Environmental determinants of fruit and vegetable consumption among adults: a systematic review

The current ecological approach in health behaviour research recognises that health behaviour needs to be understood in a broad environmental context. This has led to an exponential increase in the number of studies on this topic. It is the aim of this systematic review to summarise the existing empirical evidence pertaining to environmental influences on fruit and vegetable (FV) consumption. The environment was defined as ‘all factors external to the individual’. Scientific databases and reference lists of selected papers were systematically searched for observational studies among adults (18–60 years old), published in English between 1 January 1980 and 31 December 2004, with environmental factor(s) as independent factor(s), and fruit intake, vegetable intake or FV intake combined as one outcome measure as dependent factor(s). Findings showed there was a great diversity in the environmental factors studied, but that the number of replicated studies for each determinant was limited. Most evidence was found for household income, as people with lower household incomes consistently had a lower FV consumption. Married people had higher intakes than those who were single, whereas having children showed mixed results. Good local availability (e.g. access to one’s own vegetable garden, having low food insecurity) seemed to exert a positive influence on intake. Regarding the development of interventions, improved opportunities for sufficient FV consumption among low-income households are likely to lead to improved intakes. For all other environmental factors, more replicated studies are required to examine their influence on FV intake

Incremental prediction in long-distance dependencies: Predictive mechanisms during the processing of cataphors.

Norsk sammendrag Når vi leser eller hører språk er tolkingen begrenset av den lineære rekkefølgen som språk åpenbares i. Denne rekkefølgen er ikke nødvendigvis den ideelle for rask tolking av setninger: tolkingen av et bestemt element kan være delvis avhengig av et annet element som kommer senere i setningen. Et eksempel på en slik ‘fremoverseende’ kobling er en kataforisk kobling, hvor et pronomen som hun i (1) kommer foran antesedenten Anne. (1) Når hun kom hjem fra jobben, la Anne umiddelbart merke til det knuste vinduet. Når man leser en setning som (1) vet man ikke hvem hun er før man har sett Anne senere i setningen. Tidligere forskning har vist at tolkere takler denne utfordringen ved å forutsi hvor i setningen antesedenten befinner seg: Mens tolkere leser når hun kom hjem fra jobb... så forventer de at antesedenten vil høre til i den kommende subjektposisjon. I avhandlingen min undersøkte jeg den underliggende forutsigelsesmekanismen. I en rekke leseeksperimenter viste jeg at slike forutsigelser ikke bare skjer i subjektsposisjonen, men forekommer også i andre posisjoner som kommer etter subjekstposisjonen. I tillegg viste jeg at det er variasjon i styrken og timingen av forutsigelsene for ulike posisjoner: Hvis en posisjon er en svært sannsynlig posisjon for antesedenten kan tolkere forplikte seg til en forutsigelse tidlig i setningen, men de kan også forutsi posisjonen i siste øyeblikk når posisjonen er uforutsett eller usannsynlig som antesendentsposisjon. Samlet sett diskuterer denne avhandlingen hvordan antesedentforutsigelse kan fungere, og hva det betyr for forutsigelsesmodeller for språkprosessering generelt.English summary Language comprehension during reading or listening is constrained by the linear order in which language unfolds. This order is not always ideal for efficient interpretation of sentences: sometimes, the interpretation of one element partly depends on an element that only comes later in the sentence. One example of such ‘forward-looking’ dependencies is a cataphoric dependency, where a pronoun, like she in (1), precedes its antecedent Anne. (1) When she came home from work, Anne immediately noticed the broken window. When reading a sentence like (1), comprehenders do not know who the referent of she is until later in the sentence, when they have reached Anne. Previous research has shown that comprehenders handle this challenge by predicting where in the sentence the antecedent might show up: while reading when she came home from work…, comprehenders expect that the antecedent will show up in the upcoming subject position. In my thesis, I investigated the underlying predictive mechanism with a series of reading experiments. I showed that antecedent predictions are not confined to subject position but can also occur in positions past the subject. I also showed that the strength and timing of specific predictions may vary: comprehenders can commit early on to detailed predictions of antecedents in highly likely antecedent positions such as the subject, but they can also make last-minute predictions for less likely or unforeseen positions in a sentence. As a whole, this thesis discusses how antecedent prediction might work and what this means for models of prediction in language processing more broadly.Fulltext not availabl

The On-Line Processing of Epistemic Modal Verbs During Language Comprehension - An ERP Study

Epistemic modal verbs enable the speaker to express attitudes about the factuality of a proposition: they signal a specific degree of likelihood that the proposition in their scope is true, as evaluated by the speaker. In this ERP experiment, we investigated the degree and timing of processing of the Norwegian epistemic modal verbs å tro (to believe) and å tvile på (to doubt). In sentences presented word for word (RSVP paradigm), we recorded ERPs of nouns that rendered propositions in the scope of these verbs (3rd person singular) either true/typical or false/atypical, as verifiable through general world knowledge, for example Tora believes/doubts that birds have wings/gills. As a control condition, we embedded the same clauses in matrix clauses with the non-modal factive verb å vite (to know). We assumed that if the verbs are processed fully at the moment of encountering the critical word, then the N400 of the critical word, being sensitive to modulations of plausibility and predictability, would be modulated by the epistemic modal values of the matrix verbs. This modulation would transpire as an attenuation of the N400 typicality effect for believe compared to know, and a further attenuation or even reversal of the effect for doubt. We observed an N400 typicality effect in both the know- and the believecondition, with a larger and more wide-spread effect for believe than for know. In the doubt-condition, we observed no N400 typicality effect, but sustained anterior negativity (more negative-going for typical words) and a central-parietal typicality effect in the same direction in the time window 500-800 ms after onset. Although additional data collection should be carried out in order to confirm the robustness of the effects in this small data set (N=12), this study indicates distinct ERP modulations by the main verbs, suggesting that at least parts of the lexical semantics of believe and doubt are processed before encountering the critical word

Environmental determinants of fruit and vegetable consumption among adults: a systematic review.

The current ecological approach in health behaviour research recognises that health behaviour needs to be understood in a broad environmental context. This has led to an exponential increase in the number of studies on this topic. It is the aim of this systematic review to summarise the existing empirical evidence pertaining to environmental influences on fruit and vegetable (FV) consumption. The environment was defined as 'all factors external to the individual'. Scientific databases and reference lists of selected papers were systematically searched for observational studies among adults (18-60 years old), published in English between 1 January 1980 and 31 December 2004, with environmental factor(s) as independent factor(s), and fruit intake, vegetable intake or FV intake combined as one outcome measure as dependent factor(s). Findings showed there was a great diversity in the environmental factors studied, but that the number of replicated studies for each determinant was limited. Most evidence was found for household income, as people with lower household incomes consistently had a lower FV consumption. Married people had higher intakes than those who were single, whereas having children showed mixed results. Good local availability (e.g. access to one's own vegetable garden, having low food insecurity) seemed to exert a positive influence on intake. Regarding the development of interventions, improved opportunities for sufficient FV consumption among low-income households are likely to lead to improved intakes. For all other environmental factors, more replicated studies are required to examine their influence on FV intake

Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco.

BACKGROUND: Overeating and harmful alcohol and tobacco use have been linked to the aetiology of various non-communicable diseases, which are among the leading global causes of morbidity and premature mortality. As people are repeatedly exposed to varying sizes and shapes of food, alcohol and tobacco products in environments such as shops, restaurants, bars and homes, this has stimulated public health policy interest in product size and shape as potential targets for intervention. OBJECTIVES: 1) To assess the effects of interventions involving exposure to different sizes or sets of physical dimensions of a portion, package, individual unit or item of tableware on unregulated selection or consumption of food, alcohol or tobacco products in adults and children.2) To assess the extent to which these effects may be modified by study, intervention and participant characteristics. SEARCH METHODS: We searched CENTRAL, MEDLINE, EMBASE, PsycINFO, eight other published or grey literature databases, trial registries and key websites up to November 2012, followed by citation searches and contacts with study authors. This original search identified eligible studies published up to July 2013, which are fully incorporated into the review. We conducted an updated search up to 30 January 2015 but further eligible studies are not yet fully incorporated due to their minimal potential to change the conclusions. SELECTION CRITERIA: Randomised controlled trials with between-subjects (parallel-group) or within-subjects (cross-over) designs, conducted in laboratory or field settings, in adults or children. Eligible studies compared at least two groups of participants, each exposed to a different size or shape of a portion of a food (including non-alcoholic beverages), alcohol or tobacco product, its package or individual unit size, or of an item of tableware used to consume it, and included a measure of unregulated selection or consumption of food, alcohol or tobacco. DATA COLLECTION AND ANALYSIS: We applied standard Cochrane methods to select eligible studies for inclusion and to collect data and assess risk of bias. We calculated study-level effect sizes as standardised mean differences (SMDs) between comparison groups, measured as quantities selected or consumed. We combined these results using random-effects meta-analysis models to estimate summary effect sizes (SMDs with 95% confidence intervals (CIs)) for each outcome for size and shape comparisons. We rated the overall quality of evidence using the GRADE system. Finally, we used meta-regression analysis to investigate statistical associations between summary effect sizes and variant study, intervention or participant characteristics. MAIN RESULTS: The current version of this review includes 72 studies, published between 1978 and July 2013, assessed as being at overall unclear or high risk of bias with respect to selection and consumption outcomes. Ninety-six per cent of included studies (69/72) manipulated food products and 4% (3/72) manipulated cigarettes. No included studies manipulated alcohol products. Forty-nine per cent (35/72) manipulated portion size, 14% (10/72) package size and 21% (15/72) tableware size or shape. More studies investigated effects among adults (76% (55/72)) than children and all studies were conducted in high-income countries - predominantly in the USA (81% (58/72)). Sources of funding were reported for the majority of studies, with no evidence of funding by agencies with possible commercial interests in their results.A meta-analysis of 86 independent comparisons from 58 studies (6603 participants) found a small to moderate effect of portion, package, individual unit or tableware size on consumption of food (SMD 0.38, 95% CI 0.29 to 0.46), providing moderate quality evidence that exposure to larger sizes increased quantities of food consumed among children (SMD 0.21, 95% CI 0.10 to 0.31) and adults (SMD 0.46, 95% CI 0.40 to 0.52). The size of this effect suggests that, if sustained reductions in exposure to larger-sized food portions, packages and tableware could be achieved across the whole diet, this could reduce average daily energy consumed from food by between 144 and 228 kcal (8.5% to 13.5% from a baseline of 1689 kcal) among UK children and adults. A meta-analysis of six independent comparisons from three studies (108 participants) found low quality evidence for no difference in the effect of cigarette length on consumption (SMD 0.25, 95% CI -0.14 to 0.65).One included study (50 participants) estimated a large effect on consumption of exposure to differently shaped tableware (SMD 1.17, 95% CI 0.57 to 1.78), rated as very low quality evidence that exposure to shorter, wider bottles (versus taller, narrower bottles) increased quantities of water consumed by young adult participants.A meta-analysis of 13 independent comparisons from 10 studies (1164 participants) found a small to moderate effect of portion or tableware size on selection of food (SMD 0.42, 95% CI 0.24 to 0.59), rated as moderate quality evidence that exposure to larger sizes increased the quantities of food people selected for subsequent consumption. This effect was present among adults (SMD 0.55, 95% CI 0.35 to 0.75) but not children (SMD 0.14, 95% CI -0.06 to 0.34).In addition, a meta-analysis of three independent comparisons from three studies (232 participants) found a very large effect of exposure to differently shaped tableware on selection of non-alcoholic beverages (SMD 1.47, 95% CI 0.52 to 2.43), rated as low quality evidence that exposure to shorter, wider (versus taller, narrower) glasses or bottles increased the quantities selected for subsequent consumption among adults (SMD 2.31, 95% CI 1.79 to 2.83) and children (SMD 1.03, 95% CI 0.41 to 1.65). AUTHORS' CONCLUSIONS: This review found that people consistently consume more food and drink when offered larger-sized portions, packages or tableware than when offered smaller-sized versions. This suggests that policies and practices that successfully reduce the size, availability and appeal of larger-sized portions, packages, individual units and tableware can contribute to meaningful reductions in the quantities of food (including non-alcoholic beverages) people select and consume in the immediate and short term. However, it is uncertain whether reducing portions at the smaller end of the size range can be as effective in reducing food consumption as reductions at the larger end of the range. We are unable to highlight clear implications for tobacco or alcohol policy due to identified gaps in the current evidence base.This is the final version of the article. It first appeared from Wiley via http://dx.doi.org/10.1002/14651858.CD011045.pub

Social deprivation and exposure to health promotion. A study of the distribution of health promotion resources to schools in England

This article has been made available through the Brunel Open Access Publishing Fund and is available from the specified link - Copyright @ 2010 Chivu and ReidpathBACKGROUND: Area deprivation is a known determinant of health. It is also known that area deprivation is associated with lower impact health promotion. It is less well known, however, whether deprived areas are less responsive to health promotion, or whether they are less exposed. Using data from a national, school-based campaign to promote vaccination against the human papilloma virus (HPV), the relationship between area deprivation and exposure was examined. METHODS: Taking advantage of a health promotion campaign to provide information to schools about HPV vaccination, a cross sectional study was conducted to examine the relationship between area level, social deprivation, and take-up of (i.e., exposure to) available health promotion material. The sample was 4,750 schools across England, including government maintained and independent schools. The relationship between area deprivation and exposure was examined using bi- and multivariate logistic regression. RESULTS: It was found that schools in the least deprived quintile had 1.32 times the odds of requesting health promotion materials than schools in the most deprived areas (p = .01). This effect was independent of the school size, the type of school, and the geographic region. Conclusion The relationship between area deprivation and the impact of health promotion may be due, at least in part, to differential levels of exposure. The study was limited in scope, pointing to the need for more research, but also points to potentially important policy implications

Processing cataphors: Active antecedent search is persistent

Cataphors precede their antecedents, so they cannot be fully interpreted until those antecedents are encountered. Some researchers propose that cataphors trigger an active search during incremental processing in which the parser predictively posits potential antecedents in upcoming syntactic positions (Kazanina et al., Journal of Memory and Language, 56[3], 384–409, 2007). One characteristic of active search is that it is persistent: If a prediction is disconfirmed in an earlier position, the parser should iteratively search later positions until the predicted element is found. Previous research has assumed, but not established, that antecedent search is persistent. In four experiments in English and Norwegian, we test this hypothesis. Two sentence completion experiments show a strong off-line preference for coreference between a fronted cataphor and the first available argument position (the main subject). When the main subject cannot be the antecedent, participants posit the antecedent in the next closest position: object position. Two self-paced reading studies demonstrate that comprehenders actively expect the antecedent of a fronted cataphor to appear in the main clause subject position, and then successively in object position if the subject does not match the cataphor in gender. Our results therefore support the claim that antecedent search is active and persistent.publishedVersio

Screening for atrial fibrillation: The essential role of GPs

Asymptomatic atrial fibrillation (AF) is associated with similar stroke risk as symptomatic AF, yet is often detected only after the patient presents with a devastating stroke. The first Australian guidelines for the screening and management of AF were released in 2018 by the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. This brief, practical summary of the guidelines focuses on screening in general practice

Reducing stroke risk in atrial fibrillation: Adherence to guidelines has improved, but patient persistence with anticoagulant therapy remains suboptimal.

Atrial fibrillation (AF) is a significant risk factor for avoidable stroke. Among high-risk patients with AF, stroke risk can be mitigated using oral anticoagulants (OACs), however reduction is largely contingent on physician prescription and patient persistence with OAC therapy. Over the past decade significant advances have occurred, with revisions to clinical practice guidelines relating to management of stroke risk in AF in several countries, and the introduction of non-vitamin K antagonist OACs (NOACs). This paper summarises the evolving body of research examining guideline-based clinician prescription over the past decade, and patient-level factors associated with OAC persistence. The review shows clinicians\u27 management over the past decade has increasingly reflected guideline recommendations, with an increasing proportion of high-risk patients receiving OACs, driven by an upswing in NOACs. However, a treatment gap remains, as 25–35% of high-risk patients still do not receive OAC treatment, with great variation between countries. Reduction in stroke risk directly relates to level of OAC prescription and therapy persistence. Persistence and adherence to OAC thromboprophylaxis remains an ongoing issue, with 2-year persistence as low as 50%, again with wide variation between countries and practice settings. Multiple patient-level factors contribute to poor persistence, in addition to concerns about bleeding. Considered review of individual patient\u27s factors and circumstances will assist clinicians to implement appropriate strategies to address poor persistence. This review highlights the interplay of both clinician\u27s awareness of guideline recommendations and understanding of individual patient-level factors which impact adherence and persistence, which are required to reduce the incidence of preventable stroke attributable to AF