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Online media is important for society in informing and shaping opinions, hence raising the question of what drives online news consumption. Here we analyse the causal effect of negative and emotional words on news consumption using a large online dataset of viral news stories. Specifically, we conducted our analyses using a series of randomized controlled trials (N = 22,743). Our dataset comprises ~105,000 different variations of news stories from Upworthy.com that generated ∼5.7 million clicks across more than 370 million overall impressions. Although positive words were slightly more prevalent than negative words, we found that negative words in news headlines increased consumption rates (and positive words decreased consumption rates). For a headline of average length, each additional negative word increased the click-through rate by 2.3%. Our results contribute to a better understanding of why users engage with online media., Nature Human Behaviour, 7 (5), ISSN:2397-3374

Objectives: The internet has changed the organisation of sex work. The risk of sexually transmitted infections has frequently been a research focus, but less is known about sex workers' use of contraception for pregnancy prevention. The aim of this research was to gain a better understanding of contraceptive preferences and provider interactions of online sex workers.Methods: Data were obtained from a multi-methods study of sex workers in the UK who advertise on the internet and have sexual contact with clients, particularly in the Birmingham and Solihull areas. The study comprised an online survey among 67 participants and eight qualitative interviews.Results: Reported high rates of condom use with clients led to sex workers considering pregnancy prevention to be a personal rather than an occupational issue. Disclosure of sex working to health professionals is often seen as unnecessary and/or undesirable due to concerns about stigma. A clear distinction between contraceptive needs for commercial and non-commercial partners was evident.Conclusion: Service providers need to take account of both personal and commercial needs during contraceptive consultations and avoid making assumptions based on homogeneous understandings of sex work. Encouraging disclosure of sex work to facilitate appropriate discussions may need new approaches to combat privacy and stigma concerns.

Recent work provides evidence that the infant brain is able to make top-down predictions, but this has been explored only in limited contexts and domains. We build upon this evidence of predictive processing in infants using a new paradigm to examine auditory repetition suppression (RS). RS is a well-documented neural phenomenon in which repeated presentations of the same stimulus result in reduced neural activation compared to non-repeating stimuli. Many theories explain RS using bottom-up mechanisms, but recent work has posited that top-down expectation and predictive coding may bias, or even explain, RS. Here, we investigate whether RS in the infant brain is similarly sensitive to top-down mechanisms. We use fNIRS to measure infants’ neural response in two experimental conditions, one in which variability in stimulus presentation is expected (occurs 75% of the time) and a control condition where variability and repetition are equally likely (50% of the time). We show that 6-month-old infants exhibit attenuated frontal lobe response to blocks of variable auditory stimuli during contexts when variability is expected as compared to the control condition. These findings suggest that young infants’ neural responses are modulated by predictions gained from experience and not simply by bottom-up mechanisms. Keywords: Infant, fNIRS, Learning, Prediction, Auditory, Language, Lexical, Words, Language development, Development, Expectation, Repetition suppression, Repetition enhancement, Context, Task

The lectinHelix pomatiaagglutinin (HPA) recognizes altered glycosylation in solid cancers and the identification of HPA binding partners in tumour tissue and serum is an important aim. Among the many HPA binding proteins, IgA1 has been reported to be the most abundant in liver metastases. In this study, the glycosylation of IgA1 was evaluated using serum samples from patients with breast cancer (BCa) and the utility of IgA1 glycosylation as a biomarker was assessed. Detailed mass spectrometric structural analysis showed an increase in disialo-biantennaryN-linked glycans on IgA1 from BCa patients (p< 0.0001: non-core fucosylated;p= 0.0345: core fucosylated) and increased asialo-Thomsen–Friedenreich antigen (TF) and disialo-TF antigens in theO-linked glycan preparations from IgA1 of cancer patients compared with healthy control individuals. An increase inSambucus nigrabinding was observed, suggestive of increasedα2,6-linked sialic acid on IgA1 in BCa. Logistic regression analysis showed HPA binding to IgA1 and tumour size to be significant independent predictors of distant metastases (χ213.359;n= 114;p= 0.020) with positive and negative predictive values of 65.7% and 64.6%, respectively. Immunohistochemical analysis of tumour tissue samples showed IgA1 to be detectable in BCa tissue. This report provides a detailed analysis of serum IgA1 glycosylation in BCa and illustrates the potential utility of IgA1 glycosylation as a biomarker for BCa prognostication.

Background: A glycoproteomic study has previously shown cadherin-5 (CDH5) to be a serological marker of metastatic breast cancer when both protein levels and glycosylation status were assessed. In this study we aimed to further validate the utility of CDH5 as a biomarker for breast cancer progression. Methods: A nested case–control study of serum samples from breast cancer patients, of which n=52 had developed a distant metastatic recurrence within 5 years post-diagnosis and n=60 had remained recurrence-free. ELISAs were used to quantify patient serum CDH5 levels and assess glycosylation by Helix pomatia agglutinin (HPA) binding. Clinicopathological, treatment and lifestyle factors associated with metastasis and elevated biomarker levels were identified. Results: Elevated CDH5 levels (P=0.028) and ratios of CDH5:HPA binding (P=0.007) distinguished patients with metastatic disease from those that remained metastasis-free. Multivariate analysis showed that the association between CDH5:HPA ratio and the formation of distant metastases was driven by patients with oestrogen receptor (ER+) positive cancer with vascular invasion (VI+). Conclusions: CDH5 levels and the CDH5 glycosylation represent biomarker tests that distinguish patients with metastatic breast cancer from those that remain metastasis-free. The test reached optimal sensitivity and specificity in ER-positive cancers with vascular invasion.

DietCompLyf is a multi-centre prospective study designed to investigate associations between phytoestrogens - naturally occurring plant compounds with oestrogenic properties - and other diet and lifestyle factors with breast cancer recurrence and survival. 3159 women with grades I-III breast cancer were recruited 9-15 months post-diagnosis from 56 UK hospitals. Detailed information on clinico-pathological, diet, lifestyle and quality of life is collected annually up to 5 years. Biological samples have also been collected as a resource for subsequent evaluation. The characteristics of the patients and associations between pre-diagnosis intake of phytoestrogens (isoflavones and lignans; assessed using the EPIC-Norfolk UK 130 question food frequency questionnaire) and breast cancer (i) risk factors and (ii) prognostic factors are described for 1797 women who had complete data for all covariates and phytoestrogens of interest. Isoflavone intakes were higher in the patients who were younger at diagnosis, in the non-smokers, those who had breast-fed and those who took supplements. Lignan intakes were higher in patients with a higher age at diagnosis, in ex-smokers, those who had breast-fed, who took supplements, had a lower BMI at diagnosis, lower age at menarche and were nulliparous. No significant associations between pre-diagnosis phytoestrogen intake and factors associated with improved breast cancer prognosis were observed. The potential for further exploration of the relationship between phytoestrogens and breast cancer recurrence and survival, and for the establishment of evidence to improve dietary and lifestyle advice offered to patients following breast cancer diagnosis using DietCompLyf data is discussed.

Objective: In short-term feeding trials, replacement of other macronutrients with monounsaturated fatty acid reduces blood pressure. However, observational studies have not clearly demonstrated a relationship between monounsaturated fatty acid intake and blood pressure. We report associations of monounsaturated fatty acid intake of individuals with blood pressure in a cross-sectional study. Methods: The International Study of Macro/Micronutrients and Blood Pressure is a cross-sectional epidemiologic study of 4,680 men and women ages 40-59 from 17 population samples in China, Japan, United Kingdom, and United States. Nutrient intake data were based on four in-depth multi-pass 24-hour dietary recalls/person and two timed 24-hour urine collections/person. Blood pressure was measured eight times at four visits. Results: Mean monounsaturated fatty acid intake ranged from 8.1 %kcal (China) to 12.2%kcal (United States). With sequential models to control for possible confounders (dietary, other), linear regression analyses showed significant inverse relationship of total monounsaturated fatty acid intake with diastolic blood pressure for all participants; for 2,238 “non-intervened” individuals, the relationship was stronger. Estimated diastolic blood pressure differences with 2-SD higher monounsaturated fatty acids (5.35 %kcal) were -0.82 mm Hg (P

Purpose: This paper summarises the scientific rationale supporting the need to promote healthy diet and lifestyle choices during pregnancy and describes a pilot study assessing the impact of public health messages on diet quality and lifestyle choices among a population of pregnant women. Design/methodology/approach: 18 women (ages 21–46 years) in their second trimester of pregnancy completed an online questionnaire entitled “Your Health in Pregnancy”. Findings: Results found that knowledge of the roles of specific nutrients important in pregnancy—folic acid 89%, iron 72%, vitamin D 78%, calcium 100%—were higher than those gained for translating knowledge into practical ‘food-based’ skills, i.e., identifying food sources of the same (folic acid 61%, iron 83%, Vitamin D 67% and calcium 94%). Practical implications: Women are aware of public health messages during pregnancy but are inconsistent when translating knowledge into behaviour change. Encouraging positive changes requires a greater understanding of complexities of factors which influence dietary and health choices.

Information on dietary supplements, medications, and other xenobiotics in epidemiologic surveys is usually obtained from questionnaires and is subject to recall and reporting biases. The authors used metabolite data obtained from hydrogen-1 (or proton) nuclear magnetic resonance ( 1H NMR) analysis of human urine specimens from the International Study of Macro-/Micro-Nutrients and Blood Pressure (INTERMAP Study) to validate self-reported analgesic use. Metabolic profiling of two 24-hour urine specimens per individual was carried out for 4,630 participants aged 40-59 years from 17 population samples in Japan, China, the United Kingdom, and the United States (data collection, 1996-1999). 1H NMR-detected acetaminophen and ibuprofen use was low (�4%) among East Asian population samples and higher (>16%) in Western population samples. In a comparison of self-reported acetaminophen and ibuprofen use with 1H NMR-detected acetaminophen and ibuprofen metabolites among 496 participants from Chicago, Illinois, and Belfast, Northern Ireland, the overall rate of concordance was 81%-84%; the rate of underreporting was 15%-17%; and the rate of underdetection was approximately 1%. Comparison of self-reported unspecified analgesic use with 1H NMR-detected acetaminophen and ibuprofen metabolites among 2,660 Western INTERMAP participants revealed similar levels of concordance and underreporting. Screening for urinary metabolites of acetaminophen and ibuprofen improved the accuracy of exposure information. This approach has the potential to reduce recall bias and other biases in epidemiologic studies for a range of substances, including pharmaceuticals, dietary supplements, and foods. © 2012 The Author.

High vitamin D intake in childhood has been suggested to have an adverse influence on linear growth. In Finland, in the mid-1960s the official recommendation for infant vitamin D supplementation was 2000 IU/d (50 μg/d). We investigated whether high-dose vitamin D supplementation in infancy was associated with subsequent growth in height. We used data from a prospective population-based birth cohort study including all children due to be born in the 2 northernmost provinces in Finland in 1966 (12,058 live-births, coverage 96%). Information on each participant's height was collected at birth and ages 1, 14, and 31 y, as were possible confounding factors (data for analyses available from 10,060 singletons). Information on the frequency and dose of vitamin D supplementation was collected in 1967 when participants were 1 y of age. A weak association was found between frequency of vitamin D supplementation with greater height at age 1 y (P = 0.005), which was explained by birth characteristics and maternal and social factors (adjusted P = 0.34). Neither frequency nor dose of vitamin D supplementation was associated with height at 14 or 31 y (P > 0.13). To conclude, contrary to proposed evidence suggesting that vitamin D has a negative influence on growth rate at a dosage of ~2000 IU/d, supplementation at this level in the Northern Finland Birth Cohort was not associated with reduced height at any age studied.

The role of post-market monitoring (PMM) in the safety assessment of novel foods is critically discussed in order to derive guidelines as to in which situations the application of PMM might be warranted. Available data sources on food consumption and health status, and the methodologies for generating such data are reviewed. The paper suggests improvements to make them more applicable for PMM purposes. It is concluded that any PMM programme must be a hypothesis-driven scientific exercise. PMM can have a role as a complement to, but not as a replacement for, a comprehensive pre-market safety assessment. Its use may be appropriate to confirm that product use is as predicted in the pre-market assessment; to provide reassurance that effects observed in the pre-market assessment occur with no greater frequency or intensity in the post-market phase than anticipated; and to investigate the significance of any adverse effects reported by consumers after market-launch. However PMM is insufficiently powerful to test the hypothesis that any effects seen in the pre-market assessment are absent in the post-market phase. Current methodologies place limitations on what PMM can achieve. PMM should only be used when triggered by or when the focus is on specific evidence-based questions.

ObjectiveTo identify associations between dietary glycaemic index (GI) and weight, body mass index and other risk factors for cardiovascular disease (CVD) – waist-to-hip ratio (WHR), lipoprotein fractions, triacylglycerols (TAG) and blood pressure (BP) – in an older British population.DesignCross-sectional dietary, anthropometric and biochemical data from the National Diet and Nutritional Survey for adults aged over 65 years were reanalysed using a hierarchical regression model. Associations between body weight, CVD risk factors, and dietary factors including GI and fibre intakes were explored among 1152 healthy older people living in the UK between 1994 and 1995.ResultsIn the unadjusted model, GI was significantly and directly associated with TAG (β = 0.008 ± 0.003) and diastolic BP (β = 0.325 ± 0.164) in males. These relationships were attenuated and non-significant after adjustment for potential confounding factors. WHR (β = 0.003 ± 0.001) and TAG (β = 0.005 ± 0.002) were significantly predicted by GI in males and females combined. The association with WHR was attenuated by adjustment for sex, age, region and social class; the relationship with TAG was non-significant after adjustment for other potential dietary confounders.ConclusionAfter controlling for potential confounders, no clear links were detected between GI and body weight or other CVD risk factors. This study provides little evidence for advising the consumption of a low-GI diet in the elderly to prevent weight gain or improve other CVD risk factors.

The aim of this report is to describe INTERMAP standardized procedures for assessing dietary intake of 4680 individuals from 17 population samples in China, Japan, UK and USA: Based on a common Protocol and Manuals of Operations, standardized collection by centrally trained certified staff of four 24 h dietary recalls, two timed 24-h urines, two 7-day histories of daily alcohol intake per participant; tape recording of all dietary interviews, and use of multiple methods for ongoing quality control of dietary data collection and processing (local, national, and international); one central laboratory for urine analyses; review, update, expansion of available databases for four countries to produce comparable data on 76 nutrients for all reported foods; use of these databases at international coordinating centres to compute nutrient composition. Chinese participants reported 2257 foods; Japanese, 2931; and UK, 3963. In US, use was made of 17,000 food items in the online automated Nutrition Data System. Average time/recall ranged from 22 min for China to 31 min for UK. Among indicators of dietary data quality, coding error rates (from recoding 10% random samples of recalls) were 2.3% for China, 1.4% for Japan, and UK; an analogous US procedure (re-entry of recalls into computer from tape recordings) also yielded low discrepancy rates. Average scores on assessment of taped dietary interviews were high, 40.4 (Japan) to 45.3 (China) (highest possible score: 48); correlations between urinary and dietary nutrient values--similar for men and women--were, for all 4680 participants, 0.51 for total protein, range across countries 0.40-0.52; 0.55 for potassium, range 0.30-0.58; 0.42 for sodium, range 0.33-0.46. The updated dietary databases are valuable international resources. Dietary quality control procedures yielded data generally indicative of high quality performance in the four countries. These procedures were time consuming. Ongoing recoding of random samples of recalls is deemed essential. Use of tape recorded dietary interviews contributed to quality control, despite feasibility problems, deemed remediable by protocol modification. For quality assessment, use of correlation data on dietary and urinary nutrient values yielded meaningful findings, including evidence of special difficulties in assessing sodium intake by dietary methods.

Background: The alpha+-thalassaemias are the most common monogenic disorders of humans, characterised by microcytic and hypochromic anaemia. Their high frequency reflects selective advantage against death from Plasmodium falciparum malaria. The most common type of alpha+- thalassaemia amongst people of African descent is the -?3.7 deletional type and affects 26-33% of Ghanaians. Plasmodium falciparum malaria is a major cause of mortality amongst children in sub-Saharan Africa. Unlike HbAS, HbAC and G6PD deficiency there remains debate about whether alpha+- thalassaemia protects against malaria and the mechanism for the protection. Methods: 1672 children of ?10 years were recruited and individuals with G6PD deficiency, HbAC and Hb AS reported to protect against malaria were excluded. 732 children with Plasmodium falciparum were tested for Hb, RBC, MCV, MCH and parasite density. The subjects were then categorised into normocytic and microcytic using a cut off MCV value of 76fL and normochromic and hypochromic using a cut off MCH value of 25 pg. Microcytic hypochromic individuals were genotyped by Polymerase Chain Reaction for the -?3.7 deletional thalassaemia mutation. Results: The frequency of Plasmodium falciparum malaria in the studied population was 54.1%. There was a frequency of 21.0% for the heterozygous (-?/??) and 8.3% for the homozygous (-?/-?) alpha+-thalassaemia, resulting in a carriage rate (?/?? & -?/-?) of 29.3%. Among the microcytic patients, geometric mean parasite density (GMPD) values were lower in the presence of an alpha+- thalassaemia genotype (-?/?? GMPD 9015, n=126 and -?/-? GMPD 6852, n=49) compared to normal genotype (??/?? GMPD 51794, n=358) (p 60 months for both the homozygous and heterozygous alpha+-thalassaemia were not significant at p=0.399 and p=0.207 respectively. Conclusion: The severity of Plasmodium falciparum parasitaemia measured, as either GMPD or prevalence of severe parasitaemia was significantly lower in both the -?/?? and -?/-?- groups compared to microcytic individuals with normal genotype. Even though GMPD differed significantly amongst all alpha+-thalassemia genotypes, it was not driven by hypochromasia. Among the homozygous and heterozygous alpha+-thalassaemias, children with severe anaemia had a significantly high GMPD than their counterparts who were not severely anaemic making them more susceptible to severe malaria anaemia. No loss of protection was seen in children younger or older than 60 months and therefore the protective effect from severe malaria might not wane with age. The mechanism of protection from severe Plasmodium falciparum malaria is not clear, however the influence of microcytosis and hypochromasia on parasite density requires more research.

The sixth summary edition of McCance and Widdowson's The Composition of Foods Tables, compiled by the Food Standards Agency and the Institute of Food Research was recently published. The initial endeavours of Professor McCance and Dr Widdowson in the 1930's have been extensively developed, and this work composes a valuable reference tool for all those with an interest in UK food and nutrient consumption. This review considers the changes observed in the latest edition of these tables.

The aim of the present study was to examine the association between maternal Hb levels during pregnancy and educational achievement of the offspring in later life. We analysed data obtained from the Northern Finnish Birth Cohort Study conducted in 1966, in which, data on mothers and offspring from pregnancy through to the age of 31 years were collected. The cohort comprised 11 656 individuals born from singleton births (51 % males and 49 % females). Maternal Hb levels were available from the third, seventh and ninth gestational months. Educational achievement was measured as school scores (range 4–10) taken at the ages of 14 (self-reported questionnaires) and 16 (school reports) years as well as the highest level of education at the age of 31 years. The present results showed a direct positive association between Hb levels and educational achievement in later life. After adjustment for sex, birth weight, birth month and a wide range of maternal factors (parity, smoking, mental status, whether pregnancy was wanted or not, education, social class and marital status), only maternal Hb levels that were measured at the ninth month were significantly associated with the offspring's school performance. If the levels were ≥ 110 g/l at all the three measurement points, offspring not only had better school scores at the ages of 14 and 16 years (β = 0·048, P = 0·04 and β = 0·68, P = 0·007, respectively), but also had an increased odds of having a higher level of education at the age of 31 years (OR = 1·14, P = 0·04). The present study suggests that low maternal Hb levels at the final stages of pregnancy are linked to the poorer educational achievement of the offspring. If our observation is confirmed, it would suggest that Fe prophylaxis even at fairly late stages of pregnancy may be beneficial for the subsequent health of the offspring. However, more studies are needed to fully establish the potential pathways and the clinical importance of the present findings.

ObjectiveThe present paper describes the systematic development of an FFQ to assess the intake of fatty acids and antioxidants in school-aged children. In addition, a validation study applying 24 h dietary recalls was performed.DesignUsing the variance-based Max_r method, a list of eighty-two foods was compiled from data obtained by 3 d weighed dietary records. The foods were used to design an FFQ, the comprehensibility of which was evaluated in a feasibility study. In addition, the FFQ was validated in a subset of 101 children from the German Infant Nutritional Intervention Study (GINI PLUS) against one 24 h dietary recall.ResultsThe feasibility study attested a good acceptance of the FFQ. Mean intake of foods compared well between the FFQ and the 24 h dietary recall, although intake data generated from the FFQ tended to be higher. This difference became less apparent at the nutrient level, although the estimated average consumption of arachidonic acid and EPA using the FFQ still exceeded values recorded with the 24 h recall method by 45 % and 29 %, respectively.ConclusionsOn the basis of the systematic selection process of the food list, the established practicability of the FFQ and the overall plausibility of the results, the use of this FFQ is justified in future epidemiological studies.

OBJECTIVE: Data from the Multiple Risk Factor Intervention Trial show an independent direct association between starch intake and blood pressure in American men at higher risk of coronary heart disease. Cross-sectional data from the International Study of Macronutrients and Micronutrients and Blood Pressure (INTERMAP) were used to assess relations of dietary starch intake to blood pressure in men and women from four countries. METHODS: Data include 83 nutrients from four multipass 24-h dietary recalls and two timed 24-h urine collections; eight blood pressure readings; and questionnaire data, for 4680 participants aged 40-59 years from 17 population samples in Japan, People's Republic of China, United Kingdom, and United States of America. RESULTS: In multiple linear regression analyses - adjusted for urinary sodium, urinary potassium, consumption of alcohol, cholesterol, saturated fatty acids, polyunsaturated fatty acids, calcium, and other variables - starch intake higher by two standard deviations (14.1% kJ) was associated with systolic/diastolic blood pressure differences of -1.0/-0.9 mmHg (P = 0.09, P < 0.05). Results were similar with additional control for fiber, magnesium, or phosphorus; reduced to -0.5/-0.7 mmHg (P = 0.47, P = 0.13) with separate adjustment for vegetable protein. Findings were similar for men analyzed separately, for American men, and for American men at higher coronary heart disease risk. CONCLUSION: Our findings indicate that - if any - relations of starch intake to blood pressure are modestly inverse. Current dietary guidelines for hypertension prevention and control remain relevant.

Findings from observational and interventional studies on the relationship of dietary linoleic acid, the main dietary polyunsaturated fatty acid, with blood pressure have been inconsistent. The International Study of Macro-Micronutrients and Blood Pressure is an international cross-sectional epidemiological study of 4680 men and women ages 40 to 59 years from 17 population samples in China, Japan, United Kingdom, and United States. We report associations of linoleic acid intake of individuals with their blood pressure. Nutrient intake data were based on 4 in-depth multipass 24-hour dietary recalls per person and 2 timed 24-hour urine collections per person. Systolic and diastolic blood pressures were measured 8 times at 4 visits. With several models to control for possible confounders (dietary or other), linear regression analyses showed a nonsignificant inverse relationship of linoleic acid intake (percent kilocalories) to systolic and diastolic blood pressure for all of the participants. When analyzed for 2238 “nonintervened” individuals (not on a special diet, not consuming nutritional supplements, no diagnosed cardiovascular disease or diabetes, and not taking medication for high blood pressure, cardiovascular disease, or diabetes), the relationship was stronger. With adjustment for 14 variables, estimated systolic/diastolic blood pressure differences with 2-SD higher linoleic acid intake (3.77% kcal) were −1.42/−0.91 mm Hg ( P P

1507 Background: Triple negative breast cancer (TNBC), defined as ER-/PR-/HER2-, has a poor prognosis and limited targeted treatment options. Modifiable lifestyle factors, including body mass index...

Coding diet records is a basic element of most dietary surveys, yet it often receives little attention even though errors in coding can lead to flawed study results. In the INTERnational study of MAcro- and micronutrients and blood Pressure (INTERMAP study), efforts were made to minimise errors in coding the 18 720 diet records. Staff were centrally trained and certified before being able to process study data and ongoing quality control checks were performed. This involved the senior (site) nutritionist re-coding randomly selected diet records. To facilitate standardisation of coding in the UK, a code book was designed; it included information about coding brand items, density and portion size information, and default codes to be assigned when limited information was available for food items. It was found that trainees, despite previous experience in coding elsewhere, made coding errors that resulted in errors in estimates of daily energy and nutrient intakes. As training proceeded, the number of errors decreased. Compilation of the code book was labour-intensive, as information from food manufacturers and retailers had to be collected. Strategies are required to avoid repetition of this effort by other research groups. While the methods used in INTERMAP to reduce coding errors were time consuming, the experiences suggest that such errors are important and that they can be reduced.

Objective:To investigate the feasibility of using commercially available data on household food consumption to carry out food and nutritional surveillance.Design:Taylor Nelson Sofres (TNS) collects information on foods brought home for consumption among a representative quota sample of the British population. In total, 33 177 households and 105 667 individuals provided data between 1991 and 2000. These were used to investigate sociodemographic, geographical and temporal trends in purchase patterns of the main macronutrients and four groups of marker products.Results:Sociodemographic characteristics of the TNS sample were broadly consistent with those of the British population. Estimated energy intakes were slightly low (1667±715 kcal) in comparison with other national data. However, percentage energy contributions were consistent with national trends: e.g. consumption of alcohol in the home increased between 1991 and 2000 with higher intakes among more affluent households, while fat intakes decreased slightly over the same period. Significant temporal, geographic and socio-economic trends were found for all nutrients (P< 0.0001). Intakes of marker products were sparse (purchased by Conclusions:A prospective nutrient surveillance system could be used to trace consumption patterns of foods or nutrients to inform nutritional surveillance. However, existing data sources would require a number of modifications to increase their suitability for such a project. Increasing surveillance to consider ingredients would require the development of a central coding system, with electronically linked barcode, ingredient and nutrient information.

Extensive evidence exists that an inverse relation between education and blood pressure prevails in many adult populations, but little research has been carried out on reasons for this finding. A prior goal of the INTERMAP Study was to investigate this phenomenon further, and to assess the role of dietary factors in accounting for it. Of the 4680 men and women aged 40-59 years, from 17 diverse population samples in Japan, People's Republic of China, UK, and USA, a strong significant inverse education-BP relation was manifest particularly for the 2195 USA participants, independent of ethnicity. With participants stratified by years of education, and assessment of 100+ dietary variables from four 24-h dietary recalls and two 24-h urine collections/person, graded relationships were found between education and intake of many macro- and micronutrients, electrolytes, fibre, and body mass index (BMI). In multiple linear regression analyses with systolic BP (SBP) and diastolic BP (DBP) of individuals the dependent variables (controlled for ethnicity, other possible nondietary confounders), BMI markedly reduced size of education-BP relations, more so for women than for men. Several nutrients considered singly further decreased size of this association by > or =10%: urinary 24-h Na and K excretion, Keys dietary lipid score, vegetable protein, fibre, vitamins C and B6, thiamin, riboflavin, folate, calcium, magnesium, and iron. Combinations of these dietary variables and BMI attenuated the education-SBP inverse coefficient by 54-58%, and the education-DBP inverse coefficient by 59-67%, with over half these effects attributable to specific nutrients (independent of BMI). As a result, the inverse education-BP coefficients ceased to be statistically significant. Multiple specific dietary factors together with body mass largely account for the more adverse BP levels of less educated than more educated Americans. Special efforts to improve eating patterns of less educated strata can contribute importantly to overcoming this and related health disparities in the population.

The International Study of Macronutrients and Blood Pressure (INTERMAP) is a four-country study investigating relationships between individual dietary intakes and blood pressure. Dietary intake patterns of individuals were estimated for macronutrients (proteins, lipids, carbohydrates, alcohol) and their components (amino acids, fatty acids, starch), as well as minerals, vitamins, caffeine, and dietary fiber. The dietary assessment phase of the study involved collection of four 24-h recalls and two 24-h urine specimens from each of 4680 adults, ages 40-59, at 16 centers located in the People's Republic of China, Japan, the United Kingdom and the United States. For each country, an available database of nutrient composition of locally consumed foods was updated for use in the analysis of dietary data collected within the country. The four original databases differed in number and types of foods and nutrients included, analytic methods used to derive nutrients, and percentage of missing nutrient values. The Nutrition Coordinating Center at the University of Minnesota updated the original databases in several ways to overcome the foregoing limitations and increase comparability in the analyses of nutrient intake of individuals across the four countries: (1) addition of new foods and preparation methods reported by study participants; (2) addition of missing nutrient fields important to the study objectives; (3) imputation of missing nutrient values to provide complete nutrient data for each food reported by participants; and (4) use of adjustment factors to enhance comparability among estimates of nutrient intake obtained through each country's nutrient-coding methodology. It was possible to expand, enhance, and adjust the nutrient databases from the four countries to produce comparable (60 nutrients) or nearly comparable (ten nutrients) data on composition of all foods reported by INTERMAP participants.

Changes in the design of hospital wards have usually been determined by architects and members of the nursing and medical professions; the views and preferences of patients have seldom been sought directly. The Hospital Anxiety and Depression scale and the Disturbance Due to Hospital Noise questionnaire were administered to 64 female patients on bay and Nightingale wards together with a questionnaire designed for this study. Perceptions of social and physical factors of ward design were examined, and their relationship to psychological well-being and sleep patterns. The results show that the bay ward seemed to offer a more favourable environment for patients but some of the disadvantages of bay wards are balanced by better staffing levels and better and more modern facilities. Visibility to nurses was lower on the bay ward. The Nightingale ward was perceived as significantly noisier than the bay ward and noise levels were significantly correlated to anxiety scores. Paradoxically the increase in noise levels appeared to improve the perceived level of privacy on the Nightingale ward. Seventy-five per cent of patients were found to prefer the bay ward design, and since neither design appears to have major disadvantages their continued introduction should be encouraged. However, recommendations are made concerning the optimizing of patients' well-being within the bay ward setting.