Knowledge and practices of a control authority: impact on the environment and food safety

This study investigates the practices and knowledge of a Control Authority dealing with the environment and the safety and control of hawker foods. Experience and background education are used as likely determinants of food safety practices and knowledge of the control authority. A total of 60 questionnaires were distributed to the Health Inspectors (HIs) in the Hawkers' and Health Departments, City Hall, Kuala Lumpur. The return rate was 93%. The structured questionnaire contained 14 main food safety practices and knowledge constructs. Significance was found pertaining to knowledge of HIs with different experience backgrounds but experience was not demonstrated to impact on practices of HIs. However, education was noted to have significantly but inconsistently influenced certain Practices and Knowledge scores of HIs. A Pearson bivariate coefficient characterised an association between food safety practices and knowledge of the control authority. The findings: (1) highlight the actual shortcomings in the staff resources relating to environmental health, food safety, foodborne illnesses and their control, and (2) provide information on the control aspect within the hawker micro-industry with the view of protecting the public from health hazards arising from the hawkers' practices and consumption of hawker foods.     

Development of the good food planning tool: A food system approach to food security in indigenous Australian remote communities

Few frameworks exist to assist food system planning, especially for Indigenous Australian remote communities. We developed a Good Food Planning Tool to support stakeholders to collectively plan and take action for local food system improvement. Development occurred over a four-year period through an evolving four phase participatory process that included literature review, several meetings with representatives of various organisations and communities and application of the Tool with multi-sector groups in each of four Indigenous Australian remote communities. A diverse range of 148 stakeholders, 78 of whom were Indigenous, had input to its development. Five food system domains: (i) Leadership and partnerships; (ii) Traditional food and local food production; (iii) Food businesses; (iv) Buildings, public places and transport; (v) Community and services and 28 activity areas form the framework of the Tool. The Good Food Planning Tool provides a useful framework to facilitate collective appraisal of the food system and to identify opportunities for food system improvement in Indigenous Australian remote communities, with potential for adaptation for wider application.     

Influence of food environment on ultra-processed drinks consumption among an economically vulnerable population in a metropolitan area in Brazil: A multilevel analysis

Ultra-processed drinks (UPDs) consumption is increasing, and this intake has been associated with the risk of illness and death. Data on individuals (n = 430) and food stores (n = 231) were collected in an economically vulnerable area in Recife-Brazil, and multilevel regression models were applied to assess the association between UPDs consumption with food environment characteristics. The results show 29.5% of individuals consume UPDs, higher UPD consumption was significantly associated with age (OR: 0.96), lower educational levels (OR:2.06), high density of stores predominantly selling UPFs (OR:2.34) and lower availability of FV in stores (OR:0.49). The applied methodology can inform food environment interventions to reduce UPDs consumption.     

The Outdoor MEDIA DOT: The development and inter-rater reliability of a tool designed to measure food and beverage outlets and outdoor advertising

Few studies of the food environment have collected primary data, and even fewer have reported reliability of the tool used. This study focused on the development of an innovative electronic data collection tool used to document outdoor food and beverage (FB) advertising and establishments near 43 middle and high schools in the Outdoor MEDIA Study. Tool development used GIS based mapping, an electronic data collection form on handheld devices, and an easily adaptable interface to efficiently collect primary data within the food environment. For the reliability study, two teams of data collectors documented all FB advertising and establishments within one half-mile of six middle schools. Inter-rater reliability was calculated overall and by advertisement or establishment category using percent agreement. A total of 824 advertisements (n=233), establishment advertisements (n=499), and establishments (n=92) were documented (range=8–229 per school). Overall inter-rater reliability of the developed tool ranged from 69–89% for advertisements and establishments. Results suggest that the developed tool is highly reliable and effective for documenting the outdoor FB environment.     

Understanding the local food environment: A participatory photovoice project in a low-income area in Madrid,Spain

There is a need to partner between researchers, practitioners and residents to increase our understanding of environmental influences on dietary behaviors. We used the participatory method of Photovoice to understand key determinants of the local food environment influencing residents' diets. This project was conducted in Villaverde, a low-income area located in Madrid, Spain. From February to May 2015, 24 residents working in four Photovoice groups, took photographs related to their local food environment. Each group analyzed and critically discussed their photographs in small group sessions. Through a consensus-building process, participants identified 30 emerging categories, which followed five conceptual themes related to their food environment: 1) eating in moderation, 2) cultural diversity, 3) food stores, 4) social relationships and 5) economic crisis and poverty. Participants, researchers and practitioners successfully collaborated in analyzing, writing, disseminating the project results, and directly informing local policy-makers, media, and other residents. The project results may guide community-generated interventions for promoting a healthier food environment.     

The evolution of local food environments within established neighbourhoods and new developments in Perth,Western Australia

Temporal changes in the location of food outlets can result in disparities in the availability and access of food across geographic areas, contributing to health inequalities. This study used mixed linear models to investigate how the location of food outlets around the home evolved over time with respect to area-level socio-economic status (SES) and urban design within established neighbourhoods and new residential developments. Food outlet data (supermarket/greengrocers, convenience stores, café restaurants and takeaway/fast food) were sourced from commercial database listings (SENSIS Pty. Ltd.) in 2004, 2006, 2007, and 2011. Using 2468 addresses from the RESIDential Environments Project (RESIDE), in Perth, Western Australia (WA), a count of each food outlet type and percentage of healthy food outlets within a 1.6 km road network buffer around the home, along with the road network distance to nearest food outlet were generated relative to each address at each time point. Proximity to and count of all food outlets increased over time in both new developments and established neighbourhoods. However, unhealthy food outlets were always in greater numbers and proximity to the home. The percentage of healthy food outlets was significantly greater in established neighbourhoods compared to new developments at all four time points. There were significantly more food outlets, and within closer proximity to the home, in established neighbourhoods compared to new developments at each time point. In established neighbourhoods, there were more convenience stores, takeaway/fast food and café restaurants, a lower percentage of healthy food outlets, and closer proximity to convenience stores in lower compared to high SES areas. In new developments there were significantly less supermarket/greengrocers, a lower percentage of healthy food outlets and greater proximity to takeaway/fast food and café restaurants in low compared to high SES areas. New developments designed according to the WA government's “Liveable Neighbourhoods Community Design Guidelines” policy had significantly more of all food outlets compared to other new developments. As such, people living in new developments, and low SES areas of Perth, may be disadvantaged with poorer access to healthy food outlets and greater exposure to unhealthy food outlets. Future urban planning and policy should focus on providing incentives that support the early development of supermarkets and healthy food outlets within new developments and low SES areas of Perth.     

The role of Australian local governments in creating a healthy food environment: an analysis of policy documents from six Sydney local governments

Objective : This paper examines policies from six local governments (LGs) relevant to promoting a healthy food supply and consumer food environment. Methods : We analysed the six LGs’ food and nutrition policies against a framework based on Australian literature and international policy frameworks. Policy content was collected by searching LG websites and analysed with reference to recommended policy actions in the framework. Results : All LGs took action on reducing food waste, providing food/meal services for disadvantaged groups, and providing information/education on food and nutrition. A sub‐set also supported urban/local food production and markets selling fresh, healthy food. Our search did not identify any indication of a comprehensive policy framework to guide action on food and nutrition, nor did we find policies restricting opening of unhealthy food outlets, encouraging the opening of healthy food outlets, or reducing unhealthy food marketing. Conclusions : Local governments in Australia are implementing policies to support improved nutrition. However, there are further opportunities for action, including discouraging unhealthy food outlets and restricting unhealthy food marketing. Implications for public health : The legal remit of LGs includes responsibilities relevant to food and nutrition. Further research is needed regarding how their powers could be better leveraged to improve diet‐related health.     

Google-truthing to assess hot spots of food retail change: A repeat cross-sectional Street View of food environments in the Bronx,New York

Google Street View (GSV) images can be used to “ground-truth” current and historical food retail data from approximately 2007 - when GSV was launched in a few US cities - to the present, facilitating analyses of food environments over time. A review of GSV images of all food retailers listed in a government database of licensed establishments in the Bronx, New York enabled records to be verified, businesses classified, and retail change quantified. The data revealed several trends likely to affect food access and health: increasing overall numbers of food retailers; the growth of dollar stores; and numerous openings, closings, and ownership changes across all food retail segments. Hot spot analysis identified statistically significant clusters of new dollar stores and bodegas, purveyors of less healthy processed foods, in lower-income neighborhoods in the South Bronx that face elevated rates of diet-related diseases. This article demonstrates the benefits and limitations of using GSV to conduct “virtual” food environment research.     

The impact of changes in different aspects of social capital and material conditions on self-rated health over time: A longitudinal cohort study

Individual aspects of social capital have been shown to have significant associations with health outcomes. However, research has seldom tested different elements of social capital simultaneously, whilst also adjusting for other well-known health determinants over time. This longitudinal individual-level study investigates how temporal changes in social capital, together with changes in material conditions and other health determinants affect associations with self-rated health over a six year period. We use data from the British Household Panel Survey, a randomly selected cohort which is considered representative of the United Kingdom's population, with the same individuals (N = 9303) providing responses to identical questions in 1999 and 2005. Four measures of social capital were used: interpersonal trust, social participation, civic participation and informal social networks. Material conditions were measured by total income (both individual and weighted household income), net of taxation. Other health determinants included age, gender, smoking, marital status and social class. After the baseline sample was stratified by health status, associations were examined between changes in health status and changes in all other considered variables. Simultaneous adjustment revealed that inability to trust demonstrated a significant association with deteriorating self-rated health, whereas increased levels of social participation were significantly associated with improved health status over time. Low levels of household and individual income also demonstrated significant associations with deteriorating self-rated health. In conclusion, it seems that interpersonal trust and social participation, considered valid indicators of social capital, appear to be independent predictors of self-rated health, even after adjusting for other well-known health determinants. Understandably, how trust and social participation influence health outcomes may help resolve the debate surrounding the role of social capital within the field of public health.     

The impact of built environment on mental health: A COVID-19 lockdown perspective

Tackling mental health has become a priority for governments around the world because it influences not only individuals but also the whole society. As people spend a majority of their time (i.e., around 90%) in buildings, it is pivotal to understand the relationship between built environment and mental health, particularly during COVID-19 when people have experienced recurrent local and national lockdowns. Despite the demonstration by previous research that the design of the built environment can affect mental health, it is not clear if the same influence pattern remains when a ‘black swan’ event (e.g., COVID-19) occurs. To this end, we performed logistic regression and hierarchical regression analyses to examine the relationship between built environment and mental health utilising a data sample from the United Kingdom (UK) residents during the COVID-19 lockdown while considering their social demographics. Our results show that compared with depression and anxiety, people were more likely to feel stressed during the lockdown period. Furthermore, general house type, home workspace, and neighbourhood environment and amenity were identified to have significantly contributed to their mental health status. With the ensuing implications, this study represents one of the first to inform policymakers and built environment design professionals of how built environment should be designed to accommodate features that could mitigate mental health problems in any future crisis. As such, it contributes to the body of knowledge of built environment planning by considering mental health during the COVID-19 lockdown.     

The impact of a population-level school food and nutrition policy on dietary intake and body weights of Canadian children

Objective

The objective of this study is to assess population-level trends in children's dietary intake and weight status before and after the implementation of a provincial school nutrition policy in the province of Nova Scotia, Canada.

Method

Self-reported dietary behavior and nutrient intake and measured body mass index were collected as part of a population-level study with grade 5 students in 2003 (n = 5215) and 2011 (5508), prior to and following implementation of the policy. We applied random effects regression methods to assess the effect of the policy on dietary and health outcomes.

Results

In 2011, students reported consuming more milk products, while there was no difference in mean consumption of vegetables and fruits in adjusted models. Adjusted regression analysis revealed a statistically significant decrease in sugar-sweetened beverage consumption. Despite significant temporal decreases in dietary energy intake and increases in diet quality, prevalence rates of overweight and obesity continued to increase.

Conclusion

This population-level intervention research suggests a positive influence of school nutrition policies on diet quality, energy intake and healthy beverage consumption, and that more action beyond schools is needed to curb the increases in the prevalence of childhood obesity.     

计划生育技术机构和医疗机构在基层孕产妇保健服务提供中的关系

目的：了解计划生育技术机构和医疗机构在基层孕产妇保健服务提供中的关系。方法：应用主题框架分析法对项目基线调查中收集的访谈资料进行分析。结果：两类机构在服务提供中，即存在提供交叉的服务内容、同种服务的收费不同、服务质量差异带来的冲突，也包括互通统计信息和妇女病普查等方面的合作。结论：两类机构间的关系以冲突为主、合作为辅；建议明确机构职责以避免服务冲突，整合现有资源以提高服务质量。     

计划与市场：夹缝中的公立医院薪酬现状及制度环境

通过对公立医院薪酬制度的调查发现,不恰当的收入构成“激励”了医生过度医疗的行为,进一步造成“看病贵”的结果。通过对制度环境的进一步梳理发现,之所以会导致现在种种恶劣的局面,恰是因为公立医院一直处于计划式管控和市场调控的夹缝中,过时的、僵死的计划制度安排,与市场条件下医院的生存选择产生了结构性矛盾,表现为公共领域筹资缺位、市场领域监管缺位,以及相关的管制性规定不适应市场经济环境。因此,本文建议明确政府对公立医院的主要筹资责任,同时适当控制公立医院的数量和服务量,并鼓励私立非营利医院的发展;扩大公立医院自主权,同时加强监管;在薪酬制度方面,薪酬水平和结构应该体现医务人员的市场价值。     

Rapidly rising food prices and the experience of food insecurity in urban Ethiopia: Impacts on health and well-being

The rise in food prices since 2007 is widely recognized as signaling a crisis of food insecurity among the world's poor. Scholars sought to chart the impacts of the crisis on food insecurity by conducting simulation studies, assessing anthropometric outcomes, and evaluating shifts in experience-based measures of food security. Few studies, however, have investigated the broader impacts on those most vulnerable and how rapid rises in food prices play out in the everyday lives of those most impacted. We used qualitative methods to investigate the impact of the rise in food prices on the urban poor in Ethiopia. Twenty semi-structured interviews were conducted in August 2011, in the provincial town of Jimma. Themes identified in these interviews included coping strategies, consumption priorities, and impacts on institutional networks of sharing. Our results suggest that several important cultural practices, including funerals and coffee ceremonies, were undermined by the rise in prices, and that respondents linked food prices to increasing food insecurity, which they in turn linked to high levels of stress, poor mental health, and reduced physical health. Our results are consistent with several other studies that suggest that food insecurity has a range of non-nutritional consequences, and that these are due in part to the highly social nature of food. Recognizing the effects of food insecurity on dimensions of everyday life such as interaction with neighbors, and feelings of shame, draws attention to the potential for food price increases to have erosive effects on communal social capital, and to increase the vulnerability of affected peoples to future shocks.     

A farmers’ market in a food desert: Evaluating impacts on the price and availability of healthy food

Several studies have examined supermarket access for low-income residents, but few have explored how access to healthy food changes when a new food retailer such as a farmers’ market opens in a place previously known as a ‘food desert’. This paper uses a ‘before and after’ approach to examine the impact of the introduction of a farmers’ market on the price and availability of healthy food in an underserved urban neighbourhood. The farmers’ market had a major impact on grocery prices in the neighbourhood, which decreased by almost 12% in 3 years.     

上海地区细菌性食物中毒季节和气候特征分析

目的从历年细菌性食物中毒发生的长期趋势中探讨其发生规律,为开展细菌性食物中毒的预警研究提供基础资料。方法分析1992—2006年上海地区细菌性食物中毒发生的基本特征(包括地区和行业分布、食品和致病菌种类)、季节特征(包括中毒年均月度和累年逐日的分布,五一、十一黄金周发生情况)和气候特征(包括中毒月均、逐日发生情况与气象因素的关系,中毒的发生与中毒前3天气象因素的关系)。结果细菌性食物中毒的发生无城乡差异,发生中毒的行业、食品和致病菌较为集中。5—10月是上海地区细菌性食物中毒的高发季节,五一和十一黄金周、6月下旬到7月上旬是其中的3个高发时段。月均中毒发生起数与月均气温、相对湿度相关;除五一和十一黄金周外的其他时段,平均气温低于19.2℃或相对湿度低于60.3%的条件下,发生细菌性食物中毒的概率很小;中毒发生日概率与中毒发生前1天的平均气温(5—6月、9—10月)和相对湿度(5—6月)有关。结论上海地区细菌性食物中毒的发生具有较明显的季节和气候特点。     

大市场监管模式下基层食品安全监管能力分析——以江西省为例

目的:了解机构改革后大市场监管模式下江西省基层食品安全监管能力现状。方法:采用普查法,调查江西省822个乡镇市场监督管理分局的基本情况和房屋建设、装备资源、人力资源情况。结果:共有基层监管人员5 917名,监管对象总数为42万家,平均每名监管人员承担71家的现场检查任务。总体房屋面积达标率为62.9%,装备配备率8.48%;装备达标率仅为4.89%。男女比例4.08∶1;年龄段以45~55岁为主;具有大专以上占78%,食品医药类专业仅占到7.3%。结论:大市场监管模式下基层乡镇力量虽然有了明显增加,但存在装备严重不足、监管人员老化、专业能力不强等问题,需加大财政投入,推行基层所标准化建设,合理制定专业人才引进计划,强化顶层设计。     

Deliberating Tarceva: A case study of how British NHS managers decide whether to purchase a high-cost drug in the shadow of NICE guidance

This paper examines audio-recorded data from meetings in which NHS managers decide whether to fund high-cost drugs for individual patients. It investigates the work of a Welsh individual patient commissioning (IPC) panel responsible for sanctioning the purchase of 'un-commissioned' treatments for exceptional cases. The case study presented highlights the changing rationales used for approving or denying a cancer drug, Tarceva, during a period when NICE first suggested it was not cost effective, but then changed its position in a final technology appraisal recommending use when the cost did not exceed that of an alternative product. Our data show how decisions taken in the shadow of NICE guidance remain complex and subject to local discretion. Guidance that takes time to prepare, is released in stages, and relates to particular disease stages, must be interpreted in the context of particular cases. The case-based IPC panel discourse stands in tension with the standardised population-based recommendations in guidance. Panel members, who based their decisions on the central notions of 'efficacy' and 'exceptionality', often struggled to apply NICE information on cost-effectiveness to their deliberations on efficacy (clinical effectiveness). The case study suggests that the complex nature of decision making makes standardization of outcomes very difficult to achieve, so that local professional judgement is likely to remain central to health care rationing at this level.