1,720,970 research outputs found
Coffee consumption and liver health
No full textBeneficial associations between coffee drinking and a range of liver outcomes have been consistently reported in observational research, yet no randomised controlled trial has been conducted to investigate whether drinking more coffee might reduce the risk of progression of Non-Alcoholic Fatty Liver Disease (NAFLD). NAFLD is an umbrella term for a pathological pathway that includes steatosis, steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma, where no other aetiology is identified such as alcohol or viral hepatitis. NAFLD is an important public health issue with a general population prevalence of approximately 25% that has risen in parallel with that of obesity, and as such represents a significant burden to individuals and health systems. NAFLD has few treatment options and current best advice is to lose weight through healthy diet and exercise. If coffee was shown to have benefit in reducing the risk of NAFLD progression it would be a valuable addition to the current management of the condition.The methodological approach of a randomised controlled study could be shaped by addressing a number of current knowledge gaps. Firstly, could increasing coffee intake cause additional non-liver harm in people. To address this issue an umbrella review, or review of reviews, was conducted to draw together the vast amount of existing research between coffee intake and multiple health outcomes. Reassuringly, outside of pregnancy, drinking coffee was more frequently associated with benefit than harm. For important generic outcomes such as all-cause mortality, cardiovascular mortality, and incident cardiovascular disease, maximum relative risk reduction was associated with intakes of 3-5 cups a day. Some harmful associations, such as between coffee drinking and lung cancer, were nullified by adequate adjustment for smoking, known to be an important confounder. Liver outcomes consistently had the largest magnitude of beneficial associations with coffee drinking. Secondly, in observational research, ascertainment of coffee intake is usually measured in cups a day. This is a heterogeneous measure because of different preparation methods, cup sizes, coffee beans, and roast types, resulting in the risk of misclassification. To overcome this limitation the next stage of the research aimed to create a coffee unit measure, similar in concept to alcohol units, that took preparation method and cup size into account. The unit measure, where 1 coffee unit was equivalent to a 227mL cup of instant coffee, was then applied to a representative UK population using data from the National Diet and Nutrition Survey, and the proportion of misclassified intake, when not accounting for preparation type and cup size was derived. Overall, approximately 1 in 4 participants had misclassified intake, largely under or over estimated by one cup a day. This effect of 25% misclassification of coffee intake in existing research is of uncertain significance, but would generally be non-differential, and therefore more likely to dilute risk estimates of both benefit and harm. The coffee unit measure could be applied to a future experimental study to better quantify coffee intake or allow increases in consumption across preferred preparation types.Coffee preparation preferences were explored as part of the final element of the research, which was a mixed-methods study designed to explore patterns of coffee consumption in a secondary care population of people with NAFLD, their views about drinking more coffee, and acceptability of a randomised controlled trial in which drinking more coffee was the intervention. The mixed method study included an initial qualitative phase of 17 semi-structured interviews that were used to inform the final design of a questionnaire to explore the same phenomenon in a stratified sample of 393 people with NAFLD recruited from three NHS secondary care sites. In the survey, which was stratified across three liver stiffness groups (<7 KPa, 7-13 KPa, and >13 KPa), 78% of respondents were current coffee drinkers, and 22% non-coffee drinkers. Median coffee consumption was 2 cups a day (interquartile range 1 to 3 cups). The proportion of coffee drinkers reduced as liver stiffness increased but not the median daily cup intake. Nearly half of non-coffee drinkers thought they would be able to start drinking it, and 85% of those drinking <4 cups a day thought they would be able to drink an additional 2 cups a day. These proportions reduced to 38% and 66% respectively when considering those who also expressed an interest, albeit hypothetically, in becoming involved in a randomised controlled trial. In this group of participants, acceptable options for increasing coffee intake included 71% for drinking their own coffee at their own expense, 32% being supplied instant coffee, 27% being given a monetary allowance towards the extra coffee, and 15% being supplied ground coffee. Other aspects of a future experimental study including randomisation, and blood and imaging tests were generally considered acceptable. Importantly this data suggests that recruiting people with NAFLD into a future experimental study would be possible from an NHS secondary care setting. Arguably, now is the time for such a study, in the context of the huge burden of NAFLD, the lack of effective treatments, and the potential coffee has to offer benefi
Treatment burden and the role of the GP
No full textTreatment burden is the ‘work of being a patient’. It comprises the time, effort and financial implications of following a treatment regimen in chronic disease, and the consequent impact on patients. Treatment burden may affect adherence, quality-of-life and health outcomes. Patients vary in their capacity to manage treatment demands. The concept of treatment burden is now recognised in national guidance on multimorbidity. GPs have an opportunity to enhance patient-centred care through recognition and optimisation of treatment burden
What is the association between healthy weight in 4–5-year-old children and spatial access to purposefully constructed play areas?
No full textBackground: Childhood obesity is a global issue. Understanding associated factors is essential in designing interventions to reduce its prevalence. There are knowledge gaps concerning the leptogenic potential of playareas for very young children and particularly whether there is an association between levels of childhood obesity and play area quality.Methods: A cross-sectional observational study was conducted to investigate whether spatial access to play areas had an association with healthy weight status of 4–5-year-old children. Data from the English National Childhood Measurement Programme 2012/13 was used to measure healthy weight status and a geographic information system was used to calculate (a) the number of purposefully constructed play areas within 1 km (density), and (b) the distance to nearest play area (proximity), from child's residential postcode. A play areaquality score was included in predictive models. Multilevel modelling was used to adjust for the clustering of observations by school. Adjustment was also made for the effects of gender and deprivation.Results: 77% of children had a healthy weight status (≥2nd and < 85th centile). In a fully adjusted multilevel model there was no statistically significant association between healthy weight status and density or proximitymeasures, with or without inclusion of a play area quality score, or when accounting for the effects of gender and deprivation.Conclusions: Among 4–5-year-old children attending school, there was no association between healthy weight status and spatial access to play areas. Reasons may include under-utilisation of play areas by reception agechildren, their minimal leptogenic influence or non-spatial influences affecting play area choice.</p
Easing the impact: Public policy and the financial burden of living with multiple long-term conditions
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Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Misclassification of coffee consumption data and the development of a standardised coffee unit measure.
Full text linkBackground Associations of coffee consumption with multiple health outcomes have been researched extensively. Coffee consumption, usually reported in cups a day, is a heterogeneous measure due to numerous preparation methods and cup sizes, leading to misclassification. This paper develops a new ‘unit’ measure of coffee and uses coffee consumption data from a representative sample of the UK population to assess the degree of misclassification when cup volume and preparation type are not taken into account. Methods A coffee unit measure was created using published estimates of caffeine and chlorogenic acid concentrations, and applied across volumes and preparation types. Four-day food diary data in adults from the UK National Diet and Nutrition Survey (NDNS; 2012-16) were used to quantify coffee intake. Participant self-reported cups a day were compared with cups a day standardised by a) 227mL volume and b) 227mL instant coffee equivalents (unit measure), and the degree of misclassification was derived. Sensitivity analyses were conducted to model coffee drinking preferences of different populations and caffeine:chlorogenic acid weighting assumptions of the unit measure. Results The NDNS sample consisted of 2832 adult participants. Coffee was consumed by 62% of participants. Types varied, with 75% of caffeinated coffee cups being instant, 17% filter, 3% latte, 2% cappuccino, 2% espresso and <1% other types. Comparing reported cups to volume-standardised cups, 84% of participants had correct classification, and 73% when using the coffee unit measure, 22% underestimated and 5% overestimated, largely by 1 cup. Misclassification varied by gender, age and income. Sensitivity analysis highlighted the benefits of using the unit measure over volume alone to cater for different populations, and the stability of the unit composition assumption. Conclusion Cup volume and preparation type should be taken into account, through application of a standardised coffee unit measure, when coffee consumption is classified in future research studies
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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