Benchmarking online food delivery applications against menu labelling laws: a cross-sectional observational analysis.

OBJECTIVE: It is unknown how well menu labelling schemes that enforce the display of kilojoule (kJ) labelling at point-of-sale have been implemented on online food delivery (OFD) services in Australia. This study aimed to examine the prevalence of kJ labelling on the online menus of large food outlets with more than twenty locations in the state or fifty locations nationally. A secondary aim was to evaluate the nutritional quality of menu items on OFD from mid-sized outlets that have fewer locations than what is specified in the current scheme. DESIGN: Cross-sectional analysis. Prevalence of kJ labelling by large food outlets on OFD from August to September 2022 was examined. Proportion of discretionary ('junk food') items on menus from mid-sized outlets was assessed. SETTING: Forty-three unique large food outlets on company (e.g. MyMacca's) and third party OFD (Uber Eats, Menulog, Deliveroo) within Sydney, Australia. Ninety-two mid-sized food outlets were analysed. PARTICIPANTS: N/A. RESULTS: On company OFD apps, 35 % (7/23) had complete kJ labelling for each menu item. In comparison, only 4·8 % (2/42), 5·3 % (2/38) and 3·6 % (1/28) of large outlets on Uber Eats, Menulog and Deliveroo had complete kJ labelling at all locations, respectively. Over three-quarters, 76·3 % (345/452) of menu items from mid-sized outlets were classified as discretionary. CONCLUSIONS: Kilojoule labelling was absent or incomplete on a high proportion of online menus. Mid-sized outlets have abundant discretionary choices and yet escape criteria for mandatory menu labelling laws. Our findings show the need to further monitor the implementation of nutrition policies on OFD.

Convenience as a dimension of food environments: A systematic scoping review of its definition and measurement.

Convenience is a major driver of food choice throughout the world, yet it is often inconsistently conceptualised, defined and measured. This limits the scope for food systems policy and interventions to leverage convenience to improve diet and nutrition outcomes. We conducted a systematic literature review to determine how convenience is both defined and measured in food environment and nutrition research. Six databases were systematically searched and studies were screened by two independent reviewers based on pre-defined eligibility criteria, yielding 243 studies for inclusion in the final review. 77% of studies did not explicitly define convenience. Among those that did, the dimensions and components within definitions varied. 83% of studies used perceived measures of convenience rather than objective measures. Convenience was most commonly measured in high income countries (64%) and in relation to the home food environment (53%), followed by formal retail (40%). Very few studies measured convenience in relation to the informal retail or cultivated food environments, and no studies considered convenience in relation to wild food environments. The vast majority of studies did not consider the validity or reliability of the measures of convenience. Based on our findings we propose a definition of convenience as a characteristic that results in reduced requirement for resources including time, physical effort, mental effort and skills by the consumer in relation to the planning, acquisition, preparation, storage, transport, consumption or clean-up of food. This definition can be used to help guide the development of measurement tools that can be used to assess convenience across different dimensions and contexts in a more comprehensive way. We also propose a framework for considering convenience as an entry point in food systems to improve diets and nutrition outcomes.

Food price and availability in Solomon Islands during COVID-19: A food environment survey.

Background: In Solomon Islands, the retail food environment is an important food source, for instance, the dominant source of fresh fruit and vegetables for urban consumers is open markets. The effects of COVID-19 mitigation measures (such as restriction of human movement and border closures) in early 2020 placed food security at risk in many parts of the community. Of particular concern was the risk of price gouging in an already price-sensitive market. Aims: The study aimed to provide rapid and policy-relevant information on the pricing of foods in the urban food environment in Solomon Islands in the context of the unfolding COVID-19 pandemic. Methods: A vendor survey was conducted in July to August 2020 and repeated in July 2021 using a survey tool that collected information on type, quantity, and price of food on offer. Findings: We found price reductions among the majority of fresh fruit and non-starchy vegetables available. A trend of rising prices was reported for some other commodities, such as fresh locally caught fish. Conclusion: Our findings highlight the impact of 'schocks to the system' on food prices as a potential barrier or enabler to consumption of fresh foods purchased from urban areas - an important finding in a price sensitive market. The survey design was successful in collecting pricing data from the retail food environment during a time of external 'shock to the system'. Our approach is applicable to other settings needing a rapid survey of the external food environment.

A Typology of Food Environments in the Pacific Region and Their Relationship to Diet Quality in Solomon Islands.

Extensive literature describes the importance of food environments (FEs) as a driver of food choices and nutrition outcomes; yet existing FE frameworks do not adequately capture the diversity of FEs relevant to the Pacific Region. This limits identification of opportunities in food systems to reduce the multiple burden of malnutrition. We present a conceptual typology of FEs including six primary FEs relevant in the Pacific; wild; cultivated; kin and community; informal retail; formal retail; and food aid and services. We then apply this typology to food acquisition data from Solomon Islands 2012/13 Household Income and Expenditure Survey and analyse the relationship between FEs and diet quality. The cultivated FE accounts for 60% of the quantity of food acquired nationally, followed by wild (15%), kin and community (9%), and formal and informal retail FEs (8% each), with wide variation between urban and rural households, provinces and wealth groups. Reliance on different FEs is a significant predictor of diet quality and affirms the importance of subsistence fisheries and agriculture, and community and kinship networks. Integration of a FE typology such as the one presented here in commonly conducted household expenditure surveys offers significant opportunity to advance our understanding of food system leverage points to improve nutrition and health.

An Analysis of Healthy Food Access Amongst Women in Peri-urban Honiara.

Highly processed and energy-dense foods are contributing to the high and rising rates of non-communicable diseases and nutrient deficiencies in Solomon Islands. Non-communicable diseases currently cause 69% of deaths in Solomon Islands, and the rate is rising, fuelled in part by limited health system capacity to treat these conditions. Solomon Islands also has the highest reported undernourishment rate in the Pacific. Recent decades have seen several factors change the food and economic environment in Solomon Islands. Importantly, rural-to-urban migration has caused a disconnect between urban residents and access to land and home gardens. This study aimed to examine the complexities of nutritious food access in urban Solomon Islands. Data were collected from 32 women in Honiara, the islands' capital, using a novel survey instrument. There were 3 important findings: (1) the dominant influencers of the diet patterns described by participants in this study were food affordability and access to land on which to grow it, (2) all participants experienced food insecurity, and (3) reported diet patterns reflected unhealthy diets which were particularly high in processed and sugary foods. These findings suggest a need for improvements in the food environment in Honiara.

COVID-19 and Pacific food system resilience: opportunities to build a robust response.

The unfolding COVID-19 pandemic has exposed the vulnerability of the Pacific food system to externalities and has had far-reaching impacts, despite the small number of COVID-19 cases recorded thus far. Measures adopted to mitigate risk from the pandemic have had severe impacts on tourism, remittances, and international trade, among other aspects of the political economy of the region, and are thus impacting on food systems, food security and livelihoods. Of particular concern will be the interplay between loss of incomes and the availability and affordability of local and imported foods. In this paper, we examine some of the key pathways of impact on food systems, and identify opportunities to strengthen Pacific food systems during these challenging times. The great diversity among Pacific Island Countries and Territories in their economies, societies, and agricultural potential will be an important guide to planning interventions and developing scenarios of alternative futures. Bolstering regional production and intraregional trade in a currently import-dependent region could strengthen the regional economy, and provide the health benefits of consuming locally produced and harvested fresh foods - as well as decreasing reliance on global supply chains. However, significant production, processing, and storage challenges remain and would need to be consistently overcome to influence a move away from shelf-stable foods, particularly during periods when human movement is restricted and during post-disaster recovery.

Access to a Nutritious Diet in Samoa: Local Insights.

The adult obesity prevalence in Samoa is the third highest globally, and diet is a significant contributor. Our study aimed to explore the behavioral and demographic factors which influence diets in Samoa. The most important findings for strategic policy design were: i) cost was the most important reason for food choice, ii) participants reported high rates of consumption of sugary and fatty energy foods - along with high rates of food insecurity, and iii) the food frequency questionnaire findings from our small sample are in line with the existing evidence that the nutrition transition is underway in Samoa.

Associations between sociodemographic and behaviour factors, and dietary risk factors for overweight and obesity, in Samoan women.

Adults in Samoa have the third highest obesity prevalence in the world, and the prevalence is higher in women than men. The nutritional status of a household in most low- and middle-income countries is positively influenced by the level of control women have over financial resources. Our analysis examined how consumption of specific dietary groups was associated with different sociodemographic and individual health risk factor groups for women who participated in the 2014 Samoa Demographic and Health Survey. Our research question was explored through multivariate analysis of the 2014 Samoa Demographic and Health Survey dataset. The sociodemographic and health behaviour groups included in our analysis were: urban vs. rural residence, wealth quintile, education level, participation in physical activity program, lives with husband/partner, household size, parity, age, smoking, and alcohol consumption. The following diet variables were included: fruit, vegetables, seafood, high-fat food, sugary drinks, high-salt food, and high-sugar food consumption. There was a high prevalence of unhealthy food consumption and unhealthy dietary patterns among a) a large proportion of the population, and b) across sociodemographic and health behaviour groups, with a higher prevalence of particular at-risk patterns in some specific groups including women of younger age and women of higher wealth. Our analysis highlighted some specific opportunities for policy action, including the need to create an enabling environment for healthier food consumption for Samoan women.

How food insecurity could lead to obesity in LMICs: When not enough is too much: a realist review of how food insecurity could lead to obesity in low- and middle-income countries.

While food insecurity is a well-known cause of under-nutrition and stunting, in recent decades it has also been linked with obesity. Understanding and thus minimising the risk factors for obesity in low- and middle-income country contexts, which often lack the health system capacity to treat the consequent obesity-related illnesses, is crucial. This study adopted realist review methodology because it enabled us to analyse and organise the evidence from low- and middle-income countries into a coherent scheme. By comparing this evidence to existing theory on food security and nutrition, we aimed to provide a richer understanding of the nuances and the socio-demographic nature of the food insecurity-obesity relationship. The review generated 13 peer-reviewed articles which studied the relationship between food insecurity and overweight/obesity in low- and middle-income countries. Affordability of high-energy, processed foods was identified as a main mechanism, which determined whether or not food insecurity leads to obesity in low- and middle-income countries. Other mechanisms identified were: quantity and diversity of food consumed; spatial-temporal access to nutritious food; inter-personal food choice and distribution; and non-dietary behaviours. Despite the limited empirical evidence available, our review presents meaningful and policy-relevant insights into the food insecurity-obesity relationship in from low- and middle-income countries. Interventions to address the food insecurity-obesity link need to address diet quality, and demand a broad understanding across a variety of experiences.

Extent, causes and impact of road traffic crashes in the Solomon Islands 1993-2012: data from the orthopaedic department at the National Referral Hospital, Honiara.

INTRODUCTION: Road traffic crashes constitute a considerable public health burden and represent the eighth leading cause of death and tenth leading cause of disability adjusted life years (DALYs) globally. However, very little is known about the extent, causes and impact of crashes in low- and middle-income countries including those in the Pacific. This lack of data is particularly true for the Solomon Islands. METHODS: The study is a retrospective record review of a pre-existing, de-identified dataset. A standardised trauma form is completed for all patients presenting to the orthopaedic department at the National Referral Hospital in Honiara with a suspected fracture following a trauma. Data are coded using one of 27 unique codes. Data related to road traffic crashes were extracted from the larger dataset, cleaned and analysed in Microsoft Excel. RESULTS: The database contained 699 records coded with one of seven codes related to road traffic crashes. Patients in the database were most frequently injured whilst a passenger in a car (27.8%), as a pedestrian (24.0%), or as a passenger in an open truck (21.6%). Almost three-quarters of patients were male. Just under half (48.5%) were aged between 10 and 29 years. Alcohol was listed as a contributing factor in 23.8% of presentations. CONCLUSIONS: This is one of the first studies to provide data on road traffic crashes in the Solomon Islands. In this database, young males were most likely to be involved in a crash that resulted in a suspected fracture. Young males are in their prime years of productivity, and injuries that remove them from the workforce could have severe socioeconomic implications. This study found that more than half of injuries were borne by vulnerable road users such as pedestrians and motorcyclists, indicating a need for interventions that take these users into account. Finally, the study provides insight into the large impact that alcohol has on the risk of road traffic crashes.

Control of highly pathogenic avian influenza in Quang Tri province, Vietnam: voices from the human-animal interface.

INTRODUCTION: Highly pathogenic avian influenza (HPAI) is caused by the haemagglutinin 5, neuraminidase 1 (H5N1) influenza A virus. Around 80% of households in rural Vietnam raise poultry, which provides food security and nutrition to their households and beyond. Of these, around 15-20% are semi-commercial producers, producing at least 28% of the country's chicken. Through learning the experiences of these semi-commercial farmers, this study aimed to explore the local understandings and sociocultural aspects of HPAI's impact, particularly the aetiology, diagnosis, and the prevention and control methods in one Vietnamese rural province. METHODS: This study was conducted in Quang Tri province, Vietnam. Quang Tri province has eight districts. Five of these districts were at high risk of HPAI during the study period, of which three were selected for the present study. Within these three districts, six communes were randomly selected for the study from the list of intervention communes in Quang Tri province. Six out of the 26 intervention communes in Quang Tri were therefore selected. Participants were randomly selected and recruited from lists of semi-commercial farmers, village animal health workers, village human health workers and local authorities so that the study population (representative population) included an amount of variability similar to that of the wider population. RESULTS: A key benefit of this village-level control program was the residential proximity of animal and human health professionals. Participants were well aware of the typical clinical signs for avian influenza and of the reporting process for suspect cases. However there was extensive room for improvement in Quang Tri province regarding access to the HPAI vaccine, essential medical equipment for animal use, and available financial support. CONCLUSIONS: This qualitative research study provided an important insight for in-country policy makers and international stakeholders. It is vital that there are continued efforts to prevent and control highly pathogenic avian influenza through support programs that provide locally appropriate information and resources to those at the human-animal interface.

Hospital visits due to domestic violence from 1994 to 2011 in the Solomon Islands: a descriptive case series.

The Solomon Islands has one of the highest rates of domestic violence in the world. This paper is a descriptive case series of all cases of domestic violence presenting to the Solomon Islands National Referral Hospital (NRH) over 18 years. Data were routinely collected from a database of all patients who were treated by NRH general surgery and orthopedic clinicians between 1994 and 2011, inclusive. The total number of cases in the injury database as a result of domestic violence was 387. The average number of cases in the database per year from 1994 to 2011 was 20. There were 6% more female patients (205 of 387; 53%) than male (182 of 387; 47%). Of the cases in which the perpetrator of the violence against a female patient was specified (111 of 205 female cases), 74% (82 of 111) were the patient's husband. Only 5% (5 of 111) of cases in females were inflicted by another female. This analysis provides the best available information on domestic violence cases requiring a visit to a tertiary hospital in a Pacific Island in the specified time period and is undoubtedly an under-estimate of the total cases of domestic violence. Preventing and treating domestic violence in the Solomon Islands and in the Pacific is an important challenge and there is a significant role for secondary and tertiary health services in screening for and preventing domestic violence.

Impact of avian influenza on village poultry production globally.

Village poultry and their owners were frequently implicated in disease transmission in the early days of the highly pathogenic avian influenza (HPAI) H5N1 pandemic. With improved understanding of the epidemiology of the disease, it was recognized that village poultry raised under extensive conditions pose less of a threat than intensively raised poultry of homogeneous genetic stock with poor biosecurity. This paper provides an overview of village poultry production and the multiple ways that the HPAI H5N1 pandemic has impacted on village poultry, their owners, and the traders whose livelihoods are intimately linked to these birds. It reviews impact in terms of gender and cultural issues; food security; village poultry value chains; approaches to biosecurity; marketing; poultry disease prevention and control; compensation; genetic diversity; poultry as part of livelihood strategies; and effective communication. It concludes on a positive note that there is growing awareness amongst animal health providers of the importance of facilitating culturally sensitive dialogue to develop HPAI prevention and control options.

Quantitation of fibroblast activation protein (FAP)-specific protease activity in mouse, baboon and human fluids and organs.

The protease fibroblast activation protein (FAP) is a specific marker of activated mesenchymal cells in tumour stroma and fibrotic liver. A specific, reliable FAP enzyme assay has been lacking. FAP's unique and restricted cleavage of the post proline bond was exploited to generate a new specific substrate to quantify FAP enzyme activity. This sensitive assay detected no FAP activity in any tissue or fluid of FAP gene knockout mice, thus confirming assay specificity. Circulating FAP activity was ∼20- and 1.3-fold less in baboon than in mouse and human plasma, respectively. Serum and plasma contained comparable FAP activity. In mice, the highest levels of FAP activity were in uterus, pancreas, submaxillary gland and skin, whereas the lowest levels were in brain, prostate, leukocytes and testis. Baboon organs high in FAP activity included skin, epididymis, bladder, colon, adipose tissue, nerve and tongue. FAP activity was greatly elevated in tumours and associated lymph nodes and in fungal-infected skin of unhealthy baboons. FAP activity was 14- to 18-fold greater in cirrhotic than in non-diseased human liver, and circulating FAP activity was almost doubled in alcoholic cirrhosis. Parallel DPP4 measurements concorded with the literature, except for the novel finding of high DPP4 activity in bile. The new FAP enzyme assay is the first to be thoroughly characterised and shows that FAP activity is measurable in most organs and at high levels in some. This new assay is a robust tool for specific quantitation of FAP enzyme activity in both preclinical and clinical samples, particularly liver fibrosis.

Frequency, cost and impact of inter-island referrals in the Solomon Islands.

INTRODUCTION: Providing quality health services to people living in remote areas is central to global efforts to achieve universal access to health care. Effective referral systems are especially critical in resource-limited countries where small populations are separated by considerable distances, geographic challenges and the limitations of human resources for health. This study aimed to build an evidence base on inter-island referrals in the Solomon Islands, in particular regarding the number of referrals, reasons for referrals, and cost, to ultimately provide recommendations regarding referral practice effectiveness and efficiency. METHODS: Data were taken from the referral database collected and maintained by the National Referral Hospital (NRH) in the capital, Honiara. Data included age, sex, ward or department visited, date of travel back to home port, home port and province. Data were available and included for 2008, 6 months of 2009, all of 2010 and 1 month of 2011; a total of 31 months. Travel costs were taken from NRH administrative information and included in the analysis. In addition, 10 qualitative interviews were conducted with clinicians and policy-makers in the tertiary hospital and one provincial hospital to gather information regarding inter-island referrals, their appropriateness and challenges faced. RESULTS: In the Solomon Islands, referrals from outer islands to the NRH are substantial and are gradually increasing over time. The two most populous provinces outside of the capital, Western and Malaita, represented 51% of all referrals in the study period. Of those referred, 21% were less than 15 years of age - even though 40% of the country's population is under 15 - with 30% being young adults of 15-24 years. Orthopaedic conditions comprised the largest number of referrals, with obstetric and gynaecological conditions a close second. The cost of referrals is rapidly increasing and was almost US$350,000 per year for the NRH alone. The amount budgeted for patient travel from the provinces to the NRH was a fraction of what is needed to cover the current number of referrals leading to a substantial budget shortfall. There did not appear to be a clear link between number of doctors in each province and the rate of referrals. CONCLUSION: Improving the appropriateness of referrals can have a substantial impact on access, quality of care and costs. Improvements in equipment in remote facilities, in human resources for health and in information technology can strengthen the quality of care in outer islands. Reducing the burden on referral facilities will allow them to provide appropriate care to those most in need while building public trust in all layers of the health system.