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Utilization of Away-From-Home Food Establishments, Dietary Approaches to Stop Hypertension Diet Pattern, and Obesity
Eating meals away from home has been associated with the consumption of unhealthy foods and increased body weight. However, more rigorous assessment of the contribution of different types of away-from-home food establishments to overall diet quality and obesity is minimal. This study examined usage of these food establishments, accordance to the Dietary Approaches to Stop Hypertension (DASH) dietary pattern and obesity status in a nationally representative sample of adults in the United Kingdom.
A cross-sectional analysis of data from a national survey (N=2,083 aged ≥19 years, from 2008 to 2012) with dietary intake measured using a 4-day food diary, and height and weight measured objectively. Exposures included usage of (i.e., by proportion of energy) all away-from-home food establishments combined, and fast-food outlets, restaurants, and cafés separately. Outcomes included accordance with the DASH diet, and obesity status. Multivariable logistic regressions were conducted in 2016 to estimate associations between food establishments, diet quality, and obesity.
People consuming a higher proportion of energy from any away-from-home food establishment had lower odds of DASH accordance (OR=0.45, 95% CI=0.31, 0.67) and increased odds of obesity (OR=1.48, 95% CI=1.10, 1.99). After adjustment, only use of fast-food outlets was significantly associated with lower odds of DASH accordance (OR=0.48, 95%=0.33, 0.69) and higher odds of obesity (OR=1.30, 95% CI=1.01, 1.69).
Although a greater reliance on eating away-from-home is associated with less-healthy diets and obesity, dietary public health interventions that target these food establishments may be most effective if they focus on modifying the use of fast-food outlets.The work was undertaken by the Centre for Diet and Activity Research, a UK Clinical Research Collaboration Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration [RG72218], is gratefully acknowledged. In addition, Dr. Penney’s PhD studentship is generously supported by the Cambridge International Scholarship, a scheme funded by the Cambridge Commonwealth, European, and International Trust
Does exposure to the food environment differ by socioeconomic position? Comparing area-based and person-centred metrics in the Fenland Study, UK
BACKGROUND:
Retail food environments (foodscapes) are a recognised determinant of eating behaviours and may contribute to inequalities in diet. However, findings from studies measuring socioeconomic inequality in the foodscape have been mixed, which may be due to methodological differences. The aim of this cross-sectional study was to compare exposure to the foodscape by socioeconomic position using different measures, to test whether the presence, direction or amplitude of differences was sensitive to the choice of foodscape metric or socioeconomic indicator.
METHODS:
A sample of 10,429 adults aged 30–64 years with valid home address data were obtained from the Fenland Study, UK. Of this sample, 7270 participants also had valid work location data. The sample was linked to data on food outlets obtained from local government records. Foodscape metrics included count, density and proximity of takeaway outlets and supermarkets, and the percentage of takeaway outlets relative to all food outlets. Exposure metrics were area-based (lower super output areas), and person-centred (proximity to nearest; Euclidean and Network buffers at 800 m, 1 km, and 1 mile). Person-centred buffers were constructed using home and work locations. Socioeconomic status was measured at the area-level (2010 Index of Multiple Deprivation) and the individual-level (highest educational attainment; equivalised household income). Participants were classified into socioeconomic groups and average exposures estimated. Results were analysed using the statistical and percent differences between the highest and lowest socioeconomic groups.
RESULTS:
In area-based measures, the most deprived areas contained higher takeaway outlet densities (p < 0.001). However, in person-centred metrics lower socioeconomic status was associated with lower exposure to takeaway outlets and supermarkets (all home-based exposures p < 0.001) and socioeconomic differences were greatest at the smallest buffer sizes. Socioeconomic differences in exposure was similar for home and combined home and work measures. Measuring takeaway exposure as a percentage of all outlets reversed the socioeconomic differences; the lowest socioeconomic groups had a higher percentage of takeaway outlets compared to the middle and highest groups (p < 0.001).
Conclusions
We compared approaches to measuring socioeconomic variation in the foodscape and found that the association was sensitive to the metric used. In particular, the direction of association varied between area- and person-centred measures and between absolute and relative outlet measures. Studies need to consider the most appropriate measure for the research question, and may need to consider multiple measures as a single measure may be context dependent.This work was undertaken by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. Funding from Cancer Research UK, the British Heart Foundation, the Economic and Social Research Council, the Medical Research Council, the National Institute for Health Research [ES/G007462/1], and the Wellcome Trust [087636/Z/08/Z], under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. TLP’s Ph.D. studentship is generously supported by the Cambridge International Scholarship, a scheme funded by the Cambridge Commonwealth, European & International Trust. Core Medical Research Council Epidemiology Unit for NGF (MC_UU_12015/5) is also acknowledged. The Fenland Study is funded by the Wellcome Trust and the Medical Research Council
A network linking scene perception and spatial memory systems in posterior cerebral cortex
The neural systems supporting scene-perception and spatial-memory systems of the human brain are well-described. But how do these neural systems interact? Here, using fine-grained individual-subject fMRI, we report three cortical areas of the human brain, each lying immediately anterior to a region of the scene perception network in posterior cerebral cortex, that selectively activate when recalling familiar real-world locations. Despite their close proximity to the scene-perception areas, network analyses show that these regions constitute a distinct functional network that interfaces with spatial memory systems during naturalistic scene understanding. These “place-memory areas” offer a new framework for understanding how the brain implements memory-guided visual behaviors, including navigation
Is adolescent body mass index and waist circumference associated with the food environments surrounding schools and homes? A longitudinal analysis
Background: There has been considerable interest in the role of access to unhealthy food options as a determinant of weight status. There is conflict across the literature as to the existence of such an association, partly due to the dominance of cross-sectional study designs and inconsistent definitions of the food environment. The aim of our study is to use longitudinal data to examine if features of the food environment are associated to measures of adolescent weight status. Methods: Data were collected from secondary schools in Leeds (UK) and included measurements at school years 7 (ages 11/12), 9 (13/14), and 11 (15/16). Outcome variables, for weight status, were standardised body mass index and standardised waist circumference. Explanatory variables included the number of fast food outlets, supermarkets and ‘other retail outlets’ located within a 1 km radius of an individual’s home or school, and estimated travel route between these locations (with a 500 m buffer). Multi-level models were fit to analyse the association (adjusted for confounders) between the explanatory and outcome variables. We also examined changes in our outcome variables between each time period. Results: We found few associations between the food environment and measures of adolescent weight status. Where significant associations were detected, they mainly demonstrated a positive association between the number of amenities and weight status (although effect sizes were small). Examining changes in weight status between time periods produced mainly non-significant or inconsistent associations. Conclusions: Our study found little consistent evidence of an association between features of the food environment and adolescent weight status. It suggests that policy efforts focusing on the food environment may have a limited effect at tackling the high prevalence of obesity if not supported by additional strategies
'Gain with no pain’: anabolic-androgenic steroids trafficking in the UK
Anabolic-androgenic steroids are performance and image enhancing drugs (PIED) that can improve endurance and athletic performance, reduce body fat and stimulate muscle growth. The use of steroids has been studied extensively in the medical and psychological literature, as well as in the sociology of sport, health and masculinity. From the late 2000s, the worldwide trade in steroids increased significantly. However, trafficking in steroids remains a largely under-researched criminological phenomenon with a few notable exceptions. Currently in the UK there are only small and fragmented pieces of information available relating to steroids trafficking in autobiographical accounts of professional criminals. Drawing on original empirical data, the purpose of this article is to provide an account of the social organization of the steroids trafficking business in the UK. The trade in steroids is decentralized, highly flexible with no hierarchies, and open to anyone willing to either order the merchandise online or travel to producing countries and obtain steroids in bulk from legitimate manufacturers. The patterns of trafficking of this specific type of substance are patently conditioned by its embeddedness in the gym/bodybuilding scene and this greatly affects relations between actors in the business. In the steroids market, one typically encounters a multitude of individuals likely to drift between legality and illegality, online and offline, use and supply
Increased Cortical Thickness in Sports Experts: A Comparison of Diving Players with the Controls
Sports experts represent a population of people who have acquired expertise in sports training and competition. Recently, the number of studies on sports experts has increased; however, neuroanatomical changes following extensive training are not fully understood. In this study, we used cortical thickness measurement to investigate the brain anatomical characteristics of professional divers with extensive training experience. A comparison of the brain anatomical characteristics of the non-athlete group with those of the athlete group revealed three regions with significantly increased cortical thickness in the athlete group. These regions included the left superior temporal sulcus, the right orbitofrontal cortex and the right parahippocampal gyrus. Moreover, a significant positive correlation between the mean cortical thickness of the right parahippocampal gyrus and the training experience was detected, which might indicate the effect of extensive training on diving players' brain structure
Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy
Background
A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets.
Methods
Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis.
Results
A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001).
Conclusion
We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty
The effect of fluid resuscitation on the effective circulating volume in patients undergoing liver surgery: a post-hoc analysis of a randomized controlled trial
To assess the significance of an analogue of the mean systemic filling pressure (Pmsa) and its derived variables, in providing a physiology based discrimination between responders and non-responders to fluid resuscitation during liver surgery. A post-hoc analysis of data from 30 patients undergoing major hepatic surgery was performed. Patients received 15 ml kg(-1) fluid in 30 min. Fluid responsiveness (FR) was defined as an increase of 20% or greater in cardiac index, measured by FloTrac-Vigileo((R)). Dynamic preload variables (pulse pressure variation and stroke volume variation: PPV, SVV) were recorded additionally. Pvr, the driving pressure for venous return (=Pmsa-central venous pressure) and heart performance (EH; Pvr/Pmsa) were calculated according to standard formula. Pmsa increased following fluid administration in responders (n = 18; from 13 +/- 3 to 17 +/- 4 mmHg, p < 0.01) and in non-responders (n = 12; from 14 +/- 4 to 17 +/- 4 mmHg, p < 0.01). Pvr, which was lower in responders before fluid administration (6 +/- 1 vs. 7 +/- 1 mmHg; p = 0.02), increased after fluid administration only in responders (from 6 +/- 1 to 8 +/- 1 mmHg; p < 0.01). EH only decreased in non-responders (from 0.56 +/- 0.17 to 0.45 +/- 0.12; p < 0.05). The area under the receiver operating characteristics curve of Pvr, PPV and SVV for predicting FR was 0.75, 0.73 and 0.72, respectively. Changes in Pmsa, Pvr and EH reflect changes in effective circulating volume and heart performance following fluid resuscitation, providing a physiologic discrimination between responders and non-responders. Also, Pvr predicts FR equivalently compared to PPV and SVV, and might therefore aid in predicting FR in case dynamic preload variables cannot be used
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