A secondary analysis of the childhood obesity prevention Cochrane Review through a wider determinants of health lens: implications for research funders, researchers, policymakers and practitioners

Background Randomised controlled trials (RCTs) are often regarded as the gold standard of evidence, and subsequently go on to inform policymaking. Cochrane Reviews synthesise this type of evidence to create recommendations for practice, policy, and future research. Here, we critically appraise the RCTs included in the childhood obesity prevention Cochrane Review to understand the focus of these interventions when examined through a wider determinants of health (WDoH) lens. Methods We conducted a secondary analysis of the interventions included in the Cochrane Review on “Interventions for Preventing Obesity in Children”, published since 1993. All 153 RCTs were independently coded by two authors against the WDoH model using an adaptive framework synthesis approach. We used aspects of the Action Mapping Tool from Public Health England to facilitate our coding and to visualise our findings against the 226 perceived causes of obesity. Results The proportion of interventions which targeted downstream (e.g. individual and family behaviours) as opposed to upstream (e.g. infrastructure, environmental, policy) determinants has not changed over time (from 1993 to 2015), with most intervention efforts (57.9%) aiming to change individual lifestyle factors via education-based approaches. Almost half of the interventions (45%) targeted two or more levels of the WDoH. Where interventions targeted some of the wider determinants, this was often achieved via upskilling teachers to deliver educational content to children. No notable difference in design or implementation was observed between interventions targeting children of varying ages (0–5 years, 6–12 years, 13–18 years). Conclusions This study highlights that interventions, evaluated via RCTs, have persisted to focus on downstream, individualistic determinants of obesity over the last 25 years, despite the step change in our understanding of its complex aetiology. We hope that the findings from our analysis will challenge research funders, researchers, policymakers and practitioners to reflect upon, and critique, the evidence-based paradigm in which we operate, and call for a shift in focus of new evidence which better accounts for the complexity of obesity

Metallierung von Pyridylmetallocenen durch Platin(II), Gold(III), Quecksilber(II) und Iridium(III)

Weight management is a game of chance for most children and young people, and is dependent on service availability and the expertise of the provider. Many localities are without established weight-management services, and the effectiveness of those provided is often not well-known. SHINE (Self Help, Independence, Nutrition and Exercise) is the only documented tier 3 community-based service provider in the UK. It offers a plethora of interventions tailored to each child or young person using a stepped-care approach (SCA) to treat severe obesity: as the severity of obesity increases, so does the intensity of intervention. This article describes an SCA and uses this model to demonstrate a range of appropriate, available interventions. A SCA can provide a holistic and integrative care pathway for children and young people with severe obesity when implemented at tier 3

Total mixed dairy rations on your farm? (1991)

Total mixed dairy rations (TMR) offer an opportunity to improve business profits through improved animal performance and health, decreased feed wastage, improved labor efficiency and improved butterfat. The installation of a TMR system normally requires added investments in feed mixing and distribution equipment. The purpose of this publication is to provide a format for evaluating the economic consequences of changing to a TMR system.Reviewed October 1993 -- Extension website

Modeling the flow of digesta through the ruminant reticulorumen

Abstract only availableRuminants possess a specialized gastrointestinal (GI) tract that enables them to efficiently digest fibrous feeds. The first stomach compartment of the ruminant GI tract, the reticulorumen (RR), is the site of most fiber digestion due to the presence of cellulolytic microorganisms in conjunction with selective retention of feed particles; undigested fibrous feed particles are selectively retained and fermented by cellulolytic microorganisms in the RR until certain digestive processes are completed, enabling the particles to pass. Selective retention and the overall process of digesta flow in the RR affect feed digestibility, feed intake, and microbial efficiency—all important animal performance parameters in ruminant production. It is imperative to model digesta flow in the RR to better predict these animal performance parameters for use in ruminant production systems. Mathematical models have indeed been developed to describe the flow of digesta in the RR, typically with the RR represented as one or more mathematical compartments with flow between compartments defined by kinetic rate variables or constants. Mathematical models developed to the present use either fractional rate constants or rate variables based on the gamma distribution. The Yule distribution has also been suggested for modeling RR digesta flow kinetics, but its development has been cursory. It remains unseen what, if any, benefits may arise from applying the Yule distribution to describe the kinetics of RR digesta. In this study, a model incorporating the Yule distribution is fully developed. Physiological justification for using the Yule distribution is also provided on the basis of selective retention. A comparison between the model developed herein and a previously published model using the gamma distribution reveals that both models give similar mathematical results under certain cases. Still, it is suggested that the physiological relevance of the model treated here may make it superior. Animal feeding trials are currently being conducted to validate the structure of model. Additionally, mathematical models are being developed to describe small and large intestinal flow in ruminant and non-ruminant species, thereby expanding this modeling effort to include most of the GI tract.Life Sciences Undergraduate Research Opportunity Progra

Thermal status for different breeds of dairy cattle exposed to summer heat stress in a grazing environment [abstract]

Abstract only availableA study was conducted to investigate thermal balance of lactating dairy cattle managed in an intensive managed rotational grazing system. The farm was located at the University of Missouri Southwest Research Center in Vernon County, MO. Thirty six lactating dairy cows were blocked by parity, days in milk, milk production and breed. Cows were grouped by breed with 100% Holstein (H, n=8), 75%H:25% Jersey (J) (75H, n=5), 50%H:50%J (50H, n=8), 25%H:75%J (75J, n=7), and 100% J (J, n=8), and maintained on the same pastures from June 15 through August 1, 2006. Cows were rotated to paddocks to maintain ad libitum access to pasture. Ambient variables, including air temperature (Ta) and relative humidity, were measured continuously. Ranges of Ta and calculated THI were 12 to 38C and 55 to 87, respectively. Thermal balance was evaluated prior to morning (0500) and afternoon (1600) milkings by measuring rectal temperature (Tre) and respiration rate (RR) on 16 days throughout the study during periods of maximum and minimum heat stress. Breed groups had different body weights (p < 0.0001) ranging from 530 kg (H) to 378 (J). However, body weight was similar for 75J and 75H (460 kg versus 501 kg, respectively). Although body weights were different across breed, combined change in rectal temperature with Ta (r = 0.89) and THI (r = 0.92) was predictable (p < 0.0001). Change in Tre with increasing Ta and THI was slowest for J and 75J, and highest for H and 75H. Change in Tre was influenced more by breed more than body weight. Respiration rate was correlated with Ta (r = 0.88) and THI (r = 0.89) (p < 0.0001), with 75J being more responsive than 75H. These results suggest that breed selection can be used to improve thermal balance of cows in intensively managed rotational grazing systems.CAFNR On Campus Research Internshi

How Do You Move? Everyday stories of physical activity

Stories can be a powerful method of exploring complexity, and the factors affecting everyday physical activity within a modern urban setting are nothing if not complex. The first part of our How Do You Move? study focused on the communication of physical activity guidelines to under-served communities. A key finding was that adults especially wanted physical activity messages to come from ‘everyday people, people like us’. This finding also reflects a wider move to use more relatable imagery in health promotion campaigns. Using a portrait vignette approach to create monologues, we set out to explore the experiences of people from diverse backgrounds living in Bristol, all of whom took part in varied leisure time physical activities but would also be considered to lead ‘normal’ lives. We aim to demonstrate that stories of such ‘experts by experience’ can contribute to how physical activity is perceived and elucidate the complex interplay of barriers and enablers in everyday experiences of physical activity

Building a Systems Map:Applying Systems Thinking to Unhealthy Commodity Industry Influence on Public Health Policy

Background Unhealthy commodity industries (UCIs) engage in political practices to influence public health policy, which poses barriers to protecting and promoting public health. Such influence exhibits characteristics of a complex system. Systems thinking would therefore appear to be a useful lens through which to study this phenomenon, potentially deepening our understanding of how UCI influence are interconnected with one another through their underlying political, economic and social structures. As such this study developed a qualitative systems map to depict the complex pathways through which UCIs influence public health policy and how they are interconnected with underlying structures. Methods Online participatory systems mapping workshops were conducted between November 2021 and February 2022. As a starting point for the workshops, a preliminary systems map was developed based on recent research. Twenty-three online workshops were conducted with 52 geographically diverse stakeholders representing academia, civil society (CS), public office, and global governance organisations (CGO). Analysis of workshop data in NVivo and feedback from participants resulted in a final systems map. Results The preliminary systems map consisted of 40 elements across six interdependent themes. The final systems map consisted of 64 elements across five interdependent themes, representing key pathways through which UCIs impact health policy-making: (1) direct access to public sector decision-makers; (2) creation of confusion and doubt about policy decisions; (3) corporate prioritisation of commercial profits and growth; (4) industry leveraging the legal and dispute settlement processes; and (5) industry leveraging policy-making, norms, rules, and processes. Conclusion UCI influence on public health policy is highly complex, involves interlinked practices, and is not reducible to a single point within the system. Instead, pathways to UCI influence emerge from the complex interactions between disparate national and global political, economic and social structures. These pathways provide numerous avenues for UCIs to influence public health policy, which poses challenges to formulating a singular intervention or limited set of interventions capable of effectively countering such influence. Using participatory methods, we made transparent the interconnections that could help identify interventions in future work

Embedded researchers as part of a whole systems approach to physical activity: reflections and recommendations

Whole systems approaches are increasingly being advocated as a way of responding to complex public health priorities such as obesity and physical inactivity. Due to the complex and adaptive nature of such systems, researchers are increasingly being embedded within host organisations (i.e., those which facilitate the whole systems approach) to work with key stakeholders to illuminate and understand mechanisms of change and develop a culture of continuous improvement. While previous literature has reported on the benefits and challenges of embedded researchers in health care, little is known about the experiences and learnings of those situated within these complex whole systems approaches. In this paper, we present our reflections of being embedded researchers within four distinct whole systems approaches and outline recommendations and considerations for commissioners working with or seeking support from an embedded researcher

A whole system approach to increasing children’s physical activity in a multi-ethnic UK city:a process evaluation protocol

BACKGROUND: Engaging in regular physical activity requires continued complex decision-making in varied and dynamic individual, social and structural contexts. Widespread shortfalls of physical activity interventions suggests the complex underlying mechanisms of change are not yet fully understood. More insightful process evaluations are needed to design and implement more effective approaches. This paper describes the protocol for a process evaluation of the JU:MP programme, a whole systems approach to increasing physical activity in children and young people aged 5–14 years in North Bradford, UK. METHODS: This process evaluation, underpinned by realist philosophy, aims to understand the development and implementation of the JU:MP programme and the mechanisms by which JU:MP influences physical activity in children and young people. It also aims to explore behaviour change across wider policy, strategy and neighbourhood systems. A mixed method data collection approach will include semi-structured interview, observation, documentary analysis, surveys, and participatory evaluation methods including reflections and ripple effect mapping. DISCUSSION: This protocol offers an innovative approach on the use of process evaluation feeding into an iterative programme intended to generate evidence-based practice and deliver practice-based evidence. This paper advances knowledge regarding the development of process evaluations for evaluating systems interventions, and emphasises the importance of process evaluation. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-021-12255-w