19 results
5 LIfestyle for BRAin Health (LIBRA) Modifiable Factors Risk Score and Concussion History Associations with Cognition in Older Former National Football League Players.
- Benjamin L Brett, Neelum T Aggarwal, Avinash Chandran, Zachary Y Kerr, Samuel R Walton, J.D. DeFreese, Kevin M Guskiewicz, Ruben J Echemendia, William P Meehan III, Michael A McCrea, Rebekah Mannix
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 305-306
-
- Article
-
- You have access Access
- Export citation
-
Objective:
Traumatic brain injury is one of several recognized risk factors for cognitive decline and neurodegenerative disease. Currently, risk scores involving modifiable risk/protective factors for dementia have not incorporated head injury history as part of their overall weighted risk calculation. We investigated the association between the LIfestyle for BRAin Health (LIBRA) risk score with odds of mild cognitive impairment (MCI) diagnosis and cognitive function in older former National Football League (NFL) players, both with and without the influence of concussion history.
Participants and Methods:Former NFL players, ages ≥ 50 (N=1050; mean age=61.1±5.4-years), completed a general health survey including self-reported medical history and ratings of function across several domains. LIBRA factors (weighted value) included cardiovascular disease (+1.0), hypertension (+1.6), hyperlipidemia (+1.4), diabetes (+1.3), kidney disease (+1.1), cigarette use history (+1.5), obesity (+1.6), depression (+2.1), social/cognitive activity (-3.2), physical inactivity (+1.1), low/moderate alcohol use (-1.0), healthy diet (-1.7). Within Group 1 (n=761), logistic regression models assessed the association of LIBRA scores and independent contribution of concussion history with the odds of MCI diagnosis. A modified-LIBRA score incorporated concussion history at the level planned contrasts showed significant associations across concussion history groups (0, 1-2, 3-5, 6-9, 10+). The weighted value for concussion history (+1.9) within the modified-LIBRA score was based on its proportional contribution to dementia relative to other LIBRA risk factors, as proposed by the 2020 Lancet Commission Report on Dementia Prevention. Associations of the modified-LIBRA score with odds of MCI and cognitive function were assessed via logistic and linear regression, respectively, in a subset of the sample (Group 2; n=289) who also completed the Brief Test of Adult Cognition by Telephone (BTACT). Race was included as a covariate in all models.
Results:The median LIBRA score in the Group 1 was 1.6(IQR= -1, 3.6). Standard and modified-LIBRA median scores were 1.1(IQR= -1.3, 3.3) and 2(IQR= -0.4, 4.6), respectively, within Group 2. In Group 1, LIBRA score was significantly associated with odds of MCI diagnosis (odds ratio[95% confidence interval]=1.27[1.19, 1.28], p <.001). Concussion history provided additional information beyond LIBRA scores and was independently associated with odds of MCI; specifically, odds of MCI were higher among those with 6-9 (Odds Ratio[95% confidence interval]; OR=2.54[1.21, 5.32], p<.001), and 10+ (OR=4.55;[2.21, 9.36], p<.001) concussions, compared with those with no prior concussions. Within Group 2, the modified-LIBRA score was associated with higher odds of MCI (OR=1.61[1.15, 2.25]), and incrementally improved model information (0.04 increase in Nagelkerke R2) above standard LIBRA scores in the same model. Modified-LIBRA scores were inversely associated with BTACT Executive Function (B=-0.53[0.08], p=.002) and Episodic Memory scores (B=-0.53[0.08], p=.002).
Conclusions:Numerous modifiable risk/protective factors for dementia are reported in former professional football players, but incorporating concussion history may aid the multifactorial appraisal of cognitive decline risk and identification of areas for prevention and intervention. Integration of multi-modal biomarkers will advance this person-centered, holistic approach toward dementia reduction, detection, and intervention.
2 The Longitudinal Relationship Between Concussion History, Years of Football Participation, and Alcohol Use Among Former National Football League (NFL) Players: an NFL-LONG Study
- Brittany Lang, Zachary Yukio Kerr, Samuel R Walton, Avinash Chandran, Rebekah Mannix, Landon B Lempke, J D DeFreese, Ruben J Echemendia, Kevin M Guskiewicz, William P Meehan, Michael A McCrea, Benjamin L Brett
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 114-115
-
- Article
-
- You have access Access
- Export citation
-
Objective:
It has been posited that alcohol use may confound the association between greater concussion history and poorer neurobehavioral functioning. However, while greater alcohol use is positively correlated with neurobehavioral difficulties, the association between alcohol use and concussion history is not well understood. Therefore, this study investigated the cross-sectional and longitudinal associations between cumulative concussion history, years of contact sport participation, and health-related/psychological factors with alcohol use in former professional football players across multiple decades.
Participants and Methods:Former professional American football players completed general health questionnaires in 2001 and 2019, including demographic information, football history, concussion/medical history, and health-related/psychological functioning. Alcohol use frequency and amount was reported for three timepoints: during professional career (collected retrospectively in 2001), 2001, and 2019. During professional career and 2001 alcohol use frequency included none, 1-2, 3-4, 5-7 days/week, while amount included none, 12, 3-5, 6-7, 8+ drinks/occasion. For 2019, frequency included never, monthly or less, 2-4 times/month, 2-3 times/week, >4 times/week, while amount included none, 1-2, 3-4, 5-6, 7-9, 10+ drinks/occasion. Scores on a screening measure for Alcohol Use Disorder (CAGE) were also available at during professional career and 2001 timepoints. Concussion history was recorded in 2001 and binned into five groups: 0, 1-2, 3-5, 6-9, 10+. Depression and pain interference were assessed via PROMIS measures at all timepoints. Sleep disturbance was assessed in 2001 via separate instrument and with PROMIS Sleep Disturbance in 2019. Spearman’s rho correlations tested associations between concussion history and years of sport participation with alcohol use across timepoints, and whether poor health functioning (depression, pain interference, sleep disturbance) in 2001 and 2019 were associated with alcohol use both within and between timepoints.
Results:Among the 351 participants (Mage=47.86[SD=10.18] in 2001), there were no significant associations between concussion history or years of contact sport participation with CAGE scores or alcohol use frequency/amount during professional career, 2001, or 2019 (rhos=-.072-.067, ps>.05). In 2001, greater depressive symptomology and sleep disturbance were related to higher CAGE scores (rho=.209, p<.001; rho=.176, p<.001, respectively), while greater depressive symptomology, pain interference, and sleep disturbance were related to higher alcohol use frequency (rho=.176, p=.002; rho=.109, p=.045; rho=.132, p=.013, respectively) and amount/occasion (rho=.215, p<.001; rho=.127, p=.020; rho=.153, p=.004, respectively). In 2019, depressive symptomology, pain interference, and sleep disturbance were not related to alcohol use (rhos=-.047-.087, ps>.05). Between timepoints, more sleep disturbance in 2001 was associated with higher alcohol amount/occasion in 2019 (rho=.115, p=.036).
Conclusions:Increased alcohol intake has been theorized to be a consequence of greater concussion history, and as such, thought to confound associations between concussion history and neurobehavioral function later in life. Our findings indicate concussion history and years of contact sport participation were not significantly associated with alcohol use cross-sectionally or longitudinally, regardless of alcohol use characterization. While higher levels of depression, pain interference, and sleep disturbance in 2001 were related to greater alcohol use in 2001, they were not associated cross-sectionally in 2019. Results support the need to concurrently address health-related and psychological factors in the implementation of alcohol use interventions for former NFL players, particularly earlier in the sport discontinuation timeline.
2 Contributions of Cardiovascular Disease Burden and Concussion History on Cognitive Function in Older Former National Football League Players.
- Benjamin L Brett, Alyssa Leitzke, Zachary Y Kerr, Neelum T Aggarwal, Avinash Chandran, Samuel R Walton, Rebekah Mannix, Landon B Lempke, J.D. DeFreese, Ruben J Echemendia, Kevin M Guskiewicz, William P Meehan III, Michael A McCrea
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 302-303
-
- Article
-
- You have access Access
- Export citation
-
Objective:
Traumatic brain injury and cardiovascular disease (CVD) are modifiable risk factors for cognitive decline and dementia. Greater concussion history can potentially increase risk for cerebrovascular changes associated with cognitive decline and may compound effects of CVD. We investigated the independent and dynamic effects of CVD/risk factor burden and concussion history on cognitive function and odds of mild cognitive impairment (MCI) diagnoses in older former National Football League (NFL) players.
Participants and Methods:Former NFL players, ages 50-70 (N=289; mean age=61.02±5.33 years), reported medical history and completed the Brief Test of Adult Cognition by Telephone (BTACT). CVD/risk factor burden was characterized as ordinal (0-3+) based on the sum of the following conditions: coronary artery disease/myocardial infarction, chronic obstructive pulmonary disease, hypertension, hyperlipidemia, sleep apnea, type-I and II diabetes. Cognitive outcomes included BTACT Executive Function and Episodic Memory Composite Z-scores (standardized on age- and education-based normative data), and the presence of physician diagnosed (self-reported) MCI. Concussion history was discretized into five groups: 0, 1-2, 3-5, 6-9, 10+. Linear and logistic regression models were fit to test independent and joint effects of concussion history and CVD burden on cognitive outcomes and odds of MCI. Race (dichotomized as White and Non-white due to sample distribution) was included in models as a covariate.
Results:Greater CVD burden (unstandardized beta [standard error]; B=-0.10[0.42], p=.013, and race (B=0.622[0.09], p<.001), were associated with lower executive functioning. Compared to those with 0 prior concussions, no significant differences were observed for those with 1-2, 3-5, 6-9, or 10+ prior concussions (ps >.05). Race (B=0.61[.13], p<.001), but not concussion history or CVD burden, was associated with episodic memory. There was a trend for lower episodic memory scores among those with 10+ prior concussion compared to those with no prior concussions (B=-0.49[.25], p=.052). There were no significant differences in episodic memory among those with 1-2, 3-5, or 6-9 prior concussions compared to those with 0 prior concussions (ps>.05). CVD burden (B=0.35[.13], p=.008), race (greater odds in Non-white group; B=0.82[.29], p=.005), and greater concussion history (higher odds of diagnosis in 10+ group compared to those with 0 prior concussions; B=2.19[0.78], p<.005) were associated with higher odds of MCI diagnosis. Significant interaction effects between concussion history and CVD burden were not observed for any outcome (ps >.05).
Conclusions:Lower executive functioning and higher odds of MCI diagnosis were associated with higher CVD burden and race. Very high concussion history (10+) was selectively associated with higher odds of MCI diagnosis. Reduction of these modifiable factors may mitigate adverse outcomes in older contact sport athletes. In former athletes, consideration of CVD burden is particularly pertinent when assessing executive dysfunction, considered to be a common cognitive feature of traumatic encephalopathy syndrome, as designated by the recent diagnostic criteria. Further research should investigate the social and structural determinants contributing to racial disparities in long-term health outcomes within former NFL players.
Political Obligation and the Need for Justice
- Kevin Walton
-
- Journal:
- Canadian Journal of Law & Jurisprudence / Volume 36 / Issue 1 / February 2023
- Published online by Cambridge University Press:
- 13 December 2022, pp. 195-214
- Print publication:
- February 2023
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
This paper examines the claim that justice is necessary for a moral obligation to obey the law. By reflecting on the meaning of obedience, it identifies one version of the claim that must be right and another that must be wrong. It then focuses on the argument for a moral obligation to obey the law that most obviously includes the claim: John Rawls’s argument from the natural duty of justice. More specifically, it focuses on the degree of justice that is needed for this duty to ground a moral obligation to obey the law.
A dominance analysis of subjective cognitive complaint comorbidities in former professional football players with and without mild cognitive impairment
- Benjamin L. Brett, Zachary Yukio Kerr, Avinash Chandran, Samuel Walton, Neelum T. Aggarwal, Katherine Gifford, Rebekah Mannix, J. D. DeFreese, Ruben J. Echemendia, Kevin M. Guskiewicz, William P. Meehan III, Michael A. McCrea
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue 6 / July 2023
- Published online by Cambridge University Press:
- 30 August 2022, pp. 582-593
-
- Article
- Export citation
-
Objectives:
Subjective cognitive difficulties (SCDs) are associated with factors commonly reported in older adults and former contact sport athletes, regardless of objective cognitive decline. We investigated the relative contribution of these factors to SCD in former National Football League (NFL)-players with and without a diagnosis of mild cognitive impairment (MCI).
Methods:Former NFL players (n = 907) aged ≥ 50 years (mean = 64.7 ± 8.9), with (n = 165) and without (n = 742) a diagnosis of MCI completed health questionnaires. Multivariable regression and dominance analyses determined the relative importance of SCD factors on SCD: 1) depression, 2) anxiety, 3) sleep disturbance, 4) pain interference, 5) ability to participate in social roles and activities, 6) stress-related events, 7) fatigue, 8) concussion history, and 9) education. SCD outcomes included Neuro-QoL Emotional-Behavioral Dyscontrol and the PROMIS Cognitive Function. Fisher’s z-transformation compared comorbid contributing factors to SCD across MCI and non-MCI groups.
Results:Complete dominance of anxiety was established over most comorbid factors across the MCI and non-MCI groups. Fatigue also exhibited complete dominance over most comorbid factors, though its influence in the MCI group was less robust (general dominance). Average contributions to variance accounted for by comorbid factors to ratings of SCD across MCI and non-MCI groups did not statistically differ (Z-statistics <1.96, ps>.05).
Conclusions:Anxiety and fatigue are the most robust factors associated with SCD in former professional football players across various combinations of clinical presentations (different combinations of comorbid factors), regardless of documented cognitive impairment. Self-reported deficits may be less reliable in detecting objective impairment in the presence of these factors, with multidimensional assessment being ideal.
202 - Music Therapy Intervention to Reduce Caregiver Distress at End of Life: A Feasibility Study
- Kevin Whitford, Angela Ulrich, Travis Dockter, Brianna E. Larsen, Christina Wood, Monica Walton, Christina M. Phelps, Martha J. Siska, Amy Stelpflug, Maureen Bigelow, Maria I. Lapid
-
- Journal:
- International Psychogeriatrics / Volume 33 / Issue S1 / October 2021
- Published online by Cambridge University Press:
- 01 November 2021, p. 7
-
- Article
-
- You have access Access
- Export citation
-
Context
Music therapy is frequently provided to patients at the end of life, and studies have shown a benefit in relief of symptoms and a positive impact on quality of life (QoL), but little is known regarding the effect of music therapy (MT) on caregivers. Caregivers are at risk for anxiety, emotional distress and experience anticipatory grief as the patient nears death. Caregivers are present with patients and may also benefit from MT.
ObjectiveTo assess the impact of MT on caregivers for hospice patients and determine the feasibility of research in this population.
MethodsTwenty caregivers of patients hospitalized for general inpatient hospice care were enrolled. MT was provided by a board-certified music therapist, and sessions included pre-MT assessment, 20-45 minutes of MT, and post-MT assessment. Caregiver stress was measured with the Pearlin Role Overload Measure (ROM), QoL was measured with the Linear Analogue Self-Assessment (LASA), and depression and anxiety were measured with the Patient Health Questionnaire for Depression and Anxiety (PHQ-4). These three measures were taken pre-MT, post-MT and 6 months post-MT. Caregivers were also asked to complete a Music Therapy Program Survey post-MT.
ResultsThe MT intervention was completed for 15/20 caregivers (75%). Of those who did not complete MT, 2 withdrew prior, 1 was not available, 1 patient passed during the MT session, and 1 patient died prior to MT. 14 caregivers completed pre-MT and post-MT assessments, and 9 caregivers completed assessments at all 3 timepoints. The MT Program Survey (post-MT assessment, n=14) showed 100% of caregivers were very satisfied with MT and would recommend to others, 78% found MT effective for stress relief, 69% for relaxation, 71% for spiritual support, 86% for emotional support, and 71% for feeling of wellness.
ConclusionResearch on MT is feasible for acute hospice care caregivers with a majority of caregivers consenting to research and about half completing surveys pre-MT, post-MT, and 6-months post-MT (9/20). Future larger studies should be conducted to better assess the impact of MT on caregivers.
Disparate Associations of Years of Football Participation and a Metric of Head Impact Exposure with Neurobehavioral Outcomes in Former Collegiate Football Players
- Benjamin L. Brett, Amy M. Nader, Zachary Y. Kerr, Avinash Chandran, Samuel R. Walton, J. D. DeFreese, Kevin M. Guskiewicz, Michael McCrea
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 28 / Issue 1 / January 2022
- Published online by Cambridge University Press:
- 10 February 2021, pp. 22-34
-
- Article
- Export citation
-
Objectives:
Years of sport participation (YoP) is conventionally used to estimate cumulative repetitive head impacts (RHI) experienced by contact sport athletes. The relationship of this measure to other estimates of head impact exposure and the potential associations of these measures with neurobehavioral functioning are unknown. We investigated the association between YoP and the Head Impact Exposure Estimate (HIEE), and whether associations between the two estimates of exposure and neurobehavioral functioning varied.
Methods:Former American football players (N = 58; age = 37.9 ± 1.5 years) completed in-person evaluations approximately 15 years following sport discontinuation. Assessments consisted of neuropsychological assessment and structured interviews of head impact history (i.e., HIEE). General linear models were fit to test the association between YoP and the HIEE, and their associations with neurobehavioral outcomes.
Results:YoP was weakly correlated with the HIEE, p = .005, R2 = .13. Higher YoP was associated with worse performance on the Symbol Digit Modalities Test, p = .004, R2 = .14, and Trail Making Test-B, p = .001, R2 = .18. The HIEE was associated with worse performance on the Delayed Recall trial of the Hopkins Verbal Learning Test-Revised, p = .020, R2 = .09, self-reported cognitive difficulties (Neuro-QoL Cognitive Function), p = .011, R2 = .10, psychological distress (Brief Symptom Inventory-18), p = .018, R2 = .10, and behavioral regulation (Behavior Rating Inventory of Executive Function for Adults), p = .017, R2 = .10.
Conclusions:YoP was marginally associated with the HIEE, a comprehensive estimate of head impacts sustained over a career. Associations between each exposure estimate and neurobehavioral functioning outcomes differed. Findings have meaningful implications for efforts to accurately quantify the risk of adverse long-term neurobehavioral outcomes potentially associated with RHI.
Intakes and sources of menaquinones (vitamin K2) in the Irish population aged 1–90 years
- Ciara Kingston, Laura Kehoe, Janette Walton, Breige McNulty, Anne Nugent, Kevin Cashman, Albert Flynn
-
- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E347
-
- Article
-
- You have access Access
- Export citation
-
Recent evidence suggests that menaquinones (Vitamin K2) may be important for both bone health and cardiovascular health. With the exception of menaquinone-4 which is formed from the tissue specific conversion of phylloquinone or menadione, menaquinones are synthesized by bacteria. They are typically found in foods of animal origin such as meat, dairy and fermented foods and may account for up to 25% of total vitamin K intake. There are few data available on menaquinone intakes in population groups due to lack of available composition data. The Irish food composition database however has recently been updated to include data on menaquinones. Therefore, the aim of this study was to use these data to estimate the intakes and key dietary sources of menaquinones (menaquinone-4 & menaquinone-5–10) in the Irish population.
Analyses included data from four nationally representative surveys of the Irish population; The National Pre-School Nutrition Survey (1–4y; 2010–2011), the National Children's Food Survey (5–12y; 2003–2004), the National Teens’ Food Survey (13–17y; 2005–2006) and the National Adult Nutrition Survey (18–90y; 2008–2010) (www.iuna.net). For all of the surveys, food and beverage intake data (including supplements) were collected using food records and quantified using food scales, photographic atlases, household measures and standard portion sizes. Mean daily intakes of menaquinone-4 and menaquinone-5–10 were estimated using UK food composition tables and analytical values from published papers. The percent contribution of food groups to menaquinone intake was calculated by the mean proportion method (which provides information about the sources that are contributing to the nutrient intake ‘per person’). Statistical analyses were carried out using SPSS© V22.
Mean intakes of menaquinone-4 ranged from 8–12μg/d and 10–14μg/d in children aged 1–17 years and adults aged 18–90 years, respectively. Mean combined intakes of menaquinone-5–10 ranged from 32–43μg/d and 32–50μg/d in children aged 1–17 years and adults aged 18–90 years, respectively. ‘Meat & meat products’ were the top contributor of menaquinone-4 (50–66%) intakes across all population groups followed by ‘milks’ (9–25%). ‘Meat & meat products’ (44–61%) and ‘cheeses’ (21–37%) were important contributors to menaquinone-5–10 intakes across all population groups examined.
This study is the first of its kind to report the intakes and sources of menaquinones in the Irish population. ‘Meat & meat products’, ‘cheeses’ and ‘milks’ are important contributors to intakes of menaquinones in the Irish diet. Further research is required to fully understand the role of the menaquinones in human health.
The role of unprocessed beef and lamb in the diets of Irish children and teenagers (5–17 years)
- Jacqueline Lyons, Christopher Cocking, Laura Kehoe, Breige McNulty, Anne Nugent, Janette Walton, Kevin Cashman, Albert Flynn
-
- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E453
-
- Article
-
- You have access Access
- Export citation
-
Introduction
Meat is a nutrient-dense food that plays a central role in the diets of many children globally, contributing significantly to intakes of energy, protein and a number of essential micronutrients. However, nutritive quality is variable across meat types and cuts, and dietary guidelines across Europe typically encourage the consumption of lean meats whilst limiting the consumption of processed meats. The current work aimed to estimate intakes of unprocessed beef and lamb and their contribution to nutrient intakes in Irish children and teenagers.
MethodsAnalyses were based on data from the Irish National Children's Food Survey (NCFS) (2003–2004; 5–12 years; n 594) and National Teens’ Food Survey (NTFS) (2005–2006; 13–17 years; n 441) (www.iuna.net). Both surveys used a 7-day weighed (NCFS) or semi-weighed (NTFS) food record to collect dietary intake data from nationally representative samples of Irish children. Dietary intake data were converted to nutrient data using WISP©, based on UK and Irish food composition tables. Unprocessed beef and lamb was defined as beef or lamb that had not undergone any preserving process other than chilling, freezing or salting, and included beef or lamb dishes that were wrapped in a controlled atmosphere. Meat intakes from composite dishes (e.g. beef lasagne) were estimated following disaggregation of the non-meat components. Statistical analyses were carried out using SPSS© v23.0.
ResultsUnprocessed beef was consumed by 79% of children and 83% of teenagers, while unprocessed lamb was consumed by 19% of children and 20% of teenagers. Mean daily intakes of unprocessed beef were 21 g and 34 g in children and teenagers (consumers only), while mean daily intakes of unprocessed lamb were 14 g and 23 g. Unprocessed beef and lamb contributed 5–6% to mean daily energy intakes and contributed the following proportions to daily nutrient intakes in children and teenagers, respectively: protein (11%, 15%), total fat (7%, 9%), saturated fat (7%, 10%), monounsaturated fat (9%, 11%), iron (7%, 10%), zinc (18%, 23%), vitamin A (7%, 7%), vitamin D (12%, 16%), total niacin (9%, 13%), vitamin B6 (6%, 9%), vitamin B12 (15%, 22%), sodium (6%, 7%).
DiscussionUnprocessed beef and lamb are valuable sources of nutrients for Irish children and teenagers. Relative to their energy contribution, they contribute higher proportions of a number of important nutrients, such as protein, zinc, vitamin D, vitamin B12 and total niacin, while contributing relatively small proportions of total fat, saturated fat and sodium. This research was funded by Meat Technology Ireland.
The role of meat in the European diet: current state of knowledge on dietary recommendations, intakes and contribution to energy and nutrient intakes and status
- Chris Cocking, Janette Walton, Laura Kehoe, Kevin D. Cashman, Albert Flynn
-
- Journal:
- Nutrition Research Reviews / Volume 33 / Issue 2 / December 2020
- Published online by Cambridge University Press:
- 10 January 2020, pp. 181-189
-
- Article
-
- You have access Access
- HTML
- Export citation
-
The role of meat in the diet has come under scrutiny recently due to an increased public emphasis on providing healthy diets from sustainable food systems and due to health concerns relating to the consumption of red and processed meat. The present review aimed to summarise dietary guidelines relating to meat, actual meat intakes and the contribution of meat to energy and nutrient intakes of children, teenagers and adults in Europe. The available literature has shown that food-based dietary guidelines for most countries recommend consuming lean meat in moderation and many recommend limiting red and processed meat consumption. Mean intakes of total meat in Europe range from 40 to 160 g/d in children and teenagers and from 75 to 233 g/d in adults. Meat contributes to important nutrients such as protein, PUFA, B vitamins, vitamin D and essential minerals such as Fe and Zn; however, processed meat contributes to significant proportions of saturated fat and Na across population groups. While few data are available on diaggregated intakes of red and processed meat, where data are available, mean intakes in adults are higher than the upper limits recommended by the UK Scientific Advisory Committee on Nutrition (70 g/d) and the World Cancer Research Fund (500 g/week). While there are no recommendations for red and processed meat consumption in children and teenagers, intakes currently range from 30 to 76 g/d. The present review provides a comprehensive overview of the role of meat in the European diet which may be of use to stakeholders including researchers, policy makers and the agri-food sector.
Is Democracy Sufficient for Political Obligation?
- Kevin Walton
-
- Journal:
- Canadian Journal of Law & Jurisprudence / Volume 28 / Issue 2 / July 2015
- Published online by Cambridge University Press:
- 01 July 2015, pp. 425-442
- Print publication:
- July 2015
-
- Article
- Export citation
-
This paper examines the apparently widespread belief that the democratic pedigree of a state implies a moral obligation to obey its laws. The analysis focuses on the work of Ronald Dworkin, who is, perhaps surprisingly, alone among theorists of democracy in claiming that those whom the law addresses are morally bound to obey it whenever it is democratic. From Dworkin’s expansive conception of democracy, political obligation follows. But democracy should not be construed so widely. Rather, it ought to be conceived more narrowly, such that, as other theorists concede, it cannot be more than part of a case for a moral obligation to obey the law. Hence, belief in the sufficiency of democracy for political obligation, notwithstanding its ostensible popularity, has yet to be justified.
Contributors
-
- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
-
- Book:
- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
-
- Chapter
- Export citation
Notes on Contributors
-
- By Charles Altieri, Faith Barrett, Alfred Bendixen, David Bergman, Edward Brunner, Stephen Burt, Susan Castillo Street, Michael C. Cohen, Robert Daly, Betty Booth Donohue, Jim Egan, Richard Flynn, Ed Folsom, Stephen Fredman, Frank Gado, Roger Gilbert, Rigoberto González, Nick Halpern, Jeffrey A. Hammond, Kevin J. Hayes, Matthew Hofer, Tyler Hoffman, Christoph Irmscher, Virginia Jackson, Joseph Jonghyun Jeon, John D. Kerkering, George S. Lensing, Mary Loeffelholz, Wendy Martin, Cristanne Miller, David Chioni Moore, Walton Muyumba, John Timberman Newcomb, Bob Perelman, Siobhan Phillips, Brian M. Reed, Elizabeth Renker, Eliza Richards, Reena Sastri, Robin G. Schulze, Mark Scroggins, David E. E. Sloane, Angela Sorby, Juliana Spahr, Willard Spiegelman, Lisa M. Steinman, Ernest Suarez, Joseph T. Thomas, Lesley Wheeler, David Wojahn
- Edited by Alfred Bendixen, Princeton University, New Jersey, Stephen Burt, Harvard University, Massachusetts
-
- Book:
- The Cambridge History of American Poetry
- Published online:
- 05 December 2014
- Print publication:
- 27 October 2014, pp xi-xviii
-
- Chapter
- Export citation
Dietary vitamin D2 – a potentially underestimated contributor to vitamin D nutritional status of adults?
- Kevin D. Cashman, Michael Kinsella, Breige A. McNulty, Janette Walton, Michael J. Gibney, Albert Flynn, Mairead Kiely
-
- Journal:
- British Journal of Nutrition / Volume 112 / Issue 2 / 28 July 2014
- Published online by Cambridge University Press:
- 29 April 2014, pp. 193-202
- Print publication:
- 28 July 2014
-
- Article
-
- You have access Access
- HTML
- Export citation
-
It has been suggested that vitamin D2 is not very prevalent in the human food chain. However, data from a number of recent intervention studies suggest that the majority of subjects had measurable serum 25-hydroxyvitamin D2 (25(OH)D2) concentrations. Serum 25(OH)D2, unlike 25(OH)D3, is not directly influenced by exposure of skin to sun and thus has dietary origins; however, quantifying dietary vitamin D2 is difficult due to the limitations of food composition data. Therefore, the present study aimed to characterise serum 25(OH)D2 concentrations in the participants of the National Adult Nutrition Survey (NANS) in Ireland, and to use these serum concentrations to estimate the intake of vitamin D2 using a mathematical modelling approach. Serum 25(OH)D2 concentration was measured by a liquid chromatography–tandem MS method, and information on diet as well as subject characteristics was obtained from the NANS. Of these participants, 78·7 % (n 884) had serum 25(OH)D2 concentrations above the limit of quantification, and the mean, maximum, 10th, 50th (median) and 90th percentile values of serum 25(OH)D2 concentrations were 3·69, 27·6, 1·71, 2·96 and 6·36 nmol/l, respectively. To approximate the intake of vitamin D2 from these serum 25(OH)D2 concentrations, we used recently published data on the relationship between vitamin D intake and the responses of serum 25(OH)D concentrations. The projected 5th to 95th percentile intakes of vitamin D2 for adults were in the range of 0·9–1·2 and 5–6 μg/d, respectively, and the median intake ranged from 1·7 to 2·3 μg/d. In conclusion, the present data demonstrate that 25(OH)D2 concentrations are present in the sera of adults from this nationally representative sample. Vitamin D2 may have an impact on nutritional adequacy at a population level and thus warrants further investigation.
Vitamin D status of Irish adults: findings from the National Adult Nutrition Survey
- Kevin D. Cashman, Siobhan Muldowney, Breige McNulty, Anne Nugent, Anthony P. FitzGerald, Mairead Kiely, Janette Walton, Michael J. Gibney, Albert Flynn
-
- Journal:
- British Journal of Nutrition / Volume 109 / Issue 7 / 14 April 2013
- Published online by Cambridge University Press:
- 10 August 2012, pp. 1248-1256
- Print publication:
- 14 April 2013
-
- Article
-
- You have access Access
- HTML
- Export citation
-
Previous national nutrition surveys in Irish adults did not include blood samples; thus, representative serum 25-hydroxyvitamin D (25(OH)D) data are lacking. In the present study, we characterised serum 25(OH)D concentrations in Irish adults from the recent National Adult Nutrition Survey, and determined the impact of vitamin D supplement use and season on serum 25(OH)D concentrations. Of the total representative sample (n 1500, aged 18+ years), blood samples were available for 1132 adults. Serum 25(OH)D was measured via immunoassay. Vitamin D-containing supplement use was assessed by questionnaire and food diary. Concentrations of serum 25(OH)D were compared by season and in supplement users and non-users. Year-round prevalence rates for serum 25(OH)D concentration < 30, < 40, < 50 and < 75 nmol/l were 6·7, 21·9, 40·1 and 75·6 %, respectively (11·1, 31·1, 55·0 and 84·0 % in winter, respectively). Supplement users had significantly higher serum 25(OH)D concentrations compared to non-users. However, 7·5 % of users had winter serum 25(OH)D < 30 nmol/l. Only 1·3 % had serum 25(OH)D concentrations >125 nmol/l. These first nationally representative serum 25(OH)D data for Irish adults show that while only 6·7 % had serum 25(OH)D < 30 nmol/l (vitamin D deficiency) throughout the year, 40·1 % had levels considered by the Institute of Medicine as being inadequate for bone health. These prevalence estimates were much higher during winter time. While vitamin D supplement use has benefits in terms of vitamin D status, at present rates of usage (17·5 % of Irish adults), it will have only very limited impact at a population level. Food-based strategies, including fortified foods, need to be explored.
Obituaries
- Beau Riffenburgh, Kevin Walton, Ray Woolmore, Geoffrey Hattersley-Smith, Bruce Young, Don E. Dumond, Mina A. Jacobs
-
- Journal:
- Polar Record / Volume 36 / Issue 198 / July 2000
- Published online by Cambridge University Press:
- 27 October 2009, pp. 267-271
-
- Article
-
- You have access Access
- Export citation
Obituaries
- Kevin Walton, Gardon Robin
-
- Journal:
- Polar Record / Volume 32 / Issue 180 / January 1996
- Published online by Cambridge University Press:
- 27 October 2009, pp. 79-82
-
- Article
-
- You have access Access
- Export citation
Obituary
- George Lowe, Kevin Walton
-
- Journal:
- Polar Record / Volume 20 / Issue 124 / January 1980
- Published online by Cambridge University Press:
- 27 October 2009, pp. 83-84
-
- Article
-
- You have access Access
- Export citation
Lethe’s Law: Justice, Law and Ethics in Reconciliation edited by Emilios Christodoulidis and Scott Veitch. Oxford: Hart Publishing, 2001, xv + 235 pp (£30.00 hardback). ISBN 1 84113 1091.
- Kevin Walton
-
- Journal:
- Legal Studies / Volume 22 / Issue 1 / March 2002
- Published online by Cambridge University Press:
- 02 January 2018, pp. 154-156
- Print publication:
- March 2002
-
- Article
- Export citation