Challenges and solutions for recruiting pregnant smokers into a nicotine replacement therapy trial.

Improvements in smoking cessation interventions for pregnant smokers are needed. One major step is to examine the potential effectiveness of nicotine replacement therapy (NRT). The potential benefits of providing pregnant women with NRT to help them quit smoking are still unknown; early interventions to test the effectiveness and efficacy are vital to advancing the field. This paper describes recruitment efforts for a multiclinic trial to test the effectiveness of NRT use in addition to behavioral therapy in promoting cessation during pregnancy. The biggest challenge is recruiting sufficient numbers of pregnant women. This paper discusses specific obstacles for recruitment and solutions. Knowing the potential pitfalls to recruiting pregnant women into these trials can lead to better studies and thus improved outcomes.     

Chile's national nutritional supplementation program for older people: lessons learned

Demographic changes in developing countries have resulted in rapid increases in the size of the older population. As a result, health-care budgets face increasing costs associated with the declining health and function of older people. Some governments have responded to this situation by designing innovative programs aimed at older people. One such program, implemented by the government of Chile, distributes an instant food mix fortified with vitamins and minerals to all persons over 70 years old who are registered by the national health service. The national health service covers approximately 90% of the older population. The program specifically targets nutritional vulnerability and micronutrient deficiency, which are common among poor older people in Chile. We present here the findings of a one-year investigation into all aspects of Chile's program for the elderly. The research included in-depth interviews with policy makers and program implementers, focus group discussions with user groups, analysis of the micronutrient content of the nutritional supplement, and telephone interviews of a random sample of older people. The results demonstrate that there can be a considerable degree of self-targeting within national programs; programs need to be sufficiently flexible to permit periodic protocol change; user groups must be consulted both before and during program implementation; and the design of an effective program evaluation must be in place before program implementation. It is hoped that these results will be useful to policy makers and implementers planning programs aimed at improving the health and function of older people.     

Good governance for nutrition in the Philippines: elements, experiences, and lessons learned

Malnutrition is a multifactorial problem that needs a multisectoral solution. This article reviews the role of good governance in nutrition programs, citing the Philippines as an example. In the Philippines, these efforts are reflected in the partnership between the public and private sectors in the establishment of the country's capability in research, policy-making, and program implementation. The establishment of the different public institutions engaged in research and policy-making is discussed, highlighting the role of political will through legislation. The evolving tasks of the nutrition program are discussed by citing the tasks in two eras. In the 1970s, the challenges were limited national nutrition data, man-power, tools, and health infrastructure. The public and private institutions were able to respond by legislating national nutrition surveys and dedicated nutrition workers in each village. The challenges in the current era are improved implementation of health programs, given the devolution of health services, and the gathering of an evidence base to further strengthen and refine the strategies of supplementation, fortification, breastfeeding, and food security. In responding to these challenges, multisectoral solutions and collaboration are critical in providing an evidence base to formulate policy. The role of the private sector, with the Nutrition Center of the Philippines used as an example, is that of a supportive and collaborative partner in good governance. Finally, the lessons learned from the past decades of implementing a national nutrition program, given changes in political and economic circumstances, are summarized.     

Improving street food vending in South Africa: achievements and lessons learned

Until the late 1990s there were limited scientific data on the microbiological quality and safety of street-vended foods in South Africa, while information was already available in other developing countries, including those within the African region. At that time street-vended foods were perceived as unsafe and street food vending in South Africa was regarded as a practice, which should be outlawed. The first comprehensively documented scientific research into the safety of street-vended foods in South Africa was carried out through university-based research. This research found that street food vendors in South Africa were capable of producing relatively safe foods, with low bacterial counts, although there was still a need for proper hygiene conditions and access to basic sanitary facilities. The Department of Health of South Africa, when coordinating an FAO Technical Cooperation Programme (TCP) project on Improving Street Foods in South Africa, drew similar conclusions. This article provides information of the efforts by universities and health authorities in South Africa towards improving the safety and promoting the sale of street-vended foods. It is shown that a successful transition from street food vending being perceived as a nuisance by health authorities can be made to these authorities promoting and improving street food vending instead.     

Transboundary environmental assessment: lessons from OTAG. The Ozone Transport Assessment Group

The nature and role of assessments in creating policy for transboundary environmental problems is discussed. Transboundary environmental problems are particularly difficult to deal with because they typically require cooperation among independent political jurisdictions (e.g., states or nations) which face differing costs and benefits and which often have different technical capabilities and different interests. In particular, transboundary pollution issues generally involve the problem of an upstream source and a downstream receptor on opposite sides of a relevant political boundary, making it difficult for the jurisdiction containing the receptor to obtain relief from the pollution problem. The Ozone Transport Assessment Group (OTAG) addressed such a transboundary problem: the long-range transport of tropospheric ozone (i.e., photochemical smog) across the eastern United States. The evolution of the science and policy that led to OTAG, the OTAG process, and its outcomes are presented. Lessons that are available to be learned from the OTAG experience, particularly for addressing similar transboundary problems such as regional haze, are discussed.     

A revised model for spermatogonial expansion in man: lessons from non-human primates

We have recently described a revised scheme for spermatogonial expansion in non-human primates. We proposed that A(pale)-spermatogonia act as self-renewing progenitors and premeiotic germ cells are organized and divide as small clones. Here, we are revisiting the model described for man and propose a modified scheme for spermatogonial expansion. Our revised model shows high similarity to the scheme proposed for non-human primates and is in accordance with all previous and present data.     

Public health foundations and the tobacco industry: lessons from Minnesota

Objective: To investigate whether private foundations can be created in a way that will insulate them from attacks by the tobacco industry, using the Minnesota Partnership for Action Against Tobacco (MPAAT) as a case study.

Design: Information was collected from internal tobacco industry documents, court documents, newspapers, and interviews with health advocates and elected officials.

Results: The creation of MPAAT as an independent foundation did not insulate it from attacks by tobacco industry allies. During 2001–2002, MPAAT was repeatedly attacked by Attorney General Mike Hatch and major media, using standard tobacco industry rhetoric. This strategy of attack and demands for information were reminiscent of previous attacks on Minnesota's Plan for Nonsmoking and Health and the American Stop Smoking Intervention Study (ASSIST). MPAAT was ultimately forced to restructure its programme to abandon effective community norm change interventions around smoke-free policies and replace them with less effective individual cessation interventions. Neither MPAAT nor other health advocates mounted an effective public response to these attacks, instead relying on the insider strategy of responding in court.

Conclusion: It is not possible to avoid attacks by the tobacco industry or its political allies. Like programmes administered by government agencies, tobacco control foundations must be prepared for these attacks, including a proactive plan to educate the public about the principles of community based tobacco control. Public health advocates also need to be willing to take prompt action to defend these programmes and hold public officials who attack tobacco control programmes accountable for their actions.

     

Combating iodine deficiency: lessons from China,Indonesia, and Madagascar

This study investigated the factors contributing to a successful and sustainable elimination of iodine-deficiency disorders, drawing from salt fortification experiences in China, Indonesia, and Madagascar. Government officials, salt farmers, salt producers, and wholesalers were interviewed to collect data during field visits. Analyses used in the study include simple correlation, and wherever data permit, regression. The study found that measures crucial for combating iodine deficiency include raising public awareness of the disorders, ensuring easy access to iodated salt, promoting compliance in the salt industry, and monitoring and enforcement. Factors that ensure a reliable supply of iodated salt are equally important as those that create the demand for it. Governments must ensure that surveillance and enforcement mechanisms are functioning right from the time that salt iodation is made compulsory. For sustainability during later years, the adequacy of iodine in iodated salt must be monitored, and incentives must be modified as needed to increase compliance rates in the salt industry. Once national coverage of iodated salt reaches over 90%, the government can concentrate on fine-tuning and targeting resources at areas with a low consumption of iodated salt. Elimination of micronutrient deficiencies has a long-term impact on public health; moreover, poorer segments of the population, who are more vulnerable to such deficiencies, have more to gain from fortification programs. Thus, lessons from the successful elimination of iodine-deficiency disorders are valuable for future similar micronutrient activities.     

Media training for diabetes prevention: a participatory evaluation.

The Media and the Message - Promoting Healthy Eating and Active Living for Diabetes Prevention was a project aimed at raising awareness of diabetes risk factors and enhancing the public's access to credible, up-to-date, healthy eating and active living messages in the media. Cross-country workshops were held to teach media strategies and key diabetes prevention messages to multidisciplinary groups of health professionals. Evaluation was integral to the project; both the process and outcomes were assessed using Health Canada's Population Health Approach. Timeline and budget were tracked. Questionnaires were created to evaluate advisory committee conference calls and to determine participants' perceptions of the 19 workshops and resources. A pre-workshop/post-workshop and three-month follow-up questionnaire format, along with an online media-tracking tool, was used to collect outcome data and to measure changes in confidence and media behaviour. Sixty-three percent of participants (150 of 238) reported that multidisciplinary workshops were very valuable. Three-month follow-up revealed a significant increase in confidence in all media activities taught at the workshops, although this failed to translate into increased media activity. Sixty-eight percent (78 of 115) of responding participants disseminated workshop learning. Detailed evaluation revealed that multidisciplinary workshops are valued and effective in increasing confidence. However, eliciting behaviour change following a workshop remains a challenge.     

Analysing collaborative trials for qualitative microbiological methods: accordance and concordance

In qualitative (detection) food microbiology, the usual measures of repeatability and reproducibility are inapplicable. For such studies, we introduce two new measures: accordance for within laboratory agreement and concordance for between laboratory agreement, and discuss their properties. These measures are based on the probability of finding the same test results for identical test materials within and between laboratories, respectively. The concordance odds ratio is introduced to present their relationship. A method to test whether accordance differs from concordance is discussed.     

Changes in blood and urine composition from feeding polybrominated biphenyls to pregnant Holstein heifers.

The toxicity of a commercial preparation of polybrominated biphenyl was determined in 24 pregnant Holstein heifers that were alloted randomly to one of four experimental groups given 0 (I), .25 (II), 250 (III), and 25,000 (IV) mg per day of fireMaster BP-6 for 60 days or until the animals became moribund. Clinicopathologic determinations were on day -1 prior to dosing, days 15, 30 and 60 during dosing, and following dosing on days 80, 110, 150, and 190 from start of dosing. In addition, samples were collected from moribund heifers of Group IV immediately prior to necropsy. Toxicity was not evident in heifers in Groups I, II, or III. Toxicity was induced in heifers in Group IV. Glutamic-oxaloacetic transaminase of serum was increased and calcium decreased as early as day 15 whereas significant increases in lactate dehydrogenase, urea nitrogen, and bilirubin, and decreases in albumin were not observed until day 30 in heifers of Group IV. Analysis of urine from moribund heifers of Group IV revealed moderate proteinuria and decreased specific gravity. Evaluation of clinicopathologic data has suggested that the polybrominated biphenyls fed were renal toxins with no clear evidence of hepatotoxicity.     

Growing the service economy for sustainable wheat intensification in the Eastern Indo-Gangetic Plains: lessons from custom hiring services for zero-tillage

Zero-tillage (ZT) is a proven technology for enhancing wheat productivity and, hence, food security in the Indo-Gangetic Plains, while reducing production costs. However, very few farmers possess their own tractors much less the specialized seed drills required to implement the technology. As a consequence, adoption of ZT largely hinges on affordable access to custom hire services. In Eastern India, the service economy for ZT is expanding, but remains in the early stages of growth. ZT service businesses remain largely uncharacterized, and related business dynamics poorly understood. To address this knowledge gap and derive recommendations for an efficient targeting of public sector support for those service providers (SPs) who are poised for growth, we identified factors that influence ZT entrepreneurship, encompassing new business formation and the resulting scale of the enterprise. We used data from a census of 270 ZT SPs in Bihar, as documented by the Cereal Systems Initiative for South Asia (CSISA). To identify determinants of engaging in ZT service provision, the data were pooled with those of 1000 randomly-selected wheat farmers located in the same districts. We applied Heckman’s two-step estimation procedure to derive unbiased estimates of determinants of the scale of the ZT service businesses. ZT SPs are generally larger, tractor-owning farmers who have taken up service provision as a side business since 2010 or later. Only 8.3 % of the surveyed farm households owned a tractor, demonstrating the importance of service provision for accessing ZT and other mechanization technologies. ZT SPs expanded their businesses considerably from 2011 to 2012 to an average total of 20 clients and 50 ha serviced per SP. However, larger areas were primarily achieved by servicing larger client farms. Well-educated farmers with larger land holdings and extensive social networks are most likely to become ZT SPs. However, among this stratum, the relatively smaller scale farmers were most likely to provide services at a sizeable scale. To efficiently accelerate the spread of ZT technology, we conclude that these smaller-scale tractor-owning farmers are the most sensible targets for purchase subsidies on ZT drills as well as the primary audience for business development training. Since a considerable fraction of the ZT area expansion resulted from service provision to larger client farms, there is a need to develop business models that enhance the social inclusiveness of ZT services by reducing the transaction costs of reaching smallholders.     

Wildlife and the coal waste policy debate: proposed rules for coal waste disposal ignore lessons from 45 years of wildlife poisoning

This analysis examines wildlife poisoning from coal combustion waste (CCW) in the context of EPA's proposed policy that would allow continued use of surface impoundments as a disposal method. Data from 21 confirmed damage sites were evaluated, ranging from locations where historic poisoning has led to corrective actions that have greatly improved environmental conditions to those where contamination has just recently been discovered and the level of ecological impacts has yet to be determined. The combined direct and indirect cost of poisoned fish and wildlife exceeds $2.3 billion, which is enough money to construct 155 landfills with state-of-the-art composite liners and leachate collection systems. This cost is projected to increase by an additional $3.85 billion over the next 50 years, an amount that would construct 257 landfills. Evidence revealed through this study indicates the following: (1) for the past 45 years, environmental damage has been a recurring theme with surface impoundment of CCW, (2) the National Pollutant Discharge Elimination System has not been effective in preventing serious environmental damage from CCW, (3) EPA's Regulatory Impact Analysis of the costs and benefits of pollution control options fails to include benefits of avoided damages to natural resources, specifically, poisoned fish and wildlife, and (4) surface impoundments pose unacceptably high ecological risks regardless of location or design. Regulators should no longer ignore rigorous science and the lessons from multiple case examples. EPA and the United States need to show leadership on this issue by prohibiting surface impoundments, particularly since the rise in coal use in developing countries is leading to the same CCW pollution problems on a global scale.     

Generation of food waste in the hospitality and food retail and wholesale sectors: lessons from developed economies

Food wastage is a major challenge in the global food value chain. In an attempt to explain and better understand the determinants of food waste across the supply chain, this paper closely examines the Hospitality, Restaurants and Canteens/Cafeterias (HORECA) as well as food retail and wholesale sectors, as being interrelated with the final consumer at the post-harvest and post-processing levels. Data from 33 developed countries in North America, Europe, Asia and Oceania were compiled from secondary sources and analyzed by means of a regression model in order to identify the macroeconomic factors contributing to generation of food waste in the HORECA industry at the national level. The results of our analysis suggest that a well-defined and inclusive legislative framework, awareness campaigns as well as fiscal incentives significantly reduce generation of food waste by an average of 17.6, 21.3 and 14.3%; respectively. Accordingly, these measures can be used in conjunction as effective schemes for controlling food wastage in the HORECA industry. On the other hand, non-legally binding initiatives by government authorities among other actors did not seem to have any significant impact on the food waste generated and quantities reported.