Consumption of energy drinks by children and young people: a systematic review examining evidence of physical effects and consumer attitudes.

OBJECTIVE: To update an earlier review, published in 2016, on the health and other outcomes associated with children and young people's consumption of energy drinks (EDs). STUDY DESIGN: Review article. SYSTEMATIC REVIEW: Systematic searches of nine databases (ASSIA, CINAHL, Cochrane Library, DARE, Embase, ERIC, MEDLINE, PsycINFO and Web of Science) retrieved original articles reporting the effects of EDs experienced by children and young people up to the age of 21 years. Searches were restricted by publication dates (January 2016 to July 2022) and language (English). Studies assessed as being weak were excluded from the review. Included studies underwent narrative synthesis. RESULTS: A total of 57 studies were included. Boys consumed EDs more than girls. Many studies reported a strong positive association between ED consumption and smoking, alcohol use, binge drinking, other substance use and the intentions to initiate these behaviours. Sensation-seeking and delinquent behaviours were positively associated with ED consumption, as were short sleep duration, poor sleep quality and low academic performance. Additional health effects noted in the updated review included increased risk of suicide, psychological distress, attention-deficit hyperactivity disorder symptoms, depressive and panic behaviours, allergic diseases, insulin resistance, dental caries and erosive tooth wear. CONCLUSIONS: This review adds to the growing evidence that ED consumption by children and young people is associated with numerous adverse physical and mental health outcomes. Where feasible and ethical, additional longitudinal studies are required to ascertain causality. The precautionary principle should be considered in regulatory policy and restriction of ED sales to this population. PROSPERO REGISTRATION: CRD42021255484.

Mapping healthy planning frameworks.

AIMS: The aim of this research was to map available healthy planning frameworks to discover the range, composition, design, and implementation of healthy planning frameworks. METHODS: A systematic scoping review with date, location, and usability limitations was augmented by a grey literature search. Data were extracted on key details, design, outcomes considered, and implementation features of the final 61 frameworks. RESULTS: Data extracted indicated that most frameworks tend to focus on one element of the built environment, with active mobility, active environments, and transport being the most prevalent ones (34%). Most frameworks (40) stated their intended outcomes on health in general terms, rather than targeting specific health outcomes. Very few frameworks (12%) were aimed at the public, and only 11% of frameworks included an evaluation. CONCLUSIONS: While there are a wide variety and number of frameworks available in the field of healthy urban planning, they are generally siloed, focusing on highly specific individual urban determinants, and rarely consider health outcomes in detail. There is significantly less provision available for citizen and community use. Frameworks tend to offer limited updating mechanisms and very rarely include ongoing evaluation processes, making their success difficult to assess.

'Doing school food!': a practical toolkit for adopting a whole school food approach.

AIMS: The dietary intake and reported eating behaviours of adolescents in the UK are a public health concern. Schools are identified as an ideal 'place' setting to promote health and improve young peoples' nutrition outcomes. A gap in the understanding of how healthy secondary school food policy can be implemented, sustainable and effective, may hamper progress to improving school food provision and nutrition education in the UK. Research was conducted to understand the factors which influence healthy school food provision and the adolescent's food choice to inform and develop a practical framework for schools. METHODS: This research involves the development of a practical toolkit which synthesises evidence generated from a mixed methods study and a systematic review. This was informed by an exploration of the secondary school food environment as a potentially 'obesogenic' setting, the effectiveness of school food interventions and policy in Europe and UK, included young people's (11-18 years of age) eating behaviours and priorities in food choice. A pragmatic approach was taken in the integration of evidence, using ecological and behaviour change theory, and joint display principles. RESULT: A six-phase practical toolkit is presented, guided by 'What Good Looks Like' and 'Whole Systems Approach to Obesity' principles which can be used to translate the evidence from this research into good school food practice. CONCLUSION: Improving secondary school food provision across the school day and having a coherent whole school food approach to healthy eating have the potential to significantly improve a young person's food choice, therefore impacting the nutrient intake of adolescents in the UK. This toolkit helps working towards operationalising this idea.

Regulatory mechanisms to create healthier environments: planning appeals and hot food takeaways in England.

AIMS: To explore existing regulatory mechanisms to restrict hot food takeaway (HFT) outlets through further understanding processes at local and national levels. METHODS: The Planning Appeals Portal was utilised to identify recent HFT appeal cases across England between December 2016 and March 2020. Eight case study sites were identified using a purposive sampling technique and interviews carried out with 12 professionals involved in planning and health to explore perceptions of and including factors that may impact on the HFT appeal process. Additionally, documents applicable to each case were analysed and a survey completed by seven Local Authority (LA) health professionals. To confirm findings, interpretation meetings were conducted with participants and a wider group of planning and public health professionals, including a representative from the Planning Inspectorate. RESULTS: Eight case study sites were identified, and 12 interviews conducted. Participants perceived that LAs would be better able to work on HFT appeal cases if professionals had a good understanding of the planning process/the application of local planning policy and supplementary planning documents; adequate time and capacity to deal with appeals cases; access to accurate, robust, and up to date information; support and commitment from elected members and senior management; good lines of communication with local groups/communities interested in the appeal; information and resources that are accessible and easy to interpret across professional groups. CONCLUSIONS: Communication across professional groups appeared to be a key factor in successfully defending decisions. Understanding the impact of takeaway outlets on health and communities in the long term was also important. To create a more robust appeals case and facilitate responsiveness, professionals involved in an appeal should know where to locate current records and statistical data. The enthusiasm of staff and support from senior management/elected officials will play a significant role in driving these agendas forward.

Effect of nonsteroidal anti-inflammatory drugs on the inflammatory response of bovine endometrial epithelial cells in vitro.

Chronic postpartum uterine infection detrimentally affects subsequent fertility. Nonsteroidal anti-inflammatory drugs (NSAID) are used to alleviate pain and treat inflammatory conditions in transition dairy cows with varying success. To screen the efficacy of NSAID in the absence of animal experiments, we have established an in vitro model to study uterine inflammation. Inflammation was induced in cultured bovine endometrial epithelial cells by challenging cells with an inflammation cocktail: lipopolysaccharide and proinflammatory cytokines, interleukin-1ß (IL1ß) and tumor necrosis factor α (TNFα). Release of the inflammation markers, serum amyloid A (SAA) and α-1-acid glycoprotein (αAGP), was measured by ELISA. Concentration of these markers was used to indicate the effectiveness in dampening inflammation of 5 NSAID: meloxicam, flunixin meglumine, aspirin, ketoprofen, and tolfenamic acid. Three NSAID, meloxicam, flunixin meglumine, and tolfenamic acid, were successful at dampening the release of SAA and αAGP into cell-culture supernatant, and the corresponding treated cells were selected for down-stream mRNA expression analysis. Expression of 192 genes involved in regulation of inflammatory pathways were investigated using Nanostring. Of the genes investigated, 81 were above the mRNA expression-analysis threshold criteria and were included in expression analysis. All SAA genes investigated (SAA2, SAA3, M-SAA3.2) were upregulated in response to the inflammation cocktail, relative to mRNA expression in control cells; however, AGP mRNA expression was below the expression analysis threshold and was, therefore, excluded from analysis. Treatment with NSAID downregulated genes involved in regulating chemokine signaling (e.g., CXCL2, CXCR4, CXCL5, and CXCL16) and genes that regulate the eicosanoid pathway (e.g., LTA4H, PTGS2, PLA2G4A, and PTGDS). Of the 5 NSAID investigated, meloxicam, flunixin meglumine, and tolfenamic acid are recommended for further investigation into treatment of postpartum uterine inflammation. The results from this study confirm the immunomodulatory properties of the endometrial epithelium in response to inflammatory stimuli and suggest that NSAID may be beneficial in alleviating uterine inflammation.

The impact of COVID-19 on the hot food takeaway planning regulatory environment: perspectives of local authority professionals in the North East of England.

BACKGROUND & AIMS: Planning regulations have been used to prevent the over-proliferation of hot food takeaways, minimising the impact of local obesogenic environments. To help mitigate the effects of lockdown, the UK government introduced temporary changes in March 2020 to Planning Regulations for England, allowing food retailers to open for takeaway services beyond 'ancillary' level without needing to apply for planning permission through permitted development rights (PDR). Businesses are required to notify their local authority (LA) when they implement PDRs. To better understand the impact of regulations on the policy and practice of key professional groups, Public Health England commissioned Teesside University to undertake scoping research in the North East of England. METHODS: A focus group and interviews were conducted with 15 professionals from 7 of 12 North East LAs. Professions included Planners, Public Health Leads, Environmental Health Officers and Town Centre Managers. Data were analysed using a codebook thematic analysis approach. An interpretation meeting with some participants was conducted. RESULTS: LAs were not aware of most businesses notifying them of new regulation adherence despite taking up PDRs, but were considered low-priority with many lacking formal recording procedures. There were concerns about health consequences of the changes, and consensus relating to ongoing issues with capacity across all professional groups, largely due to the continuing pandemic and absence of a strategy out of temporary measures. Concerns existed around ensuring cessation of restaurants trading as takeaways, and hygiene inspections backlog. Many (personally) saw new takeaways as a lifeline, offering broader menus and preserving local economies. CONCLUSION: Lack of information around the number of restaurants/pubs using PDR to trade as takeaway services, ongoing capacity issues of LAs and, at the time, the absence of a strategy post regulation changes, meant there were high levels of uncertainty regarding the impacts of these temporary measures.

Where is the greatest potential for resource recovery in wastewater treatment plants?

The restorative and regenerative ability of the circular economy has led to the rapid growth of this concept over the past decade, as it facilitates the broadly adopted principles of sustainable development and beyond, through restorative and regenerative actions. The water sector is poised to benefit from this transition, due to its intrinsic circularity and the resources it handles, predominantly found in wastewater, that are valuable and critical. Currently, the vast range of resource recovery technologies coupled with few industrial examples hinder strategic decision making. Resource recovery on a regional scale improves market share and mitigates investment risk, therefore, a structured approach has been developed for the selection of priority technologies to act as a guide for strategic planning. A representative UK wastewater model acts as the baseline, with multi-criteria analysis used to select resources and create an enhanced resource recovery scenario. It was found that implementing the recovery of 5 'priority resources' (and technology pathways) increased nitrogen and phosphorus recovery by 68% and 71%, respectively. Lastly, the need for a cross-cutting approach for the holistic assessment of circular solutions is discussed.

Exploring the fast food and planning appeals system in England and Wales: decisions made by the Planning Inspectorate (PINS).

BACKGROUND: The National Planning Policy Framework advocates the promotion of 'healthy communities'. Controlling availability and accessibility of hot food takeaways is a strategy which the planning system may use to promote healthier environments. Under certain circumstances, for example, local authorities can reject applications for new hot food takeaways. However, these decisions are often subject to appeal. The National Planning Inspectorate decide appeals - by upholding or dismissing cases. The aim of this research is to explore and examine the National Planning Inspectorate's decision-making. METHODS: The appeals database finder was searched to identify hot food takeaway appeal cases. Thematic analysis of appeals data was carried out. Narrative synthesis provided an overview of the appeals process and explored factors that were seen to impact on the National Planning Inspectorate's decision-making processes. RESULTS: The database search identified 52 appeals cases. Results suggest there is little research in this area and the appeals process is opaque. There appears to be minimal evidence to support associations between the food environment and health and a lack of policy guidance to inform local planning decisions. Furthermore, this research has identified non-evidence-based factors that influence the National Planning Inspectorate's decisions. CONCLUSION: Results from this research will provide public health officers, policy planners and development control planners with applied public health research knowledge from which they can draw upon to make sound decisions in evaluating evidence to ensure they are successfully equipped to deal with and defend hot food takeaway appeal cases.

Low cost satellite constellations for nearly continuous global coverage.

Satellite services are fundamental to the global economy, and their design reflects a tradeoff between coverage and cost. Here, we report the discovery of two alternative 4-satellite constellations with 24- and 48-hour periods, both of which attain nearly continuous global coverage. The 4-satellite constellations harness energy from nonlinear orbital perturbation forces (e.g., Earth's geopotential, gravitational effects of the sun and moon, and solar radiation pressure) to reduce their propellant and maintenance costs. Our findings demonstrate that small sacrifices in global coverage at user-specified longitudes allow operationally viable constellations with significantly reduced mass-to-orbit costs and increased design life. The 24-hour period constellation reduces the overall required vehicle mass budget for propellant by approximately 60% compared to a geostationary Earth orbit constellation with similar coverage over typical satellite lifetimes. Mass savings of this magnitude permit the use of less expensive launch vehicles, installation of additional instruments, and substantially improved mission life.

Behaviour change in diabetes: behavioural science advancements to support the use of theory.

Behaviour is central to the management of diabetes, both for people living with diabetes and for healthcare professionals delivering evidence-based care. This review outlines the evolution of behavioural science and the application of theoretical models in diabetes care over the past 25 years. There has been a particular advancement in the development of tools and techniques to support researchers, healthcare professionals and policymakers in taking a theory-based approach, and to enhance the development, reporting and replication of successful interventions. Systematic guidance, theoretical frameworks and lists of behavioural techniques provide the tools to specify target behaviours, identify why ideal behaviours are not implemented, systematically develop theory-based interventions, describe intervention content using shared terminology, and evaluate their effects. Several examples from a range of diabetes-related behaviours (clinic attendance, self-monitoring of blood glucose, retinal screening, setting collaborative goals in diabetes) and populations (people with type 1 and type 2 diabetes, healthcare professionals) illustrate the potential for these approaches to be widely translated into diabetes care. The behavioural science approaches outlined in this review give healthcare professionals, researchers and policymakers the tools to deliver care and design interventions with an evidence-based understanding of behaviour. The challenge for the next 25 years is to refine the tools to increase their use and advocate for the role of theoretical models and behavioural science in the commissioning, funding and delivery of diabetes care.

The effect of hypoglycaemia during hospital admission on health-related outcomes for people with diabetes: a systematic review and meta-analysis.

AIM: To assess the health-related outcomes of hypoglycaemia for people with diabetes admitted to hospital; specifically, hospital length of stay and mortality. METHODS: We conducted a systematic review and meta-analysis of studies relating to hypoglycaemia (< 4 mmol/l) for hospitalized adults (≥ 16 years) with diabetes reporting the primary outcomes of interest, hospital length of stay or mortality. Final papers for inclusion were reviewed in duplicate and the adjusted results of each were pooled, using a random effects model then undergoing further prespecified subgroup analysis. RESULTS: In total, 15 studies were included in the meta-analysis. The pooled mean difference in length of stay for ward-based inpatients exposed to hypoglycaemia was 4.1 days longer [95% confidence interval (CI) 2.36 to 5.79; I² = 99%] compared with those without hypoglycaemia. This association remained robust across the pre-specified subgroup analyses. The pooled relative risk (RR) of in-hospital mortality was greater for those exposed to hypoglycaemia (RR 2.09, 95% CI 1.64 to 2.67; I² = 94%, n = 7 studies) but not in intensive care unit mortality (RR 0.75, 95% CI 0.49 to 1.16; I² =0%, n = 2 studies). CONCLUSION: There is an association between inpatient hypoglycaemia and longer length of stay and greater in-hospital mortality. Studies examining this association were heterogenous in terms of both clinical populations and effect size, but the overall direction of the association was consistent. Therefore, glucose concentration should be considered a potential tool to aid the identification of inpatients at risk of poor health-related outcomes.

Clinical and Psychosocial Factors Influencing Retinal Screening Uptake Among Young Adults with Type 2 Diabetes.

PURPOSE OF REVIEW: Young adults with type 2 diabetes (T2D, 18-39 years) experience early-onset and rapid progression of diabetic retinopathy (DR), the leading cause of vision loss for working age adults. Despite this, uptake of retinal screening, the crucial first step in preventing vision loss from DR, is low. The aim of this review is to summarize the clinical and psychosocial factors affecting uptake of retinal screening. RECENT FINDINGS: Barriers include lack of diabetes-related symptoms, low personal DR risk perception, high rates of depression and diabetes-related distress, fatalism about inevitability of complications, time and financial constraints, disengagement with existing diabetes self-management services, and perceived stigma due to having a condition associated with older adults. Young adults with T2D are an under-researched population who face an accumulation of barriers to retinal screening. Tailored interventions that address the needs, characteristics, and priorities of young adults with T2D are warranted.

The impact of interventions to promote healthier ready-to-eat meals (to eat in, to take away or to be delivered) sold by specific food outlets open to the general public: a systematic review.

INTRODUCTION: Ready-to-eat meals sold by food outlets that are accessible to the general public are an important target for public health intervention. We conducted a systematic review to assess the impact of such interventions. METHODS: Studies of any design and duration that included any consumer-level or food-outlet-level before-and-after data were included. RESULTS: Thirty studies describing 34 interventions were categorized by type and coded against the Nuffield intervention ladder: restrict choice = trans fat law (n = 1), changing pre-packed children's meal content (n = 1) and food outlet award schemes (n = 2); guide choice = price increases for unhealthier choices (n = 1), incentive (contingent reward) (n = 1) and price decreases for healthier choices (n = 2); enable choice = signposting (highlighting healthier/unhealthier options) (n = 10) and telemarketing (offering support for the provision of healthier options to businesses via telephone) (n = 2); and provide information = calorie labelling law (n = 12), voluntary nutrient labelling (n = 1) and personalized receipts (n = 1). Most interventions were aimed at adults in US fast food chains and assessed customer-level outcomes. More 'intrusive' interventions that restricted or guided choice generally showed a positive impact on food-outlet-level and customer-level outcomes. However, interventions that simply provided information or enabled choice had a negligible impact. CONCLUSION: Interventions to promote healthier ready-to-eat meals sold by food outlets should restrict choice or guide choice through incentives/disincentives. Public health policies and practice that simply involve providing information are unlikely to be effective.

'I'm not trusted in the kitchen': food environments and food behaviours of young people attending school and college.

BACKGROUND: Food behaviours are important in the context of health and obesity. The aim was to explore the environments and food behaviours of a sample of young people in the North East of England to further understanding of the relationship between eating behaviours and environmental context. METHODS: Focus groups were conducted with four groups of young people aged 16-20 years (n = 40; 28 male, 12 female) between November 2006 and June 2007. Analysis was informed by grounded theory methods and was an iterative process of identifying themes across the transcripts. RESULTS: Topics explored included: their main environment, home food responsibility and cooking, food outside of the home, where food was purchased/obtained and where food was eaten and with whom. Emergent themes included: the value for money in food purchases, time convenience, the car as a means of accessing food and health perceptions. CONCLUSIONS: The complexities of the food environment were illustrated. This work has highlighted the importance of the home food environment and parents, and indicated the importance of factors such as time and cost in this age group's food choices. The behavioural norms around food behaviours merit further exploration for this population in transition between adolescence and adulthood.

A meta-analysis of Hodgkin lymphoma reveals 19p13.3 TCF3 as a novel susceptibility locus.

Recent genome-wide association studies (GWAS) of Hodgkin lymphoma (HL) have identified associations with genetic variation at both HLA and non-HLA loci; however, much of heritable HL susceptibility remains unexplained. Here we perform a meta-analysis of three HL GWAS totaling 1,816 cases and 7,877 controls followed by replication in an independent set of 1,281 cases and 3,218 controls to find novel risk loci. We identify a novel variant at 19p13.3 associated with HL (rs1860661; odds ratio (OR)=0.81, 95% confidence interval (95% CI) = 0.76-0.86, P(combined) = 3.5 × 10(-10)), located in intron 2 of TCF3 (also known as E2A), a regulator of B- and T-cell lineage commitment known to be involved in HL pathogenesis. This meta-analysis also notes associations between previously published loci at 2p16, 5q31, 6p31, 8q24 and 10p14 and HL subtypes. We conclude that our data suggest a link between the 19p13.3 locus, including TCF3, and HL risk.

Exploring the built environment, physical activity and related behaviours of young people attending school, college and those not in employment.

BACKGROUND: Evidence suggests that environments impact behaviour, including physical activity (PA). The aim was to understand where young people are physically active and the environmental contexts to their activity. To explore how they perceived both barriers to, and enablers for, PA in their environment. METHODS: Focus groups were conducted with five groups aged 16-20 years (n = 42; 29 male, 13 female) in Newcastle-upon-Tyne, England between November 2006 and June 2007. Analysis was an iterative process of looking for broad themes and subthemes across the transcripts. RESULTS: Themes explored included their main environment; perceptions of their environment; PA and where they are active; activity in the past and safety concerns. Emergent themes included working and PA, transport and activity, limitations of the environment to PA and gender differences. Our results suggest PA was distributed across a range of environments, rather than focused in one locale, or setting. CONCLUSIONS: Obesity in young people is a major concern and prevention of obesity a high priority. Little is known about the PA behaviours of this age group and the context of these behaviours during this period of transition. Understanding lifestyle behaviours such as PA and context of activity is an important first step in development interventions to encourage greater activity in this transitory age group.

Laparoscopic conversion of failed gastric banding to Roux-en-Y gastric bypass: short-term follow-up and technical considerations.

BACKGROUND: The most common bariatric procedure in Australia is laparoscopic adjustable gastric banding (LAGB). Although successful, there is a substantial long-term complication and failure rate. Band removal and conversion to Roux-en-Y gastric bypass (RYGB) can be an effective treatment for complicated or failed bands. There is increasing evidence supporting good weight loss and resolution of band-related complications after conversion. METHODS: A prospective database of all bariatric procedures is maintained. Patients having revision of LAGB to RYGB between December 2007 and April 2011 were included in this study. Indications for surgery, operative details, morbidity and mortality, weight loss data, and post-operative symptoms were recorded. RESULTS: Eighty-two patients were included. Indications for surgery were inadequate weight loss (n = 42), adverse symptoms (reflux = 8, dysphagia = 2), and band complications (band erosion = 7, band sepsis = 1, band slip = 11, esophageal dilatation = 11). Seventy-eight percent of procedures were completed in a single stage and 96.3% laparoscopically. There was no 30-day mortality. Total morbidity was 46.3% (minor complications = 32.9%, major complications = 13.4%). Median BMI was 43 kg/m(2) pre-RYGB and 34 kg/m(2) after 12 months. All patients with adverse band-related symptoms had resolution. CONCLUSIONS: LAGB has a considerable complication and failure rate. Conversion of these patients to RYGB results in further weight loss and resolution of adverse symptoms. This is a challenging procedure, but can usually be performed in a single stage with acceptable morbidity and mortality. These patients should be treated in high-volume, subspecialty bariatric units.

Disaster Victim Identification: quality management from an odontology perspective.

The desired outcome of the victim identification component of a mass fatality event is correct identification of deceased persons in a timely manner allowing legal and social closure for relatives of the victims. Quality Management across all aspects of the Disaster Victim Identification (DVI) structure facilitates this process. Quality Management in forensic odontology is the understanding and implementation of a methodology that ensures collection, collation and preservation of the maximum amount of available dental data and the appropriate interpretation of that data to achieve outcomes to a standard expected by the DVI instructing authority, impacted parties and the forensic odontology specialist community. Managerial pre-event planning responsibility, via an odontology coordinator, includes setting a chain of command, developing and reviewing standard operating procedures (SOP), ensuring use of current scientific methodologies and staff training. During a DVI managerial responsibility includes tailoring SOP to the specific situation, ensuring member accreditation, encouraging inter-disciplinary cooperation and ensuring security of odontology data and work site. Individual responsibilities include the ability to work within a team, accept peer review, and share individual members' skill sets to achieve the best outcome. These responsibilities also include adherence to chain of command and the SOP, maintenance of currency of knowledge and recognition of professional boundaries of expertise. This article highlights issues of Quality Management pertaining particularly to forensic odontology but can also be extrapolated to all DVI actions.

LIFELAX - diet and LIFEstyle versus LAXatives in the management of chronic constipation in older people: randomised controlled trial.

OBJECTIVES: To investigate the clinical effectiveness and cost-effectiveness of laxatives versus dietary and lifestyle advice, and standardised versus personalised dietary and lifestyle advice. DESIGN: A prospective, pragmatic, three-armed cluster randomised trial with an economic evaluation. SETTING: General practices in England and Scotland, UK. PARTICIPANTS: People aged ≥ 55 years with chronic constipation, living in private households. Participants were identified as those who had been prescribed laxatives three or more times in the previous 12 months, or with a recorded diagnosis of chronic functional constipation. INTERVENTIONS: Prescription of laxatives, with class of laxative and dose at the discretion of the GP and patient (standard care control arm); standardised, non-personalised dietary and lifestyle advice; and, personalised dietary and lifestyle advice, with reinforcement. OUTCOME MEASURES: The primary outcome was the constipation-specific Patient Assessment of Constipation-Symptoms (PAC-SYM)/Patient Assessment of Constipation-Quality of Life (PAC-QOL). RESULTS: The trial planned to recruit and retain 1425 patients from 57 practices (19 per arm); however, only 154 patients were recruited from 19 practices. Due to these low recruitment rates it was not possible to report the conventional trial findings. Baseline characteristics of the sample from data gathered from both postal self-completion questionnaires and face-to-face interviews suggest that our sample experienced very few symptoms of constipation (PAC-SYM) and that the condition itself did not have a major impact upon their quality of life (PAC-QOL). The low level of symptoms of constipation is most likely explained by 90% of the sample using a laxative in the previous week. Most participants in our sample were satisfied with the performance of their laxatives, and levels of anxiety and depression were low. Their fibre consumption was classified as 'moderate' but their average water consumption fell below the recommended guidelines. Daily diaries, completed each day for a period of 6 months, were analysed primarily in terms of overall response rate and item response rates, and the participants accepted this method of data collection. For the economic evaluation, all of the trial arms experienced a reduction in utility, as measured by EQ-5D. There was no statistical evidence to suggest that either the personalised intervention arm or the standardised intervention arm was associated with significant changes in utility at 3 months compared with the control arm. Data on related health-care costs show a cost saving of £13.34 for those in the personalised arm, compared with the control arm, and a smaller cost saving for the standardised arm. These savings primarily occurred because of reduced hospital costs. There was no significant change measured in utility, so the personalised arm appeared to be the preferred course, producing the greatest cost savings. CONCLUSIONS: Due to the low number of participants in the trial, no firm conclusions could be drawn about the effectiveness of the interventions. However, a number of factors that contributed to the conduct and progress of the trial are highlighted, which may be relevant to others conducting research on a similar topic or population. TRIAL REGISTRATION: ISRCTN73881345. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 14, No. 52. See the HTA programme website for further project information.

Diet, physical activity, sedentary behaviour and perceptions of the environment in young adults.

BACKGROUND: Few studies have explored both food behaviour and physical activity in an environmental context. Most research in this area has focused on adults; the aim of the present study was to describe perceptions of the environment, diet, physical activity and sedentary behaviour patterns in 16-20 year olds in full-time education (Newcastle, UK). METHODS: Participants (n = 73) recruited from a college and sixth-form college completed a UK version of the Youth Neighbourhood Environment Walkability Survey, which included measures of sedentary behaviour. A validated food frequency questionnaire was completed and a factor applied to produce an estimated mean daily frequency of intake of each item, which was converted to nutrient intakes. A rank for Index of Multiple Deprivation (IMD) was assigned to their home postcode. Analysis explored associations between sedentary behaviours and nutrient intake. RESULTS: In this descriptive cross-sectional study, most participants reported being physically active for at least 1 h day(-1) on 3-4 (n = 28) or 5-7 days (n = 31). There were no significant differences in nutrient intake according to sample quartile IMD position. Sedentary behaviours were significantly associated with less healthy eating patterns. Higher total energy (P = 0.02), higher fat (P = 0.005), percentage energy from fat (P = 0.035) and lower carbohydrate intakes (P = 0.004) were significantly associated with more time spent watching DVDs at the weekend. CONCLUSIONS: This combination of sedentary behaviour and less healthy eating patterns has important implications for long-term health (e.g. the tracking of being overweight and obesity from adolescence into adulthood). Understanding behaviour relationships is an important step in developing interventions in this age group.