Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact.

BACKGROUND: Interventions to promote healthy eating make a potentially powerful contribution to the primary prevention of non communicable diseases. It is not known whether healthy eating interventions are equally effective among all sections of the population, nor whether they narrow or widen the health gap between rich and poor. We undertook a systematic review of interventions to promote healthy eating to identify whether impacts differ by socioeconomic position (SEP). METHODS: We searched five bibliographic databases using a pre-piloted search strategy. Retrieved articles were screened independently by two reviewers. Healthier diets were defined as the reduced intake of salt, sugar, trans-fats, saturated fat, total fat, or total calories, or increased consumption of fruit, vegetables and wholegrain. Studies were only included if quantitative results were presented by a measure of SEP. Extracted data were categorised with a modified version of the "4Ps" marketing mix, expanded to 6 "Ps": "Price, Place, Product, Prescriptive, Promotion, and Person". RESULTS: Our search identified 31,887 articles. Following screening, 36 studies were included: 18 "Price" interventions, 6 "Place" interventions, 1 "Product" intervention, zero "Prescriptive" interventions, 4 "Promotion" interventions, and 18 "Person" interventions. "Price" interventions were most effective in groups with lower SEP, and may therefore appear likely to reduce inequalities. All interventions that combined taxes and subsidies consistently decreased inequalities. Conversely, interventions categorised as "Person" had a greater impact with increasing SEP, and may therefore appear likely to reduce inequalities. All four dietary counselling interventions appear likely to widen inequalities. We did not find any "Prescriptive" interventions and only one "Product" intervention that presented differential results and had no impact by SEP. More "Place" interventions were identified and none of these interventions were judged as likely to widen inequalities. CONCLUSIONS: Interventions categorised by a "6 Ps" framework show differential effects on healthy eating outcomes by SEP. "Upstream" interventions categorised as "Price" appeared to decrease inequalities, and "downstream" "Person" interventions, especially dietary counselling seemed to increase inequalities. However the vast majority of studies identified did not explore differential effects by SEP. Interventions aimed at improving population health should be routinely evaluated for differential socioeconomic impact

A feasibility randomised controlled trial of a motivational interviewing-based intervention for weight loss maintenance in adults

Background Obesity has significant health and NHS cost implications. Relatively small reductions in weight have clinically important benefits, but long-term weight loss maintenance (WLM) is challenging. Behaviour change interventions have been identified as key for WLM. Motivation is crucial to supporting behaviour change, and motivational interviewing (MI) has been identified as a successful approach to changing health behaviours. The study was designed as an adequately powered, pragmatic randomised controlled trial (RCT); however, owing to recruitment issues, the study became a feasibility trial. Objectives To assess recruitment, retention, feasibility, acceptability, compliance and delivery of a 12-month intervention to support WLM. Secondary objectives were to assess the impact of the intervention on body mass index (BMI) and other secondary outcomes. Design Three-arm individually randomised controlled trial comprising an intensive arm, a less intensive arm and a control arm. Setting Community setting in South Wales and the East Midlands. Participants Individuals aged 18�70 years with a current or previous BMI of ??30 kg/m2 who could provide evidence of at least 5% weight loss during the previous 12 months. Intervention Participants received individually tailored MI, which included planning and self-monitoring. The intensive arm received six face-to-face sessions followed by nine telephone sessions. The less intensive arm received two face-to-face sessions followed by two telephone sessions. The control arm received a leaflet advising them on healthy lifestyle. Main outcome measures Feasibility outcomes included numbers recruited, retention and adherence. The primary effectiveness outcome was BMI at 12 months post randomisation. Secondary outcomes included waist circumference, waist-to-hip ratio, physical activity, proportion maintaining weight loss, diet, quality of life, health service resource usage, binge eating and well-being. A process evaluation assessed intervention delivery, adherence, and participants� and practitioners� views. Economic analysis aimed to assess cost-effectiveness in terms of quality-adjusted life-years (QALYs). Results A total of 170 participants were randomised. Retention was good (84%) and adherence was excellent (intensive, 83%; less intensive, 91%). The between-group difference in mean BMI indicated the intensive arm had BMIs 1.0?kg/m2 lower than the controls [95% confidence interval (CI) �2.2 kg/m2 to 0.2?kg/m2]. Similarly, a potential difference was found in weight (average difference of 2.8?kg, 95% CI �6.1 kg to 0.5?kg). The intensive arm had odds of maintaining on average 43% [odds ratio(OR) 1.4, 95% CI 0.6 to 3.5] higher than controls. None of these findings were statistically significant. Further analyses controlling for level of adherence indicated that average BMI was 1.2?kg/m2 lower in the intensive arm than the control arm (95% CI �2.5?kg/m2 to 0.0?kg/m2). The intensive intervention led to a statistically significant difference in weight (mean �3.7?kg, 95% CI �7.1?kg to �0.3?kg). The other secondary outcomes showed limited evidence of differences between groups. The intervention was delivered as planned, and both practitioners and participants were positive about the intervention and its impact. Although not powered to assess cost-effectiveness, results of this feasibility study suggest that neither intervention as currently delivered is likely to be cost-effective in routine practice. Conclusion This is the first trial of an intervention for WLM in the UK, the intervention is feasible and acceptable, and retention and adherence were high. The main effectiveness outcome showed a promising mean difference in the intensive arm. Owing to the small sample size, we are limited in the conclusions we can draw. However, findings suggest that the intensive intervention may facilitate long-term weight maintenance and, therefore, further testing in an effectiveness trial may be indicated. Research examining WLM is in its infancy, further research is needed to develop our understanding of WLM and to expand theory to inform the development of interventions to be tested in rigorously designed RCTs with cost-effectiveness assessed

Catholic-Protestant Wage Differentials in Northern Ireland 2011: A Re-examination with Newly Available Data

Despite an extensive literature on Catholic-Protestant unemployment differentials in Northern Ireland, little is known about wage differentials. This paper provides new evidence using the Earnings and Employees Study for 2011. We find no evidence of an overall Catholic wage penalty, with unadjusted and adjusted differentials no larger than 1.4 log per cent and statistically insignificant. Slightly larger differentials are found in some models for men, 50+ workers, and private sector workers, but again these are statistically indistinguishable from zero. Similar data linkages for 2001 and 1991 would enrich our understanding of the period when other measurable labour market disparities were wider

Photoneutron Yield for an Electron Beam on Tantalum and Erbium Deuteride

An electron beam may be used to generate bremsstrahlung photons that go on to create photoneutrons within metals. This serves as a low-energy neutron source for irradiation experiments [1-3]. In this article, we present simulation results for optimizing photoneutron yield for a 10-MeV electron beam on tantalum foil and erbium deuteride (ErD$_3$). The thickness of the metal layers was varied. A tantalum foil thickness of 1.5 mm resulted in the most photons reaching the second metal layer. When a second metal layer of ErD$_3$ was included, the photoneutron yield increased with the thickness of the secondary layer. When the electron beam was directly incident upon a layer of ErD$_3$, the photoneutron yield did not differ significantly from the yield when a layer of tantalum was included. The directional photoneutron yield reached a maximum level when the thickness of the ErD$_3$ layer was around 12 cm. About 1 neutron was generated per $10^4$ source electrons. When using a 2-mA beam current, it is possible to generate up to $10^{ 12}$ neutrons per second, making this combination a relatively-inexpensive neutron generator.Comment: 15 pages, 9 figures, 4 table

The Fission Fragment Rocket Engine for Mars Fast Transit

In this paper we discuss the advantages and challenges of utilizing Fission Fragment Rocket Engines (FFREs) to dramatically reduce transit time in space travel, for example, traveling to Mars. We discuss methods to decrease the size and weight of FFREs. These include utilizing metallic deuterides as moderators, driving the engines with electron beam bremsstrahlung, and operating the FFREs as subcritical assemblies, not as nuclear reactors. We discuss these and other new innovations based upon improved materials and technology that may be integrated into a revolutionary nuclear rocket technology.Comment: 10 pages, 2 figures, 2 table

International meta-analysis of PTSD genome-wide association studies identifies sex- and ancestry-specific genetic risk loci.

The risk of posttraumatic stress disorder (PTSD) following trauma is heritable, but robust common variants have yet to be identified. In a multi-ethnic cohort including over 30,000 PTSD cases and 170,000 controls we conduct a genome-wide association study of PTSD. We demonstrate SNP-based heritability estimates of 5-20%, varying by sex. Three genome-wide significant loci are identified, 2 in European and 1 in African-ancestry analyses. Analyses stratified by sex implicate 3 additional loci in men. Along with other novel genes and non-coding RNAs, a Parkinson's disease gene involved in dopamine regulation, PARK2, is associated with PTSD. Finally, we demonstrate that polygenic risk for PTSD is significantly predictive of re-experiencing symptoms in the Million Veteran Program dataset, although specific loci did not replicate. These results demonstrate the role of genetic variation in the biology of risk for PTSD and highlight the necessity of conducting sex-stratified analyses and expanding GWAS beyond European ancestry populations

Simulating Radiation Shielding Effectiveness Against Three Neutron Sources

Laboratories and Universities regularly apply for approval from the United States Nuclear Regulatory Commission (NRC) to use neutron generators for experimental research. To comply with the regulations set by the NRC, adequate shielding is necessary to ensure that the radiation dose rates experienced by an operator, and outside the walls of any containment buildings, are below the prescribed levels. Typically, the neutron source needs to be shielded such that the radiation dose rate experienced by any user is less than 0.25 mRem/hr (500mrem/2000-hour work-year). To address this requirement, we investigate the effectiveness of boronated concrete, boronated water, and light water shielding materials and their applicability to three neutron sources. We present our findings on the radiation shielding design and calculations for three neutron sources situated inside shielding layers. Our modeling utilized the Monte Carlo n-Particle transport codes (MCNP6.2) to simulate neutron attenuation of the shielding. The simulation results reveal that a light water shielding can sufficiently reduce the dose rate for an individual located as close as two meters from the source. Therefore, this shield design can effectively decrease the radiation dose below the maximum recommended limit.Comment: 9 pages, 6 figures, 2 table

Prospects For A New Light-Nuclei, Fission-Fusion Energy Cycle

Future advanced nuclear rocket propulsion, and the availability of new nuclear power cycle designs, will benefit substantially from the large current investment in alternative nuclear energy that is underway today. We propose a new nuclear cycle which includes the primary fission of lithium-6, followed by secondary fusion of deuterium and tritium, and a secondary fission of lithium-7 by tritium. This cycle does not produce nuclear waste from its nuclear fuel, since all byproducts of these cascade reactions are stable, provided that the triton production during the primary reaction is fully consumed in the secondary reactions. This cycle may, however, activate surrounding technical materials from its neutron flux. This light-element nuclear fuel is readily obtained through the ongoing expansion of the lithium mining industry and electric vehicle (EV) battery recycling industries.Comment: 10 pages, 2 figure

Estimating the health impact of air pollution in Scotland, and the resulting benefits of reducing concentrations in city centres

Air pollution continues to be a key health issue in Scotland, despite recent improvements in concentrations. The Scottish Government published the Cleaner Air For Scotland strategy in 2015, and will introduce Low Emission Zones (LEZs) in the four major cities (Aberdeen, Dundee, Edinburgh and Glasgow) by 2020. However, there is no epidemiological evidence quantifying the current health impact of air pollution in Scotland, which this paper addresses. Additionally, we estimate the health benefits of reducing concentrations in city centres where most LEZs are located. We focus on cardio-respiratory disease and total non-accidental mortality outcomes, linking them to concentrations of both particulate (PM10 and PM2.5) and gaseous (NO2 and NOx) pollutants. Our two main findings are that: (i) all pollutants exhibit significant associations with respiratory disease but not cardiovascular disease; and (ii) reducing concentrations in city centres with low resident populations only provides a small health benefit