The impact of financial incentives on participants' food purchasing patterns in a supermarket-based randomized controlled trial

Background: The impacts of supermarket-based nutrition promotion interventions might be overestimated if participants shift their proportionate food purchasing away from their usual stores. This study quantified whether participants who received price discounts on fruits and vegetables (FV) in the Supermarket Healthy Eating for Life (SHELf) randomized controlled trial (RCT) shifted their FV purchasing into study supermarkets during the intervention period. Methods: Participants were 642 females randomly assigned to a 1) skill-building (n=160), 2) price reduction (n=161), 3) combined skill-building and price reduction (n=160), or 4) control (n=161) group. Participants self-reported the proportion of FV purchased in study supermarkets at baseline, 3- and 6-months post-intervention. Fisher's exact and ?2 tests assessed differences among groups in the proportion of FV purchased in study supermarkets at each time point. Multinomial logistic regression assessed differences among groups in the change in proportionate FV purchasing over time. Results: Post-intervention, 49% of participants purchased =50% of their FV in study supermarkets. Compared to all other groups, the price reduction group was approximately twice as likely (RRR: 1.8-2.2) to have increased proportionate purchasing of FV in study supermarkets from baseline to post-intervention (p<0.05). Conclusions: Participants who received price reductions on FV were approximately twice as likely to shift their FV purchasing from other stores into study supermarkets during the intervention period. Unless food purchasing data are available for all sources, differential changes in purchasing patterns can make it difficult to discern the true impacts of nutrition interventions. Trial registration: The SHELf trial is registered with Current Controlled Trials Registration ISRCTN39432901, Registered 30 June 2010, Retrospectively registered (http://www.isrctn.com/ISRCTN39432901

Food is medicine: Actions to integrate food and nutrition into healthcare

A global epidemic of diet related chronic disease has prompted experimentation using food as a formal part of patient care and treatment. One of every five deaths across the globe is attributable to suboptimal diet, more than any other risk factor including tobacco. Individual interactions with the healthcare system are an important opportunity to offer evidence based food and nutrition interventions. An emerging but compelling body of research indicates that such interventions delivered in the healthcare system might be associated with improved health outcomes and reduced healthcare usage and costs. These data point to the potential for food and nutrition interventions to play a prominent role in the prevention, management, treatment, and even in some cases reversal of disease. When broadly deployed, interventions that are effective for individual patients have the potential to affect population health and shape broader food and health policy reform. Realisation of health benefits is, however, hampered by lack of investment in research, low levels of clinician nutrition knowledge and awareness of interventions, and narrow access to appropriate services and programmes. Tackling each of these challenges is critical to achieving a healthcare system in which nutrition and food are a routine part of evidence based disease prevention and treatment

Differences in Race Characteristics between World-Class Individual-Medley and Stroke-Specialist Swimmers

The purpose of the present study was to investigate differences between world-class individual medley (IM) swimmers and stroke-specialists using race analyses. A total of eighty 200 m races (8 finalists × 2 sexes × 5 events) at the 2021 European long-course swimming championships were analysed. Eight digital video cameras recorded the races, and the video footage was manually analysed to obtain underwater distance, underwater time, and underwater speed, as well as clean-swimming speed, stroke rate, and distance per stroke. Each lap of the IM races was compared with the first, second, third, and fourth laps of butterfly, backstroke, breaststroke, and freestyle races, respectively. Differences between IM swimmers and specialists in each analysed variable were assessed using an independent-sample t-test, and the effects of sex and stroke on the differences were analysed using a two-way analysis of variance with relative values (IM swimmers’ score relative to the mean specialists’ score) as dependent variables. Breaststroke specialists showed faster clean-swimming speed and longer distance per stroke than IM swimmers for both males (clean-swimming speed: p = 0.011; distance per stroke: p = 0.023) and females (clean-swimming speed: p = 0.003; distance per stroke: p = 0.036). For backstroke and front crawl, specialists exhibited faster underwater speeds than IM swimmers (all p < 0.001). Females showed faster relative speeds during butterfly clean-swimming segments (p < 0.001) and breaststroke underwater segments than males (p = 0.028). IM swimmers should focus especially on breaststroke training, particularly aiming to improve their distance per stroke

A multiple case history and systematic review of adoption, diffusion, implementation and impact of provincial daily physical activity policies in Canadian schools

BACKGROUND : Few children meet physical activity (PA) recommendations, and are therefore at increased risk for overweight/obesity and adverse health outcomes. To increase children\u27s opportunities for PA, several Canadian provinces have adopted school-based daily PA (DPA) policies. It is not clear why some jurisdictions have adopted DPA policies, and others have not, nor whether these policies have been implemented and have achieved their intended outcomes. The purpose of this study was to understand the processes underlying adoption and diffusion of Canadian DPA policies, and to review evidence regarding their implementation and impact. METHODS: We adopted a multiple case history methodology in which we traced the chronological trajectory of DPA policies among Canadian provinces by compiling timelines detailing key historical events that preceded policy adoption. Publicly available documents posted on the internet were reviewed to characterize adopter innovativeness, describe the content of their DPA policies, and explore the context surrounding policy adoption. Diffusion of Innovations theory provided a conceptual framework for the analyses. A systematic literature search identified studies that had investigated adoption, diffusion, implementation or impact of Canadian DPA policies. RESULTS: Five of Canada\u27s 13 provinces and territories (38.5%) have DPA policies. Although the underlying objectives of the policies are similar, there are clear differences among them and in their various policy trajectories. Adoption and diffusion of DPA policies were structured by the characteristics and capacities of adopters, the nature of their policies, and contextual factors. Limited data suggests implementation of DPA policies was moderate but inconsistent and that Canadian DPA policies have had little to no impact on school-aged children\u27s PA levels or BMI. CONCLUSIONS: This study detailed the history and current status of Canadian DPA policies, highlighting the conditional nature of policy adoption and diffusion, and describing policy and adopter characteristics and political contexts that shaped policy trajectories. An understanding of the conditions associated with successful policy adoption and diffusion can help identify receptive contexts in which to pioneer novel legislative initiatives to increase PA among children. By reviewing evidence regarding policy implementation and impact, this study can also inform amendments to existing, and development of future PA policies

Correction: Faught et al. “Socioeconomic Disadvantage across the Life Course is associated with Diet Quality in Young Adulthood” Nutrients, 2019, 11(2), 242

We noticed an error in the text that requires correcting as it may contribute to an incorrect understanding of our study’s scientific conclusions. In the text accompanying Table 4 (Section 3.3: Mediation Analysis (Pathways Hypothesis), page 11), the third sentence in the paragraph reads: “Adult SEP at the level of university education mediated associations between childhood SEP and mean adult HEI-2015 score (p < 0.001).” This should in fact read: “Adult SEP at the level of high school or less mediated associations between childhood SEP and mean adult HEI-2015 score (p < 0.001).” This correction is consistent with the results presented in Table 4, and in line with the scientific conclusions discussed in the article that a low socioeconomic position (SEP) in adulthood mediates associations between childhood SEP and adult diet quality. SEP at the level of university education was the reference group in this analysis

Understanding sport clubs as sport policy implementers

The original publication is available at: http://dx.doi.org/10.1080/17430430802196553This article aims at developing a theoretical framework for analysing the implementation of sport policy, as it is conducted by voluntary sport clubs at grass root level. First, three options are presented and discussed: (i) a classical top-down implementation model, (ii) the governance theory of policy tools, and (iii) the Advocacy Coalition Framework. Second, the theoretical perspectives are discussed, and criticized for failing to take sufficiently into account the implementing body of sport policy, namely the voluntary sport clubs. In that respect, an alternative theoretical framework is suggested as a possible solution for analysing the implementation of sport policy; which is the translation perspective of neo-institutionalism. It stresses that, if elements of central policy influence the implementation process at the local level, it does so by the active import, interpretation and implementation of it in the local context. The autonomy of the local sport club in relation to central policy is reinforced by the fact that the activity in sport clubs is mainly done on a voluntary basi

Biosecurity and Vector Behaviour: Evaluating the Potential Threat Posed by Anglers and Canoeists as Pathways for the Spread of Invasive Non-Native Species and Pathogens

Invasive non-native species (INNS) endanger native biodiversity and are a major economic problem. The management of pathways to prevent their introduction and establishment is a key target in the Convention on Biological Diversity's Aichi biodiversity targets for 2020. Freshwater environments are particularly susceptible to invasions as they are exposed to multiple introduction pathways, including non-native fish stocking and the release of boat ballast water. Since many freshwater INNS and aquatic pathogens can survive for several days in damp environments, there is potential for transport between water catchments on the equipment used by recreational anglers and canoeists. To quantify this biosecurity risk, we conducted an online questionnaire with 960 anglers and 599 canoeists to investigate their locations of activity, equipment used, and how frequently equipment was cleaned and/or dried after use. Anglers were also asked about their use and disposal of live bait. Our results indicate that 64% of anglers and 78.5% of canoeists use their equipment/boat in more than one catchment within a fortnight, the survival time of many of the INNS and pathogens considered in this study and that 12% of anglers and 50% of canoeists do so without either cleaning or drying their kit between uses. Furthermore, 8% of anglers and 28% of canoeists had used their equipment overseas without cleaning or drying it after each use which could facilitate both the introduction and secondary spread of INNS in the UK. Our results provide a baseline against which to evaluate the effectiveness of future biosecurity awareness campaigns, and identify groups to target with biosecurity awareness information. Our results also indicate that the biosecurity practices of these groups must improve to reduce the likelihood of inadvertently spreading INNS and pathogens through these activities

A qualitative study of the learning processes in young physicians treating suicidal patients: from insecurity to personal pattern knowledge and self-confidence

<p>Abstract</p> <p>Background</p> <p>Little empirical work has been done in studying learning processes among newly educated physicians in the mental health field.</p> <p>The aim of the study was to shed light on the meaning of newly educated physicians' lived experiences of learning processes related to treating suicidal patients.</p> <p>Methods</p> <p>Thirteen newly educated physicians narrated their learning experiences while treating suicidal patients in their own practice. The interview texts were transcribed and interpreted using a phenomenological-hermeneutical method inspired by Ricoeur's philosophy.</p> <p>Results</p> <p>There was one main theme, four themes and eleven sub themes. The main theme was: Being in a transitional learning process. The themes and sub themes were: Preparing for practice (Getting tools and training skills, Becoming aware of one's own attitudes); Gaining experience from treating patients (Treating and following up patients over time, Storing memories and recognizing similarities and differences in patients); Participating in the professional community (Being an apprentice, Relating clinical stories and receiving feedback, Sharing emotions from clinical experiences, Receiving support from peers); and Developing personal competence (Having unarticulated awareness, Having emotional knowledge, Achieving self-confidence). The informants gave a detailed account of the learning process; from recognising similarities and differences in patients they have treated, to accumulating pattern knowledge, which then contributed to their personal feelings of competence and confidence. They described their personal competence with cognitive and emotional elements consisting of both articulated and less articulated knowledge. The findings are interpreted in relation to different learning theories that focus on both individual factors and the interaction with the learning environment.</p> <p>Conclusion</p> <p>This study provides additional information about learning experiences of young physicians during the critical transition phase from medical school to early professional life. Peers are used for both learning and support and might represent a more powerful resource in the learning process than previously recognized. Emotional experiences do not seem to be adequately focused upon in supervision, which obviously has relevance both for learning and for the well-being of young professionals. The study indicates some areas of the educational system that could profitably be expanded including stimulating more systematically to critical reflection on and in practice, attention to feelings in the reflective process and provision of more performance feedback to young physicians.</p

Skeletal Site-Related Variation in Human Trabecular Bone Transcriptome and Signaling

BACKGROUND: The skeletal site-specific influence of multiple genes on bone morphology is recognised, but the question as to how these influences may be exerted at the molecular and cellular level has not been explored. METHODOLOGY: To address this question, we have compared global gene expression profiles of human trabecular bone from two different skeletal sites that experience vastly different degrees of mechanical loading, namely biopsies from iliac crest and lumbar spinal lamina. PRINCIPAL FINDINGS: In the lumbar spine, compared to the iliac crest, the majority of the differentially expressed genes showed significantly increased levels of expression; 3406 transcripts were up- whilst 838 were down-regulated. Interestingly, all gene transcripts that have been recently demonstrated to be markers of osteocyte, as well as osteoblast and osteoclast-related genes, were markedly up-regulated in the spine. The transcriptome data is consistent with osteocyte numbers being almost identical at the two anatomical sites, but suggesting a relatively low osteocyte functional activity in the iliac crest. Similarly, osteoblast and osteoclast expression data suggested similar numbers of the cells, but presented with higher activity in the spine than iliac crest. This analysis has also led to the identification of expression of a number of transcripts, previously known and novel, which to our knowledge have never earlier been associated with bone growth and remodelling. CONCLUSIONS AND SIGNIFICANCE: This study provides molecular evidence explaining anatomical and micro-architectural site-related changes in bone cell function, which is predominantly attributable to alteration in cell transcriptional activity. A number of novel signaling molecules in critical pathways, which have been hitherto not known to be expressed in bone cells of mature vertebrates, were identified

Evaluation of a health promotion program in children: Study protocol and design of the cluster-randomized Baden-Württemberg primary school study [DRKS-ID: DRKS00000494]

<p>Abstract</p> <p>Background</p> <p>Increasing prevalences of overweight and obesity in children are known problems in industrialized countries. Early prevention is important as overweight and obesity persist over time and are related with health problems later in adulthood. "Komm mit in das gesunde Boot - Grundschule" is a school-based program to promote a healthier lifestyle. Main goals of the intervention are to increase physical activity, decrease the consumption of sugar-sweetened beverages, and to decrease time spent sedentary by promoting active choices for healthy lifestyle. The program to date is distributed by 34 project delivery consultants in the state of Baden-Württemberg and is currently implemented in 427 primary schools. The efficacy of this large scale intervention is examined via the Baden-Württemberg Study.</p> <p>Methods/Design</p> <p>The Baden-Württemberg Study is a prospective, stratified, cluster-randomized, and longitudinal study with two groups (intervention group and control group). Measurements were taken at the beginning of the academic years 2010/2011 and 2011/2012. Efficacy of the intervention is being assessed using three main outcomes: changes in waist circumference, skinfold thickness and 6 minutes run. Stratified cluster-randomization (according to class grade level) was performed for primary schools; pupils, teachers/principals, and parents were investigated. An approximately balanced number of classes in intervention group and control group could be reached by stratified randomization and was maintained at follow-up.</p> <p>Discussion</p> <p>At present, "Komm mit in das Gesunde Boot - Grundschule" is the largest school-based health promotion program in Germany. Comparative objective main outcomes are used for the evaluation of efficacy. Simulations showed sufficient power with the existing sample size. Therefore, the results will show whether the promotion of a healthier lifestyle in primary school children is possible using a relatively low effort within a school-based program involving children, teachers and parents. The research team anticipates that not only efficacy will be proven in this study but also expects many other positive effects of the program.</p> <p>Trial registration</p> <p>German Clinical Trials Register (DRKS), DRKS-ID: DRKS00000494</p