Assessing the associations of sodium intake with long-term all-cause and cardiovascular mortality in a hypertensive cohort

BACKGROUND: Although higher sodium intake is known to increase blood pressure, its association with cardiovascular mortality is less established. We examined the association of baseline sodium intake in a hypertensive cohort with all-cause and cardiovascular mortality over a mean follow-up of 18.6 years. METHODS: Three thousand five hundred five subjects were participants in a worksite hypertension program. Sodium intake was estimated by 24-hour urine excretion. Mortality data were obtained from the U.S. National Death Index. Unadjusted and multivariable-adjusted associations between sodium quartiles (quartile I (QI) to quartile IV (QIV)) and mortality were assessed using Cox models. RESULTS: Estimated mean +/- SD sodium intake was 130+/-69 mmol overall (55+/-20 mmol in QI; 220+/-56 mmol in QIV). Baseline systolic blood pressure did not vary significantly between groups. Last available mean systolic blood pressure was highest in QI and lowest in QIV (137+/-16 vs. 134+/-14 mm Hg; P = 0.009). Overall there were 1,013 deaths (399 cardiovascular). Unadjusted models exhibited significant inverse relationships between sodium and mortality outcomes. In adjusted models, sodium intake was not significantly associated with cardiovascular mortality (QI vs. QIV: hazard ratio (HR) = 1.00; 95% confidence interval (CI) = 0.71-1.42; P = 0.99). A borderline significant direct association with all-cause mortality was observed (QI vs. QIV: HR = 0.81; 95% CI = 0.66-1.00; P = 0.05) driven partly by noncardiovascular deaths. CONCLUSIONS: Our study found no significant association between sodium intake and cardiovascular outcomes, although a significant association with all-cause mortality was observed. Although these findings suggest that sodium may not have a strong relationship with cardiovascular mortality, the inconsistent results cast doubt on whether a single measurement can reliably predict mortality over a prolonged follow-up period

Towards understanding balancing in exertion games

Playing exertion games with others can be engaging. However, players with different physical skill levels competing against each other can experience reduced engagement because they are either not challenged enough, or challenged too much. Balancing methods can address this; however, there is only limited understanding of balancing in exertion games. In this paper, we identify two distinct dimensional balancing techniques: "internal adjustment" and "external adjustment". We report results from a study where we measured player engagement after applying these adjustments to a digital table tennis game and the traditional table tennis game, finding two disengagement factors: "unexpected physical challenges" and "unacceptable competitive advantage". Based on these factors we derived a set of exertion game design considerations. We conclude that applying digital technology to a physical game can change the required skill level to play the game, and this can affect the impact of these adjustments on player engagement. These results enhances our understanding of balancing in exertion games, supporting the benefits of playing exertion games with others

The role of poultry transfers in diet diversity: A cluster randomized intent to treat analysis

Poultry has gained renewed attention as a promising value chain for women because it is an asset that is widely accessible to women, has low start-up costs, and provides a good source of nutritious animal-sourced foods for children in chicken meat and, especially, eggs. The current study presents evidence from an experimental intervention that randomly provided women either a poultry package transfer of vaccinated, improved-breed chickens and related inputs, or a cash grant of equivalent value within a sample of households participating in a social safety net program. These transfers were embedded in a set of intensive livelihood and enhanced nutrition interventions as part of a broader experiment in rural Ethiopia. We assess the impact of the poultry package transfer as well as the enhanced nutrition intervention on the consumption of eggs by both children and adult women. We find that the poultry transfer increased the frequency of egg consumption as well as the sale of eggs, falling between the extreme of an autarkic household and one in which production decisions are fully separable from consumption choices

Principles behind evaluations of national food and beverage taxes and other regulatory efforts

Non-PRIFPRI3; ISIPHN

School Feeding Programs in Middle Childhood and Adolescence

Almost every country in the world has a national school feeding program to provide daily snacks or meals to school-attending children and adolescents. The interven- tions reach an estimated 368 million children and ado- lescents globally. The total investment in the intervention is projected to be as much as US$75 billion annually (WFP 2013), largely from government budgets. School feeding may contribute to multiple objectives, including social safety nets, education, nutrition, health, and local agriculture. Its contribution to education objectives is well recognized and documented, while its role as a social safety net was underscored following the food and fuel crises of 2007 and 2008 (Bundy and others 2009). In terms of health and nutrition, school feeding contributes to the continuum of development by build- ing on investments made earlier in the life course, including maternal and infant health interventions and early child development interventions (see chapter 7 in this volume, Alderman and others 2017). School feeding may also help leverage global efforts to enhance the inclusiveness of education for out-of-school children, adolescent girls, and disabled persons, as called for in the Sustainable Development Goals (see chapter 17 in this volume, Graham and others 2017). Although the Disease Control Priorities series focuses on low- and middle-income countries (LMICs), evidence from high-income countries (HICs) is included because of the near universality of school feeding and the insights that inclusion can provide as economies develop. For example, the design of school feeding in countries under- going the nutrition transition 1 may provide some lessons on how to shift from providing access to sufficient calo- ries to promoting healthful diets and dietary behaviors for children and adolescents (WFP 2013). Agricultural development has increasingly gained attention. It is clear that to enable the transition to sus- tainable, scalable government-run programs, the inclu- sion of the agricultural sector is essential (Bundy and others 2009; Drake and others 2016). Accounting for the full benefits of school feeding through cost- effectiveness and benefit-cost analysis is challenging, similar to other complex interventions, but undertaking this accounting is critical for assessing the tradeoffs with competing investments. This chapter reviews the evidence about how school feeding meets these objectives and provides some indi- cation of costs in relation to benefits. The costs of the intervention are well established; estimates that encompass all the benefits of school feeding are more challenging. The benefits must be quantified and translated to the same unit to allow for aggregation. Moreover, how school feeding interventions are designed and implemented varies significantly across countries. Given that delivery of school feeding often involves multiple sectors, common policy frameworks and cross-sectoral coordination are required to achieve maximum benefit (Bundy and others 2009). Several other chapters in the volume highlight school feeding. These include chapter 11 (Lassi, Moin, and Bhutta 2017), chapter 20 (Bundy and others 2017), chapter 22 (Plaut and others 2017), and chapter 25 (Fernandes and Aurino 2017)

Tourism and toponymy: Commodifying and Consuming Place Names

Academic geographers have a long history of studying both tourism and place names, but have rarely made linkages between the two. Within critical toponymic studies there is increasing debate about the commodification of place names, but to date the role of tourism in this process has been almost completely overlooked. In some circumstances, toponyms can become tourist sights based on their extraordinary properties, their broader associations within popular culture, or their role as metanyms for some other aspect of a place. Place names may be sights in their own right or ‘markers’ of a sight and, in some cases, the marker may be more significant than the sight to which it refers. The appropriation of place names through tourism also includes the production and consumption of a broad range of souvenirs based on reproductions or replicas of the material signage that denote place names. Place names as attractions are also associated with a range of performances by tourists, and in some cases visiting a place name can be a significant expression of fandom. In some circumstances, place names can be embraced and promoted by tourism marketing strategies and are, in turn, drawn into broader circuits of the production and consumption of tourist space

Tales of the unexpected: the selection of British party leaders since 1963

Jeremy Corbyn’s election as Leader of the Labour Party in 2015 stunned observers and practitioners of British politics alike. In this article, we first outline a theoretical framework that purports to explain why political parties operating in parliamentary systems choose the leaders they do. We then examine 32 leadership successions involving five major British parties since 1963, and note that many of these were unexpected, in that they were triggered by unforeseen circumstances, such as the sudden death or resignation of the incumbent. Examining each party in turn, we briefly explain why the winners won and identify at least eight cases (a quarter of our sample) where a candidate widely expected to prevail at the outset was ultimately defeated by a ‘dark horse’, ‘second favourite’ or even ‘rank outsider’. Of these, Corbyn’s election in 2015 was the most unexpected and, consistent with the findings of studies of party leadership conventions in other parliamentary systems, namely Canada and Spain, suggests that ideological and policy concerns are sometimes more important than considerations of party unity and electability, especially when a leadership contest is dominated by party activists