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The efficacy of nudge theory strategies in influencing adult dietary behaviour: a systematic review and meta-analysis
Background
Obesity has become a world-wide epidemic and is spreading to countries with emerging economies. Previously tested interventions are often too costly to maintain in the long term. This leaves a need for improved strategies for management of the epidemic. Nudge Theory presents a new collection of methods, deemed “nudges”, which have the potential for low-cost and broad application to guide healthier lifestyle choices without the need for restrictive regulation. There has not yet been a large-scale examination of the effectiveness of nudges, despite several policy making bodies now considering their use.
Methods
To address this gap in knowledge, an adapted systematic review methodology was used to collect and consolidate results from current Nudge papers and to determine whether Nudge strategies are successful in changing adults’ dietary choices for healthier ones.
Results
It was found that nudges resulted in an average 15.3 % increase in healthier dietary or nutritional choices, as measured by a change in frequency of healthy choices or a change in overall caloric consumption. All of the included studies were from wealthy nations, with a particular emphasis on the United States with 31 of 42 included experiments.
Conclusions
This analysis demonstrates Nudge holds promise as a public health strategy to combat obesity. More research is needed in varied settings, however, and future studies should aim to replicate previous results in more geographically and socioeconomically diverse countries.
Journal Article
Re-Examining the Association between Vitamin D and Childhood Caries
Previous studies have reported an inverse association between vitamin D and childhood dental caries, but whether this is causal is unclear.
To determine the causal effect of circulating 25-hydroxyvitamin D concentration on dental caries experience, early caries onset and the requirement for a dental general anesthetic.
A Mendelian randomization study was undertaken, using genetic variants known to be associated with circulating 25-hydroxyvitamin D concentrations in 5,545 European origin children from the South West of England. Data on caries and related characteristics were obtained from parental and child completed questionnaires between 38 and 91 months and clinical assessments in a random 10% sample at 31, 44 and 61 months.
In multivariable confounder adjusted analyses no strong evidence for an association of 25-hydroxyvitamin D with caries experience or severity was found but there was evidence for an association with early caries onset, or having a general anesthetic for dental problems. In Mendelian randomization analysis the odds ratio for caries experience per 10 nmol/L increase in 25-hydroxyvitamin D was 0.93 (95% confidence interval: 0.83, 1.05; P = 0.26) and the odds ratio for dental general anaesthetic per 10 nmol/L increase in 25-hydroxyvitamin D was 0.96 (95% confidence interval: 0.75, 1.22; P = 0.72).
This Mendelian randomization study provides little evidence to support an inverse causal effect of 25-hydroxyvitamin D on dental caries. However, the estimates are imprecise and a larger study is required to refine these analyses.
Journal Article
Implications for health system reform, workforce recovery and rebuilding in the context of the Great Recession and COVID-19: a case study of workforce trends in Ireland 2008–2021
Background
Workforce is a fundamental health systems building block, with unprecedented measures taken to meet extra demand and facilitate surge capacity during the COVID-19 pandemic, following a prolonged period of austerity. This case study examines trends in Ireland’s publicly funded health service workforce, from the global financial crisis, through the Recovery period and into the COVID-19 pandemic, to understand resource allocation across community and acute settings. Specifically, this paper aims to uncover whether skill-mix and staff capacity are aligned with policy intent and the broader reform agenda to achieve universal access to integrated healthcare, in part, by shifting free care into primary and community settings.
Methods
Secondary analysis of anonymised aggregated national human resources data was conducted over a period of almost 14 years, from December 31st 2008 to August 31st 2021. Comparative analysis was conducted, by professional cadre, across three keys periods: ‘Recession period’ December 31st 2008–December 31st 2014; ‘Recovery period’ December 31st 2014–December 31st 2019; and the ‘COVID-19 period’ December 31st 2019–August 31st 2021.
Results
During the Recession period there was an overall decrease of 8.1% (
n
= 9333) between December 31st 2008 and December 31st 2014, while the Recovery period saw the overall staff levels rebound and increase by 15.2% (
n
= 16,789) between December 31st 2014 and December 31st 2019. These figures continued to grow, at an accelerated rate during the most recent COVID-19 period, increasing by a further 8.9% (
n
= 10,716) in under 2 years. However, a notable shift occurred in 2013, when the number of staff in acute services surpassed those employed in community services (
n
= 50,038 and 49,857, respectively). This gap accelerated during the Recovery and COVID-19 phase. By August 2021, there were 13,645 more whole-time equivalents in acute settings compared to community, a complete reverse of the 2008 situation. This was consistent across all cadres. Workforce absence trends indicate short-term spikes resulting from shocks while COVID-19 redeployment disproportionately impacted negatively on primary care and community services.
Conclusions
This paper clearly demonstrates the prioritisation of staff recruitment within acute services—increasing needed capacity, without the same commitment to support government policy to shift care into primary and community settings. Concerted action including the permanent redistribution of personnel is required to ensure progressive and sustainable responses are learned from recent shocks.
Journal Article
Star Wars legends epic collection
Collects the early Star Wars comics, which pick up after the events of \"A New Hope,\" and follows Luke Skywalker and his friends battle Darth Vader and the evil Empire.
Book
Changes in Relative Gas Diffusivity Explain Soil Nitrous Oxide Flux Dynamics
Nitrous oxide (N2O) is a greenhouse gas and the main anthropogenic emission contributing to stratospheric ozone depletion. Agricultural soils dominate anthropogenic N2O emissions but there is very limited information specifically relating relative soil gas diffusivity (Dp/Do) to N2O emissions. This study was conducted to determine the effects of soil bulk density (ρb) and matric potential (ψ) on Dp/Do and the associated N2O fluxes in the presence of denitrification substrates. The interaction between soil ρb and ψ on Dp/Do and N2O fluxes was investigated using 880 repacked soil cores that were saturated with a nitrate (NO3–) solution and placed on tension tables at 11 levels of ψ and 5 levels of soil ρb. After equilibration (4 d) N2O fluxes, Dp/Do, inorganic‐N concentrations, and soil physical characteristics were determined. Emissions of N2O peaked at increasingly lower levels of ψ(–1.5 to –6.0 kPa) as soil ρb increased (1.1 to 1.5 Mg m–3) due to increasing microporosity. Peak N2O emissions occurred across a relatively wide range of water‐filled pore space (WFPS) and volumetric water content. A Gaussian fit of N2O‐N fluxes against ψ showed maximum fluxes were related to the soil's air‐entry potential (r2 = 0.96). Maximum N2O emissions occurred at a Dp/Do value of 0.006 that was independent of soil ρb. Log N2O‐N flux was a function of log Dp/Do (r2 = 0.82) when Dp/Do was >0.006. Soil Dp/Do is a key indicator of N2O emission potential and needs to be further explored as a predictor of N2O emissions in a range of soil textures and denitrification substrates.
Journal Article
The further adventures of Red Sonja
\"She lived in a savage world in an uncivilized age - a world ruled by men and governed by the sword. The[y] called her... Red Sonja - for her flame red hair, and for the smoldering fire of her pride, which gave her sword-arm a strength that few men could match, and none had ever defeated. This collection contains a variety of issues from the original Marvel Comics series 'The Savage Sword of Conan,' as well as Sonja Tales from 'Kull and the Barbarians,' with each page re-mastered for this volume. Also included is a gallery of pin-ups by Frank Thorne, Howard Chaykin, and more. These tales are where it all began, and set the stage for the current Red Sonja series from Dynamite Entertainment\"--back cover.
Book
Early Enteral Nutrition Within 24 h of Intestinal Surgery Versus Later Commencement of Feeding: A Systematic review and Meta-analysis
Background
We set out to evaluate early commencement of post-operative enteral nutrition versus traditional management in patients undergoing gastrointestinal surgery.
Methods
Electronic databases were searched, references lists were scanned and authors contacted for additional information. We looked for randomised controlled trials comparing early commencement of feeding (within 24 h) with no feeding in patients undergoing gastrointestinal surgery. Primary endpoints were wound infections, intra-abdominal abscesses, pneumonia, anastomotic leakage, mortality, length of hospital stay and complications of feeding. Data were combined to estimate the common relative risk of post-operative complications and associated 95% confidence intervals.
Results
Thirteen trials, with a total of 1,173 patients, fulfilled our inclusion criteria. Mortality was reduced with early post-operative feeding. Early post-operative feeding increased vomiting. The direction of effect is suggestive of a reduction of risk of post-surgical complications and reduced length of hospital stay.
Conclusion
There is no obvious advantage in keeping patients ‘nil by mouth’ following gastrointestinal surgery. Early enteral nutrition is associated with reduced mortality, though the mechanism is not clear. This review supports the notion that early commencement of enteral feeding may be of benefit.
Journal Article