Practices and values regarding milk consumption among pre-schoolers in Bangkok

Purpose: Thai government agencies and the business sector have been promoting milk consumption. Considering the robust and continual movements by those actors to promote milk consumption among children in Thailand at the national level, this study aims to investigate milk-consumption practices and values towards milk consumption at pre-school, family and individual levels. Methods: This cross-sectional qualitative study employs observation and interview methods, along with the Ecological System Theory as a framework. Data were collected from three kindergartens used by families of varying socio-economic status, and the homes of 18 pre-schoolers, aged 3-5 years old, attending these kindergartens, from October 2013-September 2014. Results: Findings reveal kindergartens implemented daily routines to make children drink milk. Practices at home include (i) overfeeding of milk, (ii) preference for fortified milk and (iii) using sweetness to make children drink milk. These practices were underpinned by values that milk is good for children and good parents feed their children milk. These values, in combination with other macro-level measures such as the government’s milk-promotion campaigns and the milk industry’s marketing, influence the milk-drinking practices of pre-schoolers. Conclusion: The promotion of the benefits of milk prompted children to exceed the recommended milk consumption of 400ml per day. Balanced information on moderation in milk drinking was absent

Fatigue, quality of life and physical fitness following an exercise intervention in multiple myeloma survivors (MASCOT): an exploratory randomised Phase 2 trial utilising a modified Zelen design

Background: Exercise may improve fatigue in multiple myeloma survivors, but trial evidence is limited, and exercise may be perceived as risky in this older patient group with osteolytic bone destruction. Methods: In this Phase 2 Zelen trial, multiple myeloma survivors who had completed treatment at least 6 weeks ago, or were on maintenance only, were enrolled in a cohort study and randomly assigned to usual care or a 6-month exercise programme of tailored aerobic and resistance training. Outcome assessors and usual care participants were masked. The primary outcome was the FACIT-F fatigue score with higher scores denoting less fatigue. Results: During 2014–2016, 131 participants were randomised 3:1 to intervention (n = 89) or usual care (n = 42) to allow for patients declining allocation to the exercise arm. There was no difference between groups in fatigue at 3 months (between-group mean difference: 1.6 [95% CI: −1.1–4.3]) or 6 months (0.3 [95% CI: −2.6–3.1]). Muscle strength improved at 3 months (8.4 kg [95% CI: 0.5–16.3]) and 6 months (10.8 kg [95% CI: 1.2–20.5]). Using per-protocol analysis, cardiovascular fitness improved at 3 months (+1.2 ml/kg/min [95% CI: 0.3–3.7]). In participants with clinical fatigue (n = 17), there was a trend towards less fatigue with exercise over 6 months (6.3 [95% CI: −0.6–13.3]). There were no serious adverse events. Conclusions: Exercise appeared safe and improved muscle strength and cardiovascular fitness, but benefits in fatigue appeared limited to participants with clinical fatigue at baseline. Future studies should focus on patients with clinical fatigue. Clinical trial registration: The study was registered with ISRCTN (38480455) and is completed

Profinteg: a tool for real-life assessment of activities of daily living in patients with cognitive impairment

Although there are many instruments for assessing activities of daily living (IADL) in brain injured patients, few instruments specifically target cognitive impairment and its impact on IADL. The present study presents the development of the Profinteg instrument, a tool for real-life assessment as well as rehabilitation of IADL in patients with cognitive impairment. This two-stage instrument covers over 90 activities. Psychometric properties of the different Profinteg measures were explored in twenty-five patients with mild to severe cognitive difficulties and twenty-five caregivers. The feasibility of the Profinteg rehabilitation procedure was explored in three patients. Excellent interrater reliability (r > 0.90,p < 0.01) was observed for all measures. Good sensitivity to changes in IADL disability over time was also observed (T= 2.37,p < 0.02). Significant improvement of IADL functioning was found after rehabilitation guided by Profinteg assessment. The Profinteg instrument detects with precision the difficulties patients encounter in their real-life setting via (I) assessment of a large number of activities and (2) detailed decomposition of activities into sub-activities. The Profinteg tool also provides promising results for guidance of IADL rehabilitation in the patient's real-life environment

Extreme weather and civil war:does drought fuel conflict in Somalia through livestock price shocks?

Climate change leads to more frequent and more intense droughts in Somalia. In a global context weather shocks have been found to perpetuate poverty and fuel civil conflict. By relating regional and temporal variations in violent conflict outbreaks and drought incidence and severity, we show that this causality is also valid for Somalia at the local level. We find that livestock price shocks drive drought-induced conflicts through reducing the opportunity costs of conflict participation. Our estimation results indicate that a temperature rise of around 3.2 degree Celcius—corresponding to the median IPCC scenario for Eastern Africa by the end of the century—would lower cattle prices by about 4 percent and, in turn, increase the number of violent conflict by about 58 percent. Hence climate change will further aggravate Somalia’s security challenges and calls for decisive action to strengthen both drought and conflict resilience, especially in pastoralist and agropastoralist livelihoods