We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
To compare the agreement and cost of two recall methods for estimating children’s minimum dietary diversity (MDD).
Design:
We assessed child’s dietary intake on two consecutive days: an observation on day one, followed by two recall methods (list-based recall and multiple-pass recall) administered in random order by different enumerators at two different times on day two. We compared the estimated MDD prevalence using survey-weighted linear probability models following a two one-sided test equivalence testing approach. We also estimated the cost-effectiveness of the two methods.
Setting:
Cambodia (Kampong Thom, Siem Reap, Battambang, and Pursat provinces) and Zambia (Chipata, Katete, Lundazi, Nyimba, and Petauke districts).
Participants:
Children aged 6–23 months: 636 in Cambodia and 608 in Zambia.
Results:
MDD estimations from both recall methods were equivalent to the observation in Cambodia but not in Zambia. Both methods were equivalent to the observation in capturing most food groups. Both methods were highly sensitive although the multiple-pass method accurately classified a higher proportion of children meeting MDD than the list-based method in both countries. Both methods were highly specific in Cambodia but moderately so in Zambia. Cost-effectiveness was better for the list-based recall method in both countries.
Conclusion:
The two recall methods estimated MDD and most other infant and young child feeding indicators equivalently in Cambodia but not in Zambia, compared to the observation. The list-based method produced slightly more accurate estimates of MDD at the population level, took less time to administer and was less costly to implement.
Prescribers who wrote at least 1 antibiotic prescription filled at a retail pharmacy in Tennessee in 2016.
Methods:
Multivariable logistic regression, including prescriber gender, birth decade, specialty, and practice location, and patient gender and age group, to determine the association with high prescribing.
Results:
In 2016, 7,949,816 outpatient oral antibiotic prescriptions were filled in Tennessee: 1,195 prescriptions per 1,000 total population. Moreover, 50% of Tennessee’s outpatient oral antibiotic prescriptions were written by 9.3% of prescribers. Specific specialties and prescriber types were associated with high prescribing: urology (odds ratio [OR], 3.249; 95% confidence interval [CI], 3.208–3.289), nurse practitioners (OR, 2.675; 95% CI, 2.658–2.692), dermatologists (OR, 2.396; 95% CI, 2.365–2.428), physician assistants (OR, 2.382; 95% CI, 2.364–2.400), and pediatric physicians (OR, 2.340; 95% CI, 2.320–2.361). Prescribers born in the 1960s were most likely to be high prescribers (OR, 2.574; 95% CI, 2.532–2.618). Prescribers in rural areas were more likely than prescribers in all other practice locations to be high prescribers. High prescribers were more likely to prescribe broader-spectrum antibiotics (P < .001).
Conclusions:
Targeting high prescribers, independent of specialty, degree, practice location, age, or gender, may be the best strategy for implementing cost-conscious, effective outpatient antimicrobial stewardship interventions. More information about high prescribers, such as patient volumes, clinical scope, and specific barriers to intervention, is needed.
Despite an increasing awareness of the importance of spirituality in mental health contexts, a ‘religiosity gap’ exists in the difference in the value placed on spirituality and religion by professionals compared with service users. This may be due to a lack of understanding about the complex ways people connect with spirituality within contemporary society and mental health contexts, and can result in people's spiritual needs being neglected, dismissed or pathologised within clinical practice. The aim of this qualitative systematic review is to characterise the experiences of spirituality among adults with mental health difficulties in published qualitative research.
Methods
An electronic search of seven databases was conducted along with forward and backward citation searching, expert consultation and hand-searching of journals. Thirty-eight studies were included from 4944 reviewed papers. The review protocol was pre-registered (PROSPERO:CRD42017080566).
Results
A thematic synthesis identified six key themes: Meaning-making (sub-themes: Multiple explanations; Developmental journey; Destiny v. autonomy), Identity, Service-provision, Talk about it, Interaction with symptoms (sub-themes: Interactive meaning-making; Spiritual disruption) and Coping (sub-themes: Spiritual practices; Spiritual relationship; Spiritual struggles; Preventing suicide), giving the acronym MISTIC.
Conclusions
This qualitative systematic review provides evidence of the significant role spirituality plays in the lives of many people who experience mental health difficulties. It indicates the importance of mental health professionals being aware of and prepared to support the spiritual dimension of people using services. The production of a theory-based framework can inform efforts by health providers to understand and address people's spiritual needs as part of an integrated holistic approach towards care.
The illegal wildlife trade is driving declines in populations of a number of large, charismatic animal species but also many lesser known and restricted-range species, some of which are now facing extinction as a result. The ploughshare tortoise Astrochelys yniphora, endemic to the Baly Bay National Park of north-western Madagascar, is affected by poaching for the international illegal pet trade. To quantify this, we estimated population trends during 2006–2015, using distance sampling surveys along line transects, and recorded national and international confiscations of trafficked tortoises for 2002–2016. The results suggest the ploughshare tortoise population declined > 50% during this period, to c. 500 adults and subadults in 2014–2015. Prior to 2006 very few tortoises were seized either in Madagascar or internationally but confiscations increased sharply from 2010. Since 2015 poaching has intensified, with field reports suggesting that two of the four subpopulations are extinct, leaving an unknown but almost certainly perilously low number of adult tortoises in the wild. This study has produced the first reliable population estimate of the ploughshare tortoise and shows that the species has declined rapidly because of poaching for the international pet trade. There is an urgent need for increased action both in Madagascar and along international trade routes if the extinction of the ploughshare tortoise in the wild is to be prevented.
Agriculture threatens biodiversity across the tropics, particularly in semi-natural grassland landscapes, where human populations are high, habitat is easily converted and agriculture is prone to intensification. Over the last 20 years intensive, commercial dry season rice cultivation has emerged as the dominant threat to the Bengal florican Houbaropsis bengalensis, a globally threatened bustard that breeds in the seasonally inundated grasslands of central Cambodia. Although floricans have been extensively monitored for 10 years, no socioeconomic research has been undertaken to examine how local livelihood activities interact with the florican. We conducted household questionnaires and focus groups in 21 villages in the Northern Tonle Sap Conservation Landscape to gather information on household demographics, rice farming and bird hunting in protected and unprotected areas of florican breeding habitat. We identified a significant increase in dry season rice adoption by local communities since 2005. Dry season rice cultivation was strongly associated with agrochemical use and rice fields directly overlapped with florican breeding habitat, reducing habitat availability throughout the breeding season. We identified a low but significant level of bird hunting in grassland households (8%) and revealed a demand for wild bird meat amongst local communities. Our findings suggest an urgent need for conservation interventions in unprotected farmland and emphasize the role of enforcement and community engagement in improving protection within protected areas. We highlight the potential of private sector initiatives such as the Sustainable Rice Platform in reconciling conservation and development for impoverished rural communities.
Herbicide resistance is the heritable ability of a weed biotype or population to survive a herbicide application that would effectively kill a susceptible population of the weed. In the U.K. the most widespread and financially important herbicide-resistant weed is blackgrass. Investigations to elucidate the molecular mechanisms conferring herbicide resistance to blackgrass populations have been ongoing for two decades. Although the identification of target site–resistant populations has proved to be relatively straightforward (using, for example, target site assays in vitro), the study and understanding of resistance mechanisms involved in enhanced metabolism has proven to be more problematic. Research has focused on the cytochrome P450 monooxygenase and glutathione S-transferase (GST) enzyme families, both of which have been shown to be important in herbicide metabolism in many weed and crop species. GST activity and abundance are greater in a selection of herbicide-resistant blackgrass biotypes, and herbicide treatment of field populations of blackgrass results in the survival of the proportion of population possessing the greatest GST activity and abundance. In addition, GST activity in the field increases between winter and spring, and this coincides with reduced efficacy of important blackgrass herbicides. GST activities within field populations of blackgrass are highly varied, and this plasticity is discussed in relation to the development of resistant populations in field situations. This article describes research results in blackgrass and compares them with GST studies in other weed species as well as with other mechanisms for enhanced metabolism-based resistance.
Non-communicable diseases (NCD) are a major and increasing contributor to morbidity and mortality in developed and developing countries. Much of the chronic disease burden is preventable through modification of lifestyle behaviours, and increased attention is being focused on identifying and implementing effective preventative health strategies. Nutrition has been identified as a major modifiable determinant of NCD. The recent merging of health economics and nutritional sciences to form the nascent discipline of nutrition economics aims to assess the impact of diet on health and disease prevention, and to evaluate options for changing dietary choices, while incorporating an understanding of the immediate impacts and downstream consequences. In short, nutrition economics allows for generation of policy-relevant evidence, and as such the discipline is a crucial partner in achieving better population nutritional status and improvements in public health and wellness. The objective of the present paper is to summarise presentations made at a satellite symposium held during the 11th European Nutrition Conference, 28 October 2011, where the role of nutrition and its potential to reduce the public health burden through alleviating undernutrition and nutrition deficiencies, promoting better-quality diets and incorporating a role for functional foods were discussed.
Many conservation interventions seek to change resource users' behaviour through the creation and enforcement of rules. Their success depends on changing the incentives of potential rule-breakers and those who monitor and enforce compliance. Project implementers may use payments to encourage monitoring and sanctions to deter rule breaking but there has been little research to examine the effectiveness of such approaches in promoting compliance with conservation rules. The effects of payments and sanctions on poaching in a hypothetical community-based conservation project were investigated using an individual-based model incorporating individual heterogeneity and a realistic range of behaviours. Individuals could choose to poach, monitor others' behaviour, or ‘cheat’ (claim a fee without actually monitoring behaviour). They could also invest in avoidance to reduce their probability of being detected breaking rules. Community-level outcomes emerged from individuals’ choices and strategic interactions. The model demonstrates that payments and sanctions can interact strongly with one another and that their effects depend on the economic context in which they are applied. Sanctions were more reliable than payments in reducing poaching and, in some circumstances, payments produced perverse effects. It is thus important to consider individual-level heterogeneity and strategic decision-making when designing interventions aimed at changing human behaviour.
The Okenyenya igneous complex is one of a suite of intrusions which define a prominent northeast-trending linear feature in Damaraland, northwestern Namibia. Precise Rb–Sr internal isochron ages range from 128.6 ± 1 to 123.4 ± 1.4 Ma for the major phases of intrusion identified within the complex. The tholeiitic gabbros forming the outer rings of the complex, and the later alkali gabbros which form the central hills, cannot be distinguished in terms of Rb–Sr ages, although field relations clearly indicate the younger age of the latter. The intrusionsof nepheline-syenite and essexite comprising the mountain of Okenyenya Bergon the northern edge of the complex give ages of 123.4 ± 1.4 and 126.3 ± 1 Ma, respectively, and form the final major phase of intrusion. The ages obtained for early and late intrusive phases define a minimum magmatic ‘life-span’ of approximately 5 Ma for the complex. The determined age of the Okenyenya igneous complex (129–123 Ma), when taken together with the few reliable published ages for other Damaraland complexes (130–134 Ma), suggests that these sub-volcanic complexes were emplaced contemporaneously with the widespread Etendeka volcanics (˜ 130 Ma), and relate to magmatism associated with the breakup of southern Africa and South America with the opening of the South Atlantic Ocean. The linear distributionof intrusions in Damaraland is interpreted to be due to magmatism resultingfrom the upwelling Tristan plume being focused along a structural discontinuity between the Pan-African, Damaran terrain to the south, and Proterozoiccratonic basement to the north.
Objective: To review the results of surgical management of chronic parotid sialadenitis refractory to medical therapy, with particular respect to long-term symptom resolution and development of post-operative complications.
Methods: A retrospective review of parotidectomies performed for chronic intractable parotid sialadenitis. Information was collected about presentation, pre-operative investigations, surgical treatment, post-operative complications and outcome.
Results: 36 parotidectomies were performed for chronic sialadenitis between 1991 and 2002. Age at presentation was 56±9.6 years, with median symptom duration of 2.3 years. For patients with non-specific presentations, magnetic resonance imaging (MRI) was the most useful pre-operative investigation. Superficial parotidectomy with duct preservation was the main treatment with a 94 per cent success rate, and near-total parotidectomy was reserved for patients with extensive deep-lobe involvement. Duct ligation significantly increased the risk of transient facial palsy. There was a 56 per cent and 22 per cent incidence of temporary facial paresis and Frey's syndrome, respectively.
Conclusions: Controversies exist regarding the optimal pre-operative investigation and surgical treatment of chronic parotid sialadenitis. We advocate magnetic resonance image (MRI) scanning for patients with non-specific symptoms of sialadenitis, and sialography in the presence of reasonable clinical suspicion. We propose superficial parotidectomy without parotid duct ligation as the standard of care, with near-total parotidectomy reserved for extensive deep-lobe disease.
Nutrigenomics is the study of how constituents of the diet interact with genes, and their products, to alter phenotype and, conversely, how genes and their products metabolise these constituents into nutrients, antinutrients, and bioactive compounds. Results from molecular and genetic epidemiological studies indicate that dietary unbalance can alter gene–nutrient interactions in ways that increase the risk of developing chronic disease. The interplay of human genetic variation and environmental factors will make identifying causative genes and nutrients a formidable, but not intractable, challenge. We provide specific recommendations for how to best meet this challenge and discuss the need for new methodologies and the use of comprehensive analyses of nutrient–genotype interactions involving large and diverse populations. The objective of the present paper is to stimulate discourse and collaboration among nutrigenomic researchers and stakeholders, a process that will lead to an increase in global health and wellness by reducing health disparities in developed and developing countries.