Both acamprosate and oral naltrexone were associated with reduction in return to drinking. When directly compared with one another, no significant differences were found between acamprosate and naltrexone for controlling alcohol consumption. Factors such as dosing frequency, potential adverse events, and availability of treatments may guide medication choice.
Knowledge of historical fire activity tends to be focused at local to landscape scales with few attempts to examine how local patterns of fire activity scale to global patterns. Generally, fire activity varied globally and continuously since the last glacial maximum (LGM) in response to long-term changes in global climate and shorter-term regional changes in climate, vegetation, and human land use. We have synthesised sedimentary charcoal records of biomass burning since the LGM and present global maps showing changes in fire activity for time slices during the past 21,000 years (as differences in charcoal accumulation values compared to pre-industrial). There is strong broad-scale coherence in fire activity after the LGM, but spatial heterogeneity in the signals increases thereafter. In eastern and western North America and western Europe and southern South America, charcoal records indicate less-than-present fire activity from 21,000 to ~11,000 cal yr BP. In contrast, the tropical latitudes of South America and Africa show greaterthan-present fire activity from ~19,000 to ~17,000 cal yr BP whereas most sites from Indochina and Australia show greater-than-present fire activity from 16,000 to ~13,000 cal yr BP. Many sites indicate greater-than-present or near-present activity during the Holocene with the exception of eastern North America and eastern Asia from 8000 to ~2000 cal yr BP, Indonesia from 11,000 to 4000 cal yr BP, and southern South America from 6000 to 3000 cal yr BP where fire activity was less than present. Regional coherence in the patterns of change in fire activity was evident throughout the postglacial period. These complex patterns can be explained in terms of large-scale climate controls modulated by local changes in vegetation and fuel load.
Social marketing is a commonly used strategy in global health. Social marketing programmes may sell subsidized products through commercial sector outlets, distribute appropriately priced products, deliver health services through social franchises and promote behaviours not dependent upon a product or service. We aimed to review evidence of the effectiveness of social marketing in low- and middle-income countries, focusing on major areas of investment in global health: HIV, reproductive health, child survival, malaria and tuberculosis. We searched PubMed, PsycInfo and ProQuest, using search terms linking social marketing and health outcomes for studies published from 1995 to 2013. Eligible studies used experimental or quasi-experimental designs to measure outcomes of behavioural factors, health behaviours and/or health outcomes in each health area. Studies were analysed by effect estimates and for application of social marketing benchmark criteria. After reviewing 18 974 records, 125 studies met inclusion criteria. Across health areas, 81 studies reported on changes in behavioural factors, 97 studies reported on changes in behaviour and 42 studies reported on health outcomes. The greatest number of studies focused on HIV outcomes (n = 45) and took place in sub-Saharan Africa (n = 67). Most studies used quasi-experimental designs and reported mixed results. Child survival had proportionately the greatest number of studies using experimental designs, reporting health outcomes, and reporting positive, statistically significant results. Most programmes used a range of methods to promote behaviour change. Programmes with positive, statistically significant findings were more likely to apply audience insights and cost-benefit analyses to motivate behaviour change. Key evidence gaps were found in voluntary medical male circumcision and childhood pneumonia. Social marketing can influence health behaviours and health outcomes in global health; however evaluations assessing health outcomes remain comparatively limited. Global health investments are needed to (i) fill evidence gaps, (ii) strengthen evaluation rigour and (iii) expand effective social marketing approaches.
The remains of shellfish dominate many coastal archaeological sites in the Pacific and provide a wealth of information about economy, culture, environment and climate. Shells are therefore the logical sample type to develop local and regional radiocarbon chronologies. The calibration of radiocarbon ( 14 C) dates on marine animals is not straightforward, however, requiring an understanding of habitat and dietary preferences as well as detailed knowledge of local ocean conditions. The most complex situations occur where terrestrial influences impinge on the marine environment resulting in both the enrichment and depletion of 14 C (
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