The future of human malnutrition: rebalancing agency for better nutritional health

The major threat to human societies posed by undernutrition has been recognised for millennia. Despite substantial economic development and scientific innovation, however, progress in addressing this global challenge has been inadequate. Paradoxically, the last half-century also saw the rapid emergence of obesity, first in high-income countries but now also in low- and middle-income countries. Traditionally, these problems were approached separately, but there is increasing recognition that they have common drivers and need integrated responses. The new nutrition reality comprises a global ‘double burden’ of malnutrition, where the challenges of food insecurity, nutritional deficiencies and undernutrition coexist and interact with obesity, sedentary behaviour, unhealthy diets and environments that foster unhealthy behaviour. Beyond immediate efforts to prevent and treat malnutrition, what must change in order to reduce the future burden? Here, we present a conceptual framework that focuses on the deeper structural drivers of malnutrition embedded in society, and their interaction with biological mechanisms of appetite regulation and physiological homeostasis. Building on a review of malnutrition in past societies, our framework brings to the fore the power dynamics that characterise contemporary human food systems at many levels. We focus on the concept of agency, the ability of individuals or organisations to pursue their goals. In globalized food systems, the agency of individuals is directly confronted by the agency of several other types of actor, including corporations, governments and supranational institutions. The intakes of energy and nutrients by individuals are powerfully shaped by this ‘competition of agency’, and we therefore argue that the greatest opportunities to reduce malnutrition lie in rebalancing agency across the competing actors. The effect of the COVID-19 pandemic on food systems and individuals illustrates our conceptual framework. Efforts to improve agency must both drive and respond to complementary efforts to promote and maintain equitable societies and planetary health.

The Determinants of Household Spending on Alcohol and Tobacco in Tanzania

The increasing effects caused by alcohol and tobacco calls for necessary interventions. This is not only in developed countries, but also in developing countries which seems to be affected more by this problem. Studies show that 80% of smokers worldwide are living in developing countries where tobacco related diseases have become major factors contributing toward high morbidity. Moreover, excessive alcohol consumption has been among global public health problems, where it accounts for about 6% of mortality and 5% of disability in the world. In addition, the prevalence of Alcohol Use Disorders (AUD) was reported at 4% globally while in Africa it was 3%. Tanzania being the developing country and located in Africa is also at risk to be affected more if the necessary measures to control this unhealthy behaviour are not taken. However, due to limited information about the structure and behaviour of people in spending and consumption of these addictive products in Tanzania, it will be difficult to prepare relevant measures to curb those problems. Therefore, by using Tobit regression model, this study examined the influence of socioeconomic characteristics on alcohol and tobacco spending. This study found factors such income, culture, and change in preference over time to have a significant relationship with spending on alcohol and tobacco. This study creates a base for alcohol and tobacco spending behaviour in Tanzania. After determining spending behaviour, further studies need to be conducted to examine consumption behaviour and its effects to prepare relevant measures to control the risks of alcohol and tobacco in Tanzania.

Are culturally vibrant communities healthier? Relationships between performing arts activity and health outcomes in the 500 largest US cities

Aims: Recent reviews have demonstrated broad links between performing arts participation (e.g. music-making; dancing; acting) and receptive engagement (e.g. listening to music; attending a dance/theatre performance) and improved health, including reduced disease and mortality risk. However, no investigations to date have interrogated the links between community-level performing arts activity (i.e. participation + receptive engagement) and health outcomes; i.e. do the performing arts help create healthy communities? This study aims to address this question by examining links between performing arts activity and health outcomes across 500 cities in the United States. Methods: Secondary analysis of demographic, health outcome, performing arts activity (estimated by annual performing arts revenue), and preventive/unhealthy behaviour data for 500 large cities in the United States; data were extracted from the US Centers for Disease Control 500 Cities Project, Dun & Bradstreet Hoovers Database, and US Census. Links between performing arts activity and 12 health/disease outcomes were evaluated using a series of hierarchical beta regression models which progressively controlled for demographic variables and preventive/unhealthy behaviour prevalence. Results: The 500 analysed US cities comprise 33.4% of the total US population and 84,010 performing arts businesses (total annual revenue $27.84 billion). No significant associations were found between performing arts activity and nine of twelve health outcomes in fully adjusted models (p>.17). Statistically significant relationships (p<.01) between increased performing arts activity and increased prevalence of chronic kidney disease, coronary heart disease, and stroke were determined to be clinically equivocal. Conclusions: This study contributes to a growing body of conflicting epidemiologic evidence regarding the impact of the performing arts on health/disease and mortality outcomes, evaluated using a range of disparate methodologies. A consensus, psychometrically rigorous approach is required to address this prevailing uncertainty in future epidemiologic studies examining effects of performing arts activities both within and across countries and communities.

Understanding disadvantaged adolescents’ perception of health literacy through a systematic development of peer vignettes

Background Adolescence represents a crucial phase of life where health behaviours, attitudes and social determinants can have lasting impacts on health quality across the life course. Unhealthy behaviour in young people is generally more common in low socioeconomic groups. Nevertheless, all adolescents should have a fair opportunity to attain their full health potential. Health literacy is positioned as a potential mediating factor to improve health, but research regarding health literacy in adolescents and socially disadvantaged populations is limited. As part of Phase one of the Ophelia (OPtimising HEalth LIterAcy) framework, The purpose of this study was to explore the perceptions of socially disadvantaged Irish adolescents in relation to health literacy and related behaviours, and utilise this data to develop relevant vignettes. Methods A convergent mixed method design was used to co-create the vignettes. Questionnaires were completed by 962 adolescents (males n = 553, females n = 409, Mean age = 13.97 ± 0.96 years) from five participating disadvantaged schools in Leinster, Ireland. Focus groups were also conducted in each school (n = 31). Results were synthesised using cluster and thematic analysis, to develop nine vignettes that represented typical male and female subgroups across the schools with varying health literacy profiles. These vignettes were then validated through triangular consensus with students, teachers, and researchers. Discussion The co-creation process was a participatory methodology which promoted the engagement and autonomy of the young people involved in the project. The vignettes themselves provide an authentic and tangible description of the health issues and health literacy profiles of adolescents in this context. Application of these vignettes in workshops involving students and teachers, will enable meaningful engagement in the discussion of health literacy and health-related behaviours in Irish young people, and the potential co-designing of strategies to address health literacy in youth. Conclusion As guided by the Ophelia framework, the use of authentic, interactive and participatory research methods, such as the co-creation of vignettes, is particularly important in groups that are underserved by traditional research methods. The approach used in this study could be adapted to other contexts to represent and understand stakeholders’ perceptions of health, with a view to explore, and ultimately improve, health literacy.

Associations of sedentary behaviours and incidence of unhealthy diet during the COVID-19 quarantine in Brazil

Objective: Our aim was to analyse the association of change patterns on TV-viewing and computer/tablet use and incidence of elevated consumption of ultra-processed food consumption and lower consumption of fruits and vegetables during the COVID-19 pandemic. Design: Data of 39 208 Brazilian adults from a Behaviour Web Survey were used. Unhealthy nutrition habits were eating fruits or vegetables for <5 d/week and ultra-processed food (sugary foods, snacks, ready-to-eat frozen foods and embedded foods) for ≥5 d/week. For incidence indicators, we only considered participants without unhealthy behaviour before the quarantine. We created four categories of change in TV-viewing and computer/tablet use, considering a cut-off point of 4 h/d for each behaviour (1 – consistently low, 2 – become low during the quarantine, 3 – become high during the quarantine or 4 – consistently high). Analyses were adjusted for sex, age group, highest academic achievement, per capita income, working status during the quarantine, skin colour and adherence to the quarantine. Setting: Brazil. Participants: Brazilian adults (nationally representative). Results: Logistic regression models revealed that high TV-viewing and computer/tablet use incidence were associated with higher odds for elevated frequency of ultra-processed food consumption (TV-viewing: OR 1·70; 95 % CI 1·37, 2·12; computer/tablet: OR 1·73; 95 % CI 1·31, 2·27) and low consumption of fruit and vegetables (TV-viewing: OR 1·70; 95 % CI 1·29, 2·23; computer/tablet: OR 1·53; 95 % CI 1·08, 2·17) incidence. Consistent high computer/tablet use also presented higher odds for incidence of elevated frequency of ultra-processed food consumption. Conclusions: Participants with incidence of sedentary behaviours were also more likely to present incidence of unhealthy diet during the COVID-19 pandemic quarantine.

COVID-19 and psychiatric illness: rectal foreign bodies (30 stylus batteries) in a young male patient affected by Asperger syndrome

Here we present the case of a 17-year-old male patient, affected by Asperger syndrome, who reached the emergency division of our hospital after anal insertion of some stylus batteries. Transanal extraction of 30 stylus batteries avoided surgical intervention. Lockdown and boredom due to the strict domestic quarantine policies adopted during COVID-19 pandemic might have unmasked in our patient a susceptibility to unhealthy behaviour.

Acute Coronary Syndrome in Well Trained Young Adult: A Rare Cases

Acute Coronary Syndrome (ACS) has been observed in the older population (>40 years old), sedentary lifestyle and unhealthy behaviour. Recently, there is an increase of ACS reported in the younger population even without a sedentary lifestyle.We report a case of awell-trained 25-years old man thatcame with late presentation of ST elevation myocardial infarction (STEMI) occurred 10 minutes after vigorous exercise. His traditional risk factor was a smoker.Electrocardiogram (ECG) showed a pathological Q wave in V1-V3 and T wave inversion in V1-V6 with elevated cardiac biomarker. Primary percutaneous coronary intervention (PPCI) was performed due to prolonged chest pain and it showed subtotal occlusion in mid left anterior descending artery (LAD) with high thrombus burden. One drug eluting stent (DES) was implanted at mid LAD and GPIIb/IIIa inhibitor and low molecule weight heparin was given with good clinical result.

Men and loneliness in the ‘west’: A critical interpretive synthesis

BackgroundLoneliness has received considerable attention in recent years, but has seldom been investigated through a gendered lens. This review aims to critically summarise research substantively related to men and loneliness.MethodA critical interpretive synthesis, incorporating a pre-defined search strategy, was employed to analyse a broad variety of data. The searches were conducted in July 2019, across seven databases: MEDLINE; PsycINFO; Scopus, ASSIA, SSCI; Sociological Abstracts; and Social Policy and Practice. Included studies were written in English, conducted in high income nations in Western Europe, North America, and Australasia, with no date limitations. Qualitative studies required a substantive focus on sex/men or gender/masculinities and loneliness, and quantitative studies either an explicit focus on sex differences in loneliness, or data substantially relevant to loneliness and men. Seventy-nine studies met the inclusion criteria.ResultsSeven ‘synthetic constructs’ were built: i) men’s loneliness appears more associated with their social network; ii) men may be less emotionally forthright, thus both less inclined to discuss loneliness and less likely to form meaningful relationships; iii) romantic relationships may be more important for preventing loneliness in men; iv) different measurements of loneliness do not show the same sex differences in the prevalence of loneliness; v) lonely men may be more likely to engage in risky/unhealthy behaviour; vi) feeling/being ‘insufficiently masculine’ can result in loneliness; and vii) intersections of identity facilitate different gendered results.ConclusionThese constructs offer a framework that can help inform interventions aimed at preventing/alleviating loneliness in men, and a foundation for future research. Overcoming men’s emotional reticence, and facilitating better quality social networks, appeared critical goals for interventions. Men’s emotional reticence may constitute both a barrier to discussing loneliness, and to forming loneliness preventing relationships. It also appeared to be characterised either by the construction of a masculine persona, or a fear of the repercussions for initiating intimate conversation. When attempting to ascertain whether a man is lonely, acknowledging gendered variation in survey responses is required. However, it is unclear how generalisable these ‘synthetic constructs’ are, and their potential inter-relatedness requires further research.

Mureş County Women’s Behaviour Associated with Pregnancy Risk Factors

The main objective was to identify pregnancy risk factors arising from the behaviour and lifestyle of Mureş county women during pregnancy. The postpartum women monitored in this study were from Mureş county and were interviewed by applying a questionnaire during the period they were in the hospital for postnatal care immediately after birth. The questions aimed at identifying prenatal risk factors and the unhealthy behaviour of women before and during pregnancy, referring to the socio-economic and cultural status (low family income or unemployment, less than high school studies, rural background and marital status), obesity during pregnancy, alcohol consumption, coffee consumption, no physical activity. We identified, among the three major ethnicities in Mureş county (Romanian, Hungarian, Roma), the behaviour and lifestyle components with risk in pregnancy and after comparing profiles of these groups we identified the Roma ethnicity as being at the highest perinatal risk.