A systematic review of controlled trials of interventions to prevent childhood obesity and overweight: realistic synthesis of the evidence

Background: Preventing childhood overweight and obesity has become a major public health issue in developed and developing countries. Systematic reviews of this topic have not provided practice-relevant guidance because of the generally low quality of research and the heterogeneity of reported effectiveness. Aim: To present practice-relevant guidance on interventions to reduce at least one measure of adiposity in child populations that do or do not contain overweight or obese children. Design: Systematic review of eligible randomized, controlled trials or controlled trials using a novel approach to synthesizing the trial results through application of descriptive epidemiological and realistic evaluation concepts. Eligible trials involved at least 30 participants, lasted at least 12 weeks and involved non-clinical child populations. Results: Twenty-eight eligible trials were identified to 30 April 2006. Eleven trials were effective and 17 were ineffective in reducing adiposity. Blind to outcome, the main factor distinguishing effective from ineffective trials was the provision of moderate to vigorous aerobic physical activity in the former on a relatively 'compulsory' rather than 'voluntary' basis. Conclusions: By using a novel approach to synthesizing trials, a decisive role for the 'compulsory' provision of aerobic physical activity has been demonstrated. Further research is required to identify how such activity can be sustained and transformed into a personally chosen behaviour by children and over the life course. (C) 2007 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.

Designing dietary interventions: a reappraisal of the demographic and socio-economic determinants of dietary choice in the UK

The facilitation of healthier dietary choices by consumers is one of the key elements of the UK Government’s food strategy. Designing and targeting dietary interventions requires a clear understanding of the determinants of dietary choice. Conventional analysis of the determinants of dietary choice has focused on mean response functions which may mask significant differences in the dietary behaviour of different segments of the population. In this paper we use a quantile regression approach to investigate how food consumption behaviour varies amongst UK households in different segments of the population, especially in the upper and lower quantiles characterised by healthy or unhealthy consumption patterns. We find that the effect of demographic determinants of dietary choice on households that exhibit less healthy consumption patterns differs significantly from that on households that make healthier consumption choices. A more nuanced understanding of the differences in the behavioural responses of households making less-healthy eating choices provides useful insights for the design and targeting of measures to promote healthier diets.

Ethnographic methodologies for construction research: knowing, practice and interventions

Ethnographic methodologies developed in social anthropology and sociology hold considerable promise for addressing practical, problem-based research concerned with the construction site. The extended researcher-engagement characteristic of ethnography reveals rich insights, yet is infrequently used to understand how workplace realities are lived out on construction sites. Moreover, studies that do employ these methods are rarely reported within construction research journals. This paper argues that recent innovations in ethnographic methodologies offer new routes to: posing questions; understanding workplace socialities (i.e. the qualities of the social relationships that develop on construction sites); learning about forms, uses and communication of knowledge on construction sites; and turning these into meaningful recommendations. This argument is supported by examples from an interdisciplinary ethnography concerning migrant workers and communications on UK construction sites. The presented research seeks to understand how construction workers communicate with managers and each other and how they stay safe on site, with the objective of informing site health-and-safety strategies and the production and evaluation of training and other materials.

Dietary interventions affecting chylomicron and chylomicron remnant clearance

Interest in effects of diet on postprandial lipoproteins has increased in recent years as a result of accumulating evidence for adverse cardiovascular consequences of elevated concentrations of triglyceride rich lipoproteins. Particular attention has been given to ability of different fatty acids to modulate postprandial lipoprotein responses because of evidence for both harmful and protective cardiovascular properties of the saturated, monounsaturated and ω-6 and ω-3 polyunsaturated fatty acid (PUFA) classes. Evidence for direct atherogenic properties of chylomicron remnants has led to attempts to monitor effects of diet specifically on this lipoprotein class. Limitations in the methods employed to measure chylomicron remnants and the small number of human studies which have evaluated effects of meal, and background diet, fatty acid composition, makes it difficult to draw definitive conclusions at the present time. However consideration of data from both animal and human studies tends to support the conclusion that diets, and meals, rich in PUFA (particularly long chain ω-3 PUFA), result in attenuated postprandial responses of the intestinally-derived lipoproteins. Attenuated responses to high PUFA meals appear to be due to greater rates of clearance and greater activation of lipoprotein lipase (LPL). Attenuated responses to high PUFA background diets may be due to adaptive changes involving both accelerated rates of clearance in peripheral tissues and liver, as well as decreased output of the competitor for chylomicron clearance, very low density lipoprotein (VLDL).

Policy interventions to promote healthy eating: a review of what works, what does not and what is promising

Unhealthy diets can lead to various diseases, which in turn can translate into a bigger burden for the state in the form of health services and lost production. Obesity alone has enormous costs and claims thousands of lives every year. Although diet quality in the European Union has improved across countries, it still falls well short of conformity with the World Health Organization dietary guidelines. In this review, we classify types of policy interventions addressing healthy eating and identify through a literature review what specific policy interventions are better suited to improve diets. Policy interventions are classified into two broad categories: information measures and measures targeting the market environment. Using this classification, we summarize a number of previous systematic reviews, academic papers, and institutional reports and draw some conclusions about their effectiveness. Of the information measures, policy interventions aimed at reducing or banning unhealthy food advertisements generally have had a weak positive effect on improving diets, while public information campaigns have been successful in raising awareness of unhealthy eating but have failed to translate the message into action. Nutritional labeling allows for informed choice. However, informed choice is not necessarily healthier; knowing or being able to read and interpret nutritional labeling on food purchased does not necessarily result in consumption of healthier foods. Interventions targeting the market environment, such as fiscal measures and nutrient, food, and diet standards, are rarer and generally more effective, though more intrusive. Overall, we conclude that measures to support informed choice have a mixed and limited record of success. On the other hand, measures to target the market environment are more intrusive but may be more effective.

Geoarchaeology and the value of multidisciplinary palaeoenvironmental approaches: a case study from the Tehran Plain, Iran

Tepe Pardis, a significant Neolithic–Chalcolithic site on the Tehran Plain in Iran, is, like many sites in the area, under threat from development. The site contains detailed evidence of (1) the Neolithic–Chalcolithic transition, (2) an Iron Age cemetery and (3) how the inhabitants adapted to an unstable fan environment through resource exploitation (of clay deposits for relatively large-scale ceramic production by c. 5000 BC, and importantly, possible cutting of artificial water channels). Given this significance, models have been produced to better understand settlement distribution and change in the region. However, these models must be tied into a greater understanding of the impact of the geosphere on human development over this period. Forming part of a larger project focusing on the transformation of simple, egalitarian Neolithic communities into more hierarchical Chalcolithic ones, the site has become the focus of a multidisciplinary project to address this issue. Through the combined use of sedimentary and limited pollen analysis, radiocarbon and optically stimulated luminescence dating (the application of the last still rare in Iran), a greater understanding of the impact of alluvial fan development on human settlement through alluviation and the development of river channel sequences is possible. Notably, the findings presented here suggest that artificial irrigation was occurring at the site as early as 6.7±0.4 ka (4300–5100 BC).

Improving insight and non-insight problem solving with brief interventions

Developing brief training interventions that benefit different forms of problem solving is challenging. In earlier research, Chrysikou (2006) showed that engaging in a task requiring generation of alternative uses of common objects improved subsequent insight problem solving. These benefits were attributed to a form of implicit transfer of processing involving enhanced construction of impromptu, on-the-spot or ‘ad hoc’ goal-directed categorizations of the problem elements. Following this, it is predicted that the alternative uses exercise should benefit abilities that govern goal-directed behaviour, such as fluid intelligence and executive functions. Similarly, an indirect intervention – self-affirmation (SA) – that has been shown to enhance cognitive and executive performance after self-regulation challenge and when under stereotype threat, may also increase adaptive goal-directed thinking and likewise should bolster problem-solving performance. In Experiment 1, brief single-session interventions, involving either alternative uses generation or SA, significantly enhanced both subsequent insight and visual–spatial fluid reasoning problem solving. In Experiment 2, we replicated the finding of benefits of both alternative uses generation and SA on subsequent insight problem-solving performance, and demonstrated that the underlying mechanism likely involves improved executive functioning. Even brief cognitive– and social–psychological interventions may substantially bolster different types of problem solving and may exert largely similar facilitatory effects on goal-directed behaviours.

A multidisciplinary literature review of low and zero carbon technologies into new housing

The UK Government is committed to all new homes being zero-carbon from 2016. The use of low and zero carbon (LZC) technologies is recognised by housing developers as being a key part of the solution to deliver against this zero-carbon target. The paper takes as its starting point that the selection of new technologies by firms is not a phenomenon which takes place within a rigid sphere of technical rationality (for example, Rip and Kemp, 1998). Rather, technology forms and diffusion trajectories are driven and shaped by myriad socio-technical structures, interests and logics. A literature review is offered to contribute to a more critical and systemic foundation for understanding the socio-technical features of the selection of LZC technologies in new housing. The problem is investigated through a multidisciplinary lens consisting of two perspectives: technological and institutional. The synthesis of the perspectives crystallises the need to understand that the selection of LZC technologies by housing developers is not solely dependent on technical or economic efficiency, but on the emergent ‘fit’ between the intrinsic properties of the technologies, institutional logics and the interests and beliefs of various actors in the housing development process.

Ranking of interventions to reduce dwelling overheating during heatwaves

Extreme weather events, including heatwaves, are predicted to increase in both frequency and severity over the coming decades. Low house building rates and a growing population mean there is a need to adapt existing dwellings. Research presented here uses dynamic thermal simulation to model the effect of passive heatwave mitigating interventions for UK dwellings. Interventions include a range of additions and modifications to solar shading, insulation and ventilation. Results are presented for typical end and mid terrace houses, with four orientations, two occupancy profiles and using weather data from the 2003 heatwave. Results show the effectiveness of interventions that reduce solar gains through the building fabric, such as external wall insulation and solar reflective coatings. Internal wall insulation is shown to be less effective and can increase the overheating problem in some cases. Control of solar gains through glazing, using shutters and fixed shading, are also effective, particularly for south, east and west-facing rooms. Results are also presented which demonstrate how it is possible to select combinations of interventions that both eliminate overheating and reduce space heating energy use. The cost of interventions is also considered in the final analysis.

High leverage interventions: three cases of defensive action and their lessons for OR/MS today.

This paper has two aims. First, to present cases in which scientists developed a defensive system for their homeland: Blackett and the air defense of Britain in WWII, Forrester and the SAGE system for North America in the Cold War, and Archimedes’ work defending Syracuse during the Second Punic War. In each case the historical context and the individual’s other achievements are outlined, and a description of the contribution’s relationship to OR/MS is given. The second aim is to consider some of the features the cases share and examine them in terms of contemporary OR/MS methodology. Particular reference is made to a recent analysis of the field’s strengths and weaknesses. This allows both a critical appraisal of the field and a set of potential responses for strengthening it. Although a mixed set of lessons arise, the overall conclusion is that the cases are examples to build on and that OR/MS retains the ability to do high stakes work.

Economic rationale for interventions to control livestock disease

Disease in farm animals has significant economic impacts on livestock production and incurs substantial costs for societies. Impacts affect not only livestock farms and the livestock industries but also sectors outside of farming. Important negative externalities of livestock disease include impacts on the health of other producers’ livestock, on human health, and on animal welfare. Good disease risk management/biosecurity and good animal welfare are public goods. Not taking account of these externality and public good aspects can lead to a misallocation of resources for livestock disease control. In such instances, there may be a strong case for government or other authority to intervene to ensure a better use of resources. There are a number of policy instruments that can be implemented for this purpose. One potential instrument is a Farm Animal Health and Welfare Stewardship Scheme funded under Pillar II of the CAP. A number of countries have public–private partnership cost-sharing schemes that aim to share appropriately both responsibilities and costs of epidemic livestock disease. There is a strong future agenda for appropriate intervention by governments in the management of livestock disease risks, including responsibility and cost sharing for livestock disease control, within the European Union and elsewhere.