Measuring and mapping disparities in access to fresh fruits and vegetables in Montréal

OBJECTIVE: This study was conducted to evaluate disparities in access to healthy food in Montreal, focusing on the availability of fresh fruits and vegetables (F/V) as an indicator. METHOD: F/V selling area was measured in all food retail stores and public markets offering more than 75 square feet of fresh fruits and vegetables. An accessibility index was elaborated, taking into account motorization rates and the total surface of these fresh foods for sale within an easily accessible zone. The extent of that zone was determined differently for motorized (3 km) and non-motorized (500 m) consumers. Measures were calculated and georeferenced at the level of "Dissemination Areas" according to the 2001 Census. RESULTS: In general, access to healthy foods is quite good for consumers who shop by car. But 40% of the population have poor access to fruits and vegetables within a walkable distance from home. No relationship is observed between median income in dissemination areas and food supply. CONCLUSION: Improved access to healthy food by non-motorized consumers is needed in many areas of Montreal. Implications of differential access to fresh fruits and vegetables for health and environmental sustainability are discussed.     

Oportunidades to reduce overweight and obesity in Mexico?

This paper investigates the causal effect of Oportunidades, a conditional cash-transfer program in Mexico, on overweight and obesity of adolescents living in poor rural areas. Affecting youth weight was not a goal of this program. However, health economics research suggests that the provision of schooling, health information sessions and sizable cash transfers to Oportunidades participants could have substantially changed their overweight and obesity rates. Exploiting an exogenous jump in program participation by means of a fuzzy Regression Discontinuity (RD) design, the evidence of this paper suggests that Oportunidades decreased obesity among participant women. The identified local average treatment effect (LATE) at the threshold for program eligibility suggests that female obesity would decrease if the program was expanded to cover slightly better-off households. The design of the program does not allow disentangling the causal pathways that contributed to the lower prevalence of obesity among women, but the effect likely resulted from increased access to information and schooling, improved dietary quality, increased monitoring of health outcomes and (possibly) increased physical activity. Suggestive evidence shows that teen pregnancy rates were higher among non-participants. Therefore, weight gain after childbirth might also explain higher obesity rates among non-participant females.     

Smoke-free policies and non-smokers’ reactions to SHS exposure in small and medium enterprises

Introduction

Non-smoker employees can significantly improve the existing smoke-free policies in the workplace by asserting their right for smoke-free air and confronting smoker colleagues. The aim of the study was to assess the psychological and social drivers of non-smokers’ readiness to assert their right for smoke-free air in the workplace.

Materials and Methods

Twenty-six small-and-medium enterprises (SME) with diverse background were randomly selected, and 284 employees agreed to participate in the study. Our study focused on the responses of 85 non-smokers (M age = 34 years, SD = 7.98, 84.2% worked in indoor offices). A cross-sectional design was used and participants completed a structured anonymous questionnaire assessing background and demographic characteristics, and psychosocial predictors of assertiveness intentions.

Results

Although more than half of non-smokers reported they were often/almost always bothered by exposure to SHS, roughly one third of them reported having asked their colleagues not to smoke at work. Regression analysis showed that the effects of distal predictors (i.e. annoyance due to SHS exposure) were mediated by past behaviour, attitudes (protection motivation beliefs), social norms, and self-efficacy.

Conclusions

Health beliefs related to SHS exposure, and concerns about workplace health and job performance, social norms and self-efficacy can increase the assertiveness of non-smokers in workplace settings. Related campaigns should focus on communicating normative messages and self-efficacy training to empower non-smoker employees to act assertively towards protecting their smoke-free rights.     

Is personality related to fruit and vegetable intake and physical activity in adolescents?

Personality is regarded as a distal determinant of health behavior and has been found to be associated with health behavior in young adults. Research investigating the association between personality and health behaviors in adolescents, however, is lacking. The present study explored the direct associations between Big Five personality dimensions with fruit and vegetable consumption and physical activity (PA) in two Dutch adolescent samples [Sample 1: n = 504; mean age = 14.5 years (SD = 1.7); response rate 20%; Sample 2: n = 476; mean age = 14.9 (SD = 2.0); response rate 17%]. Behavioral outcomes and personality were assessed with validated self-administered questionnaires. Bivariate correlations and multiple regression analyses were conducted, and Cohen's effect sizes were used to interpret the associations found. Agreeableness was positively associated with vegetable consumption, while Openness to Experience was positively associated with fruit consumption and vegetable consumption. Extraversion was positively associated with sports-related PA. Standardized regression coefficients for personality dimensions ranged from 0.09 to 0.13, explaining 3-6% of variance in behavior, indicating small effect sizes. Our results suggest that personality dimensions are associated with fruit and vegetable consumption and sports-related PA in adolescents. Future research should explore possible mediators between personality and health behavior in adolescents.     

Clara cell protein and surfactant protein B in garbage collectors and in wastewater workers exposed to bioaerosols

Objectives: Inhalation of bioaerosols has been hypothesised to cause toxic pneumonitis that should increase lung epithelial permeability at the bronchioloalveolar level. Serum Clara cell protein (CC16) and serum surfactant protein B (SPB) have been proposed as sensitive markers of lung epithelial injury. This study was aimed at looking for increased lung epithelial permeability by determining CC16 and SPB in workers exposed to bioaerosols from wastewater or garbage. Methods: Subjects (778 wastewater, garbage and control workers; participation 61%) underwent a medical examination, lung function tests [American Thoracic Society (ATS) criteria], and determination of CC16 and SPB. Symptoms of endotoxin exposure and several potential confounders (age, gender, smoking, kidney function, obesity) were looked for. Results were examined with multiple linear or logistic regression. Results: Exposure to bioaerosols increased CC16 concentration in the wastewater workers. No effect of exposure on SPB was found. No clue to work-related respiratory diseases was found. Conclusions: The increase in CC16 in serum supports the hypothesis that bioaerosols cause subclinical toxic pneumonitis, even at low exposure.     

Mortality and life expectancy in Denmark and in other European countries: What is happening to middle-aged Danes?

Background: The trend in life expectancy in Denmark has beenless favourable than in other European countries for severalyears. The aim of this study was to compare mortality in Denmarkwith that in selected European countries, focusing on age groupsand causes of death for which the Danish trends are particularlyunfavourable. Methods: Comparisons were made for the period1952–1993 between Denmark and Norway, the former FederalRepublic of Germany, The Netherlands, the UK, France, Italyand former Czechoslovakia of age-specific mortality rates andchanges in life expectancy specific for each age group and causeof death. Results: At the end of the period only the formerCzechoslovakia had a lower life expectancy than Denmark; thedifference in life expectancy between Denmark and the othersix countries varied between 5 and 48 months. Almost all ofthe difference was due to a higher mortality rate in the 35–74years age group. All heart diseases and ‘symptoms andill-defined conditions’ were responsible for a large proportionof the Danish high mortality, the decrease in mortality fromthis group of diseases being moderate in comparison with theother countries. Lung cancer contributed to a loss of 1–6months more of life expectancy for Danish women than in theother countries. In comparison with Norway, The Netherlandsand the UK, Danish men lost 2 more months' life expectancy dueto liver cirrhosis and Danish women lost 1 month more. Conclusions:A considerable proportion of the extra deaths in Denmark couldbe prevented.     

Otitis,rhinitis, and atopy in relation to domestic endotoxin and β-glucan exposure among children in Singapore

Background  

Exposure to microbial cell wall agents (MCWAs) has been related to the risk for atopy, otitis, and rhinitis.     

Insecticide Residues in Soil,Water, and Eggplant Fruits and Farmers’ Health Effects Due to Exposure to Pesticides

Objectives

Eggplant (Solanum melongena L.) is an important vegetable crop that is widely cultivated in the tropical and subtropical areas in Asia. Globally, the top three eggplant producers are China, India, and Egypt. The Philippines has been one of the top 10 eggplant-producing countries based on area planted and crop productivity. This study aims to describe the insecticide residues found in soil, water, and eggplant fruits in eggplant farms in Sta. Maria, Pangasinan.

Methods

The study design is a cross sectional of randomly selected eggplant farms in Sta. Maria, Pangasinan. Soil, water, and eggplant fruits were collected and subjected to gas chromatography (Shimadzu) analysis for multi-pesticide residues.

Results

Farmers from Sta. Maria, Pangasinan were found to be applying a broad spectrum of insecticides on their eggplant crop. Soil samples from 11 (about 42 %) out of the 26 farms tested positive for insecticide residues, six of which from four farms exceeded the acceptable maximum residue limit. These residues were profenofos, triazophos, chlorpyrifos, cypermethrin, and malathion. No insecticide residues were detected from water samples taken from the 26 farms. Cypermethrin and chlorpyrifos were the insecticide residues detected in eggplant fruit samples. A maximum of 20 % of the eggplant samples tested positive for insecticide residues. In the eggplant fruit study, all farmers have been using Prevathon^® for 24 years at a rate of 10 ml/application, and Malathion^® for 25 years at about 16.5 ml/application, respectively equivalent to 0.24 liter-years and 0.413 liter-years of exposure. Similarly, to the findings in the soil and water study, although Brodan^® and Magnum^® were not prevalently applied, the farmers’ liter-years of exposure to these insecticides, and their active ingredients, were highest at about 18.92 and 10.0, respectively. The farmers and farm workers in the soil and water study reported experiencing itchiness of the skin (63.8 %), redness of the eyes (29.3 %), muscle pains (27.6 %), and headaches (27.6 %), as being related to their pesticide exposure.

Conclusion

In summary, a maximum of 20 % of the eggplant samples tested positive for insecticide residues at any one stage of sampling done. The farmers and farm workers also reported of pesticide-related illnesses but none of them sought any medical attention. Intervention to reduce the farmers’ pesticide exposure can focus on the risk factors identified, primarily the toxicity of pesticides used, the unsafe application practices, and the adverse health effects of pesticide exposure.

Electronic supplementary material

The online version of this article (doi:10.1007/s12199-014-0425-3) contains supplementary material, which is available to authorized users.     

Do changes in physical activity lead to dietary changes in middle and old age?

INTRODUCTION: Research examining the relationship between dietary factors and physical activity patterns has yielded conflicting findings. Few prospective studies have examined whether individuals who change their level of physical activity make corresponding changes in their diet. METHODS: The current study examined, in two randomized clinical trials of physical activity, whether self-report of dietary factors changed over a 1-year period, whether these changes differed by gender or exercise-intervention group, and whether changes in physical activity led to changes in dietary factors. Participants included 268 men and women aged 50-65 years who participated in the Stanford-Sunnyvale Health Improvement Project I (SSHIP-I) and 103 men and women aged 65-82 years who participated in SSHIP-II. In both trials we recruited participants through random-digit telephone dialing and citywide promotion. RESULTS: Overall, participants adopted healthier diets over the 1-year period. The SSHIP-I participants decreased their consumption of total calories, total fat, saturated fat, protein, and cholesterol. The SSHIP-II participants decreased their consumption of high-fat, high-cholesterol foods. The SSHIP-I women were more likely than men to decrease their intake of total fat and protein (p < 0.01), as well as total calories, saturated fat, and cholesterol (p < 0.05). However, we found that changes in physical activity were not associated with changes in self-report measures of dietary habits. CONCLUSIONS: We found no evidence to support the idea that changes in physical activity are a gateway for changes in dietary factors in middle-aged and older adults.     

Dietary and lifestyle variables in relation to incidence of Parkinson’s disease in Greece

Identification of dietary and lifestyle variables associated with the development of Parkinson’s disease (PD) may offer pathogenetic clues and prevention opportunities. In a population-based prospective cohort study, 26,173 participants in the EPIC–Greece cohort had sociodemographic, anthropometric, medical, dietary and lifestyle variables ascertained at enrolment and periodically reassessed with follow-up contacts. Based on these data, subjects were screened as possible PD cases if they (1) reported either a medical diagnosis of PD or use of anti-PD drugs and (2) did not report preceding causes of secondary parkinsonism. For diagnostic validation, possible incident PD cases were assessed by a focused 3-item telephone questionnaire. Cox proportional hazards regression was used to evaluate associations between potential predictors and incident PD. The main multivariate model included gender, age, marital status, schooling years, farming occupation, smoking status, caffeinated coffee, body mass index, physical activity and energy intake. Additional models included all above variables plus one dietary item at a time. Incidence rate adjusted to the European population was 16.9 per 100,000 person-years. In multivariate models, incident PD exhibited strong positive association with consumption of milk, but not cheese or yoghurt. This finding may help narrow down the search for potential dairy product components with a facilitatory role in PD. Concerning other dietary components, inverse association was found between polyunsaturated fat intake and incident PD. Also, inverse association was found with tobacco smoking, in line with previous studies, but not with caffeine.     

Cerebrovascular disease and gait and balance impairment in mild to moderate Alzheimer’s disease

Objectives

Gait and movement abnormalities are traditionally considered infrequent in patients with mild/moderate Alzheimer’s disease (AD). However, an increased risk of falls and gait abnormalities has been detected, even in early stages of the disease. Whether these abnormalities are associated with cerebrovascular disease, which has a high prevalence in AD, remains unclear.

Design

Cross-sectional study.

Setting

Dementia outpatient clinics.

Participants

24 mild/moderate AD patients with (AD+CVD) and 20 without (AD-CVD) cerebrovascular disease without a history of stroke and antipsychotic medications.

Measurements

Physical performance, measured with the Short Physical Performance Battery [SPPB], a summary measure combining 4-meter gait speed, balance and muscle strength, and with 8-meter gait speed with a turn was compared between the two groups.

Results

AD+CVD patients showed a significant higher prevalence of 4-meter gait speed slower than 0,8 m/s (37.5% Vs 5%, p-value=0.01) and balance impairment (37.5% Vs 10%, p-value=0.038), as well as a slower 8-meter gait speed with a turn (mean+SD=0.6±0.2 Vs 0.8±0.2, p-value=0.024). These associations were confirmed in multivariable models. No differences were observed for muscle strength.

Conclusion

In our sample, AD with cerebrovascular disease had worse gait and balance than AD without cerebrovascular disease. If confirmed, these results may have clinical implications, since cerebrovascular disease can be potentially prevented.     

Circulating 25-hydroxyvitamin D up to 3 decades prior to diagnosis in relation to overall and organ-specific cancer survival

While vitamin D has been associated with improved overall cancer survival in some investigations, few have prospectively evaluated organ-specific survival. We examined the accepted biomarker of vitamin D status, serum 25-hydroxyvitamin D [25(OH)D], and cancer survival in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Of 4616 cancer cases with measured serum 25(OH)D, 2884 died of their cancer during 28 years of follow-up and 1732 survived or died of other causes. Proportional hazards regression estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association between pre-diagnostic 25(OH)D and overall and site-specific survival. Serum 25(OH)D was significantly lower among cases who subsequently died from their malignancy compared with those who did not (medians 34.7 vs. 36.5 nmol/L, respectively; p?=?0.01). Higher 25(OH)D was associated with lower overall cancer mortality (HR?=?0.76, 95% CI 0.67–0.85 for highest vs. lowest quintile, p-trend?<?0.0001). Higher 25(OH)D was related to lower mortality from the following site-specific malignancies: prostate (HR?=?0.74, 95% CI 0.55–1.01, p-trend?=?0.005), kidney (HR?=?0.59, 95% CI 0.35–0.98, p-trend?=?0.28), and melanoma (HR?=?0.39, 95% CI 0.20–0.78, p-trend?=?0.01), but increased mortality from lung cancer (HR?=?1.28, 95% CI 1.02–1.61, p-trend?=?0.19). Improved survival was also suggested for head and neck, gastric, pancreatic, and liver cancers, though not statistically significantly, and case numbers for the latter two organ sites were small. Higher 25(OH)D status years prior to diagnosis was related to improved survival for overall and some site-specific cancers, associations that should be examined in other prospective populations that include women and other racial-ethnic groups.     

Food consumption and nutrient intake in relation to denture use in 55- to 84-year-old men and women —Results of a population based survey

Objective

To study differences in consumption of foods and intake of nutrients attributable to denture status.

Design, setting and participants

Data from a cross-sectional, nationally representative Health 2000 Survey, subjects aged 55–84 years (n=2,241).

Measurements

Denture status (edentulous with full dentures, own dentition with removable dentures, own dentition with no removable dentures) was used as an explanatory variable. The consumption of foods and intake of nutrients was used as an outcome variable and was measured using a validated Food Frequency Questionnaire.

Results

Denture status associated with food choices. Full denture wearers consumed less vegetables (p = 0.013 among men and p = 0.001 among women) and fruits (p = 0.001 among women), more sugary products (p = 0.012 among men and p = 0.008 among women), and their balance in fatty acids was less favourable than among dentate participants. Among dentate participants, the differences between the two groups were small and statistically significant differences were seen mostly in women.

Conclusions

Wearing full dentures appears to be associated with unhealthier food choices, lower consumption of some foodstuffs and lower intake of certain nutrients when compared to the food choices of dentate persons.

     

"Who wants to eat in a toilet?" A social marketing approach to breast-feeding in public places and at work

A public health project is described which used social marketing philosophy and techniques to find out how to help facilitate breast-feeding in public places and for mothers returning to work. As part of a strategy to increase local breast-feeding rates, Brighton and Hove Healthy City Partnership, representing the local Primary Care Trust, City Council and the business, academic and voluntary sectors, worked with a social marketing consultancy. The consultancy carried out a literature review and qualitative research that used creative engagement methods to consult with local people. The consultations were with key stakeholders, mothers, and groups traditionally less interested in the subject of breast-feeding, such as employers, elderly people, teenage boys, and fathers. The qualitative research generated in-depth insight and soundly-based, practical recommendations for facilitating breast-feeding. The social marketing approach helped to establish that any ensuing policies and practices would be acceptable to a wide range of the local population.     

Micronutrient Fortified Condiments and Noodles to Reduce Anemia in Children and Adults—A Literature Review and Meta-Analysis

Micronutrient deficiencies impose a considerable burden of disease on many middle and low income countries. Several strategies have been shown to be effective in improving micronutrient deficiencies. However, the impact of fortified condiments as well as fortified noodles is less well documented. We aimed to investigate existing evidence on the impact of micronutrient fortified condiments and noodles on hemoglobin, anemia, and functional outcomes in children and adults (age: 5 to 50 years). We conducted a literature review in electronic databases. In addition, we screened the homepages of relevant organizations and journals. We included randomized controlled trials (RCT). Of 1046 retrieved studies, 14 RCT provided data for the meta-analysis. Micronutrient fortification of condiments and noodles increased hemoglobin concentrations by 0.74 g/dL (95%-confidence intervals (95%-CI): 0.56 to 0.93; 12 studies) and 0.3 g/dL (95%-CI: 0.12 to 0.48; 1 study), respectively. Micronutrient fortification also led to a reduced risk of having anemia (risk ratio 0.59 (95%-CI 0.44 to 0.80)). Ferritin concentrations increased with fortified condiments. Functional outcomes were rarely assessed and showed mixed results. The use of micronutrient fortified condiments can be a strategy to reduce anemia in children and adults due to micronutrient deficiencies. The effect of fortified noodles seems to be smaller.     

Differences in physical activity and sedentary time in relation to weight in 8–9 year old children

Background

To determine whether the provision of higher levels of compulsory school physical activity is associated with higher physical activity and fitness levels and less overweight in childhood and 20 years later.

Methods

As part of the 1985 Australian Schools Health and Fitness Survey, 109 schools reported how much compulsory physical education (PE) and school sport they provided and were classified as low (<110 and <150 minutes/week for primary and secondary schools, respectively), medium (110–149 and 150–189 minutes/week for primary and secondary schools, respectively) or high (≥150 and ≥190 minutes/week for primary and secondary schools, respectively) compulsory physical activity schools by tertile cutpoints. 6,412 children reported frequency and duration of school (PE and sport) and non-school (commuting and non-organised exercise) physical activity and had height and weight measured; overweight was defined using body mass index (BMI) (m/kg²) cutpoints. 9, 12 and 15 year-olds (n = 2,595) completed a cycle ergometer fitness test (physical working capacity at heart rate 170, PWC₁₇₀). At follow-up in 2004–5, 2,346 participants kept a pedometer record, completed the International Physical Activity Questionnaire and/or a PWC₁₇₀ fitness test; and had height and weight measured (overweight = BMI≥25 m/kg²).

Results

At baseline and follow-up, median total physical activity, fitness and BMI were similar in participants who attended low, medium and high physical activity schools, and those attending high physical activity schools reported only modestly higher school physical activity. There was no difference in the prevalence of high total physical activity and fitness levels in childhood or adulthood across compulsory school physical activity categories. The prevalence of overweight in childhood and adulthood was similar across low, medium and high compulsory physical activity schools.

Conclusion

The amount of compulsory physical activity reported by schools was not associated with total physical activity, fitness or overweight in childhood or in adulthood. Policies promoting amounts of compulsory school physical activity in this range may not be sufficient to increase physical activity and fitness or reduce the prevalence of obesity in children.