilitators to participation and opinions on control group provision. Methods In-depth telephone interviews were conducted with thirty two parents (29 female) of 6–8 year olds. Data were analysed thematically. An anonymous online survey was also completed by 750 parents of 6–8 year old children and descriptive statistics calculated. Results Interview participants were interested in a parenting course because they wanted general parenting advice and ideas to help their children be physically active. Parents indicated that they would benefit from knowing how to quantify their child’s PA and SV levels. Parents wanted practical ideas of alternatives to SV. Most parents would be unable to attend unless childcare was provided. Schools were perceived to be a trusted source of information about parenting courses and the optimal recruitment location. In terms of delivery style, the majority of parents stated they would prefer a group-based approach that provided opportunities for peer learning and support with professional input. Survey participants reported the timing of classes and the provision of childcare were essential factors that would affect participation. In terms of designing an intervention, the most preferred control group option was the opportunity to attend the same course at a later date. Conclusions Parents are interested in PA/SV parenting courses but the provision of child care is essential for attendance. Recruitment is likely to be facilitated via trusted sources. Parents want practical advice on how to overcome barriers and suggest advice is provided in a mutually supportive group experience with expert input

Specific issues concerning the management of patients on the waiting list and after liver transplantation

The present document is a second contribution collecting the recommendations of an expert panel of transplant hepatologists appointed by the Italian Association for the Study of the Liver (AISF) concerning the management of certain aspects of liver transplantation, including: the issue of prompt referral; the management of difficult candidates; malnutrition; living related liver transplants; hepatocellular carcinoma; and the role of direct acting antiviral agents before and after transplantation. The statements on each topic were approved by participants at the AISF Transplant Hepatology Expert Meeting organized by the Permanent Liver Transplant Commission in Mondello on 12-13 May 2017. They are graded according to the GRADE grading system

Etiology and Surgical Management of Cervical Spinal Epidural Abscess (SEA):: A Systematic Review.

Study Design: Systematic analysis and review. Objective: Evaluation of the presentation, etiology, management strategies (including both surgical and nonsurgical options), and neurological functional outcomes in patients with cervical spinal epidural abscess (SEA). Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria were used to create a framework based on which articles pertaining to cervical SEA were chosen for review following a search of the Ovid and PubMed databases using the search terms epidural abscess and cervical. Included studies needed to have at least 4 patients aged 18 years or older, and to have been published within the past 20 years. Results: Database searches yielded 521 potential articles in PubMed and 974 potential articles in Ovid. After review, 11 studies were ultimately identified for inclusion in this systematic review. Surgery appears to be a well-tolerated management strategy with limited complications for patients with cervical SEA. However, the quantity of data comparing medical and surgical treatment of cervical SEA is limited and the bulk of the data is derived from low quality studies. Conclusion: Data reporting was heterogeneous among studies making it difficult to draw discrete conclusions. Early surgical intervention may be appropriate in selected patients with cervical epidural abscess, but it is not clear what distinguishes these patients from those who are successfully managed nonoperatively

Thinness and Obesity: A Model of Food Consumption, Health Concerns, and Social Pressure

The increasing concern of the policy maker about eating behavior has focused on thespread of obesity and on the evidence of a consistent number of individuals dietingdespite being underweight. As the latter behavior is often attributed to the socialpressure to be thin, some governments have already taken actions to ban ultra-thinideals and testimonials. Assuming that people are heterogeneous in their healthyweights, but are exposed to the same ideal body weight, this paper proposes atheoretical framework to assess whether increasing the ideal body weight is sociallydesirable, both from a welfare and from a health point of view. If being overweightis the average condition and the ideal body weight is thin, increasing the ideal bodyweight may increase welfare by reducing social pressure. By contrast, health is onaverage reduced, since people depart even further from their healthy weight. Giventhat in the US and in Europe people are on average overweight, we conclude thatthese policies, even when are welfare improving, may foster the obesity epidemic.Body Weight, Diet, Obesity, Social Pressure, Underweight.

Food Choice and Nutrition in Fiji

Obesity related health problems are a potentially significant cost to Fiji. The factors driving the trend towards increased obesity are analysed. The potential for reducing the rate of increase in obesity by influencing individual food choice decisions is evaluated and a policy framework is developed for considering this issue. The analysis points to some tentative policy recommendations for food policy in Fiji. The role of a systems perspective on the policy problem is highlighted and specific attention is focused on the role of a nutrient based food tax in a wider nutrition-health policy system.

Food Choice and Nutrition in Fiji

Obesity related health problems are a potentially significant cost to Fiji. The factors driving the trend towards increased obesity are analysed. The potential for reducing the rate of increase in obesity by influincing individual food choice decisions is evaluated and a policy framework is developed for considering this issue. The analysis points to some tentative policy recommendations for food policy in fiji. The role of a systems perspective on the policy problem is highlighted and specific attention is focused on the role of a nutrient based food tax in a wider nutrition-health policy system.food policy, externalities, nutrition, Agricultural and Food Policy, Food Consumption/Nutrition/Food Safety,