Team-based occupational stress reduction: a European overview from the perspective of the OSCAR Project

Work-related stress is a significant impediment to job satisfaction and healthy psycho-social functioning. It can alter the behaviour of the person involved and impair the quality of their life. In the European Union (EU), over the last decade, work-related stress has been consistently identified as one of the major workplace concerns--a challenge not only to the health of working people but also to the healthiness of their organizations. The study reported below attempted to address the issue of work-related stress through whole team training programmes, on a background of largely ineffective stress reduction training programmes offered to individuals within the workplace. This EU 'framework 5 Quality of Life' project focused instead on tackling the organizational level through training of mental health teams in five countries. The findings have significant implications to the conceptual, methodological and everyday organizational practice levels of tackling this central issue to the health of the workplace.

Analysis of normal and mutant iduronate-2-sulphatase conformation

Mammalian sulphatases (EC 3.1.6) are a family of enzymes that have a high degree of similarity in amino acid sequence, structure and catalytic mechanism. IDS (iduronate-2-sulphatase; EC 3.1.6.13) is a lysosomal exo-sulphatase that belongs to this protein family and is involved in the degradation of the glycosaminoglycans heparan sulphate and dermatan sulphate. An IDS deficiency causes the lysosomal storage disorder MPS II (mucopolysaccharidosis type II). To examine the structural alterations in heat-denatured and mutant IDS, a panel of four monoclonal antibodies was raised to the denatured protein and used as probes of protein conformation. The linear sequence epitope reactivity of a polyclonal antibody raised against the native protein and the monoclonal antibodies were defined and mapped to distinct regions on the IDS protein. The antigenicity of native IDS was higher in regions without glycosylation, but reactivity was not restricted to protein surface epitopes. One monoclonal epitope was relatively surface accessible and in close proximity to an N-linked glycosylation site, while three others required additional thermal energy to expose the epitopes. The monoclonal antibodies demonstrated the capacity to differentiate progressive structural changes in IDS and could be used to characterize the severity of MPS type II in patients based on variable denatured microstates.

Gene expression in Huntington's disease skeletal muscle: a potential biomarker

Huntington's disease (HD) is an incurable and fatal neurodegenerative disorder. Improvements in the objective measurement of HD will lead to more efficient clinical trials and earlier therapeutic intervention. We hypothesized that abnormalities seen in the R6/2 mouse, a greatly accelerated HD model, might highlight subtle phenotypes in other mouse models and human HD. In this paper, we identify common gene expression changes in skeletal muscle from R6/2 mice, Hdh(CAG(150)) homozygous knock-in mice and HD patients. This HD-triggered gene expression phenotype is consistent with the beginnings of a transition from fast-twitch to slow-twitch muscle fiber types. Metabolic adaptations similar to those induced by diabetes or fasting are also present but neither metabolic disorder can explain the full phenotype of HD muscle. The HD-induced gene expression changes reflect disease progression. This raises the possibility that muscle gene expression may be used as an objective biomarker to complement clinical HD-rating systems. Furthermore, an understanding of the molecular basis of muscle dysfunction in HD should provide insight into mechanisms involved in neuronal abnormalities and neurodegeneration.

Preservation of Hearing in Cochlear Implant Surgery: Advantages of Combined Electrical and Acoustical Speech Processing

OBJECTIVES/HYPOTHESIS

This study documents the importance of preserving residual low-frequency acoustic hearing as those with more residual hearing are selected for cochlear implantation. Surgical strategies used for hearing preservation with a short hybrid cochlear implant are outlined. The benefits of preserved residual low-frequency hearing, improved word understanding in noise, and music appreciation are described.

STUDY DESIGN

Multicenter, prospective, single-subject design.

METHODS

Records were reviewed of 21 individuals participating in an Food and Drug Administration (FDA) feasibility clinical trial who have received an Iowa/Nucleus 10 mm electrode. A second group of subjects receiving implants at the University of Iowa that have used the 10 mm device between 2 years and 6 months were also reviewed. Outcome measures included standardized tests of monosyllabic word understanding, spondees in noise, and common melody recognition.

RESULTS

Low-frequency hearing was maintained in all individuals immediately postoperative. One subject lost hearing at 2.5 months postoperative after a viral infection. The group has averaged a loss of -9 dB low-frequency acoustic hearing between 125 and 1,000 Hz. Monosyllabic word understanding scores at 6 months for a group being followed for an FDA clinical trial using the implant plus hearing aids was 69% correct. For the long-term group receiving implants at Iowa, monosyllabic word understanding in those who have used the device between 6 months and 2 years is 79%. Other important findings include improved recognition of speech in noise (9 dB improvement) as compared with standard cochlear implant recipients who were matched for speech recognition in quiet and near normal recognition of common melodies.

CONCLUSION

The surgical strategies outlined have been successful in preservation of low-frequency hearing in 96% of individuals. Combined electrical and acoustical speech processing has enabled this group of volunteers to gain improved word understanding as compared with their preoperative hearing with bilateral hearing aids and a group of individuals receiving a standard cochlear implant with similar experience with their device. The improvement of speech in noise and melody recognition is attributed to the ability to distinguish fine pitch differences as the result of preserved residual low-frequency acoustic hearing. Preservation of low-frequency acoustic hearing is important for improving speech in noise and music appreciation for the hearing impaired, both of which are important in real-life situations.

The 'WHO Safe Communities' model for the prevention of injury in whole populations

BACKGROUND

The safe communities approach has been embraced around the world as a model for coordinating community efforts to enhance safety and reduce injury. Over 80 communities throughout the world have been formally designated as 'Safe Communities' by the World Health Organization. It is of public health interest to determine to what degree the model is successful, and whether its application does indeed reduce injury rates in communities to which it is introduced.

OBJECTIVES

To determine the effectiveness of the Safe Communities model to prevent injury in whole populations, or targeted sub-groups of populations.

SEARCH STRATEGY

The search strategy was based on electronic searches, handsearches of selected journals, snowballing from reference lists of selected publications and contacting a key person from each WHO-designated Safe Community.

SELECTION CRITERIA

Studies were independently screened for inclusion by two reviewers. Included studies were those conducted within a WHO Safe Community that reported changes in population injury rates within the community compared to a control community.

DATA COLLECTION AND ANALYSIS

Data were independently extracted by two reviewers. Meta-analysis was not appropriate, due to the heterogeneity of the included studies.

MAIN RESULTS

Only seven WHO Safe Communities, of more than 80 worldwide, have undertaken controlled evaluations using objective sources of injury data. These communities represent only four countries from two geographical regions in the world: the Scandinavian countries of Sweden and Norway and the Pacific nations of Australia and New Zealand. Safe Communities in Sweden and Norway have resulted in significant reductions in injury rates. The Australian and New Zealand communities have been unable to replicate the same level of success.

AUTHORS' CONCLUSIONS

Evidence suggests the WHO Safe Communities model is effective in reducing injuries in whole populations. However, important methodological limitations exist in all studies from which evidence can be obtained. A lack of reported detail makes it unclear which factors facilitate or hinder a programme's success, and makes uncertain, whether the success of any particular application of the model is necessarily replicable in other communities. In evaluated programmes that did not report significant decreases in injury rates, this lack of information makes it difficult to distinguish between evidence of no effect of the model, or no evidence of effect. The four countries that have evaluated their Safe Communities with a sufficiently rigorous study design have higher economic wealth and health standards and lower injury rates than much of the world. No evaluations were available from other parts of the world, despite the designation of WHO Safe Communities in countries such as South Africa, Bangladesh, China, Vietnam, Canada, UK and USA. Generalisation of results of studies conducted in just four countries, to the international population needs to be done with caution. There is a need for more high-quality, methodologically strong evaluations of the model in a range of diverse communities and detailed reporting of implementation processes.

Antioxidant treatment of patients with Friedreich ataxia: four-year follow-up

BACKGROUND

Decreased mitochondrial respiratory chain function and increased oxidative stress have been implicated in the pathogenesis of Friedreich ataxia (FRDA), raising the possibility that energy enhancement and antioxidant therapies may be an effective treatment.

OBJECTIVE

To evaluate the long-term efficacy of a combined antioxidant and mitochondrial enhancement therapy on the bioenergetics and clinical course of FRDA.

DESIGN

Open-labeled pilot trial over 47 months.Patients Seventy-seven patients with clinical and genetically defined FRDA. Intervention A combined coenzyme Q(10) (400 mg/d) and vitamin E (2100 IU/d) therapy of 10 patients with FRDA over 47 months.

MAIN OUTCOME MEASURES

Clinical assessment using echocardiography and the International Cooperative Ataxia Rating Scale and cardiac and skeletal muscle bioenergetics as assessed using phosphorus P 31 magnetic resonance spectroscopy.

RESULTS

There was a significant improvement in cardiac and skeletal muscle bioenergetics that was maintained throughout the 47 months of therapy. Echocardiographic data revealed significantly increased fractional shortening at the 35- and 47-month time points. Comparison with cross-sectional data from 77 patients with FRDA indicated the changes in total International Cooperative Ataxia Rating Scale and kinetic scores over the trial period were better than predicted for 7 patients, but the posture and gait and hand dexterity scores progressed as predicted.

CONCLUSION

This therapy resulted in sustained improvement in mitochondrial energy synthesis that was associated with a slowing of the progression of certain clinical features and a significant improvement in cardiac function.

Cardiovascular risk in women with polycystic ovarian syndrome (PCOS)

AIMS

Studies have suggested that polycystic ovary syndrome (PCOS) is associated with increased cardiovascular risk. The aim of this study was to examine cardiovascular risk profiles in women with PCOS compared with healthy age and weight matched control subjects using novel biochemical and biophysical markers.

METHODS

After ethics committee approval, 11 women with PCOS and 12 controls were recruited (mean age, 32; SD, 6.5 years; mean body mass index (BMI), 33.1; SD, 5.9 kg/m2). Serum was analysed for lipid and lipoprotein profile (total and high density lipoprotein cholesterol, triglycerides, apolipoprotein B-100, apolipoprotein A1, lipoprotein (a)), and sialic acid, fibrinogen, homocysteine, and C reactive protein (CRP) concentrations. Endothelial function was also assessed by a standard venous occlusion plethysmography technique to measure reactive hyperaemic forearm blood flow (RH), and expressed as per cent increase from baseline.

RESULTS

There were no significant differences in glucose, lipid, or lipoprotein concentrations between the two groups. Furthermore, sialic acid (PCOS: mean, 70.5; SD, 149 mg/litre; controls: mean, 71.3; SD, 112 mg/litre), fibrinogen (PCOS: mean, 3.1; SD, 1.0 g/litre; controls: mean, 3.3; SD, 0.7 g/litre), CRP (PCOS: mean, 4.6; SD, 4.2 mg/litre; controls: mean, 5.41 SD, 5.5 mg/litre), and RH (PCOS: mean, 158.7; SD, 135.5%; controls: mean, 200.1; SD, 114.2%) were similar.

CONCLUSIONS

There were no differences in surrogate markers of the processes linked to enhanced cardiovascular risk between patients with PCOS and weight matched controls.

Population-based interventions for the prevention of fall-related injuries in older people

BACKGROUND

Fall-related injuries are a significant cause of morbidity and mortality in the older population. Summary information about counter-measures that successfully address the risk factors for fall-related injuries in research settings has been widely disseminated. However, less available is evidence-based information about successful roll-out of these counter-measures in public health programmes in the wider community. Population-based interventions in the form of multi-strategy, multi-focused programmes are hypothesised to result in a reduction in population-wide injury rates. This review tests this hypothesis with regards to fall-related injuries among older people.

OBJECTIVES

To assess the effectiveness of population-based interventions, defined as coordinated, community-wide, multi-strategy initiatives, for reducing fall-related injuries among older people.

SEARCH STRATEGY

The search strategy was based on electronic searches, handsearches of selected journals and snowballing from reference lists of selected publications.

SELECTION CRITERIA

Studies were independently screened for inclusion by two reviewers. Included studies were those that reported changes in medically treated fall-related injuries among older people following the implementation of a controlled population-based intervention.

DATA COLLECTION AND ANALYSIS

Data were independently extracted by two reviewers. Meta-analysis was not appropriate, due to the heterogeneity of the included studies.

MAIN RESULTS

Out of 23 identified studies, five met the criteria for inclusion. There were no randomised controlled trials. Significant decreases or downward trends in fall-related injuries were reported in all five of the included studies with the relative reduction in fall-related injuries ranging from 6 to 33%.

AUTHORS' CONCLUSIONS

Despite methodological limitations of the evaluation studies reviewed, the consistency of reported reductions in fall-related injuries across all programmes support the preliminary claim that the population-based approach to the prevention of fall-related injury is effective and can form the basis of public health practice. Randomised, multiple community trials of population-based interventions are indicated to increase the level of evidence in support of the population-based approach. Research is also required to elucidate the barriers and facilitators in population-based interventions that influence the extent to which population programmes are effective.

Community based prevention programs targeting all injuries for children

OBJECTIVE

Community based models for injury prevention have become an accepted part of the overall injury control strategy. This systematic review of the scientific literature examines the evidence for their effectiveness in reducing all-cause injury in children 0-14 years of age.

METHODS

A comprehensive search of the literature was performed using the following study selection criteria: community based intervention study; children under 14 years; outcome measure was injury rates; and either a community control or an historical control was used in the design. Quality assessment and data abstraction were guided by a standardized procedure and performed independently by two authors. Data synthesis was in tabular and text form with meta-analysis not being possible due to the discrepancy in methods and measures between the studies.

RESULTS

Thorough electronic and library search techniques yielded only nine formally evaluated community based all-cause child injury prevention programs that have reported actual injury outcomes. Of these nine studies, seven provided high level evidence where contemporary control communities were used for comparison; the remaining two used a pre and post-design or time trend analysis where historical data from the community were used as the comparison. Only three of the seven studies with contemporary control communities found significant effect of the intervention; the two studies without controls noted significant reductions in injury rates after the intervention period.

CONCLUSION

There is a paucity of research from which evidence regarding the effectiveness of community based childhood injury prevention programs can be obtained and hence a clear need to increase the effort on developing this evidence base.

Cardiomyocyte apoptosis triggered by RAFTK/pyk2 via Src kinase is antagonized by paxillin

Altered cellular adhesion and apoptotic signaling in cardiac remodeling requires coordinated regulation of multiple constituent proteins that comprise cytoskeletal focal adhesions. One such protein activated by cardiac remodeling is related adhesion focal tyrosine kinase (RAFTK, also known as pyk2). Adenoviral-mediated expression of RAFTK in neonatal rat cardiomyocytes involves concurrent increases in phosphorylation of Src, c-Jun N-terminal kinase, and p38 leading to characteristic apoptotic changes including cleavage of poly(ADP-ribose) polymerase, caspase-3 activation, and increased DNA laddering. DNA laddering was decreased by mutation of the Tyr(402) Src-binding site in RAFTK, suggesting a central role for Src activity in apoptotic cell death that was confirmed by adenoviral-mediated Src expression. Multiple apoptotic signaling cascades are recruited by RAFTK as demonstrated by prevention of apoptosis using caspase-3 inhibitor IV (caspase-3 specific inhibitor), PP2 (Src-specific kinase inhibitor), or Csk (cellular negative regulator for Src), as well as dominant negative constructs for p38beta or MKP-1. These RAFTK-mediated phenotypic characteristics are prevented by concurrent expression of wild-type or a phosphorylation-deficient paxillin mutated at Tyr(31) and Tyr(118). Wild-type or mutant paxillin protein accumulation in the cytoplasm has no overt effect upon cell structure, but paxillin accumulation prevents losses of myofibril organization as well as focal adhesion kinase, vinculin, and paxillin protein levels mediated by RAFTK. Apoptotic signaling cascade inhibition by paxillin indicates interruption of signaling proximal to but downstream of RAFTK activity. Chronic RAFTK activation in cardiac remodeling may represent a maladaptive reactive response that can be modulated by paxillin, opening up novel possibilities for inhibition of cardiomyocyte apoptosis and structural degeneration in heart failure.

Combining acoustic and electrical speech processing: Iowa/Nucleus hybrid implant

OBJECTIVES

In this paper we test the concept of combining electrical stimulation for high-frequency sound with acoustic hearing for low-frequency information in the same ear. In addition, we test whether residual hearing can be preserved when an electrode is placed up to 10 mm into the inner ear, and whether the site of electrical stimulation influences speech perception.

MATERIAL AND METHODS

Nine post-lingual adults with severe high-frequency hearing impairment were recruited to participate in the study. A single-subject clinical trial design was employed. A unique six-channel cochlear implant was designed for this clinical trial. The intracochlear electrodes were either 6 or 10 mm in length based on a Nucleus CI-24 multichannel implant. Monosyllabic word understanding and consonant identification in a recorded sound-only condition were used to assess changes in speech perception. Follow-up was > 12 months.

RESULTS

Acoustic hearing was preserved in all nine subjects. Preoperative monosyllabic word and sentence scores were unchanged in all subjects following implantation. A 30-40% improvement in consonant recognition occurred with the 10-mm electrode. The 10-mm electrode subjects were able to understand 83-90% of the monosyllabic words using the implant plus binaural hearing aids. Scores were more than doubled when compared to preoperative scores achieved with hearing aids only.

CONCLUSIONS

The human ear has the capability to integrate both acoustic and high-frequency electrically processed speech information. Placement of a short 10-mm electrode does not appear to damage residual low-frequency inner ear hair cell function, interfere with the micro-mechanics of normal cochlear vibration or decrease residual speech perception. The improvement in speech recognition was due primarily to the increased perception of higher-frequency consonantal speech cues. Such a device can provide a substantial benefit in terms of speech understanding to those with severe high-frequency hearing loss, while still maintaining the benefits of the residual lower-frequency acoustic hearing. The position of the electrode and the site of frequency information within the cochlea are shown to be important factors in the success of such a device.

Community based programs to prevent poisoning in children 0-15 years

OBJECTIVE

Community based models for injury prevention have become an accepted part of the overall injury control strategy. This systematic review of the scientific literature examines the evidence for their effectiveness in preventing poisoning in children 0-15 years of age.

METHODS

A comprehensive search of the literature was performed using the following study selection criteria: community based intervention study; target population was children under 15 years; outcome measure was poisoning rates; and either a community control or an historical control was used in the study design. Quality assessment and data abstraction were guided by a standardized procedure and performed independently by two authors. Data synthesis was in tabular and text form with meta-analysis not being possible due to the discrepancy in methods and measures between the studies.

RESULTS

The review found only four studies, which met all the inclusion criteria. Only two studies used a trial design with a contemporary control and only one study provided convincing evidence of an effective community program for reducing poisoning in children.

CONCLUSION

There is a paucity of research studies in the literature from which evidence regarding the effectiveness of community based childhood poisoning prevention programs can be obtained and hence a clear need to increase the effort on developing this evidence base.

A clinical, genetic and biochemical study of SPG7 mutations in hereditary spastic paraplegia

Mutations in the SPG7 gene, encoding the mitochondrial protein paraplegin, were the first to be identified in autosomal recessive hereditary spastic paraplegia (ARHSP). Four different SPG7 mutations have been described so far in association with both pure and complicated HSP phenotypes. Muscle biopsies from the most severely affected patients have shown histological evidence of an oxidative phosphorylation defect. We identified six ARHSP kindreds, in whom linkage to SPG7 could not be excluded, and 29 sporadic spastic paraplegia patients. The 17 exons and flanking regions of the SPG7 gene were screened for mutations using a combination of single-stranded conformation polymorphism (SSCP) analysis and sequencing. Three patients were found to carry compound heterozygous SPG7 mutations, comprising five novel and one previously described mutation. Muscle biopsies from two SPG7 mutation patients did not show any histological evidence of an oxidative phosphorylation defect. However, biochemical analysis revealed a reduction in citrate synthase-corrected complex I and complex II/III activities in muscle and complex I activity in mitochondrial-enriched fractions from cultured myoblasts, suggesting that either a primary or a secondary defect of respiratory chain function may play an important role in the pathogenesis of the disease.

Composting under controlled conditions

Three cylindrical reactors, each with a working capacity of approximately 200 litres, were used to investigate composting. The process was optimised and conditions were controlled so that composting on a laboratory-scale thermally resembled that occurring in the core of large open heaps. A baseline flow of humidified air aerated the reactors in five-minute bursts. The reactors operated as closed systems with facilities to analyse the composition of the off-gas for ammonia, oxygen and carbon dioxide. Temperature was used to monitor the progress of the process. Heat loss from the reactor surface was compensated for with an external heat source. A basic model of radial conductive heat losses showed that 53 watts per square-metre would be the maximum heat flux needed to keep the temperature difference across the reactor to within a degree when running at 60 degrees C. A heating cable was used, which could supply 150 watts per square-metre, and the radial temperature difference was reduced to within a degree in more than 60% of the recorded temperatures in the case studies presented. The temperature of the composting material was held at 60 degrees C using a high flow rate 'cooling' aeration with temperature feedback. This, however, led to a mean vertical temperature difference of at least 10 degrees C. The aeration strategy resulted in a well-aerated material, which favoured aerobic microbial activity and the temperature increased as a result of the internally generated heat associated with composting. Three-quarters of the ammonia was emitted in the first week.

A clinical and genetic study of SPG5A linked autosomal recessive hereditary spastic paraplegia

The authors performed a clinical and genetic study of a large consanguineous English family with uncomplicated autosomal recessive hereditary spastic paraplegia (ARHSP). Linkage to the previously described SPG5A locus was established with maximum multipoint lod score of 4.84. The locus was refined to a 23.6 cM interval between markers D8S1833 and D8S285. No evidence of oxidative phosphorylation defects was found in muscle biopsies from two affected individuals.

Injury related risk behavior--a study of Australian skydivers

Risk taking behaviour has been identified as an important host-related determinant of injury in young adults. The aim of this study is to clarify the relationship between the two key elements of risk taking behaviour--ie, risk assessment and risk acceptance--in participants of a high risk sporting activity. Skydivers registered with the Australian Parachute Federation were sampled at several jump meetings held at three 'drop-zones' in North Eastern Australia. A cross sectional survey of 215 skydivers ascertained each subject's risk assessment of each of nine hypothetical sky diving scenes and whether or not they would jump in the described conditions. Variables which independently predicted an individual's risk assessment were age group (p < 0.05). gender (p < 0.05) and scene details (p < 0.001). Risk assessment was found to be a statistically significant predictor of the decision to jump, with a 22% decrease in the odds of jumping with every unit increase in risk assessment (OR = 0.78: 95% CI: 0.76, 0.80). Gender was also found to be a statistically significant predictor of the decision to jump, with males being 19% more likely to jump than females, after controlling for age, experience, currency and risk assessment (OR = 1. 19: 95% CI; 1.04, 1.38). The importance of these results is that, by quantifying the relationship between two key elements of risk taking behaviour and several important host factor determinants, they facilitate more informed discussion about the possible role of risk taking behaviour in the causation of injury.

Competitive enzyme-linked immunoassay of monoclonal immunoglobulin G anti-D preparations

The development of monoclonal immunoglobulin G (IgG) anti-D for prophylaxis necessitates estimation of their potency in terms of their red cell-binding ability, but it is unclear which quantification methodology is most suitable for this. The aim of this study was to assess 50 monoclonal anti-D from the 4th International Workshop for quantitative and qualitative binding to red cells in a competitive enzyme-linked immunoassay (EIA) in which varying amounts of monoclonal antibodies (MoAbs) and a constant amount of biotinylated monoclonal anti-D (BRAD-5) compete for red cell binding. The potencies of the MoAb were estimated against the International Reference Preparation (IRP) for anti-D Ig. Two MoAbs as supplied were insufficiently inhibitory of biotinylated BRAD-5 binding to be quantified; the potencies of the remainder ranged from 4 to 343 IU mL-1 and included 11 MoAbs showing dose-responses that were nonparallel to those of other MoAb and the IRP. Estimation of the concentration of antibody in the supernatants by radial immunodiffusion ranged from 0.5 to 61 micro g mL-1, giving specific activities of <1-24 IU micro g-1. The results show that competitive EIA is suitable for quantitating most monoclonal anti-D for development and quality control purposes, regardless of their D epitope reactivity.

A one-quarter reduction in the salt content of bread can be made without detection

OBJECTIVE

To determine if it is possible to deliver a one-quarter reduction in the sodium content of bread without detection.

DESIGN

Single-blind, randomized, controlled trial.

SETTING

The Royal North Shore Hospital in Sydney, Australia.

PARTICIPANTS

One-hundred and ten volunteers from the hospital staff that completed 94% of scheduled assessments.

INTERVENTION

Six consecutive weeks of bread with usual sodium content or six consecutive weeks of bread with cumulating 5% reductions in sodium content each week.

MAIN OUTCOME MEASURE

The proportion of participants reporting a difference in the salt content of the study bread from week to week.

RESULTS

The intervention group were no more likely than the control group to report a difference in the salt content of the bread from week to week (P=0.8). Similarly, there were no differences between randomized groups in the scores for flavour (P=0.08) or liking of the bread (P=0.95) over the study follow-up period. However, the saltiness scores recorded on a visual analogue scale did decline in the intervention group compared with the control group (P=0.01)

CONCLUSIONS

A one-quarter reduction in the sodium content of white bread can be delivered over a short time period, while maintaining consumer acceptance. Over the long term, and particularly if achieved for multiple foods, a decrease in sodium content of this magnitude would be expected to reduce population levels of blood pressure and the risks of stroke and heart attack.