The effects of nudging and pricing strategies on the availability and purchases of ultra-processed foods: a secondary analysis of the Supreme Nudge trial.

Regular consumption of ultra-processed foods (UPF) is a risk factor for morbidity and mortality. UPF are widely available in supermarkets. Nudging and pricing strategies are promising strategies to promote healthier supermarket purchases and may reduce UPF purchases. We investigated whether supermarket nudging and pricing strategies targeting healthy foods, but not specifically discouraging UPF, would change UPF availability, price, promotion and placement (UPF-APPP) in supermarkets and customer UPF purchases. We used data from the Supreme Nudge parallel cluster-randomized controlled trial, testing the effect of a combined nudging and pricing intervention promoting healthy products. The Dutch Consumer Food Environment Score (D-CFES) was used to audit 12 participating supermarkets in terms of UPF-APPP. We used customer loyalty card data of the first twelve intervention weeks from 321 participants to calculate the proportion of UPF purchases. Descriptive statistics were used to assess differences in D-CFES between supermarkets. Mixed model analyses were used to assess the association between the D-CFES and UPF purchases and the effect of the intervention on UPF purchases. No difference in the D-CFES between intervention and control supermarkets were found. No statistically significant association between the D-CFES and UPF purchases (ß= -0.00, 95%CI: -0.02, 0.01) and no significant effect of the intervention on UPF purchases (ß= 0.02, 95%CI: -0.07, 0.12) was observed. Given the significant proportion of unhealthy and UPF products in Dutch supermarkets, nudging and pricing strategies aimed at promoting healthy food purchases are not sufficient for reducing UPF-APPP nor purchases, and nationwide regulation may be needed.Trial registration number: Dutch Trial Register ID NL7064, 30 May 2018, https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7302.

Psychometric analysis of the Group Climate Inventory-Revised in adults with mild intellectual disability or borderline intellectual functioning in a secure residential facility.

BACKGROUND: In secure residential facilities, group climate perceptions of clients with mild intellectual disability or borderline intellectual functioning are systematically assessed for quality improvement. A valid and reliable measure may ensure that this process is consistent. The Group Climate Inventory-Revised (GCI-R) is a new measure to assess group climate perceptions. METHOD: Confirmatory factor analysis was conducted in 148 adult clients (79% male) with mild intellectual disability or borderline intellectual functioning in a secure facility to examine internal structure validity and internal consistency reliability of the GCI-R. RESULTS: The results indicate support for the five-factor structure of the GCI-R ('Support', 'Growth', 'Repression', 'Peer interactions', and 'Physical environment'). The internal consistency reliability of its scales ranged from acceptable to good (α: .72-.87; ω: .76-.86). CONCLUSION: The GCI-R demonstrates evidence of psychometric adequacy when applied to adult clients with mild intellectual disability or borderline intellectual functioning in secure residential facilities.

Relationships between dynamic risk factors for externalising problem behaviour and group climate in adults with mild intellectual disability in forensic treatment.

BACKGROUND: Relationships between dynamic risk factors for externalising problem behaviour and group climate were investigated in 151 adult in-patients with mild intellectual disability or borderline intellectual functioning in a Dutch secure residential facility. METHOD: Regression analysis was used to predict total group climate score and Support, Growth, Repression, and Atmosphere subscales of the 'Group Climate Inventory'. Predictor variables were Coping Skills, Attitude towards current treatment, Hostility, and Criminogenic attitudes subscales of the 'Dynamic Risk Outcome Scales'. RESULTS: Less hostility predicted a better overall group climate, better support and atmosphere, and less repression. A positive attitude towards current treatment predicted better growth. CONCLUSION: Results indicate relationships of hostility and attitude towards current treatment with group climate. A focus on both dynamic risk factors and group climate may provide a basis for improving treatment for this target group.

Psychometric properties of the Group Climate Instrument (GCI) in individuals with mild intellectual disability or borderline intellectual functioning.

BACKGROUND: This study examined the psychometric properties of the Group Climate Instrument (GCI) in a sample of N = 189 adults (79% men) with mild intellectual disability or borderline intellectual functioning who were residents of a treatment facility in the Netherlands. METHOD: Construct validity of the GCI was examined by means of confirmatory factor analysis. Also, reliability and convergent validity of the GCI were examined. We also examined the variability in perception of the living group climate between and within living groups by computing intraclass correlation coefficients. RESULTS: The model contained four first-order factors (support, growth, group atmosphere and repression) and a second-order factor overall climate, providing preliminary support for construct validity of the GCI. Reliability coefficients were good for all factors. Preliminary evidence for convergent validity was found in significant moderate associations between subscales and single item ratings for the factors of group climate. The intraclass correlation coefficients indicated that a considerate proportion of variance can be attributed to between-group differences. CONCLUSIONS: The GCI might be used to assess perception of the living group climate for individuals with mild intellectual disability or borderline intellectual functioning in psychiatric and forensic care settings, although further development of the GCI and replication of our findings seem necessary.

Alliance and Treatment Outcome in Family-Involved Treatment for Youth Problems: A Three-Level Meta-analysis.

Alliance has been shown to predict treatment outcome in family-involved treatment for youth problems in several studies. However, meta-analytic research on alliance in family-involved treatment is scarce, and to date, no meta-analytic study on the alliance-outcome association in this field has paid attention to moderating variables. We included 28 studies reporting on the alliance-outcome association in 21 independent study samples of families receiving family-involved treatment for youth problems (N = 2126 families, M age youth ranging from 10.6 to 16.1). We performed three multilevel meta-analyses of the associations between three types of alliance processes and treatment outcome, and of several moderator variables. The quality of the alliance was significantly associated with treatment outcome (r = .183, p < .001). Correlations were significantly stronger when alliance scores of different measurement moments were averaged or added, when families were help-seeking rather than receiving mandated care and when studies included younger children. The correlation between alliance improvement and treatment outcome just failed to reached significance (r = .281, p = .067), and no significant correlation was found between split alliances and treatment outcome (r = .106, p = .343). However, the number of included studies reporting on alliance change scores or split alliances was small. Our findings demonstrate that alliance plays a small but significant role in the effectiveness of family-involved treatment. Future research should focus on investigating the more complex systemic aspects of alliance to gain fuller understanding of the dynamic role of alliance in working with families.

Studies on the mechanism of corticotrophin-mediated desensitization of corticosterone secretion by rat adrenocortical cells.

Long-term exposure of the adrenocortical cells in vivo or in vitro to high concentrations of ACTH results in a diminution of the responsiveness of these cells to a subsequent stimulation of corticosterone release by ACTH. Conflicting studies have been published on the mechanism of this 'desensitization' phenomenon. Dispersed adrenocortical cells prepared from the hypertrophic/hyperplastic adrenal glands of rats bearing the ACTH/PRL-secreting rat pituitary tumour 7315a showed an increased basal release of corticosterone, but had lost their ability to respond further to ACTH. However, corticosterone release in response to dibutyryl cyclic AMP (dbcAMP), cholera toxin and forskolin remained intact. Pretreatment of normal rats for 3, 9 and 21 days with 50 micrograms/rat/day of a long-acting ACTH depot preparation induced a dose-dependent increase in basal corticosterone release by the adrenocortical cells prepared from these animals and a dose-dependent decrease in the sensitivity to ACTH. However, the responsiveness of the adrenocortical cells prepared from the adrenal glands of control and ACTH pretreatment rats to dbcAMP, cholera toxin and forskolin was similar. In addition, pretreatment with ACTH in vivo did not affect the sensitivity of the adrenocortical cells in vitro to calmodulin inhibition by haloperidol and 11 beta-hydroxylase inhibition by etomidate. It is concluded that long-term exposure of the adrenal gland to high concentrations of ACTH in vitro results in an excessive activation of corticosterone release by the adrenocortical cells in vitro, which is accompanied by a loss of sensitivity to ACTH.(ABSTRACT TRUNCATED AT 250 WORDS)

Minimal monitoring of ovarian hyperstimulation: a useful simplification of the clinical phase of in vitro fertilization treatment.

OBJECTIVE: To investigate the feasibility of IVF treatment with minimal monitoring during ovarian hyperstimulation. DESIGN: Retrospective analysis and prospective study with real-time control group. SETTING: Transport IVF program with transport clinic and satellite clinics. PATIENTS: One hundred consecutive IVF cycles monitored at a transport clinic and 100 concurrent consecutive cycles monitored at satellite clinics, using the same stimulation-monitoring protocol and resulting in oocyte aspiration, are compared retrospectively for the number of ultrasound (US) measurements carried out during monitoring and for results of IVF treatment. No patient selection took place. After introduction of a minimal monitoring protocol at a transport clinic, a prospective study was started comparing 100 minimal monitoring cycles at a transport clinic with 100 concurrent conventional monitoring cycles at satellite clinics, all resulting in oocyte aspiration. Patients entered the retrospective or prospective study only once. In all cases the same laboratory facility was used. Monitoring of ovarian hyperstimulation was done with US measurements only. Cycles were canceled for impending ovarian hyperstimulation syndrome (OHSS) when > 35 follicles were seen to develop during hyperstimulation. RESULTS: Retrospective analysis shows no difference for the average number of US measurements at transport and satellite clinics (2.8 +/- 0.9 and 3.0 +/- 1.0; mean +/- SD). No differences were found in the number of ongoing pregnancies obtained in the two groups: 22 and 18, respectively. One case of severe OHSS occurred in the satellite clinic group. Introduction of minimal monitoring at the transport clinic gives a significant reduction of the average number of US measurements at the transport clinic compared with satellite clinics, where conventional monitoring continued to be used (1.5 +/- 0.8 versus 2.8 +/- 0.9). Ongoing pregnancies at transport and satellite clinics numbered 33 and 26, respectively. In both groups one patient developed severe OHSS. Sixty-two percent of cycles at the transport clinic were monitored with one US measurement only. No cancellations for impending OHSS occurred during the study period. CONCLUSION: A large group of patients need only one US measurement during monitoring of ovarian hyperstimulation. Minimal monitoring gives a useful further simplification of the clinical phase of IVF treatment, without adverse effects on treatment outcome and incidence of OHSS.

The ovarian response as a predictor for successful in vitro fertilization treatment after the age of 40 years.

OBJECTIVE: To determine whether age or response to controlled ovarian hyperstimulation (COH) is a better predictor of IVF outcome in women > or = 40 years. DESIGN: Retrospective analysis. SETTING: A transport IVF program. PATIENT(S): For patients undergoing IVF treatment the correlation between treatment outcome and age and response to COH was analyzed using the data of 2,588 consecutive cycles. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Pregnancy. RESULT(S): The incidence of poor ovarian response rises significantly with increasing age. Analysis of all cycles showed a significant decrease in clinical and ongoing pregnancy rate for women > or = 40 years. Analysis of cycles with a good ovarian response showed no statistically significant differences for these parameters between women > or = 40 years and those younger. A logistic regression analysis on pregnancy showed that ovarian response contributes more to the prediction of pregnancy than age. CONCLUSION(S): Patients aged > or = 40 years with a good response to COH have a good prognosis for IVF treatment. The age limit for acceptance of patients should not be set at 40 years. Instead, the response to COH can be used to predict candidates likely to have a successful IVF outcome.

A triplet pregnancy after in vitro fertilization is a procedure-related complication that should be prevented by replacement of two embryos only.

OBJECTIVE: To investigate whether the incidence and obstetric outcome of triplet pregnancies after IVF treatment justify strict limitation of the number of embryos to be replaced to two. DESIGN: Retrospective analysis. SETTING: A transport IVF program. PATIENT(S): All patients who had more than one embryo replaced. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Obstetric outcome, pregnancy. RESULT(S): High-order pregnancies occurred in 24 cases (23 triplets and 1 quadruplet). Three patients opted for selective embryo reduction (12.5%). Three triplet pregnancies spontaneously reduced to twins. Comparison of 18 triplets, reaching at least 20 weeks' gestation, with 54 twin pregnancies shows a higher perinatal mortality in the triplet group, causing 6 out of 18 patients to be confronted with at least one perinatal death. Triplets were born at a lower gestational age, had a lower birth weight, and a higher hospital admission rate of longer duration. Replacement of two, three, or four embryos did not lead to differences in pregnancy rates in the population studied. When a pregnancy occurred after replacement of three embryos, the risk of having a triplet pregnancy was 7.5%. CONCLUSION(S): The obstetric outcome of triplet pregnancies in our population indicates that triplet pregnancies after IVF treatment have to be prevented. Selective embryo reduction is acceptable for few patients only and can therefore not be seen as a solution. Replacement of three embryos results in triplet pregnancy in an unacceptably high percentage. Replacement of two embryos only gives acceptable IVF results and is the method chosen in the IVF program in Rotterdam to prevent triplet pregnancies.

[The ferret. Part 3: the diseases of the ferret classified by clinical symptoms]. / De fret. Deel 3: De ziekten van de fret ingedeeld naar klinische symptomen.

The articles regarding the ferret supply a practical hand-out for the companion animal practitioner. Features regarding housing, nutrition, and reproduction are briefly described followed by, more in detail, diagnostic procedures such as blood collection, anesthesia, small surgical procedures, preventive veterinary care and hospitalization of the ferret. Frequently seen clinical problems with their differential diagnosis are discussed including cause, clinical disease, diagnosis, therapy and if applicable prevention and control.

[The ferret. 1. General and zoologic technical information]. / De fret. Deel 1: Algemene en zoötechnische informatie.

This series of articles on the ferret provide a practical handout for companion animal practitioners. Aspects concerning the housing, nutrition, and reproduction of ferrets are briefly described, followed by a more detailed description of diagnostic procedures such as blood collection, anaesthesia, small surgical procedures, preventive veterinary care, and hospitalization. Frequently seen clinical problems with their differential diagnosis are discussed, and the cause, clinical symptoms, diagnosis, therapy and, if applicable, prevention and control of these disorders are briefly described.

[The ferret. Part 2. Veterinary medical information]. / De fret. Deel 2: Diergeneeskundige informatie.

This series of articles on the ferret provide a practical handout for companion animal practitioners. Aspects concerning the housing, nutrition, and reproduction of ferrets are briefly described, followed by a more detailed description of diagnostic procedures such as blood collection, anaesthesia, small surgical procedures, preventive veterinary care, and hospitalization. Frequently seen clinical problems with their differential diagnosis are discussed, and the cause, clinical symptoms, diagnosis, therapy and, if applicable, prevention and control of these disorders are briefly described.

Use of a GnRH agonist implant as alternative for surgical neutering in pet ferrets.

In the current study, the duration of effectiveness, owner satisfaction and side effects of a gonadotrophin releasing hormone-agonist (deslorelin) implant were investigated during a two-year follow-up study in which 61 male and 69 female entire pet ferrets were given a 4.7 mg deslorelin implant as alternative to surgical neutering. In 27 participating non-oestrous jills, a double-blind placebo controlled study was performed to investigate whether a single low dose of medroxyprogesterone (2 mg orally) four days preceding placement of the implant could prevent oestrus induction. The duration of effectiveness of the implant ranged from 301 days to over 1339 days (mean 1012±38 days), with no sex difference present. Over 90 per cent of owners were pleased with the effects of the implant. Minor local side effects were noted in less than 20 per cent of ferrets, which all resolved within a week without treatment. Oestrus was induced in 77 per cent of jills receiving medroxyprogesterone and 50 per cent of jills receiving the placebo, indicating that administration of a low-dose progestogen cannot prevent postimplant oestrus. Based on the minimum duration of effectiveness, it is advised to place a new implant on a yearly basis to guarantee continuous gonadal suppression, although biannual replacement may be sufficient in the majority of ferrets.

Contaminants and microorganisms in Dutch organic food products: a comparison with conventional products.

Organic products were analysed for the presence of contaminants, microorganisms and antibiotic resistance and compared with those from conventional products. No differences were observed in the Fusarium toxins deoxynivalenol and zearalenone in organic and conventional wheat, during both a dry period and a very wet period which promoted the production of these toxins. Nitrate levels in head lettuce produced organically in the open field were much lower than those in conventional products. In iceberg lettuce and head lettuce from the greenhouse, no differences were detected. Organically produced carrots contained higher nitrate levels than conventional products. Both organic and conventional products contained no residues of non-polar pesticides above the legal limits, although some were detected in conventional lettuce. Organic products contained no elevated levels of heavy metals. Salmonella was detected in 30% of pig faeces samples obtained from 30 organic farms, similar to the incidence at conventional farms. At farms that switched to organic production more then 6 years ago no Salmonella was detected, with the exception of one stable with young pigs recently purchased from another farm. No Salmonella was detected in faeces at the nine farms with organic broilers, and at one out of ten farms with laying hens. This is comparable with conventional farms where the incidence for Salmonella lies around 10%. Campylobacter was detected in faeces at all organic broiler farms, being much higher than at conventional farms. One of the most remarkable results was the fact that faeces from organic pigs and broilers showed a much lower incidence of antibiotic resistant bacteria, except for Campylobacter in broilers. It is concluded that the organic products investigated scored as equally well as conventional products with regard to food safety and at the same time show some promising features with respect to antibiotic resistance.