The effect of messaging on the acceptance of swaps to reduce the energy content of snacks and non-alcoholic drinks ordered in an experimental online workplace canteen: A randomised controlled trial.

Finding effective ways to increase acceptance of lower-energy swaps offered for snacks and non-alcoholic drinks may reduce population energy intake. We examined whether incrementally increasing the tangibility of information accompanying swaps offered increased their acceptance. UK adults (n = 3481) selected a sweet snack, a savoury snack, and a drink in an experimental online canteen after being equally randomised to receive one of four messages when swaps were offered; a control message providing no specific information, a vague calorie message, an exact numeric-calories message or, a physical activity calorie equivalent (PACE). Primary outcomes were the between-group differences in (i) the odds that a sweet, savoury, or drink swap would be accepted and (ii) the energy content for each type of item ordered. Compared with control, the numeric-calories and PACE messages significantly increased the odds of accepting a sweet snack swap. All interventions significantly increased the odds of accepting savoury swaps compared with control. Only the PACE message significantly increased the odds of drink swap acceptance. The numeric-calories and PACE messages significantly reduced the energy content of sweet snacks. All interventions significantly reduced the energy content of savoury snacks. None of the intervention messages significantly reduced the energy content of drinks compared with control. Increasing the tangibility of information provided when offering swaps increased swap acceptance. PACE messaging was the most promising.

Directly observed daily mouth care provided to care home residents in one area of Kent, UK.

OBJECTIVE: To gather accurate data on the daily mouth care provided in care homes including tooth brushing, oral health assessment, and recording of care provided. BASIC RESEARCH DESIGN: Direct observation and notes review. CLINICAL SETTING: Both nursing and 'regular' care homes. PARTICIPANTS: 365 Residents living in 16 care homes and their carers underwent observation, notes review or data collection in some form. MAIN OUTCOME MEASURES: Provision of mouth morning care. RESULTS: Of 161 residents observed, most (93, 58%) did not have their teeth/dentures brushed. If performed, brushing was often carried out by the resident themselves (36 cases, 53%), rather than by a carer (32 cases, 44%). Carers used a toothbrush to clean inside a resident's mouth in just 7 cases (4.3% of all personal care routines observed). Smaller care homes were no more likely to brush residents teeth than larger care homes, and nursing homes were no more likely to brush teeth than other care homes. Of the 309 sets of notes available for review, 41 (13%) contained a dedicated oral health needs assessment, and 109 (35%) contained a daily oral care chart in some form. Mouth care was often recorded inaccurately (15% of cases). CONCLUSIONS: This is the first observational study in the UK to assess oral care actually provided to residents by carers in care homes. The findings reveal a substantially different picture of daily mouth care than was previously understood and suggest that many of the nation's care home residents may not be receiving adequate, or any, oral health care.

Comparison of tolerability and adverse symptoms in oxcarbazepine and carbamazepine in the treatment of trigeminal neuralgia and neuralgiform headaches using the Liverpool Adverse Events Profile (AEP).

BACKGROUND: Adverse effects of drugs are poorly reported in the literature . The aim of this study was to examine the frequency of the adverse events of antiepileptic drugs (AEDs), in particular carbamazepine (CBZ) and oxcarbazepine (OXC) in patients with neuralgiform pain using the psychometrically tested Liverpool Adverse Events Profile (AEP) and provide clinicians with guidance as to when to change management. METHODS: The study was conducted as a clinical prospective observational exploratory survey of 161 patients with idiopathic trigeminal neuralgia and its variants of whom 79 were on montherapy who attended a specialist clinic in a London teaching hospital over a period of 2 years. At each consultation they completed the AEP questionnaire which provides scores of 19-76 with toxic levels being considered as scores >45. RESULTS: The most common significant side effects were: tiredness 31.3 %, sleepiness 18.2 %, memory problems 22.7 %, disturbed sleep 14.1 %, difficulty concentrating and unsteadiness 11.6 %. Females reported significantly more side effects than males. Potential toxic dose for females is approximately 1200 mg of OXC and 800 mg of CBZ and1800mg of OXC and 1200 mg of CBZ for males. CONCLUSIONS: CBZ and OXC are associated with cognitive impairment. Pharmacokinetic and pharmacodynamic differences are likely to be the reason for gender differences in reporting side effects. Potentially, females need to be prescribed lower dosages in view of their tendency to reach toxic levels at lower dosages. Side effects associated with AED could be a major reason for changing drugs or to consider a referral for surgical management.

Differences in cancer awareness and beliefs between Australia, Canada, Denmark, Norway, Sweden and the UK (the International Cancer Benchmarking Partnership): do they contribute to differences in cancer survival?

BACKGROUND: There are wide international differences in 1-year cancer survival. The UK and Denmark perform poorly compared with other high-income countries with similar health care systems: Australia, Canada and Sweden have good cancer survival rates, Norway intermediate survival rates. The objective of this study was to examine the pattern of differences in cancer awareness and beliefs across these countries to identify where these might contribute to the pattern of survival. METHODS: We carried out a population-based telephone interview survey of 19079 men and women aged ≥ 50 years in Australia, Canada, Denmark, Norway, Sweden and the UK using the Awareness and Beliefs about Cancer measure. RESULTS: Awareness that the risk of cancer increased with age was lower in the UK (14%), Canada (13%) and Australia (16%) but was higher in Denmark (25%), Norway (29%) and Sweden (38%). Symptom awareness was no lower in the UK and Denmark than other countries. Perceived barriers to symptomatic presentation were highest in the UK, in particular being worried about wasting the doctor's time (UK 34%; Canada 21%; Australia 14%; Denmark 12%; Norway 11%; Sweden 9%). CONCLUSION: The UK had low awareness of age-related risk and the highest perceived barriers to symptomatic presentation, but symptom awareness in the UK did not differ from other countries. Denmark had higher awareness of age-related risk and few perceived barriers to symptomatic presentation. This suggests that other factors must be involved in explaining Denmark's poor survival rates. In the UK, interventions that address barriers to prompt presentation in primary care should be developed and evaluated.

Molecular identification of a new begomovirus associated with mosaic disease of Jatropha curcas L. in Nigeria.

We report the complete nucleotide sequence of DNA-A of a begomovirus naturally infecting Jatropha curcas L. in Nigeria. Symptoms observed on infected plants were severe mosaic, mottling and blistering of leaves. The virus, which we provisionally name "jatropha mosaic Nigeria virus" (JMNV), has a monopartite genome of 2,779 to 2,789 nucleotides. Pairwise comparisons of DNA-A sequences showed that JMNV had maximum nucleotide sequence identity (72%) with a strain of tomato yellow leaf curl virus. Since there are widespread infections of jatropha in Nigeria showing similar symptoms as those investigated in the present study, JMNV may represent a significant threat to a promising bioenergy crop.

MRI and visual-evoked potentials in partners of multiple sclerosis patients.

OBJECTIVE: Some epidemiological evidence, particularly concerning the role of Epstein Barr Virus implies that multiple sclerosis (MS) may be transmissible and if correct, this might be revealed by increased prevalence of MS in cohabiting partners. METHODS: We addressed this problem by neurological assessment, visual-evoked potentials (VEP) and magnetic resonance imaging (MRI) in 112 partners of patients with MS in comparison to a control group of 93 individuals with clinically non-significant head or neck pain and in comparison to UK prevalence. RESULTS: We found one instance of conjugal definite MS. Including this case, VEP were abnormal in five instances with either significant delay (n = 3) or increased interocular latency difference (IOLD) (n = 2) in partners of MS patients thus raising the possibility of subclinical optic nerve demyelination. The mean absolute value of IOLD in partners was greater than the value in controls (P = 0.033). There were no significant differences in MRI findings between the two groups. CONCLUSION: The finding of one conjugal pair and abnormal VEP in a further four MS partners could have several explanations. It is compatible with the concept of a transmissible agent, although our observations could be due to several biases as well as the play of chance alone.

Adiposity and 'eating in the absence of hunger' in children.

OBJECTIVE: To examine the association between eating in the absence of hunger (EAH) and adiposity in children. DESIGN: Two cross-sectional studies in community settings. SUBJECTS: For study 1, 348 children (178 girls and 170 boys) aged 7-9 years were recruited as part of the Physical Exercise and Appetite in Children Study. In study 2, participants were a subsample of children aged 9-12 years (N=316; 192 girls and 124 boys) from the Twins Early Development Study. MEASUREMENTS: EAH was operationalized as intake of highly palatable sweet snacks after a mixed meal at school (study 1) or home (study 2). Weight (kg) and height (m) measurements were used to calculate the body mass index (BMI) s.d. scores. Children were grouped using the standard criteria for underweight, healthy weight, overweight and obesity. The healthy weight range was further subdivided into lower healthy weight (50th centile) to examine the distribution of EAH across the adiposity continuum. RESULTS: In both studies, EAH showed a significant positive association with adiposity in boys after adjusting for covariates (P<0.001), with a linear increase in the intake across underweight, healthy weight and overweight groups. The association between EAH and adiposity was not significant in girls in either study, although in study 1, results showed a quadratic trend, with EAH increasing through the underweight and healthy weight ranges and decreasing in overweight and obese groups. CONCLUSION: EAH is a behavioural phenotype that is not specific to overweight children but instead shows a graded association with adiposity across the weight continuum, particularly in boys. In this study, the effect was less pronounced in girls, which may reflect social desirability pressures constraining food intake among heavier girls.

Changes in the distributions of body mass index and waist circumference in English adults, 1993/1994 to 2002/2003.

BACKGROUND: Obesity rates have increased markedly in recent years. This study investigated whether increases in adiposity over the past 10 years in England reflect across-the-board gains in adiposity or differential effects in subgroups. METHODS: The data were from the Health Surveys for England, which include home-based measurements of height, weight and waist circumference in population-representative samples. Mean-difference (m-d) curves were calculated to examine increases in BMI and central adiposity at selected percentile points across the distribution between 1993/4 and 2002/3. The sample comprised 20,246 participants in 1993/1994 and 11 708 in 2002/2003. Patterning of population adiposity was examined in relation to gender, age and socioeconomic status (SES). RESULTS: Both BMI and central adiposity increased markedly more in the upper part of the distribution, with intermediate increases in the middle and little change at the lower end of the distribution. The patterning and magnitude of increases in adiposity were similar for men and women, and for lower and higher SES groups. Increases at the top of the distribution were greater for younger adults, with the 90th percentile of waist circumference increasing by more than 8 cm in 10 years in young women. CONCLUSIONS: Gains in adiposity have not been equivalent across the BMI distribution. Thinner people in 2002/3 were almost as thin as they were 10 years earlier, but fatter people were considerably fatter. This could represent progressively greater responsiveness to the 'obesogenic' environment in individuals with higher complements of susceptibility genes. These population trends have important implications for future health and services to manage severe obesity.

School-based physical activity and changes in adiposity.

OBJECTIVE: School-based physical education (PE) is often proposed as a strategy for obesity prevention, but many trials have found non-significant effects on body mass index (BMI). We examined the impact of school PE on adiposity in adolescents, using an ecological analysis to relate the number of PE sessions to changes in BMI and waist circumference. RESEARCH METHODS AND PROCEDURES: Five-year, longitudinal, school-based study involving 34 secondary schools in London, England. Students were aged 11-12 years at baseline. Twenty-five schools reported one weekly session of PE, seven schools reported two sessions and two boys' schools reported three sessions. Weights, heights and waist circumferences were measured annually, and complete data from the first and fifth years of the study were available on 2727 students. Analyses compared anthropometric changes between students in schools with higher or lower amounts of PE time. In boys, the comparisons were between those receiving 1, 2 or 3 weekly sessions. In girls, comparisons were between those receiving one and two sessions. RESULTS: There were no differences in BMI changes or the percentage of students classified as obese between schools of higher and lower frequency of PE. However, using unadjusted data, there were lower gains in waist circumference in boys and girls from the higher PE schools. Controlling for baseline demographic and anthropometric characteristics, boys in schools providing 3 weekly PE sessions gained on average approximately 3 cm less than boys in schools providing one or two sessions (P<0.001). Differences in girls were in the same direction but not significant. DISCUSSION: Higher levels of school PE were associated with lower gains in adiposity in boys. This strengthens the case for including recommendations on school PE time as part of population strategies to control adolescent obesity.

Predictors of programme adherence and weight loss in women in an obesity programme using meal replacements.

OBJECTIVE: To explore predictors of programme adherence and weight loss in patients participating in a weight management programme using meal replacements (MR). DESIGN: One hundred and fifty healthy obese women, age 48.5 years (s.d. = 8.3); weight, 97.6 kg (13.4); body mass index (BMI) 36.5 (3.7), participated in a longitudinal study with a 16-week acute weight loss phase (Phase 1) followed by 1 year of a trial of weight-loss maintenance (Phase 2). Energy intake during Phase 1 totaled 900 kcal (3.7 MJ) a day from a diet including two MR. Energy intake during Phase 2 consisted of either MR or a low-fat diet with a calculated energy deficit of 600 kcal/day (2.5 MJ). METHODS: Weight, height and waist circumference were measured and body composition assessed by air plethysmography (Bodpod). Glucose and insulin were measured by standard immunoassays and insulin sensitivity assessed by homeostatic model assessment. RESULTS: At the end of 16 weeks, 114 subjects (76%) completed Phase 1 and achieved a mean weight loss of 8.95 kg (3.38). Adherence to Phase 1 was predicted by weight loss over the first 2 weeks (p < 0.001). Weight loss during Phase 1 was predicted by initial weight and initial systolic blood pressure. Adherence to Phase 2 was not predicted by physiological measures. Weight loss maintenance in Phase 2 (not gaining more than 3% of the weight at start of phase 2) was predicted by cholesterol and triglyceride measured at the start of Phase 2 but otherwise was not predicted by the physiological measures. Initial insulin sensitivity did not predict weight loss in either phase. CONCLUSION: Participants whose weight loss over the first 2 weeks falls in the bottom third may need additional intervention if they are to continue in this type of programme. A battery of physiological measures at entry to a MR weight loss and maintenance programme explains only a very small proportion of the variation in weight loss.

Parental perceptions of overweight in 3-5 y olds.

OBJECTIVE: To assess the accuracy of parents' perceptions of their 3 to 5 y old children's weight status in a large UK sample. METHOD: Parental perception and concern about child weight, demographic variables, and children's height and weight were obtained for 564 parent-child dyads. RESULTS: Only 1.9% of parents of overweight children and 17.1% of parents of obese children described their child as overweight. The odds of parents perceiving the child as overweight were increased for overweight (2.7; 95% CI 0.4, 16.5) and obese (28.5; 7.1, 115.4) compared with normal weight children, but were not associated with parental weight or with any demographic factors. Although few parents perceived their overweight children as overweight, more (66.2%) expressed concern about their overweight child becoming overweight in the future. Odds of concern were progressively higher for overweight (2.5; 1.6, 3.9) and obese children (4.6; 2.2, 9.7), and were also higher for parents who were themselves overweight (1.9; 1.2, 2.9) or obese (2.5; 1.3, 4.8). CONCLUSION: These findings suggest that parents of 3-5 y olds show poor awareness of their child's current weight status. Reframing discussions in terms of preventing future overweight may be an effective way to engage parents.

Dietary fats and 16-year coronary heart disease mortality in a cohort of men and women in Great Britain.

OBJECTIVE: The paper aims to investigate the relationships of dietary fats to subsequent coronary heart disease (CHD) mortality in men and women while taking account of other CHD-related behaviours. DESIGN: A cohort of randomly selected men and women were interviewed in 1984-85 and monitored subsequently for 16 y for deaths. The interview covered health, health-related behaviours, physical measurements, socio-demographic details and a dietary questionnaire. Appropriate exclusions left 1225 men and 1451 women aged 40-75 with 98 and 57 CHD deaths, respectively. Saturated, polyunsaturated and total fat intakes were estimated. SETTING: The sample was randomly selected from households in Great Britain. The interviews took place in participants' own homes. RESULTS: Not consuming alcohol, smoking, not exercising and being socially disadvantaged were related to high saturated fat intake and CHD death. Cox survival analyses adjusting for these factors found that a level of saturated fat 100 g per week higher corresponded to a relative risk for CHD death for men of 1.00 (0.86-1.18) and 1.40 (1.09-1.79) for women. This difference between the effects of saturated fat in men and women was statistically significant (P=0.019). Results are also reported for total fat and the relative effects of polyunsaturated and saturated fats. CONCLUSIONS: Strong evidence was found for the within cohort relationship of dietary fat and CHD death in women while no evidence was found for a relationship in men. Possible explanations for this are discussed.

Social and demographic factors predictive of change over seven years in CHD-related behaviours in men aged 18-49 years.

It is possible that the relationship of social status to coronary heart disease is partly mediated through health-related behaviours that have been found to relate to both social status and CHD. Changes in certain health-related behaviours are known to lead to changes in CHD incidence. What are the characteristics of men who change or do not change these behaviours and their subsequent chances of CHD? This study aims to relate changes in men's CHD-related behaviours over a seven-year period to their social and demographic characteristics.A survey was carried out on a random sample of adults in Great Britain in 1984-85 and the equivalent information was obtained again on those participants who were re-interviewed seven years later in 1991-92. Results are presented for the 582 men aged 18-34 and the 584 men aged 35-49 at the first interview who were re-interviewed seven years later. Changes over the seven years in smoking, saturated fat intake, alcohol consumption and exercise were related to social and demographic factors. The two age groups showed broadly similar patterns of behaviour. In both age groups, those who continued with or took up a low fat diet and/or exercise were more likely to be in a higher social class, in employment, to live in private housing and to have more educational qualifications. For the younger men only, those in private housing were more likely to reduce the amount they smoked. Other findings are also reported. The findings suggest that those people who are in less advantageous social and economic situations are less likely to change to a more healthy lifestyle and so should be a focus for health education.

Investigation of validity of closed questions in a survey of British South Asian and white populations.

OBJECTIVES: The paper concerns the validity of closed-format questions in an interview-based population survey and focuses on a comparison of South Asian and white respondents. METHOD: A two-part interview consisting of open, respondent-centred questions followed by closed questions taken from a large-scale interview-based health survey was carried out with 15 persons from white and 14 from South Asian communities resident in the UK. Interviewees' views of their stays in hospital was the focus. RESULTS: The two-part interview was found to provide a broadly satisfactory method for the investigation of validity although a limitation was recognised. Twenty-nine per cent of the variation in response to a closed question on 'overall satisfaction' was predictable from views expressed in the open interview. The views of both groups, as expressed in the open interview, were inadequately represented by the closed questions. This appeared to be especially true for the South Asian sample. The validity of the closed question appeared greater for white than for South Asian interviewees. CONCLUSIONS: It is concluded that when designing and piloting health surveys consideration should be given to members of all communities to be included in the survey.

Estimating food and nutrient intake from food frequency questionnaire data by reference to a standard weighed diet survey.

INTRODUCTION: The food frequency questionnaire is widely regarded as more appropriate for ranking and grouping individuals according to levels of nutrient intake than for estimating absolute nutrient amounts. AIMS: To develop a method for estimation of amount of nutrient intake from food frequency questionnaires by reference to an independent weighed dietary survey. METHOD: Six stages of the method are described and illustrated in the estimation of total dietary fat from the 1984-85 Health and Lifestyle Survey using the 1986-87 Dietary and Nutritional Survey of British Adults as the reference standard. RESULTS: Several points support the validity of the approach although limitations are identified.

The effects of time delay and temperature on capillary blood gas measurements.

Monitoring of blood gas measurements is an important part of the assessment of patients with chronic lung disease. Increasingly, this is being done in the patients' homes by specialist nurses. This makes it important to know the effect of time delay and storage temperature on the reliability of capillary blood gas analysis results. In this study, the effect of a delay of 1 and 2 h and of storage at both room temperature and in ice, on blood stored in glass capillary tubes was investigated. Samples, initially taken from the earlobes, were transferred to glass capillary tubes and used to provide duplicate initial samples for immediate analysis, and then single samples at 1 and 2 h stored at room temperature or in ice. The duplicate baseline measurements showed good reproducibility. There was a small, but statistically significant, increase in PCO2 when samples were stored in capillaries at room temperature, or in ice, both at 1 and 2 h. Small changes in PO2 were not statistically significant, either in ice or at room temperature. None of the changes was considered to be sufficient to be of clinical significance, thus supporting the use of capillary blood sampling even when there might be a delay of 1-2 h and transport is at room temperature, as might be the case when taking domiciliary samples.

Diagnostic image quality of mobile neonatal chest X-rays and the radiation exposure incurred.

A study was undertaken to identify the variation of entrance skin doses (ESDs) in mobile neonatal chest radiography with regard to the European Commission (EC) reference dose and to examine potential relationships with image quality and radiographic techniques. Five sites from the former North West Thames region participated. All mobile neonatal radiographic techniques were surveyed. Dose-area product per examination was directly measured and the ESD calculated. Image quality criteria were developed from those published by the EC. Image quality was graded by two independent observers. Over the five sites, 144 examinations were recorded. Calculated ESDs ranged up to 160 microGy, with an appreciable variation not only between sites but also within sites. A clear relationship between actual rather than nominal speed and dose over all sites was demonstrated (r = -0.95, p = 0.013). No correlation between image quality and dose was noted (r = -0.044, p = 0.665). Neonatal imaging systems at participating sites, within the North Thames region, comply with EC guidelines on patient dose and image quality for mobile chest X-rays. Significant variation in ESDs was encountered between sites with no discernible relationship with image quality or the employed radiographic techniques as described by the EC. The strong inverse relationship between ESDs and actual rather than nominal speed suggests a neglected aspect of radiation protection.

Antenatal perineal massage and subsequent perineal outcomes: a randomised controlled trial.

OBJECTIVE: To study the effects of antenatal perineal massage on subsequent perineal outcomes at delivery. DESIGN: A randomised, single-blind prospective study. SETTING: Department of Obstetrics and Gynaecology, Watford General Hospital. PARTICIPANTS: Eight hundred and sixty-one nulliparous women with singleton pregnancy and fulfilling criteria for entry to the trial between June 1994 and October 1995. RESULTS: Comparison of the group assigned to massage with the group assigned to no massage showed a reduction of 6.1% in second or third degree tears or episiotomies. This corresponded to tear rates of 75.1% in the no-massage group and 69.0% in the massage group (P = 0.073). There was a corresponding reduction in instrumental deliveries from 40.9% to 34.6% (P = 0.094). After adjustment for mother's age and infant's birthweight these reductions achieved statistical significance (P = 0.024 and P = 0.034, respectively). Analysis by mother's age showed a much larger benefit due to massage in those aged 30 and over and a smaller benefit in those under 30. CONCLUSION: Antenatal perineal massage appears to have some benefit in reducing second or third degree tears or episiotomies and instrumental deliveries. This effect was stronger in the age group 30 years and above.

How much child psychiatry does a general practitioner do?

Eleven general practitioners recorded information on relevant psychological and social factors on 1,127 consecutive attendances of children and adolescents under the age of 18 years. The proportion of 'pure' psychological problems was low (3.5 per cent of all attendances), but in 25.7 per cent of attendances a psychological component to the presenting problem existed. Non-specific 'emotional' problems were the most frequent psychological symptoms noted, but management problems in infancy and early childhood were also common. There were significant differences between practitioners in the proportion of 'purely physical' diagnoses made and in action taken at the time of attendance. The findings suggest that paediatric training of general practitioners should contain a considerable child psychiatric component.