Addressing ethnic disparities in neurological research in the United Kingdom: An example from the prospective multicentre COVID-19 Clinical Neuroscience Study.

BACKGROUND: Minority ethnic groups have often been underrepresented in research, posing a problem in relation to external validity and extrapolation of findings. Here, we aimed to assess recruitment and retainment strategies in a large observational study assessing neurological complications following SARS-CoV-2 infection. METHODS: Participants were recruited following confirmed infection with SARS-CoV-2 and hospitalisation. Self-reported ethnicity was recorded alongside other demographic data to identify potential barriers to recruitment. RESULTS: 807 participants were recruited to COVID-CNS, and ethnicity data were available for 93.2%. We identified a proportionate representation of self-reported ethnicity categories, and distribution of broad ethnicity categories mirrored individual centres' catchment areas. White ethnicity within individual centres ranged between 44.5% and 89.1%, with highest percentage of participants with non-White ethnicity in London-based centres. Examples are provided how to reach potentially underrepresented minority ethnic groups. CONCLUSIONS: Recruitment barriers in relation to potentially underrepresented ethnic groups may be overcome with strategies identified here.

Every step you take: Nudging animal welfare product purchases in a virtual supermarket.

Animal welfare (AW) is a growing concern for consumers in Germany; however, not all consumers regularly purchase products that have been produced according to high AW standards. The goal of the present study is to test the effect of a multilayered nudge to increase the availability and improve the visibility of AW products in a 3D online virtual supermarket (VS). The nudge included a shelf with AW products (referred to as AW shelf) which was made visible through banners and footsteps on the floor of the VS. The sample of this pre-registered experiment consisted of n = 374 German consumers who regularly purchase meat, milk, and eggs. The results demonstrated that the multilayered nudge was highly effective: the percentage of AW products purchased in the nudging condition was almost twice as high as in the control group. Furthermore, we investigated variables that mediate (ease of finding AW products in the VS) and moderate (price sensitivity) the effectiveness of the multilayered nudge, but no evidence for an effect was obtained. We conclude that multilayered nudges may be a promising tool to increase consumers' AW product purchases. More research is needed to replicate this finding with a field study in a real supermarket.

Behavioral factors driving farmers' intentions to adopt spot spraying for sustainable weed control.

Smart Farming Technologies enable plant-specific agrochemical applications which can increase the efficiency and reduce the environmental impacts of agriculture. However, the uptake of Smart Farming Technologies remains slow despite their potential to enhance sustainable transformation of food systems. The design of policies to promote sustainable agricultural technologies requires a holistic understanding of the complex set of factors driving the adoption of innovations at farm level. This study has a focus on behavioral factors, such as pro-environmental attitude, personal innovativeness and moral norms. Based on an online study conducted in Germany, structural equation modelling is applied to test the predictions of an extended version of the Theory of Planned Behavior, using spot spraying, a smart weeding technology, as an example. The results confirm theoretical predictions and show that indicators of attitude, subjective norms, and perceived behavioral control have relevant effects on farmers' adoption intentions. The extended model revealed a medium-sized (small) direct effect of moral norms on the attitude towards spot spraying (adoption intention). Personal innovativeness had a small effect on adoption intention, whereas pro-environmental attitude did not exhibit a clear direction of impact. Methodological and policy implications derived from the results are discussed noting that the inclusion of indicators for moral norms can improve the predictive power of models used in future research in this field. Overall, initiatives aimed at facilitating the exchange of opinions and related moral norms as well as collaboration among peers may contribute to voluntary sustainable innovation as it enhances adoption intentions among farmers.

Is it all due to peers? The influence of peers on children's snack purchase decisions.

The objective of this study is to examine whether the presence of peers has an impact on children's snack purchasing decisions. In particular, the research analyzes whether the company of a classmate or friend influences children's brand awareness and price perception, and how these factors affect their snack purchases. An incentive-based discrete choice experiment was conducted with snacks varying in price, brand, and healthiness, using the presence or absence of peers as a between-subject treatment. The data was analyzed using mixed logit models and a multinomial logit model. A total of 128 primary school children aged 8 to 10 years were included in the final data analysis. The findings show that the presence of peers strongly influences children's snack purchase decisions, particularly with respect to product type and price. The results highlight that children tend to conform to the group's decision, highlighting that social influence plays a crucial role in shaping children's decision-making processes. This study is the first to investigate the influence of peers on children's actual purchase decisions, thereby extending previous knowledge of the impact of peers on primary school children to the market domain.

Deletion of Cd44 Inhibits Metastasis Formation of Liver Cancer in Nf2-Mutant Mice.

Primary liver cancer is the third leading cause of cancer-related death worldwide. An increasing body of evidence suggests that the Hippo tumor suppressor pathway plays a critical role in restricting cell proliferation and determining cell fate during physiological and pathological processes in the liver. Merlin (Moesin-Ezrin-Radixin-like protein) encoded by the NF2 (neurofibromatosis type 2) gene is an upstream regulator of the Hippo signaling pathway. Targeting of Merlin to the plasma membrane seems to be crucial for its major tumor-suppressive functions; this is facilitated by interactions with membrane-associated proteins, including CD44 (cluster of differentiation 44). Mutations within the CD44-binding domain of Merlin have been reported in many human cancers. This study evaluated the relative contribution of CD44- and Merlin-dependent processes to the development and progression of liver tumors. To this end, mice with a liver-specific deletion of the Nf2 gene were crossed with Cd44-knockout mice and subjected to extensive histological, biochemical and molecular analyses. In addition, cells were isolated from mutant livers and analyzed by in vitro assays. Deletion of Nf2 in the liver led to substantial liver enlargement and generation of hepatocellular carcinomas (HCCs), intrahepatic cholangiocarcinomas (iCCAs), as well as mixed hepatocellular cholangiocarcinomas. Whilst deletion of Cd44 had no influence on liver size or primary liver tumor development, it significantly inhibited metastasis formation in Nf2-mutant mice. CD44 upregulates expression of integrin ß2 and promotes transendothelial migration of liver cancer cells, which may facilitate metastatic spreading. Overall, our results suggest that CD44 may be a promising target for intervening with metastatic spreading of liver cancer.

Fifty shades of grain - Increasing whole grain consumption through daily messages.

Despite numerous health benefits, the majority of consumers, in particular young adults, show low levels of whole grain consumption behaviour (WGCB). In order to increase WGCB, this pre-registered experimental study investigates the effect of a two weeks message intervention. Participants (n = 329) received either information about health benefits, recipe suggestions, a combination of both, or about a control topic. We evaluated WGCB at three time points: prior to, immediately after (post), and one month after the intervention (follow-up). Our findings show that participants read the message on most of the days and on average, evaluate the health-only message most positively. Furthermore, we found that health messages, but not recipe suggestions significantly increase WGCB at the follow-up measure. This effect was serially mediated by attitudes and behavioural intentions at the post-intervention measure, with more positive attitudes and higher intentions leading to more WGCB. Although health messages are an effective tool to influence WGCB, the effect is small in magnitude and consumption levels remain rather low. We discuss implications for future research and for the communication of whole grain related health benefits among different stakeholders in the health sector.

Triggering cognitive dissonance with textual information and images: Data from three experiments with meat-eaters.

This article presents data from three experiments in which we triggered and measured cognitive dissonance in meat-eaters. Cognitive dissonance is a well-established concept in the social psychology literature; however, empirical measures are scarce. In all datasets, we used textual information and/or images related to meat consumption as means to trigger cognitive dissonance. Cognitive dissonance data was collected in Study 1 with a Likert scale, whereas Study 2 and 3 used a Semantic Bipolar scale. Each experiment was programmed with Qualtrics and consisted of four conditions. Data was collected online; Study 1 utilized social media to recruit participants while Study 2 and 3 were hosted on Prolific. All datasets contain items on participants' socio-demographic background, liking of different food products, cognitive dissonance, and a measure of meat avoidance. The data can be used to analyze the effect of information provision on cognitive dissonance and meat avoidance. Moreover, the relationship between socio-demographic variables and cognitive dissonance, as well as other exploratory purposes regarding meat avoidance can be explored. Furthermore, researchers can use the data to investigate differences between Likert scales and Semantic Bipolar scales. This data is related to the paper Can images and textual information lead to meat avoidance? The mediating role of cognitive dissonance[1].

Different and alike: Level and determinants of public acceptance of fattening pig, beef cattle and broiler farming in Germany.

Germans are critical of their animal husbandry systems although being increasingly detached from practical husbandry experience and benefitting from its low prices and high availability. Based on literature on citizens' acceptance of agriculture and the social licence to operate framework this study derives and tests the relevance of various factors determining public acceptance of fattening pig, beef cattle and broiler husbandry using structural equation modelling. An online survey n = 1208 was carried out. Results confirm the assumed negative effect of animal treatment concerns and the positive impact of perceived benefits on acceptance. While a direct effect of trust on acceptance is only revealed for cattle, there is for all three husbandry systems an indirect effect of trust on acceptance via animal treatment concerns and perceived responsible conduct. Hence, the derived conceptual framework is partly confirmed. Thus, the results of the study can help actors in the supply chains and political decision makers how to possibly regain societal acceptance of animal husbandry.

Reliability of multi-site UK Biobank MRI brain phenotypes for the assessment of neuropsychiatric complications of SARS-CoV-2 infection: The COVID-CNS travelling heads study.

INTRODUCTION: Magnetic resonance imaging (MRI) of the brain could be a key diagnostic and research tool for understanding the neuropsychiatric complications of COVID-19. For maximum impact, multi-modal MRI protocols will be needed to measure the effects of SARS-CoV-2 infection on the brain by diverse potentially pathogenic mechanisms, and with high reliability across multiple sites and scanner manufacturers. Here we describe the development of such a protocol, based upon the UK Biobank, and its validation with a travelling heads study. A multi-modal brain MRI protocol comprising sequences for T1-weighted MRI, T2-FLAIR, diffusion MRI (dMRI), resting-state functional MRI (fMRI), susceptibility-weighted imaging (swMRI), and arterial spin labelling (ASL), was defined in close approximation to prior UK Biobank (UKB) and C-MORE protocols for Siemens 3T systems. We iteratively defined a comparable set of sequences for General Electric (GE) 3T systems. To assess multi-site feasibility and between-site variability of this protocol, N = 8 healthy participants were each scanned at 4 UK sites: 3 using Siemens PRISMA scanners (Cambridge, Liverpool, Oxford) and 1 using a GE scanner (King's College London). Over 2,000 Imaging Derived Phenotypes (IDPs), measuring both data quality and regional image properties of interest, were automatically estimated by customised UKB image processing pipelines (S2 File). Components of variance and intra-class correlations (ICCs) were estimated for each IDP by linear mixed effects models and benchmarked by comparison to repeated measurements of the same IDPs from UKB participants. Intra-class correlations for many IDPs indicated good-to-excellent between-site reliability. Considering only data from the Siemens sites, between-site reliability generally matched the high levels of test-retest reliability of the same IDPs estimated in repeated, within-site, within-subject scans from UK Biobank. Inclusion of the GE site resulted in good-to-excellent reliability for many IDPs, although there were significant between-site differences in mean and scaling, and reduced ICCs, for some classes of IDP, especially T1 contrast and some dMRI-derived measures. We also identified high reliability of quantitative susceptibility mapping (QSM) IDPs derived from swMRI images, multi-network ICA-based IDPs from resting-state fMRI, and olfactory bulb structure IDPs from T1, T2-FLAIR and dMRI data. CONCLUSION: These results give confidence that large, multi-site MRI datasets can be collected reliably at different sites across the diverse range of MRI modalities and IDPs that could be mechanistically informative in COVID brain research. We discuss limitations of the study and strategies for further harmonisation of data collected from sites using scanners supplied by different manufacturers. These acquisition and analysis protocols are now in use for MRI assessments of post-COVID patients (N = 700) as part of the ongoing COVID-CNS study.

CD44 Contributes to the Regulation of MDR1 Protein and Doxorubicin Chemoresistance in Osteosarcoma.

Osteosarcoma is the most common type of pediatric bone tumor. Despite great advances in chemotherapy during the past decades, the survival rates of osteosarcoma patients remain unsatisfactory. Drug resistance is one of the main reasons, leading to treatment failure and poor prognosis. Previous reports correlated expression of cluster of differentiation 44 (CD44) with drug resistance and poor survival of osteosarcoma patients, however the underlying mechanisms are poorly defined. Here, we investigated the role of CD44 in the regulation of drug chemoresistance, using osteosarcoma cells isolated from mice carrying a mutation of the tumor suppressor neurofibromatosis type 2 (Nf2) gene. CD44 expression was knocked-down in the cells using CRISPR/Cas9 approach. Subsequently, CD44 isoforms and mutants were re-introduced to investigate CD44-dependent processes. Sensitivity to doxorubicin was analyzed in the osteosarcoma cells with modified CD44 expression by immunoblot, colony formation- and WST-1 assay. To dissect the molecular alterations induced by deletion of Cd44, RNA sequencing was performed on Cd44-positive and Cd44-negative primary osteosarcoma tissues isolated from Nf2-mutant mice. Subsequently, expression of candidate genes was evaluated by quantitative reverse transcription PCR (qRT-PCR). Our results indicate that CD44 increases the resistance of osteosarcoma cells to doxorubicin by up-regulating the levels of multidrug resistance (MDR) 1 protein expression, and suggest the role of proteolytically released CD44 intracellular domain, and hyaluronan interactions in this process. Moreover, high throughput sequencing analysis identified differential regulation of several apoptosis-related genes in Cd44-positive and -negative primary osteosarcomas, including p53 apoptosis effector related to PMP-22 (Perp). Deletion of Cd44 in osteosarcoma cells led to doxorubicin-dependent p53 activation and a profound increase in Perp mRNA expression. Overall, our results suggest that CD44 might be an important regulator of drug resistance and suggest that targeting CD44 can sensitize osteosarcoma to standard chemotherapy.

Comparative analysis of nuclear and mitochondrial DNA from tissue and liquid biopsies of colorectal cancer patients.

The current standard for molecular profiling of colorectal cancer (CRC) is using resected or biopsied tissue specimens. However, they are limited regarding sampling frequency, representation of tumor heterogeneity, and sampling can expose patients to adverse side effects. The analysis of cell-free DNA (cfDNA) from blood plasma, which is part of a liquid biopsy, is minimally invasive and in principle enables detection of all tumor-specific mutations. Here, we analyzed cfDNA originating from nucleus and mitochondria and investigated their characteristics and mutation status in a cohort of 18 CRC patients and 10 healthy controls using targeted next-generation sequencing (NGS) and digital PCR. Longitudinal analyses of nuclear cfDNA level and size during chemotherapy revealed a decreasing cfDNA content and a shift from short to long fragments, indicating an appropriate therapy response, while shortened cfDNAs and increased cfDNA content corresponded with tumor recurrence. Comparative NGS analysis of nuclear tissue and plasma DNA demonstrated a good patient-level concordance and cfDNA revealed additional variants in three of the cases. Analysis of mitochondrial cfDNA surprisingly revealed a higher plasma copy number in healthy subjects than in CRC patients. These results highlight the potential clinical utility of liquid biopsies in routine diagnostics and surveillance of CRC patients as complementation to tissue biopsies or as an attractive alternative in cases where tissue biopsies are risky or the quantity/quality does not allow testing.

Looking behind the choice of organic: A cross-country analysis applying Integrated Choice and Latent Variable Models.

This cross-country study investigates the relative role of organic labelling in consumers' purchase decisions for apples and the extent to which behavioral constructs, derived from an extension of the Theory of Planned Behavior, influence consumers' choices. We apply an Integrated Choice and Latent Variable Model, combining a discrete choice experiment with structural equation modelling. Empirical validation draws on data from an online survey conducted in three European countries (NGermany=404; NNorway=407; NUK=401). In all countries, price is by far the most important attribute in consumers' purchase decision of apples, followed by country-of-origin and production method. The results show considerable consistency across the investigated countries regarding the importance of behavioral constructs - attitudes, subjective norms, perceived behavioral control, trust, and personal moral norms - in explaining consumers' intentions to buy, and purchase choices for, organic apples, confirming the derived theoretical framework.

Strategies and action points to ensure equitable uptake of COVID-19 vaccinations: A national qualitative interview study to explore the views of undocumented migrants, asylum seekers, and refugees.

INTRODUCTION: Early evidence confirms lower COVID-19 vaccine uptake in established ethnic minority populations, yet there has been little focus on understanding vaccine hesitancy and barriers to vaccination in migrants. Growing populations of precarious migrants (including undocumented migrants, asylum seekers and refugees) in the UK and Europe are considered to be under-immunised groups and may be excluded from health systems, yet little is known about their views on COVID-19 vaccines specifically, which are essential to identify key solutions and action points to strengthen vaccine roll-out. METHODS: We did an in-depth semi-structured qualitative interview study of recently arrived migrants (foreign-born, >18 years old; <10 years in the UK) to the UK with precarious immigration status between September 2020 and March 2021, seeking their input into strategies to strengthen COVID-19 vaccine delivery and uptake. We used the 'Three Cs' model (confidence, complacency and convenience) to explore COVID-19 vaccine hesitancy, barriers and access. Data were analysed using a thematic framework approach. Data collection continued until data saturation was reached, and no novel concepts were arising. The study was approved by the University of London ethics committee (REC 2020.00630). RESULTS: We approached 20 migrant support groups nationwide, recruiting 32 migrants (mean age 37.1 years; 21 [66%] female; mean time in the UK 5.6 years [SD 3.7 years]), including refugees (n = 3), asylum seekers (n = 19), undocumented migrants (n = 8) and migrants with limited leave to remain (n = 2) from 15 different countries (5 WHO regions). 23 (72%) of 32 migrants reported being hesitant about accepting a COVID-19 vaccine and two (6%) would definitely not accept a vaccine. Participants communicated concerns over vaccine content, side-effects, lack of accessible information in an appropriate language, lack of trust in the health system and low perceived need. A range of barriers to accessing the COVID-19 vaccine were reported and concerns expressed that their communities would be excluded from or de-prioritised in the roll-out. Undocumented migrants described fears over being charged and facing immigration checks if they present for a vaccine. Participants (n = 10) interviewed after recent government announcements that COVID-19 vaccines can be accessed without facing immigration checks remained unaware of this. Participants stated that convenience of access would be a key factor in their decision around whether to accept a vaccine and proposed alternative access points to primary care services (for example, walk-in centres in trusted places such as foodbanks, community centres and charities), alongside promoting registration with primary care for all, and working closely with communities to produce accessible information on COVID-19 vaccination. CONCLUSIONS: Precarious migrants may be hesitant about accepting a COVID-19 vaccine and face multiple and unique barriers to access, requiring simple but innovative solutions to ensure equitable access and uptake. Vaccine hesitancy and low awareness around entitlement and relevant access points could be easily addressed with clear, accessible, and tailored information campaigns, co-produced and delivered by trusted sources within marginalised migrant communities. These findings have immediate relevance to the COVID-19 vaccination initiatives in the UK and in other European and high-income countries with diverse migrant populations. FUNDING: NIHR.

Reconstructing dynamics of foodborne disease outbreaks in the US cattle market from monitoring data.

Conventional empirical studies of foodborne-disease outbreaks (FDOs) in agricultural markets are linear-stochastic formulations hardwiring a world in which markets self-correct in response to external random shocks including FDOs. These formulations were unequipped to establish whether FDOs cause market reaction, or whether markets endogenously propagate outbreaks. We applied nonlinear time series analysis (NLTS) to reconstruct annual dynamics of FDOs in US cattle markets from CDC outbreak data, live cattle futures market prices, and USDA cattle inventories from 1967-2018, and used reconstructed dynamics to detect causality. Reconstructed deterministic nonlinear market dynamics are endogenously unstable-not self-correcting, and cattle inventories drive futures prices and FDOs attributed to beef in temporal patterns linked to a multi-decadal cattle cycle undetected in daily/weekly price movements investigated previously. Benchmarking real-world dynamics with NLTS offers more informative and credible empirical modeling at the convergence of natural and economic sciences.

Cluster of differentiation 44 promotes osteosarcoma progression in mice lacking the tumor suppressor Merlin.

Merlin is a versatile tumor suppressor protein encoded by the NF2 gene. Several lines of evidence suggest that Merlin exerts its tumor suppressor activity, at least in part, by forming an inhibitory complex with cluster of differentiation 44 (CD44). Consistently, numerous NF2 mutations in cancer patients are predicted to perturb the interaction of Merlin with CD44. We hypothesized that disruption of the Merlin-CD44 complex through loss of Merlin, unleashes putative tumor- or metastasis-promoting functions of CD44. To evaluate the relevance of the Merlin-CD44 interaction in vivo, we compared tumor growth and progression in Cd44-positive and Cd44-negative Nf2-mutant mice. Heterozygous Nf2-mutant mice were prone to developing highly metastatic osteosarcomas. Importantly, while the absence of the Cd44 gene had no effect on the frequency of primary osteosarcoma development, it strongly diminished osteosarcoma metastasis formation in the Nf2-mutant mice. In vitro assays identified transendothelial migration as the most prominent cellular phenotype dependent on CD44. Adhesion to endothelial cells was blocked by interfering with integrin α4ß1 (very late antigen-4, VLA-4) on osteosarcoma cells and CD44 upregulated levels of integrin VLA-4 ß1 subunit. Among other putative functions of CD44, which may contribute to the metastatic behavior, the passage through the endothelial cells also appears to be critical in vivo, as CD44 significantly promoted formation of lung metastasis upon intravenous injection of osteosarcoma cells into immunocompromised mice. Altogether, our results strongly suggest that CD44 plays a metastasis-promoting role in the absence of Merlin.

The Role of Trust in Explaining Food Choice: Combining Choice Experiment and Attribute Best-Worst Scaling.

This paper presents empirical findings from a combination of two elicitation techniques-discrete choice experiment (DCE) and best-worst scaling (BWS)-to provide information about the role of consumers' trust in food choice decisions in the case of credence attributes. The analysis was based on a sample of 459 Taiwanese consumers and focuses on red sweet peppers. DCE data were examined using latent class analysis to investigate the importance and the utility different consumer segments attach to the production method, country of origin, and chemical residue testing. The relevance of attitudinal and trust-based items was identified by BWS using a hierarchical Bayesian mixed logit model and was aggregated to five latent components by means of principal component analysis. Applying a multinomial logit model, participants' latent class membership (obtained from DCE data) was regressed on the identified attitudinal and trust components, as well as demographic information. Results of the DCE latent class analysis for the product attributes show that four segments may be distinguished. Linking the DCE with the attitudinal dimensions reveals that consumers' attitude and trust significantly explain class membership and therefore, consumers' preferences for different credence attributes. Based on our results, we derive recommendations for industry and policy.

Application of patient-derived liver cancer cells for phenotypic characterization and therapeutic target identification.

Primary liver cancer (PLC) ranks among the most lethal solid cancers worldwide due to lack of effective biomarkers for early detection and limited treatment options in advanced stages. Development of primary culture models that closely recapitulate phenotypic and molecular diversities of PLC is urgently needed to improve the patient outcome. Long-term cultures of 7 primary liver cancer cell lines of hepatocellular and cholangiocellular origin were established using defined culture conditions. Morphological and histological characteristics of obtained cell lines and xenograft tumors were analyzed and compared to original tumors. Time course analyses of transcriptomic and genomic changes were performed using next-generation sequencing (NGS). Key oncogenic alterations were identified by targeted NGS and cell lines carrying potentially actionable mutations were treated with corresponding specific inhibitors. PDCL fully resembled morphological features of the primary cancers in vitro and in vivo over extended period in culture. Genomic alterations as well as transcriptome profiles showed high similarity with primary tumors and remained stable during long-term culturing. Targeted-NGS confirmed that key oncogenic mutations such as TP53, KRAS, CTNNB1 as well as actionable mutations (e.g. MET, cKIT, KDR) were highly conserved in PDCL and amenable for individualized therapeutic approaches. Integrative genomic and transcriptomic approaches further demonstrated that PDCL more closely resemble molecular and prognostic features of PLC than established cell lines and are valuable tool for direct target evaluation. Our integrative analysis demonstrates that PDCL represents refined model for discovery of relevant molecular subgroups and exploration of precision medicine approaches for the treatment of this deadly disease.

Taiwanese consumer survey data for investigating the role of information on equivalence of organic standards in directing food choice.

The presentation of credence attributes such as the product's origin or the production method has a significant influence on consumers' food purchase decisions. The dataset includes survey responses from a discrete choice experiment with 1309 food shoppers in Taiwan using the example of sweet pepper. The survey was carried out in 2014 in the three largest Taiwanese cities. It evaluates the impact of providing information on the equality of organic standards on consumers' preferences at the example of sweet pepper. Equality of organic standards implies that regardless of products' country-of-origin (COO) organic certifications are based on the same production regulation and managerial processes. Respondents were randomly allocated to the information treatment and the control group. The dataset contains the product choices of participants in both groups, as well as their sociodemographic information.

Does the distribution frequency matter? A subgroup specific analysis of the effectiveness of the EU School Fruit and Vegetable Scheme in Germany comparing twice and thrice weekly deliveries.

OBJECTIVE: The present study aimed to examine the effectiveness of two different implementation forms of the EU School Fruit and Vegetable Scheme (SFVS). DESIGN: A quasi-experimental design was applied including a thrice as well as a twice weekly intervention group. Repeated 24 h dietary recalls were used to measure children's fruit and vegetable (F&V) intake. Effects were analysed on days with and without F&V deliveries using hierarchical linear regression models. SETTING: Twelve primary schools in North Rhine-Westphalia, Germany. SUBJECTS: Third and fourth graders (n 664). RESULTS: Average daily F&V intake at pre-intervention was 0·84 frequencies in the thrice weekly intervention group, 0·90 frequencies in the twice weekly intervention group and 1·25 frequencies in the control group. Providing children thrice weekly with F&V increased children's F&V intake on average by 0·96 (P<0·001) frequencies/d. The effects were higher on days with (1·07; P<0·001) than on days without (0·75; P<0·001) F&V deliveries. Distributing F&V twice weekly resulted in an increase of 0·75 (P<0·001) frequencies/d on average, again with higher effects on days with (1·30; P<0·001) than without (0·48; P<0·003) F&V deliveries. Subgroup analysis revealed some indications for differential effectiveness only in the twice weekly intervention group. CONCLUSIONS: The SFVS with thrice or twice weekly deliveries of F&V led to a significant increase in children's F&V intake on days with and without deliveries. The latter might provide an indication of positive long-term effects of the scheme. The scheme shows equal efficiency for almost all subgroups.

What determines the fruit and vegetables intake of primary school children? - An analysis of personal and social determinants.

The high prevalence of childhood obesity is a major concern in developed and developing countries. An increase in fruit and vegetable (F&V) intake is perceived as one of the numerous strategies to prevent and reduce the risk of adiposity. The purpose of this study was to investigate the relevance of personal and social determinants in explaining children's F&V intake. Written questionnaire data were collected from 702 parent-child pairs that included 3rd and 4th graders (aged 7 to 10) and their parents. Children's F&V intake was recorded over three food records. Hierarchical linear regression models were applied to assess the impact of personal and social determinants on children's F&V intake. Regression models focusing on personal and social determinants revealed that the most promising personal determinants pertained to the knowledge of different types of F&V and preferences for F&V. Moreover, an exclusive focus on social determinants indicated that parental modeling and peer influence had significant and positive relationships with children's F&V intake, whereas verbal directives to eat F&V exhibited a significant and negative relationship. In combination, the following four personal and social determinants were demonstrated to be significant: knowledge of different types of F&V, preferences for F&V and parental modeling, all of which had positive relationships, and verbal directives to eat F&V, which had a negative impact. The results identify important associative determinants of children's F&V intake. These are in part personal and in part social and are shown by our analysis to be of equal and perhaps mutual importance. Therefore, we suggest that interventions aimed at improving children's F&V intake should address children's preferences for F&V, impart knowledge concerning the variety of F&V and encourage parents to act as role models.