To determine the timing of spontaneous venous pulsation (SVP) relative to the ocular circulatory cycle by using the movie tool of confocal scanning laser ophthalmoloscope.max and CRAmin, respectively) and CRV  was identified during four pulse cycles. The interval between CRVmin and CRAmin, and between CRVmax and CRAmax was expressed as the number of frames and as a percentage of the ocular circulatory cycle.A video recording of the fundus was obtained using a confocal scanning laser ophthalmoscope  at 8 frames/s in 47 eyes (15 glaucoma patients and 32 glaucoma suspects) with visible pulsation of both the central retinal artery (CRA) and vein (CRV). The timing of the maximum and minimum diameters of the CRA (CRAmax to the next) lasted 7.7±1.0 frames , with a mean pulse rate of 62.6 beats/min. The diameter of the CRA was increased for 2.4±0.5 frames (301.9±58.8 ms) and decreased for 5.3±0.9 frames (656.9±113.5 ms). CRVmax occurred 1.0±0.2 frames after CRAmax , while CRVmin occurred 1.1±0.4 frames after CRAmin .The ocular circulatory cycle (from one CRADuring SVP, the diameter of the CRV began to decrease at early diastole, and the reduction persisted until early systole. This finding supports that CRV collapse occurs during ocular diastole. Spontaneous retinal pulsation (SVP) manifests as a rhythmic variation in the caliber of the retinal vein near to or on the optic disc, and is visible in approximately 80–90% of healthy individuals When SVP was first described by Coccius However, Kain et al. Our group recently demonstrated that the movie tool of confocal scanning laser ophthalmoscope  may be useful for recording SVP To the best of our knowledge, this is the first study to evaluate the phase relationship between the CRA pulse and CRV pulse.This study was a retrospective review of fundus video clips of the optic disc, which were collected for our previous study Before the study, each subject received the following comprehensive ophthalmic examinations: visual acuity measurement, Goldmann applanation tonometry, refraction tests, slit-lamp biomicroscopy, gonioscopy, dilated stereoscopic examination of the optic disc, disc photographs , retinal nerve fiber layer (RNFL) thickness measurement, and real-time fundus video recording using spectral-domain optical coherence tomography , and standard automated perimetry .A glaucoma suspect was defined as having elevated IOP or a suspicious-appearing optic disc but a normal visual field. Primary open-angle glaucoma (POAG) was defined as having characteristics of glaucomatous optic neuropathy, such as rim thinning, notching, and RNFL defect, a glaucomatous visual field defect, and an open iridocorneal angle. Glaucomatous visual field defect was defined as (1) outside normal limit on glaucoma hemifield test or (2) 3 abnormal points, with P<5% probability of being normal, one with P<1% by pattern deviation; or (3) pattern standard deviation of <5% confirmed on 2 consecutive tests. Only reliable visual field tests were included in the analysis.To be included in our previous study, subjects were required to have at least two IOP measurements before receiving antiglaucoma treatment, a best-corrected visual acuity of ≥20/40, a spherical equivalent refractive error range from −7.0 to +3.0 diopters (D), cylinder correction of >±3.0 D, an open anterior chamber angle, and reliable visual fields . Subjects with a history of ocular surgery other than uncomplicated cataract surgery, history of ocular trauma and uveitis, or other diseases affecting the visual field  were excluded. Subjects with poor quality of movie recording of the fundus (media opacity and severe eye movement) were also excluded.Of the subjects included in the previous study, only subjects who had pulsation of both CRA and CRV markedly visible on fundus movie recording were selected and included in the present study. In cases in which both eyes of a subject were eligible for the study, only one randomly selected eye was included.max and CRAmin, respectively) and CRV . In cases of disagreement in the judgments of vessel pulsation movement, a third glaucoma expert (T-W.K.) served as an adjudicator. The frame intervals between CRAmax and CRVmax, and between CRAmin and CRVmin are presented as percentages of the ocular circulatory cycle . Images from four pulse cycles were evaluated for each patient, and the measurements obtained from these four cycles were averaged and used for the analysis.SVP was observed using fundus video recordings that were acquired with a confocal scanning laser ophthalmoscope  in near-infrared mode (820 nm). Real-time fundus video clips centered on the optic nerve head of each eye were recorded by a skilled technician after inducing pupil dilation. The video clips were recorded at a frame rate of 8 frames/s for a total of 20s each, and had a resolution of 768 by 768 pixels. The video clips were reviewed after adjustment of image movement using an eye-movement correction tool that was installed in the device, and eligible subjects  were selected by a glaucoma specialist (M.K.). The video clips of the selected patients were then reviewed in slow motion (1 frame/2 s) by two glaucoma specialists (M.K. and E.J.L.), who independently evaluated the sequential changes in the diameter of the central retinal vessels, and identified the timing of the maximum and minimum diameters of both the CRA . The interobserver ICCs for measurement of the timing of the minimum and maximum diameters of the vessels are given in min and the next) was 7.7±1.0 frames, which was equivalent to a duration of 958.8±127.2 ms, with a mean pulse rate of 62.6 beats/min. Ocular systole lasted 2.4±0.5 frames (31.3% of the ocular circulatory cycle), while ocular diastole lasted 5.3±0.9 frames (68.7% of the ocular circulatory cycle). CRVmin occurred after 1.0±0.2 frames . CRVmax occurred after 1.1±0.4 frames . CRVmin, CRAmax, and CRVmax were observed at 14.8±5.1%, 31.3±5.4%, and 44.7±6.6% of the ocular circulatory cycle, respectively.min and CRVmax delays as percentages of the ocular circulatory cycle. In all patients, CRVmin occurred after CRAmin by at least 9% of the ocular circulatory cycle. Most of the patients (83.0%) exhibited a phase delay of 9–15% of the ocular circulatory cycle between CRAmin and CRVmin  and from CRAmax to CRVmax (P = 0.257) was not significantly correlated with the IOP at the time of disc scanning.d CRVmin . CRVmax ry cycle . The phamax occurred after CRAmax (peak systole) and CRVmin occurred after CRAmin (peak diastole). These findings suggest that the CRV diameter started to decrease at early diastole and reached a minimum at early systole, which is consistent with the findings of previous studies. Since the first documentation of SVP by Coccius When fluid drains from a collapsible vessel within a pressurized chamber to the external space, the walls of the collapsible vessel will oscillate within the chamber near the exit region Several hypotheses have been proposed for the mechanism by which venous collapse occurs during diastole. The first hypothesis is based on the time difference between the reductions in ICP and IOP, both of which occur during cardiac diastole min to CRVmax), suggesting that there is a considerable time window during which the retrograde axoplasmic flow could be facilitated.After collapse of the CRV, ICP increases more rapidly than the IOP in systole according to Morgan et al. 's study min and CRAmin, and between CRVmax and CRAmax. Thus, the present results may be of value only for determining the temporal relationship between the CRV and CRA pulses, and not for calculating the exact timing of the phase difference between the two. Second, only subjects who had marked observable pulsation of both the artery and vein in the fundus video recording were included. Thus, the findings may not be applicable to the general population. Some of the excluded patients might have had oscillatory blood flow in the artery and vein, although this was not clearly noticeable. It is possible that those subjects had different pulsation timing characteristics.Our study has limitations. First, the fundus video was recorded at only 8 frames/s, which was the maximum frame rate available when using the Spectralis movie tool. However, the limitation of a large interframe interval (0.125 s) was partly overcome by averaging the data from four cycles. Nonetheless, this limits the precise calculation of the interval between CRVIn conclusion, the CRV collapse associated with SVP started at ocular diastole and lasted until early systole. This observation supports the recently discovered notion that CRV collapse occurs during ocular diastole.Video S1Video clip of the fundus of the right eye of a 64-year-old woman. Note the change in the diameter of the inferotemporal artery (white arrowhead). The diameter of the indicated artery gradually decreases from frame 1 to frame 3, and then increases abruptly in frame 4, suggesting that CRAmin occurred between frames 3 and 4. The diameter of the artery gradually increases in frames 4 and 5, and then decreases from frame 6, suggesting that CRAmax occurred between frames 5 and 6. CRAmin, minimum diameter of the central retinal artery; CRAmax, maximum diameter of the central retinal artery.(AVI)Click here for additional data file.Video S2The same video recording as shown in video clip 1. Note the change in the diameter of the inferior hemiretinal vein (black arrowhead). The diameter of the indicated vein gradually decreases between frames 1 and 4, and then increases abruptly in frame 5, suggesting that CRVmin occurred between frames 4 and 5. The diameter of the vein gradually increases in frames 5 and 6, and then decreases from frame 7, suggesting that CRVmax occurred between frames 6 and 7. CRAmin, minmum diameter of the central retinal artery; CRAmax, maximum diameter of the central retinal artery.(AVI)Click here for additional data file.


A collaborative approach to patient management has been shown to improve patient outcomes. In a resource-limited NHS, critical care beds are at a premium, therefore preventing unnecessary admissions by optimising ward-based management is essential. The objective of this service quality improvement project was to improve collaboration between the critical care directorate and neurosurgical high care unit at a tertiary university teaching hospital. We proposed that the use of a simple ward round tool on collaborative rounds would facilitate systematic patient review, prompt early recognition of those critically unwell and improve patient outcomes.An initial observation period of behaviours and practice on the neurosurgical unit was conducted with qualitative and quantitative data collection. Following analysis of these outcome measures a simple ward round tool was constructed, with the mnemonic ‘DON'T FORGET', and we devised a programme for collaborative ward rounds to take place three times per week over a 1-month period. During this time further data were collected to assess whether our interventions resulted in modified behaviours and to document the number of changes made to patient management as a consequence of the collaborative approach to care.Our results showed that improvements were made in all assessed domains. Consultant-led ward rounds increased, attendance by members of the multidisciplinary team (MDT) dramatically improved and as a result MDT discussion was enhanced. In addition, documentation of structured plans improved and review of prescription charts significantly increased. As a consequence of collaborative rounds, a total of 343 changes were made to patient management under the domains of the ward round tool. This was an average of 21.4 changes per collaborative round, with most changes being made to medication charts or decisions regarding thromboprophylaxis.The use of a simple ward round tool combined with a collaborative approach to ward rounds improved MDT involvement and discussion, promoted structured patient review and resulted in positive changes to multiple areas of patient management. In conclusion, structured collaborative rounds result in significant changes to patient management that may prevent admission, or readmission, to critical care which has the potential to reduce healthcare costs and morbidity.


Introduction: Ward rounds are an essential activity for interprofessional teams in hospital settings and represent complex tasks requiring not only medical knowledge but also communication skills, clinical technical skills, patient management skills and team-work skills. The present study aimed to analyse final year students’, nurses’ as well as physiotherapists’ views on a simulation-based interprofessional ward round training.Methods: In two successive passes a total number of 29 final year students, nursing students and physiotherapy students  volunteered to participate in two standardized patient ward round scenarios: (1) patient with myocardial infarction, and (2) patient with poorly controlled diabetes. Views on the interprofessional ward round training were assessed using focus groups.Results: Focus group based feedback contained two main categories (A) ward round training benefits and (B) difficulties. Positive aspects enfolded course preparation, setting of the training, the involvement of the participants during training and the positive learning atmosphere. Difficulties were seen in the flawed atmosphere and realization of ward rounds in the daily clinical setting with respect to inter-professional aspects, and course benefit for the different professional groups.Conclusion: The presented inter-professional ward round training represents a well received and valuable model of interprofessional learning. Further research should assess its effectiveness, processes of interprofessional interplay and transfer into clinical practice. Ward rounds are an essential duty for doctors within hospital settings . ConductThe role of interprofessional communication and collaboration in health care is becoming increasingly important , 33]. I. I33]. IRecently, an innovative model for ward round training using standardized patients (SP) was introduced in final year medical education. . Hereby,In this short report, we aimed to analyse final year students’, nursing students’ as well as physiotherapist students’ views on an interprofessional ward round training. The training was based on a context-based ward round scenario with the aim of an interprofessional exchange regarding occupation specific treatment goals as well as mutual treatment planning. Therefore an interprofessional ward round training with standardized patients enfolding two different scenarios was designed on bases of the model developed by Nikendei et al. . Clinicaa patient with myocardial infarction, and a patient with poorly controlled diabetes. Participants took part in a subsequent focus group analysis. The aim of the focus group interviews was to explore students’ perceptions of their experiences during the interprofessional ward round training.In two successive passes a total number of 29 students  volunteered to participate in the study. Of these, 13 (45%) were final year medical students at Heidelberg University Medical Hospital  with a mean age of 26.7 years, 9 (31%) were final year nursing students at Louise von Marillac-School for Health Professions, Heidelberg  with a mean age of 21.9 years and 7 (24%) were physiotherapy students at IB-GIS mbH Medical Academy for Physiotherapy, Mannheim  with a mean age of 23.6 years.The two scenario ward round training sessions were embedded into a mini-curriculum of 4 interprofessional learning units of 240 min each: social gathering + PBL-case-analysis, basic life support training, interprofessional ward round training, SP-based communication training. All units were designed by an interprofessional teaching team consisting of medical doctors , nurses (GP), physiotherapists (YT), and research assistants (DH). Learning objectives were discussed according to the Basel Consensus Statement "Communicative and Social Competencies in Medical Education" .The ward around training proceeded as follows: Groups of three students each participated in two different standardized patient ward round scenarios : 50 year old, stout Mr. Behrens with stent implantation following myocardial infarction, 45 year old Mrs. Vogel with diabetes-related compliance problems, high blood pressure and leg ulcer. The three students assumed the role of doctor, nurse or physiotherapist according to their own profession and received role-specific instructions. Doctors’ tasks involved gaining an overview of the patient case, related patient files and patient medication charts. Doctors were further required to define consultation goals, conduct the ward round consultation and subsequently re-evaluate the patient’s therapy. The re-evaluation included completion of medication charts, provision of instructions for the nursing staff and the preparation of written notes regarding the proposed management. Nurses’ tasks involved bringing questions about patients’ mobilisation and activation into the ward as well as talking about patients’ discharge management. Due to their more personal relationship to patients they also played an important role as crucial link between patients’ demands and wishes on the one hand and doctors’ decisions on the other hand. The physiotherapists were asked to bring patients’ physical activities into the wards. They were to suggest specific measures like ergometer trainings or walking units. Ward round sessions were followed by an instructor-guided debriefing and feedback round in which teachers of all health professions were actively engaged.A qualitative approach is not only appropriate for exploring what students are thinking but also why they are thinking it . Focus gAn experienced moderator actively encouraged input from all participants and ensured that different opinions could be expressed. The students were asked to note their thoughts on a topic before these were discussed in the group. Each ward round training was followed by a focus group session which resulted in four interviews in total, lasting approximately 20 minutes each. The sessions were moderated by one of the authors (DH). In order to ensure consistency across groups, an interview guide was used for the interviews  see Tab. During The verbatim-transcribed discussions were analyzed via qualitative content analysis using the software MaxQDA . In accordance with guidelines for qualitative inductive content analysis  thematicThe qualitative analysis of the transcripts identified 45 relevant single tutees’ statements. From these statements, nine themes and two main categories were derived. The main categories included (A) ward round training benefits and (B) ward round training difficulties. These main categories contained four themes each (i.e. A.1 to A.4).In the following, we provide definitions for the main categories. This category describes different positive and beneficial experiences participants reported concerning the ward round training. The category includes four relevant themes. The theme (A.1) “Improved understanding of the situation, tasks and common objective” envelopes students’ sustainable experiences of other professional groups as well as their tasks, an improvement in the understanding of the task distribution between the different professional groups and the experience of the professional groups’ mutual support considered as beneficial for the patients’ overall treatment. (A.2) “Ward round practice” describes the beneficial experience of understanding the basic ward round sequence as well as the individual role and behaviour in a realistic setting. The theme (A.3) “Involvement of all professional groups” includes students’ feelings of interprofessional action and care given through the fact that all professional groups were equally involved during ward round training. The fact that ward round training was held in casual attire and evaluations took place without pressure was perceived to contribute to the relaxed and informal tone of the setting, summarized under the theme (A.4) “Relaxed learning atmosphere”. For more details see Table 2 The second category highlights students’ critical aspects concerning the ward round training. Five relevant themes emerged. The theme (B.1) “Ward round training versus reality” includes the participants’ perception that the training was unrealistic as usual everyday stresses were omitted and all professional groups were present, which is rarely the case during genuine ward rounds. (B.2) “Ward rounds: a flawed starting point for inter-professional action” describes the students’ experience that ward rounds generally failed to offer the best opportunity for inter-professional learning and action since the subsequent situations after rounds were of more interest. The theme (B.3) “Unfavourable time management” summarises the participants’ statements that ward round preparation had received too much attention, while time at bedside had been neglected. Finally, (B.4) “Lack of equal benefit” includes students’ criticism concerning the fact that the training did not provide all professional groups with equal learning benefit; in these opinions, nurses and physiotherapists had not been able to gain the same added value from the training. More detailed information is given in Table 3 The three professional groups mostly agreed that the training allowed them to learn a great deal from each other and could be a potential benefit to patients as well. They liked the course’s atmosphere and perceived themselves as being part of a valuable interdisciplinary learning opportunity. However, the groups were also in agreement in voicing criticism that the training was too artificial and distant from reality.The groups mostly differed in the aspect of how beneficial a ward round practice was to them: While medical students appreciated the scenario, since they had never practiced ward rounds before, nursing students where already quite familiar with this format; and physiotherapy students indicated they would not go on ward rounds in real life anyway. Nursing and physiotherapy students also complained about the project’s focus on medicine, with medical students performing the majority of the tasks.Our study describes an interprofessional ward round training for final year medical, nursing and physiotherapy students and its evaluation using focus groups. The qualitative analysis of the focus group interviews revealed that the training was well received by participants and proved a valuable source of interdisciplinary learning. Students criticized the ward round simulations’ degree of realism, time management and the fact that the training failed to benefit all participating professions equally.The training was perceived as a valuable resource enabling participants to learn from the other professions’ perspectives, their occupation related responsibilities, task distribution as well as diagnostic and therapeutic procedures. The patient was experienced as being a common and combining element resulting in a feeling of team coherence. Although the lack of equal involvement of all three professional groups was criticized and suggestions regarding other scenarios for interprofessional team work were made, our ward round training represents a valuable opportunity to introduce students to ward round sequence and procedures as well as to the required interprofessional team work. This seems especially important, as ward rounds in particular continue to be characterized by suboptimal supervision and the trainees’ insufficient specific guidance .From a methodological point of view, participants perceived ward round training as rather artificial and idealized. Furthermore, time management was criticized and participants felt that the lacking possibility to equally involve all three professional groups in the role-play instructions and tasks was unfavorable. Although standardized patients are perceived to portray a high degree of realism , the traThe participants criticized the “lack of an equal benefit” concerning the different professional groups. To be of equal benefit to all professional groups, the relevance for the future professional practice of each discipline must be recognizable in all learning subunits . This miNevertheless, we are convinced that these interventions represent an important step towards students’ improved preparation for on-ward clinical practice and in turn towards the further assurance of patients’ safety. Further research should investigate interprofessional teams’ ward round skills in a real life setting. As this is the first interprofessional ward round training of its kind to be performed in our faculty, criticism of insufficient time management and weighing of roles must be taken in to account and amended for further implementations. Especially, nursing and physiotherapy students must become more involved within the scenarios in future.There are several limitations regarding our study. The number of participants was limited and objective measures of success are missing. Besides, the qualitative content analysis revealed only two main categories, the benefits and difficulties of the ward round training, both issues could be derived from the interview guide. Another point of criticism is the fact that only the overall results could be presented due to the small amount of data; the two sub items, similarities and divergences between the subitems groups, are of only an exemplary nature. Furthermore, the current study focusses on medical student education. Further research is needed to assess whether gained insights can be transferred to postgraduate ward-round training. The use of in-depth focus group interviews and quotations enabled us to develop a comprehensive picture of this multi-layered topic and led to a number of new aspects regarding interprofessional training. Our interprofessional ward round training represents a well received and valuable model of interprofessional learning. Further research should assess its effectiveness, processes of interprofessional interplay and transfer into clinical practice.This study was supported by the Ministry for Science, Research and Art Baden-Württemberg, Germany, project: „Assurance of academic success in high-risk groups – study for the improvement of intercultural communication“; project identification number: D 100011720; AZ32-402.17(05)/34.The authors declare that they have no competing interests.


The association of social capital and alcohol consumption is one of the most robust empirical findings in health economics of the past decade. However, the direction of the relationship between the two is heavily dependent on which dimension of social capital is studied and which alcohol measure is used. In this paper, we examine the effect of social interactions and generalised trust on drinking in the general Danish population survey.n = 2569) were recruited as part of a larger study. The double-hurdle model for the volume of alcohol consumption and the multivariate logistic model for heavy episodic drinking were estimated.Participants (We found evidence that social networking with male friends, membership in voluntary organisations, and generalised trust were significantly associated with the mean volume of alcohol consumption and heavy drinking. We also observed that social support at the community level had a buffering effect against heavy episodic drinking.The findings support previous findings in which social interactions and generalised trust were found to predict individuals’ volume of drinking and heavy episodic drinking. However, the results varied across the indicators. During the past three decades or so, the concept of social capital has received much attention by practitioners and academicians from different disciplines. The work of Coleman  in socioThere are several mechanisms through which social capital indicators are related to individual health. Social interaction increases the utility of its performers, and it also improves allocation of resources by improving information sharing, coordination of activities, and collective decision making . Bolin aSocial participation is viewed as strengthening self-esteem and coping strategies as well as facilitating a greater degree of empowerment and accountability . Such enThere has recently been a growing interest in the various indicators of social capital as the major correlates of drinking behaviour. Despite mixed results, previous studies documented a significant association between social capital indicators and alcohol use. Some of the empirical evidence suggested that a high level of social capital is protective against engaging in risky health behaviours. For instance, Weitzman and Kawachi  found thTaken together, the link between social capital indicators and alcohol use has been demonstrated by the abovementioned studies. However, there are some important shortcomings in the previous literature. Firstly, the majority of the studies relied heavily on dichotomous outcomes of alcohol consumption measures, which might result in a loss of information and loss of statistical power in the results. A few studies even employed least square methods, and in the presence of zero alcohol consumption, this approach generally leads to inconsistent parameter estimates. In the present study, this issue was addressed by using a double-hurdle model that is appealing to investigate participation decision (drinking or not) and the amount or consumption decision (volume of drinking when it is positive). Thus, the model enabled us to not only assess how social capital indicators predict the probability of drinking but also the intensity of alcohol consumption.Secondly, many studies examining the effect of social capital on alcohol measures used observational data sets. Since social capital indicators are also likely to be influenced by alcohol use, the relationship between the two may be simultaneously determined, in which case the results will be biased and inconsistent. Additionally, Kim et al.  pointed Data for the present study came from the 2011 Danish alcohol and drug survey that was carried out by Statistics Denmark for the Centre for Alcohol and Drug Research of Aarhus University. A representative sample of the Danish general population aged 16 to 79 years old was randomly chosen using the central person registry (CPR) as a sampling frame. Among this, we used 2569 individuals, who were randomly selected and additionally interviewed on dimensions of social capital.volume of alcohol consumption and heavy episodic drinking as outcome variables. Respondents were asked how many glasses or units of the various types of alcoholic beverages  they drank in the last 30 days. These beverage-specific quantity-frequency measures were then summed up to create a measure of total alcohol consumption in grams of pure alcohol on an average per day. Heavy episodic drinking was defined as drinking five or more units on one occasion in the previous 12 months. It was a dummy variable taking 1 if the individual engaged in heavy episodic drinking and 0 otherwise.We used Social interaction among friends and colleagues was derived from the following questionnaire item: ‘How often have you had interaction  with colleagues, female friends, and male friends in the last 30 days?’. Response categories ranged from ‘daily (5)’ to ‘have no relative/colleague (0)’. Social support was constructed based on the following questionnaire item: ‘How easy or difficult is it to get help from friends if you need it?’. Response categories ranged from ‘4’ representing ‘very easy’ to ‘1’ representing ‘very difficult’. As for indicators of social participation, a dummy variable was created for the question which reads: ‘Are you a member of an organisation, club, or other organisations?’. Finally, generalised trust was measured with the following item: ‘To what extent do you trust most people?’ The response category ranged from ‘to a high extent’ (4) to ‘never’ (1).The model also included the following variables: Age ; gender; personal annual income  or less , and the upper category was 400.000 kr.  and more; education ; employment status ; civil status ; and a dummy for living with children under 18 years old.In our sample, about 7 % of respondents were abstainers, and in the presence of censoring , least square estimates will be inconsistent. Among a number of available estimation procedures, the double-hurdle model proposed by Cragg  can be u(i)y = d × y * *Observed equation: (ii)Participation equation: (iii)Consumption equation: Following Aristei et al. , we usedw and x are factors including the social capital indicators that are likely to influence participation and consumption decisions, respectively. The error terms in the two decision equations are given by u and, respectively. A positive level of alcohol consumption (y = y∗) is only observed if the individual participates in drinking (d = 1) and actually consumes alcoholic beverages (y∗ > 0). In this model, we assumed that the decision to drink and the amount to drinking (consumption) are independent.Where: i in postal code area z, the average social capital indicators excluding own contribution was constructed as follows:As mentioned earlier, heavy episodic drinking was a dichotomous variable taking the value 1 if the individual participated in the outcome of interest and 0 otherwise. In this regard, multivariate logistic regression was used to predict social capital indicators on heavy episodic drinking. In the spirit of Lundborg , for an N is the number of respondents in Z postal code area and yj is a Likert scale or binary indicator (for membership in organisation) value representing responses of an individual j. For an individual i, the heavy episodic drinking decision can be defined as:Where: Xi1 represents the vector of factors that is likely to influence heavy episodic drinking, Si represents the average social capital indicators excluding the individual contribution, βj is the associated vector of coefficients, and εi is the random error term.The latent variable With respect to the validity of the constructed models, the pair-wise correlation coefficient test and the variance inflation factor (VIF) test could not confirm multicollinearity in any of our tested equations (see Appendix Table As noted earlier, the double-hurdle model uses two equations: participation and consumption equations. In the former, all non-participants have zero alcohol consumption, whereas participants have a positive volume of alcohol consumption in the latter. The two equations are estimated simultaneously using the user written STATA command by Burke . The samIn sum, the results suggest that membership in an organisation and generalised trust were positively associated with both the likelihood of alcohol use and the number of drinks consumed in the previous year. Furthermore, social networking with male friends was positively related to the number of drinks consumed.The results of the multivariate logistic regression examining heavy episodic drinking as an outcome are reported in Table As seen in the results, women were less likely to engage in heavy episodic drinking compared to men. The probability of engaging in heavy episodic drinking appeared to decrease among individuals in the older age cohorts in comparison to individuals in the young age cohort. The results for the estimated coefficients of the socioeconomic variables were qualitatively comparable. For instance, the result indicates that income had a significant positive effect on the probability of heavy episodic drinking. We also found that individuals who identified themselves as pensioners and in the ‘other’ employment category were less likely to engage in heavy episodic drinking compared to their counterparts in the employed category. Civil status is also related to heavy episodic drinking: Individuals who identified themselves as widow/divorced/separated were likely to engage in heavy episodic drinking compared to married individuals. With respect to children, individuals who reported having children were less likely to engage in heavy episodic drinking compared to those who did not live with children.In sum, the results suggest that after controlling for socioeconomic and demographic variables social support at the community level, which is defined as community effects elsewhere , 36, wasThe current study examined social interactions and generalised trust as predictors of alcohol use among a representative sample of Danish adults. We used the double-hurdle model to not only explore the probability of drinking but also the intensity of alcohol consumption. Furthermore, to address the simultaneity issue, we used the average value of the social interaction and generalised trust variables by excluding own contribution to predict the likelihood of heavy episodic drinking. Our result demonstrates that social interactions and generalised trust were significantly correlated with alcohol use measures.With respect to our first outcome measure, i.e., volume of alcohol consumption, we found that social networking with male friends was positively associated with the volume of drinking. Our finding supports the qualitative research by Järvinen  who repoFocussing on heavy episodic drinking as an outcome variable, the same general findings are evident for our examination of social interactions and generalised trust variables in relation to the frequency of engaging in heavy episodic drinking. When analysing the average social capital indicators, i.e., community effects, independently, we found that individuals who reported high social support were less likely to engage in heavy episodic drinking. Thus, our result suggests that adequate support may help as a buffering mechanism against risky health behaviour by reducing stressful actions . It is aFurthermore, consistent with earlier research in Denmark and elsewhere, age and being female were observed to be inversely associated with heavy episodic drinking . Our finIt was observed that the results for the social interactions and generalised trust variables were somewhat consistent across the outcome variables. However, except for social support, the magnitude and significance of the results tended to attenuate when we control for average social capital indicators in relation to heavy episodic drinking.In conclusion, this study examined the role of social interactions and generalised trust in alcohol consumption while controlling for other important socioeconomic and demographic variables. The effect of social capital has been conceptualised to be inversely associated with alcohol use. However, our results have provided no conclusive support to the argument that individuals who reported higher levels of social capital are less likely to be involved in drinking than their counterparts with less social capital. In this regard, while our result for social support and membership in an organisation supports the argument put forward in the introduction section of the study, the findings from the other aspects of the social capital indicators are observed as working in the opposite direction. Therefore, further studies should be conducted to support these findings and extend the research.There are a number of limitations that must be acknowledged. Firstly, the study was cross-sectional, which limits interpretations to associations rather than causality. Furthermore, a reverse causation may arise because a person is likely to drink with the aim of socialisation, and, thus, tends to have more social networking and drink more. Additionally, as social networking may influence heavy drinking, the reverse could be true as heavy drinkers may be expected to be isolated and consequently lose friends. However, we addressed this issue partially by considering the average values of the variable of interest at the community level. Secondly, because of the use of self-report data in our analyses, we are aware of the risk of recall bias. Thirdly, despite controlling for a number of individual socio-economic and demographic covariates, the possibility of respondents choosing friends who are similar to them in terms of drinking was not accounted for; that is, we could not control for friends’ drinking behaviour. Furthermore, gender difference may also be important when the influence of friends is considered. Male friends may have a different influence on men than women and female friends may also have a different influence on men than women. For instance, women may fear the embarrassment of being seen drunk by women, but men may take pride in showing other men how much they can drink. Fourthly, we analysed social networking at the friends’ level, but we were unable to take into account the drinking behaviours across contexts. For instance, respondents may drink more at bars than at home or vice-versa . In one In sum, this study examined how social interactions and generalised trust could influence alcohol consumption, controlling for other important socioeconomic and demographic variables. Our main finding is that social interactions and generalised trust were found to predict individuals’ volume of drinking and heavy episodic drinking. However, the results varied across the indicators. It is also worth mentioning that our estimated results are not interpreted as causal relationships, and it is therefore of interest to investigate the causal relationships in future studies.


Nutrition is the intake of food in relation to the body's dietary needs. Malnutrition results from the intake of inadequate or excess food. This can lead to reduced immunity, increased susceptibility to disease, impaired physical and mental development, and reduced productivity.To perform a systematic review to assess research conducted by the International Network for the Demographic Evaluation of Populations and their Health (INDEPTH) of health and demographic surveillance systems (HDSSs) over a 15-year period on malnutrition, its determinants, the effects of under and over nutrition, and intervention research on malnutrition in low- and middle-income countries (LMICs).Relevant publication titles were uploaded onto the Zotero research tool from different databases (60% from PubMed). Using the keywords ‘nutrition’, ‘malnutrition’, ‘over and under nutrition’, we selected publications that were based only on data generated through the longitudinal HDSS platform. All titles and abstracts were screened to determine inclusion eligibility and full articles were independently assessed according to inclusion/exclusion criteria. For inclusion in this study, papers had to cover research on at least one of the following topics: the problem of malnutrition, its determinants, its effects, and intervention research on malnutrition. One hundred and forty eight papers were identified and reviewed, and 67 were selected for this study.The INDEPTH research identified rising levels of overweight and obesity, sometimes in the same settings as under-nutrition. Urbanisation appears to be protective against under-nutrition, but it heightens the risk of obesity. Appropriately timed breastfeeding interventions were protective against malnutrition.Although INDEPTH has expanded the global knowledge base on nutrition, many questions remain unresolved. There is a need for more investment in nutrition research in LMICs in order to generate evidence to inform policies in these settings. Nutrition has been defined as the ‘science of food, the nutrients and other substances therein, their action, interaction and balance in relation to health and disease, and the processes by which the organism ingests, absorbs, transports, utilises and excretes food substances’ .In low- and middle-income countries (LMICs) studies of nutrition generally focus on malnutrition, defined by the World Health Organization (WHO) as ‘inadequate or excess intake of protein, energy and micronutrients such as vitamins, and the frequent infections and disorders that result’ . It is eThe long-term impact of malnutrition cannot be overemphasised –9. Such The member centres of INDEPTH have played an important role in their efforts to measure the prevalence of nutritional disorders, understand their determinants and effects, and assess the effectiveness of interventions to tackle the problem . INDEPTHIn Africa and Asia, the HDSS centres have examined the problem of malnutrition using various methods, including cohort studies, nested surveys, case–control studies, qualitative focus group discussions, key informant interviews, literature reviews, clinical trials, and the testing of diagnostic tools. The centres have also developed and tested measurement and screening tools to facilitate a more accurate diagnosis of nutritional problems and to draw a more robust picture of food intake patterns in low- and middle-income settings.In this paper, we review studies of malnutrition conducted by HDSSs published in peer-reviewed English language journals, and we outline the key findings reported by INDEPTH member centres and discuss their implications for future nutrition policy. This study includes 67 published papers on malnutrition between 1998 and 2013, covering nine countries in Africa and four in Asia.Standard systematic review methods by Higgins and Green  and the This paper deals with five tropical issues: The problem of malnutrition as manifested in member centres' demographic surveillance areas, including the prevalence of malnutrition and population groups most affected; the biological and social determinants of malnutrition; the effects of malnutrition; the interventions that have attempted to tackle malnutrition; and concludes with discussion and policy and research recommendations .Insufficient or inadequate food intake – be it from lack of quantity or lack of essential nutrients including protein and specific micronutrients – remains a blight across the developing world. Under-nutrition can have effects throughout the life cycle. Physical stunting (defined by the WHO as low height-for-age) can affect cognitive development, increase susceptibility to infection, and impair school attainment and future productivity of survivors as well as of later generations. Deficiencies in iron, iodine, zinc, and vitamins can cause problems ranging from brain damage to blindness, anaemia, and stunted growth. Being underweight makes it harder to fight off infection and recover from illness, and harder to study and work.Inadequate food intake in the early years of life is particularly damaging. In a cohort survey of children at Nouna HDSS in Burkina Faso, the authors found a reduction in underweight prevalence from 40% in June 1999 to 35% in June 2009 and from 43% in December 1999 to 34% in December 2009. The prevalence for wasting and severe wasting prevalence remained high in under-five children . In a 20Being undernourished poses great risk for infants. A cohort study by researchers at the Nouna HDSS in Burkina Faso found that children aged between 6 and 30 months who were malnourished were more than twice as likely to die during the seven-month research period than other children .Adult under-nutrition receives less attention than under-nutrition affecting children, but a population-based study at the Purworejo HDSS in Java, Indonesia, found that 15% of adult women were classified as suffering from chronic energy deficiency resulting from insufficient food intake . A laterA study of 457 people aged 60 years and above in rural Bangladesh found that 50% of older adults had chronic energy deficiency, and 62% were at risk of malnutrition . The autUnder-nutrition is not the only form of malnutrition. Overweight and obesity, caused by an over-consumption of calories relative to energy expended, has long been considered a problem only in high-income countries, but in recent years it has begun to emerge as a threat in poorer countries.As countries grow wealthier, the intake of refined and fatty foods and foods of animal origin increases. In 2002, the WHO ranked being overweight as the fifth most serious risk factor underlying the disease burden in low-mortality developing countries. INDEPTH member centres have begun to track the rise of obesity in developing countries over the past decade and a half. In the study of adult women by the Purworejo HDSS in Indonesia, researchers found an obesity rate in 1997 of 14% and showed that the rate had increased by almost three percentage points over the previous 12 months .A 2005 study of 3-year-old children in the Limpopo province of South Africa found that 22% were overweight and 24% were obese. Nineteen percent of children were found to have both stunted growth and obesity  investigLike under-nutrition, over-nutrition can also have harmful impacts on health. A cohort study of 1,888 rural women in Bangladesh found that those with the highest body mass index (BMI) had a higher mortality risk than those with intermediate BMI . Table 1Under-nutrition does not only come about because of lack of food. Exposure to disease can increase the risks posed to health by under-nutrition.In a study at the Agincourt HDSS in South Africa, Kimani-Murage et al.  found thNyakeriga et al.  found a INDEPTH member centres have extensively investigated the social factors that increase the risk of malnutrition in LMICs. Three major contributors have been identified.The first is wealth. Families themselves recognise this as important. Focus group discussions among mothers in Gambia revealed that poverty is one of the key constraints preventing mothers from putting into practise their knowledge of child health and nutrition . In simiEducation is a second key factor. Children born to Nairobi mothers who had been educated to primary level had a 94% lower chance of stunting than those born to mothers with no education . In one Linked to both wealth and education is the associated process of urbanisation. Five of the nutrition studies carried out by INDEPTH member centres between 1998 and 2013 demonstrate a link between urban residence and reduced malnutrition. In a study in FilaBavi, Vietnam, Nguyen et al.  found anOne additional, yet less extensively studied social factor, which also appears to have an impact on nutrition, is paternal involvement in caring for children. Children in a study in South Africa whose fathers did not provide financial support were found to be at higher risk of malnutrition , while iObesity is a relatively new threat in LMICs and is, as yet, not generally widespread in these countries. Therefore in researching the effects of malnutrition, HDSS centres have largely focused their attentions on the problem of under-nutrition.A study by the Kilifi HDSS in Kenya found that among children admitted to a rural district hospital, under-nutrition was a factor in half the in-hospital deaths and half the morbidity from severe diseases such as malaria, gastroenteritis, lower respiratory tract infection, HIV, and invasive bacterial disease . At WestAs well as increasing mortality, under-nutrition also impairs the development of those who survive it. In a study in Bangladesh, stunting in early childhood, which is in part the result of a combination of disease and under-nutrition, was found to be a significant predictor of stunting in adolescence . A four-The effect of under-nutrition on malaria outcomes is disputed in the literature. In a Kilifi HDSS study, Berkley et al.  found thNutrition in infancy, as we have seen, is important to an individual's prospects of a good life. Breastfeeding has therefore been the subject of much analysis by nutrition researchers, who have assessed its benefits and analysed breastfeeding practices in LMICs.Working at the Kintampo HDSS in Ghana, Edmond et al.  demonstrThe positive effects of breastfeeding have also been demonstrated in older children. Vohr et al.  found thHowever, breastfeeding is not universally practised. Researchers at Nanoro HDSS in Burkina Faso who conducted a multi-centre study of women infected with HIV, highlighted the size of the task facing those engaged in breastfeeding promotion efforts. In sub-Saharan Africa, fluids other than maternal milk are often introduced within the first six months of life, notwithstanding WHO guidelines that recommend exclusive breastfeeding for the first six months (including where the mother is HIV-positive). Although 53% of women in the Nanoro study saw exclusive breastfeeding as the preferred feeding method, only 11% reported exclusively breastfeeding after previous pregnancies . ConversA number of interventions to prevent or cure malnutrition have been tested by HDSS sites. The vast majority of the trials have focused on infants, children and women of childbearing age.Efforts to tackle malnutrition in infants and children have met with mixed success. Studies by the Bandim HDSS in Guinea-Bissau of malnutrition campaigns during that country's 1998 civil war found that vitamin A supplementation for children  and a suIn a randomised controlled trial in Vietnam, fortification with multiple micronutrients of biscuits provided in schools was found to reduce the risk of anaemia and of iron and zinc deficiencies by 40% . At NounThe effectiveness of vitamin A supplementation has also been questioned. Although it appeared to be beneficial in the above-mentioned trial in Guinea-Bissau, researchers at Kintampo HDSS in Ghana found no positive effect of vitamin A supplements in combination with vaccines during the first few months of life . This fiOnly two studies investigated methods to treat children suffering from severe malnutrition. Current guidelines for treating children who develop shock as a result of severe malnutrition recommend using low-dose hypotonic fluid resuscitation. Working at the Kilifi HDSS in Kenya, Akech et al.  tested tStudies of malnutrition prevention campaigns for women of childbearing age also had mixed results. In Ghana, vitamin A supplementation was found to increase liver reserves of mothers during the postpartum period, with the effects persisting for at least five months . A studyTwo studies conducted by INDEPTH members in South Africa and Bangladesh addressed the problem of implementing nutrition programmes. In the first, at Dikgale HDSS, the majority of people with type 2 diabetes had poor glycaemic control and were obese or had high blood pressure. Quantitative and qualitative research showed that these patients were often given incorrect and inappropriate dietary advice by health educators . In the Over the past 15 years, INDEPTH member centres have expanded the global knowledge base on nutrition. They have shown how under-nutrition continues to plague children and adults of all ages in LMICs and they have highlighted the emergence of obesity as a growing threat. In some areas, combined under-nutrition early in life with overweight and obesity in adolescence and adulthood, warns of rapidly escalating risk for cardiometabolic disease. The HDSS centres have demonstrated how malnutrition early in life continues to have effects on physical and mental development throughout the life-cycle. They have examined links between disease and malnutrition, and shown how wealth, education, and urbanisation all reduce the risks of under-nutrition but at the same time can increase the risks of obesity. The double burden of malnutrition in LMICs is of major concern to the World Bank, the WHO, and other international bodies.In terms of tackling malnutrition, INDEPTH members have demonstrated the importance of breastfeeding for infant nutrition and health, and for the health of the infants as they grow older, and they have assessed the reasons why some women choose not to breastfeed or to wean infants too early or too late. Interventions such as micronutrient supplementation for children and their mothers can have beneficial impacts on child health and survival, with some studies suggesting that multiple micronutrient supplementation may be more effective than supplementation with single micronutrients .Nutrition is something of an under-researched field; however, over the period 1999–2013, INDEPTH member centres produced almost four times as many published papers on HIV/AIDS as they did on nutrition. Many issues remain unresolved – for example, the impact of malaria on malnutrition and of malnutrition on susceptibility to malaria. There was little attention paid to nutrient supplements or to education and information campaigns to help families improve their diet, while activism campaigns to encourage companies to label foods accurately or to reduce sugar or fat content received no attention from HDSS centres. Likewise, the economic benefits of nutrition interventions also received little attention from HDSSs. One study by the Africa Centre calculated the costs of adding nutritional supplementation to the management of HIV-infected children , but stuIn this review, we noted the importance of adopting a multi-pronged approach to tackling malnutrition. Countries including Vietnam and South Africa have had some success in reducing malnutrition in recent years. Researchers at Kaya HDSS in Burkina Faso carried out a nine-site study to assess the impact of United Nations Millennium Project guidelines to reduce child stunting. This holistic approach incorporated nutrition-specific, health-based interventions with food system and livelihood-based approaches, and its adoption reduced stunting in children by up to 43% over 3 years . ProgramAlthough a small number of studies have examined the success of efforts to implement nutrition programmes, there is a need for further investigation in this area. How to effectively change dietary habits, how to educate individuals in LMICs about the availability of healthy natural foods, how to improve compliance with food supplementation programmes, and how to train health workers to provide useful nutrition advice and effective treatment for nutrition problems, are just a few of the many implementation challenges that remain.The INDEPTH HDSSs have unearthed important findings over the past decade and a half – for example, the vital role of breastfeeding in promoting infant and child health, the benefits of multiple micronutrient supplementation, the under-appreciated prevalence of malnutrition in adults and the elderly, and the rise of obesity in lower-income settings. Although much knowledge generation has already been achieved, there is broad scope for future research to inform policy-makers and researchers on ways to tackle the double burden of malnutrition in order to have a major impact on policy and on the lives of people living in LMICs.


Differential impacts of drinking location profiles were observed on severe negative alcohol-related consequences (SAC). Relative to those classified as low or intermediate in both dimensions, no significant difference experiencing SAC was found among those who were classified as high in the non-party-dimension only. However, those who were classified as high in the party-dimension alone or in both dimensions were more likely to experience SAC. These differential effects remained after adjusting for alcohol consumption (volume and risky single-occasion drinking), personality traits, and peer-influence , indicating independent effects of drinking location on SAC. The inclusion of sociodemographic factors did not alter this association. The fact that this cluster of party-dimension locations seems to predispose young men to experiencing SAC has important implications for alcohol control policies.In adolescents and young adults, acute consequences like injuries account for a substantial proportion of alcohol-related harm, especially in risky single-occasion (RSO) drinkers. The primary aim of the study was to characterize different drinking profiles in RSO drinkers according to drinking locations and their relationship to negative, alcohol-related consequences. The sample consisted of 2746 young men from the Cohort Study on Substance Use Risk Factors who had reported drinking six or more drinks on a single-occasion at least monthly over the preceding 12 months. Principal component analysis on the frequency and amount of drinking at 11 different locations was conducted, and 2 distinguishable components emerged: a  From the public health perspective, risky single-occasion drinking (RSOD) is considered one of the major problems stemming from alcohol consumption among adolescents and young adults. RSOD has been consistently identified as a stronger predictor of negative alcohol-related consequences among young adults than total drinking volume –4. AccorTo investigate the relationship between drinking and alcohol-related consequences, not only drinking pattern – including the frequency and volume of drinking over a given time period – but also the demographics , psychological state , and social context  of drinkers must be considered , 12. A mThe primary aim of the present study was to characterize drinking profiles according to drinking location and their differential impact on negative alcohol-related consequences in a population-based Swiss sample. It can be assumed that specific drinking locations and occasions are associated with a lack of supervision and social control, thereby raising the likelihood of negative consequences. Findings should have further implications for public health interventions aimed at lowering problematic alcohol consumption in young people, which is one of the main strategic goals of the National Alcohol Program 2013–2016 of the Swiss Federal Office of Public Health .All analyses conducted for this study were based on data collected for the Cohort Study on Substance Use Risk Factors (C-SURF). The study design and study sample for C-SURF have been detailed elsewhere . The stuOut of the 15,074 young men who showed up at the recruitment centers, 1829 (12.1%) were not seen by the research staff. Among the 13,245 conscripts who were informed about the study, 7563 (57.1%) gave written informed consent to participate, among whom 5990 (79.2%) subsequently filled out the baseline questionnaire. For the purposes of this study, only those men who reported having consumed six or more standard drinks on a single-occasion at least monthly over the preceding 12 months were included in analysis [2746 (45.8%) of the 5990 C-SURF participants], as risky single-occasion (RSO) drinking contributes substantially to the risk of alcohol-related harm in young men. Fifty participants had to be excluded due to missing data on drinking locations. Hence, ultimately, the sample consisted of 2696 subjects.Drinking volume (the average number of drinks per week) was calculated by multiplying the usual frequency  and the usual quantity (number of standard drinks per occasion) of the past 12 months. RSOD was defined in accordance with Murgraff et al. , as consDrinking locations were categorized according to the 2000 New Zealand National Alcohol Tracking Survey ; type of residence, defined as “rural”  or “urban” ; and linguistic region, defined as “German” or “French.” Furthermore, data concerning family affluence , the highest achieved education of the study subject , and the highest achieved education of the father  were included in analysis.The following sociodemographic factors were assessed by means of self-report: This personality trait was measured using the Brief Sensation Seeking Scale (BSSS) , a scaleThree different personality traits were measured, in accordance with the Zuckerman–Kuhlmann Personality scale (ZKPQ-50-cc) . Each scFinally, subjects were asked whether any of their closest friends had what they would call a “significant drinking problem” – meaning one that did or should have led to treatment. Answer categories were as follows: “no one,” “one or two,” “some of them,” and “most of them.”Continuous variable data are presented as medians and inter-quartile ranges (IQR), and categorical variable data as percentages. Principle component analysis (PCA) of drinking location was conducted to identify variable combinations. Each of the resulting components was then classified into three categories, according to their factor scores. For this purpose, two cut-off values at the 33.3 and the 66.6 percentiles were applied, and the components divided into low (≤33.3 percentile), intermediate (>33.3 and ≤66.6 percentile), and high (>66.6 percentile), as per their factor scores. Logistic regression models were used to evaluate the associations between SAC and the drinking profiles identified by PCA. SAC served as the dependent variable, and the drinking profiles as independent. Adjustments were made for sociodemographic variables , personality factors , and peer-influence in logistic regression models. Classification of cases served to evaluate model adequacy. Statistical analyses were performed using SPSS version 21.0.non-party-dimension and included a total of five drinking location items with loadings between 0.65 and 0.86. The second component was termed a party-dimension, incorporating six locations with loadings between 0.51 and 0.74 , other clubs/societies , restaurants, and sports events. In contrast, the party-dimension loaded highly for someone else’s home, pubs/bars, discos/nightclubs, outdoor public places , special events , and at home. Drinking at home was the drinking location with the smallest difference in loading between the two dimensions, meaning that this location contributed the least to any distinction between them.To investigate whether drinking locations might cluster in a way as to identify different dimensions of drinking profiles, PCA with varimax rotation was conducted on the frequency and amount of drinking at the 11 different types of location. The factor analysis was exploratory, and two distinguishable components emerged. The two resulting components explained 56.1% of the total variance in the grouping items. The first component was termed as a non-party-dimension and party-dimension ; (2) those who only had high scores for the non-party-dimension ; (3) those who only had high scores for the party-dimension ; and (4) those who had high scores for both dimensions . The mean ages for the four profiles were 19.83 (SD = 1.10), 19.91 (SD = 1.26), 19.98 (SD = 1.10), and 19.88 (SD = 1.09), respectively. Baseline characteristics for these four profiles are shown in Tables The factor scores from the two resulting PCA components were each divided into three categories . Consequently, subjects were allocated to one of four profile categories: (1) subjects who had low to intermediate factor scores for both the = 1115);  those whAlmost half (48.9%) of our subjects reported having experienced SAC within the previous 12 months . The most frequently mentioned consequences within the LL profile group were accident or injury (16.8%), unintended sexual intercourse (15.5%), and arguments or fights (14.6%). Corresponding figures were 14.0, 17.8, and 16.3% within the NH profile group, 28.9, 27.5, and 28.2% within the PH profile group, and 31.5, 33.3, and 32.4% within the HH profile group.non-party-dimension alone [crude OR (95% CI) = 0.87 (0.72–1.06)]. However, those classified as high for the party-dimension alone or for both dimensions were more likely to report having experienced SAC: crude OR = 2.30 (1.89–2.79) in the PH profile group and 2.63 (1.94–3.57) in the HH profile group.Analysis revealed differential impacts of drinking location profiles on SAC among young adults who engaged in RSO within the preceding 12 months. Relative to those classified as low or intermediate for both dimensions, no significant difference in SAC was detected among those classified as high for the p = 0.055]. In the PH profile group, the adjusted OR fell to 1.79 , while the OR in the HH profile group was now 1.88 . These results indicate that the effect of drinking location on SAC was only partially mediated through alcohol consumption.In order to rule out the possibility that the higher odds of experiencing SAC was solely explained by more drinks being consumed at specific locations, we further adjusted for drinking volume in a regression model. The median (IQR) drinking volumes for the LL, NH, PH, and HH profile groups were 8 –12, 8 55–12, 14 p = 0.062) within the NH profile group relative to LL; OR = 1.79  within the PH profile group; and OR = 1.94  within the HH profile group.In a second model, the association between the drinking location profiles and SAC was further adjusted for the sociodemographic factors – age, linguistic region, residence, highest achieved education of the participant, family affluence, and highest achieved education of the father Table . Howeverp < 0.001, and OR = 1.76 (1.26–2.46), p = 0.001, respectively], and remained unchanged within the NH profile group . All the above personality traits – except for sociability – were significantly associated with an increased likelihood of SAC. However, personality traits failed to fully explain differences in the association between drinking profiles and acute negative alcohol-related consequences.In contrast, when personality factors  were included in regression analysis, the odds of SAC declined among those within the PH or HH profile group , whereas the OR of SAC slightly decreased in the PH and HH profile groups  , non-party-dimension that loaded highly for theater/cinema, sport clubs, other clubs/societies, restaurants, and sport events; and a party-dimension that loaded highly for drinking at someone else’s home, pubs/bars, discos/nightclubs, outdoor public places, special events, and drinking at home.Principle component analysis on the frequency and amount of drinking at 11 different types of drinking location revealed two dimensions: a non-party-dimension only. However, those who were classified as high for the party-dimension alone or for both dimensions were more likely to experience SAC. These effects persisted after adjusting for a variety of variables, including the degree of alcohol consumption, indicating that drinking location has independent effects on drinking consequences.Subsequent regression analysis revealed differential impacts of drinking location profiles on SAC among adolescents and young adults who had engaged in RSO drinking over the previous 12 months. Relative to those classified as low or intermediate for both dimensions, no significant difference in reported SAC was found among those classified as high for the party-dimension seemed to predispose young men to experiencing SAC.Differences in the associations between the drinking profiles and alcohol-related problems were attenuated, but persisted after controlling for alcohol consumption (volume and RSOD), personality traits, and peer-influence, indicating independent effects of these variables on SAC. In contrast, including sociodemographic factors did not alter the associations. The self-selection hypothesis of choosing drinking locations based on personality traits  only expLocation-specific differences related to RSOD and drinking problems have been examined in several previously published studies. In a study by Single and Wortley , drinkinOur results are also partly consistent with those of Stockwell et al. , who demSociodemographic variables could not explain the difference in the association between drinking profile by drinking location and SAC. One reason could be that only young males were included in our study. Furthermore, our results are consistent with previous studies that failed to identify socio-economic status or age as independent predictors of alcohol-related consequences once drinking patterns were controlled for , 28. In Our study has several potential limitations. First, all data were self-reported. Results may therefore be distorted because of assessment bias, recall bias, or social desirability. For example, students willing to experience consequences might have been more likely to report such consequences . Moreoveper se. We discovered a cluster of drinking locations that are not bound to a specific type of drinker, like sensation seekers, indicating independent effects of drinking location on SAC. This, in turn, has important implications for alcohol control policies. It supports the need for structured measures like policies, regulations, and compliance checks tailoring this cluster of drinking locations to substantially reduce alcohol-related harm.Numerous studies have demonstrated that problematic alcohol consumption, like RSO drinking, is widespread in young people , 33; andOn one hand, compliance with alcohol policies and existing legislation at sensible locations with on-premise alcohol purchases – like pubs/bars, discos/nightclubs, and special events – should be monitored more closely. For instance, continuing to serve obviously intoxicated customers has been shown to be the best predictor of negative alcohol-related consequences . HoweverThe fact that negative alcohol-related consequences from RSOD may yet appear in the early adulthood emphasizes the need for timely preventive measures. Successful interventions in early life may not only reduce negative alcohol-related consequences during adolescence, but also prevent adult drinking problems .In summary, it can be stated that a structure of timely preventive measures is needed to reduce alcohol-related harm. However, as the availability of alcoholic beverages is high and there is a long tradition of including alcohol consumption in daily life in Switzerland, the implementation of structural changes poses several challenges , somethiThe present findings suggest that problematic alcohol consumption and negative alcohol-related consequences are strongly associated with a cluster of specific drinking locations. This may, together with further, recently collected data, serve as a basis for specific targeting of public health interventions that aim to lower risky drinking patterns and their negative consequences.Since RSO drinkers with different cultural backgrounds or different demographics, like higher age or female gender, may select different drinking locations, research also is needed to positively influence regulations drafted by policy makers , 40, 41.Gerhard Gmel and Meichun Mohler-Kuo are the study’s main investigators. Caroline Bähler and Meichun Mohler-Kuo conceptualized the manuscript. Caroline Bähler analyzed the data and wrote the first draft of this manuscript. Michelle Dey and Simon Foster assisted in data analyses. Gerhard Gmel made major contributions to the content of the manuscript. Petra Dermota was involved in data collection and questionnaire development. All authors contributed to manuscript writing and helped to improve it.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The present study investigated what impact the presentation style of a classroom lecture has on memory, mind wandering, and the subjective factors of interest and motivation. We examined if having a professor lecturing live versus on video alters the learning experience of the students in the classroom. During the lectures, students were asked to report mind wandering and later complete a memory test. The lecture format was manipulated such that all the students received two lectures, one live and one a pre-recorded video. Results indicate that lecture format affected memory performance but not mind wandering, with enhanced memory in the live lectures. Additionally, students reported greater interest and motivation in the live lectures. Given that a single change to the classroom environment, professor presence, impacted memory performance, as well as motivation and interest, the present results have several key implications for technology-based integrations into higher education classrooms. The way that educational information is conveyed has changed greatly in recent decades. One major change has been in the increase in courses offered online or through distance education. For example, Allen and Seaman  report tThe present study investigated whether memory and mind wandering differ between a traditional classroom and a classroom where the lecture is presented via pre-recorded video. By manipulating only the "live" quality of the professor and maintaining all other aspects of the classroom setting  we can begin to isolate what aspects of the lecture, live versus video format, impact the learning experience. In the following pages we highlight the technological shifts in educational settings that have recently taken place, and review how these relate to past investigations of memory and mind wandering (as a measure of inattention) in classroom settings.Advances in technology have allowed for learning in various locations and modalities . The growth of non-traditional classroom-based learning is demonstrated by the breadth of the courses and programs offered online. At Canadian universities up to 20% of all students enroll in online courses . And preAs hundreds of thousands of students from around the world sign up for online courses there has arisen the opportunity for large quantities of data to be collected—these data have focused on lecture length, drop-out rates, accessibility, participation, overall sense of satisfaction and interest –10. But To gain an understanding of how different learning environments impact the learning experience, and whether there are cognitive costs or benefits when the classroom setting is changed, we must first consider which cognitive factors are likely to be impacted. To date, researchers have focused largely on memory performance when comparing classroom environments. However, studies have yielded mixed outcomes ranging from: equivalent performance in technology-based learning and live classrooms –4, to beAnother factor that may be impacted by changes to the classroom environment is attention, a cognitive process that is often measured with regard to mind wandering reports. Indeed, a daily diary study found educational settings to be the most common location for mind wandering to occur , which iTo date, fundamental methodological differences between learning environments prevent a straightforward comparison between the performance effects of live and online situations. For instance, students in e-lecture environments can re-watch material and are often encouraged to do so ,11. AddiWe believe that investigating the cognitive impact of live professor presence is a unique and critical first manipulation to the classroom setting. Studies on the impact of social presence have indicated a cognitive and behavioural impact of feeling as though one is being watched –23 and tBy manipulating only live professor presence we maintain all other factors that might vary between a live and online setting: the social presence of peers, consistent pacing , physical environment  and any other factors that might differ between settings. This means that any effects found can be attributed to the single manipulation: live professor presence. One additional benefit of the present study’s design is that it is more ecologically valid than traditional lab-based studies . That isEthics approval for this study was obtained from the University of British Columbia Behavioural Research Ethics Board. Written, informed consent was obtained from participants.Mage = 19.84 years, SD = 3.41) participated in both sessions of the study in return for course credit. An additional 82 participants  did not complete both sessions of the experiment and so were excluded from analyses (with one notable exception which we flag for attention in the Results section).An invitation to participate in the study was extended to students registered in two sections of Psychology 102: Introduction to Developmental, Social, Personality, and Clinical Psychology at the University of British Columbia. A total of 276 students  differed for each class section, such that one class was presented material on Psychotherapy and another received material on Drug Treatment. These lectures were video-recorded by a researcher and then presented for the second session of the experiment (Video version). This allowed us to change the topic for Session 2 (Video) so that students did not see a repeat of the same topic. Each lecture was approximately 60 minutes in length. Lecture material was supplemented with PowerPoint slides.against our finding an advantage for the Live lecture relative to the Video lecture, i.e., it represented a conservative test of the working hypothesis that Live lectures enhance student performance. In other words, student performance in the Live lecture would suffer any cost of being first, and the Video lecture any benefit of being second . As we report in the results, our intuitions were validated and our discovery of a Live lecture advantage may be a conservative estimate of the actual difference between Live and Video lectures.The order of conditions led to an unbalanced design however there are practical, conceptual, and statistical reasons for. First, a practical consideration: the professor needed to present the material so that we could record it and we did not want to tamper with her presentation style in any way that could negatively impact the ecological validity of the study or quality of the Live versus Video comparison . Therefore, we recorded the Live lectures that came immediately before the Video lecture presentations, thereby minimizing any other differences between conditions, while counterbalancing the lecture topic. A conceptual consideration is that, in actuality, the live lecture condition is just one of many live lecture experiences that the students have had, and will continue to receive, in their educational experiences, and thus its occurrence is not uniquely defined with regard to the Video condition, i.e., as coming before or after the video condition. Finally, we reasoned that if there was any effect of order, placing the Video lecture second would, if anything, operate Over the course of each lecture 6 mind wandering probes were displayed on lecture slides. The timing of these slides was predetermined, such that probes occurred just after the presentation of lecture material that would later be part of the memory test. The slide presented the question “In the moment prior to this slide, were you mind wandering?” To identify differences in retention between Live and Video lecture settings a 6 item True-False memory test was given at the end of each lecture .To investigate whether motivation to remain attentive differed between the two lecture settings a 5 point scale was created and included on the participant response sheet (where 1 = very unmotivated and 5 = very motivated). To further compare motivation across the lectures, at the second session (Video lecture) students were also asked to rate which version they were most motivated to attend to: Live, Video or Equally Motivated.Participants completed the experiment during their regularly scheduled class, across two class sessions. Prior to the study date a researcher attended the class and explained the broad nature of the study to the students and, critically, that they were under no obligation to participate in the study, nor would the decision to not participate have any impact on their course grade. The day of each lecture, students were provided separate informed consent and response sheets and given instructions for the experiment by the researcher. The instructor did not provide any information about the experiment to the students. Students were asked to provide basic demographic information on the participant response sheet. Students were provided a definition of mind wandering: “Any thoughts that are experienced that are not related to the material being presented” and examples were provided . There were no differences in instruction provided to the two sessions. Upon completion of the class participants turned in the consent form and response sheet to the researcher.We counterbalanced across lecture topic as it was not a variable of interest in our study. Nevertheless, we conducted a mixed effect model analysis with topic as a factor to examine if it might have a differential impact on our data. This analysis revealed that topic was a significant factor for mind wandering reports, but not for any other variable. There were no meaningful interactions in the data. This analysis allowed us to be confident that collapsing across the two counterbalanced lecture topics to increase our statistical power would not compromise the results and interpretations of the data.Memory test performance, Mind wandering reports, Interest and Motivation Ratings were all assessed using paired samples tests, with Lecture Style as the Independent variable. We used an alpha level of .05 for all statistical tests. SD = 20%) and 70% (SD = 21%) during the Video lecture. A paired-samples t-test indicated that participants performed significantly better on the Live lecture memory test compared to the Video lecture memory test, t(275) = 2.83, p = .005, Cohen's d = .17.The average Memory accuracy from the Live lecture was 74%  against a randomly selected subset of Video condition participants (n = 45) who attended both the Live and Video sessions . This analysis revealed that those who received the Video condition second performed significantly better (M = .71) on the memory test compared to those who received the Video condition “first” (M = .61), t(88) = 2.2, p = .03, 95% CI . This confirmed our hypothesis, that the enhanced memory performance of those in the Live condition, who received the test material first, relative to the memory performance of those participants who received the Video condition second, is a conservative estimate of the benefit of receiving a Live lecture.Note that in the Methods section it was proposed that our unbalanced design, with Live preceding Video sessions, may actually yield a conservative estimate of the actual difference between Live and Video memory performance. This is because participants in the Video session could use their previous experience in the Live session to correctly anticipate that they would be tested on lecture material that co-occurred with the mind wandering probes. To test this we compared Memory accuracy for the participants who only completed the Video session (SD = 23%) during the Live lectures and 49% (SD = 27%) during the Video lectures. A paired-samples t-test revealed no significant effect of Lecture Style, t(275) = -.81, p = .42.Average Mind wandering reports was 48% (N = 255). Average Interest rating was 3.08 (SD = .82) for the Live lecture and 2.84 (SD = .87) for the Video lecture. As Interest rating was reported using an ordinal scale, a non-parametric, Wilcoxon Signed Rank test was completed. This test revealed that Interest Ratings were significantly higher (indicating greater interest) in the Live lecture compared to the Video lecture, Z = -4.26, p < .001.Twenty-one students did not complete this section of the response sheet for one or both of the sessions, meaning that their data could not be included for this analysis (N = 255). As per Interest ratings, an ordinal scale was used to measure Motivation rating and so a Wilcoxon signed rank tests was completed. This test revealed that Motivation Ratings were significantly higher (indicating greater motivation) in the Live lecture  compared to the Video lecture , Z = -5.05, p < .001.Twenty-one students did not complete this section of the response sheet for one or both of the sessions, meaning that their data could not be included for this analysis (N = 265), 61% of individuals reported being more motivated to attend the Live lecture, 28% reported equal motivation and only 11% reported they were more motivated to attend to the Video lecture, a chi-squared one-variable test indicated that the ratings were significantly different, X2  = 101.65, p < .001. These results are consistent with the Motivation Rating reports made at the end of each session which revealed greater motivation to attend to the Live lecture over the Video lecture.The response sheet for the second session (Live condition) included a second motivation question: participants were asked to reflect on both sessions and select which lecture they had been most motivated to attend to. Of the participants who completed this section of the response sheet , we predicted a negative relationship between mind wandering and interest, where greater Interest ratings would be related to fewer mind wandering reports. Indeed, correlations were significant for both Live and Video sessions: r= -.27, p < .001, 95% CI  and r= -.32, p < .001, 95% CI , respectively. Finally, and as per research in non-classroom domains, there was a negative relationship between mind wandering and motivation. This result suggests that lower motivation ratings are associated with a higher number of mind wandering reports, for both Live and Video sessions: r= -.24, p < .001, 95% CI  and r= -.34, p < .001, 95% CI , respectively.The correlation between mind wandering and memory was found to be non-significant for the Live lecture, however was significant for the Video lecture, indicating that increased mind wandering reports were related to decreased memory test performance, The current study investigated how different learning environments (live in-class versus pre-recorded video) impact two aspects of the learning experience: memory performance and mind wandering. We also examined how subjective experiences, specifically interest and motivation, differ between these environments and what impact, if any, they have on memory and mind wandering.Our finding that memory performance was significantly higher in the Live session compared to the Video session suggests that the acquisition and retention of the lecture information benefitted from having the lecture delivered by a professor who was physically present in the classroom. Moreover, as noted previously, the design of the present study was such that this significant difference is, if anything, an underestimation of the actual magnitude of the Video lecture disadvantage. Perhaps the most obvious and important implication of this finding is that in real world settings, where lecture material is delivered in an online format over video , students taking such courses may retain much less lecture information than those who receive the material in a classroom with a professor.impact of mind wandering in the Live versus Video conditions does not appear to be equivalent. The correlation data reveal a negative relationship between mind wandering and memory in the Video condition, such that memory declined as mind wandering increased, but a similar relationship was not observed in the Live condition  it was a novel experience, (ii) the students received the video information in their usual classroom and normal lecture time, and (iii) students were surrounded by their peers, which offers a well-established social benefit –33. ThusInterestingly, several prestigious institutions such as Stanford University, Harvard University and the University of British Columbia have bridged the gap between a completely traditional class setting and online learning, via blended-learning designs. These settings employ course-credit classroom sessions where part of the learning takes place in a traditional classroom however much  of the learning takes place online, requiring students to watch lectures on their own time and participate in online tasks. This setting combines the "perks" of online learning  with the traditional learning environment. In light of the present study, one obvious next step would be to monitor students’ access of the online material and measure performance  and subjective experience for both environments. As the critical benefit of the present study was that it took place in a natural environment, a future more longitudinal investigation where lectures are systematically alternated between live and video presentation, as in blended-learning, would provide the opportunity to extend the present results and further determine the cumulative effects of professor presence  on student learning. Similarly, how these effects vary as a function of individual differences in aptitude and learning motivation styles, is also very much an open and interesting question ripe for future investigation.The present study spearheads a much needed initiative for careful examination of differences in cognitive impact and subjective experience between traditional classroom learning and online learning environments. We recognize that there may be benefits to online learning  or at least different ways that students can interact with materials compared to with a live lecture ,10,11. WS1 Appendix(DOCX)Click here for additional data file.S1 FigViolin plots indicate the density distribution each dependent variable. Light coloured plots represent performance in the Live condition and Dark coloured plots represent performance in the Video condition. The white dot represents the median and the black bar represents the interquartile range. (A) Memory performance percentage. (B) Percentage of mind wandering reports. (C) Interest Ratings, where 5 indicated high interest and 1 indicates low interest. (D) Motivation Ratings, where 5 indicated high motivation to attend and 1 indicates low motivation to attend.(PDF)Click here for additional data file.S2 FigJittering was used to distinctly display data points that would otherwise overlap  and provide a clear visualization of the data. (A) Displays correlations between the variables for the Live condition. (B) Displays correlations between the variables for the Video condition.(PDF)Click here for additional data file.


Recruitment in randomised controlled trials (RCT) has been the topic of research for many years. This study, nested within the NIHR Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial, looks into the main reasons for non-participation in a Trial investigating the quality of life and cost-effectiveness of two established glaucoma treatments, and whether the use of audiovisual material (video) improves recruitment rates.Prospective participants to the LiGHT Trial were approached by a member of the research team and were given an explanation of the Trial. Patients who refused to participate were asked to explain the reason for their refusal choosing from a pre-populated list of 12 items and were also given the option to add other reasons. Fifteen months into the Trial a video was also used to facilitate recruitment. The material of the video was the same as delivered by the recruiting team, but was delivered by the Principal Investigator (PI).Preliminary data indicate that the overall non-participation rate is 14.2%. The most common reasons for non-participation are treatment preconceptions (63.5%) and unwillingness to participate in research (25.4%). A minority of patients chose to have no treatment at all (6.3%). Incorporation of the video significantly reduced refusal rates from 21.1% to 8.5% (p<0.01).Treatment preconceptions are the predominant reason non-participation in a RCT. Incorporation of the video significantly reduced non-participation rates; it is possible that the involvement of the PI might have a positive effect on recruitment.


A binge drinking model with the impact of media in the scale-free network is proposed. The basic reproduction number  It is well known that excessive drinking is not only harm to personal health, but also induce serious consequences for the family and society. It harms the nervous system and the internal organs, furthermore, it causes cancer easily. According to the third national cancer survey in America, the consisting alcohol abuse is an important reason for the mouth, throat and esophagus cancer. The growing excessive drinking increases the risk of breast cancer by 13 % every year. In addition, there are data show that, on average, heavy drinkers die 10–20 years earlier than nondrinkers. 40 and 32 % of family divorce are caused by alcohol, in America and China, respectively Inoue . At the Heavy drinking has been treated as a chronic disease. More and more researchers study the harmfulness of binge drinking through establishing mathematical models to find some way to control the drinking behavior Mulone  and refeMedia, being the prime source of information, can not only influence the individuals’ behavior, but also affect the governments’ attitude. Generally, an effective method of reducing the spread of the disease is to make people understand the preventive measures as soon as possible. And media coverage has played a good role in controlling the infectious diseases. Many scholars introduced mathematical models with the impact of media to reduce the contact rate , which is defined as the probability that a vertex randomly chosen has k links  of those who are aware of risk and avoid contacting with the heavy drinkers.Motivated by the above, in this paper, we construct a binge drinking model with the influence of media coverage in the scale-free network, which ignores the recruitment and death. Due to the effect of media coverage, nondrinkers form a separate class The organization of this paper is as follows: In “N into n (n is the maximum degree) groups according to the degree of nodes, that is to say,k; k, who avoids contacting with binge drinkers; k; M(t) represents the cumulative density of awareness programs driven by media. d’Onofrio et al. (M(t) only summarizes information about the current state of the disease, i.e. M(t) only depends on current values of state variables, and (b) M(t) also summarizes information about past values of state variables. Motivated by Wang et al. (M(t) only depends on current values of state variables and is a linear function of the current prevalence of the binge drinkers. ThenTo account for the heterogeneity in the contacts amongst individuals, we divide the total population o et al.  considerg et al. , we assuk links, turning to The model’s structure is shown in Fig. mentclass2pt{minimAccording to the practical significance of system , if bingLetbe the solution of system  and summing over k, we obtain the resultLet right side of system  be equalThe permanence of system  is proveLetbe an irreducible matrix, iffor allthen there exists an eigenvectorzofAsuch thatand the corresponding eigenvalue iss(A).s(A) is defined by A, Re denotes the real part.The stability modulus Consider the systemwherePis anmatrix andN(y) is continuously differentiable in a regionAssumethe compact convex setis positively invariant with respect to system  eigenvectorzofsuch thatfor allfor allandis the largest positively invariant set for system . When Firstly, we investigate the time evolution for the total density of population entclass1pt{minimaf system  finally entclass1pt{minimak is, the greater density of binge drinkers is in that group, and the slower the phenomenon of binge drinking vanishes, when k. However, Secondly, we present the time evolution of the density of nondrinkers or moderate drinkers Thirdly, we study the influence of parameter ers Fig. . With \dIn this paper, we use mean-field theory to propose a binge drinking model with the impact of media in the scale-free network. The outcomes show that Comparing with the drinking model on homogeneous networks Huo and Wang . The bas