System dynamics modelling and its implications for childhood obesity prevention: evidence from improving the consumption of portion size and meal frequency

The childhood obesity has rapidly increased, though little is known about the impact of frequency of meals and portion size on weight and obesity. The objective of this study is to compare and to determine the effective strategy for obesity prevention by improving the consumption of portion size and meal frequency. This study utilised the secondary data obtained from the Health Survey for England for the child population aged between 2 to 15 years in United Kingdom. This study combines the different strands of knowledge from nutrition, physical activity and body metabolism and synthesizing this knowledge into a system dynamics model which the model offers unique insights into the cause-and-effect relationships among the influencing factors. Findings from the simulation analysis demonstrated that reducing meal frequency is the most effective controlling strategy for obesity prevention. This is asserted by the fact that the highest reduction in average weight (3.14%-4.5%) and average body mass index (3.14%-4.5%) between 2020 and 2030 was observed by improving meal frequency. This paper concludes that system dynamics utilised in this study will be advantageous to guide the food stakeholder to gain insight into the complex of eating behavior and to experiment with various intervention strategies for obesity prevention

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Integrating and ranking sustainability criteria for housing

Numerous researchers have determined building sustainability criteria relating to environmental performance, but the other two sustainability components – economic and social performance – have not been taken into consideration in an integrated and hierarchical manner. Existing sustainability assessment methods generally ignore economic and social aspects, and sustainable criteria are not prioritised for facilitating decision making. This paper reports how a fuzzy analytic hierarchical process tool was employed to prioritise sustainability criteria for residential buildings for environmental, economic and social performance in an integrated manner. A structured expert-based development process, comprising 17 building practitioners and eight academics from 16 nations was conducted globally. A fuzzy weighted hierarchy for all three aspects of sustainability in residential buildings was developed at the end of the study. Assisted by programmers, the hierarchy is expected to be developed into computer software in the near future to improve construction management