Select dietary changes towards sustainability: Impacts on dietary profiles, environmental footprint, and cost.

Healthy sustainable diets have the power to improve dietary intakes and environmental resource use. However, recommendations for improving food choices need to consider the effects of any changes across multiple dimensions of health, environmental sustainability, and dietary cost to promote long-lasting behaviour change. The aim of this study was to identify differences between original diets, and the diets that can be achieved through the implementation of select small dietary changes towards sustainability. Twelve hypothetical sustainable actions were investigated for the potential effects of these actions on dietary markers (protein, saturated fat, sugars, salt, iron, and calcium), environmental footprints (greenhouse gas emissions, freshwater withdrawals, and land use), and dietary cost. Dietary data from 1235 individuals, aged 19-94 years, participating in the UK National Diet and Nutrition Survey (2017/19) provided the original diet. Dietary changes were implemented as required by each sustainable action, and differences between the original diet and each new diet were investigated. Results revealed benefits to dietary markers and environmental characteristics from eleven sustainable actions (range: F(1,728) = 5.80, p < .001 to F(1,506) = 435.04,p < .001), but effects were stronger for some actions than for others. Greatest benefits for all three outcomes were found for actions which reduced meat consumption and/or replaced meat with pulses or eggs. The remaining sustainable actions tended to be beneficial for improving outcomes individually or to some degree. Our results demonstrate the possible impacts of a number of small sustainable dietary actions for dietary, environmental, and cost outcomes, and provide a hierarchy of actions based on benefit. Findings may facilitate dietary behaviours towards improved health, whilst also offering fruitful contributions towards environmental footprint targets in the UK

Consumer communication when eating out of home: the role of technology

Purpose Despite growing demand, little product information is available when eating out. Information that is provided is often not well understood leading to a lack of consumer control and acting as a barrier to healthy food choices. The AIDA model which highlights the key stages of effective marketing communication (Awareness, Interest, Desire and Action) is applied. Information provided through technological solutions is examined to provide clear guidance on future use. Methodology Exploratory qualitative methods through four focused group discussions, allowed consumers views to be probed in-depth and key themes to emerge through thematic analysis. Findings In addition to the four key elements of the AIDA model, Accessibility and Relevance are found to be key constructs relevant to food information provision. Accessibility highlights the need for quick, and clear data display, while relevance stresses how salient information is key to each consumer. Technological solutions may offer the most responsive, effective and trusted way to provide enhanced information. Practical Implications With increasing consumer demand for clear information, a competitive advantage can be gained through the provision of personalised enhanced dish information when eating out. Findings from this study highlight consumers desire for online (app or web-site based) platforms. Social Implications The provision of enhanced food information when eating out has clear public health implications and may influence choice leading to a reduction in non-communicable disease. Originality and Value This study, evaluates consumers perceptions to the provision of enhanced food information out of home providing novel insights and guidance for both managerial and societal impact

Respite care and short breaks for young adults aged 18–40 with complex health-care needs: mixed-methods systematic review and conceptual framework development

BackgroundThe number of young adults with complex health-care needs due to life-limiting conditions/complex physical disability has risen significantly over the last 15 years, as more children now survive into adulthood. The transition from children to adult services may disrupt provision of essential respite/short break care for this vulnerable population, but the impact on young adults, families and providers is unclear.AimTo review the evidence on respite care provision for young adults (aged 18–40 years) with complex health-care needs, provide an evidence gap analysis and develop a conceptual framework for respite care.DesignA two-stage mixed-methods systematic review, including a knowledge map of respite care and an evidence review of policy, effectiveness, cost-effectiveness and experience.Data sourcesElectronic databases and grey/unpublished literature were searched from 2002 to September 2019. The databases searched included Cumulative Index to Nursing and Allied Health Literature, MEDLINE, EMBASE, PsycINFO, Applied Social Sciences Index and Abstracts, Health Management Information Consortium, PROSPERO, Turning Research into Practice, COnNECT+, British Nursing Index, Web of Science, Social Care Online, the National Institute for Health Research Journals Library, Cochrane Effective Practice and Organisation of Care specialist register, databases on The Cochrane Library and international clinical trials registers. Additional sources were searched using the CLUSTER (Citations, Lead authors, Unpublished materials, Scholar search, Theories, Early examples, Related projects) approach and an international ‘call for evidence’.Methods and analysisMultiple independent reviewers used the SPICE (Setting, Perspective, Intervention/phenomenon of interest, Comparison, Evaluation) framework to select and extract evidence for each stage, verified by a third reviewer. Study/source characteristics and outcomes were extracted. Study quality was assessed using relevant tools. Qualitative evidence was synthesised using a framework approach and UK policy was synthesised using documentary content analysis. GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research) was used to assess confidence in the evidence. Logic models developed for each type of respite care constituted the conceptual framework.ResultsWe identified 69 sources (78 records) from 126,267 records. The knowledge map comprised the following types of respite care: residential, home based, day care, community, leisure/social provision, funded holidays and emergency. Seven policy intentions included early transition planning and prioritising respite care according to need. No evidence was found on effectiveness and cost-effectiveness. Qualitative evidence focused largely on residential respite care. Facilitators of accessible/acceptable services included trusted and valued relationships, independence and empowerment of young adults, peer social interaction, developmental/age-appropriate services and high standards of care. Barriers included transition to adult services, paperwork, referral/provision delay and travelling distance. Young adults from black, Asian and minority ethnic populations were under-represented. Poor transition, such as loss of or inappropriate services, was contrary to statutory expectations. Potential harms included stress and anxiety related to safe care, frustration and distress arising from unmet needs, parental exhaustion, and a lack of opportunities to socialise and develop independence.LimitationsNo quantitative or mixed-methods evidence was found on effectiveness or cost-effectiveness of respite care. There was limited evidence on planned and emergency respite care except residential.ConclusionsPolicy intentions are more comprehensively met for young people aged Future workResearch to quantify the effectiveness and cost-effectiveness of respite care to support service development and commissioning. Development of a core set of outcomes measures to support future collation of evidence.Study registrationThis study is registered as PROSPERO CRD42018088780.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 6. See the NIHR Journals Library website for further project information

Increasing vegetable consumption out-of-home: VeggiEAT and Veg+projects

© 2020 The Authors. Nutrition Bulletin published by John Wiley & Sons Ltd on behalf of British Nutrition Foundation Adequate vegetable consumption is fundamental to a healthy, balanced diet; however, global compliance with recommendations to increase consumption is poor. There is a growing interest in the sustainability of current dietary patterns in light of expected climate change and an expanding global population where part of the response is increasing vegetable intake. Two international projects, VeggiEAT and Veg+, explored the determinants of vegetable liking and consumption in different age groups and countries and the effect of a nudging strategy on vegetable consumption in an out-of-home setting. The projects found that the importance given by consumers to natural or healthy ingredients, social norms, female gender and positive attitudes towards nudging all influenced vegetable consumption. Some sensory factors, such as bitterness and sourness, had a negative loading, while others, such as sweetness, had a positive effect on liking for vegetables. ‘Dish of the day’, as a nudging strategy in a workplace canteen setting, increased vegetable dish selection for some of the sample (adolescent females) but not for males or older people. Globally, there is a strong need to promote the consumption of vegetables as a public health issue but also to improve their availability and uptake, especially within out-of-home foodservice

The specification, acceptability and effectiveness of respite care and short breaks for young adults with complex healthcare needs: protocol for a mixed-methods systematic review

IntroductionThe number of young adults with complex healthcare needs due to life-limiting conditions/complex physical disability has risen significantly as children with complex conditions survive into adulthood. Respite care and short breaks are an essential service, however, needs often go unmet after the transition to adult services, leading to a significant impact on the life expectancy and quality of life for this population. We aim to identify, appraise and synthesise relevant evidence to explore respite care and short breaks provision for this population, and to develop a conceptual framework for understanding service models.Methods and analysisA mixed-methods systematic review conducted in two stages: (1) knowledge map and (2) evidence review. We will comprehensively search multiple electronic databases; use the Citations, Lead authors, Unpublished materials, Google Scholar, Theories, Early examples, and Related projects (CLUSTER) approach, search relevant websites and circulate a ‘call for evidence’. Using the setting, perspective, intervention/phenomenon of interest, comparison and evaluation framework, two reviewers will independently select evidence for inclusion into a knowledge map and subsequent evidence review, extract data relating to study and population characteristics, methods and outcomes; and assess the quality of evidence. A third reviewer will arbitrate where necessary.Evidence will be synthesised using the following approaches: quantitative (narratively/conducting meta-analyses where appropriate); qualitative (framework approach); policy and guidelines (documentary analysis informed approach). An overall, integrated synthesis will be created using a modified framework approach. We will use Grading of Recommendations Assessment, Development and Evaluation (GRADE)/GRADE-Confidence in the Evidence from Reviews of Qualitative Research to assess the strength and confidence of the synthesised evidence. Throughout, we will develop a conceptual framework to articulate how service models work in relation to context and setting.Ethics and disseminationEthical approval is not required as this is a systematic review. We will present our work in academic journals, at appropriate conferences; we will disseminate findings across networks using a range of media. Steering and advisory groups were established to ensure findings are shared widely and in accessible formats.PROSPERO registration numberCRD42018088780

Psychosis risk candidate ZNF804A localizes to synapses and regulates neurite formation and dendritic spine structure

BackgroundVariation in the gene encoding zinc finger binding protein 804A (ZNF804A) is associated with schizophrenia (SCZ) and bipolar disorder (BP). Evidence suggests that ZNF804A is a regulator of gene transcription and is present in nuclear and extranuclear compartments. However, a detailed examination of ZNF804A distribution and its neuronal functions has yet to be performed.MethodsThe localization of ZNF804A protein was examined in neurons derived from human neural progenitor cells (hNPCs), human induced pluripotent stem cells (hiPSCs) or in primary rat cortical neurons. Additionally, siRNA-mediated knockdown of ZNF804A was conducted to determine its role in neurite formation, maintenance of dendritic spine morphology and responses to activity-dependent stimulations.ResultsEndogenous ZNF804A protein localized to somato-dendritic compartments and co-localized with the putative synaptic markers in young neurons derived from hNPCs and hiPSCs. In mature rat neurons, Zfp804A, the homolog of ZNF804A, was present in a subset of dendritic spines and co-localized with synaptic proteins in specific nanodomains, as determined by superresolution microscopy. Interestingly, knockdown of ZNF804A attenuated neurite outgrowth in young neurons, an effect potentially mediated by reduced neuroligin-4 (NLGN4) expression. Furthermore, knockdown of ZNF804A in mature neurons resulted in the loss of dendritic spine density, and impaired responses to activity-dependent stimulation.ConclusionsThese data reveal a novel subcellular distribution for ZNF804A within somato-dendritic compartments and a nanoscopic organisation at excitatory synapses. Moreover, our results suggest that ZNF804A plays an active role in neurite formation, maintenance of dendritic spines and activity-dependent structural plasticity

Characterization of the ATP4 ion pump in Toxoplasma gondii

The Plasmodium falciparum ATPase PfATP4 is the target of a diverse range of antimalarial compounds, including the clinical drug candidate cipargamin. PfATP4 was originally annotated as a Ca2+ transporter, but recent evidence suggests that it is a Na+ efflux pump, extruding Na+ in exchange for H+. Here we demonstrate that ATP4 proteins belong to a clade of P-type ATPases that are restricted to apicomplexans and their closest relatives. We employed a variety of genetic and physiological approaches to investigate the ATP4 protein of the apicomplexan Toxoplasma gondii, TgATP4. We show that TgATP4 is a plasma membrane protein. Knockdown of TgATP4 had no effect on resting pH or Ca2+ but rendered parasites unable to regulate their cytosolic Na+ concentration ([Na+]cyt). PfATP4 inhibitors caused an increase in [Na+]cyt and a cytosolic alkalinization in WT but not TgATP4 knockdown parasites. Parasites in which TgATP4 was knocked down or disrupted exhibited a growth defect, attributable to reduced viability of extracellular parasites. Parasites in which TgATP4 had been disrupted showed reduced virulence in mice. These results provide evidence for ATP4 proteins playing a key conserved role in Na+ regulation in apicomplexan parasites.This work was supported by National Health and Medical Research Council Grant 1042272 (to K. K.) and Australian Research Council Discovery Project Grant DP150102883 (to K. K. and G. G. v. D.), Linkage Project Grant LP150101226 (to K. K.), Discovery Early Career Researcher Award DE160101035 (to A. M. L.), QEII Fellowship DP110103144 (to G. G. v. D.), and Future Fellowship FT120100164 (to C. J. T.). C. J. T. is grateful for institutional support from the Victorian State Government Operational Infrastructure Support Program and the National Health and Medical Research Council Independent Research Institute Infrastructure Support Scheme