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Scalable methods are required for population dietary monitoring. The Supermarket Transaction Records In Dietary Evaluation (STRIDE) study compares dietary estimates from supermarket transactions with an online FFQ.
Design:
Participants were recruited in four waves, accounting for seasonal dietary variation. Purchases were collected for 1 year during and 1 year prior to the study. Bland–Altman agreement and limits of agreement (LoA) were calculated for energy, sugar, fat, saturated fat, protein and sodium (absolute and relative).
Setting:
This study was partnered with a large UK retailer.
Participants:
Totally, 1788 participants from four UK regions were recruited from the retailer’s loyalty card customer database, according to breadth and frequency of purchases. Six hundred and eighty-six participants were included for analysis.
Results:
The analysis sample were mostly female (72 %), with a mean age of 56 years (sd 13). The ratio of purchases to intakes varied depending on amounts purchased and consumed; purchases under-estimated intakes for smaller amounts on average, but over-estimated for larger amounts. For absolute measures, the LoA across households were wide, for example, for energy intake of 2000 kcal, purchases could under- or over-estimate intake by a factor of 5; values could be between 400 kcal and 10000 kcal. LoA for relative (energy-adjusted) estimates were smaller, for example, for 14 % of total energy from saturated fat, purchase estimates may be between 7 % and 27 %.
Conclusions:
Agreement between purchases and intake was highly variable, strongest for smaller loyal households and for relative values. For some customers, relative nutrient purchases are a reasonable proxy for dietary composition indicating utility in population-level dietary research.
Young people with social disability and severe and complex mental health problems have poor outcomes, frequently struggling with treatment access and engagement. Outcomes may be improved by enhancing care and providing targeted psychological or psychosocial intervention.
Aims
We aimed to test the hypothesis that adding social recovery therapy (SRT) to enhanced standard care (ESC) would improve social recovery compared with ESC alone.
Method
A pragmatic, assessor-masked, randomised controlled trial (PRODIGY: ISRCTN47998710) was conducted in three UK centres. Participants (n = 270) were aged 16–25 years, with persistent social disability, defined as under 30 hours of structured activity per week, social impairment for at least 6 months and severe and complex mental health problems. Participants were randomised to ESC alone or SRT plus ESC. SRT was an individual psychosocial therapy delivered over 9 months. The primary outcome was time spent in structured activity 15 months post-randomisation.
Results
We randomised 132 participants to SRT plus ESC and 138 to ESC alone. Mean weekly hours in structured activity at 15 months increased by 11.1 h for SRT plus ESC (mean 22.4, s.d. = 21.4) and 16.6 h for ESC alone (mean 27.7, s.d. = 26.5). There was no significant difference between arms; treatment effect was −4.44 (95% CI −10.19 to 1.31, P = 0.13). Missingness was consistently greater in the ESC alone arm.
Conclusions
We found no evidence for the superiority of SRT as an adjunct to ESC. Participants in both arms made large, clinically significant improvements on all outcomes. When providing comprehensive evidence-based standard care, there are no additional gains by providing specialised SRT. Optimising standard care to ensure targeted delivery of existing interventions may further improve outcomes.
Traditional dietary assessment methods in research can be challenging, with participant burden to complete an interview, diary, 24 h recall or questionnaire and researcher burden to code the food record to obtain a nutrient breakdown. Self-reported assessment methods are subject to recall and social desirability biases, in addition to selection bias from the nature of volunteering to take part in a research study. Supermarket loyalty card transaction records, linked to back of pack nutrient information, present a novel opportunity to use objective records of food purchases to assess diet at a household level. With a large sample size and multiple transactions, it is possible to review variation in food purchases over time and across different geographical areas.
Materials and methods:
This study uses supermarket loyalty card transactions for one retailer's customers in Leeds, for 12 months during 2016. Fruit and vegetable purchases for customers who appear to shop regularly for a ‘complete’ shop, buying from at least 7 of 11 Living Cost and Food Survey categories, were calculated. Using total weight of fruits and vegetables purchased over one year, average portions (80g) per day, per household were generated. Descriptive statistics of fruit and vegetable purchases by age, gender and Index of Multiple Deprivation of the loyalty card holder were generated. Using Geographical Information Systems, maps of neighbourhood purchases per month of the year were created to visualise variations.
Results:
The loyalty card holder transaction records represent 6.4% of the total Leeds population. On average, households in Leeds purchase 3.5 portions of fruit and vegetables per day, per household. Affluent and rural areas purchase more fruit and vegetables than average with 22% purchasing more than 5 portions/day. Conversely poor urban areas purchase less, with 18% purchasing less than 1 portion/day. Highest purchases are in the winter months, with lowest in the summer holidays. Loyalty cards registered to females purchased 0.4 portions per day more than male counterparts. The over 65 years purchased 1.5 portions per day more than the 17–24 year olds. A clear deprivation gradient is observed, with the most deprived purchasing 1.5 portions less per day than the least deprived.
Discussion:
Loyalty card transaction data offer an exciting opportunity for measuring variation in fruit and vegetable purchases. Variation is observed by age, gender, deprivation, geographically across a city and throughout the seasons. These insights can inform both policymakers and retailers regarding areas for fruit and vegetable promotion.
In late antiquity, there was no single conception of Armenian space. Instead, there were different notions of what constituted Armenia, each contingent on date, context and perspective. For authors operating within an Armenian cultural milieu, Armenian space was automatically defined in terms of the land occupied by an imagined community because the standard expression for the land of Armenia was ašxarh/erkir Hayoc‘, the homeland of the descendants of Hayk, the eponymous ancestor of the Armenian people.1 This social construction, therefore, created Armenian space wherever those who identified as Armenians were settled. It was not tied to a specific territory with fixed boundaries. At the same time, however, Armenian space was understood in terms of a political landscape, albeit a historic one, comprising the lands of the Arsacid kingdom before its demise in 428 AD.
Although Roman and Persian engagement with late antique Armenia has been analysed from several perspectives, its juridical dimension has been largely ignored. This chapter provides a reassessment of the legislation pertaining to Roman Armenia from the reign of Justinian, arguing that it offers a reflection of legal practices operating beyond the newly reorganised Roman provinces, in districts of Armenia under Persian hegemony. It may also attest the seeping of Roman legal culture beyond the formal limits of the jurisdiction. Crucially, the local inheritance practices which the legislation prescribes find analogues in Sasanian jurisprudence. Although not every aspect of Persian legal culture will have been replicated in the districts of Armenia or received in the same way, the rich Armenian literary tradition from late antiquity reveals a proximate legal culture, expressed in terms of concepts employed and processes followed. Three illustrations from Łazar P‘arpets‘i History are examined. Furthermore two later compilations preserve valuable evidence of law in practice. The tenth-century compilation titled History of Ałuank’ contains a collection of documents deriving from the Council of Partav convened in 705 ce. One of these confirms that land across Caucasian Albania was still being bought and sold at this time, that there was current uncertainty over whether the transfer of a village included the village church and its endowment, and that laymen had been represented as holding clerical status to circumvent this. A specific case is then outlined. The late thirteenth-century History of Siwnik’ on the other hand contains transcripts of fifty-two documents, and summaries of twelve more, recording property transactions in favour of the bishops of Siwnik’ and the see of Tat‘ev. It is argued that the earliest of these, dating from the middle of the ninth century, preserve clear vestiges of Sasanian legal culture. Armenian sources have much to tell us about law and legal tradition in Sasanian Persia.
Armenia was wholly partitioned between the ‘great powers’ of Rome and Persia throughout late antiquity. Although the manner and the degree of intrusion on the part of the two imperial powers may have fluctuated over the course of the two centuries following the eclipse of the Arsacid kingdom in 428 ce, every district of Armenia was under the hegemony of one or the other.