School Nutrition Professionals' Employee Safety Experiences During the Onset of the COVID-19 Pandemic.

OBJECTIVE: To explore the real-time personal/employee safety experiences and perspectives of school nutrition professionals ranging from frontline staff to state leadership across the US as they responded to the initial weeks of the coronavirus pandemic. METHODS: A cross-sectional survey was administered electronically March 31-April 20, 2020, to school nutrition staff, managers, directors, and state agency personnel. Descriptive statistics were calculated, and a thematic analysis of an open-ended item was conducted. RESULTS: School nutrition professionals (n = 504) from 47 states responded. Most (86.6%) reported that ensuring employee safety was somewhat or much more difficult during the pandemic, and they were unaware of an emergency plan. Themes from open-ended responses regarding employee safety concerns included, exposure and transmission risk, processes, and personal concerns. CONCLUSIONS AND IMPLICATIONS: Attention to the safety and concerns of school nutrition employees is vital for continuation of these programs during this pandemic and for future emergency situations.

Nutrition and maternal health: a mapping of Australian dietetic services.

BACKGROUND: Strong associations between diet and maternal and child outcomes emphasise the importance of evidence-based care for women across preconception, antenatal and postnatal periods. A 2008 survey of Australian maternal health dietetic services documented critically low resourcing with considerable variation in staffing levels and models of care. This study repeated the survey to examine resourcing in Australian maternal health services. METHODS: A cross-sectional online survey was emailed to publicly-funded Australian maternal health dietetic services in May 2018. Quantitative and qualitative variables collected across preconception to postnatal services (including diabetes) included; births per year (BPY), number of beds, staffing (full time equivalents; FTE), referral processes, and models of care. Results were collated in > 5000; 3500 and 5000; and < 3500 BPY. RESULTS: Forty-three eligible surveys were received from seven states/territories. Dietetic staffing levels ranged from 0 to 4.0 FTE (> 5000 BPY), 0-2.8 FTE (3500-5000 BPY), and 0-2.0 FTE (< 3500 BPY). The offering of preconception, antenatal and postnatal services varied significantly between hospitals (format, staffing, referral processes, delivery models). Few sites reported service effectiveness monitoring and only one delivered gestational diabetes mellitus care according to nutrition practice guidelines. Low staffing levels and extensive service gaps, including lack of processes to deliver and evaluate services, were evident with major concerns expressed about the lack of capacity to provide evidence-based care. CONCLUSIONS: Ten years after the initial survey and recommendations there remains an identified role for dietitians to advocate for better staffing and for development, implementation, and evaluation of service models to influence maternal nutrition.

Food Hygiene Practices at the Ghana School Feeding Programme in Wa and Cape Coast Cities.

Objective: The integrity and the wholesomeness of the food served to school pupils cannot be overlooked, especially when one considers the magnitude of health and sanitation issues that are plaguing the West African nations. This study aimed to investigate some of the personal hygiene practices by the pupils and the hygienic conditions in which food is cooked and served to these school-going children under the Ghana School Feeding Programme (GSFP). Design: A cross-sectional and descriptive survey research designs were used in the study. Purposive and simple random sampling techniques were employed in selecting participants. Participants. There were 720 respondents for the study, comprising 600 pupils, 60 teachers, and 60 kitchen staff members from 20 schools. Information was obtained using questionnaire, observation, and unstructured interview instruments. Results: Findings from the study revealed that the majority of pupils (92% in Wa and 65% in Cape Coast) did not wash their hands with soap under running water. No hand washing centers for pupils were also seen in most of the schools studied. Majority of the cooks did not have health certificate, and neither had attended any in-service training in two years. In both Wa and Cape Coast municipal schools, none of the kitchen staff admitted that pupils and teachers ever complained about the meals they served to the pupils. Conclusion: The GSFP in basic schools forms part of the integral diet of the school children; hence, provision of good quality food can affect the health, learning, and physical activities of these children. Observational checklist revealed that most of the kitchen staff do not strictly adhere to basic food hygiene practices, and this affects the wholesomeness of the food served to the children. There is, therefore, a need for kitchen staff training on hygiene and food preparation practices.

[Menus offered in long-term care homes: quality of meal service and nutritional analysis].

BACKGROUND: Institutionalization is a risk factor for malnutrition. Low energy intake and/or nutrient deficiencies are considered to be the main causes. OBJECTIVE: To evaluate the quality of meals and meal service as well as the nutritional value of the main menus (regular menu, menu for diabetics, and pureed menu) offered in three long-term care (LTC) homes located in the metropolitan area of Granada (Spain). METHODS: Cross-sectional study. A validated "quality of meals and meal service" set of indicators was applied. The menus were assessed by weighed food records on 14 consecutive days. The results were compared with the dietary reference intakes (DRIs) and the recommended number of servings. RESULTS: Important deficiencies in the quality of meals and meal service have been reported. Average energy varies from 1,788 to 2,124 kcal/day in the regular menus, from 1,687 to 1,924 kcal/day in the menus for diabetics, and from 1,518 to 1,639 kcal/day in the pureed menus. Average protein varied from 71.4 to 75.4 g/day, from 72.6 to 76.1 g/day, and from 50.5 to 54.7 g/day, respectively. None of the menus complied with the recommendations for fiber, potassium, magnesium, iodine, vitamin D, vitamin E, folate, nor for vegetables, fruit, milk products, olive oil, legumes, or nuts. CONCLUSIONS: It is necessary to ensure the implementation of regular routines for controlling the quality of meals and meal service as well as the nutritional value of the menus offered in LTC homes.

Programa de comedores escolares de la Comunidad de Madrid (2001-2015): diseño, protocolo, metodología y actualización.

Introducción: a finales del siglo xx, no se conocía con precisión si la comida del comedor escolar contribuía adecuadamente a la dieta de la población infantil. Además, este servicio complementario no se contemplaba en el proyecto educativo del centro pese a considerarse fundamental en todas sus dimensiones.Objetivo: describir el origen y desarrollo del programa de comedores escolares de la Comunidad de Madrid (CM) en 15 años desde su implantación.Métodos: se elaboró una normativa a cumplir por las empresas de restauración, y que contemplaba aspectos nutricionales y de composición y variedad de los menús, que se utilizó en los concursos para acceder a la prestación del servicio de comedor escolar, publicados en los años 2001, 2002, 2005, 2009 y 2013. Además se realizaron visitas acreditadas a los centros sin previo aviso para verifi car el cumplimiento de la documentación aportada durante el concurso.Resultados: los criterios más actuales sobre programación y elaboración de menús escolares se recogen en el Pliego de Prescripciones Técnicas del año 2013 (C-504/001-2013). Un 92% de las empresas de restauración superaron los cinco concursos habidos en los 15 años de funcionamiento. Hasta el año 2014, se han realizado 755 visitas, revisándose un total de 574 centros.Conclusiones: el programa de comedores escolares de la CM, desde su implementación pionera en España, ha contribuido a la mejora del servicio complementario de comedor. En estos años se han ido incluyendo nuevos requisitos dietéticos y nutricionales que han logrado menús cada vez más ajustados a las recomendaciones de la población escolar.

¿Qué y cuánto comemos? El método Recuerdo de 24 horas / What and how much do we eat? 24-hour dietary recall method

La dieta, junto con los estilos de vida, es un importante factor determinante del estado de salud del individuo y de la comunidad. La valoración de la ingesta dietética a nivel poblacional nos aporta información básica para conocer la frecuencia y la distribución de posibles desequilibrios dietéticos y/o nutricionales, así como para orientar el diseño de políticas nutricionales dirigidas a mejorar los hábitos alimentarios y los niveles de salud de una comunidad. En este artículo se revisan las características, ventajas y limitaciones del método de recordatorio dietético de 24h (RD24h), uno de los métodos mas ampliamente utilizados en epidemiologia nutricional para determinar ingesta de alimentos, energía y nutrientes, en encuestas nutricionales a nivel nacional, en estudios transversales, ensayos clínicos, estudios de cohortes y también en valoraciones individuales y en evaluación de Dieta Total. Se destaca la importancia, para reducir los principales puntos de sesgo, de la formación de los encuestadores, las herramientas de apoyo y las aportaciones de las nuevas tecnologías (AU)

Diet, along with lifestyle factors, is an important determinant of the health status of an individual and of a community. Dietary assessment at the population level provides us with key information on the frequency and distribution of possible inadequate diets and/or nutritional status. It is also useful as input into the elaboration of food and nutrition policies aiming to improve dietary habits and the health status of a community. This article reviews the characteristics, advantages and limitations of the 24-hour dietary recall method (24hDR), which is one of the most widely used tools in nutrition epidemiology to identify food, energy and nutrient intake in national nutrition surveys, cross-sectional studies, clinical trials and cohort studies as well as in the evaluation of individual dietary intake and Total Diet assessment. To reduce the key factors associated with bias, the importance of previously trained interviewers is highlighted, as well as the role of support materials and the contribution of novel technologies (AU)

Identificación, impacto y tratamiento de datos perdidos y atípicos en epidemiología nutricional / The identification, impact and management of missing values and outlier data in nutritional epidemiology

Cuando se realiza un estudio epidemiológico nutricional, es inevitable que aparezcan valores perdidos y atípicos. Los datos perdidos aparecen, por ejemplo, por la dificultad de recoger los datos en las encuestas dietéticas que conducen a una falta de información sobre la cantidad de alimentos consumidos y una pobre descripción de ellos. Un inadecuado tratamiento durante el proceso de recolección nos conduce a sesgos y pérdida de precisión y consecuentemente una incorrecta interpretación de los resultados. El objetivo de este artículo es proporcionar recomendaciones sobre el tratamiento de datos perdidos y atípicos, y algunas orientaciones sobre el software existente para calcular el tamaño de muestra y realizar el análisis estadístico. También se realizan recomendaciones sobre la recolección de datos que es un paso importante en la investigación nutricional. Se comentan los métodos que se usan para hacer frente a los datos perdidos, específicamente, el método eliminación de casos, imputación simple o múltiple con indicaciones y ejemplos. También se relata cómo se identifican datos atípicos, el impacto que tienen en el análisis estadístico, las opciones para un adecuado tratamiento y se ilustra mediante un ejemplo. Finalmente, se menciona el software existente que aborda total o parcialmente las cuestiones tratadas, específicamente el software de libre distribución (AU)

When performing nutritional epidemiology studies, missing values and outliers inevitably appear. Missing values appear, for example, because of the difficulty in collecting data in dietary surveys, leading to a lack of data on the amounts of foods consumed or a poor description of these foods. Inadequate treatment during the data processing stage can create biases and loss of accuracy and, consequently, misinterpretation of the results. The objective of this article is to provide some recommendations about the treatment of missing and outlier data, and orientation regarding existing software for the determination of sample sizes and for performing statistical analysis. Some recommendations about data collection are provided as an important previous step in any nutritional research. We discuss methods used for dealing with missing values, especially the case deletion method, simple imputation and multiple imputation, with indications and examples. Identification, impact on statistical analysis and options available for adequate treatment of outlier values are explained, including some illustrative examples. Finally, the current software that totally or partially addresses the questions treated is mentioned, especially the free software available (AU)

La creación de un nuevo mercado alimentario en España; las vitaminas en la prensa periódica (1917-1950) / The creation of a new nutritional market in Spain: Vitamins in the press (1917-1950)

Objetivo: Analizar el grado en el que las vitaminas jugaron un papel en la estrategia de creación de un nuevo mercado de alimentos, alimentos-medicamento y especialidades farmacéuticas en España durante la primera mitad del siglo XX. Material y métodos: Se estudiaron todas las menciones a las vitaminas aparecidas en los diarios "ABC", "Heraldo de Madrid", "El Imparcial", "El Liberal" y "El Sol", publicados en Madrid; "La Vanguardia", publicado en Barcelona, y en el semanario "Blanco y Negro" entre 1917 y 1950. La fecha inicial, 1917, se fijó por ser el año en el que aparecieron las primeras noticias sobre vitaminas. La fecha final, 1950, se fijó por considerarse concluida la etapa más dura de la autarquía impuesta por el Franquismo. Las noticias aparecidas se clasificaron en las categorías: consejos dietéticos, curiosidades, noticias científicas, noticias económicas, noticias políticas, trivialidades y uso metafórico. Resultados: Los anuncios que usaron las vitaminas dentro de su estrategia comercial son el apartado más importante en el que se utiliza el concepto vitaminas con porcentajes superiores, en casi todos los casos, al 50%. Las noticias científicas sobre vitaminas le siguen en importancia. Las menciones a las vitaminas en el resto de categorías son inferiores al 5%. Conclusiones: Las vitaminas constituyen un elemento fundamental en la creación de un nuevo mercado de productos en España en la primera mitad del siglo XX, a juzgar por las menciones que aparecen en la prensa periódica analizada (AU)

Aim: To analyze the extent to which vitamins played a role in the strategy to create a new market of food, foodmedicines, and medicines in Spain during the first half of the twentieth century. Materials and methods: A study was made of references to vitamins in the years between 1917 and 1950 in the daily newspapers "ABC", "Heraldo de Madrid", "El Imparcial", "El Liberal" and "El Sol", published in Madrid, "La Vanguardia", published in Barcelona, and the weekly publication "Blanco y Negro". The starting date was selected as the year in which the first news of vitamins appeared. The year 1950 marked the end of the harshest stage of autarky imposed by Franco’s regime. The news that appeared was classified in the following categories: scientific news, nutritional advice, advertising, economy, politics, anecdotes and metaphors. Results: The advertisements that used vitamins as part of their marketing strategy are the most important section with over 50% of total references to the vitamin concept in almost all the newspapers. Scientific news on vitamins ranks second in importance. References to vitamins in the remaining categories were below 5%. Conclusions: Judging by the references which appear in the most important newspapers of the time vitamins represent a fundamental element in the creation of a new food product market in Spain in the first half of the twentieth century (AU)

Survey of bariatric surgical patients' experiences with behavioral and psychological services.

BACKGROUND: Bariatric surgery continues to grow in popularity as a treatment of obesity; however, weight regain and noncompliance with behavioral recommendations remain an issue. Little is known about the type and frequency of services completed by bariatric patients and their satisfaction with these services. However, preliminary research has shown that the use of behavioral and psychological services is less common after surgery. We assessed the behavioral and psychological services completed by bariatric patients before and after surgery, patient satisfaction with the surgery and services, and the relationship between the completed services and the outcomes. The participants were solicited for participation using an on-line support Web site dedicated to obesity and bariatrics. METHODS: A convenience sample of 380 subjects were included in the present study. They completed an Internet-based survey that assessed the psychological, dietary, exercise, and lifestyle services completed before and after surgery, their satisfaction with these services, and their weight loss outcomes. RESULTS: Overall, the participants reported completing more services before surgery. After surgery, the most frequently reported services completed were support groups and dietary consultation. More than one half of the participants did not meet with either a mental health professional or an exercise professional after surgery. The participants expressed high satisfaction with their surgery and services, with exercise services receiving the lowest satisfaction rating. A statistically significant relationship was found between the total number of postoperative psychological and behavioral services completed and a greater percentage of excess weight lost. The t tests showed that participants who completed group exercise sessions and nutritional consultation after surgery lost more weight than did those who did not complete these services. CONCLUSION: The participants in the present sample reported completing few behavioral and psychological services after surgery. However, our findings showed that these services could promote greater weight loss and maintenance. Thus, it is recommended that bariatric facilities and insurance providers consider requiring patients to complete postoperative behavioral modification programs that target improvement in diet and physical activity behaviors.

Restaurant staff's knowledge of anaphylaxis and dietary care of people with allergies.

BACKGROUND: Deaths caused by food-induced anaphylactic reactions are increasing, with most caused by food purchased outside the home. Primary prevention by allergen avoidance is desirable, but is easier in the home than when eating out, where the responsibility is shared with restaurant staff. OBJECTIVE: To investigate restaurant staff's knowledge about food allergies. METHOD: A structured telephone questionnaire was administered to a member of staff at 90 table-service restaurants in Brighton. RESULTS: Fifty-six percent (90/162) restaurants that were contacted agreed to participate. Responders included seven owners, 48 managers, 20 waiters and 15 chefs. Ninety per cent (81/90) reported food hygiene training; 33% (30/90) reported specific food allergy training. Fifty-six percent (50/90) could name three or more food allergens. Eighty-one percent reported confidence (very or somewhat) in providing a safe meal to a food-allergic customer. Answers to true-false questions indicated some frequent misunderstandings: 38% believed an individual experiencing a reaction should drink water to dilute the allergen; 23% thought consuming a small amount of an allergen is safe; 21% reported allergen removal from a finished meal would render it safe; 16% agreed cooking food prevents it causing allergy and 12% were unaware allergy could cause death. Forty-eight percent expressed interest in further training on food allergy. CONCLUSIONS AND CLINICAL RELEVANCE: Despite a high confidence level, there are obvious gaps in restaurant staff's knowledge of allergy. Food-allergic patients need to be aware of this and adapt their behaviour accordingly. Our data challenge the impact of current food allergy training practice for restaurant staff, and support the need for more rigorous and accessible training.

The effects of the National School Lunch Program on education and health.

This paper estimates the effects of participating in the National School Lunch Program in the middle of the 20th century on adult health outcomes and educational attainment. I utilize an instrumental variables strategy that exploits a change in the formula used by the federal government to allocate funding to the states. Identification is achieved by the fact that different birth cohorts were exposed to different degrees to the original formula and the new formula, along with the fact that the change of the formula affected states differentially by per capita income. Participation in the program as a child appears to have few long-run effects on health, but the effects on educational attainment are sizable. These results may suggest that subsidized lunches induced children to attend school but displaced food consumption from other sources. Alternatively, the program may have had short-run health effects that dissipated over time but that facilitated higher educational attainment.

Multidisciplinary team contributions within a dedicated outpatient palliative radiotherapy clinic: a prospective descriptive study.

PURPOSE: Patients with bone metastases may experience pain, fatigue, and decreased mobility. Multiple medications for analgesia are often required, each with attendant side effects. Although palliative-intent radiotherapy (RT) is effective in decreasing pain, additional supportive care interventions may be overlooked. Our objective was to describe the feasibility of multidisciplinary assessment of patients with symptomatic bone metastases attending a dedicated outpatient palliative RT clinic. METHODS AND MATERIALS: Consecutive patients referred for RT for painful bone metastases were screened for symptoms and needs relevant to their medications, nutritional intake, activities of daily living, and psychosocial and spiritual concerns from January 1 to December 31, 2007. Consultations by appropriate team members and resulting recommendations were collected prospectively. Patients who received RT were contacted by telephone 4 weeks later to assess symptom outcomes. RESULTS: A total of 106 clinic visits by 82 individual patients occurred. As determined by screening form responses, the clinical Pharmacist, Occupational Therapist, Registered Dietician and Social Worker were consulted to provide assessments and recommendations within the time constraints presented by 1-day palliative RT delivery. In addition to pain relief, significant improvements in tiredness, depression, anxiety, drowsiness and overall well-being were reported at 4 weeks. CONCLUSIONS: Systematic screening of this population revealed previously unmet needs, addressed in the form of custom verbal and written recommendations. Multidisciplinary assessment is associated with a high number of recommendations and decreased symptom distress. Our findings lend strong support to the routine assessment by multiple supportive care professionals for patients with advanced cancer being considered for palliative RT.

Targeting of home-delivered meals programs to older adults in the United States.

The Home-Delivered Meals Program (HDM) is an essential component of home-and community-based services available through the National Aging Service Network in the United States. It has the potential to help delay institutionalization and stem rising health care costs for older Americans; little is known, however, about the targeting practices used for HDM. A nationally representative telephone survey of state and local program providers showed that a variety of outreach measures were being employed, but challenges such as inadequate resources, waiting lists, rural delivery, and misconceptions about the program require resolution to ensure optimal service outcomes.

Designing and implementing ethnic congregate nutrition programs for older Americans.

Montgomery County in Maryland is one of the most ethnically diverse regions in the United States. Since the 1970s, traditional American and Kosher meals have been offered at congregate sites in this County, but few seniors of varied ethnicity participated. This article describes creative approaches used in the County Senior Nutrition Program within the Older Americans Act from 1990 to 2007 to develop nutrition sites targeted to seniors in Korean, Vietnamese, and Chinese communities. The services provided are culturally sensitive, and the meals meet both nutritional and food safety standards. With secure funding, programs can be made available to other ethnic groups.

Nutrition risk screening in acute care: a survey of practice.

The Joint Commission-accredited acute care hospitals are required to screen patients for nutrition risk, but criteria and procedures in use have not been described. The purpose of this study was to survey managers of clinical nutrition services in acute care hospitals regarding procedures for screening for nutrition risk. Members of the Clinical Nutrition Management Dietetic Practice Group were surveyed using an e-mailed link to an electronic survey. Of 1668 members contacted, 522 usable surveys were completed (31%). Most respondents (84%) reported that nursing staff had primary responsibility for nutrition screening; 10% used nutrition services staff; 4% used a computerized system. Where nursing staff did nutrition screening (n=441), 57% (n=252) said that nutrition services staff do a secondary admission screen. Dietitians most often performed secondary screens (70%), followed by dietetic technicians (16%), 4-year-degreed staff (4%), and clerks (3%). Most nutrition services staff screens (61%) used different data than nursing staff screens; 12% collected the same data as nursing staff. Screening criteria most often used by nursing staff were a history of weight loss (95%), poor intake prior to admission (81%), nutrition support (79%), chewing/swallowing issues (75%), and skin breakdown (72%). Criteria most commonly used by nutrition services staff were diagnosis (90%), nutrition support (81%), nothing by mouth (NPO)/clear liquid diet order (78%), visceral proteins (71%), and specific diet orders (68%). Most respondents had not formally evaluated their screening systems for sensitivity or specificity. There is a need to further evaluate the nutrition screening systems used in acute care hospitals in the U.S.

[Provision against food allergy in the school lunch program in Japan].

BACKGROUND: We speculated that 130000 students suffer from food allergy in Japan. We have had no information about food allergy students at school diet. METHOD: The Aggregate Corporation of All Japan School Dietician Conference cooperated with our investigation. We sent a questionnaire by mail to all school dieticians who belong with the conference. RESULT: We could collect up 10190 cooking place and 8035306 students. The cooking places which didn't investigate food allergy accounted for 1031 facilities. Although food allergy children were in the school, the cooking place which didn't take measures to prevent food allergy in school diet accounted for 1031 facilities. 5476 cooking places supplied school diet which managed food allergy students. But alterative school diet was supplied only 2122 cooking places. CONCLUSION: We could know current state of food allergy in school diet. We must develop to take measure against food allergy accidents at the school diet for food allergy students.

Archiving of food samples from restaurants and caterers--quantitative profiling of outbreaks of foodborne salmonellosis in Japan.

The Ministry of Health, Labor and Welfare (former MHW) of Japan issued a Directive in 1997 advising restaurants and caterers to freeze portions of both raw food and cooked dishes for at least 2 weeks. This system has been useful for determining vehicle foods at outbreaks. Enumeration of bacteria in samples of stored food provide data about pathogen concentrations in the implicated food. Data on Salmonella concentrations in vehicle foods associated with salmonellosis outbreaks were collected in Japan between 1989 and 1998. The 39 outbreaks that occurred during this period were categorized by the settings where the outbreaks took place, and epidemiological data from each outbreak were summarized. Characteristics of outbreak groups were analyzed and compared. The effect of new food-storage system on determination of bacterial concentration was evaluated. Freezing and nonfreezing conditions prior to microbial examination were compared in the dose-response relationship. Data from outbreaks in which implicated foods had been kept frozen suggested apparent correlation between the Salmonella dose ingested and the disease rate. Combined with results of epidemiological investigation, quantitative data from the ingested pathogen could provide complete dose-response data sets.