Measures of schoolchild height and weight as indicators of community nutrition, lessons from Brazil

Many countries measure the heights and weights of children in primary and secondary school. Individual children are usually monitored at school against growth charts, with appropriate referrals. Schoolchild data aggregated to the community, state or nation, and validated against population surveys, led to interventions such as school-based dietary supplementation and feeding, and community or national dietary education. Nutritional programs rarely target dietary needs of children 5-19. Influences on anthropometric nutritional status for children 0- 5 are widely examined in population surveys; but similar data are lacking for children 5-19, undesirably, as differences in growth and development from 5-19 are strongly associated with health in later life. Nutritional status of older children requires study in the context of household, community and national economic conditions. Many such details were surveyed by the Pesquisa de Orcamentos Familiares (POF), across the 27 provinces of Brazil, 2002-2003, conducted by the Instituto Brasileiro de Geografia e Estatistica (IBGE), a national agency publishing industrial activity, agricultural production, employment, prices, and GDP series. The POF sampled 48,470 households, and 178,375 persons, for household and social characteristics, anthropometrics, economic activity, sources of income, and detailed expenditures (for example 3,256 foods). Here, nutritional status of 50,237 persons aged 5-19 is estimated using WHO 2007 Reference Standards for age, sex, height, weight and BMI. Characteristics of students (public or private, age in grade) and children not enrolled in school, part and full-time employment, personal income and expenditure on food, entertainment and stimulants, were related to relative and seasonal differences in nutritional status. Child nutritional status also responded to household education, income, employment, spending (particularly on food), food consumption, adult and cohort anthropometrics, and community factors, such as urbanization and location. Outcomes and explanatory factors were mapped for spatial autocorrelation and tested for Granger causation over the survey period. Child nutritional status varied seasonally; annual school censuses do not model average nutritional status. Nutritional status of enrolled children incompletely modeled children not in school. Accordingly, continuing population surveys are necessary to monitor the nutritional status of all children 5-19. Variations in nutritional status of enrolled children were sensitive to economic data available at monthly or quarterly intervals in most places, such as local prices, economic activity and employment, suggesting these as factors in active policy. Despite its size, the POF sample was insufficient to very significantly model the responses of child nutritional status to local economic conditions. These are strong reasons to support the annual collection of height and weight for all schoolchildren, and to expand monitoring of the influence of community economic conditions on child nutritional status.Schoolchild Nutritional Status; Educational Attainment; Community Nutrition; WHO Child Growth Reference; Brazil; Local Regression; Spatial Statistics; Granger Causation; Multilevel Analysis

Understanding quit decisions in primary care: a qualitative study of older GPs

This is the final version of the article. Available from the publisher via the DOI in this record.OBJECTIVE: To investigate the reasons behind intentions to quit direct patient care among experienced general practitioners (GPs) aged 50-60 years. DESIGN AND SETTING: Qualitative study based on semistructured interviews with GPs in the South West region of England. Transcribed interviews were analysed thematically. PARTICIPANTS: 23 GPs aged 50-60 years: 3 who had retired from direct patient care before age 60, and 20 who intended to quit direct patient care within the next 5 years. RESULTS: The analysis identified four key themes: early retirement is a viable option for many GPs; GPs have employment options other than undertaking direct patient care; GPs report feeling they are doing an (almost) undoable job; and GPs may have other aspirations that pull them away from practice. Findings from this study confirmed those from earlier research, with high workload, ageing and health, family and domestic life, and organisational change all influencing GPs' decisions about when to retire/quit direct patient care. However, in addition, GPs expressed feelings of insecurity and uncertainty regarding the future of general practice, low morale, and issues regarding accountability (appraisal and revalidation) and governance. Suggestions about how to help retain GPs within the active clinical workforce were offered, covering individual, practice and organisational levels. CONCLUSIONS: This research highlights aspects of the current professional climate for GPs that are having an impact on retirement decisions. Any future changes to policy or practice to help retain experienced GPs will benefit from this informed understanding of GPs' views. Key factors to take into account include: making the GP workload more manageable; managing change sympathetically; paying attention to GPs' own health; improving confidence in the future of general practice; and improving GP morale.This study was funded by the South West Academic Health Science Network (grant number: SWAHSN 4.21.019) and the University of Exeter Medical School

Estimating everyday portion size using a 'method of constant stimuli': in a student sample, portion size is predicted by gender, dietary behaviour, and hunger, but not BMI

This paper (i) explores the proposition that body weight is associated with large portion sizes and (ii) introduces a new technique for measuring everyday portion size. In our paradigm, the participant is shown a picture of a food portion and is asked to indicate whether it is larger or smaller than their usual portion. After responding to a range of different portions an estimate of everyday portion size is calculated using probit analysis. Importantly, this estimate is likely to be robust because it is based on many responses. First-year undergraduate students (N=151) completed our procedure for 12 commonly consumed foods. As expected, portion sizes were predicted by gender and by a measure of dieting and dietary restraint. Furthermore, consistent with reports of hungry supermarket shoppers, portion-size estimates tended to be higher in hungry individuals. However, we found no evidence for a relationship between BMI and portion size in any of the test foods. We consider reasons why this finding should be anticipated. In particular, we suggest that the difference in total energy expenditure of individuals with a higher and lower BMI is too small to be detected as a concomitant difference in portion size (at least in our sample)

Letter from Jim Calitri to Rev. Kenneth Sicard, O.P.

Providence College Department of Theatre, Dance & Film Letter from Jim Calitri to Rev. Kenneth Sicard, O.P. inviting him to a production of Bat Boy: The Musical. October 1, 2018https://digitalcommons.providence.edu/bat_boy_pubs/1008/thumbnail.jp

Mild traumatic brain injury in contact sport athletes and the development of neurodegenerative disease

Every year an estimated 42 million people worldwide suffer a mild traumatic brain injury (MTBI) or concussion, with approximately 3.6 million sports related concussions occurring yearly in the United States alone (Bailes, 2015, Azad et al., 2015). An MTBI is an acute brain injury resulting from mechanical energy to the head from external forces (Bailes 2015). Symptoms of an MTBI include visual disturbances, dizziness, nausea and vomiting, light sensitivity, loss of balance, and a general feeling of fatigue (Bailes 2015). MTBI’s are first diagnosed through changes in ImPACT baseline scores as well as Vestibular Ocular Motor Screening (Mucha et al., 2014). Repetitive MTBI and/or repetitive sub-concussive head trauma have been tentatively linked to increased risk for a variety of neurodegenerative diseases including chronic traumatic encephalopathy (CTE) (Gardner et al., 2015). The major limitation of the link between MTBI and CTE is that CTE can only be diagnosed post-mortem (Azad et al., 2015). Due to that limitation, the prevalence of CTE is unknown and the amount of MTBI or sub-concussive trauma exposure necessary to produce CTE is unclear (Gardner et al., 2015). Newer methods of research including SNTF immunostaining and L-COSY are being further developed and studied to better diagnose MTBI and its link to CTE by exploring changes in brain protein formation and brain neurochemistry (Johnson et al., 2015, Lin et al., 2015). Through research development and case studies on professional American football players and boxers, a link between MTBI, particularly repetitive MTBI and CTE has been formed (Maroon et al., 2014)

Alternative Concepts of Geology and Time in Secondary Science Education

This study examines students’ concepts of time and geologic processes and probes for alternative conceptions in these areas which would be of relevance for science education

Cognitive biases to healthy and unhealthy food words predict change in BMI

The current study explored the predictive value of cognitive biases to food cues (assessed by emotional Stroop and dot probe tasks) on weight change over a 1-year period. This was a longitudinal study with undergraduate students (N = 102) living in shared student accommodation. After controlling for the effects of variables associated with weight (e.g., physical activity, stress, restrained eating, external eating, and emotional eating), no effects of cognitive bias were found with the dot probe. However, for the emotional Stroop, cognitive bias to unhealthy foods predicted an increase in BMI whereas cognitive bias to healthy foods was associated with a decrease in BMI. Results parallel findings in substance abuse research; cognitive biases appear to predict behavior change. Accordingly, future research should consider strategies for attentional retraining, encouraging individuals to reorient attention away from unhealthy eating cues

Community-based Rehabilitation Training after stroke: Protocol of a pilot randomised controlled trial (ReTrain)

Introduction: The Rehabilitation Training (ReTrain) intervention aims to improve functional mobility, adherence to poststroke exercise guidelines and quality of life for people after stroke. A definitive randomised controlled trial (RCT) is required to assess the clinical and cost-effectiveness of ReTrain, which is based on Action for Rehabilitation from Neurological Injury (ARNI). The purpose of this pilot study is to assess the feasibility of such a definitive trial and inform its design. Methods and analysis: A 2-group, assessor-blinded, randomised controlled external pilot trial with parallel mixed-methods process evaluation and economic evaluation. 48 participants discharged from clinical rehabilitation despite residual physical disability will be individually randomised 1:1 to ReTrain (25 sessions) or control (exercise advice booklet). Outcome assessment at baseline, 6 and 9 months include Rivermead Mobility Index; Timed Up and Go Test; modified Patient-Specific Functional Scale; 7-day accelerometry; Stroke Self-efficacy Questionnaire, exercise diary, Fatigue Assessment Scale, exercise beliefs and self-efficacy questionnaires, SF-12, EQ-5D-5L, Stroke Quality of Life, Carer Burden Index and Service Receipt Inventory. Feasibility, acceptability and process outcomes include recruitment and retention rates; with measurement burden and trial experiences being explored in qualitative interviews (20 participants, 3 intervention providers). Analyses include descriptive statistics, with 95% CI where appropriate; qualitative themes; intervention fidelity from videos and session checklists; rehearsal of health economic analysis. Ethics and dissemination: National Health Service (NHS) National Research Ethics Service approval granted in April 2015; recruitment started in June. Preliminary studies suggested low risk of serious adverse events; however (minor) falls, transitory muscle soreness and high levels of postexercise fatigue are expected. Outputs include pilot data to inform whether to proceed to a definitive RCT and support a funding application; finalised Trainer and Intervention Delivery manuals for multicentre replication of ReTrain; presentations at conferences, public involvement events; internationally recognised peer-reviewed journal publications, open access sources and media releases

Implementing telephone triage in general practice: a process evaluation of a cluster randomised controlled trial

Background: Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. However, limited evidence exists of the challenges GP practices face in implementing telephone triage. We conducted a qualitative process evaluation alongside a UK-based cluster randomised trial (ESTEEM) which compared the impact of GP-led and nurse-led telephone triage with usual care on primary care workload, cost, patient experience, and safety for patients requesting a same-day GP consultation. The aim of the process study was to provide insights into the observed effects of the ESTEEM trial from the perspectives of staff and patients, and to specify the circumstances under which triage is likely to be successfully implemented. Here we report perspectives of staff. Methods: The intervention comprised implementation of either GP-led or nurse-led telephone triage for a period of 2-3 months. A qualitative evaluation was conducted using staff interviews recruited from eight general practices (4 GP triage, 4 Nurse triage) in the UK, implementing triage as part of the ESTEEM trial. Qualitative interviews were undertaken with 44 staff members in GP triage and nurse triage practices (16 GPs, 8 nurses, 7 practice managers, 13 administrative staff). Results: Staff reported diverse experiences and perceptions regarding the implementation of telephone triage, its effects on workload, and on the benefits of triage. Such diversity were explained by the different ways triage was organised, the staffing models used to support triage, how the introduction of triage was communicated across practice staff, and by how staff roles were reconfigured as a result of implementing triage. Conclusion: The findings from the process evaluation offer insight into the range of ways GP practices participating in ESTEEM implemented telephone triage, and the circumstances under which telephone triage can be successfully implemented beyond the context of a clinical trial. Staff experiences and perceptions of telephone triage are shaped by the way practices communicate with staff, prepare for and sustain the changes required to implement triage effectively, as well as by existing practice culture, and staff and patient behaviour arising in response to the changes made. Trial registration: Current Controlled Trials ISRCTN20687662. Registered 28 May 2009