Optimal sampling of pelvic lymphadenectomy specimens following radical prostatectomy: is complete tissue submission justified?

There is currently no consensus among pathologists on the optimal method of sampling pelvic lympadenectomy specimens (PLND) in prostate cancer. We evaluated the impact of complete PLND submission on lymph node (LN) yield, detection of metastasis and laboratory workload in a series of 141 cases. Following isolation of grossly identifiable LNs/potential LNs, the remaining fatty tissue was embedded in toto. Complete PLND submission increased median LN yield from 10 (1-42) to 17 (3-57). Metastatic deposits were identified in nine non-palpable LNs, which altered the pN category in four cases (3%). The primary tumour (pT) was grade group ≥3 and/or pT3 at radical prostatectomy in 96% of pN+ cases. A median of seven additional blocks (1-28) was required for complete tissue embedding. Our findings indicate that submission of the entire fat can optimise PLND assessment but has a significant impact on laboratory workload. Complete submission of selected high-risk cases may be a reasonable alternative.

"It's not a food issue; it's an income issue": using Nutritious Food Basket costing for health equity advocacy.

OBJECTIVES: Ontario's public health units (PHUs) face considerable challenges in addressing the social determinants of health, even though "reducing health inequities" is a primary population health outcome in the Ontario Public Health Standards (OPHS). Since 1998, the OPHS mandated PHUs to use the Nutritious Food Basket (NFB) protocol to document food costs, a requirement that was removed in 2018. This study examined how the NFB advanced health equity advocacy by Ontario PHUs, and why some have used this tool more strategically than others. METHODS: Semi-structured qualitative phone interviews were conducted with 18 public health dietitians (PHDs) and three key informants between May and October 2017. Interviews were audio-recorded, transcribed, inductively coded, and analyzed. RESULTS: The PHDs agreed that the NFB tool provides essential localized evidence of inadequate incomes for people living in poverty, and supports the health equity mandate of PHUs in Ontario. Factors that support NFB research and advocacy work include strong PHU leadership regarding health equity, participation in community coalitions, and engagement with Ontario Dietitians in Public Health (ODPH). Interviewees identified lack of support at the PHU level and lack of coordination of food insecurity work at the Ministry of Health as significant barriers to PHUs' use of the NFB to advance health equity mandates. CONCLUSION: This study offers compelling evidence for reinstating NFB costing in the Ontario Public Health Standards as a mandatory requirement of PHUs. Without this requirement, the already-limited capacity of PHUs to advance health equity in Ontario will be further compromised.

Implicating municipalities in addressing household food insecurity in Canada: A pan-Canadian analysis of news print media coverage.

OBJECTIVES: Household food insecurity (HFI) affects approximately 13% of Canadian households and is especially prevalent among low-income households. Actions to address HFI have been occurring primarily at the local level, despite calls for greater income supports from senior governments to reduce poverty. News media may be reinforcing this trend, by emphasizing food-based solutions to HFI and the municipal level as the site where action needs to take place. The objective of this study was to examine the level and framing of print news media coverage of HFI action in Canada. METHODS: Using a quantitative newspaper content analysis approach, we analyzed 547 articles gathered from 2 national and 16 local/regional English-language newspapers published between January 2007 and December 2012. RESULTS: News coverage increased over time, and over half was produced from Ontario (33%) and British Columbia (22%) combined. Of the 374 articles that profiled a specific action, community gardens/urban agriculture was most commonly profiled (17%), followed by food banks/meal programs (13%); 70% of articles implicated governments to take action on HFI, and of these, 43% implicated municipal governments. Article tone was notably more negative when senior governments were profiled and more neutral and positive when municipal governments were profiled. CONCLUSION: News media reporting of this issue in Canada may be placing pressure on municipalities to engage in food-based actions to address HFI. A more systematic approach to HFI action in Canada will require more balanced media reporting that acknowledges the limitations of food-based solutions to the income-based problem of HFI.

Should Canadian health promoters support a food stamp-style program to address food insecurity?

Food insecurity is an urgent public health problem in Canada, affecting 4 million Canadians in 2012, including 1.15 million children, and associated with significant health concerns. With little political will to address this significant policy issue, it has been suggested that perhaps it is time for Canada to try a food stamp-style program. Such a program could reduce rates of food insecurity and improve the nutritional health of low-income Canadians. In this article, we explore the history of the US food stamp program; the key impetus of which was to support farmers and agricultural interests, not to look after the needs of people living in poverty. Though the US program has moved away from its roots, its history has had a lasting legacy, cementing an understanding of the problem as one of lack of food, not lack of income. While the contemporary food stamp program, now called Supplemental Nutrition Assistance Program (SNAP), reduces rates of poverty and food insecurity, food insecurity rates in the USA are significantly higher than those in Canada, suggesting a food stamp-style program per se will not eliminate the problem of food insecurity. Moreover, a food stamp-style program is inherently paternalistic and would create harm by reducing the autonomy of participants and generating stigma, which in itself has adverse health effects. Consequently, it is ethically problematic for health promoters to advocate for such a program, even if it could improve diet quality.

Municipal-level responses to household food insecurity in Canada: a call for critical, evaluative research.

Household food insecurity (HFI) is a persistent public health problem affecting 3.8 million Canadians. While the causes of HFI are rooted in income insecurity, solutions to HFI have been primarily food-based, with the bulk of activity occurring at the municipal level across Canada. We conceptualize these municipal-level actions as falling within three models: "charitable", "household improvements and supports" and "community food systems". Many initiatives, especially non-charitable ones, generate widespread support, as they aim to increase participants' food security using an empowering and dignified approach. While these initiatives may offer some benefits to their participants, preliminary research suggests that any food-based solution to an income-based problem will have limited reach to food-insecure households and limited impact on participants' experience of HFI. We suspect that widespread support for the local-level food-based approach to HFI has impeded critical judgement of the true potential of these activities to reduce HFI. As these initiatives grow in number across Canada, we are in urgent need of comprehensive and comparative research to evaluate their impact on HFI and to ensure that municipal-level action on HFI is evidence-based.

Obesity determinants in Mexican preschool children: parental perceptions and practices related to feeding and physical activity.

BACKGROUND AND AIMS: Obesity represents a major public health problem worldwide. In Mexico, overweight and obesity have increased dramatically, affecting 26% of school-aged children. The aim of this study was to explore perceptions and practices of key obesity determinants among parents of preschool children attending child care centers. METHODS: We conducted five focus groups with 38 parents from six Mexico City child care centers. Inquiry topics were 1) childhood obesity causes and consequences; 2) child feeding practices at the child care center and home; 3) healthful and unhealthful foods for young children; 4) significance of physical activity in childhood; and 5) physical activity-promoting factors and barriers. We analyzed these data using content analysis. RESULTS: We identified a number of barriers to healthful eating, including parental time constraints, permissive feeding styles, unhealthful food preparation practices, lack of knowledge about nutrition, food advertisement, and high availability of unhealthful foods in public places. Facilitators to healthful eating included recognition of childhood overweight prevention and consequences, and healthy food choices. Main barriers to childhood physical activity included influence of young family members to play video games, parental time constraints, street safety, low access to sports facilities, and insufficient communication with child care centers. CONCLUSIONS: Understanding parental views and perceptions of the main factors influencing preschoolers' weight-related behavior can inform home-based or environmental interventions that support healthful eating and regular physical activity.

Conceptualizing food security or aboriginal people in Canada.

Food insecurity is an urgent public health issue for Aboriginal people in Canada because of high rates of poverty; the effects of global climate change and environmental pollution on traditional food systems; and high rates of diet-related diseases. However, to date, public health has operated with conceptualizations of food security that were developed in non-Aboriginal contexts; they do not take full account of the traditional food practices of Aboriginal people or Aboriginal conceptualizations of food security. In this paper, I argue that there are unique food security considerations for Aboriginal people related to the harvesting, sharing and consumption of country or traditional foods, which impact the four pillars of food security: access, availability, supply and utilization. Thus food security conceptualizations, policies, and programs for Aboriginal people must consider both the market food system and traditional food system. Given the centrality of traditional food practices to cultural health and survival, I propose that cultural food security is an additional level of food security beyond individual, household and community levels. Conceptualizations of food security for Aboriginal people will be incomplete without qualitative research to understand Aboriginal perspectives; such research must take account of the diversity of Aboriginal people.

Economic abuse and intra-household inequities in food security.

Food insecurity affected over 2.3 million Canadians in 2004. To date, the food security literature has not considered the potential impact of economic abuse on food security, but there are three ways in which these two important public health issues may be related: 1) victims of economic abuse are at risk of food insecurity when they are denied access to adequate financial resources; 2) the conditions that give rise to food insecurity may also precipitate intimate partner violence in all its forms; 3) women who leave economically abusive intimate heterosexual relationships are more likely to live in poverty and thus are at risk of food insecurity. This paper presents a case of one woman who, during a qualitative research interview, spontaneously reported economic abuse and heterosexual interpersonal violence. The economic abuse suffered by this participant appears to have affected her food security and that of her children, while her husband's was apparently unaffected. There is an urgent need to better understand the nature of intra-household food distribution in food-insecure households and the impact of economic abuse on its victims' food security. Such an understanding may lead to improved food security measurement tools and social policies to reduce food insecurity.

Determinants of healthy eating among low-income Canadians.

This paper draws on four bodies of literature to consider the determinants of healthy eating for low-income Canadians: a) the social determinants of health; b) socio-economic gradients in diet; c) food security; and d) the sociology of food. Though there is a paucity of data for Canada, it is very likely that, as in other industrialized countries, there are socio-economic gradients in diet such that those who are better off consume healthier diets than those less well-to-do. The available evidence suggests that income affects food intake both directly and indirectly through the dispositions associated with particular social class locations. Thus, there may be both economic and cultural thresholds for some food groups or particular foods in food groups. Understanding these thresholds is especially important in addressing the issues facing those who are the most vulnerable among Canadians with low incomes: the food insecure. The literature reviewed suggests that improved nutrition for low-income Canadians may be difficult to achieve a) in isolation from other changes to improve their lives; b) without improvement in the nutrition of the general population of Canadians; and c) without some combination of these two changes. Four major areas of research need were identified: a) national data on socio-economic gradients in diet; b) sociological research on the interaction of income and class with other factors affecting food practices; c) sociological research on Canadian food norms and cultures; and d) research on the costs of healthy eating.

Toward understanding in postmodern interview analysis: interpreting the contradictory remarks of a research participant.

How is the qualitative research analyst to understand apparently contradictory remarks made by a research participant? Although social scientists in the positivist tradition rely on methods such as triangulation to find "truth," interpretive social scientists listen beyond, between, and underneath participants' words to understand the social conditions that produce apparent contradictions in their accounts. In this article, the author presents a case study of making sense of a research participant's contradictory comments, using a theoretical framework to understand the participant's "logic of practice." Through interpretive listening and reflexivity during the data analysis, she came to understand the participant's contradictory remarks in a way that illuminated the contradictions, as well as a significant process in the participant's life at the time: the transformation from carefree daughter to responsible mother. Such an interpretive analysis does not produce "truth" as positivist social scientists require but offers instead the satisfaction of understanding.